Congressional Record United States Th of America PROCEEDINGS and DEBATES of the 111 CONGRESS, FIRST SESSION

E PL UR UM IB N U U S Congressional Record United States th of America PROCEEDINGS AND DEBATES OF THE 111 CONGRESS, FIRST SESSION

Vol. 155 WASHINGTON, FRIDAY, NOVEMBER 20, 2009 No. 173 House of Representatives The House was not in session today. Its next meeting will be held on Tuesday, December 1, 2009, at 2 p.m. Senate FRIDAY, NOVEMBER 20, 2009

The Senate met at 9:45 a.m. and was to the Senate from the President pro care bill. The debate will be controlled called to order by the Honorable JEFF tempore (Mr. BYRD). in alternating, hour-long blocks until MERKLEY, a Senator from the State of The assistant legislative clerk read 10 p.m., from 10 until 10, with the ma- Oregon. the following letter: jority controlling the first hour. The U.S. SENATE, majority will control the time from 10 PRAYER PRESIDENT PRO TEMPORE, until 10:30 and the Republicans will The Chaplain, Dr. Barry C. Black, of- Washington, DC, November 20, 2009. control the time from 10:30 until 11 fered the following prayer: To the Senate: p.m. Under the provisions of rule I, paragraph 3, Let us pray. There will be no rollcall votes during of the Standing Rules of the Senate, I hereby today’s session of the Senate. The next O Lord, Your Holy Word and our own appoint the Honorable JEFF MERKLEY, a Sen- good sense tell us that all we are and ator from the State of Oregon, to perform vote will occur tomorrow night at 8 all we call our own belong to You. Help the duties of the Chair. p.m., Saturday, November 21. That us to find ways of living and sharing ROBERT C. BYRD, vote will be on the motion to invoke with others that will reflect this truth. President pro tempore. cloture on the motion to proceed to the Today, shower our lawmakers with Mr. MERKLEY thereupon assumed health care legislation. Your blessings. Enable them to see and the chair as Acting President pro tem- experience evidences of Your love. Give pore. f them the wisdom to walk humbly and f to see everything with faith’s eyes. Let RECOGNITION OF THE MINORITY them live with true thanksgiving, re- RECOGNITION OF THE MAJORITY LEADER membering Your love and presence LEADER The ACTING PRESIDENT pro tem- which can turn deserts into paradise. The ACTING PRESIDENT pro tempore. The Republican leader is recog- Give them boldness to take stands for pore. The majority leader is recognized. what You have revealed is the applica- nized. tion of Your principles and justice for Mr. REID. Mr. President, I suggest f our Nation. We pray in Your great the absence of a quorum. Name. Amen. The ACTING PRESIDENT pro tem- HEALTH CARE REFORM f pore. The clerk will call the roll. Mr. MCCONNELL. Mr. President, our The assistant legislative clerk pro- good friends on the other side of the PLEDGE OF ALLEGIANCE ceeded to call the roll. aisle have spent 6 weeks behind closed The Honorable JEFF MERKLEY led the Mr. REID. Mr. President, I ask unan- doors putting together this trillion-dol- Pledge of Allegiance, as follows: imous consent the order for the lar experiment in health care that I pledge allegiance to the Flag of the quorum call be rescinded. raises premiums, raises taxes, and United States of America, and to the Repub- The ACTING PRESIDENT pro tem- makes drastic cuts to Medicare. We lic for which it stands, one nation under God, pore. Without objection, it is so or- have now had less than 48 hours to look indivisible, with liberty and justice for all. dered. through this 2,074-page bill, but there f f are 10 things we know for sure that every American should begin to under- APPOINTMENT OF ACTING SCHEDULE stand. There are 10 things about this PRESIDENT PRO TEMPORE Mr. REID. Mr. President, at 10 bill we can begin to convey to the The PRESIDING OFFICER. The o’clock this morning, the Senate will American people with certainty, start- clerk will please read a communication resume debate on H.R. 3590, the health ing this morning.

∑ This ‘‘bullet’’ symbol identifies statements or insertions which are not spoken by a Member of the Senate on the floor.

S11825

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00001 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.000 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11826 CONGRESSIONAL RECORD — SENATE November 20, 2009 The Democratic bill includes nearly not have that option anymore. Those higher taxes, and cuts to Medicare that $1⁄2 trillion in new taxes that hit vir- are the kinds of Americans for whom produce more government is not re- tually every single American, includ- the cost of insurance is going to go up form. Yet that is precisely what we ing, most importantly, middle-class dramatically. would get were we to pass this 2,074- families who make less than $250,000 a What else do we know about this page bill sitting here beside my desk. year—almost $1⁄2 trillion dollars in new 2,074-page bill? It creates a government I yield the floor. taxes, a substantial part of it hitting plan that the Congressional Budget Of- f middle-class families who make under fice has said would bring about higher $250,000 a year. premiums. The majority has said the RESERVATION OF LEADER TIME The second thing we know about this whole point of the government plan, The ACTING PRESIDENT pro tem- massive 2074-page bill is it will raise in- having the government, in effect, get pore. Under the previous order, the surance premiums for the 85 percent of into the insurance business, is to offer leadership time is reserved. Americans who already have health in- a lower cost alternative, but the only f surance in our country. So we know way to do that is to subsidize costs, ra- SERVICE MEMBERS HOME OWNER- buried in this 2,074-page bill are higher tion care, and undermine private insur- SHIP TAX ACT OF 2009—MOTION insurance premiums for all Americans. ance, which could lead to a government TO PROCEED The third thing we know about this takeover of health care. massive 2,074-page bill is there will be In the Democratic plan, the Congres- The ACTING PRESIDENT pro tem- huge cuts in Medicare, $1⁄2 trillion in sional Budget Office actually says the pore. Under the previous order, the cuts in Medicare over 10 years, and it government insurance company would Senate will resume consideration of will limit many of the choices seniors have higher premiums. So, clearly, the the motion to proceed to H.R. 3590, now have. only way it could have a positive im- which the clerk will report. Additionally, this monstrous 2,074- pact on the cost of insurance would be The assistant legislative clerk read page bill, according to the Congres- to subsidize costs, ration care, and un- as follows: sional Budget Office, will not lower dercut private insurers. Of course, that Motion to Proceed to H.R. 3590, to amend health care costs. My recollection was would be the first step toward what the Internal Revenue Code of 1986 to modify that the principal reason we went down some of the more candid liberals in the the first-time homebuyers credit in the case this path in the first place was to do House have said is a single-payer sys- of members of the Armed Forces and certain something about the cost increases tem. They are actually disappointed other Federal employees, and for other purposes. that are hitting American businesses this bill doesn’t go far enough to create and individuals. So we go through pass- a government insurance company, The ACTING PRESIDENT pro tem- ing, presumably—I hope we don’t, but which then leads to a single-payer, Eu- pore. Under the previous order, there if we pass this 2,074-page bill, we will ropean-type system. will be debate until 10 p.m., the time actually increase costs. The true cost What else do we know about this bill? controlled in alternating 1-hour blocks, of this bill, which was not stated by The Democratic bill, for the first time the majority controlling the first hour. the majority at the announcement of in history, would allow Federal pro- The Senator from New Mexico is rec- the bill—if you look at the 10-year pe- grams to pay for elective abortions. ognized. riod when everything is implemented, How do people out in America who feel Mr. BINGAMAN. Mr. President, I rise the true cost of the bill is $2.5 trillion. strongly about that issue—what do to speak for a few minutes about the Certain gimmicks were employed to they say about it? According to an AP health care legislation that has now try to make the bill look like it actu- story just this morning, a direct quote been proposed by the majority leader ally was deficit neutral or even raised from the person with the Catholic and that we will be hopefully pro- money for the Government over 10 bishops who work with this legislative ceeding to for serious discussion, delib- years. The way that was done was to issue here on the Hill—here is what he eration, and opportunity for amend- delay the implementation of parts of had to say. This is a quote from this in- ment. Let me talk first about where we the bill. But once everything kicks in, dividual who works for the Catholic are today without health care legisla- if you look at a 10-year window after bishops on legislative issues. ‘‘This is tion. everything kicks in, in this monstrous the worst bill we have seen so far on What are the circumstances faced by 2,074-page bill, it would actually cost the life issue.’’ That is from a spokes- the average American family without $2.5 trillion, a massive expansion of the man for the Catholic bishops on what enactment of health care legislation? Federal Government. is buried in this 2,074-page bill on the The cost of medical care is rising. In The sixth thing we know about this issue of whether the government will, fact, it is unaffordable for many indi- bill for sure is, if you like the health for the first time, allow Federal pro- viduals and businesses. In addition, insurance you have, you may not be grams to pay for elective abortions. there are 46 million who are uninsured able to keep it. Buried in this 2,074- Another observation he made about in the country. That number continues page bill are provisions that clearly in- it—and this is a direct quote, two to grow. I have been in the Senate and dicate that if you like the health insur- words by the spokesman for the Catho- continued to watch that number grow ance you currently have, you may not lic bishops: ‘‘Completely unaccept- for the last decade at least. Those most be able to keep it. According to the able.’’ Completely unacceptable, the in need of health insurance often are Congressional Budget Office, the abortion language in this 2,074-page denied coverage. Many others worry Democratic bill would force millions of bill. That is how the Catholic bishops about whether they are one diagnosis Americans off the health insurance apparently feel about this. away from financial ruin because of they currently have. Finally, Americans should know this their lack of adequate coverage and The seventh thing we know about bill does not have the commonsense re- their lack of ability to afford adequate this bill is it would let government bu- forms they have been asking for all coverage. reaucrats dictate what kind of health along. There is nothing in this massive We are working in the Senate to plans Americans can buy. No longer bill about getting rid of junk lawsuits craft a national health reform proposal would they have the option to buy against doctors and hospitals that CBO that would remedy the situation and whatever health care plan might make said costs us $54 billion over a period of would do so by reducing the growth in sense for their family. The Government time. There is nothing in the bill about the cost of health care. Let me be will prescribe what kind of insurance leveling the playing field when it clear. We are not saying the cost of plans Americans can buy and, thereby, comes to health care taxes. What the health care is going down substan- of course, what benefits they can re- American people would like for us to tially. We are talking about the growth ceive. Some bureaucrat in Washington do is to, step by step, address the cost in the cost of health care. That is what is going to dictate the plans that are issue—to them. This bill doesn’t do we are trying to moderate as part of available for the American people. I that in any way. this legislation. suspect people who are young and Americans would like to have health We are also providing insurance to healthy and have high deductibles may care reform, but higher premiums, everyone in the country, regardless of

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.002 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11827 their health status and medical condi- able to buy a policy, perhaps, the pol- choices of quality, affordable health tion. This health reform proposal is de- icy in its own language will exclude care. That is even when a person loses signed to lower health care costs, lower them from getting medical treatment their job, when a person switches jobs, than what they otherwise will be in the that might result from that preexisting when a person gets sick, or a person de- future. This health reform legislation medical condition. This legislation cides to move from one community to caps what insurance companies can would end that. It would end the dis- another. This legislation will ensure force patients to pay in their out-of- crimination of charges that currently that they have access to health care pocket expenses and in their exist where the charge for health care even in those circumstances. deductibles. The legislation would let is based on one’s health status or gen- It creates a health insurance ex- small businesses and individuals join der. change. This exchange would be a place purchasing pools and give them the During the course of this year and where families and businesses could lower costs that benefit larger groups the last few years, while we have been easily compare insurance plans and today. I have heard from hundreds of studying the health care delivery sys- prices and make a judgment based on small business owners in my State over tem, I have come to a new under- that comparison. This puts families, the years who have complained that standing of what the word ‘‘under- rather than insurance companies or the cost of health care to them and writing’’ means. I used to think I knew government bureaucrats, in charge of their employees is so much higher than what the word ‘‘underwriting’’ meant their own health care. It helps people the cost of health care to large employ- in insurance. What I have found it to decide which quality, affordable in- ers and their employees. We would means is the screening out of people surance option is right for them and solve that. We would create a system who might actually need the insurance for their family. that helps to prevent illness and dis- that is being sold. So much of the ef- It keeps government and insurance ease instead of just treating it when it fort of the health insurance industry bureaucrats, because there are bureau- is too late and when the cost is exces- today is not focused on assisting the crats working for insurance companies sive. patient or the policyholder; it is fo- just as there are bureaucrats working This health reform proposal will re- cused on screening out those individ- for the government, both from coming duce health care fraud and waste and uals who might, in fact, wind up sick between each individual and his or her abuse and overpayment to insurance and might need health care. We try to doctor by simplifying insurance paper- companies. It is estimated by most ex- end that in this legislation, and we do work, by cutting out the pages of fine perts to be in the range of $60 billion so effectively. print, by eliminating all of the per year under the current health care The legislation provides tax credits ‘‘gotcha’’ clauses people discover once delivery system. This legislation would to middle-class families to make sure they get sick. They find out they were eliminate most of the cost of uncom- they can afford quality coverage. There not covered for whatever it is that now pensated care. This is a substantial are many middle-class families in my afflicts them. part of the premium people with health State who, frankly, cannot afford ade- By promoting computerized medical insurance are required to pay. They are quate and quality coverage for the par- records, this legislation will dramati- not only paying for their own health ents and the children. cally improve efficiency in our health care when they pay their premium, This legislation strengthens em- care system and, through that effort, they are paying for the uncompensated ployer-based health care by offering also reduce cost. care that hospitals, physicians, and small businesses a tax credit so that Let me talk a little bit about the im- others are providing to people who employers can offer competitive, af- pact of this legislation on my State. I don’t have insurance. That is the 46 fordable rates to their employees, if represent New Mexico. Frankly, this million uninsured figure I mentioned they choose to do so. legislation is critically important to before. It creates incentives that reward doc- my State. This chart is a depiction of This legislation reduces the growth tors for healthy outcomes, not only for what is projected by the experts about in the cost of public programs such as more and more procedures. We have the cost of health care in New Mexico. Medicare and Medicaid and helps to the unfortunate circumstance today, Without health care reform, my State rein in the Federal deficit. We have the for which this Congress and this ad- is expected to experience the largest unusual circumstance that many of the ministration and previous Congresses increase in health insurance premiums individuals who opposed the establish- and previous administrations are re- of any State in the Union. For exam- ment of Medicare and claimed it was sponsible, where we have set up a sys- ple, the average employer-sponsored socialized medicine are now resisting tem of payment, under Medicare in insurance premium for a family in New any effort to put it on a sounder finan- particular, where the amount the Mexico in the year 2000 was $6,000. By cial footing and doing so purportedly in health care provider receives depends 2006, that had almost doubled to $11,000 the name of defending the beneficiaries on how many procedures they perform, for a family of four. By 2016, the ex- of Medicare. We need to speak the not on whether the patient gets better, pected increase goes to an astonishing truth to the American people and say: not on whether they have done the $28,000. Medicare and Medicaid are going to right thing to assist that patient. We In addition, this third chart high- continue. There are going to have to be are trying to begin changing that with lights the health insurance premiums reductions in the growth of those pro- this legislation. This will result in bet- and the percentage those premiums grams in the future, the growth of the ter health care for all Americans. represent of the income of the average cost of those programs, and some of Health reform is also designed to im- New Mexico family. It is higher in my those changes are incorporated in this prove the choices people have when State, unfortunately, than in any other legislation. That is a good thing for they go out to obtain coverage or to State in the Union. Today, 31 percent Medicare beneficiaries. That is a good obtain health care itself. Most Ameri- of a family’s income is going to pay for thing for people who are going to be de- cans get their insurance through an health care. That is for the folks who pendent upon Medicare in the future. employer. Many are satisfied with the have coverage today in New Mexico. They will know Medicare is there. plans they currently have. They are That is expected to grow to an as- They will know Medicare is solvent and satisfied with the physician or the doc- tounding 56 percent. Over 56 percent of will benefit accordingly. tor they currently have. It is clear in a family’s income is expected to be Health reform will also ensure all the legislation we are considering that consumed just paying premiums for Americans have access to quality and this legislation does not require them health care by 2016. That is totally affordable insurance. We prevent insur- to change that. This legislation says unsustainable and unaffordable. ance companies from the current prac- they can keep that policy. They can The health reform proposal that has tices in which they are engaged. One of renew that policy. They can add family been developed by the majority leader, the worst of those practices is the prac- members to that policy if they choose based on the work of the Finance and tice of denying health coverage for pre- to do so. But this health reform also HELP Committees, intends to slow the existing medical conditions. If one has provides security that ensures that growth of health care costs around the a preexisting medical condition and is families always will have guaranteed Nation. The nonpartisan Congressional

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.003 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11828 CONGRESSIONAL RECORD — SENATE November 20, 2009 Budget Office forecasts that the legis- here legally. Most of them are citizens. issue and follow the debate. As I say, lation would not add to the Federal They do not have coverage. This gets the more people do study the issue and deficit. In fact, it would reduce the def- back to the point I was making before follow the debate, the more people will icit by $130 billion by 2019 and by more about people’s premiums today are cov- conclude this is worth doing, this is than $400 billion by 2029. ering not only the cost of their own important to do. Most experts believe these reductions health care needs, but they are cov- So I very much urge my colleagues to also will drive down the cost in the pri- ering the cost of the uncompensated rally around this effort. I hope, frank- vate health insurance market. Thus care that is provided to this large red ly, we will get some Republican sup- this legislation is critically important wedge of people shown down here on port for this legislation. I think it is to my State because it will help to the chart. So it is a serious problem very unfortunate we are going into this curb increases in health care costs for that needs attention. debate with reports that all Repub- all New Mexicans. New Mexico will benefit from this licans are agreeing to oppose health Let me show you a fourth chart. This legislation in very important ways. care reform. That is not the way to one is a chart based on—I guess this is The legislation will provide new Fed- move our country forward. If there are data from the Census Bureau. It is a eral tax credits for private insurance, amendments they would like to offer, chart that was developed by the Com- and it will also expand the Medicaid obviously, they will have every oppor- monwealth Fund. It is the percent of Program for individuals with incomes tunity to offer those, and some of them adults ages 18 to 64 who are uninsured of up to 133 percent of poverty. may prevail. by State. It has two maps shown on it. This is a very important provision That certainly was the case in the The first is for 1999 through 2000 and for my State: It is projected that insur- Finance Committee when we marked the second is 2007 through 2008. ance market reform and Federal tax up the legislation. That certainly was You can see what has happened just credits may reduce the cost of coverage the case in the HELP Committee when in that relatively short period. In 1999 in the individual/private market for we marked up the legislation. Amend- to 2000, there were two States that had the average family in my State by as ments were offered from Republican more than 23 percent of its population much as 40 percent. So this last chart members, and some were adopted. But uninsured, and those two States were tries to take the previous information to just say no, to just say: We are op- Texas and New Mexico. The only State and say what would likely occur by posed to reform, is not a good option. I in the Union that has a higher unin- 2019—10 years from now—if, in fact, we think the American people deserve bet- sured rate than we do in New Mexico is are able to enact this legislation. ter than that. I hope we will have a se- Texas. That was the case then, in 1999 You can see what the two biggest rious, substantive discussion about through 2000. It is still the case today, changes in the legislation are. The what the elements of health care re- I would point out. green wedge in the pie chart shows form should be. But what you can see from this map that we will have more people covered I compliment the majority leader for on the right of the chart for 2007 to 2008 by Medicaid and CHIP. We would have putting together a very credible pro- is that many other States—particu- 29 percent rather than the 22 percent posal that will move this country very larly the States shown in dark blue we had before. It shows we will have far toward meeting the health care across the South and California—many many more people covered by private needs of all Americans. I hope by the other States have joined the ranks of insurance. I believe for the first time in end of this year we are able to enact States that have over 23 percent of the history of our State, we will have that legislation or pass it through the their population uninsured. Their aged over 50 percent of our population—ex- Senate and go to conference with the 18-to-64 population was uninsured. This actly 53 percent is what is estimated— House of Representatives. is a very serious problem. who will be covered by private insur- Mr. President, I see my colleague is I think my State has the lowest rate ance and have an insurance policy they in the Chamber to speak on this issue, of employer-sponsored insurance in the can depend upon. and I will yield the floor at this time. Nation. We also have the highest rate So this would still leave undocu- The ACTING PRESIDENT pro tem- of uninsured among employed individ- mented immigrants—which is still es- pore. The Senator from Ohio. uals in the Nation. timated to be 4 percent of the popu- Mr. BROWN. Mr. President, I appre- Let me show you this next chart, this lation—without any guaranteed source ciate following Senator BINGAMAN. fifth chart I have in the Chamber. This of coverage. But we would have about Senator BINGAMAN perhaps knows more is a pie chart that shows what the cur- 124,000 New Mexicans newly eligible for about this issue than anybody in the rent status of folks in New Mexico is. I Medicaid coverage, and covered by Senate. He was the only Democratic know it is difficult to read from a dis- Medicaid, we would hope. We would Senator to be on both committees that tance, but let me explain what it is. have an additional 238,000 New Mexi- wrote this bill and did such great work We generally think of most people cans who would be eligible for private both in the Finance Committee and the having private health insurance cov- coverage through the exchange or from Health, Education, Labor, and Pen- erage. In New Mexico, 38 percent of our their employers if their employers sions Committee. population has private health insur- chose to provide that coverage. I would follow up his words by point- ance coverage. So it is not a majority; We will have a lot of opportunity ing out that this process—I was on a C– it is 38 percent. We have 14 percent who over the next few weeks to debate par- SPAN show this morning, and I heard are covered by Medicare. We have 22 ticular parts of this legislation. I look the previous Senator who was on the percent who are covered by Medicaid forward to that debate. I think the show, a Republican, say this bill was and the Children’s Health Insurance more the American people understand written behind closed doors and that it Program. We have 4 percent who are what is in this legislation, the more is a partisan bill. undocumented immigrants in our wholeheartedly they will support us I went through this process, as did State, estimated at about 80,000 indi- moving ahead and enacting this legis- the Acting President pro tempore from viduals. They do not have coverage lation. Oregon, and we sat through 11 days of today, and they will not have coverage This debate has been a long time in markup in the Health, Education, once this legislation becomes law, if we coming. In the 27 years I have been in Labor, and Pensions Committee—all are able to pass this legislation and the the Senate, we have not gotten to this televised, all public, with hundreds of President is able to sign it. point previously, where we were begin- amendments. We accepted 160 Repub- Then this large red area shown down ning a serious debate that might actu- lican-sponsored amendments. The Sen- here at the bottom of the chart is 22 ally result in the passage of legislation, ator from Oregon and I and Senator percent, and that represents individ- major comprehensive reform legisla- BINGAMAN and Senator MURRAY, also uals who have no coverage, excluding tion. But I think we are to that point. on that committee, voted for most of undocumented immigrants. So we have This is legislation that is currently those 160 amendments. This bill had a the undocumented immigrants, at 4 available for anyone to review on the lot of bipartisanship. percent. Then we have 22 percent with- Internet, and I encourage people to do But on the big issues, the issues such out coverage. These are folks who are that. I encourage people to study the as the public option, such as issues on

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.003 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11829 how we are going to pay for it—some of from Ohioans who have written me care coverage. A public option is essential to the big issues—there is a clear philo- about this health insurance bill. What making sure this happens. sophical disagreement. We can go back has come through in these letters I Patricia understands the public op- to 1965, when Medicare passed. Repub- have gotten is a couple things—or tion will—again, whether you choose licans opposed it in those days because maybe three things. Aetna, whether you choose the public they had a different view of the world. No. 1, I have found that most of the option, or a not-for-profit in Ohio Their philosophy is government will people who have written these letters— called Medical Mutual, you have that never do anything right. Our philos- if I met them a year ago and asked option, and the public option is, in ophy is Medicare has been a pretty them: Are you satisfied with your fact, an option that will give people darn good program and has lifted a health insurance, most of them would that opportunity. whole lot of seniors out of poverty, and have said: Yes. But then something Joyce from Lawrence County, sort of so has Social Security. Medicare, in happened. They lost their job or they straight southern Ohio along the Ohio fact, has given people longer, healthier got sick, and it was very expensive and River near the Ironton area of the lives as a result. they lost their insurance because they State, writes: So this issue is not so much par- got cancer or they had a child born I have been notified that any Medicare tisan—although my friends on the with a preexisting condition. They can- Part D monthly premiums will increase 25 other side of the aisle made it that—it not get insurance. So they once were percent in 2010. I simply cannot afford this really is a difference in philosophy. increase and I need my medications. I am a happy with their insurance—until they senior, live on fixed income, and suffer from They wanted to continue—my friends needed it. That has happened too many multiple sclerosis. I do not know how to han- on the other side of the aisle pretty times. dle this situation except give up my drug typically do the bidding of the insur- The second thing I see over and over therapy and live with frequent episodes that ance industry. We cannot have health in these letters from the people—simi- require hospitalization. I support your ef- care reform and do it the insurance lar to the man from Indiana I men- forts for health reform that includes a public companies’ way or there will be no tioned earlier—is people who are 61, 62, option. health care reform. 63 years old, maybe 59 years old, who One of the things that will happen We stood on the Senate floor—Sen- are sick or they are not sure about under our health care bill is that the ator MERKLEY and I, and Senator their health and they cannot get insur- doughnut hole that keeps people such KAUFMAN and Senator WHITEHOUSE and ance, they just say: I wish I was 65. I as Joyce around Ohio and around the Senator TOM UDALL and others—talk- cannot wait until I am 65 so I can get State and around the country who ing about some of the things insurance covered because I know Medicare is don’t—it means people pay so much companies have done, such as having stable and will not cut me off their out of pocket for their prescription preexisting condition exclusions, where plan. drugs coverage, we will close—ini- someone who has an illness cannot get What kind of health care system do tially, we will close it by half, and we insurance. we have when a 61-year-old writes a are going to offer some four amend- When I was on the C–SPAN show letter to their Senator saying: I cannot ments to close the doughnut hole en- today, a gentleman from Indiana wait until I am 65 so I have health care tirely so that people don’t get hit so called. He is 63 years old. He has a pre- protection, I have health care security? hard by drug costs. existing condition, and he cannot get There is something wrong with that. Karen from Morrow County up near insurance. He has 2 years to wait to get We fix that too. where I grew up in the Mount Gillian on Medicare. But he knows when he is The third thing I hear in these let- area, sort of north-central Ohio—Karen on Medicare, Medicare will not take ters—then I will read them briefly—is writes: away his coverage, exclude his cov- people call for the public option be- Please vote for health care reform for all erage because of a preexisting condi- cause they know a public option will that includes a public option. As a middle- tion. Neither will the public option ex- help them, will help discipline insur- aged female small business owner in rural Ohio, I am tired of seeing my community clude him from coverage because of a ance companies and make them be- preexisting condition. ravaged by the loss of affordable and acces- have, make them more honest. The sible health care. With a preexisting condi- But you know Cigna does, you know public option will save money because Aetna does, you know WellPoint does, tion, I have no option but to stay with my they will compete. present provider and cross my fingers each you know Blue Cross—the insurance In southwest Ohio, Cincinnati—in year on my birthday that I won’t be dropped. industry so often excludes them be- Hamilton and the three adjoining coun- This is a small business owner. cause of a preexisting condition. That ties to Hamilton: Clermont, Warren, One of the things we knew right away is why they can afford to pay their CEO and Butler; those four counties—two and that Senator MURRAY and Senator at Aetna $24 million a year. That is insurance companies in those four MERKLEY and I worked on in the HELP why insurance company profits have counties control 85 percent of the in- Committee was to make sure there gone up 400 percent over the last 7 surance policies. Obviously, with that were good, strong incentives for small years—because the insurance compa- lack of competition, the quality is low businesses to be able to afford health nies deny care for so many people, so and the cost is high for that insurance. insurance for their employees. Whether they cannot get covered, they cannot Injecting a public option will inject it is in Olympia or Spokane or Port- get insurance. Then they turn down so confidence. The existence of a public land or Eugene or Cleveland or Toledo, many claims. Thirty percent of insur- option will inject competition and we have all been in similar situations ance company claims are turned down make those insurance companies work where we have small business owners initially by the insurer. So even if you better. approach us all the time. eventually appeal and get your claim This first letter is from Patricia from I have 20 employees. One of them got can- covered, get your claim paid for from Hamilton County: cer. It costs so much for this one employee the company that you have paid pre- I am a senior who has been on Medicare for that they are either dropping my small busi- miums to—if you ultimately get your several years now. I also have a supple- ness coverage or the cost has spiked so much claim paid for—why should you have to mental insurance plan with reasonable pre- that we can no longer afford it. What are we get on the phone day after day and call miums and copays, but that has continued to going to do? your insurance company and complain rise over the last two years. Therefore, I Our bill will bend the cost curve for and complain and cajole and persuade don’t have any problems accessing the care I them and will give them tax credits so and finally get it paid? That is not how need now. However, I have multiple sclerosis they can buy insurance and allow them our reform will work. That is not how and when I was younger and living in an- to go into the exchange so they are in the public option will work. other state, I was subjected to the pre- a larger pool. So 1 or 2 illnesses in a existing condition exclusion. Fortunately, I Mr. President, I know Senator MUR- was employed by the state which allowed me company of 20 or 30 people won’t cause RAY is here to speak in a moment. I to obtain a reasonable health plan. But I the price spikes that a larger pool of just want to, as I have done many know a lot of people are not as fortunate as insurance will be able to blunt. times on the Senate floor in the last 3 I am. It is our responsibility as citizens to The last letter—and then I will turn months, share three or four letters make sure all of our people have good health it over to Senator MURRAY—is from

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.005 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11830 CONGRESSIONAL RECORD — SENATE November 20, 2009 Gail from Belmont County, which is sharing those stories. It tells the com- letters and e-mails from people across eastern Ohio near St. Clairsville, pelling reasons why tomorrow night’s Washington State sharing their health Flushing, that area of the State. Gail vote to move to this bill is so impor- care stories with me. Those stories writes: tant, and we are all honored to be a came from small business owners, from I am a teacher and my husband is retired. part of that. employees, from moms and dads who In March 2009 I was diagnosed with cancer After a lot of hard work, it is amaz- told me how they are struggling with and began treatment soon after. I had sur- ing that our country really is now clos- the cost of care today. So many of geries, radiation therapy, and chemotherapy. er than we have been in decades to them cannot afford the status quo and I have an employer based plan, but it doesn’t passing a real health insurance reform deserve health insurance reform that cover the entire costs of some of my expen- allows them to keep coverage if they sive drugs which can cost thousands of dol- bill that will help provide our families lars. How does someone without insurance and our businesses with affordable and like it, gives them additional options if afford such treatment? The fact is, they stable health insurance coverage. they don’t, makes their care more af- can’t. I really didn’t realize how expensive There is a lot of debate and there is a fordable, and guarantees, finally, sta- health care had gotten until I got sick. lot of work still ahead of us, but it ble coverage that cannot be taken Which is kind of the situation with should not go unnoticed that this is a away when it is needed the most. all of us. big moment for our country, and you I have come to the floor many times over the last several months as we One of my sons is a veteran and has cov- know what. It couldn’t come soon erage that way. One son is in college and is enough. have worked to put together our Sen- still covered under my insurance. But my Our economy is hurting. Americans ate bills and I have shared some of third son works seasonally and is not cov- across the country are so worried these stories on the floor. Now that we ered at all. He had an appendectomy several about keeping their jobs and making have a plan on the table, I wish to tell years ago and the resulting medical bills de- their mortgage payments. The last two of these stories once more to really stroyed his credit. I don’t know what will stress people need today is to worry demonstrate the desperate need for us happen if he ever gets sick again. It is not to move quickly and to get this bill right to leave the poor to flounder without about the cost of getting sick or being dropped from their insurance plan or passed. proper medical coverage. It is time to end Chris Brandt, from Spokane, WA, opening the mail and seeing yet an- the greed of insurance and drug companies told me a story about his problems and have them face fair competition. other premium increase. Health insurance premiums for fami- finding coverage. Chris told me he is a That is really all we are saying here. healthy young man who works for a We want to create a system with con- lies in my home State of Washington have more than doubled in the last 10 small business that cannot afford to sumer protections so that insurance provide coverage to its employees, so years, and they are rising at a rate companies can’t drop people for pre- Chris, as do a lot of Americans, had to that is five times faster than people’s existing conditions; can’t put a limit find coverage on his own through the salaries. Families and small business on their coverage so that when they individual market. He told me that owners are paying more and more for get sick they lose their insurance; after paying his mortgage, his car pay- their coverage, and often they are get- can’t discriminate against women, ment, and his student loans, the only ting less and less in return. These num- whom they usually charge more for insurance he could afford is a cata- bers demonstrate clearly what families premium costs for their insurance poli- strophic plan that might keep him out and small business owners across my cies than they charge men; can’t dis- of bankruptcy if he gets sick. But even State of Washington understand all too criminate based on geography or dis- the cost of that plan has doubled—has ability. We want to give incentives to well. The status quo in the health in- more than doubled in the last 2 years. small businesses so they can insure surance system is unsustainable and So here is a man named Chris who more of their employees, and we want the cost of inaction is just too high for wants insurance. He doesn’t want to be to bring competition into the system them to bear. a burden to anybody else if he gets so insurance companies have to com- The news we got back from the Con- sick, but he cannot keep up with the pete better than they have, driving gressional Budget Office on Wednesday rising cost. We have to have a system prices down. That is what this legisla- is encouraging. It shows the American that encourages people such as Chris to tion does, not to mention a lot in pre- people that our bill, our legislation will get high-quality insurance that covers vention and wellness. Prevention is in save money while protecting Medicare, preventive care so that those small, in- the bill, which really will help keep and it ensures that families and busi- expensive medical problems can be people out of hospitals and live longer nesses can take back control over their treated before they become large, ex- and healthier lives. That is our mis- own health care choices. pensive medical problems. That is what sion. If we do not pass this bill, health in- will keep our families healthy, and it This Congress has tried to do this for surance premiums are going to con- will save money in the system in the seven decades. Tomorrow will be a his- tinue to skyrocket. If we fail to act, long run. toric moment when we vote in the health insurance companies will con- I also received a very compelling evening to move this bill to the floor of tinue to deny patients coverage simply story from a woman named Patricia the Senate so we can begin this proc- because they are sick. And if we let an- Jackson who lives in Woodinville, WA. ess. It is the most important thing pro- other year go by without reform, more Like a lot of working families, the fessionally I have ever done in my life. and more families are going to lose Jacksons told me they have insurance I feel privileged to have the oppor- their coverage and more and more busi- through their employer and they pay tunity to be a part of this and to fight nesses are going to collapse under the their premiums each month directly for 11 million Ohioans. I know this growing burden of the cost of health in- through Patricia’s paycheck. But also isn’t a bill just for uninsured Ohioans; surance. It doesn’t have to be this way. like a lot of our families, the burden of it is a bill to make businesses more We have been talking about reforming those premium payments is rising too competitive, to help small businesses, our health insurance system for a very quickly. Patricia told me that to care to give consumer protections to those long time here. Now we owe it to the for her family of four, she paid $840 a who are happy with their insurance American people to give them more month in 2007—$840 a month. In 2008, and want to keep it, and to help Medi- than just talk; to give them, finally, her payments jumped to $900 a month. care beneficiaries by closing the dough- the stability and security of a health This year, Patricia paid $1,186 a month. nut hole and bringing some of their insurance system that will be there for Now, before this year is even over, she out-of-pocket costs down so they can them when they need it and that can- got a new bill and her rates have been live healthier, longer lives. not be taken away from them if they hiked to $1,400 a month. That is an in- Mr. President, I yield the floor. get sick or if they lose their jobs. crease of over 66 percent for her pre- The ACTING PRESIDENT pro tem- Six months ago, I sent a letter to my miums in just 3 years. pore. The Senator from Washington is constituents asking them for their sto- Patricia, not surprisingly, told me recognized. ries and their thoughts on health insur- she and her family can no longer afford Mrs. MURRAY. Mr. President, I wish ance reform, and the response I got was to pay this, and she is not alone. Fam- to thank the Senator from Ohio for overwhelming. I received over 10,000 ily health care coverage rose over 86

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.006 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11831 percent between 2000 and 2007. That is Mr. DURBIN. Mr. President, we gath- care reform proposal. Again, ours is an increase in my State of over $5,600 er on the floor today at a time that is democrats.senate.gov/reform. What is per family. Wages during that time pe- historic. It is hard to imagine, to put it the Republican Web site? Where can we riod only grew 16 percent. in the appropriate context, but this de- find the Republican bill? I know the The largest private insurance com- bate over health care reform is re- answer. There is no Web site where you pany in my State sent out a letter in markably similar to the national de- can find the Republican health care re- August to all of the people who get in- bate over the creation of Social Secu- form bill—at least not today. I hope it surance through them and told them rity, or the creation of Medicare. It is will come soon. They have spent their they were raising rates by 17 percent— that historic. It affects that many time criticizing our efforts to change 17 percent. Some of my small business Americans and their futures. That is this system. That is healthy in a polit- owners are telling me premium in- why it is important that all of us come ical system like ours, but at some creases are going up 40 percent. This forward to understand what this debate point criticizing isn’t enough. Stand makes families and businesses have to is about, the important issues that are and tell us what you are for, what you make choices about what they can pay. before us. are going to propose. Families are really struggling today The starting place for those who If we start moving on this, as we ex- in this tough economic climate. It is want to get into it is, of course, a Web pect to tomorrow, the procedures will the worst since the Great Depression. site in today’s technology and reality. take us to the consideration of the They cannot afford these cost in- The Web site is democrats.senate.gov/ Senate Democratic amendment offered creases. So the bill we are about to reform. If you visit that Web site, you by Senator HARRY REID. I want to sug- bring to the floor will finally—finally— will be able to see the bill that will be gest and heartily recommend to the make insurers compete for the business before Congress in its entirety. You Republican side of the aisle—I see my of the American people. That is what will have your chance to read it, friend, Senator JOHN BARRASSO, of Wy- families and small business owners in though it will be challenging. It is dif- my State and across the country want oming, who is here. He is a medical ficult not having all of the Federal doctor, an orthopedic surgeon. We are and need, and it is what they deserve. statutes before you. But most of it is The bill we are going to bring before friends. We may disagree on this issue, fairly clear in terms of what we are but we agree on many other issues. I the Senate will make health insurance trying to achieve. more stable. It will end the unfair and hope he will encourage his leadership There have been critics of the bill to produce a bill, show us what they deceptive insurance company practices who have come to the floor and argued such as cherry-picking and cancelling believe. It would even be good if they that this bill should be defeated be- send it to the CBO, as we did, and let us coverage because of preexisting condi- cause it is too long, too many pages. tions. It is going to reward what works know what it would cost for the Repub- They bring to the floor more than a lican plan for health care reform. in this system and change what copy of the Senate bill; they bring the I will tell you what we have received doesn’t. Finally, it will start reining in House bill and the Senate bill and from the Republican side of the aisle. those costs so that health care can be- stack them up here to say how long come more affordable. It is going to It is three pages long. If you are look- this is. Well, of course, we are not allow people such as Chris to get high- ing for brevity, it is a very brief anal- going to vote on the House bill; it is quality coverage, and it is going to rein ysis of the health care reform issue in the Senate bill. That is a bit of an ex- in the costs for people such as Patricia. America. It is a press release from Sen- aggeration, but it is a long bill, over This is more important now than ever ator MITCH MCCONNELL, where, as of 2,000 pages. I won’t talk about whether before as our economy struggles and yesterday, Senator MCCONNELL laid out it is small or large print, but it is 2,000 the cost of that care continues to rise. everything—maybe not everything but pages plus. We have been talking about health most of the things he thought were You may ask, why does it take so insurance reform for a long time, and wrong in the Senate Democratic ap- many words to address this? But wait a while we were talking, families and proach. It is all negative. There is not minute, this is about health care in small businesses have suffered. It is one positive in here in terms of what America. One out of every six dollars now time to end the politics and end the Republicans would do. Are they in our economy is spent on health care. the partisanship and come together to sensitive to the reality of health care It affects every single American cit- bring our families and our small busi- in America today? Do they know the izen, and it will be challenged in court ness owners the health insurance re- cost of health care insurance premiums by the health insurance companies forms they deserve. have gone up three times faster than that want to stop this health care re- As we move forward in this debate, I wages, that fewer businesses are offer- form. We have to make sure this is am going to be working very hard to ing health insurance coverage to their carefully and well written, perhaps err- make sure that the needs and priorities employees, and that more and more ing on the side of adding more lan- of Washington State families and busi- Americans have no health insurance guage so there is no question as to our nesses are preserved and that we move protection because of unemployment intent. But that is it. forward in a way that ensures that the and because of the cost of health insur- future health of our families and the The obvious question I ask back to the critics on the Republican side of ance today? Are they aware that two strength of our economy is there. So I out of three people filing for bank- urge all of our colleagues to work with the aisle, who say we should vote against this bill because there are too ruptcy today are doing so because of us now in a very constructive way over medical bills—two out of three—and the next several weeks as we debate many pages in it, is: Where is your bill? Where is the Republican health care re- that 75 percent of them have health in- this bill. and to rise above the par- surance that isn’t any good? And they tisanship. Let’s make health insurance form bill? I know that in a few moments—in are in bankruptcy court. Are they work for our families, our economy, about 10 minutes—Republican Senators aware of this cost challenge? If so, and for our country. That is what this will come to the floor to talk about what will the Republicans do about it? debate is about. They will show us a stack of paper Mr. President, I yield the floor. this important issue. I welcome that. I that Senator BARRASSO will show when I suggest the absence of a quorum. wish we could come to the floor at the The ACTING PRESIDENT pro tem- same time. We might get close to he speaks, but they won’t show us the pore. The clerk will call the roll. something called ‘‘debate,’’ which Republican alternative. What is it? The bill clerk proceeded to call the would be an interesting phenomenon in How much does it cost? How many peo- roll. the Senate, as it is something we have ple will it cover? Mr. DURBIN. Mr. President, I ask gotten away from. When they come to I hope my friend from Wyoming is unanimous consent that the order for the floor, I hope the first Senator who the first Republican Senator who will the quorum call be rescinded. stands up will do what I did. I hope the come to the floor and join us in at least The ACTING PRESIDENT pro tem- first Republican Senator will read a saying there is one thing we agree on— pore. Without objection, it is so or- Web site where the American people that health insurance companies are dered. can go to to read the Republican health running roughshod over consumers and

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.007 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11832 CONGRESSIONAL RECORD — SENATE November 20, 2009 families of America. I hope this Sen- 5-percent tax on cosmetic surgery. He Mr. DURBIN. Mr. President, I am ator from Wyoming, and other Repub- went on to say that this bill would looking forward to reading their bill. lican Senators, will say there is one cover breast reconstruction surgery I yield the floor. thing we can agree on with the Demo- after a mastectomy—in other words, The ACTING PRESIDENT pro tem- crats: We should stop these abuses by imposing a tax on a surgery for breast pore. The Senator from Wyoming. health insurance companies. We should reconstruction. I want to respond to Mr. ENZI. Mr. President, I ask unani- not allow these health insurance com- him and say he is wrong and inac- mous consent that the Republican Sen- panies to turn you down for a pre- curate. I want to make sure the record ators, during their hour, be permitted existing condition when you get sick. is clear. The bill we are proposing says to engage in a colloquy with fellow Re- We should demand that the health in- the surgery is not a cosmetic surgery if publican colleagues. The ACTING PRESIDENT pro tem- surance companies cover our children it is ‘‘necessary to ameliorate a de- pore. Without objection, it is so or- beyond the age of 23. formity arising from, or directly re- dered. My wife and I have been through this lated to . . . disfiguring disease.’’ That Mr. ENZI. Mr. President, I rise to with our kids, and a lot of others have, is in the bill. talk about the health care reform bill. too. Here comes your son or daughter, The bill points to the current defini- This country needs health care reform. fresh out of college and looking for a tion for deductible medical expenses The status quo in health care is unac- job—oops, he or she is 23 years old, so for the interpretation of this language. ceptable. Health care costs are sky- now they need their own health insur- The IRS has already dealt with this. rocketing, insurance premiums are in- ance. Our bill moves that age to 26. IRS publication 502 specifically states creasing, and too many small busi- Could the Republicans endorse that that breast reconstruction surgery fol- nesses can no longer afford to offer idea? It would be great if they did. lowing a mastectomy for cancer is de- health insurance to their workers. No Would they endorse the idea that ductible. It is clearly not taxable under one on either side of the aisle denies we your health insurance would stay with our bill. need health care reform. you if you lose your job, and that we That statement on the floor by Sen- We need to enact reforms to bring should not put caps on the coverage of ator COBURN was inaccurate. I wanted down costs so everyone will have ac- a catastrophic illness so it won’t wipe to make that clear. The Senator was cess to quality, affordable health care. out a family? I hope they will join us in mistaken. Breast reconstruction sur- We need to take a step-by-step ap- health care reform. gery is not elective cosmetic surgery proach to reduce health care costs and Of all the criticisms, I have yet to for the purpose of this bill and is not lower insurance premiums for individ- hear the first Republican Senator take subject to the bill’s 5 percent excise tax uals and employers. We need to elimi- on the health insurance companies. on elective surgery. nate discrimination based on pre- That is what this battle is about. Who I know we have a limited amount of existing conditions and ensure that will win? Will it be the American peo- time before the other side of the aisle people can take their insurance with ple or the health insurance companies? has a chance to speak. I will save my them from job to job. I support com- I hope our friends on the Republican remarks I had planned relating to some monsense reforms that would achieve side of the aisle will join us in saying people in my home area back in Illi- all these goals. that it is clear it will be the American nois, who are battling health insurance Unfortunately, this 2,074-page Reid people. companies. On the Senate floor, I told bill fails to address these issues. In- Finally, this bill will expand cov- the story of Danny Callahan, a baseball stead, this bill would raise taxes by erage to 30 million more Americans. coach at Southern Illinois University $493 billion. It would cut another $464 How many more Americans will be cov- who is fighting cancer. WellPoint has billion from the Medicare Program. ered by the Republican health care returned down the drug he was using, The bill would reduce wages and elimi- form plan? I am sorry to say I can’t which his doctor recommended, to nate the jobs of millions of Americans. tell you. No one can tell you, because fight cancer and said they won’t pay It would actually drive up health insur- they have not produced a plan. We for it. It is a good drug for him, but it ance premiums for many more Ameri- don’t know what they are planning on is expensive. It stopped the spread of cans and still leave 24 million people doing. cancer. His doctor said this drug without insurance coverage. We need This bill we are bringing before the works, but the health insurance com- to do better than that, and I think we Senate tomorrow for a procedural vote pany won’t pay for it. The drug costs can. and to start the debate is a bill that is $12,000 a month. Danny Callahan can- Our country currently faces one of not perfect. I would have written it a not afford that. He will get a couple the worst economies in a generation. lot differently. But it is a bill that we more treatments, but that is it. At the Our unemployment rate is 10.2 percent, are working toward a working major- first of the year, the health insurance which means there are 15.7 million Americans without jobs. ity on. That means concessions. Some company is cutting him off from this of these concessions are painful, from At the same time, the bill we are de- lifesaving drug that is attacking the bating, or will be debating when we ac- my personal point of view, but they are cancer in his body. They made that de- tually get to the real thing, would im- necessary. It would be great to have cision. His doctor said it was the wrong pose $28 billion in new taxes on em- one Republican Senator cross the aisle decision. He is another of many Ameri- ployers. This new tax will eliminate tomorrow night and say, all right, I cans who are at the mercy of the millions of American jobs and reduce may not agree with everything in your health insurance companies when you wages for millions of American work- bill, but I do believe this is an impor- need help the most. ers. tant national issue; the Senate should Can we change this? Can we give the When employers struggle with extra debate it, and this Republican Senator American people a fighting chance costs, workers and their families feel will join the Democrats in saying let’s when it comes to these situations? I the impact. American workers depend proceed to the issue, proceed to the de- think we can. But we won’t do it by on a strong economy to create jobs bate. I don’t think that is too much to saying no. That is what we have heard that help them feed their families and ask. In fact, I think most Americans from the other side of the aisle—no to build their dreams. Unfortunately, the would say: Why wouldn’t they want to everything. I hope that after 11 o’clock policies being pushed by the majority debate it? Tomorrow night, they will today, on Friday, November 20, the will only make it more difficult for have a chance to vote on that cloture first Republican speaker will say: Here America’s businesses to hire workers motion on the motion to proceed to is the Republican health care reform or pay current employees more. that debate. I hope they will join us at bill. You can find it on the Web site. The Congressional Budget Office, that point. You can read it and compare it to the health researchers, and nationally rec- I will address one particular issue Democrats’ bill. Again, the Democratic ognized economists all agree that Sen- raised by one Republican Senator yes- version is available at ator REID’s new job-killing, employer terday. Senator COBURN of Oklahoma, a democrats.senate.gov/reform. Read it. tax will mean one thing: More Ameri- medical doctor, said of the Democratic The ACTING PRESIDENT pro tem- cans will be out of work if this bill be- health care reform bill that there is a pore. The majority’s time has expired. comes law.

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.008 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11833 As I mentioned, this bill will raise afford. The intensity of the country’s sort of thing, how to deal with this, taxes by $1⁄2 trillion—$1⁄2 trillion. The disapproval is apparent in townhall how to comprehend it. What does it authors of the bill truly believe the meetings, letters to newspaper editors, mean? What if I like something on page greatest problem in our health care citizen protests, constituent calls, and 208 but don’t like something on page system is that we do not pay enough letters from all across the Nation. I re- 1,200? taxes for our health care. ceived some of those that said: My Sen- We ought to be using a step-by-step Under this flawed bill, if you take a ator is not listening but you are. process. My colleague has a wonderful prescription drug, you will pay a new I wish to find solutions. Ask most of program, a 10-point plan to improve tax. If you use any medical devices or my colleagues and they will tell you, our health care, and any one of those equipment, ranging from walkers to time and time again, I have been would be a positive step to actually wheelchairs, you will pay a new tax. If known to work across the aisle on com- helping American families, helping you do not have health insurance, you monsense reforms on all kinds of them get the health care they would will pay a new tax. If you do have issues. I have fought for years to enact like and they need. But not these health insurance, you will also pay a commonsense reforms that will help bills—one through the House, one new tax. If the government decides slow health care cost growth and make through the Senate. your health insurance is too expensive, the insurance market work better for I don’t know if my colleague wants there will be a new tax for that as well. small businesses. to join me in discussing the townhall The problem with our current health I worked closely with Senator BEN meetings, where people said: We want system is not that we don’t pay enough NELSON from Nebraska on a bill that health care reform; we want things taxes. Americans actually want to would allow small businesses to com- that are going to make life better but lower their health care costs—that is bine their purchasing power across to help keep down our premiums, help the message—not just pay more taxes State lines, even nationwide, and col- keep down the cost of our care. Eighty- to the Federal Government. All these laboratively buy health insurance at five percent of Americans have health taxes will only increase costs, making discounted rates. care coverage. They are just not happy health care even more unaffordable. I worked closely with the late Sen- with the cost. What I heard for the last The third major problem with this ator Ted Kennedy on a bill to reform hour from my colleagues on the other bill is it will actually increase the cost the drug approval process at the Food side of the aisle is we need to cover of health insurance for millions of and Drug Administration. more people; we need to cover more Americans. The bill mandates that in- I worked closely with then-Senator people. That is only part of it. We need surance premiums for younger, Clinton on a bill to save lives and de- to keep down the cost of care for the 85 healthier workers be tightly tied to the crease costs by promoting greater use percent of people who like the care costs for older, sicker individuals. This of electronic medical records. they have. will immediately drive up costs for the Time after time, I have advocated That is what happens when we get to- young, healthy individuals who, coinci- that we set partisan differences aside gether with groups of people from dentally, make up a significant portion and work on the 80 percent of the issue around the State of Wyoming who of our current uninsured population. that will make a difference for most come out for our townhall meetings to The bill also eliminates consumer people. discuss the issues, to listen. We are choices, requiring Americans to buy Unfortunately, rather than working there mostly to listen; they are there richer types of plans that cover more of with Republicans to develop a com- mostly to talk. the deductibles and cover more out-of- monsense solution, the majority draft- I ask my colleague, is that not ex- pocket expenses. These plans typically ed a flawed bill that spends too much, actly what we heard: We need changes have much higher premiums. does too little to cut health care costs, but not this? Taken together, these insurance and puts seniors’ benefits on the chop- Mr. ENZI. Absolutely and not just changes will increase costs for millions ping block. townhall meetings. That is how the let- of Americans. In looking at more mod- The White House and Democratic ters, e-mails, and phone calls are com- est provisions included in the Senate leaders should have responded to these ing in, greatly in response to what they Finance bill, nationally recognized ac- concerns with alternative ideas that anticipated they were going to get, counting and business consulting firms actually address the health care issues which was going to be lower costs. found these changes would increase in- that most Americans care about—their They don’t mind helping other people surance premiums by 20 to 50 percent. cost. Unfortunately, they decided to to have insurance and subsidizing that The practical effect of this bill is, simply try a more aggressive sales insurance or in some cases providing it Washington could dictate to every sin- pitch. As a result, opposition to it will for free. But they expected to get some- gle American, even those who have in- only continue to grow. thing out of it themselves. We miss the surance they now like, the coverage If this bill continues to move for- mark on this. You can tell they missed they would need to purchase. Wash- ward, in spite of what most Americans the mark. The bill that has been ington will tell you what is good are telling us, I am going to keep offer- brought up to be voted on is just a lit- enough coverage. The bill does not give ing amendments geared to bringing tle 2-page bill. Why didn’t they put up people affordable options, and it penal- down health care costs for American the House bill? Because they couldn’t izes those who do not purchase high- families, scaling back total health care get 60 votes for the House bill. They end, expensive plans, regardless of spending, and protecting seniors. know that is wrong. This is a whole lot what they want, need or can afford. I yield the floor to my colleague from different from the House bill. It is dif- Before I was a Senator, I was a small Wyoming who has copies of the bills. ferent. I give them some credit for businessman. My wife and I owned The ACTING PRESIDENT pro tem- that. They couldn’t put this bill up be- three shoe stores. When I was showing pore. The Senator from Wyoming. cause they can’t get 60 votes, and they someone a shoe and he said he did Mr. BARRASSO. Mr. President, in have to get 60 votes to move on to de- didn’t like it or couldn’t afford it, I joining my colleague from Wyoming, bate. didn’t try another sales pitch. I knew he and I had a townhall meeting to- They brought up the Service Mem- it was time to find another shoe, one gether in Gillette, WY, his hometown, bers Home Ownership Tax Act of 2009, he liked and could afford. If the cus- a wonderful community. I was just which is actually two pages and a sum- tomer is complaining, get something there last week for a Veterans Day pa- mary. So there is not much to that else to show. The customers are com- rade. What Senator ENZI knows and I bill. Their hope is they can get the 60 plaining. The voices of August are still know is when we talk to the people of votes and people will not concentrate out there, and they know this bill is Wyoming, they want commonsense soon the fact of what is in this bill. just more of the same. lutions. I appreciate all the efforts of the Sen- There is a lesson in that story when As I am here with the House-passed ator from Wyoming. He has been in- it comes to reforming health care. It is bill and the Senate bill we are now volved in the health care industry as a time to listen to our customers and looking at, people of Wyoming are as- provider for a long time and a real stu- find an alternative they want and can tonished at the amount of pages in this dent of what is in these bills. He has

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.010 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11834 CONGRESSIONAL RECORD — SENATE November 20, 2009 looked at these bills in detail, so he going to be there anymore because But when the bill was printed, that knows a lot of the flaws. I appreciate they will have spent it on the increased was left out. Staff, without talking to him taking the time to point those out. cost of medical care because these bills any one of the Members, had taken it Mr. BARRASSO. Mr. President, there do nothing to get the cost of care out. I think that is unprecedented are a lot of flaws in these bills because down. around here. But that was not the only what Senator ENZI and I both hear KENT CONRAD, Democratic Senator instance either. I would like to direct when we go to townhall meetings—but from North Dakota, do you know what the attention of Senators to the costs also I had a telephone townhall meet- he called this part of the bill, the on this bill, which the Senator from ing the other day—is: Don’t cut my Democratic bill on which we are going Wyoming has mentioned. As an ac- Medicare. Yet when we take a look at to be asked to vote? He called it a countant, I look at those. They say the details of these bills, it is going to Ponzi scheme of the first order. He said they are going to reduce the deficit in cut $500 billion—$500 billion—from our it is the kind of thing that Bernie the first 10 years and even more in the seniors who depend on Medicare for Madoff would be proud of. That is a second 10 years. There are two ways their health care. Democrat talking about what is in this they can do that. One of them is to They also say: Don’t raise my taxes. bill. raise taxes. The other is to steal money But taxes are going to go up across the What has the Washington Post said? from other people, which is what they board. Every family is going to notice ‘‘It’s a gimmick. These are not savings are doing from Medicare. That, maybe, an increase in their costs, whether that can honestly be counted on the means they are overtaxing? So that through taxes, premiums, an increase balance sheet of reform.’’ might mean they want to stick in some in the cost of their lives in terms of Do we need reform? Yes. Do we need other things that will be spending. Is how it is going to impact the care they health care reform? Do we need to there anybody out there who thinks are going to receive. They say: Don’t change the system? Absolutely. But you can do a $1 trillion new program make my family pay more for health this is not the way to go. and it will not cost a dime? care. But across the board, people look Senator ENZI is here. He has done a I hope people are taking a look at at this and say they are going to end remarkable job as a member of both matters such as the Wednesday edi- up having to pay more. the Finance Committee and the HELP torial by the president of Harvard who When Senator REID brought this bill committee, and he has been part of the made some comments about how out, he said: Of all the bills I have seen, markups for both of the bills. He has things are working. I hope everybody it is the best. To me, it is the best of focused relentlessly on trying to get reads that. This is a good way for our the worst bills I could ever see. It the costs down so the premiums for the Nation to go broke. We are not in very raises taxes. It is not just me speaking. American people will not go up, and he good shape right now, but that is a If you read what the people who had a has offered amendment after amend- good way to go broke, and there are a chance to read the bill say—the Associ- ment, and they have been rejected time lot of gimmicks in this bill too. ated Press, the Washington Post, the and time again. I appreciate the Senator from Wyo- Then Senator REID gets these two New York Times, others throughout ming pointing that out, and I assume bills—one from the HELP committee, the country, our e-mails from home— the Senator from New Hampshire, who one from the Finance Committee— there are higher payroll taxes, compa- is the chairman—ranking member on tries to stitch them together behind nies would pay a fee, rely primarily on the Budget Committee now—and has a closed doors, and there is an amend- new taxes, new fees, and then cuts in handle on a lot of these gimmicks will ment that Senator ENZI had put into Medicare. It is beyond me that this share some of those too. Senate—that this Senate, the Senate of the bill, one of the bills—it was voted Mr. GREGG. If I could join this col- the United States—is ready to tell the on and approved—and then it magi- loquy with my colleagues from Wyo- seniors of this country they are going cally disappeared without the knowl- ming—what a great State to have two to cut $500 billion from the care these edge of any members of the committee. such exceptional Senators. First off, I seniors get from Medicare. That is a It was something intended to help the want to make this point: Obviously, a growing number of people. Year after American people, but that got taken lot of folks are pointing at this bill year, more people are on Medicare but out and thrown away in the dead of which I have right here—the Senator yet the cuts are going to be there. night. from Wyoming has one, and the other The gimmicks, the budget gimmicks I don’t know if Senator ENZI would are astonishing. The advertised like to comment on that, but this is a Senator from Wyoming has one—be- pricetag is an astonishingly large num- Senator who was working to improve cause it is real. Up until now most of ber, over $800 billion. To get down to the lives and health and pocketbooks the debate that has been occurring that astonishingly high number, they of the American people, and his great around here has been media. A lot of it have used quite a few gimmicks. You idea is thrown away. has been theater. Some of it has been get taxes, you get Medicare cuts, and Mr. ENZI. I would like to comment good theater, I hope, but it has been then you get the gimmicks. on that, in some way, unprecedented theater to a large degree. I visited with Senator GREGG from action by a committee. We agreed in Now we are dealing with something the Budget Committee earlier today. committee on some amendments. Then that is extremely real. Every page of He is going to be on the floor to discuss when the bill was actually printed, this 2,074-page bill will have an impact the gimmicks. One of the things they which was not done for 2 months— on Americans. Every page of this bill have done is basically hidden the true which was, I think, so people couldn’t will make a decision and direct a pol- cost of the bill. The true cost of the bill actually look at it during the August icy that will affect the health care of is going to be close to $2.5 trillion over recess, during that 2 months—when it every American everywhere. a 10-year span. They have done it by was finally printed, some of the things It is an extraordinarily intrusive and putting in a whole new program called that were agreed to were left out. One expensive bill. The Senators from Wyo- the Community Living Assistant Serv- of the big ones was an actual wellness ming have been alluding to this, but it ices and Support Act. It is a new Fed- program, one that worked for Safeway, really is historic. The colleagues on the eral long-term care program. that helped cut their cost in the first other side say this is a historic bill. It What happens in these long-term year by 8 percent. is historic. Never in my experience, and care programs? They take in the Have you heard of anybody cutting I don’t think in any experience, has the money early on and then they do not their costs in health care? Their pro- Congress taken up a bill which is essen- spend it until many years later. But in gram did. Since that time it has been tially going to restructure and fun- the way they count money around held level because of what they were damentally change the way that 16 to here—they do kind of a 10-year score, able to do with wellness programs. We 20 percent of the national economy is they call it. For the first 10 years they got that wellness program approved. going to be affected in such an imme- are going to be taking in all of this We didn’t get much approved when we diate and intrusive way. money, and then when it is time to pay were doing that bill, but we got that Essentially, the Federal Government the money out, that money is not approved. will affect every decision that has to do

VerDate Nov 24 2008 02:24 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.011 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11835 with health care as a result of this leg- What they do not account for is when move through the years it will become islation, every decision that has to do those folks go into their long-term care apparent because what will happen is with health care. facility and the money goes out, the the costs of private health care will go The cost this is going to create in the money goes out at an incredibly fast up so much that private employers will area of increasing the size of the gov- rate, and the program balloons radi- start to drop their health care. They ernment is astronomical. We have cally in its costs. They do not account will take the penalty, which is not that heard this number, that this is a $890 for that. They just account for the high in this bill compared to what they billion bill. That is pretty big. I sus- years when people are paying in, and have to pay in health care costs, and pect that would run the State of Wyo- they claim that as surplus money they move their people, and say: Sorry, I am ming for a few years, maybe a century. apply to try to reduce the cost of the not going to give health care any- I think the State of New Hampshire bill. So they spend the money. more—or never did—and go get this would probably run for pretty close to This is classic. First, they take in government plan. a century—in fact, more than a cen- the money and claim it as an adjust- Then down the road Congress will tury, to be honest with you. I don’t ment against the debt they are running change this government plan a little think our budget is $8 billion yet. So up, and then they spend it so it will not bit, and they will start to put price that is a lot of money, $800 billion plus. even be available to pay for the pro- controls in, just like they want to do in But that is not the real number. That gram they claim they are going to fund Medicaid. Basically, that will mean is a phony number. That is a bait-and- with it. It is just inconceivable. people will get fewer products because switch number. Bernie Madoff is in jail. Whoever as you put price controls in you will That number is arrived at by claim- thought up this program and scored it have less innovation, fewer drugs. ing, over a 10-year period, that the pro- in this bill, Bernie Madoff would be Fewer devices will be developed be- grams that are initiated in this bill— proud of that person. He would say: My cause people will not be getting a re- which is a massive new entitlement— type of guy. That is the way you do ac- will not start until the fourth and fifth turn on their investments because counting—fake it. year. In fact, the House bill was at these will be price-controlled events. It is unbelievable. There are a whole You will find delays because that is least a little more honest than the Sen- series of these types of games in here. what happens when you move to a gov- ate bill. It started in the fourth year. The States are going to be taken to the The Senate bill starts in the fifth year ernment program that controls costs. cleaners by this bill. The allegation with most of the spending. But the The government can only control cost that we are going to expand Medicaid taxes which the Senator from Wyo- by controlling price. That creates by 20 to 30 million people, and the ming, the senior Senator from Wyo- delays in access which is what happens States are not going to end up paying ming was just talking about, and the in England and Canada. So the quality fees and the reductions in Medicare, a huge bill as a result of that? Absurd of the health care system goes down. they start pretty much in the first on its face. It is absolutely absurd on I ask my colleague from Wyoming, year. its face. who is uniquely qualified to comment So they have taken 10 years of taxes, More importantly, when we expand on this because he is a doctor and he fees, and cuts in Medicare, and they Medicaid by 20 or 30 million people, the has experienced the problems of deal- have matched them against 4 or 5 years doctor will tell you, back here, the rea- ing with Medicaid, is this not a reason- of actual spending and claimed that son Medicaid is in such dire straits is ably accurate reflection of what will they are in budget balance and that the because doctors will not see Medicaid happen if we move another 20 or 30 mil- bill only costs $890 billion—only. patients. Why? Because they are reim- lion people into the Medicaid Program? In fact, CBO has scored this over the bursed at 60 percent of the costs. Who Doesn’t that mean that private insur- real period, when all the programs are pays the other 40 percent, by the way, ance policies have to go up, fewer doc- in place. Over that period, over that 10- for the present Medicaid recipients? tors will see fewer people, and inevi- year window when all the programs are Who pays the other 40 percent? I will tably we will end up with a cost shift functioning that are created under this tell you who pays. Mary and Joe Jones, which forces private insurers to drop bill—all of them being Federal pro- who are working down at the local res- insurance? grams, brandnew entitlements, ex- taurant who have health insurance, Mr. BARRASSO. Mr. President, that traordinarily expensive initiatives— they pay it with their premium. Bob is exactly what is going to happen. No. when that occurs, this bill costs, by and Marie Black, who are working over 1, we will get this huge push of an un- CBO’s estimate, $2.5 trillion. In order at the local software company, they funded government mandate onto the to pay for that we would have to cut pay it with their health care premium. States, a mandate that both Repub- Medicare by over $1 trillion. In order to The 40 percent of Medicaid that is not lican and Democratic Governors have pay for that we would have to raise paid for by the government is paid for called the mother of unfunded man- taxes, fees, by over $1.5 trillion. This is by people who are in private insurance. dates, and they are across the board a massive increase in the size of gov- Their insurance premiums go up be- opposed. This is the way that Wash- ernment, a massive increase in tax bur- cause they are subsidizing Medicaid re- ington, with its wisdom, will say: We den, a massive effect on Medicare. imbursements because the hospitals keep the price down, but what we will The Senator from Wyoming men- have to get paid for the cost, and they do is make the American people pay for tioned there are a few gimmicks in are only getting 60 percent of it from it in a roundabout way. The more peo- here on top of the huge gimmick, that the government and the other 40 per- ple you have on Medicaid, the program it is a bait-and-switch, that this is a cent is being picked up by the private to aid the poor—and we have seen this $800 billion bill when in fact it is a $2.5 sector. in Massachusetts with their health trillion bill. There are a lot of other When we expand Medicaid by another care plan; there are not enough doctors games in here that deal with budg- 20 or 30 million people, we are inevi- to take care of everyone so the system eting. I found one of the more enter- tably going to drive up the costs of pri- is swamped, which is why it is taking taining ones: the fact they take credit vate insurance again. So the private in- now up to 9 weeks to get an appoint- in this bill for creating a new program, surance policies go up. What does that ment to see a doctor in Massachusetts, the CLASS Act, a massive new pro- do? It does what this bill is basically but also about 40 percent of doctors do gram, a long-term care program. They intended to do: it will force employers not see Medicaid patients because the take credit in this bill as that being a to drop private insurance and move reimbursement rate is so low. budget surplus item. How do they fig- people over on to the public plan. That, What you said, 60 percent of the cost, ure that out? Because on a long-term when you get down to it, is what this is that is exactly right. It doesn’t cover care program, basically people in their all about. This is an exercise in having the cost of seeing the patient. We are twenties, their thirties, their forties, the Federal Government get control talking about hiring a nurse, turning even into their fifties, pay into it. It is over all health care. It is being done in the lights on, paying the rent on the like buying insurance under this plan, an incremental way. They are setting office, doing all of those things, the so that money comes into the Federal up a scenario that will not be imme- medical charts, the liability insurance, Treasury. diately apparent to people. But as we the whole list of the costs of having an

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.012 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11836 CONGRESSIONAL RECORD — SENATE November 20, 2009 office opened. You cannot keep the of- When I hear my colleague from New This page right here, page No. 1, cost fice open if all of your patients are Hampshire talk about all of the gim- the American people $2 billion. You Medicaid patients. As a result, physi- micks being used in an effort to claim could pick almost any page in this bill. cians—and I saw every Medicaid pa- this is a good bill, I refer to this morn- And I don’t think they are worth $2 bil- tient who wanted to see me. My part- ing’s column ‘‘Health Bill Hoax.’’ Only lion a page. This page here, what does ners and I have the same program Bernie Madoff could believe the Sen- that say? I don’t know. I am just pick- where anyone can call and get an ap- ate’s health care bill will expand cov- ing this out: Transfer to the Secretary pointment, regardless of the ability to erage to 31 million while cutting the of Treasury a list of individuals who pay. But we know 40 percent of the doc- deficit by $127 billion over 10 years. It are issued a certification under sub- tors don’t see patients on Medicaid. would be the first profitable entitle- paragraph (h), including the name and Mr. GREGG. If I may ask a question ment. Kind of like when the President taxpayer identification number for on that point, this is an important of the Senate, at an AARP townhall each individual, the name and taxpayer point. As a practicing physician, if all meeting this year, said: We have to identification number of each indi- your patients had been Medicaid, would spend money to keep from going bank- vidual who was an employee of an em- you have been able to pay your bills? rupt. On its face, we know how abso- ployer but who was determined to be Mr. BARRASSO. The answer is no. lutely ridiculous that sounds. You eligible for the premium tax credit Doctors’ offices cannot stay open at can’t do that. This is an incredible ex- under section 36(b) of the Internal Rev- the rate that Medicaid reimburses, and pense: taxes galore, all over the place. enue Code of 1986 because, A, the em- no hospital in the country can stay The word ‘‘tax’’ is used in the Senate ployer did not provide essential cov- open if they are getting paid across the bill 183 times; ‘‘taxable,’’ 164 times; erage, and B, the employer provided board at Medicaid rates. You have to ‘‘taxes,’’ 17 times; ‘‘fee,’’ 152 times; such minimum essential coverage, but have other people who are paying more ‘‘penalty,’’ 115 times. it was determined under section—and to make up for the underpayment by For people who believe this will keep on it goes—section 36 (b)(c)(2)(c). the government on Medicaid. down the cost of care, it will not. As I don’t understand what that said. We Mr. GREGG. If I might follow up, my colleague from Wyoming said ear- now will have about 72 hours to figure doesn’t that inevitably mean that the lier, I advise Members to take a look at it out. But I know this much: When a people who are paying more are in the an editorial by the dean of Harvard bill costs $2 billion a page and when it private sector, which means premiums Medical School, living in a State where includes language such as that, it is for people in the private sector go up, they have the Massachusetts health something we should spend some time which means fewer people are willing care plan, which is government-forced on. This bill is being rushed. It should to give that type of coverage because insurance, government-mandated care, not be rushed. This vote that will occur the cost is too high for the business to government-run care. According to the tomorrow at 8 o’clock at night, after cover; right? dean of Harvard Medical School in an having this size of a bill on our desks Mr. BARRASSO. The people who editorial this week, the health debate for less than 2, 3 days, is very serious. have private insurance end up paying deserves a failing grade. The plan is We are firing real bullets here. This is more for their insurance premiums to wrong and those who support it are liv- no longer theater. It is no longer polit- help make up the difference because ing in collective denial. This is what is the government has across the board ical media. This is the passage of a wrong with this. This will markedly piece of legislation, the potential pas- been the greatest deadbeat payer. accelerate national health care spend- Washington is a deadbeat when it sage of a piece of legislation. Tomor- ing rather than restrain it. It will do row’s vote is a critical vote because it comes to paying for health care costs, nothing or little to improve the quality both for Medicare as well as Medicaid basically will mean we are on the road of care. to passage. In fact, 97 percent of the across the board. That has been the That is what we started with at the bills that come to the floor of the Sen- long tradition of Washington and beginning—to improve quality, im- ate under a motion to proceed pass. health care. The other people who are prove access, and lessen the cost. What penalized under this situation are peo- So this piece of legislation is serious. we have is a bill which, if passed into It is real bullets at $2 billion a page. ple who have no health insurance, be- law and signed by the President, will cause they are being charged at a high- Tomorrow’s vote is something we need decrease quality, increase cost, and to look at as a vote that is not some er rate. The person who works hard and lessen the access of Americans to sort of a procedural vote. It is a sub- says, I will kind of self-insure in case health care providers. stantive vote on whether we are going something happens, I get sick and I I appreciate my colleague’s com- have to pay the full bill, they pay the ments. The numbers are so high. These to fundamentally change the way full bill to cover themselves as well as are staggering figures. How do you health care is delivered, cause the size more to help for the underpayment communicate to the folks back home of this government to grow by trillions done by Washington. how astonishingly large these numbers and trillions of dollars, and put the That is how, when you have more and are? Because people say: We do want Federal Government virtually into more people on the Medicaid rolls, you to fix things, but don’t cut Medi- every decision that has anything to do more and more people forced onto that care, don’t raise our taxes. Drive down with health care. With the way you through Washington’s wisdom, it is the cost of medical care. Improve ac- choose a doctor, the way you get your going to be harder on people who have cess to providers. Create more choices. insurance, with the type of procedures insurance through their jobs. Insurance As I look at this, to me this is going to you get, with the type of drugs you can premiums, for people who have insur- mean higher health insurance costs, obtain—the Federal Government will ance and like their insurance, those higher taxes, Medicare cuts and then, be involved. How much it costs, the rates are going to go up. It is going to unfortunately, more government con- Federal Government will be involved. make it harder for American families trol over health care decisions. And with the type of debt that will be and for small businesses that want to Mr. GREGG. I thank the Senator passed on to our children. This bill will hire someone, because the rates of in- from Wyoming. He has a unique per- play a major role. surance will go higher. It will make it spective which we should listen to, as a Remember something about the Fed- harder for small businesses to provide practicing physician for how many eral Government: Once you give the health insurance for their workers, and years? Federal Government power, you don’t those who continue to provide health Mr. BARRASSO. I have 24 years prac- get it back. This bill is all about mov- insurance will not be able to give raises ticing orthopedic surgery, taking care ing power here to Washington. That is because the costs are going to go up. of the families of Wyoming. what this legislation is about, about This whole approach to health care Mr. GREGG. That is impressive. He centralizing the decision process, the reform was supposed to be designed to understands this whole issue and the national decision process on health help keep the cost of care down. That point on cost. It is very hard to concep- care. In the end, the goal, as openly is what the President and the Senate tualize that this is a $2.5 trillion bill stated by some of my colleagues on the promised all through the year. But it when honestly scored. When honestly other side of the aisle—and I appreciate does not. It drives prices up. scored, it is a $2.5 trillion bill. the fact that they are forthright—is to

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.017 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11837 have a single-payer system where the person goes in and receives a service, think we have the greatest health care government essentially runs health but the reimbursement is less than the delivery system in North Carolina, care top to bottom, much as it does in cost of the service, and what is left both public and private, some based in Canada and England. I believe that fun- over is shifted. Usually that is where academia. I think what North Carolina damentally undermines quality and is the debate stops. says is: Do not hurt my quality of care. fundamentally unaffordable. It passes But under Medicaid, the current sys- If we are going to talk about reforms, on debt to our kids which we obviously tem, we reimburse 72 cents of every $1 let’s talk about how we increase the don’t want. In the process, it will take provided, meaning 28 cents is shifted to quality of care, not decrease it. Medicare, which is already in serious the private pay side, out-of-pocket and Unfortunately, this misses the boat trouble—there is already a $55 trillion insured side. In this reform package, on reform. It is the most expensive ap- unfunded liability in Medicare—it will we are increasing the rolls of Medicaid proach to coverage expansion that any- take Medicare’s problems and aggra- by 15 million Americans. We are taking body could ever imagine. The question vate them dramatically. To the extent a program today where, if the attempt is, if we took some time, if we worked savings are taken out of Medicare and is to eliminate cost shift—which it in a bipartisan way, could we find a used to create this new entitlement, should be in health care reform—we way to do this more efficiently and which has nothing to do with Medicare would be eliminating Medicaid and we more effectively for quality of care, or Medicare recipients but is going to would be putting the Medicaid bene- where the outcome was different? be funded by Medicare both on the tax ficiaries in a program that actually This is a town obsessed with process, side with the HI tax in here and in the provided them a medical home, pro- as my colleagues know. This is a prod- cuts in Medicare benefits with the vided them an opportunity at preven- uct where we should be focused on out- elimination basically of Medicare Ad- tion, wellness, and chronic disease come, not process. Because at the end vantage, all of that is Medicare money management. of the day, there is an American family that should be going, if you are going But, no, we are keeping Medicaid in- who is going to be the recipient of the to do those things, to making Medicare tact. And in the bill it says to the rules, the regulations, and also the out- more solvent for seniors, not to cre- States: You cannot change your pro- come of what this produces. ating a new entitlement. gram. You have a maintenance of ef- Mr. GREGG. The Senator has made a I see the Senator from North Caro- fort. You may find a more efficient way very good point, which is how you do lina wants to jump in here. to do it, but if that efficiency means health care correctly. You do not cre- Mr. BURR. I thank my colleagues you are cutting any benefit, you are ate a massive new Federal entitlement. from New Hampshire and Wyoming. asking them to select where they You do not spend $2.5 trillion we do not Let me say on the same note, an $800 choose health care differently, you can- have. There are a couple things you billion-plus bill, when you ask anybody not do that, States. We are locking you could do, though, on a step-by-step in America, do you think this will in- in for 10 years. And we are going to in- basis. crease the deficit, everybody’s hand crease the rolls in Medicaid by 15 mil- One of them—and I would be inter- goes up. But the claim is that this is lion Americans. We are actually exac- ested to know if the Senator under- deficit neutral, that there is no no con- erbating the problem we are trying to stands why it is not in here—one of tinuation of increasing the debt. Let solve, which is, either shifting from them is to correct lawsuit abuse. It is me pick three areas, one you were just people who do not pay or where there estimated $250 billion a year of medical talking about, Medicare. This bill pro- are reimbursements that under- expenditure is defensive medicine poses that we shift $464 billion over 10 reimburse for a service. We are increas- which doctors order and hospitals un- years to pay for this new program. ing the rolls by 15 million Americans. dertake simply to avoid the potential Mr. GREGG. Fully phased in, it is a Forget the fact, as the good doctor of a lawsuit being filed. CBO estimates trillion dollars. from Wyoming knows, that when you it would be a $50 billion savings if we Mr. BURR. But in that 10-year pe- lock them into Medicaid, you have would adopt the proposals they use in riod, if you took Medicare, the proposal locked them out of having a medical Texas, California. That is one ap- to shift over, if you face the reality home. You have locked them into a proach. that we will not cut doctor reimburse- system that is there to treat them Another approach would be to allow ments 23 percent, which is another $246 when they get sick and not to spend a employers to pay employees more who billion worth of revenue, and the cre- dime on trying to keep them well. The live healthy lifestyles, such as employ- ation of a new program called the truth is, health care reform, in large ees who stop smoking or employees CLASS Act actually has people paying measure, is about our ability to change who get the tests they need—whether in for 20 years before the first person the lifestyles of the American people so it is mammograms or colonoscopies— might take out a benefit, those three we make healthier choices. when they should have them or em- items alone come to $700 billion of the In part, you do that by creating a ployers who live healthy lifestyles and $800 billion we are paying for it with. medical home. It is the reason most of lose weight. Under the bill that is not Most Members would agree there are us, if not all of us, have argued that ev- allowed, other than what present law cuts that probably will never happen. erybody should be covered in some is, which is very restrictive. That On the face, it says it is going to con- fashion. Health care should be acces- would save a lot of money, by the way. tribute to the deficit. It will continue sible and affordable. The debate is The first proposal, as I understand, to add to the deficit at greater num- over: where and what type. And, more was opposed by the trial lawyers. Do bers, as the ranking member of the importantly, should the American peo- you think that is why it is not in this Budget Committee has stated. ple have the ability to have choice? bill—saving $54 billion on abusive law- But let me try to point out some- Should the American people have the suits? thing I know my colleagues under- ability to construct a health care plan The second proposal—allowing em- stand. This is a bill about coverage ex- that meets their age, their income, and ployers to pay a differential and pay pansion. This is not a bill about health their health conditions? employees who are living a healthy care reform. There are very few re- What we are doing is, we are taking lifestyle more—is opposed by the big forms, if any, in this bill. The Senator on a one-size-fits-all government ap- labor unions here in Washington. Do from Wyoming was talking earlier proach to say: If you do not like what you think that is why it is not in this about Medicaid. One of the funda- is out there, we are not going to let bill? mental reforms that has to be made in what is out there change. We will give I wonder whether maybe the Senator health care is that we have to elimi- you an option, and it is to be insured from North Carolina has some nate cost shifting where an individual and to be managed and to be run by the thoughts on those two approaches as to who is uninsured goes in, receives a Federal Government. whether they would help the health service, does not pay, and the cost is I am not sure how others in other care system in this country, and why shifted to the private side, with people States have found it. In North Caro- they did not find their way into a 2,000- who pay out of pocket, people who have lina, it has been overwhelmingly re- page bill, since we seem to have a lot of insurance. For the underinsured, the jected by the population. I daresay, I room in this bill for things.

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.018 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11838 CONGRESSIONAL RECORD — SENATE November 20, 2009 Mr. BURR. I think the Senator eration? And, thank goodness, the cur- every disease that can be detected at makes a good point. I think many in rent beneficiaries in Medicare are an early stage provides, one, more the Congress who have worked on screaming as loud as anybody because treatment options, greater surviv- health care for a period of time have they understand the ramifications of ability and, in the long run, less expen- seen private businesses across this what we are getting ready to do. sive cost to treat that disease. country reach new efficiencies in As the Senator from New Hampshire It troubles me we have these deter- health care. Why? Because they have said, this is all going to happen tomor- minations being made on cost that are self-insured their employees. Where row. This is going to happen at 8 not true costs because they are not have they focused? They have focused o’clock Saturday night. People are putting into the calculation the treat- on exactly what the Senator has talked going to come to the floor and they are ment cost. But, more importantly, in- about: prevention, wellness, chronic going to vote on a bill, 2,074 pages—one corporated in this bill we are putting disease management, paying employees that, at best, takes a team of people fees on medical device companies, we to enroll in chronic disease manage- reading and a computer searching are putting fees on pharmaceutical ment courses, working with dietitians words in hopes you can identify every- companies, we are putting fees on to make sure they lose weight, having thing of importance that is in the bill. health care equipment companies. cessation programs that are offered for Mr. BARRASSO. The Senator from Why? Because they have to pay for free. North Carolina, who has been a cham- them. We are replicating the same thing. The things we have seen in private pion of early detection, early treat- We are disregarding the fact that when companies across the country that ment, and prevention of disease, did see an innovative drug comes off the re- have brought down health care costs a preview of rationing this past week search bench, there is a likelihood we are absent in this piece of legislation. when this Preventive Services Task could cure disease versus maintaining, Force made a decision and rec- It is as though they have come to that we might have a new treatment ommendation about breast cancer. Washington and shared their tremen- option that cuts down on the cost. dous experience, and we have ignored it The Senator talked about our sen- As the Senator knows, even though when we sat down to write the bill. iors. I worry about rationing of care, he is an orthopedic surgeon, we have Mr. GREGG. That is because we delaying care, denying care. They said cholesterol-busting drugs that now would have to change something called for women under 50 they should not people take who would have been in HIPAA. have mammograms anymore. They line for bypass surgery. And after that, Mr. BURR. That is exactly right. should not do a breast self-exam. They we got stents that we put in, in place of Mr. GREGG. It is a technical term, said for women over 75, they should not bypass surgery, and that bypasses the but it basically allows companies to have a mammogram anymore. last resort. pay an employee who lives a healthy I will tell you that my wife is a Sure, the creation of those block- lifestyle more than other employees, breast cancer survivor, and she was di- buster drugs was expensive. As they go and that is opposed, as I understand it. agnosed by a mammogram under the off patent, generic competition comes It was originally in one draft, and it age of 50. And they cannot say that in, and they become very inexpensive. got dropped somewhere. mammograms are not helpful. What But when compared to the $70,000-plus Mr. BURR. Well, the Senator makes they are saying is that the number of of bypass surgery, those drugs all of a a tremendous point about the rational, mammograms done per life saved is not sudden look inexpensive. But, more im- reasonable reforms that the American cost effective. portantly, when you look at the qual- people are looking for, and saying: Why I know both of the Senators who are ity of the care, where a patient did not can’t we purchase insurance across on the floor, from New Hampshire as have their chest cracked, they did not State lines if that creates competition? well as from North Carolina, have have rehab time, they did not have a Why can’t we have insurance reform talked about early detection, early hospital cost, we save a tremendous that allows us to construct the prod- treatment, not using cost as the issue amount of money in the health care ucts? Why does the Federal Govern- on comparative effectiveness research. system. ment have to mandate: Here is what We say let’s use some clinical judg- Mr. GREGG. If I could jump in at this the structure is? ment. Let’s see what we can learn. But, point. Many Americans have chosen over no, because for women under 50, they I think the Senator has touched on the past several years to have flexible have to do 1,900 mammograms to save something that is important; that is, spending accounts, to have the ability a life. For women over 50, it drops when you start putting these major to put their money in to take care of down to 1,300 mammograms to save a fees on things such as medical devices their health care needs. What does this life. So that is what they are putting and drugs, you reduce the willingness bill do? It basically reduces the ability the cost of a life at: a 600-mammogram of people to invest in creating the next to fund flexible spending accounts at difference. device, and not only do you end up the amounts that are sufficient to let But for my wife—who is alive today, with a device being priced out of the them continue to access their health after three operations, and two full market or maybe not being produced, care, in many cases with their own bouts of chemotherapy, and is now 6 but—— money. In fact, that is going back- years cancer free—having that mam- The ACTING PRESIDENT pro tem- wards from what we have learned. mogram under the age of 50 meant the pore. The Republican time has expired. Mr. GREGG. Then I will yield the The Senator from New Hampshire difference between life and death. floor. mentioned earlier this shift of money That is what this bill has to do with. Mr. President, I ask unanimous con- from Medicare to this new program. It is the difference between life and sent we be allowed to speak for an ad- Think about our Nation’s seniors, death for people. If you get into ration- ditional minute each, so we may wrap those who are relying on Medicare for ing care, delayed care—that is why up our time. their health care, and the next genera- people come to the United States for The ACTING PRESIDENT pro tem- tion that is getting ready to go in— their care. It is the best care in the pore. Is there objection? some of us in this room. Well, when world. That is why Canadians and Eu- The Chair hears none, and it is so or- you shift $464 billion, you are shifting ropeans come here, because they have dered. $1,063 per senior per year. Over the 10- to wait too long. That is why our tech- Mr. GREGG. My point is, this bill year life of this score, we are going to niques and our treatments and our sur- fundamentally undermines innovation, shift $10,363 per senior, per beneficiary vival for cancer is so much better in and innovation has been at the essence on Medicare today. the United States than these other of what has made American medicine Is that fair to our country’s seniors countries. Because the Senator from better than the rest of the medicine in who have paid a lifetime of premiums North Carolina knows it is that early the world. We are the most innovative into Medicare to receive a benefit, that treatment that makes a big difference. country in the world in the areas of because of fiscal irresponsibility that Mr. BURR. I think the Senator from drugs and medical devices and proce- benefit may be cut in the future or the Wyoming, being a medical professional, dures. I think this bill undermines premium may go up for the next gen- would probably agree with this: that that.

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.019 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11839 Mr. BURR. I might add, that level of finding affordable insurance. If you Fact: Rather than weaken Medicare, innovation is what makes the U.S. have your insurance through an em- health care reform will strengthen the health care system unique to the rest ployer, as do about 60 percent of the financial status of the Medicare Pro- of the world. We may not do primary people in my State, and if you are a gram—strengthen it for the future. care very well, and I think we have all large employer, then you can get a bet- We know Medicare has been a great admitted that, but if you get sick, ter rate because you have a large group American success story, and we want where do you want to be treated? Right plan. If you are a small business, you to make sure it is on strong financial here in the United States of America don’t get that same treatment today. If footing to go forward for all of us who because of the innovation that takes you are an individual, if you are, like are baby boomers and beyond, to our place. many people today, operating out of children. This comes from the AARP Mr. BARRASSO. Mr. President, there your home as a businessperson, a single Web site. So we strengthen Medicare. are improvements that need to be done entrepreneur, or maybe you are cre- We protect Medicare. to the system. There are simple things ating that next great invention in your Then we focus like a laser on stop- we can do to keep down the cost of garage and you are trying to find ping insurance abuses. We have heard care, such as allowing people to buy in- health insurance as a single individual so many times, unfortunately, story surance across State lines as well as for yourself and your family, you can’t after story about families who cannot giving individuals the same tax breaks do that right now in a very affordable find insurance because someone in the big companies get, ending lawsuit way. family has a preexisting condition of abuse and dealing with what is needed So we want to fill in the gaps in a some kind—a child who has leukemia, to be done in terms of incentives to system that has worked well for many someone who is a diabetic. Even for help people stay healthy so they have people with employer insurance and women, pregnancy has been used as a opportunities to save money them- certainly for people in Medicare and preexisting condition. We want to selves, and allowing small businesses our veterans with the VA and our mili- make sure all Americans have the op- to join together. tary personnel and others. But we have portunity to find affordable insurance. The bill we are looking at here is a little less than 20 percent of the pub- We want to make sure that if you have going to raise premiums for people who lic right now that is left out there insurance you have paid for your whole already have insurance. It is going to without a way to get affordable insur- life, you have paid the premiums, you raise taxes on all Americans. It is ance, so we want to bring down their feel confident that because you have going to cut Medicare—cut Medicare— costs. We want to bring down the costs health insurance, when somebody in for our seniors who depend upon Medi- for our bigger businesses as well. the family gets sick, the companies care for their health care needs. And We want to make sure we are stop- can’t drop you on a technicality. while they are doing it, they are going ping people from using emergency So we have a number of areas in to fund a whole new program rather rooms inappropriately and raising the which we want to stop abuses and, than save Medicare—a system we know cost on everybody with insurance and frankly, strengthen the system. We is going to go bankrupt. instead give everyone the opportunity want your children to be able to stay Thank you, Mr. President. I yield the to see their own doctor, their family on your policy until age 26 if they need floor and note the absence of a quorum. doctor, and make sure their children that. That is something I have often The ACTING PRESIDENT pro tem- and their families get the care they de- said that I wish had been in place a pore. The clerk will call the roll. serve. couple of years ago because I know The bill clerk proceeded to call the We know this also saves money for what it is like to have a son or daugh- roll. the Federal Government, for States, ter come out of college and that first Ms. STABENOW. Mr. President, I ask for our economy as a whole, and we job doesn’t have health insurance. unanimous consent that the order for know what the numbers are in terms of We want to make sure early retirees the quorum call be rescinded. inaction, the fact that we need to bring get the health care they need and are The PRESIDING OFFICER (Mr. down costs across the board. able to afford their health insurance KAUFMAN). Without objection, it is so This bill protects Medicare. We know with the Federal reinsurance plan, to ordered. we would not have the AARP endorsing help businesses keep costs down for Ms. STABENOW. Mr. President, I am the House plan and hopefully sup- people who—frankly, many have been very proud to be here with colleagues porting ours as well—I know they are forced to retire at age 55 or age 60 and of mine who have today joined me on still looking through the specifics, but don’t yet qualify for Medicare. the floor. Senator MERKLEY from Or- they certainly support health care re- So this is the bottom line: We are egon and Senator MARK BEGICH from form, and we welcome their support. saving lives, we are saving money, we Alaska are such strong, passionate They want health care reform. They protect Medicare, and we stop insur- voices for people in this health care de- have said certain things that I think ance abuses. bate, for what we need to do to stop the are very important that debunk what I wish to focus for a moment on insurance abuses and to save lives and we have heard from the other side of something else we are doing that is ab- save money. I am so pleased they are the aisle. solutely critical to me and, I know, to both here with me. Let me take a mo- We have heard over and over that colleagues across the country, because ment before turning it over to them to health care reform will hurt Medicare. this plan will also save jobs. Folks talk about what this is really all about The AARP Web site has up on its site: have said to us: Well, don’t talk about for us. Myth: Health care reform will hurt health care; let’s talk about jobs. Low- Right now, the bill in front of us ba- Medicare. And then it says—not from ering the cost of health care is about sically saves lives and saves money. We us but from the AARP, a champion for jobs. It is about jobs. We lose jobs over- save lives through making sure that senior citizens in this country—Fact: seas to other countries that have lower the 47,000 people who lost their lives None of the health care reform pro- health care costs than we do. We have last year because they couldn’t find af- posals being considered by Congress seen plants—in fact, in Michigan—go fordable health insurance to be able to would cut Medicare benefits or in- across a river that you could swim see a doctor—making sure we change crease your out-of-pocket costs for across, the Detroit River, from Michi- that; by focusing on prevention, also, Medicare services. None of the pro- gan into Canada, everything else being so people have early detection and peo- posals we have introduced as the equal—a unionized labor force, envi- ple can find out earlier when they have Democratic majority, supported by ronmental standards—everything else cancer and get the treatments they President Obama, would do that. equal but one thing: the health care need to save their lives. There are so Fact: Health care reform will lower costs are less. So this is about jobs, and many ways in which this bill in front prescription drug costs for people in it is about keeping jobs in America. of us literally will save lives. the Medicare Part D coverage gap, or We know our plan will allow big em- We save money. We save money for what has now been dubbed the ‘‘dough- ployers to save $9 billion over the next individuals and small businesses that nut hole,’’ so that they can get the bet- 10 years—$9 billion. What will they do are currently having a difficult time ter, affordable drugs they need. with that? They will put that back in,

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.023 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11840 CONGRESSIONAL RECORD — SENATE November 20, 2009 reinvesting in equipment, building surance companies in the individual as the book I have here. It is not hard. other plants, hiring more people. market don’t offer maternity care as If you want to do it—and former Sen- Health care reform is about jobs. basic health care. They say let the in- ator Martinez, who left us recently, I Small businesses are estimated to surance companies decide. Let them be took his book, and it is an easy read. save 25 percent in their costs over the the ones between you and your doctor. Maybe you would have to read it twice. next 10 years with the tax credits we When a doctor says what he wants to It is not as they describe—like it is have in the bill—the ways we create do when you are sick, what is the first some complicated, huge document that the ability to buy through a large pool, call they make? To the insurance com- is bigger and taller than they are. It is to be able to lower costs, and with the pany. They say that is OK, let the in- not a fair representation of what we tax cuts in the bill to small business. surance companies be the ones deciding are doing. There are tax credits to help all the what you are going to pay or get, As you know, we have lots of pages companies that don’t have insurance to whether you are going to be able to here who work hard every day. I know be able to find affordable insurance. find coverage. Let them stand between they were surprised when I grabbed one The bottom line is, it is estimated you and your doctor. We say: No, we of their textbooks for just one subject that if we do nothing, the costs to busi- have had enough of that. matter that they are required to study nesses will double, and we will lose 3.5 Finally, they say higher costs for in order to be proficient. If you con- million jobs. We can turn this ship middle-class families and small busi- verted it into bill language, it would be around and begin to bring down costs. nesses are OK. Higher costs are OK be- four times the size of that document It is estimated we can save 3.5 million cause they are willing to allow this that they stack next to them. We ask jobs. craziness to continue. Mr. President, our young people to be well educated, People in America understand we we are not. to learn the topics, and understand have to focus on jobs and the economy. Let me emphasize, again, the bottom what they are referring to when they They also know the one-two punch is line: This is about saving lives, about are tested. It is a simple thing. I encourage our colleagues on the that when you lose your job, you lose saving money, and it is about pro- other side to not be so extreme in the your health care. So in our bill, we spe- tecting Medicare and stopping insur- way they display the bill. It is not ac- cifically create policies that make sure ance abuses. We are committed to curate. I think it is important to rec- that if you lose your job, you don’t lose doing those things, getting through all ognize that. This book is short. Prob- your health care. the misinformation. All those who ably people cannot see this book be- We want businesses, large and small, make so much money off the current cause it is so low on this table. to be able to redirect the spending on system are just flailing and saying The other thing, as a new Member, I ballooning health care costs and pre- anything right now to try to stop us am learning the elements of the proc- miums, to be able to redirect that on from getting control of the system and ess here. I heard some colleagues on hiring people and doing what we know bringing costs down and making health the other side talk about the process. how to do best, which is making things care available. We are committed to The motion to proceed is a simple in America and putting people to work. getting this done for the American peo- issue. It is an issue of are we going to This is about jobs. It is saving lives ple. debate this in earnest. Are we going to and saving money and saving jobs in I yield the floor. put ideas on the table rather than just this country. I will conclude by saying The PRESIDING OFFICER. The Sen- talk about it and talk about it? We that what are we hearing from our col- ator from Alaska is recognized. tried this a few weeks ago on the Medi- leagues on the other side is the same Mr. BEGICH. Mr. President, I thank care fix. The idea was a motion to pro- kind of tactics that were argued in the Senator STABENOW for her leadership. ceed so we could move forward and de- 1960s before Medicare. You can take Last night, I had the honor of presiding bate how we were going to pay for it. some of the same arguments and lift while she spoke. I heard her first com- The Medicare fix is critical to Alas- them right from the pages of the CON- ment after she heard the other side de- kans. We have Alaskan seniors who GRESSIONAL RECORD and you would scribe the bill, saying it is so big they want to make sure the reimbursement think it was today’s debate, but it was cannot read it, but they had great de- rate is the right one to ensure long- actually back in 1964, 1965, with Medi- tail, for some reason. She even said she term coverage. But they didn’t want to care. We know the arguments they wouldn’t support a bill as they de- move on the motion to proceed. There- used then about destroying the econ- scribed it. I agree with her. After hear- fore, we never debated how to pay for omy, about costs going up, about peo- ing the last hour and what they de- it. We couldn’t get there with the ple losing access to doctors, and about scribed, I wouldn’t support it either. amendments that many of my col- how this would hurt businesses—it But that is not what this bill is leagues on the Democratic side were didn’t happen then. We know it will about. This bill is about saving lives anxious to put forward. That is where not happen now. But what we are hear- and saving money, protecting Medicare it is. ing is: Just wait, wait, wait, wait—that and stopping insurance companies and To the American public and for folks is all we heard in the Finance Com- their abuse. I sat here for a few days— listening to this forum here, it is im- mittee. Don’t do it now. What is the and I preside quite a bit, and I enjoy portant we keep to the facts, and they rush? the opportunity to watch. I see the are very simple. This bill saves lives, Well, if you are not getting those pre- props brought out by our opponents. money, protects Medicare, and stops mium increases in the mail, maybe you They always bring out the bill. It is al- insurance abuses. It is proconsumer, don’t feel the rush. If you are not los- most always taller than they are. It is pro-patient. It creates more affordable ing your job and health care, maybe interesting that the prop is not real- access to health care. It strengthens you don’t feel the rush. But we have istic. The American public should Medicare, as I said. It is fiscally re- been talking about this for 100 years. know that. They make it look like it is sponsible. We have a long way to go. I We are tired of waiting. The American such a large bill that they are incapa- hear, again, my colleagues on the other people are tired of waiting. They are ble of studying it and reading it in a side say rush, rush, rush or, as the Sen- saying business as usual for insurance fashion—something that drives one- ator from Michigan said, they always companies: Let the insurance compa- sixth of our economy. I learned one want to wait, wait, wait. The fact is, nies decide whether we are going to thing. In the last 11 months, I have got- we are going to have weeks of debate, have maternity care covered under ten so many different books on dif- and there are items I will bring forward basic insurance. That is not necessary. ferent issues, and it is amazing. I took to improve this, similar to many of my It is an option. Let them decide wheth- the bill—one of the pages out, page 114, colleagues on both sides who will bring er we are going to focus on prenatal and I was curious and thought, if we forth amendments. That is what we care. converted this into a regular book page should let happen in the process—de- We are 29th in the world in the num- similar to the ones we read on a reg- bate it, discuss it, and end up with a ber of babies who live through the first ular basis—or all the books I get that product that will improve the health year of life—below Third World coun- people want me to read—I said, how big care system of this country. That is tries. Right now, 70 percent of the in- would it be? Well, it is just about as big the goal.

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.023 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11841 When I hear, on the other side, that Medicare; she is 71 years old. She dis- On the plain-silly end, we had a stack somehow this bill will be rationing, de- cussed this with me just this week, as of paper about the complexity of a bill laying, and denying care—I don’t know I visited her at her home in Carson that addresses one-sixth of our econ- about you, but I get letters every sin- City, NV. She described her sister, my omy and quality of life for every single gle day about people who have been de- Aunt Audrey, who has a disease. She is American. My friend from Alaska has nied care by their insurance company, in the doughnut hole, where she has to pointed out that if you put it in a nor- who have been rationed out because pay for prescription drugs that she had mal size print, that is about equal to a they have preexisting conditions. They no idea she would have to pay for. normal book. I think we ought to real- cannot get coverage because of the Today, this bill is trying to rectify and ize that with a topic as serious as delay of the private insurance compa- fix that problem and make sure seniors health care reform, which is touching nies and the techniques being utilized. who are struggling out there don’t end the lives of every American, you are It is important to know the debate up having enormous out-of-pocket ex- going to want to be thoughtful enough on this side of the aisle on this bill is penses. This issue around Medicare is to address it in that detail. about ensuring that we will no longer not real. What we are trying to do is We also had in the last hour a con- have insurance companies denying or solve the problem and make sure to ex- versation about how much does the bill dropping coverage. We are asking intend its length of stability but making cost per page. Senator GREGG from New surance companies in this bill not to sure seniors get more. They have Hampshire said the bill is going to cost place limits on your coverage and ra- earned it and they deserve it. This bill $2 trillion and there are 2,000 pages, so tion your care. As I said, there will be moves it forward. it costs $2 billion a page. Last I no discrimination for preexisting con- Again, I wish to reemphasize the checked with my schoolchildren, 2 di- ditions, and there will be preventive point that this bill reduces the deficit. vided by 2 is 1, not 2 divided by 2 is 2. care, making sure people can access It has a positive impact for this gen- But that is not the point. The point is, their health care and their insurance. eration and future generations—$127 health care reform is not an issue to be As was said by Senator STABENOW, billion in the first 10 years, $650 billion played with hysterics, to be played who clearly understands the job issues in the next 10 years. That is what it with phony visuals, to be played with because of the struggle in her State, does. phony math. This is about our future, a there is a report—I will cite a few You will hear all kinds of numbers— future in which our businesses can things, and I know Senator MERKLEY and I am sure people who watch this compete around the world and in which from Oregon has many items, because get confused, as I do at times, listening our small businesses are able to pro- as we have sat here as freshmen talk- to all these numbers they throw out. vide health care. In fact, this is about ing about health care, I know he has But that is the fact. That is not de- quality of life for every single Amer- more to share from the small business cided by us as Democrats or Repub- ican. In the course of my colleagues from perspective. licans; that is the independent office of across the aisle discussing the bill, My wife has been a small business- CBO that made that determination. they actually made a pretty good case person for many decades. A report was They determined that is the positive for it. Let me start with Senator BURR. done by the Small Business Majority, impact to the deficit. Senator BURR said health care reform working with MIT. Here is the basic We need to push aside all the debate should be about choice but this bill data. The largest employers in this and rhetoric that is out there that is takes one-size-fits-all. Boy, I thought, country are small businesspeople. not factual and focus on what is right. he is absolutely right. Health care re- Small businesses will pay $2.4 trillion Again, as we move forward on health form should be about choice, and this over the next 10 years for health care care and insurance reform, there will bill before us is about choice. costs for their workers. With minor re- be a lot of stuff put on the table. There Right now in America, we have one form, I believe that is what we are of- will be items I will put on the table to dominant player in most major health fering, at minimum. It will save them work to improve health care and to care markets. Even if we have more as much as $855 billion. That is not me protect Alaskans—yes, I will be paro- than one, we have antitrust exemp- or a bunch of politicians coming up chial at times—but also look to the tions that enable the health care com- with this; it is people in the small busi- greater picture for America. This will panies to collaborate and cooperate. So ness community working with folks to be a great debate. It won’t end Satur- you don’t have real choice in the mar- do the research who determined this. day at 8 o’clock; it will continue on ketplace today. That means more small business can and on, probably to some folks’ dismay What does this bill do? This bill says employ people and raise capital, ex- because it will be longer than people we are going to give every American pand employment, create new jobs. As want. the same type of choice Federal em- described earlier, it saves real money The fact is, we will debate this issue. ployees have. I became a Federal em- for small businesspeople. We will struggle with it. We will strug- ployee in January after I was elected I can tell you my brother-in-law who gle with it within our own caucus of and sworn in. I was told to go to a Web owns and manages one of my wife’s op- what the right decision is. But when site and look at all the choices I had. erations has diabetes, a preexisting done, our focus is the American people, My wife and I sat down and looked at condition, and he has a $15,000 deduct- improving the system—the status quo the situation facing our family, and we ible. He pays an enormous amount each is not acceptable—and ensuring that chose the health care plan we thought month, with no preventive care or we save lives, save money, improve would be best for us. We had that chronic maintenance. It is a program Medicare, and hold our insurance com- choice. What this bill does is it creates that will not do much for him until he panies accountable for their actions. a health care exchange or health care ends up in a hospital in a severe condi- The PRESIDING OFFICER. The Sen- marketplace that creates those choices tion. ator from Oregon. and puts them in front of every family. This bill is not just about making Mr. MERKLEY. Mr. President, it has I will tell you that right now it is sure the insurance companies are held been a pleasure to listen to the com- very hard for an insurance company to accountable and do the right thing for ments of my colleagues from Michigan go into a new market. Why is that the people who buy and have insurance and Alaska, Senators STABENOW and case? Because in health care, unlike in today; it is also about creating jobs BEGICH. life insurance, you have to do contracts and making sure the private sector The bill before us saves lives, saves with the providers. You cannot sell continues to grow. money, saves jobs, strengthens Medi- health insurance if you don’t have ar- The last thing I will mention right care, and ends insurance abuse. You rangements with the hospitals and the now—and we talked about this—is pro- wouldn’t have known that is the case if doctors. It is very expensive to do. You tecting Medicare. This bill protects you were tuning in earlier to the Re- don’t yet have any customers. So it is Medicare. Why I know this is because I publican discussion in the last hour be- very hard to break into a new market. have looked at that component of the cause what we had were a series of in- But now, if you have a computer mar- bill and, most recently, I had to ex- teresting arguments ranging from the ketplace that citizens who go to the explain this to my mother who is on plain silly to the flat wrong. change are going to see and have a

VerDate Nov 24 2008 02:24 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.024 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11842 CONGRESSIONAL RECORD — SENATE November 20, 2009 chance to change plans every year, you you are on your own now. What kind of Ms. STABENOW. Mr. President, I have automatic access to the cus- insurance is that when it is not there wish to take a few moments and con- tomers and you can then afford to when you need it? This bill reforms tinue this discussion and then turn it make contracts with the hospitals and that. over to the distinguished Senator from physicians. It encourages competition This bill adds nondiscrimination for New Mexico, Mr. UDALL. We are so across State lines. Take Oregon. You gender, which is a fundamental value I pleased to have him. We served to- may have a company operating in think all Americans share. gether in the House. We are pleased to Washington, Idaho, or California now This bill says you cannot be dumped have him as a colleague in the Senate. say: Yes, we want to be on that ex- off your insurance when you get sick or They are a terrific team of people who change in Oregon. you have an accident. How many are so smart, who care so much and I say to my colleague from North Americans have paid health care insur- have such great experience. Our pre- Carolina, he is right, reform should be ance premiums for years, paid those vious speaker, coming from Oregon as about choice, and this bill is about premiums month after month, are very the leader in the State legislature, and choice. healthy, rarely go to the hospital, rare- Senator BEGICH, as a leader, as a My colleague, Senator BARRASSO, ly go to the doctor, but then they have mayor—we bring a wealth of experi- told a poignant story. He told a story a car accident and are seriously injured ence of people who have been serving, about his wife having breast cancer and or they have bad news and have gotten problem-solving, trying to make gov- how fortunate he was and she was and a serious disease and they get that let- ernment work, make the right deci- their family was that it was detected ter from their insurance company say- sions at various levels of government. by a mammogram and how important ing: Sorry, we are not renewing your It is wonderful to be working with that type of preventive care is. I insurance; you are on your own. So them today. couldn’t agree with him more. But mil- now, because preexisting conditions are I wish to take a moment because I lions of Americans—45 million, 47 mil- not allowed, they cannot get insurance understand that the Republican leader- lion, one report says 50 million—do not from anybody else either. They truly ship, our colleagues, are currently have health care, and therefore they are on their own. This bill reforms holding a press conference talking cannot get those preventive tests. They that. about what we are doing is somehow cannot get that mammogram if they I am glad to let my colleague from rationing care. This is the same argu- are a woman. They cannot get that North Carolina know that this bill is about reform. ment, by the way, used back in the six- prostate checked if they are a man. Senator ENZI noted the story of sell- ties with Medicare. Somehow seniors Senator BARRASSO makes a very good ing shoes, that he had three shoestores would not be able to get care, it would point about why we need to expand and that when a customer came in and be rationed, which, of course, is the health care coverage throughout this he showed him a shoe and that cus- exact opposite of what happened. Nation. The bill Senator REID has put tomer said that shoe is too expensive, before us will reach between 94 to 98 Now people hold their breath if they he knew he shouldn’t keep pushing the percent of all Americans. retire early and don’t have insurance, same shoe, he should not keep trying The question came up: Why not 100 just waiting to turn 65 so they can get to sell it. No, he should show him a dif- percent? Because Americans move a Medicare and they can see whatever ferent shoe. That is exactly what the lot. Americans have crises and may not doctor they want, not the one the in- public option does in this bill. surance company says they can see but be paying attention when they are sup- Those who are in support of the sta- the doctor they believe they need to posed to sign up. There will always be tus quo and don’t want reform, they see, the specialist they believe they a small part of the population that is want to keep sending the same shoe, need to see. not signed up for health care. That is keep saying: Americans, you have only why it is a few percentage points. Let’s one choice or maybe a couple choices. We know that for too many people in put it this way: 100 percent of Ameri- But within a situation where there are this country, there is the ultimate in cans will have the opportunity to have no antitrust provisions, you just have rationing. Over 45,000 people lost their affordable, accessible health care. That to keep going back to that private lives last year because of the ultimate is what this bill is about. company—no new shoe for you; no dif- rationing. They couldn’t find afford- Returning to my colleague from ferent product for you. But this bill able health insurance. They couldn’t North Carolina, he made the point that says: No, if you are not happy with see a doctor. They couldn’t get the care the bill before us is not about reform that, there is another alternative. In they needed. Mr. President, 45,000 peo- and that it should be about reform, fact, this bill not only gives you one ple in the greatest country in the world about insurance reform. I have good new shoe, it gives you two. Nonprofit paid the ultimate price. Shame on us. news, good tidings for my colleague co-ops can be set up—a provision that We want to stop that. This legislation from North Carolina. Embedded in this came to us through the Finance Com- will head us in the direction to stop bill are all kinds of reforms that are mittee—and it gives you a strong pub- that, to say as a matter of principle in important for every person who has in- lic option, a plan dedicated to healing, this country that it is not acceptable surance in the United States of Amer- not dedicated to profits. So if you are that any American would lose their ica. not satisfied with the insurance you life, any mom or dad would lose their First of all, guaranteed issue. You have, you have some alternative child because they could not find af- cannot be turned down because you choices. fordable insurance in this great coun- have a preexisting condition if we pass I think my colleagues across the try. this bill. I cannot tell you how many aisle made a very good case—maybe We also know that every year we Oregonians—and I am sure it is true in better than the case I could make—for push as hard as we can to increase the North Carolina—have been turned the fact that we need health care re- amount of money going to the National down for health care insurance because form. We need it for large businesses so Institutes of Health to gather informa- of some health care problem they had they can compete around the world, tion, to do research to save lives—to in the past, maybe in the far past of and we need it for our small businesses save lives through research, through their life. so they can afford to provide health information. In this legislation we This bill says you cannot have a life- care to their employees. We need it for want to make sure as the NIH is doing time limit. What kind of insurance do our families because health care is more research, as we are looking at you really have if you have a $50,000 or about the biggest stress families face better prescription drugs or new cures, $100,000 lifetime limit? After 20 years of in America. If you have health care, paying your premiums, you get sick you are worried about losing it, and if that we are giving physicians and pa- and, as you all know, you can wipe out you don’t have it, you are worried tients the very best information. $50,000 or $100,000 in a week or two. And about getting sick. We need health care I am not scared of information. I now you are informed—you paid health reform today. want information for my family, for care insurance for 20 years, you have The PRESIDING OFFICER. The Sen- myself. I have been in a situation—I been in the hospital for 2 weeks—sorry, ator from Michigan. am sure that we all have—talking to

VerDate Nov 24 2008 02:24 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.026 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11843 my physicians, where they said accord- I would say to the women of Amer- As you can see here, keeping the in- ing to the latest data we now think a ica: Listen to your doctors, not to Rush surance companies honest, inserting little bit differently about a particular Limbaugh. competition into the market, and giv- procedure or a particular medicine. Senator BEGICH from Alaska is on the ing the uninsured access to affordable And they make a different rec- floor. I am happy to join with him and coverage—that is what we are talking ommendation. I want my doctor to Senator MERKLEY and DEBBIE about here. When we say a ‘‘public op- have that information. That is not ra- STABENOW—with all these great Sen- tion,’’ we are not talking about sub- tioning. In fact, we specifically say in ators down here—to talk about this sidized by the government. This is this bill, we specifically prohibit the bill. But there is something that—I going to be fully financed by pre- Secretary of Health and Human Serv- look on the other side and I see these miums. The public option is not going ices from denying coverage of treat- huge stacks of paper. We should be a to make a profit for its shareholders, it ment solely based on research, solely little bit truthful and talk to people in is going to focus on health care. It based on information. But we certainly a truthful way about these stacks of would have low administrative costs want the information. paper. First of all, they are one-sided, since it operates as a nonprofit. It I think it is kind of silly to even so you only have print on one side, would exert bargaining power to obtain argue about whether we want medical which is not even the way we print discounts from providers. It would offer research and information so our doc- them up around here. I have had mine savings to its subscribers with lower tors have the very best information to printed up on both sides so I use both premiums, greater benefits, or lower be able to treat us. Right now, less sides of the paper. They have made an out-of-pocket expenses. It should fol- than 1 percent of our health care attempt here to make it look a lot low the same insurance requirements spending goes to examining what treat- higher than it is, as Senator BEGICH as private plans. What you are going to ments are most effective. We want to pointed out here earlier today, and if see is the public option offering low make sure the information is there for you take the type and reduce it to the cost and high value. physicians. Physicians support that, by regular type of a book, you come out I think at this point what I wish to the way. This is something in the with an average size book. talk a little bit about is what has hap- We are doing a piece of health care House bill, endorsed by the AMA, en- pened with some of our major health legislation that is very important to dorsed by medical professionals all care insurance companies in the last this Nation, a significant part of our across the country. We want our doc- couple of months. We have reached the economy, and we want it to be some- tors to have more information to do a end of a quarter. You see Wall Street thing that will rein in these insurance better job for us, not less. has completed its third quarter earn- We are hearing, over and over, scare companies, bring in competition, bring ings. Two of the big health care compa- tactics. We know we are going to con- in more choices, so we have to be care- nies, Humana and Cigna, released their tinue to hear that until we get to the ful about what we put in it. I think we end and pass this bill. But none of the should focus on the substance rather reports a couple of weeks ago. Let’s groups—doctors, nurses, family groups, than focus on the gimmicks. We are just say that both companies did very consumer groups, business groups— getting a lot of gimmicks from our well last quarter. How well, you ask. Humana reported none of those who currently support friends on the Republican side with a 65-percent jump in profits over the this legislation would be doing so if these big stacks of paper. Let’s talk same period. That is a big number. But, they thought it was in fact doing the about the substance. ironically, Humana’s earnings seem things the other side is claiming it is I hope we are going to see someday in doing, and certainly not if it was ra- this debate an actual Republican bill positively restrained compared to tioning care. The ultimate rationing and proposal so we can debate it back Cigna’s report. That is because Cigna right now occurs when people arbi- and forth. We have not seen that yet. reported a 92-percent increase in third trarily get dropped because the insur- We have just heard an awful lot of quarter profits—92 percent. Many companies right now are just ance company doesn’t want to pay the rhetoric. getting back on their feet after the bill; when people cannot get the cov- One of the things I want to talk worst recession since the Great Depres- erage they need because of a pre- about today is what is a very impor- existing condition; or when they lose tant part of this bill and that is the sion. Although the economy is improv- their life because they can’t find af- public option section. A public option ing, times are still tough. When you fordable insurance. Our legislation is would bring to the Nation more com- take that into consideration, an earn- about saving lives and saving money. petition. What we want more than any- ings report with a 65-percent jump or a I wish now to turn the floor to my thing is to have more choices when it 92-percent jump in profits makes you colleague from New Mexico. comes to insurance. We want to see as wonder how Humana and Cigna are The PRESIDING OFFICER. The Sen- many choices out there in the market- doing so well in such tough economic ator from New Mexico is recognized. place. times. Mr. UDALL of New Mexico. Mr. Sometimes I don’t understand, when I will tell you how they do it. They President, I thank Senator STABENOW my Republican friends talk about this, do it by putting profits above people. for that very good statement on what I because we are talking on their While Humana and Cigna touted earn- think is a very important issue. As we terms—about competition, about ings that are incomprehensible to the speak, and as I have watched the floor, choice in the marketplace, giving peo- average person, or the average business I hear my Republican friends talking, ple more choices. I don’t understand for that matter—the average busi- as Senator STABENOW said, about ra- why they are opposed to those kinds of nesses, the business people I talk to tioning. They are seeming to imply solid principles that are the backing of say, are making 10 percent, 15 percent this legislation somehow would do this particular bill. profit if they are doing well. Yet here that. They also look at this adminis- The other thing a public option these folks are making these huge prof- tration and see that a prevention task would do is keep insurance companies its. force report of some of the key experts honest. That is tremendously impor- While these health insurance compa- in the country, trying to give us the tant. We have these insurance companies are doing that, 47 million Ameri- very best science, the very best medi- nies out there, we know they are doing cans continue to struggle without cine—that somehow that could be ra- very well in terms of their profit mak- health insurance. While Humana’s tioning. ing. I am going to be talking about total revenue jumped 8 percent to al- My advice to women, listening to that in a little bit. We know they have most $8 billion, and Cigna predicted this debate, is that they should be con- very high administrative costs. If you profits of more than $1 billion this sulting their doctors when it comes to have a public option that is actually year, small businesses began reporting things such as this. They should be lis- dedicated to providing health care that their premiums are expected to tening to their doctors. Their doctors rather than to making a profit, then jump more than 15 percent next year. are up on the best research, they are up you are going to have something going Unfortunately, Humana and Cigna on the best science, they are up on the on in the marketplace that will keep are not alone in their ‘‘profits above best medicine and get on top of it. everybody honest. people’’ business model. Over the past 7

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.028 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11844 CONGRESSIONAL RECORD — SENATE November 20, 2009 years, publicly traded health insurance own their own businesses, who are The PRESIDING OFFICER. The Sen- companies, companies that include doing the right thing, pursuing their ator is correct. Humana and Cigna, saw a 428-percent own American dream. These folks can- Mr. ALEXANDER. That will extend increase in profits—428 percent in- not achieve that dream when they are until about 2:05. crease in profits. While the companies paying outrageous costs for health cov- The PRESIDING OFFICER. The Sen- were raking in the cash, so were their erage for themselves and their employ- ator is correct. CEOs, who in 2007 alone made $118 mil- ees. A public option would help small Mr. ALEXANDER. Mr. President, the lion between 10 of them. That is why businesses succeed by giving them an- debate has begun. The debate is about health insurance premiums more than other, more affordable choice in the in- reducing health care costs—the cost of doubled over 9 years. Health insurance surance market. premiums every American has or the premiums doubling over 9 years, three This is something we need to focus cost to the government that every times faster than wages increased. on. As we flip through the bill, as the American has to be responsible for. The Giant insurance companies are happy American people look at this bill, ask bill we have been presented goes in the with the status quo. For them it means themselves: Are you for the status quo, opposite direction. It raises taxes. It little competition, skyrocketing prof- are you for keeping these premiums means higher premiums. It cuts Medi- its and the ability to do just about going up, are you for the insurance care. It transfers major new costs to whatever they want to do to boost companies dominating the market or States which, in turn, will damage their bottom lines. A public option are you for competition? When it fi- higher education and/or increase taxes would change all of this. It would keep nally comes down and we look at the or both. Our purpose on the Republican side is insurance companies honest by putting overall package, it is going to be clear. to take this next hour, as we intend to much needed competition back into The PRESIDING OFFICER. The time take several hours, all the hours allo- the market. It would provide real of the majority has expired. The Senator from Florida. cated to us today and tomorrow, and choice for Americans by giving them Mr. NELSON of Florida. Mr. Presi- help the American people have a another option that best meets their dent, I will vote for the motion to pro- chance to read the bill section by sec- needs. And it would help small busi- ceed. That gets us to the point at tion, to understand what it costs and nesses and the self-employed by mak- which we can have the bill before the to understand how it affects them. ing health insurance for their employ- Senate in order to debate and to amend In this next hour, the Senators from ees more affordable. the legislation. It is a debate we must Georgia, Mr. CHAMBLISS and Mr. I urge my colleagues on both sides of have. It is a debate we cannot afford ISAKSON, and the Senator from Kansas the aisle to pay close attention to not to have. Mr. BROWNBACK, will be focusing on tax these earnings reports. I urge them to The PRESIDING OFFICER. The time increases. We will be referring specifi- take a hard look at the skyrocketing of the majority has expired. cally to page 348, title I, subtitle (f), profits these health insurance compa- Mr. NELSON of Florida. I ask unani- part 2 of this 2,074-page bill, which has nies have reported and ask themselves: mous consent that I be able to proceed to do with the tax on employers. We Whose side am I on? The insurance for 2 minutes. believe a great many employers will companies that continue to put profits Mr. ALEXANDER. That is OK as long look at this big bill, look at the tax on above people, or the people I was sent as it is taken from the Democratic them, if they don’t pay insurance, look to Washington to represent? time. at the new government program and I know which side I am on. I know a The PRESIDING OFFICER. Without say: It is going to be a lot easier for me public option is the right thing for objection, it is so ordered. to pay the fine and write a letter to the Americans and the right thing for this Mr. NELSON of Florida. I will vote employees and say: Congratulations, I country. for the motion to proceed to bring the have written a check to the govern- One of the things we hear in this de- legislation before the Senate. This is a ment. You are on the government plan. bate—all of us, as Senators, stay in debate we must have. It is a debate we Then we will go to page 2,040 of the constant contact with our constitu- cannot afford not to have. What is be- bill, which is the new Medicare payroll ents. We get mail, we get telephone fore us is to make health insurance tax. That is a tax on hiring. You heard calls, we get e-mails. My constituents available and affordable. The legisla- that right, a tax on hiring in the mid- in New Mexico have talked to me a lot tion that will come before us will pre- dle of a 10-percent unemployment situ- about their health care problems. They vent someone from being denied insur- ation. How is that going to create any have talked to me about their rising ance because they have a preexisting jobs? We don’t think it will. premiums. They have talked to me condition. It will not allow the insur- Then Senator CHAMBLISS, especially, about losing their insurance. And they ance companies to cancel policies be- and Senator ISAKSON, because of his send me some very powerful stories I cause someone is sick. It will bring in background as a small businessperson, want to share. millions of uninsured people who will will talk about what Republicans want Here is a story from a woman in then be able to have insurance and can to accomplish. If you are waiting for Placitas, NM. Here is what she wrote afford it. By the way, that brings down the Republican leader to roll in a me in an e-mail. the cost of all the rest of our premiums wheelbarrow with a 2,074-page Repub- Dear Senator Udall: I own a small busi- because they get health care at the lican version of health care reform, you ness—just me and my secretary. I just got emergency room, and guess who pays. will never see it. We don’t believe in my notice from my insurer about the rate in- All the rest of us do, to the tune of a that. What we do believe in is identi- crease for next year, which is between 9 and national average of about $1,000 per fying a goal—reducing the cost of your 10 percent. For two people I will now be policy. This legislation will reduce the premium, reducing the cost to the gov- asked to pay $2,300 per month in premiums. deficit, $130 billion over the next 10 ernment, and then going step by step We can’t afford it. I am now faced with the years and over $650 billion in the sec- toward that goal; for example, by re- likelihood of having to drop insurance, which for two cancer survivors is not the right an- ond 10-year period. There is room for ducing junk lawsuits, by allowing swer. improvement. That is why we need to small businesses to pool their resources I know you support the public option and debate it. That is why we need to to purchase insurance, which we have that you are a reliable vote for reform. But amend it. I will be offering an amend- offered but the Democrats will not if anyone on the Hill is keeping a record of ment that will produce savings to the allow to come forward, and by allowing how the inanity of this debate is actually af- taxpayers of another $100 billion by people to purchase health insurance fecting real people, please include this e-mail lowering the cost of drugs to Medicare across State lines. Senator CHAMBLISS in the log. recipients. Let the debate begin. I look and others of us will talk about this How would a public option help in forward to it. during the next hour. that circumstance the woman just The PRESIDING OFFICER. The Sen- That is the Republican plan, to do wrote in about? A public option would ator from Tennessee. what most Americans want done, to re- provide another, more affordable Mr. ALEXANDER. Mr. President, the duce the cost of premiums, and to not choice for small businesspeople such as Republican side should now have 60 increase premiums and taxes, or cut this lady from Placitas, people who minutes; correct? Medicare.

VerDate Nov 24 2008 23:50 Nov 20, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.028 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11845 There is one hidden tax I wish to talk Mr. ISAKSON. I thank the Senator drives people to a public option and about because it is in the bill, and it is from Tennessee. drives small business away from pro- in the news. Most Americans may have Mr. President, I am delighted to be a viding that insurance. seen that the University of California part of the debate for all the right rea- There is another way it hurts small yesterday raised tuition 32 percent. sons, to talk about things we can do business. It also says, if you do provide There are, in our country, around 18 but also talk about things that the pro- health insurance to an employee and million students who are in higher edu- posed legislation, in fact, does do to the cost of their part of the premium cation. What I wish to say to them is, the American people, to small business, exceeds 9.8 percent of their annual in- if this bill passes, their tuition is going and to our future. come, then you have to move them to up. California’s tuition is going up When I end my speeches in Georgia, I the public option, and they get sub- again. It is going up in Tennessee. It is always end with the same line. I say: I sidized. But you get fined $3,000 a year going up in North Dakota, in Nebraska, am 65 years old. I have nine grand- for the rest of the number of years that in Georgia, everywhere there is a pub- children; in fact, No. 9 was just born. person works for you because their cost lic college, university, or community His name is Hunter. He is 5 weeks old. to their insurance was more than 9.8 college there are going to be new taxes I always say my life is about their percent of their income. You might or higher tuition or both. lives. The rest of my life is about mak- say: Well, whose insurance would be In California right now, they are ing their lives as rich, as prosperous, as more than that? Well, if you take a re- pointing fingers at each other about safe, and as free as the one my parents ceptionist or someone like that today the 32-percent tuition increase. But left to me. in a business, who may be making they should be pointing the finger at Legislation such as this severely $25,000 or $30,000—an entry-level job— us, Washington, DC, Congress, because threatens that. I wish to talk about 9.8 percent of that is only $2,800, $2,900. it is we who have allowed the Medicaid two ways in which it does. It would be more than easy for their Program, the largest government-run The heart and soul of America is the share of their premium to exceed 9.8 program we have in the country, to go small businessman, as 73 percent of our percent. So the company gets fined, the year after year with increases of 7 or 8 employees are employed by small busi- employee gets driven to a public plan, percent. We require every State, if it ness. I ran one. I had 200 employees and and more revenue goes to the govern- opts in, to have a government-approved 800 independent contractors. By law, I ment through an indirect tax of a fine. Medicaid Program. In our State, it is could provide health insurance to the Mr. ALEXANDER. I wonder if the called TennCare. That Medicaid Pro- 200 employees, and I did. But contrac- Senator would yield for a question? gram is helping bankrupt the States. tors, because they are independent, the Mr. ISAKSON. Absolutely. Here is a State of Tennessee head- IRS will not let an employer provide Mr. ALEXANDER. If the employee line: ‘‘State looks at $1 billion in cuts.’’ that benefit. That is one of the reasons were eligible for the Medicaid Program Part of that is from the recession. But you have a large number of uninsured in Georgia and lost employer insurance part of that is because of the increased who are actually working—real estate and went into the Medicaid Program, cost of Medicaid. What does this bill isn’t it true that the employee who do? It sends to the States another $25 agents, sole proprietors, contractors. The Senator from Tennessee and I and went into the new government plan billion in increased Medicaid costs. under this bill is likely to pay a higher the Senator from Wyoming, Mr. ENZI, What will that mean? Higher tuition premium and have a harder time find- rates, higher taxes, or both. The Uni- then as chairman of the HELP Com- mittee, proposed a small business ing a doctor? versity of California has the reputation Mr. ISAKSON. There is no question. I health care reform act, a Republican as the best public university in the say to the Senator, you are exactly act proposed in this body to cover one- world. It will not be that very long if right. To think that it actually bene- third of the uninsured without raising the Congress of the United States fits the employee by doing that is doesn’t rein in Medicaid and reduce its rates or without raising premiums or wrong. They will have fewer doctors cost so Californians can afford to have without raising taxes. We had to get to providing the coverage, and their cost both a health program and a fine uni- a cloture vote of 60, and we only got to might, in fact, be higher. versity system. The Governor of Ten- 57. So 3 years ago we missed a chance But I want to talk about one other nessee has said the same thing. He has to cover one-third of the uninsured by thing on the small businessman before been outspoken about this. He has a change in our law which would make I yield to one of my other colleagues. talked about exactly the dollars it will it more affordable and accessible for There is another tax—and we have cost us. In the House bill, it is $1.4 bil- independent contractors. That is what heard the business about taxing the lion over 5 years. In my view, I don’t we were for. rich. This bill provides a surtax on pay- Let me tell you what this bill does to see how the State of Tennessee can pay roll—a payroll Medicare tax on any a small businessperson. No. 1, if you that without a big State tax increase employer who makes more than have more than 50 employees and you or without damaging higher education $200,000 if they are an individual or do not offer them health insurance, or both. $250,000 if they are a couple. The Medi- Someone might look at this and say: you have to pay a fine of $750 per em- care tax goes from 1.25 percent—your What does health care have to do with ployee for ad infinitum. If it is 500 or share; the company matches it—to 1.95 a 32-percent tuition increase in Cali- 51, you have to pay a $750 fine. I ran a percent. fornia? It has everything to do with it. company for 20 years. When I ran that Now, $200,000 is a lot of money, and so Instead of reining in Medicaid, we are company, I did provide insurance to 200 is $250,000. But to a small business in- expanding Medicaid. By doing that, we employees. I paid about $3,200 a year corporated as an LLC, a sub S, or are making it impossible for virtually for the company’s expense of their something like that, that pays taxes as every State to properly support higher group health insurance. They paid the an individual, that is 1.95 percent dou- education. The only choice they have, balance. If this offer were before me as bled, which will increase the tax to 3.9- other than taxes, is raising tuition for a small businessman, then I would have percent on every dollar that company 18 or 20 million students across the said: Well, I have a $750 fine if I don’t makes on gross, not profit, if they’re country. Californians, if this bill insure them and a $3,200 cost if I do. above $200,000. It is a tax on their busi- passes, your tuition is going up one What should I do? Well, as a business- ness for Medicare to pay for a public more time. man, you are going to elect not to pro- option, not for Medicare. And Medicare I call on the Senator from Georgia, vide insurance, to pay the less expen- goes broke in 2017. Mr. ISAKSON. He spent a number of sive cost, which is the $750-per-person So we are raising taxes on Medicare years as the leader of the Republicans fine, and drive them into a public op- for the alleged rich, which really is in the Senate. He dealt with the Med- tion. most small businesspersons, all to pay icaid question. He dealt with the ques- This is not about a public option, it for a program that does not benefit tion of taxes. As a small businessman is about a public ultimatum, because Medicare. The unintended con- for most of his life, he understands well as you look at the revenue-raising pro- sequences of this legislation are disas- the impact of new taxes on hiring and cedures, the tax-raising procedures, trous to small business, it is inappro- mandates on businesses. and the policy procedures, it basically priate in the way they are handled, and

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So these 14 CHAMBLISS, has a few facts to add as ica today, there is not one mention of million people are not even addressed. well. reforming the tort system in this coun- Then there are another 15 million Mr. CHAMBLISS. Mr. President, I try, the malpractice reform area. If people to whom Senator ISAKSON just thank both my colleagues from Ten- you go to any doctor and you ask him referred. They are people who are ei- nessee and Georgia. what is the No. 1 issue on his mind ther those independent contractors or I want to talk just for a minute when it comes to reducing the costs in they are employees who work for em- about what Republicans are for. We his office, I bet in 99 percent of the ployers who do not provide health in- have been criticized by the folks on the cases—maybe 100 percent—they are surance, but all of them are gainfully other side of the aisle for being just going to tell you that tort reform must employed, and they have the ability to against what they are for, and that is be implemented if we are ever going to purchase health insurance. Some of not at all true. There are actually four hope to drive down the cost of the de- these people are dealt with in this other plans that were filed in both the livery of health insurance in this coun- 2,074-page bill. Some of them are not HELP Committee and the Finance try. because if you are an employer with 50 Committee, three of which were strict- Senator GRAHAM and I have an or fewer employees, then you are ex- ly Republican plans, one was a bipar- amendment we will be talking about empt, you would not be covered, still, tisan plan, that never saw the light of that is a tort reform measure that is a as a part of that 15 million. day, simply because the folks on the loser-pays style of tort reform. It does Then there are about another 12 mil- other side of the aisle had their minds not take away the right from anybody lion to 15 million whom I refer to as made up that they were going to have who is injured. Anybody who is injured the hard-core uninsured. Those are the their plan with a government option, ought to have the right to have their folks whom we really ought to try to and they were going to do whatever day in court. But it does eliminate the reach, and those are the folks to whom they could to move us toward universal potential for the extensive, frivolous the bulk of the $2.5 trillion this bill is health care coverage. lawsuits that our docs and our hos- going to cost during the 10 years when I want to say to those folks on the pitals have to deal with every single it becomes fully implemented seeks to other side of the aisle who have stood day that drive up the cost of health reach. up and said on the floor of this Senate: care. I would simply say, if we are going to Yes, by putting a government option in I want to talk, too, about one other truly have a health reform bill, we place, our intention is for the govern- measure we are for that has been need to start and take it step by step. ment to take over health care—some of talked about a lot today; that is, cov- If the folks on the other side of the them have been very straightforward ering the uninsured. I think, without aisle are serious about health care re- about that, and they have been honest. question, if you want to drive down the form, we can get the appropriate com- There have been others who have been cost of delivery and the cost of health mittee chairmen together this after- not so honest about that. But that insurance, you need to cover those peo- noon, tomorrow, or whenever, and truly is the reason there is a govern- ple in this country who need to be cov- begin work on these issues I have just ment option in the plan we have up for ered. laid out about which there should be no a vote tomorrow night. We have a little disagreement with disagreement. We could move forward But what are Republicans for? First folks on the other side of the aisle as to with developing a true and meaningful of all, everybody in this body is in the exact number they seek to cover health insurance reform package. agreement that we want to drive down with this 2,074-page bill. But there is I want to come back in a minute and the cost of health care and we want to one area where we do agree; that is, talk about Medicare taxes and the way drive down the cost of insurance, and there are somewhere between 47 mil- Medicare is going to be dealt with here. those are integrally linked. If you drive lion and 50 million people in America But I would simply throw it back to down the cost of health delivery, then today who are truly in that uninsured the Senator from Tennessee, as well as you will drive down the cost of health category whom we all, as a body of 100, to my colleague from Georgia, because insurance. would like to see have affordable insur- they have both been involved in a very There are a number of ways we can ance available to them. honorable way at the State level. Sen- agree today to enact legislation that Now, who are these uninsured? First ator ALEXANDER is a former Governor will help drive down the cost of health of all, there are about 6 million people of Tennessee. Senator ISAKSON was an care. What are those things? in this country today who are unin- elected member of our State house, as Preventive health care. Well, there is sured who are here illegally, and they well as our State senate. some mention of preventive health are illegal, undocumented aliens. I say to the Senators, you gentlemen care in Senator REID’s bill somewhere Folks on the other side—and there is have experience dealing with Medicaid, in these 2,074 pages. There is the men- some question about this when you and you know what the taxation side of tion of preventive health care, but look at the language in this 2,074-page Medicaid does from a State level. I there is not the incentive in place to bill, whether they cover those illegal would like to ask for your thoughts on encourage people to move toward pre- aliens, but let’s assume we all agree what this 2,074-page bill is going to do ventive health care as was done in the they ought not to be covered. There are to Medicaid in this country as we know private sector with Safeway, a grocery another 14 million people in America it today. store chain where the CEO has visited today who have health insurance avail- Mr. ALEXANDER. Mr. President, I both Republicans and Democrats and able to them from the Federal Govern- thank the Senator from Georgia. I am talked about the way Safeway was suc- ment in one form or another. Either going to throw the question right back cessful in doing that. they are Medicaid eligible or they are to Senator ISAKSON in just a minute. We all want to make sure those who eligible for some form of SCHIP, the I appreciate Senator CHAMBLISS tak- do not have insurance today are cov- State Children’s Health Insurance Pro- ing time to point out what Republicans ered. We want to cover preexisting con- gram. In Georgia, it is called are for because it seems as if no matter ditions. We want to make sure we put PeachCare. For whatever reason, these how many times a day we say it, our competition into the insurance market 14 million people have not taken the Democratic friends do not hear it. by allowing policies to be sold across initiative to go out and sign up, for ex- Let me put it this way: Let’s say State lines. All of those things will ample, in Georgia, at the Department Senator ISAKSON, who has been a small work in concert to drive down the cost of Family and Children Services. I do businessman, buys a new small busi- of delivery, as well as the cost of insur- not know what it is in Tennessee, I say ness. He takes it over, and he sees that ance policies per se. to Senator ALEXANDER, but there is a generally it is working pretty well but

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.031 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11847 it has some problems with it. I wonder plans that allow independent contrac- taxes on Medicare beneficiaries and if the first thing he would do is come in tors and contractors to be covered; those in the workplace again to ulti- and say, I tell you what, let’s just turn that is one. Have an immediate identi- mately pay for Medicare benefits down it all upside down and change it all, or fication and registration system for the road. would he say, let’s identify the prob- people who are eligible for Medicare, The other part of this I wish to ad- lem, and let’s take a few steps in the Medicaid, or SCHIP so that when they dress with respect to Medicare is the direction of fixing that problem. come to a provider or a doctor they end Senator from Florida got up as we were What Republicans are saying is, we up getting covered. Then, third, come coming on the floor and talked about have a big health care system that in up with a program that meets that last this so-called deficit reduction. What general works pretty well. Mr. Presi- third, which Senator CHAMBLISS re- do they mean when they say we are dent, 250 million of us have health in- ferred to as hard core, those who by going to have a $32 billion deficit re- surance plans; 47 million do not. Sen- choice or by chance are not covered. duction over 10 years? Well, here is how ator CHAMBLISS has just pointed out The last thing I would have done is it works. The deficit reduction is who those people are. Thirteen million said, We are going to throw out the 85 brought about primarily by the addi- or 14 million are already eligible for percent of this that works in order to tion of a program in this bill to Medi- plans and for one reason or another do fix the 15 percent that doesn’t, and care, what is called the CLASS Act. not sign up. A few million are illegally that, in effect, is what this bill does. The CLASS Act is a long-term policy here. Some others are young and think Mr. ALEXANDER. I say to Senator of insurance to take care of long-term they are invulnerable and do not sign CHAMBLISS, one of the most difficult health care needs. Young people are up. But we are saying the problem is issues I think for many Americans who going to be required—young people in the cost, people cannot afford to buy are watching what we are doing is the the 20, 30, 40-year age bracket will pay their own insurance, the government plan to cut Medicare. The new bill goes into the so-called Medicare trust fund cannot afford its health care costs, and a step further. The way I read it—and that will be used to pay benefits for people are going broke over this. So we I indicated the sections in the bill a long-term care for those individuals want to reduce the cost. moment ago—we are not only cutting when they start reaching the age where Senator CHAMBLISS identified this Medicare, we are going to tax Medi- they need long-term care. So CBO has step-by-step approach. He mentioned care. Then we are not even going to said that because these folks are 20, 30, reducing junk lawsuits against doctors. spend the money on Medicare. In other and 40 years old and they are going to We have proposals for that. Combating words, we are going to cut grandma’s be buying these policies, they are not waste, fraud, and abuse—we have intro- Medicare, tax grandma’s Medicare, going to be getting any benefits for an- duced legislation for that. Senator then spend grandma’s money on some- other 20, 30, or 40 years. So we are ISAKSON talked about allowing small body else, and grandma’s Medicare is going to take the position that all of businesses to pool their resources. Ad- going broke in 3 or 4 years, according those premiums, which go into the gen- ditional ways to reduce cost is allowing to the Medicare trustees. eral fund, by coincidence, will go to re- people to purchase insurance across Mr. CHAMBLISS. In addition to that, duce the deficit. But guess what is State lines, so you can shop for more we are going to continue to tax young going to happen, even according to insurance and reduce your cost people who are in the workplace for ad- CBO, when all of these young people through competition, and amending ditional Medicare taxes that are in- who have been paying into the CLASS the health savings account laws so you tended to be used by them in what is Act start getting benefits. All of a sud- can withdraw your money in a tax-free called the CLASS Act, which is an- den we are going to start seeing defi- way to pay for your insurance pre- other part of this monstrous bill, and cits in the outyears, and our children mium, and encouraging wellness and chances are those people are never and our grandchildren are going to prevention. We could take those six going to see those benefits. There is have an additional debt put on them steps, reduce costs, and then take six one tax after another in this bill that because of the way this particular pro- more. applies to Medicare. vision is scored—and it is being touted I wonder, Senator ISAKSON, with your One other aspect of Medicare that is as a deficit-reducing provision right experience in business, if you think it of such critical importance here is that now—that truly is going to be a provi- makes any sense for us to just come in they have an $850 billion pricetag, ac- sion that adds to the deficit and the here and say: OK, we are really smart cording to the Democrats. According to debt our children and grandchildren here in the U.S. Congress. This is a big the numbers and the figures of Senator are going to have to pay. country, with 300 million people. We GREGG, the ranking member of the Mr. ALEXANDER. It must be a little are just going to turn the whole health Budget Committee, who came down confusing to the American people. I care system upside down, write a 2,074- here this morning and talked about it, mean, one day Senator REID comes out page bill, change the premiums, raise that $850 billion is for the first 10 and, a big hurrah, we are going to re- the taxes—do all these things—or years. The taxes begin next year. The duce the deficit and we are only going would you go step by step in the right benefits don’t begin until 2014. When to spend $800 billion, and then the next direction and try to re-earn the con- you look at 2014 to 2025, the first 10 day Republicans come out and say, No, fidence of the American people who years of full implementation, the cost when the program gets going, it is $2.5 have lost a lot of confidence in Wash- of this bill is actually $2.5 trillion, not trillion over 10 years. I wonder if I ington, DC? $849 billion. could say to the Senator from Georgia, Mr. ISAKSON. I think it is an excel- Why is it $2.5 trillion? Well, it is be- while we have heard you talk about lent question, because every year in cause the scope of government has these projections, the senior Repub- my company we had an annual plan- broadened to such an extent that the lican on the Joint Economic Com- ning retreat at the end of the year for expense of providing the services is mittee has come to the floor, the Sen- the next year, and ironically—and I going to be greater. We are going to ator from Kansas. didn’t know we were going to get into have more people coming onto Medi- How do you explain this to people in this discussion—but our No. 1 topic care. We know now, as Senator ALEX- Kansas, Senator BROWNBACK, who must that I would send out to all of my man- ANDER said, according to the bipartisan be very confused by this back and agement team is: What is the No. 1 Medicare Commission, we will be pay- forth? thing we need to correct or do in our ing out more in Medicare benefits than Mr. BROWNBACK. I don’t think they company? We would spend the entire we receive in Medicare taxes in the are particularly confused. I think they retreat talking about that one thing. If year 2017. There are only two ways to smell a rat in this and they know if that one thing was the uninsured, then fix that: either raise taxes or decrease you are going to add this big of a pro- what we would have talked about is benefits. The majority that is in power gram, somebody is going to tax me what do you do to insure that 14 to 15 in Congress today has a habit of not somewhere here. percent who don’t have coverage. seeing a tax they don’t love, so my The interesting way this is actually Senator CHAMBLISS hit the nail on guess is that is the direction in which scored in the bill is the government the head: Small businesses with health they are going to want to go: Raise uses the old heavy hand of inflation. As

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It demonstrates how we are said this to Treasury Secretary have as an inflation factor that is not going to have these Chevrolet plans— Geithner yesterday: Our experience has indexed. It is not indexed. you have heard of these health insur- never been to do something like that. I wish to show these charts here to ance plans. Let me put this chart up. So where does the money go? It goes prove it. At the end of how this is We are going to tax the Cadillac plans, right on the deficit and the debt and scored, we will end up having people all right? Well, it turns out under this you are going to add to that $12 trillion who have subsidized insurance when bill, the Chevy becomes a Cadillac. So estimate. We are hemorrhaging Fed- they start out, but that in the outyears you are going to tax the Cadillac when eral money and, at the same time, the in the scoring will be taxed for having it is still a Chevy. That is because of global community is saying, you have subsidized insurance. So we will be inflation. to get your fiscal house in order. both taxing them at the same time as Most people know their health insur- We just had our President over in we are subsidizing their insurance. And ance premiums have been going up China, hat in hand, with our bankers we are also—and I will show a chart pretty consistently over time. Well, it saying, OK, we think human rights is here in a minute—taxing their insur- turns out that the Chevy will meta- pretty important, but we need that ance plan that we are subsidizing at morphose into a Cadillac and it gets loan. What we are going to see take the same time, and that is built into taxed and that is in the CBO scoring of place, because this is a fiscally irre- the base score. So then that is how you this bill, and that is how you come out sponsible package, I think we are going get to a CBO score that, presto chango, with balancing the cost of the bill. to see the international community the budget is balanced; we are even None of this is going to happen. You saying words are one thing but action producing a surplus. It is this cruelty will have some sort of AMT-type fix is what talks, and we are going to start of inflation. that will take place on an annual basis, pulling capital out of the U.S. market- People can remember back to the and at the end of the day you get a big place. It is going to drive up interest Jimmy Carter days with 10 percent in- debt and deficit you are going to have rates, it is going to drive up inflation. flation. They know what that did to with it or horribly cruel high levels of So maybe this scenario happens, but them. Look at this. This is all in the inflation or maybe both. it is cruelly done through inflation, CBO scoring. This is from the Joint Mr. CHAMBLISS. I would ask the and it is not fair to the American pub- Economic Committee staff who have Senator from Kansas if he would yield lic. been working through these calcula- for a question. The question is: The Mr. ALEXANDER. I wonder if I tions to see, How do you come up with Senator from Kansas and I were elected might ask Senator ISAKSON from Geor- adding a multitrillion-dollar entitle- to Congress in the same year. This is gia, we talked a little bit about his ex- ment program and come to a budget our 15th year, I believe, of serving. You perience as a small businessman. Sen- deficit-neutral facet to it? What we see have been over here longer than any of ator BROWNBACK has talked about taxes here is surtax levels—and this is kind us have, and you were involved in and how they are going to go up. Ac- of a busy chart—but this red line is 100 State government as well. cording to the Republican Budget Com- percent of poverty in 2009 and 100 per- Have you ever seen a Federal pro- mittee analysis, the new taxes in this cent of poverty built out over 100 gram that was projected to be at X bill that we have on our desks would be years, which is also part of the scoring number of dollars of expenditure which about $850 billion over a 10-year period system, and then the median income of came in on time and on budget? of time. Senator ISAKSON has been a married households. What you see is Mr. BROWNBACK. No, I haven’t seen small businessperson. Some of those families receiving subsidies beginning that take place. taxes would be on you. Who is going to to pay the surtax in the scoring of this. Mr. CHAMBLISS. Do you think that pay the taxes? That is all due to the cruelty of infla- when Senator REID comes down here Mr. ISAKSON. My customer. The tion. and says this bill is going to cost $849 thing is, business is the collector of Mr. ALEXANDER. I wonder if I could billion over 10 years, that is a correct taxes for the government. Government ask the Senator from Kansas, haven’t figure for a massive reform of health imposes a fee, a fine, a cost to business, we heard this story somewhere before? care? and it rolls into the base of what that As I remember, back in the late 1960s Mr. BROWNBACK. No, and I don’t business has to pay to produce its prod- there was a so-called millionaires’ tax. know that there would be 5 percent of uct and it is upon that which they We were going after 155 very rich peo- the public in my State who would be- make a profit. So this business of tax- ple in America who weren’t paying any lieve that, because their experience ing business, they are getting business taxes and now we call it the alter- tells them differently. Their experience to collect a tax from the ultimate con- native minimum tax, and if we don’t tells them: Look, I know you guys sumer. That is all it is. fix it every year more and more people make these great promises and every- I want to throw something else in. I will end up paying this tax. I think last thing, but I also know the further out appreciate Senator BROWNBACK very year there were 28 million Americans you make this promise, the less reli- much. I was in Georgia a few weeks who would have had to pay the tax. able your data, and I have seen that ago, Albany, near where Senator Mr. BROWNBACK. That is absolutely whenever the government gets into CHAMBLISS raised his family, at a Ro- correct, and it is the same technique. things, it always costs a lot more and tary Club. I was asked by a fellow: You This is the alternative minimum tax it seems as though our debt and deficit keep talking about a trillion. How on steroids in the insurance industry always keeps growing and it is way too much is that? I babbled and fumbled. and in the insurance field. It is the big. Have you ever tried to explain that same thing. We fix it every year. That What is troubling is that this is built number and quantify that? It is a huge is why this is such a fraud. Do you real- into the base of how we get to the num- number. We are talking about $2.5 tril- ly think we are going to tax people for bers of getting this as a budget-neutral lion in the first full 10 years. I got so their health insurance at the same matter. This isn’t going to happen. On frustrated that I got on the calculator time we are subsidizing their purchase top of all of that, you say we are going to figure out an analogy as to how of health insurance? That isn’t going to save $400 billion in Medicare. We much it is. I decided, I wonder how to happen, so those dollars aren’t going have now voted four times for the so- many years would go by for a trillion to arrive. So where are those dollars called doctor fix, which was a slight re- seconds to pass. I got on the calculator going to come from? It will be from duction in Medicare spending for pro- and worked it out. It is 31,709 years for deficit and debt, or you are going to viders, and I voted for it three times, a trillion seconds to go by. That gives

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.033 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11849 you some proportion of the volume of against this bill. You are dictating a not just about health care. This is, as dollars we are talking about in taxes State budget. Initially the Feds are President Obama said one time, a and costs and, as the Senator said so putting in the full amount, but I have proxy for a national debate about the rightly, debt. That is a lot of money, seen this before too. You start with the role of government in Washington and and the American taxpayer ultimately Federal Government wiggling the car- in everyday American life. This is is on the bill for every dime of it. rot, saying: Take a bite. You can do it. about the stimulus package, about the Mr. CHAMBLISS. I ask my colleague Then once you get hooked, you say: Washington takeover of car companies. from Georgia, we talked about this, OK, we are going to reel it in now, and This is about the growing debt; this is and he has had extensive experience at you will pay more of it. It will be the about the takeover of student loans; the State level with respect to Med- Federal Government dictating the this is about every Washington take- icaid. Take our State—and I think we State budget, putting it into Medicaid over, and every increase in debt. That are representative of all 50 States. We and taking it away from schools. That is what this debate is about. I think have a Medicaid Program now that pro- is what will take place. That is what is that is why we are seeing such inten- vides for coverage or eligibility at 100 happening in my State now. sive opposition. I wonder if you have percent of the poverty level. This bill It is not fair to do that. It is not any reflection? takes that to 133 percent of the poverty right for us to do that. Most of the peo- Mr. BROWNBACK. I certainly think level. Talk for a minute about the imple across Kansas think this whole it is. What I observe, too, is people pact of going from 100 to 133 percent to issue is fiscal insanity—literally fiscal coming up to me in large numbers and cover some of those uninsured I re- insanity—what we are looking at doing very passionately saying they are both ferred to earlier. What is the impact on with that level of debt, $12 trillion a mad and scared. They are mad about our State? year. With my State having the level of this taking place, and they are scared Mr. ISAKSON. Right now, Georgia’s debt it has, making this requirement— it is going to actually happen to them. current year budget for the cost of a multi-trillion-dollar entitlement ex- They feel like, how can this happen to Medicaid is $2.15 billion, or about 12 pansion when the Federal Government them in this country? They look at percent of the State appropriations. is hemorrhaging money, as well as that huge debt and at our President This bill, as currently configured, State governments—is fiscal insanity. over in China talking as if he is going raises that eligibility by 33 percent. The world community is saying: Get to see the banker, and they don’t like But the Feds hold harmless the States your fiscal house in order. This makes it. This isn’t their country the way for the first 3 years of that increase, no sense. they want it to be. They want our and then it is a 90/10 split for the next Mr. CHAMBLISS. I don’t think we country to be fiscally sound instead of 7 years, and then it is silent. To give can overstate what the Senator has going to beg hat-in-hand to the ‘‘bank- everybody the benefit of the doubt, say said. Not only is the Federal Govern- er’’ in a foreign country. Then you are States only have to pay 10 percent ment looking at the largest deficit we going to add another big entitlement more. That is one-quarter of $1 billion have ever seen in the history of our on top of that? They are saying: Don’t more in Georgia—from $2.15 billion to country—just this past year, $1.3 tril- ask me, the taxpayer, for more money $2.4 billion in the State budget. lion—but every State is having the because I don’t have it. They are mad We all know what is going to hap- same problem. That deficit is trickling and scared about this. It is very dis- pen—what happened with the original down. concerting for people in the country. Medicaid program. The State will even- In Georgia, for example, we have one Mr. ISAKSON. I agree with Senator tually have to pay the full 35 percent county that has run into these edu- BROWNBACK. I guess I could sum it up match, which would mean that over cation reductions that Senator ALEX- in four phrases. There will be less ac- time, at the end of the 10 years, using ANDER is talking about, which univer- cess, seniors fear, because of cuts in today’s numbers without inflation, sities are facing. That one school sys- Medicare. They will have less access. Medicaid costs in Georgia for about 12 tem reduced the days the children are There will be higher costs because of percent of the population would go going to school from 5 to 4 days to save the bending of the way in which they from $2.15 billion to $3.4 billion a year the cost of buses running and other calculate premiums and the additional for Medicaid. bills, for heating and whatnot, for that taxes. Everybody knows that will be a Mr. CHAMBLISS. Whether it is paid extra day. That is not what we need to higher cost. There is a great fear of ra- by the Federal Government after that 3 be doing as Americans. We need to fig- tioning, which is a component part of years or by the State of Georgia, whose ure out a way to struggle through this. almost every plan to get from where we pocket will it come out of? Instead of struggling through it, we are to where they want to take us. Mr. ISAKSON. The taxpayers of the are now in the toughest times we have Lastly, I hear a lot from young peo- United States of America. ever seen, as Senator BROWNBACK said, ple who are considering a medical ca- Mr. ALEXANDER. As we were dis- we are adding these huge taxes that reer either in research or in applied cussing earlier, it could be paid out of will stifle the small business commu- medicine. They fear that medicine will the pockets of the 18 million or 20 mil- nity on top of the debt that we have not be the practice in this country in lion students who go to, for instance, seen created in this country just in the the future that it has been in the past. the University of Kansas and Kansas past 12 months. If that is true, if they leave and go to State. We began this discussion by Mr. ALEXANDER. I have a question other fields, we will have less innova- pointing out that California raised tui- I will ask any of the Senators who tion and research and development tion yesterday 32 percent for its stu- want to comment. Someone asked me and, in the end, less quality health care dents. They are pointing fingers at yesterday: Where is all this opposition for the American people. each other, but they should be pointing to these health care bills coming from? Mr. CHAMBLISS. These are not peo- at us for not reining in Medicaid be- We have seen the Gallup poll and the ple who are on the extreme right or ex- cause over time that is the biggest rea- Pew poll. These are not Republican treme left who are bombarding us with son. Polls. They are well-respected polls in phone calls, e-mails, and letters as all Mr. BROWNBACK. In my State of this country that are showing that of us get on airplanes, as I did Monday. Kansas, a huge budget debate is going independent voters, by 2 to 1, say they I had people come up as I walked on about where we are going to come don’t want this bill. through the airport, and as I was on up with the shortfall this year in the I have been in and out of politics for the airplane, and when I got off the air- State budget. People can save in some many years. I have never had as many plane, saying: Please stop this bill. places, but you have to do this on Med- people stop me on the street or in the Don’t pass this foolish bill that you all icaid. It ends up, in all probability, airport or wherever, and say, ‘‘Please are talking about up there now. It is that a disproportionate share will come don’t do this.’’ Somebody asked me amazing, the type of folks who will out of the schools for the school- yesterday: Why is there that much op- come up and say that. children. Is that what we at the Fed- position? I have two quick anecdotes I would eral level want to see take place? No. My answer was—and this is what I like to read. One is a letter I got from That is one of the reasons I am voting would appreciate comments on—this is a doctor. It reads:

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.035 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11850 CONGRESSIONAL RECORD — SENATE November 20, 2009 Dear Senator: than pass a 2,074-page bill that will trillion a year and still be so lacking in I am a vascular surgeon in Rome, GA, with bankrupt the country. the essential health care services for a patient population that is 70 percent Medi- I yield the floor. the people of this country. We spend care. I am deeply concerned about the pro- Mr. BROWNBACK. Mr. President, I posed Medicare cuts. After 8 years of college twice as much in this country on and medical school, and 7 years of training, suggest the absence of a quorum. health care as Europe. Yet we have I have accumulated a large debt in loans and The PRESIDING OFFICER. The twice as many people sick with chronic interest. Plus there is the huge administra- clerk will call the roll. illnesses. That does not seem to make tive burden of a large Medicare population in The bill clerk proceeded to call the sense. my practice. I don’t know how I and other roll. We have some of the highest of high- physicians are going to be able to afford to Mr. HARKIN. Mr. President, I ask tech medical devices and procedures continue to see Medicare patients if these unanimous consent that the order for and interventions anywhere in the cuts go through. As it stands now, I am paid the quorum call be rescinded. world and, of course, people who have a only 23 cents on every dollar charged. I The PRESIDING OFFICER. Without would appreciate help in staving off these lot of money in other countries—we al- cuts. objection, it is so ordered. ways see kings and princes and wealthy Mr. HARKIN. Mr. President, the de- people from other countries come here. The other one is an e-mail I got in bate has now begun on the bill we call the last few days about a good friend of They come here for the very high-tech, our health care reform bill. It has high-cost interventions. We are very Senator ISAKSON and mine, Bob Lovein, taken us a long time to get here. After a funeral director in Nashville, GA, good at that. We are the best. We are a lot of hearings, a lot of markup, a lot unequaled in that. But where we fall which is close to my hometown. It says of public discussion, a lot of town this: short is helping the very broad mass of meetings around the country, now we American people to have the peace of A lady walked into the funeral home and are at the final pivotal moment, a his- mind knowing that if something hap- gave him a letter from the VA. The letter toric moment in the long march to stated that they (the VA) owed her $307 on pens to them, if they do get ill, they her husband’s death benefits. Bob pulls her pass meaningful health care reform. are not going to lose everything. husband’s file and he had buried him 10 years I say long march because it started The single biggest cause of bank- ago . . . and we trust the government to run with Theodore Roosevelt and continued ruptcy—I know in my State of Iowa health care? on through the New Deal, continued on and I think most of the country, the That is how ridiculous it is in the to Harry Truman’s administration, and single biggest cause of bankruptcy is minds of people in this country who are on to this time. Every time we have because of medical expenses because calling and writing our offices—cer- been turned back by the status quo people bump up against lifetime caps tainly the offices of every one of the forces, those who want to stick with or annual caps, they cannot make it, Members of this body—because they what we have, those who are afraid of and they declare bankruptcy. In no don’t understand why we are mort- making changes. This time they are other country in the world is this al- gaging and sacrificing our children’s not going to stop us. This time it is lowed to happen. It is incumbent upon future, or why, as Senator BROWNBACK unstoppable. We have come this far, us to get this bill through. says, when the President goes to China and we are not going to turn back. At the beginning, I wish to salute our to see their banker—China owns al- Just listening to a little bit of the majority leader HARRY REID for what most $1 trillion worth of our debt—the discussion on the Republican side he has done. We had our bill that came Chinese Premier asked the President today and listening to what the Repub- out of the committee that I am now about the health care bill because he is licans have had to say about health privileged to chair after the untimely concerned about the way we are spend- care reform in the last few months and death of our esteemed colleague and ing money here. anticipating what we will hear from friend, Senator Ted Kennedy. Our I can never remember any foreign Republicans in the next few weeks, it HELP Committee bill came through leader ever asking the President of our will be a message of fear that somehow under the great leadership of Senator country about anything to do with the by changing the status quo, the Amer- CHRIS DODD. We passed it on July 15. financial condition, particularly a pro- ican people are going to be worse off Then the Finance Committee, under gram like this, which would affect us. than they are now, that somehow we the able leadership of my friend and Mr. ALEXANDER. I am afraid our are going to take away something they classmate Senator MAX BAUCUS of time is almost up. have, that somehow if we just stick Montana, did their work. Then the two Mr. BROWNBACK. Yes, our President with what we have, everything will be bills had to be put together and that got lectured by the Chinese regulator fine. But you will hear a lot of words was done by the majority leader and he about our financial system. This is un- and messages from the Republican side did a masterful job of putting the two believable. This exacerbates it, if we meant to frighten people, to put a pall bills together and getting it down to pass this bill. of fear over what we are trying to do. the Congressional Budget Office and Mr. ALEXANDER. I thank Senators The frightening thing for the Amer- getting a score on what it would cost, BROWNBACK, CHAMBLISS, and ISAKSON. I ican people is if we do nothing, if we what it would cover. When we saw the think all four of us want the American stick with the status quo. Too many bill come back—the bill we now have in people to know above all that we have people in this country have no health front of us, the so-called merged bill— repeatedly said that instead of 2,000- insurance whatsoever. Thousands every it truly is a work of genius by the ma- page bills that raise taxes, raise pre- day in this country, every single day jority leader. miums, cut Medicare, and transfer thousands of people lose health care in- I said the other day that he has the costs to States, we would rather iden- surance coverage. So many people who patience of Job, the wisdom of Sol- tify the goal of reducing costs and go have preexisting conditions cannot get omon, and the stamina of Sampson to step by step toward that goal. We have coverage at all. People who are begin- get this job done. introduced specific legislation to take ning to retire but they are not quite 65 I also salute all the Senators—Demo- those steps, which could be bipartisan, and cannot get on Medicare are left in crats and Republicans—whose ideas are such as allowing small businesses to a state of limbo, where they cannot get incorporated in this bill. It is a robust pool their resources to purchase insur- health care coverage. bill. It went through a long, bipartisan ance, that Senator ISAKSON talked So many people in this country are process. In our committee, we had pro- about, and reducing junk lawsuits, as being discriminated against in health ceedings that spanned 13 days, 54 hours. Senator CHAMBLISS talked about, and insurance because—well, because they Republicans were full-fledged partici- allowing competition across State are a woman or perhaps because they pants. They offered 210 amendments. lines. We have our step-by-step plan. are older, perhaps they are a person We accepted 161, many of them making We believe the American people have with a disability. For a variety of rea- substantive changes in the bill. lost confidence in Washington and that sons, they are being discriminated A similar open and inclusive process they would prefer that we go step by against in health insurance coverage. was followed in the Finance Com- step in the right direction to reduce We have to make these changes. We mittee. I daresay, when we got our bill costs and re-earn their trust rather cannot continue to spend over the $2 through, after all that, after all the

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.036 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11851 amendments offered, accepted or themselves in their old age to supple- know what that means. For example, adopted, not one Republican would ment their Social Security because the our bill right now would ban lifetime vote for our bill—not one. It is truly money will be used for an illness. and excessive annual limits on cov- unfortunate now that we have put As I said earlier, 62 percent of U.S. erage next year—not 2014 or 2015, next these bills together, we have gone bankruptcies are linked to medical year. Think about that in your own through this long process that has bills. What is the kicker in this is that policy. Your policy, I guarantee, has taken most of this year, that Repub- 80 percent of those were people who ac- some kind of lifetime cap or annual licans have now chosen the path of tually had health insurance, but they caps. Next year, they will not be able delay and filibuster and obstruction. ran up against their lifetime cap. to do that any longer. Why are we even here today? We are Abuses, abuses by the health insurance Our bill bans rescissions. What that here because the Republicans are try- industry because they can do it and means is that right now so many peo- ing to prevent us from even bringing they can get by with it. ple don’t know that their health insur- the bill to the floor for debate. How Think about it this way: Health in- ance policy can drop them. There is a many people in America know that? surance companies employ armies of clause in it that says that when you The reason we are here is because the claims adjustors who routinely deny are up for renewal, they can drop you Republicans do not even want to bring requests for medical tests and proce- for any reason. The reason they use is, the bill to the floor for debate and dures. Why do they do that? Because if you get sick. Think about that. amendment. That is their right under they get bonuses by saying no to the I can’t tell you how many people I the rules of the Senate. It is their policyholder. Think about that. An in- have talked to in my State of Iowa who right. They can filibuster. They can surance company says to their claims have come up to me, especially during delay. They can obstruct. They can say adjustors: We will pay you more the the town meetings we have had this no. But just as surely as that is their more people you deny. What a system. summer, and have said: I like my right, it is our responsibility, as Demo- It is outrageous. It is intolerable, and health insurance policy. I have a good crats, to move this bill forward. we cannot afford to let it go on any policy, and I would like to keep it. I remind my colleagues on the other longer. My rejoinder is: That is fine, but I side of the aisle that last year voters One of the many things we do in this want to ask you a couple of questions. overwhelmingly voted for Barack bill is to crack down on these health What is your lifetime or annual cap? Obama to make changes, and one of the insurance companies’ abuses in a very Most often, people say: I don’t know. changes he campaigned so hard on was strong and robust way. Again, I deeply I say: Do you have a lifetime or an- changes in the health care system and, regret that our Republican colleagues nual cap in your policy? just as surely, voters elected Demo- refuse to join us in this reform effort. They aren’t certain. crats to majorities—big majorities—in They have chosen to defend the status I say: Do you have a rescission clause the House and the Senate to do the quo, protect the insurance companies in your policy? same thing. So it is our responsibility and their profits over the health of the I can tell you 100 percent of the peo- to lead, and that is what we are doing American people. ple I have talked to said: What does now by bringing this bill to the floor. Indeed, my friends on the Republican that mean? We are taking another giant step to- side and the health insurance compa- I said: What it means is, if you get ward fulfilling the mandate—the man- nies are now joined at the hip—same sick, if you have to have a kidney date—the people of this country gave talking points, same distortions, same transplant or if you have cancer or to President Obama and the Demo- untruths about this bill, same bogus, heart disease, can your insurance com- cratic Party last November to under- cooked-up studies, the same deter- pany drop you when your policy comes take a comprehensive reform of Amer- mination to obstruct and kill any due, with no explanation whatsoever? ica’s health care system. health care reform effort. They don’t know. As not only the long debate has made As I said earlier, this time they will I said: You have to look at your pol- clear to the American people, but in- not succeed. The more the American icy and find out, because most policies nately the American people know and people learn about this bill and what is have those rescission clauses. they understand the current system is in this bill, the more they like it and I daresay, when a lot of people say hugely dysfunctional, it is wasteful, the more they are demanding that we they have a good health insurance pol- and it is abusive. People are aware of get the job done. icy, they answer yes, they do have a the abuses that have become standard President Obama pledged that we good health insurance policy, as long practice in the health insurance indus- would do health reform and not add to as they are healthy. As long as you are try: denied coverage because of pre- the deficit. We have done that with healthy. Once you get sick, out the existing conditions; health insurance this bill. The Congressional Budget Of- window it goes because you have a cap, being dropped because they get sick; fice says this bill will actually reduce either a lifetime or an annual, or you their insurance premiums jacked up 100 the deficit by $130 billion next year and have a rescission clause. percent, 200 percent in a year simply by $650 billion in the next decade—$650 The other thing I hear from a lot of because they had an illness. billion—and it will reduce the deficit families: You know, my kids were cov- People know they can be charged continually every decade thereafter. ered when they were in school. They higher rates simply because they are a All the budget concerns have been put are now out of school, they have not woman. We know, we have the data. to rest. Now we can focus on what is in quite gotten a job yet, and I can’t keep Woman, man, same age, same occupa- the bill. them on my policy and it costs a lot of tion, same status—a woman is charged The Congressional Budget Office says money to put them on a different pol- more than a man for the same policy or our bill will cover 94 percent of the icy. they are charged more if they are American people; 94 percent will now Our bill says that now these young older. We know about annual caps and be able to have the peace of mind to people can stay on their family policy lifetime caps I just mentioned that know they have health insurance cov- until they are age 26. This is a huge cause people to go into bankruptcy. erage. benefit to working families. The bottom line is this: Every Amer- Our bill says if you have a health I have said many times that the two ican family knows that in many cases, care plan that you like and that you biggest winners under our health care they are one illness away from finan- want to keep, nothing will disturb reform bill are small businesses and cial catastrophe. If you want to talk that—nothing. You can keep whatever the self-employed. Small businesses— about fear, that is what people are plan you want if you like it. we are in a deep recession. If we want afraid of, not so much of getting sick— A lot of people say this plan doesn’t to get out of that recession, we better that is part of life—but the fact that go into effect until 2014. It does take start focusing on small businesses be- illness will drive them to financial some time to get these exchanges and cause it is small businesses that create ruin, that they will not have enough things set up, but there are some im- over 65 percent of the jobs in this coun- money to take care of their kids, to mediate things that will happen next try. Yet small businesses are thwarted send them to college, or to take care of year, and the American people ought to in their effort to expand and grow. One

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.039 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11852 CONGRESSIONAL RECORD — SENATE November 20, 2009 of the biggest reasons is because of the I have often said that we don’t have bate. Hopefully, over the next weeks cost of health care for their employees. a health care system in America, we that will change and people will learn So many small businesses now have have a sick care system. If you get what is really in this bill versus the ru- dropped health care coverage for their sick, you get care. Almost all of our ex- mors of what is in this bill. They are employees because they simply cannot penditures go for interventions and very different things. afford it or the premiums have gone up, patching and fixing and mending once I again thank the Senator from Iowa the deductibles are huge, and basically somebody gets sick. Very little goes for for his leadership. It made a real dif- what it has gotten to be is basically prevention. About 96, 97 cents of every ference to the quality of this bill. catastrophic coverage for their em- dollar goes for taking care of you after Why are we here? We are here be- ployees. Small businesses need help in you get sick. Only about 3 or 4 cents cause we face a completely order to grow and expand and get us goes to prevention. It is time to do unsustainable situation in health care out of this recession. This bill will pro- more for that, time to do more for pre- in this country. Medicare is going vide immediately, next year, up to a 35- vention and wellness, keeping people broke, premiums are rising 3 times as percent tax credit for health insurance healthy in the first place. fast as wages, 46 million people have no policies for their workers. That is a big In this bill, we have a provision that health insurance, spending is twice as deal. It is not just for small businesses, says that if you want to go in for your much per person in our country as in it is for my farmers and for those who annual checkup and your annual almost any other country in the world, are self-employed—for so many self- screening, no copay, no deductions, and and the outcomes of our system for our employed in this country, next year, a for certain other screenings, such as people are not as good as they should tax credit of up to 35 percent. colonoscopies, breast cancer be. So it is very clear: The status quo Next year, we are going to have a screenings, and things like that, no co- is unacceptable. Doing nothing is not new policy option for people who have pays, no deductibles. an option. Failure is not an option. It preexisting conditions. So if you had In the ensuing days and weeks when is critically important that we reform an illness in the past, if you have been we debate that, I will be talking a lot the health care system in this country. living with cancer and you have it more about the prevention and If we do not, our families’ budgets will under control, you have a chronic ill- wellness part of this bill. It is big. It is be threatened, our businesses will be ness, next year we are going to provide the first time we have ever done any- threatened, and the Government itself a new policy option to put people like thing like this, to begin to move the is threatened. That is the reality. that into a high-risk pool and provide paradigm in this country away from I want to praise Leader REID for put- that they can get insurance coverage sick care to health care. Our goal in ting together a responsible package at prices they can afford. When the ex- this bill with this provision is to and a really very good first step. I also changes come on in 3 years, all of that change America into a wellness soci- want to praise Senator BAUCUS for his will go by the wayside. They will not ety, where it is easier to be healthy leadership in the Finance Committee. be able to discriminate because of pre- and harder to be unhealthy—just the He did an outstanding job. I have never existing conditions. But next year, opposite of what it is today. It is easy seen, in my 23 years, any committee right away, people who have pre- to be unhealthy in America today. It is chairman have as diligent and focused existing conditions can get policies at hard to be healthy. We are going to an effort as Senator BAUCUS gave this prices they can afford. change that around, and we are going in the Senate Finance Committee over How many times do I hear people tell to start with this bill. a 2-year period. Our group of 6 alone me: Here I am, I have been working One of the most important parts of met 61 times, and there were dozens hard, I have been a construction work- this bill is the massive change we are and dozens of other hearings, meetings, er, or something like that, that is hard going to make in prevention and forums, roundtables. Senator BAUCUS work. I am 55. I have had some acci- wellness. organized a health care summit last dents. I have a bum leg and my back is I note the presence on the floor of my year, and that was a model of how Con- bad. I can’t work until I am 65. But distinguished colleague from North Da- gress ought to approach an issue. So I what am I going to do about my health kota. I yield the floor. give high praise to Senator BAUCUS. insurance? The PRESIDING OFFICER (Mr. Senator DODD, who was called in at We have in here, starting next year, KAUFMAN). The Senator from North Da- the eleventh hour to replace Senator if you are an early retiree, we have a kota is recognized. Kennedy because of Senator Kennedy’s program to protect your coverage and Mr. CONRAD. Mr. President, I thank at the same time reduce your pre- illness, deserves enormous credit, enor- the Senator from Iowa, Mr. HARKIN, miums, both for you and your em- mous praise for picking up the ball at and I commend him for the out- ployer, until the time you get to be age a critical juncture and carrying it standing work he did on the HELP 65. This is a big deal for so many people across the line in the HELP Committee Committee, especially on the preven- in this country. as well. Last, in whatever time I have left— tion provision. I don’t think there is Senator REID had the very difficult parliamentary inquiry: How much time anyone in the Senate who has been task of bringing together the Finance does the Senator from Iowa have left? more dedicated to moving us from a Committee bill and the HELP Com- The PRESIDING OFFICER (Ms. sickness system to a wellness system mittee bill, combining them into a ve- KLOBUCHAR). The Senator has 37 min- than the Senator from Iowa. He did hicle for consideration here. utes 13 seconds. outstanding work on the prevention This bill is not perfect. No work of Mr. HARKIN. Madam President, I un- provisions in the Health Committee humans ever is. Certainly more needs derstand my friend from North Dakota bill, many of which now are in the bill to be done to control cost. That is what wishes to speak. I will wrap this up by before us. I applaud him for his leader- I believe. But this is a very good begin- saying there is one other part of this ship because in many ways those are ning. This bill makes an important bill that is so important that doesn’t the most important provisions. If we contribution to improving health care. get much play but I consider to be one can encourage people to lead healthy Those who labored for months and of the most significant parts of this lifestyles and have an emphasis on months to produce it deserve our bill, and that is an emphasis on preven- wellness, we can change the quality of thanks and praise. tion and wellness, keeping people millions of people’s lives. I am somewhat taken aback by healthy in the first place. I personally think the provisions speeches I have heard from colleagues There is a lot of talk about bending Senator HARKIN authored that are part over the last several days acting as the cost curve and how we are going to of this legislation are in many ways though this vote tomorrow is the end bend that curve and get costs down. I the most important pieces of this bill. of the story. Anybody who understands submit that not only the best way but What is interesting is they have re- Senate procedure even a little bit perhaps the only way we are going to ceived very little attention in the pub- knows this is the beginning of the do this is by keeping people healthy in lic debate. In fact, many of the most story. This is the beginning of the de- the first place, putting more emphasis important provisions in this bill have bate. This is the beginning of a process on prevention. very little attention in the public de- to amend and improve the bill. This is

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.040 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11853 the beginning of the discussion on the health insurance. It is interesting be- families and businesses. That simply floor of the Senate about legislation to cause every other industrialized coun- cannot be the result for our Nation. reform the health care system. I don’t try in the world has universal cov- On Medicare and Medicaid spending, know of a single credible reason to vote erage. They have figured out a way to in 1980, if you put the two together, against going to consideration of legis- provide health insurance to every fam- Medicare and Medicaid consumed 2 per- lation to reform the health care system ily in their countries. France, Ger- cent of our gross domestic product; $1 in this country. This isn’t about the many, Great Britain, Japan, every in every $50 in this economy was going final result. This is about beginning other major industrialized country has to Medicare and Medicaid. In 2010, we the discussion and the debate. Who figured out a way to provide health in- are up to almost 6 percent of GDP for would want to prevent a discussion and surance for every one of their citizens. Medicare and Medicaid, three times as debate? Who would want to prevent It is time for America to do the same. much as a share of our economy. But Senators from being able to offer That is a moral issue. That is not just look where we are headed. By 2050, amendments to improve the legisla- a financial issue; it is a moral issue. again on the current trend line, we tion? What kind of country are we going to would be spending 12.7 percent of gross If people are dissatisfied with the be? domestic product just on Medicare and product at the end of the process, that This is a letter I received from a con- Medicaid, six times as much as back in is when they can vote no. They can stituent in September. I wanted to 1980. If we look at the indebtedness of vote no against cloture. They can vote share it with my colleagues. the country, there is no bigger contrib- no against the package. There are lots Dear Senator Conrad, I am 51 years old and utor than Medicare. It is the 800-pound of opportunities to oppose it if you are have never given much thought to writing a gorilla: $37.8 trillion of unfunded liabil- unhappy with the final result. But Senator until now. Three days ago, we re- ity in Medicare. The comparable num- being unwilling to even discuss the ceived some of the worst news a person can ber for Social Security is $5.3 trillion. subject strikes me as a preposterous get. My husband has been diagnosed with We can see the unfunded liability in position. bladder cancer. He does not have health in- Medicare is seven times the unfunded surance. We are self-employed. Our income is liability in Social Security. This plan meets key health care re- low but we do own some property which form benchmarks. It is fully paid for. For those who say, let’s not even go makes us ineligible for most assistance pro- to a debate, let’s not even go to a dis- In fact, according to the Congressional grams. A few years ago we both dropped our Budget Office—not controlled by Re- Blue Cross Blue Shield because the pre- cussion on reforming health care, what publicans or Democrats; it is strictly miums were too high. I re-applied and got is their proposal? Are they afraid to nonpartisan—this measure reduces the my insurance back but my husband was de- offer one? Do they not have one? Is deficit by $130 billion over the first 10 nied due to his weight. (He quit smoking 4 their answer do nothing? Is their an- years. That is their judgment. In the years ago and put on weight gradually since swer really to do nothing in the face of then.) second 10 years, they say this legisla- a crisis of this magnitude? Their an- We are stunned by the diagnosis and are swer is: Let’s not even debate it; let’s tion will reduce the deficit by $650 bil- terrified by the uncertainties of his prog- lion. When people come out here and not have even have a chance to amend nosis. We already owe $2,000 just for emer- it? say this increases the deficit, this in- gency room costs and he has surgery sched- That is not a credible position. It is creases the debt, I don’t know what uled for September 22 with at least an over- not a responsible position. It is not a legislation they are talking about. It is night stay in the hospital. The medical bills serious position. That is a position of not the legislation before us. They are, will be astronomical. If the cancer is not lo- obstruction, pure and simple. of course, free to make up whatever calized, he will be referred to oncology and will begin chemotherapy/radiation treat- If we look at our system, we have had numbers they want, but the official ment and possibly even more surgery. We a review by Dartmouth Medical School. evaluation of this legislation by the will have to sell almost everything we own They concluded: nonpartisan CBO, the Congressional to pay [the] bills. Although many Americans believe more Budget Office, is that this bill reduces Please, sir, consider our story when think- medical care is better care, evidence indi- the deficit in both the short and long ing about health care reform. Any change cates otherwise. Evidence suggests that terms. will happen too slowly to help us but others states with higher Medicare spending levels It also expands coverage, according will benefit. Don’t give up. We are counting actually provide lower quality care. on you to make a difference. to the CBO, to 94 percent of Americans. They went on to say: It contains critical insurance market To that woman, I make this pledge: I We may be wasting perhaps 30% of U.S. reforms and, perhaps even more impor- am not going to give up. I think health care spending on medical care that tant, delivery reforms. We will get into enough of my colleagues will not be does not appear to improve our health. those in a minute. giving up so that we can at least begin As a country, we are spending almost Let’s talk about the need for action. the debate on whether there should be $2.5 trillion a year on health care. If 30 This chart shows what is happening to health care reform in this country. I percent of that money is being wasted, premiums for health insurance cov- repeat, I can’t think of a single cred- is not contributing to better health, 30 erage. Premiums are projected to con- ible reason why somebody would vote percent of $2.5 trillion is $750 billion a tinue to rise on American families. In against beginning the debate, to have a year. The answer by some of our col- 1999, premiums averaged $6,050. In 2009, chance to amend. If you don’t like the leagues is, let’s not even debate it. they increased by 117 percent. What the product as it has come to the floor, Let’s not even discuss it. Let’s not experts are telling us is, from 2009 to that is what legislating is about, the even attempt to address it. 2019, they will go up another 71 percent opportunity to amend, the opportunity That is a remarkable position to to average premiums in 2019 of $22,440 to improve, the opportunity to con- take. to an American family for health care vince colleagues that we need to move If we look at our country versus oth- premiums. How many families will be in a different direction. I don’t know ers around the world, we see we are able to afford premiums of $22,440? what could be more clear than that we spending far more as a share of our in- At the same time we see employer- have to move in a different direction come than they are. If we look country based health care coverage—and the on health care. by country: Japan is spending 8 percent vast majority of our people receive We are now spending 17 percent of of GDP; the United Kingdom, 8.4; Bel- coverage at their place of employ- our gross domestic product on health gium, 10 percent; Germany, about 10; ment—is in decline, from 68 percent to care. That is $1 in every $6 in this econ- Switzerland, almost 11; France, 11; and 62 percent in 2008. In 2000, 68 percent of omy. The experts tell us by 2050, we we are at 16 percent. That is as of 2007. companies were offering health care will be spending 38 percent of our gross We have gone up to 17 percent of GDP coverage. That is down to 62 percent in domestic product on health care, if we in 2009 on health care. We are spending 2008. stay on the current trend line. That as a share of the economy almost twice At the same time we know 46 million would be more than $1 in every $3 in as much as any other major industri- fellow citizens do not have health in- this economy on health care. That alized country in the world. Yet we surance. That is projected to increase, would be a disaster for the American still have 46 million people without any by 2019, to 54 million who will not have economy, a disaster for the budgets of health insurance.

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.042 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11854 CONGRESSIONAL RECORD — SENATE November 20, 2009 Under the British model, they have icit. It lowers it by $130 billion over the The Congressional Budget Office on universal coverage. Under the so-called first 10 years. It lowers it by $650 bil- the Senate health plan and reducing Bismarck model, countries of Ger- lion over the second 10 years, according long-term deficits: many, France, Japan, Switzerland, and to the Congressional Budget Office. . . . CBO expects that the bill, if enacted, Belgium have universal coverage. Yet So when somebody asks, How can a would reduce federal budget deficits over the if we remember their costs, we see even deficit hawk like Senator CONRAD be ensuing decade [beyond 2019] relative to though they are providing universal for this bill? It is because this bill low- those projected under current law—with a coverage in these other countries, their ers the deficit. That is not my analysis. total effect during that decade that is in a costs are much lower than ours. That is the official analysis of the Con- broad range around one-quarter percent of gross domestic product. If we look further at the quality of gressional Budget Office which is non- health care outcomes, quite an inter- partisan. Gross domestic product over that esting story emerges. Those countries This bill also expands coverage to 94 second 10-year period is forecast to be have universal care, lower costs. And if percent of the American people. It pro- $260 trillion. One-quarter of 1 percent we look at quality outcomes, they do motes choice and competition. It re- of $260 trillion is $650 billion. better than we do. On preventable forms the insurance market. It im- . . . CBO anticipates that the legislation deaths, the Commonwealth Fund, proves the quality of care. All of these would probably continue to reduce budget which is very distinguished and non- issues are at the heart of what reform deficits relative to those under current law in subsequent decades. . . . partisan, looked at preventable deaths must be. around the world. They found the The Senate health plan reduces In other words, it would continue to United States came in nineteenth. But short- and long-term deficits. It ex- reduce deficits beyond the first 20 other countries that have much lower tends Medicare solvency. Medicare is years. costs and have universal coverage, for going to go broke in 8 years. This bill The excise tax, which virtually every example France and Japan, are ranked extends the life of Medicare by 4 to 5 analyst has said needs to be part of a 1 and 2. With much lower costs and uni- years. It extends the solvency of Medi- package if you are going to be serious versal coverage, they are getting better care by 4 to 5 years. It includes reforms about controlling the explosion of results. And some do not even want to to improve delivery of care and reduces costs, will target plans that have a debate going to health care? They are costs. value of more than $23,000 a year. The going to have a tall order to explain It curbs overpayments to Medicare average premium in 2013 is projected to why they do not even want to discuss Advantage plans. Some Medicare Ad- be $15,740. So these Cadillac plans are it. vantage plans are now costing 150 per- plans that would have a value of more On infant mortality, the United cent of traditional fee-for-service Medi- than $23,000 a year. There are very few States is ranked 22nd, again, according care. Medicare Advantage was started people in the country who have plans to the Commonwealth Fund. Again, on the basis it would save money. In of that value today, and there will be these are countries that have universal fact, it was initially capped at 97 per- very few who will have plans of that coverage, with much lower costs than cent of traditional fee-for-service Medi- value in 2013. we do. Ranked No. 1 was Japan. France care. It was supposed to save money. The Senate health care plan also ex- was No. 5. Germany was No. 9. From Now there are Medicare Advantage pands coverage. According to the Con- my earlier chart, you will remember plans that cost 150 percent of tradi- gressional Budget Office, it covers 94 each of those countries has universal tional fee-for-service Medicare. It is percent of the American people by coverage and much lower costs than we not saving money, it is costing much building on our existing employer- do, and yet they are getting, on these more money. And it will break Medi- based system. It creates State-based metrics, better outcomes than we are. care if we do not reform it. That is exchanges for individuals and small It does not stop there. Here is life ex- clear. businesses. pectancy, as shown on this chart. The This bill also creates an Independent It provides tax credits to help indi- United States is ranked 24th. This is Medicare Advisory Board to make rec- viduals and small businesses buy insur- according to the OECD, the inter- ommendations on how we can have fur- ance. In fact, there is more than $400 national scorekeeper. Again, Japan, ther savings to extend further the sol- billion of tax credits here. Somebody Switzerland, France—universal cov- vency of Medicare. It also includes an said: Well, this is a big tax increase. It erage, much lower costs—still ranked excise tax on insurers offering Cadillac is a big tax increase. Well, they must much higher than we do on that met- plans. Virtually every analyst who have left out the $400 billion of tax ric. came before the Finance Committee credits. They must not have gotten to Japan, with universal coverage, said one of the most important things that page in the bill. much lower cost than we have—in fact, we could do was to start with a levy on It expands Medicaid eligibility with half as much as ours—yet they were Cadillac health insurance plans to re- assistance to States so they are able to No. 1. Switzerland, No. 2—they have duce overutilization and to begin to afford it. universal coverage, with much lower control the exploding costs. The Senate health plan also pro- cost than we have, and yet they rank When I say this bill reduces the def- motes choice and competition. It cre- No. 2. France, with universal coverage, icit, that is not my assertion or the ates a public option to compete with much lower cost, is ranked sixth in the work of the Senate Budget Committee. private plans, but not one based on world. That is the judgment of the official Medicare levels of reimbursement. I It would seem to me we ought to look scorekeeper here, the nonpartisan Con- think many of my colleagues know I to evidence, and evidence shows us gressional Budget Office. Here is a page strongly resisted a public option tied there is a better way, and that is what from their report, and it shows very to Medicare levels of reimbursement this legislation seeks to find. It seeks clearly, from 2010 to 2019, this legisla- because that would work a real hard- to find a better way to expand cov- tion reduces the deficit by $130 billion. ship in my State. But in this plan, erage, to improve quality, and to con- I have heard colleagues come to the there is no tie of a public option to tain exploding costs. floor and give all kinds of speeches Medicare levels of reimbursement. And The key elements of this Senate about how this increases the deficit. States can opt out. It also provides health care reform plan are these: One, They have every right to come here seed money for nonprofit coopera- it reduces both short- and long-term and make up any numbers they want to tives—member-run, member-controlled deficits. I noticed in one of the news- make up. They can make any claim cooperatives—to compete with private papers circulated on the Hill today a they want. But let’s be clear, the offi- plans. full-page ad asking: How can Senator cial analysis of this bill by the agency This chart shows the Medicare reim- CONRAD, who is a deficit hawk, be for we have all empowered to give us ob- bursement per enrollee for 2006. You this bill? Well, because I have read the jective analysis has concluded that this can see, New York was getting nearly CBO analysis, the Congressional Budg- bill reduces the deficit by $130 billion $10,000; North Dakota, though, $6,000. et Office analysis, that says clearly and over the first 10 years, and $650 billion That is the kind of disparity that ex- unequivocally this bill lowers the def- over the second 10 years. ists in Medicare reimbursement. It is

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.042 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11855 even more dramatic if you look at in- To conclude, if we look at the Senate iors, from the Medicare Advantage Pro- stitution to institution. In fact, for Democratic plan and the only Repub- gram, which we will talk about in a many years, I was shown a hospital in lican plan, and compare them, the Sen- minute, from nursing home care, home Devils Lake, ND—Mercy Hospital— ate Democratic plan contains delivery health care, and hospice care. Medicare that would get one-half as much as system reforms. There are none in the already faces a severe challenge, in- Lady of Mercy Hospital in New York Republican proposal. The Senate cluding a whopping $38 trillion in un- City to treat the exact same illnesses— Democratic proposal reduces the num- funded liabilities and insolvency by the one-half as much. That is all based on ber of uninsured by 31 million people. year 2017. That is almost incomprehen- formulas based on historic costs. That The Republican plan makes no progress sible—in just a few short years, $38 tril- is why many of us believe it would be on that front. The Senate Democratic lion in unfunded liabilities and insol- unfair to tie a public option to Medi- plan reforms the insurance industry, vency. Obviously, seniors want us to care levels of reimbursements. That banning preexisting conditions and re- fix that problem rather than raiding disparity across the country would scissions of coverage and health status Medicare to pay for a new health care work an extreme hardship on low reim- ratings and lifetime benefit limits. The program, and they want to preserve bursement States such as mine. Republican plan has no similar provi- Medicare Advantage. The cooperative plan allows for not- sions. I receive letters from worried seniors for-profit co-ops to provide an afford- The Senate Democratic plan im- every day about this Democratic plan able, accountable, transparent alter- proves rural Medicare reimbursement. to cut Medicare Advantage, which is a native to private insurance. The mis- The Republican plan does not. very popular program in Arizona. Medi- sion is to provide the best value for The PRESIDING OFFICER. The care Advantage is the opportunity we consumer members. It could operate at Democrats’ hour has expired. have given seniors to enroll in a pri- a State, regional, or national level. Mr. CONRAD. Mr. President, I ask vate insurance company to help them They are self-governed by members unanimous consent for 30 seconds. receive Medicare benefits. What these with an elected board—not controlled The PRESIDING OFFICER. Without private insurance companies do is by the Federal Government—subject to objection, it is so ordered. make a more attractive program by the same State and Federal rules and Mr. CONRAD. The Senate Demo- adding some additional benefits to the regulations as private plans. There cratic plan extends Medicare solvency basic set of benefits that are promised would be $6 billion in startup funding by 4 to 5 years. The House Republican under Medicare. What our seniors are for capitalization by the Federal Gov- plan has no extension of Medicare sol- telling us is, these are very important ernment. And that would be the end of vency. And, finally, the Senate Demo- benefits to them, things such as vision the Federal Government role. cratic plan reduces the deficit, accord- care and hearing. Now that I am get- The Senate plan also reforms the in- ing to CBO, by $130 billion—twice as ting a little bit older, I can tell you surance market. It prohibits insurers much as the Republican plan from the that both my vision and hearing is from denying coverage for preexisting House. starting to go, and I would like to have conditions. It prohibits insurers from I thank the Chair. I thank my col- that kind of benefit. Dental benefits, rescinding coverage when people be- leagues. preventive screenings, free flu shots, come sick after they have paid pre- The PRESIDING OFFICER. The Re- home care for chronic illnesses, premiums for years. It bans insurers from publican deputy leader. scription drug management tools, lifetime caps and unreasonable annual Mr. KYL. Thank you. Mr. President, wellness programs, personal care, and limits on health care benefits. And it we are going to focus for the next hour durable medical equipment, all very prevents insurers from charging more on perhaps one of the most pernicious important for seniors. By the way, based on health status. aspects of Leader REID’s bill: the fact physical fitness programs, one of which This plan also improves the quality that it cuts Medicare by almost $1⁄2 has a great name—it is called the of care. It covers preventive services. It trillion—almost $500 billion in Medi- SilverSneakers Program, and the sen- provides incentives for healthy life- care cuts. iors are very supportive of this because styles. It promotes adoption of best There are a lot of seniors in my State it keeps them physically fit which is, practices in comparative effectiveness of Arizona and in the States rep- of course, what we should be doing. research, and includes delivery system resented by my other Republican col- I get letters and phone calls from my reforms to encourage quality over leagues. Those seniors are scared of constituents, and they are sharing quantity of care. these cuts. It is not because of any- their anxieties about losing these bene- When we look at the major reforms thing Republicans have said to try to fits, losing prescription drug coverage; that are in this bill on the delivery sys- scare them; they have simply become about the overall decline in the quality tem and compare them to the House aware of what is in these bills. By of care that they understand will occur bill, we see that the Senate has ac- ‘‘these bills,’’ I am talking about both when their doctors’ payments are cut, countable care organizations; the the Senate bill offered by the majority when all these other cuts under Medi- House a pilot. Both have primary care leader and the House bill, which are care that my colleagues are going to payment bonuses. Both have readmis- the two bills that would presumably discuss in a moment finally hit. They sions reforms. Only the Senate has hos- try to be reconciled in conference. Our know it is going to impact their care. pital value-based purchasing. Both seniors have been told that under both They don’t like this interference from have comparative effectiveness re- bills, their benefits are going to be cut government bureaucrats, in effect, get- search. Both have CMS innovation cen- by about $500 billion, and that is ting between them and their physicians ters. Only the Senate has an Inde- enough to scare them. when it comes to their health care. pendent Medicare Advisory Board. And In fact, all of America is concerned Let me read portions of three letters only the Senate has a full platform for about this. A recent USA TODAY Gal- from constituents and then I will yield bundling. The House just has a pilot. lup Poll shows that an overwhelming to my colleagues. Debunking the myths: There is no number of Americans—61 percent—op- A constituent from Surprise, AZ, government takeover of health care pose cutting Medicare to pay for health writes: here. The public option, according to care reform. Yet, despite that over- Dear Senator Kyl: CBO, would get 2 percent of the Amer- whelming opposition, Democratic lead- Please fight the cuts to Medicare Advan- tage. I am on Social Security disability and ican people—2 percent. That is hardly a ers in Congress have moved ahead with on a fixed income. The Medicare Advantage 1 government takeover. And there is no this bill to slash, as I said, nearly $ ⁄2 insurance I have has literally been a life- tying of the public option to Medicare trillion from Medicare to pay for the saver for me. I cannot afford to lose the cov- levels of reimbursements. There is no new health insurance programs. They erage that includes prescription drugs. I need cut in the guaranteed benefits for sen- are simply not listening to what Amer- your help on this. iors. There is no coverage for illegal icans have to say about this. Two Medicare beneficiaries, a hus- immigrants. There are no ‘‘death pan- If Democratic leaders have their way, band and wife from Mesa, AZ, write: els.’’ And there is no expansion of Fed- hundreds of billions of dollars will be We believe that our health is our responsi- eral funding for abortion services. slashed from hospitals that treat sen- bility and that we have a right to make all

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.043 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11856 CONGRESSIONAL RECORD — SENATE November 20, 2009 the decisions regarding our health. We do ents outlining why the people of Ari- have in the State of Mississippi and not need permission from our government to zona are legitimately fearful for the that we have in these districts that are take actions that will protect and preserve coverage they have enjoyed. I would represented by these comments. our health. We do not need a third party who tell my colleagues that the opposition So I wanted to jump in now, before has never met us and who is not acting in the Senator from Arizona concludes his our best interests in making decisions about to these Medicare cuts has come in a our medical care and we do not want to lose bipartisan way. We heard a great deal portion of the initial remarks, and say our Medicare HMOs. about that from our friends at the that the concerns are not only coming from Republicans, they are coming That is the Medicare Advantage other end of the building when the from actuaries, they are coming from about which I spoke. House of Representatives was talking people who have analyzed this bill, and Then, a constituent from Sun City about this. they are coming from Democrats who West, AZ, who incidentally is a World The president of the Blue Dog Demo- have read the bill, who understand its War II veteran, wrote a very powerful crats, MIKE ROSS, a senior Democrat meaning and who understand that letter about how Medicare Advantage from Arkansas who has worked to try to make this palatable to people in his these cuts to Medicare are real and improved his life and his wife’s life. He they are hurtful. said: constituency, had this to say about these Medicare cuts: I yield back to the Senator. As a B–17 pilot I flew 50 combat missions Mr. KYL. Mr. President, the Senator With more than $400 billion in cuts to out of England and I earned five air medals from Mississippi is exactly right. It is after flying B–24s on coastal submarine pa- Medicare, it would force many of our rural hospitals to close, providing less access to not just Members of the House and trol. When we moved to Arizona to be near Members of the Senate, Republicans our children I visited a local VA hospital to care for our seniors. find out that I had a $50 copay for each visit Less than 12 days ago, Representa- and Democrats and senior citizens in the State of Arizona. Here are some and I never saw a physician, just an assist- tive ROSS from Arkansas said this. His ant. In desperation, I purchased a Medicare constituency in Mississippi is very other third-party sources. I will just supplement for my wife and myself. The cost much like mine, and I can assure my cite three: The Centers for Medicare was almost $600 per year and I only receive colleagues that a great number of our and Medicaid Services; that is, CMS. $833 a month on Social Security. Fortu- That is the outfit that runs Medicare. hospitals in Mississippi and throughout nately, here in Arizona, my wife and I were They confirm that cuts will indeed the country are rural and no doubt both able to sign up for MediSun, an Advan- compromise the services seniors now they are in Arizona too. So there is a tage plan, with no monthly payment and receive. simple $10 or $20 copays. That made it pos- very real concern. The gentleman from The Washington Post—how about sible for us to purchase a home. With the Arkansas flatly says it can force many that for a third-party source—summa- health care reform being considered, we un- of these hospitals to close. derstand that Advantage plans will be re- rizes a report in a November 13 article Representative LARRY KISSELL from entitled ‘‘Bill Would Reduce Senior duced or eliminated. What happened to ‘‘if I North Carolina said this: like my insurance, I can keep it’’? Care.’’ That is a fairly specific head- From the day I announced my candidacy line. It says: Well, it is a good question from my for this office, I promised to protect Medi- A plan to slash more than $500 billion from constituent. Of course, he is exactly care. I gave my word I wouldn’t cut it and I future Medicare spending, one of the biggest right. When the promise was made: If intend to keep that promise. you like your insurance you get to sources of funding for President Obama’s Representative KISSELL from North proposed overhaul for the Nation’s health keep it, unfortunately, that is not the Carolina concluded that in his judg- care system, would sharply reduce benefits way this legislation works. As a result, ment, the only way he could keep that for some senior citizens and could jeopardize a lot of the benefits they are currently promise was to vote no on this legisla- access to care for millions of others. receiving, for example, from Medicare tion. Then Politico, which is a Capitol Hill Advantage, would be cut or eliminated. Representative MICHAEL MCMAHON of newspaper, reported that, by 2014, en- My constituents are right to be wary New York said: rollment in Medicare Advantage would of cuts to their Medicare Advantage. Medicare Advantage, which serves approxi- drop from 13.2 million to 4.7 million be- They depend on it. They realize you mately 40 percent of my seniors on Medicare, cause of less generous benefit pack- can’t cut $1⁄2 trillion from Medicare would be cut dramatically. ages. That is a 64-percent decrease. without adversely affecting your This is not a Republican scare tactic; Looking at my colleague’s chart health care. this is a flat statement by an elected there, Medicare Advantage, which I Mr. WICKER. Mr. President, I won- Democrat from the State of New York spoke about and which my constitu- der, before the Senator closes, if he in the Northeastern part of our coun- ents wrote to me about, the concern would yield. try, one of the larger States. But he there is that people now enrolled—13.2 Mr. KYL. I am happy to yield to my said flatly that Medicare Advantage million—are going to be reduced down friend. would be cut for 40 percent of his sen- to 4.7 million because the reductions in Mr. WICKER. Mr. President, I think iors and he voted no on that basis. the benefits are simply no longer suffi- it is important for us to understand Representative IKE SKELTON, the cient incentive for them to enroll in that there are some differences be- chairman of the Armed Services Com- that program. tween the bills—the HELP bill, the Fi- mittee, said: Of course, that is what the pro-gov- nance Committee bill, and the bill that The proposed reductions to Medicare reim- ernment-run health care folks want to has come out of the House of Rep- bursement could further squeeze the budgets happen. They are all for a public com- resentatives—but in each and every of rural health care providers. pany competing with private insurance case the proposals put forward by the Chairman SKELTON goes on to say: companies in the market for folks, but Democrats do have this $1⁄2 trillion cut I also oppose the creation of a new govern- when it comes to Medicare, they don’t in Medicare. Indeed, as the Senator ment-run public option and continue to have want the private companies that pro- pointed out, these involve cuts to hos- serious concerns about its potential unin- vide Medicare Advantage care com- pitals, to Medicare Advantage, Medi- tended consequences for Missourians who peting with the government program. care cuts to nursing homes, to home have private insurance plans they like and, Under this bill, they will get their way. health, and to hospice. There is no of course, we know that this Reid bill also It is going to go from 13.2 million down question about that. I appreciate the has the government-run option. to 4.7 million. That is a lot of senior Senator bringing some information to Finally, to quote Representative citizens who will lose their Medicare the public and to the Senate about the RICK BOUCHER, another senior Demo- Advantage coverage. concerns of his constituents. crat from Virginia, he said: I will conclude by confirming what In the previous hour, I heard a Sen- I also intend to oppose the bill because of the Senator from Mississippi said. It is ator from the other side of the aisle my concern that a government-operated not just Representatives in the House talk about scare tactics Republicans health insurance plan could place at risk the or Senators who have sworn to help will be putting forward during the com- survival of our region’s hospitals. protect our constituents, but it is ing weeks of this debate. Of course, you I am concerned, and I am determined third-party sources as well in the gov- have read letters from your constitu- to protect the rural health care we ernment and in the media that have

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.044 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11857 confirmed that this bill will cut bene- cated, enrolled in Medicare Advantage. vided only by the government, do not fits. They will certainly do it for senior That represents about one out of four like the Medicare Advantage Program. citizens. of all Medicare beneficiaries in the So it is not surprising that we see this We will talk later about the Repub- United States. In my State of Idaho, level of cuts in this program. lican ideas. Republicans have suggested there are more than 60,000 Medicare During the Finance Committee a step-by-step approach to target spe- Advantage beneficiaries, which is markup, CBO estimated that the value cific solutions to specific problems, in- about 27 percent of the population in of extra benefits that Medicare Advan- cluding things such as medical liability Idaho. tage plans provide will drop from $135 a reform; allowing Americans to pur- In addition, this is an extremely pop- month to $42 a month of extra benefits. chase insurance across State lines, ular program. A 2007 study reported The CBO Director, Mr. Elmendorf, con- which would expand competition for very high overall satisfaction with the firmed this during the markup. I asked patient business; association health Medicare Advantage Program. Eighty- him: plans to help reduce costs. Most of our four percent of the Medicare respond- So approximately half of the additional ideas are cost-free; they won’t cost a ents said they were happy with their benefit would be lost to those current Medi- dime. They wouldn’t cut Medicare or coverage and 75 percent would rec- care Advantage policyholders. diminish the quality of care for any- ommend Medicare Advantage to their His answer was: body. They have been rejected by our friends or family members. Yet, despite For those who would be enrolled otherwise Democratic colleagues. this, there are massive cuts coming under current law, yes. I hope my colleagues will agree that forward in the bill. Why would that be In other words, compared to current a place to start in this legislation is the case? law, if these cuts are put into place, not to cut Medicare. Why would you I don’t think most Americans who about half of the benefits would be lost want to cut Medicare if the whole idea are not on Medicare recognize the dif- to these Medicare Advantage bene- here is to provide greater opportunity ference between Medicare generally ficiaries. for affordable and quality health care and Medicare Advantage. Medicare Ad- We now have more detail on that. I for American citizens? It makes no vantage was a modification of the tra- am sorry we don’t have a bigger chart. sense to me. ditional Medicare Program that, frank- We will have one in the future. If you I yield the floor to my colleague from ly, was put into place—I ask my col- can see the United States here, the Idaho. league from Arizona to comment. States in the deep red are those that Mr. CRAPO. Mr. President, I appre- Wasn’t it put into place when the Re- have cuts in excess of 50 percent to ciate the opportunity to be here with publicans were in control of the Con- their Medicare Advantage bene- my colleagues from Arizona, Mis- gress to try to help get market forces ficiaries; those in the lighter red are sissippi, and Florida. more engaged and involved in the ad- between 25 and 50 percent. In the white, When the people of the United States ministration of Medicare benefits? there are only five States; they are the talk about health care reform, they are Mr. KYL. Mr. President, the answer ones that don’t have a negative impact. seeking some way to control the pun- to that is yes. The idea was that sen- So 45 of the 50 States will see signifi- ishing and skyrocketing increases, iors were complaining about the exist- cant reductions in the Medicare Advan- year after year, in health care insur- ing program. One thing was that a lot tage benefits that are provided to their ance costs and medical costs and better of folks in rural areas were not receiv- constituencies. You just have to look access and quality of health care. Yet ing good, efficient, and quick care be- at the map to see it is a large percentage of those 45 States that are getting when this 2,074-page bill, which was cause they had to drive long distances cuts in excess of 50 percent of their crafted in secret for the last 2 or 3 and couldn’t find a doctor to serve benefits. weeks, was finally revealed, that is them and hospitals couldn’t take care Mr. LEMIEUX. Will the Senator yield hardly what we got. In fact, the reality of them. is that this bill will drive up the cost of for a question? Republicans tried to figure out, how Mr. CRAPO. Yes. health care insurance and medical care could we incent the insurance compa- Mr. LEMIEUX. The Senator is saying in this country. It will increase taxes nies to put together pools of physicians that seniors who have Medicare Advan- by hundreds of billions of dollars. It and hospitals to go into rural areas and tage now will have big reductions in will cut Medicare by hundreds of bil- take care of citizens who live there. the benefits they receive. My under- lions of dollars. It will grow the Fed- The Medicare Advantage Program was standing is that includes flu shots, eye- eral Government by $2.4 trillion of new one of the ways in which that was glasses, and hearing aids—as the Sen- spending over a 10-year period. It will done. It has proved to be very success- ator from Arizona said, programs to push the needy uninsured not into sub- ful. keep seniors healthy. My folks in Flor- sidized health care insurance but into a Mr. CRAPO. If you look at the Fed- ida very much appreciate the Medicare failing entitlement program, Medicaid. eral entitlement program Medicare, Advantage Program. We have more It will impose a damaging unfunded the portion of Medicare that truly does than 900,000 Floridians who are on mandate on States that are already have some private sector involvement, Medicare Advantage. strapped financially. It will leave mil- where private sector companies can I want to make sure I understand lions of Americans uninsured, while come in and contract to provide the this correctly—that under the proposal probably creating the most enormous government’s responsibilities under put forward by Senator REID, we are and massive government extension of Medicare, it is the most popular of all going to make substantial cuts to Federal control over our economy that Medicare programs, the one that was Medicare Advantage and the benefits we have seen in our country, starting growing and letting the private sector Medicare Advantage provides. with creation of a new federally owned deliver the benefits. Mr. CRAPO. The Senator is right. and managed insurance company. One of the aspects of the Medicare The way I look at it is that it is the ex- As the Senator from Arizona indi- Advantage Program is that senior citi- tras. Some say Medicare benefits aren’t cated, today we are here to focus on zens on Medicare Advantage actually being cut by these proposals, but that the Medicare cut aspect of this legisla- get additional benefits beyond those is a real stretch. When you look at tion. The Senate bill contains some- traditional Medicare benefits that Medicare Advantage, it is an outright thing in the neighborhood of $500 bil- those in the normal or standard Medi- misrepresentation. The benefits are vi- lion of cuts in Medicare. The first one care Program get because the private sion benefits, dental benefits, and the I want to focus on is the one the Sen- sector options have been able to iden- kinds of preventive medicine, such as ator from Arizona already identified; tify ways to enhance and create oppor- the mammograms, the PSA tests, and that is, the Medicare Advantage cuts. tunities for greater and stronger bene- other types of things we have found The Senate bill contains $118 billion fits. that help you to dramatically increase in cuts to the Medicare Advantage Pro- Yet those who don’t want to have your health, if you pursue these kinds gram. Let me talk about that program anything but a single-payer system, of preventive medicine options. They for a minute. Currently, there are near- those who want to make sure the gov- are the ones that will be deprived ly 11 million seniors, as has been indi- ernment-provided health care is pro- through these benefits.

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.046 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11858 CONGRESSIONAL RECORD — SENATE November 20, 2009 Mr. WICKER. Will the Senator yield? 30 percent of its home health care pro- ductions in the benefits to providers? Mr. CRAPO. Yes. viders. They are going out of business By the way, the Senator’s chart says Mr. WICKER. I notice that in Florida because we are squeezing them down so ‘‘other Medicare cuts to providers.’’ We that reduction, according to the CBO tight. And that included Idaho’s larg- use that term ‘‘providers’’ as a short- map, would be 81 percent. That is an est provider. The providers that are cut term. Will my colleague explain unthinkable, drastic change in Medi- still in business are working under the what it means to a 70-year-old woman care Advantage. In my area of the same Medicare reimbursement levels in Idaho who is a provider and how im- country, over in Arkansas, for exam- they received in 2001—8 years ago. If portant is that, what happens when ple, it has a 40-percent reduction. My the kinds of cuts contemplated by this you don’t pay that provider so that State, Mississippi, has a 41-percent re- legislation go into effect, on top of the provider is no longer available to take duction. Our neighboring State of Lou- current reimbursement issues, the situ- care of her? isiana—these are some examples—has ation will get worse. Mr. CRAPO. Mr. President, I appre- an 81-percent reduction, the same as Gary said that he compared this situ- ciate that question, who are the pro- the proposed reduction this legislation ation for home health and hospice providers. If this Medicare beneficiary is would cause for the State of Florida. I viders to the farmers in Idaho. He said in a skilled nursing facility, the pro- think it is important for our constitu- that most farmers don’t grow just one vider is the facility itself, which I said ents to understand the magnitude of crop. Similarly, home health agencies we already lost 30 percent of our facili- these Medicare Advantage reductions. do more than just provide home health; ties. It is the nurses and the nurse as- Mr. CRAPO. That is absolutely true. they provide hospice and private-duty sistants who are there to assist them Taking a couple of other States, Cali- care along with medical supplies and and care for them. fornia is 68 percent; Arkansas, 40 per- equipment. All of this will get reduced. The bottom line is, you simply can- cent; New York, 69 percent; New Mex- Let me give another example. Robert not cut hundreds of billions of dollars ico, 65 percent. The list goes on. The Vande Merwe of the Idaho Health Care out of these services and expect to pro- point here is this: The CBO Director Association talked to me about the im- vide the same level of access and qual- made it clear that these will be bene- pact of these cuts on skilled nursing fa- ity and available health care. fits Medicare Advantage holders will be cilities. The same would be true if the care losing. Skilled nursing facilities, such as the were being provided in a home setting, I want to move on to some of the hospice facilities, already face a budget which a lot of the home care services other reductions in Medicare. The ar- challenge under recent CMS rules re- are compensated by Medicare or in a gument being made by the proponents stricting their compensation for the hospital which is there to provide care of this bill is that we can cut $500 bil- services they provide. The cuts they in some of the most serious types of lion out of Medicaid and not impact have already received, not counting circumstances. Whatever it is, whether anybody’s benefits or the quality of the what will come at them in this bill a it is home hospice care, skilled nursing medical care they are receiving. That hundredfold more, have already caused facility, a hospital or what have you, is not true. Where are the other cuts, a reduction in reimbursement in Idaho what we see is a reduction in the num- non-Medicare Advantage cuts, coming by over $4 million per year to skilled ber of facilities and personnel avail- from? They come from home health nursing facilities. able, and that is nothing other than ra- agencies, hospice, skilled nursing fa- He pointed out to me that in the tioning. cilities, hospitals that provide care to nursing home world, more than 70 per- It is a different kind of rationing seniors, and other Medicare providers cent of the expenses they have are than will occur under some other parts in what is called the market basket. labor, primarily nurses and nursing as- of this bill where the government will You might say we can just continue sistants. He said when payment cuts actually get in the business of saying to cut the compensation or the alloca- like these occur, they cannot go to what kind of health care you can get tion of return for procedures and their buildings and take bricks out of and at what time in your life you can health care provided in these medical it. What they have to do is reduce their get it. But it is a kind of rationing that providers’ services and not have any employment. That cuts employees. simply forces the availability of health impact. The reality is far from that. That cuts benefits and services to care down so far that the system itself What will happen is this. I will give a those who are there. rations it out. couple of specific examples. In general, Let me make this clear. First of all, Mr. LEMIEUX. Will the Senator what happens is, when a home health these cuts are going to reduce jobs and, yield? agency or a skilled nursing facility or secondly, they are going to directly tie Mr. CRAPO. Yes. a hospital receives these massive re- to the quality and number of staff Mr. LEMIEUX. I wanted to follow up ductions of over $100 billion worth of there to provide care for those in the on my colleague’s point. With all these cuts in these areas, they have to adjust Medicare system. cuts to Medicare, $464 billion in this somehow. Let me give you some exam- Mr. KYL. Mr. President, I ask if my proposal, $192 billion in reductions to ples. The adjustment is this: In some colleague will yield for a quick ques- most services, $118 billion in cuts to cases, providers simply stop taking tion. Medicare Advantage, $21 billion cuts to Medicare patients because they can no Mr. CRAPO. Yes. hospitals serving low-income patients, longer make a profit. In that case, the Mr. KYL. We talked a lot about the $23 billion from other sources, it seems Medicare population loses access be- rationing of health care that is the in- inevitable that seniors are going to cause they have fewer providers from evitable result of these cuts in this bill; have a lower quality of health care. We which to choose. In other cases, they that when you reduce the amount of were told by the President that if you reduce services or reduce employees. money you compensate hospitals, doc- liked your health care, you were going Again, both the quality and the quan- tors, nurses, and others, they cannot to be able to keep it. But it seems to tity of health care services to seniors is provide as many services. Some leave me that we need to change that a little reduced. the business altogether. As the Senator bit because under this proposal, you Let me give some examples. A few from Idaho pointed out, some busi- might be able to keep it unless you are weeks ago, I spoke to Gary Thietten of nesses go out of business. So there are a senior and that seniors are going to Idaho Home Health and Hospice about fewer entities providing the care. That have a diminished quality of health the impact of Medicare cuts to home means it takes longer for patients to care under this proposal; is that cor- health and hospice providers, which is obtain the care where it is available, rect? his business. He described to me just and frequently they do not get as good Mr. CRAPO. The Senator is abso- how bad the fiscal situation has al- of care because folks cannot take that lutely correct. I will comment on that ready become for home health, hospice, much time to take care of them in that and then conclude and turn the floor and other Medicare providers in Idaho. sense. over to my colleagues from Mississippi Idaho has already lost nearly 30 per- Will my colleague please talk about and Florida for their comments. That cent of its home care providers. Let me his concerns about the overall problem is exactly right. In fact, one of the repeat that. Already, it has lost nearly of rationing that comes from the re- most clear and obvious places in which

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.047 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11859 this legislation violates the President’s have all seen folks are almost falling eye doctors, hearing aids, programs to pledge—that if you like what you have over themselves backing away from the make sure folks stay in shape, all sorts you can keep it—is in Medicare Advan- news on the mammograms that came of things that contribute to the health tage because one out of four Medicare out. But it is a very clear example in a and wellness of seniors. Our seniors beneficiaries in America will not be way a study can come out from a gov- enjoy this program. The popularity of able to keep what they have and will ernment source or otherwise to say we this program is sky high. see their benefits cut. don’t need to have this kind of health But we are finding out today—and I There are also other parts of this bill care in the United States, it is a cost am looking at this map—that Florida that impact people outside of Medicare saving. What do you think is the poten- is getting the worst impact of any in terms of the kind and quality and tial for this commission to say: We are State in America. Only Louisiana is extent of health care insurance cov- charged with saving costs in these pro- going to get it as badly as Florida. We erage they have and expect that will be grams, and we are going to do that. get the hurricanes, and now we are impacted. It would impact beyond this. I suspect that the mammogram issue going to get the Medicare Advantage This is about as clear a case there is of is one they would not do it on today be- cuts—an 81-percent reduction in the violating that promise. cause of the reaction to it. Somewhere benefits to our seniors. Mr. WICKER. Mr. President, before this commission is going to save tens What is that going to mean? It means the Senator leaves that subject matter, of billions of dollars, in addition to they are not going to have the health I wonder if I could interject. My friend these kinds of cuts, by reducing serv- care they enjoy now, which is what the from Idaho also has listed specific cuts ices. Color it as you want, you cannot President promised. Right now this bill says the benefits under this legislation: hospitals, Medi- make this kind of reduction of health offered will drop from $135 a month to care Advantage, cuts to nursing homes, care services, personnel, and infra- $42 a month. Florida seniors will lose 81 cuts to home health, and hospice. But structure without reducing the access percent of this additional coverage. I also I think Senators and Americans to and the quality of care that Ameri- have some constituents who have writ- need to understand that the Reid bill cans receive. ten to me because they have been hear- also establishes a permanent board of I will conclude by saying these issues ing about these problems. I want to unelected members appointed by the face every State in America. We are read one or two of these letters from administration which, in this case, ini- going to see in this arena a dramatic Floridians who are concerned about tially at least would be the Obama ad- reduction of the quality and content losing Medicare Advantage. This one is ministration, and they would dictate and quantity of health care that our from Dennis Shelton in Plant City, FL, further savings under Medicare. Medicare beneficiaries today see be- which is in central Florida. He writes This gets to the question of my cause of these proposals, and they are to me: friend from Arizona about rationing. It being done not in order to make the Senator LeMieux, I am writing this letter would dictate annual Medicare cuts Medicare system more solvent but to geared toward reducing Medicare to express my deep concern about the pro- finance yet another major Federal en- spending. These people are not going to posed cuts in Medicare Advantage funding. I titlement program that will cost hun- be like us—accountable. They will not am currently enrolled in an advantage pro- dreds of billions of dollars. As a matter gram that is crucial for me to get medical have to go back to their district every of fact, if you look at the true num- attention. The plan provides doctors, medi- 2 years or their States every 6 years. bers, the cost will be over $2 trillion in cines, urgent care and my diabetic supplies. But they will have the unbelievable a full 10-year period of time. The plan does this significantly better than power under this legislation to dictate There is a lot more we could say, but traditional Medicare at a reduced cost. additional cuts that we know not. The By regular visits . . . I have been able to I know my colleagues from Mississippi maintain reasonable health. If the cuts re- Wall Street Journal called this a ra- and Florida have some remarks they tioning commission. This ties right in duce services then my health will suffer wish to make. I yield to them at this along with other seniors that are in the Ad- with the concerns that Americans have time. vantage program. had over the last 2 or 3 days about Mr. LEMIEUX. Mr. President, I This is distressing and I sincerely hope these recommendations with regard to thank the Senator from Idaho for his that you will strongly advise fellow con- mammograms. great remarks today. I want to follow gressmen how important Medicare Advan- I realize I am intruding on the Sen- tage programs are to seniors all across the up on what he started to discuss and ator’s time, but I have a letter from a United States. continue also with the comments from physician in Mississippi who is fearful I am new to this body. I have only my colleague from Arizona about Medi- that this sort of rationing board is had the honor of serving here for a cou- care Advantage because it seems to me, going to impose the requirement that ple of months, so I am still learning being a Senator from Florida where we mammograms not be given until after the ways of Washington. But my under- have the second highest senior popu- age 50. He says: standing of this health care process lation in the country, the highest per and this health care bill is we were My wife and I have two daughters who had capita senior population, we have 3 breast cancer in their 40s. One daughter was going to maintain quality, we were age 42 and it was picked up on a routine million people on Medicare, more than going to try to cut costs for people who yearly mammogram. The other daughter was 900,000 on Medicare Advantage, that have experienced the high cost of in- age 49 and she found an abnormality by self Florida is going to receive the worst surance, and we were going to try to breast exam and it was confirmed by a mam- impact perhaps of any State in the provide more access. mogram. . . . country because of this proposal. But what I am finding out from this Now we have a group of unelected I am here today to talk about this proposal is that we are going to cut people coming forth and saying you are not just as an American but as a Flo- quality for seniors, and we are not not supposed to get a mammogram, ridian because I want my fellow Florid- going to reduce the costs of health care you are not entitled to a mammogram, ians to know, especially seniors, what for the 170 million people who actually and we learned that some insurance is in this bill and what it means to have insurance. companies have already decided to fol- them. That is our job. It is our respon- It occurs to me that the goals that low that dictate. This gentleman, a sibility to read through this document, were set are not being achieved by this physician, says my two daughters this 2,074-page bill that we received a plan. Worse still, we are taking a pro- would be dead from breast cancer if day and a half ago and to talk about gram that seniors rely on and that sen- that were imposed. what it means for the average Amer- iors paid into their whole life through I am afraid that in addition to these ican and, in my case, the average Flo- their wages and we are going to cut $1⁄2 very definite cuts, this permanent ridian. trillion out of it, a program that in 7 or board of unelected members would im- We find out today this Medicare Ad- 8 years is going to run a deficit and be pose the very type of requirement that vantage Program that 900,000-plus Flo- in tremendous trouble. we are fearful might come forward on ridians enjoy is going to have a sub- The question I have—and maybe my mammograms. stantial cut to the benefits. This is not colleague from Mississippi can help me Mr. CRAPO. The Senator is correct. I just extras or fringe benefits. These are with this since I am new to the Cham- will conclude with this. I think we things people need to stay healthy— ber—is why are we going down this

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.048 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11860 CONGRESSIONAL RECORD — SENATE November 20, 2009 path? This doesn’t seem good for sen- the $2.5 trillion that this spends per room if we can get a doctor at all, they iors. It doesn’t seem good for people in decade, once it is fully implemented. will be rationing the care, they won’t any walk of life in America, especially So the answer to the question of why be providing mammograms such as this in light of what my colleague from we are doing it is, it is not necessary. recommendation that came out this Mississippi pointed out with the mam- I guess the reason people might be week by the Government task force, mogram issue that came out and the doing it is that they believe that big for women in their forties to be dis- self breast exam issue that came out government works well. I have a dif- couraged from self-breast exams, and this week. Why are we going down this ferent view on that. we will all have very poor health care path? I see, as the Senator pointed out, all unless you are wealthy. Mr. WICKER. I appreciate the Sen- of these Federal programs that are not What is already happening now is ator asking that question. The answer exactly working as efficiently as they that those folks who are wealthy— is there is no reason for us to go down were projected to be. My dad is on there are doctors now who are not tak- that path. Medicare. We are going to protect ing Medicaid, they are not taking Early in our hour, the Republican Medicare. Republican and Democrat, Medicare, and they are not even taking whip pointed out that there are many we are going to do that. But as the insurance. So what concerns me— proposals the Republicans have that do Senator pointed out, it goes broke in maybe the Senator from Mississippi not require the huge expenditure, the the year 2017. We certainly do not need can comment on that—if we enter on huge expansion of Federal power and to be taking from Medicare to pay for this path, we are going to a world actually are relatively simple and rel- a new entitlement. where the majority, the vast majority atively inexpensive. For example, we Medicaid, as has been pointed out— of Americans are going to have poor have a proposal: many doctors will not take Medicaid quality government-run health care To reduce junk lawsuits against doc- payments anymore because it is broke and only the very rich will have access tors, by Senator ENSIGN, the Medical and it doesn’t reimburse at a market to good doctors and all the best quality Care Access Protection Act. It is only rate. So we see in my home State of of health care. That does not seem to 28 pages, compared to these huge pieces Mississippi, 60 percent of the doctors me like an America we want to live in. of legislation in front of us. That would will not take Medicaid. Yet there are Mr. WICKER. I think this con- not cost anything. It certainly would some people in this building, there are stituent of mine, from Brandon, MS, not require any reduction in Medicare. some people in this country within the said it very well in a recent e-mail I re- To combat waste, fraud, and abuse, sound of my voice, who believe that ceived. Obviously she is dependent by my friend from Florida, and I con- somehow a huge $2.5 trillion takeover upon home health care. gratulate him for that. It is only 21 of one-sixth of our economy can work I support the goal of health care for all. pages, something Republicans have and will not be like the Census and However, that goal should not come at the expense of frail, elderly and disabled home- been begging for and arguing for for Fannie and Freddy, like the post office bound Medicare beneficiaries receiving care years and have been stymied on. and the highway trust fund, and will in their homes and communities. . . To allow small businesses to pool re- not be broke. She points out what this legislation sources to purchase health insurance It comes down to a difference in phi- would do to home health care. for employees. Small business people in losophy. But certainly we ought to all Truly, this bill before us and the one restaurants and realty companies, agree that savings we find in Medicare from the House and the one from the small motels, ought to be able to pool ought to be used to shore up Medicare, two committees takes money from together and have the same purchasing to make sure it is there for people such America’s seniors to the tune of $1⁄2 power the huge corporations have. But as my dad and people who are going to trillion, and instead of shoring up the that would only take 8 pages, it would rely on that program for years to system that needs to be enhanced and not involve a cost to the Federal Gov- come. protected, it puts that money in the ernment, and certainly not involve Mr. LEMIEUX. I thank the Senator new government entitlement program these draconian cuts of $1⁄2 trillion to for that explanation. That is very help- we have exhibited here. I certainly be- Medicare and Medicare Advantage. ful to me. What is disconcerting about lieve we can do better. Further, we could purchase health in- the path it seems we are on is we are Mr. KYL. Mr. President, I want to insurance across State lines. We cer- going to have this government-run terrupt my colleague from Mississippi tainly agree there is not enough com- health care system and if already now for a moment and ask him—or I think petition in health care purchasing. I people cannot go see their doctor if the Senator from Idaho has some expe- would love to see a commercial some- they are on Medicaid because doctors rience with this as well—we have been day with someone coming in saying, ‘‘I won’t take Medicaid, and if it is grow- talking about $1⁄2 trillion in cuts to have great news, I just saved a ton of ing more and more the case that you Medicare. But we have not even talked money on my health insurance by cannot see a doctor if you are on Medi- about the biggest one yet. We have switching to XYZ Company.’’ We see care—I have some information here talked about cuts to Medicare Advan- that in car insurance and life insur- about 29 percent of beneficiaries sur- tage, we have talked about the cuts ance. There is vibrant competition. But veyed saying they are having a prob- that will be ordered by this new Medi- if we opened competition across State lem finding a doctor who will take care Commission. But I guess I would lines to the 50 States and if I could buy Medicare. ask my colleague from Idaho, isn’t it insurance from Idaho, I might find a There is a senior from Sanford, FL, true that the biggest dollar cuts to company that gives me better service, Earl Bean, who was interviewed this Medicare are going to come because we that provides better care or reduced week and he said: are going to pay the doctors and the premiums. Or if I could look at a Flor- I called about 15 doctors and was told re- hospitals and the nurses a lot less ida insurance company, the Senator peatedly that they were not accepting Medi- money? from Florida might look at a Mis- care patients. . . . Of course, every one of my constitu- sissippi company. We would use good They wouldn’t even take his name ents who has talked to me about it said old American competition that has when he called. So what I am worried wait a minute, if you are going to pay worked in our market society for years about is we are going to enter into a them a lot less money—I am having a but has not been allowed to work in system where 5 years from now, 10 hard time finding a doctor who will the area of health insurance. years from now when everybody in the take Medicare patients. Isn’t that Then, of course, health savings ac- country is basically on a government- going to result in delay of care for me counts—a one-page bill by my friend run health care program—Medicare, and denial of care, in effect rationing from Arizona and our colleague Sen- Medicaid, or this new program which of care? There will not be enough doc- ator DEMINT. And then wellness and unfortunately we all think will push tors and nurses to take care of me be- prevention, again only a simple 14 the private insurers out of the business cause they are not being paid enough pages. eventually and we all have government to even keep their doors open. None of these would require cuts to health care—is we will be going places, Mr. CRAPO. The Senator is right. As Medicare. None of these would involve there will be 100 people waiting in the a matter of fact, if I understand the

VerDate Nov 24 2008 03:51 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.049 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11861 legislation correctly, it assumes the have to vote on the House-passed Let me correct that. There are 43 current projected cuts for physicians health care bill. It doesn’t appear to be million people on Medicare. There is are going to happen. That is how it very popular out in America. In fact, some number less than that who are says it is not going to increase the def- by about 2 to 1 the American people now getting their drugs under Medicare icit. You and I both know this Congress say they don’t want to have anything Part D. But, in fact, they don’t get the will not let that happen. to do with that bill. So, instead, we are same discounts that those very same But even today, 29 percent of Medi- going to a shell bill that has nothing to people in Medicaid would get, even care beneficiaries looking for a pri- do with health care and then the leader though they are eligible for those dis- mary care doctor had a problem finding will simply shift to his substitute counts. Those people are called dual one because, both with regard to Med- health care bill. As my colleague from eligibles because they are eligible be- icaid and Medicare, because of the Florida knows, once you vote to begin cause they are poor to get it under problems we have been discussing here, the debate on this bill, you have put in Medicaid, but they are also over 65. there are fewer and fewer providers motion the process by which it could, Therefore, dual eligibles should be able who will take patients in those pro- and in 97 percent of the cases does, end to get cheaper drugs. No, we can’t do grams. up getting passed into law. that. Because in the Medicare prescrip- Mr. LEMIEUX. Mr. President, I was For those colleagues who say I am tion drug benefit passed 6 years ago, wondering if I could ask my colleague, not sure I like this bill but you know I those kinds of discounts were not al- the leader from Arizona, a question be- will move the process along by at least lowed. cause we are about at the end of our going to it, the time to stop it and to That is a huge additional cost to the time. My understanding is we are going say let’s fix it before is the time right taxpayers. The overall amount of Medi- to have a vote tomorrow at 8 o’clock. now, not after you get on the bill. It is care drugs being sold, if you got those Again I am new here. I was hoping the too late. discounts, would be something in ex- Senator could explain this for me. My Mr. WICKER. Will my colleague cess of saving the American taxpayer understanding is we are going to vote yield? This Reid substitute that will be $200 to $250 billion. For those who are whether to proceed on this bill. It is substituted for the shell bill contains dual eligible—they qualify for Medicaid not going to be this bill, it is going to taxpayer funding of abortions and it but get their drugs under Medicare— be some kind of shell bill or something, contains a government-run company to the savings would be $109 billion. which hopefully can be cleared up for compete with the private sector. So This Senator is going to offer that me. But I am told by folks who work Senators who vote to proceed on that amendment. It is a high threshold of 60 with me that the Congressional Re- bill, in my opinion, are playing with votes that we have to get but, indeed, search Service has said when there is a fire and very much risking that type of we will see and on down the line. vote to proceed on a bill, that 97 per- legislation might come out of the Why am I insisting on continuing to cent of the time that bill passes. So it closed room that will be the House- offer this? Well, it is interesting that seems to me if we are voting tomorrow Senate conference. just recently an AARP study has come to proceed, that is really a vote on this Mr. KYL. The point is this: Unless out, along with another study called bill. they have a way to get 60 votes to get IMS. They have noted that the cost of Do I understand that correctly? those provisions out they are in effect Mr. KYL. Mr. President, I would say drugs, brand name drugs, their whole- to my colleague from Florida that is endorsing them by voting to proceed to sale prices have increased, in the year exactly right. I was interested in that the bill because they can’t get them 2008, 9.3 percent. Contrast that to the Congressional Research Service report, out. My colleague is exactly right. rate of inflation, which was about zero The PRESIDING OFFICER (Ms. a totally nonpartisan report, which es- percent. So you see that the cost of KLOBUCHAR). The time of the Repub- sentially makes the point if you vote drugs is continuing to go up. It is time to proceed to the bill, 97 percent of the licans has expired. to give our people some relief. The Senator from Florida. time you are voting to approve the bill We could do a lot with that extra $109 Mr. NELSON of Florida. Mr. Presi- because they end up passing. Those of billion. First, we could lower the def- dent, I rise to support the majority our colleagues who say they have prob- icit by $109 billion. So whereas this bill leader and his motion for cloture to cut lems with this bill, serious problems brought forth by the majority leader off debate to allow us to vote on the with the bill, are enablers if they vote saves the Treasury money over the 10- motion to proceed which will allow us, to proceed to the debate of this bill. year period and reduces the deficit by then, to get the bill to the floor so that They are enabling those who want to $130 billion, we could add another $100 we can debate and start amending this pass a bad bill to do so because that is billion to that. We could be lowering bill. I wish to use the next several min- exactly what will happen. the deficit $230 billion. But we could In order for them to try to fix the bill utes to lay out a comprehensive reason take part of that money that we would it would take 60 votes to get an amend- of why this Senator supports moving to save the taxpayers and use that to fill ment agreed to and that is a very tall take up this legislation. the doughnut hole. order around here. I look forward to the amending proc- That is the strange creature in stat- The second part of the question, yes, ess, and there will be vigorous at- ute that gives senior citizens under this may be a little confusing, but tempts to amend it. I had offered a Medicare some reasonable compensa- what the majority leader has asked is number of amendments in the Finance tion for their drugs, up to a certain that we vote on a cloture motion to Committee. Most of those amendments level. That level is, generally, between proceed to a House bill that has to do were, in fact, adopted, but there was about $2,500 and $4,500 of total drug with bonuses for AIG people. You say, one in particular that was not adopted purchases within a year. But once they What does that have to do with this? on a vote of 13 to 3. It would save the get into that zone, that doughnut hole, The answer is it has nothing to do with American taxpayers $109 billion by in fact, they get no assistance from this. The leader ordinarily would have having the price of drugs that are sold Medicare. That is called the doughnut taken the House bill, which is the bot- to Medicare recipients under the Medi- hole. We could help senior citizens fill tom half of this stack here, would have care Part D who also are eligible for that doughnut hole so they are not taken the House-passed health care bill Medicaid but get their drugs under bearing the full cost of those drugs and asked to proceed to that bill. If we Medicare, it would cause those drugs to when they get hit with huge drug ex- then agree to proceed to that health be sold at the same discounts that they penses in a particular year. care bill, he would then substitute his get the drugs under Medicaid. There We will see what the will of the Sen- own version, which is the second half of have been discounts for a couple dec- ate is as we come out here and start to the stack here, and then you would ades because of the bulk purchases of vote. have a Senate version that we would millions and millions. It is close to 50 The reason it is important, tomorrow begin to amend or act on or at least de- million people who get drugs under night at 8, for us to get 60 votes to shut bate. Medicaid. There are about 43 million off debate is so we can go to the motion I don’t think the majority leader people who get their drugs under Medi- to proceed to get this bill to the floor. wants those on his side of the aisle to care. The reason is we need a debate. We

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.050 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11862 CONGRESSIONAL RECORD — SENATE November 20, 2009 can’t afford not to have a debate. In there is an additional $130 billion that counted to the Federal Government what is known as the world’s most de- is left over. That is surplus that will go when it is buying drugs in bulk for mil- liberative body, that is what we do—de- directly to lower the deficit. The pro- lions of Medicare recipients, it also set bate and amend and try to perfect. Is jection by the Congressional Budget up that we are going to give a cushy ar- anyone denying that health care, the Office for the second 10-year period is rangement to insurance companies cost of health care, the availability of at least a $650 billion reduction of the where insurance companies that want health care, the availability of health budget deficit in that 10-year period to sign up Medicare recipients are insurance, the availability of health in- and possibly as high as $1 trillion in going to get 14 percent more per pa- surance at a reasonable price, is any- lowering the deficit. tient—114 percent instead of 100 per- body disagreeing that is not a problem? What does that tell us? What it tells cent of Medicare fee for service. Is it Our people are hurting. us is that one of the reasons we need a any wonder costs are exploding in One of the main purposes of bringing bill coming out on the floor is that not Medicare if suddenly a program gets 14 this legislation out here and trying to only do our individual Americans have percent more per patient than what the find a reasonable solution is to make difficulty paying for the cost of health standard baseline ought to be, which is health insurance and health care avail- care, the U.S. Government is having Medicare fee for service? It does not able and affordable. difficulty paying for the cost explosion take a rocket scientist to figure that For example, what about if you have of Medicare. out. a preexisting condition. You can’t get Unless we start getting those costs Because insurance companies—Medi- health insurance. We are going to under control, then, in fact, we are care HMOs; the fancy name is ‘‘Medi- change that in this legislation. going to be in an unsustainable propo- care Advantage’’—because they get What about if you are sick and your sition with Medicare. A system of re- more, 14 percent more, then they can insurance company suddenly comes vising health delivery capabilities so offer additional things to the senior and says: We are going to take away people are not being canceled, no pre- citizens, and this has proved to be your insurance, we are going to cancel existing conditions, people can get quite popular. Basically, 30 percent of your health insurance. Is that a good health insurance at affordable rates all Medicare recipients in my State of outcome? There is nobody in America but at the same time starts lowering Florida have signed up for Medicare who thinks that is a good outcome. the overall cost to not only individuals Advantage. Indeed, the biggest thing That is what we are trying to change. but to the U.S. Government, it seems they have that is desirable—you hear By the way, that is what the bill pro- to me that is desirable. about eyeglasses and hearing assist- posed by the majority leader will, in So you will hear and we have just ance and so forth, but the biggest thing fact, do. heard comments about how Medicare is that is the most popular is that be- What about all those 46 million peo- going to be cut. Well, there are clearly cause the insurance company is getting ple who don’t have health insurance? inefficiencies in Medicare that need to paid so much more per person, it can First of all, a lot of those folks do get be wrung out. Let me give you an ex- then use part of that money to pay the health care, but where do they get it? ample. Right now, we have what is copays on Medicare, such as Medicare They get it at the most expensive place known as Medicare fee for service. It hospital insurance, Part A and part B, at the most expensive time. They go to basically pays the doctor’s bill that is as well as Part D, the drugs. So it is the emergency room, after what could submitted for the person who is eligible very popular. have been very possibly prevented be- for Medicare. But what happens is, the So what I said in the Finance Com- comes an emergency. So it is at the Medicare patient goes to this spe- mittee is—obviously, we ought to re- most expensive place at the most ex- cialist, that specialist, that specialist, form the system. And I can tell you, pensive time. By the way, guess who and all of them are not talking to each this Senator did not vote for it 6 years pays. Do you think all those costs sud- other. This one orders this particular ago, which set up this system, which denly evaporate in the ether? No. They set of tests, and that one, because he was a cushy system for insurance com- are costs in a hospital that are ulti- does not know what the other one is panies as well as the drug companies. mately borne by all the people who doing, is ordering the same test, but But the fact is, we have not. support the health insurance system; Medicare is getting all of the same So this Senator said, in the Finance that is, those who have health insur- bills. This bill, in reforming health Committee: All right, what I want to ance policies and pay premiums. It is care delivery, is going to try to get at do is I want to grandfather the people no small amount that we pay. As a that. It is going to set up accountable who have it in Florida so that, on a matter of fact, nationwide, the addi- care organizations. It is going to set up going-forward basis, when this takes tional cost to a family health insur- electronic records so there is no more effect—in this bill, it takes effect in ance policy to take care of uninsured of this shifting around and, oh, I didn’t 2013—when it takes effect, it is only people is between $900 and $1,000 per get the report. It is going to be there those new people signing up who will year extra. It is a hidden tax on all the available immediately. These are obvi- operate under the new system that will rest of the people who are paying their ous technology increases we have to make it more streamlined but that health insurance premiums. do. That is Medicare fee for service. those who have the existing benefits In my State of Florida, it is even How about a program called Medicare from Medicare Advantage will not be higher. It is estimated to be $1,400 per Advantage? Let me tell you what Medi- cut. I offered that amendment along family policy per year, a hidden tax. care Advantage is. Medicare Advantage with other Senators in the Senate Fi- That is a hidden tax that will dis- is a fancy word for a Medicare HMO. Do nance Committee, and that amendment appear, if we can bring in those 46 mil- you know what an HMO is? An HMO is was adopted. lion people nationally who are unin- an insurance company. It was origi- So the statements that have been sured, 4 million of whom are in Florida, nally designed in the late 1990s that made on this floor about Florida Medi- if we can bring them into the system. you could deliver health care cheaper care Advantage recipients being cut in Will we bring them into the system? to senior citizens in Medicare through Florida is not accurate on this bill. I The bill the majority leader has put on an HMO. So when it was first set up, fought for that. Everybody knew I the table will cover 98 percent of all Medicare HMOs were given 95 percent fought for that. And of the 949,000 Americans with health insurance. That of fee for service because they were Medicare Advantage recipients in Flor- is the entire spectrum of Americans going to save costs. They were going to ida, at least 800,000 are operative under who receive health care. Is that worth- save costs to the individual, they were the formula we put in and the remain- while doing? I certainly think it is. going to save costs to the govern- ing 149,000 virtually would not be af- I said at the outset this bill also tries ment—95 percent. fected anyway. I cannot speak for the to approach this in a responsible finan- But, lo and behold, in 2003, in the other States, but I can sure speak for cial way. The actual cost of the bill is Medicare prescription drug benefit, it Florida. That is in this bill. Those about $848 billion over 10 years. But not only set up what I described a other Senators who offered the amend- that $848 billion is more than paid for while ago as this unusual doughnut ment with me in the Finance Com- because, at the end of that 10 years, hole and drugs that cannot be dis- mittee had things that tended to their

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.052 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11863 States, as well, that were part of that my State get their health care from going to shut off the filibuster in order amendment. But that is what the situ- Medicaid because they are either quali- to get to the motion to proceed which ation is with regard to this legislation. fied under the income level or they are will then allow us to get to the bill Let me say that if we can get this disabled. Now add that up. That is 76 after Thanksgiving. legislation out of the Senate and get it percent right there of all the people of It is absolutely essential for the sake to a conference committee with the Florida. That includes children. OK. of our people that we bring this legisla- House, the House has a whole different What about the remaining 24 percent? tion to the floor and that ultimately approach. The House works on stream- About 4 or 5 percent of our people also we get a product we can pass and get it lining Medicare Advantage from the have health insurance but they pay on to a conference with the House and basis of not something known as com- through the nose because they are buy- have an agreement that the President petitive bid, which is in the Senate bill, ing it as individuals as opposed to a can then sign into law. but what is known as fee for service, as group policy. If you are buying it indi- Madam President, I yield the floor. the target benchmark. That does not vidually, where all the health risk is on The PRESIDING OFFICER. The Sen- have the Draconian cuts, in my opin- one life, the cost of those premiums is ator from Delaware is recognized. ion, to many of our Medicare Advan- very high. The remaining 19 percent Mr. KAUFMAN. Madam President, I tage recipients. are the uninsured. That is as to the rise this afternoon to talk about the But I want the record clear here that population of my State of Florida. topic that is on the mind of each and with regard to Florida, Florida Medi- That will vary with different States. every Senator today: health care re- care Advantage people have been Obviously, in Florida we have more form. First off, I wish to congratulate grandfathered in of those who are in people aged 65 and older and therefore our majority leader, Senator REID. He existence and those who still will be in eligible for Medicare than most States. has accomplished something that has existence having signed up for Medi- But you can see now that what we not been done in years. He has the Sen- care Advantage until the date at which are going to do is, over here for this re- ate on the precipice of debating a the new system would start. maining 24 percent, we are going to set major health reform bill on the Senate I see we have changed Presiding Offi- up a health insurance exchange. In the floor. cers, and it is such a pleasure to have case of Florida, it is going to have po- I agree with the Senator from Flor- the esteemed Senator from Minnesota tentially 4 million people in it. It is ida. Tomorrow night at 8 o’clock we in the chair. Madam President, there is going to be the uninsured who are now should come to the floor and we should room for improvement. We spent 2 full going to have access to health insur- move this bill. It is essential that we weeks in the Senate Finance Com- ance with no preconditions, and they pass health care reform this year. The mittee on amending this legislation. cannot cancel their policies, and it is present system lets down all Ameri- We had spent 3 months prior to that affordable. It is also going to be avail- cans and we need a new, reformed discussing it. You can imagine, in a na- able to those people who, in fact, have health care system. We should move tion as diverse and complicated as ours policies they cannot afford, usually the this bill and then we can debate, we and a health care industry where ev- individual policies. There will be some can amend, as the Senator from Flor- erybody and his brother and sister have small business employers—for example, ida said, and we can deal with this bill their fingers in the pie, how com- those with 50 employees or fewer—who then. But it is essential that we move plicated this is. But that is the reason will not be offering health insurance, this bill. for the amendatory process: to im- and their employees will, for the first Senator REID has melded the good prove, to perfect. time, be able to go to the health insur- work of the Finance Committee and I want to wind up my remarks by giv- ance exchange and be able to get the Health, Education, Labor, and Pen- ing a picture of the totality. We have health insurance. sions Committee into one bill that we had so much of the debate, ever since All right. The competition in that stand ready to bring to the Senate summer, dominate on the concept of a health insurance exchange is going to floor. If people don’t acknowledge that public plan. Many organizations have have a public plan, if a State approves. accomplishment, they are forgetting now come out and said that a public That is why it comes down to such a history. For all the efforts to reform plan, at max, is going to affect 4 mil- small percentage. That is why an issue our health care system back in 1994, lion or 6 million people. If it affects 6 has dominated the debate but is not the Senate never came close to bring- million people who sign up for a public the main issue. The main issue of this ing a bill to the floor to debate. Be- plan—if there is one in existence. And, legislation is to provide health insur- cause of the searing experience the of course, the majority leader has in ance and health care to our people that Congress went through back then, it here not one that is mandatory. He has is available and affordable. took another 15 years to pass before it as an option where a State can with- I will close with this: We have all Congress attempted another major re- draw from having a public plan. But if heard these stories because people have form of our present dysfunctional the max of 6 million people signed up been coming to us in our townhall health care system. on a public plan, that is 2 percent of meetings, on the phone, in the airport, I believe if we don’t get it done this the entire country. Yet you would back during the parades, at the meet- year, it might take another 15 years or think that was the only thing when ings, and they have been telling us more before we will bring it up again, you listen to the arguments—and these very tragic stories: the woman and Lord only knows what will happen sometimes we watched fights in these who is in the middle of chemotherapy to the health care system in this coun- townhall meetings back in the sum- and suddenly gets a cancellation notice try in the interim. But thanks to Sen- mer—you would think that was the from her health insurance company; ator REID and Chairmen BAUCUS, DODD, only thing this whole health care re- the person who desperately needs and HARKIN, as well as the tremendous form was about. In the max, it is going health insurance and can’t get it and efforts of their members, the com- to affect 2 percent. who has had it for some period of time; mittee staffs, all the long hours, week- Why is that? Why is it that it only the person who is hanging on for dear ends in the office and time spent away affects 2 percent? Well, look at the life to that job because that job they from their families, we stand here this whole population to whom we want to have is not only their means of finan- afternoon literally a day away from give health care delivery. cial remuneration but is also their the first procedural vote on the Patient Take my State of Florida. Approxi- ticket to having health insurance. Protection and Affordable Care Act. mately—and I am rounding these num- These are the tragic stories we want Make no mistake. We cannot afford to bers—approximately 50 percent of our to change. We want to make people’s wait another day to fix our health care people in Florida get their health in- lives better. We have to start some- system. surance from their employer and they where. That point of starting is going We need to pass health care reform are in a group policy. Another 16 per- to be at 8 o’clock tomorrow night, Sat- because the trajectory of our national cent in my State get their health care urday night, because the Senators are health care expenditures is out of con- from Medicare because they are eligi- going to parade on this floor and indi- trol. In 1979 we spent approximately ble at their age. Another 10 percent in cate yea or nay on whether we are $220 billion as a nation on health care—

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.053 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11864 CONGRESSIONAL RECORD — SENATE November 20, 2009 $220 billion. By 1992 we spent close to all government expenditures. They now Medicare and good for the Federal $850 billion. And in 2009 we will spend account for 20 percent. If we do nothing budget. $2.5 trillion on health care—from $220 to start bending the cost curve down As I mentioned earlier, small busi- billion in 1979 to $2.5 trillion in 2009. for health care costs for Medicare and ness owners struggle to provide their The trajectory clearly is absolutely Medicaid, we will eventually spend employees with affordable health in- unsustainable. more on these two programs than all surance. This bill will help small busi- We need to pass health care reform other Federal programs combined. ness in this quest. The bill will provide because premium costs for middle-class I am pleased the Patient Protection a sliding scale tax credit based on the Americans are rising at an astronom- and Affordable Care Act begins to tack- number of employees and annual aver- ical rate. Take my home State of Dela- le these problems and begins to reform age wages of these employees to help ware, for example. In 2000, the average our health care system. It is passed these small employers pay for health premium for family health coverage time. insurance for their employees. This tax was just over $7,500. In 2008, that num- This bill is fiscally responsible. Any- credit is estimated to reach more than ber had jumped to $14,900, almost dou- one who is concerned about our budget 3.6 million small businesses nation- bling in just 8 years. If we do nothing deficits should embrace this bill. Ac- wide. In addition, small businesses will and allow the current health care sys- cording to the Congressional Budget be able to purchase insurance through tem to continue, the same premium for Office, the bill will reduce deficits by the new State-based exchanges. These family coverage is expected to reach an estimated $130 billion over the first exchanges would allow small busi- $29,000 in 2016, another doubling of the 10 years from 2010 to 2019, and by more nesses to expand their risk pool and price. Think about it. Every 8 years, than one-quarter percent of GDP in the thereby lower premiums. The bill is a our premiums doubling in size. That is decade after. This amounts to about $55 win for small business. simply unaffordable. billion in 2020 and several hundred bil- The bill helps protect middle-class We need to pass health care reform lion dollars over the next 9 years. This Americans against the worst abuses of because failure to do so will drive more is not chump change. This is real, ef- the insurance industry. No longer will and more Americans into bankruptcy. fective deficit reduction that will help Americans be denied coverage because Today, bankruptcies involving medical our economy over the next 10 to 20 of preexisting conditions. Let me re- bills account for more than 60 percent years. peat that: No longer, if we pass this of U.S. personal bankruptcies, a rate In addition to reducing the deficit, bill, will Americans be denied coverage 11⁄2 times that of just 6 years ago. Keep the bill strengthens the Medicare Pro- because of preexisting conditions. No in mind, keep in mind, 75 percent of gram. Contrary to claims of the bill’s longer will insurers be able to rescind families entering bankruptcy because critics that we hear on the Senate people’s coverage once they get sick of health care costs actually have floor, the Patient Protection and Af- and they actually need the insurance health insurance. To repeat: More than fordable Care Act adds coverage for they have been paying premiums on. two-thirds of all bankruptcies due to Medicare beneficiaries. It doesn’t cut a No longer will insurers be able to medical expenses are of Americans who single service. Let me repeat: It doesn’t charge people more based on their have health care insurance. That num- cut a single service. health status or gender. ber is simply appalling. For instance, the bill provides sen- The bill helps protect the finances of We need to pass health care reform iors with three annual wellness visits middle-class Americans and helps re- because small business owners and under Medicare where they can develop duce the number of medical-related their employees are desperate for relief personalized prevention plans with bankruptcies by placing a cap on what from the cost of health insurance. their doctors to address their health insurance companies can require fami- Right now small business owners and conditions and other risk factors for lies to pay out of pocket. It also re- their employees pay much higher pre- disease, making the conditions easier stricts the use of annual limits and miums than their counterparts in large and less costly to treat. The bill also prohibits the lifetime limits on insur- corporations. In fact, during the past 5 eliminates out-of-pocket costs for rec- ance benefits, which is especially im- years, one in five small businesses re- ommended preventive care and portant for Americans with high-cost ported premium increases of 20 percent screenings such as mammograms. In conditions to treat. It creates a health annually. Add that up and that is 100 terms of restrictions on drug coverage, insurance exchange that provides a percent over 5 years. Imagine paying a the bill helps seniors manage the cost public insurance option to compete 100-percent increase. of the doughnut hole in Medicare Part with private insurers to provide con- Largely because of the increase in D coverage by giving a 50-percent dis- sumers with more choice. premium rates, fewer and fewer small count on brand-name drugs and bio- This will make a great difference in businesses offer coverage to their em- logics to low- and middle-income sen- States where one or two insurance pro- ployees. For example, in 2000, 68 per- iors. viders dominate the marketplace and cent of small businesses were able to Most importantly, the act helps en- where there is no true competition. offer health insurance coverage to sure the sustainability of the Medicare These are good, strong provisions their employees. By 2007, just 59 per- Program for years to come. In the past that will help provide health security cent of small businesses offered health year, Medicare spending has increased and stability to all Americans. benefits. That is a reduction from 68 by roughly 8 percent a year. According The bill is strong in two other areas percent to 59 percent in just 7 years. to the CBO, under this bill, the annual as well: promoting prevention and Small businesses are the engine of growth rate for Medicare dropped sub- wellness and cracking down on waste, our economy and will be the catalyst stantially to 6 percent for the next sev- fraud, and abuse. On the prevention to get us out of this recession. It is eral decades. Adjusted for inflation, front, the bill recognizes that we have time to make it easier for small busi- CBO estimates that Medicare spending to move away from a system that en- ness owners to provide health insur- per beneficiary under this bill will in- courages people to wait until they are ance for their employees so they can crease the annual average rate of sick to seek treatment. Instead, it en- retain the workers they have and hire growth of roughly 2 percent during the courages prevention and early treat- more to help lift us out of this eco- next two decades, much less than the ment of diseases which can help lower nomic distress. roughly 4 percent annual growth rate the cost of treating patients. We need to pass health care reform of the past 20 years. The bill recognizes the need to shift because failure to do so could bankrupt Right now, the Medicare Hospital In- this emphasis by eliminating any co- the country. Just look at Medicare and surance Trust Fund is projected to be- payments or deductibles for rec- Medicaid. One of the biggest driving come insolvent in 2017. But with the ommended preventive care and forces—in fact, the biggest driving measures to strengthen the Medicare screenings, such as cancer screenings, force—behind our Federal deficit is the Program contained in this bill, the colonoscopies, and mammograms. The skyrocketing cost of Medicare as well date of insolvency of the trust fund is bill would allow employers to offer pre- as Medicaid. In 1966, Medicare and Med- put back by at least 4 to 5 years. Sim- mium discounts and other awards for icaid accounted for only 1 percent of ply put, this bill is good for seniors and up to 30 percent of the total premium

VerDate Nov 24 2008 00:16 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.054 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11865 for individuals who quit smoking, lose Ms. KLOBUCHAR. Mr. President, I company, and it is now up to 15 em- weight, lower their cholesterol or blood am going to focus for the next 10 min- ployees. He has a family of four and is pressure, or take other steps to im- utes on the issue of costs. I know many paying $24,000—in Two Harbors, MN— prove their health status. people are focused on important issues for his family to make sure they have We have already seen how successful like the fact that this bill will finally health insurance. He said if he knew it this type of program can work at com- eliminate the limitations on pre- would have cost that much, he might panies such as Safeway. All of these existing conditions, so if your kid gets not have started that company. Now measures will help increase the use of sick, you don’t have to lose your they are providing beautiful, great preventive measures and reduce the health care; and the fact that people backpacks for our troops who are serv- need of costly new treatments as a re- will be able to keep their kids on their ing us—high-quality backpacks. Those sult of waiting too long to treat a con- health care until they are 26. These are backpacks wouldn’t have existed if he dition or disease. very important parts of the bill. It is knew what was happening. Those jobs Finally, I wish to highlight the meas- very important to people of my State. would not have existed. He could be ures contained to reduce the waste, The other facet that is very impor- working at a big company and paying fraud, and abuse that exist in our cur- tant to people in my State is some- less. But he was an entrepreneur, and rent system. Each year, health care thing I heard about all over the last we should reward that. fraud drains between $72 billion and few months: the issue of more afford- The American people know inaction $220 billion from doctors, patients, pri- able health care. This is why: At $2.4 is not an option. If we don’t act, costs vate insurers, and State and Federal trillion per year, health care spending will continue to skyrocket, and 14,000 Government. Left unchecked, fraud represents close to 17 percent of the Americans will continue to lose their drives up the cost of care while reduc- American economy. It will exceed 20 health insurance every single day. We ing public trust in our health care sys- percent by 2018 if the current trend must keep what works and fix what is tem. I am pleased this bill will increase continues. broken. the funding for the Health Care Fraud Hospitals and clinics are providing an Let me tell you about some good and Abuse Control Fund to fight fraud estimated $56 billion in uncompensated news. It is encouraging news that the in public programs. In fact, CBO esti- care. In fact, today, Peter Orszag, the Senate will start considering the bill mates that every $1 invested to fight Budget Director for the President, that will reduce the Federal deficit by fraud results in approximately $1.75 in wrote an opinion piece for the Wash- $127 billion in 10 years. If we go out 20 savings. ington Post that highlights the fiscal years, it is a $650 billion reduction in In fact, CBO estimates that every $1 importance of passing health care re- the deficit. That is good news. We invested to fight fraud results in ap- form. One of the things he said is, look- achieve these long-term savings by proximately $1.75 savings. ing forward, if we do nothing to slow making our health care system more The bill will also establish new pen- the skyrocketing costs of health care, efficient, rewarding quality, and im- alties for submitting false data on ap- the Federal Government will eventu- proving patient outcomes, and reduc- plications, false claims for payment, or ally be spending more on Medicare and ing administrative spending and waste. for obstructing audit investigations re- Medicaid than all other government Most health care is purchased on a lated to Medicare, Medicaid and the programs combined. He notes that it is fee-for-service basis. So more tests and State Children’s Health Insurance Pro- time to move toward the high-quality, more surgery mean more money— gram. lower cost health care system of the fu- quantity not quality pays. By reducing the amount of waste, ture. According to researchers at Dart- fraud and abuse tolerated in the health As you know, Mr. President, coming mouth Medical School, nearly $700 bil- care system, we will be able to bring from Wisconsin, we know how to de- lion per year is wasted on unnecessary health care costs down for everyone. liver high-quality, highly efficient or ineffective health care. That is 30 Mr. President, this is a good bill. care. They do it in Wisconsin and in percent of total health care spending. I have only touched on parts of the Minnesota. They also do it in Wash- One study showed if the hospitals in bill, as time does not allow me to dis- ington State. A number of States have some of these inefficient areas would cuss every provision—including the figured out how to do this. Those are follow the high-quality protocol the fact that the bill will extend insurance the models we need to see all across Mayo Clinic uses—and a lot of people coverage for an additional 31 million the country. We need to make health would like to have that kind of health Americans. care affordable for everybody, and we care—we would save $50 billion in tax- But it is a good bill. It is fully paid need to reduce the waste and fraud payer money every 5 years for chron- for. It reduces short and long term defi- that plagues the current system in this ically ill patients—$50 billion. That is cits. It strengthens the Medicare pro- country. just one example for one set of pa- gram. It provides security and stability In 2008, employer health insurance tients. for the middle class. It provides Ameri- premiums increased by 5 percent, two That is what we do in Minnesota. We cans with greater insurance choices. It times the rate of inflation, and the an- want that same kind of health care, promotes prevention and wellness. It nual premium for an employer health the same kind of high-quality care, the cracks down on waste, fraud and abuse. plan covering a family of four averaged incentives on the Federal level that I applaud the hard work that went into nearly $12,000. aren’t there now, and that is what we the drafting of this bill. In fact, I tell people around me that are seeing in this reform package. As I have said many times, it is time they have to know 3 numbers: 6, 12, and I am pleased the ‘‘value index’’ I pro- to gather our collective will and do the 24. Ten years ago, the average family posed, which was cosponsored by Sen- right thing during this historic oppor- was paying $6,000 for their health care ator CANTWELL of Washington and Sen- tunity by passing health care reform. premiums. Now it is $12,000. That is av- ator GREGG of New Hampshire, was in- We can’t afford to wait another 15 erage. A lot of small companies in Min- cluded in the Senate bill. This indexing years. We need to act now. We can do nesota—the owners of companies are will help reduce unnecessary proce- no less. paying more than that. But right now dures because those who produce more The American people deserve no less. the average nationally is $12,000. If we volume will need to also improve care I suggest the absence of a quorum. do nothing to bend the cost curve, the or the increased volume will negatively The PRESIDING OFFICER (Mr. average family will be paying, on an impact their fees. Doctors will have a KOHL). The clerk will call the roll. annual basis, $24,000 for their health financial incentive to maximize the The legislative clerk proceeded to care 10 years from now. value and quality of their service in- call the roll. Meanwhile, a new study found that stead of the quantity. This is supported Ms. KLOBUCHAR. Mr. President, I small businesses pay up to 18 percent by doctors in my State. ask unanimous consent that the order more to provide health insurance for Linking rewards to the outcomes for for the quorum call be rescinded. their employees. We are talking about the entire payment area creates an in- The PRESIDING OFFICER. Without a backpack company up in Two Har- centive for doctors and hospitals to objection, it is so ordered. bors, MN. A guy started that small work together to improve quality and

VerDate Nov 24 2008 03:51 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.055 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11866 CONGRESSIONAL RECORD — SENATE November 20, 2009 efficiency. In too many places patients As we enter the homestretch, the greatest Moreover, what is the point of rais- struggle against a fragmented delivery risk we run is not completing health reform ing the cost of health insurance and system, running all over with x rays in and letting this chance to lay a new founda- then subsidizing a portion of the in- the back of the car, seeing specialists, tion for our economy and our country pass us by. crease? You are still raising premiums. and not having someone in charge, or a It is nonsensical to have a health care I argue one of the most important quarterback running the team, having reform that makes families worse off things we can do—and I know every- 20 wide receivers running this way and and then gives them a government sub- body is focusing on who pays and what that way. That is why we need the in- sidy to help make up for part of the the provision means—is to change the tegrated care that is rewarded in the cost. delivery system in this country, reward bill—bundling of services. What you Second, new mandated benefits will that kind of high-quality, highly effi- pay for is the result, the combination increase costs. Under the Reid bill, the cient care, so that our big companies of services that gives you good results. government will require insurers to are able to compete with companies in That is what bundling is about. cover a broad range of new medical other countries that have more highly There is another good thing about benefits determined by Washington, re- efficient delivery systems so our small the bill. In 1 year, hospital readmis- gardless of whether those benefits are companies are able to exist and mul- sions cost Medicare $17.4 billion. A actually needed by each individual pa- tiply and keep their employees on study found that Medicare paid an av- tient. health care, so that individuals in this erage of $7,200 per readmission that was These additional benefits might help country aren’t cut off just because likely preventable. Who wants to go some patients, of course, but the gov- their child gets sick. That is what this back in the hospital if you don’t need ernment cannot provide them to every- reform is about. Thank you. I look for- to? One of the problems, if we don’t one for free. So the cost will be shared ward to the vote tomorrow. have quality indexes in place—my by everyone in the insurance pool, and State has one of the lowest hospital re- I yield the floor. The PRESIDING OFFICER. The Sen- that means increased premiums for admission rates in the country. If we ator from Arizona. many Americans. don’t have that index in place, we are Mr. KYL. Mr. President, the whole In fact, the Council for Affordable rewarding bad practice. We want to re- point of health care reform is to bring Health Insurance estimates the new ward high quality and put the patient down costs and to make health care mandated benefits would increase the in the driver’s seat. That is what we do more affordable for American families. cost of basic health coverage between with the provisions in the bill. 20 and 50 percent. That is the second I am encouraged the Senate bill in- So why have Democratic leaders produced a health care bill loaded with way insurance premiums are increased. cludes a provision that calls for re- Here is the third way: limits on plan duced payments to hospitals if they provisions that will increase premiums? types. Under this Reid bill, insurers are have preventable readmissions. limited to offering a total of only four In this bill, we also work to better re- Independent studies from the nonpartisan Congressional Budget Office specific kinds of insurance plans. So ward integrated health care systems. the low-cost, high-deductible plans At places such as Mayo Clinic or and the Joint Committee on Taxation that currently families and individuals Health Partners in Duluth, a patient’s and even a study by the chief actuary enjoy will be virtually eliminated. overall care is managed by a primary at the Department of Health and They will have to buy more expensive care doctor in coordination with spe- Human Services confirmed this: that plans, again paying more in premiums. cialists, nurses, and other care pro- the Democrats’ plan will drive up pre- Whatever happened to getting to keep viders, as needed—one-stop shopping. miums and overall health care spend- In our rural communities, critical ac- ing faster than in the absence of these what you have? Just as one size do not cess hospitals utilize this model and so-called reforms. fit all, in this case, four sizes do not fit provide quality health care for resi- How is this so? Let me mention five all either. dents in their communities with a specific ways. Here is the fourth way premiums in- team of providers. First, new insurance mandates and crease: New taxes are imposed on To better reward and encourage col- new taxes on the insurance industry. groups such as medical device makers. laboration, we encourage the creation New insurance requirements and new According to the Congressional Budget of accountable care organizations. This taxes on the insurance industry will Office and the Joint Committee on is what I hear from the people in my force premiums to rise for many Amer- Taxation, a new tax on medical devices State and across the country: We want icans, particularly the young and will increase premiums and increase more accountability in this health care healthy. According to an independent the price of everything from wheel- system. analysis that studied the effect of the chairs to diabetes testing supplies, to Do you know what else account- new insurance reforms and new taxes pacemakers, and it will be paid en- ability means? It means better enforce- on the insurance industry, insurance tirely by the patients. ment of Medicare fraud. When the dol- premiums in my home State of Arizona Its cost, according to the Joint Com- lars are so tight and people are having could skyrocket by as much as $2,619 mittee on Taxation? It is $19.3 billion so much trouble affording health care, for individuals and $7,426 for families. over 10 years. This tax will hit cutting- why do we want to waste $60 billion a Think of that, an increase of $7,426 edge technology such as CT scanners, year on fraud? Think what that money for families in my State. That is out- replacement joints, and the arterial could be spent for to make it easier to rageous. stents that doctors use during go to the hospital or doctor instead of What can $7,426 buy an Arizona fam- angioplasty. This tax will clearly stifle $60 billion wasted on fraud. ily? A lot of things. It could pay for a innovation. This bill and some of the amend- year’s tuition at the University of Ari- As the Wall Street Journal editorial- ments we are going to propose in the zona. It could pay for a year and a half ized: next month will bring us much closer of groceries or nearly 2 years of utility This new tax will eventually be passed to reducing that fraud, bringing that bills or it could pay for 2 years’ worth through to patients, increasing healthcare fraud down, and will hold the perpetra- of gasoline. Families have a lot of ex- costs. It will also harm innovation, taking a tors accountable, including criminal penses and a lot of ways to spend $7,426. big bite out of the research and development penalties—that is important—making They don’t need the Federal Govern- that leads to medical advancements. sure we have direct deposit, a bill that ment intruding on them and dictating The fifth way in which this legisla- Senator SNOWE and I have, so nobody that money has to go somewhere else. tion will increase costs for the insured can make out false checks and try to Our friends on the other side of the is it actually taxes the insurance plans get the money that way; giving our law aisle will say they could provide sub- themselves for the first time. You buy enforcement officers more tools to go sidies. In fact, the legislation will pro- insurance, you get taxed. The Reid bill, after Medicare fraud. We can save $60 vide subsidies to help with this infor the first time, directly accom- billion a year. creased cost. But not every family will plishes this. As the independent Joint In today’s Washington Post, Peter qualify, and the subsidies may not even Committee on Taxation told us, this Orszag writes: cover the total cost of the increase. new tax will increase the cost of health

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.057 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11867 insurance for everyone, since insurers doing is adopting the provisions in the enrolled in at least a bronze plan will will pass the costs along to their pa- Reid bill, which will actually increase face a new $750 fine. tients. health care premiums. Let’s look at what this means. In my This tax alone could raise some Let’s keep in mind that health care home State of Maine, 87.5 percent of Americans’ premiums by $487 per year. reform is all about making things bet- those purchasing coverage in the indi- Because this tax is indexed to regular ter for Americans, and this bill does vidual market today have policies with inflation rather than to health care in- not meet that test by a long shot. an actuarial value of less than 60 per- flation, just as with the alternative The PRESIDING OFFICER. The Sen- cent. In other words, they have policies minimum tax, it could soon start hit- ator from Maine. that do not qualify under the standards ting middle-income families. Ms. COLLINS. Mr. President, I rise that would be established by this bill. According to former Congressional to discuss the health care bill that the The most popular individual market Budget Office Director Douglas Holtz- Senate will begin voting on tomorrow policy sold in Maine costs a 40-year-old Eakin, half of all families making less evening. Let me begin by making clear about $185 a month. Under Senator than $100,000 per year could end up pay- that I believe our health care system REID’s bill, that 40-year-old would have ing this tax. needs fundamental reform. to pay at least $420 a month, more than Those are five specific ways in which One of my top priorities as a Senator twice as much, for a policy that would this bill will increase your costs, in- has been to work to expand access to meet the new minimum standard, or crease the premiums you pay for affordable health care. The fact is, pay the $750 penalty. health insurance once this bill is in ef- however, that the greatest barrier to I believe Americans should have the fect. We believe there are better ideas. health care coverage today is the ex- choice to purchase more affordable Republicans have proposed a variety of ploding cost. Monthly health insurance coverage if that is what works best for solutions to target specific problems premiums in Maine have risen at an them. Health care reform should be and, in particular, the problem of cost. alarming rate. They now often exceed a about expanding affordable choices, I, specifically, want to conclude by family’s mortgage payment. Whether I not constricting them. It should not be mentioning the Republican health care am talking to a self-employed fisher- about forcing millions of Americans to alternative in the House of Representa- man, a displaced mill worker, the buy coverage that is richer than they tives. The majority voted it down, but owner of a struggling small business, want, need, or can afford. Yet under the truth is, it would, in fact, lower or the human resource manager of a this bill, even an individual who does premiums for individuals, families, and large company, the soaring cost of not qualify for any taxpayer assist- small businesses. Contrast the House- health insurance is a vital concern. ance, for any subsidy, would have to Much of the health care reform de- passed bill which increases premiums, buy a prescribed plan rather than, for bate so far in this Congress has cen- the Reid bill which increases pre- example, a low-cost, high-deductible tered around the need to expand cov- miums, but the Republican House bill erage to the uninsured, a goal I em- policy that, when combined with a which would actually decrease pre- brace. The fact is, however, it will be health savings account, may best meet miums and you will see Republicans in difficult to achieve our goal of uni- his needs. Moreover, the very tight rating the Senate proposing similar ideas. versal coverage until we find a way to According to the Congressional Budg- bands in this bill will increase costs for control health care costs that have et Office, under the Republican plan, young people. driven up the cost of insurance cov- Why does that matter, when we are premiums would be $5,000 lower than erage for families, employers, and gov- trying to expand coverage for those the cheapest plan under the Pelosi bill. ernments alike. Small businesses, too, would see While I agree that our health care who are uninsured? For this reason: their premiums decrease by as much as system is broken and in need of major More than 40 percent of uninsured 10 percent, again according to the Con- reform, the bill we are about to con- Americans are between the ages of 18 gressional Budget Office. sider falls far short when it comes to and 34. Extreme price increases for the Those in the small group market reining in health care costs. This is a young and healthy will simply force would also see a 10-percent decrease critical issue because the high cost of them out of the market because most under the House Republican bill, again health care is the biggest barrier for young people, I fear, will just do the according to the nonpartisan CBO. those who lack insurance. The high math. They will decide to pay the new The House Republican bill included cost of health care is what is driving up $750-a-year fine, rather than paying such reforms as allowing States to sell the cost of insurance premiums, caus- $5,000 a year or more for health insur- policies across State lines. You have ing many middle-income families and ance. This is particularly true because heard a lot of Senators on the Repub- small businesses to struggle to meet under the bill, if they do get sick later, lican side talk about that point. That these rising costs. they can still buy insurance with no would have enabled 1,000 companies to I am concerned that this bill takes us penalty, no increased cost. That is why compete nationally, and that helps to in the wrong direction and that it will the National Association of Insurance drive down the costs. Medical liability actually drive up costs and reduce Commissioners—keep in mind, this is reform, a proven way to cut costs. My choices for many middle-income Amer- the association of State officials which State of Arizona, Texas, and Missouri icans and small businesses. regulates insurance; these are public have all seen premiums go down be- Health care reform should give Amer- officials—according to the NAIC, these cause of medical malpractice reform. icans more, not fewer, choices of af- provisions will lead to severe adverse Health savings accounts, which put pa- fordable health insurance options. selection that will drive up the cost of tients in charge of their own health Under this bill, many Americans will premiums for everyone else who is in care by allowing them to save their be required to purchase health insur- the insurance pool. health care dollars to spend as they ance that is more expensive, not less Proponents of this legislation con- choose, this, too, would have been expensive, than the coverage they cur- tend that the subsidies included in the strengthened by the House bill, and rently have. bill for low- and moderate-income you heard Republican Senators talk Under the majority leader’s bill, all Americans will compensate for any about that as a reform. There are many individual and small group policies premium increases. Let’s take a look other ideas we have. We will be talking sold in our country must fit into one of at that. First of all, it is important to more about those ideas as we go for- four categories: bronze, silver, gold, or know that the subsidies do not go into ward. platinum, and they must have an actu- effect until the year 2014 yet a lot of I wish to conclude my remarks about arial value of at least 60 percent. Post the taxes which I am going to discuss the Reid bill, loaded with provisions reform—if this bill becomes law—it later, which are also going to drive up that increase insurance premiums, and will be illegal to issue new policies in the cost of premiums, go into effect to make the point that since, as I said the individual or small group markets next year. So that is a problem as well. at the beginning, the whole point of that do not meet those standards. Moreover, these subsidies are going the exercise is to reduce health care Moreover, unless they are grand- to be available, it is estimated, to premiums, the last thing we should be fathered, most Americans who are not fewer than 8 percent of Americans.

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.058 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11868 CONGRESSIONAL RECORD — SENATE November 20, 2009 Moreover, if you receive your health purchasers and would ultimately raise insur- because of the exceptional challenges they insurance from your employer, as the ance premiums by a corresponding amount. face. They experience the most volatile pre- vast majority of Americans now do, The Joint Committee on Taxation mium increases, are the most cost-shifted you are not eligible for a subsidy under looked at the tax on the so-called Cad- market, see the most tax increases and have the least competitive marketplace. For all this plan. But your premiums are still illac plans, the 40-percent excise tax. these reasons, they especially need reform, going to go up because of the increased Here is what it said: but these reforms can’t add to their cost of taxes and fees imposed by the bill. As insurers pass along the cost to con- doing business. The impact from these new When Americans understandably are sumers by increasing the price, the cost of taxes, a rich benefit package that is more so upset about the high cost of health employer-provided insurance will increase. costly than what they can afford today, a care, and when health insurance pre- I do not believe that the American new government entitlement program, and a miums are going up by double digits, people have sent us to Washington to hard employer mandate equals disaster for making it so difficult for most Ameri- small business. raise their taxes and call it health re- ‘‘We are disappointed that, after so many cans to afford health insurance, the form—especially now, in the midst of a months of discussion, small business could last thing we should be doing is to recession, with unemployment above 10 be left with the status quo or something make the situation worse. I can’t help percent. even worse. Unless extreme measures are but think of the Hippocratic Oath, ‘‘do This leads me to another point. I am taken to reverse the course Congress is on, no harm.’’ Should not that be our first so concerned about the impact of this small business will have no choice but to rule? bill on our small businesses. They are hope for another chance at real reform down Americans who are already shoul- the job creators in our economy, and the road. ‘‘Congress is running out of opportunities dering the burden of too high health the rising cost of health care has been to prove to small business that they are seri- care costs would hardly consider a bill particularly burdensome for them. A ous about helping our nation’s job creators. to be ‘‘reform’’ if it drives those costs small business owner in Maine recently We are hopeful that a robust bipartisan de- up further. Yet I fear that is exactly e-mailed me to say the following: bate will produce a bill that small businesses what will happen if this bill becomes I just received our renewal proposals for see as a solution and not another govern- law as written. our small business. The plans are all up any- ment burden.’’ In light of this, I think it is a legiti- where from 12 to 32 percent on the three Ms. COLLINS. Mr. President, there mate question to ask whether this bill plans that we offer. . . . You are right when are some provisions in the bill that are may actually increase the number of you say we need to address the cost of health intended to try to help small business uninsured Americans by driving up the insurance, not create another vehicle to de- but again they miss the mark. I sup- cost of health insurance for years be- liver the services. The current legislation, as I understand it, totally misses the mark. port and have long proposed the idea of fore the subsidies go into effect? tax credits for small businesses to help Let me take a further look at some How does this bill help small busi- them afford to provide health insur- of the increased taxes that are in this ness? On balance, it doesn’t. That, ance for their employees. But the cred- bill. Americans will face at least a again, is not just my opinion; that is its for small businesses in this bill are dozen new or increased taxes and fees the opinion of our Nation’s largest poorly structured. Only businesses amounting to $73 billion before the sub- small business group, the NFIB. In a with no more than 10 workers, paid an sidies go into effect in 2014. What kind statement on the bill released yester- average of $20,000, can get the full tax of new taxes are we talking about? day, the NFIB said: credit. So if a small business hires ad- This chart shows just some of the taxes This kind of reform is not what we need. ditional employees or pays more, its that will hit Americans when the bill New taxes . . . new mandates . . . new enti- credit begins to decline and it is even- goes into effect—and there are many tlement programs . . . paid for on the backs of small business. tually phased out. Businesses with more. Here are a few. more than 25 workers, or paying aver- In fact, NFIB described the bill as ‘‘a There is a tax on pharmaceutical age wages of above $40,000 get no tax disaster.’’ manufacturers, a tax on health insur- credit whatsoever. I ask unanimous consent a copy of ance providers, a tax on medical de- Take a look at this. I realize this the NFIB statement be printed in the vices. Think of what we are talking chart is a bit busy, but stay with me. RECORD. about taxing here: We are talking Under the Finance Committee bill, if There being no objection, the mate- about insulin pumps, artificial hips and you have 10 employees and you pay rial was ordered to be printed in the knees, stents put into hearts—all sorts them on average $20,000, you get a 50- RECORD, as follows: of medical devices. If a new fee is put percent tax credit applied to the cost of on these devices, that is going to be [From NFIB—Small Business News, Nov. 19, the insurance. But if you give them a 2009] passed on to consumers and reflected in raise, the tax credit begins to decline. insurance premiums. SENATE BILL FAILS SMALL BUSINESS For example, if you have 10 employees All in all, as I mentioned, these taxes (By Stephanie Cathcart) and you pay them $25,000 on average, will cost $73 billion before 2014. These WASHINGTON, DC.—Susan Eckerly, senior you only get a tax credit of 38 percent. taxes will be paid right away by Ameri- vice president of the National Federation of Let’s say you are trying to improve cans in the form of higher health insur- Independent Business, the nation’s leading their quality of living. They have done small business association, issued the fol- ance premiums. That is not just my lowing statement in reaction to the Patient a great job for you, so you give all your opinion, that is the view of the Con- Protection and Affordable Care Act: employees a raise, bringing their aver- gressional Budget Office, which evalu- ‘‘Small business can’t support a proposal age wage to $30,000. Now the tax credit ated the impact of several of these that does not address their No. 1 problem: is only half as much as when you paid taxes. For example, here is what the the unsustainable cost of healthcare. With them $20,000. CBO said about the $6.7 billion in- unemployment at a 26-year high and small If you pay them $40,000 on average— creased tax on insurers: business owners struggling to simply keep zero. You lose the tax credit alto- their doors open, this kind of reform is not We expect a very large portion of the pro- gether. what we need to encourage small businesses posed insurance industry fee to be borne by What we have here is a tax credit to thrive. purchasers of insurance in the form of higher ‘‘We oppose the Patient Protection and Af- that is structured in such a way that it premiums. fordable Care Act due to the amount of new discourages small businesses from add- The problem is, the way these taxes taxes, the creation of new mandates, and the ing employees and paying them better. are structured, they are going to be establishment of new entitlement programs. That doesn’t make any sense at all. passed on to consumers, and it is not There is no doubt all these burdens will be That makes no sense at all. only the taxes on insurers that will be paid for on the backs of small business. It’s This legislation would have enor- passed on. Here is what the CBO Direc- clear to us that, at the end of the day, the mous consequences for our economy tor said about new fees on the pharma- costs to small business more than outweigh and for our society. We have to remem- the benefits they may have realized. ceutical industry and also on medical ‘‘Small businesses have been clear about ber that this bill would affect every devices. The CBO said: their needs in health reform; they have been single American, every small and large Those fees would increase costs for the af- working for solutions for more than two dec- employer, every health care provider. fected firms, which would be passed on to ades. They have a unique place in this debate It affects 17 percent of our economy.

VerDate Nov 24 2008 03:51 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.060 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11869 There are many reforms, such as al- don’t want any part of this bill, noth- know about yet, we will discover in the lowing small businesses to pool to- ing to do with it, to the point that they future, but we at least know some ways gether to have better bargaining clout, have sent doctors in my home State that are going to cause the premiums that I support and that have strong bi- and States surrounding the Mayo Clin- to go up. partisan support, that could have been ic who refer patients—and I practiced Let me first talk generally about the the basis for further debate and amend- medicine in Wyoming for 25 years, have bill and what some of the problems are ments. So it disappoints me greatly taken care of families there as a physi- and just briefly on some alternative that we are about to proceed to a divi- cian, and we sent patients to the Mayo ideas Republicans have come up with sive, partisan bill. I continue to believe Clinic—they just said: Stop sending pain more of a step-by-step type ap- that the American people would be bet- tients on Medicare or Medicaid. We proach. ter served by a bipartisan bill that want nothing to do with it because the We know this bill cuts Medicare by brings together the best ideas on both government is the biggest deadbeat $465 billion, including $118 billion in sides of the aisle, and I pledge to con- payer. The Mayo Clinic said: Every Medicare Advantage cuts. That means tinue to work with Members on both time we get one of those patients, we millions of seniors who are on Medi- sides of the aisle to develop alter- have to charge the people who pay care Advantage today will lose the plan natives that will bring about true their own way, the people who have in- they have. Medicare Advantage plans health care reform. surance. We have to charge them more. in my State are incredibly popular The PRESIDING OFFICER. The Sen- We don’t want to take any more pa- among senior citizens. I know they are ator from Wyoming. tients on Medicare and Medicaid. Hos- across the country. We know taxes are Mr. BARRASSO. Mr. President, I find pitals and the communities in Maine, going to go up by almost $500 billion. it fascinating, listening to the com- South Dakota, and Nevada, hospitals We know premiums are going to go up ments from the Senator from Maine. in those States have to take all those for millions of Americans. This bill was supposed to bend the Maine and Wyoming are similar in a patients. number of ways. One is that the engine So what happens to people who pay cost curve. Because it is actually def- that drives our economy is small busi- their own way because they buy insur- icit neutral, maybe it helps the deficit nesses. What we heard is that this bill ance themselves or they get it through a little bit because of the smoke and right here, this large bill which is the work is the hospitals have to charge mirrors they play with it. They say that bends the cost curve, but when we bill the Senate is considering right them more to make up for the biggest look at the American people and the now, over 2,000 pages—underneath it is deadbeat payer of all time—the Federal actual cost they will be paying for the bill that passed the House—I hear Government. these are actually going to penalize the I see the Senator from Nevada rising health care, their cost curve continues small businesses of Maine and the to his feet. I imagine the exact same to go up and up and up into the future. This bill will also lead to rationing. small businesses of Wyoming when thing is happening to hospitals in Ne- We saw this week a Federal board that those businesses try to hire another vada. Premiums are going up on the 85 talked about mammograms, and it employee. percent of the people who have insur- caused an outrage in women across We are looking at 10.2 percent unem- ance they like. Yet we in the Senate America. That is the sort of thing that ployment right now. People in our tomorrow night are going to vote on a is going to happen because of this legis- States are well aware of those num- bill which, to me, the people of Amer- lation. Federal bureaucrats are going bers. I don’t know if that number is ica don’t like. Do you know who to be in charge of your health care, not being neglected by others, but for doesn’t like it the most? Seniors. They your doctor and you. We need to have small businesses trying to hire people, are concerned. They know Medicare is legislation that focuses on that doctor- this health care bill makes it much going broke. And by the year 2017, patient relationship that should be so tougher. It will certainly make it there will be $500 billion of cuts in sacred in our health care system today. tougher for them to provide insurance, Medicare. Yet the money that is being Republicans have come up with the and it will make it tougher for those cut from Medicare isn’t being used to idea of medical liability reform to small businesses to give raises to peo- save Medicare; it is to start a whole start driving down the cost of all of ple. new program that will cause Ameri- this defensive medicine that is prac- It is, indeed, unfortunate that we are cans who have insurance to pay more. ticed. We all know doctors order all here in the Senate Chamber looking at It will cause people who don’t have any kinds of unnecessary tests to prevent a bill that is going to raise premiums insurance to make it harder to get or if themselves from being sued in all these for the American people who have in- they go to an emergency room and frivolous lawsuits. surance and who like the insurance have to pay a bill, that bill will be Both sides agree, let’s eliminate the they have. Their big concern isn’t cost. higher, all because of what I believe is preexisting conditions. That is kind of We are looking at a bill that is going to an irresponsible piece of legislation a given. That is something on which we cut Medicare for seniors who depend on that is going to be a huge weight on all agree. That is part of the step-by- Medicare, and the numbers are huge, the American economy at a time when step approach this side of the aisle almost $500 billion. And we are looking we have 10.2 percent unemployment. would certainly be willing to do. at a bill that is going to raise taxes on I see the Senator from Nevada. He I also believe we need to encourage the American people. has a similar copy of the bills next to healthier behavior in America because I heard the Senator from Maine, and him. He may want to chime in on what 75 percent of all health care costs are she can jump in and correct me if I am he sees in his home State and what he because of people’s behavioral wrong. What I heard her say is that it is hearing from people who live in Ne- choices—smoking, people who are over- is not just a tax on the rich; it is a tax vada, from small businesses as well as weight. We know obesity contributes on people all across the board because hospitals and providers. to every kind of cancer, to heart dis- the taxes are going to be passed on. I Mr. ENSIGN. Mr. President, these ease, diabetes. It is epidemic in this see the Senator nodding her head in pieces of legislation were put on our country. Look at our young people. If the affirmative. When taxes are raised desks to show the American people we don’t turn around people’s behavior, on medical devices or on medication, what we are dealing with. We have only get them to exercise more, eat right, on one thing after another after an- just started going through these bills. quit smoking, I don’t care what health other, those are costs that will get Already we have found major problems care reform you pass, we are not going passed on to all the consumers of with the legislation. to do anything about driving down the health care. What we are going to talk about over cost. And the high cost of health care Right before this party took the the next few minutes is the premium is the No. 1 problem with our system. floor, we had the senior Senator from increases for the American people. If We believe we should have small Minnesota talking about the Mayo you have insurance now, your pre- business health plans where small busi- Clinic and the wonderful care that is miums are going to go up because of nesses can join together to buy health given there. It is wonderful care. But this legislation we have before us. insurance, take advantage of pur- the Mayo Clinic has also said they Probably in other ways we don’t even chasing power that larger businesses

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.061 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11870 CONGRESSIONAL RECORD — SENATE November 20, 2009 have. We believe individuals should be Mr. ENSIGN. How many more people The Senator from Nevada talked able to buy across State lines the way are going to go on the Medicaid rolls? about buying insurance across State you do with car insurance. If your Mr. BARRASSO. It is millions and lines to help people get the costs down. State is too high on insurance, buy it millions of people, with the cost to the This bill prevents that. It also prevents in another State where it is cheaper, States. You say we will take it out of small business groups from getting to- where maybe they don’t have as many here. You won’t see it in this bill be- gether, which would be a great help. mandates. Doesn’t that make sense? cause they are going to make the I know the Senator from South Da- We also believe we should have trans- States pay over $20 billion in money kota is interested in getting into the parency on cost and quality. When you because it is a matching program, so discussion. I invite him to discuss this walk into your doctor’s office, you they get it off the Washington books. very aspect and the impact of all these should be able to get a written esti- But it is still the taxpayers and the increasing premiums on the folks in his mate of what it is going to cost. You States, and we all come from States. State. should be able to shop that estimate so That is going to drive up the cost for Mr. THUNE. Mr. President, Wyoming that we have more consumers making individuals as well as increase taxes is not a lot unlike the States of South more intelligent choices on health around the country. Dakota or Nevada, as the Senator care. When was the last time you went Mr. ENSIGN. Because you were in knows, although they have a few larger into your doctor’s office and got a writ- the practice of medicine, I ask the Sen- businesses in Nevada. But the people ten estimate or knew how much some- ator from Wyoming, I have heard num- who get hit hardest under this bill are thing was going to cost? I practiced bers as high as 15 million new people on small businesses. veterinary medicine for many years. Medicaid, plus we have a new public op- We heard the Senator from Maine, When you walk into my practice, you tion, so there will be more people on Ms. COLLINS, point out the impacts on get a written estimate. We have you another government plan. What will small businesses. The ironic thing sign that written estimate because we happen as far as cost shifting to those about that is a lot of small businesses, have to give that. That is part of our of us who have private insurance? For where you would want to encourage general practice. We need to bring that those tens of millions of Americans them to offer health insurance to their into human medicine, whether it is who have private health insurance, employees, will be discouraged from hospitals or doctors’ practices. We need what will happen to their cost of insur- doing so under this bill. In fact, what to have transparency for cost and qual- ance when more people are on govern- most of them are probably going to do ity. ment plans? is pay the $750 penalty and then push How does this bill drive up premiums Mr. BARRASSO. Those costs will everybody off into the government for Americans? have to go up. Premiums will go up for plan. First, there are nine new taxes put in all people who have insurance, private The assumption that is being made in by the Democratic majority: a 40-per- insurance. The Senator from Nevada is here is that the government plan—it cent insurance plan tax for what are correct. Some people think the number will grow over time, obviously. I think called Cadillac plans; another tax on is 15 million more who will go onto the 5 million people will lose their private insurance companies; an employer tax; Medicaid rolls because there is a dif- insurance, according to CBO. My guess a drug tax; a lab tax; a medical device ference between the Senate bill and the is that number is going to be much tax; a failure to buy insurance tax; a House bill as to how many more folks higher because I think what is going to cosmetic surgery tax, brand new in this they move onto the Medicaid rolls. But happen is small businesses that are im- bill; and also an increased employee either way, we are talking tens and pacted the most by these tax increases Medicare tax, a brandnew tax structure tens of billions of dollars that will are going to find themselves less and on Medicare taxes. Who pays for these come out of the taxpayers’ pockets less able to provide health insurance kinds of taxes? It isn’t just insurance. around the States. But that is still for coverage to their employees. On the failure to buy insurance, 71 per- a government-run program that The other thing I want to point out, cent of that tax is going to be paid for doesn’t reimburse, doesn’t pay the hos- as to what my colleagues from Wyo- by people who make less than $120,000 a pitals, doesn’t pay the doctors even ming and Nevada have said, is that I year. what the cost of delivering the care is. would be somewhat, I guess, interested Almost every one of the taxes I just Across the board, hospitals will tell in what is being proposed by the other put up of those nine new taxes—the you they cannot keep their doors open side if it did anything to impact cost. vast majority of them are paid by peo- if everyone is paid at Medicaid or Medi- But it does not. The whole purpose of ple who President Obama, when he was care rates. The only way they can pay this exercise, at least in the minds of campaigning, said would not pay one the nurses, keep the lights on, take the most Americans, is to drive the cost dime more in new taxes. He repeated food in the trays around to the pa- curve down. I heard my colleagues on that promise time after time. He said: tients, do all the things a hospital has the other side get up and talk about, No new fees, no new taxes, capital to do, or keep a doctor’s office open, well, their plan is going to decrease gains. He went through the whole lit- the only way they can do it is because costs for people in this country. any of types of taxes that would not be they charge more to people who have Well, here is the cost curve, as shown raised. Yet in this plan approximately private insurance than they get paid on this chart. The blue represents the 80 percent of all of the new taxes are for people on Medicare or Medicaid. cost curve; that is, what would happen paid by people making less than And Medicaid is worse than Medicare if we do nothing. That is the expected $250,000 a year. in terms of the payment. increase in health care costs in this Another way this massive piece of So it is this cost shifting that occurs. country if we do nothing. legislation raises premiums is this Who pays that? The people who have What is ironic is, the red represents thing known as cost-shifting. The doc- regular insurance. It is the hard-work- what happens under this bill. So in- tor from Wyoming practiced medicine. ing men and women of America stead of bending the cost curve down, He was talking about the Mayo Clinic through their jobs who pay for that. We it actually increases the cost curve. So and why the Mayo Clinic, the Cleve- just heard from the Senator from we are going to spend $160 billion more land Clinic, and other places and other Maine. Anytime we try to help that in- on health care in this country by en- doctors don’t want to take Medicaid dividual—I see the Senator from South acting this bill, this monstrosity of a and Medicare patients anymore. Why? Dakota is in the Chamber as well, and bill right here, which, as my colleagues Because the government pays 20 to 30 he may want to jump in as well be- have pointed out, is 2,074 pages. The percent less than private health insur- cause South Dakota is a State like Senators from Nevada and Wyoming ance in reimbursement to doctors; isn’t mine where we have lots of small busi- both also have the House version, that correct? nesses that are going to be hit specifi- which is 2,200 pages. But look at this Mr. BARRASSO. Plus, when you read cally hard as they try to continue to thing. You would think somewhere in this bill, one of their so-called solu- provide insurance. This does not even here, in all this volume of paper, there tions is they will put more people on allow small businesses to group to- would be a way to actually do some- the Medicaid rolls. gether to get better deals. thing to actually bend the cost curve

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.062 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11871 down. But all that represents more pate in any sort of an exchange. These day, a lot of this gets passed on. And spending. are the cold, hard facts. the taxes in the bill, the premium in- In fact, if you look at the amount of I have heard countless Democratic creases in the bill, are all going to be spending in the bill when it is fully im- colleagues come down here and talk borne by the people who are probably plemented, it is much more than what about bending the cost curve down and least able to absorb that and take that, the CBO estimated it would cost. There reducing premiums for people in this and it is going to be the people in the was all the publicity when they un- country. As shown on this chart, this is lower income categories. veiled this health care plan a couple the Congressional Budget Office num- So the Senator from Nevada is abso- days ago that it is going to be under $1 ber. This is not anything the Repub- lutely right. I again come back to the trillion. Well, in fact, we all know they licans put together. This is the CBO basic premise of this whole purpose of have used a lot of accounting gim- cost estimate of what it would do to health care reform, which should be to micks, a lot of scoring tricks, a lot of the cost curve. As I said before, the red get health care costs down, not raise ways to obscure the true cost. In fact, represents the increase: a $160 billion them. The Senator from Wyoming has even in the first 10 years it understates increase in health care spending over 10 alluded to a number of things we be- the cost, which is over $1 trillion. But years—all of which is going to be borne lieve would do that, that actually do the 10-year fully implemented cost of by those 182 million Americans in this put downward pressure on health care this bill is $2.5 trillion—a $2.5 trillion country who already have insurance. costs in this country. It is done in a expansion in the size of the Federal Mr. ENSIGN. If the Senator from step-by-step way. It is done in a way Government. South Dakota would yield, I wish to that does not call for throwing out ev- If you look at how that plays out and get your comments—maybe from both erything that is good about the health how it is paid for over the fully imple- of my colleagues—on a couple of quotes care system in this country, creating 1 this massive new expansion of the Fed- mented phase—we all talked about $ ⁄2 from the Congressional Budget Office trillion in Medicare cuts. For 10 years, as well as the Joint Committee on Tax- eral Government here in Washington, fully implemented, it is over $1 trillion ation dealing with these premium in- DC, with $2.5 trillion in costs over a 10- they have to cut Medicare to pay for creases and who is actually going to year period when it is fully imple- this thing, and then to raise taxes by bear the taxes. Because a lot of people mented. And probably—who knows—if a lot of another $1 trillion. So you are talking think that: Well, let’s tax the insur- these things do not happen, if the tax about not only cutting Medicare to ance companies. Let’s tax the medical increases, for some reason, do not hap- senior citizens, as the Senators have device companies. Let’s tax somebody pen, if the Medicare cuts do not occur, talked about, but also raising taxes else. Well, this is what the Congres- it means borrowing from future genera- substantially on small businesses. But sional Budget Office says. Let me read at the end of the day, after all is said tions. They talk about reducing the a couple quotes. One quote is: deficit by $130 billion only because they and done, what do you end up with? Although the surcharges would be imposed did not include the physician fee fix in You end up with an increase in cost on the firms, workers in those firms would this, only because they added $72 bil- above and beyond what we would see if ultimately bear the burden of those fees, just lion in revenue from something called we did nothing. Tell me how you can as they would with pay-or-play require- the CLASS Act, which we know is call that reform. ments. . . . Many of those workers are more The other point I will make before I likely to have earnings at or near the min- never going to become law—and even if yield back to my colleagues is, if you imum wage. it does, it is a huge money loser in the are someone who already has insur- So it is the low-income people who outyears. So you have all these things that ance—and 182 million people in this are going to end up paying when you they did, including delaying the imple- country have insurance—you are not actually put some of these taxes that mentation date by 5 years so it under- going to be able to participate in the we have talked about in. Here is another quote from the Con- states the true cost of this thing—all exchange. these things that have been done to try You get no more options out of this. gressional Budget Office. Let’s remind to make this turkey look like some- There are 19 million Americans who folks, the Congressional Budget Office thing other than what it is, which is a would, perhaps, benefit from being part is nonpartisan. It is not Republican, massive increase in spending, massive of an exchange. But if you are one of not Democratic. They are kind of the tax increases on the American people, the 182 million people in this country objective scorekeeper around here. and increased premiums for Americans, who currently have insurance, you can- They say, these taxes ‘‘would increase costs for the affected firms, which particularly those 182 million Ameri- not get into an exchange and you can- cans who already have health insur- would be passed on to purchasers and not get any subsidy. What you get are ance who are going to get hit the hard- would ultimately raise insurance pre- big fat tax increases and increases in est by this. your insurance premiums, for all the miums by a corresponding amount.’’ Mr. ENSIGN. Maybe we could have The last economic quote is this. This reasons that have been mentioned. Be- the Senator from Wyoming comment. cause when you tax the health insur- is by the Joint Tax Committee: One of the big things Republicans have ance companies—as this bill does— Generally, we expect the insurer to pass been talking about—instead of driving when you tax the medical device manu- along the cost of the excise tax to consumers premiums up, which this bill does—is by increasing the price of health coverage. facturers—as this bill does—when you driving premiums down. Maybe the tax the pharmaceutical companies—as I say to the Senator, this is what you Senator can discuss medical liability this bill does—and create all new kinds are talking about on that other chart reform, which the Congressional Budg- of mandates on insurance companies, you have up. I wish to hear your com- et Office, which is a very conservative including changing these age band rat- ments on that. estimate, has said would save about ings, going to a 3-to-1 age band rating, Mr. THUNE. Well, the Senator is ab- $100 billion in medical costs in this you are going to raise premiums for a solutely right. I think what the CBO country. lot of people in this country, and you has pointed out is—and I have the As a practicing physician, maybe the are going to raise them the most for Joint Tax Committee there; the data Senator could talk about the unneces- people who are age 18 to 34. The people they produced is very similar to what sary tests that are ordered, the huge who are age 18 to 34 do not realize what CBO said—84 percent of the tax burden increases in medical liability insurance is coming at them today, but it is is going to fall on people making less costs that physicians face today. about a 69-percent increase in their in- than $200,000 a year. And half of the Mr. BARRASSO. Mr. President, if surance premiums. They are the ones families making under $100,000 a year you do a poll of doctors, with the ques- who get stuck the hardest. are going to get hit with new taxes tion: Have you ever ordered a test that But if you are any of these 182 mil- under this bill. So it is going to fall on was not going to help that person get lion people, your taxes are going to go those people in this country. And I better, that patient get better, but you up, your insurance premiums are going think they like to think they are tax- were doing it because you did not want to go up, and you are not going to see ing medical device manufacturers and to miss something for fear of a mal- any benefit from being able to partici- everybody else, but at the end of the practice suit, every hand will go up of

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That is a se- of the major national publications this from the Senator from South Dakota— rious disease, but one that modern medicine week, and he gave this whole thing—he their premiums are going to go up—did knows how to manage. If this bright, feisty, dazzling young woman had lived in say, said: I give this whole thing a failing I hear 69 percent? Japan, the world’s second richest Nation, or grade. He said people who support Mr. THUNE. Mr. President, 69 per- Germany, the third richest, or Britain, this—the legislation that is being pro- cent. If you are 18 to 34, that is what France, Italy, Spain, Canada, et cetera, the posed—are engaged in collective denial. you are looking at in the form of pre- health care systems there would have given We need to do some things that will mium increases, not to mention the her the standard treatment for Lupus and help with cost, with access, with qual- fact that future generations are going she could have lived a normal life span. But ity. All this bill is going to do is drive to deal with all of the debt we continue Nikki White was a citizen of the world’s up the cost, with no improvement at to pile on them, which I think bears richest country—the United States of Amer- ica. Once she was sick, she couldn’t get all in quality. heavily on this debate right now, when health insurance. Like tens of millions of her So there are step-by-step things we you are looking at trillion-dollar defi- fellow Americans, she had too much money can do: letting people buy insurance cits as far as the eye can see. This is to qualify for health care under welfare, but across State lines, getting the same not a good deal if you are a young per- too little money to pay for the drugs and the tax breaks as others. The Senator son in America. doctors she needed to stay alive. She spent talked about helping people stay Mr. BARRASSO. It is the wrong pre- the last months of her life frantically writ- healthy—exercising, getting down the scription for America. ing letters and filling out forms pleading for cost of their care by getting their cho- I am going to continue to speak on help. When she died, Nikki White was 32 lesterol down. the floor about the things that I think years old. But also you have to deal with law- are problems with this bill. I think it is That is a story that should move suit abuse. It is out there. You could do the wrong approach. I think it costs every one of us, move every one of us a thing as easy as loser pays. Obvi- way too much. I think it raises taxes to action. ously, there are great objections to on all Americans. It cuts Medicare. Look, we have spent years studying trying to do that. There are people who What we have heard now, and what we and analyzing what is working in our would oppose that all the way. But it know for sure, is it is going to raise health care system and what is not would help eliminate—eliminate—a lot premiums for people who have insur- working. What it comes down to is of the unnecessary tests and certainly ance, who like the insurance they have, this: Too many of our fellow citizens a lot of the costs of the system. Be- who want to keep the insurance they are suffering because of the broken cause two-thirds of the cost of that have; and their costs are going to con- promises of a health insurance system whole liability system goes to the sys- tinue to go up if this becomes law, at a that abandoned them when they needed tem, it does not even go to the injured rate faster than, as we saw from the it the most. Too many cannot afford person. If somebody is injured, you graph, if nothing was passed at all. health insurance. Too many are get- want to take care of them. But this The PRESIDING OFFICER (Mr. BEN- ting sick after praying to God that does not do it at all. NET). The time has expired. they wouldn’t because they knew that One of the things the Senator from The Senator from California. sickness could leave them in economic South Dakota mentioned, fairly quick- Mrs. BOXER. Mr. President, what is ruin. Praying is not a health care in- ly in passing, was age band ratings, the order? surance plan. which flies in the face of the things we The PRESIDING OFFICER. The Americans will spend over $2.5 tril- have been talking about: individual re- Democrats control the next hour. lion on health care next year; $2.5 tril- sponsibility, opportunities for people Mrs. BOXER. Thank you very much, lion. In all, we spend twice as much per to stay healthy. The big problem is Mr. President. person on health care as other ad- that we know 50 percent of all the I have listened to several of my Re- vanced nations. Yet, the United States money we spend on health care on this publican colleagues and I wish to note of America, out great Nation, ranks country is on 5 percent of the people— that they have the bill in front of them near the bottom of the 30 leading in- the people who eat too much, exercise and they are attacking this health care dustrialized nations in basic measures too little, and smoke. But yet under bill, but nowhere on their desks do we of health, such as infant mortality rate this government-forced insurance, see their bill. They have no answers, no and life expectancy—the bottom of the where people are going to be forced to solutions. list. That is where we are. So we spend buy insurance—and if young people do Mr. THUNE. Will the Senator from twice as much and the results are not not buy it, they are going to be listed California yield? anywhere near where they should be. It as either tax cheats or criminals be- Mrs. BOXER. I can’t yield. is clear why. Too many people don’t cause they are going to get fined or They have no solutions at all on an have affordable health insurance, and they are going to get taxed an amount issue that affects every single Amer- they wait too long before they get the for not buying the insurance—they are ican. help they need. Or, they are like Nikki going to have to buy insurance. What we have before us is the Reid and they never get the help they need. As the Senator from South Dakota bill which I think is an excellent piece Health care premiums have more talked about a 3-to-1 ratio—and the of legislation that will make life better than doubled in the last 9 years—more Senator from Maine mentioned the for every single American. I will spell than doubled in the last 9 years—and same thing—what that means is for the that out in the course of my remarks. one respected nonpartisan study says if youngest, healthiest person buying in- We all know change isn’t easy. It is we fail to act, the average American surance—that kid out of college who is easy to come down here and demagog family will have to spend 45 percent of staying healthy or might be working and pound your fists and complain. It their income on health insurance pre- construction, who is in good shape, is human nature to resist change. But miums alone, and that is by 2016. By going to the gym—what they are doing every once in a while a situation cries 2016, 45 percent of their income, the av- on a 3-to-1 ratio is that person has to out for change, and that is the case erage family, by 2016, if we do nothing. pay a lot of insurance compared to the today with our health care system. My friends on the other side stand person who does eat too much, exer- The status quo is not benign. It is there with the bill and downgrade what cises too little, and smokes. The ratio hurting our people. I wish to share the we are doing and never address that of their insurance premiums—this per- story of Nikki White as brought to us issue. son can pay no less than one-third of in the book ‘‘The Healing of America’’ It is time for change. When we know what this person pays, when you might by T.R. Reid. He talks about Nikki in that two-thirds of all bankruptcies are have 100 young people where their total the prologue where he poses it as a due to a health care crisis, it is time

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In other ing who think the uninsured are not more rescissions, no more caps. words, there will be a government op- their problem, that it doesn’t affect Parents will be able to keep their tion, but there won’t be anything dif- their health care. They are flat wrong. children on their health care policy up ferent about the government plan in Right now, every one of us with insur- to the age of 26. Small businesses will terms of the way it negotiates with the ance is paying $1,100 a year—each of have immediate access to tax credits insurance companies. our families—for those who are unin- to make covering their employees There has been a lot of shouting from sured. Why? Because we have to pay for more affordable. And seniors will have my colleagues about the public option. the emergency room services they get a more generous benefit through their Why shouldn’t the American people when they are rushed into the hospital prescription drug coverage. We all hear have access to a public option? because they have neglected a health about that doughnut hole that affects I ask that question. I don’t hear my care problem and it is very expensive, seniors as soon as they need to buy Republican friends coming down to the and we are paying for it. That tells me more pharmaceuticals. This will give floor and saying they are going to give it is time for change. them another $500 before they reach up their public option. More than 90 When family after family tells us that point. Those are just a few of the percent of us have a public option right they paid for insurance for years, but immediate benefits of the Patient Pro- now—the Federal Employee Health when they had a crisis their insurance tection and Affordable Care Act. Benefits Program. I don’t see one of my company walked away from them—in Here is a sample of other major pro- colleagues who have been trashing the T.R. Reid’s book, we learn about a man visions. This is a very important one. public option coming to the floor and who paid all his life for insurance and In this bill, no family of four making saying I wish to get rid of mine. Oh, no. he got struck by an automobile and he less than $88,200 a year will have to pay They like it. But they don’t want it for was in the hospital with a terrible situ- more than 9.8 percent of their income the rest of the people. I don’t under- ation, and the insurance company for health insurance premiums. Let me stand it. knew it was going to cost them a lot. say that again. No family of four mak- There are lots of public options we You know what they did? They re- ing less than $88,200 a year will have to have here. Medicare is a public option, scinded his insurance. They told him pay more than 9.8 percent of their in- run by the government. I don’t hear my that he weighed more than he should come for health care premiums. So if Republican friends coming here and have, and they walked away from him. you make anything between say the saying we should end Medicare. They Story after story. Good, hard-working poverty rate all the way up to $88,200, used to say that. They don’t say it anymore. Now they say they depend on it. people unable to get health insurance, you never have to pay more than 9.8 It is a public option; 45 million Ameri- knowing that their future is dark. It is percent of your income for health care cans are covered by it. Not one of them time for a change. premiums, and if you are on the lower Today, I want to say to America’s said get rid of Medicare. end, it is even less. It goes down to I don’t hear any of my Republican families: Change is definitely on the about 2 percent. So it ranges from 2 friends coming to the floor saying we way. It won’t be easy. It is going to be percent to 9.8 percent at $88,200. That should get rid of another public option tough. But all these things I have said means that more than 62 percent of all called Medicaid. That is for the poor. It are truths. Everybody here has to be of our families will be able to be as- works well. It is tough, and there are moved by that. I believe we will finally sured that they will not have to go problems with it, but it works and it bring change. I am hopeful. I am hope- broke to buy health insurance. covers 60 million Americans. So you ful because of the work of so many of Remember what I said. A respected have 45 million Americans in a public our colleagues and the work of Senator study has already stated that if we do option called Medicare, 60 million HARRY REID. He has put a bill before us nothing, by 2016 people will be paying Americans in a public option called that, as I said, will make life better for 45 percent of their income on pre- Medicaid. every single American. It is called the miums. In this bill, we ensure that our How about the veterans health care Patient Protection and Affordable Care middle class down to our working poor program? I don’t hear them pounding Act. First and foremost, if you have do not have to worry about those kinds the table and saying get rid of the pub- health insurance you like, this bill of premium increases. lic option for our veterans. I will tell gives you the security of knowing it For the rest of our Nation’s families you, maybe they want to, but they will be there for you when you need it. who are more affluent, there is the se- would not say it because the veterans And if you don’t have health insurance, curity of knowing that the insurance would be at their door because that you will be able to get affordable cov- company reforms in this bill are going public option covers 7.9 million vet- erage through a new exchange which to help you. The insurance company erans. Not one of my Republican col- includes the public option. can’t walk away from you. If you have leagues say they want to end it. Ultimately, under this bill, we are a preexisting condition, they can’t turn I don’t hear my Republican friends expanding health care to cover more you down. If you have a child you want coming to the floor to say we should than 94 percent of the American people, to keep on until age 26, you can. If you end our TRICARE program for our and all the while we are cutting the are a small business, you will get tax military. That is a public option for 9.5 Federal deficit by an estimated $130 credits to help you pay for your em- million people. I don’t hear them say- billion over 10 years, because there are ployees. There are many other benefits, ing stop that public option. real savings and real revenues in this including some free prevention cov- Again, their own health care, bill to offset the new important pro- erage that kicks in right away. So no brought to them by FEHBP, Federal grams. more discrimination against those with Employees Health Benefits Program, When this bill is signed into law, a preexisting condition. that is a public option that covers 8 America’s families will see immediate By the way, no longer will insurance million people, including them, and improvements to their health care. companies be able to discriminate they don’t seem to want to end that. They won’t have to wait. based on gender. Right now, women in But when it comes to everybody else, For example, right away, when Presi- my home State of California are pay- they come down here and basically say: dent Obama signs this bill, your insur- ing almost 40 percent more for the a government takeover of health care. ance company won’t be able to kick same insurance as men. There is gender False. you off your plan for some made-up discrimination. That will end when The public option is just one option reason because they no longer want to this bill becomes law. in the exchange. It has to run by the cover you. They will no longer be able In this bill we increase competition, rules of all the other insurance compa- to cap your coverage. I can’t tell my which is perhaps one of the most im- nies. I say if it is good enough for a Re- colleagues how many people think they portant things we can do to bring down publican Member of the Senate and a

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In Cali- spend on health care is on prevention. to afford to get them insurance any- fornia, we have seen increased pre- Yet more than half our people live with more. He asked that I support a public miums to small businesses that have one or more chronic conditions. option, and I do. My Republican col- meant a choice between laying off em- Five chronic diseases—heart disease, leagues are saying: Douglas, no, we are ployees or not providing health insur- cancer, stroke, chronic obstructive pul- not going to help you. It goes on. The ance at all. More and more of these monary disease, and diabetes—are re- stories go on. businesses are dropping health care sponsible for more than two-thirds of One of the stories is from a doctor, a coverage. If you are in the position the deaths in America. retired pediatrician in Sacramento, where you work for a small business, This bill will eliminate copays and Robert Meagher, who wrote and said you don’t have health care coverage, deductibles for preventive care so peo- that some parents begged him not to and you want to stay there, when this ple don’t get to that serious illness. write on the form—after he saw a child bill goes into effect, you can go into Those preventive services go into effect with asthma, they asked: Please don’t the exchange and then you will have immediately. write down asthma. Say it was bron- some buying power or your small busi- That is an overview of the Patient chitis. If you write down that my child ness can go into the exchange. Protection and Affordable Care Act. has asthma, they will have a pre- This bill will protect our seniors, and My friends on the other side have al- existing condition and when they go it will strengthen Medicare. Medicare ready come out against this bill. They out on their own, they cannot get in- is a success story. Before Medicare be- say it is too long, too complex. One of surance. came law, half our senior citizens went them said it is ‘‘holy war.’’ This bill Can you imagine a doctor having to without health insurance. Now, 98 per- will cause them to fight a ‘‘holy war,’’ face a parent like that? My Republican cent of our seniors are covered by for some reason. Where is their bill? friends don’t want to think about that. Medicare. They believe in the program They don’t have one. After all the They seem to be thinking about poli- and they want it to continue. Those of things we know are wrong with the sys- tics and the next election. us supporting this bill want to make tem—and you don’t have to agree with We all know the bill before us isn’t Medicare stronger, and we do. This bill us on everything, but where is your perfect. They should vote to start de- will ensure a stronger, more sustain- bill? bate. They can try to make it better. able Medicare Program. It lowers pre- It seems like my Republican friends There are many issues I am working on scription drug costs, as I mentioned be- care more about playing politics than for California. There is the Dispropor- fore. It increases access to preventive about protecting our families. That is tionate Share Hospital Program. I am services for our seniors, and it extends what it feels like. They seem to care working to get better prevention for the solvency of the Medicare Program more about bringing down our Presi- women. by 4 to 5 years. dent than bringing down the cost of At the end of the day, this is where My Republican colleagues are stand- health care. we are. Health care coverage for all of ing here saying that Democrats want They seem to care more about all America’s families has been an elusive to hurt Medicare—by the way, Medi- that than Tim and Josie Jentes, of Los goal since Teddy Roosevelt first pro- care is a public option. They are saying Angeles, CA. Tim is retired from posed it nearly a century ago. Our dear the Democrats want to hurt Medicare, Raytheon. He gets his health care friend, Senator Ted Kennedy, whom we a public option. Honestly, who could through his retirement plan. During believe that? miss so much, fought for health care 2007, the first year of his retirement, right here on this Senate floor from In 1964, George H. W. Bush called their monthly health care premium Medicare ‘‘socialized medicine.’’ the moment he arrived in the Senate in was $460. During 2008, it rose to $630. In 1962 to the moment he died. Today, I Newt Gingrich, when he was Speaker 2009, it rose to $850. That is an 85-per- of the House, said he wanted to see am proud to say we are moving closer cent increase in 2 years for this retiree. to fulfilling this promise of health care Medicare ‘‘wither on the vine.’’ Tim wrote to me and said: In 1995, while seeking the Republican for all. I understand that compared to many we Robert Kennedy once said: nomination for President, Senator Bob are fortunate to have good health care and Dole bragged that he voted against cre- insurance. But we look forward to you, Sen- Few will have the greatness to bend his- ating Medicare in 1965. He bragged ator Boxer, the Senate, and the House . . . tory itself; but each of us can work to change about it and said: ‘‘I was there fighting addressing the seemingly unbounded in- a small portion of events, and in the total of the fight, voting against Medicare . . . crease in health care cost. all those acts will be written the history of this generation. because we knew it wouldn’t work in We do it in this bill. People such as 1965.’’ Tim will be protected. But my friends This is our time. This is our moment. The Republicans are saying the across the aisle say: No, we are not This is the moment for us to come to- Democrats want to destroy Medicare in going to help Tim. gether as a nation and make sure our this bill. That is beyond ridiculous. What about Madeleine Foote of Costa people never again have to face what The American people know who is on Mesa, California? She turned 25 and Nikki White faced in her last days— their side when it comes to protecting lost the health care coverage she had filling out forms, praying to God she Medicare. We didn’t just wake up this under her parents. She tried to get cov- could get health care, not being able to morning. We know who brought us erage, but because she is taking medi- get it, and dying at age 32. That is im- Medicare. cine, she was denied. They said it was moral. It is not necessary. We can fix This bill expands Medicaid. That is a preexisting condition. They said you it, and we should. for the poor to ensure that the poorest can have health care, but you have to I yield the floor. and sickest among us can get into the have a $3,000 deductible and premiums The PRESIDING OFFICER. The Sen- program. We are going to get those of $300 a month. She wrote: ator from North Dakota is recognized. Mr. DORGAN. Mr. President, I note with incomes below 133 percent of the As a young person working in a restaurant, poverty level into the program. That repaying student loans and trying to make it that this has been a lengthy discussion means that more than 1.5 million Cali- on my own, this is a huge financial burden. already. My guess is that because this fornians who are uninsured or are I cannot afford insurance that charges me so is merely a motion to proceed to a sub- struggling with the cost of health care, much. . . . For now, I am forced to hope that ject on the floor of the Senate—my that will allow them to be covered. nothing extremely bad befalls me. guess is that were this motion to be ap- I thank the majority leader for work- She is another one who prays not to proved, we will have weeks on the floor ing with us to ensure that California get sick. That is not a health care plan. of the Senate talking specifically

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.066 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11875 about amendments, about approaches prevent people from getting sick. Polio What should happen? Is that fair? I that will strengthen and improve some was cured. Smallpox was cured. Think don’t think so. portions of the legislation that will be of the changes over all of these years. Shouldn’t there be some opportuni- before us. The subject is health care. And, yes, it is the case that if you have ties to address those kinds of things— Frankly, health care is personal to a very serious illness, in most cases the denial of coverage, the termination everybody—from senior citizens on you want to be in this country. of coverage? I think so. Medicare to people who get their It is the case, however, that many in Let me also say as we discuss these health care policy from their employ- this country cannot afford to access policies, there is another element that ment, to families who are struggling to the health care that exists. But people is not very often discussed that I want pay for increasing costs of health care come here, not elsewhere, for good to amplify, and that is the issue of per- year after year. So the question before health care. We have terrific clinics sonal responsibility—personal responsi- the Senate tomorrow evening is: and opportunities for people to get bility that goes well outside legislative Should we debate and vote on these good health care in this country. The activities. matters? It is not should we approve a problem is, the cost is relentlessly in- Two-thirds of the people in this coun- health care bill but should we proceed creasing every single year and pricing try are overweight. One-third are to the bill to have a discussion and health care out of the reach of too obese, according to statistics. I invited have some amendments. many Americans. Too many families someone from Safeway Corporation to Health care has changed dramati- cannot figure out how to pay for health meet with our caucus. The CEO of cally in a very short period of time. My care. They cannot pay for the increased Safeway, Steve Burd, has met with background is from a town of 300 peo- insurance premium that is going up folks in both caucuses in the Senate. ple. In my little town, as was the case double digits every year. They have to He told of a very interesting program many decades ago, we had a town doc- go to the grocery store and stop in the at Safeway. tor in a town of 300 people. It doesn’t pharmacy to figure out what a pre- I think there were about 45,000 em- happen much anymore. We had a doc- scription drug is going to cost. They ployees in this group, and he did the tor, Doc Hill. He came when he was a buy their medication first and see what following. He said: Here is your health young man, and he stayed until he they have left for groceries. insurance plan. Here is the amount the died. He delivered probably 1,500 babies. The fact is, prices of health care are Safeway company will pay, and here is They had a Doc Hill Day once, and all marching relentlessly upward, so too the amount that you pay. So that the babies he birthed came to march in many people do not have coverage. amount the employee pays is X. But the parade in my little hometown. Families often cannot afford it. Small the company said to the employees, As times changed, medicine changed, businesses cannot afford the price in- you can reduce the amount you pay if things changed. Doc Hill used to go on creases for health care. So what do we you do four things. You can reduce it house calls to the farms, yes, to deliver do about that? in four steps: Do you have high blood babies and to deal with illness, house If there is a sick child, should a sick pressure? You have to be on medicine calls all around the region. Times child who is crying because of pain be to control it, and we will pay for the changed and those practices changed as told: Your visit to a doctor depends on medicine. well. how much money your parents have? I Do you have high cholesterol? You The big debates in the last half cen- don’t think so. So we passed legislation have to be on medicine to control it, tury or perhaps century about health dealing with that, providing health and we will pay for it. care have, in most cases, advanced care opportunities for children who Are you overweight? Then you have health care. I was not here, of course, come from families of meager means. to be on some sort of weight reduction nor were most of my colleagues—I The question for us now is, Is there a program, and we will pay for that. guess a couple of them were perhaps way for us to extend health care cov- Are you smoking? Then you have to here—during the debate on Medicare. I erage and also to put the brakes on stop or be in a smoking cessation pro- remember vividly as a very young boy these relentlessly increasing costs? If gram, and we will pay for that. the old folks in my hometown, some of at the end of the day legislation that is If you don’t do any of those things, whom had nothing, lived in little considered here does not put the brakes you don’t want to do those things, you shacks, certainly had no health care, on price or cost increases, I don’t want have high cholesterol, high blood pres- no health care coverage, because when to be a part of that. I am not going to sure, smoke, and are well overweight, you got old, back in those days, no in- be supporting things that really do not that is all right, here is your copay. It surance company wanted to cover you, put the brakes on these relentless in- will be higher. But if you do all four of even if you could pay for insurance. creases in health care costs. That is those things, and the company will pay Nobody was chasing old folks to say: the purpose of all of this, is to try to in each instance for the cost of it, you Now that you are 70, 80 years old, can’t get a handle on costs somehow. will pay four steps below, less money we sell you a health insurance policy? There was an author named Barbara every single month. They couldn’t find health insurance. Ehrenreich who described visiting with He says with that program, they have Half the senior citizens in this coun- a friend of hers from a European coun- had flat health costs for 5 straight try couldn’t get health insurance. So try. She told her friend that she had years. Think of that: 5 years flat cost. the Congress came together and said: breast cancer and had difficulty get- While the rest of the country is seeing What do we do about the people in ting insurance because she had breast these relentlessly increasing costs, their sunset years, those who helped cancer. She said: But isn’t that when that program provided flat costs, no build this country, went to war, built you would most need insurance? Not cost increases. Why? Because they the roads, built communities? What do understanding, of course, in our coun- incentivized personal behavior in the we do about that? So they passed Medi- try you are least likely able to get right way: Do this, improve your care. what you need when you need it the health, we will pay the cost of it and Medicare has been an unbelievable most. save yourself some money. That is ex- success. Yes, there are financial strains That is another question in this set actly the right thing to do. on Medicare, but that is born of suc- of issues, preexisting conditions. Is I hope as we have this discussion, a cess. People are living longer and over there a way for us to make it easier for fair amount of that impulse can be a a period of a longer life, they often people to access health insurance when part of what we are trying to do— need more health care. But that is a they really need health insurance be- incentivize the right behavior, personal success, not a failure. We have changed cause they have a debilitating illness? responsibility. That makes a great deal medicine in our country in many ways. I would hope so. of sense to me. Medicare is one example. What should happen when you pay an One of the things I have always sup- Miracle medicines, medicines that insurance company premiums for 10 or ported is the issue of health care cov- did not exist some decades ago now can 15 years? You pay every month and all erage at the workplace. That is where be used to keep people out of acute of a sudden the insurance company most Americans get their health care care hospital beds. Vaccines can now says: We are going to terminate you. coverage. I don’t want to do anything

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.066 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11876 CONGRESSIONAL RECORD — SENATE November 20, 2009 to disincentivize that. I want, whether the freedom to access the same iden- gives the American consumer the free- it is small, medium, or large busi- tical FDA-approved drug when it is dom to shop for those prescription nesses, for us to say: You know what, sold in Spain or Italy or Canada—name drugs where they are sold for the most good for you. You are providing health the country—when it is sold in a num- reasonable prices. I am not interested care to your employees. We support ber of countries for a fraction of the in having consumers buy their drugs that. I don’t want to disincentivize price, then somehow it will harm re- from other countries. I am interested that; I want to incentivize that. search and development on new drugs. in the opportunity to buy drugs at a I know it is hard for small businesses That is not true at all. Those name- fraction of the price, forcing the phar- during tough economic times to pay 10 brand drugs are sold for a much lower maceutical to reprice their drugs in percent more this year than last year price in Europe, and they do more re- this country. and 10 percent more next year than search in Europe—at least that was a I sat on a straw bale once at a farm this year. That is what they are seeing couple years ago. I haven’t seen recent where we had a town meeting. We all in health care costs. That is why it is data. The fact is, they have lower sat around on these bales and talked. important for us to put the brakes on prices and they have done more re- An old codger there, about 80 years old, these cost increases, for small busi- search. said to me: My missus—he meant his nesses, medium-size businesses and In any event, there is more money wife—my wife has been fighting breast large businesses as well, to help them spent on advertising, promotion, and cancer for 3 years. Every 3 months, we be competitive. marketing than there is on research. have driven to Canada to buy We have to find a way to do that. I Watch television tonight and see when Tamoxifen. That is the medicine my am not talking about diminishing the you see the next commercial that says: wife has taken to fight breast cancer. quality of health care. I am saying let’s Shouldn’t you be taking some Every 3 months, we drive to Canada to put the brakes on the price increases Flomax—whatever that is. Shouldn’t buy Tamoxifen. year after year. Let’s find out what is you ask the doctor whether the purple I said: Why do you drive to Canada? causing it—and I have some ideas pill is right for you? Go find a doctor about that—and let’s put the brakes on and say: I don’t have any aches and He said: Because it costs me 20 cents it. That is what this debate needs to be pains, there is nothing wrong with me, for what I would pay a dollar in the about. but isn’t the purple pill right for me? United States. I can’t afford it in the I want to talk about an amendment I That is what the commercial tells you United States, so we drive to Canada. intend to offer as soon as we are able to to do. The fact is, they will allow someone offer amendments. It is an amendment, I haven’t the foggiest idea what the like that to drive across with 90 days of by the way, that is bipartisan, unlike a purple pill is used for, but they relent- use. But most Americans do not have lot of things in this Chamber. My lessly push this advertising. Knock it that opportunity and most Americans amendment was cosponsored by the off. Maybe they should use some of could not access that drug from Canada late Ted Kennedy. It is also cospon- that money for a little more research because it would be against the law at sored by Senator OLYMPIA SNOWE, Sen- and development, I say. this point. ator JOHN MCCAIN, Senator CHUCK To put a finer point on it, if I might, I want to give the American people GRASSLEY, Senator DEBBIE STABENOW, this is the price of Lipitor. This is the the freedom to be able to access FDA- and the list goes on including Repub- new price, by the way—$4.78 in the approved drugs, and the legislation I licans and Democrats. The amendment United States for a 20-milligram tablet will introduce with my colleagues has is about prescription drug prices, and I and $2.05 in Canada. the most substantial safety provisions, want to describe it. By the way, here is what the two bot- including batch lots and pedigrees on It says let’s give the American people tles look like. The same pill is put in these drugs that will make the entire the freedom to access the identical these bottles, made by the same com- drug supply much safer than it is now. FDA-approved drugs when they are pany—Lipitor. It is the same manufac- sold for a fraction of the price every- turing plant in Ireland. They put the Price increases in 2009. The paper where else in the world. The American same pill in these two bottles. This one this week described what is happening consumer is charged the highest prices goes to the United States; this one goes with the pharmaceutical industry in in the world for brand-name drugs. to Canada. The American consumer has pricing drugs. Enbrel, an arthritis By the way, here is what is hap- the privilege of paying $4.78 per tablet, drug, increased 12 percent this year. pening to price increases for prescrip- and the Canadian buys it for $2.05. That Nexium, for ulcers, increased 7 percent tion drugs. We see the rate of inflation was June 4, 2009, when I priced it. this year. Lipitor is up 5 percent this in this country. That is the yellow line. It is not just Lipitor, although year. Singulair is up 12 present this Take a look at drug prices, the red Lipitor is the most popular cholesterol- year. Plavix’s price increased 8 percent line. By the way, this past year, there lowering drug. But Zocor, a 20-milli- this year; that is an anticoagulant. was a 9 percent increase in prescription gram tablet, the same thing, $5.16, Osteoporosis—if you are taking Boniva, drug pricing. $2.45, U.S. price versus Canadian price. there was an 18-percent increase this This issue is not some irrelevant I used Canada because it is a close year. What is the deal? Does anybody issue. There are a whole lot of folks neighbor. I could have used Spain, understand what the reason for this is, who use prescription drugs to manage Italy, France, Germany. these kinds of unbelievable price in- their disease and keep them out of a By the way, some folks on the floor creases? hospital. I understand many of these of the Senate will support the pharma- I am going to offer this amendment drugs are miracle drugs. I don’t want ceutical industry’s pricing policies of with my colleagues. My expectation is to slow the ability of companies to cre- pricing their brand-name drugs the if you want to say at the end of the day ate drugs, do research and so on. highest in the United States—I don’t that you have really done something to A substantial amount of the research support that. Some will. They will say address the issue of skyrocketing goes on at the National Institutes of you can’t really import drugs safely. prices in health care—you can’t say Health, which is publicly funded. The The fact is, in Europe they have been that if you decide you are not going to knowledge from that research is made importing drugs for 20 years. They do something to put the brakes on pre- available to the drug companies, and have something called parallel trading. scription drug pricing, because the that knowledge leads to a product. If you are in Germany and want to buy American people should no longer pay Good for them. a prescription drug from Spain, no the highest prices for brand-name But what I don’t like is the fact that problem. If you are in Italy and want drugs in the world. That is not some- those same pharmaceutical companies to buy it from France, no problem. You thing that should be allowed. It is cer- charge the American consumers the have parallel trading of prescription tainly not something that is fair to the highest prices in the world. They will drugs. The consumers have the freedom American people and not something say: If you offer an amendment, you to buy it where it is least expensive. that we ought to turn a blind eye to Senators, Republicans and Democrats, In our country, consumers don’t have when we are talking about legislation that tries to give the American people that freedom, and our amendment here.

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.067 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11877 My legislation will be about giving Washington Post this week when the the sale of a Toyota Land Cruiser, but the American people freedom—the free- President was in Asia. It talks about: you couldn’t buy a Ford Explorer in dom to access those drugs from a num- [Folks from the] 21 Pacific Rim Nations at Japan under the cash for clunkers pro- ber of other countries named in our bill an annual event that this year has put some gram. that have an identical chain of custody of America’s policies in the line of fire. Yet we have these folks saying to us to our country, where it will be safe A chorus of complaints about U.S. trade that we are not for free trade? Excuse and secure for the American consumer policies . . . in the hour before the Presi- me? How much gall do you have to sug- to access those drugs at a fraction of dent’s arrival [in Singapore]. Leaders of gest that a country with a $600-plus bil- Mexico, China and Russia broadly con- lion annual trade deficit, $260 billion of the cost. demned protectionism . . . endorsing free I want to say that some are pointing trade as the best engine of growth— which is from China—to have our out that the issue of health care is also President go overseas and have others And so on. a jobs issue because the fact is, this is suggest that somehow we are not own- a significant burden on employers; that The bluntest criticism . . . [said] America ing up to our responsibilities in trade? is moving in the opposite sense of free trade. is, those who hire workers and who are The reason I make this point is this covering them with benefits, as part of China and others have said the same. is about jobs. I think restarting the their compensation including health Let me just say, it takes an unbeliev- economic engine is an unbelievable pri- care. So it is a jobs issue, and when the able amount of gall to suggest that we ority in this country. A good job that burden becomes too great, it destroys are moving in the opposite direction of pays well makes almost everything jobs. That is just a fact. So I want to free trade. We have an unbelievable else possible. There is no social pro- talk about jobs for a moment because trade deficit, and this is a trade deficit gram in America as important as a even as we describe these issues, which with China. It is a sea of red ink that good job that pays well. That is what I think are very important, they relate has gotten worse and worse—a $266 bil- makes everything possible for you and to jobs. But I want to go further to lion deficit last year, a $266 billion your family. talk about jobs just because I have a trade deficit with China, and China is When we see the millions of people bit of time today. telling us we have a problem with free who have been laid off as a result of the I have seen some things in the press trade? They are the ones that have deepest recession since the Great De- recently that have bothered me, some closed markets. We are the sponge for pression, we need to get about our busi- stories. I want to describe them. all the goods China wants to send us, ness. Senator REID and Senator DURBIN First of all, Senator DURBIN and I are only to find out we can’t get into their and I are working on that need, to ad- leading a task force to talk about how markets. This is about jobs. This is dress it. One of the ways to address it we put together a new effort to try to about jobs that leave our country and is with this trade issue as well. create jobs. What kinds of incentives go there. When we start talking about Let me conclude as I started, talking will allow small- and medium-size busi- how to create jobs, maybe we ought to about the bill that is before us. The legislation we are dealing with is nesses to create new jobs? What are the straighten out this trade mess. health care, and the vote that will things that will get the economic en- Let me say, there is a discussion in occur is on the motion to proceed. gine restarted, not just in GDP but the same story about Korea and the There is a lot of hyperbole about these putting people back on payrolls, put- trade agreement with Korea. I think it issues. This is a motion to proceed to a ting people back to work? is pretty interesting. This is what hap- I noticed that small- and medium- pened with Korea last year. They sent piece of legislation that we will then size businesses are having great dif- us about 600,000 cars. They put them on debate for weeks and we will amend, I expect. ficulty in this country, even those that ships and sent them to America to be I just described one of my amend- want to expand, because they can’t find sold. We were able to sell them 100,000 ments that I feel very strongly about. cars. Why? They don’t want American the financing to do it. I saw a report It will be bipartisan. I fully expect it to cars on the streets of Korea. Ninety- this week about the large financial in- pass. I have a couple of other amend- eight percent of the cars on their roads stitutions that got TARP funds, the ments as well that I will offer. bailout funds. The 22 banks that got are made in Korea because that is what I don’t want health care to be con- the most help from the Treasury’s bail- they insist and that is what they want. cluded by the Congress in some way or out programs cut their small business They are criticizing us about the lack another without the Indian Health loan balances by a collective $10.5 bil- of free trade? That is unbelievable. Care Improvement Act, which has been lion over the past six months. And the Let me describe the Cash for languishing for many years here in the fact is that Wells Fargo got $73.8 bil- Clunkers Program in this country. We Congress, being a part of it. These are lion in TARP funds, and in the last 4 did a Cash for Clunkers Program. Yes, the first Americans, and too often months they have cut the amount of fi- it put people in some showrooms and these days the first Americans have nancing of small business loans by 3.9 sold some cars. The Chinese and the second-class health care despite the percent. Think of that—a company Koreans had cash for clunkers pro- fact that we signed the treaties on the gets $73.8 billion in TARP funds and grams. A lot of us would have liked to dotted line and we owned up to the cuts lending needed by small busi- have said: You know what, if you are trust obligations that we have, that we nesses by 3.9 percent. Bank of America, going to spend some money on cars, have never quite delivered in health $41.9 billion in TARP funds, and they maybe at least spend it on cars that care, housing, and education. I have cut small business lending by 5 per- are made in manufacturing plants in spent a lot of time, as have some of my cent. I am quoting from a Treasury De- this country. But that was not a re- colleagues, on the subject of the Indian partment report, by the way, com- quirement because it was so-called ille- Health Care Improvement Act. I hope paring 4/30/90 to 9/30/09. JPMorgan gal under the WTO rules. very much that in this discussion—and Chase, $25.4 billion in TARP funds, and For example, when Japan and Korea I certainly will raise it as an amend- they cut lending to small business 2.9 decided, for their own economy, on a ment—we will have the opportunity to percent. American Express—the list cash for clunkers program, they fig- do what we need to do with respect to goes on. I don’t understand this at all. ured out a way to favor their domesti- Indian health care. So the question is, How do we try to cally produced cars. I know there will be a lot of oppor- give some help to small- and medium- In Japan, only 5 percent of the cars tunity in the coming weeks to describe size businesses and see if we can restart were imports and 95 percent were made virtually all the things people want to this economic engine so that they can in Japan because that is the way they describe about every single issue. I put people back to work? They are the wanted it in 2007. After the cash for want to come back to something I job generators in this country. And we clunkers program, even fewer cars mentioned in the middle of my presen- are looking for a mix of ideas. What are came from imports. Why? Because tation; that is, personal responsibility. the best ideas we can use to try to put Japan had what was called a certifi- We can do all we want to do. We can people back on payrolls? cation requirement that was open to have all kinds of legislation. But there But what I want to talk about just only a small number of foreign vehi- also has to be some personal responsi- for a moment is something I saw in the cles. For example, they would allow bility with respect to health care. I

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.069 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11878 CONGRESSIONAL RECORD — SENATE November 20, 2009 hope, whatever we do legislatively, if, mind getting them from the car to the these technologies, and I am proud to in fact, at the end of the day the legis- doctor’s office safely. By the time you report that much of the cutting edge lation moves forward, I hope we re- get to the doctor’s waiting room, you work is being done in the Pacific member the lessons we have learned feel like you have run a marathon. It’s Northwest. Their discoveries address from some companies around the coun- the opposite of the well-oiled machine everything from depression to neuro- try that are deciding that personal re- you would expect from a country that logical disorders. For example, new sponsibility and the incentives for that leads the world in health care innova- technologies can help isolated seniors kind of personal behavior is the right tion. stay connected to the world through a way to address some of these rising Our current health care system variety of social networking sites. This costs of health care. Certainly the seems modern, but it is actually based would be a simple, high-tech fix that Safeway example I described is in that on a 19th century model of institu- can help cure the loneliness that so genre. tionalized health care. It is like riding many seniors suffer from, and that Our time is about up. I want to say a horse-drawn wagon all the way from often leads to depression. Some seniors again that we will vote tomorrow here to Oregon. Just because the Pio- with cognitive issues are being taught night, come back after Thanksgiving, neers did it and found the beauty of Or- how to use personal computers to play and my guess is that for 3 or 4 weeks egon at the end, it doesn’t mean that is games that exercise the brain, like we will have a substantial, generous the best way to get there in 2009. Like- Sudoku puzzles. Neurologists can then amount of discussion about how best to wise, just because the majority of analyze the changes in patients’ suc- put the brakes on health care costs. American health care is delivered in a cess at the games over time and to un- This has to be done in a way that is fis- doctor’s office or hospital doesn’t mean derstand how and when their cognitive cally responsible. It has to be done in a that is the best way either. abilities start to deteriorate. way that is effective. If not, there There is a lot of wasted time and ef- Technologies like this give us the ought not be legislation passed, in my fort spent on services that could be chance to learn about devastating dis- judgment. If so, if we can do this in a done more easily—and in some cases, eases like Alzheimer’s so that, hopefully, we can one day find new drugs way that is fiscally responsible, in a more effectively—done from home and treatments for those who suffer way that helps the American people thanks to something called ‘‘telehealth technologies.’’ Telehealth technologies from it. and begins to put the brakes on the Other technologies are moving for- are simple-to-use, home-based systems skyrocketing health care costs, then I ward to help those with memory loss that use tools, such as home security would want to be part of that. and help to improve the quality of life I yield the floor. sensors and the internet to connect pa- for our seniors. ‘‘Caller ID on Steroids’’ Mr. WYDEN. Mr. President, trans- tients to their medical providers. Home is what one technology has been called forming American health care so that telehealth has already been used by the that would be life-changing, and give more Americans get good health care Veterans’ Administration and has low- them more confidence as they age, de- at home, instead of only in a doctor’s ered costs for treating patients with spite possible memory loss. It is a sys- office, is an idea whose time has come. multiple chronic diseases like diabetes Quality, affordable home-based care tem that brings up a whole host of in- and high blood pressure. formation on a senior’s telephone every makes sense for patients. It generates Here’s how it works. Some systems time someone calls. The system would good-paying jobs for our people and help patients with chronic conditions show a photo of the person and their sparks development of exciting tech- like diabetes or high blood pressure name. It would tell them the last time nologies through research that will pay send their daily blood sugar or blood they spoke on the phone—and even a even bigger dividends in the years pressure readings straight to their brief description of what they talked ahead. Care at home is an idea that medical professional. There, the read- about. Another new invention would Democrats and Republicans, conserv- ings can be checked and monitored for help seniors remember to take their atives and progressives, can all come signs that the patient’s care needs to medications on schedule. together on and get behind. be adjusted. Sudden weight gains, There is a day-a-week pill caddy with Right now, getting to see a doctor in which can be a sign that someone’s sensors built it to tell whether or not a their office can be an onerous process. about to go into congestive heart fail- patient had come close to it or opened You start by calling the doctor’s office ure, can also be noted and addressed the particular day’s drawer. A screen and testing your patience while you sit right away, so that the patient can be on the caddy displays reminders or through menu after menu of options treated and avoid that outcome. hints about how to take the medica- just to get past the doctor’s voicemail These are just a few of the ways that tion. This kind of technology improves system. You are in trouble if you don’t telehealth technologies can help pa- patients’ adherence to taking their listen carefully and miss the option tients better manage their health medications as prescribed, which in- you wanted. You might get sent to issues from home, instead of waiting creases their effectiveness and im- records or accounting and have to start for their occasional checkup in a doc- proves their overall health. Imagine all over again. After you have run that tor’s office, when it might be too late the differences these kinds of tech- gauntlet, you have to match your to correct their health problems. Tele- nology would make in the life of a sen- schedule up to whatever days the doc- health technologies give medical pro- ior who is suffering frightening and de- tor’s in. With doctors having other ob- fessionals a new tool by increasing the bilitating memory loss. ligations like surgeries or teaching, amount of data they can collect on In the case of neurological illnesses you could be up against a schedule their patients over a long period of like Parkinson’s disease, telehealth has where the doctor only has office hours time. That aggregated information im- been shown to be a better way to man- a few days a week. That will lead to proves the quality of care that the pa- age medications and personalize treat- your getting an appointment two tient then receives when they do visit ment. Parkinson’s patients can per- months from now. That won’t do much the doctor’s office. form neurological tests on a laptop at good if you are sick today. Some of these telehealth tech- home and have their success at these Once you have won that prized ap- nologies are so advanced they sound tasks reported to the doctor in real pointment, you have to navigate to the like science fiction, but they are real, time. No longer will an annual visit to doctor’s office on the day in question. they are here today and they need to the doctor be the only opportunity to In rural areas, you might end up driv- be part of building our new health care demonstrate how their illness is pro- ing yourself and your family long dis- system. They offer more than just gressing and be the basis for the pre- tances to get there. In urban areas, unique, time-saving solutions. Tele- scription the doctor writes. This kind workers lose a big part of their day health technologies also open a new of innovation could improve the qual- getting themselves, or maybe their el- world of jobs and services that will ity of life for such patients and reduce derly parent, to and from the doctor’s shore up our economy with good-pay- the physical and economic toll that un- office or hospital. That can be a dif- ing work right here at home. necessary medications cause. ficult task if your parents have a hard Researchers from around the country But telehealth technologies do more time getting around at home—never are working to tap the potential of than just help patients. There are some

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.070 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11879 that also help the people who care for home can become a fundamental loca- joined the Army following his gradua- them. Many caregivers for people with tion for health and wellness and also a tion from Upton High School. He loved Alzheimer’s find themselves, caring for priority for reform. In addition, all this his country, and loved serving his their patients in the middle of the can be done with a focus on stimu- country. His mother JoAnn says this is night. Telehealth technologies have lating our economy with new jobs, what he lived for. He was on his third been developed to let someone else technologies, and services for a world tour of duty in Iraq. His family and his from their caregiver support group that will share the challenge of caring faith were very important to him. know that they’re up and available to for an aging population. Friends and neighbors remember him talk, even at 3:30 in the morning. A I encourage my colleagues to ensure as always open and friendly, with a ‘‘presence lamp’’ system uses simple that health care reform is about new broad smile and a wonderful sense of home security sensors and the internet approaches to patient care, quality of humor. He was dependable and gen- to turn on a lamp in one person’s home life, and growing old with independence erous, always willing to help others when their friend also happens to be and dignity, not just about who’s pay- without hesitation. awake in the middle of the night, and ing the bill. This is a chance to rede- It is because of Ryan Zorn that we vice versa. It becomes a lifeline be- sign our health care system with a new are allowed to go about our daily lives tween family caregivers who could vision that sees the patient as the cen- as free people. America’s men and reach out for emotional and social sup- ter of a more efficient and effective women who answer the call to service port, even in those darkest and system. It is a chance to change our and willingly bear the burdens of de- bleakest of hours. health care system to one that helps fending our Nation deserve the deepest All these innovations point to the prevent disease, treat patients, support respect and gratitude of all Americans. fact that a technological revolution is family caregivers, and enable seniors They put their very lives on the line going on right now in home health care to maintain their independence, by every day, and because of them and solutions, and it’s time health care re- bringing health care reform home. their families, our Nation remains free form brought those solutions into the f and strong in the face of danger. mix. If done right, reform should do Jesus says in the Book of John that, more than give affordable, quality care MORNING BUSINESS ‘‘Greater love has no man than this, to all Americans. As these technologies Mr. DORGAN. Mr. President, I ask that he lay his life down for his prove, health care reform should also unanimous consent that the Senate friend.’’ SSG Ryan Zorn gave his life, stimulate the economy with new jobs proceed to a period of morning busi- that last full measure of devotion, for and industries that will allow us to ness, with Senators permitted to speak you, me, and every single American. He care for our rapidly aging population. up to 10 minutes each. gave his life serving and defending his Home health care will help put Amer- The PRESIDING OFFICER (Mr. country and its people, and we honor ica at the forefront of a new health BEGICH). Without objection, it is so or- him for this selfless sacrifice. care services industry that will gen- dered. Staff Sergeant Zorn is survived by erate more than a million new jobs his mother JoAnn, his father Myron, that can never be outsourced. Those f and his brother Todd. He is also sur- jobs will come from inventing new VOTE EXPLANATION vived by his brothers and sisters in home-based care technologies and arms of the U.S. Army. We say goodbye Mr. BAUCUS. Mr. President, due to using those technologies to deliver vir- to a son, a brother, a friend, and an an unfortunate illness in my family, I tual and remote care services here at American soldier. The United States of regrettably missed rollcall No. 352. If I home and abroad. America pays its deepest respect to had been present, I would have voted I have already introduced legislation SSG Ryan L. Zorn for his courage, his ‘‘aye’’ on the passage of S. 1963, the that uses the concept of coordinated love of country and his sacrifice, so Caregivers and Veterans Omnibus home health care to help people on that we may remain free. He was a Health Service Act of 2009. This legisla- Medicare live healthier by managing hero in life and he remains a hero in tion is very important to veterans liv- their chronic conditions and reducing death. All of Wyoming, and indeed the ing in Montana. Many of Montana’s duplicative and unnecessary services, entire Nation, is proud of him. May veterans live in rural areas, hours hospitalization, and other health care God bless him and his family and wel- away from the closest VA facility, and costs. This bill has broad bipartisan come him with open arms. this bill will improve access to health support, from Senators BURR and care in those rural areas. I am pleased f CHAMBLISS to Senators STABENOW, MI- to see this bill passed with bipartisan NATIONAL AMERICAN INDIAN AND KULSKI, and, previously, the late Sen- ator Kennedy. support. We must uphold our promise ALASKA NATIVE HERITAGE My bill, the Independence at Home to honor our veterans and provide MONTH Act, establishes a 3-year Medicare pilot them with the benefits they have Mr. JOHNSON. Mr. President, each project that helps Medicare bene- proudly fought for and deserve. November, we celebrate National ficiaries with multiple chronic condi- f American Indian and Alaska Native tions remain independent for as long as Heritage Month to honor the original HONORING OUR ARMED FORCES possible in a comfortable environment. inhabitants of our great nation and cel- It provides for coordinated-care pro- STAFF SERGEANT RYAN L. ZORN ebrate their formative impact on grams that hold physicians, nurse prac- Mr. BARRASSO. Mr. President, I rise American history. This month is an op- titioners, physician assistants, and today to express our Nation’s deepest portunity to promote the tenets of other team members accountable for thanks and gratitude to a special tribal sovereignty and recommit to the quality, patient satisfaction, and man- young man and his family. I was sad- Federal Government’s treaty and trust datory minimum savings. The act was dened to receive word that on Novem- responsibilities to American Indians. I accepted into the Senate Finance Com- ber 16, 2009, SSG Ryan Zorn of Wright, would like to personally honor the nine mittee health reform bill and I will WY, was killed in the line of duty while treaty tribes of South Dakota: the pull out all the stops to see it included serving our country in support of Oper- Cheyenne River Sioux, the Crow Creek as part of the final health reform legis- ation Iraqi Freedom. Staff Sergeant Sioux, the Flandreau Santee Sioux, the lation that the Senate will vote on. Zorn died near the town of Talifar in Lower Brule Sioux, the Oglala Sioux, Before Congress finishes writing the northwestern Iraq from injuries sus- the Rosebud Sioux, the Sisseton- bill for 21st century health care reform, tained when his armored vehicle over- Wahpeton Oyate, the Standing Rock it is important to define what Ameri- turned. Sioux, and the Yankton Sioux. Each cans are paying for, how best to deliver Staff Sergeant Zorn was assigned to tribe’s rich heritage greatly influences much-needed personalized care to pa- the 1st Battalion, 34th Armor Regi- the character of South Dakota. tients where they live, work, and play, ment, 1st Brigade, 1st Infantry Divi- It is fitting that hundreds of tribal and how to make the U.S. a world lead- sion, out of Fort Riley, KS. Staff Ser- leaders journeyed to our Nation’s Cap- er in home-based care industries. The geant Zorn grew up in Upton, WY, and ital in early November to participate

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.072 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11880 CONGRESSIONAL RECORD — SENATE November 20, 2009 in the White House Tribal Nations Con- and sustainability. American Indian these young people is a real crisis. We ference. President Barack Obama has communities have demonstrated that must provide tribes with the resources committed to placing American Indian society can thrive and prosper without they need to implement culturally sen- issues at the center of his administra- destroying the natural environment. sitive suicide prevention programs. It tion, and the multiday conference was I hope this month provides students is critical to strengthen the social fab- an important testament to the Presi- with the opportunity to explore the ric to help improve mental health. On dent’s pledge to involve American In- Thanksgiving story from the American American Indian reservations in South dian people in constructive dialogue. Indian point of view. Observance of Na- Dakota, I have seen the catastrophic The conference allowed leaders from tional American Indian and Alaska Na- ripple effect that one suicide can have. the 564 federally recognized tribes to tive Heritage Month reaffirms this Na- Given the alarming occurrence of ‘‘sui- interact directly with the President tion’s respect for American Indian peo- cide clusters’’ and imitative deaths and representatives from the highest ple. I encourage everyone to partici- that have occurred in Indian Country levels of the administration. The tribal pate in our celebration of American In- this year, it is imperative to provide leaders in attendance displayed the dians. I would like to pay tribute to support for those left behind. very diverse face of Indian Country. the more than 65,000 American Indians I hope that National Suicide Sur- Each individual tribe forms a distinc- in South Dakota whose heritage en- vivors Day is an opportunity to pro- tive chapter of the American Indian riches our communities. While the mote the broad based support that each story, yet the narrative contains many month of November serves as an impor- survivor deserves. We are not doing common themes of triumph and trag- tant testament to American Indian enough to fight this tragic epidemic edy. culture, it is critical to make a daily that is taking the lives of so many in President Bill Clinton hosted the commitment to advancing the quality our communities. We must concentrate first tribal nations conference at the of life of American Indians, in order for our efforts on addressing the root White House in 1994. It is not without our Nation to walk forward with causes of suicide in Indian Country and precedent that President Obama in- strength and purpose. throughout the Nation. It is critical to vited leaders from all federally recog- f expand access to mental health serv- nized tribes; however, I believe that ices, including a focus on education, NATIONAL SURVIVORS OF SUICIDE this year’s event is unmatched in its prevention and intervention. Further- DAY potential for progress. President more, we need to acknowledge the ob- Obama has charged each Cabinet agen- Mr JOHNSON. Mr. President, I rise stacles that suicide survivors face dur- cy with delivering a detailed plan of today to recognize Saturday, November ing their grieving and encourage the how to improve tribal consultation and 21, as National Survivors of Suicide involvement of survivors in healing ac- how to address the complex challenges Day. National Survivors of Suicide Day tivities and prevention programs. This facing Indian Country. This Congress, is a day of healing for those who have is one of the goals of the South Dakota with the leadership of President lost someone to suicide. In 1999, a Sen- Strategy for Suicide Prevention. Fi- Obama, has an exceptional opportunity ate resolution created this annual nally, I believe that with appropriate to improve the quality of life for Amer- event behind the efforts of Senator support and treatment, suicide sur- ican Indian tribes by consulting with HARRY REID, who lost his father to sui- vivors can lead effective advocacy ef- tribal leaders and focusing on tribal cide. This year, on November 21, over forts to eliminate stigma and reduce sovereignty and the empowerment of 230 conferences will take place inter- the incidence of suicide. Indian communities. For far too long, nationally to allow survivors of suicide American Indians have endured a dras- to connect with others who have expe- f tically underfunded health care sys- rienced the tragedy of suicide loss. tem, crumbling education facilities, The statistics about suicide are deep- AMERICAN DIABETES MONTH dismal economic prospects, and a sub- ly concerning. In our Nation, suicide is par standard of living. It is essential to the eleventh leading cause of death for Mr. JOHNSON. Mr. President, I wish address this erosive cycle of poverty all ages. Among young adults ages 15– today to recognize November as Amer- and marginalization in a thoughtful 24, there are approximately 100–200 at- ican Diabetes Month. National studies manner. tempts for every completed suicide. estimate 23.6 million Americans live The diversity of American Indian Suicide takes the lives of approxi- with diabetes, and nearly one-quarter tribes reflects the vibrant origins of mately 30,000 Americans each year, and of this population has not yet been di- our Nation. As the First Americans, a person dies by suicide about every 16 agnosed. The number of South Dako- sound American Indian policy is a pre- minutes. Suicide is an epidemic that tans living with diabetes has doubled cursor to our Nation’s capacity to tears families and communities apart, since 1998, with more than 39,000 adults evolve and progress in an ever chang- and we must do all that we can to pre- diagnosed as diabetics in 2008 and an ing, diversifying society. We need to vent it. estimated 10,000 not yet diagnosed. celebrate the proud ancestry and in- A suicide survivor is an individual American Diabetes Month focuses on credible sacrifices of American Indians. who has lost someone to suicide. It is increasing awareness of the disease, National American Indian and Alaska estimated that for each suicide, seven strengthening prevention efforts, and Native Heritage Month reminds us to other lives are altered forever because identifying associated health risks. promote diversity rather than suppress of the death. Every year, approxi- The disease carries with it an increased it, as diverse values and cultures erect mately 200,000 people become survivors rate of heart disease and stroke, high the foundation of the United States. due to this tragic loss of life. Many sui- blood pressure, kidney disease, blind- American Indians contributed to the cide survivors are left devastated, con- ness, and amputation of the lower ex- formation of modern political institu- fused and weakened by their loss. tremities, among other associated tions as tribal confederacies influenced Friends and family often experience de- health problems. For the past few dec- the foundations of early American depression, guilt, shock and anger. Unfor- ades, the prevalence of overweight and mocracy. In every conflict since the tunately, there remains a stigma sur- obesity has steadily increased nation- Revolutionary War, tribal members rounding suicide and mental illness, wide, increasing the prevalence of type have courageously sacrificed their lives and victims often shoulder some of the 2 diabetes. As the prevalence of diabe- to help defend and preserve these blame. tes increases, we are beginning to un- democratic ideals. As the Federal Gov- South Dakota is among a group of derstand the costs to both our citizens’ ernment works to assert a modern en- Western States that consistently has a health and to our economy. The high vironmental ethic that can address cli- higher rate of suicide than the rest of costs to our government in direct med- mate change and natural resource scar- the country. The suicide rate for Amer- ical and indirect costs of lost produc- city, we have much to learn from ican Indians ages 15–34 is more than tivity, coupled with the personal costs American Indian communities. The en- two times higher than the national av- of rising health care coverage and vironmental consciousness inherent in erage and is the second leading cause of treatment, make type 2 diabetes con- tribal culture promotes conservation death for this age group. The loss of trol and prevention a national priority.

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00056 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.021 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11881 Throughout my career, I have strong- Virginia Redday. Winfield and Virginia and 17 countries, Bill was the voice of ly supported initiatives to advance dia- were blessed with 7 children, 16 grand- Legionnaires and veterans, meeting betes research, prevention, and edu- children, and 29 great-grandchildren. with leaders such as President Ford cation efforts. I commend the work Winfield was preceded in death by his and President Carter. Maine and our conducted at the National Institutes of wife. Nation could not have had a better Health, the National Institute of Dia- SGT Winfield Thompson Sr. em- champion for the American Legion and betes and Digestive and Kidney Dis- bodied South Dakota values with his our brave and noble veterans than Bill eases, and the Centers for Disease Con- unwavering devotion to family and Rogers. trol and Prevention to explore cures country, and I extend my deepest sym- Throughout his life, in word and and treatments for type 1 and type 2 di- pathies to his family on the loss of this deed, Bill placed service above self and abetes and prevent the development of great man.∑ country above self-interest. He held sa- type 2 diabetes. f cred our country’s obligation to stand Americans diagnosed with diabetes, TRIBUTE TO WILLIAM J. ROGERS by those who have stood by us, and I whether insured or not, often face sig- ∑ cannot imagine a more perfect testa- nificant barriers in receiving timely, Ms. SNOWE. Mr. President, I wish ment to this outstanding Mainer and affordable treatment in our current today to extol the enormous legacy of American who placed such a high pre- health care system. Congress is cur- selfless service, contribution, and, mium on contributing to our Nation above all, patriotism of an extraor- rently considering comprehensive re- than to name Auburn’s American Le- dinary Mainer and American, William form of our Nation’s health care sys- gion Post after him.∑ J. Rogers, and to recognize with the tem. This is a historic opportunity to highest esteem the American Legion f improve access to quality, affordable Post in Auburn, ME, founded by Bill health care for all Americans and bet- MESSAGES FROM THE PRESIDENT and his fellow veterans, which will be ter manage the treatment of chronic appropriately named the ‘‘William J. Messages from the President of the diseases. Given the cost of diabetes to Rogers American Legion Post 153’’ in United States were communicated to our citizens’ health and personal fi- his honor on November 29, 2009. This the Senate by Mrs. Neiman, one of his nances and to our national economy, fitting accolade pays tribute to an indi- secretaries. we must also continue to push to in- vidual who devoted his life to serving f crease funding for diabetes research and defending our country, as well as and prevention programs. American Di- tirelessly advocating for those who EXECUTIVE MESSAGES REFERRED abetes Month provides an opportunity placed their lives in harm’s way on our As in executive session the Presiding to learn more about the causes and behalf—our courageous veterans. Officer laid before the Senate messages health risks of diabetes and recognize Bill was one of the great sons of my from the President of the United its impact on our Nation and our fami- hometown of Auburn, ME, where my States submitting sundry nominations lies. roots run deep. In fact, on a personal which were referred to the appropriate f note, I am proud to say we both grad- committees. ADDITIONAL STATEMENTS uated from the same high school, Ed- (The nominations received today are ward Little. As fate would have it, printed at the end of the Senate pro- years later, I enjoyed the pleasure of ceedings.) REMEMBERING SERGEANT having Bill and his lovely wife, Connie, f WINFIELD THOMPSON SR. as wonderful neighbors of mine on Not- ∑ Mr. JOHNSON. Mr. President, I wish tingham Road. MESSAGE FROM THE HOUSE As a young man, Bill answered his today to recognize the life of SGT Win- At 10:40 a.m., a message from the country’s call to serve during World field Thompson Sr., an honored mem- House of Representatives, delivered by War II and joined the U.S. Navy, train- ber of the Sisseton-Wahpeton Oyate. Ms. Niland, one of its reading clerks, ing to be a pilot at the University of When this war hero and South Dakota announced that the House has passed North Carolina at Chapel Hill along native passed away November 6, 2009, the following bills, without amend- with Boston Red Sox legends, Ted Wil- our State lost a respected tribal mem- ment: liams and Johnny Pesky Bill’s room- ber and a wonderful citizen who served mate. As a naval aviator, Bill fought S. 1599. An act to amend title 36, United as an inspiration to us all. heroically and was awarded the Air States Code, to include in the Federal char- ter of the Reserve Officers Association lead- After entering the U.S. Army in Medal and Presidential Unit Citation April 1941, SGT Winfield Thompson Sr. ership positions newly added in its constitu- for his wartime service, having de- tion and bylaws. was captured by Japanese forces in the ployed to fight in the Pacific, where he Philippines on April 9, 1942. He was S. 1860. An act to permit each current valiantly flew F6F Hellcats and Lock- member of the Board of Directors of the Of- forced to march 90 miles over rough heed Venturas. fice of Compliance to serve for 3 terms. terrain with little food and water along While Bill departed from active mili- The message also announced that the with thousands of captured soldiers in tary service in 1946, his commitment to House has passed the following bills, in what is today known as the Bataan veterans and a lifetime of advocacy on which it requests the concurrence of Death March. After his capture, Ser- their behalf was just beginning. Bill the Senate: geant Thompson was held at various was a founding member of American H.R. 1834. An act to amend the Small Busi- prison camps and suffered horrible con- Legion Post 153 in Auburn, where he ditions until he was finally liberated in ness Act to expand and improve the assist- held several offices at both the local ance provided to Indian tribe members, Alas- September 1945. Upon his rescue, he and State levels including adjutant, ka Natives, and Native Hawaiians, and for stood at attention, saluted, and said, vice commander, and department com- other purposes. ‘‘Sergeant Thompson reporting to mander. On the national level, Bill be- H.R. 2781. An act to amend the Wild and duty, Sir.’’ During Sergeant Thomp- came Maine’s national executive com- Scenic Rivers Act to designate segments of son’s extraordinary military career, he mitteeman, a member of the liaison the Molalla River in Oregon, as components was awarded the Prisoner of War committee to the National Public Re- of the National Wild and Scenic Rivers Sys- tem, and for other purposes. Medal, American Defense Service rib- lations Commission, and from 1965 to bon with Bronze Star, Victory Medal, H.R. 3961. An act to amend title XVIII of 1966 national vice commander. In 1976, the Social Security Act to reform the Medi- Asiatic Pacific Theater Ribbon with Bill received the tremendous distinc- care SGR payment system for physicians and three bronze battle stars, Philippine tion of being elected national com- to reinstitute and update the Pay-As-You-Go Defense Ribbon, eight Overseas Service mander of the American Legion, the requirement of budget neutrality on new tax Bars, one Service Stripe and the Good first national commander from the and mandatory spending legislation, en- Conduct Medal. State of Maine—and we could not have forced by the threat of annual, automatic se- After his honorable discharge from been more proud. questration. the U.S. Army in May 1946, Sergeant Traveling more than 300,000 miles The message further announced that Thompson returned home and married throughout the world in all 50 States the House has agreed to the following

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00057 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.015 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11882 CONGRESSIONAL RECORD — SENATE November 20, 2009 concurrent resolution, in which it re- Homeland Security and Governmental Af- tion, Department of Transportation, trans- quests the concurrence of the Senate: fairs. mitting, pursuant to law, the report of a rule EC–3761. A communication from the Broad- entitled ‘‘Airworthiness Directives; Rolls- H. Con. Res. 212. Concurrent resolution ex- casting Board of Governors, transmitting, Royce Deutschland Ltd. & Co. KG. (RRD) pressing the sense of Congress on the occa- pursuant to law, the Board’s Performance Tay 650–15 Turbofan Engines’’ ((RIN2120– sion of the 20th anniversary of historic and Accountability Report for fiscal year AA64)(Docket No. FAA–2007–0037)) received events in Central and Eastern Europe, par- 2009; to the Committee on Homeland Secu- in the Office of the President of the Senate ticularly the Velvet Revolution in Czecho- rity and Governmental Affairs. on November 13, 2009; to the Committee on slovakia, and reaffirming the bonds of EC–3762. A communication from the Fed- Commerce, Science, and Transportation. friendship and cooperation between the eral Co-Chair, Appalachian Regional Com- EC–3771. A communication from the Pro- United States and the Slovak Republic and mission, transmitting, pursuant to law, the gram Analyst, Federal Aviation Administra- the Czech Republic. Semiannual Report, as amended, of the In- tion, Department of Transportation, trans- f spector General for the period from April 1, mitting, pursuant to law, the report of a rule 2009, through September 30, 2009; to the Com- MEASURES REFERRED entitled ‘‘Airworthiness Directives; Airbus mittee on Homeland Security and Govern- Model A300–600 Airplanes’’ ((RIN2120– The following bills were read the first mental Affairs. AA64)(Docket No. FAA–2008–0979)) received and the second times by unanimous EC–3763. A communication from the Sec- in the Office of the President of the Senate retary, Department of Housing and Urban consent, and referred as indicated: on November 13, 2009; to the Committee on Development, transmitting, pursuant to law, Commerce, Science, and Transportation. H.R. 1834. An act to amend the Small Busi- the Department’s Performance and Account- EC–3772. A communication from the Pro- ness Act to expand and improve the assist- ability Report for fiscal year 2009; to the gram Analyst, Federal Aviation Administra- ance provided to Indian tribe members, Alas- Committee on Homeland Security and Gov- tion, Department of Transportation, trans- ka Natives, and Native Hawaiians, and for ernmental Affairs. mitting, pursuant to law, the report of a rule other purposes; to the Committee on Small EC–3764. A communication from the Sec- entitled ‘‘Airworthiness Directives; General Business and Entrepreneurship. retary of Transportation, transmitting, pur- Electric Company CF6–80C2 Series Turbofan H.R. 2781. An act to amend the Wild and suant to law, the Department’s Performance Engines’’ ((RIN2120–AA64)(Docket No. FAA– Scenic Rivers Act to designate segments of and Accountability Report for fiscal year 2009–0018)) received in the Office of the Presi- 2009; to the Committee on Homeland Secu- the Molalla River in Oregon, as components dent of the Senate on November 13, 2009; to rity and Governmental Affairs. of the National Wild and Scenic Rivers Sys- the Committee on Commerce, Science, and tem, and for other purposes; to the Com- EC–3765. A communication from the Pro- gram Analyst, Federal Aviation Administra- Transportation. mittee on Energy and Natural Resources. EC–3773. A communication from the Pro- tion, Department of Transportation, trans- gram Analyst, Federal Aviation Administra- The following concurrent resolution mitting, pursuant to law, the report of a rule tion, Department of Transportation, trans- was read, and referred as indicated: entitled ‘‘Airworthiness Directives; Amer- mitting, pursuant to law, the report of a rule H. Con. Res. 212. Concurrent resolution ex- ican Champion Aircraft Corp. Models 7ECA, entitled ‘‘Airworthiness Directives; Airbus pressing the sense of Congress on the occa- 7GCAA, 7GCBC, 7KCAB, 8KCAB, and 8GCBC Model A300 B4–601, B4–603, B4–605R, B4–620, sion of the 20th anniversary of historic Airplanes’’ ((RIN2120–AA64)(Docket No. B4–622, B4–622R, F4–605R, F4–622R, and C4– events in Central and Eastern Europe, par- FAA–2009–0745)) received in the Office of the 605R Variant F Series Airplanes Equipped ticularly the Velvet Revolution in Czecho- President of the Senate on November 13, with Simmonds Precision Products, Inc., slovakia, and reaffirming the bonds of 2009; to the Committee on Commerce, Fuel Quantity Indicating System Sensors friendship and cooperation between the Science, and Transportation. and In-Tank Harnesses Installed in Accord- United States and the Slovak Republic and EC–3766. A communication from the Pro- ance with Supplemental Type Certificate the Czech Republic; to the Committee on gram Analyst, Federal Aviation Administra- (STC) ST00092BO’’ ((RIN2120–AA64)(Docket Foreign Relations. tion, Department of Transportation, transmitting, pursuant to law, the report of a rule No. FAA–2009–0324)) received in the Office of f entitled ‘‘Airworthiness Directives; Boeing the President of the Senate on November 13, EXECUTIVE AND OTHER Model 747 Airplanes; and Boeing Model 757– 2009; to the Committee on Commerce, COMMUNICATIONS 200, –200PF, and –300 Series Airplanes’’ Science, and Transportation. ((RIN2120–AA64)(Docket No. FAA–2008–1326)) EC–3774. A communication from the Pro- The following communications were received in the Office of the President of the gram Analyst, Federal Aviation Administra- laid before the Senate, together with Senate on November 13, 2009; to the Com- tion, Department of Transportation, trans- accompanying papers, reports, and doc- mittee on Commerce, Science, and Transpor- mitting, pursuant to law, the report of a rule uments, and were referred as indicated: tation. entitled ‘‘Airworthiness Directives; Airbus EC–3767. A communication from the Pro- Model A300 Airplanes’’ ((RIN2120– EC–3756. A communication from the Dep- gram Analyst, Federal Aviation Administra- AA64)(Docket No. FAA–2009–0997)) received uty Archivist, National Archives and tion, Department of Transportation, trans- in the Office of the President of the Senate Records Administration, transmitting, pur- mitting, pursuant to law, the report of a rule on November 13, 2009; to the Committee on suant to law, the report of a rule entitled ‘‘36 entitled ‘‘Airworthiness Directives; Rolls- Commerce, Science, and Transportation. CFR Chapter XII, Subchapter B, Federal Royce Deutschland Ltd. & Co. KG Model EC–3775. A communication from the Acting Records Management; Revision’’ (RIN3095– BR700–715A1–30, BR700–715B1–30, and BR700– Director of Sustainable Fisheries, National AB16) received in the Office of the President 715C1–30 Turbofan Engines’’ ((RIN2120– Marine Fisheries Services, Department of of the Senate on November 17, 2009; to the AA64)(Docket No. FAA–2009–0045)) received Commerce, transmitting, pursuant to law, Committee on Homeland Security and Gov- in the Office of the President of the Senate the report of a rule entitled ‘‘Fisheries of the ernmental Affairs. on November 13, 2009; to the Committee on Exclusive Economic Zone Off Alaska; Pacific EC–3757. A communication from the Chair- Commerce, Science, and Transportation. Cod in the Central Regulatory Area of the man, Federal Energy Regulatory Commis- EC–3768. A communication from the Pro- Gulf of Alaska’’ (RIN0648–XS79) received in sion, transmitting, pursuant to law, the gram Analyst, Federal Aviation Administra- the Office of the President of the Senate on Commission’s Performance and Account- tion, Department of Transportation, trans- November 18, 2009; to the Committee on ability Report for fiscal year 2009; to the mitting, pursuant to law, the report of a rule Commerce, Science, and Transportation. Committee on Homeland Security and Gov- entitled ‘‘Airworthiness Directives; EC–3776. A communication from the Acting ernmental Affairs. Eurocopter France (ECF) Model EC 155B and Director of Sustainable Fisheries, National EC–3758. A communication from the Chair- EC155B1 Helicopters’’ ((RIN2120– Marine Fisheries Services, Department of man, U.S. Nuclear Regulatory Commission, AA64)(Docket No. FAA–2009–0952)) received Commerce, transmitting, pursuant to law, transmitting, pursuant to law, the Commis- in the Office of the President of the Senate the report of a rule entitled ‘‘Fisheries Off sion’s Performance and Accountability Re- on November 13, 2009; to the Committee on West Coast States; Modifications of the West port for fiscal year 2009; to the Committee on Commerce, Science, and Transportation. Coast Commercial and Recreational Salmon Homeland Security and Governmental Af- EC–3769. A communication from the Pro- Fisheries; Inseason Actions No. 4, No. 5, No. fairs. gram Analyst, Federal Aviation Administra- 6, and No. 7’’ (RIN0648–XR27) received in the EC–3759. A communication from the Acting tion, Department of Transportation, trans- Office of the President of the Senate on No- Director, Office of Personnel Management, mitting, pursuant to law, the report of a rule vember 18, 2009; to the Committee on Com- transmitting, pursuant to law, a report enti- entitled ‘‘Airworthiness Directives; Hartzell merce, Science, and Transportation. tled ‘‘Agency Financial Report, Fiscal Year Propeller Inc. ( )HC–( )2Y(K,R)–( ) Series Pro- EC–3777. A communication from the Acting 2009’’; to the Committee on Homeland Secu- pellers’’ ((RIN2120–AA64)(Docket No. FAA– Director of Sustainable Fisheries, National rity and Governmental Affairs. 2006–25244)) received in the Office of the Marine Fisheries Services, Department of EC–3760. A communication from the Chair- President of the Senate on November 13, Commerce, transmitting, pursuant to law, man, U.S. International Trade Commission, 2009; to the Committee on Commerce, the report of a rule entitled ‘‘Fisheries of the transmitting, pursuant to law, the Commis- Science, and Transportation. Exclusive Economic Zone Off Alaska; Pacific sion’s Performance and Accountability Re- EC–3770. A communication from the Pro- Cod by Catcher Vessels 60 ft (18.3 m) LOA and port for fiscal year 2009; to the Committee on gram Analyst, Federal Aviation Administra- Longer Using Hook-and-Line Gear in the

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00058 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.012 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11883 Bering Sea and Aleutian Islands Manage- By Mr. MENENDEZ: cosponsors of S. 812, a bill to amend the ment Area’’ (RIN0648–XS72) received in the S. 2813. A bill to increase corporate respon- Internal Revenue Code of 1986 to make Office of the President of the Senate on No- sibility, and for other purposes; to the Com- permanent the special rule for con- vember 18, 2009; to the Committee on Com- mittee on Banking, Housing, and Urban Af- tributions of qualified conservation merce, Science, and Transportation. fairs. contributions. EC–3778. A communication from the Acting By Ms. COLLINS (for herself and Mr. Assistant Administrator for Fisheries, Na- CONRAD): S. 1067 tional Oceanic and Atmospheric Administra- S. 2814. A bill to amend title XVIII of the At the request of Mr. FEINGOLD, the tion, Department of Commerce, transmit- Social Security Act to ensure more timely names of the Senator from North Da- ting, pursuant to law, a biennial report rel- access to home health services for Medicare kota (Mr. DORGAN) and the Senator ative to the use of federal assistance pro- beneficiaries under the Medicare program; to from South Dakota (Mr. JOHNSON) were vided to Department of Commerce partners; the Committee on Finance. added as cosponsors of S. 1067, a bill to to the Committee on Commerce, Science, By Mr. GRASSLEY: support stabilization and lasting peace and Transportation. S. 2815. A bill to extend certain housing— in northern Uganda and areas affected f related deadlines in the Heartland Disaster by the Lord’s Resistance Army through Tax Relief Act of 2008; to the Committee on REPORTS OF COMMITTEES Finance. development of a regional strategy to support multilateral efforts to success- The following reports of committees f were submitted: fully protect civilians and eliminate SUBMISSION OF CONCURRENT AND the threat posed by the Lord’s Resist- By Mr. KERRY, from the Committee on SENATE RESOLUTIONS ance Army and to authorize funds for Foreign Relations, without amendment: S. 2727. A bill to provide for continued ap- The following concurrent resolutions humanitarian relief and reconstruc- plication of arrangements under the Pro- and Senate resolutions were read, and tion, reconciliation, and transitional tocol on Inspections and Continuous Moni- referred (or acted upon), as indicated: justice, and for other purposes. toring Activities Relating to the Treaty Be- By Ms. COLLINS (for herself and Ms. S. 1297 tween the United States of America and the SNOWE): At the request of Mr. CONRAD, the Union of Soviet Socialist Republics on the S. Res. 358. A resolution designating De- name of the Senator from South Da- Reduction and Limitation of Strategic Of- cember 12, 2009, as ‘‘Wreaths Across America kota (Mr. JOHNSON) was added as a co- fensive Arms in the period following the Pro- Day’’; to the Committee on the Judiciary. tocol’s termination on December 5, 2009 sponsor of S. 1297, a bill to amend the (Rept. No. 111–100). f Internal Revenue Code of 1986 to encourage guaranteed lifetime income f ADDITIONAL COSPONSORS payments from annuities and similar INTRODUCTION OF BILLS AND S. 146 payments of life insurance proceeds at JOINT RESOLUTIONS At the request of Mr. KOHL, the name dates later than death by excluding The following bills and joint resolu- of the Senator from South Dakota (Mr. from income a portion of such pay- tions were introduced, read the first JOHNSON) was added as a cosponsor of ments. and second times by unanimous con- S. 146, a bill to amend the Federal anti- S. 1317 sent, and referred as indicated: trust laws to provide expanded cov- At the request of Mr. LAUTENBERG, By Mr. CORNYN (for himself, Mrs. erage and to eliminate exemptions the name of the Senator from Rhode Is- HUTCHISON, Mr. INHOFE, Mr. from such laws that are contrary to the land (Mr. REED) was added as a cospon- LIEBERMAN, Mr. COCHRAN, and Mr. public interest with respect to rail- sor of S. 1317, a bill to increase public BURR): roads. safety by permitting the Attorney Gen- S. 2807. A bill to ensure that the victims S. 588 eral to deny the transfer of firearms or and victims’ families of the November 5, 2009, At the request of Mr. KERRY, the the issuance of firearms and explosives attack at Fort Hood, Texas, receive the same licenses to known or suspected dan- treatment, benefits, and honors as those names of the Senator from West Vir- Americans who have been killed or wounded ginia (Mr. ROCKEFELLER), the Senator gerous terrorists. in a combat zone overseas and their families; from Florida (Mr. NELSON), the Senator S. 1583 to the Committee on Armed Services. from Maine (Ms. SNOWE) and the Sen- At the request of Mr. ROCKEFELLER, By Mrs. SHAHEEN: ator from New Jersey (Mr. LAUTEN- the name of the Senator from South S. 2808. A bill to improve the Express Loan BERG) were added as cosponsors of S. Dakota (Mr. JOHNSON) was added as a Program of the Small Business Act; to the cosponsor of S. 1583, a bill to amend the Committee on Small Business and Entrepre- 588, a bill to amend title 46, United States Code, to establish requirements Internal Revenue Code of 1986 to extend neurship. the new markets tax credit through By Mrs. GILLIBRAND: to ensure the security and safety of S. 2809. A bill to amend the Public Health passengers and crew on cruise vessels, 2014, and for other purposes. Service Act to authorize grants for treat- and for other purposes. S. 1672 At the request of Mr. REED, the name ment and support services for Alzheimer’s S. 619 patients and their families; to the Com- of the Senator from Maryland (Mr. At the request of Ms. SNOWE, the mittee on Health, Education, Labor, and CARDIN) was added as a cosponsor of S. name of the Senator from Hawaii (Mr. Pensions . 1672, a bill to reauthorize the National AKAKA) was added as a cosponsor of S. By Mr. COCHRAN (for himself, Mr. Oilheat Research Alliance Act of 2000. WICKER, and Mrs. LINCOLN): 619, a bill to amend the Federal Food, S. 1780 S. 2810. A bill to require the Secretary of Drug, and Cosmetic Act to preserve the At the request of Mrs. LINCOLN, the Agriculture to provide emergency disaster effectiveness of medically important name of the Senator from Oregon (Mr. assistance to certain agricultural producers antibiotics used in the treatment of MERKLEY) was added as a cosponsor of that suffered losses during the 2009 calendar human and animal diseases. year; to the Committee on Agriculture, Nu- S. 1780, a bill to amend title 38, United trition, and Forestry. S. 654 States Code, to deem certain service in By Mr. MERKLEY: At the request of Ms. MIKULSKI, the the reserve components as active serv- S. 2811. A bill to amend the Migratory Bird name of the Senator from Pennsyl- ice for purposes of laws administered Treaty Act to provide for penalties and en- vania (Mr. CASEY) was added as a co- by the Secretary of Veterans Affairs. forcement for intentionally taking protected sponsor of S. 654, a bill to amend title avian species, and for other purposes; to the S. 1790 Committee on Environment and Public XIX of the Social Security Act to cover At the request of Mr. DORGAN, the Works . physician services delivered by name of the Senator from Oregon (Mr. By Mr. BINGAMAN (for himself, Ms. podiatric physicians to ensure access MERKLEY) was added as a cosponsor of MURKOWSKI, and Mr. UDALL of Colo- by Medicaid beneficiaries to appro- S. 1790, a bill to amend the Indian rado): priate quality foot and ankle care. Health Care Improvement Act to revise S. 2812. A bill to amend the Energy Policy S. 812 and extend that Act, and for other pur- Act of 2005 to require the Secretary of En- ergy to carry out programs to develop and At the request of Mr. BAUCUS, the poses. demonstrate 2 small modular nuclear reactor names of the Senator from Vermont S. 1803 designs, and for other purposes; to the Com- (Mr. LEAHY) and the Senator from Cali- At the request of Mr. MERKLEY, the mittee on Energy and Natural Resources. fornia (Mrs. FEINSTEIN) were added as name of the Senator from Tennessee

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00059 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.011 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11884 CONGRESSIONAL RECORD — SENATE November 20, 2009 (Mr. ALEXANDER) was added as a co- vide for clarification on the use of for other purposes; to the Committee sponsor of S. 1803, a bill to amend title funds relating to certain homeland se- on Energy and Natural Resources. 31, United States Code, to authorize re- curity grants, and for other purposes. Mr. BINGAMAN. Mr. President, I rise views by the Comptroller General of S. RES. 341 today to introduce the Nuclear Power the United States of emergency credit At the request of Mr. CARDIN, the 2021 Act, which is cosponsored by Sen- facilities established by the Board of name of the Senator from Connecticut ator MURKOWSKI and Senator UDALL Governors of the Federal Reserve Sys- (Mr. LIEBERMAN) was added as a co- from Colorado. tem or any Federal Reserve bank, and sponsor of S. Res. 341, a resolution sup- This bill, along with Senator UDALL’s bill S. 2052 are designed to give the De- for other purposes. porting peace, security, and innocent partment of Energy a set of specific S. 1939 civilians affected by conflict in Yemen. programmatic authorities to help ad- At the request of Mrs. GILLIBRAND, f dress ways to lower the up-front cap- the names of the Senator from Penn- STATEMENTS ON INTRODUCED ital cost of nuclear reactors. The Na- sylvania (Mr. CASEY) and the Senator BILLS AND JOINT RESOLUTIONS tional Academies of Science in their from Alaska (Mr. BEGICH) were added recent America’s Energy Future study as cosponsors of S. 1939, a bill to amend By Mr. MERKLEY: determined that by 2030 we will need title 38, United States Code, to clarify S. 2811. A bill to amend the Migra- tory Bird Treaty Act to provide for essentially to double the existing base presumptions relating to the exposure load power provided by nuclear energy of certain veterans who served in the penalties and enforcement for intentionally taking protected avian spe- or about another 100 gigawatts. vicinity of the Republic of Vietnam, But before we can make such a large cies, and for other purposes; to the and for other purposes. and dramatic increase in nuclear en- Committee on Environment and Public S. 2097 ergy, I believe we must demonstrate Works. At the request of Mr. WEBB, the name the ability to construct ‘‘first-mover’’ Mr. President, I ask unanimous con- of the Senator from Connecticut (Mr. reactors in the U.S. that are on cost sent that the text of the bill be printed LIEBERMAN) was added as a cosponsor and schedule. The National Academies of S. 2097, a bill to authorize the rededi- in the RECORD. likewise confirmed this as one of two cation of the District of Columbia War There being no objection, the text of principal demonstrations that must be Memorial as a National and District of the bill was ordered to be printed in carried out during the next decade to Columbia World War I Memorial to the RECORD, as follows: more fully understand the range of honor the sacrifices made by American S. 2811 available options for controlling car- veterans of World War I. Be it enacted by the Senate and House of Rep- bon emissions from energy production. resentatives of the United States of America in S. 2129 The other challenge of commensurate Congress assembled, At the request of Ms. COLLINS, the importance that they identified is the SECTION 1. SHORT TITLE. name of the Senator from Alaska (Mr. demonstration of carbon capture and This Act may be cited as the ‘‘Migratory sequestration on a large scale for fos- BEGICH) was added as a cosponsor of S. Bird Treaty Act Penalty and Enforcement 2129, a bill to authorize the Adminis- Act of 2009’’. sil-fuel based energy production. In that regard, the bill I am intro- trator of General Services to convey a SEC. 2. AMENDMENT OF MIGRATORY BIRD TREA- parcel of real property in the District TY ACT. ducing today addresses the topic of of Columbia to provide for the estab- Section 6 of the Migratory Bird Treaty Act small modular reactors, which are lishment of a National Women’s His- (16 U.S.C. 707) is amended by redesignating typically rated with a capacity of less tory Museum. subsections (c) and (d) as subsections (d) and than 300 electrical megawatts; and that (e), respectively, and by inserting after sub- can be constructed and operated in S. 2747 section (b) the following: combination with similar reactors at a At the request of Mr. BINGAMAN, the ‘‘(c)(1) Except in the case of hunting and single site. These reactors can be less name of the Senator from Montana other activity allowed under section 3, who- capital intensive than the larger 1,000 (Mr. TESTER) was added as a cosponsor ever, in violation of this Act, intentionally megawatt reactors currently being li- and maliciously takes by any manner any of S. 2747, a bill to amend the Land and censed at the Nuclear Regulatory Com- Water Conservation Fund Act of 1965 to migratory bird shall be guilty of a felony and, upon conviction, shall be fined not more mission; they have the potential to be provide consistent and reliable author- than $50,000 or imprisoned for not more than built in a modular fashion much like ity for, and for the funding of, the land two years, or both, for each violation. our current fleet of nuclear sub- and water conservation fund to maxi- ‘‘(2) Any person who intentionally and ma- marines. mize the effectiveness of the fund for liciously commits any other act or omission This bill is similar to the Depart- future generations, and for other pur- in violation of this Act or any regulations ment of Energy’s Nuclear Power 2010 poses. issued under this Act shall be guilty of a fel- program; it concentrates not so much ony and, upon conviction, shall be fined not S. 2757 on the research and development of more than $50,000 or imprisoned for not more At the request of Mr. MENENDEZ, the than two years, or both, for each violation. these reactors but demonstrating the name of the Senator from Alaska (Mr. ‘‘(3) The Secretary or the Secretary of the ability to license them. Senator BEGICH) was added as a cosponsor of S. Treasury shall pay, from sums received as UDALL’s bill authorizes the Department 2757, a bill to authorize the adjustment fines under this subsection and subject to to conduct research on these reactors of status for immediate family mem- the availability of appropriations, a reward with the goal of reducing cost while op- bers of persons who served honorably to any person who furnishes information erating them in a safe and secure fash- in the Armed Forces of the United that leads to an arrest or a criminal convic- ion. tion for any violation of this Act. The More specifically, this bill authorizes States during the Afghanistan and Iraq amount of the reward, if any, shall be des- conflicts and for other purposes. the Secretary of Energy to work in a ignated by the Secretary or the Secretary of public private partnership to develop a S. 2785 the Treasury, as appropriate. Any officer or standard design for two modular reac- At the request of Mrs. LINCOLN, the employee of the United States or any State tors, one of which will not be more name of the Senator from Indiana (Mr. or local government who furnishes information or renders service in the performance of than 50 megawatts; obtain a design cer- BAYH) was added as a cosponsor of S. his or her official duties is ineligible for pay- tification from the Nuclear Regulatory 2785, a bill to provide grants to improve ment under this paragraph.’’. Commission for each design by 2018; after-school interdisciplinary edu- and obtain a combined operating li- cation programs, and for other pur- By Mr. BINGAMAN (for himself, cense from the Commission by 2021. poses. Ms. MURKOWSKI, and Mr. UDALL All of this effort would be cost shared S. 2793 of Colorado): by non-federal funds and selected under At the request of Mr. LEAHY, the S. 2812. A bill to amend the Energy competitive merit review process while name of the Senator from New York Policy Act of 2005 to require the Sec- emphasizing efficiency, cost, safety (Mrs. GILLIBRAND) was added as a co- retary of Energy to carry out programs and proliferation resistance. sponsor of S. 2793, a bill to amend the to develop and demonstrate 2 small The climate change issue we face Homeland Security Act of 2002 to pro- modular nuclear reactor designs, and today is too large to exclude any one

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00060 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.005 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11885 technology that can produce energy ‘‘(B) LICENSING DEMONSTRATION.—Notwith- the supervising physician was located without emitting carbon dioxide. The standing section 988, the Secretary shall re- 60 miles away. National Academies report acknowl- quire that not less than 75 percent of the A nurse practitioner told me about edges the important role nuclear en- cost of the licensing demonstration of each another case in which her collabo- small modular reactor design under para- ergy has and must play in a carbon graph (2)(B) be provided by a non-Federal rating physician had just lost her fa- constrained energy world; this bill I source. ther and was not available. As a con- hope is another step to address some of ‘‘(C) CALCULATION OF AMOUNT.—Non-Fed- sequence, the patient experienced a the recommendations of this report. I eral contributions under this subsection two-day delay in getting needed care hope my colleagues join me as cospon- shall be calculated in accordance with sec- while they waited to get the paperwork sors of this legislation. tion 988(d).’’. signed by another physician. Another Mr. President, I ask unanimous con- nurse practitioner pointed out that it sent that the text of the bill be printed By Ms. COLLINS (for herself and is ridiculous that she can order phys- in the RECORD. Mr. CONRAD): ical and occupational therapy in a There being no objection, the text of S. 2814. A bill tb amend title XVIII of subacute facility but cannot order the bill was ordered to be printed in the Social Security Act to ensure more home health care. One of her patients the RECORD, as follows: timely access to home health services had to wait 11 days after being dis- S. 2812 for Medicare beneficiaries under the charged before his physical and occupa- Be it enacted by the Senate and House of Rep- Medicare program; to the Committee tional therapy could continue simply resentatives of the United States of America in on Finance. because the home health agency had Congress assembled, Ms. COLLINS. Mr. President, I rise difficulty finding a physician to certify SECTION 1. SHORT TITLE. today on behalf of myself and Senator the continuation of the same therapy This Act may be cited as the ‘‘Nuclear CONRAD to introduce legislation to en- that the nurse practitioner had been Power 2021 Act’’. sure that our seniors and disabled citi- able to authorize when the patient was SEC. 2. NUCLEAR POWER 2021 INITIATIVE. zens have timely access to home health Section 952 of the Energy Policy Act of in the facility. services under the Medicare program. The Home Health Care Planning Im- 2005 (42 U.S.C. 16272) is amended by adding at Nurse practitioners, physician assist- the end the following: provement Act will help to ensure that ants, certified nurse midwives and clin- ‘‘(f) NUCLEAR POWER 2021 INITIATIVE.— our Medicare beneficiaries get the ‘‘(1) DEFINITIONS.—In this subsection: ical nurse specialists are all playing in- home health care that they need when ‘‘(A) COMBINED LICENSE.—The term ‘com- creasingly important roles in the deliv- they need it by allowing physician as- bined license’ has the meaning given the ery of health care services, particularly sistants, nurse practitioners, clinical term in section 52.1 of title 10, Code of Fed- in rural and medically underserved nurse specialists and certified nurse eral Regulations (or a successor regulation). areas of our country where physicians ‘‘(B) DESIGN CERTIFICATION.—The term ‘de- midwives to order home health serv- may be in scarce supply. In recognition ices. Our legislation is supported by sign certification’ has the meaning given the of their growing role, Congress, in 1997, term in section 52.1 of title 10, Code of Fed- the National Association for Home eral Regulations (or a successor regulation). authorized Medicare to begin paying Care and Hospice, the American Nurses ‘‘(C) SMALL MODULAR REACTOR.—The term for physician services provided by Association, the American Academy of ‘small modular reactor’ means a nuclear re- these health professionals as long as Physician Assistants, the American actor— those services are within their scope of College of Nurse Practitioners, the ‘‘(i) with a rated capacity of less than 300 practice under state law. American College of Nurse Midwives, electrical megawatts; and Despite their expanded role, these ad- ‘‘(ii) that can be constructed and operated the American Academy of Nurse Prac- vanced practice registered nurses and titioners, and the Visiting Nurse Asso- in combination with similar reactors at a physician assistants are currently un- single site. ciations of America. I urge all of my able to order home health services for ‘‘(2) DUTY OF SECRETARY.—The Secretary colleagues to join us as cosponsors of shall carry out, through cooperative agree- their Medicare patients. Under current this important legislation. ments with private sector partners— law, only physicians are allowed to cer- ‘‘(A) a program— tify or initiate home health care for By Mr. GRASSLEY: ‘‘(i) to develop a standard design for each Medicare patients, even though they S. 2815. A bill to extend certain hous- of 2 small modular reactors, at least 1 of may not be as familiar with the pa- ing-related deadlines in the Heartland which has a rated capacity of not more than tient’s case as the non-physician pro- Disaster Tax Relief Act of 2008; to the 50 electrical megawatts; and vider. In fact, in many cases, the certi- ‘‘(ii) to obtain a design certification from Committee on Finance. the Nuclear Regulatory Commission for each fying physician may not even have a Mr. GRASSLEY. Mr. President, of the 2 standard designs by January 1, 2018; relationship with the patient and must today I have introduced a bill to extend and rely upon the input of the nurse practi- deadlines by one year for three provi- ‘‘(B) a program to demonstrate the licens- tioner, physician assistant, clinical sions in the Heartland Disaster Tax Re- ing of small modular reactors by— nurse specialist or certified nurse mid- lief Act of 2008. ‘‘(i) developing applications for a combined wife to order the medically necessary The Heartland Disaster Tax Relief license for each of the designs certified pur- home health care. At best, this require- Act has been critical in rebuilding the suant to subparagraph (A); and ment adds more paperwork and a num- ‘‘(ii) obtaining a combined license from the lives and communities of those affected Nuclear Regulatory Commission for each of ber of unnecessary steps to the process by the terrible floods and tornadoes the designs by January 1, 2021. before home health care can be pro- from last year. ‘‘(3) MERIT REVIEW OF PROPOSALS.—The vided. At worst, it can lead to needless Because of delays in Federal funding Secretary shall select proposals for coopera- delays in getting Medicare patients the and tighter credit conditions, many tive agreements under this subsection— home health care they need simply be- homeowners affected by the 2008 floods ‘‘(A) on the basis of an impartial review of cause a physician is not readily avail- and storms will be unable to meet the the scientific and technical merit of the pro- able to sign the form. deadline for the tax relief intended to posals; and The inability of advanced practice ‘‘(B) through the use of competitive proce- help with recovery. dures. registered nurses and physician assist- It is only fair to extend the deadline ‘‘(4) TECHNICAL CONSIDERATIONS.—In evalu- ants to order home health care is par- and give these homeowners the chance ating proposals, the Secretary shall take ticularly burdensome for Medicare to recover and rebuild. A lot of people into account the efficiency, cost, safety, and beneficiaries in medically underserved are still trying to fix their ruined proliferation resistance of competing reactor areas, where these providers may be homes or move on to new housing. A designs. the only health care professionals house is ruined in a few minutes, but ‘‘(5) COST-SHARE REQUIREMENTS.— available. For example, needed home banks and governments take what ‘‘(A) DESIGN DEVELOPMENT.—Notwith- health care was delayed by more than seems like an eternity. standing section 988, the Secretary shall require that not less than 50 percent of the a week for a Medicare patient in Ne- The first provision is a one-year ex- cost of the development of each small mod- vada because the physician assistant tension of the provision allowing dis- ular reactor design under paragraph (2)(A) be was the only health care professional aster victims with damage to their pri- provided by a non-Federal source. serving the patient’s small town, and mary residence to use their own assets

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00061 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.022 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11886 CONGRESSIONAL RECORD — SENATE November 20, 2009 to buy a new home or repair an exist- bers nationwide, will continue their tradi- title), shall be fined under this title, impris- ing home by withdrawing money from tion of escorting a tractor-trailer filled with oned for not more than 20 years, or both; and their retirement plans without tax pen- donated wreaths from Harrington, Maine to ‘‘(C) if the violation results in death, shall alties. Arlington National Cemetery; be fined under this title, imprisoned for any Whereas thousands of individuals volun- term of years or for life, or both. The second provision is a one-year teer each December to escort and lay the ‘‘(2) MANDATORY MINIMUM SENTENCING.—In extension of a provision allowing dis- wreaths; imposing a sentence under paragraph (1), if aster victims that have borrowed from Whereas December 13, 2008, was previously the violation of subsection (a) involves a loss their retirement account for disaster designated by the Senate as ‘‘Wreaths Across of not less than $100,000, the defendant shall recovery to repay their own account America Day’’; and be imprisoned for not less than 6 months.’’. without penalty. Whereas the Wreaths Across America f project will continue its proud legacy on De- The final provision is a 1-year exten- NOTICES OF HEARINGS sion of a provision allowing disaster cember 12, 2009, bringing 15,000 wreaths to Arlington National Cemetery on that day: victims whose banks cancel mortgage COMMITTEE ON ENERGY AND NATURAL Now, therefore, be it RESOURCES debt to not have the cancelled debt Resolved, That the Senate— counted as taxable income. I urge my (1) designates December 12, 2009, as Mr. BINGAMAN. Mr. President, I colleagues to help me in getting this ‘‘Wreaths Across America Day’’; would like to announce for the infor- important legislation enacted into law (2) honors the Wreaths Across America mation of the Senate and the public as soon as possible. project, the Patriot Guard Riders, and all of that a hearing has been scheduled be- Mr. President, I ask unanimous con- the volunteers and donors involved in this fore the Subcommittee on National sent that the text of the bill be printed worthy tradition; and Parks. (3) recognizes the sacrifices our veterans, The hearing will be held on Thurs- in the RECORD. servicemembers, and their families have There being no objection, the text of day, December 3, 2009, at 2:30 p.m., in made, and continue to make, for our great room SD–366 of the Dirksen Senate Of- the bill was ordered to be printed in Nation. the RECORD, as follows: fice Building. f S. 2815 The purpose of the hearing is to receive testimony on the following bills: Be it enacted by the Senate and House of Rep- AMENDMENTS SUBMITTED AND resentatives of the United States of America in PROPOSED S. 760, to designate the Liberty Me- Congress assembled, morial at the National World War I SA 2787. Mr. SPECTER submitted an Museum in Kansas City, Missouri, as SECTION 1. EXTENSION OF SPECIAL RULES FOR amendment intended to be proposed to the ‘‘National World War I Memorial’’; USE OF RETIREMENT FUNDS. amendment SA 2786 submitted by Mr. REID Section 702(d)(10) of the Heartland Disaster (for himself, Mr. BAUCUS, Mr. DODD, and Mr. S. 1838, to establish a commission to Tax Relief Act of 2008 (Public Law 110–343; HARKIN) and intended to be proposed to the commemorate the sesquicentennial of 122 Stat. 3916) is amended— bill H.R. 3590, to amend the Internal Revenue the American Civil War; (1) by striking ‘‘January 1, 2010’’ both Code of 1986 to modify the first-time home- S. 2097, to authorize the rededication places it appears and inserting ‘‘January 1, buyers credit in the case of members of the of the District of Columbia War Memo- 2011’’, and Armed Forces and certain other Federal em- rial as a National and District of Co- (2) by striking ‘‘December 31, 2009’’ both ployees, and for other purposes; which was lumbia World War I Memorial to honor places it appears and inserting ‘‘December ordered to lie on the table. 31, 2010’’. the sacrifices made by American vet- f SEC. 2. EXTENSION OF EXCLUSION OF CERTAIN erans of World War I; CANCELLATION OF INDEBTEDNESS TEXT OF AMENDMENTS S. 2722, to authorize the Secretary of INCOME. the Interior to conduct a special re- Section 702(e)(4)(C) of the Heartland Dis- SA 2787. Mr. SPECTER submitted an source study to determine the suit- aster Tax Relief Act of 2008 (Public Law 110– amendment intended to be proposed to ability and feasibility of adding the 343; 122 Stat. 3918) is amended by striking amendment SA 2786 submitted by Mr. Heart Mountain Relocation Center, in ‘‘January 1, 2010’’ and inserting ‘‘January 1, REID (for himself, Mr. BAUCUS, Mr. 2011’’. the State of Wyoming, as a unit of the DODD, and Mr. HARKIN) and intended to National Park System; f be proposed to the bill H.R. 3590, to S. 2726, to modify the boundary of the SUBMITTED RESOLUTIONS amend the Internal Revenue Code of Minuteman Missile National Historic 1986 to modify the first-time home- Site in the State of South Dakota, and buyers credit in the case of members of for other purposes; SENATE RESOLUTION 358—DESIG- the Armed Forces and certain other S. 2738, to authorize National Mall NATING DECEMBER 12, 2009, AS Federal employees, and for other pur- Liberty Fund D.C. to establish a me- ‘‘WREATHS ACROSS AMERICA poses; which was ordered to lie on the morial on Federal land in the District DAY’’ table; as follows: of Columbia to honor free persons and Ms. COLLINS (for herself and Ms. On page 1738, between lines 3 and 4, insert slaves who fought for independence, SNOWE) submitted the following resolu- the following: liberty, and justice for all during the tion; which was referred to the Com- (3) HEALTH CARE FRAUD PENALTIES.—Sec- American Revolution; mittee on the Judiciary: tion 1347 of title 18, United States Code, is H.R. 1849, to designate the Liberty amended— S. RES. 358 (A) by striking ‘‘Whoever’’ and inserting Memorial at the National World War I Whereas 18 years ago, the Wreaths Across the following: Museum in Kansas City, Missouri, as America project began an annual tradition, ‘‘(a) IN GENERAL.—It shall be unlawful for the National World War I Memorial, to during the month of December, of donating, any person, in connection with the delivery establish the World War I centennial transporting, and placing Maine balsam fir of or payment for health care benefits, commission to ensure a suitable ob- holiday wreaths on the graves of the fallen items, or services, to’’; servance of the centennial of World heroes buried at Arlington National Ceme- (B) by striking ‘‘executes, or attempts’’ War I, and for other purposes; and tery; and inserting ‘‘execute, or attempt’’; H.R. 3689, to provide for an extension Whereas since that tradition began, (C) in subsection (a)(2), as so designated, by through the hard work and generosity of the striking ‘‘program,’’ and inserting ‘‘pro- of the legislative authority of the Viet- individuals involved in the Wreaths Across gram.’’; and nam Veterans Memorial Fund, Inc. to America project, hundreds of thousands of (D) in the matter following subsection establish a Vietnam Veterans Memo- wreaths have been sent to national ceme- (a)(2), as so designated, by striking ‘‘in con- rial visitor center, and for other pur- teries and veterans memorials in every state nection with the delivery’’ and all that fol- poses. and to locations overseas; lows and inserting the following: Because of the limited time available Whereas in 2008, wreaths were sent to 372 ‘‘(b) PENALTIES.— for the hearing, witnesses may testify locations across the United States, as well as ‘‘(1) IN GENERAL.—Subject to paragraph (2), by invitation only. However, those 24 sites overseas; whoever violates subsection (a)— Whereas in December 2009, the Patriot ‘‘(A) shall be fined under this title, impris- wishing to submit written testimony Guard Riders, a motorcycle and motor vehi- oned for not more than 10 years, or both; for the hearing record should send it to cle group that is dedicated to patriotic ‘‘(B) if the violation results in serious bod- the Committee on Energy and Natural events and includes more than 177,000 mem- ily injury (as defined in section 1365 of this Resources, United States Senate,

VerDate Nov 24 2008 02:38 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00062 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.022 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11887 Washington, DC 20510–6150, or by email tection and Affordable Care Act of 2009: SEC. 2. The Speaker of the House and the to [email protected] Sara Selgrade, Bill McConagha, Steph- Majority Leader of the Senate, or their re- .gov. anie Hammonds, Joe Hutter, and Caro- spective designees, acting jointly after con- For further information, please con- line Fichtenberg. sultation with the Minority Leader of the House and the Minority Leader of the Sen- tact David Brooks at (202) 224–9863 or The PRESIDING OFFICER. Without ate, shall notify the Members of the House Allison Seyferth at (202) 224–4905. objection, it is so ordered. and the Senate, respectively, to reassemble COMMITTEE ON ENERGY AND NATURAL Mr. ROBERTS. Mr. President, I ask at such place and time as they may des- RESOURCES unanimous consent that my staff mem- ignate if, in their opinion, the public interest Mr. BINGAMAN. Mr. President, I ber, Mr. Brett King, be granted the shall warrant it. privileges of the floor. would like to announce for the infor- f mation of the Senate and the public The PRESIDING OFFICER. Without that a hearing has been scheduled be- objection, it is so ordered. ORDER FOR STAR PRINT—S. 1194 fore the Senate Committee on Energy Mr. DORGAN. Mr. President, on be- Mr. DORGAN. I ask unanimous con- and Natural Resources. The hearing half of Chairman BAUCUS, I ask unani- sent that S. 1194, as reported by the will be held on Tuesday, December 15, mous consent that the list of staff from Committee on Commerce, Science, and 2009, at 10:00 a.m., in room SD–366 of the Senate Finance Committee which Transportation, be star printed with the Dirksen Senate Office Building. is at the desk be granted the privileges the changes at the desk. The purpose of the hearing is to re- of the floor during debate on the mo- The PRESIDING OFFICER. Without ceive testimony on S. 2052, a bill to tion to proceed to H.R. 3509 and the objection, it is so ordered. cloture vote on the motion to proceed. amend the Energy Policy Act of 2005 to f require the Secretary of Energy to The PRESIDING OFFICER. Without carry out a research and development objection, it is so ordered. APPOINTMENT The list follows: and demonstration program to reduce The PRESIDING OFFICER. The manufacturing and construction costs Laura Hoffmeister, Scott Berkowitz, Mary Baker, Bridget Mallon, Blaise Cote, Maryum Chair, on behalf of the majority leader, relating to nuclear reactors, and for Janjua, Audrey Schultz, Kaitlin Guarascio, pursuant to Public Law 111–25, another purposes and S. 2812 the Nuclear Margaret (Angela) Franklin. nounces the appointment of the fol- Power 2021 Act. f lowing individuals to serve as members Because of the limited time available of the Ronald Reagan Centennial Com- CONDITIONAL ADJOURNMENT OF for the hearing, witnesses may testify mission: the Honorable DIANNE FEIN- THE HOUSE AND CONDITIONAL by invitation only. However, those STEIN of California vice Frank wishing to submit written testimony RECESS OR ADJOURNMENT OF Fahrenkopf of Nevada and the Honor- THE SENATE for the hearing record may do so by able JIM WEBB of Virginia vice Sig sending it to the Committee on Energy Mr. DORGAN. Mr. President, I ask Rogich of Nevada. and Natural Resources, United States unanimous consent that the Senate f Senate, Washington, D.C. 20510–6150, or proceed to the immediate consider- by e-mail to Rosemarie ation of H. Con. Res. 214, the adjourn- EXECUTIVE SESSION [email protected] ment resolution received from the For further information, please con- House and at the desk. tact Jonathan Epstein at (202) 224–3357 The PRESIDING OFFICER. The EXECUTIVE CALENDAR or Rosemarie Calabro at (202) 224–5039. clerk will report the concurrent resolu- Mr. DORGAN. Mr. President, I ask f tion by title. unanimous consent that the Senate The legislative clerk read as follows: proceed to executive session to con- AUTHORITY FOR COMMITTEES TO A concurrent resolution (H. Con. Res. 214) sider en bloc Executive Calendars Nos. MEET providing for a conditional adjournment of 535, 536, 537, 538, 539, 540, 541, 542, 543, COMMITTEE ON ARMED SERVICES the House of Representatives and a condi- 544, 545, 546, 547, 548, 549, 551, and all tional recess or adjournment of the Senate. Ms. STABENOW. Mr. President, I ask nominations on the Secretary’s Desk unanimous consent that the Com- There being no objection, the Senate in the Foreign Service; that the nomi- mittee on Armed Services be author- proceeded to consider the concurrent nations be confirmed en bloc; the mo- ized to meet during the session of the resolution. tions to reconsider be laid upon the Senate on November 20, 2009, at 2 p.m. Mr. DORGAN. I ask unanimous con- table en bloc; that no further motions The PRESIDING OFFICER. Without sent that the concurrent resolution be be in order; that any statements relat- objection, it is so ordered. agreed to and the motion to reconsider ing to the nomination be printed in the be laid upon the table. COMMITTEE ON FINANCE RECORD; that the President be imme- The PRESIDING OFFICER. Without diately notified of the Senate’s action, Ms. STABENOW. Mr. President, I ask objection, it is so ordered. unanimous consent that the Com- and the Senate resume legislative ses- The concurrent resolution (H. Con. sion. mittee on Finance be authorized to Res. 214) was agreed to, as follows: meet during the session of the Senate The PRESIDING OFFICER. Without H. CON. RES. 214 objection, it is so ordered. on November 20, 2009, at 10 a.m., in 215 Resolved by the House of Representatives (the Dirksen Senate Office Building. The nominations considered and con- Senate concurring), That when the House ad- firmed are as follows: The PRESIDING OFFICER. Without journs on the legislative day of Thursday, objection, it is so ordered. November 19, 2009, or Friday, November 20, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION f 2009, on a motion offered pursuant to this concurrent resolution by its Majority Leader Paul K. Martin, of Maryland, to be Inspec- PRIVILEGES OF THE FLOOR or his designee, it stand adjourned until 2 tor General, National Aeronautics and Space Mr. BINGAMAN. Mr. President, I ask p.m. on Tuesday, December 1, 2009, or until Administration. the time of any reassembly pursuant to sec- unanimous consent that the privileges EUROPEAN BANK FOR RECONSTRUCTION AND tion 2 of this concurrent resolution, which- DEVELOPMENT of the floor be granted to Nassim ever occurs first; and that when the Senate James LaGarde Hudson, of the District of Zecavati, who is a fellow in my office. recesses or adjourns on any day from Friday, Columbia, to be United States Director of The ACTING PRESIDENT pro tem- November 20, 2009, through Wednesday, No- the European Bank for Reconstruction and vember 25, 2009, on a motion offered pursuant pore. Without objection, it is so or- Development. dered. to this concurrent resolution by its Majority DEPARTMENT OF STATE Mr. HARKIN. Mr. President, I ask Leader or his designee, it stand recessed or unanimous consent that the following adjourned until noon on Monday, November Jose W. Fernandez, of New York, to be an 30, 2009, or such other time on that day as Assistant Secretary of State (Economic, En- HELP Committee fellows be granted may be specified in the motion to recess or ergy, and Business Affairs). the privilege of the floor for the dura- adjourn, or until the time of any reassembly Frederick D. Barton, of Maine, to be Rep- tion of consideration of H.R. 3590, the pursuant to section 2 of this concurrent reso- resentative of the United States of America legislative vehicle for the Patient Pro- lution, whichever occurs first. on the Economic and Social Council of the

VerDate Nov 24 2008 03:51 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00063 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.026 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11888 CONGRESSIONAL RECORD — SENATE November 20, 2009 United Nations, with the rank of Ambas- LEGISLATIVE SESSION government’s spending by rationing sador. The PRESIDING OFFICER. The Sen- your access to health care. Let me re- MILLENNIUM CHALLENGE CORPORATION ate will resume legislative session. peat that. This bill aims to control the government’s spending by rationing Daniel W. Yohannes, of Colorado, to be f Chief Executive Officer, Millennium Chal- your access to health care. There are lenge Corporation. ORDERS FOR SATURDAY, at least four government entities—we INTER-AMERICAN DEVELOPMENT BANK NOVEMBER 21, 2009 decided to call them ‘‘the rationers’’— Gustavo Arnavat, of New York, to be Mr. DORGAN. Mr. President, I ask that will stand between you and your United States Executive Director of the unanimous consent that when the Sen- doctor, and these four entities are rep- Inter-American Development Bank for a ate completes its business today, it ad- resented by the four walls on this chart term of three years. journ until 9:45 a.m., tomorrow, Satur- behind me blocking the doctor-patient DEPARTMENT OF STATE day, November 21; that following the relationship. You can see a pair of sen- Frederick D. Barton, of Maine, to be an Al- prayer and pledge, the Journal of pro- ior citizens and with frowns on their ternate Representative of the United States ceedings be approved to date, the faces and then we have the rationers. of America to the Sessions of the General morning hour be deemed expired, the We have an institute, a board, a center, Assembly of the United Nations, during his time for the two leaders be reserved for and a task force, some of which are in tenure of service as Representative of the their use later in the day, and the Sen- place now and some are not. But every United States of America on the Economic ate resume consideration of the motion Senator should know about them and and Social Council of the United Nations. to proceed to H.R. 3590, with debate as every health care recipient or espe- Robert R. King, of Virginia, to be Special cially senior citizen should know about Envoy on North Korean Human Rights provided for under the previous order. them. Senator REID’s bill establishes Issues, with the rank of Ambassador. Finally, I ask that the Republicans William E. Kennard, of the District of Co- control the time from 8 p.m. until 9:30 the Patient-Centered Outcomes Re- lumbia, to be Representative of the United p.m. tonight. search Institute—that is the first States of America to the European Union, The PRESIDING OFFICER. Without wall—to conduct something called with the rank and status of Ambassador Ex- objection, it is so ordered. comparative effectiveness research, or traordinary and Plenipotentiary. f CER, which is research that compares Carmen Lomellin, of Virginia, to be Per- two or more of the same treatment op- manent Representative of the United States PROGRAM tions for the same condition to see of America to the Organization of American Mr. DORGAN. Mr. President, at 8 which one works best. That sounds like States, with the rank of Ambassador, vice a good idea. But, unfortunately, when Hector E. Morales, resigned. p.m. tomorrow, the Senate will proceed CER is conducted by a government Cynthia Stroum, of Washington, to be Am- to a rollcall vote on the motion to in- bassador Extraordinary and Plenipotentiary voke cloture on the motion to proceed under pressure to meet a budget, it can of the United States of America to Luxem- to H.R. 3590, the legislative vehicle for be manipulated in some very sinister bourg. the Patient Protection and Affordable and counterproductive ways, as has Michael C. Polt, of Tennessee, a Career Care Act of 2009. been demonstrated by the United King- Member of the Senior Foreign Service, Class f dom’s CER Institute. They call theirs of Minister-Counselor, to be Ambassador Ex- the National Institute for Health and traordinary and Plenipotentiary of the ORDER FOR ADJOURNMENT Clinical Excellence. The acronym is United States of America to the Republic of Mr. DORGAN. I ask unanimous con- NICE, but NICE is not very nice in Estonia. sent that following the remarks of Sen- Great Britain. John F. Tefft, of Virginia, a Career Mem- ator ENZI, the Senate adjourn under NICE is notorious for delaying or ber of the Senior Foreign Service, Class of Minister-Counselor, to be Ambassador Ex- the previous order. outright denying access to health care traordinary and Plenipotentiary of the The PRESIDING OFFICER. Without treatments based on CER that takes United States of America to Ukraine. objection, it is so ordered. into account the cost of the treatment David Huebner, of California, to be Ambas- The Senator from Kansas. and the government’s appraisal of the sador Extraordinary and Plenipotentiary of f worth of the patient’s life or comfort. the United States of America to New Zea- Some of the more shocking CER deci- SERVICE MEMBERS HOME OWNER- land, and to serve concurrently and without sions handed down by NICE over the SHIP TAX ACT OF 2009—MOTION additional compensation as Ambassador Ex- years include: restricting access to traordinary and Plenipotentiary of the TO PROCEED—Continued United States of America to Samoa. drugs to save seniors’ vision from Mr. ROBERTS. Mr. President, I ask macular degeneration until the patient Peter Alan Prahar, of Virginia, a Career unanimous consent that I be permitted Member of the Senior Foreign Service, Class is blind in one eye, inconceivable; de- of Counselor, to be Ambassador Extraor- to engage in a colloquy with my Re- nying access to breakthrough treat- dinary and Plenipotentiary of the United publican colleagues. ments for aggressive brain tumors; and States of America to the Federated States of The PRESIDING OFFICER. Without refusing to allow Alzheimer’s therapy Micronesia. objection, it is so ordered. until the patient deteriorates. DEPARTMENT OF HEALTH AND HUMAN SERVICES Mr. ROBERTS. Mr. President, this is The Patient-Centered Outcomes Re- Pamela S. Hyde, of New Mexico, to be Ad- the health care bill. There are a lot of search Institute will be the American ministrator of the Substance Abuse and things in this bill that I object to. The version of NICE using CER to save the Mental Health Services Administration, De- $2.5 trillion cost, the 24 million people government money by rationing your partment of Health and Human Services. still left uninsured, the unconscionable health care. 1 NOMINATIONS PLACED ON THE SECRETARY’S $ ⁄2 trillion cuts to Medicare and our Over the past few months, I have of- DESK senior citizens, with another $1⁄2 tril- fered several amendments, along with FOREIGN SERVICE lion in job-killing tax increases, in my Senators KYL, COBURN, and ENZI, to view, the stunning assaults on liberty, PN282–2 FOREIGN SERVICE nomination of protect American patients from NICE- Terence Jones, which was received by the and the Orwellian policies making style rationing, to prohibit this bill Senate and appeared in the Congressional health insurance even more expen- from valuing cost containment over Record of April 20, 2009. sive—any one of these things would the care of patients. Unfortunately, PN929 FOREIGN SERVICE nominations make me vote no on this bill. But one they have all been voted down on (126) beginning Andrea M. Cameron, and end- issue has me troubled the most; that is, party-line votes in the HELP Com- ing Aleksandra Paulina Zittle, which nomi- the issue of rationing. We have several mittee, the Finance Committee, and nations were received by the Senate and ap- of my colleagues here who will speak previously on the floor. peared in the Congressional Record of Sep- to this subject, and we will engage in a Let’s move to the independent Medi- tember 10, 2009. colloquy. I don’t think this issue has care advisory board. That is the second PN964 FOREIGN SERVICE nominations (168) beginning Laurie M. Major, and ending sunk in with the American people and, wall between patients and their doctor. Maria A. Zuniga, which nominations were re- for that matter, the media. The Obama-Reid bill establishes a new ceived by the Senate and appeared in the I want everyone to understand some- independent Medicare advisory board, Congressional Record of September 17, 2009. thing. This bill aims to control the an unelected body of 15 experts who

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00064 Fmt 0637 Sfmt 0634 E:\CR\FM\A20NO6.015 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11889 will decide Medicare payment policy sibility for these screenings and for the summer that, as patients get closer to behind closed doors with minimal con- health care needs they could poten- the end of their life: ‘‘Maybe you’re gressional input—something that is tially reveal will be greatly expanded if better off not having the surgery, but happening all too often around here. this health care reform bill passes. taking the shots and the painkiller’’ Although the bill says this anonymous In the words of one prominent Har- instead. board shall not include any rec- vard professor: Well, as someone who falls toward ommendation to ration health care, Tens of thousands of lives are being saved the end of Dr. Emmanuel’s bell curve what else would you call denying cov- by this screening, and these idiots want to do here—as shown over here on this erage for Medicare patients based on away with it. It’s crazy. It’s unethical, real- chart—this type of thinking is unbe- cost? That is what this board will do— ly. lievable: Telling someone they cannot deny payment for knee replacements or The outcry from oncologists, the have a knee replacement because they heart surgery or breakthrough drugs, American Cancer Society, the Amer- are too old? How old is too old, accord- all to achieve an arbitrary government ican College of Radiology and breast ing to Dr. Emmanuel? spending target. I don’t know what you cancer survivors and families across The Wall Street Journal reported on the age rationing that occurs in Can- call that, but I call it rationing. Also the country has forced our Health and ada. In that country, apparently 57 is notice that this board will necessarily Human Services Secretary, Kathleen too old for hip surgery. Perhaps they ration access to health care based on Sebelius, to backpedal away from the can drive south and find care right here age and disability. Its payment policies task force recommendation, saying in the United States. But I am not sure will only affect the elderly and dis- they do not affect government policy. As a matter of fact, Secretary Sebelius where they will go if this bill passes. abled who receive Medicare. The White House may complain that said: Let you and your doctor make the What will be a patient’s recourse if I am taking Dr. Emmanuel’s musings decision. But this bill relies on the Medicare refuses to pay for an innova- out of context. My response to that is task force’s recommendation, some 14 tive new therapy that could save or this: This is the context right here. prolong their life? These are the rea- times throughout the legislation, to This is how the government will con- sons why the Wall Street Journal has set benefits and determine copayments tain costs. All these policies must be dubbed this board the rationing com- and make grant awards. So contrary to viewed through the prism of these mission. the Secretary’s assertion, if this bill ideas: This institute, this board, this Let us move now to the CMS innova- passes, the recommendation of the task center, this task force follows that tion center. We come to the third wall force will become government policy. blueprint. This is the goal: to save the between the doctor and patients. The Not only that, it will be forced onto government money by rationing care, Centers for Medicare and Medicaid private insurers as well. by basing that rationing on some pseu- Services, or CMS—and every provider Some may ask, after my comments: doscientific graph such as this. At least knows what that is—administers the Why so cynical? Why not trust these in the United Kingdom they are honest Medicare Program upon which 43 mil- tools that they will only be used for about it. lion Americans rely. That is almost 15 good, to advance medical science and These are the tools of rationing. percent of the population. CMS already patient care. I hope that is the case. To These tools will restrict your ability, rations care. This has already been re- those folks I answer by showing this and your family’s ability, to get a knee ferred to by Senator THUNE and others chart over here by Dr. Ezekial Emman- replacement or a breakthrough cancer in their comments on the floor. It is uel and his ‘‘complete lives system.’’ drug or treatment for Alzheimer’s or a not authorized to but it does so indi- As many of you know, Dr. Emmanuel is mammogram. rectly through payment policies that the brother of White House Chief of They will destroy the American curtail the use of virtual colonoscopies, Staff Rahm Emmanuel. He is a health care system—the best health certain wound-healing devices, and bioethicist, one of those special advis- care system in the world. And they are asthma drugs. In fact, courts recently ers to the President. Perhaps he could the main reason why I will vote no on had to intervene to prevent CMS from actually be the rationing czar. this bill. rationing a relatively expensive asth- Dr. Emmanuel has published very I yield to Senator SNOWE. ma drug in Medicare because rationing disturbing ideas on how to ration care, The PRESIDING OFFICER. The Sen- is currently against the law. which could be summed up by this ator from Maine. However, the Reid bill establishes a ‘‘Brave New World’’ humpback whale Ms. SNOWE. Mr. President, as I rise new CMS innovation center which will, graph we have here, along with aging this evening after months of effort and for the first time, grant CMS broad au- groups of the population. countless hours of meetings, discussions, and markup in the Senate Fi- thority to decide which treatments to Dr. Emmanuel’s Complete Lives Sys- nance Committee to craft a health care ration. tem—something that sounds a little bit Let’s go now to the U.S. Preventive like a cure-all elixir sold out of Del reform bill, I have come to the floor to talk strictly about the substance and Services Task Force. That is the last Rio, TX—basically works off the policy of one of the most complex and one right here. The U.S. Preventive premise that the older you are, the intricate undertakings the Congress Services Task Force is yet another more you have lived and, therefore, the has ever confronted. panel of appointed experts—a lot of less you deserve in terms of health Instead, we are confronted with pro- those in this bill—who make rec- care. cedural gyrations that are as baffling ommendations on what preventive I would like to point out that the av- to those living outside the beltway as services patients should receive. erage age of a Senator is 62—just some- they are, unfortunately, for those who Currently, the task force rec- thing for all of you to think about, as would prefer to achieve broader agree- ommendations are optional, but the you look at this chart depicting the ment on some of the most critical ele- Reid bill bequeaths this unelected and Complete Lives System. ments of health care reform. unaccountable body with new powers As shown on this chart, if you are 10 As one who has worked construc- to determine insurance benefit require- years old, you are doing pretty good tively to forge solutions to this en- ments in Medicare, Medicaid, and even right here. Twenty years old, that is demic problem plaguing our health in the private market. when you think you are bulletproof care system, I think it is absolutely an The task force has already revealed and you do not want insurance, but you imperative to ensure affordable health the types of recommendations it will have a lock under this plan. Thirty insurance coverage to the people of be making. Just last week it decided to years old, you are in pretty good shape. this country. But it must be done in an reverse its longstanding recommenda- Forty, here comes the roller coaster. effective, commonsense, and bipartisan tion that women get regular, routine Fifty, you are in trouble. Sixty, you way. It matters what is in those 2,000 mammograms to detect breast cancer might as well forget it. Seventy, well, pages. starting at age 40. One has to wonder if you are off the chart. That is why I find it deeply dis- the task force’s abrupt about face has President Obama has clearly listened concerting that the Senate, in its arti- anything to do with the fact that the to Dr. Emmanuel’s counsel. Remember ficially generated haste to begin de- Federal Government’s financial respon- his observation in an interview this bate, has resorted to this convoluted

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00065 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.076 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11890 CONGRESSIONAL RECORD — SENATE November 20, 2009 process before us in which we first vote So even as everyone has differing tion give deference to the scope and to proceed to an empty shell bill, which opinions on how to address this issue, complexity of the issue—and there is then replaced with actual health re- virtually everyone I have encountered should be an inclination by the major- form legislation that is the result of agrees the system is broken. In a re- ity to earn broader support. The bot- behind-the-scenes integration of the cent poll that asked: ‘‘How much, if at tom line is, policies that will affect two bills that were passed by the Sen- all, should the health care system in more than 300 million people simply ate Finance Committee as well as the the U.S. be changed,’’ an astounding 84 should not be decided by partisan, one- Health, Education, Labor, and Pen- percent said either ‘‘a great deal’’ or ‘‘a vote-margin strategies. sions Committee. moderate amount’’—84 percent. Thinking back over the last century, The reality is, beginning our delib- The National Small Business Asso- just consider for a moment if Social erations in the Senate with tactics ciation reports that 62 percent of all Security, civil rights, or Medicare rather than transparency does nothing small business owners want Congress could have been as strongly woven into to enhance credibility with the Amer- to enact some kind of reforms—and no the fabric of our Nation had they ican public at a time when so many are wonder, as our small businesses have passed by only one vote and on purely already understandably wary of the experienced annual premium increases partisan lines. Instead, as you can see speed and direction of Congress on this of at least 20 percent, year after year from this chart, these votes all oc- transformational issue. after year. curred during a time when Democrats As I have mentioned on numerous oc- The reality that this is not simply a controlled both the Congress and the casions, it took a year and a half to solution in search of a problem is what White House. pass Medicare to cover 20 million sen- brought us together in the Senate Fi- Social Security passed the Senate iors. So we simply cannot address nance Committee in the so-called Gang with 64 percent of Republican support, health care on the legislative fast of 6 that I—and I commend Chairman 79 percent of Republican support in the track. I am truly disappointed we are BAUCUS and Senator GRASSLEY as well. House; civil rights, 82 percent of the commencing this historic debate on Chairman BAUCUS wanted to convene Senate Republicans, and in the House, one of the most significant and press- on a bipartisan basis earlier this year, 80 percent of Republicans; Medicare, ing domestic issues of our time with a which was the only bipartisan effort in when it passed, in 1965, had the support process that has drawn a political line any committee of the House or Senate. of 41 percent of Senate Republicans, in the sand and forestalled our ability We met more than 31 times to debate and in the House, 50 percent of the Re- to arrive at broad consensus on some of policy, not politics, in attempting to publicans. the most crucial elements of health reach a bipartisan consensus on reform So there was significant bipartisan care reform. legislation. This reflected the kind of support because it engendered a proc- Again, I arrive at this moment as one extensive, meticulous process that an ess that yielded bipartisanship and a who has been fully immersed in this issue of this magnitude requires. Be- consensus-based approach. Those are issue with the Senate Finance Com- cause the American people understand not only impressive numbers illus- mittee process and the so-called Group intuitively that when you are debating trating the strong bipartisan support that landmark legislation has garnered of Six within the committee, where we the future of one-sixth of our economy, in the past, but they would be nothing engaged in deliberations for almost 4 and a matter of such personal and fi- short of mythological in today’s polit- months, intensively, on a weekly nancial significance to every Amer- ical environment. Because at a time basis—recognizing the perilous state of ican, we should not be railroading solu- when we are supposed to be in a world health care coverage in America and tions along partisan lines. of postpartisan politics, here we are also recognizing the looming trajectory To that point, on a cautionary note facing a vote along partisan lines. of unsustainable costs in our health for all of us, a recent Gallup poll con- When it comes to the subject at hand, care system is a critical problem that, cluded that neither party can boast the most consequential health care leg- indeed, must be solved. that a majority of Americans are cur- islation in the history of our country Ten million more Americans have rently behind them on this issue. With- and reordering $33 trillion in health lost their insurance since the last at- out question, people are already appre- care spending over the coming decade, tempt at health care reform in 1993. hensive about Congress’s ability to re- surely, we can and must do better. Today, 75 million Americans are bur- form this system—with Gallup also In a recent column, David Broder dened by inadequate or nonexistent finding that 66 percent of Americans captured perfectly the path we should coverage. Over the last decade, insur- also believe their Member of Congress be following. He wrote: ance premiums alone have risen by 131 does not have a ‘‘good understanding’’ Scholars will also make the point that percent—if you look at this chart, 131 of the issues involved in the current de- when . . . complex legislation is being percent, contrasting that with the bate. shaped, the substance is likely to be im- growth in wages of 38 percent and infla- Well, if there is one thing I have proved when both sides of the aisle con- tion at 28 percent. That is what has learned from my more than 30 years of tribute ideas. happened over this last decade alone legislative experience, it is that the I could not agree more. So when it when it comes to health insurance only way to allay people’s fears is by comes to procedural gymnastics de- costs. systematically working through the signed to move us to a purely partisan In my home State of Maine, from 2001 concerns, the issues, and the alter- bill as quickly as possible, on an issue to 2009, we have been hammered with a natives. In fact, it was an adherence to as monumental as health care, that stunning 271-percent increase in aver- those very tenants that led up to the only serves to enhance public cynicism age health insurance premiums in our Finance Committee markup that was at a time when congressional approval small group insurance market. It has reported out of the committee and ratings already hover consistently in been estimated by the Business Round- which I supported because, while far the 20th percentile range and after a table that we can expect premiums to from perfect, it produced watershed, bi- vote on the House reform bill that oc- grow 166 percent by 2019, absent any re- partisan market reforms and navigated curred after a grand total of two form. the ideologies on both ends of the polit- amendments and 12 hours 32 minutes of So given this current trend, health ical spectrum—by bolstering what debate on almost 2,000 pages of a docu- care costs will continue to grow, and works in our current system, building ment. more than double the rate of inflation, upon the employer-based system, and Consider that it has been more than further driving up premiums, sending fostering choices, competition in cov- a month since the Finance Committee the entirety of our health insurance erage, and changing the accelerating completed its work on legislation— system into a death spiral. cost curve of our health care spending. even as it concluded that, work re- Health care spending could total over At the same time, that was one, al- mained to be done—a month in which $33 trillion in the next decade, and av- beit significant, step in the process. As progress might have been made toward erage costs of an employer-based fam- said in my remarks at the conclusion building greater consensus on some of ily health plan will reach $30,800 just a of the markup, it would be imperative the most critical and contentious mat- decade from now, should we fail to act. moving forward that our course of ac- ters in this debate.

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00066 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.077 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11891 But that opportunity was regrettably inhibit the entry of new competitors America. Just yesterday, the NFIB re- forsaken. I cannot support moving to a and could undermine achieving the leased a statement opposing the bill— health care reform bill on a procedural highly competitive environment we the National Federation of Independent motion designed to prevail not on pol- must have to make industry deliver Businesses—saying that enactment of icy grounds but on partisanship. Be- lower cost coverage. it would make health care for small cause the result is, this procedural vote Just when we want to provide Ameri- businesses more expensive than what tomorrow presents a serious obstacle if cans a wide variety of competitive they can afford today—a ‘‘disaster for you have substantial concerns about plans, can inserting a public option small business’’ is how NFIB describes the legislation—as the process going into smaller States such as my own ac- it. That is coming from a group that forward will likely require a threshold tually encourage new plans to enter supported the Senate Finance legisla- of 60 votes to add, change, or remove those markets or will we see just a pair tion and has been a constructive voice any major provision, including a public of plans—the existing dominant insurer throughout the debate, so that ought option plan, that was not included in and the government, and is that lim- to grab our attention. the final Finance Committee legisla- ited option really the choice Ameri- Furthermore, in the Finance Com- tion. cans want? When we also consider the mittee I insisted that CBO provide an I think we all appreciate the impetus difficulties we have experienced in im- affordability analysis of what a ‘‘sil- for the public option; that is, a funda- proving care and assuring prompt, fair, ver’’ plan would look like, for example, mental mistrust of the insurance in- and accurate payments in Medicare and I used that analysis to do my own dustry. That is a sentiment I strongly and Medicaid, we certainly must ask modeling on all of the plans. It helped share, as many have been victimized by whether a public plan would spur the me to assess premium affordability and their egregious practices in denying innovation that is so vital in health render an informed evaluation about coverage based on preexisting condi- care coverage. the approach overall. For the measure tions, rescinding coverage because But we also cannot leave the per- before us now, the CBO has yet to as- someone actually has the temerity to formance of insurance companies and sess the question of affordability on get sick, or discriminating based solely the success of reform to chance. I have this revised, integrated bill. So exactly on one’s gender. proposed there is a role for a Federal how do we go forward on this legisla- In my home State of Maine, that safety net plan if affordable choices tion and consider it when we don’t even mistrust couldn’t be more profound— that are specifically defined aren’t of- understand some of the most funda- where two companies controlling 88 fered in a given State. Moreover, under mental aspects of this legislation? percent of the market has resulted not my provision, companies would submit None of us can tell with adequate spec- only in the inconceivable increases in their pricing a year prior to the open ificity at this point what an average premiums I described earlier but has enrollment period, and if it is deter- plan will look like, which is what forced thousands in my State to pur- mined that affordable plans aren’t Americans are going to be asking us. chase plans with a remarkable $15,000 available in a State, the insurer would What are the premiums? What are the deductible for an individual and $30,000 have 30 days to resubmit their bid. At deductibles? What are the copays? for a family. that point, if affordable plans still What are the coinsurance require- As I was told by one of our insurance aren’t offered, a Federal fallback is ments? companies—one of the two in Maine provided without delay. This will pro- These are questions Americans right- that dominate the market—it has be- vide the certainty that affordable op- fully will ask and are asking. What will come one of the most popular plans by tions exist so that no one falls through reform mean to them? What will it virtue of its affordability, by virtue of the cracks, while CBO also reports that look like? What will they pay for? the fact that it is all people can afford the threat of a fallback in a State Those are the answers to the questions in the State of Maine and certainly would also pressure industry to lower we do not have because we haven’t had among small business owners. Well, premiums. a chance to evaluate this legislation, that is unconscionable. That is unac- In stark contrast, the bill we will and we are going to have a vote tomor- ceptable. When we think of their basic consider on the floor not only incor- row night to move along party lines— coverage having a $15,000 deductible for porates a public option but also a State to ram it, to jam it—and that is what an individual, $30,000 for a family, that opt-out provision that will allow any I am hearing from my constituents. is not what you would describe as rea- State at any time to drop that public They say: Do you really know what is sonable coverage. plan for any reason whatsoever, irre- in those 2,000 pages? They are asking In response to that, I have worked to spective of whether their residents in the right questions with great validity. implement principles on which many of that State actually have access to af- They believe their lives are out of con- us have been adamant: ending fla- fordable plans. So if affordability is our trol because they see Washington and grantly unfair practices so no Amer- goal—and it certainly is—then will they think Washington is out of con- ican can be denied coverage, no policy someone explain to me exactly how an trol because we don’t have a profound can be rescinded when illness strikes, indiscriminate opt-out achieves that understanding of what we are doing. and no plan can be priced based on end when a State could decide on a po- That is why it took so long in the Fi- health status or gender. litical whim it would not allow a public nance Committee for 4 months. It To address the dearth of competition plan and leave its residents without af- wasn’t enough to be immersed in inten- in the market, we created health insur- fordable choices? sive discussions and deliberations. ance exchanges to become a powerful It simply makes no sense. Rather, we There were artificial deadlines that marketplace for creating competition ought to take the safety net approach were set time and time again from and lowering premiums by bringing in at the forefront as we did in Medicare March to April to May to June, July, potentially 30 million new customers, Part D, which spurred competition and, August, September, October. It has which CBO believes could reduce costs as a result, it never was triggered, and gone on. Christmas now is the deadline. up to 10 percent. That is not even talk- to ensure affordability not just in some The State of the Union is the deadline. ing about the tax credits and the sub- States but in all 50 States. I happen to Why not just try to get it right? sidies. So clearly the exchanges will believe a person’s Zip Code should I have heard time and again people have a significant effect on lowering never dictate their ability to access af- say we just have to do something. Well, prices through administrative changes fordable health care coverage. what I am hearing from my constitu- in competition. So the public option provision is of ents and from many Americans is that I would argue that we have taken paramount concern. At the same time, it is not just doing something, it is these groundbreaking steps to alter the in examining the proposed legislation, doing the right thing. Every line and competitive landscape. I strongly beit is not my only concern. There are every word in this 2,000-page document lieve that inserting a government- practicalities to what we are doing, matters because it is going to have pro- sponsored plan in today’s dysfunctional and I am concerned, quite frankly, that found ramifications and implications. marketplace—before reforms can work this legislation misses the mark as far There are unintended consequences. It to improve the market—could actually as addressing the needs of Main Street is not just about cobbling something

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00067 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.078 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11892 CONGRESSIONAL RECORD — SENATE November 20, 2009 together in the dark of night. It is similar benefits just 4 years before the America remembers that the House about making sure those mechanics Social Security disability insurance passed their health care bill, H.R. 3962, work and what it is going to cost the trust fund is expected to be exhausted on November 7, late at night, on a Sat- average consumer, what it is going to as opposed to first fixing that program? urday night, the same type of thing we do to small businesses, what it is going I intend to offer amendments as leg- are looking at here. to do in this time of perilous economic islation is considered on the Senate Let me say one thing. I was surprised climate. We simply must ensure that floor, and the impending amendment to hear the unanimous consent request an affordable coverage option is avail- process will be a true test of whether that was made just a few minutes ago able to every individual and small busi- there is a will to improve this legisla- because it was an admission—and I ap- ness. tion in a nonideological, bipartisan preciate their honesty—that what we I get back to the affordability ques- manner. On that note, I hope the past are going to be voting on tomorrow tion because that is the heart and soul is not a predictor of the direction we night has nothing to do with H.R. 3590. of this matter. We have to be assured are headed because in the final anal- Yet that is what we are going to be that we are going to provide affordable ysis, no one has a monopoly on good moving to. health insurance plans. That is why I ideas. It is not a conservative idea, They stated that at 8 p.m. tomorrow recommended—and I am going to push moderate idea, or a liberal idea. It is a night the Senate will proceed to a roll- that through the amendment process— good idea to improve this legislation call vote on the motion to invoke clo- that we open the ‘‘young invincible’’ or because that is what is going to be our ture on the motion to proceed to H.R. the catastrophic plan as described in most pressing, most focused, singular 3590, the legislative vehicle for the Pa- the majority leader’s bill. We should goal—to improve the legislation that tient Protection and Affordable Care open up to everybody. It is now avail- will be before us, irrespective of who is Act. My thinking was—and I still think able to those under the age of 30, but offering the amendment or who has the there are a lot of Democrats who would we should open these plans to all to en- votes or whether it is the 60 votes. end up voting for this tomorrow night sure that no one has to buy up into a That is my concern, if it is going to and would send out a letter to con- more expensive plan if they don’t take 60 votes to undo and change those stituents: Oh, this is a vote that is choose to. provisions that are absolutely essential going to help our military with some of I have also advocated throughout to be modified. the problems they have. this process for the very first time na- The American people have expressed This reminds me so much, the way tional plans which I included in the Fi- a sharp and legitimate note of caution this is taking place, of what happened nance bill, as small businesses should as we pursue health care reform, espe- in the Environment and Public Works Committee when they were trying to be able to purchase plans with uniform cially during these challenging eco- get through the massive cap-and-trade benefit packages sold across State nomic times. It is a message we would bill which they did and they voted it lines which is vital to enhancing com- do well to reflect. So let the tone we out without any Republicans there. It petition and increasing choices for con- set for this unprecedented debate rise is on the Senate floor right now. It is sumers, and portability, and driving to the level of the problems we have a not going to be brought up because it is down premiums. In fact, we drive down responsibility to resolve. This is al- dead on arrival. The people of America premiums by more than 12 percent. ready an undertaking of historic pro- realize they don’t want to have the I will be introducing an amendment— portions. Let’s ensure this isn’t the largest tax increase in the history of because, regrettably, it is not going to only historic legislation passed in the be in the bill we will be considering— America on something that would do last half century on purely partisan no good. that States cannot opt out of these na- lines. But the point is, the deceptive meth- tional plans because these plans should Thank you, Mr. President. I yield to od to bring up that bill is the same be able to be available to every State the Senator from Oklahoma. thing we are dealing with now. I think The PRESIDING OFFICER. The Sen- in the country. by virtue of the fact they rammed it Finally, with our mounting deficits ator from Oklahoma. and jammed it, to borrow the terms and our struggling economy, if any- Mr. INHOFE. First of all, I thank the from the Senator from Maine, out of thing, we should be scaling back the Senator from Maine. She used the very the Environment and Public Works scope of health care reform wherever descriptive terms of ‘‘ram it’’ and ‘‘jam Committee caused it to go down. I possible. We should take our cues from it.’’ That is essentially what is hap- think the same thing is going to hap- the American people who rightly reject pening right now. I think everyone is pen here. more taxes and expanded government aware—all the media have taken pic- The second thing is a motion to pro- bureaucracy that will constrain our futures of the closed doors. They know ceed at 8 p.m. on Saturday night. Well, ture economic prosperity. So I am dis- that just a handful of Democrats were Saturday night. What are people doing turbed that the legislation we will be in there. Ironically, there are a lot of on Saturday night? They are not considering will increase Medicare pay- Democrats who didn’t know what was watching TV. They are not listening to roll taxes by $54 billion over the next 10 going on, either. But they came out the radio. They have ball games and years. That is diametrically opposed to with a product. It is not a good prod- other things the American people do in the tack we should be taking. We uct, and I will talk more about the the American way of life on a Saturday should be finding ways for cutting back product in a moment. night. and scaling back. ‘‘Practicality’’ But I think probably more signifi- Do you think it is just coincidental? should be the word of the day. cant and more concerning to a lot of That is the same time of night they Then we have the insertion of an- the people I talk to is the manner in ended up voting on the House health other new and costly program, the so- which this bill is being brought to the care bill, on a Saturday night. Of called CLASS Act. I understand its floor. It is beyond just being deceptive course, it got out with barely a major- laudatory goals. If it is going to be pro- that the Democratic leadership plans ity. viding long-term care, it is obviously to vote on Saturday night at 8 o’clock Now, not only is the way in which very important. Proponents point to to proceed to H.R. 3590, a bill that has the bill is being brought up question- the fact that it will raise $72 billion nothing to do with health care. This able, the substance of the bill is defi- over the first 10 years, but that is a bad bill is one that passed the House in Oc- nitely questionable. It has been re- timing shell game as it collects pre- tober of this year, 416 to 0. It would peated—I am trying to make a couple miums in 2011 but doesn’t begin paying pass the Senate by a unanimous vote, I of comments about this that have not benefits until 2016, near the end of our am sure. The bill is an eight-page bill really come to our attention as much current budget window. CBO has con- to ensure that our military service as other issues, the government-run cluded in the decade following 2029 the members are not excluded from the health care bill—that Republicans are CLASS Act will begin to increase the first-time home buyer tax credits, and working to ensure that Washington bu- deficit. How much sense does it make no one had any quarrel with that. The reaucracy does not get between the pa- to create this new bureaucracy, this House side wouldn’t have any quarrel, tients and their doctors. That is the new program, that will begin providing nor would we. But we all remember and big issue.

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00068 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.079 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11893 Now, you are going to hear shortly have covered that. The fact that they ceptable. But where we differ is cer- from my junior Senator from Okla- have taxes such as the 40-percent ex- tainly what leads us to the discussion homa, Mr. COBURN, who is an OB–GYN. cise tax on the so-called Cadillac this evening, and tomorrow, and up to He will talk about that. plans—that means if you, through your the vote tomorrow evening at 8 I don’t think you have to have a doc- own decision, decide that for your fam- o’clock. tor explain to you that if you, as in my ily you want to have more extensive Typically, this time of year, going case, have a very large family, with a coverage, you will get penalized. You into Thanksgiving and then the holi- lot of grandkids—we don’t want the could have a tax imposed upon you of days that follow in December, we con- government telling us what we can and 40 percent because you wanted to have sider this the season of giving, where cannot do. A government-run universal better treatment for your family. The we give thanks and do a lot of giving health care system or a socialized sys- CBO and the Joint Committee on Tax- back. Unfortunately, what we are look- tem is not the answer. ation have testified that these taxes ing at this particular November, with All you have to do is listen to some and fees would be almost entirely this particular bill, kind of makes it a of the testimony from individuals who passed on to consumers. The fact is season of taking—taking away your have come here, such as members of that they estimate, by 2019, 89 percent ability to choose the health insurance the Parliament in Great Britain, who of the taxes would be paid by those you want, taking away nearly $1⁄2 tril- came and addressed us in this building making less than $200,000 a year. It re- lion by cutting from Medicare—a pro- and said: We cannot believe that some- minds me of the regressive nature of gram that is already strapped, a pro- thing that has been such a failure, that the cap-and-trade tax, which would af- gram that provides so much for our we are trying to get away from, is fect the poor people more than the seniors and the disabled. But we recog- something you are now trying to move wealthier people. nize that program is seriously under- toward. Anyway, with the penalties and ev- funded and looking to literally go off a The other day, in the Wall Street erything else in there, we are going to cliff by 2017—by taking more of your Journal they talked about a Canadian be looking at something that the salary and increasing the Medicare citizen who waited in pain for more American people don’t want and should payroll tax for government intrusion than a year to see a specialist for his not have. That doesn’t mean Repub- into your health care decisions. arthritic hip. The specialist rec- licans don’t want to have reforms. We This health care bill is a massive ommended a state-of-the-art proce- need reforms. We need medical mal- overreach by the Federal Government dure, but the government bureaucrats practice reforms. I have two friends in that will result in our government hav- determined that the patient, who was Tulsa, two man-and-wife teams. There ing more involvement in your family’s only 57, was too old for that procedure. is Rick and Lisa Lowry. He is a cardi- health care decisions and greater gov- Rationing is alive and well. If you ologist and she is a dermatologist. ernment intervention, cutting into 16 don’t believe it, go up in the northern They moved to Texas. They will tell percent of our economy. part of the United States, to the Mayo you the only reason they did it is be- Before we get into the policy debate Clinic or some of those others, and you cause of the tort laws in Oklahoma. on the health care bill, I asked one of will see the large number of Canadians Then there is Boris and his wife Kathy, the interns in my office to go down to who come down to ‘‘barbaric’’ America, another pair of doctors. Boris is an the Dirksen post office. We had gotten with our system, because they couldn’t electrophysiologist, and she is a pain an inquiry from a constituent from get the treatment they needed through management doctor. They moved to Alaska wanting to know if we could rationing in Canada. Fayettville, AR. This is what is hap- send a copy of the bill. The bill, as you The Democrats’ bill represents an un- pening right now. can see on some of the Members’ desks, precedented expansion of government’s We know what reform is. We know is large. When it was weighed at the control over health care. Oklahoma that HSAs have worked, giving people post office in the Dirksen building, it physicians shared with me in a July choice. We want to have some reform. weighed in at 20 pounds 5.5 ounces. 23rd letter that they are concerned a We should keep in mind for tomorrow That is probably close to the size of the public option plan will unfairly com- that, at 8 o’clock, if just one Democrat turkey my family and I will purchase pete with the private market and ulti- would say, no, I don’t want a govern- for Thanksgiving. It is going to take mately crowd it out. It is a no-brainer. ment-run system—just one—they about $45 to mail that by priority mail You cannot compete with the Federal wouldn’t have 60 votes. It is going to be to Alaska. So we suggested that per- Government. All they have to do is interesting to see if there isn’t one. haps the Internet is a better option. change and the competition is gone. They will never get by with saying it In this 2,000-plus page bill, you will Under this bill, the government will was just a motion to proceed to a bill find the government requiring that you tell people what type of coverage they having to do with housing for the mili- comply with an individual mandate can and cannot have, mandate that tary. It will not happen. People are where the Federal Government is going every American have health care or smarter than that. I hope at least one to tell you you have to buy health in- pay a tax, mandate employers to pro- Democrat will oppose a government- surance, regardless of whether the pre- vide a certain level of benefits or pay a run system. We will find out tomorrow miums are affordable. This goes back fine, introduce a government-run plan night. to the concerns of the Senator from designed to destroy the private mar- With that, I yield to the Senator Maine. So much of this is about the af- ket, include new policies designed to from Alaska, Senator MURKOWSKI. fordability. If we require individuals to control what drugs and procedures The PRESIDING OFFICER. The Sen- purchase health care insurance but we Americans can receive, and require a ator from Alaska is recognized. have not done anything, or enough, to historic expansion of Medicaid. Accord- Ms. MURKOWSKI. I thank my col- make it more affordable for them, all ing to the Oklahoma Health Care Au- leagues and I thank particularly the we are doing is setting them up for ad- thority, the ones who administer the senior Senator from Maine for her ditional penalties. Failure to comply Medicaid Program called Soonercare, long, arduous work as part of a small will result in a $750 penalty per person they estimate that this type of expan- group of Senators who did try, hon- to a family. sion could cost Oklahoma an additional estly and with great integrity, to ad- We also know in this bill our govern- $128 million each year, resulting in vance this process so we would have a ment is going to be telling employers harmful cost to existing State prior- bipartisan product to deal with. I ap- they have to comply with employer ities. By the way, the Oklahoma Gov- preciate her efforts. I heard a little bit mandates, which place onerous pen- ernor and the State legislature are of her frustration as she spoke on the alties on a large number of our small talking about going into a special ses- floor this evening. I thank her for her businesses. These are businesses that sion because of the problems we have— leadership. have 50 or more employees. I think it is the budget problems. Of course, we I concur with my fellow Senator from important to recognize that the SBA, would then inherit this. Oklahoma that we all agree reforms Small Business Administration, defines This bill violates the President’s are needed in the health care world. We a small business as one with 500 or promise not to raise taxes. I think we all agree that the status quo is not ac- fewer employees. But for the purposes

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00069 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.080 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11894 CONGRESSIONAL RECORD — SENATE November 20, 2009 of the employer mandate, we are going keeping Medicare solvent—I mentioned are about to hit the magic age of 65, to say that if you have over 50 employ- earlier the insolvency cliff out there— going on Medicare, you have Medicare ees, you will be required to provide for and we are going to divert that money as your primary insurance whether you that insurance. not to keep Medicare solvent, not to like it or not. Let’s use an example here. Say you increase funds to Medicare, not to in- What you learn when you are on have a small business, you employ 51 crease patient access to doctors and Medicare is you have very few doctors employees, and one of those employees nurses, which so many of my constitu- willing to see you. Eighty-three per- receives a Federal subsidy for health ents are suffering from but, instead, we cent of the primary care doctors in insurance. Under this Democratic institute a new Medicare payroll tax Alaska’s largest city will not see Medi- health care reform bill, the employer that is used to pay for expanding the care patients. These individuals, who will be fined $750 for each of its 51 em- size of the Federal Government and before they were 65 enjoyed unfettered ployees—not just the one employee creating yet another federally run access to care when on private health who receives a subsidy but for all of health plan. We recognize that the in- insurance, whether they had it through them. So if you are a small business solvency of Medicare is real. The Medi- the municipality, Anchorage, or they owner in Alaska, in Anchorage, or care trustees report from 2009 said that worked for a private employer, they Fairbanks, or Juneau, who runs a res- Medicare is going to be insolvent by are now realizing the harsh realities of taurant or a small hotel, that employer the year 2017. But the drafters of the Medicare and that they are going to needs to know he could be subject to a bill don’t write a reform bill to fix face some severe restrictions in access total of over $38,000 in penalties if only Medicare insolvency. Rather, they are to a primary care doctor. one of his employees seeks a govern- using this as an opportunity to tax We are seeing it on a very accen- ment subsidy. This penalty provision Medicare funds to pay for the creation tuated basis in Alaska, but we are see- alone in the bill is estimated to raise of another Medicare-like system. This ing it in many parts of rural America. $28 billion to pay for the Democratic is truly the height of hypocrisy. It is It is almost unthinkable to me. A num- health program. working against what is right and what ber of constituents have come up to me The bill before us today also subjects should be done for Medicare. and have said: Look, just get us out of Americans to health insurance that the The inclusion of a 5-percent Medicare the Medicare system. Let us go out to Federal Government is going to define payroll tax is bad enough, but when the private market and purchase that this is what you have to have. one realizes that the tax is not indexed health insurance like we were able to What the drafters of this 2,000-plus to inflation, one can only cringe at the do before we were on Medicare because, page bill declare is it is an insurance financial pain that is ahead for Amer- regardless of the contributions I make, plan with a 60-percent actuarial value. ica’s middle class. regardless of how much I have paid In other words, all of the discussion There may be many people out there into the Medicare system, it doesn’t about ‘‘if you like the health care plan saying, oh, you are increasing taxes on mean anything to me if I don’t have ac- that you have, you can keep it’’—yes, the rich and individuals earning cess to care. in fact, you can, but only if it meets $200,000 or more, and couples earning They are saying: I know I have the definitions we are setting forth $250,000 or more, but you need to put worked all these years to pay in, but I within this, and the requirement is this in context and recognize how far want my old insurance back. It is be- that it is 60 percent of actuarial value. from the truth this can be. cause what we have done is restricted In Alaska, we have over 88 percent of Back in 1969, Congress enacted the al- their access to services, and it is some- the health benefits that are provided to ternative minimum tax, the AMT, to thing they have never dealt with be- individuals and small businesses by the ensure that fewer than 200 individuals fore. largest insurance company operating paid their fair share of taxes. Unfortu- This problem is not just in my State. there, Premera Alaska Blue Cross/Blue nately, the AMT was not indexed to in- According to GAO, we have States such Shield. We are told that 88 percent will flation, and today we have nearly 30 as Colorado, Oregon, and New Mexico not meet this 60-percent threshold re- million taxpayers who face the long that are facing these major restrictions quirement. So what does that mean? hand of the AMT tax, with many of in access to primary care doctors. Sen- You have had your insurance plan them falling squarely in the middle of ator Daschle, when he was doing his through Premera and your employer the middle class. health care tour last year, when he was provided it. But if it doesn’t meet this Congress has consistently taken ac- in Dublin, IN, and talking to doctors threshold requirement, what then hap- tion to protect the middle class from about how best to reform our health pens is that those small business em- the AMT. We do this, as we know care system, the doctors in Dublin told ployees will not be in compliance with around here, on a year-by-year basis, the Senator that the Medicare reim- the provisions of the bill, so you are and each year it is costing more than bursement rates are not keeping pace going to see penalties assessed. Many the previous year with the number of with the costs of a medical practice. So of my constituents will see those pen- people who face the tax growing each if we know that private insurance pays alties assessed. They may lose the in- year. The recent 1-year patch cost $70 significantly more than government insurance they have, which they like, but billion. A 10-year fix is expected to cost surance, then access under a govern- the penalty will be a massive increase $447 billion. Sadly, history has a habit ment plan will undoubtedly be reduced. in health care insurance premiums. of repeating itself, and Congress has We have seen this both in the Medicare When we talk about the promises of demonstrated a consistent inability to and the Medicaid Programs. health care reform and what we are learn from its mistakes. Under the Medicaid expansion pro- going to make available to you, I think My prediction is if the Medicare pay- gram in this health care bill, we know most people believe that with health roll tax increase becomes law, Congress that Medicaid is now going to include care reform would come a reduction in will, once again, need to spend large individuals up to 133 percent of pov- premiums, or at least not incredible in- sums of money to protect the middle erty. Under the Democrats’ health bill, creases in premiums. class from this onerous new tax. the Federal Government pays all the In this bill, we raid the strapped Let’s delve into the Medicare and costs covering newly eligible enrollees Medicare Program to pay for expanding Medicaid restrictions on doctors and through 2016. This is good for the the role of government in health care nurses under these government health States. It will allow Alaska, for exam- reform. We raid future payments to the programs. In my State of Alaska, in ple, to expand the roll of the Medicaid Medicare patients through increased our most populated city, Anchorage, Program and include more Alaskans on payroll taxes. I think it is important to we have very few general care doctors the State’s Medicaid Program. CBO recognize that this is an unprecedented who are willing to accept Medicare pa- said after 2016, the share of the Federal and dangerous step that plays a shell tients. We had a study done not too spending is going to vary somewhat game with Americans. We are going to long ago, and the number given in that from year to year but ultimately would increase your taxes through the Medi- study is there are 13 providers, 13 doc- average about 90 percent. care payroll tax, but then we are going tors who are taking on new Medicare- If you are responsible for your to divert that money to pay not for eligible individuals. In Alaska, if you State’s budget and your State can no

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00070 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.082 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11895 longer afford the Medicaid Program in I wish to mention, because there stance, the one about eliminating dis- the year 2017, when the Federal Gov- have been multiple accounts in the crimination based on preexisting con- ernment drops that coverage to some- media about, no, we are not intending ditions—it delays the implementations where around 90 percent, if your State that this task force recommendation is of some of the more worthwhile provi- is a balanced budget State such as going to change in any way what cov- sions until the year 2014. Alaska and your State revenues are erage might be available to women. I We have bipartisan support on many going down because of what is hap- know that some of my colleagues on of these pieces individually. So why pening with tourism or a bad fishing the other side of the aisle have recog- would we not try to work on those season or the price of oil, what then do nized, in fact, that these recommenda- areas where we do have agreement, the States do to continue the Medicaid tions do hold great weight with the where we do have consensus rather Program? policymakers and the insurance com- than waiting until 2014? It seems to me there are a couple op- panies. I held a townhall meeting in tions. They can either drop the ex- One of my colleagues from Maryland Chugiak, AK, last week. It was a pretty panded Medicaid population or they has said she plans to offer an amend- tough night. We had winds that were could reduce reimbursements rates and ment that would address or limit the howling off the mountains, snow all place the Medicaid enrollees who once cost of breast cancer tests for women over the place, and real slick and icy had decent care in Alaska in the same 40 and older. She said otherwise insur- roads. Over 200 people decided to brave predicament as my Medicare constitu- ance companies may use this new rec- the weather to come and speak out on ents are currently in. ommendation as yet another reason to the issue of health care reform and There is a reason why Democratic deny women coverage for mammo- what is happening in Washington, DC. and Republican Governors have said grams. I will tell you, the one thing those this Medicaid expansion is the mother In fact, in the bill, there are at least constituents stood and repeated over of all unfunded mandates. 14 references to the U.S. Preventive and over was: Don’t pass health care While all these provisions I men- Services Task Force. In section 4105 is reform that is going to raise our taxes, tioned are certainly enough for me to a provision that would authorize the that is going to increase our premiums, decide not to support this health care Secretary to modify benefits under and that will cut Medicare. bill, the most troubling aspect we are We need to listen to these folks. We Medicare if consistent with task force seeing played out in the news right need to listen to the American people. recommendations and deny payment now is the impact of government ra- We have an opportunity to do it right. for prevention services the task force tioning, which will allow the govern- There is a lot of good work that goes recommends against. on by a lot of good people in this body ment to deny access to health care This could be a situation we should services. and outside this Chamber. But we are be very concerned about how, with rec- This is something Republicans have at a point now where because of dead- ommendations such as we are seeing been speaking about all summer with lines—artificial deadlines—we are come out of the task force, they inad- regard to various health care bills. We forced to a process tomorrow evening vertently or perhaps advertently will have all seen throughout the news a where we are going to have a vote on a impact a woman’s access to care. great deal of concern over the an- cloture motion on the motion to pro- I know I have probably gone over my nouncement from the U.S. Preventive ceed. As my colleague from Oklahoma time, and the Senator from Oklahoma Services Task Force that it no longer pointed out, it is a bit of a shell. We is waiting. I will close my comments recommends routine mammogram think we are going to this health care by saying we do need health care re- screening for women between the ages bill that is 2,000-some-odd pages, but, form. I echo the remarks of the Sen- of 40 and 49. This task force’s rec- in fact, the vehicle we will be using on ommendation is just a look behind the ator from Maine. We need to do it the the motion to proceed is not what this curtain of what we can expect if the right way. Setting an arbitrary is. I am not going to suggest it is bait government runs your health care. timeline, saying we have to get it done and switch, but it could be bait and Under this bill, we are going to pro- by this holiday or that holiday or mov- switch. vide one person, the appointed position ing down the calendar—we have to I do believe our opportunity to share of the U.S. Secretary of Health and take the time to do it right. our concerns about what is contained Human Services. We are going to give We have to bring down the premium in this legislation is now. We need to her the ability to make a wide variety costs so everyone can have access to af- take the time to explain to our con- of determinations, both on the health fordable health care. Imposing man- stituents the concerns we have, the exchanges as well as in the govern- dates on individuals or on employers, if problems we have, the unintended con- ment-run plan. we haven’t done anything to provide sequences we believe are part and par- I am very concerned about what we for greater affordability, we haven’t cel of this legislation. are finding from this task force and helped the situation. I thank the Presiding Officer for the what it means for both men and women Unfortunately, this bill does not help time this evening and thank all my who suffer from this deadly disease. I us with the affordability piece. I am fo- colleagues for their coordinated efforts can tell you, without a doubt, what cused, as many of my colleagues are, to help provide a little bit of insight to this has caused is great confusion. The on an alternative, a step-by-step ap- the American people on what we are task force came out with their rec- proach to reduce our health care costs dealing with in the proposed legislation ommendations and then, shortly there- to allow businesses to buy across State from the Democratic leader. after, Secretary Sebelius came out say- lines, allow co-ops to be formed so that I yield the floor. ing women in their forties should con- fishermen in my State or other coastal The PRESIDING OFFICER (Mr. tinue to get mammograms. The task States or employees of a small business KAUFMAN). The Senator from Okla- force is saying women should not even can pool together to purchase afford- homa. conduct self-breast exams. We have able comprehensive coverage. Mr. COBURN. Mr. President, first, I constituents who don’t know what they Just as important is certainly the would like to say thank you for pre- should or what they should not be need to preserve the rights of patients siding. You drew the unlucky number doing. This is why we need a hearing to to see the doctors of their choice. We tonight and I appreciate it. better understand how this task force must make sure we are protecting We are embarking on a process that came to their conclusions. Medicare coverage for seniors. We have is going to start tomorrow night and But the bigger picture is, what we to eliminate the discrimination based people are going to cast a vote on a bill need to appreciate is this ordeal we on preexisting conditions, ensure that they have not read, and saying we have been dealing with this week is a expansion of government health pro- ought to go on with it. glimpse into the chaos of what we grams will not result in restrictions in For just a little history, 97.8 percent could see with a federally run health access to care because of reduced reim- of the time in the Senate that a cloture plan and a massive expansion of the bursements to doctors and hospitals. motion passed to proceed to the bill, Federal Government’s role in your While this bill does attempt to ad- the bill becomes law. That is an inter- health care. dress several of these issues—for in- esting statistic, especially when we are

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00071 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.083 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11896 CONGRESSIONAL RECORD — SENATE November 20, 2009 going to hear those who say they just that $1 out of every $3 we spend on What I see is, we have limited the op- want to have the debate. The fact is, health care is not helping health care. tions for people in this country. If your that is not what is going to happen. That is our pot of gold. That is where employer buys your health insurance, As one of the two practicing physi- we lower the cost. Just think what you have very limited options. You get cians in the Senate, I thought I would health care would cost if it costs one- take it or leave it most of the time. spend a little bit of time tonight talk- third less today or if it costs the same Here is what we are providing: You get ing about what I see is wrong with our for the next 5 years. That means we to take it. If you don’t take it, then health care system as well as talk could cover everybody who is not cov- you have to go outside and you loose about what I see as good about our ered for free and have about $400 billion that $2,700 advantage, so it comes out health care system and then talk about left over if we just went after where of your pocket. the approach this bill takes. My staff the pot of gold is. We don’t have the freedom to choose has been through the vast majority of The second problem with our health within our employer. We also have the this bill. I personally have not, but I care system is we have disconnected States. We heard the Senator from will. I will talk about how it affects us. the purchase of health care from the Maine talking about the greatly in- What is the real problem in health payment of health care, so that when I creased costs in Maine. There is a rea- care today? What is it that keeps peo- go to make a purchase I no longer use son Maine has the massive inflation in ple from getting care? The No. 1 prob- the discrimination that I use in every- their health care insurance. They cre- lem that keeps people from getting thing else that I purchase, such as see- ated the State plan that caused it, that care is cost. It costs too much. Fully ing if it is of value to me. I don’t ask truly limited the competition. So they either one-fourth or one-third of every what it costs, I don’t ask if it is the have seen the results of limited com- dollar we spend on health care does not best way to get this, if it is the most petition because of what they installed. help anybody get well and does not pre- economical way to get there. I don’t But every State has an insurance com- vent anybody from getting sick. question to make sure—are you sure I mission that both decides who is eligi- have to have this done? I don’t nec- There is an interesting study out by ble to sell in the State but also follows essarily get a second opinion. I don’t the Thomson Reuters report that says the mandates; here is what the min- ask, if it has to be done, where is the that $600 billion to $850 billion is wast- imum is that you have to buy in your ed annually in all American health best place as far as efficiency and dol- State. care. lars to get it done. Then, of course, if you have Med- When you break it down, it is broken The reason we don’t ask those ques- icaid, you have limited options because down like this: 40 percent is health tions is because most of the time the 40 percent of the physicians in this care waste, unwarranted treatment, money isn’t coming out of our pocket country will not see you. If you have overuse of antibiotics, use of diagnostic because we have this perceived false Medicare, you have limited options be- lab tests to protect against mal- belief that our insurance company or cause now about 15 percent of physi- practice exposure. That accounts for the government is paying for it. If our cians, fast rising to 30 or 40 percent of $250 to $350 billion in annual health insurance company is paying for it, we the physicians in this country, aren’t care spending. It is attributed to extra are paying for it because for every 3.5 tests and procedures generated mainly percent cost our company is paying for going to see you. Then if you have VA, you get VA and from defensive medicine or Medicare’s insurance, 2 percent of that would have that is it. You don’t get to choose your fee-for-service system. been our wages. And for every $1 that doctor or you don’t even get to choose The second biggest factor out of this we spend on Medicare, our grand- $800 billion we are wasting is health children and our children are paying your location. Here is where you will care fraud. It is 19 percent of health into that fund to pay for our Medicare. be, no matter how many miles it is, care waste—at least $125 billion to $175 In fact, it does cost us, but we have dis- and here is the doctor you will see. The billion a year, and most of that is in connected that cost. same thing with TRICARE essentially government-run health care programs. The third thing we have done is we because TRICARE has limited coverage Not the private—the private sector has have a Tax Code that says if you are in terms of availability of all the phy- less than 1 percent of fraud. They also fortunate enough to have your em- sicians. have a denial rate that is one-half to a ployer pay for your health care bene- The fifth thing I see that is wrong is one-third of Medicare’s rate in terms of fits, you get $2,700 more in tax benefit there is an absolute lack of trans- denial of payment claims. than everybody who doesn’t have their parency as to what something costs The third most important thing in employer paying for their insurance. and what you can expect as far as qual- terms of waste is administrative ineffi- You get about $100 in tax benefit if you ity outcome. That makes it hard to ciency. The large redundant volume of don’t get your insurance through your know how to buy, where to buy, or who paperwork in the U.S. health care sys- employer. So we have a 27-fold dis- to buy from. Who do you trust? So if tem accounts for $100 billion to $150 bil- crimination that advantages those there is no transparency in either qual- lion in spending annually. whose employer pays for their health ity or price, you are going to have a The fourth most important area, 12 care versus those who have to buy it on tough time making a decision. All of percent of health care waste is health their own or their employer doesn’t the things I am describing describe a provider errors, errors we make caused offer it. lack of liberty, a lack of freedom. by me as the doctor, or a hospital, that That is wrong. It is not fair. It is un- We have government mandates. Have causes us to spend money we should equal treatment, and it creates this you ever gone to a hospital—this is a not have to spend. maldistribution. But, even having said great question. One of my constituents Six percent of the health care waste that, the cost for an individual plan wrote in and told me this, and I never is preventable conditions, such as versus the plan bought through your had thought about it. Go to a hospital somebody with diabetes getting their employer, if you buy it in a nationwide in the middle of the day and try to get blood sugar out of control and ending marketplace, if you could, it would be a parking spot. Then go to a hospital up in the hospital; whereas if they had 20 percent less than what you could at 10 o’clock at night, and the parking good care, coordinated care, it buy it for through your employer. lot is almost empty. What you are see- wouldn’t have happened. Those are the real statistics. ing in the difference in the parking lot Of course, No. 6 is 6 percent of health Then the fourth thing I see that is is the administrative bureaucratic care waste, and that is lack of coordi- wrong, as both a patient—I ought to overhead that is required in a hospital nated care, where we do not coordinate stop here in a minute and tell every- to manage the mandates that the gov- the care, where doctors don’t talk to body, at 61, almost 62 years of age, I am ernment has put or the insurance com- one another, doctors don’t talk to the a two-time cancer survivor. I have had pany has put on the hospital. hospital, doctors don’t get all the in- malignant melanoma and metastatic If you look at it, fully one-third of formation, so consequently we waste colon cancer. I also have atrial fibrilla- the people in every hospital in this money. tion. I have been a patient. I have been country don’t do anything to help any- So the first problem that plagues us on the other side of my stethoscope as body get well. They are filling out is that cost is too high. We fully know a patient. forms, they are pushing the paper,

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00072 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.084 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE November 20, 2009 CONGRESSIONAL RECORD — SENATE S11897 much like this study I mentioned from Here is another thing that is wrong really doesn’t matter what type can- Thomson Reuters. with our health care system. We are cer. There are some differences on Then we have the insurance mandate. starting to experience it. There is a some, but overall you are 50 percent What is wrong? If, in fact, you have a maldistribution of physicians both in more likely to be alive. preexisting illness, you don’t get in- terms of geographic location and physi- The third thing that is great about sured. That is wrong. We need to fix cian specialty. One in 50 graduates of our country is, innovation in health that. Or if you get sick, insurance com- med schools last year went into pri- care is two-thirds of the world. Actu- panies have figured out a way to drop mary care. Everybody else went into ally, last year it was 74 percent of all you. That can’t be right. That is why specialty and subspecialty residencies. innovation in health care came out of you bought insurance in the first place, Why did that happen? The reason it this economy. We have invested in the and that is not just in the health insur- happened is because the earning power research. We have the scientists. We ance industry. Try filing a claim for a of somebody who has 7 years of medical have the researchers who have pulled new roof on your house and see what training is one-third of somebody who together technology, thought, experi- your insurance costs do next year or if has 8 or 81⁄2 or 9. How did that happen? ence, and research, and come up with they will insure you. We get hail all Because Medicare set the payment great innovations that make big dif- the time in Oklahoma and we get roof rates. Medicare set the payment rates, ferences in life expectancy and quality. damage and a lot of times if you have so they created a maldistribution in The other thing is we have a very that 2 out of 10 years, they will not terms of the payment for physicians. skilled workforce. We have some short- even reinsure you. So you have to go Another thing I noticed as a prac- ages. Our nursing shortage has been find somebody else. ticing physician and as a patient is created by the government because we It is a practice of risk management that our whole system right now has created a health care system that has that they are using that doesn’t think its emphasis on sick care, not on pre- both hospice care and home health about the potential market of who venting disease, not on prevention, not care, but we made the only way that their customer is. So I agree we ought on the maintenance of chronic disease. can effectively work is through reg- to fix those things. We wait until people get sick and treat istered nurses. So we sucked all the Then we have the costs. Already the them. That is expensive. The reason it registered nurses out of the hospitals Senator from North Dakota tonight is that way is because Medicare won’t because of time constraints and lack of talked about drug prices. The one thing pay for prevention. They refuse to pay holiday work and lack of shift work. he didn’t tell everybody is that the rea- for prevention. If you sit down with a The best nurses want to go where they son drugs are cheaper in Canada is be- patient in your office, a Medicare pa- don’t have any of those things. We cre- cause they threaten not to honor intel- tient, and spend the time to go through ated a shortage when we could have lectual property of this country. the risk factors and the lifestyle created a different class of somebody There is a real good way to make changes and their medicines, the doing home health care rather than an sure drug prices go down. Both the things they need to do, you will not be RN. But that is what we have done. We Bush administration failed on this and compensated enough to pay the elec- have created this sucking sound, as the Clinton administration failed on tricity bill for that office visit. So Ross Perot used to say, and sucked the this—and this administration. If Can- what has happened is we have nurses out of the hospitals. Now we ada wants to tell our drug companies incentivized people not to spend time have this critical shortage of nurses in what price they will pay, then we will with the patient. We have incentivized our country because of what the gov- tell them what we will pay for their them to see more patients for shorter ernment did. lumber, and we will tell them what we periods of time and not listen to the The other thing besides the skilled will pay for anything else they want to patient and not spend the time on pre- workforce, the nurse practitioners, the import to our country. But we put all vention because our dollars have been PAs, nurses, physical therapists, phar- the focus on the drug companies in- incentivized against it. macists, radiologists, doctors, surgical stead. Then, finally, government systems nurses—they are great in this country. So I am going to get to my point. are designed to be defrauded. If you Then we have great medicines. If you The other thing that is wrong is, on av- think about it, it is easy to make think about it, the combination of erage it costs $1 billion per new drug $500,000 a month off Medicare; it is hard medicines that saved my life with just to go through the FDA process in to get caught. All you have to do is metastatic colon cancer were all devel- this country because we have such a li- know a whole lot about medicine, have oped here. Six months of chemo- tigious society, that it costs two to a little bit of guts, and set up a vacant therapy, of being sick every day, has three times more to approve a drug in office somewhere and put one computer been worth every morning I see the this country than it does anywhere else in it and run everything over the line, Sun. It is this research, the investment in the world. and you can rip off Medicare like crazy. in NIH, the quality of research, the We have drugs that are fantastic We know the drug dealers in Florida committed doctors who will do the re- drugs that are made by companies in are starting to shift away from drugs search, committed doctors who will this country that are not allowed to be and into Medicare fraud because it is take care of you when you are sick and sold in this country that have passed easier to do. They can make more you don’t feel like communicating all the safety and efficacy standards of money. It is harder to get caught, and with anybody, but yet they are patient the European common market, but when you do, the penalties are much with you—they love you, they nurture they can’t get them through our Food less. It is designed to be defrauded, but you. We have a great system here. and Drug Administration because the we haven’t changed that. If you have a cardiovascular event, Food and Drug Administration is wor- I have talked about the problems. this is the best place in the world to ried about somebody criticizing them if Let me talk about what is great about have one. If you have a heart attack, a they ever make a mistake. They met American health care. stroke, if you get cancer, if you have the standards, did it right, recalled it, I want to make the point in a minute an acute fracture of a limb or joint de- now they are afraid to approve any- that the worst thing we can do in try- generation, this is the best place in the thing because they are afraid somebody ing to fix what is wrong is destroy world to have it. will be critical of them. what is right. We have the greatest So I have outlined the problems, Another thing that is wrong is we acute care anyplace in the world. If which are big, and the things that are have the lack of any real market you get sick, there is no better place in good. What do we do with that? Our forces. Insurance companies really the world to get sick than in the goal ought to be to not destroy all don’t have to compete. United States. I don’t care where you these good things while we fix the They really don’t have to compete. are. The statistics bear that out. There things that are not good. The government sets the price for ev- is no question. If you get cancer in this How did we get in trouble? How did erything, essentially, because Medicare country, you have a 50-percent greater we get to where we have the highest says what they will pay and everything likelihood of being alive 5 years from percentage of our GDP, this thing that else is priced off that. now than anywhere else in the world. It really limits people in care, cost—how

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00073 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.085 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11898 CONGRESSIONAL RECORD — SENATE November 20, 2009 did we get where we are? Why is it? party lines want to see. We need to So with 61 percent of the health care Part of it has been innovation. About meet in the middle. in this country already supplied by the 30 percent of the cost increase we see in Just so I can tell you what is in here government—and either bankrupt or our country is because of innovation. It or what is not in here, there is no pro- going bankrupt or not giving the care takes money to get innovation. When vision in here guaranteeing that tax- that is promised; look at Native Amer- innovation comes out, we have to pay payers will not finance abortion. There ican care—we are going to do more for the research that was not paid for is no provision prohibiting the ration- government health care. upfront. About 30 percent of the health ing of health care. You will see ration- Senator MCCAIN had a great analogy care inflation we see is from new prod- ing of health care with this bill. We are the other day on this bill. This bill ucts, new innovation, new ideas, new seeing it now in Medicare more every starts collecting taxes right away. The treatments, new strategies or proce- day. CMS is not supposed to be doing American people need to know the rea- dures. But the rest of it goes back to it, but they have a reason not to do it. son there is the delay in the onset of this Thomson Reuters, where we have There is a law that says they are not the benefits in this bill. It is because this inefficient delivery system of supposed to do it, but it doesn’t pro- that is the only way they can make it health care. hibit them. Now they are rationing score and look like it is not spending A question I asked my staff—and we about 17 things. They have made a de- the amount of money it is spending. did the research—what was health care cision on practicing medicine. You will But he used this analogy and I inflation before 1970? Do you realize see that. thought it was really great: This bill is There is zero number of Senators who that most of the time it was less than like you buying a new home; you go are going to be required to enroll in the the regular increase in inflation? What get your mortgage, and you start pay- health care bill we will put everybody was the difference? What happened? ing on your mortgage, and you get else on. There are nine new taxes cre- What happened is the government got ready to move in the house, and they ated in this bill, nine new separate say: Uh-oh, the deal was you can move involved in health care. We created de- taxes. There are 13 pages in the bill’s in in 5 years, because that is when the mand that was price-controlled de- table of contents, single-spaced. This mand, and all of a sudden the bubble bill weighs 20.8 pounds. There are 36 benefits start, 5 years from now. But started squeezing up. pages in the CBO explanation of what we want you to pay on it for 5 years be- The other point I wish to make is they think it might or might not do. It fore you get to move into it. that most people don’t realize that 61 has 70 new government programs. None of us would do that. Yet that is percent of the health care in this coun- Think about what that means in terms exactly what this bill does. It is not a try today is run through the govern- of bureaucracy and then think about bait and switch. It is just deceptive, ment. If we have a problem with health your choices, about who you want tak- and it is dishonest in its accounting. care, we have to look at not where the ing care of you and whether you and And, of course, Washington has been 39 percent of it is but where the 61 per- that caretaker, that physician are dishonest. We use Enron accounting. cent is. Let me explain what that is. going to get to decide what is best for Anything that makes it look less ex- That is Medicare, TRICARE, VA, Med- you or some of these 70 new govern- pensive or us look better, that is how icaid, Indian Health Service, SCHIP, ment agencies. And 1,697 times in this we account for it. DOD, and FEHPB. That accounts for 61 legislation we allow the Secretary of Finally, I would say this, and then I percent of the people in this country Health and Human Services to create, will yield to my colleague and fellow who have health care. They are getting determine, and define critical things in physician, Senator BARRASSO. it through the government now. Our this bill and write the regulations— Of the things that are wrong with answer is more government? Our an- 1,697 times. There are going to be 1,697 health care in America and the things swer to the solution is more govern- new sets of regulations in health care that are right—the things that are ment? in this bill alone. There are 2,074 pages. right are because we have a patient- What should our goals be? Our goals There are 2.5 million people who will centered system; the things that are should include access for everybody; af- lose their health insurance with this wrong are associated with a govern- fordable prices; liberty to choose what bill who have it today. They are going ment-centered system. is best for you and yours, not limited to get moved into some government This is a government-centered health by your State, not limited by the Fed- program. There are still going to be 24 care fix, and it is not even a fix. It does eral Government, it should be your million people left without health in- not address malpractice costs. It is choice; freedom to choose your care- surance, if this is fully implemented, somewhere between $100 billion and giver. You don’t get that in Medicaid. according to CBO. This bill costs $6.8 $175 billion a year in tests we are order- You don’t get that at the VA. You million a word. It is $1.2 billion per ing that people do not need because we don’t get that at Indian Health Serv- page. Ten billion will be needed every refuse to address the tort system in ice. You limitedly get it through Med- year for the IRS just to follow the reg- this bill. icaid. Another goal is security in your ulations for the tax collection in this What we need is a patient-centered health care, knowing that no matter bill. That isn’t even considered in the result. What we need is meeting in the what happens, you will have health CBO score. There is going to be $8 bil- middle to solve this problem for the care. Those are things I think the Pre- lion in taxes levied on uninsured indi- American people. siding Officer would agree with. viduals. There is going to be at a min- Abraham Lincoln said: America will I am joined on the floor by the other imum $25 billion a year in increased never be lost by being destroyed from physician in the Senate, Senator mandates on States for Medicaid; there the outside. If we falter and lose our BARRASSO from Wyoming. I welcome is $28 billion in new taxes on employers freedoms, it will be because we have him. not providing government-approved destroyed ourselves. I wanted to spend 1 additional second plans; there is $100 billion of fraud an- This bill is the path to destruction outlining a few things. nually in Medicare; there is $118 billion for health care in America. Eighty per- Here is the bill we have on the floor, in cuts to Medicare Advantage; there is cent of the people in this country will the Reid substitute. I will not talk $465 billion in total cuts to Medicare; get along just fine with this bill. Twen- about the parliamentary shenanigans there is $494 billion in revenue from ty percent are going to suffer dras- that have gone along with what we are new taxes and fees levied on individ- tically under this bill because it to- doing. The fact is, we are going to have uals, on American families, and busi- tally ignores the clinical practice of a debate on health care. It couldn’t nesses. Mr. President, $2.5 trillion is the art of medicine. Everything is have been said any better than by Sen- the non-Enron accounting cost for this based on a government-run, govern- ator SNOWE. Every major piece of legis- bill. ment-mandated, government-con- lation that has affected most people in Finally, there is $12 trillion worth of trolled fiat that takes away your lib- this country has occurred on a bipar- national debt today, and this bill by erty, takes away your choice, takes tisan basis. If this gets passed, you will itself will take it to $15 trillion in 10 away your freedom; and now we will see a revolt in this country because it years. It will increase the national debt move physicians from having to be 100- is not what the vast majority across in less than 10 years by $3 trillion. percent advocates for the patient to an

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Mr. President, con- get just the minimum number of votes that focuses on that individual patient, tinuing along this line—because both to pass this—not because they want to a patient-centered approach, as op- of us have practiced medicine—I took say, let’s see what we have that will posed to a government-centered ap- care of families in Wyoming as an or- work for people. proach or an insurance company-cen- thopedic surgeon for the last 25 years; As doctors, we try to find solutions tered approach? I see nothing here that Dr. COBURN in Oklahoma for longer that work for people. We do not say: is really focused on the individual pa- than that. We know there are things What is the very minimum we can do? tient, giving them incentives, giving that need to be corrected. There are That is what we are seeing here. We are them opportunities, giving that indi- improvements that need to be made. saying: What can we do to get it right? vidual, American citizen more control, We need to fix what is wrong with the What this bill is saying is: What can we more freedom of choice, to help stay system, and that is what I hear every do to get 60 votes, the minimum we can healthy and keep down the cost of weekend when I go home. It is what I do to get this, to drag it over the next their care. have talked about in the surgeons’ step along the line—not to solve the Mr. COBURN. Mr. President, in an- lounge in the hospital. That is what I health care issue that faces our coun- swer to my colleague’s question, there have talked about in the office with my try. is not an incentive. This bill is full of patients. So we need to fix what is We know we need to deal with access mandates. And what it does not man- wrong with the health care system. to care, quality of care, and the cost of date it sets up panels to mandate. It But whatever we do, we have to make care. As my colleague from Oklahoma sets up panels of bureaucrats to man- sure we do not make matters worse. So said earlier, it is the cost of care that date. The real difference on this bill— I say to my friend from Oklahoma, ab- needs the attention right now. Eighty- and I believe we have big problems solutely, my concerns are that this ab- five percent of people like the care with the insurance industry, but I do solutely is going to make matters they have but they do not like the cost not think you eliminate it. I think worse. It is going to increase premiums of that care. So what can we do to help what you do is you clean it up and for families who have insurance. It is get that cost down? make it have to be competitive and going to take almost $500 billion away Everything I read and everything I fair and open and honest. What the bill from our seniors who depend upon know and everything I study and ev- does is it mandates. Just this week, the Preventative Medicare for their health care. It is erything I believe from my years of Services Task Force came out with going to raise taxes on everyone in practicing medicine and taking care of new recommendations for mammo- America—not just on people above a patients tells me this is going to drive grams. If you are only thinking about certain income level, on everyone. the cost up for everyone in the coun- They all are going to be impacted try. And that is not just me. cost, they are great recommendations. when you look at all the taxes that are The dean of Harvard Medical School If you are looking at it only from going to be thrown on this. It is going said it just the other day. He gave the cost—how do we most effectively spend the dollars—their recommendations to be passed along. People in America whole thing a failing grade. He said are absolutely right. But if you are understand that. People know exactly those ‘‘people who favor the legislation thinking about health, their rec- what is happening here. That is why are engaged in collective denial.’’ And he went on to say that when you talk ommendations are absolutely wrong. when I had a telephone townhall meet- You ask the thousands upon thou- about the problems of cost and access ing earlier this week and asked: ‘‘Is sands of women last year under age 50 and quality—with the cost, he said, this the right way or the wrong way? who had their breast cancer diagnosed this ‘‘will markedly accelerate na- Do you think you are going to pay early with a mammogram what they tional health-care spending rather than more?’’ Everybody thinks they are think about the Preventative Services restrain it’’ and will ‘‘do little or noth- going to pay more. When asked: Do you Task Force’s recommendation and lis- think your system is going to get bet- ing to improve quality.’’ ten to what they have to say. What Well, if you are going to spend much ter or worse? They think it is going to they are going to say and what they more money, you ought to get in- get worse. Americans do not want to are going to tell us is that would have creased quality. But the problem is not pay more and get less. That is not the made me odd woman out because I that we are not spending enough value we as Americans want. It is not would not have had a mammogram. I money. We are spending enough money what we expect. am talking not high-risk patients. People say: Don’t cut my Medicare. in the system. Half of all the money we What they are talking about not Especially, if you are going to try to do spend in this country for health care screening—and that is what the major- anything with Medicare, do it to save goes for just 5 percent of the people— ity of these mammograms find, with no Medicare, which is already going to go people who eat too much, exercise too symptoms, no increased risk—you are broke in the year 2017. Don’t do it to little, and smoke. But there is nothing going to see that multiplied one- start some whole new, big government in this bill anywhere that gives an in- hundredfold in this system. program. They say: Don’t raise my centive to those individuals, to that I know the Senator is old enough to taxes. People want to know what is one person to say: Hey, look, we want have been trained in medicine the same going to happen to them, what is going you to quit smoking. We want to help way I was. There are three real tenets to happen to their family. you lose weight. We want to help you in medicine. The three tenets they drill What happens if they get sick? Well, get your cholesterol under control, into you are—the first thing is do not they look at this and they say: We through exercise get your diabetes hurt anybody. Whatever you do, try want practical, commonsense health under control, get your blood sugar not to hurt anybody. And in the prac- solutions, not higher insurance pre- down. There is nothing that gives an tice of medicine and the art of medi- miums, not higher taxes, not Medicare incentive to any one individual. cine sometimes that happens, we do cuts, not more government control Now, there is a lot of money in here hurt people. Sometimes we hurt them over health care decisions. We want to for roadways and streetlights and jun- on purpose to try to get them better. have lower costs, improved access to gle gyms to encourage community But the first is to do no harm. providers, more choices. That is the health. But that does not work. What The second is to listen to the patient. whole crux of why we are doing health works better is an individual incentive Well, the patient at this time in Amer- care reform, at least that is what I was to some person to say you are going to ica is the American citizenry, where 85 told 9 or 10 months ago. When they save this much money, get this much percent of the people pretty well like said: We need health care reform. I money, if you take responsibility for what they have, and they want the said: Yes, we do. your own health. A lot of people try to good kept as we fix what is wrong. I served 5 years in the Wyoming do that on their own. But those are the Finally, the third tenet of medicine State Senate. We did major pieces of 95 percent, not the 5 percent who are that almost every doctor is taught is,

VerDate Nov 24 2008 02:52 Nov 21, 2009 Jkt 089060 PO 00000 Frm 00075 Fmt 0637 Sfmt 0634 E:\CR\FM\G20NO6.093 S20NOPT1 wwoods2 on DSK1DXX6B1PROD with SENATE S11900 CONGRESSIONAL RECORD — SENATE November 20, 2009 if it has already been done and it is not with health care and how health care is businesses. It is a shift of a brain trust working, do not do it again, and do not being done. I am glad they point out and it makes the small businesses grow keep doing it. that vast difference. Obviously, it was and they stay the engine in the econ- Well, let me tell you something. Med- a very effective program. It was so ef- omy. icaid is not working. Indian health care fective that the other side decided to As many of my colleagues know, be- is not working. Medicare is broke. The have a show too. They put up the two fore I came to the Senate I was a small States are broke under the weight of lawyers, and it shows one of the prob- business owner. My wife and I owned Medicaid. We should give great pause lems. three small shoe stores in Wyoming as we break the three tenets of medi- When the President did speak to us and Montana. When I talk about small cine in hopes of saying we reformed at the joint session, he talked about business, I don’t talk about it in the health care. medical malpractice reform and how he vacuum of the Senate floor; I speak When President Obama spoke to us was going to do it the next day. The from my life experience. I know what it under a joint session of Congress, this only problem is what he was referring is like to manage a small business, to is what I believe he should have said. to was a bill I did with Senator BAUCUS keep the books, to pay the vendors, and This is an important matter for Amer- that was ignored in the HELP Com- always to serve your customers. In the ica. It is important to us economically. mittee and it was ignored in the Gang Small Business Committee I like to re- It affects every individual in this coun- of 6 and it was ignored in the Finance mind them that even though the Fed- try. And what he should have said is: I Committee, something that would have eral definition of small business is 500 have not been leading very well on this gotten some medical malpractice re- employees or less, the real engines of because we are way over here on one form going. I think that only saves the economy are much smaller than side on this issue, and I am going to about $54 billion. That is still a lot of that. Some of them are the ones that admit I have not been leading very money to me. It is a lot of money even are just starting, where the owner of well. But here is what I am going to do. in this bill, although this is a $1 tril- the business sweeps the sidewalk, I am going to bring us together in the lion bill. cleans the toilets, waits on customers, middle where we can all agree on—it is I appreciate the doctors. I particu- and does the books, and definitely not kind of like Senator ENZI’s 80-percent larly appreciate my colleague from in that order. That is the small busi- rule. It is a great rule. Senator ENZI Wyoming who has been here all day ness. That is a small business growing. has joined us. He is the ranking mem- adding comments from his medical Those are the kinds of businesses that ber of the Health, Education, Labor, background and making a substantial becomes the big businesses. A lot of and Pensions Committee. I want to contribution to having the people of them fail. A lot of them know they are bring us together and find something America understand this bill. But the taking a risk, but thank goodness they on which 80 percent of us can agree. people of America understand the bill are willing to take that kind of risk. Had he done that, he would have been better than the people in this Chamber. They never expect the government to a hero in solving the problems in which That is the problem. In August there add to their risk, but they know it we find ourselves. Instead, we are going were town meetings and people were does. to try to pass something that, before appalled at the number of people who I faced the challenges of making pay- we are through with it, the vast major- wanted to go to those town meetings roll and trying to negotiate good, af- ity of Americans are not going to want. and the way they wanted to speak, and fordable benefits for my employees. I And if you do pass it, and he does sign they explained to us why this method have had that experience of sitting bolt it, they are going to revolt. won’t work. It wasn’t because anybody upright in the middle of the night and So as our friend LAMAR ALEXANDER organized them. If Republicans were saying, Tomorrow is payroll. How am I said: What we ought to do is start over. that good at organization, we would going to meet payroll? Sometimes you We ought to fix one step at a time the still be in the majority. These were do it without paying yourself, but the things we know are most important, as people who were concerned about business keeps going. the author and promoter of association health care and where it was going. I have to say in a small business the health plans suggests, where we in- They had read a lot about what had employees are very close to the busi- crease the buying power; transparency been said, and they are still reading ness. They understand how tenuous it in the insurance market; risk reevalua- about it, and they are still mad. This is. They work and they participate and tion so people can’t cherry-pick; elimi- isn’t where they want to go. The aver- in the good businesses, they are all like nate preexisting illnesses so they can’t age person in America thought we were family. So they don’t have some of the cancel insurance. All of those things going to cut their health care costs or same choices that the big, flexible we can do without creating all of these at least keep them from escalating. companies do. I see where a company new programs, all these 1,697 times That isn’t what this bill does. This bill in Virginia is about to lay off—Amer- that the Secretary of HHS is going to builds a whole bunch of new programs ica On Line is about to lay off 2,500 write the rules and regulations. and taxes people and steals from Medi- people. The person who lays them off, I thank Senator BARRASSO, No. 1, for care. That is not where the country do you think they know those 2,500 his insight and experience. I would wants to go. I know that is not where people? No, they won’t know those 2,500 leave our colleague, the senior Senator the seniors want to go. I have been sur- people. I suppose that makes it a lot from Wyoming, with this thought: You prised at the AARP endorsing the bill. easier. But in small business, they have two doctors down here who hap- Their members don’t think so. Their know their people. They want to do pen to be Senators, who have well over members are appalled at what is in whatever they can to keep that brain 50 years of practice experience. I had a here and how it is going to affect Medi- trust, that skill, that ability around, business career in the health industry care. and they sacrifice a lot to get to do prior to going into medicine. We diag- But my real intent tonight is to dis- that. nosis this bill as sick. We diagnosis it cuss this bill and how the increase in As a former small business owner, I as something that should be pulled health care costs raises taxes and par- also understand that if we pass this from the market, just as the FDA ticularly affects small businesses. It bill, it will harm the engine of eco- pulled Vioxx. It will not solve the prob- makes them less competitive. Small nomic growth, and it will be a disaster lem; it will make the patient sicker. businesses across America are the en- for millions of Americans. This bill With that, I yield the floor. gine of the economy. I don’t know how will impose $493 billion in new taxes, The PRESIDING OFFICER. The Sen- many times I hear that around here— and those fall disproportionately on ator from Wyoming. the engine of the economy. If small the backs of small business men and Mr. ENZI. Mr. President, I wish to business is growing, the economy is women. thank the two doctors for their com- growing. If small business is stagnant, For instance, the new $54 billion in- ments. I have been enthralled with people are still losing jobs in big busi- crease in the Medicare payroll tax will what they have been saying. They have nesses, and it is usually the ones who hit approximately one-third of the been doing a series of programs to help lose the jobs in big businesses that small business owners across the coun- people understand what we could do eventually get absorbed into the small try. These are the same businesses that

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The bill even though they have to take most of Businesses would be able to band to- will also impose expensive new man- it and put it back into the business in gether through their associations dates and requirements on insurance order to keep the business going and to across State lines, even nationwide, that will have the effect of dramati- grow the business. But some of them and build a big enough pool that they cally increasing costs for small em- look like they make a lot of money. could effectively negotiate with the in- ployers. One of the worst provisions There are some businessmen in Gil- surance companies or with the pro- dealing with insurance market reform lette, WY, and they started a res- viders. I have to tell you, when I pro- is the so-called shared responsibility taurant. They now have six res- posed that, the insurance companies for employers. What the authors of the taurants. I happened to be in one of didn’t like it. We went ahead with it bill are trying to hide behind and what their restaurants in Casper. Sanford’s anyway. I got it through committee. I sounds harmless is a $28 billion job- is the name of it. It is a brandnew res- brought it here to the floor of the Sen- killing tax on employers. taurant, and when I was there, the ate, and I understand how hard it is to Under the bill, if an employer doesn’t owner happened to be there and he rec- get health care reform done. I had a provide health insurance benefits to ognized me and he came over and vis- bill that was filibustered on the motion any employee eligible for the new in- ited. He knew we were working on this. to proceed. I got 55 votes. I had three surance subsidies, which includes fami- He said, You know, they keep piling people who would have voted for it who lies making up to $90,000 a year, then stuff on us. They think we are rich. weren’t here. I got 55 votes. That the employer has to pay a fine. The Sometimes the things we have to file wasn’t enough. You have to have 60 in penalty is equal to $750 per employee with the government because of our order to move on. for all the employees. Subchapter S corporation make us Here is the real irony. OLYMPIA Let me say that again. If an em- look rich and cost us a lot in taxes. We SNOWE was ready to do the amendment ployer doesn’t provide benefits to an are helping them to keep this govern- that probably would have taken care of employee eligible for the new insur- ment going, but we don’t get to put it 80 percent of the concerns of the peo- ance subsidies, which includes families in our pocket. He said, When we start- ple, but because we couldn’t do the mo- making up to $90,000 a year, that em- ed that first business, we each had $200 tion to proceed, we couldn’t offer that ployer has to pay a fine. The penalty is in our pocket and we were able to bor- amendment. We couldn’t finish the equal to $750 per employee for all the row enough money to start that res- bill. As a result, there are no small employees, not just the one eligible for taurant. Each restaurant that we built business health plans that cross State a subsidy. has been a little fancier and a little lines. Yes, there are small business The nonpartisan scorekeepers at the nicer. The one you are sitting in right health plans. Ohio is the laboratory CBO plus nationally recognized econo- now cost $500 million to build. He said, that I used to work the idea. Ohio al- mists have said the costs of this new You know, me and my partner still ready had this kind of thing within its tax bill will ultimately be paid by only have $200 bucks in our pocket. The State boundaries. There is a lot of pop- workers. Businesses that cannot afford rest of it we have had to plow back into ulation in Ohio. Wyoming doesn’t have to provide health insurance will pass the business. And when we plow it back much population so we can’t form the costs of these new penalties on to into the business, it creates more jobs. these big pools, but Ohio could. I their workers in the form of stagnant There are more people working. I will looked at what they had done and it or lower wages, reduced hours, and tell you, those are good jobs, too. was marvelous. It saved money. It gave eliminated jobs. I don’t understand at a time when more benefits than most of the insur- According to one recent study by the small business owners are struggling to ance plans in the State. You know Heritage Foundation, this new job-kill- pay their bills and to keep the lights what they said to me? We could do bet- ing tax will place more than 5 million on, the majority leader has decided we ter if we could cross that State line. If low-income workers at risk of losing ought to increase their taxes. These we could go nationwide or even across their job, or having their hours re- businesses are fighting for their very to one more State, we could do better duced, and an additional 10 million survival. This bill makes it harder for for every one of our people, because we workers could see lower wages and re- them. Small business owners are also would have a little bigger pool and we duced benefits. That is what they have health care consumers like the rest of could save more money. They said, in to do to stay in business. us. They take prescription drugs to the initial phase of this, you know The bill contains a narrow exemption treat diseases such as cholesterol and where most of the money is saved? I for small businesses with 50 or fewer hypertension from the stress they are said, No, where? They said, In adminis- employees. Similar to many of the under, and they might also use a pace- trative costs. Each of those little busi- other poorly conceived provisions of maker or have a hip or a knee replaced. nesses having to do their own buying, the bill, even this exemption is likely If this bill is passed, the prices they figuring, paying, costs a lot of money, to create unintended and harmful con- pay for all of those items will increase. about 38 percent of health care. That sequences. They increase for the employees they doesn’t show up in premiums; that is a What is the likelihood that a small have too who have those same things cost. Do you know what the Ohio small employer with 50 employees right now done. businesses were able to save? Twelve will agree to expand their business if This bill contains over $40 billion in percent. Twelve percent. That is a huge by adding that single extra employee new fees for prescription drugs and savings, just in administrative costs. they expose themselves to this new job- medical devices. The nonpartisan Joint But, no, we weren’t able to pass that on killing tax? Small businesses are the Commission on Taxation has said these to these small businesses. Instead, we engine of economic growth. I cannot types of fees will ultimately be passed are coming up with a way to tax them say that enough. They create the jobs through—to whom? To the consumer, more, regulate them more, which is not in this country. But this provision will meaning that the small business owner exactly my idea of how to fix health discourage the creation of new jobs. is going to pay more for his health care care. Fifteen million Americans are cur- and for the health care of his employ- Rather than lowering the costs, this rently unemployed and 19 percent of ees. Reid bill will actually increase the cost small businesses have reported that Many small businesses still manage of insurance by creating a new $60 bil- they reduced employment in their to provide health insurance coverage lion tax on insurers. Just like the new firms in the last 3 months. If this bill for their employees, despite the ever- taxes on drugs and devices, the cost of is passed, the Reid job-killing employer increasing cost of health insurance. I the new insurance tax will be passed tax will mean that more Americans

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Similar to most has the same choices and everybody we have here who understand and had new regulatory schemes imposed on gets to buy from the private market small businesses, they understand how small businesses, this one will also and everybody can pick how much they this works. That is without even get- mean increased costs for small busi- want to pay in premiums compared to ting into the fact that the government, nesses. deductibles. You can pay more pre- in Medicaid and Medicare, cuts what Small business owners know the cur- mium, less deductible, or less premium they pay so it is below their cost. You rent market for health insurance is not and more deductible. The two balance know how hard it is to run a business sustainable. According to a recent Kai- out. People know that. Some of the as- below cost? It is impossible. You have ser Family Foundation report, costs tute kids in my office took a look at to shift the cost somewhere else so the for small businesses, those with less buying the insurance as opposed to people under private insurance pick up than 200 employees, rose by 5 percent doing the high deductible and putting the costs. from 2008 to 2009, and they are expected it in a health savings account. They I am reminded of some farmers who to rise again next year. found out they could take the money it decided they could make a killing and We all agree the status quo for health would cost for the regular plan and, in- drive the truck over to North Dakota insurance is not acceptable. Equally stead, buy this high deductible and and buy some eggs for just 24 cents a unacceptable, however, should be any take the difference and put it in a sav- dozen. They could bring them back to proposals that make the current situa- ings account. The savings account their home State and they could sell tion worse. Unfortunately, that is ex- grows tax free. It has to be used for them for a lot more. Of course, when actly what the Reid bill will do. health care, but it pays for health care they sold them and figured in the ex- The nonpartisan Congressional Budg- things as they come up. In less than 3 pense of picking them up, they found et Office, the administration’s own ac- years, the one putting in the least cov- out they were only getting 20 cents a tuaries, the National Association of ered the entire deductible. So for the dozen for them. If that is the case, you State Insurance Commissioners, and at rest of the time, she would not have to cannot just buy a bigger truck and least six other private studies have all put any more into that savings ac- solve the problem. That is what doc- looked at provisions similar to what is count. But she is smart. She said: I am tors are finding. They are saying: I in the Reid bill, and they all found that putting that in there tax free, and cannot afford to take Medicaid pa- these provisions will drive up health someday I will need it. So she is con- tients or Medicare patients. If you can- insurance costs. tinuing to grow that. not see a doctor, you don’t have any in- Actuaries at the consulting firm Oli- We have decided that is a bad deal. I surance at all. That is where we are ver Wyman, which did one of the stud- will tell you, people around here are driving this thing. ies, estimated these provisions will in- smarter than us. They are figuring out Unfortunately, a number of the pro- crease premiums for small businesses how to save money on health insurance visions in the Reid bill will devastate by at least 20 percent. Last year, they already. I don’t think they are going to these small health provider businesses. had an increase of 5 percent. This is like that. The bill cuts over $460 billion from Another thing you can do as an em- going to do 20 percent. I suspect most Medicare over the next 10 years, slash- ployee here is have a flexible savings small businessmen will notice that, ing Medicare payments to hospitals, account. That happens in a lot of busi- and they will also know where the nursing homes, and home health agen- nesses across the country. If you have blame lies. WellPoint, the largest Blue cies. Cross/Blue Shield plan in the Nation, company insurance, you can do a flexi- The Reid bill will cut over $15 billion looked at their actual claims experi- ble savings account. This bill is going in Medicare payments to the nursing ences in the 14 States in which they op- to do away with that too. That is the homes. In a rural State such as mine, erate and concluded that the premiums way to do it if you know you are going this level of cut will destroy many to have health expenses the next year for healthier small businesses will in- small business nursing homes and force that don’t fall within your policy. You crease in all 14 States—in Nevada by as the closure of the facilities that cur- can put that money in the bank tax much as 108 percent. rently provide nursing home care to The bill also eliminates consumer free and use it as those bills come due. We are going to limit that, and that hundreds of Medicare patients. choices, requiring Americans to buy Connie Jenkins, the executive direc- limit isn’t going to have any fluctua- richer types of plans that cover more tor of the Star Valley Senior Center, tion dealing with inflation, so in 2 or 3 deductibles and out-of-pocket expenses. south of Jackson, WY—a lot of people years that program is gone. I don’t These plans typically have much high- know where Jackson is, over on the know why these ones that encourage er premiums. That is right. Wash- western side of the State; it is the people to save and plan for the future ington is going to tell you what kind of home of the Grand Teton National are such bad ideas. insurance you have to have, even if it According to the Kaiser Family Park, below Yellowstone National is a lot better than what you have now Foundation, 11 percent of small busi- Park. The director recently wrote to and you like what you have now. That ness employees are enrolled in HSAs. me about the important role nursing is not good enough. Washington knows Average HSA premiums for small busi- homes play in rural small towns in Wy- better for you what you need in the nesses are 20 percent lower than the oming. She noted that many small way of health insurance. They are traditional PPO plans, and the number communities depend on nursing facili- going to see that you get it. Boy, are of employers offering HSAs has nearly ties to provide a large portion of the you going to get it. These plans typi- doubled over the last 3 years. available jobs. She wrote that ‘‘in a cally have much higher premiums. We If you work for Starbucks, that is rural State, such as ours, closing of have looked at the studies to see how one of the small companies—not really. nursing homes would mean families many people have the quality of insur- But Starbucks provides insurance to traveling further to visit loved ones ance we are talking about at the lowest their people. They do it through HSAs. and, in some cases, loss of access alto- acceptable level. If you don’t do that, We are talking about getting rid of gether.’’ It is important to be near the you get fined. OK. that, saying it is not good enough. people who are in a nursing home. We Well, these new mandates will make There are going to be upset people. have great distances and very small it more difficult for small businesses to The new mandates in the bill will towns. adopt new, affordable, high-deductible prevent some high-deductible health The Reid bill would also cut more health plans. These plans, when com- plans from being sold because they do than $40 billion in Medicare payments bined with health savings accounts, not provide a rich enough benefit. to home health agencies. According to have been enormously successful in re- Small businesses are not just pur- the analysis done by one industry asso- cent years in helping small businesses chasers of health care, they are also ciation, this level of cuts could put

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If these cuts are enacted save Medicare. Medicare money should debating these policies at a time when and these agencies are forced to close, go to Medicare. small businesses face their most severe the patients will have to go back into The Reid bill also drives up health economic challenges since the Great institutional facilities to receive their care costs for small businesses by its Depression. care. In addition to devastating these massive expansion of Medicaid. This As I mentioned, unemployment is al- small businesses, this proposal would bill includes the largest expansion of ready at 10.2 percent. Even that num- clearly break the President’s promise the Medicaid Program since it was cre- ber, which is the worst we have seen in to protect Medicare beneficiaries and ated in 1965. In addition to trapping 15 26 years, may actually understate the not reduce their benefits. million low-income Americans in the severity of the situation. The govern- Many doctors, such as my colleague, worst health care program in America, ment estimates that up to 17.5 percent JOHN BARRASSO, who has been on the this Medicaid expansion will also in- of the population may be entirely with- Senate floor all day, have also been crease costs for many small businesses. out a job or underemployed. small business owners. Doctors are cur- Medicaid uses government price con- Other economic indicators paint a rently facing a 21-percent reduction in trols to set private rates far below grim picture for a potentially jobless Medicare payments that is slated to go what private insurers pay, often below recovery. In October, new housing into effect in January. Despite cutting the cost of what it costs to provide the starts fell 10.6 percent, which is 30 per- $460 billion from the Medicare Pro- care. According to one estimate, Med- cent lower than 1 year ago. Federal Re- gram, the Reid bill does nothing to fix icaid pays only 60 percent of the rates serve Chairman Ben Bernanke recently the Medicare payment formula for phy- paid by private insurers. This forces noted that the ongoing financial crisis sicians. Since 40 percent of doctors will doctors to make up for their losses on has led to the reduction or elimination not take Medicaid patients, that is now Medicaid patients by increasing their of bank credit lines for many small moved into Medicare, and I think 20 costs to other purchasers. According to businesses. He also noted that the frac- percent will not take Medicare pa- a recent estimate by the accounting tion of small businesses reporting dif- tients. How would you like asking for firm Milliman, inadequate Medicaid ficulty in obtaining credit is near a an appointment and they say: Are you payment rates resulted in physicians record high, and these conditions are Medicare? And if you are, we are not shifting $23.7 billion in costs onto pri- expected to tighten further. taking you. vate sector purchasers. Small businesses are the engine of It can happen. That is not health in- Enrolling 15 million more Americans surance at all. Also, it is fascinating economic growth that can lead this Na- into the broken Medicaid Program will tion out of its current economic crisis. that Medicare doesn’t have cata- only worsen this cost shift. That means strophic coverage. We will talk about Unfortunately, the Reid bill will have if this bill is enacted, small business that. Unlike the Federal Government, the effect of sand being poured into the owners will see their health care costs small business owners cannot lose gears of that engine. increase as physicians and hospitals money on every Medicare patient and The recent statement of the National struggle to make up for inadequate then hope to make it up on volume. A Federation of Retail Businesses does payments for many more Medicaid pa- 21-percent payment cut is not sustain- the best job of summarizing the impact tients. of the Reid bill on small businesses. able, and it highlights why we need to In addition to doctors and hospitals, fix the broken Medicare physician pay- They said: States also cannot afford to pay for ment formula. Rather than stealing We oppose the Patient Protection and Af- this expansion of the Medicaid Pro- $460 billion from Medicare to create a fordable Care Act due to the amount of new gram. The Reid bill imposes approxi- new entitlement program for the unin- taxes, the creation of new mandates, and the mately $25 billion in new unfunded establishment of new entitlement programs. sured, we should use those moneys to Medicaid costs on State budgets at a There is no doubt all these burdens will be strengthen and improve Medicare. time when the States are facing a paid for on the backs of small business. It’s Medicare is going broke. You saw the clear to us that at the end of the day, the charts over there earlier. It is going worse economic crisis in general than perhaps our economic crisis because costs to small business more than outweigh broke. We are going to take $460 billion the benefits they may have realized. from it. Oh, but don’t worry. The bill they cannot just print the money. When we were working with the Gang I see I have run a few minutes over. has a little provision in there where we I apologize to the Chair. are going to form a commission that, of 6, we had a table that showed how f every year, will give us suggestions on the $25 billion was distributed among how we ought to cut Medicare so that the different States. The CBO estimate ADJOURNMENT UNTIL 9:45 A.M. it stays solvent. of the $25 billion never changed. But TOMORROW every day, we got a new sheet and the I don’t know any other way you can The PRESIDING OFFICER. Under different States paid different put that: Cut Medicare to stay solvent. the previous order, the Senate stands amounts. Did you know that finally We had to form a commission to do adjourned until 9:45 tomorrow morn- New York and Nevada got theirs down that after we steal $460 billion from the ing. to what they thought was a workable program. It cannot afford to have that Thereupon, the Senate, at 9:36 p.m., level? I don’t know if that is actually taken out. adjourned until Saturday, November the way it will come out if people are Another interesting thing on that 21, 2009, at 9:45 a.m. commission is they already made a just jimmying the numbers. deal with the hospitals, and they can- What this will mean for small busi- f not cut them, and the doctors were nesses will be even higher taxes and NOMINATIONS fees, as States struggle to close the es- supposed to have a deal, although I Executive nominations received by timated $22 billion budget shortfall think the deal has been broken because the Senate: the low payments did not get fixed and they will face in fiscal year 2011. Ac- DEPARTMENT OF DEFENSE the medical malpractice did not get in- cording to the National Association of State Budget Officers, States have al- MARY SALLY MATIELLA, OF ARIZONA, TO BE AN AS- cluded as they were promised. So I SISTANT SECRETARY OF THE ARMY, VICE NELSON M. don’t know if they are still in there. In ready enacted $23.8 billion in new taxes FORD. and fees in the current fiscal year. PAUL LUIS OOSTBURG SANZ, OF MARYLAND, TO BE exchange, they were supposed to not GENERAL COUNSEL OF THE DEPARTMENT OF THE NAVY, get any cuts. These numbers are only expected to in- VICE FRANK R. JIMENEZ. crease as States see no end in sight to SOLOMON B. WATSON IV, OF NEW YORK, TO BE GEN- The pharmaceutical companies were ERAL COUNSEL OF THE DEPARTMENT OF THE ARMY, not supposed to get any cuts. I would their current fiscal crisis. VICE BENEDICT S. COHEN, RESIGNED.

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DEPARTMENT OF EDUCATION DEPARTMENT OF STATE JOHN F. TEFFT, OF VIRGINIA, A CAREER MEMBER OF THE SENIOR FOREIGN SERVICE, CLASS OF MINISTER- KATHLEEN S. TIGHE, OF VIRGINIA, TO BE INSPECTOR JOSE W. FERNANDEZ, OF NEW YORK, TO BE AN ASSIST- COUNSELOR, TO BE AMBASSADOR EXTRAORDINARY AND GENERAL, DEPARTMENT OF EDUCATION, VICE JOHN ANT SECRETARY OF STATE (ECONOMIC, ENERGY, AND PLENIPOTENTIARY OF THE UNITED STATES OF AMERICA PORTMAN HIGGINS, RESIGNED. BUSINESS AFFAIRS). TO UKRAINE. SECURITIES INVESTOR PROTECTION FREDERICK D. BARTON, OF MAINE, TO BE REPRESENT- DAVID HUEBNER, OF CALIFORNIA, TO BE AMBASSADOR ATIVE OF THE UNITED STATES OF AMERICA ON THE ECO- EXTRAORDINARY AND PLENIPOTENTIARY OF THE CORPORATION NOMIC AND SOCIAL COUNCIL OF THE UNITED NATIONS, UNITED STATES OF AMERICA TO NEW ZEALAND, AND TO WITH THE RANK OF AMBASSADOR. SHARON Y. BOWEN, OF NEW YORK, TO BE A DIRECTOR SERVE CONCURRENTLY AND WITHOUT ADDITIONAL COM- OF THE SECURITIES INVESTOR PROTECTION CORPORA- MILLENNIUM CHALLENGE CORPORATION PENSATION AS AMBASSADOR EXTRAORDINARY AND TION FOR A TERM EXPIRING DECEMBER 31, 2012, VICE PLENIPOTENTIARY OF THE UNITED STATES OF AMERICA TODD S. FARHA. DANIEL W. YOHANNES, OF COLORADO, TO BE CHIEF EX- TO SAMOA. ORLAN JOHNSON, OF MARYLAND, TO BE A DIRECTOR ECUTIVE OFFICER, MILLENNIUM CHALLENGE PETER ALAN PRAHAR, OF VIRGINIA, A CAREER MEM- OF THE SECURITIES INVESTOR PROTECTION CORPORA- CORPORTATION. BER OF THE SENIOR FOREIGN SERVICE, CLASS OF COUN- TION FOR A TERM EXPIRING DECEMBER 31, 2011, VICE INTER-AMERICAN DEVELOPMENT BANK SELOR, TO BE AMBASSADOR EXTRAORDINARY AND ARMANDO J. BUCELO, JR., TERM EXPIRED. PLENIPOTENTIARY OF THE UNITED STATES OF AMERICA TO THE FEDERATED STATES OF MICRONESIA. DEPARTMENT OF STATE GUSTAVO ARNAVAT, OF NEW YORK, TO BE UNITED STATES EXECUTIVE DIRECTOR OF THE INTER—AMER- DAVID ADELMAN, OF GEORGIA, TO BE AMBASSADOR ICAN DEVELOPMENT BANK FOR A TERM OF THREE DEPARTMENT OF HEALTH AND HUMAN SERVICES EXTRAORDINARY AND PLENIPOTENTIARY OF THE YEARS. PAMELA S. HYDE, OF NEW MEXICO, TO BE ADMINIS- UNITED STATES OF AMERICA TO THE REPUBLIC OF DEPARTMENT OF STATE SINGAPORE. TRATOR OF THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, DEPARTMENT OF OVERSEAS PRIVATE INVESTMENT CORPORATION FREDERICK D. BARTON, OF MAINE, TO BE AN ALTER- NATE REPRESENTATIVE OF THE UNITED STATES OF HEALTH AND HUMAN SERVICES. THE ABOVE NOMINATIONS WERE APPROVED SUBJECT ELIZABETH L. LITTLEFIELD, OF THE DISTRICT OF CO- AMERICA TO THE SESSIONS OF THE GENERAL ASSEMBLY TO THE NOMINEES’ COMMITMENT TO RESPOND TO RE- LUMBIA, TO BE PRESIDENT OF THE OVERSEAS PRIVATE OF THE UNITED NATIONS, DURING HIS TENURE OF SERV- QUESTS TO APPEAR AND TESTIFY BEFORE ANY DULY INVESTMENT CORPORATION, VICE ROBERT A . ICE AS REPRESENTATIVE OF THE UNITED STATES OF CONSTITUTED COMMITTEE OF THE SENATE. MOSBACHER, RESIGNED. AMERICA ON THE ECONOMIC AND SOCIAL COUNCIL OF THE UNITED NATIONS. DEPARTMENT OF STATE ROBERT R. KING, OF VIRGINIA, TO BE SPECIAL ENVOY NATIONAL AERONAUTICS AND SPACE HARRY K. THOMAS, JR., OF NEW YORK, A CAREER MEM- ON NORTH KOREAN HUMAN RIGHTS ISSUES, WITH THE ADMINISTRATION BER OF THE SENIOR FOREIGN SERVICE, CLASS OF MIN- RANK OF AMBASSADOR. PAUL K. MARTIN, OF MARYLAND, TO BE INSPECTOR ISTER—COUNSELOR, TO BE AMBASSADOR EXTRAOR- WILLIAM E. KENNARD, OF THE DISTRICT OF COLUMBIA, DINARY AND PLENIPOTENTIARY OF THE UNITED STATES TO BE REPRESENTATIVE OF THE UNITED STATES OF GENERAL, NATIONAL AERONAUTICS AND SPACE ADMIN- OF AMERICA TO THE REPUBLIC OF THE PHILIPPINES. AMERICA TO THE EUROPEAN UNION, WITH THE RANK ISTRATION. AND STATUS OF AMBASSADOR EXTRAORDINARY AND f PLENIPOTENTIARY. FOREIGN SERVICE CARMEN LOMELLIN, OF VIRGINIA, TO BE PERMANENT CONFIRMATIONS REPRESENTATIVE OF THE UNITED STATES OF AMERICA FOREIGN SERVICE NOMINATION OF TERENCE JONES. TO THE ORGANIZATION OF AMERICAN STATES, WITH THE FOREIGN SERVICE NOMINATIONS BEGINNING WITH AN- Executive nominations confirmed by RANK OF AMBASSADOR. DREA M. CAMERON AND ENDING WITH ALEKSANDRA the Senate, Friday, November 20, 2009: CYNTHIA STROUM, OF WASHINGTON, TO BE AMBAS- PAULINA ZITTLE, WHICH NOMINATIONS WERE RECEIVED SADOR EXTRAORDINARY AND PLENIPOTENTIARY OF BY THE SENATE AND APPEARED IN THE CONGRESSIONAL EUROPEAN BANK FOR RECONSTRUCTION AND THE UNITED STATES OF AMERICA TO LUXEMBOURG. RECORD ON SEPTEMBER 10, 2009. DEVELOPMENT MICHAEL C. POLT, OF TENNESSEE, A CAREER MEMBER FOREIGN SERVICE NOMINATIONS BEGINNING WITH OF THE SENIOR FOREIGN SERVICE, CLASS OF MINISTER- LAURIE M. MAJOR AND ENDING WITH MARIA A. ZUNIGA, JAMES LAGARDE HUDSON, OF THE DISTRICT OF CO- COUNSELOR, TO BE AMBASSADOR EXTRAORDINARY AND WHICH NOMINATIONS WERE RECEIVED BY THE SENATE LUMBIA, TO BE UNITED STATES DIRECTOR OF THE EURO- PLENIPOTENTIARY OF THE UNITED STATES OF AMERICA AND APPEARED IN THE CONGRESSIONAL RECORD ON PEAN BANK FOR RECONSTRUCTION AND DEVELOPMENT . TO THE REPUBLIC OF ESTONIA. SEPTEMBER 17, 2009.

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HIGHLIGHTS Senate agreed to H. Con. Res. 214, Adjournment Resolution. Senate Senator Feinstein vice Frank Fahrenkopf of Nevada Chamber Action and Senator Webb vice Sig Rogich of Nevada. Routine Proceedings, pages S11825–S11904 Page S11887 Measures Introduced: Nine bills and one resolu- Nominations Confirmed: Senate confirmed the fol- tion were introduced, as follows: S. 2807–2815, and lowing nominations: S. Res. 358. Page S11883 James LaGarde Hudson, of the District of Colum- Measures Reported: bia, to be United States Director of the European S. 2727, to provide for continued application of Bank for Reconstruction and Development. arrangements under the Protocol on Inspections and Jose W. Fernandez, of New York, to be an Assist- Continuous Monitoring Activities Relating to the ant Secretary of State (Economic, Energy, and Busi- Treaty Between the United States of America and ness Affairs). the Union of Soviet Socialist Republics on the Re- William E. Kennard, of the District of Columbia, duction and Limitation of Strategic Offensive Arms to be Representative of the United States of America in the period following the Protocol’s termination on to the European Union, with the rank and status of December 5, 2009. (S. Rept. No. 111–100) Ambassador. Page S11883 Frederick D. Barton, of Maine, to be Representa- Measures Passed: tive of the United States of America on the Eco- Adjournment Resolution: Senate agreed to H. nomic and Social Council of the United Nations, Con. Res. 214, providing for a conditional adjourn- with the rank of Ambassador. ment of the House of Representatives and a condi- Carmen Lomellin, of Virginia, to be Permanent tional recess or adjournment of the Senate. Representative of the United States of America to Page S11887 the Organization of American States, with the rank Measures Considered: of Ambassador. Service Members Home Ownership Tax Act— Cynthia Stroum, of Washington, to be Ambas- Agreement: Senate continued consideration of the sador to Luxembourg. motion to proceed to consideration of H.R. 3590, to Daniel W. Yohannes, of Colorado, to be Chief Ex- amend the Internal Revenue Code of 1986 to modify ecutive Officer, Millennium Challenge Corportation. the first-time homebuyers credit in the case of mem- Gustavo Arnavat, of New York, to be United bers of the Armed Forces and certain other Federal States Executive Director of the Inter-American De- employees. Pages S11826–79, S11888–S11903 velopment Bank for a term of three years. A unanimous-consent agreement was reached pro- Frederick D. Barton, of Maine, to be an Alternate viding for further consideration of the motion to Representative of the United States of America to proceed to consideration of the bill at approximately the Sessions of the General Assembly of the United 9:45 a.m., on Saturday, November 21, 2009, with Nations, during his tenure of service as Representa- debate as provided for under the order of Thursday, tive of the United States of America on the Eco- November 19, 2009. Page S11888 nomic and Social Council of the United Nations. Appointments: Robert R. King, of Virginia, to be Special Envoy on North Korean Human Rights Issues, with the Ronald Reagan Centennial Commission: The rank of Ambassador. Chair, on behalf of the Majority Leader, pursuant to Public Law 111–25, announced the appointment of Michael C. Polt, of Tennessee, to be Ambassador the following individuals to serve as members of the to the Republic of Estonia. Ronald Reagan Centennial Commission: John F. Tefft, of Virginia, to be Ambassador to Ukraine.

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Paul K. Martin, of Maryland, to be Inspector Harry K. Thomas, Jr., of New York, to be Am- General, National Aeronautics and Space Adminis- bassador to the Republic of the Philippines. tration. Pages S11903–04 Pamela S. Hyde, of New Mexico, to be Adminis- Messages From the House: Pages S11881–82 trator of the Substance Abuse and Mental Health Services Administration, Department of Health and Measures Referred: Page S11882 Human Services. Executive Communications: Pages S11882–83 David Huebner, of California, to be Ambassador Additional Cosponsors: Pages S11883–84 to New Zealand, and to serve concurrently and with- Statements on Introduced Bills/Resolutions: out additional compensation as Ambassador to Pages S11884–86 Samoa. Additional Statements: Page S11881 Peter Alan Prahar, of Virginia, to be Ambassador to the Federated States of Micronesia. Amendments Submitted: Page S11886 Routine lists in the Foreign Service. Page S11904 Notices of Hearings/Meetings: Pages S11886–87 Nominations Received: Senate received the fol- Authorities for Committees to Meet: Page S11887 lowing nominations: Privileges of the Floor: Page S11887 Mary Sally Matiella, of Arizona, to be an Assistant Adjournment: Senate convened at 9:45 a.m. and Secretary of the Army. adjourned at 9:36 p.m., until 9:45 a.m. on Saturday, Paul Luis Oostburg Sanz, of Maryland, to be Gen- November 21, 2009. (For Senate’s program, see the eral Counsel of the Department of the Navy. remarks of the Acting Majority Leader in today’s Solomon B. Watson IV, of New York, to be Gen- Record on page S11888.) eral Counsel of the Department of the Army. Kathleen S. Tighe, of Virginia, to be Inspector General, Department of Education. Committee Meetings Sharon Y. Bowen, of New York, to be a Director (Committees not listed did not meet) of the Securities Investor Protection Corporation for a term expiring December 31, 2012. NOMINATIONS Orlan Johnson, of Maryland, to be a Director of Committee on Finance: Committee concluded a hearing the Securities Investor Protection Corporation for a to examine the nominations of Lael Brainard, of the term expiring December 31, 2011. District of Columbia, to be Under Secretary, Mary David Adelman, of Georgia, to be Ambassador to John Miller, of Maryland, to be Assistant Secretary, the Republic of Singapore. and Charles Collyns, of Maryland, to be Deputy Elizabeth L. Littlefield, of the District of Colum- Under Secretary, all of the Department of the Treas- bia, to be President of the Overseas Private Invest- ury, after the nominees testified and answered ques- ment Corporation. tions in their own behalf. h House of Representatives Chamber Action COMMITTEE MEETINGS FOR SATURDAY, The House was not in session today. The House NOVEMBER 21, 2009 is scheduled to meet at 2 p.m. on Tuesday, Decem- (Committee meetings are open unless otherwise indicated) ber 1, 2009, pursuant to the provisions of H. Con. Res. 214. Senate No meetings/hearings scheduled. Committee Meetings House No committee meetings were held. No committee meetings are scheduled. Joint Meetings No joint committee meetings were held.

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Next Meeting of the SENATE Next Meeting of the HOUSE OF REPRESENTATIVES 9:45 a.m., Saturday, November 21 2 p.m., Tuesday, December 1

Senate Chamber House Chamber Program for Saturday: Senate will continue consider- Program for Tuesday: To be announced. ation of the motion to proceed to consideration of H.R. 3590, Service Members Home Ownership Tax Act, with controlled debate in alternating blocks, and vote on the motion to invoke cloture on the motion to proceed to consideration of the bill at 8 p.m.

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