November 21, 2009 CONGRESSIONAL RECORD — SENATE S11907 obviously someone who has not read RESERVATION OF LEADER TIME public’s time by provoking arguments the bill. One of the things we have in The PRESIDING OFFICER. Under over their distortions about what this legislation is a provision called the previous order, the leadership time health reform means. Spurious rumors the CLASS Act. What does it do? It al- is reserved. were spread about death panels. One lows someone to voluntarily pay $120 a mailing opposing this bill claimed that month into a fund. They do it for 5 con- f reform would mean denying care to secutive years. If they become dis- SERVICE MEMBERS HOME OWNER- people based on their voting records. abled, there is money there for them. SHIP TAX ACT OF 2009—MOTION How desperate can these entrenched Ever since I have been in the Congress, TO PROCEED powers get, those who want to stop we have been looking for a way to take The PRESIDING OFFICER. Under health care reform? These are the tac- care of the aged, infirm, and disabled. the previous order, the Senate will re- tics of obstruction in the service of the It is not an entitlement; it is voluntary sume consideration of the motion to status quo. Meanwhile, what the American peo- and fully paid for, as is the rest of the proceed to H.R. 3590, which the clerk ple yearn for are constructive solu- bill. will report. tions. They want an honest debate, not To talk about all this debt—I don’t The bill clerk read as follows: know what world, what sphere they are a filibuster. That is what they deserve, Motion to Proceed to H.R. 3590, to amend living in. The Congressional Budget Of- and that is what we owe them. the Internal Revenue Code of 1986 to modify A Vermonter came by my office to fice, a nonpartisan organization—not the first-time home buyers credit in the case always good—I wish they would have of members of the Armed Forces and certain talk about health reform, as so many come up with some other numbers be- other Federal employees, and for other pur- have over the last several months. I cause we got no credit for all the poses. hear this every time when I am home wellness things we do in this bill that The PRESIDING OFFICER. Under in Vermont. If I am in the gas station will save lots of money. We received no the previous order, there will be debate putting gas in my car, if I am in the credit for that. But in spite of that, ev- until 6 p.m., with the time controlled grocery store, if I am coming out of erything in the bill is fully paid for. It in alternating 1-hour blocks, with the church on Sunday, I hear this. This reduces short- and long-term debt. It majority controlling the first hour. Vermonter is a physician. He has a spe- expands coverage. This chart says ‘‘94 The Senator from Vermont. cial perspective from inside the sys- percent,’’ but it is actually 98 percent Mr. LEAHY. Madam President, I am tem. He recalled stories about his fa- because CBO does not give us credit for glad to see my colleague and neighbor ther, also a very respected doctor, who people in Medicare. So 98 percent of from New York in the chair, an ex- practiced in the days before Medicare. Americans are covered. It contains in- traordinarily hard-working Member of He remembered the devastation his fa- surance market reforms, and lots of the Senate. I am not surprised, on a ther felt when he was forced to turn away elderly Vermonters because they them. It contains delivery system re- Saturday morning, that she is here. forms. Before I begin, I wish to state my ap- did not have health insurance. It may be difficult today to even The key elements of this health care preciation for the kind words from the imagine this, but before Medicare, reform bill, I repeat: It reduces short- majority leader for the Senator from older Americans were routinely driven and long-term deficits, expands cov- Vermont. He and I have been friends erage, promotes choice and competi- into poverty during their retirement for decades. I am glad to see the work years by health expenses. Before Medi- tion, reforms the insurance market, he has done in bringing this bill to the and improves quality of care. All we care was launched in 1964, nearly half floor. I intend to work closely with of seniors over 65 had no health cov- are asking today is to have a debate on him. it. Why would anyone be afraid, in the erage and more than one in three lived Decision time is near on health in- in poverty. Today, because of Medicare, greatest debating society, supposedly, surance reform. I will vote today to in the world, to debate health care? virtually everyone 65 and older has end the filibuster so the Senate can health insurance. The poverty rate What are they afraid of? begin this important, historic debate He said anyone who votes for this is among seniors has plummeted. More to improve and reform our Nation’s going to have a lot of explaining to do. than 100,000 Vermonters have Medicare health insurance system. Let’s not That is really Orwellian. Have a lot of insurance. duck the debate. Let the debate begin. explaining to do if they vote to allow The arguments that were made Let’s not hide from votes. Let’s have the debate to continue? I think quite against creating Medicare may sound the courage to vote. Stand up and vote the opposite. I think any reasonable familiar. Opponents of Medicare, when on the amendments. Let the American human being would feel the same way. it first came up, tried to demonize the people know where we stand and not Shouldn’t we debate health care reform plan. They claimed it would never say: Well, it never came up because of in America today, with 50 million peo- work. How could government run a ple uninsured, and this legislation is the filibuster. We can end the filibuster program like this? They ignored those going to take care of 98 percent of today. We can get going. We can let older Americans living in poverty. But Americans? every American know where we stand. eventually Members from both sides of This legislation looks out for small The sentries of the status quo again the aisle, Republicans and Democrats, businesspeople. Right now, most small have spared no effort to kick the can worked together. They passed a bill businesses don’t have health insurance down the road, as they have done be- that is one of the most successful and for their employees. Do they not have fore. The country suffers when there is popular programs in America today. health insurance because they are a failure to act on serious challenges Vermont’s entire congressional delega- mean or cheap? No. They can’t afford that millions of ordinary Americans tion, which at that time was Repub- it. The insurance industry has made it face in their daily lives. This is a defin- lican, supported passage of that land- impossible to pay for because of their ing moment for the Senate and for the mark legislation. huge profits. country. I rank this along with other Today, we have a health system with Someone not voting to allow the de- major decisions such as the creation of contradictions. Federal investments in bate to continue is going to have a lot Social Security and Medicare and the research and private investments in de- of explaining to do. Even though my Civil Rights Act. We have been talking velopment have produced modern med- friend is Orwellian and said that if you about health insurance reform for more ical marvels in the equipment, train- vote to allow debate to continue, you than 70 years, before I was born. The ing, techniques, and drugs that are will have a lot of explaining to do, how Senate should not now prevent a real available to many Americans. Yet in could you be a Senator and be afraid to debate on health reform by hiding be- the prices we pay, in the lack of access debate health care reform? hind the figleaf of a procedural fili- to basic medical care, in the loopholes Simply, this legislation, on which we buster. and the redtape that plague ordinary will vote on a motion to proceed to this A bill worthy of this debate has been Americans in our health insurance sys- evening at 8, saves lives, it saves produced, after months of arduous tem and in overall results in so many money, and it saves Medicare—a pretty work. Opponents of reform, unfortu- categories, we get far less for our enor- good deal. nately, have wasted much of the mous health care spending than do the

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.003 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11908 CONGRESSIONAL RECORD — SENATE November 21, 2009 citizens of countries whose health care malpractice insurance providers. Clos- tempered will of the Senate’s member- costs are only a fraction of what ours ing this loophole in our antitrust laws ship. are. Tens of millions of Americans have is long overdue, and I will offer my leg- This Senate can do that again. Our no health insurance at all. Employers islation as an amendment to the bill to dear friend, Senator Ted Kennedy, said who want to offer health insurance to do that. Antitrust enforcement pro- it so well in the letter about the health their workers are being priced out of motes competition. It helps to lower reform imperative that President even having that option anymore. Self- prices and expand consumer choice. Obama read to a joint meeting of Con- employed Americans must pay dearly Another factor that contributes to gress. This is what Senator Kennedy to afford any insurance, and they can the rising medical costs all Americans reminded us: lose their coverage at the whim of an face is fraud within the health insur- What we face is above all a moral issue; insurance company’s bureaucracy. In ance system. The scale of health care that at stake are not just the details of pol- no modern nation except ours are fami- fraud in our system today is stag- icy, but fundamental principles of social jus- lies actually driven into bankruptcy by gering. Studies estimate that between tice and the character of our country. illness. In fact, medical expenses are 3 percent and 10 percent of all our This is such a time. It is my hope and one of the top reasons for bankruptcy health care spending, both public and belief the Senate I love will once again in America today. private, is wasted through health care rise to the occasion. In the absence of a fair and sensible fraud. That is somewhere between $60 Madam President, I yield the floor. health insurance system, families, billion and $220 billion each year— The PRESIDING OFFICER. The Sen- businesses, and taxpayers have been money we should have for health care, ator from Colorado. dragged along by an inflationary curve not going in the pockets of crooks. Mr. BENNET. Madam President, I that only worsens with time. Next To help wring this waste out of our would like to first thank the Senator year, small businesses, already suf- system, Senator KAUFMAN and I and from Vermont for his excellent re- fering from skyrocketing medical others have proposed the Health Care marks in support of what is, after all, costs, will see their premiums rise by Fraud Enforcement Act. Our bill would just a vote to get us started on the de- an average of 15 percent. That is twice toughen sentences for those who com- bate on health care, a procedural vote the rate of last year’s increases. Drug mit health care fraud, strengthen sup- to allow us to be able to amend and im- companies have boosted prices of port for prevention, investigation, and prove the bill in the coming weeks. brand-name drugs by about 9 percent prosecution of health care fraud, and Madam President, virtually every over the last year—the steepest in- sharpen the legal tools we need to go single Member of this body in the Sen- crease in years. All you have to do is after this fraud. It would prevent waste ate is a Member of the baby boom gen- look at the huge salaries paid to their in spending. It would hold accountable eration. In my view, it is a generation executives, and you know where that those who do the stealing. Experience of Americans—I was born in the last money is going. It is not going to help shows antifraud efforts give taxpayers year of that generation—given more the health care of the average Amer- a superb return on investment, with a opportunity than any generation of ican. payback of between $6 and $14 for every people in the history of this planet be- Can’t we fashion an American-made dollar we spend on enforcement. cause our grandparents and our parents solution so our citizens can have high- I am pleased the majority leader in- were willing to make hard choices, un- quality, affordable care and access to cluded provisions in this bill to address derstanding that part of our national basic health insurance? Of course we the issue of health care fraud. I will creed, part of our legacy is assuring can. We are Americans. We can develop work with Senator KAUFMAN and oth- that we are expanding opportunity for that. ers to strengthen that bill. those who come after us. The bill introduced this week by the Vermont has helped pave the way for We are having this health care debate majority leader and by Senators BAU- some of the reforms included in this at a moment in our country’s history CUS, DODD, and HARKIN will give mil- bill, and now, for the third year in a beset by incredible economic difficul- lions more Americans access to qual- row, Vermont has been ranked as the ties. This is the worst recession since ity, affordable health care. It would healthiest State in the Nation. the Great Depression. But we now end discriminatory treatment of those Vermont is one of the earliest leaders know even during the period of eco- who change jobs or have preexisting in expanding the State Medicaid Pro- nomic growth before our economy fell conditions. gram, under reforms led by former Gov. into this terrible recession that work- I have pushed and will continue to Howard Dean and others. Yet under the ing families were struggling. push to accomplish the three c’s of current form of this bill, Vermont During the last period of economic choice, competition, and cost control, would not share the enhanced Federal growth, median family income in the as we reform our health insurance sys- match to be offered to other States. United States actually declined. As far tem. That would amount to a regressive pol- as I know, it was the first period of re- I am encouraged that the Senate bill icy with adverse practical ramifica- covery in the history of the United includes a public option that I have tions for Vermont, a State that is a States when median family income ac- strongly supported. I might say, the leader in expanding access to health tually went down. It was at the same majority of Americans strongly sup- care. I was heartened in my conversa- time the cost of health insurance was port it. I will stand with others as we tion this morning with the majority soaring—in my State by 97 percent— make our case for keeping it in the re- leader when he told me he will try to with the cost of higher education in my form plan as part of this process. correct that problem. But we cannot State going up by 50 percent. I was proud to join Senator BROWN correct any of these problems until we We were saying to working families: and a core group of more than 20 other debate the bill. Let’s not hide under You are living in an economy with in- Senators who introduced a resolution our desks because we are afraid to credible weakness, where the growth is affirming our support of a public op- stand up and vote and debate. surging ahead of a mountain of debt, tion. A public option would give con- The people of Vermont have given me but you are not getting ahead. sumers more choices to select afford- the honor of representing them in the Just this week, we learned that in able and quality health insurance Senate for 35 years. I have joined in the great State of California they are plans, while helping to drive down many debates that were contentious increasing the tuition for their univer- overall medical costs through real yet ultimately productive. I have been sities by 30 percent. The University of competition in the health insurance on the winning side. I have been on the California, the California system has market. losing side. But as we leaf through the been the envy of the world for decades, To further enhance the advantages of pages of history, we can read of many and now it is being put out of the reach a competitive market, I have intro- times when the Senate has shown its of working families. duced the Health Insurance Industry remarkable ability to rise up to reflect So we have much to do—much to Antitrust Enforcement Act of 2009. the conscience of the Nation. Those do—to make sure we honor the legacy This would repeal the antitrust exemp- moments were forged in the crucible of of our parents and our grandparents. tion for health insurance and medical national need, against the anvil of the We honor the legacy of the ‘‘greatest

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.004 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11909 generation’’ and this generation, the mestic product. That is utterly two places: Medicaid, if they are poor baby boom generation, to ensure that unsustainable. We know the biggest enough, or in the emergency room, get- we leave behind us not diminished op- driver of our medium-term deficits is ting covered with uncompensated care portunity but more opportunity for our rising Medicare and Medicaid costs, that we, the taxpayers, are paying for. kids and our grandkids. and the biggest driver of those is rising We have a public option. It is the There is much we need to do to make health care costs. least intentional and most expensive sure we have a health care system that This bill, unlike Medicare Part D—a public option you can imagine. When works not just for a few people but for very worthy program passed during the we are talking about the changes we everyone, an education system that last administration—this bill is paid are making here, we need to under- works not just for a few kids but for for. That drug program for seniors was stand what is going on in the daily everyone, and that we have an econ- not paid for. Instead of paying for it, lives of people all across our country. omy in the United States that values instead of making hard choices, what The figures we have from the Con- the contribution that everybody can we said to our kids and our grandkids gressional Budget Office show that this make. was: You pay the bill. By the way, that bill will reduce the deficit, not add to My sense in this health care debate is is what we have said about tax cuts. it, will cut our deficits over the first 10 that the people of my State—and I That is what we have said about the years by $130 billion, over the next 10 know people around the country—are wars in Afghanistan and Iraq. We have years by $650 billion. That is $780 bil- deeply dissatisfied with business as to put an end to this. This bill at least lion. usual. They hate the current system. starts to head us in the right direction. One thing we know about those num- They know it is not working for them It does not fix our fiscal crisis, but it is bers is they are not going to turn out and their families. They know they are an important step forward. to be exactly accurate. But here is the As I mentioned a few minutes ago, not able to make the choices they need goods news: The CBO is unable to score for working families, the current sys- to make to have stability for their the benefit of prevention. They are un- tem has been a complete disaster, as families so they can get ahead eco- able to score the benefit of wellness. their income has remained flat or gone nomically. They are unable to score or focus on down, as their health care premiums But, on the other hand, they are primary care instead of emergency have gone up by 97 percent. Even deeply worried about our capacity to room care. There is good reason for though there is a lot of conflict out make it worse. It is hard to blame peo- that because that comes down to exe- there about what the way forward ple when you hear the special interests’ cution—how well is the program imple- should be, about a specific policy rhetoric coming out of Washington, mented. Those of us who are pro- choice here versus a specific policy DC, or when you turn on your cable tel- ponents of reform carry a very heavy choice there, I can tell you, one thing evision set at night and watch what burden to make sure the execution is everyone in my State agrees with is people have to say. You can understand good and that we carry this through. that their health care has not im- why people are concerned that we have proved by 97 percent over the last 10 But the good news is, if we do a good the capacity to make it worse. years. They are paying more and get- job, we will save money. But that is why I am so pleased about I want to say a word about Medicare ting less. Coverage is getting weaker, the piece of legislation the majority because there has been a lot of discus- as it gets more expensive. leader has brought before us. We have Small businesses are getting crippled sion from people who are opposed to re- never been closer to reforming our by the system we have today. They pay form who are saying we are cutting health care system, so we can address 18 percent more than large businesses Medicare. They are saying we are hurt- runaway health care costs, enact insur- to cover their employees, just because ing seniors. But what they will not tell ance reform, construct stability and they are small. Sometimes people say you is that the worst possible scenario predictability in health care for fami- to me: Well, Michael, don’t you know is not taking action now on critical lies and small businesses. that is because the pool of employees is Medicare reform. As I said earlier, and The Senate legislation before us is smaller? It is harder to spread the risk. said in many speeches, our Medicare that promising new way forward. Colo- I say: I understand that. But as a busi- Program, on its current path, is headed radans, as I said, have not been shy at nessperson, from a business perspec- for fiscal crisis. all about letting me know about their tive, that is ridiculous—the idea that a Policy experts on both sides of the views of the current system and what small businessperson, trying to execute aisle have said we need to reform our their concerns are about what we their business plan, trying to execute Medicare delivery system. We need to might do. their vision to grow their business, is stop basing payments on every proce- Like people across the country, they going to spend 18 percent more for dure and every test. Instead, we should know the current system does not work something and not get 18 percent more look at successful models such as our for them. But they are worried, as I productivity out of it, or not get 18 per- own Denver Health, the Rocky Moun- said a minute ago, that we are going to cent, in this case, better health care tain Health System, and the Mayo make it even worse. coverage out of it. In fact, the reverse Clinic in Minnesota. We know they This bill represents a substantial im- is true. It is ridiculous. have better quality and better out- provement over business as usual. I By the way, one of the things that is comes, not just for seniors but for ev- congratulate the majority leader for interesting to me about this debate eryone. listening to not just a small group of over a public option is that people do This bill builds on what works lo- people but to people across the aisle, to not seem to understand what is actu- cally. That means protecting the guar- people all across the country in ally happening before our eyes. As the anteed Medicare benefits for every sen- crafting this piece of legislation. costs of insurance are going up every ior, and for years to come. It improves First of all, the most important prin- year, few and fewer people are able to Medicare solvency. We make sure doc- ciple of the bill is that it is paid for. We get insurance through their employer, tors will not see a 20-percent cut in already had about $5 trillion of debt fewer and fewer employers are able to their payments. It makes the entire when the last President became Presi- offer insurance to their employees, Medicare system more affordable and dent. We are now at $12 trillion. There which is heartbreaking for many of our will save taxpayer dollars. has been an unbelievable spike between small business owners because these Critics say no to reform. They are 2000 and today. We have put an enor- are family businesses that for years content with a system that pays by the mous burden—as the father of three have provided health insurance to their test, test after test, instead of out- young girls, I feel this very personally employees. They view it as part of comes and patient-centered care. That and very keenly—an enormous burden their pact with their employees to help approach will assure that Medicare is on our kids and our grandkids. them get ahead. But they cannot do it. bankrupt by 2017. We need to do better Our debt is now $12 trillion. Our en- So they are dropping them from the than that for seniors. We need to pro- tire gross domestic product—our entire rolls. tect Medicare. economy—is $14 trillion. Our deficit is Where are these folks ending up, Included in this health care reform $1.4 trillion, 12 percent of our gross do- those who are now uninsured? Well, bill is a version of a bill I introduced

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.005 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11910 CONGRESSIONAL RECORD — SENATE November 21, 2009 based on great work being done in Col- we should do is make sure we allow the the near brawling we have seen in orado. It is called the Medicare Care Senate to debate the bill, to improve townhall meetings where folks sit in Transitions Act. We looked at the $17 the bill. There are things in this bill I opposite sections depending on their billion Medicare was spending on hos- want to change and things I want to political points of view. That is not the pital readmissions. Currently, one out make better in the coming weeks. But American way to face big challenges. of every five patients leaves the hos- I believe that if we pass this reform, we This certainly is such a challenge. pital and returns within the same will have taken a very important step I believe fixing the economy and fix- month. We looked at places in Denver forward to saying we are here to honor ing American health care are two sides and Grand Junction where the readmis- the legacy of our parents and our of the same coin. We can’t spend more sion rates are 2 percent compared to grandparents. We are here to say as than 16 percent of our gross product on the national rate at 20 percent. What one generation to the next that we are health care, spot our foreign competi- we saw was that they coordinate care. going to carry that legacy forward and tion hundreds of millions of dollars a As people go from place to place, these make sure we are making the hard de- year, and have enough money left over health care systems track where they cisions to provide more opportunity for to focus on education, transportation, go with a system of electronic medical you, not less. This is only one step of and domestic needs. The reason so records, what medications they use, that. many Americans don’t see their take- what doctors they see. They focus on I mentioned education earlier. I men- home pay go up is because health care patients—on patients—when making tioned our economy earlier. My hope is gobbles up all the costs in sight. So decisions. So when we talk about these that in this debate, what we can do is this is certainly a big enough challenge delivery systems being unnecessary, begin to learn how to set the special in- that it demands that the Senate get be- tell that to the 12 million Medicare terests aside for the benefit of the yond the fighting—near brawling— seniors who got readmitted to the hos- American people. If we can do that, about this subject across the land. On pital within the very first month they there is not a doubt in my mind that the basis of the conversations I have were let out of the hospital. We owe so we will honor our grandparents’ legacy. had with colleagues, I continue to be- much more to these seniors, and we Thank you, Madam President. I yield lieve the Senate can break through and owe a lot more to the American people. the floor. produce a bipartisan bill, working with Health care reform must stop the ris- The PRESIDING OFFICER. The Sen- Senator REID, working with colleagues ing costs that are bankrupting working ator from Oregon. on both sides of the aisle. families, small businesses, and our Mr. WYDEN. Madam President, even In terms of the real reforms that are economy. If you like your coverage, though America has the best doctors in Senator REID’s bill, some of the you should be able to keep it. We need and the best nurses, our Nation spends most important have to do with the de- to put an end to denials based on pre- too much on health care for what it livery system—the way American existing conditions. We need to give gets. Because the problem in American health care is essentially experienced people more affordable options, includ- health care will not cure itself, I rise in across the land. The fact is that to- ing a public option. One thing is clear. support of this motion to proceed to day’s delivery system essentially re- Business as usual cannot be an option. beginning the debate about how to fix wards inefficiency. Payments are based The debate is bigger than politically American health care. on volume rather than quality. In my charged issues. We have to keep our Before I lay out the many provisions part of the country, we have plans like eye on the ball and not get distracted in Majority Leader REID’s bill that Kaiser and Group Health, and we have by the same old, tired, special interest constitute real reform, I wish to talk actually been in the forefront of trying politics that have kept us from reform- for a couple of minutes about how the to move away from a system that re- ing our health care system since Harry Senate can come together, Democrats wards inefficiency, rewards volume. Truman was President. and Republicans, to fix American What we have shown is that changing Health care reform should not be health care. I have had a chance to these incentives pays off. People can be about changing our laws on abortion. I visit with almost every Member of the healthier and America can do it for less think the House went astray when it Senate in their office on this issue, to money. adopted new language with unintended listen to them, and it is very clear to Senator REID’s bill begins to move in consequences for women. The Senate me that both Democrats and Repub- the direction of what we have been bill already makes sure we do not use licans have valid points. I believe my doing in our part of the country for taxpayer dollars to fund abortion. That party is absolutely right in saying you some time. His bill promotes what are is why I opposed the House Stupak lan- cannot fix American health care unless called accountable care organizations. guage. all Americans get good quality, afford- There are also changes in reimburse- I want to end this morning on what I able coverage. If you don’t cover every- ment. Probably folks on Main Street am for. I am for insurance reform. I am body with that kind of coverage, what are not familiar with what is called for making our small businesses more happens is those who are uninsured ‘‘bundling.’’ In effect, instead of paying competitive by reining in skyrocketing shift their bills to the insured folks for each specific service, under bun- health care costs. I am for reducing who are already getting shellacked, dling there is essentially one payment premiums for working families. I am and there is an underemphasis on pre- to reward trying to deliver care in an for more consumer choice, including vention. So my party is right that to integrated fashion. the ability to voluntarily choose a pub- fix this, we have to offer all Americans We have been able to have included lic option. By the way, one thing I have secure, quality, affordable coverage. in the legislation incentives to care for noticed is that as people start to un- I think colleagues on the other side folks at home. The majority leader in- derstand they are going to be required of the aisle have valid points as well. cluded a version of the bill I introduced to have health insurance as part of this They focus on the need for marketplace called the Independence at Home Act plan, what they are saying is, I want forces, for choice, for competition. I that is backed by many colleagues on all the options. I want a private option, subscribe to each of these principles as the other side of the aisle, and many a public option, a nonprofit option. I well. Democrats as well. When we think want to be in a position to make the I think many believe it is an absurd about the challenges of American best decision for my family. fantasy that before the Senate com- health care going forward, we certainly I am for reform that squeezes our pletes its work on this legislation, the ought to agree it makes sense to de- wasteful spending so we can reduce our Senate could actually come together, liver more good quality, affordable deficits in the long term. Throughout Democrats and Republicans. I simply care at home, rather than forcing the this entire debate, my focus has been don’t share that view. Let me be clear: sickest Americans to spend a big chunk on our working families and small It is my intent when this bill gets to of their day fighting through traffic businesses. There is plenty in this bill the floor to work very closely with Ma- simply to get to a doctor’s office, and for you. jority Leader REID and with all of our we have the technologies, we have the The time for talking is over. We colleagues to finally break through, to trained physicians and nurse practi- should pass this bill. But tonight what get beyond some of the polarization, tioners to offer these kinds of services

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.007 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11911 at home. I highlight the fact that this have been interested in for years, real- health insurance at all. We have been is real reform, it is in Senator REID’s ly going back to the days when I was able to do it. According to the CBO, we bill, and Republicans and Democrats co-director of the Oregon Gray Pan- will be able to add an additional mil- alike are behind it. thers, because I think it is simply bi- lion people, middle-class folks walking The majority leader makes a number zarre that it is possible in other parts on an economic tightrope, at 10 percent of long overdue changes in the private of American life—in a Costco store or or less of what it would cost to have health insurance market. In many re- any other big store—to compare prod- those people get their coverage spects, today the private health insur- ucts, look at alternatives, have a meas- through Medicaid or through subsidies. ance system is simply inhumane. What ure of uniformity, and not have that in It is my intent to work with the major- we have is a system that rewards cher- American health care. ity leader and Chairman BAUCUS close- ry picking; where the private insurance What Senator REID’s bill does is set ly to allow others to have a chance to companies take only the healthy peo- the foundation for a marketplace so be part of this kind of competitive sys- ple and send the sick people over to that health care in 2009 will be dra- tem. I commend the majority leader government programs more fragile matically different than it was, say, 60 and Chairman BAUCUS for their com- than they are. What we need is a very years ago, in 1949, when I was born. I mitment to work with me, as this bill different system where the private in- don’t see anybody outside the Capitol goes to the floor, to expand access to surance companies compete on the driving a car from 1949, but much of the marketplace. basis of price, benefit, and quality, and American health care still resembles Let me close with one last point. I not who is the best at selecting out the the middle of the last century. Senator see my colleague from New Mexico in good risks. REID, through his legislation, lays the the Chamber, and he is a welcome addi- Senator REID’s bill does away with foundation for modernizing that. tion to the Senate. the unconscionable practice of pre-ex- I would like to see more people in A lot of Americans listening may isting condition exclusions and the these new marketplaces, the ex- wonder why the Senate is turning its practice of rescission where the insur- changes, more quickly. Under the esti- attention to health care when there is ance companies abruptly drop coverage mates we have been given, only about so much economic hurt in our land. for the sick. The bill also does away 10 percent of our population would be The fact is, fixing the economy and fix- with charging a person more simply be- able to enjoy the fruits of real choice ing American health care are literally cause they are sick, because they are a and real competition. Real choice and two sides of the same coin. We have to woman, or because they work in a real competition in that marketplace rein in these costs. We have to rein in high-risk job. is the path to holding premiums down. these costs for Americans to have more These are very constructive insur- My goal in the years ahead is to allow take-home pay, to be in a position to ance reforms. We are going to try to every consumer—every consumer, for pay for essentials, and to allow our build on those as we go forward in the example, in New York and Oregon—to workers to compete in ferociously legislation. Colleagues should make no be able to deliver an ultimatum to challenging markets around the world. mistake about it: The insurance their insurance company. That ulti- It is time to move beyond the town- changes in Senator REID’s bill are very matum should be: Treat me right or I hall brawls of this past summer and for real reform. am taking my business elsewhere. It is the Senate to work with Senator REID I wish to focus for a few minutes, that simple. That is the way we do it in and all colleagues to break through though, on what I think is the great every other part of American life. promise of this legislation for health By the way, that is the way it works and deal with this critical issue, the care in the future. Since World War II, for all of us here in the Senate. We be- premier long-term challenge of our there has essentially been no market long to a real marketplace. We belong time for our economy, and do it in a bi- for American health care. Back in the to a real exchange called the Federal partisan way. I urge my colleagues to days of wage and price controls, we Employees Health Benefits Program. If vote for the motion to proceed. didn’t have a way to get good health a Member of the Senate doesn’t like his I yield the floor. care to Americans and we simply said health care coverage in November of The PRESIDING OFFICER. The Sen- we will put it on the backs of employ- 2009, come January of 2010, that Mem- ator from New Mexico is recognized. ers. They were patriotic citizens then, ber of the Senate can take his business Mr. UDALL of New Mexico. Madam like there are patriotic citizens now, elsewhere, to another insurer that does President, I appreciate very much lis- and they said, We will figure out how a better job. I think that kind of mar- tening to Senator WYDEN and his com- to do it. We are going to have to pass ketplace—the marketplace every Mem- ments on health care reform. He has on the costs in the form of higher ber of the Senate now enjoys—ought to been one of the leaders when it comes prices for goods and services. That be available to everybody else in the to working in the Finance Committee probably made sense back then. We had country. I think there ought to be pub- and looking for significant reforms on people essentially work at a job for 20 lic choices. I think there ought to be health care. I look forward to working or 25 years, and after their last day at private choices. I think all Americans with him in that capacity. work they got a gold watch and a dig- ought to be able to have access to all of The health care reform we are debat- nified retirement. Today, there is a those choices. We are not going to be ing today will impact every person in very different economy. The typical able to have real insurance company this country. Whether you are search- worker changes their job 11 times by accountability, real choice, and real ing for affordable insurance for your- the time she is 40. She needs a different competition unless we make the ex- self or watching helplessly as a loved set of health care choices. She needs changes robust and get more people in. one is denied coverage, every American the opportunity to be empowered to go To illustrate the fact that the major- stands to gain something through this into the marketplace to hold insurance ity leader and other leaders, such as historic legislation. companies accountable and to get more Chairman BAUCUS, are open to new In my home State of New Mexico, the value for her health care dollar. The ideas, just yesterday the majority lead- people I represent don’t just have a lot majority leader in his bill lays the er and Chairman BAUCUS and I agreed to gain from this reform, they also foundation for this kind of system. on an approach that will allow more have a lot to lose if this reform is not He establishes a system of what are people to enjoy the marketplace, the enacted. For New Mexicans, the status called health insurance exchanges. fruits of a competitive system, more quo isn’t an option. That is because They are kind of like farmers markets quickly, when they indicated yesterday without this health care reform our for health insurance. Senator REID has they would support my legislation to State is expected to experience the improved this so that these farmers expand access to the exchanges for largest increase in insurance premiums markets, these exchanges, could only those who otherwise would have for- of any State in the Union. In 2016, let in good-quality plans, and under gone having health insurance under without this reform, a family of four in Senator REID’s bill, it will be possible health reform. Let me emphasize New Mexico can expect to pay an as- to more easily compare the plans in that—letting folks get to the ex- tounding $28,000 a year in health care these exchanges. This is something I changes who otherwise would have no premiums. That will consume more

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.008 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11912 CONGRESSIONAL RECORD — SENATE November 21, 2009 than 56 percent of that family’s pro- downturn. This legislation would re- They couldn’t get the score they want- jected income for the year. Afford- quire the Federal Government to cover ed—they couldn’t get the score they ability is already one of the key bar- 100 percent of the cost of the Medicaid wanted from CBO, so they moved back riers to obtaining coverage in my expansion from 2014 to 2016 and 95 per- another year in the 10-year cycle. They State. Since 2000, premiums for resi- cent of that cost after that. went from 4 years to 5 years as to the dents have risen 110 percent. As a re- When it comes to health care today, starting point of most of the spending sult, almost one in four people doesn’t too many New Mexicans are living on a in this bill. have insurance, giving us the second cliff, teetering on the edge of financial What they claim to the American highest uninsured rate in the Nation. ruin. All it would take is an illness or people is the 10-year bill is going to Enactment of this reform legislation job loss, and they could fall into the cost about $800-plus billion. But what would make as many as 249,000 middle- abyss of medical invoices, bill collec- they don’t tell the American people is class New Mexico residents eligible for tors, and bankruptcies. For these New they are not spending anything in the premium credits to ease the burden of Mexicans, the status quo isn’t an op- first 4 or 5 years of the bill. No, they do these high costs. In addition, almost tion. This bill offers a life rope to these raise your taxes throughout the 10-year 238,000 New Mexicans would be eligible New Mexicans to pull them back from period. They do cut Medicare through- for new private coverage through the the precipice. Passing it would provide out the 10-year period. But they don’t exchange or through their employer stability and security to those who spend the money. They don’t start the and another 124,000 would be eligible have insurance, affordable coverage to programs until the year 2014, when this for the new expanded Medicaid cov- those who don’t, and lower costs for bill is fully phased in. erage. For the families who already families, businesses, and government. When all these new programs, this have insurance, they win too. They will This is a historic moment. I urge my massive expansion of entitlements is likely see lower premiums, thanks to colleagues to join me in seizing it. created, brand-new entitlements, when the increased competition in the mar- Let’s begin the debate on this long- all this new spending occurs, this bill ket. The bottom line is that with this overdue legislation to reform our bro- will cost $2.5 trillion over that 10-year reform the vast majority of New Mexi- ken health care system. period—$2.5 trillion. That is the real cans would have access to quality, af- With that, I yield the floor. cost of this bill. That is how this gov- fordable health care for themselves and The PRESIDING OFFICER. The Sen- ernment is going to grow in a 10-year their families. ator from New Hampshire is recog- window as a result of this spending. Reform will also benefit New Mexi- nized. I say to my colleagues, I think most co’s small businesses. In 2006, less than Mr. GREGG. Madam President, I ask of us understand we already have a 35 percent of small businesses in my unanimous consent to be allowed to huge debt problem in this Nation. We State offered coverage for their em- speak in a colloquy as it evolves on our are passing on to our kids a country ployees. That figure means our State side. with so much debt they are not going ranks dead last in employer-sponsored The PRESIDING OFFICER. Without to be able to afford it. Every year for insurance in the Nation—a dubious dis- objection, it is so ordered. the next 10 years, without this health tinction, to say the least. I have talked Mr. GREGG. We are joined by a num- care bill, the President has proposed to a lot of these small business owners ber of the distinguished members of budgets which will run a $1 trillion def- over the past month. They all tell me our caucus. They have thoughts they icit, every year, on average, for the pretty much the same thing: I would want to express. We want to discuss a next 10 years. Sometime this month, love to offer coverage to my employ- couple of points. we are going to have to raise the debt ees, but it is just too expensive. They Before I turn to the Senator from ceiling of this country because we say they are having a hard time afford- Missouri, I want to make a point, be- reached $12 trillion in debt. Then it is ing insurance for their own families. cause I have been listening to a lot of going to have to be raised again be- To those small business owners, I say the discussion on the floor, and I have cause we are running up these massive that help is on the way. The Patient participated and listened to a lot of it deficits. Protection and Affordable Care Act on television, from my colleagues on The debt owed by this country will will help you provide insurance to your the other side of the aisle. They con- exceed 80 percent of our gross national employees by providing Federal tax tinue to use this number. They claim product—80 percent of our gross na- credits of up to 50 percent of premiums this bill will cost $800-some-odd billion tional product at the end of that 10- should you choose to offer coverage. and that is the number that has been year period—and will exceed 60 percent In addition to lowering costs for indi- reached as the expenditure on this bill. of our gross national product within 2 viduals and families and helping small That is a totally dishonest number. years. Those are unsustainable num- businesses, this reform would also give That is the ultimate shell game. That bers. Yet a bill is being proposed that our rural communities additional tools is Washington cynical politics. is going to expand the size of govern- to provide quality, affordable health Do you know how they get to that ment by $2.5 trillion. care for all of their residents. number of $800 billion as a cost of the It is alleged it is paid for, and we are Of the 2 million people who call New bill? It is a 10-year number, by the way. going to get into a discussion in some Mexico home, about 700,000 live in rural That is a lot of money, $800 billion. depth because I think that is an equal- areas. They are more likely to be unin- That would run the State of New ly cynical number as a result of bait sured and often must travel hundreds Hampshire for probably 100 years. Mis- and switch. of miles for preventive or emergency souri is a little bigger, but it would run I just wished to clear the air as to care—if they are able to find any care that State for a while, and it would the real cost of this bill because I found at all. probably run Alabama for a little it uniquely cynical that it would be In this bill, we have included pay in- while. South Dakota could probably represented that this bill costs $890 bil- centives to recruit more physicians to run for 200 years on that. That is not lion, whatever the number is. It does serve in these underserved rural areas. the real cost of this bill, though. That call into issue the credibility of the We will improve dental services in is not the cost of the bill. rest of the numbers that are being rural areas, we will extend Medicare The way that number was arrived thrown out by the other side of the payments for ambulances in rural at—and I think the American people aisle when they use that number, areas, and we will expand the Tele- need to understand this. If that number which is a 5-year number that they health Program so that rural residents was so dishonestly arrived at for the claim covers the 10-year cost, when may receive specialized treatment not number of the bill, what is wrong with they don’t do anything in the first 5 available in their local areas. the rest of the bill that they haven’t years. Finally, we make sure this legisla- been told about? That was a 10-year I appreciate the indulgence of the tion won’t result in an unfunded man- score for what the bill cost was, but Senator from Missouri. I understand he date for our State government, which they don’t start spending money under wishes to speak and then we will go to is already experiencing the pain of this bill until the fourth and fifth year. the Senator from Alabama and then budget cuts, thanks to the economic In fact, the cynicism exceeds that. the Senator from South Dakota and

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.009 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11913 then have a discussion about some of to go broke. So we suggested, when I a bill that will take over one-sixth of the issues, such as costs, how it affects was chairman of the Budget Com- our economy and likely kill jobs. Medicare, how it affects small busi- mittee—and everybody in this room Don’t get me wrong, our health care nesses, how it is going to affect your voted for it, by the way—that we system is in need of reform. It costs personal insurance. should reduce the rate of growth of too much, too many people are unin- Mr. BOND. Madam President, I thank Medicare by $10 billion on a $1 million sured, there are too many junk law- the Senator from New Hampshire. I timeframe. In other words, Medicare suits and too much defensive medicine wish to clarify some things he said be- was going to spend $1 trillion over a pe- and not enough focus on prevention cause they are truly important. I wish riod, 5 years. We were going to suggest and wellness. to make sure everybody understands it a $10 billion reduction in that rate of While we all agree reform is nec- because Senator GREGG, in his position growth which was going to be paid for essary, the American people expect us on the Budget Committee, as well as by requiring people who were getting to answer the questions: How much his other positions in writing this bill, Part D premiums and had high income will reform cost and can we afford it? is intimately acquainted with the costs to pay for part of their premiums—peo- Will it lower health care costs? Can of this bill. ple such as Warren Buffett would not you keep your current plan? What role The cost for 2010 to 2019, how much be subsidized by people working down will the government play? was the cost for that 10-year period? at the local restaurant. The answer to two and three on this Mr. GREGG. That is $1.2 trillion be- We did not get one vote from the bill is: No, it will not lower our health cause between the period 2010 and 2014, other side of the aisle. We passed it by care costs; no, you will not be able to there are no expenditures because they having the Vice President sit in the keep your current plan. don’t start the programs until 2014. chair and break the tie. That was $10 Then the question is: Who will make Mr. BOND. Is this the total expendi- billion over 5 years. health care decisions? We are seeing ture or are these just the expenditures So I think this idea that you are evidence that they have government that are not covered after 2014, that are going to do $1 trillion over 10 years and committees that say when you can get not covered by the so-called tax or rev- pay for this—first off, if you are going a mammogram, when you should get enue raisers? In other words, does this to reduce spending or raise Medicare Pap screening. all go onto the debt? taxes, it should go to pay for Medicare Will Americans and Members of Con- Mr. GREGG. No, those are total ex- solvency because Medicare is insolvent. gress have time to evaluate what is in penditures which are represented to be It shouldn’t go to create a new entitle- the legislation? We hope today, as yes- offset by cuts in Medicare, increased ment. Senior citizens, paying into terday, that we will bring out for the fees, and increased taxes. Medicare all their lives, should not American people the cost of this bill Mr. BOND. Cuts in Medicare. How have their money taken to start a because what we are seeing in this much are the cuts in Medicare? brand-new entitlement for other peo- massive pot, 2,047 pages, is there is a Mr. GREGG. When fully phased in, in ple, and that is what this bill does. lack of commonsense reform. It is the 10-year period, 2014 to 2023, the As a practical matter, we are not filled with costly budget gimmicks and Medicare cuts are $1.1 trillion. going to do that. We know that. We asks the people of America to spend Mr. BOND. Madam President, $1.1 know this is all going on the debt. over $2 trillion on proposals that will trillion cuts in Medicare. How much Ninety percent of this is going to end heap a mountain of debt on our chil- are the taxes and the other ‘‘revenue up on the debt. dren and grandchildren. raisers’’ in that period? Mr. BOND. I thank my colleague Two trillion dollars is an almost Mr. GREGG. The taxes and fees dur- from New Hampshire because he has unfathomable amount of money. But in ing that period—this period, when it is been a very solid, consistent, credible Washington, trillion is the new billion, fully phased in—are approximately $1.5 voice. What he is pointing out today is and that is not the kind of health care trillion. that the legislation we are debating reform Americans want. It is not re- Mr. BOND. So how much will go onto has major implications for every Amer- form at all. It spends too much, it the debt? How much is uncovered? ican family, every American taxpayer, taxes too much and it cuts Medicare Mr. GREGG. Actually, if you accept every American small business. too much and does not provide reforms these assumptions that we are going to In the 1992 election, President Clin- we need. Nearly $1⁄2 trillion in taxes cut Medicare by $1 trillion and take ton’s famous slogan was: ‘‘It’s the will be added on the backs of the Amer- that to create a new entitlement in- economy, stupid.’’ Seventeen years ican people, $28 billion in taxes on busi- stead of using it to help Medicare be later, it is again the economy that is a nesses, which will kill jobs at a time more solvent and then we are going to major issue facing the people. But this when we have over 10 percent unem- raise taxes and fees by $1 trillion—re- time the majority party does not seem ployment and even higher if you in- member, most of this is not going to to be paying attention. Instead, the clude the number of people who are no come out of the wealthy. It is going to majority has used its supermajority longer working or underemployed. come out of small businesses and high- position to spend trillions of dollars These higher costs will ultimately be er premium costs to people on insur- that we don’t have, including a mis- passed on to American workers and ance or it is going to come out of HI named stimulus that stimulated the consumers. taxes. If you accept that logic, which I growth of the deficit and the Federal Anybody who thinks you are going to find to be a bit of a reach, then it will Government but not jobs. We had take- tax health care insurers, device pro- not have any impact on the deficit in overs and bailouts of banks, insurance viders and expect that those costs will that timeframe because they have cut companies, and major auto manufac- not be passed on to the consumers— Medicare to pay for it, and they have turers. They have adopted a budget that is you and me, Madam President. raised all these taxes to pay for it. that would double the debt—the debt The head of the Congressional Budget Mr. BOND. My friend has been very our grandchildren owe—in 5 years and Office and the Joint Committee on active in the Budget Committee. How triple it in 10. Taxation have said these higher taxes many times have we cut Medicare, It is little wonder that the unemploy- are passed along, and they will land on have we allowed Medicare cuts to go ment rate has skyrocketed, because families, small businesses, and individ- into effect? I think that is a rather employers are afraid to hire. Families uals. rare occurrence, isn’t it? are seeing their budgets strapped such It will also force Americans into a Mr. GREGG. That is a fascinating as never before. But the bill before us government-run health care plan. It question because I was chairman of the is a crowning achievement of the drive will ration care and limit access to Budget Committee the last time we to destroy our economy and hope for lifesaving treatments and put a bu- tried to do something in the area of the the future. reaucrat between you and your doctor. rate of Medicare costs because we re- Just 1 year after a narrowly averted In life, two things you can count on are ceived a directive from the Medicare financial collapse, with unemployment said to be death and taxes. I didn’t ex- trustees that Medicare had to be made at its highest level since 1983, instead pect to see them both in a health care more cost-effective or else it was going of how to create jobs, we are debating reform proposal.

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.011 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11914 CONGRESSIONAL RECORD — SENATE November 21, 2009 We call this a pig in a poke. The only savings the majority has been touting. coverage for these new Medicaid eligi- way to sell a pig in a poke is to hide No wonder. And the true cost, as the bles for the 2 years that they will get from Americans what their tax dollars Senator from New Hampshire has covered and then they will dump it on are buying. If I were to outline all the pointed out, is $2.5 trillion. But it will the States—$25 billion. There is a $25 problems in this 2,000-page bill, we also be increasing taxes. In fact, every- billion cost. would be here until Thanksgiving. It is one will be taxed one way or another. The Senator from New Hampshire sort of like a mosquito in a nudist col- Forget what the President promised and I were both Governors of our ony—there are so many targets to at- about no taxes. Sections 9004 and 9010 States. I can tell you, States do not tack in this bill we don’t know which will tax Americans who have insur- need that kind of burden, particularly one to hit. ance. Section 1501 will tax Americans in their difficult circumstances. Let me give you just a few. As the who do not have insurance—almost $8 Slashing Medicare for seniors? In Senator from New Hampshire pointed billion. Taxes will be placed on medical Missouri, Medicare already only pays out, the real cost of this bill to the device manufacturers, section 9009; and 80 percent of the costs. More and more American people is a whole lot more as the CBO has said, those taxes will be hospitals and doctors have to limit the than they admit. The majority is passed on in the form of higher prices number of Medicare patients they can claiming that the bill only costs $850 and thus in the form of higher insur- accept. If we continue, and if they push billion, but the way the majority gets ance premiums. through this Medicare cut, then fewer to say that is because they are pulling Because of the tax on health insur- and fewer Medicare patients are going a great smoke-and-mirrors trick. ers, section 9010, the CBO and the Joint to be able to get health care. Even more incredible is the Demo- Committee have said these taxes will I hope my colleagues will listen to crats’ claim their bill will cut the def- be passed on in the form of higher what the American people are telling icit. It is a great scheme, but no one health care premiums. Pricewater- us and vote against the bill. That is outside Washington actually believes houseCoopers says that is $487 a year certainly the message I am getting this health care bill will do anything per family. That is how much these from Missouri. but increase costs and pile more debt taxes on the health insurers and health I yield the floor. on our kids and grandkids, and they payment plans will cost the average The PRESIDING OFFICER. The Sen- are right. family. ator from Alabama is recognized. Right now, as the ranking member of Employers will be taxed. About $2 Mr. SESSIONS. Madam President, I the Budget Committee has pointed out, billion in new taxes will be placed on thank Senator BOND. He has certainly the national debt already exceeds $12 employers who do not meet govern- delineated some of the fiscal impos- trillion. This bill will put more on ment approved health care plans. That sibilities in this bill, as has our former that. The true cost of the bill is not is section 1513. That is where American Budget chairman, now ranking member just a ‘‘he said, she said.’’ Even the workers are going to pay for it because of the Budget Committee, JUDD GREGG. nonpartisan Congressional Budget Of- that is where they lose their jobs. He studied this very hard. The informa- fice acknowledges that the majority’s Headlines in the Wall Street Journal tion he provided to this Congress and bill includes gimmicks that hide the and letters I have seen from leaders of to the American people is accurate. true cost of the bill. businesses say we are not expanding; I have tried to think what I should Part of the majority’s scheme to hide we cannot afford to expand; we cannot say about this bill this morning and be from Americans the true cost is the afford to take on more employees. realistic and honest and boil it down to great stunt, as the Senator from New Why are we having a jobless recov- its essence. The 2,000 pages that sit on Hampshire described, to push back im- ery? Because the threats of Washing- that desk, how should we talk about it? plementation of parts of the reform to ton’s overspending, overcontrolling, Let me just say the claim from our 2014 but start collecting money in overtaxing, and overregulating are tell- colleagues is that they have a great taxes now. That means tax now and ing prospective employers that they plan to reform health care and it will pay later. That sure makes your num- are about to hit the ditch with all the fix the problems in health care. We do bers look good, doesn’t it? things the Government is putting on have problems in health care that need For example, Medicaid expansion them. to be fixed. They are going to provide does not begin until 2014. That is in For all of the taxes and mandates, methods and additional funding and section 2001. Section 1311 says health according to CBO, about 5 million provide millions of people with insur- insurance exchanges are not fully oper- Americans would lose their employer ance who didn’t have it before—al- ational until January 2014. Section 1323 coverage. That is because the costs though 24 million will remain unin- says a public health insurance option is would go up, the regulations would go sured. At the same time, they will save not available until 2014. Most of the up. Currently, 83 percent of Americans $130 billion over 10 years, and we are major insurance reforms, however, in have health insurance, and they are supposed to be grateful and say how section 1253 take effect in 2014. concerned that it costs too much. pleased we are that you have been able The tax on health insurance starts in Americans want affordable health care, to pull off this event. 2010. That is section 9010. Section 9009 but this bill raises the cost of health But the first reaction most American says the tax on medical devices starts care. New taxes and mandates will be people have had, and it is a sound one, in 2010. Section 9008 says the tax on passed on to American families, the is, wait a minute, that is pretty dubi- pharmaceutical manufacturing starts American taxpayers, and American ous. How can you do that? Do you re- in 2010. That is even worse than the small businesses. member that song from the ‘‘Sound of Senate Finance Committee bill which The bill still leaves 24 million Ameri- Music’’? ‘‘Nothing comes from nothing, initially had it starting in 2013, but it cans without insurance. According to nothing ever could,’’ sang Julie An- is a great gimmick to allow them to the CBO, the government-run plan will drews. hide the cost of the bill. Claiming sav- have higher premiums, and the CBO The result is the phrase I came up ings of $122 billion by recording taxes said it will drive up the cost of health with: ‘‘Shell game.’’ Senator GREGG over 10 years and only scoring costs care. This was supposed to lower the used that phrase. I think that is ex- over 6 years would get an officer in a cost of health care. It will not do any- actly what we are talking about. When publicly traded corporation sent to thing of the kind. it became obvious to everybody who jail. Move over, Bernie Madoff. Tip To sum up, $2 trillion in more spend- could add that this great vision, the your hat to a trillion-dollar scam. This ing gets the American taxpayer, in the wild chimera they had that they could is magnificent, and that is in this bill. 2,074 pages, a Federal bureaucracy that do all these things, would not work as I am glad all Americans can read it. increases the cost of health care, raises they dreamed it, the mountebanks They can check out the sections I premiums, slashes Medicare for sen- began their chicanery. cited. iors, and puts unfunded burdens on In my remarks I will not attempt to Even the Congressional Budget Office States. point out all the manipulations in this has called ‘‘bull’’ on this stunt, saying Let me just make two last points: bill, just some of the more obvious that it would be difficult to maintain the The States, according to CBO, will get are inescapable.

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.012 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11915 First, you ask: Why do they do this? dicated they plan to do? It costs $250 Medicare is going broke. Everyone The answer is the numbers don’t add billion. That is a lot of money. That is knows that. We have been working on up. They cannot make the numbers do not a new program, this is an obliga- that for a number of years. All of us what they want them to do. So they ei- tion that we have now. Does this plan are concerned about this iceberg in ther have to be honest and talk about fix that? It fixes it for 1 year. So it front of the Titanic which is Medicare’s massive cuts openly or massive tax in- goes out 1 year and then the CBO score deficiency. creases. The American people are not assumes the doctor payments will drop The PRESIDING OFFICER. The Sen- sure about that. To add a whole new 23 percent and be 23 percent lower for 9 ator has consumed 5 minutes. monumental health care program at a years. Mr. SESSIONS. I thank the Chair. time of colossal financial stress in our If we add that up, that is $250 billion. We need to save this program before country, with debts the likes of which It allows the folks in the know here to we create a new one. It is so simple. If our Nation has never ever seen before, manipulate the numbers and hide a we are going to raise taxes $500 billion, are we now going to start off on a mon- $250 billion debt we owe. We can’t cut has anybody asked where that money umental multitrillion-dollar bill that doctors that much, and we are not should go? Should the $500 billion in will not pay for itself? going to do it. We have not been doing new taxes go to create a new program We have this great promise, and it is it, and we will fix it every year, in fact, or maybe should it be used to put Medi- not adding up. Do they slow down? Do and that is—what I will say is, we will care on sound footing or maybe it they begin to think if they can’t do ev- spend the $250 billion, and it should be should be used to pay for military ex- erything they promised in the cam- in this bill. They didn’t do it. penditures that have the highest budg- paign, and they would love to do, and Just a few weeks ago, they met in et in years, or maybe to reduce the they wanted to do, what progress can this secret room down the hall, and debt which, I point out to friends and they make step by step in a rational they got to talking and said: What are colleagues, is the greatest debt this Na- way that we can afford in this time of we going to do about the doctors? How tion has ever seen. There has been unemployment and unprecedented defi- are we going to fix the doctors? nothing like it ever. In 2008, our debt cits? No, that is not what they decided We could raise taxes. was $5.8 trillion. In 5 years, 2014, it will to do. Well, we raised taxes $500 billion. We be $11.8 trillion. In 2019, it will be $17.3 What they decided to do is go forward can’t raise them any more. Can we cut trillion, tripling in 10 years. According anyway and call anyone who had the Medicare? to the Congressional Budget Office temerity to say their ‘‘emperor has no Gosh, we have cut it $500 billion. We score, it does not include money to clothes,’’ that they are ‘‘Dr. No,’’ they can’t do that. fund the health care program. are against everything. They don’t be- What can we do? We promised the How big are those numbers? I won’t lieve in any reform. doctors fix to get them their pay. spend a lot of time on it. I will point That is kind of the idea we are hear- So they offered—it would be hilarious out that people can understand when ing, and that is not correct. if it weren’t so serious—they offered you borrow money, this debt doesn’t The bill is just too much, it goes too legislation a few weeks ago to just pay come from thin air. You borrow it. far, too fast, and costs too much. We the doctors all this money perma- China, other places loan us money. We don’t have the money. The American nently, outside of the health care re- owe them money. That is how we get people know this. That is why they op- form in a separate bill, every penny of the money. And look at the interest pose this bill. They are not opposed to it going to the debt, unpaid for. rate. My goodness. Alabama’s budget is reform and progress. They are opposed Even 13 Democrats couldn’t swallow about $8 billion a year; $800 billion in to this legislation, this 2-foot tall, 3- that. They voted no, and it failed. But this year is 100 years of our budget. The foot tall, 2,000-page piece of legislation. the House did it. They passed it, did interest the United States paid on our They don’t dislike President Obama, they not, I ask Senator GREGG, unpaid debt in 2009 was $170 billion. That is a but they don’t like this policy he is for? Horrible. Another $250 billion lot of money. The Federal highway bill trying to promote. You say: Let’s have added to our debt. is $40 billion. All of the Federal high- some facts about it. I can’t explain ev- So that is a shell game. It is like you way spending is around that amount. erything, but I want to share a few have a hole in your roof and you don’t But in 10 years, according to the CBO, things. want to spend the money to fix it, so we are going to be paying in that 1 Madam President, I ask to be notified you move across the hall into another year interest of $799 billion. It is like after 5 minutes. room and pretend the hole isn’t there. nothing we have ever seen before. That The PRESIDING OFFICER. Without Somehow you are not going to fix it is why people say our spending is on an objection, it is so ordered. when you know you have to fix it. unsustainable course. Mr. SESSIONS. A critical, essential They say: Don’t worry. See, our plan The first thing we need to do to bring part of fixing a broken health care sys- is budget neutral. It is deficit neutral. spending under control is to fix the tem is to end the growing problem of If you take the $250 billion, one thing critical problems that must be met. payments to our doctors. Republicans right there, it is not neutral. It is in You don’t start new programs that are and Democrats have not been good on deficit already. It is in deficit already. likely to spiral out of control and far this issue in the past, but the problem You have to watch that pea and see exceed the prognostications we have grows worse each year. Essentially, in how it moves around in the shell. But seen today. the balanced budget amendment of 1997 what we need to have a sense of is that I thank the Chair for the opportunity we limited the amount of payments to this is a program we have never had be- to share my thoughts. I am glad our doctors. After a while it became clear fore. It not only adds to the debt by not colleagues are here. I know others the cuts were too severe, and each year fixing the doctor payments, it raids ex- would like to talk. we put money back in. But the law still isting programs, Medicare and Med- I yield the floor. mandates major cuts. In fact, today if icaid, both of which are in serious trou- The PRESIDING OFFICER. The Sen- we don’t do what we call the doctor fix ble. It raids them in the first 10 years ator from South Dakota. each year, they will have a 23-percent and, as Senator GREGG said, much Mr. THUNE. Madam President, I ap- reduction in reimbursements, they get more later, $549 billion. And it raises preciate the great job done by my col- paid less. This is for Medicare. And taxes $493.6 billion. So it is pretty easy leagues from Missouri, Alabama, and they get paid less for Medicare than to say I have a deficit-neutral program New Hampshire in pointing out many other insurance already, so doctors are if I assume I am going to take $500 bil- of the concerns we have with regard to going to quit doing it if we have a 23- lion out of Medicare and raise taxes this bill and why we think this is a bad percent reduction in what they get $493 billion. It is budget neutral. Every- direction to go. paid for doing their work. body should thank me. That is what You have heard my colleagues talk How much does it cost to perma- the paper said the other day: Budget about a massive expansion of govern- nently fix that as the medical profes- neutral. We are so proud of ourselves. ment, tax increases, premium in- sion assumed we were going to do and The American public are not buying creases; obviously, the very serious as the President and his team have in- this. They are a little bit skeptical. problem we have with our national

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.013 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11916 CONGRESSIONAL RECORD — SENATE November 21, 2009 debt and the deficits we are racking up under the Democratic plan. In fact, Mr. THUNE. That is where a big every single year, to the tune of about their lives will get much worse—in par- share of the savings is going to hit, $1 trillion or north of there, $1.4 tril- ticular, those who already have health senior citizens, right squarely between lion last year, on a pathway to hit that care. the eyes, if they get benefits under target this year. There are some in this proposal who Medicare Advantage. In addition, $135 I have heard my colleagues on the will get some subsidies to buy insur- billion comes from hospitals; $15 bil- other side talk repeatedly about Re- ance in a health care exchange. That lion from nursing homes; $40 billion publicans not having their own solu- affects about 19 million Americans. But from home health agencies; $8 billion tion. I have to say, maybe the reason there are 182 million Americans who from hospices. Does anybody believe they haven’t been seeing the Repub- currently have health care who, if this all that will happen? And if it doesn’t lican solution is because they have bill passes, are going to be faced with happen, guess what, it all goes on the been hiding behind this voluminous higher taxes and higher premiums. Federal debt. 2,100-page bill at a cost of $1.2 billion That is the way it works. They are in- I thought it was interesting that last per page. Republicans—hundreds of eligible to get any subsidies to buy in- week when the President was in Asia, times, if not thousands—have come to surance. In fact, they don’t have any the Chinese raised the issue with him the floor and outlined a step-by-step more options available to them. What about what happens if health care re- solution to dealing with the health they are facing is higher taxes that form passes. They weren’t worried care crisis and the concerns most they will be faced with under this bill, about universal coverage or a public Americans have which is the high cost as well as higher premium costs. option. They were worried about what of health care. Unfortunately, many of If you are the average person who is impact it is going to have on the def- my colleagues on the other side per- worried about cost, which I think most icit. Americans are, and you are watching haps have not been able to see that be- According to the New York Times what is happening here in Washington, cause they can’t see around this $2.5 and their reporting on his trip: trillion expansion of the Federal Gov- you have to be asking yourself: What is The Chinese wanted to know in pains- ernment they seem intent on pushing the whole purpose of going through a health care reform debate if, in fact, it taking detail how the health care plan would through the Senate. Republicans have affect the deficit, said one participant. talked about buying insurance across doesn’t do anything to drive down the They are worried about their invest- State lines, small business health cost of health care? ment because they are the biggest plans, tort reform, incentives for My colleagues have pointed out that buyer of American debt. What happens wellness and chronic disease manage- when you spend $2.5 trillion, when you to all these Medicare cuts that are pro- ment. There is a whole range of things expand the Federal Government by posed? We couldn’t get 51 votes to cut that could be done to address the con- that amount, when you raise taxes on $2 billion a year out of Medicare a few cerns of the American people about the medical device manufacturers, on pre- short years ago, and they are talking high cost of health care that do not in- scription drugs, on health plans them- about cutting, when it is fully imple- volve a $2.5 trillion expansion of the selves, and when you cut Medicare pro- viders and, if you believe this, this is mented, $100 billion a year. Does any- government, a 2,100-page bill, at a cost something that seems hard to fathom, body believe we will cut $15 billion out of $1.2 billion per page. The other thing I have heard my col- that any of this would ever take effect, of nursing homes? I don’t think so. leagues say is we have to do something. but this $2.5 trillion is paid for in the Here we are. How do we pay for it? People in this country are dealing form of Medicare cuts and tax in- If it isn’t paid for in Medicare cuts or about the high cost of health care. creases, tax increases when it is fully tax increases, it all goes on the Federal They are. We all hear it. We hear it implemented over a 10-year period, as debt which is growing at over a trillion from small businesses, from families, the Senator from New Hampshire dollars a year. pointed out, about $1.2 trillion, about and from individuals. Everybody is This is a bad deal for the American $1.1 trillion in Medicare cuts—who in concerned about the high cost of health taxpayer. It is a bad deal for the 182 this Chamber believes that $1.1 trillion care. In fact, a number of my col- million Americans who already have in Medicare cuts is going to occur? leagues on the other side have said of insurance. They don’t get anything out There was a discussion between the all the bankruptcies that occur every of this. What do they get? Higher taxes Senator from New Hampshire and the year, most occur because of the high and higher premiums. Senator from Missouri about what hap- cost of health care. Get this, America: Listen to what CBO says: $160 billion pened a few years ago when the Sen- Under their proposal, you will go bank- in additional health care costs over ator from New Hampshire was chair- rupt sooner. Because they drive the this time period. It bends the cost man of the Budget Committee and pro- cost of health care up. They don’t do curve not down but up. That is what we posed cutting $10 billion out of Medi- get. That is why so many business or- anything to bend the cost curve down. care over a 5-year period, which I want to show a chart which points ganizations have come out opposed to amounts to $2 billion a year. What we out what happens to the cost curve this, because they know the impact it are talking about here is $1.1 trillion under the Democratic plan we are talk- will have on small businesses. The best over 10 when fully implemented or $100 ing about. The blue represents the cur- way to get health care coverage to billion a year. When he proposed cut- rent cost curve. That is the increase in more people in America, as long as we ting $2 billion a year over 5 out of health care costs we would see if noth- continue to have an employer-based Medicare, there wasn’t a single Demo- health care system, is to get people a ing is done, year-over-year increases cratic vote in support of that. In fact, into the future. What we would expect, job. People who are struggling with the the Vice President had to come back economy right now and losing jobs, the if we were going to reform health care, from a trip to Pakistan to vote on it to is that line starting to bend down a lit- thing we ought to be doing is figuring try and reduce Medicare by $10 billion. out how can we provide incentives for tle bit so that health care increases go They are talking about, when it is fully small businesses to put people back to down over time instead of up. implemented, $1 trillion in Medicare What happens? Under this proposal— work, not how can we kill jobs by rais- cuts. Do you know who that hits? and this is the CBO; this isn’t what I Mr. GREGG. Will the Senator yield? ing taxes on small businesses. am saying or any of my Republican Mr. THUNE. Yes, sir. That is exactly what we are doing colleagues, this is what the Congres- Mr. GREGG. It is important to know right here. That is why every business sional Budget Office says—the Demo- where that cut is proposed to primarily organization—the National Federation cratic plan we are talking about in- fall. Is Medicare Advantage used by a of Independent Businesses, to the creases the cost of health care. It bends number of seniors in South Dakota? Chamber of Commerce, the National the cost curve up; $160 billion more will Mr. THUNE. It is. I assume it is in Association of Wholesaler-Distributors, be spent on health care if their plan New Hampshire. right on down the list—is opposed to gets enacted. All those people who are Mr. GREGG. Under this plan, it will this bill. They know the impact it concerned about the high cost of health be eliminated for all intents and pur- would have on small businesses and care today are not getting any relief poses. their ability to create jobs. The best

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.014 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11917 way—best way—you can get health in- of that theme. It is another big dot Americans. So that is a problem with surance today in America is to get a they will be connecting in that trend, regard to ballooning Federal Govern- job. This bill kills jobs. and I share that concern. ment intervention, power, domination I yield to the Senator from Lou- One specific issue that goes to that of the marketplace. isiana. concern is the so-called government Again, as I said a few minutes ago, The PRESIDING OFFICER. The Sen- option or public option because that another part of that theme and concern ator from Louisiana. strikes a lot of people, including me, as I heard over and over was ballooning Mr. VITTER. Madam President, I rise a big, open door to dramatically in- Federal Government spending and to share the same sorts of concerns as creasing the Federal Government’s role debt. Here again, this Reid bill does my colleague from South Dakota. I and dominance in health care in our nothing to allay those fears. In fact, it share the concerns, more importantly, country—one-sixth of our economy. does a lot to increase those fears. of citizens all across Louisiana who Why do I say that? I truly believe the There has been a lot of talk and a lot have echoed those same thoughts to me government option—if this bill passed of reports of the CBO score of $848 bil- over and over again as I have traveled or anything similar to it passed—would lion over 10 years. First of all, $848 bil- the State. Like so many of my col- be the dominant option overnight and, lion is a lot of money. That is a lot of leagues, I have spent a lot of time perhaps, the only option in a few years. Federal Government spending and these last few months reaching out to Let me explain why. I will just point growth. It is hard to get your hands my constituents, my fellow citizens in to one provision, which is the so-called around that figure. What does that Louisiana, in every part of the State. pay-or-play mandate on business. mean? If someone had started spending During the August recess, obviously, Under this Senator Reid bill, as under $1 million a day when Jesus Christ was there were lots of townhall meetings previous versions of this idea, such as born and kept spending $1 million a around the Nation. I held 21 in Lou- the Senate HELP Committee bill, a day, we would not yet be up to that fig- isiana, in every corner of the State. business—virtually any business in the ure. So that is a lot of money. Since then, I have held six more town- country—would, for the first time, But what is worse, that figure is arti- hall meetings. I continue to do other have a legal mandate, and the mandate ficially low. The true cost of the bill is types of outreach. For instance, yester- would be to provide health insurance much greater. There are a number of day—since we had a 1-day oppor- up to a certain minimum defined by budget gimmicks the ranking member tunity—I flew home specifically to do a Federal bureaucrats or the business on Budget, Senator GREGG, and others few things, including having a round- would have a choice. The choice would have talked about that prove that $848 table of doctors, including two past be, if you do not want to provide that billion figure is truly low compared to presidents of the AMA, other health health insurance, well, you can write a the full cost of the bill. care providers, small business rep- penalty or fee check to the government What am I talking about? Well, the resentatives, leaders in the pro-life instead. community, and it was a roundtable What is wrong with that? Well, the biggest budget gimmick is the fact discussion specifically to focus on the penalty or fee check in this bill is pret- that the spending side of the bill does Reid bill. ty much set at $750 per employee per not kick in for the first 4 years. The In all that process, since the August year. How does that equate into a tax side, of course, as always, kicks in recess and even before, I have heard business’s bottom line in the choice immediately. So the tax increases, the certain themes over and over again, no businesses would face? Well, businesses fee increases, et cetera, kick in imme- matter where I was in Louisiana. One that do provide health insurance na- diately. But the benefit spending side of those themes was great concern tionally pay an average of not $750 per of the bill does not kick in for the first about what this Congress is thinking of employee per year but $6,100 per em- 4 years. So that is what will occur in doing on health care but not just be- ployee per year. So what sort of choice the first 10 years of the bill’s life, cause of the significance of health care, do you think that is going to present to should it be passed. Therefore, in that which is vitally important, which is business? What sort of result would you CBO score of the first 10 years, what personal to every American, but also expect? the CBO is scoring is 10 years of tax in- because of how it fits into a trend so In this brave new world, if the bill creases and only 6 years of spending. many Louisianians and so many Amer- passes, everyone is guaranteed cov- So that is a huge budget gimmick icans are seeing over the past year—a erage in some form or fashion, and which helps produce that artificially trend of dramatically increasing Fed- business has a choice: $6,100 per em- low $848 billion or so. eral Government power and interven- ployee per year or $750 per employee In fact, we should be looking at the tion and dramatically increasing Fed- per year. I think, for a lot of small first 10 years of full implementation; in eral Government spending and debt. businesses under extreme competitive other words, the first 10 years when not People have been passionate about pressure, that is not going to be a hard only all the tax provisions are kicked health care. Again, part of that is be- choice. It is going to be an easy choice. in but everything on the benefits cause that is a very personal issue, and The result for tens of millions of Amer- spending side is kicked in. That is basi- a bill such as this affects literally icans who have coverage now they are cally from 2014 to 2024. What are the every single American. But, again, a reasonably satisfied with through their numbers there when you look at the big part of it has been that Louisian- employer, the result is going to be get- real first 10 years, the first 10 years of ians are also connecting the dots. They ting dumped off that coverage, with full implementation? The real numbers see a bigger picture, which concerns businesses saying: Well, there are other are not $848 billion—as big a figure as them. Louisianians have been con- options now. There is the government that is, spending $1 million a day since necting the dots to a government take- option. Good luck. We can’t afford it. Jesus Christ was born and you still over of banks and insurance companies We have to be competitive. We have to would not be up to it—but there the and car companies, with the CEO of go with our bottom-line decision— analysis is $2.5 trillion over 10 years. GM literally being fired and hired in $6,100 per employee per year or $750 per Again, Louisianians see this, Ameri- the Oval Office, and now, potentially, employee per year. I think the clear re- cans see this as another big dot to con- one-sixth of the U.S. economy through sult will be tens of millions of Ameri- nect, part of a huge trend of exploding health care. cans getting dumped off coverage they Federal Government power and explod- So there is a broader concern and have now that they are reasonably sat- ing Federal Government spending and theme I have heard over and over, isfied with. debt. What does that represent in which is an explosion of Federal Gov- Do not take my word for it. Other terms of that explosion of spending and ernment power and intervention and an outside experts, the Lewin Group and debt? It also represents enormous new explosion of Federal Government others, say dumping will occur and taxes, and that goes to the cost issue spending and debt. This bill, unfortu- could, in fact, be massive; tens of mil- my distinguished colleague from South nately, does nothing except to confirm lions of Americans—under their anal- Dakota was talking about. my constituents’ worst fears in that re- ysis of a previous bill that had largely When I talk to Louisianians specifi- gard. It is more of the same. It is more the same provisions—over 110 million cally about health care—not just these

VerDate Nov 24 2008 01:42 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.015 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11918 CONGRESSIONAL RECORD — SENATE November 21, 2009 broader trends and these broader con- Mrs. GILLIBRAND. Madam Presi- The bill before us lays a foundation cerns they are very focused on but spe- dent, I ask unanimous consent that the for truly reforming our health care sys- cifically health care; OK, we have to fix next hour be under the control of the tem. I commend Majority Leader REID certain issues in health care—what is majority controlled as follows and in for his work in merging the two Senate the top issue? Virtually everyone in the order listed: Senator GILLIBRAND, 5 committee bills. Louisiana says cost, ballooning cost. minutes; Senator WHITEHOUSE, 20 min- This bill includes a robust public Whether they have coverage now or utes; Senator LANDRIEU, 17 minutes; plan for which I have strongly advo- they are struggling to get coverage, and Senator CANTWELL, 18 minutes. cated. I believe this will increase com- the issue is cost. What can we do about The PRESIDING OFFICER. Without petition and lower costs across the sys- cost? objection, it is so ordered. tem. Through a public plan and the es- Again, this bill does nothing to fix Mrs. GILLIBRAND. Madam Presi- tablishment of health insurance ex- that. It makes it worse. As was illus- dent, as I rise today to speak in sup- changes, the bill makes quality health trated with Senator THUNE’s graph, it port of the Patient Protection and Af- care truly affordable and accessible to pushes the cost curve up and not down. fordable Care Act, I wish to say that everyone—all Americans. The health Part of the reason it does that is, in this is truly historic legislation which insurance exchanges will streamline that $2.5 trillion of activity there are I am very proud to support which will the system and offer insurance at af- enormous taxes, and those taxes be- ensure all Americans will have access fordable premium rates, capped by in- come built into health insurance pre- to quality, affordable health care. It come, for low- and middle-income miums. So premiums do not go down, will at long last make the necessary Americans. No longer will health care they go up. They go up in a major way. changes to contain costs that have be out of the reach of millions because What are some of these we are talk- truly spiraled out of control, and it of cost. ing about—again, enormous tax in- will make enormous progress to ad- This bill also ends discrimination creases, enormous tax increases across dress the many disparities in our against women, which we have faced in the board, taxes on choice and well- health care system that are discrimi- our health care system for far too long. being. Flexible spending which allows natory toward women. Women shoulder the worst of the individuals to have a tax-free account The Congressional Budget Office has health care crisis, including outrageous determined this bill will provide cov- for medical needs, that is limited. That discriminatory practices in care and erage for more than 94 percent of is downgraded and capped at $2,500 a coverage. The National Women’s Law Americans—98 percent when account- year. Taxes on over-the-counter medi- Center reports that a 25-year-old ing for the elderly population—while cines that many patients’ families and woman pays up to 45 percent more for reducing the spiraling costs of health seniors depend on, that is a tax in- the same health insurance coverage care and trimming the deficit over the crease of $5 billion; reduced deductions than a man her age. Some of the most next 10 years and beyond. essential services required by women for health expenses, again, another tax Sixty years after Harry Truman first are simply not covered by insurance increase; higher Medicare payroll talked about the need to guarantee af- taxes; the rate on wages in excess of fordable, quality health care for all plans, such as childbearing, Pap $200,000, a very large tax increase; over Americans, we are on the brink of a smears, and mammograms. A standard and over again, major tax increases. historic vote to move one step closer to in-hospital delivery costs between The bill would impose $28 billion in achieving this goal. $5,000 and $10,000, and much more if new taxes on employers that do not In 1994, the last time we seriously there are complications. This bill ends provide government-approved health considered health care reform, oppo- the practice of denying health care to care plans. There is a tax increase of nents argued that if we reformed our those with preexisting conditions. In $53.8 billion, over 10 years, in terms of health care system, health care spend- the current system, pregnant women the Medicare population. ing would skyrocket and health care are often turned down for health care So, again, there are huge tax in- quality and access would decrease. The coverage because insurance companies creases that are part of that, and that opponents succeeded in 1994, and health would rather evade this cost. Preg- is the major reason that cost curve is reform was defeated. But in the ab- nancy should never be the basis for los- not being pushed down. In fact, it is sence of reform, look at what has actu- ing coverage. In America, this sort of being pushed up. ally occurred. Since 1994, family pre- institutionalized discrimination is As I approach this bill, after looking miums have risen by over 150 percent. wrong. This reform bill ends the prac- at it carefully over the last few days, In 1993, the average annual premium tice of charging women more than men my first bottom-line question is: How for employer-sponsored family cov- and requires that these basic health does it respond to those dominant con- erage was $5,000. This year, the cost for care services are included. cerns I have heard over and over again coverage is over $13,000 per year. By The bill also lays the groundwork to from Louisiana citizens all across the 2016, family health insurance is ex- reward health care providers for the State over the last several months? pected to reach over $24,000. In my quality of care they provide, not nec- What does it do about ballooning Fed- State of New York, that is simply essarily the quantity. Hospitals and eral spending and debt? What does it do unaffordable. clinics across the country will model about the growth of government power Today, we spend more than 16 per- the success at places such as Bassett and intervention and the cost of health cent of our gross domestic product on Healthcare in Cooperstown in upstate care? health care, nearly twice the average New York. It also uses new methods to Sadly, it fails on all those accounts. of other developed nations—an as- reduce medical errors and prevent cost- It moves us in the wrong direction on tounding $2.2 trillion every year. What ly illnesses. all those accounts. So I urge my col- do we get in return? More than 47 mil- Some would prefer that we continue leagues to adopt a different approach, lion Americans are uninsured. In 2007 on the current path, leaving millions to vote no tonight, to not move to this and 2008, 86.7 million Americans—1 out without insurance and paying for it approach, to adopt a far more focused, of every 3 Americans under 65—went through a hidden tax that all insured positive approach that responds di- without health insurance for a period Americans pay to cover the cost of rectly to those concerns of the Amer- of time. Every day, 14,000 Americans emergency care. But the majority of ican people. lose their health insurance. Americans think the time has now I yield back my time. Many of the same opponents who de- come to address this problem and fix Mr. GREGG. Madam President, what feated reform in 1994 are trying to do it our broken system. is the regular order? again. I ask them to please consider The vote today is an important step The PRESIDING OFFICER (Ms. what has actually occurred over the on the road to reform. In the next few CANTWELL). The Democrats control the last 15 years. Think about the damage weeks, we will all have the opportunity next hour. The Republican time is ex- that has been caused to our economy, to debate this bill and make important pired. our families, our workers, and consider modifications. I am encouraged to see Mr. GREGG. Thank you, Madam taking a stand that is on the right side improvements from previous bills in President. of history this time. the merged bill before us, including

VerDate Nov 24 2008 01:42 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.015 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11919 better protections for middle-class public option. Why do I say that? I say the automatic way you should treat a families’ benefits and increased fund- that because the Director of the Con- particular condition. When he filed it ing to States for Medicaid, both of gressional Budget Office has said that with his insurance company, some which I look forward to continuing to changes in government policy which we faceless bureaucrat said: No; we know improve. adhere to in this bill have the potential better than the top expert at the Na- The PRESIDING OFFICER. The Sen- to yield large reductions in both na- tional Institutes of Health. That is not ator’s time has expired. tional health expenditures and Federal the indicated treatment. Mrs. GILLIBRAND. May I have an health care spending without harming From that, and from thousands and additional 30 seconds? health. It is not just a possibility. He thousands of Americans who have had The PRESIDING OFFICER. Without goes on to say: Many experts agree on their claims denied and have had insur- objection, it is so ordered. the general direction in which the gov- ers try to intrude between them and Mrs. GILLIBRAND. I thank the ernment must go to get those cost sav- their doctor and interfere with the care Chair. ings. But they conclude they can’t put their doctor thinks they need, we can I welcome the opportunity to work a specific score on them yet for the fol- tell one thing: the insurance companies with my colleagues on this historic leg- lowing reason: The specific changes do this for a bad motivation, which is islation. For the next few weeks, I will that might ultimately prove most im- to save costs. Of all of the stories I work to strengthen the provisions for portant cannot be foreseen today and have heard, of all of the stories our col- States such as New York that have could be developed only over time leagues have related here on the Sen- strong Medicaid Programs, and I will through experimentation and learning. ate floor, never once has there been a also work to ensure that funding for Now, who is going to develop those story of an insurance company that our safety net hospitals remains in- changes that will save costs while im- stepped in and said: Oh, wait a minute, tact. proving the quality of our health care that is not the indicated treatment; Now is the time to act. The bill be- system over time through experimen- the indicated treatment is actually fore us provides quality affordable tation and learning? The public op- more expensive than what your doctor health insurance for every American, tions. There will be public options, if has indicated. Always, it is less expen- reins in the high costs, makes our sys- the original health plan is followed, in sive. Go figure. tem more efficient, and addresses some all 50 States. Each would have to stay I wish to share another story today of the grave disparities in the system within its State on balance, solvent, about a person who is close to me, a that discriminate against women. I could not go to the Federal Treasury to member of my staff. His name is Rich- urge my colleagues to join me in vot- make up losses. So they have to look ard Pezzillo, and he has hemophilia. He ing yes on the motion to proceed on for reform in order to continue to suc- has gotten the treatment he has needed so far, but he has been lucky, and it il- this bill. ceed. They would be 50 engines of re- lustrates how luck now enters into our The PRESIDING OFFICER. The Sen- form, of experimentation, and of learn- ator from Rhode Island. equation in health care. ing. In 2003, after a very turbulent air- Mr. WHITEHOUSE. Madam Presi- Who is against the public options? plane flight, Rich unfastened his seat- dent, I had the occasion to listen to The insurance industry, because they belt from the airplane, collected his some of the remarks of our colleagues don’t want the competition. They love things, and suddenly realized things on the other side of the aisle. It forces an environment in which they are im- were going badly wrong. He started to the conclusion that the irony depart- mune from the antitrust laws—almost feel tremendous pain. He started vom- ment of the Republican Party is work- uniquely in American business—and in iting blood. Simply wearing his seat- ing overtime these days. which they have incredible market The criticisms of this bill are over belt in that turbulent aircraft had share. In many cases, there are only caused Rich to begin to bleed inter- deficit and cost. We are hearing these two dominant insurers in the entire criticisms about deficit from the party nally, inside of his stomach, eventually market around this country. So they requiring that his gallbladder be re- that, when it had control in the Bush love having these huge market shares years, ran up over $8 trillion in our na- moved. to be able to dictate price, to be im- Rich is a kind and thoughtful young tional debt—$8 trillion, the biggest mune from the antitrust laws, and they man from North Providence, RI. He spendthrifts in history, an orgy of fair- don’t want the competition. was hospitalized in very serious condi- weather debt. They didn’t have any Guess who else is against the public tion. He spent nearly 3 weeks in the hesitation about deficits then. On the options. Our Republican friends. It is hospital. Thankfully, he received excel- wars in Iraq and Afghanistan, we have very hard to find any daylight between lent treatment, and today he works never heard any interest in having the position of the insurance industry here in my Washington office. The doc- those paid for on a current basis. Bor- and the position of our Republican tors, the nurses, and the hospital staff rowing for wars is completely satisfac- friends. in Rhode Island gave Rich the best tory to them, it appears. When they The problem with this is that it is treatment. He now leads an energetic, had the chance to amend Medicare, not just about numbers and it is not vigorous life and does well at a chal- they added Part D, and they ran up the just about statistics; it is about people. lenging job. cost immensely by providing a special It is about people by the hundreds of But the stunning part about Rich’s protection for the pharmaceutical in- thousands, but it makes their stories story is his treatment and his treat- dustry so that it can dictate prices to better when you actually come down to ment cost—$1.5 million. At least that the Federal Government. The Federal cases. So let me mention a few cases. is what they said. If you look at a copy Government can’t negotiate with the I talked a few weeks ago about one of of the billing sheet, you will see that pharmaceutical industry for Part D my very dearest family members who the insurance company said that his pharmaceuticals. That costs the Fed- fell victim to the system when his in- billing, here, for instance, was $366,240. eral Government a fortune. Do they surance company tried to deny him the The insurance company allowed only mind? No. They spend on deficits over indicated treatment prescribed by a $106,000. That is what was actually and over. Now, when at last we take on world-class physician from the Na- paid, which gives you a sense of how the insurance industry, suddenly they tional Institutes of Health on the much funny business is going on in the discover a concern about deficits. Well, grounds that it was so-called ‘‘not the private health insurance industry and I would urge that based on that trajec- indicated treatment.’’ This was an in- in the health care sector, when an in- tory, these remarks have a lot less to dividual who had received a dev- surance company can get away with do with the deficit than they do with astating diagnosis. He had gone to the paying about one-third of the bill’s protecting the insurance industry. top expert for that diagnosis in the cost. There is another clue of this as well, country at the National Institutes of We have heard a lot of talk about and that is the concern about cost. We Health. He had been told what he how burdensome it is for Members of all, indeed, are concerned about cost. should do. He had been told, indeed, Congress to make it through a 2,000- But I think the best thing we could do that was very standard. This was not page long health care bill. If you actu- about cost in health care is to pass a anything exotic; this was essentially ally reduce its size to the substantive

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.017 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11920 CONGRESSIONAL RECORD — SENATE November 21, 2009 language—and I am elaborating on Last year, United Healthcare’s CEO, month delay between the time Blue Cross de- what the House bill would do, which is Stephen Helmsley, made $3.2 million nied the MRI until the time Mrs. Hymel was about the same as ours—the sub- and holds almost $120 million in stock able to pay for it by herself. Additionally stantive language is less than a Harry options. . . . this delay also caused the tumor’s quick recurrence, necessitating the second surgery. Potter novel. My daughter could read The health care reform bill we are Harry Potter novels when she was 13. I talking about today would right this In ruling for Mrs. Hymel in her law- don’t think it is asking too much of massive power imbalance between the suit against Blue Cross, the court de- our colleagues to plow through a bill health insurance industry and ordinary scribed the consequences for Mrs. that represents one-sixth of our econ- Americans who are getting rolled over Hymel of this 3-month delay the insur- omy—when it is the size of a Harry by it. It would empower average Amer- ance company caused by denying her Potter novel. It would be a good idea. icans to take control of their health MRI: Rather than fighting about the 2,000- and financial future. Rather than tak- Mrs. Hymel testified that when she first page bill, how about Rich’s $1.5 million ing their health insurance premium woke up from surgery, she could not move health care bill? The hard truth is, dollars to the health insurance ‘‘ca- her arms or head and she thought she was Rich was able to get lifesaving treat- sino,’’ they could take them to the paralyzed. She felt painful burning sensa- ment because he was lucky, since he bank. tions in her body. . . . While she was in the hadn’t graduated from college yet and Unfortunately, many on the other surgical ward, she contemplated committing suicide. During her hospital stay, she suf- was still covered by his parents’ insur- side of the aisle wildly misrepresent fered from bowel obstruction, fecal impac- ance policy. Because he was covered, both the status quo and how reform tion, and had to wear diapers. Mrs. Hymel the hospital only charged his insurer would empower consumers. The oppo- didn’t see her children in the hospital until less than half of that—$106,000. What if nents of reform depict our bill as an two weeks after the surgery, and when her things had been different? What if he Orwellian takeover of the system. children finally saw her, they were scared of needed treatment a couple of years Madam President, let me close with a her and would not touch her. Mrs. Hymel later when he wasn’t on his parents’ story that illustrates how ironic and spent approximately eight months in a policy and couldn’t afford his own? completely wrong these cries of ‘‘death wheelchair after her surgery. What if he had applied for his own cov- panels’’ or ‘‘government interference’’ Mrs. Hymel is house-bound, she cannot erage but was denied by an insurance really are. take a shower, work in her garden, ride a bike, swim, or drive, as she had frequently company because his illness was In 2000, Christiane Hymel—insured by enjoyed prior to the surgery. . . . Mrs. deemed a preexisting condition? What a subsidiary of Blue Cross Blue Shield Hymel must also take large doses of medica- if Rich’s father lost his job and his of Louisiana—scheduled an appoint- tion to relieve the burning and shocking sen- health insurance along with it or what ment for a routine physical. During the sations from which she suffers. She cannot if Rich’s parents’ policy had a limit on examination, she reported to her doc- be touched on her back or leg, because the benefits, and they had to pay the rest tor her history of back pain and weak- second something touches her lower back, of the $1.5 million out of pocket? ness in her legs over the past year and it’s like fireworks that go off. Rich would have been a victim not a half. Her doctor ordered x rays of her Every day that insurance companies just of his illness but of the health care spine and referred her to a neurologist. delay or deny payment is another day status quo. If he or his family had been The neurologist, after detecting trou- they earn interest on your premiums, uninsured, they almost certainly would bling symptoms, ordered an MRI. In ac- adding to their profits and adding to not have been able to afford the full cordance with her insurance policy, the the funds that support their massive care Rich needed. Their financial fu- doctor sent Blue Cross a request to executive pay packages. When Blue ture would have been irrevocably al- preauthorize the MRI. The day before Cross of Louisiana failed to pay for tered—probably ruined. the MRI was scheduled, Blue Cross de- Mrs. Hymel’s MRI, it wasn’t just mak- Luck is no way to run a health care nied that request on the basis that the ing a mistake, it was making a cal- system. Unfortunately, Americans service was for a preexisting condi- culated decision—a heartless, profit- need all the luck they can get when tion—Mrs. Hymel’s back pain. maximizing decision. Christiane dealing with health insurance compa- Mrs. Hymel appealed the insurance Hymel’s story isn’t just a sad tale, it is nies that use every bit of their bureau- company’s decision in accordance with a symptom of a disease that is spread- cratic guile and financial might to the terms of her policy, but Blue Cross ing through the private health insur- delay and deny health insurance bene- never processed the appeal. ance system. fits they are obligated to provide. After Blue Cross denied coverage for For many Americans like Christiane For example, in March 2006, the Ari- the MRI, Mr. and Mrs. Hymel were told and Rich, our health care system is a zona Department of Insurance ordered that the MRI would cost about $4,000. casino, where a roll of the dice or spin health insurance giant United They started saving up for it. It took 3 of the roulette wheel determines one’s Healthcare to pay fines of more than months to save up the money nec- fate. Such an irrational and random $364,000—the largest in the depart- essary to pay cash for the procedure, system doesn’t comport with the soci- ment’s history. Regulators found that but they eventually did. The MRI ety that Franklin Roosevelt described the company illegally denied more showed that Mrs. Hymel had massive in his 1944 State of the Union: than 63,000 claims by doctors without tumors involving ‘‘nearly the entire examining all of the information need- cervical and thoracic [spinal] cord.’’ We have come to a clear realization of the ed to accept or deny a claim. It looks fact that true individual freedom cannot She was immediately scheduled for exist without economic security and inde- as if they were just on automatic pilot surgery. Helpfully, Blue Cross stepped pendence. Necessitous men are not free men. to deny them. in to deny coverage for that as well, In January 2008, California insurance stating it was for a preexisting condi- These days I think it would be more regulators found that a subsidiary of tion. proper to say necessitous men and United Healthcare had committed Mrs. Hymel’s neurosurgeon later tes- women are not free men and women. more than 130,000 violations of law in tified at trial: By passing health care reform, we handling claims. For example, the Tumors inside the spinal cord are growing will take health insurance off the ca- company inappropriately denied more tumors, as they grow, they cause damage to sino floor for the average American than $750,000 in claims on the grounds vital structures in the spinal cord, which are family and make it a reliable part of that insureds had a preexisting condi- important to walking, sensation, and breath- every family’s economic foundation. tion. The regulators found that the ing. No longer will happenstance or chance companies ‘‘made large-scale and will- The longer the wait in removing a determine whether treatment will be ful decisions to use broken systems to tumor, the more damage the tumor paid for. No longer will the casino process claims and respond to pro- will cause to the spinal cord. The doc- wheel determine whether Rich Pezillo viders, while continually and effec- tor testified: gets his treatment or that Christiane tively collecting premiums.’’ The total Two-thirds of Mrs. Hymel’s current condi- Hymel does not. Parents of kids like potential liability of the company for tion and disabilities were the direct result of Rich Pezillo would not worry whether all violations is $1.3 billion. the growth of the tumor during the 3 to 4- their son’s illness could lead him to be

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.019 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11921 turned down for that preexisting condi- go to $1.56 trillion. That is because we more than what they are paying for tion or whether a layoff or lack of in- are not controlling health care costs, their health insurance today for the surance could deny their son the treat- baby boomers are reaching retirement, same health care benefits. That is why ment he needs. and Medicaid and Medicare costs are doing nothing and not advancing this Necessitous men and women are not ballooning. One-third of our Federal bill is just acquiescing to the fact that free men and women. Let’s redeem budget is a big enough bite. But if we everybody is going to pay more for FDR’s promise by passing health care do nothing, then our health care prior- health care. reform. Let’s bear in mind, as we go ities are going to push out other prior- What makes this number so scary is forward, the nature of the arguments ities of our Federal Government. that it is four times the rate of infla- that are made against health care re- The biggest area where we could con- tion over the same period. That means form and the astonishing coincidence trol costs is in Medicare. Medicare is 57 what we need to do is look at general between the arguments made between percent of all Federal spending, and it inflation, which is usually about 2 per- health care reform by our Republican is getting bigger. By 2020, Medicare cent. But health care inflation, as is colleagues and by the barons of the spending alone will reach $1 trillion, shown on this chart, is more like 8 per- health insurance industry. There seems doubling the $466 billion we spend cent. If we do nothing to change this, to be literally no daylight between today. That is to say that Medicare Americans are going to continue to do those arguments. spending has been doubling in the last with less because health care costs are If we are going to turn around the ex- 10 years, and if we do nothing as our demanding more and more of their traordinary spiraling costs of health colleagues on the other side of the aisle budget. care, we are going to have to do it by are suggesting by not moving forward What do we do about this? We cer- reforming the delivery system. The on this legislation, then it is going to tainly want to make sure that we best way to do that is the public op- double again. This is unsustainable be- change the system, and that is one of tion. Yet they oppose it. cause if we do not address this, Medi- the reasons I support driving down Madam President, I yield the floor care is going to bankrupt us. costs by having a public option. We and suggest the absence of a quorum. The prospects are just as daunting know that two factors are involved: We The PRESIDING OFFICER. The when it comes to our Medicaid budget don’t have enough competition and clerk will call the roll. because Medicaid spending over the there are very concentrated markets in The legislative clerk proceeded to next several years will also double, and health insurance across the country. call the roll. it has doubled in the last 10 years. Many times there are only one or two Ms. CANTWELL. Mr. President, I ask States are struggling, as many of us insurance providers providing coverage unanimous consent that the order for know, with what they can do to help in a market. They might have 94 per- the quorum call be rescinded. sustain Medicaid since they pay for cent of the market. It is too con- The PRESIDING OFFICER (Mr. part of that for individuals. centrated. We know if we provide an al- WHITEHOUSE). Without objection, it is So we see we are in a situation where ternative in the marketplace, we can so ordered. doing nothing is an irresponsible way help drive down costs. Ms. CANTWELL. Mr. President, my to go. In fact, for our constituents, One provision in this bill of which I colleague, Senator LANDRIEU, was they are seeing a 120-percent increase am very supportive is the basic health going to be next, but I will switch in insurance premiums. While we are plan because it lets States negotiate times with her. She will join us on the worried about the impact on the Fed- with private insurers for lower costs. floor shortly. eral Government, they are worried In my State, this program has been in I want to join my colleagues this about the impact on them, on their in- place for 20 years. It has been able to morning and talk about this important dividual budgets. That means the aver- provide those who participate in the issue of controlling health care costs. age family today pays about $7,000 program—about 70,000 people today—a That is why we are here. We know more per year for the same health care 30- to 40-percent savings if they had to Americans are facing higher and higher benefits than they did a few years ago. buy that plan as an individual from a health care costs and that we can do If you think about that, that means private insurer. That is incredible suc- something to drive down the costs of that is less money for them, less cess in driving down the cost. our health care system. We know money for their families, less money to Why? I call it the Costco model be- health care costs are not only stran- meet the other bills in the family. cause like when you go to Costco and gling us, but they are impacting our Why has this happened? If we look at you buy in volume, the State of Wash- constituents, our budget, and they are what has happened in our country, we ington, buying in volume on behalf of leaving 47 million Americans without see that wages have not gone up. In those individuals, was able to drive insurance. fact, during that same 10-year period of down the cost of health care for those Our aim is to promote better quality time, wages have only gone up 29 per- individual citizens. They were able to care and get costs under control. cent, health insurance premiums have choose between four different plans, Whether those costs be to consumers gone up 120 percent. And where has the and they were able to get access to a struggling to pay insurance premiums insurance industry been? The insur- very good proposal for health care for or to our government, we need to make ance industry has seen a 428-percent in- them. sure we are doing all we can. Doing crease in profits over the last 10 years. The underlying bill includes lan- nothing in this debate is allowing That is why we need to do something guage that says you could provide this health care costs to continue. I want to about controlling health care costs. We basic health plan if States opted into it make sure my colleagues on the other cannot let the American people con- and cover 70 percent of the currently side of the aisle who talk a lot about tinue to be subject to such huge in- uninsured in America. I like this pro- this legislation understand that if we creases in premiums and then have the posal because it gets us cheaper insur- do nothing, we are going to leave the insurance industry walk away with ance for that population. American people and our budget in se- huge profits and American consumers Why subsidize insurance companies rious danger by not controlling health make less and less. by giving tax incentives to buy more care costs. What is going to happen if we do expensive insurance when what Ameri- As always, in this debate we must nothing, if we do not advance this bill cans want is to drive down the cost of keep in mind Federal spending, and the to control health care costs? Those health care by having the same negoti- numbers on Federal spending are stark. same premium increases we have seen ating clout that big businesses or other In terms of doing nothing, if the U.S. in the last 10 years are also going to go entities have? Government does nothing, health care up again. In fact, they are projected to I hope we can continue to work and spending will double in the next dec- go up another 7.9 percent in annual maybe even expand this provision to ade. That is, we spend about $810 bil- growth. That is, every year, they are make it even more robust and to drive lion on health care. That is one-third going to go up another 8 percent. That down costs. of our total Federal budget. If we do is unsustainable. That means some- What is clear is that the cost of the nothing, Federal spending is going to body is going to be paying $10,000 or uninsured is adding to our health care

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.019 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11922 CONGRESSIONAL RECORD — SENATE November 21, 2009 costs. In fact, the fact there are people costs. Everybody is going to be paying health care and what we need to do? in America who are uninsured is adding higher health care premiums because Why are we here talking about advanc- about $1,000 to our health care pre- of it. ing this legislation so we can get this miums overall. That is about $43 bil- What we need to do, which is what debate on the floor for the American lion a year to our health care system. exactly this bill sets us on a course and people? If we can change our health care sys- path to do, is to pay for value not for It is clear we need to have more com- tem and get more people into some- volume, to pay physicians on the value petition through a public option, we thing such as the basic health plan, we they deliver and the outcome of their need smarter reimbursement rates to would be able to drive down costs, and patients instead of volume. incentivize value, and we need better that is why that plan is so valuable. If we did nothing else in health care use of Medicaid dollars. We should not forget that our current reform but to change our payment The PRESIDING OFFICER. The Sen- system, besides insurance reform, structure to focus on this premise— ator’s time has expired. needs provider reform. The reason why paying for value and not for volume— Ms. CANTWELL. I thank the Pre- provider reform is so important is be- then we would be delivering great long- siding Officer. I hope my colleagues on cause our current health care system is term savings to our health care sys- the other side of the aisle will consider flawed. It is driving up the cost of tem. the important cost controls in this Medicare and health care in general be- We have other things we need to do, measure. cause of the payment system. Basi- and that is in the area of long-term I yield the floor. cally, the current payment system per- care and Medicaid because in our long- The PRESIDING OFFICER (Ms. petuates more spending. In fact, there term care system, we are seeing a dou- CANTWELL). The distinguished Senator is something like $700 billion in waste bling in health care costs, primarily from Louisiana is recognized. in our current system. If you think because of long-term care. When you Ms. LANDRIEU. Madam President, I about it, it is this fee-for-service loop think about our Medicaid budget, ev- first want to commend my colleague, that I call it where you order more and erybody thinks Medicaid is this pro- Senator CANTWELL, the Senator from you end up having more waste in the gram to help the low-income popu- Washington State, who has worked so system, you have more spending, you lation. Medicaid is turning into a long- hard and so long and in such a profes- have more use, and it keeps going. term care program for the elderly in sional way. She has been extremely That is primarily because we pay doc- America. That is, they cannot get long- helpful to me through this process, and tors on volume. We pay doctors for how term care access so they are spending I want to acknowledge that and thank many patients they see every day, and down so they qualify under Medicaid to her. we pay them for how many tests they basically get on that system to cover Before I make a statement, I also order. Consequently, the cost continues their long-term care. want to comment about a few other We can see that right now Medicaid to spin out of control. colleagues who have been extremely is paying half of its funds, and that is As I was saying, we spend about $700 helpful and supportive, not just to me an expense that is going to continue to billion on health care that we do not but I think to the entire Senate, begin- grow. ning with Senator HARRY REID, our need to spend. That is in duplicated We have made some reforms in the tests, unnecessary procedures, exces- leader, who, with patience and persist- State of Washington to make that ence and care, has led us to a bill that sive insurance overhead, uncoordinated cheaper. We have said let’s invest in is before the Senate. The question speciality care, and preventable hos- home care instead. Instead of having today is whether we should proceed. I pitalization. everybody go to nursing homes, wheth- would like to say that, in my view, no We heard from many people during er they need to be there or not, let’s other Member of the Senate could have the health care debate that we have to focus on the long-term care system re- accomplished what he has today. I do something to change this system. In forms that keep people in their com- think many Senators share that senti- fact, one of the witnesses before the munity and instead use the Medicaid ment. health care committee said: budget to advance other things while No. 2, I want to recognize the ex- We have to go after how we reimburse phy- keeping patients at home. sicians. The current system is the most bro- I think every senior in this country traordinary work of the Senator from ken part of Medicare. would rather have their health care de- Oregon, Senator RON WYDEN, who, 2 What are we doing in this legislation livered at home than in a nursing years ago, before the Presidential elec- to fix that? We are changing the way home, but our current Federal system tion had really gotten underway, be- we reimburse for health care. In fact, continues to reward long-term care in fore it was really ever clear as to who we are going to look at how to get nursing homes instead of in commu- might win, Senator WYDEN put down a lower costs with better results. This is nity-based care. This legislation starts bill called the Healthy Americans Act, important because I don’t think there us on a path to change that direction, which I was very proud to support, and is a person in America who doesn’t to move closer to long-term care com- I still am so proud of that effort today. know what it is like to go into a doc- munity services. That bill has the support of seven Re- tor’s office and feel they are always in We did this in the State of Wash- publicans and seven Democrats. It is a a hurry or feel as if the doctor didn’t ington, again, over 20 years ago and truly bipartisan effort that would ac- hear everything you had to say. This is have reaped huge benefits. If we took complish, in my view, what many about changing and rewarding physi- an individual in the system today, the Americans are asking for: a market- cians on the outcome of your health cost is only about $22,000 per indi- place that is fixed and reformed, more care so you can have shorter waiting vidual. If we had not reformed the sys- affordable choices for individuals and times, better access to doctors, more tem as we did 20 years ago, we would be small businesses and families, and a coordinated care, and better outcomes. paying $42,000 for that same individual. real effort to curb the rising and We think if you change the health So we have been able to drastically cut alarming cost to the Federal tax- care system, which this bill does, to the amount of money we are spending payers, given that the percentage now drive down costs and get better out- on long-term care. of our GDP spent on health care is al- comes, we are going to have better This legislation includes the same most exceeding 16 percent, twice as health care in America. kind of cost control reforms in long- high as any nation in the world. That We can continue on the path which I term care as some States have already is alarming. The Healthy Americans think my colleagues on the other side implemented. That is why we have to Act went a long way to help frame my of the aisle want by not voting to move get at controlling health care costs. If thoughts on this debate. We are going forward on this legislation, we can we do not control health care costs in to continue to work together through have less coordinated care, going from this area of long-term care, we are not this process. specialist to specialist without having going to control health care costs over- I also thank Senator BLANCHE LIN- that care coordinated and have unnec- all in America. COLN who, because of her persistent essary tests, but then everybody in What does reform mean? Why are we leadership, has pushed and prodded America is going to be paying for those here today to talk about the cost of Members of this body to ensure that we

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.020 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11923 had the time necessary to review this Small business owners across the would pay no more than 10 percent of bill. In so doing, she helped to assure country have told me time after time their income for health care. That is our constituents, whether they are for that in order to grow their businesses still high. But today families in Lou- or against the direction we are moving, and create jobs, they need affordable isiana pay an average of 30 percent of knew that we had the time necessary health insurance and they need stable their income on healthcare costs. And to make an informed decision. I think and predictable costs. Yes, they would economists project that if we do noth- I have used that time very well these like their costs to be lowered, and I am ing, that total will climb to 60 percent last 21⁄2 days. I have been in meetings going to stay focused like a laser on of an average family’s income that will with economists, on the phone with doing just that. But what they also have to be spent trying to afford health health care experts, talking with peo- need is predictability—they need to be care. This bill changes that trajectory. ple from my State as well as around able to plan for the future, something So while some people still think that 10 the Nation. I have used that time well they cannot do when the cost of percent or 12 percent may be too high, and wisely. Senator LINCOLN led the healthcare spikes violently from year it is a lot better than 60 percent, which charge to ensure that we had the time to year. is the direction we are heading today if we needed, and I am glad to have sup- As we all know, today, under the sta- we do nothing. That is real progress. ported her in that effort. I know she tus quo, small business owners are fre- These reforms I have just mentioned will be speaking on the floor later quently confronted with impossible are necessary and are too important a today, giving her final views on where choices when an employee or employ- goal for the Senate to abandon its work. But, as I have said, there is a we are. I commend her for her leader- ee’s family member gets seriously ill. great deal more work that needs to be ship. They can expect exorbitant cost in- Madam President, I come to the floor creases of up to 20 percent in their pre- done. I would like to mention briefly just a today to acknowledge to speak on the miums when just one of their employ- few of the significant changes I would business before the Senate today, and ees gets sick. Then they are confronted like to see be made to this bill. that is the question of whether to pro- with the excruciating choice of going No. 1, in order to increase choices for ceed to debate on the Patient Protec- to that employee and those family small businesses, we must enhance and tion and Affordability Act, a bill that members and saying: I am sorry, to expand tax credits that are in this bill is the best work of the Senate to date save my business and the other 10 em- for small businesses, particularly for on a subject of significant importance ployees, we need to let you go. Here is business with 25 fewer employees. If we to the people of my State and the coun- $1,000 or $2,000 or $5,000. You are on can expand tax credits for slightly try. I have decided to vote today to your own. Good luck. larger small businesses with between 25 move forward on this important de- That is a tragic story, painful, de- and 50 employees, that would be sig- bate. pressing, and it has to stop. nificant progress. Current projections My vote should in no way be con- I appreciate the hard work of many are that 96 percent of all businesses strued by the supporters of this current business owners and organizations that that have more than 50 employees have framework as an indication of how I have helped to craft portions of this coverage. That is a good statistic, and might vote on the final bill. My vote is framework because they have remained those larger businesses have some a vote to move forward, to continue at the negotiating table. They didn’t choices. But we need to give small the good and essential and important run and hide, they remained at the businesses more choices. It is these and imperative work that is underway. table. I am asking them today to stay small businesses that are leading the After a thorough review of the bill, at this table. country on its way out of this reces- 1 2 Before I discuss the work that needs as I said, over the last 2 ⁄ days, which sion. And we need to help them in that to be done to improve this bill, I would included many lengthy discussions, I effort. have decided that there are enough sig- like to discuss some of the points in In addition, I will continue to fight nificant reforms and safeguards in this this bill that encourage me to move for more tax equity for the 27 million bill to move forward, but much more forward. Americans who are currently self-em- work needs to be done before I can sup- Small business owners, under the ployed. Every chairman of the Small port this effort. current framework of this bill, would Business Committee—both Republican Over the past many years, and in par- no longer be confronted with these and Democrat, I understand, for the ticular the last 6 months, I have heard kinds of volatile costs. This bill pre- last 25 years—has asked for this to be from people all across Louisiana that vents insurance companies from esca- addressed. It is time to make progress their insurance premium costs are sim- lating their rates or dropping their on that effort now. ply too high and continue to rise with- coverage after someone gets sick. That No. 2, in order to really deliver our out warning, threatening the financial important change goes a long way in promise to hold down costs for fami- stability of their families and their stabilizing the amount small busi- lies, we should think about focusing on businesses. I have also heard the pleas nesses will have to pay for their health ways to prevent premiums from being and cries of many people who need plans, and it allows business owners to excessively raised between the time health coverage but they cannot find it do what they do best—plan smart in- this bill is enacted, if it ever is, and the anywhere within reach of their budg- vestments, grow their businesses, and time it actually goes into effect. Many ets. then help us grow our economy. of the provisions in this bill, because of Through months of public meetings In recent years, economists have cost considerations, which I under- in VFW halls, school gyms, and in hos- found that workers’ wages have re- stand, do not go into effect until 2014. pitals and health clinics from New Or- mained largely stagnant. Why? Be- Well, today is 2009. That’s a long time leans to Shreveport, and in large and cause employers are paying more and between now and then, and we need to small communities throughout my more for health care that we are indi- make sure that companies do not jack State, it is clear to me that doing rectly subsidizing through the current up their premiums in anticipation of nothing is not an option, nor is post- Tax Code and so have less and less the market reforms this bill will make, poning the debate. money to pay real wages that workers as we have seen the credit card indus- Spirited debate and good-faith nego- in large and small businesses could ac- try do in anticipation of the important tiations in this Senate have produced a tually take home, put in their pockets, reforms we made earlier in the year. bill that contains some amazing and and spend in much more productive Americans cannot afford to allow that cutting-edge reforms that will, I am ways. The bill we are debating would kind of predatory behavior. hopeful, reduce costs for families and encourage employers to move away Finally, I remain concerned that the small businesses while reducing the from high-cost benefit plans, and in- current version of the public option in- debt burden of the Federal Govern- stead increase the amount that work- cluded in this bill could shift signifi- ment. But these reforms must be im- ing families can take home. That is an cant risks to taxpayers over time un- plemented properly and carefully, and important change from the status quo. necessarily, and I will continue to they must be put in place in a timely In addition, this bill would ensure work with my colleagues to find a bet- fashion. that the majority of Louisiana families ter and bipartisan solution for this

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.022 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11924 CONGRESSIONAL RECORD — SENATE November 21, 2009 issue. I have suggested that a free- mist can tell us always happens after a They confirmed that 61 percent of the standing, premium-supported, competi- natural disaster. As a result, when we American population do not support tive community option that would did the calculation under the law, it Federal funding for abortion. This vote trigger on a date certain, if our private made us seem as if we were a state should serve as a strong signal to each market reforms fail to work, might be with a high per capita income like Con- Member that these protections cannot a possible compromise. That would in- necticut and not a state with a low per be ignored and must be contained in clude language that Senator SNOWE capita income like Louisiana, almost any measure we adopt. Unfortunately, and other of my colleagues have been as if we had become rich overnight. the language in the Reid bill explicitly working on for several months. That was not the case. Our State is allows what the Stupak-Pitts language Because I am hopeful we can make still as poor as it was, if not poorer as would prevent. The Reid language au- progress on each of these concerns and a consequence of those devastating thorizes abortion in the government- others through an amendment and de- storms. I am not going to be defensive operated health plan or the public op- bate process that is open and trans- about asking for help in this situation. tion and Federal subsidies for insur- parent, I believe that it is incumbent It is not a $100 million fix, it is a nearly ance coverage that include abortion. It upon me to allow the bill to move to $300 million fix. It is the No. 1 request is not the Stupak-Pitts language. debate on the Senate floor. of my Governor who is a Republican. The sanctity of life is not an issue I stand ready to work together with He explicitly asked that I pursue these that can be traded away for political my colleagues to fashion a principled funds. It is unanimously supported by expediency. During committee consid- and hopefully bipartisan compromise every Member of our delegation, Demo- eration of the health reform legisla- in the end to achieve what the people cratic and Republican. I am proud to tion, I offered two important pro-life in my State need, and what many have asked for it. I am proud to have amendments. The first amendment, Americans need, and which we really fought for it. I will continue to. But which I offered in both the HELP Com- have to do our best to try to give them. that is not the reason I am moving to mittee and the Finance Committee, Finally, I know my time is up, but I debate. strictly prohibited Federal dollars would like to ask a personal privilege The reason I am moving to the de- being used to finance elective abor- for just 1 more minute to address an bate, as I expressed in this statement, tions. The second amendment provided issue that has come up, unfortunately, is that the cost of healthcare is bank- conscience clause protections to med- in the last 24 hours, driven by some rupting families and it is bankrupting ical providers opposed to abortion. In very partisan Republican bloggers. So I our government. We cannot afford the other words, we should never force peo- think I need to respond and will do so status quo. ple who have a conscience against now. I thank my colleagues for their gra- abortion to have to perform abortions One of the provisions in the frame- ciousness. I know I have gone over my or participate in abortions. This lan- work of this bill has to do with fixing time, but I wanted to get that on the guage was based on the Hyde-Weldon a very difficult situation that Lou- record. I support moving forward with provision contained in every Labor- isiana is facing. For reasons that are the debate and look forward to working HHS appropriations bill since 2004. It simply beyond my comprehension, with them to improve it. also was included in the House-passed some partisans have decided to attack I yield the floor. bill. Both my amendments were de- me for leading an effort to address a se- The PRESIDING OFFICER. The Sen- feated. rious budget shortfall facing my state. ator from Utah. I notice my colleagues, Senators The reason for this situation goes Mr. HATCH. Madam President, I wish BROWNBACK and JOHANNS, are in the back to the disastrous hurricanes of to express my deep concerns about Sen- Chamber. I ask both of them: What is 2005. I am not going to review the hor- ator REID’s bill on two very critical wrong with including the Stupak-Pitts rors of Katrina and Rita. The levees issues. These are not the only things of language in the Reid bill? broke, and by the way, the courts have which I am critical but I wish to focus Mr. BROWNBACK. Madam President, just ruled that the Corps of Engineers on two issues: coverage of abortion and I, first, thank my colleague for offering was, as I have said from the beginning, conscience clause protections for med- these amendments in committee. responsible. But I will comment more ical providers opposed to abortion. In both the HELP and Finance Com- on that at another date. As we can see, the Stupak com- mittees, you said: Let’s put in the But, nonetheless, in 2005 Louisiana promise amendment, which was sup- Hyde language, and both times the experienced two of the worst natural ported by 64 House Democrats and a amendments were defeated in com- disasters in recent memory. In an ef- majority of Republicans, reads: mittee. I appreciate my colleague rais- fort to aid the recovery, Congress No funds authorized or appropriated by ing it. Proponents of the Reid bill will stepped in with a massive aid package this Act may be used to pay for abortion or tell us the abortion funding language is for Louisianans—thank you—that in- to cover any part of the costs of any health essentially the Hyde language included fused grant dollars and direct assist- plan that includes coverage of abortion. in the annual Labor-HHS appropria- ance. That is all it says. It should be abun- tions bill. That is plain wrong. The Some of necessary one-time recovery dantly clear to each Member of this Hyde amendment specifically removes dollars, in addition to the increased body. The House of Representatives abortion from government programs. economic activity, were calculated overwhelmingly passed pro-life lan- The Reid bill specifically allows abor- into our State’s per capita income. The guage exactly 2 weeks ago that is tion to be offered in two huge new gov- result has been that Louisiana’s per markedly different from that con- ernment programs. The Reid bill tries capita income—— tained in the Reid proposal. The House to explain this contradiction by calling The PRESIDING OFFICER. The time provisions, in contrast to the terribly for segregation of Federal dollars when of the Senator has expired. flawed provisions in the Reid bill, con- Federal subsidies are used to purchase Ms. LANDRIEU. I ask for 1 addi- tain language that would not only safe- health plans. This segregation of funds, tional minute? guard the rights of the unborn but though, actually violates the Hyde The PRESIDING OFFICER. Without would also prevent medical providers amendment, which prevents funding of objection, it is so ordered. from being coerced into performing abortion not only by Federal funds but Ms. LANDRIEU. The result is Louisi- procedures that violate their con- also by State matching funds within ana’s per capita income was abnor- science. The Stupak-Pitts amendment the same plan. Simply put, today Fed- mally inflated. You can understand was adopted by a significant margin, eral and State Medicaid dollars are not that. There were billions of dollars 240 to 194. That represents 55 percent of segregated, and the Reid bill specifi- that came in from insurance and road, the House of Representatives, includ- cally authorizes something the Hyde home, and community development ing 25 percent of the Democratic cau- amendment specifically rejects. block grants. cus. Mr. JOHANNS. If I might join in, it In addition, labor and wage costs Even more telling happens to be two is enormously important we lay a good went up because there was a constric- polls released this week by the Wash- record as to what this is all about and tion in the market, which any econo- ington Post and ABC News and CNN. why the Hyde amendment has been the

VerDate Nov 24 2008 23:35 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.023 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11925 law of our Nation for so long. It is im- to be covered in the government op- of elective abortions. This is a clear de- portant. Therefore, I direct a question tion. It also mandates that there must parture from current law, and I cannot to Senator HATCH. be abortion coverage in every insur- imagine us forcing people to pay for in- Please, if you would, describe how ance market in the country. This is an surance that covers abortions when it the Hyde amendment works today. enormous expansion, a radical depar- is so unconscionable to so many of the Mr. HATCH. Today’s Hyde language, ture from the 30-year policy that rep- American people. which has been in every annual Labor- resents the Hyde amendment. The I also would like to make one other HHS appropriations bill since 1976, spe- abortion language that was included in point perfectly clear. The Stupak-Pitts cifically prohibits Federal dollars the bill is a huge departure from 30 compromise amendment would not pro- being used to pay for abortions except years of bipartisan Federal policy pro- hibit the ability of women to obtain if the pregnancy was the result of rape, hibiting Federal tax dollars paying for elective abortions as long as they use incest, or the life of the mother is in elective abortions. The language in the their own money to purchase these danger. The Hyde language applies to Senate bill explicitly authorizes the policies. I think it is important we get all five of the federally funded health Secretary of Health and Human Serv- that piece of it clear as well. care programs: Medicare, Medicaid, In- ices to include abortion in the public Mr. HATCH. I am glad the Senator dian Health Services, TRICARE, and option and permits government sub- did clarify that. the Federal Employees Health Benefits sidies for plans that pay for abortion. I say to Senator JOHANNS, isn’t it Program or the FEHBP. However, it is The Capps language, commonly re- true that the Stupak amendment, important to note that today there is ferred to in the Senate bill, contains a passed in the House by a considerable no segregation of Federal funds in any clever accounting gimmick that pro- margin, allows women to purchase, Federal health care program—none. ponents say separates private and pub- with their own money, separate supple- For example, the Medicaid Program re- lic funds for abortion coverage. How- mental health coverage that may in- clude the coverage of elective abor- ceives both Federal and State dollars. ever, it has been proven over and over tions—if they do it with their own There is no segregation of either Fed- by outside reviewers that the Capps eral Medicaid dollars or State Medicaid money? measure would include both abortion Mr. JOHANNS. I say to Senator dollars. States that do provide elective coverage and funding in the govern- HATCH, I am glad you raised that issue. abortions for Medicaid beneficiaries ment-run public option as well as for Yes, that is correct. Your under- must do so from a completely different those plans in the insurance exchange. standing is correct. Women would be account; that is, State-only dollars. No Representative BART STUPAK, a Demo- allowed to purchase separate elective Federal or State dollars from the State crat from Michigan, explained the abortion coverage with their own Medicaid Program may even be placed issue very clearly in an op-ed he wrote money. in that ‘‘State only’’ pot of money. yesterday. He wrote: I ask Senator BROWNBACK, do you Mr. JOHANNS. That was an excellent The Capps amendment, which is the basis have a comment on that, or a question? explanation of what Hyde is about. It of the Senate language, departed from Hyde Mr. BROWNBACK. Well, I think this underscores why we are so upset about in several important and troubling ways: By is a key thing for us to keep in mind, the unbelievable expansion that is mandating that at least one plan in the that it is true that women can pur- going to occur if this Reid bill is health insurance exchange provide abortion coverage; by requiring a minimum $1 month- chase separately, with their own passed. You mentioned the Federal money, use their own funds to be able Employees Health Benefits Program. ly charge for all covered individuals that would go towards paying for abortions; and to provide for their own abortion cov- Let me take a minute to talk about by allowing individuals receiving Federal af- erage. But what we are saying here how that works because, again, I think fordability credits to purchase health insur- today is that we should not have this it underscores the point we are making ance plans that cover abortion. Hyde cur- as part of the Federal Government. We today. Let me give an example. The rently prohibits direct Federal funding of should not have it as part of the Fed- current Federal Employees Health Ben- abortion. The Stupak amendment is a con- eral funding program. We should not be efits Program does this. It has 250 par- tinuation of that policy—nothing more, using taxpayer dollars to fund abor- nothing less. ticipating health plans that do not tions, as we have not done for 30 years. cover abortion. Federal employees pay I would like to ask Senator HATCH That has been the longstanding bipar- a share of the cost. about this provision, about what we tisan program. But it is not prohibited The Federal Government, through need to talk about on the exchanges that an individual could go ahead and tax dollars collected, pays the balance. and the types of plans that will be in- buy this service on their own. So it is a mixture of Federal employ- cluded in the exchanges and about how Mr. HATCH. Well, I would add, too, it ees’ contributions through their pay- this is an expansion of the abortion is absolutely correct that the Stupak checks and the Federal Government language. language allows women to purchase getting the money through tax dollars. Mr. HATCH. Isn’t it true that one both a supplemental policy for the cov- Federal employees cannot opt for elec- health plan must be offered in the ex- erage of elective abortions and a com- tive abortion coverage because tax- change that covers elective abortions? prehensive health care plan that in- payer dollars are subsidizing the cost Isn’t that a departure from Federal cludes coverage of elective abortions as of their employee plan. You can see policy? long as they pay for their plan with how we have tried to remain true to Mr. BROWNBACK. The Reid health their own money. It allows that. the distinction you talked about. As care reform bill would require at least Mr. JOHANNS. Let me just interject many have said during the debate, if it one health care plan to offer elective something here because I think this is is good enough for Federal employees, abortions in each State health insur- a very important point to make, fol- then why isn’t it good for the rest of ance exchange. However, nothing in lowing up on what Senator HATCH just the citizens? the Reid bill ensures that the one plan said. Some say that a person would I ask Senator BROWNBACK, what is in that must cover elective abortions be never want to purchase a separate rider the Reid bill that does not reflect the the plan that is most affordable or to cover abortion. It just would not current Hyde language? And if I could least affordable. In other words, if I do happen, they say. But they misunder- maybe direct that to both of you or to not wish to have a plan that covers stand what the Stupak language actu- Senator HATCH. elective abortions but all I can afford is ally allows. Mr. BROWNBACK. Well, if I could that plan, where does that leave me? Let me be clear about this. If a follow up quickly on the last point, I Should my constituents have to com- woman wants her health insurance think it is clear that if we are not promise their own moral code in order plan to provide elective abortion serv- going to put this in the Federal em- to receive health care; in other words, ices, she does have the choice to pur- ployees benefit insurance system, then that they would have to buy a plan chase a health insurance plan that pro- we should not put it in this system. that covers abortion? vides that on the exchange. She just Yet this is a billing expansion that is Mr. HATCH. That is right. has to pay for it with her own money. taking place. The Democratic health Mr. BROWNBACK. Today, no Federal Am I correct in that interpretation or bill would explicitly authorize abortion health program requires the coverage have I misunderstood that?

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.024 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11926 CONGRESSIONAL RECORD — SENATE November 21, 2009 Mr. HATCH. That is correct. A health care providers who have objec- abortions? I say to Senator woman may purchase with her own tions of conscience to abortion so they BROWNBACK, I would like to hear his funds either a supplemental policy that are not forced to provide abortions? thoughts on that. covers elective abortions or an entire Mr. JOHANNS. Absolutely. As the Mr. BROWNBACK. I was there that health plan that includes the coverage Senator offers this explanation about a evening, along with the Senator and of elective abortions. Look, a woman Catholic health care provider, it hits Senator HATCH and almost all of the has always been able to do that, and right to the heart of this issue. I most Senators, when the President was ad- frankly, we do not deny her the right certainly agree with the Senator and I dressing us on health care. I remember to do that. What we say is, taxpayers want him to know that many Nebras- vividly sitting there and listening to should not be paying the cost of it. kans agree with him and agree with me these words, the ones you just men- They should not be called upon to pay on this issue. tioned. He was very clear, very concise; for elective abortions. I got a letter recently from a gen- there was no fudging around on it: Mr. BROWNBACK. I say to Senator tleman out in western Nebraska, from And one more misunderstanding I want to HATCH, as someone who has been in a little community called Ainsworth— clear up—under our plan, no federal dollars this body for some years and as some- a great area of our State. He wrote to will be used to fund abortions, and federal one who has followed this issue coura- me and said this: conscience laws will remain in place. geously for many years, what we are I urge you to support freedom of con- Yes, that is specifically violated in asking for, again, is just what has been science which protects professionals from the bill, and they had a very simple established since 1977 in this body and being forced to participate in abortion and route to change it. They could have in the House. other anti-life practices, which include end- just put the Stupak language in that Mr. HATCH. Yes. That is current law, of-life issues. has already passed the House. That is that Federal funds may not pay for I had another constituent from Gret- the Hyde language that has been abortion or plans that cover abortion. na, NE, more on the eastern side of our agreed to by this body and others for 30 Now that is the fundamental compo- State, and this constituent wrote to years here. Instead, they put in this nent of the Hyde language. And to be me and said this: abortion-expansion language. clear, the Stupak language does not I am also very disturbed to learn that I will show another chart here a lit- prevent people from purchasing their health care workers may be forced to act and tle bit later on. The last time we fund- own private plans that include elective speak contrary to their own consciences. I ed abortions here was between 1974 and abortion coverage. find it shocking to believe that this is being 1977, right after Roe v. Wade and before Let me just change for a second here. considered within a serious conversation/de- the Hyde language in 1977. Do you I would like to now talk about the con- bate. know how many abortions were funded science clause. To me, this is ex- We are going to put up a chart. Presi- annually by the Federal Government tremely important: the conscience dent Obama has weighed in on some of at that period of time? If we are going clause protections for medical pro- these issues. President Obama gave a back to that policy, if we are looking viders. The conscience clause protec- speech to a joint session of Congress. to go back to that era where the Fed- tions in the final House bill for pro-life We all remember that was on Sep- eral Government was funding it, Med- providers are not included in the Reid tember 9 of this year. He said this: icaid funded as many as 300,000—300,000 bill. They are in the House bill but not And one more misunderstanding I want to annually. Now, I would ask everybody, in the Reid bill. The House adopted clear up—under our plan, no federal dollars pro-choice or pro-life, do you want language that codified the essence of will be used to fund abortions, and federal your taxpayer dollars to pay for 300,000 the Weldon-Hyde conscience protec- conscience laws will remain in place. abortions a year? I do not think any- tions, including in the annual HHS ap- The President has gone on to state on body wants to see us do that. propriations bills since 2004. multiple occasions that he would not President Clinton we all remember This summer, the House Energy and support abortion in a health care bill. very clearly saying often that he want- Commerce Committee accepted these The President has stated that over and ed to make abortion safe, legal, and protections unanimously during con- over. The President has also stated on rare. Adding 300,000 does not do that. sideration of their bill. Let me empha- multiple occasions—both as a can- So the President took the time, in a size that point: unanimously, there was didate and as President—that it is his carefully tailored and vetted speech not one objection to it. That means all goal to lower the incidence of abortion. that all of us were there to hear—the members of the committee—with That is what he says, not what the Presiding Officer, as well; it was na- ideologies ranging from the chairman, Democrat-led Senate has done, though, tionally televised in prime time—to HENRY WAXMAN, who represents Holly- relative to this bill, which he has em- wood, CA, to the ranking Republican, tell Congress the words we have quoted braced. And it is not what the leader- here today and to make that specific JOE BARTON, who represents a conserv- ship has done in this bill. ative congressional district in Texas— promise. And that promise is broken in You see, my colleagues, I see this as they all recognized the importance of the Reid legislation before us today. a radical abortion approach, a radical adopting this language. We sat there in the House Chamber and In contrast, the Reid bill has strong- piece of language. And you can go right heard him say those words. Our con- er protections for abortion providers to the bill itself, to pages 116 to 124 of stituents watching the speech at home than for providers who have conscience this 2,074-page bill, and you can read it heard those words. I have to believe objections to abortion. On one hand, yourself. these are the kinds of broken promises abortion providers may not be ‘‘dis- I have to tell you, there is so much that are making our constituents lose criminated’’ against for performing about this bill that is bad policy, but their trust in government. any abortion anywhere. On the other this is especially damaging. The Presi- But the fact is, as so many people hand, pro-life providers must cite a dent promised us he would not let it have pointed out, abortion is very particular ‘‘moral or religious belief’’ happen. Do the President and the Mem- much in this health care bill. Many to prevent discrimination. This is nar- bers of his party, who control the Sen- Democrats and Republicans acknowl- rower than current law under Hyde- ate, who wrote the bill behind closed edge this. Mr. STUPAK, whom I have Weldon. doors, do they really believe abortion quoted several times, is just one of Moreover, it does not extend the pro- is health care? Why didn’t they just them. tections to pro-life health plans. In strip this language out? Why didn’t If we want to do more than just pay other words, a Catholic health system they adopt the Stupak language, which lipservice to lowering the incidence of that requires a local hospital to stop was voted upon in the House, the Stu- abortion, we need to oppose the motion providing abortions in order to become pak compromise? Why didn’t they to proceed, and we should have had the part of its health system could be ac- adopt that, knowing that 64 Democrats Stupak compromise language included cused of discrimination. had signed on to that language? in the bill in the first place since the What is wrong with this picture? What do you think about the Presi- President clearly stated he did not Let me ask Senator JOHANNS, don’t dent’s commitment and his promise to want Federal dollars to be used for the you think it makes sense to protect us not to use Federal dollars to fund funding of abortion.

VerDate Nov 24 2008 02:25 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.025 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11927 Consider the fact that when Federal The United States Conference of would mention a few of these since funding is not available for abortion, Catholic Bishops has weighed in. They they are on point here, as far as I am fewer abortions occur. When Federal said this one is the worst bill so far— concerned. funding is available, as we have seen in the worst one so far on this issue. Here is one from a woman, a Ph.D., the past, thousands more will occur. Again, I am quoting: the President of AUL Action, As shown on this chart, here is why The conference believes the bill violates Charmaine Yoest: the Hyde amendment is so important. the long-standing Federal policy against the DEAR SENATOR: On behalf of Americans The administrators running the Med- use of Federal funds for elective abortions in United for Life, AUL Action, I write to ex- icaid Program funded, as I noted, over health plans that include such abortions, a press our strong opposition to the Senate 300,000 per year. That is almost 1 mil- policy upheld in all health programs covered proceeding to Majority Leader Reid’s health care reform bill, the Patient Protection and lion abortions paid for by the country’s by the Hyde amendment: the Children’s Health Insurance Program, the Federal Em- Affordable Care Act. Majority Leader Reid’s taxpayers out of their pockets when ployee Health Benefits Program, and now in bill does not include the Stupak-Pitts lan- the Hyde language was not the law of the House-passed Affordable Health Care for guage added to H.R. 3962, which is necessary the land. That was until the Hyde America Act. We believe legislation that vio- to prevent Federal funding of abortion. AUL amendment was enacted in 1976 be- lates this moral principle is not true health Action will score against all votes to proceed cause the American people disagreed care reform and must be amended to reflect to this bill because it does not contain the with being forced to pay for abortions. it. If that fails, the current legislation Stupak-Pitts language. Majority Leader Reid’s bill explicitly allows the Secretary of Whether they are pro-choice or pro- should be opposed. The Family Research Council says the Department of Health to include abor- life, they did not want taxpayer dollars tion coverage in the ‘‘community health in- to go for this. this, describing the legislation as a: surance option’’ and allows Federal subsidies One other example of government . . . direct attack on the principles set to go to private insurance plans that include ushering abortion policy through forth in the Hyde amendment over 30 years abortion coverage. In addition, the bill also health care legislation is when the ago. This bill is one only an abortionist requires that at least one private plan in Commonwealth of Massachusetts re- could love. each exchange provide coverage for all abor- cently passed its State-mandated in- Concerned Women for America said tions. The passage of a health care reform the following: bill without language explicitly excluding surance, Commonwealth Care. They abortion coverage and funding is unaccept- failed to include an explicit exclusion In a dramatic departure from current pol- able to pro-life Americans. We strongly en- of abortion, like Senator HATCH tried icy, the Patient Protection and Affordable courage you to vote against all procedural to get in committee or like they had in Care Act will provide government funding motions to move to the majority leader’s the House language, the Stupak lan- for elective abortions. Over all, this bill bill, including cloture on the motion to pro- raises serious pro-life concerns. guage, so abortions there were funded ceed. Senator HATCH referred to polls. The immediately in Massachusetts. In fact, Sincerely, polls indicate the majority of Ameri- CHARMAINE YOEST, PH.D., according to the Commonwealth Care cans do not want their tax dollars pay- President and CEO of AUL Action. Web site, abortion is considered cov- ing for elective abortions. According to Here is another one. It is from one of ered under ‘‘outpatient medical care.’’ The Federal Government should not that CNN/Opinion Research Corpora- my personal constituents. go down this road. The President made tion survey, 6 in 10 Americans favor a DEAR SENATOR: As an American with a ban on the use of Federal funds for growing disdain for the heavy handedness a commitment to the American people, and disregard for the wishes of the American and the Democrat-led Senate has failed abortion. It also indicates that the public may also favor—literally favor— people, I adamantly oppose any plan brought to include that commitment in this to the table that would require me to pay for bill. They included radical language legislation that would prevent many abortions with my tax dollars. Any govern- that will increase the incidence of women from getting their health insur- ment-run health care system with this provi- abortion. ance plan to cover the cost of abortion sion is bad for America and violates the deep convictions of many Americans. Further- I say to Senator JOHANNS, don’t you even if no Federal funds were involved. more, I am infuriated by Senate Majority think it makes sense to protect health This poll indicates that 61 percent of the public oppose the use of public Leader Harry Reid’s deceptive course of ac- care providers, when we look at that tion in secretively creating his own version issue here, who have objections of con- money for abortions for women who of a health care reform plan. Reid’s under- science to abortions so they are not cannot afford the procedure. handed tactic diminishes the opportunity for forced to provide abortions? I have to ask the question of Senator public debate and scrutiny which flies in the Mr. JOHANNS. Absolutely. It abso- HATCH: When will we listen to the face of our legislative process. I strongly op- lutely makes sense. I say to Senator American people on this important pose Harry Reid’s health care overhaul plan to nationalize our system. I urge you to op- HATCH and Senator BROWNBACK, one of issue? Mr. HATCH. I ask Senator JOHANNS, pose any nationalized health care bill and the things that has been very remark- any plan containing an abortion mandate. able to me—this bill just came out, as have you seen similar polls indicating that a majority of Americans do not Here is another one. This is an e-mail you know. It was behind closed doors to me. It says this: for weeks and weeks and came out in want their taxpayer funds used for pay- ing for elective abortions? Have the Hello, Mr. Hatch. I am writing for 4 reg- the middle of the night, actually. istered voters in my family which include Mr. JOHANNS. Madam President, Senator seen those national polls? Mr. JOHANNS. I have. We have seen my husband, my parents, and myself. We are pro-life groups weighed in on this bill very concerned about the Federal health immediately. For all of the com- the polls. We have gotten letters from care legislation. We believe that it must sup- plexity, for all of the definitions, for our constituents. Consistently, in poll port several of our beliefs. We believe that all of the buried language, they saw after poll, we can see what the Amer- life must be respected and cared for from immediately what this bill was all ican people are saying. They do not conception to natural death. As such, we do want their tax dollars to fund abor- not want any of our tax dollars going to about. Pro-life groups across the board abortions or euthanasia. We have a desire for have opposed the provisions of this leg- tions. Mr. HATCH. Madam President, let the continued support of the Hyde amend- islation. No pro-life group has taken me ask a question to both Senator ment of 1976. Our family supports charities the bait. They represent millions of which provide counseling and material goods BROWNBACK and Senator JOHANNS. I Americans across this great country. needed by families who have an unplanned Let me, if I might, take a moment know my constituents are very upset pregnancy. We want to support them in hav- and quote from what they have said. about the possibility of their tax dol- ing the baby and caring for themselves and The National Right to Life Com- lars being used to pay for elective abor- the child. We do this by donating things that tions. I even brought a few of their let- are needed by the mom-to-be during her mittee—and again I am quoting—says pregnancy. We also have donated furniture this: ters down to the floor so I could read them. If you don’t mind, I wish to read and other things needed by the baby. These Senate Majority Leader Harry Reid has re- have been given to Birthright—a program jected the bipartisan Stupak-Pitts amend- them. Can I take a few minutes to do supported by donations. We want access to ment and has substituted completely unac- that? health care for all. This includes fair treat- ceptable language that would result in cov- Mr. BROWNBACK. Please do. ment of our immigrants. We do not want any erage of abortion on demand in two big, new Mr. HATCH. These are just a few. We of their health care that they may be receiv- Federal Government programs. have all kinds of letters. I thought I ing right now to be taken from them. In the

VerDate Nov 24 2008 02:25 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.026 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11928 CONGRESSIONAL RECORD — SENATE November 21, 2009 Bible, God tells the Jews to be kind to the chose a few, at random, to read on the unlikely to be in the final bill. I wish aliens, as they themselves were aliens at one Senate floor this afternoon. somebody could disprove this. But, time in their promised land. Our family also Mr. BROWNBACK. I was recently at very simply, there aren’t enough pro- wants a freedom of conscience clause that al- a Veterans Day parade in Leavenworth, life Senators to break this provision lows for health care workers to refuse to KS, and I had a number of people com- take part in procedures involved in an activ- and get the Stupak amendment passed ity that goes against their choice. Please ing up to me opposed to the health care on the Senate floor if we propose it as consider our beliefs. bill. I had one come up to me and say an amendment—and I am sure it will they were in favor of it and all the rest Whether you agree with every word be—there just aren’t enough. were opposed. It starts on the basis of these, they are interesting. That is why I have been making the that it is fiscally insane what we are Here is another one: case over the last 48 hours that the mo- considering doing with $12 billion in tion to proceed is the key vote on abor- During the floor debate on the health care debt, and then we are going to add a reform bill, please support an amendment to tion in the health care debate. The incorporate long-standing policies against multitrillion-dollar entitlement pro- most important pro-life vote that a abortion funding and in favor of conscience gram on top of this. The Federal Gov- pro-life Senator will cast, I believe, in rights. If these serious concerns are not ad- ernment is hemorrhaging money. Why the entire time they are here is on this dressed, the final bill should be opposed. Life on Earth would we do that? Then they motion to proceed. I have seen all the should be respected from conception to nat- are scared about what else is in the arguments from many, saying this is a ural death. I am a retired teacher and am bill, and then this feature comes up as hoping to be able to receive the care I choose procedural vote; that there is nothing well. to worry about; that it just begins de- to have until my natural death. My care Finally, Senator JOHANNS was put- bate, and we might potentially vote should not be based on my productivity in ting in statements from various society years from now. Thank you for your this bill down, and we can do some groups, and I ask unanimous consent stand on abortion in the past. amendments and some tweaking. that this statement from the United Then she has a PS: States Conference of Catholic Bishops But the facts suggest otherwise. The My parents don’t have and do not know be included at the end of our colloquy. Congressional Research Service has how to use a computer to contact you. They The PRESIDING OFFICER. Without looked into this. Between the 106th and feel the same as my husband and I feel about objection, it is so ordered. 110th Congresses, there were 41 cases, the above issues. (See exhibit 1.) according to the Congressional Re- Then she lists the names of her par- Mr. BROWNBACK. The Catholic search Service, in which the Senate ap- ents. Bishops issued this yesterday and said proved a motion to proceed and then Here is another one: this: proceeded to a vote on the final bill. Do DEAR SENATOR HATCH: I am a registered The legislative proposal recently unveiled you know what the end result of those Democrat strongly in favor of health care re- in the Senate does not meet these moral cri- 41 cases were, when the motion to pro- form. I am also committed to protecting the teria. Specifically, it violates the long- ceed was approved? It was 40 times out unborn and to safeguarding the conscience of standing Federal policy against the use of of 41—about 97 percent—went on to re- each health care provider who is uncomfort- Federal funds for elective abortions and ceive final approval. In other words, all able with providing abortion services. During health plans that include such abortions—a floor debate on the health care reform bill, policy upheld in all health programs covered but one passed into law. please support an amendment to incorporate by the Hyde Amendment, the Children’s This suggests to me this vote tonight long-standing policies against abortion fund- Health Insurance Program— at 8 o’clock on the life issue is very ing and in favor of conscience rights. If these SCHIP, which Senator HATCH helped well determinative. Some of my col- serious concerns are not addressed, the final to get started— leagues also argue if we don’t like the bill should be opposed. Genuine health care the Federal Employees Health Benefits Pro- bill, we should not block the oppor- reform should protect the life and dignity of gram— tunity to amend it, and they say let us all people from the moment of conception until natural death. that Senator JOHANNS spoke about— proceed. I don’t believe, if you are truly pro- Another one. and now in the House-passed ‘‘Affordable Health Care for America Act.’’ We believe life as a Senator, you can make that SENATOR HATCH: During floor debate on the legislation that violates this moral principle argument. Here is why: Everybody in health care reform bill, please support an is not true health care reform and must be amendment to incorporate long-standing the Senate knows what it will take to amended to reflect it. If that fails, the cur- amend the Reid bill on something like policies against abortion funding and in rent legislation should be opposed. favor of conscience rights. If these serious this. It will take 60 votes. It is the way concerns are not addressed, the final bill This is the Catholic Bishops, gen- the Senate operates. It will take 60 should be opposed. Genuine health care re- erally in favor of health care reform, votes. Again, I say to Senator HATCH and they are saying this fails on this form should protect the life and dignity of and Senator BROWNBACK, I wish I could all people from the moment of conception account and must not be in this legis- count 60 pro-life Senators. I wish I until natural death. lation and can’t be considered as part could do that. But by anybody’s count, I also have a petition to Senator of health care reform. I believe—mine included—there aren’t Mr. HATCH. I ask Senator JOHANNS, ORRIN G. HATCH opposing using tax- 60 here. where do we go from here? We are payer dollars to fund abortion. This pe- I believe if you are pro-life, every op- tition says: going to have a cloture vote at 8 o’clock tonight on the motion to pro- portunity you get to stand for the life One out of every three babies conceived is issue, you must stand for that issue. a victim of abortion, a tragedy that has ceed. What would be the advice on that? These truly are our most vulnerable claimed more millions of innocent lives since citizens. I feel very strongly that at 8 the Roe v. Wade Supreme Court decision le- Mr. JOHANNS. I thank the Senator. galizing abortion on demand. Every abortion Let me, if I might, before I address o’clock, when we are gaveled to a vote, is a gruesome act that ends an innocent that, tell my colleagues how proud I we need to stand up on this issue—this human life and cannot be tolerated in a civil am to stand here with these two cham- life issue—or there is a 97-percent society. The pro-abortion lobby is seeking to pions of this issue, Senator BROWNBACK chance it is lost. hide abortion funding into virtually every and Senator HATCH. They have a re- I will conclude my thoughts on this piece of ‘‘must-pass’’ legislation, including markable history of every time they by saying this: There were many strong continuing resolutions, budget and author- and courageous pro-life Democrats in ization bills, so-called ‘‘economic’’ bills, and had an opportunity standing strong on even the Defense authorization bill. I urge an issue that I must admit is not the the House. I watched that. That was re- you to actively oppose and, if necessary, fili- most popular issue in Washington, DC, markable. Can you imagine the pres- buster all attempts to use the budget to to promote, and I admire their courage. sure they were put under? This force Federal funding of abortion and abor- To address the relevant question of evening, we just need one—not many, tionists and to pack the courts with activist, the day, the Stupak protections, that just one Democrat—who will come here pro-abortion judges. compromise that was reached in the and say I am pro-life. If we don’t stand I thought I would read a few of those House, it is not in this bill. together tonight, this bill will radi- interesting letters to set a tone here. I Of course, since it is not in this un- cally expand abortion, and I cannot have received all kinds of letters, but I derlying bill, this Reid bill, it is very live with that.

VerDate Nov 24 2008 02:25 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.027 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11929 Mr. HATCH. I thank the Senator for a longstanding ethic and moral code. moral criteria. Specifically, it violates the his remarks. I thank both Senators We are a moral people, and we have longstanding federal policy against the use BROWNBACK and JOHANNS. been from the outset. Some people say of federal funds for elective abortions and Before coming here, the Senator was this or that, but a big part of that has health plans that include such abortions—a policy upheld in all health programs covered the Secretary of Agriculture. He is been that basic moral code, that basic by the Hyde Amendment, the Children’s from Nebraska. By any measure, he is thought within the Judeo-Christian Health Insurance Program, the Federal Em- a very sincere, dedicated, and prin- ethic that we respect life. This goes ployee Health Benefits Program—and now in cipled person. We all know that, and I back to when Moses talks to the people the House-passed ‘‘Affordable Health Care think the world of the Senator. about going into the Promised Land. for America Act.’’ We believe legislation I appreciate standing on the Senate He is giving his last lecture to the Jew- that violates this moral principle is not true floor with the Senator to chat about ish people before going into the Prom- health care reform and must be amended to reflect it. If that fails, the current legisla- this matter. Senator BROWNBACK, with- ised Land. In that last lecture—Moses tion should be opposed. out question is a leader in this body in doesn’t get to go in himself, but he gets PROTECTING HUMAN LIFE AND CONSCIENCE protecting the rights of the unborn. It the people together. They march for 40 Specifically, we urge you to include the is one of the things I most love about years in the wilderness. He knows he is House-passed provision that keeps in place him. There are many things that cause not going in, but they are, and he gives the longstanding and widely supported fed- all of us to hold the Senator from Kan- a lecture. eral policy against government funding of sas in very high regard and esteem. He Deuteronomy 30:19 says something elective abortions or plans that include elec- is principled and dignified about it. He that is applicable here: tive abortions. is friendly to everybody. But the Sen- This day I call heaven and earth as wit- In the aftermath of the overwhelming and ator doesn’t mince words when it nesses against you that I have set before you bipartisan House vote for the Stupak-Smith- Ellsworth-Kaptur-Dahlkemper-Pitts Amend- comes to standing up on these very im- life and death, blessings and curses. Now choose life, so that you and your children ment, there has been much misunder- portant issues. standing of what it does and does not do. Look, all we are saying is, let’s pro- may live. This is in the fundamental ethic and This amendment does not change the current tect the Hyde language. You do that situation in our country: Abortion is legal with the Stupak-Pitts language. What background of our country. That is and available, but no federal dollars can be is wrong with including that language? what we have to choose today. Do we used to pay for elective abortions or plans All we want to do is not have federal choose life or death? Choose life, so that include elective abortions. This provi- funds pay for abortion. The vast major- that you and your children might live. sion simply keeps in place existing policy ity of people in this country feel that As Senator JOHANNS notes, we just and allows Congress to honor the President’s commitment that ‘‘no federal dollars will be way too. need one vote on the other side to change this, and this language gets used to fund abortions.’’ The amendment Second, why should people of con- does not restrict abortion, or prevent people science, who really and sincerely be- pulled out and Stupak gets put in. Just one vote. If we cannot get to 60—and from buying insurance covering abortion lieve that abortions are wrong, be with their own funds. It simply ensures that forced to participate in abortions in you have to get there—and that one where federal funds are involved, people are any way, shape, or form? Unfortu- person says: I am not going to do it, not required to pay for other people’s abor- nately, this bill could lead to that unless you put Stupak in this, it tions. Thus far, the pending Senate bill does not forced participation. I just do not un- changes. We need just one to choose life, and it will change. It has been a live up to President Obama’s commitment of derstand what is so difficult about in- barring the use of federal dollars for abortion cluding the same language included in pleasure to join with both Senators today. and maintaining current conscience laws. the bill passed by the House of Rep- The bill provides federal funding for plans resentatives. What is so problematic EXHIBIT 1 that cover abortion, and creates an unprece- about our body doing the same? UNITED STATES CONFERENCE dented mandatory ‘‘abortion surcharge’’ in If you are a nurse, doctor, health OF CATHOLIC BISHOPS, such plans that will require pro-life pur- care practitioner, Catholic hospital, or Washington, DC, November 20, 2009. chasers to pay directly and explicitly for U.S. SENATE, an LDS hospital out of Utah, if we have other people’s abortions. Its version of a pub- Washington, DC. lic health plan (the ‘‘community health in- the Stupak-Pitts conscience protection DEAR SENATOR: On behalf of the United surance plan’’) allows the Secretary of HHS language passed by the House, you can- States Conference of Catholic Bishops to mandate coverage of unlimited abortions not be forced to participate in abor- (USCCB), we strongly urge the Senate to in- nationwide, and also allows each state to tions. These are highly religious people corporate essential changes to the Senate’s mandate such abortion coverage for all state with highly religious motivations who health care reform bill to ensure that needed residents taking part in this federal program have made this the greatest country in health care reform legislation truly protects even if the Secretary does not do so. The bill the life, dignity, consciences and health of seriously weakens the current non- the world. If we do not change this lan- all. We especially urge the Senate to act as guage in the Reid bill, there will be discrimination policy protecting providers the House has in the following respects: who decline involvement in abortion, pro- Federal funding of abortion, and there Keep in place current federal law on abor- viding stronger protection for facilities that will be people who could be pushed to- tion funding and conscience protections on perform and promote abortion than for those ward participation in abortion. abortion; which do not. The legislation requires each Mr. BROWNBACK. It has been my Protect the access to health care that im- region of the insurance exchange to include migrants currently have and remove current pleasure to join Senators HATCH and at least one health plan with unlimited abor- barriers to access; and tion, contrary to the policy of all other fed- JOHANNS on this effort. I have worked Include strong provisions for adequate af- eral health programs. Finally, critically im- with both of them in many different fordability and coverage standards. capacities and jobs. The Catholic Bishops of the United States portant conscience protections on issues be- This is as serious a pro-life vote as I have long supported adequate and affordable yond abortion have yet to be included in the bill. To take just one example, the bill fails have seen. If this gets passed, the Fed- health care for all. As pastors and teachers, we believe genuine health care reform must to ensure that even religious institutions eral Government will be funding some- would retain the freedom to offer their own where north of 300,000 abortions a year. protect human life and dignity, not threaten them, especially for the most voiceless and employees health insurance coverage that If it was 300,000 back in the 1974-to-1976 vulnerable. We believe health care legisla- conforms to the institution’s teaching. On timeframe, with the growth in U.S. tion must respect the consciences of pro- these various issues the new Senate bill is an population, you are probably looking viders, taxpayers, and others, not violate enormous disappointment, creating new and at north of that number of Federal tax- them. We believe universal coverage should completely unacceptable federal policy that payer dollars funding abortions. I can- be truly universal, not deny health care to endangers human life and rights of con- science. not imagine many people in this coun- those in need because of their condition, age, IMMIGRANTS AND HEALTH CARE COVERAGE try being satisfied about that kind of where they come from or when they arrive We support the inclusion of all immi- number taking place. I can’t imagine here. Providing affordable and accessible health care that clearly reflects these funda- grants, regardless of status, in the insurance that. But that is our past experience mental principles is a public good, moral im- exchange. The Senate legislation forbids un- when the government funds abortion. perative and urgent national priority. documented immigrants from purchasing Those are the numbers we are talk- Sadly, the legislative proposal recently un- health-care coverage in the exchange. Un- ing about. I note, too, the country has veiled in the Senate does not meet these documented immigrants should not be

VerDate Nov 24 2008 02:25 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.029 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11930 CONGRESSIONAL RECORD — SENATE November 21, 2009 barred from purchasing a health insurance and ministries purchase health care for now on with the cost of health care, plan with their own money. Without such ac- many thousands of employees and their fam- and will avert an otherwise inevitable cess, many immigrant families would be un- ilies. Our emergency rooms, shelters, clinics, catastrophe to our health care system able to receive primary care and be com- and charities pick up the pieces of a failing and our economy. pelled to rely on emergency room care. This health care system. Our Catholic moral tra- would harm not only immigrants and their dition teaches that health care is a basic The reality right now is that we are families, but also the general public health. human right, essential to protecting human denying millions of Americans their Moreover, the financial burden on the Amer- life and dignity. shot at the American dream because of ican public would be higher, as Americans For many months, our Bishops’ conference our irrational health insurance system. would pay for uncompensated medical care has been working with members of Congress, Right now, if you have been sick, in- through the federal budget or higher insur- the Administration and others to fashion surance companies can refuse to cover ance rates. health care reform legislation that truly pro- you or charge you ridiculous pre- We also support the removal of the five- tects the life, dignity, health and con- miums. If you get sick, your insurance year ban on legal immigrants accessing fed- sciences of all. Our message has been clear benefits can run out when you need eral health benefit programs, such as Med- and consistent throughout. We hope and pray icaid, the Children’s Health Insurance Pro- that the Congress and the country will come them the most. gram, and Medicare. Legal immigrants, who together around genuine reform. Right now, people without insurance work and pay taxes, should have access to Sincerely, do not get preventive care. Instead, such programs if needed. Removing the ban BISHOP WILLIAM F. they go to the emergency room when would help ensure that legal immigrants, MURPHY, they cannot hold out any longer. This who were widely praised in past immigration Diocese of Rockville is the least-efficient and most expen- debates for their many contributions and for Centre, Chairman, sive way to deliver care, and those of playing by the rules, will still have access to Committee on Do- us who do have insurance pay for it. It health care. mestic Justice and Human Develop- costs every insured family more than ACCESSIBLE AND AFFORDABLE HEALTH CARE $1,100 a year in additional premiums to The Catholic bishops have advocated for ment. CARDINAL DANIEL pay for those who don’t have health in- decades for affordable and accessible health surance. care for all, especially the poor and DINARDO, marginalized. The Senate bill makes great Archdiocese of Gal- Right now, if you are a woman who progress in covering people in our nation. veston-Houston has had a C-section or if you have been However, the Senate bill would still leave Chairman, Com- a survivor of domestic violence, health over 24 million people in our nation without mittee on Pro-life insurance companies can arbitrarily health insurance. This is not acceptable. Activities. decide not to cover you. That is be- BISHOP JOHN WESTER, The bishops support the expansion of Med- cause having had a C-section or being a icaid eligibility for people living at 133 per- Diocese of Salt Lake City, Chairman, survivor of domestic violence is consid- cent or lower of the federal poverty level. ered by many insurance companies to The bill does not burden states with exces- Committee on Migra- sive Medicaid matching rates. The afford- tion. be a preexisting condition. That is ability credits will help lower-income fami- Mr. HATCH. Madam President, I wrong. lies purchase insurance coverage through the yield the floor and suggest the absence What is even more egregious is that Health Insurance Exchange. However, the of a quorum. while millions of Americans struggle Senate bill would still leave low-income fam- The PRESIDING OFFICER. The to pay for health care, insurance execu- ilies earning between 133 and 250 percent of clerk will call the roll. tives continue to make obscene sala- the federal poverty level financially vulner- The assistant legislative clerk pro- ries. From 2000 to 2007, a period of 8 able to health care costs. Overall, the aver- ceeded to call the roll. years, Americans saw their premiums age subsidy provided for in the Senate bill is almost double. During that same time, $1,300 less than the average subsidy in the Mr. FRANKEN. Madam President, I House bill. Improvements to the bill should ask unanimous consent that the order we saw more than 6 million more be made so that low-income families have for the quorum call be rescinded. Americans become uninsured. During reasonable out of pocket expense for health The PRESIDING OFFICER. Without that same time, insurance company care. objection, it is so ordered. profits rose 428 percent—428 percent. Immediate reforms are included in the bill Mr. FRANKEN. Madam President, I That is all you need to know to under- that should be helpful in providing relief to ask unanimous consent that the next stand why we have to pass this bill—428 the uninsured and underinsured. Addition- hour be equally divided between the percent in 8 years. No wonder the in- ally, reforms that will strengthen families and protect low-income and vulnerable peo- following three Senators: FRANKEN, surance companies are fighting this ple such as eliminating denial of coverage LINCOLN, and LEVIN. bill. Of course they don’t want to be based on pre-existing conditions including The PRESIDING OFFICER. Without subject to antitrust laws. They are pregnancy; eliminating life time caps; offer- objection, it is so ordered. making outrageous profits by gouging ing long-term disability services; and ex- Mr. FRANKEN. Madam President, I American families. Make no mistake, tending dependent coverage to uninsured rise today to express my strong support that is what this is about. young adults—are significant steps toward for the Patient Protection and Afford- This bill will change all that. It will genuine health care reform. We urge the Sen- able Care Act. fundamentally transform how health ate to maintain these provisions. I commend Leader REID, Chairman insurance works in this country. This These moral criteria and policy objectives are not marginal issues or special interest HARKIN, Chairman BAUCUS, and Sen- bill guarantees secure coverage that concerns. They are the questions at the ator DODD for their leadership that has will be there for Americans and stay heart of the health care debate: Whose lives brought us to this critical point. We there when they need it the most. This and health are to be protected and whose are are on the verge of passing legislation is not going to help just individual not? Will the federal government, for the that will do more than any bill in re- Americans; it is going to help small first time in decades, require people to pay cent history to make our country businesses too. for other peoples’ abortions? Will immi- healthier, our economy more stable, There are urgently needed changes grants be worse off as a result of health care and our working families more secure. that will go into effect the day the reform? At their core, these health care choices are not just political, technical, or Make no mistake, this bill will President signs this bill into law. Ef- economic, but also moral decisions. This leg- change. There will be amendments to it fective immediately, preventive serv- islation is about life and death, who can take that will make it an even better bill. ices, such as colonoscopies and choles- their children to the doctor and who cannot, There may be amendments that make terol tests, will be covered by all insur- who can afford decent health care coverage it less to my liking and, therefore, a ance plans at no cost. This will make and who are left to fend for themselves. less good bill, to my point of view. But prevention a priority, not an after- Our appeal for health care legislation that the final bill will make health care thought. We will detect cancers earlier truly protects the life, dignity, health and available to more tens of millions of and stop chronic diseases, such as dia- consciences of all reflects the unique per- spectives and experience of the Catholic Americans. It will make health insur- betes, in their tracks. Not only will community. Our hospitals, clinics, and long- ance more secure for all Americans this save innumerable lives, it will term care facilities provide quality health who have it and will put an end to the lower the long-term cost of health care care to millions. Our dioceses, institutions, unsustainable trajectory that we are for all of us. This is one of the key

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.001 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11931 ways health care reform transforms its out of the health insurance indus- I am pleased to tell you this bill will our system of sick care into a true try—not taking them out but lowering bring real relief to small businesses health care system. them to a reasonable level—Minnesota across our country. We will even the Effective immediately, any new health plans do a better job of helping playing field so small businesses can do health insurance plan will let your our residents live healthier, longer the right thing for workers without children remain on the family policy lives. As we begin debating this bill on sacrificing their bottom line. This will until they are 26. That is big. Say you the Senate floor, it is essential that make them competitive with large em- are a parent whose kid has been ill in health insurance companies get the ployers and with companies from over- the past, maybe she had asthma and message loudly and clearly that their seas so they can attract the best and she just graduated, say, from the Uni- top priority must be serving patients, brightest workers. versity of Minnesota. Your daughter is not creating more and more profits, Right now, small businesses are often just out of school, and she wants to not a 428-percent increase in profits in priced out of the markets. They may be find a job. We all know this is a big 8 years. lucky to find just one or two carriers enough challenge in this economy. Under the Senate bill, we will stop willing to cover their workers. So the While she plans for her future, the last insurance companies from denying you first important change that health care thing she should have to worry about is coverage or charging you more because reform can bring is choice of plans for how she is going to get health insur- of preexisting conditions. This will end small businesses. They will be able to ance. the egregious industry practice of dis- participate in the exchange which will The good news is, after health care criminating against survivors of do- offer them a choice of reliable plans. reform, she will have secure coverage mestic violence. Insurance companies This coverage will be less expensive until she gets on her feet. She can ei- also will no longer be able to charge and provide better coverage than what ther stay on your plan until she is 26 or women more for their health coverage is available today. once the exchange is up and running, just because they happen to be a Right now, if you are a business with, she can purchase an affordable plan woman. say, 15 employees and 1 of them gets through the exchange. We will ban lifetime caps and end un- sick or has a baby, your premiums are Also, effective immediately, we will reasonable annual limits on your bene- going to go up dramatically. That is hold health insurance companies ac- fits. These insurance market reforms because your risk pool is 15. But when countable by making them give rebates will help Americans, but they will be you choose from policies on the ex- if they spend more than 20 percent of particularly life changing for families change, your risk can be pooled with premiums toward profits, marketing, such as the Battersons who live in hundreds or even thousands of other or administration. I am proud to have Bloomington, MN. Linda Batterson has businesses. That is the whole point of championed this safeguard with my three daughters. She owns her own insurance, to spread the risk over the colleagues, Senator ROCKEFELLER and business, and her husband Bud is a re- greatest number of people. Senator WHITEHOUSE. altor. The second key benefit for small The current reality is, most of us do The Battersons have some relatively businesses is tax credits to help busi- not know where our health insurance minor health problems—asthma, aller- ness owners purchase coverage. Effec- premiums go. It is challenging enough gies, and back problems. But because tive immediately, these credits will to understand a billing statement from health insurance companies can charge ease the burden on small business own- your health insurer, much less track them more based on their health his- ers who offer coverage but are being where your money is being spent. We tory, their only health care option in squeezed in the current market. For are going to change that. Minnesota is a high-risk pool. This business owners who have not been Thanks to Senator JACK REED, the year they are paying nearly $21,000 for able to offer insurance, the tax credits Senate bill also requires transparent health care—$21,000 for their insurance. will provide a new incentive to begin reporting of how health insurance com- This is not a Cadillac plan. Neither the covering their workers, keeping the panies are spending your money. This Battersons’ businesses nor their family workforce healthy and productive. transparency is especially important as can sustain these costs. Today I have touched on just a few we cover an additional 3l million But the good news is, the Battersons elements of the health care reform bill. Americans under this bill. We know will get relief under our bill. They will I will be back. I have touched on insur- from their profit margins that right be able to go to the exchange and find ance market reforms and provisions now insurance companies are price an affordable plan. Health insurance tailored to the needs of small busi- gouging. But clear reporting will help companies will not be able to charge nesses. But this just scratches the sur- us hold them accountable for every dol- the family more because of their face. The public option will bring much lar we invest in health insurance. health history. If companies are going needed competition, and the incentives Based on our experience in Min- to raise rates, they will have to pub- for high-quality care will make us all nesota, I know we can do even more to licly disclose and justify any increase. healthier. Taken together, these ele- rein in marketing, wasteful adminis- I think we can all agree that one ments will bring our country into a trative costs, and profits in health in- group of Americans who suffer under new era in which high-quality and af- surance. In the coming weeks, we will our current system is small businesses. fordable health care is a reality in this debate this bill, amend it, and make it Across Minnesota—from Bemidji to country. even better. I will be pushing to require Spring Valley—I have talked to small Passing national health care reform an even higher percentage of your pre- business owners who want to do the this year is my top priority because I miums go toward actual health care. right thing. They want their workers have listened to Minnesotans across The reason I believe we can provide to be healthy, but they cannot afford my State. They have told me loudly higher quality care without excessive the current unpredictable and sky- and clearly that the current health in- profits is because Minnesota already rocketing rates. surance system is not working for does it. We are distinguished by the In Minnesota, we have 92 percent of them, and they have told me they want fact that 90 percent of Minnesotans are our State covered, and we have in- access to care. I have heard them. served by a nonprofit health plan. vested resources to create the They want to know they can start a These plans outperform their national MinnesotaCare Program to make sure small business without worrying about peers and are able to put an average of low-income residents are covered. But the cost of health insurance because 91 cents of every premium dollar to- even with all this success, the uncon- one of their kids has a preexisting con- ward actual health care services—91 trolled cost of health insurance is forc- dition. They want to know they will cents out of every dollar. ing us to tighten our belts and make have health care when they need it the In other plans throughout the Na- sacrifices that no American should most. They want insurance companies tion, you may find less than 60 percent have to make, such as small businesses to prioritize health services over prof- of your premium is put toward health having to choose between laying off its. They are looking for us to fulfill care. The rest is for overhead, mar- workers or dropping health insurance our promise to pass comprehensive keting, and profits. By taking the prof- for everyone. health care reform this year.

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.031 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11932 CONGRESSIONAL RECORD — SENATE November 21, 2009 I look forward to working with all of wellness, prevention, and good manage- perative that we build on what is al- you to make this a reality. ment of illness that keeps people out of ready working for health care in Amer- I yield the floor. the hospital and from having the most ica and not turn away from the prob- I suggest the absence of a quorum. costly care needs. lems we face. We keep building until The PRESIDING OFFICER. The Our current health care system we can truly say one day that all clerk will call the roll. wastes money and is so inefficient that American citizens will have access to The bill clerk proceeded to call the the United States spends more than quality and affordable health care. In roll. twice as much per person while insur- order to improve upon and build upon Mrs. LINCOLN. Madam President, I ing a smaller portion of our population what we already have, I do not support ask unanimous consent the order for than the average spending in 29 other the creation of a so-called robust, gov- the quorum call be rescinded. industrialized nations. There simply ernment-administered public plan. The PRESIDING OFFICER. Without are not enough health insurance op- I believe we should work to make objection, it is so ordered. tions available to most Americans sure we do not expose American tax- Mrs. LINCOLN. Madam President, I today when in at least 17 States, in- payers and the Treasury to long-term have asked for this time today not only cluding my home State of Arkansas, risks that could occur over future gov- to address my colleagues in this body only one insurance company controls ernment bailouts of a public plan. but to speak directly to my constitu- more than half the insurance market, Rather than create an entirely new ents at home in Arkansas. After many and in at least 22 States still only two government-run health plan to com- months of debate on health care, we carriers control half or more of the pete with private insurers, I support are nearing yet another important step market. health insurance reform that focuses in a very deliberative process. Today Patients and doctors are routinely on changing the rules of our existing we are voting on whether to continue making treatment decisions with little employer-based private health insur- to discuss how to improve health care or no objective information about ance system. I believe we should in America or to stop the debate. which treatments are more effective. change the current rules that permit I personally have carried the mantle American capitalism is based on choice insurance companies to bully their cus- to improve health care for Arkansas and competition because when these tomers and cherry-pick healthy pa- throughout my public service, like elements are present, consumers can tients, so we can force them to com- many of my colleagues and so many most always find the best value for pete with each other. others as well who have worked hard their money. That is not true in health My first loyalties are with the people on this issue. Over the last several dec- care. So by creating health insurance of Arkansas—not insurance companies, ades the advance of medical technology exchanges through which small busi- the health care industry, or my polit- and our Nation’s changing demo- nesses and individuals can choose from ical party. In fact, I authored an graphics have placed new demands on a menu of private plans, we can en- amendment during consideration of our health care system that it is not hance cost transparency, create head- legislation in the Senate Finance Com- designed to meet. to-head competition, and allow market mittee which limits taxpayers’ sub- Our vote later this evening is not the forces to reduce prices. sidies for health insurance companies first step toward making the necessary These are facts. These are facts, and that pay their top executives millions adjustments in health care, nor will it whether we are Republicans or Demo- in salaries. Responsible health insur- be the last, without a doubt. The Fi- crats or independent, I believe we can ance reform should ensure that insur- nance Committee on which I serve and agree on most all of them. I know the ance executives are not receiving a per- great majority of Arkansans believe which is led so ably by my good friend sonal windfall, and that companies these facts and want to see us accom- from Montana, Chairman BAUCUS, has they work for are not receiving exces- produced what I still describe as the plish these reasonable goals. For months now, groups from outside sive tax breaks while at the same time most responsible approach to health in- my State have assigned various mo- profiting from government require- surance reform. We deliberated for tives to my deliberations on health ments on consumers to buy insurance. more than 22 months, incorporating The reason we are having this vote is care and tried to define the meaning of recommendations from experts all because our Republican colleagues ob- my vote. According to the last tally, across our great Nation and proved, ject to beginning debate and consider- there has been more than $3.3 million through our bill, that America can ation of amendments on health care worth of media ads that have been pur- achieve unprecedented health insur- legislation. Although I do not agree chased in my home State of Arkansas ance reforms that expand coverage, re- by groups from outside of our State— with everything in this bill, I have con- duce cost, and provide stability for certainly none by me—and most with cluded that I believe it is more impor- those with existing coverage. my name in the ad. Still, I have contin- tant that we begin this debate to im- We accomplished these goals without ued to approach this issue as I always prove our Nation’s health care system posing long-term risk for taxpayers. It do. These outside groups seem to think for all Americans rather than simply was not a perfect bill. We never see per- this is all about my reelection. I sim- dropping the issue and walk away. fect bills around here, quite frankly, ply don’t think they know me very That is not what people sent us here to but I can honestly say I will fight hard well. do. so our final product will more closely I am focused on my opportunity to Attempts by the National Republican resemble the commonsense, deficit-re- influence the final version of health Party and other conservative groups to ducing plan we produced in the Senate care legislation in a way that most portray this as a vote for or against Finance Committee. helps my State. That is why the people this particular health care reform bill At times like this I think it is very of Arkansas sent me here. They sent are untrue and deliberately misleading. important for each of us to remember me here because they know I am going The vote tonight will mark the begin- the very reasons we began this debate. to work hard to do the best job possible ning of consideration of this bill by the Small businesses and working families and to do the right thing; to stand my full Senate, not the end. Republicans are reaching the breaking point finan- ground on my principles. have sought to revive their political cially because of the relentless rise in I have avoided the extremist claims party by opposing any real solution to health care costs. Nationally, our eco- from the left and from the right and our Nation’s health care crisis. In fact, nomic recovery will only be slowed by tried to pull the commonsense solu- this vote for or against a procedure the inflationary cost of health care. tions from among all the policy options that allows us to begin debate on Taxpayers and the insured are already so that we get health care reform that health care reform is nothing more and bearing the cost of medical treatment benefits Arkansans and all Americans. nothing less. Put simply, those who for the uninsured at the most expen- That is our job in this body, to rep- vote yes on this vote believe our Na- sive point of delivery, in our emer- resent our States in this unbelievably tion’s health care system needs reform- gency rooms. Health care in America historic body, the Senate. ing, and they are ready to have an hon- today is a model that waits until peo- The truth is, this issue is very com- est and open debate in the Senate ple get sick rather than focusing on the plex. There is no easy fix, and it is im- about how to best achieve that reform.

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.032 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11933 I am not afraid of that debate, nor am ernment, not expanding it more. With- ment about solutions, but I can assure I afraid of coming before this body to out the public option, we could still my colleagues that each Arkansan I say what I believe is the most impor- force private insurance plans that par- speak to expects us to roll up our tant thing we can do to reform health ticipate in the exchanges to provide sleeves and get this right. We can. Fol- care. I hope none of us are. Our country standard benefit packages that are lowing the vote tonight, the bill that needs us too desperately now to be easy to compare and more fairly will be laid before us will not be the making good decisions and moving for- priced. We will be bringing millions of only possible solution. I know my deci- ward. new customers to the exchanges so in- sion to support cloture on the motion I will not allow my decision on this surers should be motivated to lower to proceed is not my last or only vote to be dictated by pressure from prices and be competitive. chance to have an impact on overall my political opponents, nor the liberal I have pledged to dialog with Leader health care reform. My strongest hope interest groups from outside Arkansas REID regarding my concerns that re- is that each of us can lay political for- that threaten me with their money and main about this bill. I look forward to tunes aside and make the tough, com- their political opposition; the mul- continuing that dialog on improve- monsense choices our constituents ex- titudes of e-mails and ads we have re- ments that I believe are necessary in pect of us, whether you are a Democrat ceived, unbelievable types of threats order to meet the challenge. I will be or Republican, and look at what we about what they are going to do and asking my colleagues to consider these face and the challenges of our Nation. how they are going to behave. The fact additional important changes I believe Make sure that as we are working to- is, I am serious about changing our will improve our chances for real ward an end result, that each of us is health care system, as most Arkansans health insurance reform and that can working as hard as we can to come up and most Americans are. I am not with also enjoy the support of most Arkan- with a pragmatic solution that our those who seek to avoid the debate, nor sans and most Americans. constituents expect of us. We may not with those who use political attacks to Some of these include that the legis- get this opportunity again in our life- achieve their narrow goals. I will vote lation remain deficit neutral, now and time. in support of cloture on the motion to in the future, and curbs future cost, Today I am thinking about the Ar- proceed to this bill. that it protects Medicare beneficiaries kansas working family who can’t pay But let me be perfectly clear. I am for seniors and extends solvency of the their mortgage because of their sick opposed to a new government-adminis- Medicare Program, that it improves child’s medical bills. I am thinking of tered health care plan as a part of com- accessibility and affordability of the Arkansas small business owner who prehensive health insurance reform, health insurance for employees and told me that more than 20 percent of and I will not vote in favor of the pro- owners of small businesses and the self- the cost of running his business now posal that has been introduced by employed through access to health in- goes to health insurance for him and his workers. I am thinking about the Leader REID as written. I, along with surance exchanges and tax credits, that 450,000 Arkansans who have no health others, expect to have legitimate op- it enhance choice and competition of insurance. I am not thinking about my portunities to influence the health care health insurance plans for small busi- reelection, the legacy of a President, or reform legislation that is voted on by nesses and individuals without the in- whether Democrats or Republicans are the Senate later this year or early next clusion of a government-run public op- going to claim victory in winning the year. I am also aware there will be ad- tion, and that it build our Nation’s debate. I hope all of my colleagues join ditional procedural votes to move this health care workforce and ensure con- me in looking forward to working with process forward that will require 60 tinued access to quality health care the leader and all of our colleagues in votes prior to conclusion of the floor providers, especially in rural America. the days and weeks ahead as we strive debate. I have already alerted the lead- Today I know I will ultimately be to solve a problem whose solution is er and my colleagues that I am pre- held accountable by my constituents in pared to vote against moving to the long overdue. Arkansas for all of my votes on health I yield the floor. next stage of consideration as long as a care, not the National Republican Sen- The PRESIDING OFFICER. The Sen- government-run public option is in- atorial Committee, not by other groups ator from Michigan. cluded. The public option, as a part of from outside my State that continue to Mr. LEVIN. Madam President, in a health insurance reform, has attracted engage in a conversation they have few hours we will take an important far more attention than it deserves. begun. I know my decision to support step on the road to health care reform. While cost projections show that it the upcoming cloture vote on the mo- Our vote will come after months of may reduce costs somewhat, those pro- tion to proceed is not my last nor only analysis and debate and years of grow- jections don’t take into account who chance to have an impact on health ing concern on the part of our constitu- pays if it fails to live up to expecta- care reform. ents that the American health care tions. If, in fact, premiums don’t cover I am optimistic and encouraged system is in need of fundamental re- the cost of the public plan, it is tax- about the step we are preparing to take form. Two Senate committees have ap- payers in this country who are faced in the Senate, to amend and craft a bill proved reform legislation. We will vote with the burden of bailing it out. that will improve access to quality, af- later today on whether to open debate Our colleagues cannot ignore the fordable coverage options for the resi- on a third one which merges the two growth in the Federal Government dents and businesses of my State who produced by the Senate Finance and since the year 2000. I can assure you desperately need relief, a bill that im- HELP Committees. Much time and at- that the American people have not ig- proves the quality and efficiency with tention has been focused on the provi- nored it. According to the American which we deliver health care, all with- sions in this legislation which will ex- Institute for Economic Research, gov- out adding to our Nation’s deficit and pand the number of Americans who are ernment spending grew by 55 percent while lowering the cost of health care covered by health insurance, a goal I under President Bush. As he was leav- over the long term. I am committed to wholeheartedly share. But a compel- ing office, government launched a mas- using every power of my office to ling reason for reform and a major rea- sive bailout of Wall Street. Then it was achieve success on this issue by enact- son to vote in favor of allowing the the domestic auto manufacturing in- ing meaningful reforms that will ben- Senate to debate health care reform is dustry that needed taxpayer funds to efit the people of Arkansas and our Na- the serious and worsening signs that survive. And finally, in order to revive tion. for those Americans who have health a dying economy, it took a government I have spent the last several months insurance, our health care system is no economic recovery package to save or in a passionate dialog with my con- longer working as it should. create hundreds of thousands of jobs. stituents about health care reform. It Increasingly, Americans with health We can argue about the necessity of was not only in townhall meetings insurance are at catastrophic financial these unprecedented steps, but we need where I heard from Arkansans. I had risk, if they get sick. Increasingly, not argue about the impression they hundreds of conversations with many working families with insurance are have made on the American people. We of them in groups and one-on-one con- unable to afford the escalating pre- should be stopping the growth of gov- versations. They may not be in agree- miums they face to maintain their

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.033 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11934 CONGRESSIONAL RECORD — SENATE November 21, 2009 often inadequate coverage. Increas- do not like the bill. But why deny the is bankrupting them, in many cases lit- ingly, businesses large and small that Senate the opportunity to debate the erally bankrupting them. A study this offer health insurance to their employ- subject of health care reform? Why pre- year, published in the American Jour- ees are buckling under the crushing vent us from considering it? Why not nal of Medicine, found that in 2002, 62 weight of spiraling costs for their em- offer amendments to the bill if you do percent of all individual bankruptcies ployees. Increasingly, families find not like it or offer a substitute meas- in the United States involved medical that caps on their coverage leave them ure for it? costs. exposed to devastating medical bills. There are parts of the bill in which I That is a tragedy. You should not be And increasingly, arbitrary insurance would like to see changes. I would like forced into bankruptcy because you get company practices that boost their to make health insurance even more sick. But it gets worse. Three-quarters own profits are shortchanging Ameri- affordable for working families, and I of those bankruptcies involved people cans, denying coverage because of pre- am willing to require that those earn- who had health insurance when they existing conditions, and searching for ing more than $250,000 a year, for in- got sick. Let me repeat that. In the ways to deny patients the treatments stance, pay a higher and, in my view, United States, almost two-thirds of all they need and have paid for through more fair and more appropriate tax bankruptcies are linked to medical their premiums. rate to make that greater affordability costs, and three-quarters of those Democrats are not alone in pointing for working families possible. bankruptcies occurred even though the out these problems. The Republican Income data shows that in recent debtor had health insurance. That is leader himself has said: years only the wealthiest 10 percent of adding absurdity to tragedy and dem- Every Republican in Congress supports re- Americans have seen any real increases onstrates the inadequacy of health in- form. in income and that those increases are surance for those who are covered. That is the Republican leader who concentrated in the wealthiest 1 per- We must act to reform a health care said that every Republican in Congress cent of the country, while the vast ma- system so broken that it crushes Amer- supports reform. He did not say many jority of Americans have lost ground. icans under a mountain of debt. One of Republicans. He did not say most Re- At the same time, most Americans are my constituents, a Kalamazoo man, publicans. Every single Republican in coping with falling income, they have had what he thought was adequate both Chambers of Congress, the Repub- been hit with massive increases in health care coverage when 3 years ago lican leader tells us, wants to reform health insurance premiums. So I am he needed surgery to replace two sec- the health care system. willing to support an increase in upper tions of his aorta. But his coverage left How will any reform happen, reform income tax brackets to end that unfair- him an out-of-pocket cost of nearly proposed by Democrats or by Repub- ness. $40,000. That is the sum that stood be- licans or by anybody? Only when this Other sources of revenue, such as tween this man and lifesaving surgery. body can bring a bill to the floor of the ending the abuse of offshore tax ha- Financially devastated by the costs, he Senate for debate and amendment, vens, can and should go toward doing declared personal bankruptcy. He only when we work with our colleagues other things we should be doing in this wrote to me: in the other Chamber to resolve dif- bill. For instance, I am concerned that No one should die because they cannot af- ferences between legislation approved the annual fee on insurance providers ford health care, and no one should go broke by the Senate and that approved by the contained in the merged bill would because they get sick. House, only when Congress sends the treat nonprofit and for-profit insurers He is right. President a bill he is prepared to sign the same way. Millions of Michigan We must act to reform a health care into law. Speeches will not reform residents receive their insurance from system so broken that it leaves the health care. Polls and cable television Blue Cross Blue Shield of Michigan, a mother of a young Michigan State Uni- shout fests, none of that will reform nonprofit company, which is the in- versity student worried that her health care. We, the Members of the surer of last resort in our State, pro- daughter will not get the care she U.S. Congress, and we alone, can re- viding coverage to residents who can- needs. This 24-year-old student has in- form health care. not find it elsewhere. We need to find surance. Yet when she began to have We must listen to constituents, advo- ways to reform the insurance market unexplained seizures, her coverage cacy groups, physicians, insurers, without negatively impacting the not- would not pay for all the tests needed health care experts, economists and for-profit insurance companies that are to determine their cause. Even after anyone else with constructive ideas. the insurers of last resort and that pro- declining some prescribed tests because Ultimately, it is we who must act. To vide high levels of coverage in return she could not afford them, the young do that, we must begin to debate here for the premiums they collect. woman’s doctors eventually discovered on the floor of the Senate the many On these and other issues, I will con- the cause of her seizures: a brain complex issues that must be resolved. tinue to study the details of the legis- tumor. This mother worries that her That is all today’s vote will do, give lation, discuss them with colleagues daughter will lose her insurance, will the Members of the Senate the chance and constituents, and I will support be forced to declare bankruptcy, and to come together in a sincere effort to improvements where needed. What I that the family will have to find some work together, resolve our differences, will not do is vote to block efforts to other way to cover the massive expense and address an issue on which there is, reform a system that simply is not of her lifesaving care—all while coping we are told, even by the Republican working well for those who have health with the other financial strains hitting leader, general agreement on the need insurance, as well as for those who do her family and so many others. The for reform. not. mother writes: Two Senate committees have already The need for reform is generally ac- We will lose too many bright young people spent months seeking the proper ways knowledged. How can we then not open if something is not done. to reform the health care system. The debate? How can we not discuss, offer She is right. Senate Finance Committee has held amendments, consider alternatives, We must reform a health care system over 50 meetings on health care reform make changes, and vote on reform leg- so broken that it sent a minister from legislation in the last year. The islation? That is the only path to Jackson, MI, on a weeks-long odyssey Health, Education, Labor and Pensions health care reform. There is no other to keep her insurance because she be- Committee spent 13 days marking up way. And for those who proclaim their came pregnant—a joyous event for its legislation. So we have made belief in the need for reform to stand in most families but apparently just an- progress. We are at least in position to the way of that debate is, at best, other preexisting condition to insur- do what this body was designed to do starkly inconsistent. ance companies. When this expectant and is supposed to do: deliberate and A vote against even opening debate is mother moved from a church in Massa- decide. a vote in favor of the status quo, which chusetts to one in southern Michigan, The minority opposes the legislation my constituents and the vast majority her new church immediately sought, we are trying to bring to the floor for of Americans can no longer afford. for their new minister, to find her debate and amendment. They say they They can no longer afford it because it health insurance. But company after

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.034 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11935 company declined to cover her because Chamber to debate on one of the most CBO, 31 million additional people. But of her pregnancy. She and her church urgent problems Americans face. I ask the expansion that causes that to occur spent weeks researching the issue, our colleagues to allow the Senate to is that 15 million people now will be on changing insurance agents, providing begin deliberations on health care re- Medicaid who are not on Medicaid. It is document after document, pleading form and not to turn away from the op- the largest expansion of Medicaid in with insurance companies. She wrote portunity and the responsibility before U.S. history. me: us. What we are doing to make sure this I had two volunteers, myself, and two in- Madam President, I yield the floor. works budgetarily is we are forcing surance agents working on the situation con- The PRESIDING OFFICER. The Sen- States to pick up the tab. I got an e- stantly for over a month. ator from Tennessee. mail last night from my State—and I And she said: Mr. CORKER. Madam President, I know other States are going to be talk- If you have the time and energy, and some know the time is slightly before the ing about that, or people from other good help, and are willing to spend a month hour. I do not know if there are any States. But last night, the State sent hassling with the system pretty much con- Democrats who want to speak beyond me an e-mail and said this was going to tinuously . . . then you can sometimes, with the Senator from Michigan during this cost our State almost $800 million. a great deal of luck, work the system. hour. With that, I think we are anxious Our State has been well governed for Reflecting on her experience, this to get going. years. The senior Senator from Ten- minister writes: Madam President, I ask unanimous nessee was Governor in the middle- It is clear to me that we are desperately in consent that the Republican speakers eighties. We have had both Republicans need of health care reform. be permitted to enter into a colloquy and Democrats who have governed our She is right. during the time controlled by the mi- State very well. In our State, we do not The legislation the majority leader nority, which I understand ends at 4 expect our revenues to be back to 2008 has brought forward will do much to o’clock today. Is that correct? levels until 2013. So you can imagine ease the hardship on millions of Ameri- The PRESIDING OFFICER. That is that our Governor, who is on the other cans. It has benefits for those who al- correct. side of the aisle, is very concerned ready have insurance through their Without objection, it is so ordered. about us here in Washington saying he employer, with steps to rein in sky- Mr. CORKER. Madam President, just has to expand his Medicaid Program. rocketing premiums and to reduce the to make sure people who may be We are going to expand it around the risk of financial ruin for those who watching the Senate floor understand country by 15 million people, and he have health insurance. what is happening, Republican Sen- has to pay for it. He is more than upset In addition to helping those with pri- ators took all day yesterday and today about that particular issue. vate insurance, this legislation pro- to read the bill and to actually go I know people here in Washington— vides important benefits for seniors through sections of the bill to discuss the Washington establishment—gen- covered by Medicare. Medicare bene- it and make sure all of us are very fa- erally speaking, are upset about the ficiaries will receive free preventive miliar with the various pieces of it. fact that States actually balance their care benefits, and the bill will reduce I think all of us are united in concern budgets. We don’t do that here, but in the enormous costs many seniors face about the way this bill is paid for. It is order to show almost disrespect for the when they fall into that doughnut hole, hard for me to believe that anybody way our States, in most cases, have to so-called, in the Medicare Part D pre- could suggest that taking $464 billion balance their budgets, what we are say- scription drug program. Because of out of Medicare, which is insolvent, ing is we are going to make it more dif- these important improvements in care would be a way to fund a new entitle- ficult on them by making sure that in for seniors, AARP has recommended ment; or that pushing down an un- order to reach a goal, we force our that Senators vote in favor of begin- funded mandate to States, which we States, through an unfunded mandate, ning debate on this bill tonight. are going to talk about in just one mo- to cover an additional 15 million people The legislation also contains impor- ment, makes any sense at all—$25 bil- under their Medicaid programs. tant provisions to improve information lion worth; or increasing the Medicare Let me just mention that I thought technology in the health care sector, tax, which would not be a tax to make we were actually going to do health pushing for uniform billing practices Medicare more solvent, but instead go care reform. I know there is probably a and developing standards that will lead to a new entitlement program—we all lot of laughter taking place in the halls to the computer systems of health care know Medicare is going to be insolvent of this building today because I providers being able to talk to the by the year 2017; and to have a bill that thought when we talked about health computer systems of insurance compa- pays for itself over 10 years by having care reform, that is what we were nies, reducing mountains of paperwork 6 years’ worth of costs against 10 years going to do. and other inefficiencies that drive up worth of revenue; and then to have We know Medicaid is one of the worst health insurance premiums. something such as the CLASS Act, programs that ever existed as it relates Americans who move from one em- which I know the chairman of the to health care. Let me just mention a ployer to another will no longer face Budget Committee has called a Ponzi couple stats. The Cancer Journal pub- the risk of being denied coverage at scheme, where, in essence, you create a lished that Medicaid recipients were their new job because of a preexisting program that takes in premiums over a two to three times more likely to die condition. 10-year period on a new entitlement for from the disease than people who were We must allow debate to begin. If we long-term care—another new entitle- not on Medicaid. The American College act, millions of those who already have ment, I might add, in addition to the of Cardiology in 2005 said Medicaid pa- insurance at work will benefit. If we one we are talking about today—it tients were almost 50 percent more act, millions without insurance will takes in those premiums but bars any likely to die after coronary artery by- get it, along with help to pay for it, so money from going out for 5 years. So pass surgery than patients on Medicare we can end the current wasteful situa- what you have is, in essence, a collec- or private pay. Forty percent of physi- tion in which emergency room care— tion system that creates $72 billion. So cians in our country don’t even take vastly more expensive than primary I think all of us are very concerned Medicaid. In urban areas, 50 percent of care through a family doctor—is used about how this is funded. specialists have blocked patients from for nonemergency purposes by those But today we want to talk about our entering their program. without health insurance. tremendous concerns with the Med- So I wish to say just this and then I We can only accomplish these things icaid expansion that is taking place. I will stop because I want to hear from if we vote today to begin debate on this am joined by a number of Senators who other colleagues who have been around legislation. We can only accomplish have had vast experience in State gov- here for awhile. But when I was back these things if we are willing to hon- ernment and vast experience in health home during August, citizen after cit- estly and vigorously debate the best care. izen said to me: I know we are going to ways to achieve it. So I urge our col- I think the American people have have health care reform. What I would leagues not to close the doors of this now realized this bill insures, per the like is just to have what you, Senator,

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.035 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11936 CONGRESSIONAL RECORD — SENATE November 21, 2009 have. That is what I would like to find are the words ‘‘require,’’ ‘‘must,’’ their reimbursement doesn’t suffi- have. I know Senator BURR worked on or ‘‘shall’’ 4,677 times. You find the ciently meet the needs of the cost of a bill that would do that. It would cre- words ‘‘tax,’’ ‘‘fee,’’ or ‘‘revenue’’ 899 that service delivered. But it doesn’t ate the ability for people to partici- times. You find the word ‘‘agency,’’ stop there. Medicaid reimburses at 72 pate, as we do, in choice. I know Sen- ‘‘department,’’ ‘‘bureau,’’ ‘‘commis- cents of every dollar of service pro- ator ALEXANDER worked with Senator sion,’’ or ‘‘panel’’ 470 times. But we are vided. Today, for every Medicaid bene- WYDEN and others, and I worked with told this bill does reform health care. ficiary in America, every time they re- Senator BURR in the first Congress to We are told it increases competition, it ceive a service from a doctor, a hos- create legislation that did that. As a provides more choice, it stimulates in- pital, or wherever, 28 cents is shifted matter of fact, Senator WYDEN, from novation. Yet we find the word over to the private side to those who the other side of the aisle, created a ‘‘choice’’ 40 times. We find the word pay out of pocket, to those who have bill that did away with Medicaid. It ‘‘innovation’’ 25 times. We find the private insurance. gave Medicaid recipients the same kind word ‘‘competition’’ 13 times. If you are reforming health care, you of choice that we in the Senate have. I suspect their intent is to fix what can’t reform health care without elimi- nating cost shifting. Yet in this plan, But it seems to me, Senator REID’s bill they haven’t reformed by allowing the goes in exactly the opposite direction. Secretary of Health and Human Serv- we increase the rolls of Medicaid by 15 What it does, in order to add 31 mil- ices, in 1,677 spots, to define or deter- million individuals. In essence, what lion people to the rolls, 15 million peo- mine what congressional intent was. that means is we are going to have cost ple are being forced into Medicaid. So I Think about that. This bill basically shifting on steroids now. We are going would think, then, that in order to turns over a lot of the decisionmaking to have more cost shifting than we had make sure we are treated just like our to the current or future Secretaries of before, which means a higher inflation citizens, one of the first votes we might Health and Human Services to decide rate on private health care, that which take is that we agree, as Senators, to what we meant in the Congress. we pay out of pocket or that which em- be treated the way the majority of peo- Well, my good friend from Tennessee ployers, in fact, provide for their em- ple in this program are being treated, raised a lot of things on Medicaid, and ployees. As a matter of fact, incorporated in and I assume that going on Medicaid I wish to talk about Medicaid, but I this bill is a disincentive for small also wish to mention that, once again, with those same results for our fami- business success. I am not sure every- we are paying for this by cutting $464 lies would be something we would em- body has read to that point in the bill billion from our Nation’s seniors. That brace. I think all of us heard from citi- yet, but for a company that today can’t is a trust fund. They have paid in pre- zens across this country that they afford, because of their competition to miums. Similar to the CLASS Act—it want the same choices we have. But in offer health care—the day they hire shouldn’t be a surprise to us that they the name of reform, we are going in the their 51st employee, the Federal Gov- opposite way and, again, locking them are going to steal money out of the ernment will send them a tax bill of into nonchoices, nonphysicians, bad CLASS Act that hasn’t even been cre- $38,250. At a time when we have 10.2 outcomes, and going in exactly the ated yet because in the bill it is taking percent unemployment, 11 percent in wrong way we should be going and, to $464 billion from seniors who have paid North Carolina, small business is going boot, making States pay for it. into it for a lifetime, and within that to be the engine of job creation in this There is one class of people, though, group of seniors, 11 million seniors are country, and we are saying as soon as who are not treated that way in this going to have their benefits cut be- you are successful enough that you bill. I have tremendous respect for cause they chose Medicare Advantage hire the 51st person, if you don’t offer those immigrants who have come into as their preferred insurance product. It the health care we tell you you have to our country in a legal way. Let me is not a question of whether they can offer, we are going to send you a tax make sure people understand that. keep what they have; they can’t keep bill of $38,250. Sometimes my southern drawl confuses it because their benefits are going to be Unfortunately, it doesn’t stop there. people. I have tremendous respect for cut, and that affects America’s low-in- For the Medicaid beneficiaries, for the people who have come into this coun- come seniors the most. Medicare beneficiaries, for everybody try in a legal way. The Reid bill does As a matter of fact, in this bill, we in America where we have said drugs this. He respects them too. What the fix doctor payments for 1 year. So, in are too high, devices are expensive, in- Reid bill says is, if you are born in 2011, doctors’ reimbursements are novation costs money, what are we America and you are from 100 to 133 going to be cut 23 percent. I see Dr. going to do? We are going to tax drug percent of poverty, then you are barred BARRASSO on the floor. So we know companies. We are going to tax med- from receiving a subsidy and are forced more doctors are going to stop cov- ical device companies. We are going to to be on Medicaid, but if you come into ering Medicare beneficiaries. The pool actually raise the cost of our ability to this country as a legal immigrant, you is going to get smaller. We are going to detect something earlier, where our op- actually can receive a subsidy to pur- affect every senior’s health. tions are greater and, hopefully, chase a private insurance policy. I find Mr. CORKER. In essence, Medicare through having those options earlier, that most interesting. I don’t know if will become more similar to Medicaid in fact, we are going to be able to treat some of my other colleagues—I know because of this bill. Less physicians a disease or cure it much cheaper. Senator BURR has spent a lot of time will be covering Medicare recipients I might add it is somewhat ironic on this. because this bill, instead of using the that we are going to tax vaccines at a I find this reform very troubling. I $464 billion to make sure physicians are time when the industry is trying to know the Senator has worked hard to paid, will leverage a new entitlement. meet the needs for vaccines for H1N1 give Medicaid recipients the same So my assumption is, this program, un- across this country. This bill puts a choice as we have. I don’t know how less something else happens, will be- new tax on the vaccine industry we you feel about the reform that is before come more similar to Medicaid. Medi- have tried to revitalize in America. us. care will become similar to Medicaid. Let me suggest to my colleagues, Mr. BURR. I thank my colleague Mr. BURR. The Senator from Ten- this is not a health care bill. This is a from Tennessee. I think it is impor- nessee is 100 percent correct. Today, 40 layaway plan. In fact, what we have tant, throughout this education of the percent of our Nation’s physicians been presented is a plan where they are American people of what is in 2,074 under Medicaid will not see patients asking Americans to pay for it for a pages, to remind them that for every because the reimbursements are so low. number of years—4, to be exact—before word in here, it costs the American Reform in health care means you they get their product. We are going to taxpayer $6.8 million; for every page, have to eliminate cost shifting. As Dr. pay in, in taxes; we are going to pay in, $1.2 billion. BARRASSO knows, cost shifting means in Medicare shift; we are going to begin I think one has to look a little fur- when somebody goes in for a service, to increase the rolls in Medicaid, to ther at this reform aspect. Does this gets health care delivered, and doesn’t wait 4 years down the road before we bill truly reform health care? I think pay or somebody goes in who is under- get the product, before we get any ben- as you read through the bill what you insured, gets delivered a service, and efit out of it. What we are going to find

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.037 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11937 4 years down the road is that costs Mr. BARRASSO. As the senior Sen- ator is concerned for them in Ten- change. You see, it sold as a $849 billion ator from Tennessee said, it is like nessee. How will they get the care they plan today, an $849 billion health care having a bus ticket when no bus is need? More people are coming of Medi- reform package. Well, that is not what coming. Others commented in the care age every day. it is. If you look at it truly over 10 paper that it is like putting more peo- This big bill, this monstrosity, will years, it is a $1.2 trillion plan. If you ple into a sinking ship. cut close to $500 billion from people wait to start until the benefits are paid Why would the renowned Mayo Clinic who depend on Medicare for their care. and look at it for a real 10 years of rev- not want to see these patients? They The American people—those watch- enue and benefits, it is a $2.5 trillion are sending out letters saying if you ing—need this care. But this takes it plan. are from these surrounding States— away to start a whole new government We can’t even be honest enough with Wyoming and others in the Midwest program. It is not fixing the program the American people that we tell them and the Rocky Mountain West send that is going broke already. exactly what it is going to cost. But many patients there—you cannot do it. So the hard reality is—and I think you would expect that out of a layaway The Mayo Clinic is able to provide the the spokesperson for the Mayo Clinic plan, and, in fact, that is what we have kind of care they do because they take said it well. She said that ‘‘it simply is in front of us. very few Medicaid patients, they take the reality of the health care business Let me suggest to my colleagues that very few Medicare patients, and they and how we are going to be able to con- if you reform health care, you can have take people who have insurance. That tinue our mission when these payments coverage expansion without additional is why we know premiums go up when are so far below what it costs to pro- taxpayer investment. You can’t take more people are on Medicaid. There are vide the care.’’ the things that are broken in our sys- actually two hospitals in Rochester, You are not even talking about stay- tem and actually increase their use, MN—Mayo Clinic, where 5 percent of ing open, keeping the doors open, such as Medicaid, and expect at the end their patients are on Medicaid. At the breaking even. The reimbursements are of the day you are going to be able to neighbor hospital in the same commu- so far below what it even costs the save money, provide a better level of nity, it is 29 percent of their patients. Mayo Clinic—the model being held up care; more importantly, that you are The hospitals in Tennessee cannot by Senators on the other side of the going to have a population that gets take everybody out of town. We have aisle—so far below what it costs them the benefits everybody else does: a to take care of those people. When re- to provide care. So as we look at this medical home, preventive care, chronic imbursement is so low by the Federal and say how can we take care of and disease management. It doesn’t happen Government, which is the biggest dead- help the people of America get health in Medicaid today. It will not happen beat payer in the world when it comes care, quality care, what we need to do when you increase the rolls of Med- to health care—the deadbeat Federal is be aimed at driving down the cost of icaid. It will only happen when you re- Government pays so little, the Mayo care. This means an increase of the form health care, and this bill does not Clinic wants nothing to do with them. cost of care and premiums. They are do it. That is why they came out against going to do it by raising taxes, and ev- I thank my colleague from Ten- these proposals. erybody will be affected. The Senator nessee. Harvard Medical School gave these from North Carolina, a State with an Mr. CORKER. Our colleague from proposals a failing grade and said peo- incredible background in technology North Carolina has worked extensively ple who support these are collectively and advances in medical devices—any- on this issue. I think we have a couple in denial, because they know we are thing that taxes them will be passed on Senators who have some business off looking at a health care bill that will to everybody, regardless of income the floor that is very important. I raise the cost of care, to be paid for by level. Every patient in America will think Senator BARRASSO may be one of raising taxes and cutting Medicare for suffer. The Mayo Clinic—the world-re- those, and I think Senator JOHANNS is seniors. Our seniors on Medicare can- nowned Mayo Clinic, where anybody in in the same boat. I know as a physi- not even get into the Mayo Clinic. It is America would like to go for their cian, the Senator actually knows some- fascinating. Mayo set up a branch in care—I heard the Senator from Ten- thing about health care. Arizona. They say they will no longer nessee say, in addition to what the Mr. BARRASSO. Twenty-five years accept Medicare for patients seeking Senator from North Carolina said, that taking care of families and the people primary care at its facility in Arizona: people in his State want to have the of Wyoming. I have taken care of peo- We don’t want them. No vacancies for same level of care you would have. We ple on Medicaid and Medicare. We you. If you want to come in, you have would all want that. The Mayo Clinic heard from Senator BURR about North to pay additional fees—a $250 annual says if you are on Medicare or Med- Carolina and Medicaid as well as Medi- fee plus anywhere from $174 to $400 a icaid, like many of the other States, care and I have concerns about both. I visit if you are on Medicare. don’t come here, because we cannot af- take care of all patients, regardless of Mr. CORKER. I assume that by the ford to have you, because Washington— their ability to pay. So what we know Reid plan taking $464 billion out of the biggest deadbeat payer of all right now is that the Mayo Clinic—and Medicare savings and not using that time—isn’t paying enough to keep our the Mayo Clinic in Rochester, MN, has money to deal with this huge doc fix doors open. been held up in the Senate by our col- issue—the fact that physicians are Mr. CORKER. I know to the people in leagues. It has been held up by the going to have a 23-percent cut in a Tennessee this doesn’t pass the com- President of the United States as the year, they are not dealing with that. I monsense test—a whole new entitle- model for what we should try to get to know it costs about $247 billion to keep ment when we cannot take care of the do in America for health care. The them whole. I assume that would keep ones we have. I know the people in Wy- Mayo Clinic has now told Medicare and many physicians, such as the Senator’s oming are also that way. The people in Medicaid patients they are not wel- former colleagues from—it would cause Tennessee know this bill will cause the come. It has put out the sign: No va- them to drop Medicare recipients, is private insurance they now have to go cancies for you. It is astonishing. It is that correct? up, which is exactly the opposite effect hard to believe the Mayo Clinic would (Mr. LEVIN assumed the Chair.) Americans want. We have a former say: No thank you, we don’t want you, Mr. BARRASSO. It will absolutely Governor here, who has important but they have done that. prevent new Medicare and Medicaid pa- business off the floor in a minute. He Mr. CORKER. So I guess if you had tients from getting in. The Medicare has run their Medicaid Program. He Medicaid, it is kind of like, in many cuts will prevent doctors from taking wants to speak to this issue. I thank cases, you have something that is not new patients and may cause them to the doctor, Senator BARRASSO, some- usable; is that correct? I know Senator drop others. The concerns are so large, body who actually knows about health ALEXANDER has spoken to an analogy and the concerns aren’t just for the care, for being here to talk about this in the past in that regard, but it makes doctors. I am concerned for the people issue. it pretty difficult if you are a Medicaid in Wyoming, who depend upon Medi- Mr. JOHANNS. I thank Senator recipient. care for health care. I know the Sen- CORKER on behalf of not only myself

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.037 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11938 CONGRESSIONAL RECORD — SENATE November 21, 2009 but the folks back home in Nebraska if you look at the map, it will bring JOHANNS for being here. I know he has for giving me a few minutes today, and home what I am talking about. Be- a meeting off the floor. I also thank Dr. BARRASSO. When he tween Chadron, NE, in the northwest The PRESIDING OFFICER. The Sen- talks, I want to listen. I am so tempted part of the State, and O’Neill, NE, clos- ator from Texas is recognized. to yield my time to him because he is er to the north central part of the Mr. CORNYN. I express my gratitude so knowledgeable in this area. I do State, lies Valentine. That little hos- to the Senator from Tennessee for lead- have a few things I want to say. pital in Valentine is the only hospital ing this important discussion on Med- It occurs to me that after the vote in that northern area that is providing icaid. If I can pull back for a moment, tonight, what we should do is declare a deliveries for babies. I think it is important because this is recess for 2 weeks. We should take this When you pass this bill and you ex- such a complex subject, as we can see bill out across our States and listen to pand Medicaid that they can’t live on, from this 2,074-page bill. We need to de- the people. We should listen to the doc- and the reimbursement rates are disas- fine our terms. Medicaid, obviously, is tors, like Dr. BARRASSO, who are on the trous for them—if you mess around a program for low-income people, front lines every day. We should listen with that hospital’s ability to deliver shared by our State and Federal Gov- to the nurses and hospital administra- babies, you have a crisis in the north- ernments. Medicare is for seniors, paid tors and say: What do you think? I ern part of my State. You can tell that for entirely by the Federal trust fund, think we would get an earful. story over and over. $38 trillion in unfunded federal liabil- I did four townhall meetings during I wanted to talk about this last ities to two entitlement programs, the short recess around Veterans Day thing, and I will do it quickly, because both of which are in terrible financial on health care issues. I have been all other colleagues want to speak. As a shape. Rather than make this better, over the State of Nebraska. Let me tell former Governor, I dealt with Medicaid this bill makes it worse. I will describe you a story—and every single Senator to try to balance the budget. I was the very quickly how in my State of Texas. can tell this same story. I visited a Governor in Nebraska post-9/11, when I have watched on C–SPAN and on the small hospital in our State, the critical our economy and the Nation’s economy floor Senators come here and say to- access hospital—and Dr. BARRASSO is tanked. We had to cut budgets over and night we are having merely a proce- familiar with these. Under Federal law, over. My State of Nebraska just fin- dural vote on whether to proceed to the these hospitals are 25 beds or under. ished a special session. They cut about debate. They are in our small communities, $300 million from the State budget. I thought we had been having a de- not only in Nebraska but all across Four hundred people, the Associated bate about health care reform for the America. They have no margin for Press reported, will lose their jobs be- last year or so. I point out that under error, because all they do is hospital cause of these very difficult budget de- the Senate rules, we will not be able to services. They don’t have an exercise cisions. change one period, one comma, one program or whatever. It is hospital Here is the point I want to make: sentence, one part of this bill unless we care they provide. I asked the same When this is fully in effect, we will can get 60 votes to do so. So the in- questions to those doctors and admin- drop into the States—my State in- crease in premiums, the taxes on small istrators. I would say: Let me ask you, cluded—billions of dollars worth of un- businesses and the middle class, the first, could you run this hospital and funded mandates for Medicaid—billions cuts in Medicare, this expansion of keep it open on Medicaid reimburse- of dollars in a program where already Medicaid—all of these are a fait ments? It was 100 percent unanimous: 35 to 40 percent of our doctors cannot accompli unless 60 Senators vote to We would go broke. afford to take Medicaid patients, and change it. That is under the rules of I asked a second question: Could you they are saying: We would go broke if the Senate. keep this hospital open on Medicaid we had to. We are adding insult to in- It is not true, in my humble opinion, and Medicare reimbursements? It was jury by telling our Governors they that people can come in here and say: 100 percent unanimous. They say: No, have to figure out that in addition to We are going to vote yes to proceed to- we would go broke. the historic problems they are having night at 8 o’clock, but it doesn’t make What does this bill do? It expands with their budgets, they have to deal any difference, the debate is just begin- Medicaid. Fifteen million people will with an unfunded mandate. In a mo- ning. Not so. be added to Medicaid—the largest sin- ment of candor, one of my colleagues I again thank the Senator from Ten- gle expansion in Medicaid in the pro- who worked on this for years said nessee for raising this concern. Both of gram’s history. Nearly half of the re- something when I asked: Why Med- our Tennessee colleagues have been in duction of the uninsured in this bill is icaid? It is so problematic. Why all the forefront of discussing this issue. due to moving people onto Medicaid, a these millions on Medicaid? In a mo- I think this is shameful. The expan- program that if you had to live on ment of candor he said to me: Because sion of Medicaid in this bill to cover 60 those reimbursements, and you were a it makes the score look better. million Americans is shameful. It con- critical access hospital, you would Mr. CORKER. Yes, it is the cheapest signs people to a health care gulag close your doors. That is shocking to route for us and the most expensive which they cannot get out of, where me. Who were they listening to when way for the States. This has been most- they get bad outcomes in terms of they wrote this bill? Why can’t we take ly about moving money around. I have their health care, where they cannot these staff people, who have been holed not seen a lot in here that has a lot to find doctors who will treat them at the up in the majority leader’s office for 6 do with reform. I appreciate the com- low rates paid for by Medicaid, and it weeks, to Nebraska or Wyoming or ments about Medicaid and what it will bankrupts our States. Oklahoma or Tennessee or Texas? It do to your State. After having been a The Medicaid officials in Texas have makes no sense to me. Governor, I know that Dr. COBURN, the told me, after their preliminary review I came here saying I was going to Senator from Oklahoma, is here, and of this 2,074-page bill, it will cost Texas work to solve real problems for real we have the Senator from Texas, who taxpayers, in addition to their Federal people. We say that a lot out there. Let has been highly involved in every liability, $20 billion over the next 10 me give you a real people perspective health care meeting we have had. Sen- years. about my State. Again, every Senator ator HATCH helped create SCHIP years Our friends who have been Governors can tell this story. I was in a beautiful ago. I think he knows that in this bill have told us, as Governors and as State little community hospital—a critical not only is there an unfunded mandate legislators, they have to make terribly access hospital, with 25 beds or less—in for Medicaid, not only are there taxes hard choices. But when the Federal Valentine, NE, in a beautiful part of and Ponzi schemes, such as the CLASS Government imposes an unfunded man- our State along the northern tier. It is Act, that have been put together, it date on the States to pick up $20 bil- a beautiful area, the Niobrara River doesn’t fund an existing program such lion over the next 10 years, what does Valley. There are great people there. It as SCHIP. That is another huge burden that do to our ability to do other is off the interstate. It is a beautiful of $40 billion or $50 billion. I don’t things, such as law enforcement, high- part of our country. Pick up a Ne- know if Senator ALEXANDER wants to er education, and the like? It shoves braska map, because when I say this— speak to that. I thank Senator those to the side because the Federal

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.038 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11939 Government is going to jam this down I agree with the Senator from Ten- or D.O.s, 1 in 50 went into primary the States’ throats—another unfunded nessee. We need to provide the Amer- care. That is general internal medi- mandate—and it disrupts those States, ican people with choices that Members cine, family practice, or pediatrics, as the Senator says, that are operating of Congress have, among an array of only 1 in 50. on balanced budgets. They do not have choices. What this does with the man- We have 50 million baby boomers the luxury of printing money like the dates, with the force-feeding Medicaid going to hit Medicare in the next 71⁄2 Federal Government. on people such as Ruth Guerra and on years, and we are not going to have the Mr. CORKER. Mr. President, did the the States, along with the huge budget primary care doctors there to take care Senator from Texas see this weekend deficits that are going to come from it of them. The reason is because through where college students in California is shameful. government programs, we have were having public protests about the Mr. CORKER. I thank the Senator for incentivized doctors not to do primary huge increase in tuition out there? Yet his contributions, being down here on a care. Consequently, we don’t get there. here we are getting ready to pass some- Saturday on a very important issue. I The other point I will tell you is that thing that is going to drive that up know Senator COBURN is here. Senator if you look at perinatal mortality rates even more because the State of Cali- ALEXANDER is here. I don’t know what in our population across the country, it fornia will have to cover more Med- order they may want to speak. It looks is, No. 1, directly related more to pov- icaid recipients without the money like it is Dr. COBURN. erty than it is to anything else. But being provided. So this is going to ex- Again, each Monday, typically in his the second most important factor is acerbate that situation. I don’t know if State, he is actually seeing patients. that if you are in Medicaid, you are the Senator saw it this weekend. He knows something about Medicaid. twice as likely to have a perinatal mor- Mr. CORNYN. The Senator is correct. He knows something about health care. tality event—in other words, your It is a 32-percent increase in fees and Many of the reforms he put forth would child dies after childbirth—than if you tuition, and that is in California alone, give people a choice, low-income citi- are in private insurance. It doesn’t which is bankrupt already. This is the zens a choice like we have. But, in- matter what your culture is. If you are direct result of the irresponsibility stead, this bill confines them to Med- poor, but you have private insurance, coming out of Washington, DC, forcing icaid. I know he is going to talk about the likelihood your baby is going to do more costs on them. better is greater. I know there are other colleagues that. I thank the doctor very much for Think about that: a promise we are who want to talk about this topic, and going to give you care, but the result I want to have this continued conversa- being here. Mr. COBURN. Mr. President, I thank of the care is going to be less good. We tion. I think this is a good format for Senator CORKER. are going to give you care, but it is not parsing what is in this bill. as good care, and it is not available Let me mention one anecdote in Dal- I have had the distinct pleasure of de- livering over 2,500 babies for Medicaid care. We are going to make you wait in las, TX. If you are a Medicaid recipi- line, but we are going to call it care. ent, or a low-income child or bene- insurance and taking care of their chil- dren. These are wonderful folks. I Care delayed is care denied. Let me ficiary in Dallas, TX, only 38.6 percent say that again. Care delayed is care de- of the doctors will see a new Medicaid didn’t do any differential between Med- icaid and private insurance in my prac- nied. If, in fact, you have a problem patient—38.6 percent. In other words, 61 that needs attention, and you cannot percent will have restricted access to tice, but most of my colleagues did. The heartbreaking part about Med- get what you need, it does not matter Medicaid because, as the Senator from what Medicaid does if you cannot get Tennessee and the Senator from Wyo- icaid is that when you have a sick child who needs a specialist, you cannot get treatment. ming pointed out, it only pays about 72 If you look at the subspecialities in one. You just cannot get one. You say: percent of what a private insurance Medicaid, 65 percent of them do not see Why can’t you? Do they not care? Yes, policy would cover. Medicaid patients. We have about 40 they care. But you know what. Because Mr. President, 85 percent of Ameri- percent in primary care who will not of the Medicaid reimbursement for pe- cans have private insurance, and they see a Medicaid patient. We have about diatric subspecialities—pediatric cardi- pretty much like what they have. They 65 percent of the specialities, because think it costs too much, and we agree. ologists, pediatric oncologists, pedi- there is such a shortage in the speciali- We want to help them bring down that atric hematologists—there are not any. ties, that what we are saying is we are We only have two pediatric cardiolo- cost. But we have these safety net pro- going to have 60 million people in a gists in the city of Tulsa serving 1.9 grams which, frankly, do a lousy job. system that says: You get care, but They promise coverage, but they deny million people. Try to get an appoint- guess what. It is not available; you are access because of low reimbursement ment for a Medicaid patient there. I on Medicaid. rates. can hardly get a regular one. How did Senator WYDEN did offer a plan, I say Let me give an anecdote of what this that happen? The reason we have a to Senator CORKER, that would put means to 6-year-old Ruth Guerra in shortage of pediatric subspecialities is every Medicaid patient in this country, Dallas, TX. I took this article from the directly related to the Medicaid system except dual eligibles, into private in- Dallas Morning News, dated June 3. It in this country because the reimburse- surance. So did we with the Patients’ says: ment is so low that you cannot afford Choice Act, the first bill introduced on When Ruth Guerra, 6, tries to write, hold- to have a high percentage of Medicaid our side of the aisle. We take the stig- ing the pencil puts just enough pressure on patients in your practice and still pay ma off saying you have a low-paying her left pinky to make it bleed. With her your bills. plan, and we give them the same kind condition, if she falls down while playing or So what consequently has happened of insurance we have right here in this a classmate accidentally brushes against is doctors do not go into pediatrics, her, she bleeds. body. By doing it, we save the States $1 Last week [her mother] Sandra Ramirez and then they do not go into the sub- trillion over the next 10 years. Think . . . took time off from her hourly job at the specialities of pediatrics. So I end up about that. Dollar General after another one of Ruth’s having 8-month-old children seen by But that isn’t nearly as important as bleeding episodes. adult cardiologists or adult hema- we have a major increase in the posi- Unfortunately, because she qualifies tologists because there is no available tive outcomes for Medicaid patients. for Medicaid—and while people in doctor to see them because we have You cannot talk about Medicaid with- Washington say: Isn’t it great; we are created a system through the sub- out talking about Indian health care going to give 60 million people Med- standard reimbursement of Medicaid because as you add up Medicaid to icaid—what it means for Ruth Guerra that has directed people coming out of Medicare to TRICARE to VA to Indian is that she has to wait 6 months to get medical school away from that spe- health care, when you add all that up, an appointment with a doctor who will ciality. the government is running 61 percent actually see her. That is what I mean As a matter of fact, last year, if you of our health care right now. No won- when I say this bill consigns 60 million take all the medical students who der we are in trouble. people to a health care gulag they can- graduated from medical college, wheth- I do not deny there are big problems not get out of. er it is osteopaths or allopaths, M.D.s with the insurance industry. I do not

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.039 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11940 CONGRESSIONAL RECORD — SENATE November 21, 2009 deny we need a Patients’ Bill of Rights other side of the aisle who would vote Washington of our health care system, that protects people’s rights and their for this bill if you and I offered it; do calls for the biggest Medicaid expan- interests. I do not deny we need trans- you think that? sion ever—133 percent of the Federal parency in the insurance industry both Mr. COBURN. Probably not. But the poverty level. That is 150 percent in the on price and quality. I do not deny any- Senator sparks one question. Think House bill, if we pass that monstrosity. thing. about this, and I have experienced this My home State of Utah only allows The question we ought to ask is, if we as a physician. Medicaid coverage of up to 133 percent are going to truly reform health care, I care for patients and they lose their of the Federal poverty level for infants, are we going to allow everybody, when job, they have a financial catastrophe, children under the age of 5, and preg- they say they have health care, no and all of a sudden they become de- nant women. Other categories of citi- matter where they get it, to have an pendent on Medicaid. We continue to zens are, however, covered at different equal shot at getting equal care? see those patients. But do you know levels. For example, nonworking par- You see, this bill does not do that. what normally happens? You lose your ents are only covered up to 48 percent This bill puts Medicaid patients in jail insurance, you loss your job, you come of the Federal poverty level. and says: If you happen to be lucky on hard times and go on Medicaid. You This bill will now massively expand enough, the lucky 60 percent to get can’t go back to the doctor you had be- the level of Medicaid coverage to 133 into the line, you will be OK. And if fore because they are not taking new percent for everyone. Who is going to you need a subspecialty, if you happen Medicaid patients. So somebody you pay for that? Our colleagues say the to be part of the lucky 35 percent, you have been with for 15 years, all of a Federal Government will. What are will be OK. But everybody else is in sudden you can’t get back in because they going to pay for it with? We are jail. You are in monopoly jail. We are they are not going to pay enough for running the Federal Government right promising—the government—to do them to care for you. It is a discrimi- into bankruptcy. It is ultimately going that. natory system that says we will send to be the responsibility of the States A final point—and then I will yield so you down the line. and the States can’t do it. Think of That doesn’t mean there are not others can talk—is the idea that my New York, New Jersey, California, just truly caring physicians in this country, State—Texas is a big State. It is our to mention three. Let’s not forget that but it has to be said, outside of pediat- southern neighbor. They sometimes the House has already passed a Med- rics, if you want to look at quality pa- have a better football team than we do. icaid expansion of 150 percent of the They certainly did this year. We are rameters, the Medicaid population ends up going to the less-qualified, the less- Federal poverty level. The Congres- about one-eighth the size of Texas in sional Budget Office estimates this terms of population. We cannot afford experienced, the less-good-outcome physicians in this country. massive entitlement expansion will $2.8 billion over the next 10 years, I say Mr. CORKER. I thank the doctor. It cost States an additional $25 billion to Senator CORNYN. We are going to is so good to hear from somebody who over the next 10 years. say we are going to cover 15 million has dealt, year after year, with Med- You heard me right, $25 billion more. people and some of those will be in icaid recipients with his compassion. That is over the next 10 years. Oklahoma. We cannot afford it. Senator HATCH from Utah, I don’t However, if history has taught us What we can afford is to insure them think there is a person in this body on anything about the way things work in if we make true changes in care, if we this side of the aisle who has spent Washington, I believe this number is truly change and incentivize preven- more time trying to make sure the actually a huge underestimation and tive care, management of chronic dis- poor children of our country have the real impact on our States will be ease—if we truly reform health care. health care. No one has done that. I much higher. I would like to read the These bills do not reform health care. know he is here to speak today about following excerpt from a letter sent to What they do is grow government. this huge Medicaid expansion. I thank me by Governor Herbert, our Governor They are not going to change out- the Senator for the leadership he has in the great State of Utah, and what comes, other than except they are shown in this body for years, ensuring this Medicaid expansion would mean going to limit what you can and cannot that young children in this country for my State. It is a quote. This is what do through cost-effective comparative- have appropriate health care. my Governor has to say: ness. Mr. HATCH. I thank my colleague for As I am sure you know, Utah, like most As we look at this bill, what we need leading out here, talking about this other states, is suffering from the negative to do is think about those we are going very important issue. You and your impacts of nationwide recession. As we pre- to promise something we are not going senior colleague from Tennessee are pare the state’s fiscal year 2011 budget, we to deliver. We are going to call it a sys- great Senators and mean a lot to all of face continued cuts to agency budgets and tem, but they are not going to have it us. reduced government services on top of pain- available. It is funny to me that the people in ful reductions made last year. The unfunded mandate of a forced Medicaid expansion will I thank Senator CORKER for leading this body don’t listen to the only two this discussion, and I yield. only exacerbate an already dire situation. If doctors in the body, and both of them required to increase our Medicaid program Mr. CORKER. I thank Dr. COBURN. As are excellent physicians. Both of them as envisioned in Washington, Utah, and most I listen to him, I realize we have a are concerned about people. Both of every other state, will be forced to find the health care reform bill before us where them make such cogent arguments in money to do so through other means. This half the money, $460 billion, is taken the field of health care. I think we have will require states to either raise taxes or from a program that is insolvent. In- had a very good argument by Senator continue to cut budgets in areas currently suffering from a lack of funding, such as pub- stead of making it more solvent—a pro- COBURN, from Oklahoma—one of our lic and higher education. gram that would take $38.6 trillion in two doctors in the Senate. the bank today, earning Treasury rates Senator BARRASSO is an orthopedist, We are seeing a real life example of to make it solvent—it is a pretty big a specialist. He has come here to fight this in California right now. Faced number—we are taking $1⁄2 trillion out for the causes he believes to be right. with a mounting State budget crises, of that program to leverage a new enti- He knows what is trying to be put off we recently saw that the State-run tlement. The reform we are getting out on America today is not right. University of California system had to of that is we are moving half the folks Our States are facing a historic def- hike its tuition rates by 32 percent—32 into a program that not a person in icit of more than $200 billion right now. percent! this body would want to be a part of; is Yes; that is what our States are facing I don’t know about anyone else, but I that correct? right now without this bill. One of the will not allow this to happen in my Mr. COBURN. That is correct. biggest drivers behind this is the Med- home State of Utah just because Wash- Mr. CORKER. That is not the kind of icaid Program, which takes up an in- ington thinks it is a good idea to keep health care reform I thought we were creasing share of our States’ budgets expanding government programs on the going to be doing. I am shocked. As a across the country. back of our States. matter of fact, as I said many times, I The Senate bill, which is nothing Here is the reality that our States don’t think there is a person on the more than a 2,074-page takeover by are facing:

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.040 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11941 Unemployment rates rose in 29 If this bill passes, it is going to be an largest single expansion of Medicaid in States in October. A significant num- explosion of health care costs such as the program’s history. Why? Because ber of States are facing unemployment we never dreamed possible. nearly half of the reduction of the un- rates much, much higher than our na- I am very concerned about this. It is insured in the Reid health care bill is tional rate of 10.2 percent—the highest all driven by a desire to get, right here due to people moving into the govern- in 26 years: Michigan, 15.2 percent; Ne- in Washington, control over all of our ment-run program that is Medicaid. vada, 13 percent; Rhode Island, 12.9 per- health care. If we do that, we deserve Expanding Medicaid to cover unin- cent; California, 12.5 percent. In fact, the problems we are going to have. sured individuals is a terrible vehicle California, Florida, Delaware and I thank my colleagues for the great for health care reform, because dump- Washington, DC, posted their highest work they are doing. ing this many more people into that unemployment rates since 1976. Mr. CORKER. I thank the Senator program will increase problems for The last thing we need right now is very much for coming. No one in this beneficiaries getting access to care and for Washington to impose more liabil- body knows more about what is hap- for maintaining quality. Plus the pro- ity on the states. pening in public programs than he. We gram is already riddled with fraud and This alone should be a reason enough heard for the last 55 minutes from the abuse; this would just invite more of for every Senator to stop and rethink Senators from Texas, Oklahoma, Wyo- that. Most Governors are struggling their decision about letting this ‘‘tax ming, Utah, North Carolina, Nebraska. with Medicaid in its current form, and and spend’’ bill move forward. I can’t think of a better person to close they agree that expansion is a bad idea. But I have to tell you, I know what is us out this afternoon than the distin- This includes Democratic Governors. behind all this. Ever since I have been guished Senator from Tennessee. I am Tennessee’s Medicaid Program is here, there has been a push to have fortunate to serve with this Senator. called TennCare. The Tennessean from more and more people moved into Med- He was a Governor, an education Sec- Thursday printed an article that re- icaid. Why is that? Because if they can retary. He knows what he is talking ports how ‘‘People covered by push more and more people into Med- about. I am proud the senior Senator TennCare may face new limits on their icaid, then ultimately we will have a from Tennessee is going to close us out coverage and reductions in their bene- single-payer system—in other words, on what I think has been an out- fits next year, under a plan unveiled socialized medicine in this country, standing hour on the floor. Wednesday to help slice state spend- where the government will control ev- Mr. ALEXANDER. Mr. President, for ing.’’ The article continues, ‘‘The lim- erything. That is what is behind a lot those who are watching, Republican its are meant to help TennCare, the of this bill. Senators are reading through the bill, State’s Medicaid program for the poor, I have to tell you, what bothered me reading the bill in its entirety. It is pregnant women and children, meet an awful lot about this bill is that even kind of like reading the entire New Govenor Phil Bredesen’s goal of reduc- the CBO Director, whom I find to be an Testament in Greek. It is better to ing spending by most State agencies by honorable, honest man, Dr. Elmendorf, have somebody help interpret it. We as much as 9 percent as the State deals he said that if we go to a government have been talking about page 396, title with a shortfall in tax receipts that plan—which is a hallmark of what our II, subtitle A, section 2001, which ex- could reach as much as $1.5 billion over friends on the other side want to do— pands Medicaid. We have heard elo- the next two fiscal years.’’ then you could have almost 10 million quent statements about how moving 15 If the Reid health care bill is passed, people going into that plan. However, if million low-income Americans into a TennCare might introduce a $10,000 an- you look at the Lewin Group study, program called Medicaid, which is a nual cap on hospital coverage for the they say if you go to a government medical ghetto, is not health care re- 1.2 million enrollees. Additionally, plan, we could have 119.1 million people form. We have also heard Senator after they might also eliminate coverage for going into the new plan. What is it going to be, the 10 million Senator say what right do we have to occupational, speech and physical ther- or the 119.1 million? I guarantee it is expand Medicaid and tell the States apy, and limit enrollees to no more going to be a lot closer to the 119.1 mil- that you are going to pay for it. What than 15 outpatient procedures and 15 lion than it will be to the 10 million. kind of arrogance do we have to say lab procedures in a year. This past Our friends on the other side started that to States that are in their worst Sunday, the Tennessean ran another criticizing the Lewin Group after this fiscal condition since the Depression? story titled, ‘‘Bredesen faces painful report. They have quoted them for The Reid bill requires states to ex- choices as TN begins budget triage’’ years before this report. Now that they pand Medicaid eligibility to cover all which states ‘‘there is no quarrel with don’t agree with our colleagues on the persons under 133 percent of poverty, the general position that Tennessee other side, they think it will only be 10 which means those earning about State Government faces a grim situa- million. Don’t kid yourselves. If you $14,000 per year for an individual and tion’’ and the Governor anticipates had to choose between the 10 and the about $29,000 per year for a family. In- that roughly $750 million in cuts will 119 million, you know doggone well it dividuals who are not otherwise cov- be needed for the next fiscal year. To will be closer to the 119. ered by an employer-sponsored insur- make matters worse ‘‘state tax collec- If we move millions of more people ance would not be eligible for tax cred- tions are already $101.3 million less over from private insurance into gov- its. In effect, every American below 133 than assumed when this year’s budget ernment health care, I can’t tell you percent of poverty would be locked into was enacted.’’ the pressure that will be on America, Medicaid which is like confining them Another article from the Tennessean the pressure that will be on the health to a medical ghetto. With this bill we reported that the State ‘‘might release care professionals. are on path to expand the largest ‘‘pub- as many as 4,000 non-violent felons, We heard from one of the great doc- lic option’’ we already have, Medicaid, possibly even including people con- tors in this body, whom we ought to and it could bankrupt the States, be- victed of drug dealing or robbery, listen to, that we can’t get the primary cause they will be paying for it. As the under a plan outlined Monday by the care people to take care of people now former Governor of Tennessee, I do not Department of Corrections to deal with on Medicaid, let alone adding millions see how Tennessee can pay for their the state’s budget crisis,’’ and Ten- more under this expansion. part of the Medicaid expansion in- nessee is not alone in its budget crisis. I thank my colleague from Tennessee cluded in Senator REID’s health care Even though many States are going for his leadership on this. I am happy bill without a new income tax, or seri- through budget crises much like Ten- to be here to say a few things about it ously damaging higher education by nessee, Senator REID has proposed to as because I have spent a lifetime work- raising tuition like California just did, even more costs onto these States. Ear- ing on health care issues. Before I ever or both. lier this month, the National Gov- got here, I actually tried medical li- I am opposed to this expansion of ernors Association released a fiscal ability and defense cases, defending Medicaid, which, according to the CBO, survey of the States and an accom- doctors, nurses, hospitals, health care would cost States an additional $25 bil- panying release, ‘‘The State Fiscal Sit- providers. I know what these costs are. lion, and add 15 million people to the uation: The Lost Decade.’’ They are just beginning to explode. Medicaid Program. This would be the That report said:

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.004 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11942 CONGRESSIONAL RECORD — SENATE November 21, 2009 The recent economic downturn started in The final example I will give today of to, is about $800 million over 5 years. In December 2007 and likely ended in August or why dumping 15 million more people my view, finding that much money September 2009, making it one of the deepest into Medicaid is such a bad idea comes would seriously damage higher edu- and longest since the Great Depression. from the Government Accountability cation, raise tuition in Tennessee like It went on to say: Office, GAO. The GAO has determined California’s, which just went up, or re- Medicaid spending, which is about 22 per- that the program is plagued by fraud quire us to enact a new State income cent of state budgets, averaged 7.9 percent and abuse. In 2009, the GAO labeled tax, or all of those things at once. growth in FY 2009, its highest rate since the end of the last downturn six years ago. Med- Medicaid as a ‘‘high-risk’’ program, I yield the floor. icaid enrollment is also spiking, with pro- finding $32.7 billion in improper pay- The PRESIDING OFFICER. The Sen- jected growth of 6.6 percent in FY 2010 com- ments in 2007 alone. That is 10 percent ator from New York. pared with 5.4 percent in 2009. of the program’s total spending. Mr. SCHUMER. I ask unanimous con- We don’t yet have an estimate from As a former Governor, I am particu- sent the next hour of Democratic time Tennessee of how much Senator REID’s larly concerned about the impact and be controlled as follows: 10 minutes bill will cost the state, but we expect it expansion of Medicaid would have on under the control of SCHUMER, with the to be in the ballpark of what the Sen- the State budgets and the resulting remaining 50 minutes of time available ate Finance bill would have cost, which squeeze on higher education spending. for various Democratic Members to en- according to Governor Bredesen would When a governor looks at his budget gage in colloquies. have cost an additional $735 million and sees the things he has to pay for The PRESIDING OFFICER. Without over 5 years. Tennessee can’t afford to like elementary and secondary edu- objection, it is so ordered. get a $735 million bill from Wash- cation, prisons, roads, and Medicaid. Mr. SCHUMER. Mr. President, today ington. Not only is it wrong to ask Then a Governor looks at the things we stand at a crossroad. We can con- states to pay for expanding this pro- they want to spend money on like tinue to turn a blind eye to the very gram, but I think it is wrong to dump higher education and a Governor, real, very dangerous threat burgeoning low-income Americans into a govern- knowing they have to balance their health care costs pose to our economic ment-run program that is failing. budgets every year, can’t spend money future or we can choose the path to re- Medicaid is a program that, if given he or she doesn’t have, so something storing economic opportunity in this the choice, none of us would join. A has to give, and it’s usually higher edu- country by tackling what my dear 2002 Medicare Payment Advisory Com- cation. As I noted earlier, the New friend, Ted Kennedy, called the ‘‘great mittee survey found that ‘‘approxi- York Times reported Friday that the unfinished business of our society.’’ mately 40 percent of physicians re- University of California Board of Re- As so often is the case at any major stricted access for Medicaid patients,’’ gents will raise undergraduate fees 32 crossroads in our history, embarking meaning they won’t take new Medicaid percent by next fall to make up for on what we all know is the right path patients, because reimbursement rates steep cuts in state funding. The article is difficult. Indeed, this is the single are so low. Only about half of U.S. phy- goes on to report that ‘‘The University most difficult undertaking I have ever sicians accept new Medicaid patients, of California now receives only half as seen in my 30-year career as a legis- and yet this is how the majority leader much support from the state, per stu- lator. But my colleagues and I know proposes we cover the uninsured. dent, as it did in 1990. Even with the what has to be done. Tonight is only Why is there such an access problem higher student fees, the system needs a one step down the road. There will be for people on Medicaid? It is because $913 million increase in state financing more procedural hurdles, more dis- Medicaid reimbursement rates to doc- next year to avoid further [budget] agreements, more pressure from our tors and hospitals are so low. Medicare cuts.’’ opponents, more television ads, and pays 80 percent of what the private in- From 2000 to 2006, spending by State many amendments. But I have no surers pay and Medicaid pays about 72 governments on Medicaid has risen 62.6 doubt we will pass this bill. percent of what Medicare pays. Which percent, because of that higher Med- There have been many attempts over means if you are a doctor or a clinic, or icaid spending; higher education has many decades in many Congresses to a hospital, you get paid about 60 per- only seen an increase of 17.1 percent reform health care. This time, moral cent for serving a Medicaid patient over the same time period. As a result, and economic necessity will guide us versus one of us who has his or her pri- tuition at a public 4 year university over the finish line. It is unacceptable vate health care. You can see why this has risen an average of 63.4 percent. So that in this country—the wealthiest, spells trouble, and the Senate bill does Congress passes a generous Medicaid greatest country in the world—there nothing to fix this problem. In fact, by benefit, and the governors have to pay are Americans who are forced to choose dumping 15 million more people into the bills. Then the governor has to say between their health care and rent, be- the program it will only make things to our college students: your turn, pay tween their health care and food, be- worse. Who would want to be one of up. Expanding Medicaid is exactly the tween their health care and an edu- those 15 million people? opposite of real health care reform. cation. But there are. And there are In addition to access problems, the Senator CORKER, you were the chief too many of them, and that must quality of care for Medicaid patients is financial officer of the State of Ten- change. significantly lower than those with pri- nessee. You were the mayor of Chat- Consider these facts: Health care vate insurance, and even those with no tanooga. How would you like it if costs are out of control. Premiums for insurance. According to a survey by someone in Washington passes a pro- New York families have doubled in the the National Hospital Ambulatory gram and sends you the bill? last decade. Premiums have risen far in Medical Care, Medicaid patients visit Mr. CORKER. I would be losing a lot excess of inflation while median in- the emergency room at nearly twice of sleep right now. I know people all come has remained stagnant. Costs the rate of uninsured patients, and a across the country who have to act re- have risen so much that more than 20 2007 study published in the Journal of sponsibly, unlike us, are losing sleep million Americans have skipped a doc- the American Medical Association over what we are getting ready to do to tor’s visit for no reason other than cost found that patients enrolled in Med- States across the country. and 23 million Americans have pre- icaid were less likely to achieve good Is the Senator finished? Is that the miums so high they consume $1 out of blood pressure control, receive breast point? every $8 earned. Health care costs now cancer screening, or have timely pre- Mr. ALEXANDER. I think we are out account for a staggering 16 percent of natal care than similar patients en- of time. our GDP, far more than any other in- rolled in private plans. Another study The PRESIDING OFFICER. The Sen- dustrialized country in the world. For of cancer patient outcomes found that ator has 25 seconds remaining. every dollar a small business in the even after adjusting for patients who Mr. ALEXANDER. The Governor of United States spends on health care, became eligible as a result of their can- Tennessee, who is a Democratic Gov- its foreign competitors spend a mere 63 cer diagnosis, Medicaid patients have ernor, has estimated that the cost to cents. Yet the health care of the U.S. significantly lower survival rates than our State of this bill, of moving 15 mil- workforce lags behind all other indus- non-Medicaid patients. lion Americans into this medical ghet- trialized countries. Plain and simple,

VerDate Nov 24 2008 03:09 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.046 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11943 our small businesses will no longer be ica’s economic future. They will con- ing too much. They tried something able to compete unless we act to re- tinue to speak with two tongues else. For routine cases, they said they form health care. against government health care and for will see nurses and see them more Even among those Americans fortu- Medicare. You can’t have it both ways. often. The more difficult cases went to nate enough to have coverage, nearly Our Republican colleagues will not endocrinologists, and they reviewed 88 million don’t have health care they stand in our way. The road ahead is not the routine patients’ records. Higher can rely on. That is half of all Ameri- a smooth one, but the wind is now at quality care, happier patients, better cans age 18 to 64 and their families. our backs. The American people want care, lower costs—$200 per patient per And 46 million of these Americans have reform, and we will have the votes to month—that is what happened. They a serious preexisting condition that finally deliver it to them. Sure, got less money for that higher quality has made it harder or more expensive changes will be made to improve the care, less money. That is what we are for them to get coverage. In addition, bill as we move forward, but we will talking about. We want to use those 37 million of these Americans had a gap pass this bill. We will finish this great, kinds of models so we get higher qual- in their coverage during the last year. unfinished business. ity care for America at a more efficient Our health care system is holding our I yield the floor. rate. economy hostage. The entrepreneur in The PRESIDING OFFICER. The Sen- Some of my colleagues across the Binghamton who does not take a ator from Minnesota. aisle have been using the name of the chance, who does not leave a job to Ms. KLOBUCHAR. I ask unanimous Mayo Clinic in vain. This matters to start his own firm because he is afraid consent to engage in a colloquy with me because I come from Minnesota. It of losing his family’s health care; the the Senators from Maryland, Delaware, is the home of the Mayo Clinic. The college graduate in Oswego, days away Massachusetts, and others who will be minority has suggested that the Mayo from losing her parents’ coverage, joining us later in the hour. Clinic doesn’t want any part of this takes a job because it provides health The PRESIDING OFFICER. Without bill. They have said the Mayo Clinic care, even though that health care eats objection, it is so ordered. wants nothing to do with this bill. up a quarter of her paycheck—each of Ms. KLOBUCHAR. Mr. President, as They have said the Mayo Clinic—and these individuals who limit their po- the Senator from New York has so elo- this is an exact quote from the Senator tential because they are concerned quently stated, the time for health from Wyoming—‘‘is no longer taking about their health care should inspire care reform is now. We cannot afford to Medicare or Medicaid patients.’’ action among all of us. wait any longer. We can’t afford to Let me set the record straight. Like Passing this bill is an economic im- wait, for the middle class. anyone in this country, the Mayo Clin- perative. The broken system we have is There are a lot of numbers that get ic is looking at this bill. They like not only a burden on the present, it is thrown out in the debate, but I think some provisions, and they don’t like a tax on the future. Every day we do we can say it pretty simply by just others. They have specifically said not act to fix the health care system is using three numbers. Those numbers they support the creation of account- a day that handcuffs our economy. It are 6, 12, and 24. What do those num- able care organizations, bundling of drains it of productive workers who do bers mean? Ten years ago, the average payments, the creation of an inde- not treat illness. It drains businesses of family in this country paid $6,000 for pendent commission to evaluate Medi- money they could otherwise use to in- their health insurance. Now they are care solvency, which is in the Senate novate and outperform their foreign paying $12,000. That is an average. I bill, the MedPAC idea. They are sup- competitors, and it drains it of savings know of one small business in northern portive of these issues because right and wealth that every American should Minnesota, a backpack company, pay- now it is becoming harder and harder have in retirement as a reward for a ing $24,000 for a family of four. One guy for them to cope with the current lifetime of hard work. started a company with five employees. Medicare payment system. Inaction is not an option. The con- He now has 15—a growing business. He This allegation that they are no sequences of failure are simply too is paying $24,000. The average right longer taking these patients is com- high. Premiums will climb higher, ben- now is $12,000 for a family of four. pletely incorrect. They made a decision efits will erode further, businesses will Where is it headed if we don’t bend the not to take about 80 patients a year buckle under the cost of insurance, and cost curve for middle-class families— from the State of Nebraska because Medicare will go bankrupt. Yet our Re- $24,000 average, little towns all over they weren’t getting paid. They are publican colleagues would rather see us America, $24,000, 10 years from now. still taking all Medicare-Medicaid pa- fail. At every turn, they have ob- That is not the kind of stability the tients from Minnesota and the contig- structed our path with procedural middle class needs. uous States. This is not a small delays, with calculated misinforma- The middle class needs to know, peo- amount. Forty percent of Mayo pa- tion, and sometimes with outright ple I know all over my State need to tients are on Medicare. Six percent—I falsehood. I am amazed they are know that if their kid gets sick, they wrote this on the back of an envelope against a government health care plan, still can have health care coverage; driving in with one of their chief doc- but they want to protect Medicare. that if their kid goes to college and tors, so you know it is accurate, unlike Medicare is a government health care they want to keep them on their pol- the ‘‘facts’’ we are hearing over there. plan. You can’t have it both ways. icy, they can still do that. That is what Forty percent of their patients are on Yet when Democrats move to protect we are talking about when we talk Medicare, 6 percent on Medicaid, 46 consumers from insurance company about stability. percent are on Medicare or Medicaid. abuses, Republicans fight to allow The other piece of this reform effort Sixty percent of their business is from these companies to drop, deny, or limit that is so important, coming from Min- Medicare or Medicaid. coverage for the people who need it nesota, a State with high-quality, It is just false. But what is true is most. When Democrats tackle waste, highly efficient care, is the cost issue, that they want to see reform. They fraud, and abuse in our health care sys- that we begin the long journey of re- want to see reform of the Medicare and tem, Republicans cry foul to preserve forming our Medicare cost so that we Medicaid system. They want to have it the status quo. When Democrats fight actually promote the kind of high- based on quality, not on quantity. That to protect and strengthen Medicare for quality care we see in my State at is why they support the quality index I future generations, Republicans try to places such as the Mayo Clinic and we sponsored, along with Senator CANT- weaken it. promote the kind of efficient care we WELL of Washington. Tonight, there is no question what need to see. Just putting your head in the sand path our Republicans will take. They My favorite example is in Pennsyl- and hiding behind the stacking of that will follow the map handed to them by vania, the Geisinger Clinic. They had bill—by the way, we had a three-page the big insurance companies—pro- diabetic patients. They decided it was bill with the Bush TARP plan, that tecting industry profits, defending un- not going that well. The patients didn’t didn’t work out that well when there fair practices, and ignoring the threat feel that good about their treatment, were no accountability measures in rising health care costs pose to Amer- and the quality they wanted was cost- that. That is not going to bring us the

VerDate Nov 24 2008 01:39 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.044 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11944 CONGRESSIONAL RECORD — SENATE November 21, 2009 kind of health care reform the Mayo surance with this bill. It reduces the prosecutors. We are going to get more Clinic wants to see for the rest of this growth rate of health care costs in FBI people. We are going to get more country. America. It provides an affordable op- people to make sure we bring this I heard a lot in Minnesota from small tion for every American. This is a criti- health care fraud down. That is part of businesses. Small businesses are paying cally important bill. this bill. 20 percent more than big businesses for The Senator mentioned small compa- But I do not understand—to follow up their health care right now. Why nies. I am glad the Senator did because on what the Senator from Maryland should employees of little businesses, small companies are the ones that are said—how can you say you do not want which are really the entrepreneurial most discriminated against today in to debate the bill, when you look at the engine of our States and the Nation, our health care system. They pay 20 fact that the alternative is our present why should they have to pay 20 percent percent more for the same coverage as health care system, which is totally, more than people who work for big a larger company. They do not have op- completely broke? How can you say businesses? This reform effort allows tions. They do not have a lot of choices you do not want to do it? You say you them to pool their numbers, allows about who they can get to insure them. are fiscally responsible. How can you them to join together so they can buy Not only is the cost so high, the annual say you are fiscally responsible when private insurance off an exchange with increases are unpredictable. How do you are not going to do anything about the same kind of numbers you have at you run a business, if you are a small Medicare and Medicaid health costs a major corporation. business owner, not knowing whether and the cost of health benefits in this I know the Senator from Maryland your health care cost is going to go up country? has been very devoted to the idea of by 10 percent, 20 percent, or 40 percent As we have said many times before helping small businesses. in the following year? You cannot. on the floor, my State is one of the I ask Senator CARDIN about this spe- As the Senator knows, we have had worst cases; that is, in 2016, a family of cific issue. How does the Senator see small businesses come before us and four making $50,000 a year would be this as helping small businesses in tell us they are going to have to decide paying $29,000 in health care premiums. Maryland and helping the middle class to eliminate their health care. In one They cannot afford $29,000 in health in his State? case, we had a small business owner care premiums. So what is going to Mr. CARDIN. Let me thank Senator who said: Look, I am going to have to happen? They are going to have the KLOBUCHAR for setting the record give up my business and start to work equivalent of half what they have straight as it relates to the Mayo Clin- for a larger company because I can’t af- today. If they can afford $12,000 or ic. It is interesting, I have had con- ford the health care. $13,000, they are going to have half the versations with people at Johns Hop- We are at a crisis. I do not under- program. kins University, the University of stand my colleagues on the other side I heard my colleagues on the other Maryland Medical Center. I hear the saying they do not even want to have a side talking about rationing. What is same thing. They desperately want to debate on this issue, they do not even going to happen to these people when see health care reform. The cost issues want to vote so we can take up this they are getting half as much health are beyond their ability to maintain issue. Instead, they want to protect the care from these health care companies? the excellence of our health care sys- private insurance companies and let And the health care companies are the tem. We have to get health care costs them continue to make these profits, ones that decide what procedures you under control. continue to cause real problems for our can have, when you can have them, and If I might point out, I was listening consumers. those kinds of decisions. When people to my colleagues on the other side give I have letter after letter from people have their health care insurance cut by every reason why we should not move who are confronting the problems of this amount, you have to worry about forward with the debate, saying: Don’t private insurance today, where they whether they are going to be able to worry, things will be OK. Those were are denying coverage based on pre- get the things they need. the same arguments they made 15 existing conditions or not covering a Of course, Medicare and Medicaid years ago, which was the last oppor- specific drug under their policies. prices are going through the roof. It is tunity we had to debate comprehensive There is no effective way to challenge going to bankrupt the country. In 6 or health care reform. They blocked it private insurance companies today. 7 years, Medicare and Medicaid costs from being on the floor of the Senate 15 This bill will give the consumers of will cost more than everything else in years ago. America a chance against our private the Federal Government. So how you What has happened in the last 15 insurance companies. can talk about—— years, after they said: Don’t worry Ms. KLOBUCHAR. Mr. President, if Mr. CARDIN. Will my colleague about it. Everything will be OK. Just the Senator would yield, I see the Sen- yield? keep on with our current system of ator from Delaware is in the Chamber. Mr. KAUFMAN. Absolutely. protecting the private insurance com- Both the Senator from Maryland and Mr. CARDIN. On the Medicare issue, panies. They will do a great job. the Senator from Delaware serve on during the last hour we heard all these In the last 15 years, we have seen the Judiciary Committee, and we have people, who for a long time have been health care costs go up, $912 billion, al- had several hearings in that committee trying to privatize Medicare and reduce most a three-time increase. We have about an issue people do not always the program, now saying that Medicare seen the per capita cost of health care think about that hurts the middle is going to be in jeopardy if this bill go from $3,400 to $8,100. We have seen class, and that is the money that is moves forward. It is very interesting. that share of our economy in the last being sucked down the fraud tube. The AARP gets it right when it says: 15 years go from 13 percent of our econ- Medicare fraud is $60 billion a year, I The new Senate bill makes improvements omy to over 17 percent of our economy. think. to the Medicare program by creating a new We need to act. Mr. KAUFMAN. It is up to $220 bil- annual wellness benefit, providing free pre- One more number I want to give be- lion. ventive benefits, and—most notably for cause it affects Mayo Clinic and affects Ms. KLOBUCHAR. Mr. President, $220 AARP members—reducing drug costs for sen- Johns Hopkins because in many cases billion. This bill will give us the tools. iors who fall into the dreaded Medicare they are the provider of last resort, I know I wish to add even more to it on doughnut hole, a costly gap in prescription where no one else will give care. Also, this subject, to go after that money, so drug coverage. the number of the uninsured has in- that money can go back to help the This bill strengthens our health care creased since 1993 from 39 million to 46 middle class afford health care. system, strengthens Medicare for the million. I yield to the Senator from Delaware. future, and that is what is going to be The legislation that is being brought Mr. KAUFMAN. That is absolutely critically important to our seniors. forward by our vote later today will re- right. What we are going to do is in- I thank my colleague. duce the number of uninsured by 31 crease the number of whistleblowers, Mr. KAUFMAN. I think that is abso- million. Mr. President, 98 percent of people who will see health care fraud lutely right. Right now, medical bank- Americans will be covered by health in- and report it. We are going to get more ruptcies are 60 percent of U.S. personal

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.045 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11945

bankruptcies—a rate 11⁄2 times what it duces the Nation’s deficit. It stimu- how sorely missed he is here, and we was 6 years ago—because of medical lates competition. It expands coverage. are proud you are representing that bills. The thing that is striking about It strengthens Medicare. It attacks vote here on the floor of the Senate to- this is, 75 percent of the families enter- fraud, waste, and abuse. It increases night. ing bankruptcy because of medical transparency. It eliminates patient dis- Mr. KIRK. Mr. President, I thank the bills actually have health insurance. crimination. It promotes flexibility Senator from Maryland very much. Two-thirds of all Americans filing for and innovation. It rewards quality and Ms. KLOBUCHAR. Mr. President, if bankruptcy because of medical bills al- value—not quantity and volume—of the Senator would yield, I also see the ready have health insurance. We can- health care. It provides affordable, Senator from Rhode Island in the not stop that unless we change the sys- quality health care choices for individ- Chamber. Rhode Island is a State that tem and give people more insurance uals, families, and small businesses has one of the highest unemployment and give them better insurance and across America. rates right now in the country, and it make sure you cannot be denied for It introduces, through Senator Ken- certainly is a State that would wel- preexisting conditions and make sure— nedy’s leadership, a provision which come this kind of reform. And also on the killer—once you get sick—it is bi- provides long-term services for the el- the issue we have been talking about, zarre. You get sick, and then the derly and the disabled. Medicare, the Senator from Rhode Is- health insurance company comes in Mr. CARDIN. Mr. President, will the land has long fought for seniors. and cuts off your health insurance. No Senator yield for one moment? As to Medicare, as has been pointed wonder so many people are going into Mr. KIRK. Before I do, I say to the out, if we do nothing, it is going to go bankruptcy. Senator from Maryland, there is one in the red by 2017. The seniors I know Ms. KLOBUCHAR. If the Senator large, major question. If this bill prom- who are 65 want to live to be 95 and would yield, I see the Senator from ises to do all these things, for the life still have Medicare. People who are in Massachusetts is in the Chamber, who of me, I cannot understand how 1 of the their fifties want to make sure Medi- I think has firsthand knowledge of the 100 of us could go home for Thanks- care is there for them when they are 65. importance of this bill, having taken giving and be able to explain to middle- That is why it is so important we make the seat once held by our dear friend class families, who are stretched and these smart reforms, to raise the qual- Senator Kennedy, who worked so hard looking for health security and finan- ity of the care, and to make sure we to get this bill done, to get health care cial stability, that he or she would not preserve and save Medicare. And that to the people of his State. vote even to debate the merits of this is what this bill is about. I say to the Senator, maybe he would legislation. I yield to the Senator from Rhode Is- want to talk about what this would Mr. CARDIN. I was going to com- land. mean to the people of Massachusetts. ment, listening to the Senator, at the Mr. REED. Mr. President, I thank the Mr. KIRK. I thank the Senator. desk that was Senator Kennedy’s desk, Senator from Minnesota. I want to add I thank Senator KLOBUCHAR for her how proud he would be of the state- my comments to that of the Senator leadership, as we approach the impor- ments the Senator is making here this from Maryland and the Senator from tant moment on voting on a motion to evening. Senator Kennedy was our Delaware to commend the new Senator proceed with this debate. champion for middle-income families from Massachusetts. He not only car- I was appointed by the Governor of in America. He understood they needed ries on the great work of Ted Kennedy, the Commonwealth basically in con- a voice in the Senate, and he was their but he does it with the same passion formity with Senator Kennedy’s wish- strong, passionate voice. and eloquence. es. He knew how divided this body was This bill speaks to middle-income What struck me in this legislation— over the important health care legisla- families. It is what Senator Kennedy and reminiscent of Senator Kennedy— tion and the importance of 60 votes so fought his whole career for here in the is that this legislation will provide real we could proceed to debate the merits Senate, to do something that would help to real people. It is about solu- of this bill. I am honored and humbled help middle-income families. tions, not slogans. to be standing at his desk, to be one As the Senator points out, we need to Let me illuminate, if I may. Pre- voice and one vote from Massachusetts. bring down the cost of health care. mium relief. What is troubling so many It is a historic moment, and it is a Health care costs are rising three times middle-class families? They are too poignant moment. As I reflect on my faster than wages. Senator Kennedy wealthy to qualify for direct public as- experience on his staff, as Senator understood better than any of us that sistance in terms of the Medicaid Pro- KAUFMAN was on Senator BIDEN’s staff Americans are falling farther and far- gram, but they are not wealthy enough at that time, my experience began 40 ther behind because of the health care to pay for insurance. years ago under the leadership of Sen- issues, because of health care costs. This legislation will cap family out- ator Kennedy. That was the time he Private insurance companies can make lays on medical insurance premiums. first spoke about the need for national lots of money if health care costs go Families making under $88,000 will pay health insurance that would be afford- up. They are not losing. It is the mid- no more than 10 percent of their in- able and accessible to every single dle-income families who are getting come on premiums. They will be given American—in hearing after hearing, in hurt by the system. direct assistance through the tax sys- speeches on the Senate floor, and in He understood that small businesses tem. There will be a rebate. So people field hearings throughout America, could not survive unless we figured out now, rather than staring at 20 percent, prodding, listening, leading. a way to deal with the health care 15 percent, 18 percent increases, will at I can only reflect on how proud he issues. And as to people on Medicare— least know there is a cap. And perhaps would be of his colleagues and the lead- most people on Medicare are from mid- if we do our work well enough, the ership of Senator REID and Senator dle-income families. We need to protect whole system will begin to reduce DODD, Senator HARKIN, Senator BAU- Medicare for the future. That is why, below the 10-percent mark, and every- CUS, all his colleagues who are now again, I get very concerned when I hear one will benefit. uniting in this moment of history to do what we have heard over the last hour It is also notable that real families for the American people what they in the discussions, because one of the worry about many things. They worry have waited for for several decades, principal reasons we need to bring this about educating their children. They even since the first utterance of this bill forward on the floor of the Senate want them to be educated, but they important health insurance coverage tonight is to strengthen Medicare, to also recognize as full-time students in by former President Harry Truman. make sure it is there for the future, to higher education, they can stay on the Having read through this bill and make sure it stays strong, and to make family health care plan. It is inter- knowing how proud Senator Kennedy sure we expand benefits, as we do under esting to note that decisions made would be of this legislation, I will tell this bill. about education are tied into health you why he would be. If you look I thank the Senator because those of care, and also, in fact, as to where you through the bill, what does it do? It us who have heard Senator Kennedy work, if you should keep your job you saves money. It controls costs. It re- speak on the floor of the Senate know do not like because you have health

VerDate Nov 24 2008 02:25 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.047 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11946 CONGRESSIONAL RECORD — SENATE November 21, 2009 care or go on, whether you strike out The way you can tell there is not but he can’t obtain health insurance to start a new business because you competition? You don’t have to have because of this condition. Without have this brilliant idea or stay in your an advanced degree in economics to health insurance, his life is gravely in current position because there is figure out there is no competition. How danger. He repeatedly uses the emer- health care there. But what this bill do you know there is no competition? gency room for care. does, again, is provide real help for real Every January, my premiums go up. To make matters worse, he has a 2- people and allows families to keep The only other thing I know that I get year-old son who has hemophilia and their children on their health care plan that goes up every January is my cable has to be taken to the emergency room until they are 26 years old. bill, right? There is no competition in every time he bumps his head, which It also reforms dramatically the in- cable. You either take cable or you sometimes can cost, for a 2-day supply surance system. Again, we listen to don’t. They say there is competition. of medicine, $4,600. The family makes many of the complaints: Oh, we don’t So every year, whether it is January, too much money to qualify for Med- want a government-run health care February, or March my cable bill goes icaid and, obviously, with these pre- system; we don’t want bureaucrats up. And every year, just like clock- existing conditions, health insurance is telling us what to do. The irony, of work, my health insurance premiums way out of reach for them. It is heart- course, as you mentioned, and Senator go up. So clearly, there is not competi- breaking for this family. What the fa- SCHUMER did, too, is that one of the tion. ther has decided to do is to purchase most popular health care programs in That is why a public option is so im- life insurance instead of trying to get this country is Medicare, which is gov- portant. We have to have a public op- health insurance, and he is 29 years ernment run. One of the other most tion so there is competition not only in old. popular health care programs in this the top 39 States where one firm has Ms. KLOBUCHAR. If the Senator will country is run through the Veterans’ over 50 percent—two firms have over 50 yield, I think what the people will be Administration, which is a government percent of the business—but in all 50 shocked to find out is that I think in agency. The least popular programs are States. eight States domestic abuse is actually private health insurance, where every- That is what this bill does. It is a preexisting condition. You talk about one has complaints—doctors, patients, amazing to think on the other side, the gender discrimination. If a woman is a providers. This legislation will prevent support they have for competition, and victim of domestic abuse, she will basi- lifetime limits that insurance compa- I believe they do and I know them and cally not be able to get certain insur- nies dictate. It will also do many other I respect them and they all are con- ance policies. Is that right? things. cerned about competition—except Mrs. HAGAN. That is right. In all but So let me conclude because I appre- every once in a while they kind of turn 12 States, insurance companies are cur- ciate very much—and if the time al- a blind eye to the fact of how powerful rently permitted to charge women lows, I have a question for the Senator competition is. Competition is valuable more than men for the exact same poli- from Massachusetts. But this is a bill and powerful in keeping costs down and cies. that when you move past all of the rhe- increasing benefits and quality of Mr. CARDIN. If the Senator will torical smokescreens—because, frank- care—only when there is actually com- yield for a moment, as Senator ly, most of our colleagues on the other petition. So we are going to have to KLOBUCHAR pointed out, if you don’t side don’t want to do anything. They have competition. This bill will actu- have competition—and Senator KAUF- didn’t want to do it in 1993 and 1994; ally do it. MAN said the same thing—if you don’t they didn’t want to do it in 1933 and Ms. KLOBUCHAR. If the Senator will have competition, what is your choice? 1935; and they still don’t want to do yield, I think we have been joined by You are going to have to pay the pre- it—this legislation helps real people the Senator from North Carolina, who mium. with solutions not slogans about na- is a member of the HELP Committee There was a Washington Post article tionalization and bureaucrats. and I know has a background in busi- written about a street in Gaithersburg. Ms. KLOBUCHAR. The Senator from ness and understands a little bit about Gaithersburg is a growing suburban Delaware. competition. community not far from here, cer- Mr. KAUFMAN. I was presiding yes- So how does she see this as being a tainly middle-class families. They terday for I don’t know how many problem? I know in the State of the think they are doing fairly well. It hours. When you listen to what is said Senator from Maryland there is lim- talked about one street in Gaithers- on the Senate floor by the other side, ited competition, and in a number of burg, and they gave half a dozen stories they are talking about a model where our States one or two providers—Min- about people—real stories—about peo- there is no competition. Any tax on an nesota is an exception, but one or two ple having problems with our current insurance company is going to be providers dominate the market, jack- system. They talk about Patty, who passed on to the consumer. What kind ing up the prices. has private insurance and thought she of a business—I don’t know anybody in The Senator from North Carolina. was in good shape. She talks about business who, if they get an increase in Mrs. HAGAN. I think one of the key having to search a book in order to find cost, they just pass it on to the con- points is the fact that this bill is going out what doctor she could go to to stay sumer. Right? I mean, we have a law of to eliminate discrimination based on in the network because it is too expen- supply and demand the last time I gender and preexisting conditions. I sive to go out of network, and then she checked. But every single one got up have two children right now who are in hits her deductible and finds that her and talked about the cost and said this their midtwenties. My daughter is pay- fees and copayments come in fast and is going to hurt the consumer. It is not ing more per month for health insur- strange, making it unaffordable for her going to hurt the insurance companies ance than her brother. Yet it is the with her current insurance coverage. because they are just going to pass it exact same policy. The same with pre- She has no other choice. That is the on to us. The reason they are going to existing conditions. How many people only insurance she can get. pass it on to us is kind of obvious. do we know who have a condition such Two doors down the road is Chuck Here is a list, a small list, that lists as diabetes or asthma, or a woman who who needs oxygen, needs certain medi- all the States in America and how has had a C-section who is, therefore, cines. He had to fight with his insur- much of their insurance is tied up in denied from getting health insurance? ance company to get the prescription two or less companies. Do you know We have to be sure we correct this, and drug covered. He got the prescription what you have to do? You have to get that is what this bill does. drug covered, only to find out the down to No. 40, Oregon, because the Let me give a couple of examples. So nurse who administered the drug was first 39 States on this list, two insur- many people in North Carolina I have not covered, and it cost $400—another ance companies make up over 50 per- heard from have some of these situa- problem with a private insurance com- cent of the market in their State. How tions. Recently, I got an e-mail from a pany. can you have competition when you family in Greensboro. It is a working Across the courtyard, Will and have so much of the business tied up in family. The husband has Graves dis- Sarah, they have insurance today. just one entity? ease, which is a treatable condition, They are going to lose it because he

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.048 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11947 just lost his job, and he has no prospect kind of example where someone wants spouses or our kids with this kind of a for being able to afford insurance. to buy coverage, they are willing to decision? The sad part of the story, as The last one is Martha. This is a very pay for some coverage, but they can’t. if it is not sad enough, is that Angela interesting one. Martha went to the They basically are cut out because was so anxious to ensure that every- emergency room for delivery of her they are sick. thing possible was done for a healthy child. She needed an epidural. She This is one of the saddest letters. We baby and the system threw up road- made sure she went to a hospital that just got this from Cheryl from Bemidji, blocks. Pregnancy should not be con- was in-network because she wanted to MN. She says: sidered a preexisting condition. make sure it was covered. Guess what. I am writing to you because I just got off People in this country who are preg- That anesthesiologist she had no con- the phone with my daughter Mickey. At first nant should not have to worry, in addi- trol over was not in-network and she I couldn’t understand her because she was tion to going through the trauma of had to pay all that extra money. sobbing so hard. Her husband had just been being pregnant for 9 months and the Again, no choice. She had no choice in told by his boss that they wouldn’t be car- baby being healthy and all the fears the system. There is no competition. rying health insurance on their employees you have and on top of that fear they any longer. They are a small company in I know we have Senator KIRK here northern Minnesota and it was costing them may go into bankruptcy because they who is our newest Member. Perhaps the $13,000 a month. For her, for my daughter, cannot afford to pay for the doctor Senator could tell us what he is hear- this is a matter of life and death. She has bills for their baby. This is real stark ing from Massachusetts. He is a new cystic fibrosis. Because it is a preexisting to me. Member here. I don’t know whether he condition, the insurance companies won’t We are going to vote tonight on clo- is getting the same stories of what is touch her unless it is under a group plan ture so we can move to a bill that will, happening in his State. such as the one her husband just lost. once and for all, make sure Angela Mr. KIRK. Well, it is exactly the She says: Austin and all the women similar to same story, with one exception, I You need to stand and be my voice, be her who have the ‘‘preexisting condi- would say to the Senator from Mary- Mickey’s voice. Mickey is a fighter, but she tion’’ of pregnancy will only have to land, which is that 3 years ago, Massa- can’t keep fighting a system that is so worry about their baby and what is chusetts adopted its own health re- against her. Mickey has already lived longer going to happen to her and not worry form. Now, 97 percent of the people in than any of the doctors expected. I want her about what she is going to do when the Massachusetts are covered with health to live to see her 5-year-old son become child is 2 and she is in bankruptcy, be- President one day. insurance. cause so many people are going into As you have said and as the Senator That is from a mom in Bemidji, MN. bankruptcy. from Rhode Island has said, the best il- So I will just ask my colleagues, how Ms. KLOBUCHAR. Maybe the Sen- lustrations of the need for health re- can we continue to go down this path ators can answer this. In these thou- form are the individuals, the real peo- where hardworking families—a man sands of letters and calls we get from ple. So I will tell my colleagues a story who has a job, who is working for a these people, they are asking us to be about a young lady. She is a waitress, small business, gets cut off from his in- their voice. They don’t want to say we a 24-year-old girl. Her name is Jessica surance, and because his wife has cys- are not going to debate this bill at all, Wheeler from Somerville, MA. She is a tic fibrosis, they aren’t going to be able that we are going to put it in a drawer waitress and works part time as an in- to afford insurance. and pretend it didn’t exist. tern. She had dreams of graduate The Senator from Delaware. Mr. CARDIN. That is the interesting school, but she was concerned about Mr. KAUFMAN. I think the reason point. These are all real stories, people health insurance. We have an exchange we use these examples so much is be- who are being denied health care today in Massachusetts not dissimilar to cause certain words kind of roll off because of arbitrary practices from pri- what is being offered in this legislation your lips; words such as ‘‘preexisting vate insurance companies or the way where there is increased competition condition.’’ our system is currently organized. from private insurers and others. She Here is an example involving Angela The vote tonight is a pretty simple applied to the exchange and was found in Dover, and she is a bartender, not a vote. If you think the current system eligible and enrolled and took out an waitress. Her income is from tips. She is what you want, OK, I understand insurance plan. has no health insurance through her why you are voting against cloture. I Shortly after, she was stricken employer. She became pregnant. She understand that you say the status quo gravely ill with organ failure and was tried to find private health insurance, is fine; we don’t even want to debate hospitalized for an extended period of but she was declined coverage because the issue; we don’t care about the peo- time. She was made well. She has to pregnancy was considered a preexisting ple who have been affected by the arbi- take a pill every day in order to keep condition. trary actions of private insurance com- up with her condition, but her coverage Now, just do a visual for a minute. panies and saying that pregnancy and was complete. She has applied now to This woman has been living off of tips. childbirth is a ‘‘preexisting condition’’ graduate school, and although she She is about to have a baby, and there or when you are using over-the-counter probably has her tuition issues stretch- is nowhere she can go to get health in- drugs to keep your cholesterol under ing her means and so forth, she is free surance. She applied for Medicaid to control and the insurance company of the concern and need of expensive find prenatal care for herself and her says that was a preexisting condition. health care bills; otherwise, she would baby, was denied coverage because she All we are saying tonight is: Is this have been without. So it is just an- earned $200 more than the monthly in- worthy of debate on the floor of the other illustration. come limit. I mean, just picture this Senate—a clear vote? Those who vote Just one other point on competition now, if you were in this situation. She for cloture say this is worthy. The peo- that keeps coming back and back, I ask called organizations and clinics and ple who have written us these letters myself: Why do middle-class families was unable to find a payment plan she are entitled to have the Senate take up save their hard-earned money to buy could afford. this issue. That is why we point out health insurance? Obviously, the an- Midway through her pregnancy, An- that there are numerous groups, in- swer is so that they will have coverage gela decided to cut back her work cluding the American Medical Associa- if they get sick. Without competition, I hours so she could qualify for Medicaid. tion, that say vote for cloture, let’s will tell you what is going on. Insur- She worked all 9 months of her preg- have this debate before the American ance companies—now get this—are de- nancy and delivered the baby on May people. nying coverage because people are sick 27. The Medicaid coverage she got was Ms. KLOBUCHAR. Along those lines, or they say: Well, you reached a cer- especially crucial because she had com- before I yield to the Senator from Mas- tain limit, and we didn’t realize you plications with hyperthyroidism and sachusetts, I started out talking about were going to get that sick, so we was able to get the necessary prescrip- the cost issue. I wanted to put in the dropped the coverage. tions to control her condition. RECORD the statement of November 5, Ms. KLOBUCHAR. If the Senator OK. Do we have the picture? How 2009, from the Mayo Clinic. There have could yield, I have exactly the same would we like to see ourselves with our been things said about their position.

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.050 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11948 CONGRESSIONAL RECORD — SENATE November 21, 2009 My friends on the other side have said and address geographic variation into the statutory criteria, including quality meas- they ‘‘don’t want any part of this bill’’ Medicare payment system. The proposal is urements, to be recognized as Accountable and they ‘‘want nothing to do with it.’’ consistent with Mayo Clinic’s focus on cre- Care Organizations (ACOs) and to be eligible Those are exact quotes. They said they ating a mechanism to better define value, to share in the cost-savings they achieve for measure it, and create new payment meth- the Medicare program. Both houses propose ‘‘are not taking Medicare and Medicaid odologies that reward it. to start an ACO pilot program January 1, patients anymore.’’ Most of us, as patients or family members, 2012. Those are exact quotes. They are all don’t stop to think that our doctors and hos- Mayo Clinic believes that under this ap- incorrect. I will put this in the RECORD. pitals are generally paid more for doing proach, a group of physicians would be re- It is dated November 5, 2009. ‘‘Points of more tests and procedures—whether or not sponsible for quality and overall annual Agreement and Divergence.’’ They say: we need it. Take for example, the story of a Medicare spending for their patients. Dif- patient eventually seen here at Mayo Clinic: ferent payment models could be tested. For We are encouraged by much—including An older gentleman went to an emergency example, physicians would be paid FFS provisions to pay for value in health care, an room because he fainted. A CT scan of the rates, less a withhold, and then receive bo- insurance exchange, individual mandate, heart was done and showed calcification. Ur- nuses for meeting resources use and quality subsidies for people to achieve coverage, and gent heart catheterization was recommended targets over the course of a year. Options pilot projects on accountable care organiza- and then bypass surgery was performed. should include creating virtual accountable tions and bundling of payments. Later, when a stress test was done, an abnor- care organizations based on physician-hos- To be fair, they also say they are mality was found and a second heart cath- pital referral relationships. Such an ap- ‘‘concerned about other areas including eterization showed a complication—one by- proach would create incentives for physi- a public option that is based on Medi- pass was blocked. Stents were placed in the cians and hospitals to work together to pro- care rates. . . .’’ heart artery where the bypass was blocked. vide better value care. As you know, the options in the However, the fainting spells continued. With BUNDLING PAYMENTS CAN HELP CONTAIN COSTS his issue unresolved, the patient came to House and Senate bills are not based on Both the House and Senate bills have pro- Mayo Clinic, where we conducted a lengthy visions to test a system of bundling pay- Medicare rates but negotiated rates. assessment by a team of physicians. It was ments for Medicare Parts A and B. We are They are concerned about the long determined that all he needed was an adjust- pleased with the pilot projects on Medicare timeline for implementation of value ment of his medications. In the end, the payment bundling. However, we would like provisions, as I am. They are concerned tests, stents, and surgery performed at the to see a more aggressive implementation other facility were not needed, did nothing about across-the-board cuts for pro- timetable—not one that starts in 2014 or to help the patient, but were paid for by viders. They neither endorse nor sup- later, but finishes by 2014—so that we can see Medicare. On the other side, the additional port the bill. To say they don’t want more immediate financial results for the office time spent at Mayo to fully assess pa- any part of the bill is false. Medicare system. tient’s situation and ensure proper diagnosis I ask unanimous consent that this To realize cost savings quickly, Mayo Clin- and treatment was not covered by Medicare. ic believes Medicare should start bundled material be printed in the RECORD. Doctors and hospitals are usually paid payments for high-cost hospital episodes There being no objection, the mate- more for doing more tests, visits, hospital such as total knee replacement, heart at- rial was ordered to be printed in the admissions, and surgeries rather than spend- tack, and lumbar disc herniation. Over time, ing time with the patient and assessing their RECORD, as follows: bundled payments could be considered for individual needs. What if instead, the system A PERSPECTIVE ON CURRENT HEALTH REFORM some chronic conditions as well. The bundled rewarded doctors and hospitals for spending ISSUES FROM MAYO CLINIC payment should include hospitalization time with patients, for doing a procedure (Part A), physician (Part B) and post-acute REFORM BILLS: POINTS OF AGREEMENT AND successfully, for the fact that you leave the care (nursing home, home health care, etc.) DIVERGENCE hospital without a fall or infection, and for services. The outcome would be defined as As the House and Senate prepare to bring providing excellent service to you while you reasonably attainable improvement in their final bills to their respective floors, were under their care. health status in the safest, most cost-effec- Mayo Clinic would like to highlight the SUPPORT CANTWELL AMENDMENT TO tive way and would cover the entire episode areas of agreement and divergence in the INCENTIVIZE VALUE IN MEDICARE of care through the patient’s return to func- bills and our positions on health care reform. We support a similar provision in the Sen- tion. We are encouraged by much—including pro- ate Finance Committee bill introduced by The goal is to reduce practice variation visions to pay for value in health care, an in- Sen. Cantwell that will help move Medicare and focus on an outcome-based goal. Such a surance exchange, individual mandate, sub- in the direction of paying for value by cre- reformed payment model would encourage sidies for people to achieve coverage, and ating a value modifier for physician pay- improved coordination of care among physi- pilot projects on accountable care organiza- ments that will create incentives around cians, hospitals and nursing homes, and it tions and bundling of payments. value in the Medicare physician payment would encourage utilization of nursing and At this juncture, Mayo Clinic will neither formula. other non-physician caregivers. endorse nor oppose entire bills in the House or Senate, but will continue to point out pro- INSURANCE REFORM THAT GIVES ACCESS TO ALL CMS INNOVATION CENTER TO ENHANCE QUALITY, visions that we think move the country to- We believe coverage can be achieved with- IMPROVE PATIENT SAFETY ward patient-centered health care and areas out creating or expanding a government-run, Mayo Clinic also supports the proposal in where we have concerns. price-controlled, Medicare-like insurance the Senate Finance Committee bill that While many provisions in the bill are model. A public option that employs a true calls for the HHS Secretary to create an In- aligned with our recommendations, Mayo negotiated rate process is better than a sys- novation Center within the CMS. The Inno- Clinic remains concerned about other areas tem based on Medicare rates. However, we vation Center will be authorized to test, including a public option that is based on are concerned that the exchange could be evaluate, and expand different payment Medicare rates, the long timeline for imple- opened to large employers, which could re- structures and methodologies which aim to mentation of pay for value provisions and sult in a large shift from private to public in- foster patient-centered care, improve qual- across the board cuts to providers. surance plans. ity, and slow the rate of Medicare cost It is critically important that we accel- We support reforms to the current insur- growth. The provision calls for promoting erate the timeline to adjust the Medicare ance system that eliminate pre-existing con- improved quality and reduced cost by devel- payment system to pay for value in order to dition exclusions, and create an individual oping a collaborative of high-quality, low- truly bend the cost curve—especially in light mandate where individuals can purchase pri- cost health care institutions. The collabo- of the growing number of baby boomers vate insurance in various ways: rative would develop best practices and prov- reaching retirement age. Through employers, en care methods in improved quality and ef- These payment reform provisions should On the individual market, ficiency, as well as assist other health care not lag behind expanding coverage to more Through co-operatives, or institutions on how best to employ such best Americans. In any event, we must focus on Through an exchange model like the Fed- practices and proven care methods. ensuring the financial viability of health eral Employees Health Benefit Plan INDEPENDENT COMMISSION TO EXTEND care for the long term to ensure that pa- (FEHBP). MEDICARE SOLVENCY tients have access to quality care across the We also believe that the government The Senate Finance Committee proposal country. should help people afford the insurance includes a provision to establish a 15-mem- through sliding scale subsidies as needed. SUPPORT HOUSE IOM STUDY OF HIGH VALUE ber Independent Medicare Commission to de- CARE AND GEOGRAPHIC VARIATION ENCOURAGED BY ACCOUNTABLE CARE velop and submit proposals to Congress Mayo Clinic supports the provision that ORGANIZATION PILOT PROJECT aimed at extending the Medicare program’s was added to the House bill that will charge Mayo Clinic is encouraged by provisions in solvency and improving its quality. Each the Institute of Medicine to study and design the House and Senate bills that allow groups year, beginning in 2013, the Medicare Actu- new payment methodologies to build value of providers who voluntarily meet certain ary’s Office would make projections about

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.051 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11949 whether Medicare’s per-capita spending put her into debt for the rest of her favor of allowing critical health care legisla- growth rate in two years will exceed a tar- life. She has health insurance, but it tion introduced by Senator Harry Reid this geted rate. In years when Medicare costs are ran out when she hit a $50,000 cap. Her week to be debated on the Senate floor. With projected to be unsustainable, the Commis- bills far exceed the cap. It is sinking thousands of cancer patients being denied sion’s proposals will take effect unless Con- coverage, charged excessive premiums, and gress passes an alternative measure. her entire family into debt. She is sick facing exorbitant out-of-pocket costs, it is Mayo Clinic believes that this commission and stuck. urgent that the Senate take action now, not can insulate many health care decisions How many people do we know who later, to protect and extend health coverage from direct political influence in Congress have a spouse or themselves who have to millions of Americans in need. while still being accountable to Congress. We health insurance, and they are work- Last week, Cynthia and Eric also believe that the commission should ing, but they cannot switch jobs be- Cathcart were here in the Senate. They have the authority to change the health care cause they would lose their health in- are two people who are self-employed. payment system with the goal to move away surance? I have a good friend whose from fee-for-service medicine and toward They cannot even get an insurance pol- paying for team-based, coordinated care. husband has cancer. She wants to icy to cover their family. They have to In addition to payment reform, the com- change jobs, but she cannot do it be- have two separate policies, with two mission could serve as a trusted national cause of the condition of her husband. deductibles and two premiums, and data aggregator, making performance and Once again, people are sick and they they cannot afford it. We must take up pricing information publically available so are stuck. We have to be sure we can this issue for the Cathcarts and the that stakeholders can identify best practices have a debate, that we can move for- and high performers. millions of Americans who cannot This perspective is written by Jeffrey O. ward on health care reform so we can make it under this current system. Korsmo, Executive Director, Mayo Clinic help people. Middle-income families are depending Health Policy Center; and Bruce Kelly, Di- Mr. KAUFMAN. We are all concerned upon us tonight. rector of Government Relations, Mayo Clin- about the economy. Even with health Ms. KLOBUCHAR. There is a lot of ic. care reform, I think for every Senator talk about Medicare and our seniors Mr. KIRK. I know time is running I talk to on both sides of the aisle, and what this bill does. Think of the short. I want to say one thing about their biggest problem is getting people woman I talked about who is a fighter, this. We have heard talk about the sta- back to work again and getting the as her mom says, but she cannot keep tus quo. Make no mistake, this is a sit- economy moving. It is truly tragic fighting a system that is so against uation with respect to—we assume when you think so many people are los- her. As you pointed out, the advantage when we hear the words ‘‘status quo’’ ing their jobs. Under our present sys- of this bill is, it gives our seniors a bet- that things will remain as they are. tem, the way it is structured, when you ter playing field with the drug compa- In the area of health care and health lose your job, you not only lose the nies paying for their drugs in the insurance, things are not going to re- money coming in to you, you lose your doughnut hole. Also, it is my under- main where they are. The status quo is health insurance. You lose your self-re- standing that AARP wants to advance not the status quo. We either move for- spect because we are all judged on the bill. Certainly, AARP has stood up ward or we fall back. If we don’t ad- where we work. That is how people for seniors for years and years and dress or at least debate the merits of judge us. years. They know we need to preserve the bill and don’t move it forward, we As has been said, the longest walk is Medicare and keep it safe. all know what is going to happen. The the walk home to tell your spouse and Can the Senator comment on AARP? figures are there. The average family your kids that you lost your job. The Mr. CARDIN. AARP not only wants premium, which is now over $13,000, in irony of ironies and the thing that us to advance the bill; they support the 2016 will double to $24,000. That is not makes this so incredible is that you bill. They believe this bill will improve the status quo. That is falling back. don’t just lose your job and self-re- the Medicare system, make it stronger, Similarly, the number of uninsured spect, you lose your health care insur- and provide additional benefits, par- will rise from 47 million today to 54 ance. ticularly in reducing the dread Medi- million in 2014. That is not the status We have a system, and we have to care doughnut hole. They want the quo. That is falling back. Fourteen- change the system so these people out Members of the Senate to vote to allow thousand people will continue to be their right now can maintain their this bill to come to the floor. dropped from coverage each day. That health care insurance and care for Ms. KLOBUCHAR. Maybe we should is not the status quo. That is falling their children and their families, as end with the Senator from Massachu- back. I could go on. they and everybody in their families go setts, the home State of Ted Kennedy, There is a reason this bill needs to be through this very traumatic experi- having the last word of this very inter- debated. It is because the average mid- ence. esting colloquy, in which we heard dle-class working family deserves and Mr. CARDIN. We are running out of from the Senators from North Caro- needs health care security and finan- time, with only a few more minutes lina, Rhode Island, and Maryland. cial stability. This bill will bring them left. I want the people in Maryland and Mr. KIRK. I thank the Senator. I am that. At least I hope that the Members of the Nation to understand what this honored to be a Senator in this body. of the Senate—all 100—would say that, vote means. We are going to bring an Back home, they think I am the 60th on the merits, this bill and this need amendment to the floor of the Senate vote. I would like to believe we would should be debated. for debate. Any Senator will be able to have a more enlightened full body and Ms. KLOBUCHAR. I thank the Sen- offer an amendment to how we should that 60 would be a number we would ator from Massachusetts. The Senator advance health care. The Senator from pass through. from North Carolina is here. I know Massachusetts is absolutely correct. The American people are looking for- the people of North Carolina and the We are either going to continue to see ward to debate on this issue. I think people in the South have concerns our health care system with more peo- they believe they deserve many of the about the current state of affairs in ple being denied coverage, with the aspects that are contained in the bill. health care as well. costs escalating much faster than our On behalf of my constituents in Massa- Mrs. HAGAN. Yes. A lot of what we economic growth, with businesses hav- chusetts and those who, for so many have been talking about are people who ing to decide to terminate plans—that years, revered and loved and elected don’t have health insurance and who is what is going to happen—or we can and reelected Senator Kennedy—I want it enhanced because of pre- take up health care reform and try to think they all, as we do, have him in existing conditions. We have people rein in the practices of private insur- our minds and hearts tonight, and we who are sick and stuck with health in- ance companies and provide a way hope we can advance this bill to the surance. where every American can get access American people, knowing his spirit I received an e-mail from a young to affordable health care. That is why and years of work are a reminder of our North Carolinian who works for the American Cancer Society Cancer obligation. AmeriCorps. She was the valedictorian Action Network says: I hope we will have a successful vote of her high school class. She suffers The American Cancer Society Cancer Ac- this evening. That will provide an op- from a brain abscess. Her illness has tion Network urges all Senators to vote in portunity for the American people to

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.008 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11950 CONGRESSIONAL RECORD — SENATE November 21, 2009 hear a debate and perhaps allow correc- ufacturers fee, another $2 billion, will had my respect. For the majority lead- tions by whatever amendments may be begin in 2010. The medical insurance er, who cannot rebut the facts in David needed, so we proceed, keeping in provider fee, that will begin in 2010. Broder’s column, to come to the floor mind, as is true in all legislation, we The cosmetic surgery fee, that will and excoriate one of the most respected cannot let the perfect be the enemy of begin in 2010. In 2011, there will be a columnists in America is remarkable. the good. The good is something our limit on contributions and in 2013 a One of the things, I say to my friend people have been waiting for, for dec- high-cost insurance excise tax. All the from Utah, is that I do not think Amer- ades. The time is now. Let the debate taxes are front-loaded, but all of the re- icans really understand the scam that begin. forms they promise this bill will bring is going on here of beginning to collect I thank the Chair and yield the floor. to all of the people whose stories they taxes. Tax increases and Medicare cuts Ms. KLOBUCHAR. I thank the Sen- told us will not take place until 2014. of approximately $1 trillion begin 40 ator. I believe our hour has ended. We The status for them will remain quo. days from now. In other words, on the yield the floor. For all of these attacks on the status first of January, according to this plan, The PRESIDING OFFICER. The Sen- quo, the one change we will get is they Americans will begin experiencing cuts ator from Utah is recognized. will start charging the taxes but they in Medicare and increases in taxes, 40 Mr. BENNETT. I ask unanimous con- will not start delivering any kind of days from now. But then it will be 208 sent that during the next hour, those health care reform until 2014. weeks and 1,460 days before any bene- Senators who come to the floor may be Why are we delaying until 2014? Not fits from the legislation come about. allowed to proceed in a colloquy. because they do not think people need Tell me, isn’t that like a couple goes The PRESIDING OFFICER. Without it but because they realize that if they to buy a house and they say: OK, you objection, it is so ordered. start spending at the same time they can have the house for X amount. And Mr. BENNETT. I came to the floor start taxing, the score they will get by the way, you have to start making early so I could listen to what my out of the Congressional Budget Office the payments now and for the next 4 Democratic friends have had to say. I will point out the true cost of this bill. years before you can move into the found it quite enlightening, and I have And it is the true cost of this bill that house. Is there anybody who would a few comments with respect to it. is the kind of thing we need to be de- agree that is nothing but a scam on the They have been debating vigorously bating and talking about rather than American people? I do not think the against the status quo. They have been listing story after story. My State is American people truly understand the giving us examples, heart-tugging, full of them, and I am just as sympa- reason why—and why would they do real-life examples of people who are thetic as anybody of people who have that? To disguise the real cost of this finding difficult problems in the situa- problems with the present health care $2.5 trillion bill. That is why they do it. tion as it now exists—as if the debate system. That is a false debate. I think Bernie Madoff went to jail for were between the status quo and doing We all realize, all 100 of us realize this kind of behavior. something. that something has to be done to make Mr. BENNETT. I say to my friend The debate is between the solution the health care system better. This is from Arizona, he reminds me of a real- that has been offered by the majority not, should we do nothing; this is a de- life experience of a husband who at leader and other solutions, which peo- bate about what should be done. The Christmastime came back to his wife ple on this side of the aisle have been proposal we have from the majority and presented her with a brilliant trying to bring forward through the en- leader is not the answer to the prob- Christmas present that she had not tire time and have not been allowed to lems we face. been expecting. She said to her hus- come forward. Mr. KYL. Mr. President, I wonder if I band: How could we afford this because We recognize that things need to be may interrupt to ask, when the Sen- the only amount we had in our Christ- done to fix problems with respect to ator said this is not the approach, the mas budget was—pick a number—$200, the health care situation. We realize approach taken by the Democratic and this is obviously worth more than the legislation we have been living leader, among other things, because of $200. with for all these years needs to be the cost of it—my colleague from Ari- He said: Oh, don’t worry about it. I amended. We have been unable to get zona is here, and I think no one takes paid $200 for it. any of our ideas to come forward. Now second place in this body to him in She said: How in the world did you we are told there is such urgency to carefully looking at the cost of every get $200? deal with the status quo that we must bill we have on this floor. He fre- He said: The department store agreed pass this bill, and we must pass it vir- quently proposes amendments to re- to take the other $1,000 in payments tually without amendment. duce the cost of the bills. later on. I would like to point out, as I have I wonder if my colleague from Ari- That is exactly what is happening done before, if there is such urgency zona agrees with my colleague from here. We are making a downpayment with respect to the challenges we have Utah and is aware of the respected col- and telling ourselves that the total in health care, why do we wait until umnist David Broder who wrote in to- cost is covered as outlined by the Con- 2014 to have those changes come? We day’s Washington Post—actually, it is gressional Budget Office. have heard all these examples coming for publication tomorrow—a column, Mr. MCCAIN. Again, it is so impor- on the Democratic side of the aisle of the title of which is ‘‘A Budget Buster tant that we read this hernia-inducing people who have terrible problems in the Making.’’ bill, that we understand the details of under their health care plan. We must Mr. MCCAIN. Mr. President, I say to it. Specifically in these cuts, which are act, we must act immediately, and the my colleague, not only is David going to take place in 40 days—40 days act will be to say to all of these people: Broder’s column this morning impor- from now; Happy New Year, America— We will solve your problem in 2014. We tant, but he is probably the most re- in 40 days, it will cut $135 billion from will delay all of these reforms we are spected columnist in America. He talks hospitals, it will cut $120 billion from talking about until 2014. about it in far more eloquent terms 11 million seniors on Medicare Advan- I made that point the other day, and than I can. tage. the Senator from Maryland said, no, I ask my friend from Arizona—a very I would like to pause there for a mo- some parts of this bill will begin imme- unusual event happened today. The ment. Senator KYL and I represent the diately. And he is exactly right. The majority leader, I guess proceeding on State of Arizona. We have thousands parts of the bill that would begin im- the concept, the age-old tried tactic of and thousands—and I am going to get mediately are the taxes. We will start ‘‘shoot the messenger,’’ came to the the number before this debate is over— taking in money in 2010 if this bill floor of the Senate and excoriated of seniors who are on Medicare Advan- passes. The annual pharmaceutical David Broder, of all people, probably tage. They are going to cut out the manufacturers fee would drive up the the most respected columnist. I might Medicare Advantage Program and tell price of everybody’s drugs, an annual say, Mr. Broder from time to time has the American people that if you like nondeductible $2.3 billion fee. That will written an article or two or more that your insurance policy you have, you begin in 2010. The medical device man- has been critical of me, but he always can keep it? How does that work? Then

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.052 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11951 there is $15 billion going to be cut from Chamber. It seems as if every other American people are pretty smart nursing homes, $40 billion from home word we hear coming from the other about this. The question in this health agencies, and $8 billion is going side is that this vote tonight is his- Quinnipiac poll read: to be cut from hospice care—my God, toric. I agree, it is historic. But I think President Obama has pledged that health hospice care, $8 billion. my view of why it is historic is a little insurance reform will not add to our Federal Here we are telling the American different from their view. budget deficit over the next decade. Do you people that we are going to fix health I wonder if my colleagues would not think that President Obama will be able to care in America, and the way we are agree with me that this bill is historic keep his promise? Or do you think that any going to pay for the massive govern- in its arrogance? It is historic in its ar- health care plan that Congress passes and ment takeover of health care is President Obama signs will add to the Fed- rogance to think that we in Congress eral budget deficit? through cuts. It is terrible on its face, are wise enough to take this entire Answer: Less than one-fifth of the voters, but does anybody really believe these complex health care system, that 19 percent to be exact, think he will keep his cuts are going to take place? Does any- serves 300 million Americans and is 16 word. Nine out of 10 Republicans, 8 out of 10 body really believe the doctors are percent of our economy, and think we independents said that whatever passes will going to be cut $247 billion in the next can write a 2,074-page bill and be wise add to the torrent of red ink and by a margin 10 years? Does anybody believe we are enough to change it all at once. It is of 4 to 3 even Democrats agreed that this is likely. going to cut $247 billion—or whatever historic in its arrogance by dumping 15 it is—from Medicare? We are not. Why million low-income Americans into a That is why, Broder says at the end: are we not? Because we are a loving, medical ghetto called Medicaid, which By a 16 point margin the majority of this caring nation. We are not going to tell poll said that they oppose the legislation none of us or any of our families would moving through Congress. our seniors that they are not going to ever want to be a part of for our health So while it is true they are rather ar- receive a high quality of Medicare. care. It is historic in its arrogance by rogantly trying to contend there will Of course, this latest mammogram sending the States, that are going not be any big budget deficit from this, incident where a board, not unlike the broke, a big chunk of the bill for what the reality is the American people have one that is envisioned in this bill, said we have just done. It is historic in its broken the code they will. One of two that women over 40 should not have arrogance because it tells Americans things will happen. My colleague from mammograms—by the way, I have a that the bill costs $849 billion and then Arizona put his finger right on it. Ei- close friend, Carly Fiorina, who has thinks we are not smart enough to read ther we will make cuts in Medicare, for just recovered from chemotherapy. the print and figure out that the real example, that we have never had the What would her situation be today if cost is $2.5 trillion when it actually is political ability to make in the past, in she had not had a mammogram? implemented. It is historic in its arro- which case our seniors will be hurt, or Women all over America are rising up gance by telling us that paying for re- else, as David Broder said, this bill will about it. If you think that is bad, wait imbursement for physicians is not an until you get this legislation. truly be a budget buster. important part of a health care bill. It By the way, while my friends are Neither of those results are very san- is historic in its arrogance because it standing, I would like to say please sit guine outcomes to an attempt to trans- down, I have shocking news. The three cuts and taxes grandma’s Medicare, form or reform our health care. which according to the trustees will be Senators we were worried about—the Mr. MCCONNELL. Will the Senator Senator from Louisiana, the Senator broke by 2015 to 2017, and then spends from Arizona yield for an observation? from Arkansas, and the Senator from it on somebody else other than grand- Mr. KYL. Absolutely. Nebraska—shocking news. They are ma. The bill is arrogant because its Mr. MCCONNELL. I certainly share going to vote for this bill to move for- telling us it will reduce premiums for the views of Senator MCCAIN that let- ward. That was an issue of tremendous most Americans, when, in fact, it in- ting these cuts stand is not likely. On speculation with the media. I certainly creases premiums for most Americans. the other hand, the President of the did not know that with all the protes- So People say: Where is the Repub- United States said he would veto any tations we had from those three Sen- lican health care bill? My answer to measure seeking to reverse these cuts. ators that, by golly, they were think- that is, don’t expect Senator MCCON- So we have a Hobson’s choice: Either ing long and hard. Guess what. So, OK. NELL to come rolling in here with a the cuts will occur in which case sen- Mr. BENNETT. I say to my friend wheelbarrow with a 2,074-page budget- iors will be devastated or they will not from Arizona, and then I will yield to busting, debt-ridden, arrogant piece of occur, as the Senator from Arizona has my friend from Tennessee, Senator legislation because that is not what we pointed out, and the deficit will bal- MCCAIN just asked a question: Does believe in. loon further. anybody really believe these cuts will What we need to do as a Congress is Mr. MCCAIN. Did the majority leader take place? re-earn the trust of the American peo- happen to notice that the AARP has I share with him an experience I had ple by setting a clear goal of reducing now endorsed this bill? It has endorsed driving home from the Senate just this health care costs, showing some humil- a bill that will cut people, 300,000 of week. I was listening to the radio, and ity, and starting to move step by step them in my State, from their Medicare the first story on the radio was this in that direction. I hope during this Advantage Program, that would cut $15 vote coming up. The Senate is going to hour that we have a chance to talk billion from nursing homes, that would vote at 8 o’clock on Saturday. The sec- about the specific steps to reduce cut $8 billion from hospices, and that ond story was that the House of Rep- health care costs that we Republicans AARP, which, by the way, I understand resentatives just passed a doc fix of have offered day after day to no avail. gets some $60-some million out of this $200 billion. So we already have action Mr. KYL. Mr. President, if I can in- deal—I say to the senior citizens in my by the House of Representatives prov- terrupt my colleague and compliment State: Take your AARP membership ing that the comment by Senator him on the phrase ‘‘arrogance.’’ Maybe card, cut it in half, and send it back to MCCAIN is exactly right. Before this ‘‘hubris’’ is another word. To think we AARP because they have betrayed you. bill even gets passed, they are revers- are smart enough in Washington to fig- Mr. BENNETT. If I could make the ing the cuts over in the House of Rep- ure out what is best for 300 million comment, Mr. President, among the resentatives. Senator REID tried to do Americans is truly arrogant. people who do not believe these it here before we got to this bill, and A question posed by my colleague changes would not occur is CBO itself. we voted him down. So the House is from Arizona a moment ago: Do they CBO itself agrees this is smoke and going to take care of it, and they will really think they can whiz this by the mirrors. They do it in very polite lan- ping-pong the bill over here. American people with regard to it not guage, but let me share with you the There is no question that these cuts adding to the deficit, for example? language. They say: will not take place. Good question. These longer-term calculations assume My friend from Tennessee wishes to I want to get back to that Broder that the provisions are enacted and remain comment. piece my colleague from Arizona unchanged throughout the next 2 decades, Mr. ALEXANDER. Mr. President, I quoted. There is actually a survey that which is often not the case for major legisla- see the Republican leadership in the answers that question. It turns out the tion.

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00047 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.053 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11952 CONGRESSIONAL RECORD — SENATE November 21, 2009 That is about as gentle a way as CBO to them the ones I just gave out to con- Mr. BENNETT. Obviously, I would can put it. They don’t believe this trol health care costs in America. We not respond in the way the folks across thing is going to stand without these stand willing to do it. the aisle have responded to this health kinds of changes. Yes, they have come After this bill fails, because the care crisis. The example the Senator forward because their computers say: American people overwhelmingly are has given is a valid one. That is not You put the numbers in this way, this beginning—it may pass the Senate. It how you deal with it. is the result you get. But human beings may pass the House. It will not pass. The other point I would make is that are saying that is not what is going to Then why don’t we sit down together if I had a serious problem that was happen over the next two decades. for a change, Republicans and Demo- causing difficulty for the survival of Mr. KYL. If my colleague will yield, crats, and move step by step to fix the the company, I would not put the solu- Broder, in his column as to this esti- health care problems in America? tion off for 4 years while I raised prices mate of budget deficit, he says it de- Mr. ALEXANDER. The Senator from on the existing products to try to pay pends upon two big gambles. Arizona is exactly right. for it. I would try to do what I could to Will future Congresses actually impose the There is no Senator in the Chamber get the fix upfront as soon as possible. assumed $420 billion cuts to Medicare, Med- who has a better record of working As both Senators have pointed out, icaid and other Federal health care pro- across party lines on bipartisan steps we Republicans have fixes that could grams? They never have. in the right direction than the Senator start now and don’t have to wait until Mr. MCCAIN. Also, I would like to from Arizona. But going to Mr. 2014 in order to get a good CBO score. follow up on what the Senator from Samuelson’s comment—I was talking Mr. MCCAIN. Along those lines, Tennessee has said because, particu- to a businessman this morning. again, about this Madoff-type budg- larly from some quarters on the other I said: If you had a problem in your etary procedure, I am not that good at side of the aisle, we have been at- company, would the first thing you math. I am sure the Senator from Ten- tacked: Where is the Republican plan? would do is to tear the whole company nessee is. Help me out. A very important article was written down and start over again? Or if the We have $1 trillion that they want to by Robert Samuelson in the Wash- football team had lost two or three make in offsets, right, in this 10-year ington Post on November 16—again, games, would you blow up the stadium plan. If you started the program at the one of the most respected economists and run everybody off? No, that is not same time that you enacted the sav- in America. the way you do it. ings, that would be $1 trillion, right? I don’t lay off these opinions of my The person I was talking to said: That would be $2.5 trillion. So the def- own on them, but the fact is, when you What I would do, I would identify the icit, if you used correct accounting have highly respected people like Rob- problem, I would test the solution, I procedures—in other words, you bring ert Samuelson, one of the most re- would phase it in, and I would make in the benefits at the same time you spected economists in America, I quote sure we can afford it. start paying for it—you would end up from his column—the title is ‘‘Obama The American people know that. I with a $1.5 trillion deficit to the budg- Care, Buy Now, Pay Later.’’ That is the think they are sitting up there looking et? Does that make sense? title of it. He says—which I think is di- at us saying: What are these guys Mr. ALEXANDER. It sounds right to rectly in consonance with what the doing? Two-hundred-fifty million of us me. It is another part of the arrogance Senator from Tennessee said: have health care policies, 85 percent. of this bill, which is to say we are not [A] prudent society would embark on long- We would like for the rest of America smart enough to figure it out. The ma- term policies to control health costs, reduce to have that opportunity too. But we jority is saying the 10-year cost of the government spending and curb massive fu- know we can’t afford that until we get bill is $849 billion, but it doesn’t start ture deficits. the costs down. counting until the fifth year, and Sen- Then he goes on to say: Why don’t we do as the Senator from ator REID thinks the American people So what do they do? Just the opposite. Arizona suggested, let’s move step by are not smart enough to figure that Their far-reaching overhaul of the health step in the right direction to re-earn out. That is part of the arrogance of care system—which Congress is halfway to- the trust of the American people by re- the bill. ward enacting—would almost certainly ducing costs? Mr. MCCAIN. If the benefits kicked make matters worse. It would create new, He said: Why haven’t we done that? open-ended medical entitlements that in at the same time the taxes did, you threaten higher deficits and do little to sup- One of those steps is to allow small would be talking about a $2.5 trillion press surging health costs. The disconnect businesses to pool their resources and cost. between what President Obama says and purchase a health plan, which the Con- Mr. ALEXANDER. That is $2.5 tril- what he’s doing is so glaring that most peo- gressional Budget Office has said would lion, right? ple could not abide it. allow nearly 1 million more employees Mr. BENNETT. I point out the CBO That is strong language from an of small businesses to be covered. Their makes the same point at these 10 economist. I think what the Senator rates would be lower than they are years. Again, quoting the CBO letter, from Tennessee is saying, and what we paying today. It would save $1.4 million talking about the 10 years following, are trying to say is, let’s go forward. of Medicaid. This is what the Congres- when you have the full 10 years of ex- Let’s have malpractice reform. That is sional Budget Office said. So it would penditures instead of just 5 or 6 years nowhere in this monstrosity. Why reduce costs, increase insurance cov- of expenditure, it says: don’t we encourage health savings ac- erage, and lower premiums. The reason Under the legislation federal outlays for counts and expand them? Why don’t we we are not considering it is because health care would increase during the 2010– let people go across State lines to get when we brought it up, the Democrats 2019 period, as would the federal budgetary health insurance policies of their said no. They filibustered it. They commitment to health care. choice? Why don’t we reward wellness didn’t come across the aisle and say So those who are saying this is going and fitness? There is a long list of that is a pretty good idea; let’s put to be a saving to the government and amendments, of fixes to the long-term that together with two or three of ours, you are going to turn the cost of health costs of health care that we could con- and we will reduce costs. care—turn the cost curve with respect trol, that we could enact tomorrow on I say to Senator BENNETT of Utah, to health care down, the CBO has said: a bipartisan basis. They do not add to you have founded a company. You have No, that is not the case. The Federal the deficit. In fact, what they do is run a company. If you were having a commitment would go up in those control health care costs, which is problem with the cost of a product or years. what is wrong with health care in some other fundamental problem, is Again, by delaying the implementa- America. the first thing you would do, is to tion of the expenditure while imple- The quality of health care in Amer- think you were wise enough to tear the menting immediately the implementa- ica is outstanding. It is the cost. We whole thing down and start over again? tion of the revenue, they are creating could be working together step by step, Or if you called in a consultant and he the kind of financial chicanery that, as as the Senator from Tennessee says, recommended that to you, what would Senator MCCAIN has said, put Bernie with a long list. I am sure he will add you say to him? Madoff in jail.

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00048 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.055 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11953 Mr. MCCAIN. Could I bring up an- I have enjoyed the comments by the the bureaucrats here in Washington. other issue to the Senator from Ten- distinguished Senators from Arizona, More numbers: 2,074 total pages of this nessee and the Senator from Arizona Utah, and Tennessee. If you look at bill—look at that—2010, the year Amer- and Utah. A New York Times article what they are trying to do, they are icans start paying higher taxes to sup- this week stated: ‘‘Drug Makers Raise going to throw out a system that 85 port this bill. My colleague from Utah Prices in Face of Health Care Reform.’’ percent of the American people feel is and my colleagues from Arizona and Even as drugmakers promise to support basically OK, because they have not Tennessee have brought that out in no Washington’s health care overhaul by shav- taken care of the 15 percent who don’t uncertain terms. The year when this ing $8 billion a year off the Nation’s drug have insurance. But when you deduct bill actually starts is 2014, most of the costs after the legislation takes effect, the the 6 million people who work for com- major provisions of this bill. Some of industry has been raising its prices at the panies that provide insurance but they them don’t even begin until 2015. The fastest rate in years. don’t take it—they would rather have number $6.8 million is the cost to tax- In the last year, the industry has raised the wholesale price of brand-name prescrip- the money—and you take out the 11 payers per word in this bill; $8 billion is tion drugs by about 9 percent, according to million people who basically qualify the total amount of new taxes on industry analysts. That would add more than for Medicaid or SCHIP but are not en- Americans who do not buy Wash- $10 billion to the nation’s drug bill, which is rolled, and you deduct those who earn ington-defined health care; $465 billion on track to exceed $300 billion this year. By over $75,000 a year and can afford their in cuts in Medicare at a time when at least one analysis, it is the highest annual own insurance, and then you take the Medicare faces a $38 trillion unfunded rate of inflation for drug prices since 1992. illegal aliens, the documented workers liability to finance more government So the moral of the story is, you lie and undocumented workers, you basi- spending; $494 billion is the total down with dogs and you get fleas. So cally come down to 17 million people amount of new taxes in this bill. they cut a deal with the administra- who need and deserve our help. We are If you think that is all, I think you tion to cut drug costs, and guess what. going to throw the whole system out have something coming here. Accord- With inflation zero, no inflation, they for 85 percent of the people when we ing to the Budget Committee, using have decided to raise costs by more could, through subsidization, help CBO figures, $2.5 trillion is the real than 8 percent. Oh, the Consumer Price those who deserve help. cost of this bill over a 10-year period. Index has fallen by 1.3 percent. The It doesn’t make sense. What are they Our total national debt will be $12 tril- Consumer Price Index has fallen by 1.3 thinking over there? I hope it is not lion. These numbers are facts and they percent, and the prescription drugs that they want to take us to socialism are indisputable. have increased in cost by 9 percent. or to Europeanize us, when Europe is Let me finish by reading an excerpt What does this do to seniors? Seniors trying to get away from from a fellow Utahn from Provo who is are not going to get a COLA in Social Europeanization. worried about what this bill will do to Security this year because the con- We are rapidly approaching one of our country. sumer price index has fallen—which is the most important votes for all of us I am writing out of deep concern over the the indicator as to whether cost of liv- in the Senate. This is bigger than any increasing expansion of government. I moved ing adjustments are given to Social Se- of us, our parties or our ideologies. here from Germany 20 years ago. I love America because it is free—free-er than Ger- curity recipients. So what does the This is about the future of the greatest many in that I have the freedom to choose drug industry do? Without inflation, Nation in the history of the world. It is among other things how I want to insure my they raise the cost of prescription about your children and my children. family (we have six children). I’m all for af- drugs by some 9 percent at a time when It is about your grandchildren, my fordable health insurance which requires af- Americans are hurting more than ever. grandchildren. Elaine and I have three fordable health care. I am self employed and Shame on the drug industry. Shame on great-grandchildren and two more on have been hit hard by the economy. There is those people, and shame on the admin- the way. It is about giving the future a good chance that we would actually benefit from [this bill]. Business has been so bad istration for cutting a deal with them. generation the same opportunities and that we would qualify for free school lunches Mr. KYL. Mr. President, I see our same sense of pride. It is about every if we asked for it. But I don’t want more gov- other colleague from Utah here. I know American’s way of life. ernment handouts. I don’t want the govern- that during Finance Committee delib- Every American business will be sub- ment telling me what kind of insurance I erations, he was directly involved in ject to this. Look at that thing, a 2,074- need to have. I don’t want the government one of the conversations about the page edict from Washington. I am telling me what services I can receive when drug costs and also has been working going to spend my time before this his- I need them. I don’t want them taking an on his own ideas for alternative ap- toric vote to highlight some very im- ever greater part of my income to help fi- nance government programs such as the proaches to some of these problems. I portant numbers. Every Member of this ‘‘public option’’ and the army of government will ask a question and then if my col- Chamber should understand what they employees it will take to administer such a league from Utah, Senator HATCH, may are voting to advance. Make no mis- program. I do not want more government. like to comment further, we would in- take, our actions today will not be I want less. A lot less. vite that. without consequences. History and fu- These people from Germany have Is it the case that the Joint Com- ture generations will judge us by what been living in our country as citizens mittee on Taxation, which reported to we do here today. for 20 years. They know what it was the Finance Committee, and the Con- Zero is the number of provisions pro- like to have their type of a system. I gressional Budget Office both said that hibiting the rationing of health care, think we ought to pay attention to not only would the increased taxes on not one word prohibiting the rationing that humble person who, in spite of the the pharmaceutical industry, the med- of health care. All you have to do is travails they have, don’t want this big, ical device industry, and the insurance look at some of the things that hap- massive government program to be- industry be passed on to consumers in pened this week and you start to worry come law. the form of higher premiums but that about it. How about this? Zero is the Mr. MCCAIN. Mr. President, I thank overall under the legislation that is be- number of government-run entitlement both Senators from Utah for their fore us, for the average family as com- programs that are financially sound thoughtful comments and significant pared to what prices are today, insur- over the long term. Consider these im- involvement. I wish to return to the ance premiums would actually go up portant numbers: 10.2 percent national issue of what we need to do. I say that and this was one of the two major rea- unemployment rate, the highest in 26 because criticism has been leveled at sons, the other being mandated bene- years; 70, the total number of govern- this side of the aisle that we have no fits? ment programs authorized by this bill, plan; therefore, since we have no plan, Mr. HATCH. The Senator is abso- 70 new programs at a time when we are we should embrace this. The fact is, we lutely right. They even said the pre- going into fiscal insolvency; 1,697 times have had plans. We have had proposals. miums of the so-called government the Secretary of Health and Human We have tried to get them listened to. plan would be higher than private sec- Services is given authority to deter- They range from medical malpractice tor insurance premiums. It is incred- mine or define provisions in this bill. reform to other free market cost reduc- ible. We are turning the whole thing over to tion measures that add competition

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00049 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.056 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11954 CONGRESSIONAL RECORD — SENATE November 21, 2009 and quality to the health care system. enough to change every aspect of grams is it possible their recommenda- Our objective is affordability and avail- health care in America, why don’t we tions could be used to deny coverage or ability. re-earn the trust of the American peo- reduce payments or deny payments? I want to talk with the Senator from ple, who have lost a lot of confidence in Well, here is the exact language, if Tennessee about the issue of medical those of us in Washington, and start my colleagues would like to hear it. malpractice reform. Here is a huge taking steps in the right direction to The Secretary of HHS is, of course, the piece of legislation. Yet I ask my reduce cost? We could do it by adopting person who implements this. It is not friend from Tennessee, is there any our legislation to reduce unwarranted the task force. The task force makes measure in this bill we have been able medical malpractice suits. That would the recommendations, and then the to detect so far—we have been able to be one step. Secretary of HHS issues the regula- detect $100 million in additional Med- Mr. MCCAIN. Could I revisit with the tions. Quoting: icaid benefits for the State of Lou- Senator an issue we talked about a lit- Notwithstanding any other provision of isiana, but we haven’t been able to de- tle earlier and with my friend from this title, effective beginning on January 1, termine all of the aspects of this bill. Utah as well. This is the recent spate 2010,— On the issue of medical malpractice re- of publicity concerning a recommenda- That is just a couple months from form, physician after physician in tion that women wait until 50 years of now— America says they have to practice de- age before—I see our physician Dr. if the Secretary determines appropriate, fensive medicine for fear of finding BARRASSO is here also—getting routine the Secretary may— themselves in court. Why is it that we mammograms. That ignited a (1) modify— have literally no addressing of an issue firestorm throughout America and (A) the coverage of any preventive service described . . . to the extent that such modi- that could significantly reduce cost? story after story of women who have fication is consistent with the recommenda- As I recall, the CBO said that med- experienced breast cancer who state tions of the United States Preventive Serv- ical malpractice reform could reduce categorically that if they hadn’t gotten ices Task Force. . . . direct medical costs by some $54 billion the mammogram when they did, it is So there you have modifying the cov- over 10 years. There are other esti- possible they would not be alive today. erage. Then, secondly, as my colleague mates that say if we added in the cost Now that is a nice academic discus- was just reading: of the practice of defensive medicine sion. But I would ask—maybe Dr. (2) provide that no payment shall be made over prescription medicines and drugs BARRASSO would answer it—isn’t that under this title for a preventive service de- because of fear of finding themselves in the kind of advisory board this legisla- scribed in subparagraph (A) of such section court, this could be as much as $200 bil- tion could put into law; that those that has not received a grade of A, B, C, or lion. Yet there is not one significant kinds of mandates could come down, I by such Task Force. addressing of the issue of medical mal- which could literally jeopardize the In other words, they make the rec- practice in this legislation. I think health and lives of Americans? ommendation, and they say this does that is a testimony to the influence of Mr. BARRASSO. Mr. President, I not meet our standards, so she can say, the American trial lawyers association. would say to my colleague and friend therefore, we are not going to pay for Mr. ALEXANDER. Mr. President, I from Arizona, this type of legislation it. would say to the Senator from Arizona, would have cost my wife her life. She is That is taking the recommendations that is a part of the problem. But I a breast cancer survivor, diagnosed by of this task force and translating it think of it a little different way. There a routine screening mammogram. She into the rationing of health care. This has been a lot of talk this week about was in her forties when that mammo- is how rationing begins. medical care availability for women in gram was performed. She went through Mr. BENNETT. Mr. President, if I America. In Tennessee, in 45 of our 95 the testing and had the operation. In could share with Senators this sta- counties, there are no OB/GYN doctors. that age, in her forties, she already had tistic. We hear a lot of talk about ev- So pregnant women in Tennessee in the breast cancer spread from her erybody has to be covered. We talk those counties have to drive 50, 60, 70 or breast to one of the lymph nodes. It about the United Kingdom, where they 80 miles for prenatal health care. They was a screening mammogram that have a plan where everybody is cov- might have to check into a hotel for a saved her life. She has had three oper- ered. The cancer survivor rate for few days in a big city in order to have ations, two bouts of chemotherapy. As women with breast cancer in the their baby. a result, she is a survivor—6 years United Kingdom, after diagnosis, is 57 Mr. MCCAIN. Could I add, the mirror later. percent. The cancer survivor rate in opposite of that is the State of Texas But this piece of legislation says: No, the United States, where we have peo- which was hemorrhaging medical doc- no, do not worry about it. There is not ple who are not covered, is 67 percent. tors and care providers and then, after going to be any denial of care. There is I do not think we want to move in the they enacted a very modest mal- not going to be anything like that. But direction of bringing that rate down. practice reform, there was a flood of if you turn to page 1,150, it talks spe- Mr. BARRASSO. The reasons for that physicians returning to the State of cifically about this preventative task are they are not doing early enough Texas. Isn’t that the case? force, specifically saying when they screening, and even once they are able Mr. ALEXANDER. That is exactly make their recommendations there is to find the cancer in Great Britain, right. In fact, a number of us have of- going to be money that taxpayers are how long do they have to wait in line fered to the Senate, as a part of the going to pay to tell people what those until they actually receive the sur- way we would go about reducing health recommendations are. Then, if you go gery? The delay of care is the denial of care costs, basically adopting the same to page 1,190, it says that if it is not ap- care, and that is what is going to hap- kind of provisions they did in Texas proved, they will deny payment for pen under this bill. which still leaves anyone who is hurt, that service—deny payment. It does I see my colleague from Idaho stand- a complete right to recover from that not say they might. ing as well because he is familiar with injury, but makes a major change in Mr. MCCAIN. I say to the Senator, this situation. But I look at this and the availability of doctors to that pa- you would not describe that as a see the numbers. They said: Well, we tient. And in the case of Tennessee, we ‘‘penal panel’’? don’t want to cover this service be- were talking about OB/GYN doctors to Mr. BARRASSO. Some people might. cause it would only save 1 life out of women who are about to have babies. Mr. KYL. Mr. President, I went back 1,900 women in their forties. Well, in The Senator from Arizona said that to my office and got the exact pages my case, that 1 life out of 1,900 was my would save at least $54 billion over 10 our doctor colleague has just been wife Bobbi. years. No one doubts that reform of talking about—page 1,189 and page 1,190 I know the Senator from Idaho wants medical malpractice, junk lawsuits of the actual bill. My colleague from to get involved in this discussion. against doctors, would reduce costs. Arizona asked the question—this enti- Senator RISCH. The point we are trying to make here ty, this U.S. Preventive Services Task Mr. RISCH. Mr. President, as you is, instead of that historically arrogant Force; the entity that made the rec- read these pages, most of it is incom- 2,074-page bill that presumes we know ommendations with regard to mammo- prehensible. But, interestingly enough,

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.058 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11955 the point made by the good Senator Mr. MCCAIN. Mr. President, I thank to purchase health insurance across from Arizona about the ability of the the Senator. State lines, expand health savings ac- U.S. Government to cut off health care Could I go back, again, and reempha- counts, and promote wellness and pre- to people is stated so clearly on page size with my colleagues and the Amer- vention. 1,189 of the bill. The title of the provi- ican people what is very odious about Mr. BENNETT. Mr. President, I wish sion is ‘‘Authority to Modify or Elimi- the bill that is before us; that is, the to make the point, again, following up nate Coverage of Certain Preventive Madoff-style budget gimmickry associ- on what the Senator from Tennessee Services.’’ How much clearer can it be? ated with this legislation. In 40 days— has had to say, that the argument we This bill gives authority to the group in 40 days—tax increases and Medicare are hearing from the other side is a that was identified to modify or elimi- cuts of approximately $1 trillion will false argument when they say it is ei- nate coverage of certain preventive begin—in 40 days. That is 6 weeks from ther this bill or the status quo and the services. now. But any benefits that would ac- Republicans have nothing to offer. Had this bill been in effect in the last crue from this legislation would begin We have been offering proposals all week when the recommendations came in 208 weeks—1,460 days. along. I have been immersed in this for out on mammograms, American So why in the world would we ap- 31⁄2 years, cosponsoring, with my Demo- women would be denied coverage for prove—and, obviously, we know why it cratic friends, ideas on the way to go mammograms in the time period that is done. It is to make the budget look forward. Those proposals were not even was identified by this group. This is ab- better, when it is deception being per- allowed to be considered in committee. solutely clear on this. This is just the petrated on the American people be- The 2,000 pages we see before us were beginning of the kind of health care ra- cause we are not telling them the true written without a single Republican tioning you are going to see under this cost. We are not telling the truth be- knowing where the room was, let alone bill. Americans are frightened, and cause, if the benefits started at the being in the room. Then we are told: they should be. Health care rationing same time the taxes started, it would But you stand for the status quo, and is coming to America if this bill is be a $2.5 trillion deficit over 10 years. the status quo is unacceptable. passed. It is unfair to the American people, I repeat what I said earlier: The way Mr. BENNETT. Mr. President, I who are going to have to foot the bill this bill is constructed, the status will would like to share another statistic in for this massive piece of legislation—it remain quo until 2014, as far as benefits this whole circumstance that I think is unfair to them to tell them they are are concerned, but the taxes will start we need to focus on because, back to going to have to start paying the taxes immediately. But we all know the rev- the Broder column Senator MCCAIN and footing the bill for it and only 4 enue that comes from those taxes will talked about, we are talking about the years later would any benefits come to not be held in trust to pay for the bene- amount of expenditures and the cre- them. I think that is a really wrong fits in 2014. They will go for other ation of a new entitlement. thing to do to the American people. things, to pay for the $1.4 trillion def- Let’s go back to the debate on the Do you know what. The American icit we have this year. Then, in 2014, budget. We got the numbers that said people are beginning to figure it out. when the expenses start, the money the projected revenue for fiscal year Mr. President, 51 to 35, the American will all have been spent that had been 2009 was $2.2 trillion. The entitlement people do not want this. The American brought in, in the 4 years previously, spending for 2009 was $2.2 trillion. That people do not want an increase in the and, as the CBO says, there will be means everything we have done in gov- deficit. They want the spending change. ernment—our embassies overseas, our stopped, and they are figuring it out. I I yield the floor. military, the national parks, edu- am afraid my friends on the other side The PRESIDING OFFICER. The time cation, whatever it is—absolutely ev- of the aisle may have underestimated reserved for the Republicans is expired. erything in 2009, other than entitle- the intelligence of the American peo- Under the previous order, the time ment spending, had to be borrowed ple. until 6:30 p.m. will be controlled by the money. Mr. ALEXANDER. Mr. President, I majority. What are we doing with this bill? We would like to thank the Senators from The Senator from Michigan. are going to increase entitlement Arizona, Utah, and Idaho. Reading that Ms. STABENOW. Mr. President, it is spending. We are going to increase the big bill is very hard to do. So for those my pleasure and honor this evening to role of government that this Congress who are watching, what we have been be here to strongly support this mo- or future Congresses have no direct trying to do—as Senator MCCAIN and tion, this historic motion to proceed to control over through the appropria- Senator KYL just did—is take specific a historic debate about whether we, as tions process. I have been chairman of provisions and discuss them and inter- America, the greatest country in the an appropriations subcommittee. The pret them. world, are going to make sure all amount we have control over in the Ag We have done that with the higher Americans have access to affordable Subcommittee is about $17 billion. The premiums. We have done that with the health care insurance. This is some- total bill was $80 billion. The rest of higher taxes that the bill will require. thing that has been debated for 100 that $80 billion was off-limits to the We have done that with the Medicare years. Now we have the opportunity, Appropriations Subcommittee because cuts. Earlier today we had an hour dis- with the House having passed their it was on autopilot as entitlement cussion, led by Senator CORKER, that version, to move forward to this debate spending. discussed how the bill would send the where we will have lots of opportunity The entitlement spending for farm costs for Medicaid expansion to States. to offer amendments and to debate subsidies is small potatoes, to use a We have talked now about what we honest differences in policy. But in the farm subsidy word, compared to the en- would do if this bill were to fail, which end, I believe confidently that we will titlement spending for health care. So we hope it does. We think this bill is come together to move forward to pass facing the kinds of deficits we are fac- historic in its arrogance—arrogance legislation that will save lives, that ing, facing the runaway entitlement that we could turn over this whole sys- will save money for the American peo- spending we have, the largest portion tem, that we think the American peo- ple, that will protect Medicare, and of which is entitlement spending for ple cannot figure out that the bill costs that will stop insurance abuses hap- health care, what are we being told to $2.5 trillion, instead of the $849 billion, pening for families every single day. do? Increase the entitlement spending as advertised. I have come to the floor so many for health care and put future Con- What we propose is, we move step by times to talk about health insurance gresses in an even deeper financial bind step in the direction of cutting health reform, as has the distinguished Pre- by taking even more of the total por- care costs for individuals and for our siding Officer from Rhode Island. I wish tion of the Federal budget that is out- government. We have proposed legisla- to take just a moment to say thank side the appropriations process and tion that would reduce junk lawsuits, you to a few people because, as the Pre- putting it on autopilot. That is the combat waste, fraud, and abuse, allow siding Officer knows, we would lit- issue we must keep in mind as we look small businesses to pool resources to erally not have this opportunity today at this whole circumstance. purchase insurance, allow Americans if it were not for Senator HARRY REID,

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.059 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11956 CONGRESSIONAL RECORD — SENATE November 21, 2009 our distinguished majority leader. He affordable insurance. Is it everything I 29th in the world in the number of ba- is a quiet, smart, determined, focused would do if I was writing it by myself? bies who make it through the first year leader who has listened to everyone, Of course not. Every Member can say of life. Of all of the insurance compa- who has looked at the work products the same thing. But the Democratic nies a woman can choose from if she from the Finance Committee and the process is coming together with the goes into the private individual insur- HELP Committee and brought together best ideas and negotiating and doing ance market—59 percent don’t provide a combined bill that is the best of both. the best we can to be able to solve as maternity care, basic care, prenatal He is going to give us the opportunity much as we can in the best way pos- care, care for mom and baby during the to continue to debate and improve it sible. I am going to continue to work first year. So that is going to change on the floor before final passage. So I to make health care truly affordable because of the values we bring to this. thank Senator REID. I know he is pas- and will be sponsoring and cospon- We are going to protect Medicare. sionate about his State of Nevada, and soring amendments as we move for- Folks don’t have to believe us. There is that is his No. 1 love after family, but ward to improve on what I believe is a a lot of debate about what is happening I think No. 2 is the Senate and the abil- very good bill. I am confident that at in Medicare. I am very proud to say we ity to lead and get things done, and I the end, again, we will pass legislation have received a very strong letter from thank him. that saves lives, that saves money, the AARP supporting a ‘‘yes’’ vote this I thank Senator BAUCUS for his in- that protects Medicare, and that stops evening to move forward on this de- credible leadership on the Finance insurance abuses. bate, and that is critically important Committee; Senator DODD for his lead- When we first started this effort, I for us. ership and stewardship in bringing the set up the Health Care People’s Lobby Let me share from the Web site of HELP Committee through with their on my Web site so that people could AARP what they say—the champions legislation; Senator HARKIN, Senator share their stories, how they felt about for seniors in this country; what they WYDEN, and Senator BENNETT, who is what we should be doing. Should we say, not what we say—about what is on the floor. We are not agreeing on move forward and act? What should being done in health care reform. the movement forward on this bill, but happen? What were their experiences On their Web site: there have been 2 years of working on with their health insurance and the Myth: Health care reform will hurt Medi- health care that I appreciate, and their companies that cover them now? I have care. efforts together to work on health heard so many stories. I wish to thank Fact: None of the health care reform pro- care. everyone—thousands of people—who posals being considered by Congress would I thank Senator SNOWE. I don’t know has shared their story. I want to put a cut Medicare benefits or increase your out- of-pocket costs for Medicare services. if she is going to be with us this face on this debate and vote tonight by Fact: Health care reform will lower pre- evening, but her courageous vote on sharing just a couple with you. scription drug costs for people in the Medi- the Finance Committee is something When we say saving lives, this is not care Part D coverage gap or doughnut hole we desperately appreciate. I know she just a slogan. We are talking about so they can better afford the drugs they is going to continue to provide input, saving lives. Forty-five thousand peo- need. and I am hopeful she will be with us on ple have the ultimate rationing every Fact: Rather than weaken Medicare, the final vote because her input and year because they can’t find affordable health care reform will strengthen the finan- her knowledge have been extremely insurance. As a consequence, they lose cial status of the Medicare program. important in this process. their lives—45,000 people in the great- That is why AARP has written a let- I also thank the memory of a very est country in the world. We can do ter urging us all to vote yes on the mo- important Senator named Ted Ken- better than that, and that is what this tion this evening we will be voting on, nedy, who I know is here in spirit, for bill is about. because we are strengthening Medicare 40 years of dedication to this cause. I wish to share just one story of a for the future. Finally, I thank President Obama. If young man, Joe, from Okemos, MI. He Then let me speak to the question of not for his vision, we would not be here is a recent graduate of dental school. insurance reforms because the reality today. For 8 years under a former He worked very hard, was very bright. is that the majority of people have in- President, we did not have the oppor- He was just between jobs after com- surance. The majority of us so far have tunity to get here to this place. We did pleting his residency, and we know how insurance through our employer, and not have the opportunity to be able to long and hard that is, to get to that we hope that as we bring down the end insurance abuses and truly protect point. He suddenly fell ill. This was costs and save money, that, in fact, we Medicare for the future, to put forward only a few months ago. He called his will be able to make sure people are health care reform, to save lives, and mom. She urged him to go to the doc- going to be able to continue to have to save money. I also thank President tor, but because Joe didn’t have insur- the coverage they are paying for today. Obama for understanding that health ance, he was worried about going to So we are talking about insurance care is also about jobs and that we the doctor, so he didn’t. He continued abuses and stopping those insurance have too many people in this country to feel worse. His family finally got abuses. today who are losing their job, and him to agree to go to the hospital, but I wish to share a couple of stories with that they are losing their health by then it was too late. Joe died at age from individuals who have found them- insurance. So it is impossible to talk 27 of an aneurism—27 years old—be- selves in a very difficult situation. I re- about health care reform without also cause in America, he didn’t have insur- alize my time has come to an end, so I talking about jobs because for most ance and was afraid he couldn’t afford will be brief, but I do want to share families they are connected and one it if he went to a doctor. just a couple of stories in conclusion. and the same. This is about saving lives. This is From the newspaper recently: Ben- I have spoken on the floor so many about saving money for businesses that jamin French, a young boy in Michi- times on health care cost and access. are trying to keep the doors open, that gan, was born with his right arm miss- Frankly, health care is something that may provide insurance now but are at ing below the elbow. In his 12 years, he brought me to public service 30 years a point where either the jobs go or they has been fitted with seven prostheses. ago; when I was 5, I just want to say have to stop providing insurance. So His most recent replacement will cost that for the record. I led an effort in people come in, and the owner says: I nearly $30,000, and his doctor says he our community to keep a nursing home want to keep you working, but we are will soon grow out of it. He is a 12- open in Okemos, MI, and ever since not going to be able to have health year-old who is growing up, so as he then have been fighting to get to this care for you anymore. gets an artificial arm, it has to be re- debate, to get to this point in terms of This is about the fact that our coun- placed periodically to be able to grow affordable health insurance for all try is spending twice as much as any with him. But according to his insur- Americans. other country on health care and yet ance company, the boy is ineligible for So tonight, after this vote, we start sometimes having outcomes that are future coverage of prosthetic devices the real debate. This bill provides a far worse than we would like to see as because he has already spent his life- framework for every American to find it relates to other countries. We are time maximum benefit. That is going

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.061 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11957 to stop. We are going to eliminate cial Security Act. They said no when credits to help them buy health insur- those lifetime caps that get in the way John Kennedy and Lyndon Johnson ance and ease the burden of premiums, of a 12-year-old being able to have the fought for Medicare. They said no to deductibles, and copayments; 107,000 artificial arm he needs as he grows up the Civil Rights Act. They said no to small businesses in New Jersey could so he can lead a normal life. the Voting Rights Act. They said no to get a small business tax credit—up to I wish to share one other story, and the Clean Air and Clean Water Acts. 50 percent of premium. Health care re- that is from Glen from Sterling They said no to jobs programs. They form will end the hidden tax that gets Heights. He is 62 years old. He got laid said no to increasing unemployment passed along with the $1.1 billion spent off in December. It doesn’t look as if he insurance, when people needed it the on uncompensated care in New Jersey. will be called back. He writes: most. They said no to government It will provide portability, security, I am too young for Medicare. I have pre- oversight of polluters who poison our and choice through the health insur- existing conditions, so nobody wants to in- land with toxic waste, and then they ance exchange for 1.5 million New Jer- sure me. If I get sick before I can get Medi- said no to cleaning it up. They have sey residents who don’t have health in- care, my savings and everything else will be been on the wrong side of history for surance at all. wiped out. This is not the way I pictured re- almost a century on every major piece The bottom line is that Senator tirement was going to be. I raised four chil- dren, got them through school, and married; of legislation that has leveled the play- REID’s merged bill helps New Jersey paid taxes and did what I thought was the ing field for average Americans. They and America. It is fair, balanced, and right and moral thing to do. I didn’t create are on the wrong side of history once fixes a badly broken system. It is truly this mess, but I am sure paying for it. again. a historic piece of legislation and will He did the right and moral thing, and All we hear from the other side of the be remembered as such. Yet there are that is what we are being asked to do aisle is the dim echo of the past, with all those who will stand against all of on behalf of the American people. no plan for the future. Americans are it, those who will stand firmly on the Vote to move forward tonight. Vote tired of the naysayers, tired of the wrong side of history once again, those for the debate. Doing nothing is not an shrill voices of no, when so much is at who will use every legislative tactic to option when we are losing jobs, people stake. It is time to say yes, time to say stop this legislation as they tried to are losing lives; when we are losing the yes to stopping greedy insurance com- stop Social Security and Medicare. I capacity of the country to be able to panies from standing between doctor am afraid history is about to repeat provide the health care for our families and patients, time to say yes to ending itself. that we need to provide. It is our turn medical decisions based on risk man- We have seen that the truth has been tonight to vote yes on proceeding to a agement and the bottom line rather a victim on the Senate floor today. We debate that I believe, working to- than on saving people’s lives. listened to some of the most dire pre- gether, will result in legislation on This historic legislation, like so dictions, some of the most incredible health care that will save lives, save many other pieces of legislation de- statements, with figures thrown out money, protect Medicare, and stop in- bated on this floor, is about people— there that are astronomical, simply surance abuses. their lives, their hopes, their health, not true, and in defiance of what the Thank you, Mr. President. I yield the and their dreams for a better life for nonpartisan CBO said, which we all de- floor. themselves and their families. We can pend on—Democrats and Republicans. The PRESIDING OFFICER. The Sen- be proud of this legislation. I know They said this bill actually cuts the ator from New Jersey is recognized. that when the dust settles and the pro- deficit by $130 billion in the first 10 Mr. MENENDEZ. Mr. President, for visions of this bill become clear, Amer- years and $650 billion in the second 10 many months the voices of opposition ica will be proud of it as well. years. to any health care reform have been This landmark reform legislation in- In the face of a health care system loud and clear. They have been shout- cludes State-based exchanges creating that seems to work only for health in- ing at townhall meetings and heard in a fair, open, and competitive market- surers—certainly not for average debates in this Chamber. All too often, place for affordable health care cov- Americans—one must ask what, if any, we have heard shrill voices raised in erage. It includes an amendment I pro- health care reform are my friends on anger from those who are either mis- posed for long-overdue consumer pro- the other side for. What were their informed or who would choose the sta- tections for emergency services with- predecessors for when Americans were tus quo that benefits insurers at the out having to call your health care pro- standing in bread lines and needed un- expense of families. For too long those vider and get a prior authorization. It employment insurance? What were voices have gone unanswered. requires insurance plans to provide be- they for when they voted against Medi- The Patient Protection and Afford- havioral health treatments, such as care? What are our Republican col- able Care Act we are about to consider those for children who face the chal- leagues for now? They seem to be for is our answer. It is loud and it is clear. lenges of autism, as part of the min- one thing only: protecting the status It is thoughtful and historic. Once imum benefit standards. It encourages quo, leaving health care just the way it again, like so many other pieces of investments in youth therapies to pre- is, letting insurers make medical deci- landmark legislation in the last cen- vent, diagnose, and treat acute and sions, letting insurers collect pre- tury, it is a product of this side of the chronic disease. There is a tax credit miums and then find creative ways to aisle. for innovative biotechnology research. deny coverage. Those who have chosen to block any It ensures that minor children qualify On the other hand, this bill rep- attempt at health care reform this as exchange-eligible and provides for resents the change America voted for. year are on the wrong side of history, the availability of child-only health in- But as we have seen, change does not just as those who came before them surance coverage in the exchanges. It come easily. You have to work for it. had one response to every landmark stops insurance companies from deny- You have to fight for it. Sometimes, in piece of legislation for the last 80 ing coverage for some preexisting con- the face of the naysayers and fear mon- years. Their response has been a re- dition, some preexisting health status, gers, you need more than the truth, sounding ‘‘no.’’ They told us that it is or gender. It ends the medical benefits common sense, and even a good plan; not good for business, that it is social- shell game that insurers have played you need to fight for what you know is ism, that it stifles free market forces, with people’s lives. the right thing to do for every Amer- and that it is too much and it goes too As soon as this bill passes and the ican, not the few, not the powerful and far. President signs it into law, 1.3 million the well-connected but everyone. We have heard the same fear seniors in New Jersey will receive free At the heart of it, this vote we will mongering and innuendo since the New preventive care, such as colonoscopies cast tonight is about change. We can Deal. There are those who raised the or any other recommended preventive see how hard real, honest, common- specter of socialism then and said no to service; 227,000 New Jersey seniors will sense change is. We must ask our- Social Security. They said no to unem- have their brand-name drug costs in selves: Do we continue to be the agents ployment insurance when President Medicare Part D cut in half; 854,000 of change or do we stand with the sta- Roosevelt proposed it as part of the So- New Jerseyans will qualify for tax tus quo that discriminates against

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.061 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11958 CONGRESSIONAL RECORD — SENATE November 21, 2009 hard-working Americans who are de- down with cancer or heart disease or problems with our health care system. nied health coverage because of pre- some other chronic illness. They fear There are important steps we need to existing conditions? Do we continue to that if they have a serious illness, they take to fix the problems in our system. be agents of change or do we stand will have to go into bankruptcy to pay But the excesses of this bill appear with the status quo and deny coverage the bills. Sixty-two percent of all the willfully ignorant of what is going on to women when they are pregnant? Do bankruptcies in this country are be- outside health care. Those things deal we continue to be agents of change, cause of medical causes. Eighty per- with our economy. Those excesses however hard it may be, or do we con- cent of those are people who already make this bill far worse than doing tinue to deny millions of Americans ac- had coverage. That is what people real- nothing. cess to quality, affordable care? ly fear. We are a nation facing challenging History calls on us to stand on rare Another reason I think conservative economic times. We have seen the auto occasions for what is fair and just and forces will fail this time is because industry go into bankruptcy. We have right for the American people. This is they believe people who have good seen banks shutter their doors. one of those occasions. It requires more health insurance really lack compas- I want to refer to a chart of our na- than parliamentary maneuvers to slow sion and they don’t care about the 46 tional debt. The Federal debt has in- the process. It requires more than million other Americans who don’t creased by $1.4 trillion since inaugura- voices raised under the banner of free have it. I disagree. People care deeply tion. This chart shows the growing market values at the expense of funda- about those 46 million Americans who amount of debt the Federal Govern- mental human values. It requires doing don’t have insurance. It is a national ment is taking on. The amount of in- what is right for the American people. shame when children don’t have access creased debt added since the inaugura- Only then will we find ourselves on the to a doctor. tion is $11,535 per household. The na- right side of history. That is what this It is unfortunate that our Republican tional debt now exceeds $12 trillion for vote is about. friends are determined to prevent us the first time in history. Mr. President, I yield the floor. from even debating and amending the I wish to show a chart on Federal The PRESIDING OFFICER. The Sen- bill. That is what the vote tonight is health spending. As this chart illus- ator from Iowa is recognized. about. Republicans and the health in- trates, this bill bends the Federal spending curve further upward by $160 Mr. HARKIN. Mr. President, I thank surance industry are joined at the hip, billion over the next decade. The red the Senator from New Jersey for his using the same talking points, same area of this chart is that net additional very strong and poignant statement. I distortions, same cooked-up scare tac- Federal health spending, not according listened to it all. I think he really tics. summed it all up. All I can say is, since the Repub- to this Senator but according to the nonpartisan Congressional Budget Of- Let me add to that by saying we are licans’ goal is to obstruct, obstruct, fice. Americans have rightly lost faith at a momentous crossroads right now and obstruct, the people of this coun- when in the face of the current eco- in the history of our country. We are at try are looking to us, to the Demo- nomic crisis Congress thinks this $2.5 a time that likens itself to 1935, when crats, as they did in Social Security trillion restructuring of the health this Congress passed the Social Secu- and as they did in Medicare, they are rity Act. It is like the time in 1965 care system happens to be a good idea. looking to us to move this country for- Perhaps one of the biggest warning when Congress passed Medicare. Both ward. So this is a call to arms for our of them were giant steps forward in the signs that this bill will saddle tax- caucus. I hate to put it in those kinds payers with more spending and debt is health and economic security of the of partisan terms, but what can I do the fact that the budget fail-safe mech- American people. But as much as they when every single Republican says anism was dropped from the bill behind are part and parcel of our American they want to obstruct and stop this closed doors in the Capitol where this life today, both Social Security and bill? It is now on us, the Democratic bill was written—and I emphasize Medicare were bitterly opposed in this caucus, all 60 Members, to come here ‘‘closed doors.’’ The Grassley budget Senate by conservatives who did not and stand strong for the American peo- fail-safe mechanism was cut from the want to change. In fact, one conserv- ple. Now is not the time to go wobbly bill and lots of budget gimmicks were ative Republican Senator said that in the knees, I say to my friends in the added. passing Social Security would put an Democratic caucus. Now is the time to Former Congressional Budget Office ‘‘end to the progress of our great coun- stand strong, the time to come to the Director Douglas Holtz-Eakin wrote in try.’’ They attacked Medicare as so- well at 8 o’clock tonight and move this yesterday’s Wall Street Journal that cialized medicine. As Senator Robert country forward. It is time to say yes this bill is ‘‘fiscally dishonest’’ and Taft said at that time, ‘‘It is going to to the American people and no to these that it uses ‘‘every budget gimmick Sovietize America if we have Medicare. fears and unfounded allegations you and trick in the book . . . leave out in- It is going to be a government take- will hear from the other side. Now is convenient spending, back-load spend- over.’’ Well, here they go again. They the time to take the next step forward ing to disguise the true scale, front- are unduly frightening people in this in the real progress of this country. load tax revenue, let inflation push up country. We saw it earlier with the The PRESIDING OFFICER. Under tax revenues, promise spending cuts to death panels—all bogus. It was to in- the previous order, the time until 7:15 doctors and hospitals that have no still fear in people. p.m. will now be controlled by the Re- record of materializing,’’ and so on. It is hard to change, but the people of publicans. This bill is simply irresponsible. It is America voted last November over- The Senator from Iowa. worse than doing nothing. whelmingly for Barack Obama and for Mr. GRASSLEY. Mr. President, I Let’s talk about some of the excesses Democrats in the House and Senate be- wish to be notified when I have spoken in the bill. It increases the size of gov- cause they wanted to change the sys- 20 minutes, please. ernment by a staggering $2.5 trillion tem. They knew we had to change. The PRESIDING OFFICER. The when fully implemented. It imposes $1⁄2 People don’t fear change. They know Chair will gladly do that. trillion in new fees and taxes. Imposing it is tough, but they don’t fear it. They Mr. GRASSLEY. Mr. President, on these new fees and taxes as the econ- don’t fear change in our health care November 10, former President Clinton omy is struggling to recover is worse system either. What people fear is visited the Democratic Senate caucus. than doing nothing. This $1⁄2 trillion in keeping the present system. That is It has been widely reported that his new taxes will hurt small businesses what I hear. They fear being denied message to Senate Democrats was that and destroy job creation. It breaks coverage because they have a pre- on health care reform, the worst thing President Obama’s campaign promise existing condition or one of their chil- to do is to do nothing. by increasing taxes on individuals and dren has a preexisting condition and With all due respect to the former families making less than $250,000 per they will not be able to get health care President, that is simply wrong. Mr. year. Adding insult to injury, these coverage. That is what people fear. Clinton, the worst thing we can do is fees and taxes will also cause health They fear they will be dropped from pass this bill. This is not something I care premiums to go up beginning next their policy because they have come say lightly because there are serious year.

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.064 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11959 But I don’t want you to take my cause States will be forced to raise So according to CBO, after these bills word for it. Both the nonpartisan Com- taxes to pay for this increased cost— spend $1 trillion, many of the people mittee on Taxation and the Congres- another unfunded mandate. By drop- struggling to afford their premiums sional Budget Office have confirmed ping the equivalent of a 10,000-pound today will actually end up paying more these taxes and fees will be passed weight through to our frayed Medicaid if this bill moves forward and is en- through to the consumers in the form safety net, this bill does worse than acted. By increasing costs when people of higher health insurance premiums, nothing. This bill also compounds desperately need Congress to lower and these taxes and fees will start in- these long-term entitlement spending costs, this bill does worse than noth- creasing premiums 4 years before most problems by creating yet another new ing. of the reforms in this bill take effect in entitlement program called the CLASS It does not have to be this way. When 2014. Act. This one is a voluntary Federal the debate began last year, interested Let’s take a look at what happens to program for long-term care insurance. legislators of both parties set forth Medicare and Medicaid in this bill. I devoted several years of effort to benchmarks that were no-brainers. Both of these health care entitlement improving long-term care support, par- Health care reform should lower the programs are already on perilous finan- ticularly for the disabled and the elder- cost of premiums. It should make cial footing. Both are facing a financial ly. health care more affordable. It should meltdown. This bill adds to that bur- I understand the issues that sup- do so without Medicare cuts that jeop- den. porters of the CLASS Act want to ad- ardize access to care for seniors. It First of all, the Medicare trust fund dress. But the CLASS Act is simply not should do so without overloading the started going broke last year. In the viable in its current form. Medicaid safety net until it rips. It year 2008, the Medicare Program began The CLASS Act is almost certain to should do so without adding to the al- spending more out of the trust fund attract people who are most likely to ready unsustainable, unfunded liabil- than was coming in. The Medicare need it. This is known as adverse selec- ities by creating yet another tion. That will cause premiums to in- trustees have been warning all of us for unsustainable entitlement program. It crease and healthier people to drop out years that the trust fund is going should have done all those things. That of the program. It is a classic insurance broke. They now predict it will go is what we intended to do when we death spiral. started out. broke right around the corner, about On November 13, the administration’s Instead, this bill threatens the eco- 2017. But rather than work to bridge own chief actuary confirmed this. The nomic recovery. It is $1⁄2 trillion of new Medicare’s $37 trillion in unfunded li- chief actuary issued a dire warning in a 1 taxes hurting small business and de- abilities, this bill cuts $ ⁄2 trillion from report on the CLASS Act in the House stroying job creation. It calls for an that Medicare Program to fund yet an- bill, which is virtually identical to the even bigger and more unsustainable other unsustainable health care enti- Senate version. Quoting the chief actu- Federal budget. It adds to that burden tlement program. ary: with a massive new government-run Medicare has a major problem with There is a significant risk the problem of physician payments that will cost adverse selection would make the CLASS health plan. It makes health care more more than $250 billion to fix. But this program unsustainable. unaffordable and lowers quality. bill ignores that problem by pretending For the first 10 years, the CLASS Act I know some people believe we should the problem does not exist. This bill saves money. It saves money at the be- get on to the bill and try to fix it by would leave future Congresses virtually ginning because it collects premiums amendment. But this 2,000-page bill has no way to restructure Medicare to do before benefits start getting paid out. many more problems than can be fixed the doctors fix. But some time afterwards, it starts to by amendment on the Senate floor. By diverting Medicare resources else- lose money. We all know what happens If you want to improve it, it should where and ignoring major problems from there. It will become the tax- be stopped right now and get back to- such as that one, this bill does worse payers’ responsibility to rescue the gether where we were at one time. than nothing. program as it fails. Look at financial Democratic leaders and the White Then there is Medicaid. The Medicaid struggles of Social Security. Look at House have put together one extreme Program serves 59 million low-income Medicare. Look at Medicaid. Now go health care plan after another. After children and families. It is our health home and look at your children and the bailouts for Wall Street and De- care safety net and it, too, is on very grandchildren. troit, a stimulus bill that led to the shaky financial ground. The Govern- Creating an unsustainable CLASS highest unemployment in 26 years, and ment Accountability Office has re- Act is not a responsible thing to do for the Fed shoveling money out the door ported to Congress that States are our children and grandchildren. By without any accountability, this reaching a financial and budgetary cri- adding the ticking time bomb of yet health care reform bill is the straw sis with Medicaid. Like Medicare, Med- another unfunded liability to our chil- that broke the camel’s back. icaid is essentially going broke. The dren and grandchildren through the What Senate Republicans are trying Government Accountability Office CLASS Act, this bill, again, does worse to say tonight, with tonight’s vote, is models predict that State spending on than nothing. we don’t support reform just for the Medicaid will grow faster than State Health care is one-sixth of the econ- sake of reform. Changes to the health revenues for at least the next 10 years. omy. The American people do not want care system must be responsible and Here is what the Government Ac- a bill that makes the economy worse. not break the backs of the taxpayers countability Office has said about this The nonpartisan Congressional Budget and the job-creating engine in Amer- situation: Office, the Committee on Taxation, ica, small business. Since most State and local governments and even the Office of the Actuary of It doesn’t make any sense to make are required to balance their operating budg- the U.S. Department of Health and major new unsustainable commitments ets, the declining fiscal conditions shown in Human Services have told us what the to entitlement spending. Already, our simulation suggest that, without inter- American people already knew: These Medicare’s solvency is in jeopardy and vention, these governments would need to massive partisan health care reform the Reid bill would make things worse make substantial policy changes to avoid for Medicare. Seniors are in a tough growing fiscal imbalances. bills are going to make the problem worse when it comes to the cost of situation today with the way the econ- But this bill does not fix this problem health insurance. omy has hit their retirement savings. either. Here again, this bill makes the According to a September 22 letter We have to step back and remember it problem worse. This bill adds another from the Congressional Budget Office is not our money, it is their money. It $374 billion in spending to the Medicaid to Chairman BAUCUS about the Finance is the taxpayers’ money we are talking Program. It adds 15 million people to Committee bill, CBO wrote: about—$21⁄2 trillion of taxpayers’ dol- the rolls of the worst delivery system Premiums in new insurance exchanges lars over the decade when this bill is in health care. It increases State would tend to be higher than the average fully implemented. spending by $25 billion, and that hap- premiums in the current law individual mar- Generations of hard-working Ameri- pens to be a hidden tax increase be- ket. cans will be forced to pay the costly

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.066 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11960 CONGRESSIONAL RECORD — SENATE November 21, 2009 price for this bill if it moves forward. It Mr. ENZI. Mr. President, as morning powers a task force just like that to de- is irresponsible for Democratic leaders broke over our Nation today, millions termine which preventive services to use their filibuster-proof majority in of Americans woke to a typical, crisp should be covered by every health plan the Senate and their control of the fall day. It seemed ordinary as shop- in America. House and the White House to push owners opened their local grocery As one of the only Members of the through such massive legislation, re- stores; children filled soccer fields and Senate to sit on both committees of shaping one-sixth of the American families made preparations for Thanks- health care jurisdiction, I understand economy. The unintended consequences giving holiday. It seemed ordinary. But the complexities at work in com- of this legislation could have a desta- today is anything but ordinary in the prehensive health care legislation. And bilizing effect at just the wrong time as life of our Nation. I understand that this bill gets it America’s economy struggles to re- We have all heard the phrase and re- wrong. cover and working families are doing peated it so many times, that we have Instead of taking a step-by-step ap- everything in their power just to hold almost grown numb to it—America is proach to health reform, identifying on. facing the worst economic crisis since consensus reforms where we can fix The late Senator Moynihan often the Great Depression. Think about what is broken and leave what works, warned about the perils of a majority that for a minute. What that really the majority leader has chosen a dif- party pushing through major bills and means is that for every single legis- ferent approach. Without Republican changes in a partisan way. It is a well- lator in this Senate, we are in unchart- support and without the approval of a founded warning that Democratic lead- ered territory. growing majority of the American peo- ership has not heeded—this time, at We have never been here before and EID has chosen to shake least. If a bill like this one cannot get ple, Senator R recent signs of a slow, unsteady and nearly 20 percent of our economy in its support more broadly, then something jobless recovery are troubling. And, the is wrong with it. foundation in attempting to jam American people know it. In a survey Moreover, grassroots America has through a strictly partisan bill. spoken out against this legislation. It from this past week, 82 percent of This bill will increase our health care is alarming how those voices have been Americans said that our Nation’s eco- costs, do nothing to improve the qual- disregarded by congressional leaders. nomic conditions are poor. ity of our care, it will increase our Na- President Andrew Jackson made it Consider the news reports from just tion’s debt and deficit and it will harm clear that our duty is to tune in to the yesterday that 14 percent of all mort- our Nation’s tenuous job market. common sense of the American people gage loans—meaning 7.4 million house- There is no credible study and there who sent us here. I quote President holds—were delinquent or in fore- will be no serious, unbiased economist Jackson: closure in the last quarter. That is the who will say that this bill will create Our Government is founded upon the intel- highest number since the mortgage jobs or strengthen our economy. And ligence of the people. I, for one, do not de- bankers industry began this survey in that is what the people in the most re- spair of the republic. I have great confidence 1972. cent election said was mot important. in the virtue of the great majority of the Consider the unemployment rate—it Recently, in an op-ed in the Wall people, and I cannot fear the result. reached a 26-year high of 10.2 percent in Street Journal, the dean of Harvard Listen to what President Jackson October. We lost 190,000 jobs in just the Medical School Dr. Jeffrey Flier gave said. Listen to the concerns of the peo- month of October alone. And, accord- the current health reforms a ‘‘failing ple. They are telling us to reconsider ing to the Department of Labor’s grade.’’ Dean Flier wrote about the re- this massive, complicated legislation broadest measure, some 17.5 percent of form bills being debated in Congress, and take a path that leads to less Americans are without a job entirely that ‘‘there are no provisions to sub- spending, less taxes, and less debt. In- or underemployed. We have shed 3.5 stantively control the growth of costs stead of continuing to mortgage the fu- million jobs since January of this year or raise the quality of care. So the ture of our children and grandchildren, and the average work-week is now overall effort will fail to qualify as re- we need to get back to basics. Congress down to 33 hours for the American form.’’ should pass commonsense medical mal- worker. Dean Flier went on to write: practice reform to stop wasting so It is against this backdrop that the much money on defensive medicine. Senate majority leader has chosen to In discussions with dozens of health care leaders and economists, I find near una- Congress should empower consumers to bring up this health care bill. Health shop around for health care and lower nimity of opinion that, whatever its shape, reform is a huge undertaking. the final legislation that will emerge from costs with competition just like with Every one of the 2,074 pages in this Congress will markedly accelerate national other services the consumers buy. Con- bill will have a dramatic impact on the health-care spending rather than restrain it. gress should make market reforms that health care of every American. I have Likewise, nearly all agree that the legisla- help small businesses and the self-em- to tell you, that is a bridge. This is a tion would do little or nothing to improve ployed have greater access to health bigger problem than anyone can imag- quality or change health-care’s dysfunc- insurance at an affordable rate. ine because it will affect every single tional delivery system. These issues can be addressed with- American. This bill represents a mas- I ask unanimous consent that this out upending the entire health care sive government intrusion into the editorial be printed in its entirety in system with the result of higher taxes, medical care of every American. the RECORD at the conclusion of my higher insurance premiums, and defi- Under this bill, the government will statement. cits and debts that will get in the way review every employer health insur- The PRESIDING OFFICER. Without of the opportunity that results from ance plan in the Nation to determine if objection, it is so ordered. the ingenuity and industry of the it satisfies all of the government man- [See exhibit 1.] American people. Mr. ENZI. With ratings of failed re- If we were sitting around a coffee dated benefit requirements. If it does form like the dean of the Harvard Med- shop in Springfield, IL, or Little Rock, not, the government will then tax ical School, why are we talking about AR, and we were discussing health care many of those employers. reform and I told them we are talking The government will also now deter- taking the time to tweak a failure of about a bill that is going to raise taxes, mine whether it believes your health ideas so we can say we did something. cut Medicare, raise premiums, and not insurance costs too much. It will de- We are not fooling the American peo- do anything about costs, they would cide what benefits should be covered ple. The voices of August are still echo- say that is not health care reform. and what preventive services you ing and coming from a vast majority. I encourage my colleagues to listen should receive. Other experts have weighed in on the to the American people and to send Earlier this week, the U.S. Preven- provisions in the Reid bill and their po- this bill back to the drawing board. tive Services Task Force recommended tential impact on jobs. One such provi- I yield the floor. that women under age 50 should not re- sion is the job-killing tax of $28 billion The PRESIDING OFFICER (Mr. ceive annual mammograms. Anyone that will disproportionately fall on the KOHL). The Senator from Wyoming is who was concerned about this decision backs of small business employers in recognized. needs to understand that this bill em- the form of a mandate on employers to

VerDate Nov 24 2008 03:09 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00056 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.067 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11961 provide Washington government-ap- resentatives of the American people homes are the only places you can cut proved insurance. here in Washington. it, if you let those other people off the This job-killing tax has been studied In this bill we create yet another hook. That is what the bill does. by the non-partisan score keepers at stream of mandatory spending in per- When it comes to the long-term care the Congressional Budget Office as well petuity—or until it runs out—that is provisions in this bill that Budget as nationally recognized economists not reviewed by Congress on an annual Committee Chairman CONRAD has re- and health experts. These experts have basis. ferred to as a Ponzi scheme, you have said that the costs of this new tax will I remind my colleagues that our Fed- to be a little bit worried. If Washington ultimately be paid by the American eral deficit is nearly nine times the accounting had to come under the working men and women. size of the deficit just 2 years ago. Dur- same laws as private business, the ad- Businesses that cannot afford to pro- ing the same 2-year period, our Nation ministration and Congress would be in vide health insurance will pass the lost 8 million private sector jobs. Our jail. To attempt to claim the mantle of costs of these new penalties on to their total Federal debt is now around 85 fiscal responsibility, the majority lead- workers in the form of lower wages, re- percent of GDP. According to David er has jammed 10 pounds of entitle- duced hours and jobs cut. Yes, this so- Walker, the former head of the Govern- ment spending into a 5-pound sack. called health reform bill will threaten ment Accountability Office, at the end Again, entitlement means the pay- your jobs and if this vote is successful of the fiscal year 2000, the Federal Gov- ments automatically go on forever we will spend weeks debating this bill. ernment had about $20.4 trillion in with no further review or constraint. And just like committee work so far, total liabilities and commitments and That is not fiscal responsibility and the majority will reject real solutions unfunded promises for just Social Se- the American people are not buying it. just like they have through the two curity and Medicare. That number rose They know, evidently better than we amendment processes that have been to $56.4 trillion at the end of fiscal year do, what we are talking about. A large majority of Americans be- merged to make this flawed bill. 2008. That is a 176-percent increase in According to one recent study by the only 8 years. By the end of this year, lieve their prescription drug costs will go up under this bill and that the cost Heritage Foundation, this new job-kill- that number is expected to rise to $63 of their premiums will go up. They are ing tax in the Reid bill will place more trillion. With these staggering statis- right. What the CBO score doesn’t pro- than 5 million low-income workers at tics, it is astonishing we are even de- vide us with and can’t provide us with risk of losing their jobs or having their bating the creation of a new entitle- is the cost of this bill to each and every hours reduced and an additional 10 mil- ment obligation forever. one of us. But we know that cost will lion workers could see lower wages and A couple days ago, Majority Leader be great. The CBO evaluation says it is reduced benefits. At a time of unprece- REID stated that this bill will be deficit going to be paid for. Paid for? That is dented economic peril, the majority neutral, but you have to understand an evaluation of whether it is going to has chosen to bring a bill to the Senate what that means. First, the true cost cost the government anything. It is not that will threaten our Nation’s jobs of this bill is hidden by implementing the massive middle-class tax increases an evaluation of whether it is going to and our economic growth. cost the people anything. The only This bill will also increase our Na- and Medicare cuts in the first year and place to get that money is from the tion’s growing debt and deficit. Cur- pushing the massive costs in health people or, in this case, also stealing it rently, our Nation’s debt is greater care subsidies out to the fifth year. Re- from Medicare. In order for this bill to than $112 trillion and our deficit for fis- publican Leader MCCONNELL referred to this gimmick as being akin to paying a reduce the deficit, the majority leader cal year 2009 was greater than $1.4 tril- has to assume that the Medicare pay- lion. As a percentage of the economy, mortgage for 4 years before actually moving into the house. I wish to em- ments to physicians will be cut by 21 our deficit is 10 percent of GDP—the percent next year. He also has to as- phasize that a little bit. It is a gim- highest it has been since the Second sume these payments will be annually mick. You collect the money to begin World War. Once again, we are not de- cut another 5 percent for the next 9 with, but you don’t provide the bene- bating this bill in a vacuum. Rather, years. we are debating this bill at a time fits until further down the road. Then In order for this bill to reduce the when our credit card is maxed out. you say: We covered all those costs. deficit, the majority leader also has to I worry about the country that I am But when you extend it on out, it will assume that more and more middle- leaving for my children and grand- not continue to cover those costs. So class Americans will pay this new tax children. Our Nation is being buried disaster. on high-cost health insurance plans. As the only accountant in the Sen- under a mountain of debt, which poses According to the Congressional Budget ate, I am shocked to see that what a deadly threat to the future of our Na- Office, 84 percent of the revenue col- tion. would constitute as fraud in the ac- lected by this new tax will come from The Federal Government will spend counting world seems to be reason to Americans earning less than $200,000 in $1.4 trillion more than it receives in hold a press conference to do a hollow 2019. This reminds me of another tax revenue this year. The government will boast. The gimmicks in this bill are which was originally intended to target make up that deficit by borrowing stunning, whether it comes to imple- just 155 individuals who made more more money, mostly from China and mentation of the tax on so-called Cad- than $200,000 and did not pay any in- other foreign governments. illac health plans or the increased come tax. Today the alternative min- These levels of debt are not sustain- taxes or the $464 billion in Medicare imum tax now hits millions of middle- able and, our foreign creditors are be- cuts—Medicare cuts. We are already class Americans, and every year Con- ginning to recognize this fact. As our having a problem with Medicare sol- gress has to enact legislation to pre- creditors grow more concerned about vency. It is going to go broke. We are vent it from hitting millions more. our ability to pay our debt obligations, going to take $464 billion from Medi- This bill is drafted that same way. It the interest rates we pay will grow. care. Then we are going to form a spe- will creep up there and catch every- That means that it will soon cost us cial commission and this commission body in increased taxes. considerably more to allow Washington will be able to tell us, on an annual In order to believe that this bill will to continue to borrow the money it basis, where we can make cuts in Medi- reduce the deficit, its sponsors must needs to fund its current spending care so it doesn’t go broke. But let’s believe that future Congresses will binge. see, there is a deal with the hospitals allow millions of middle-class Ameri- With our current and growing debt, that they are not going to be touched. cans to be subject to these new taxes. Congress should be concerned. Think There is a deal with the doctors that While the majority leader claims all about it—our most fundamental duty they will not be touched; in fact, theirs these things will happen, the American as Members of Congress is to wisely is going to be increased. There is a deal public isn’t fooled. manage the power of the purse for our with PhRMA where they will not be In this morning’s Washington Post, Nation. The Framers wisely put in touched. Who does that leave? That the dean of Washington journalists, place a process of appropriations that means cutting benefits for seniors. David Broder, not a politically conserv- would be annually checked by the rep- They and home health care and nursing ative columnist and someone often

VerDate Nov 24 2008 01:46 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00057 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.012 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11962 CONGRESSIONAL RECORD — SENATE November 21, 2009 cited by the other side, pointed out care money, that is what you are want. We haven’t checked the inven- that a recent survey found that less doing. The seniors have figured it out. tory or we have said: We don’t have than one-fifth of the American people That is why it was so raucous in Au- anything in here that you need, but we believe that health care reform will be gust and ever since. They have been have some things to take care of other deficit neutral over the next 10 years. concerned about their future and the people. That is not going to sell. By a 16-point margin, the majority in promises made to them. We have a sys- We have a big decision to make to- this poll said they opposed the legisla- tem that is going broke, and then we night. It will have a lasting effect on tion moving through Congress. Mr. are going to take money from it. We our country, a lasting effect in that if Broder called this legislation a ‘‘budg- ought to back up and make sure Medi- the motion to proceed passes, we are et-buster in the making.’’ care money goes to Medicare. I know going to debate it for a long time. A It is difficult to quantify the scope of part of that is listed as fraud and bill this size deserves a lot of time. It this bill. I have heard some of my col- abuse. I am always fascinated when is necessary. And it is more com- leagues talk about how many years government talks about fraud and prehensive than we are going to be able would elapse in 21⁄2 trillion seconds. I abuse because we talk about it, but if to get into, no matter how long we de- heard some of my colleagues talk we have known that these billions of bate it. about how many cars $2.5 trillion dollars of fraud and abuse were out So the American people are going to would buy or how many school dis- there, why haven’t we been collecting be surprised at the time we waste when tricts it would fund or how many dec- that money? Once we turn it over to we could be solving jobs and the econ- ades it would fund State budgets across the government to do that, it is no omy, which is their biggest concern at America. I don’t think people are un- longer needed. Well, it is needed to pay the present time. derstanding how comprehensive this the bills, but it is no longer that much Mr. President, I yield the floor. bill is that entails 100 percent of the of a care because the paid-for has al- EXHIBIT 1 people. That is the difficulty we in the ready been taken care of. HEALTH ‘‘REFORM’’ GETS A FAILING GRADE Gang of 6 had coming to any conclu- There ought to at least be a separate (By Jeffrey S. Flier) sion because it is so big that as we get account set up that you have to actu- As the dean of Harvard Medical School I into one area and scratch the surface ally collect the fraud and abuse money am frequently asked to comment on the and find out what we don’t know, it before you can spend it, but we are not health-reform debate. I’d give it a failing takes a lot of research time to get going to do that. grade. there to be able to make basic deci- Every senior can tell you some in- Instead of forthrightly dealing with the sions. But it was easy to cram into a stances of fraud and abuse that they fundamental problems, discussion is domi- bill and say: This solves it, solves it for think are happening, and we have nated by rival factions struggling to enact or passed those on. I see some effort to defeat President Barack Obama’s agenda. $1 trillion. We should never say $1 tril- The rhetoric on both sides is exaggerated lion because that sounds like one, and collect that but not a lot. and often deceptive. Those of us for whom one is not a very big number. As many of my colleagues know, be- the central issue is health—not politics— It is $1,000 billion. We don’t know fore I came to the Senate, I was a small have been left in the lurch. And as con- what 1 billion is either, but 1 billion is business owner. My wife and I owned troversy heads toward a conclusion in Wash- 1,000 million. So we are talking about a three small shoestores in Wyoming and ington, it appears that the people who favor lot of money here. Montana. When I was showing someone the legislation are engaged in collective de- Perhaps the best way to quantify this a shoe and he or she said they didn’t nial. bill is, it keeps me up nights and, more like it or couldn’t afford it, I didn’t try Our health-care system suffers from prob- importantly, these issues we are debat- to give them a sales pitch. I knew it lems of cost, access and quality, and needs major reform. Tax policy drives employ- ing keep our constituents up at night. was time to try to find another shoe, ment-based insurance; this begets overinsur- I am sure everybody has been hearing one they liked and could afford. There ance and drives costs upward while creating from their constituents. We worry im- is a lesson from this in this health care inequities for the unemployed and self-em- mensely about the cost and the obliga- bill. The people of America are com- ployed. A regulatory morass limits innova- tions we are passing on to our children plaining, and we are showing them the tion. And deep flaws in Medicare and Med- and grandchildren. Where is this bill shoe we want to show them. They don’t icaid drive spending without optimizing taking our country, and will we have want to see that shoe. They said: We care. the courage in our time to preserve and thought you were going to lower my Speeches and news reports can lead you to believe that proposed congressional legisla- protect our Nation’s great strengths costs. Every person out there thought tion would tackle the problems of cost, ac- for future generations? These are the they were going to have the benefit of cess and quality. But that’s not true. The questions that keep me up at night, reduced costs, and they are not seeing various bills do deal with access by expand- and I know these concerns are shared it in this bill. They wanted to help out ing Medicaid and mandating subsidized in- on the other side of the aisle. I sense it other people, and some of that is in surance at substantial cost—and thus ad- in conversations I have had with the here, to a limited extent. But that isn’t dresses an important social goal. However, senior Senator from Delaware and the the main thing that they expected to there are no provisions to substantively con- senior Senator from Nebraska. I sensed have happen from this. Small busi- trol the growth of costs or raise the quality of care. So the overall effort will fail to qual- it in my work over the summer with nesses out there are particularly hurt- ify as reform. the chairman of the Budget Com- ing, and this will react on small busi- In discussions with dozens of health-care mittee. I know they share these con- nesses, those shoestores all over the leaders and economists, I find near una- cerns on the other side. That is why I United States, the grocery stores, the nimity of opinion that, whatever its shape, believe passionately that we must de- dry cleaners. This is even going to af- the final legislation that will emerge from feat the motion to proceed on this bill. fect doctors. They are small businesses, Congress will markedly accelerate national I am sometimes an optimist, and I for the most part. health-care spending rather than restrain it. still hope we can start over and get to So there is a lesson in this story Likewise, nearly all agree that the legisla- tion would do little or nothing to improve work on a bipartisan bill that has the when it comes to reforming health quality or change health-care’s dysfunc- trust and support of the American peo- care. It is time to listen to the cus- tional delivery system. The system we have ple. Any major piece of legislation that tomers and find the alternative they now promotes fragmented care and makes it has gone through this body has done so expected, that they wanted, and they more difficult than it should be to assess in a bipartisan way. It has been nec- can afford. outcomes and patient satisfaction. The true essary to get the confidence of the Probably the biggest help to me in costs of health care are disguised, competi- American people. They don’t have con- legislating has been the experience of tion based on price and quality are almost fidence in Congress right now. This bill working in a shoestore. The people tell impossible, and patients lose their ability to you what they want, and they have be the ultimate judges of value. is not helping. Worse, currently proposed federal legisla- We say we are spending our children told us what they want. We haven’t lis- tion would undermine any potential for real and grandchildren’s money. Actually, tened. If you want to make the sale, innovation in insurance and the provision of we are doing that plus spending sen- you better listen. You better see how care. It would do so by overregulating the iors’ money. When you take that Medi- your inventory matches what they health-care system in the service of special

VerDate Nov 24 2008 02:02 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00058 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.068 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11963 interests such as insurance companies, hos- ner, this bill was drafted in secret and I believe the provisions contained in pitals, professional organizations and phar- Republicans were excluded. As a can- this bill are bad for America. We must maceutical companies, rather than the pa- didate and now as President Obama, he work to enact policies that preserve tients who should be our primary concern. In effect, while the legislation would en- even went so far as to tell the Amer- patient access to care, rein in ever in- hance access to insurance, the trade-off ican people that the negotiations creasing costs in the health system would be an accelerated crisis of health-care would be broadcast live on C–SPAN. In- while ensuring the viability of current costs and perpetuation of the current dys- stead of the change Americans thought programs, and promote choice. This functional system—now with many more they voted for, we have gotten more of bill is a budget buster that does none of participants. This will make an eventual so- the same. those things. lution even more difficult. Ultimately, our The bill we are moving to consider Mr. President, I cannot support this capacity to innovate and develop new thera- will cost $2.5 trillion once fully imple- bill. pies would suffer most of all. The PRESIDING OFFICER. The There are important lessons to be learned mented; nearly three times the official from recent experience with reform in Mas- CBO score of $848 billion. The Demo- Chair recognizes the Senator from sachusetts. Here, insurance mandates simi- crats are playing a shell game to hide Montana. lar to those proposed in the federal legisla- the true cost of this legislation. With Mr. BAUCUS. Mr. President, a noted tion succeeded in expanding coverage but— this bill we get 10 years of taxes and psychologist once said: despite initial predictions—increased total only 6 years of programs. While some To be mature means to face, and not evade, spending. may claim that the bill is deficit neu- [a] crisis. . . . A ‘‘Special Commission on the Health Care tral, the Federal Government’s finan- Our health care system is in a crisis. Payment System’’ recently declared that the This crisis has been decades in the Massachusetts healthcare payment system cial commitment to health care under must be changed over the next five years, this bill actually grows. Health care making, and history has made clear most likely to one involving ‘‘capitated’’ costs are not contained or reduced, that this crisis will not solve itself. It payments instead of the traditional fee-for- they are simply offset by reductions is time for us to face the crisis. It is service system. Capitation means that newly and tax increases elsewhere in the Fed- time for Congress to show mature lead- created organizations of physicians and eral ledger. ership. It is time for us to reform other health-care providers will be given A central premise of this legislation health care, once and for all. limited dollars per patient for all of their is that Congress will allow nearly half For years now, we have prepared for care, allowing for shared savings if spending a trillion dollars in Medicare cuts to go this moment. The Finance Committee is below the targets. Unfortunately, the de- and the HELP Committee studied the tails of this massive change—necessitated by into effect. Congress has not had the skyrocketing costs and a desire to improve political will to allow these types of issues thoroughly. We have held nearly quality—are completely unspecified by the cuts to stand in the past, so why should 70 hearings, roundtables, and walk- commission, although a new Massachusetts we believe that future Congresses will throughs. We have studied this issue state bureaucracy clearly will be required. not follow suit. Case in point, the ‘‘doc very thoroughly and exhaustively. We Yet it’s entirely unclear how such unspec- fix.’’ When we passed the Balanced each produced a blueprint for reform— ified changes would impact physician prac- Budget Act in 1997, we included a for- each committee—and we worked to- tices and compensation, hospital organiza- gether with Leader REID and President tions and their capacity to invest, and the mula to limit the cost growth in physi- ability of patients to receive the kind and cian spending in Medicare. Congress al- Obama to combine those blueprints quality of care they desire. Similar chal- lowed that formula to reduce payments into one solid plan. This week, tonight, lenges would eventually confront the entire to physicians only once and has not we have brought that plan to the Sen- country on a more explosive scale if the cur- done so again. We leave the flawed for- ate floor. Tonight, we seek to begin rent legislation becomes law. mula in place and each year we act to that momentous debate. Tonight, we Selling an uncertain and potentially un- block the scheduled cuts to physician seek, at last, to face the crisis. welcome outcome such as this to the public payments instead of fixing the prob- We have a bill that will put Ameri- would be a challenging task. It is easier to cans, patients, and their doctors back assert, confidently but disingenuously, that lem. This bill increases doctor pay- decreased costs and enhanced quality would ments by half a percent in 2010 and in control. We have a bill that will end result from the current legislation. then assumes a 23-percent cut in 2011, harmful insurance industry practices. So the majority of our representatives may budget gimmickry at its finest. Under our bill, no longer will insurance congratulate themselves on reducing the Medicare is currently $36 trillion in companies be allowed to deny you number of uninsured, while quietly under- the hole, but as we have seen, Congress health insurance. No longer will insur- standing this can only be the first step of a doesn’t have the will to cut Medicare ance companies be allowed to hike up multiyear process to more drastically by fifty cents, much less $500 billion. rates for Americans with preexisting change the organization and funding of conditions, such as heart disease, can- health care in America. I have met many When we tried to rein in Medicare costs people for whom this strategy is conscious in the budget in 2007, we proposed $33 cer, or diabetes. No longer will health and explicit. billion in savings and only got two insurance companies be able to take We should not be making public policy in dozen votes. away your health insurance or reduce such a crucial area by keeping the electorate In a nod to Congress’ traditional ac- benefits when people get sick. Under ignorant of the actual road ahead. tions, or lack thereof, Democrats even our bill, no longer will insurance com- Mr. GRAHAM. Mr. President, the bill included an Independent Medicare Ad- panies be able to limit the amount of we have before us today is a 2,074-page, visory Board that can cut Medicare health care you can use in a lifetime. multi-trillion-dollar bill written in the provider payments if Congress fails to No longer will insurance companies be dark of night. This process brings back act. Cutting an already cash-strapped able to put unreasonable limits on the the worst of Washington. The sub- program is not the way to finance amount of health care you can use in 1 stance of the bill raises taxes during a health care for the uninsured. year. If you pay your bill, the insur- recession, compromises individual In addition to the nearly half trillion ance company must renew your cov- health care choices, cuts Medicare to dollars in cuts contained in this bill, erage and provide your benefits. No pay for the uninsured and will eventu- we get a half trillion dollars in new and longer will insurance companies be ally explode the deficit—the combina- increased taxes. The bill would tax able to discriminate based on gender or tion of which will jeopardize the finest Americans who choose higher cost in- health status. No longer will insurance health care system in the world with- surance plans, it would tax employers companies be able to charge more for out lowering costs. Today we are vot- for not providing health coverage, it women or for people who are sick. ing on the motion to proceed to the bill would tax Americans for not buying Our bill will also require insurance and I will vote no because this bill is health coverage, and it would increase companies to disclose the share of pre- broken beyond repair. Instead of pro- the Medicare payroll tax on some miums that goes to medical benefits. ceeding to a flawed bill, we should stop Americans to fund a new health care That is new and very important. No and start over. entitlement program. In the midst of longer will insurance companies re- Despite President Obama’s repeated the worst recession this country has ceive tax credits when they use their statements that Democrats would leg- seen in decades, how can these job-kill- profits to provide excessive executive islate in an open and transparent man- ing tax increases be justified? paychecks.

VerDate Nov 24 2008 03:09 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00059 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.005 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11964 CONGRESSIONAL RECORD — SENATE November 21, 2009 Our bill is fully paid for. It is fiscally to consider this plan. We have the Well, for one thing, health care rep- responsible. It will lower health care chance to make it even better. We hope resents one-sixth of our economy and costs, and it will reduce the Federal to have a full debate. But more impor- affects 100 percent, as we all know, of budget deficit. tant than the process or rhetoric, we the population of this country. And it According to the Congressional Budg- have the opportunity, at last, to face is true that skyrocketing health care et Office, our bill will reduce the def- the crisis. We have the opportunity to costs are the single biggest threat to icit by $130 billion in the first 10 years. show mature leadership. At long last, the financial future of our fellow citi- Over the next decade, it will further re- we have the opportunity, the historic zens. duce the deficit by about one-quarter opportunity, to reform health care, But the reason tonight’s vote is so of 1 percent of gross domestic product. once and for all. History is knocking historic, beyond those last two points, That is hundreds of billions of dollars on the door. Let’s open it. Let’s begin is that never, ever before—never be- in deficit reduction. the debate to improve this bill before fore—has this body, elected to serve As well, our bill will provide billions us today and provide the service all the American people, confronted di- in tax cuts for American families and Americans expect us to perform when rectly this simple truth: Nothing, abso- small businesses. Our bill will create they elect us to this office. lutely nothing, matters more to you new marketplaces called insurance ex- I yield the floor. and to your family than the ability to changes. Individuals and small busi- The PRESIDING OFFICER. The Sen- get the health care you need, when you nesses will be able, quickly and easily, ator from Connecticut. need it, from the doctor you choose, at to view, compare, and buy health in- Mr. DODD. Mr. President, I rise in the price you can afford. Health care is our most basic need. surance plans. very strong support of this melded bill, Today, many Americans already re- drafted and put together by our distin- Health care is the most basic commit- ceive quality health care coverage guished leader, the Patient Protection ment we should be willing to make to each other. No matter what your fam- through their employers. Many are and Affordable Care Act. ily finances, no matter what your happy with their current insurance Before I begin with some brief re- hopes and dreams are, no matter who plans. This bill will not change that. marks, let me extend my heartfelt you are or where you live or what your We keep the best of our current health thanks to our majority leader for his job is in America, in our 21st century care system. People who are satisfied tireless work and thank MAX BAUCUS of Montana for his tireless work and the America, you should be able to get the with their current health insurance members of the committees who have care you need. coverage will be able to keep it. But worked over the past many months to But for too many American fami- too many others do not have access to bring us to this moment. lies—perhaps your family, as you insurance, to quality insurance. For Others this evening have spoken with watch this tonight from your homes— too many, this system is broken. great eloquence, in my view, about the health care has become your most Under our bill, new exchanges will provisions of this bill, what we hope to basic fear. If you do not have health in- provide one-stop shops where plans are achieve for our fellow citizens with the surance, you go to bed every single presented in a simple, consistent for- adoption of this legislation. night knowing that if you wake up sick mat. Americans will be able to know I commend the Senate HELP Com- or your child does, you might not be exactly what they are buying. Insur- mittee, which did such heroic work able to see that doctor or afford one if ance companies will have to compete during the writing of our portion of the you can even find one. Even if you have on price and on quality, not on their bill—my colleagues, TOM HARKIN of health insurance, you are paying more ability to select the healthiest people Iowa, BARBARA MIKULSKI of Maryland, and more in premiums and getting less or hide restrictions. Americans will be JEFF BINGAMAN of New Mexico, PATTY and less coverage for your money. able to count on the health care cov- MURRAY of the State of Washington, Millions of you are seeing your pre- erage they buy. And tax credits will and so many others. miums skyrocket. Yet you lie awake at help to ensure all Americans can afford I thank my Republican colleagues on night—millions do—wondering: What if quality health insurance. that committee as well. While we did I lose my job? What if I get sick and Small businesses will also have ac- not end up with a bipartisan vote at find out my policy does not cover the cess to exchanges and tax credits. the end of that very long process, we costs and the care I need—or, even Through small business exchanges, did end up adopting more than 160 worse, your insurance company cancels these companies will be able to pool to- amendments offered by my Republican your policy altogether? What if you gether to spread their risk, increase colleagues to that bill, which I think run out of benefits and have to pay out their leverage, and enhance their strengthened the legislation, made it a of your pocket? I wish I could say these choice, just as big companies do. better piece of legislation, and many of fears are irrational fears, but they are Members of Congress will be required which are a part of this legislation this not. There is nothing irrational about to buy their health insurance through evening. those fears. Insurance does not allow the same exchanges that people in I also want to pause for a moment, if you to be sure of anything these days. their own States use—exactly the I can, to recognize a colleague who is Our system, all 100 of us here know, same. No longer will there be a sepa- here tonight only in spirit, Ted Ken- is broken. People are losing their rate congressional health plan. nedy. So much has been said and writ- homes because they get sick. People Our bill will strengthen Medicare. It ten about his lifelong quest to ensure are dying because they cannot afford will improve benefits for seniors. And that every American—every Amer- the cure. This is just not acceptable in it will help to ensure Medicare is sus- ican—has decent health care. Tonight our America. That is why we are here tainable for future generations. Our and in the days to come, we will pay on a Saturday night. bill will cut costs, but it will not cut him the highest compliment, as our If you have watched the news over benefits. Our bill will increase Medi- colleague, by fulfilling that quest of the past few months, you have prob- care benefits. Our bill will provide sen- achieving the goal all Americans aspire ably noticed there is a wide range of iors with free preventive care and for; that is, a national health care plan opinions on how we should fix things. wellness checkups. It will improve care that serves every one of our citizens. And that is as it should be. We need all for seniors with chronic conditions. I would like to speak briefly, if I the good ideas we can get, and hope- And it will provide a 50-percent dis- could, to the American people who are fully this debate will produce that. But count on brand-name prescription at home this evening and I suspect are if you have also watched the debate in drugs to help close the doughnut hole, just tuning in to this debate. the Senate over the last 2 days, you the gap in benefits in the Medicare pre- This important vote will occur mo- have probably noticed something else scription drug program. mentarily. Why does this issue and this as well. I don’t believe a single person Our plan is a good, commonsense an- debate matter? Why are we here on a in this body has stood up at any point swer to the crisis facing American fam- Saturday evening? But then again, for and said we are OK doing nothing at ilies and businesses. that matter, why are you watching C– all. Therefore, in the weeks ahead we On this floor, here in the Senate, to- SPAN on a Saturday evening, I might will have a full and open debate about night, we have a historic opportunity add? every provision of this bill.

VerDate Nov 24 2008 02:02 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00060 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.071 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11965 But tonight’s vote is nothing more no tonight, he would be saying no to have to be that way. If you want to than a choice—a choice between doing the premium increases, no to the tax lower costs and premiums, then we can something or doing nothing. I urge my cuts, no to the Medicare cuts—just one work together step by step and pass the colleagues this evening to join us, on the other side of the aisle. Then we commonsense reforms the American hopefully unanimously, to say we could start over with a commonsense, people have been asking for all along. should do something. We should do step-by-step approach to fix the prob- We can end junk lawsuits against something about this most basic right lem that got us here in the first place, doctors and hospitals which drive up that all Americans deserve. and that is that health care costs too costs. We can encourage healthy I yield the floor. much. choices such as prevention and The PRESIDING OFFICER. The Re- That is the sad irony of this whole wellness programs which hold down publican leader is recognized. debate. The problem that got us here is costs. We can lower costs by letting Mr. MCCONNELL. Mr. President, the that health care costs are out of con- consumers buy coverage across State Nation is watching the Senate tonight. trol. Yet the neutral, nonpartisan Con- lines. We can allow small businesses to The American people know how impor- gressional Budget Office, the score- band together to get lower insurance tant this vote is. They have seen the keeper around here, says under this rates. And certainly we can address the bill the Democratic leaders want to im- bill—this massive bill—health care rampant—absolutely rampant—waste, pose upon them, and they want to costs are actually going to go up, not fraud, and abuse that drives up costs. know where the rest of us will stand. down, and the American people All of those, my colleagues, are This bill itself is a massive monu- thought that is what this whole debate changes worth making. ment to bureaucracy and spending. But was about in the first place. So 2,074 The American people are looking at at its core it is quite simple. At a mo- pages and trillions of dollars later— the Senate tonight. They are hoping we ment when more than 1 of 10 working 2,074 pages and trillions of dollars say no to this bill so we can start on a Americans is looking for a job, at the later—this bill doesn’t even meet the better plan that fixes the problem the time when the Chinese are lecturing us basic goal the American people had in American people care about most, and about our debt, this bill—this bill right mind in what they thought this debate that is cost. They want us to start here—costs $21⁄2 trillion the govern- was all about—to lower costs. This bill over. There is nothing about this mas- ment doesn’t have and cannot afford. It will actually make the situation worse, sive bill they like. They want us to imposes punishing taxes on almost ev- and now we are about to vote on it. start over. They want us to address eryone. It raises health insurance pre- We have heard some Senators come their real concerns. All it would take, miums on the 85 percent of Americans to the floor today and say that they op- Mr. President and my colleagues, is who already have health insurance. pose this bill, but they don’t want to one Member of the other side of the And if that were not bad enough, it stop the debate. They oppose the bill, aisle—just one—to give us an oppor- slashes Medicare by $1⁄2 trillion. Any- but they don’t want to stop the debate. tunity not to end the debate but to one who votes aye tonight is voting for Nobody is suggesting we stop the de- change the debate in the direction the all of these things. bate. No one. Not a single Senator on American people would like us to go. It is a fact: A vote in favor of pro- this side of the aisle have I heard sug- I yield the floor. ceeding to this bill is a vote in favor of gest that we stop the debate. But if we The PRESIDING OFFICER. The ma- adding to the tax burden of the Amer- don’t stop this bill tonight, the only jority leader. ican people in the midst of double-digit debate we will be having—the only de- Mr. REID. Mr. President, my dear unemployment. A vote in favor of pro- bate we will be having—is about higher friend, the Republican leader, has had ceeding to this bill is a vote to raise premiums, not savings for the Amer- since Wednesday to read this bill. Obvi- health insurance premiums on people ican people; higher taxes instead of ously he hasn’t done so because the who were told—they were told—that lower costs, and cuts to Medicare rath- facts he is talking about do not exist they could expect their health insur- er than improving seniors’ care. That except in the minds of a few people who ance costs to go down. A vote in favor is what the debate will be about. don’t understand this legislation. of proceeding to this bill is a vote in The American people and 40 of us in For 200 years we have styled our- favor of deep cuts to Medicare for tens this room sitting on this side of the selves the world’s greatest deliberative of millions of seniors who depend on it aisle are not asking to end the debate. body. Deliberation necessarily implies totally. A vote to proceed to this bill is That is not what we have in mind, to discussion and great issues, necessarily a vote to continue the completely out- end the debate. What we want to do is requires great debate. Today we vote of-control spending binge this Congress change the debate—not end it, change on whether to even discuss one of the has been on all year. A vote in favor of it—because once we get on this bill, la- greatest issues of our generation; in- this bill tells every American family dies and gentlemen, the basic dimen- deed, one of the greatest issues this sitting in a waiting room tonight, won- sions will not change. The basic dimen- body has ever faced: whether this Na- dering when they will get to see a doc- sions will not change. tion will finally guarantee its people tor or how much it is going to cost: It So I ask: Why should we consider a the right to live free from fear of ill- is not our concern. Worst of all, a vote bill we already know the American ness and death which can be prevented in favor of this bill is a vote in favor of people oppose? This is not anything by decent health care for all. In the the spending binge that is leading to a anybody is in doubt about. The Amer- coming weeks, we will finally put peo- massive and unsustainable, long-term ican people think if you don’t like this ple, not insurance companies, in charge debt that will shackle our children to a bill, you have an obligation to try to of their lives. future they can’t afford. stop it, and that opportunity will come The road to this point has been start- That is what tonight’s vote is all at 8 o’clock. ed many times. It has never been com- about. If it weren’t, none of us would be I am sure this won’t come as a sur- pleted. Merging two such large and here on a Saturday night with the Na- prise to any Member of the Senate, but consequential bills has never been done tion watching and waiting to see what it is going to take 60 votes to change before. It has been an enormous under- we do. They are watching because they this bill. That means the bill as intro- taking and we would not be in this po- know that none of this—none of this— duced—this bill we are looking at right sition without the unflagging dedica- is inevitable. here—will fundamentally be the bill we tion of many Senators and extremely All it takes is one vote—just one. will be asked to pass sometime in the loyal staff members. At the top of the The simple math is this: If there were future. That is a fact. list are Chairmen BAUCUS and DODD one Democrat, just one of our friends After tonight’s vote we will all go who have shown dedication and deter- on the other side of the aisle, just one home and face our constituents. We mination in recent weeks and months who would say no tonight, none of this will have to tell them how we voted on that has rarely been seen. would happen. The voices of the Amer- raising their premiums, raising their I am proud of every single Senator’s ican people would be heard. We have taxes, and cutting their Medicare. For input, and I am especially proud of the seen all the surveys. We know how some of us, that is not going to be a two most recent classes of Senators. they feel. If one Democrat were to say very easy conversation, but it doesn’t Elected with strong mandates for

VerDate Nov 24 2008 02:02 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00061 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.073 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE S11966 CONGRESSIONAL RECORD — SENATE November 21, 2009 progress, they have demonstrated a on—now that we have a plan on paper There is an emergency that exists, studious approach to our historic en- and not just wild rumors—will they and it exists now. The right response to deavor and an unwavering belief that refuse to debate? disagreement is not dismissal, it is dis- all Americans should be able to afford After all, if we are not debating, if we cussion. Democracy is discussion. De- to live a healthy life. refuse to let the Senate do its job, what mocracy needs deliberation. Let us de- I wish to explain why we are holding are we doing here? If Senators refuse to bate our differences. On some, we will this important vote at this hour. As a debate about a profound crisis affecting find common ground; on others, we matter of principle that I respect, the every single citizen, the Nation must may not. But let’s at least tell America senior Senator from Arkansas insisted ask, what do you fear? In whose voice their legislators in the Senate are will- we vote only after Senators had time do you speak? In whose interest do you ing to find where we can come to- to read and understand this bill. Sen- vote? gether. ators all have now had ample time to Surely, deliberating health reform Nobel Prize awardee Andre Sakharov, do so. That is because of the chairman cannot be more difficult than deciding, one of the great thinkers of the past of the Agriculture Committee, Senator as Americans have to do, whether to century, knew that when opposing BLANCHE LINCOLN, of Arkansas. pay your mortgage or your medical sides come together, some of their As I have done many times this year bills. It can’t be more painful than not ideas can outweigh its parts. Sakharov privately, personally, as well as pub- taking your child to the doctor because said: licly, I again invite my Republican col- it costs too much. It cannot be more Profound thoughts arise only in debate, leagues to join on the right side of his- humbling than facing your own em- with a possibility of counter-argument. . . . tory. I, again, invite them to join us, at ployees and telling them: I am sorry, the very least, in a debate about our So come on, my friends, let us share you can’t count on me for your health our ideas in the Senate. Let us legis- future. insurance next year. You are on your Around dining room tables in Nevada late. Let us negotiate. Let us delib- own. erate. Let us debate. Our country cries and across the Nation, families are ag- It can’t be more upsetting than hav- onizing over what to sacrifice next to for this debate. Our country deserves ing an insurance company take away this debate. Our country needs this de- buy health insurance. They are ques- your coverage at the exact moment tioning whether to fill a prescription or bate. you need it the most. I extend my great appreciation to the go without it and hope for the best. My Republican friends, there is noth- Employers are wondering whether they truly tireless men and women at the ing to fear in debate. President Ken- Senate Finance Committee, Senate can afford to provide health care to nedy once said: their employees. They are asking how HELP Committee, Congressional Budg- Let us not be afraid of debate or discus- et Office, Senate Office of the Legisla- their businesses can survive while sion. Let us encourage it. health care costs grow faster than ever. tive Counsel, Joint Committee on Tax- Be not afraid of debate. It is our job, Americans need health insurance re- ation, the Department of Health and and it is exactly what the legislative form. Human Services, the Center for Medi- Debate is constant between tele- process is all about—discussing, care and Medicaid Services and the vision commentators and the editorial amending, improving. We Democrats White House: stand ready to do what needs to be pages of great newspapers and maga- CONGRESSIONAL BUDGET OFFICE zines. The only place where silence is done. We welcome debate, encourage debate. Doug Elmendorf, Director; Holly Harvey, even considered is in the Senate of the Deputy Assistant Director for Budget Anal- Does any Senator seriously think the United States. ysis; Kate Massey, Unit Chief, Low-Income Tonight—finally—we have the oppor- Founders conceived the Senate rules in Health Programs and Prescription Drugs tunity to bring this debate where it be- the hopes that legislation would never Cost Estimates; Tom Bradley, Unit Chief, longs. We finally have the opportunity be deliberated? Of course not. Health Systems and Medicare Cost Esti- to bring this great deliberation to this Did the Framers of the Constitution mates; Phil Ellis, Unit Chief, Health Policy great deliberative body. That—and explicitly enumerate the powers of the Analysis; Jean Hearne, Lara Robillard, Lori Senate but in truth hope this body Housman, Mindy Cohen, Stephanie Cameron, nothing more—is what tonight’s vote and the rest of their staffs. does. A ‘‘yes’’ vote says to America: I would avoid the hardest and most ur- SENATE OFFICE OF THE LEGISLATIVE COUNSEL know this issue is important to your gent questions of the day? Of course family and to our country, and the not. Jim Fransen, Bill Baird, Ruth Ernst, John Goetcheus, Kelly Malone, Mark Mathieson, Senate should, at the very least, talk Did our Nation’s visionaries build this Capitol Building and design this Mark McGunagle, Stacy Kern-Scheerer, Alli- about it. son Otto, and the rest of their staffs. Let’s be real transparent. Beyond all great Chamber we stand in tonight JOINT COMMITTEE ON TAXATION the hype, the hyperbole, and the only so it would remain dark and si- hyperventilation, that—and nothing lent? Quite to the contrary. Thomas Barthold, Adam Block, John more—is what tonight’s vote does. A Imagine if, instead of debating either Bloyer, Tanya Butler, Jim Cilke, Tom Dowd, Robert Harvey, Marjorie Hoffman, Melanie ‘‘yes’’ vote says to America: I know of the historic GI bills—legislation that has given so many brave Ameri- Houser, Deirdre James, Rachel Levy, Julie this issue is important to your family Marshall, Pam Moomau, John Navratil, Ned and to our country, and the Senate cans the chance to attend college—this Newland, Mary Risler, Cecily Rock, Bernard should at least talk about it. body stood silent. Imagine if, instead of Schmitt, Chris Simmons, Carrie Simons, Some of my Republican friends would debating the bills that created Social Lori Stuntz, Kristeen Witt. like the American people to think that Security or Medicare, the Senate DEPARTMENT OF HEALTH AND HUMAN SERVICES voting to debate the bill is voting to voices had been stilled. Jeanne Lambrew, Meena Seshamani, Caya pass the bill. Any high school civics Imagine if, instead of debating Lewis. whether to abolish slavery, instead of textbook will tell you that suggestion CENTER FOR MEDICARE AND MEDICAID SERVICES debating whether giving women and is absolutely false. Tonight’s vote is Erin Clapton, Ira Burney, Amy Hall, Maria not the end of the debate, it is only the minorities a right to vote, those who Martino, Isabella Leung, Anne Scott, Nancy beginning of the debate. disagreed had muted discussion and DeLew, Sharon Arnold, Allison Orris, Jen- It is clear by now that my Repub- killed any vote. nifer Snow, Jill Gotts, Chantelle Britton, lican colleagues have no problem talk- I say to my Republican Senators, Molly Long, Adam Aten, Lisa Joldersma, ing about health care in press con- don’t try to silence a great debate over Sylvia Yu, Laura McWright, Greg Jones, Dan ferences, radio interviews, television a great crisis. Don’t let history show Miller, Ariel Novick, Rick Foster. interviews, and townhall meetings. My that when given the chance to debate Program Experts in the following offices/ distinguished counterpart, the Repub- and defend your position and work centers (in alphabetical order): Center for with us for the good of our constitu- Drug and Health Plan Choices (Tim Hill); lican leader, has given many speeches Center for Medicare Management (Jon Blum, in this Chamber on the issue of health ents, you ran and hid. You cannot wish Liz Richter); Center for Medicaid & State care reform. away a great emergency by closing Operations (Cindy Mann, Penny Thompson); Yet now that we have the actual leg- your eyes and pretending it doesn’t Office of Clinical Standards & Quality (Barry islation to debate, to amend, and build exist. Straube); Office of E-Standards and Services

VerDate Nov 24 2008 02:02 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00062 Fmt 0637 Sfmt 0634 E:\CR\FM\G21NO6.074 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE November 21, 2009 CONGRESSIONAL RECORD — SENATE S11967 (Tony Trenkle); Office of Financial Manage- Leahy Nelson (NE) Specter Mr. REID. I suggest the absence of a ment (Deborah Taylor); Office of General Levin Nelson (FL) Stabenow quorum. Counsel (Janice Hoffman); Office of Legisla- Lieberman Pryor Tester Lincoln Reed Udall (CO) The PRESIDING OFFICER. The tion; Office of Research, Development and McCaskill Reid Udall (NM) clerk will call the roll. Information (Tim Love). Menendez Rockefeller Warner The assistant legislative clerk pro- THE WHITE HOUSE Merkley Sanders Webb Mikulski Schumer Whitehouse ceeded to call the roll. Nancy-Ann DeParle, Mike Hash. Murray Shaheen Wyden Mr. BROWN. I ask unanimous con- sent that the order for the quorum call I suggest the absence of a quorum. NAYS—39 The PRESIDING OFFICER. The be rescinded. Alexander Crapo LeMieux The PRESIDING OFFICER. Without clerk will call the roll. Barrasso DeMint Lugar The assistant legislative clerk pro- Bennett Ensign McCain objection, it is so ordered. ceeded to call the roll. Bond Enzi McConnell f Brownback Graham Murkowski Mr. REID. Mr. President, I ask unan- Bunning Grassley Risch HEALTH CARE REFORM imous consent that the order for the Burr Gregg Roberts quorum call be rescinded. Chambliss Hatch Sessions Mr. BROWN. Mr. President, we just The PRESIDING OFFICER. Without Coburn Hutchison Shelby did one of the most important things I Cochran Inhofe Snowe objection, it is so ordered. have ever done in my professional life, Collins Isakson Thune and I join my colleagues in noting Mr. REID. Mr. President, I ask unan- Corker Johanns Vitter imous consent that Senators vote to- Cornyn Kyl Wicker that. We have taken a major step in doing several things today—in pro- night from their desks. NOT VOTING—1 The PRESIDING OFFICER. Without viding health insurance to tens of mil- Voinovich lions of Americans who don’t have in- objection, it is so ordered. The PRESIDING OFFICER. On this Mr. REID. Mr. President, I ask con- surance, in building consumer protec- vote, the yeas are 60, the nays are 39. tions around 80 percent of Americans sent that we start the vote 5 minutes Three-fifths of the Senators duly cho- early. who are insured so people will no sen and sworn having voted in the af- longer be disqualified from preexisting The PRESIDING OFFICER. Without firmative, the motion is agreed to. conditions, no more discrimination objection, it is so ordered. (Disturbance in the galleries.) based on gender. The PRESIDING OFFICER (Mr. The PRESIDING OFFICER. Expres- As the Presiding Officer knows from DODD). Under the previous order, the sions of approval are not allowed. his work in Minnesota, women pay sig- clerk will report the motion to invoke Under the previous order, all nificantly higher health insurance pre- cloture. postcloture time is yielded back, and miums than men on average. Those The assistant legislative clerk read the motion is agreed to. days are behind us. There will no as follows: The clerk will report the bill by title. longer be lifetime caps so if somebody CLOTURE MOTION The assistant legislative clerk read gets sick and their cost of treatment— We, the undersigned Senators, in accord- as follows: from physician care, from hospital vis- ance with the provisions of rule XXII of the A bill (H.R. 3590) to amend the Internal its—so high, the insurance company Standing Rules of the Senate, hereby move Revenue Code of 1986 to modify the first-time chooses to do what they call rescission, to bring to a close debate on the motion to home buyers credit in the case of members of proceed to Calendar No. 175, H.R. 3590. cutting their insurance coverage off, the Armed Forces and certain other Federal those days are behind us, once we move Harry Reid, Tom Harkin, Jack Reed, Ed- employees, and for other purposes. ward E. Kaufman, Jeff Merkley, Roland forward with this bill. W. Burris, Daniel K. Akaka, Patty AMENDMENT NO. 2786 Tonight is the first step. Even though Murray, Richard J. Durbin, Sherrod Mr. REID. Mr. President, I call up none of my Republican colleagues, not Brown, Michael F. Bennet, Jeanne my amendment that is at the desk. 1 of the 39 who voted, not 1 of them Shaheen, Sheldon Whitehouse, Bill The PRESIDING OFFICER. The wanted to proceed with the debate, Nelson, Mark Udall, Benjamin L. clerk will report the amendment by clearly the country wanted us to move Cardin, Christopher J. Dodd, Patty title. Murray. forward. Now everybody has a fair shot. The legislative clerk read as follows: If they don’t like the public option, The PRESIDING OFFICER. By unan- The Senator from Nevada [Mr. REID], for they can try to get rid of it. If they imous consent, the mandatory quorum himself, Mr. BAUCUS, Mr. DODD, and Mr. HAR- don’t like the way we are paying for it, call is waived. KIN, proposes an amendment numbered 2786. they can try to change it. If they don’t The question is, Is it the sense of the Mr. REID. Mr. President, I ask unan- like what we have done with biologics, Senate that debate on the motion to imous consent that the reading of the those opportunities are in front of us proceed to H.R. 3590, the Service Mem- amendment be dispensed with. now for the next 2 or 3 weeks. bers Home Ownership Tax Act of 2009, The PRESIDING OFFICER. Without I have come to the Senate floor lead- shall be brought to a close? The yeas objection, it is so ordered. ing up to this debate, since July, shar- and nays are mandatory under the rule. (The amendment is printed in the ing letters from people in my State The clerk will call the roll. RECORD of Thursday, November 19, 2009, who have a few things in common. Al- The legislative clerk called the roll. under ‘‘Text of Amendments.’’) most every single letter I get comes Mr. KYL. The following Senator is Mr. MCCONNELL. I ask for the yeas from somebody who a year or two ago necessarily absent: the Senator from and nays. was pretty satisfied with their health Ohio (Mr. VOINOVICH). The PRESIDING OFFICER. Is there a insurance. Then maybe they had a The PRESIDING OFFICER. Are there sufficient second? baby with a preexisting condition or any other Senators in the Chamber de- There is a sufficient second. they lost their insurance or they owned siring to vote? The yeas and nays were ordered. a small business and 1 person out of 50 The result was announced—yeas 60, The PRESIDING OFFICER. The ma- employees got cancer and their pre- nays 39, as follows: jority leader. miums spiked so high, the insurance [Rollcall Vote No. 353 Leg.] f was either terminated by the company YEAS—60 or it was so expensive they couldn’t af- MORNING BUSINESS Akaka Cardin Hagan ford it. Someone got so sick and the Baucus Carper Harkin Mr. REID. Mr. President, I ask unan- costs were so high, the insurance cut Bayh Casey Inouye imous consent that there now be a pe- them off. In almost every one of these Begich Conrad Johnson Bennet Dodd Kaufman riod for the transaction of morning letters, people were generally satisfied Bingaman Dorgan Kerry business, with Senators allowed to with their insurance. Boxer Durbin Kirk speak therein for up to 10 minutes I get letters from a lot of people in Brown Feingold Klobuchar each. their early sixties, people from Spring- Burris Feinstein Kohl Byrd Franken Landrieu The PRESIDING OFFICER. Without field to Troy to Zaynesville. These peo- Cantwell Gillibrand Lautenberg objection, it is so ordered. ple in their early sixties who have lost

VerDate Nov 24 2008 03:09 Nov 22, 2009 Jkt 089060 PO 00000 Frm 00063 Fmt 0637 Sfmt 0634 E:\CR\FM\A21NO6.010 S21NOPT1 smartinez on DSKB9S0YB1PROD with SENATE