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, DECEMBER 11, 2009 No. 186 Senate The Senate met at 10 a.m. and was Lord, make them willing to listen, to the Senate from the President pro called to order by the Honorable JEFF even to people with whom they expect tempore (Mr. BYRD). MERKLEY, a Senator from the State of to differ, united by the desire to rep- The legislative clerk read the fol- Oregon. resent You with exemplary conduct. We pray in Your great Name. Amen. lowing letter: PRAYER U.S. SENATE, f The Chaplain, Dr. Barry C. Black, of- PRESIDENT PRO TEMPORE, fered the following prayer: PLEDGE OF ALLEGIANCE Washington, DC, December 11, 2009. To the Senate: Let us pray. The Honorable JEFF MERKLEY led the Gracious God, through the power of Pledge of Allegiance, as follows: Under the provisions of rule I, paragraph 3, of the Standing Rules of the Senate, I hereby Your spirit, empower us to live vibrant I pledge allegiance to the Flag of the lives that glorify You. Awaken our United States of America, and to the Repub- appoint the Honorable JEFF MERKLEY, a Sen- lawmakers to the opportunities all lic for which it stands, one nation under God, ator from the State of Oregon, to perform around them. Help them to hear Your indivisible, with liberty and justice for all. the duties of the Chair. ROBERT C. BYRD, call to move forward and to accomplish f the things that honor You, as You President pro tempore. guide them in the pursuit of wisdom APPOINTMENT OF ACTING PRESIDENT PRO TEMPORE Mr. MERKLEY thereupon assumed and truth. May they confidently face the chair as Acting President pro tem- their duties, knowing that You are The PRESIDING OFFICER. The pore. their sufficient shield and defense. clerk will please read a communication

NOTICE If the 111th Congress, 1st Session, adjourns sine die on or before December 23, 2009, a final issue of the Congres- sional Record for the 111th Congress, 1st Session, will be published on Thursday, December 31, 2009, to permit Members to insert statements. All material for insertion must be signed by the Member and delivered to the respective offices of the Official Reporters of Debates (Room HT–59 or S–123 of the Capitol), Monday through Friday, between the hours of 10:00 a.m. and 3:00 p.m. through Wednesday, December 30. The final issue will be dated Thursday, December 31, 2009, and will be delivered on Monday, January 4, 2010. None of the material printed in the final issue of the Congressional Record may contain subject matter, or relate to any event, that occurred after the sine die date. Senators’ statements should also be formatted according to the instructions at http://webster/secretary/conglrecord.pdf, and submitted electronically, either on a disk to accompany the signed statement, or by e-mail to the Official Reporters of Debates at ‘‘[email protected]’’. Members of the House of Representatives’ statements may also be submitted electronically by e-mail, to accompany the signed statement, and formatted according to the instructions for the Extensions of Remarks template at http:// clerk.house.gov/forms. The Official Reporters will transmit to GPO the template formatted electronic file only after receipt of, and authentication with, the hard copy, and signed manuscript. Deliver statements to the Official Reporters in Room HT–59. Members of Congress desiring to purchase reprints of material submitted for inclusion in the Congressional Record may do so by contacting the Office of Congressional Publishing Services, at the Government Printing Office, on 512–0224, between the hours of 8:00 a.m. and 4:00 p.m. daily. By order of the Joint Committee on Printing. CHARLES E. SCHUMER, Chairman.

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

S12971

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00001 Fmt 0624 Sfmt 8633 E:\CR\FM\A11DE6.000 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12972 CONGRESSIONAL RECORD — SENATE December 11, 2009 RECOGNITION OF THE MAJORITY ready with two important amend- makers almost seem to be flouting LEADER ments. their ability to spend taxpayer money. The ACTING PRESIDENT pro tem- One of those amendments, by Sen- This bill contains many worthy pore. The majority leader is recog- ator CRAPO, would enable the President projects. Unfortunately, the majority nized. to keep one of the pledges he made as has piled on so much spending, so much a candidate and as President about debt and new controversial policies f what the Democratic plan for health that I certainly can’t support it. SCHEDULE care reform would look like. He said As you may know, the Senate is con- that no family making less than Mr. REID. Mr. President, following sidering a bill that would make basic $250,000 a year and no individual mak- leader remarks, the Senate will be in a changes in the country’s health care ing less than $200,000 a year would see period of morning business. Senators system. We have been debating it for a tax increase of any kind. The Crapo will be permitted to speak for 10 min- weeks. What I keep hearing on the motion would ensure that promise is utes each during that period. Repub- other side is no reference to what the kept. licans will control the first 30 minutes, American people think. I hear these ar- An amendment by Senators and the majority will control the next guments about making history. Ignor- HUTCHISON and THUNE would ensure ing the public is not a great way to 30 minutes. We will continue work on that none of the taxes imposed by this an agreement to vote in relation to the make history. We have not seen poll bill would go into effect a day earlier data for months that indicate the drug reimportation matter, the Crapo than the benefits. In other words, you motion to commit, and the side-by-side American people support the Reid bill. don’t get taxes before you get benefits. The most devastating one came out to the Crapo motion. These amend- This is a commonsense amendment. ments and the motion are with respect last night. A CNN opinion research poll You certainly wouldn’t ask someone to taken December 2 and 3, this week— to H.R. 3590, the health insurance repay for the mortgage on a house 4 form legislation. not exactly a bastion of conservatism— years before they were allowed to move indicates that 61 percent of the Amer- Yesterday, we filed cloture on the in. In the same way, we should not tax bill we got from the House, the appro- ican people oppose this health care bill people for a benefit they don’t get for 4 and only 36 percent favor it. priations bill, H.R. 3288, which includes long years. Commerce-Justice-Science, Military We are looking for one courageous The Hutchison-Thune amendment Member of the other side of the aisle— Construction, Labor-HHS, Transpor- also aims to keep government honest, tation, financial services, State and just one—to stand up and say he or she because most Americans have a hard will not ignore the overwhelming opin- Foreign Operations. We are going to time believing Washington would col- have at least two rollcall votes on mo- ion of the American people, he or she lect taxes on one thing for 4 years and will not be so arrogant as to assume we tions to waive with respect to the ap- actually have the discipline not to use propriations conference report today. have the right answer here and 61 per- the money on something else. This cent of the American people somehow Senators will be notified when these amendment would guard against that. votes are scheduled. don’t know what they are talking For the moment, the majority has about. I direct this question through the decided to take us off health care. It Chair to my friend from South Dakota. The American people are pretty has moved to an Omnibus appropria- smart. They have been watching this I offered a unanimous consent request tions bill that has all the hallmarks of yesterday evening that set up a sched- carefully. This health care bill, like no all the other bloated spending bills we other issue, affects every single Amer- ule of votes on the Crapo motion and, have seen this year. It is really out- of course, the Dorgan amendment. Last ican regardless of age. Everybody is in- rageous, actually. At a time of double- terested in the subject. They have night, I was told the Republicans were digit unemployment, at a time when not ready yet. I ask my friend, are the watched the debate closely. They are Democrats are talking about increas- telling us: Please, Congress, please do Republicans ready to vote? ing by nearly $2 trillion the amount of Mr. THUNE. Mr. President, the Re- not pass this bill. money the government is legally al- I yield the floor. publican leader has just arrived. I re- lowed to borrow, the majority has serve any statement for him. moved us off of one $2.5 trillion spend- f Mr. REID. I suggest the absence of a ing bill and on to a 1,000-page omnibus RESERVATION OF LEADER TIME quorum. that would cost the American taxpayer The ACTING PRESIDENT pro tem- The ACTING PRESIDENT pro tem- another $1⁄2 trillion right in the middle pore. Under the previous order, the pore. The clerk will call the roll. of a recession. The legislative clerk proceeded to Once again, the majority has shown a leadership time is reserved. call the roll. lack of restraint when it comes to f Mr. MCCONNELL. I ask unanimous spending. At a moment of record debt, MORNING BUSINESS consent that the order for the quorum at a moment when inflation is nearly call be rescinded. flat, this bill represents a 12-percent The ACTING PRESIDENT pro tem- The ACTING PRESIDENT pro tem- annual increase in government spend- pore. Under the previous order, there pore. Without objection, it is so or- ing. Let me say that again. Inflation is will now be a period of morning busi- dered. flat. Yet we are increasing discre- ness, with Senators permitted to speak f tionary spending by 12 percent in this for up to 10 minutes each, with the Re- omnibus spending bill. The American publicans controlling the first 30 min- RECOGNITION OF THE MINORITY people are not increasing their spend- utes and the majority controlling the LEADER ing 12 percent. Moreover, it includes a next 30 minutes. The ACTING PRESIDENT pro tem- number of controversial, unrelated pro- The Senator from Texas. pore. The Republican leader is recog- visions, including, among other things, f nized. language to weaken restrictions on ORDER OF PROCEDURE f abortion funding. This $1⁄2 trillion spending bill spends Mrs. HUTCHISON. Mr. President, as I HEALTH CARE AND THE OMNIBUS $50 billion more than last year. All this understand it, we are now in the 30- Mr. MCCONNELL. Mr. President, Re- spending comes right on the heels of a minute timeframe for the Republicans; publicans are fully engaged in the new report from Treasury that says the is that correct? health care debate. It is our view that government ran a deficit of nearly $300 The ACTING PRESIDENT pro tem- there is no more important work we billion in October and November—the pore. That is correct. can do here than to show Americans worst deficit we have ever had at this Mrs. HUTCHISON. Mr. President, I what the Democratic plan for health point in a fiscal year, ever. At a time ask unanimous consent that we be al- care would mean to them. Once we re- when families across the country are lowed to have a colloquy so we can go turn to the debate, Republicans will be struggling to make ends meet, law- back and forth.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00002 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.001 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12973 The ACTING PRESIDENT pro tem- posed to lower health care costs take Mrs. HUTCHISON. So I would ask the pore. Without objection, it is so or- effect? Senator from South Dakota—because dered. Mr. THUNE. I would say to my friend it is our amendment, the Hutchison- Mrs. HUTCHISON. I thank the Act- from Texas, Senator HUTCHISON, that Thune amendment—and surely the ing President pro tempore. as we have examined this legislation American people, who would look at f and have looked at its cost and its ben- the debate, would say: We are missing efits and how that is distributed over something. This cannot be right. We HEALTH CARE REFORM time, it has become clear that what the can’t have taxes that are increasing Mrs. HUTCHISON. Mr. President, I other side has tried to do—the Demo- our premiums, increasing our prescrip- think the Republican leader just stated crats have tried to do—with this bill is tion drug costs, increasing our medical the case for why it is so important that understate its true cost by front-load- devices we must have for our health we have the votes and that we go back ing the tax increases and back-loading care for 4 years. Did he say that right? to the drawing board on this bill. the spending. In other words, the tax Did he say we would be paying those Americans are looking at the fine print increases kick in right away, when higher costs for 4 years before there is of this bill. They are seeing $1⁄2 trillion much of the benefit of the bill does not any option available to allow more in taxes. kick in for several years. people to have health care coverage? Just this week, the President has had So I want to point something out, Mr. THUNE. I would say to my friend a jobs summit because we are all con- just to illustrate what the Senator from Texas, it is kind of the same old cerned about jobs. My goodness, since from Texas has said; that is, the tax in- Washington game, the same old Wash- the President took the oath of office, creases in the bill begin on January 1 ington gimmick, the same old back- more than 3.5 million Americans have of this year. So 21 days from now, room deal that has been cut basically lost their jobs—300,000 Texans—our Americans, individuals, families, and that, of course, we have had no input budget has tripled to $1.4 trillion, and small businesses are going to see their into. Incidentally, there is another taxes go up. Unfortunately, they are the Federal debt as a portion of the now, the latest permutation of this dis- not going to see any benefit come until U.S. economy has risen to its highest cussion, going on right now behind level since World War II. So we are 1,482 days later. What that, in effect, does is it under- closed doors, which is the Medicare ex- very concerned about these taxes. In pansion, which is a subject for a whole fact, the small businesses of our coun- states the total cost of this legislation. They have said: We want to get this other day. try have said: No, do not do this to us. But I think the American people are under $1 trillion. The President said: I The NFIB, which is the National Fed- looking at this and saying: How does need a bill under $1 trillion. So they eration of Independent Business, sent a this impact me? More than anything have tried to come up with a bill that letter just this week saying: else, they are watching this big debate is about $1 trillion. But what they do When evaluating healthcare reform op- not tell you is that by delaying the in Washington, DC, and saying: How tions, small business owners ask themselves benefits and front-loading the tax in- does this impact me? I think what they two specific questions. First, will the bill are concluding is that 90 percent of the lower insurance costs? Second, will the bill creases, you are actually going to have a 4- or 5-year period where people are American public, according to the Con- increase the overall cost of doing business? gressional Budget Office, would see Well, the answer to the first question having to experience tax increases. That is going to impact the small busi- their premiums stay the same at best is clearly no because the business taxes or at worst go up, and when I say ‘‘stay start on January 1, 2010—3 weeks or so nesses because you have a Medicare payroll tax increase, which, by the the same,’’ that means double the rate from now—and going forward, the man- of inflation annual increases in their dates and taxes in 2014 to small busi- way, for the first time, will not be used for Medicare but will be used to create health insurance premiums. ness are egregious. It could be $750 per So the best you can hope for, if you employee or it could be $3,000 per em- a whole new entitlement health care program. are an American today, is the status ployee if you do not have exactly the You have an employer mandate quo when it comes to your health in- right mix of health care coverage for which is going to hit small businesses. surance premiums. your employees. Well, at $3,000 per em- You have the tax on medical device If you buy in the individual market- ployee, small businesses are telling me: manufacturers, on prescription drugs, place, your premiums are going to go I am out of here. We are just going to on health plans. You have all these up 10 to 13 percent above the annual, let people go to the government option taxes that kick in right away. double the rate of inflation increases because we cannot afford that. So what happens? These taxes get that we are currently seeing. So the answer to question No. 2 in passed on to the consumers in this So that is what happens to the Amer- the NFIB letter—which is, ‘‘Will the country in the form of higher pre- ican public, the average person out bill increase the overall cost of doing miums, so people are going to see their there, in terms of their health insur- business?’’—is, well, of course it will, premiums go up. Small businesses are ance premiums. If you are a small busi- at a time when we are seeing the num- going to see their taxes go up imme- ness, you are looking at tax increases. bers of people employed go down. diately—well, 21 days from now. But You are looking at a whole new raft of We are in a financial crisis in this Americans are not going to see any tax increases that you are going to end country. People are jobless. We are in a benefit from this for 1,482 days. So up having to pay, which is why all of holiday season. People are very what we have is a gimmick that has the small business organizations—the stressed, and here we have a health been used to disguise the total cost of Senator from Texas pointed out the care bill being rushed through, without this bill, which we all know when fully letter from the National Federation of amendments being able to come for- implemented is not $1 trillion but $2.5 Independent Business, which says this ward with a real chance for passing trillion. is going to drive the cost of doing busi- them. The cost of business is going to So the Senator from Texas and I have ness up. This is going to increase the go up, which means more people are a motion, which I believe is supported cost of health care, not lower it. What going to be laid off. by the Senator from Wyoming, who is they want to see in reform—small busi- Now, I want to ask my friend, the in the Chamber, that would delay the nesses that are the economic engine Senator from South Dakota, a question tax increases until such time as the that creates jobs in this economy—is because he and I are teaming up on an benefits begin so we synchronize or they want to see health care reforms amendment. If we are going to have align the tax increases and the fees to put in place that drive health care taxes increase in 3 weeks, you would begin at the same time the benefits do costs down. say: Oh, OK, well taxes are going to so we will reflect the true cost of this We know from every estimate that start in 3 weeks, so, then, where is the legislation to the American people and has been done, such as from the Con- package I signed up for that is going to not unfairly begin punishing small gressional Budget Office—we have lower my health care costs? So I would businesses by raising their taxes before some data now from the CMS actuary ask the Senator from South Dakota, a single dollar of benefit is going to be that just came out yesterday that says when do the programs that are sup- distributed to the American people. overall health care expenditures are

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00003 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.002 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12974 CONGRESSIONAL RECORD — SENATE December 11, 2009 going to go up, health insurance pre- and say we have now reached an all- passed. That is what the American peo- miums are going to go up. So small time high of American people opposed, ple say. The Democrats seem to be ig- businesses are looking at higher taxes. completely opposed, to this piece of noring the voice of the American peo- If you are a senior citizen in Amer- legislation. The Republican leader read ple. At a time of 10 percent unemploy- ica, and one of the 11 million people a poll that said 61 percent of Americans ment, at a time when the National who get Medicare Advantage, your ben- now oppose this bill. Well, it is because Federation of Independent Business efits are going to be cut. So you have they are learning more about it. The points out that we will lose over a mil- higher premiums, increased taxes on more people of America see what is in lion more jobs if this passes, we should small businesses, Medicare benefit cuts this bill, the more they realize they be looking at ways to help small busi- to senior citizens across this country, cannot believe any of the promises that nesses hire more workers, hire more and cuts to providers, and if you are a were made by the Democrats, by the people. young American, you are faced with a administration, the promises that were The small businesses continue to be $2.5 trillion new entitlement program made, and the polling shows it. the engines that drive up the economy. that you are going to have to pay for. Two specific questions that were Senator COLLINS from Maine was on That is what the American people, as asked in the poll were two specific the floor and gave an explanation of they are observing this debate, can ex- promises that the President made. One some of the taxes on all of the small pect to come out of this, if the bill that is, he said he will not sign a bill if it businesses in Maine. If you have 10 em- has been proposed by the majority is adds one dime to the deficit. OK. We do ployees and you go to an 11th em- enacted. That is why we are working so not want to add to the deficit, al- ployee, if this bill passes, that small hard to defeat that and put in place though the Democrats want us to vote business gets penalized for growing some commonsense reforms that actu- this weekend on raising the debt level their business. ally make sense to the American peo- by well over $1 trillion. And why? Be- We want to have an opportunity to ple. cause they cannot control the spend- hire people. I know the Senator from Wyoming, ing. But the question was, do you think She also explained that if we actually who is a physician, knows full well the the Federal budget deficit would or try to work ways through small busi- impact of many of these policies from would not increase if this bill is nesses to give raises to people, those being on the front line. He is someone passed—when the President said it will businesses get penalized from a tax who has had to deliver health care not raise it by a dime? standpoint. services in a rural State. So I would Mr. President, 79 percent of Ameri- As I look at this health care bill, we ask him to give us his thoughts about cans said this is going to increase the need health care reform that is going what these tax increases and Medicare deficit. Only 19 percent believe what to bring down the cost of care. This bill cuts are going to mean to health care the President is telling the American is going to raise the cost of care for all delivery in places such as Wyoming. people. Americans. It is going to hurt our sen- Mr. BARRASSO. I thank my col- Then the question of taxes. The iors by taking almost $500 billion out league from South Dakota because President said: My plan will not raise of Medicare, a program on which the South Dakota and Wyoming are very your taxes one penny. What do the seniors depend. It is going to raise $500 similar in many ways. Both have rural American people think when the Presi- billion in taxes which is going to hurt areas all spread across the State, with dent speaks? Question: Do you think the engine that drives the economy. It people needing health care. And I have seen it. I have seen the your taxes would or would not in- is going to hurt small business. It is concerns from people, but also from crease? This is the CNN poll the Repub- going to cause people to lose their jobs. small businesses. My colleagues men- lican leader just talked about, done I think it is foolish for people to con- tioned the National Federation of Inde- earlier this month: Do you think your tinue to support this bill. It makes no pendent Business. A lot of businesses in taxes would or would not increase? The sense. Wyoming are members of that organi- number of people who believe their I listened to my colleague from zation, and rightfully so, because small taxes will increase if this passes, 85 South Dakota who showed the chart business is the engine that drives the percent. Eighty-five percent of the that says 21 days until the tax in- economy. They are the job creators in American people believe they are not creases begin but almost 4 years until this country. getting it straight from the President the benefits begin. What do the people I see these taxes—4 years of taxes— of the United States. Only 14 percent in South Dakota have to say about before the first health care services are believe him when he says he will not this? given as going to hurt our small busi- raise taxes a penny. Mr. THUNE. Let me, if I might, enter nesses in Wyoming. It is going to hurt So we have the Democrats bringing into a discussion with the Senator small businesses all around the coun- forth a bill—to me, as a practicing phy- from Wyoming because, as he said, his try. sician in Wyoming, taking care of fam- State and my State are not unlike in In one of the morning papers, it talks ilies in Wyoming, talking to doctors, terms of the composition of population. about the plans that are being pre- talking to patients, having townhall We have big geographies in Wyoming sented by the Democrats, with all the meetings in the State, having tele- and in South Dakota and in the West increases in health costs—the fines, the phone townhall meetings, the Demo- and a lot of rural health care delivery. taxes, that this will cost 1.6 million crats bring forth a bill that the people The primary job creator in places such jobs before the first health care serv- of Wyoming and the people of America as Wyoming and South Dakota is small ices are given in 2013—1.6 million jobs realize is going to cost them more, is business. Small businesses are the eco- across the country. That affects all of going to add to the deficit, and hurt nomic engine that creates jobs. our States. the health care they receive. As the Senator from Wyoming men- At a time when unemployment is at Eighty-five percent of Americans are tioned, according to many of the anal- 10 percent, at a time when Investor’s happy with the health care they re- yses that have been done of this legis- Business Daily, this morning, says: ceive. They do not like the cost. They lation, it would be a job killer. It has ‘‘Job Cuts Hit Hardest on Low-Skill do not like the price. But this bill we been suggested by the National Federa- Men; Outlook Is Gloomy,’’ at a time are looking at is going to raise pre- tion of Independent Business that 1.6 when we are looking at an outlook miums for people who have insurance. million jobs would be lost. which they call in the headlines of the The President promised that for fami- What is ironic about that is I have front page of their paper ‘‘gloomy,’’ lies all across America, their premiums heard our colleagues on the other side why would we say: Lets increase taxes would drop by $2,500 per family. But if repeatedly say this is going to be great on Americans, and then cut Medicare you go out there trying to buy insur- for jobs. This is going to be good for from our seniors who depend upon ance, if this bill passes, you are going the economy. If that is true, then why Medicare, and lets not improve services to end up paying $2,100 more than you are all of these business organizations for 4 more years? would otherwise if nothing passes. coming out and saying it would in- It is no surprise then that the Repub- That is why the majority of Americans crease the cost of doing business and it lican leader would come to the floor say we would be better off if nothing would increase health care costs? We

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00004 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.003 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12975 have that now validated by the Con- able Health Care, they say in the let- desperately needs as it continues to struggle gressional Budget Office, by the CMS ter: in a faltering economy with double-digit unemployment. Those new costs include: Chief Actuary at Health and Human If this bill is enacted, the small business Services saying overall health care community will be forced to divert resources A small business health insurance tax costs under this legislation are going away from hiring and expansion, the very in- Though small business has repeatedly vestments our country so desperately needs called for reducing the cost of health insur- to go up, not down, both as a percent- ance, the Senate bill includes a devastating age of the gross domestic product as as it continues to struggle in a faltering economy with double-digit unemployment. new $6.7 billion annual tax ($60.7 billion over well as for individuals who are going to ten years) that will fall almost exclusively see it in the form of higher health in- Then they go on to talk about what on small business and the self-employed be- surance premiums. those costs are going to be: a small cause they purchase in the fully-insured I say to my friend from Wyoming, be- business health insurance tax; an em- market. While the fee is levied on the insur- cause he and I represent similar con- ployer mandate that encourages job ance company, a recent CBO report confirms stituencies and the economies are simi- cuts, not job creation; and the tem- the small business insurance tax ‘‘would be porary small business tax credit falls largely passed through to consumers in the lar, although he has—we wish we had form of higher premiums for private cov- more oil and gas in South Dakota short. erage.’’ This will send costs upward—the op- along the lines of what they have in I am glad they mentioned this tem- posite of what the nation’s small employers Wyoming—but the small business sec- porary small business tax credit be- need. tor is what creates jobs. cause I have heard them say on the An employer mandate that encourages job He mentioned the National Federa- other side of the aisle: But there is a cuts, not job creation tion of Independent Business. I wish to tax credit for small business that will The only certainty of an employer man- mention one other letter we received alleviate the pain. date is that it punishes both the employer from an organization called the Small Well, that credit is for employers and employee. The employer bears the first with fewer than 25 employees with av- blow in trying to afford the new unfunded Business Coalition for Affordable mandate and the second blow is borne by the Health Care. In it they state that these erage annual wages of less than $40,000. employee in the form of lower wages and job reforms fall short of long-term, mean- Very few small businesses are going to loss. The mandate in H.R. 3590 devastates the ingful relief for small business. Any po- be able to qualify for this tax credit. small business community in two ways. tential savings from these reforms are That is a very strict standard. The av- First, since the bill does little to make in- more than outweighed by the new erage annual wages of less than $40,000 surance more affordable and the tax credit is taxes, new mandates, and expensive are going to be very difficult. However, so limited, few will be able to obtain afford- if they qualify, the credit is temporary. able insurance. Second, the penalties as- new government programs included in sessed on firms—both offering and non-offer- the bill. This is signed by 50 small busi- The credit is temporary. It is not a per- ing—will most certainly result in a reduc- ness organizations, one of which, by manent credit that helps people who tion of full-time workers to part-time work- the way, is the American Farm Bureau would be able to qualify for this credit. ers and discourage the hiring of those en- Association, which is a big presence in So, in effect, this is not a tax credit at trants into the workforce who might qualify my State, represents a lot of farmers all, and certainly when it goes away it for a government subsidy. Overall, the man- and ranchers, small business people, will help no one. date included in this legislation is especially I ask unanimous consent to have troubling because it fails to recognize how and I am sure represents a lot of mem- the cost of health benefits directly impacts bers in the State of Wyoming as well as printed in the RECORD the letter from wages of the employee. Instead, H.R. 3590 in the State of Texas. the Small Business Coalition for Af- blames the employer for a cost (health insur- I think what they are saying is, what fordable Healthcare. ance) that is beyond their control. all of these business groups are saying, There being no objection, the mate- The temporary small business tax credit and that is we don’t find anything in rial was ordered to be printed in the falls short this—there may be some good things in RECORD, as follows: A short-term tax credit only puts off the it, but we find the overall core ele- DECEMBER 10, 2009. inevitable—increased cost in future years. ments of this bill to be a detriment to DEAR REPRESENTATIVE: Representing the The effectiveness of the tax credit in H.R. job creation, will kill jobs, and will country’s largest, oldest and most respected 3590 is limited: the full value of the credit is small business associations who have spent only available to those with wages of less drive up the cost of doing business in than $20,000 and phases out at $40,000. While this country. more than a decade working to increase access and affordability of private health in- the credit is designed to offset the cost of in- It is hard for me to believe that some surance, the Small Business Coalition for Af- surance, its ‘‘savings’’ potential is merely of the statements made by the other fordable Healthcare is writing to express our temporary since it only applies if you buy inside—and I assume they are making opposition to the Patient Protection and Af- surance in the exchange and it expires after them with the greatest sincerity, but fordable Care Act (H.R. 3590). just two years. they are factually wrong. If they Small business has been a constructive Health insurance exchange plans lack afford- weren’t, we wouldn’t have every busi- participant in the current healthcare debate. able choices ness organization in this country com- Our small business and self-employed entre- Small business has long sought a simpler ing out and saying we are opposed to preneurs have been clear about what they and more efficient way to shop for insurance. need and want: lower costs, more choices and H.R. 3590 creates a framework for exchanges this because it is going to increase the greater competition for private insurance. that can help ease administrative and over- cost of doing business, it is going to These reforms are critical, but to be work- head costs. However, those savings are kill jobs, and it is going to increase the able and sustainable, they must be balanced quickly erased if the exchange plans are cost of health care. against the overall cost of doing business. more expensive than what small employers So to our colleague from Texas I Unfortunately, with its new taxes, mandates, can afford. A recent CBO analysis of pre- would say I suspect she has a lot of growth in government programs and overall miums under H.R. 3590 paints a disheart- small businesses in her State, not un- price tag, the Patient Protection and Afford- ening picture: small group premiums, at like Wyoming and South Dakota, that able Care Act costs too much and delivers best, would decrease by about 2 percent and could increase 1 percent. The impact on non- share that view. too little. While a few of the provisions in the bill regroup premiums is even more devastating, as Mrs. HUTCHISON. Mr. President, I flect some of the insurance market reforms they are expected to increase an average of am glad you mentioned the Farm Bu- that the small business and self-employed 10–13 percent per person. Those estimates, in reau because my constituents in the communities have long sought, those re- addition to the financing provisions included Farm Bureau, 400,000 members of the forms fall short of long-term meaningful re- in the bill, slam the ‘savings’ door shut. Texas Farm Bureau, have contacted me lief for small business. Any potential savings Steps must be taken to ensure that a greater repeatedly about how bad this will be from those reforms are more than out- variety of more affordable plans are available to small employers and their employees. for the farmers, the small businesses weighed by the new taxes, new mandates and they own, and the few people they em- expensive new government programs in- Limited value of Simple cafeteria plans cluded in the bill. Those new costs of doing ploy. Maybe they have five employees. The inclusion of Simple cafeteria plans in business are also disproportionately targeted H.R. 3590 has the potential to bring about a This will be a killer for them. at small business. If this bill is enacted, the new option for small employers seeking to To reinforce the letter that the Sen- small business community will be forced to offer coverage in an employer-sponsored set- ator from South Dakota read from the divert resources away from hiring and expan- ting. The bill, however, currently lacks lan- Small Business Coalition for Afford- sion—the very investments our country so guage to permit owners of many ‘‘pass-

VerDate Nov 24 2008 04:50 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00005 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.004 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12976 CONGRESSIONAL RECORD — SENATE December 11, 2009 through’’ business entities to participate in malpractice legal system, and reduce unnec- Stock Artist Alliance; The PGA of cafeteria plans. Unless owners can partici- essary litigation and legal costs. America; Tire Industry Association; pate in the plan, they will be less likely to A public option that threatens choice and U.S. Chamber of Commerce. provide insurance to their workforce. competition Mrs. HUTCHISON. Mr. President, I Insurance rating reforms that result in ‘‘rate A government-run plan cannot compete am from a State that has big cities, shock’’ fairly with the private market and threatens but the vast majority of my State is Employers in the small group and non- to destroy the marketplace, further limiting rural, as is Wyoming and as is South group market have long lived with the fear choices. We believe that, with proper re- Dakota. I see my employers, my small that a single illness could either price them forms, the private market can be held ac- out of affordable insurance or that they countable and provide greater competition business owners, which are the largest could be rejected for coverage altogether. and lower-cost solutions where insurers com- bulk of the employers in my State, While H.R. 3590 attempts to ensure that in- pete based on their ability to manage, rather every day. I talk to them or I see them. surance will be more widely available to all, than shed risk. Unfortunately, we are in Washington the restrictive rating (3:1 on age) and lack of While our nation’s entrepreneurs in the every day right now, 7 days a week, but a phase-in for existing plans threatens to un- small business and self-employed commu- when I am home I see them and when dermine the viability of both plans that peo- nities strongly believe that the status quo is I am here and talking to them on the unsustainable, the measure of success is not ple own today or plans that they will buy in phone, or they are visiting me, I talk the future through the exchange. Only bal- simply to produce reform legislation. As anced rating reforms that are phased-in over some in the media have recently emphasized, to them and they are aghast. They are an appropriate timeframe have the potential the choice is not between the status quo and aghast that Congress would actually be to transform these poorly functioning insur- the bills we have seen emerge from this proc- putting more strain on small business ance markets. ess. The choice is between flawed legislation at a time when we know the jobless New paperwork burdens and costs for small and workable alternatives. In short, the leg- rate is the highest since World War II businesses islation must improve the status quo. H.R. and people are trying to do their part 3590 fails to provide those much-needed im- The Patient Protection and Affordable to increase our economy and they can’t provements, and instead makes things worse Care Act imposes a new tax-compliance pa- than they are today. We greatly hope that do it with more taxes, more mandates, perwork burden on small businesses. The the Senate will refocus its energy and work more burdens. So it is time we look at ‘‘corporate reporting’’ provision is an expan- with small business to develop the common- the tax burden and do something about sion of reporting requirements (for trans- sense solutions that make our core needs a it. actions of more than $600), which adds an- top priority. The Senator from South Dakota and other $17 billion to the cost of doing business Sincerely, for small business. I are trying to do something about it. Aeronautical Repair Station Association; A waiting period that lacks flexibility We are saying, at the very least we American Bakers Association; Amer- should not allow this bill to go forward Small employers, including those who em- ® ican Farm Bureau Federation ; Amer- when the taxes start next month—Jan- ploy full-time, part-time, temporary and sea- ican Hotel & Lodging Association; sonal workers, face much higher turnover American International Automobile uary 2010—because none of the pro- rates than their large business counterparts. Dealers Association; American Rental gramming gets up and running until They face significant challenges related to Association; AMT—The Association 2014. So we are going to have the man- providing healthcare benefits to their For Manufacturing Technology; Asso- dates and the business taxes and we are workforces. The Patient Protection and Af- ciated Builders and Contractors, Inc.; going to have the program that is sup- fordable Care Act presents two specific prob- Associated Equipment Distributors; posed to alleviate the health care crisis lems. First, it defines a full-time employee Associated General Contractors of in our country in 2014. Shouldn’t we as working an average workweek of 30 hours. America. start all of the taxes in 2014 rather Second, it outlines a 90-day waiting period, Association For Manufacturing Tech- but then implements fines (at the 30–60-day nology; Association of Ship Brokers & than asking people to pay for 4 years and the 60–90-day timeframe) of $400 and $600 Agents; Automotive Aftermarket In- the taxes that will increase insurance per affected worker respectively. In indus- dustry Association; Automotive Recy- premiums, increase prescription drug tries with above average turnover (e.g. the clers Association; Commercial Photog- costs, and increase medical equipment restaurant industry has roughly a 75 percent raphers International; Electronic Secu- costs—$100 billion in new taxes on turnover rate annually) these provisions rity Association; Independent Elec- those items—shouldn’t we at least put would lead to fewer full-time workers and trical Contractors; Independent Office it off until the supposed program less hiring overall. Products & Furniture Dealers Alliance; comes into place. Because in 4 years, Employers and employees lose flexibility and International Foodservice Distributors choice Association; International Franchise with any luck in America, we won’t have these programs start. Small employers need more affordable Association. health insurance options. However, the pro- International Housewares Association; There is hope for America that we hibition of HSA, FSA and HRA funds to pur- International Sleep Products Associa- can stop this program by 2014 as people chase over-the-counter medications, along tion; National Association of Conven- learn what is in it and protest enough with the $2,500 limit on FSA contributions, ience Stores (NACS); National Associa- that the Members of Congress who are diminishes flexibility and threatens to fur- tion of Home Builders; National Asso- elected in 2010, elected in 2012, will say: ther limit the ever-shrinking options em- ciation of Manufacturers; National As- No, we now know that this would be a sociation of Mortgage Brokers; Na- ployers have to provide meaningful disaster for our country. There is hope. healthcare to their employees. tional Association of Wholesaler-Dis- tributors; National Automobile Dealers I would ask the Senator from Wyo- An unprecedented increase in the Medicare ming, when people start learning about payroll tax Association; National Club Associa- tion; National Federation of Inde- the Medicare cuts about which you Since its creation the payroll taxes dedi- pendent Business. have spoken so eloquently, and the cated to Medicare programs have been dedi- National Lumber Building Material taxes on the small businesses in your cated specifically to funding Medicare. How- Dealers Association (NLBMDA); Na- State and all of our States, do you ever, the Patient Protection and Affordable tional Retail Federation; National Re- Care Act changes the purpose of the tax think that perhaps not putting these tail Lumber Association; National taxes in place is a good policy, because while setting the precedent to use payroll Roofing Contractors Association; Na- taxes to pay for other non-Medicare pro- tional Tooling and Machining Associa- maybe we can still stop this when peo- grams. Furthermore, it will raise taxes for tion; National Utility Contractors As- ple find out what is in it, when it is some small businesses. sociation; Northeastern Retail Lumber supposed to take effect 4 years from No meaningful liability reform Association; Precision Machined Prod- now? Our medical liability litigation system cre- ucts Association; Precision Mr. BARRASSO. Mr. President, I ates a disincentive for affordability and effi- Metalforming Association; Printing In- would respond to my colleague from ciency while creating a climate where the dustries of America. Texas that I think she is absolutely practice of defensive medicine increases Professional Photographers of America; right. The more people learn about this healthcare spending, and overall costs. Those Self-Insurance Institute of America increased costs extract a particularly heavy (SIIA); Service Station Dealers of bill and the details of the bill, the more toll on the ability of small business to access America and Allied Trades; Small the American people oppose this bill. affordable healthcare for their employees Business & Entrepreneurship Council; My colleague from Texas made a and dependents. Meaningful liability reform Society of American Florists; Society wonderful point yesterday and again will inject more fairness into the medical of Sport and Event Photographers; today when she said if they start this

VerDate Nov 24 2008 04:50 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00006 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.002 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12977 tax collecting right now, do we even So that is why we see all of these expect: No. 1, that we would not start know the money is going to be there 4 studies coming out saying premiums the taxes until the program takes ef- years from now to start supplying the are going to go up, taxes are going to fect; No. 2, that it would be deficit neu- services. There was a story in today’s go up, and Medicare benefits are going tral. USA TODAY talking about unemploy- to be cut, particularly for seniors who By my math, I ask the Senator from ment in this country, and the story have Medicare Advantage. At the end South Dakota, it looks to me like we says: of the day, this ends up being a $2.5 bil- are $1.5 trillion into the deficit, and we Public Gain, Private Pain. For Federal lion expansion of the government here are already at a debt ceiling that is workers there is a hiring boom. The Federal in Washington, DC. higher than we have had as a percent- Government is adding jobs this year at a But to the point the Senator from age of our GDP since World War II. So rate of nearly 10,000 per month. Texas made—and I think—I know we it is a $12 trillion debt ceiling we are We have read about all of the dif- are running out of time. We want to hitting right now, and we are talking ferent bureaucracies that will be vote. We want to vote on this motion. about a $1.5 trillion deficit in the bill brought into play if this passes: over 70 We don’t think you ought to start tax- we are being asked to vote for. new bureaucracies, 150,000 more Fed- ing people in 21 days and not start de- I ask the Senator from South Da- eral employees, more Washington bu- livering benefits for almost 1,500 days. kota, who is my cosponsor on this very reaucrats to make rules and regula- The ACTING PRESIDENT pro tem- important amendment, don’t we owe tions that affect the people of America. pore. The time of the Senator has ex- the American people the transparency, It talks about the 10-percent unem- pired. as well as the policy, that we would ployment in the country. It says, it is Mr. THUNE. That is what our motion eliminate the deficit and we would stop the new Federal jobs—not the small would do: Synchronize the tax in- these disastrous taxes from taking ef- business jobs, the Federal jobs—that creases with the benefits. fect, so maybe we would have a chance have helped bring down the unemploy- I yield the floor. to change this product going forward in ment rate from 10.2 to 10 percent. It is Mrs. HUTCHISON. Mr. President, I the next 4 years so the American peo- the Federal jobs. ask unanimous consent that until the ple will not be saddled with these ex- I am looking at all of this money Democrats take over, we may continue penses, taxes, and mandates? that Washington is going to collect. I to talk. Mr. THUNE. We do want to get a used to think it was a big gimmick so The ACTING PRESIDENT pro tem- vote—a vote on our amendment and on they could say, Well, we have kept the pore. Without objection, it is so or- other amendments. Right now, that is number under $900 billion. I still be- dered. being prevented or blocked. We haven’t lieve it is a big gimmick, but I am con- Mrs. HUTCHISON. Mr. President, to had a vote since Tuesday. We have cerned they are going to spend the continue with the Senator from South amendments that are ready to go. money as well so the money won’t be Dakota, I am glad he made the point The other side said they are open to there, which is the point of the Senator because we are very much hoping our amendments and they want to get the from Texas, who has been very fiscally amendment will be in the order when bill moving forward, but we are being conservative, out there always making we start voting on the health care prevented from getting votes on sure we are not spending the taxpayer amendments. amendments. In the meantime, this money in any way that is not a wise The amendment is so clear; it is very backroom deal that is being cut, which use of the money. simple. I have it here. For Washington, we haven’t seen—supposedly it has Is that one of the concerns the Sen- it is half a page. That is something ev- been sent to the CBO to find out what ator has? I know the Senator from eryone will be able to appreciate—the it will cost. We are waiting for that South Dakota has similar concerns: motion to commit with instructions: deal to emerge. In the meantime, we Will the money be there if they are Senator Hutchison and Senator Thune are looking at a piece of legislation going to hire more Washington bureau- move to commit the bill to the Committee that costs $2.5 trillion when fully im- crats, which is what USA TODAY says? on Finance with instructions to report back plemented. Mr. THUNE. That is exactly what our to the Senate with changes to align the ef- As the Senator said, it relies on concern is. I would also add this recent fective dates of all taxes, fees, and tax in- Medicare cuts and tax increases to fi- study that came out yesterday by the creases levied by such bill so that no such nance it. Just yesterday, the chief ac- tax, fee, or increase takes effect until such CMS chief actuary sheds a lot of addi- time as the major insurance coverage provi- tuary at the Center for Medicare and tional light on what is a very bad pro- sions of the bill, including the insurance ex- Medicaid Services basically said the posal, a big government proposal that changes, have begun. savings that are relied upon, in terms does create 70 new programs here in The committee is further instructed to of Medicare cuts, are unlikely to be Washington, DC, but does nothing to maintain the deficit neutrality of the bill sustainable on a permanent basis. They affect in a positive way the health care over the 10-year budget window. raise the question about whether those costs that most Americans are dealing That is what was promised. This was cuts are actually going to occur and, if with right now. The actuary goes on to going to be deficit neutral. It is not they do, whether they will be sus- say that access to care problems is deficit neutral. The cost of this bill is tained. If they are not, then you have plausible and even probable under the $2.5 trillion over the 10-year period the question of whether a lot of these Reid bill. when it starts, in 2014 until 2023. It is providers out there—if the cuts do So the issue we have talked about in $2.5 trillion. The ‘‘offset’’—I put that in occur, and they continue to lose more States such as Wyoming and South Da- quotes because the offsets are $500 bil- and more every time they see a Medi- kota, where people travel long dis- lion in tax cuts to Medicare, which will care patient, then they are going to tances to get access to health care, lower the ability of hospitals to stay in quit participating in the Medicare Pro- would be aggravated by this legislation business and treat Medicare patients gram. You will have fewer providers of- because there would be a need for more and doctors to be able to treat Medi- fering services, making it more dif- and more providers—hospitals, physi- care patients. ficult for people—especially in places cians—who currently don’t take Med- So the quality of Medicare is going to such as Wyoming and South Dakota— icaid patients. You expand Medicare, go down. Medicare Advantage will be to get access to health care. which is the latest proposal the Demo- severely restricted. So you have $500 You are assuming all these cuts in crats have put forward, and as a con- billion in cuts to Medicare, and then Medicare are going to occur, and you sequence of that you get fewer and you have $500 billion in tax increases are assuming all these tax increases. fewer hospitals, fewer and fewer physi- and mandates. That is a total of $1 tril- Even with all that, you have a $2.5 tril- cians who are accepting Medicare pa- lion in offsets in a bill that costs $2.5 lion expansion of the Federal Govern- tients, because Medicare and Medicaid trillion. ment, which inevitably is going to rely are both underreimbursed, therefore What the Senator from South Dakota more and more on borrowing. You are creating a cost shift where the cost is and I are trying to do is let’s keep our going to see more and more of this shifted over to private payers whose word. Let’s keep our word and do two going on the debt, and we will pass it premiums continue to go up and up. things that the American people should on to future generations.

VerDate Nov 24 2008 04:50 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00007 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.005 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12978 CONGRESSIONAL RECORD — SENATE December 11, 2009 As CMS pointed out, it is unlikely That is why we cannot pass this bill, not just one country. This bottle is these Medicare payment cuts are going which will hurt seniors, raise taxes on shipped to virtually every other coun- to be sustainable without driving hos- the American people, cost jobs, and try, including Great Britain, France, pitals and doctors and other health cause people who have insurance to Germany, Spain, Canada, and it is sold care providers out of business. When have their premiums raised. For all at a much lower price. they start reacting to this and those these reasons, this bill is the wrong The question is, Should the American Medicare cuts are no longer sustain- prescription for America. people be required to pay the highest able, then you have built in all this The ACTING PRESIDENT pro tem- prices in the world for prescription new spending, and there is no way to pore. The Senator from North Dakota drugs and not have the freedom to ac- pay for it without raising taxes dra- is recognized. cess those drugs in the global market- matically, which would be, I guess, Mr. DORGAN. Mr. President, first of place? something the other side—since they all, I ask unanimous consent that the Some say: Well, if you did that—if have already demonstrated a signifi- amount of time by which the other side you allow the American people to ac- cant willingness to raise taxes in this went over the allotted time be added to cess that drug from Canada or Ger- bill or borrowing, neither of which is our block of time. many at a fraction of the price, we good for the future of the country or The ACTING PRESIDENT pro tem- would get counterfeit drugs. our economy. pore. Is there objection? It is interesting that in our amend- Right now, our economy is trying to Without objection, it is so ordered. ment we actually have more safety provisions than exist in our domestic come out of a recession. Small busi- f nesses, which create the jobs in our drug supply. There does not now exist a economy, are faced with higher taxes PRESCRIPTION DRUG PRICING tracing capability, pedigree, or batch under this bill. They have come for- Mr. DORGAN. Mr. President, I have lots. That would be a part of our ward and said—every conceivable busi- come to the floor to speak about some- amendment. That doesn’t exist for ness is saying this will drive up the thing a colleague of mine spoke about America’s drug supply today. We will cost of doing business, and it will raise last night, which I think he believes actually improve the safety of the drug the cost of health care in this country. separates us when, in fact, it doesn’t. supply with this amendment. So you have all these small busi- Before I do that, I wish to talk for a I didn’t offer this amendment to nesses saying we are not going to be moment about the amendment of mine cause trouble for people. I know this is able to create jobs. You have that spec- now pending on the floor of the Senate, causing great angst in the Senate. We ter out there. You also have the idea of dealing with the issue of prescription have been tied up several days now on the Medicare cuts, which are, accord- drug pricing. this issue. I know the pharmaceutical ing to the CMS actuary, unlikely to be I offered this amendment, along with industry has a great deal of clout. This sustainable, leading to borrowing and my colleague, Senator SNOWE, with the issue revolves around $100 billion, $19 debt, which means we are already run- support of a broad bipartisan group of billion of which will be saved by the ning a $1 trillion deficit every year and Members of the Senate—Republicans Federal Government in the next 10 piling more on the Federal debt and and Democrats—at a time when there years and nearly $80 billion saved by there will be a movement here to raise has been so few bipartisan amend- the American consumers because they the debt limit by almost $2 trillion. So ments. The amendment I have offered can access FDA prescription drugs at a we will pass this on to future genera- is, in fact, bipartisan and had bipar- fraction of the price. So I understand why some are fight- tions, future young Americans, who are tisan speeches in favor of it in the last ing hard to prevent this. But this is im- going to bear the cost of this massive several days. That is unusual, but I portant public policy. The price of pre- expansion of the Federal Government. think it is also refreshing. scription drugs has gone up 9 percent There isn’t anything in this that is The amendment is very simple. It has this year alone. Every single year, the good for the American public, which is been around for a long time. It has price of prescription drugs goes up. why they are reacting the way they been hard to get passed because the Every year since 2002, drug price in- are, and why you are seeing these 61 pharmaceutical industry is a very percent of Americans coming out in creases have risen above the rate of in- strong, assertive industry. It is a good flation. We can’t, in my judgment, pass the polls against it. industry, but I have strong disagree- I say to my friend from Wyoming, his health care reform through the Con- ments with their pricing policies. This thoughts with regard to this issue, gress and say: Yes, we did that, but we amendment simply says the American these Medicare cuts being sustainable, did nothing about the relentless in- people ought to have the freedom to ac- how it is going to impact the delivery creases in the price of prescription cess FDA-approved drugs wherever of health care around this country, and drugs. We will solve that not by impos- they are sold—as long as they are FDA what it will do to future generations in ing price controls but by giving the approved—and offered at a fraction of terms of the additional debt and bor- American people freedom. They are rowing. the price they are sold at in the United told it is a global economy. Well, it is Mr. BARRASSO. As my friend knows, States. a global economy for everything except small communities—— I ask unanimous consent to show on the American people trying to access Mrs. HUTCHISON. I am sorry to in- the floor, once again, two bottles of prescription drugs at a fraction of the terrupt my friend. I ask unanimous pills. price in most other countries. consent that he have 1 minute to fin- The ACTING PRESIDENT pro tem- Again, I didn’t offer this amendment ish, after which the floor would go to pore. Without objection, it is so or- to try to cause trouble; I offered this the majority. dered. amendment to try to solve a problem. The ACTING PRESIDENT pro tem- Mr. DORGAN. This bottle contained This Congress should not, in my judg- pore. Without objection, it is so or- Lipitor, perhaps the most popular cho- ment, move ahead with health care re- dered. lesterol-lowering drug in the world. form and decide it ought to leave the Mr. BARRASSO. To follow up, the This was made by an American com- question of the American people paying small communities of this Nation have pany in an Irish plant—made in Ireland the highest prices for prescription great concerns about these cuts in and shipped around the world. This drugs—leave that alone and let that Medicare because the small community bottle, as you can see, is identical to continue to be the case for the next 10 hospitals that stay open know they this one. One has a red label and one years or the next 20 years. I will speak have to live within their means. When has a blue label. more about it later. 1 Medicare cuts total over almost $ ⁄2 The only difference in a cir- f trillion, it is the small communities cumstance, where you have the same that have just one hospital in a fron- pill, put in the same bottle, made by TRADE WITH CUBA tier medicine mode taking care of peo- the same company, is the price. Ameri- Mr. DORGAN. Mr. President, I came ple who may live 50, 100, or 150 miles cans pay $4.78 per tablet and, in this to the floor to speak about a speech a away, those hospitals’ very surviv- case, folks in another country pay colleague, for whom I have great affec- ability is at stake. $2.05. Why the difference? Again, it is tion, gave yesterday on the floor of the

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00008 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.006 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12979 Senate. He was concerned about a pro- buying from the United States which is re- Let me say also, my colleagues—I use vision in the appropriations bill that is quiring payment before shipment of the food the term plural—who feel very strongly now being considered, a provision deal- sales. about this issue, the Cuba issue, we ing with the sale of agricultural com- As I said, President Bush tightened have common cause. I have no truck modities to Cuba. the rules to say that ‘‘cash in ad- for the Cuban Government. I want the My colleague said the provision vance,’’ in a law I wrote, shall be inter- Cuban people to be free. I have no sym- would undo current law, where the Cas- preted as meaning you must pay even pathy for the Cuban Government. But tro regime in Cuba would have to pay before the shipment. I have never even it is interesting to me that our engage- in advance for goods being sold to them considered the phrase could be inter- ment with Communist China and Com- because of their terrible credit history. preted like that, but that is the way munist Vietnam, for example, is to say That is not an accurate statement. I the law is now being administered. that constructive engagement through expect there is just a misunder- In the pending appropriations bill, trade and travel is the best way to ad- standing. I would be very happy if my there is an amendment I included. It is dress those issues. We believe that. Ex- colleague would wish to have a col- not, in my judgment, something we cept we say in Cuba that we do not be- loquy on the floor to set out the law ought to debate. It is just there. We lieve it. We restrict the right of the and the provision in the bill so all of us ought to understand it. It very simply American people to travel to Cuba, understand the same thing. says this. which is slapping around the rights of No. 1, I helped write the law that fi- During fiscal year 2010, for purposes of . . . the American people in order to poke nally opened just a small crevasse—the the Trade Sanctions Reform and Export En- our finger in the eye of Fidel Castro, I ability of our farmers in America to hancement Act of 2000 . . . the term ‘‘pay- guess. And we do other things that sell their agricultural commodities ment of cash in advance’’ shall be inter- make no sense. into the Cuban marketplace. Why did I preted as payment before the transfer of title My colleagues who have raised these do that? Because we have an embargo to, and the control of, the exported items to issues actually won on one issue that the Cuban purchaser. on Cuba that, in my opinion, has failed kind of bothers me. I also put an for 40 or 50 years. At the time that em- It takes the definition of ‘‘payment amendment in this legislation that I bargo included restricting the sale of of cash in advance’’ back it to how it understand now has been emasculated. food to the Cuban people. was originally interpreted after I got Let me describe what that was. I do not think we ought to ever em- my bill passed and we started selling Most people do not know this, but we bargo food shipments anywhere in the into the Cuban marketplace. It re- have airplanes flying over Cuba, at world. I think it is immoral. I do not stores it to what it was. least in international waters, broad- think we ever ought to use food as a My colleague yesterday said this casting television signals to Cuba. I weapon. Yet that is exactly what has would undo the current law where the was able to get that shut down in an been done. Castro regime would have to pay in ad- amendment in the appropriations proc- Our farmers could not sell agricul- vance. Obviously, that is not the case. ess because we are broadcasting tele- tural commodities into Cuba. Canadian It is just not the case. ‘‘Payment of vision signals to Cuba to tell the Cuban farmers could. French farmers could. cash in advance shall be interpreted’’ people how great freedom is—they can German farmers could. American farm- to mean ‘‘payment before the transfer hear that on a Miami station 90 miles ers could not. of title to, and control of, the exported away—but we are broadcasting tele- I changed the law, along with a Re- items . . . ’’ There is nothing here sug- vision signals being broadcast by an publican colleague, with a Dorgan- gesting credit be offered to the Cuban airplane and the signals are signals the Ashcroft amendment. We changed the regime. This only resolves an issue Cuban people cannot see. Isn’t that in- law. We opened it just a crack so Amer- that was created when President Bush teresting? It is called TV Marti. Here is ican farmers could sell their commod- wanted to shut off agricultural com- a picture of what TV Marti broadcasts. ities into the Cuban marketplace. But modity shipments to the country of That is the television screen for TV it had to be for cash. The Cubans had Cuba. As I indicated, the result of the Marti. The Cubans block it easily, and to pay cash in advance. I support that. Bush administration’s interpretation is the Cuban people do not see it and can- I helped write the law. what the Calgary Herald wrote about: not see it. In fact, what I would like to do is put American farmers, watch the Cana- We started out broadcasting that up a copy of the current law. The cur- dians grab your market. with aerostat balloons. They called it rent law indicates ‘‘cash in advance.’’ Why on Earth should we withhold Fat Albert. This is the second one. The We have sold about $3 billion of agri- food shipments anywhere? It makes no first one got loose. Fat Albert got cultural commodities into the Cuban sense to me. Why should we say to our loose. It was tethered on a big, long marketplace since the law was passed, farmers who produce foods—and we tether, hanging way up in the air, to and they have paid cash in advance. need to export that food—that the Ca- broadcast television signals to the What happened was, President Bush nadians can have an advantage, the Eu- Cuban people that the Cubans were decided just prior to an election that ropeans can have an advantage, they blocking. So we are spending a lot of he wanted to send a signal that he was can service that market but we cannot, money broadcasting television signals really tightening things with Cuba. He even though we require cash in ad- that nobody can see. In the first case, decided to change the definition—not vance. Lets make it even harder by re- we had aerostat balloons, huge bal- by law but by administrative fiat—and quiring payment before shipping even. loons, tethered way up in the air, he said ‘‘cash in advance’’ will mean That makes no sense to me. That is spending millions of dollars a year. One the Cubans have to pay for the com- why I wanted to correct it. I wanted to got loose and flew over the Everglades, modity even before it is shipped from a correct it to get it back to what the and they had a devil of a time trying to port in the United States. For four law reads. capture Fat Albert. So they got a sec- years up to then, the government al- My colleague who spoke on this issue ond Fat Albert and kept broadcasting lowed U.S. farmers to ship the goods yesterday is a good Senator and some- signals no one could see. But that from the port and then have the Cu- body I like a lot, but he indicates that wasn’t good enough. In fact, they de- bans pay cash when the commodity ar- this amendment of mine undoes cur- cided: You know what, we are going to rives in Cuba. The President made that rent law where the Castro regime get ourselves a big fat airplane and we change as an attempt to shut down the would have to pay in advance. That is will fly that airplane around and sale of agricultural commodities to just not the case. That is not the case. broadcast signals to Cuba from an air- Cuba. Maybe the best way for us to resolve plane. And those signals, too, by the Here is what the Calgary Herald, a this is, let’s do a colloquy on the floor way, are routinely blocked and no one Canadian newspaper, said: ‘‘Cuba to to put in the RECORD the exact lan- can see them. In my judgment we Buy $70 Million of Canadian Wheat.’’ guage, because the shipment of agricul- should not waste that kind of money. Then in the body of the article it says: tural commodities to Cuba in the fu- John Nichols, professor of commu- Cuban food purchases from Canada will in- ture will continue to require cash pay- nications and international affairs at crease 40 percent this year due to difficulties ments in advance. That is just a fact. Penn State University had this to say.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00009 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.007 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12980 CONGRESSIONAL RECORD — SENATE December 11, 2009 He is one of the experts on communica- The chart on my left makes a couple able death recently of Deamonte Driver tions policy. of fundamental points. of Maryland, a young boy who lost his TV Marti’s quest to overcome the laws of For children, health care reform life because his family did not have the physics has been a flop. Aero Marti, the air- must follow one simple principle, and I coverage for an infected tooth—an in- borne platform for TV Marti, has no audi- also say it is only four words: No child fected tooth, not something that is ence currently in Cuba, and it is a complete worse off. When I say ‘‘no child,’’ of complicated to deal with. His family and total waste of $6 million a year in tax- course I am speaking of children who couldn’t afford the care. A child in payer dollars. do not often have a voice. Obviously, if America died from an infected tooth The $6 million is just for the air- they are children from a family that is that would have cost $80 to treat. plane. They spend much more than very wealthy, I think they will be just So when we talk about insuring ben- that on TV Marti. fine no matter what happens here. But efit packages that include oral and vi- It is a total and complete waste of $6 mil- children who are poor and children who sion care, that doesn’t say it too well lion a year in taxpayer dollars. The audience experience and have to live with spe- until you connect it to the life and the of TV Marti, particularly the Aero Marti cial needs are the ones I am talking death—the tragic death—of a young platform, is probably zero. about when I say ‘‘no child worse off.’’ child not too far from Washington, DC. We have been doing this for 10 years I filed many weeks ago—actually, Thirdly, the Patient Protection and and more. Since I raised this issue, we months ago now—a joint resolution, Affordable Care Act will mandate pre- have spent $1⁄4 billion broadcasting tel- No. 170. I was joined in that resolution vention and screenings for children. evision signals into a country that can- by Senator DODD, Senator ROCKE- This is so important. We know our not see them. FELLER, Senator BROWN, Senator poorest children, who have the benefit Let me continue: WHITEHOUSE, and Senator SANDERS. We of being covered by Medicaid, get these TV Marti’s response to this succession of filed that resolution just to make this kinds of services so we can prevent a failures over a two-decade period has been to point with a couple more words than child from getting sicker or prevent a resort to ever more expensive technological ‘‘no child worse off,’’ but that was the disease or a condition or a problem gimmicks, all richly funded by Congress, and none of those gimmicks, such as the air- fundamental point to guide us through from becoming that much worse for plane, have worked or probably can work this process because sometimes in a de- that child. without the compliance of the Cuban Gov- bate on something that is this signifi- As I said before, children are not ernment. It is just the law of physics. cant, and parts of it are complicated to small adults, so we have to make sure In short, TV Marti is a highly wasteful and be enacted into law—it is a challenge we have strategies and procedures in ineffective operation. to pass health care reform. I think we place that deal with the special needs I put in an amendment that cut $15 will. I think we must. But we do need and the special challenges that chil- million out of this program. I know it guiding principles, and I believe one of dren face in our health care system. is radical to say you should not broad- these should be ‘‘no child worse off’’ for Finally, the act has increasing access cast to people who cannot see them. I special needs children. to immunizations. I don’t think I have suspect this must be considered some A lot of the child advocates across to explain to any American how impor- sort of jobs program. That would be the America have told us, for many years, tant immunizations are. The Centers only excuse for continuing funding. something so simple but something for Disease Control will provide grants I had an amendment that shut down very meaningful in terms of providing to improve immunizations for children, TV Marti. If ever—ever, ever—there further guidance for this debate. Chil- adolescents, and adults. were an opportunity to cut government dren are not small adults. That does Let me move to the third chart. The waste, this is it. This is just a program not sound so profound, but it really third chart outlines some other provi- that accomplishes nothing and has no matters when it comes to health care. sions for children. Here are three more intrinsic value at all. But in the middle We can’t just say: If you have a health ways the Patient Protection and Af- of a very significant economic down- care plan for adults, it will work for fordable Care Act helps children, turn, when deficits have spiked up, up, kids, do not worry about it. Unfortu- among many others. It creates pedi- way up, I apparently cannot even get nately, that is not the case. atric medical homes. People may say: this done. I got it done in the Senate, If we do not do the right thing, we What is a medical home? What does but it did not get through the con- could lose our way on that basic prin- that mean? Well, I need simplicity just ference. I guess for the next year or ciple. We have to get it right, and we like anyone does. This is my best sum- so—Fat Albert is retired—the airplane have to give poor and special needs mary of a medical home. will still fly. And here is a television children a voice in this debate. I do not A medical home obviously isn’t a set in Cuba sees of TV Marti snow, think there is any question that Sen- place. It is treating people in the way static. We will continue to spend $15 ators on this side of the aisle are guid- they ought to be treated in our health million or so so the Cubans can look at ed by that basic principle. care system. The ideal—and I think static on their television sets. It is not I want to next turn to the bill, the this bill gets us very close to meeting much of a bargain for the American Patient Protection and Affordable Care this goal—is that every American taxpayer, I would say. Act, and walk through some of the pro- should have a primary care physician I only point this out because I lost on visions. There are many good provi- and then be surrounded by the exper- this issue. Those who feel strongly that sions in the bill for children, but I want tise of our health care system. Children we ought to continue to do this won. I to walk through a couple. especially need that kind of help. So we hope that one day, perhaps we could How does it help children? That is a want to make sure every child not only agree that when we spend money, let’s fundamental question. You cannot es- has a primary care physician—in this spend it on things that work, spend it cape the basic implications of that. case a pediatrician—but also has access on things that are effective, spend it on First, the bill eliminates preexisting to all of the expertise that pediatri- things that advance our interest and condition exclusions. That is in the cians and our system can give them ac- our values. This certainly does not. first couple pages of the bill. Obvi- cess to. Mr. President, I yield the floor. ously, it has an enormously positive Next, the act strengthens the pedi- The ACTING PRESIDENT pro tem- impact for adults. We have heard story atric workforce. We can’t just say we pore. The Senator from Pennsylvania. after story of literally millions of want children to have access to pedi- f Americans denied coverage year after atric care. We have to make sure we year because of the problem of pre- have the workforce in America to pro- HEALTH CARE REFORM existing conditions. It has special vide that kind of care. Mr. CASEY. Mr. President, I rise this meaning when it comes to children. Thirdly, the act expands drug dis- morning to speak about health care No. 2, the bill ensures that benefits counts to children’s hospitals. Before and our children and the health care packages include oral and vision care. this act, before the act that we are de- reform, the Patient Protection and Af- We know what that means for children, bating, children’s hospitals did not fordable Care Act, as relates to our and in particular we are thinking have access to a program that provides children. about the horrific, tragic, and prevent- discounts on the drugs they need for

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00010 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.008 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12981 sick children. Now children will benefit consideration of H.R. 3590 for the pur- ups work things out like this and with from the discounted prices that result pose of considering the pending Crapo an understanding that we will resolve from the passage of this act. This is vi- amendment to commit and the Dorgan them? If we can’t, then for goodness’ tally important. amendment, No. 2793, as modified; that sake don’t subject us to these argu- Let me go to one more chart. Senator BAUCUS be recognized to call ments on the Senate floor that we are Parliamentary inquiry, Mr. Presi- up a side-by-side amendment to the not calling amendments for a vote. We dent: How much time do I have remain- Crapo motion; that once that amend- have just tried 2 days in a row, and the ing? ment has been reported by number, Republicans once again have stopped The ACTING PRESIDENT pro tem- Senator LAUTENBERG be recognized to us with objections. That is a fact. pore. Two minutes. call up his side-by-side amendment to I would implore the leadership—not Mr. CASEY. Two minutes. I will just the Dorgan amendment, as modified; my friend from Wyoming; I know he is do one chart and then we will move that prior to each of the votes specified doing what he is instructed to do by quickly. in the agreement, there be 5 minutes of the leaders—for goodness’ sake, let’s This chart makes a very fundamental debate equally divided and controlled break this logjam. Let’s not, at the end point. At a time in our history when in the usual form; that upon the use or of the day, say, well, we stopped debat- over the course of a year the national yielding back of the time, the Senate ing this bill when we should have been poverty rate went up by 800,000, and the proceed to a vote in relation to the debating it, when we have offered 2 number of people without insurance is Lautenberg amendment; that upon dis- days in a row in good faith to have ac- going up—and in the midst of a reces- position of the Lautenberg amendment, tual amendments offered and debated. sion, you would understand and expect the Senate then proceed to vote in re- I would also say, Mr. President, this that—the one thing we don’t focus on lation to the Dorgan amendment; that is the bill we are considering, H.R. 3590, is that because of the effectiveness of upon disposition of that amendment, when we return to it. This is the health the Children’s Health Insurance Pro- the Senate proceed to vote in relation care reform bill, and this is a bill which gram, there is one number on this to the Baucus amendment; and that has been the product of a lot of work. chart that is going down—and we hope upon disposition of that amendment, A lot of work has gone into it both in it keeps going down—and that is the the Senate proceed to vote in relation the House and in the Senate. In the number of uninsured children. to the Crapo motion to commit; that Senate, two different committees met It is interesting that on this chart no other amendments be in order dur- literally for months writing this bill, between 2007–2008, as the child poverty ing the pendency of this agreement, and they should take that time because rate went up by 800,000 children, the and that the above referenced amend- this is the most significant and his- number of children without insurance ments and motion to commit be sub- toric and comprehensive bill I have is down by that same number—800,000. ject to an affirmative 60-vote thresh- ever considered in my time in Con- It shows the Children’s Health Insur- old; that if they achieve that thresh- gress—more than 25 years. This bill af- ance Program is working, even in the old, they then be agreed to and the mo- fects every person in America—every midst of a recession. So I have an tion to reconsider be laid upon the person in the gallery, everyone watch- amendment that strengthens the Chil- table; if they do not achieve that ing us on C–SPAN, every person in dren’s Health Insurance Program in threshold, they then be withdrawn. America. It addresses an issue that the bill. The ACTING PRESIDENT pro tem- every American is concerned about— I know I am out of time, Mr. Presi- pore. Is there objection? the future of health care, how we are dent, and I yield the floor. Mr. ENZI. Mr. President, reserving going to make it affordable. The ACTING PRESIDENT pro tem- the right to object, we are going to At a time when fewer businesses offer pore. The Senator from Illinois. have three Democratic amendments the protection of health insurance, at a Mr. DURBIN. Mr. President, it is my and one Republican amendment voted time when individuals find themselves understanding that we have gone over on, and the Democrats wrote the bill. unable to buy health insurance that is the original allocation of time, and The Democrats are doing a side by side good and that they can afford; at a Senator MCCAIN is coming to the floor. to their own amendment. time when health insurance companies We will, of course, offer to the minor- It looks to me like they ought to get are turning down people right and left ity side whatever extra time we will together and get some things figured for virtually any excuse related to pre- use so that there will be a like amount out. There ought to be a little bit more existing conditions, we cannot con- available to them, and I will make fairness on the number of amendments. tinue along this road. Those who are every effort to shorten my remarks. So I object. fighting change, those who are resist- The ACTING PRESIDENT pro tem- The ACTING PRESIDENT pro tem- ing reform, are basically standing by a pore. The majority has not exceeded its pore. Objection is heard. broken system. time. There is 12 minutes remaining on Mr. DURBIN. Mr. President, this is There are many elements in Amer- the clock. the second time we have offered to call ican health care that are the best in Mr. DURBIN. Sorry, I was mis- amendments for a vote, and the com- the world, but the basic health care informed. But whatever we promised plaint from the other side is, you are system in America is fundamentally the minority side, they will receive not calling amendments for a vote. flawed. This is the only civilized Na- like treatment on whatever time we How many times do we have to ask tion on Earth where you can die for use. for permission to call amendments for lack of health insurance—literally die. f a vote, run into objections from the Mr. President, 45,000 people a year die Republican side, and then hear the because they do not have the health in- UNANIMOUS CONSENT REQUEST— speech: Why aren’t we voting on surance they need to bring them to the H.R. 3590 amendments? doctor they need at a critical moment Mr. DURBIN. Mr. President, yester- I am certain that in the vast expan- in life. They do not have the health in- day, the majority leader propounded a sion of time and space, we can work surance they need to afford the sur- unanimous consent request to have out something fair in terms of the gical procedure they need to avoid a four votes with respect to the health number of amendments on both sides. deadly disease. care bill. The Republican leader ob- In fact, maybe the next round will have If a person has a $5,000 deductible on jected to the consent, since he indi- more Republican amendments than their health insurance, and a doctor cated they had just received a copy of Democratic amendments. I don’t know tells them—as a man who wrote me Senator LAUTENBERG’s side-by-side how many Republican amendments or from Illinois said—you should have a amendment to the Dorgan amendment Democratic amendments we have voted colonoscopy, sir; there is an indication and so they needed time to review the on so far. We can get an official tally, you could have a problem that could amendment. but that really seems like a very minor develop into colon cancer and it could Therefore, I now ask unanimous con- element to stop the debate on health be fatal. sent that following the period of morn- care—because we need to have an equal The man says: How much is the ing business today, the Senate resume number of amendments. Can’t grown- colonoscopy?

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00011 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.010 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12982 CONGRESSIONAL RECORD — SENATE December 11, 2009 Well, it is $3,000 out of pocket. tion in the Senate . . . Without question, thinking about what we might have The man says: I can’t afford it. I just they could have won more deficit-reducing said on the floor or what we are going can’t pay for it. cost savings in the Medicare program by set- to say tomorrow. But the fact is, we So he doesn’t get the colonoscopy ting limits on spending growth and reform- have to stay and do our job, not just in ing the way health care is organized, pro- and bad things can occur. That happens passing health care reform but doing in America, but it doesn’t happen in vided and paid for. And they could have begun to realize their goal of ‘‘consumer- something significant to help the un- any other civilized country. driven health care’’ by insisting that the new employed and deal with jobs and the It is true in some systems he may insurance exchanges offer at least one plan economy before we leave here to try to have had to wait an extra week or a built around individual health savings ac- enjoy Christmas, or what is left of it or month, but he gets the care he needs. counts and catastrophic coverage. the holiday season, with our families. He doesn’t die for lack of health insur- Pearlstein goes on to talk about the This is a job that has to be done. I am ance. That is what is going on in Amer- possibilities. He says: sorry we have reached a point where ica. Almost 50 million Americans with- They could have taken a page from John the Republicans have not been actively out health insurance today—almost 50 McCain’s platform and insisted on replacing involved in creating this bill. We tried million in this great and prosperous the current tax exclusion of health-care ben- for the longest time. In the HELP Com- Nation—went to bed last night without efits with a flat tax credit that would be mittee, where Senator ENZI serves as the peace of mind of the coverage of more progressive and put downward pressure the ranking Republican, more than 100 health insurance. This bill addresses on insurance premiums. Republican amendments were accepted that. I am not guaranteeing that any of as part of this debate and still not one At the end of the day, 94 percent of those proposals would have been in, but single Republican Senator would vote the people living in America will be they all could have been in if we had a for the bill in that committee. able to sleep at night knowing they dialog. Instead of a dialog, we have a So far the scorecard on Republican have a decent health insurance plan. shouting match, one side of the aisle participation in health care reform de- That is an amazing step forward. That shouting at the other side of the aisle. bate is a lot of speeches, a lot of press is a step consistent with the establish- It is exactly the stereotype of Wash- releases, a lot of charts on the floor but ment of Social Security, which finally ington which America has come to only two votes—one from a Republican took the worry away from seniors and hate. America wants us to solve prob- Congressman in Louisiana for the their families about what would hap- lems, not get into these, you know, fur- House bill; one from Senator SNOWE of pen to grandma and grandpa when they flying debates, where we see who can Maine for the Senate Finance version stopped working. get the rhetorical better of the other. of this bill. I remember those days. There was a They want us to solve problems but, time when grandma and grandpa re- The ACTING PRESIDENT pro tem- unfortunately, we are still waiting for pore. The time of the majority has ex- tired and moved in with their kids. Re- the first Republican to cross the aisle member that era? I do. It happened in pired. on the passage of this bill and work Mr. DURBIN. That is it. I urge my our family, and they didn’t have any with us. The door is still open. The in- choice. They had to because they had colleagues to join us in a cooperative vitation is still there. The idea of doing effort to try to come up with some- modest jobs and not a lot of savings nothing is unacceptable and that and they put it on their kids to find thing more positive than just our lone- should be the message. ly speeches on the floor. that spare bedroom or let them sleep in The fact is, there is no comprehen- basement that was made over so that The ACTING PRESIDENT pro tem- sive Republican health care reform pore. The time of the Senator has ex- they would have a comfortable and safe bill—period. Senators come to the place to be. pired. The Senator from Arizona is rec- floor, such as Senator COBURN, and say: Social Security changed that for ognized. I have some good ideas. I bet he does. most American families. This bill will Mr. MCCAIN. Mr. President, while I may even subscribe to them. But his change health care for most American my friend from Illinois—— ideas have not gone through the rigor families. The same thing is true with Mr. DURBIN. Mr. President, I ask this bill has gone through. This bill Medicare. The critics of Medicare—and unanimous consent morning business was sent to the Congressional Budget they have been legion on the floor of be closed. I wish to make sure Senator Office and scored, asking the basic the Senate—ignore the obvious: 45 mil- MCCAIN has time. questions: No. 1, will it add to the def- lion Americans will have peace of mind Mr. MCCAIN. I ask for an additional icit? They came back and told us: No, to know that they can get affordable 10 minutes of morning business so I the Democratic health care reform bill health care once they reach the age of could maybe engage in a colloquy with will, in fact, save money, $130 billion in 65. They would not lose their life sav- my favorite combatant here. 10 years; $650 billion in the second 10 ings. They will get a good doctor, a The ACTING PRESIDENT pro tem- years. We asked them: Is it going to in- good hospital, and a good outcome. pore. Without objection, it is so or- Isn’t that what America is all about? sure more Americans? They came back dered. Isn’t that why we are supposed to be and said: Yes, 94 percent will be insured Mr. MCCAIN. Maybe we can talk a here? Why don’t we have more support? when this is over. That same rigor has little bit about his remarks. The Republican side of the aisle only not been applied to the Republican I have to say, I appreciate the elo- comes to say what is wrong with the ideas because it is hard, it is tough, quence and the passion the Senator idea of health care. and it takes time. I commend them for from Illinois has brought to this de- Steven Pearlstein, in this morning’s their thoughtful ideas, but to say they bate. He makes some very convincing Washington Post—which I hope some have something they can match points. One of the major points—and I of my Republican colleagues will against this bill, comprehensive re- would be glad to listen to the Senator. read—talks about a lost opportunity form—just go to the Republican Senate I think it is fair for us to respond to which the Republicans have. Web site and look for the Republican each other’s comments very quickly. We have invited the Republicans comprehensive reform bill. Do you The Senator from Illinois said we have from day one to be part of the con- know what you will find? You will find been engaged in the negotiations and versation about health care reform. the Democratic bill. That is all they inputs have been made into the formu- Senator ENZI of Wyoming is one who can talk about. They don’t have a com- lation of this bill. assiduously gave every effort, spent 61 prehensive health care reform bill. I have to tell the Senator from Illi- days trying to reach a bipartisan But we are not going to quit. Amer- nois, I have been engaged in many bi- agreement. It failed, but at least he ica, we cannot go home for Christmas partisan compromises, whether it be tried. I commend him for trying. until we get this job done. issues such as campaign finance re- Too many others on the other side After we have been here 12 straight form, whether it be—a whole large didn’t try. But Steven Pearlstein days debating, we kind of get into a number of issues, including defense writes: trance-like, catatonic state, where we weapons acquisition reform. I say to One can only imagine how Republicans can’t remember what our last speech the Senator from Illinois, do you know could have reshaped health-reform legisla- was about and we go to sleep at night what the process was? People sat down

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00012 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.011 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12983 at the table together when they were said—the bill came to the committee some Republicans on board, and it was writing the legislation. I am a member without a bit, not 1 minute of negotia- clear we couldn’t achieve that if we of the HELP Committee, OK? I say to tion before the bill was presented to kept the public option in. There are the Senator from Illinois, do you know the committee. The ranking member is other elements here. We are going to what the process was—because I am on on the floor. He will attest to that. have a real profound difference when it the committee. A bill was brought be- Please go ahead. comes to the issue of medical mal- fore the committee without a single— Mr. DURBIN. I would say to the Sen- practice and how to approach it. But I Senator ENZI will attest to this—with- ator from Arizona, I went through think, even on that issue, we could out a single period of negotiations, bankruptcy reform with Senator have worked toward some common where we sat down together with the GRASSLEY and a similar process was ground, and I hope someday we still chairman of the committee, where they followed when the Republicans were in can. said: What is your input into this legis- the majority. He produced the base-line Mr. MCCAIN. Could I ask my friend lation? bill, and I made some modifications about the situation as it exists right We had many hours of amendments and, ultimately, at one point in time, now? Right now, no Member on this in the committee, all of which, if they we agreed on a bill, came up with a side has any idea as to the specifics of were of any real substance, were re- common bill. The starting point is just the proposal the majority leader, I un- jected on a party-line vote. that, a starting point. But I say to the derstand, has sent to OMB for some I have to tell the Senator from Illi- Senator from Arizona, look at what kind of scoring. Is that the way we nois he can say all he wants to that happened to the issue of public option. want to do business, that a proposal there have been efforts to open this to I believe in public option passionately. that will be presented to the Senate bipartisanship. There have not. My ex- I believe it is essential for the future of sometime next week and voted on im- perience in this Senate—I know how health care reform, for competition for mediately—that is what we are told—is you frame a bipartisan bill and that private health insurance companies to that the way to do business in a bipar- has not been the process that has been give consumers a choice, to make sure tisan fashion? Should we not at least pursued by the majority. we have one low-cost alternative at be informed as to what the proposal is I understand what 60 votes mean. But least in every market. Yet, at the end the Senate majority leader is going to in all due respect, I say to the elo- of the day, I did not get what I wanted propose to the entire Senate within a quence of my friend from Illinois, that and what is being proposed, now at the couple days? Shouldn’t we even know has not been the process which I have Congressional Budget Office, is not my what it is? Mr. DURBIN. I would say to the Sen- successfully pursued for many years, version of public option. where people have sat down together at We ended up bending toward some of ator from Arizona, I am in the dark al- the beginning, where you are there on the more moderate and conservative most as much as he is, and I am in the the takeoff and also then on the land- members of the Democratic caucus and leadership. The reason is, because the ing. toward the Republican point of view. I Congressional Budget Office, which I would be glad to hear the response don’t know of a single Republican who scores the managers’ amendment, the so-called compromise, has told us, once of the Senator from Illinois. came out for public option. Maybe I am you publicly start debating it, we will I ask unanimous consent if the Sen- forgetting one. At the end of the day, publicly release it. We want to basi- ator and I could engage in a colloquy. the point I am making to the Senator cally see whether it works, whether it The ACTING PRESIDENT pro tem- is there was an effort at flexibility and works to continue to reduce the deficit, pore. Without objection, it is so or- an effort at change to try to find some whether it works to continue to reduce dered. common ground. Unfortunately, the the growth in health care costs. Mr. DURBIN. First, those who are ground we are plowing has only 60 watching, this is perilously close to a We had a caucus after this was sub- Democratic votes. It could have been mitted to the Congressional Budget Of- debate on the floor of the Senate, much different. It could still be much fice, where Senator REID and other which rarely occurs in the world’s most different. Senators who were involved in it basi- deliberative body, where Senators with Mr. MCCAIN. May I ask my friend, cally stood and said: We are sorry, we opposing views actually, in a respectful wasn’t the reason the public option was can’t tell you in detail what was in- way, have an exchange. I thank the abandoned was not because of a Repub- volved. But you will learn, everyone Senator—— lican objection, it was because of the will learn, it will be as public informa- Mr. MCCAIN. Respectful but vig- Democratic objection? The Senator tion as this bill currently is on the orous. from Connecticut stated, unequivo- Internet. But the Congressional Budget Mr. DURBIN. I thank the Senator cally, the public option would make it Office has tied our hands at this point from Arizona. Here is what I under- a no deal. putting it forward. Basically, what I stood happened. I know Senator DODD I appreciate the fact that Republican know is what you know, having read came to the HELP Committee with a objections were observed. But I don’t press accounts of what may be in- base bill to start with, but it is my un- believe the driving force behind the cluded. derstanding, in the process, 100 Repub- abandonment of this public option, if it Mr. MCCAIN. Could I ask my friend lican amendments were accepted on actually was that—we have not seen from Illinois—and by the way, I would that bill. If I am mistaken, I know the the bill that is going to come before like to do this again. Perhaps when he Senator will correct me, but—— us—was mainly because of the neces- can get more substance into many of Mr. MCCAIN. I will be glad to correct sity to keep 60 Democratic votes to- the issues. the Senator from Illinois. Senator ENZI gether. Mr. DURBIN. Same time, same place is here. None of those amendments Mr. DURBIN. The Senator from Ari- tomorrow? were of any significant substance that zona is correct. But I add, Senator Mr. MCCAIN. I admit these are un- would have a significant impact on the SNOWE has shown, I believe, extraor- usual times. But isn’t that a very un- legislation, I have to say to the Sen- dinary courage in voting for this bill in usual process, that here we are dis- ator from Illinois. For example, med- the Senate Finance Committee and cussing one-sixth of the gross national ical malpractice, we proposed several made it clear she could not support the product; the bill before us has been a amendments that would address what public option. We are hoping, at the product of almost a year of sausage- we all know, what the Congressional end of the day, she will consider voting making. Yet here we are at a position Budget Office says is $54 billion—other for health care reform. That was part on December 12, with a proposal that estimates as much as $100 billion—in of the calculation. none of us, except, I understand, one savings. There were no real funda- Mr. MCCAIN. We are hoping not. person, the majority leader, knows mental amendments. Mr. DURBIN. I understand your point what the final parameters are, much I have to say that some of those of view, but I would say—you are right. less informing the American people. I amendments were accepted. But it still But we were moving toward our 60 don’t get it. doesn’t change the fact that at the be- votes, but it would be a great outcome Mr. DURBIN. I think the Senator is ginning, as the Senator from Illinois if we end up with a bill that brings correct, saying most of us know the

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00013 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.012 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12984 CONGRESSIONAL RECORD — SENATE December 11, 2009 fundamentals, but we do not know the to address an obvious aspect of cost is going broke and then expand it to important details behind this. What I savings such as malpractice reform, people between age 55 and 64? The math am saying is, this is not the choice of such as going across State lines to ob- doesn’t work. It doesn’t work under the the majority leader. It is the choice of tain health insurance, such as allowing present system which is going broke. the Congressional Budget Office. We small businesses to join together and To add on to it, any medical expert will may find that something that was sent negotiate with health care companies, tell you, results in adverse selection over there doesn’t work at all, doesn’t such as other proposals we have, then and therefore increases in health care fly. They may say this is not going to that is where we have a difference. We costs. work, start over. So we have to reserve share a common ambition, but we dif- Mr. DURBIN. If I may respond, why the right to do that, and I think that is fer on the way we get there. I do not is Medicare facing insolvency? Why is why we are waiting for the Congres- see in this bill, nor do most experts, a it going broke? Why are the other sys- sional Budget Office scoring, as they significant reduction in health care tems facing it? Because the increase in call it, to make sure it hits the levels costs except slashing Medicare by some cost in health care each year outstrips we want, in terms of deficit reduction $1⁄2 trillion, which everybody knows inflation. There is no way to keep up and reducing the cost of health care. doesn’t work, and destroying the Medi- with it unless we start bending the cost It is frustrating on your side. It is care Advantage Program of which in curve. We face that reality unless we frustrating here. But I am hoping, in a my home State 330,000 seniors are a deal with the fundamentals of how to matter of hours, maybe days, we will part. have more efficient, quality health receive the CBO report. Mr. DURBIN. I say to the Senator care. Going broke is a phenomena not I would like to ask the Senator from two or three things. First, the CBO reflective in bad administration of the Arizona, if he wouldn’t mind respond- tells us this bill will make Medicare program but in the reality of health ing to me on this. Does the Senator be- live 5 years more. This bill will breathe care economics. lieve the current health care system in into Medicare extended life of 5 addi- What I am about to say about the ex- America is sustainable as we know it, tional years. Second, I have heard a lot panded Medicare is based solely on in terms of affordability for individuals of negative comments about govern- press accounts, not that I know what and businesses? Is the Senator con- ment-sponsored health care. I ask the was submitted to CBO in detail. I do cerned that more and more people do Senator from Arizona, is he in favor of not. But the 55 to 64 eligibility for not have the protection of health in- eliminating the Medicare Program, the Medicare will be in a separate pool sus- surance; fewer businesses offer that veterans care program, the Medicaid tained by premiums paid by those protection? Program, the CHIP program to provide going in. If they are a high-risk pool by The ACTING PRESIDENT pro tem- health insurance for children, all basi- nature, they will see higher premiums. pore. The 10-minute time period has ex- cally government-administered pro- What happens in that pool will not pired. grams? Does he believe there is some- Mr. MCCAIN. I ask unanimous con- have an impact on Medicare, as I un- thing fundamentally wrong with those derstand it. It will be a separate pool of sent for 5 additional minutes. programs that they should be jetti- The ACTING PRESIDENT pro tem- those receiving Medicare benefits that soned and turned over to the private pore. Without objection, it is so or- they will pay for in actual premiums. sector? dered. It won’t be at the expense or to the The second question, does the Sen- Mr. DURBIN. Is the Senator con- benefit of the Medicare Program itself. ator from Arizona want to justify why cerned as well with the fact that we What I have said is based on press ac- have 50 million Americans without Medicare Advantage, offered by private counts and not my personal knowledge health insurance and the number is health insurance companies, costs 14 of what was submitted to CBO. growing; that in many of the insurance percent more than the government Mr. MCCAIN. The Senator has seen markets across America there is no plan being offered, and we are literally the CMS estimates this morning that competition, one or two take-it-or- subsidizing private health insurance this will mean dramatic increases in leave-it situations? Does that lead him companies to the tune of billions of health care costs. You may be able to to conclude we cannot stay with the dollars each year so they can make expand the access to it, but given the current system but have to make some more profits at the expense of Medi- dramatic increase, one, it still affects fundamental changes and reforms? care? the Medicare system and, two, there Mr. MCCAIN. I say to my friend, ev- Mr. MCCAIN. First, obviously I want will obviously be increased costs, if you erything he said is absolutely correct. I to preserve those programs. But every see the adverse selection such as we are am deeply concerned about the situa- one of those the Senator pointed out is talking about. tion of health care in America. I know going broke. They are wonderful pro- I see the staff is getting restless. I the Senator from Illinois is deeply con- grams. They are great things to have. ask my friend, maybe we could do this cerned about the fact that it is going But they are going broke. He knows it again during the weekend and during to go bankrupt, about the fact that the and I know it, and the Medicare trust- the week. I appreciate it. I think peo- Medicare trustees say that within 6 or ees know it. To say that we don’t want ple are helped by this kind of debate. I 7 years it is broke. From what we hear, these programs because we want to fix respect not only the passion but the there is now a proposal over there to them is obviously a mischaracteriza- knowledge the Senator from Illinois extend eligibility for Medicare, which tion of my position, our position. We has about this issue. obviously puts more people in the sys- want to preserve them, but we all know Mr. DURBIN. I thank the Senator. they are going broke. It means cost tem, which obviously, under the f present setup, would accelerate a point savings. It means malpractice reform. of bankruptcy, at least from what I It means all the things I talked about. CONCLUSION OF MORNING know of this. The Senator mentioned Medicare Ad- BUSINESS But the fundamental difference we vantage. That is called Medicare Part The ACTING PRESIDENT pro tem- have, in my opinion, is not what we C. That is part of the Medicare system. pore. Morning business is closed. want—we both share the deep ambition There are arguments made that there f that every American has affordable and are enormous savings over time be- available health care—it is that we because seniors who have this program, TRANSPORTATION, HOUSING AND lieve a government option, a govern- who have chosen it, who haven’t vio- URBAN DEVELOPMENT, AND RE- ment takeover, a massive reorganiza- lated any law, are more well and more LATED AGENCIES APPROPRIA- tion of health care in America will de- fit and have better health over time, TIONS ACT, 2010—CONFERENCE stroy the quality of health care in thereby, in the long run, causing sig- REPORT—Resumed America and not address the funda- nificant savings in the health care sys- The PRESIDING OFFICER (Mr. mental problem. We believe the quality tem which is what this is supposed to BEGICH). The clerk will report. is fine. be all about. I ask in response: How in The bill clerk read as follows: We think the problem is bringing the world do you take a Medicare sys- Conference report to accompany H.R. 3288, costs under control. When you refuse tem which, according to the trustees, making appropriations for the Departments

VerDate Nov 24 2008 04:50 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00014 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.013 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12985 of Transportation and Housing and Urban should have done last year but we could not site says the secret of its success is due Development, and related agencies for the because of the difficulty we had with work- to its position without the crucial gov- fiscal year ending September 30, 2010, and for ing with President Bush. ernment support typical in most world other purposes. I wonder if we are going to blame capitals. Then, of course, we always get The PRESIDING OFFICER. The Sen- President Bush for this one. If it back to Hawaii: $13 million on fisheries ator from Arizona. rained, if it didn’t rain? We blamed him in Hawaii, nine projects throughout Mr. MCCAIN. Mr. President, one of for almost everything. Whatever it is, the islands ranging from funding the the troubling aspects of this conference let’s blame President Bush. The point bigeye tuna quotas, marine education report is that the appropriators air is, what this bill is, and another one and training, and coral research. dropped three very significant spending that will be coming up in a couple The list goes on and on. The next bills into the text during conference. In days, is exactly the same business as time you are in New York, go to Lin- other words, three bills without any usual, a porkbarrel-laden bill with in- coln Center. We are spending $800,000 of debate, discussion or amendment were creases in spending when the American your money for jazz at the Lincoln air dropped into this pending legisla- people are hurting in the worst possible Center. Jazz lovers, rejoice. For those tion. The three bills are the Labor- way. The American people are hurting who are not jazz lovers, we have HHS-Education, financial services and and the Labor, Health and Human $300,000 for music programs at Carnegie general government, and the State- Services and Education appropriations Hall; $3.4 million for a rural bus pro- Foreign Operations appropriations bill has $11.3 billion or a 7-percent in- gram in Hawaii. Apparently, the $1.9 bills. Combined, these three bills spend crease in spending over last year’s million in the 2009 omnibus was not over $237 billion and contain 2,019 ear- spending level. Where are we? This is enough. In other words, we gave $1.9 marks. It is remarkable and unaccept- America. Americans are hurting. There million for this rural bus program in able that the Senate is willing to ap- is 10 percent unemployment. People Hawaii so we have to now give them prove expenditure of such huge sums can’t stay in their homes. They can’t $3.4 million more. without the opportunity to debate and keep their jobs. We are passing a piece Custer County, ID, with a population amend their content. of legislation with 1,749 earmarks just of 4,342, as of the year 2000—I am sure I see the Senator from Hawaii, who in the Labor, Health and Human Serv- they have grown since—$500,000 for de- will say: This is the way we have had ices piece of over $806 billion. velopment of a community center in to do business before. We have to do Do you want to hear a few of them? Custer County, ID. The list goes on. They are fascinating. Here is my favor- this because of the pressure of time, Then, of course, it is loaded with con- the fiscal year ended, et cetera, et ite of all—there are a lot of good ones— troversial policy riders that should cetera. Again, we get back to this old $2.7 million to support surgical oper- have been debated in the Senate. line that we heard for an entire year ations in outer space at the University In the Department of Labor bill, the and even early this year about change, of Nebraska. I assure my colleagues, I conference rescinds $50 million from about how we were going to change am not making that up. That is an ap- unobligated immigration enforcement things in Washington. We are going to propriation in this bill. Let me repeat: funds under section 286(v) of the Immi- change the way we do business. $2.7 million to support surgical oper- gration and Nationality Act. This will President Obama said about the last ations in outer space. There are a lot of result in a decrease in the enforcement omnibus bill passed last March, 3 compelling issues before the American of immigration law. I guarantee you, if months into the Obama administra- people. Surgical operations in outer that provision had been debated here tion: space at the University of Nebraska? I on the floor of the Senate, that $50 mil- The future demands that we operate in a guess the University of Nebraska has lion would never have been removed. different way than we have in the past. So some kind of expertise that they need The conference agreement includes let there be no doubt: this piece of legisla- $2.7 million so we could support sur- new language providing authority to tion must mark an end to the old way of gical operations in outer space. I won- the International Labor Affairs Bu- doing business and the beginning of a new der when the next surgical operation is reau, the agency charged with carrying era of responsibility and accountability that scheduled in outer space? Maybe we out the Department of Labor’s inter- the American people have every right to expect and demand. ought to go into that. national responsibilities. This may be a I will be spending more time on the worthy program, but it should be ad- What are we doing today? The exact floor on this. But $30,000 for a Wood- dressed in legislation. same thing that we were doing before. stock film festival youth initiative? There are so many other policy pro- Here is a quote from the White House Woodstock was a pretty neat experi- visions in this bill which have not been Chief of Staff Rahm Emanuel about the ence, but do we need to spend $30,000 to authorized, which is supposed to be last omnibus bill. This is the one we revisit that one? There is $200,000 to done by authorizers. weren’t going to do anymore. renovate and construct the Laredo Lit- The conference agreement provides Second, this is last year’s business. tle Theater in Texas. The next time $35 million for the Delta Health Initia- He was talking about the one we you are in Laredo, be sure to stop by tive. The Delta Health Initiative pro- passed in March. the theater and see $200,000 of your vides a service to individuals in only And third, most importantly, we are going money which is going to renovate and one area of the country, the delta re- to have to make some other changes going construct this little theater. There is gion of Mississippi. I have visited the forward to reduce and bring more—reduce $500,000 for the Botanical Research In- delta region in Mississippi, and there the ultimate number and bring the trans- stitute of Texas in Fort Worth; $200,000 are severe health needs. But couldn’t parency. And that’s the policy that he enun- we authorize this program? Couldn’t for a visitors center in Bastrop, TX, a ciated in his campaign. we authorize it? Couldn’t we have the visitor center there in Bastrop with a proper debate and discussion? Bob Schieffer: population of 5,340 people. We are going But it sounds to me like what you’re— The list goes on and on. to spend $200,000 of my taxpayers’ dol- Of course, there is $25 million ‘‘for what he’s about to do, here, is say, well I lars to build them a visitor center. don’t like this but I’m going to go ahead and patient safety and medical liability re- sign it— There is $200,000 for design and conform demonstrations’’ that was not in- struction of the Garapan public market Talking about the last omnibus bill— cluded in the House or Senate. Medical in the Northern Mariana islands; liability reform demonstrations—there but I’m going to warn you, don’t ever do it $500,000 for development of a commu- again. Is that what’s about to happen here? is a demonstration project already in nity center in Custer County, ID, popu- being. It is called the State of Texas, Emanuel: lation 4,342. If my math is right, that is where they have reduced medical mal- In not so many words, yes. about $100 per person. Right here in our practice costs dramatically, and the And then, of course, the Senate ma- Nation’s Capital, $200,000 to the Wash- physicians and caregivers are flowing jority leader said about the last omni- ington National Opera for set design, back into the State of Texas. bus: installation and performing arts at li- Mr. President, I will be talking more We have a lot of issues we need to get to braries and schools. They have an oper- later this afternoon about all the pork after we fund the government, something we ating budget of $32 million. Their Web and earmarking that is in this bill.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00015 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.014 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12986 CONGRESSIONAL RECORD — SENATE December 11, 2009 I have to tell you that the anger and Mr. President, I raise a point of order the full committee. As I pointed out, the frustration out there is at an in- that the conference report violates the three of them were passed unanimously credibly high level. Those of us who—I provisions of rule XXVIII. and the other three by a vote of 29 to am sure most of us do—spend a lot of The PRESIDING OFFICER. The Sen- 1. Every one of them has been written time at townhall meetings and hearing ator from Hawaii. in a bipartisan fashion with consider- from our constituents know there is a Mr. INOUYE. Mr. President, I move able input on the part of the minority level of anger out there, the likes of to waive all applicable sections of rule party. which I have not seen before. Here they XXVIII, and I ask for the yeas and The negotiations with our House are, hurting so badly because they can- nays. counterparts have been spirited at not keep their homes and their jobs. The PRESIDING OFFICER. Is there a times, but I can assure my colleagues My home State of Arizona is No. 2 in sufficient second? that on the difficult issues, our sub- the country of homes where the mort- There appears to be a sufficient sec- committee chairmen and ranking gage payment is higher than the home ond. members have done an excellent job of value—48 percent of the homes in my The yeas and nays were ordered. defending Senate positions and of com- State. So here we are with 10-percent Mr. MCCAIN. Mr. President, I yield ing to fair and equitable compromises unemployment, with deficits—this year the floor. when such was necessary. of $1.4 trillion—and there are dramatic The PRESIDING OFFICER. Under I would also note that on Tuesday increases, a 7-percent increase in rule XXVIII, there is up to 1 hour evening, we held a full and open con- spending in one, a 14-percent increase equally divided. ference with the House at which every in spending in the other, and they do The Senator from Hawaii. conferee, including 22 Members of the not get it. They do not get it. They do Mr. INOUYE. Mr. President, I yield Senate, bipartisan Members, and 14 not get it. Americans are having to myself 10 minutes. Members of the House, also bipartisan, tighten their belts. Mr. President, I rise today with was afforded the opportunity to offer My home State of Arizona is in a fis- mixed emotions. When I assumed the amendments on any provision of the cal crisis. They are having to cut serv- chairmanship of the Appropriations legislation. For the record, comity was ices to our citizens because we cannot Committee last January, I imme- demonstrated by the Senate conferees, print money in Arizona. They only diately reached out to the senior Re- and no amendments—no amendments— print money here. And here we are publican member of the committee were offered on our side. At the conclu- with Omnibus appropriations bills with from Mississippi, Senator COCHRAN, to sion of the conference, 16 conferees, in- as high as a 14-percent increase in seek his support in achieving my cen- cluding 4 Republican members, signed spending, loaded down with billions of tral objective for the fiscal year: to re- the conference report. dollars worth of porkbarrel projects. turn this appropriations process to the Finally, I can say this is a clean bill. regular order. The vice chairman, Sen- I predict to my colleagues that the There are no extraneous measures at- ator COCHRAN, agreed wholeheartedly, anger out there will be manifest in a tached. For this reason, as I just men- and together we committed to passing number of peaceful ways, including in tioned, we have bipartisan support of all 12 appropriations bills individually the ballot booth. They are sick and the bill, and I am proud of that fact. and to sending each of the completed Some have criticized this bill as tired of this. I saw a poll yesterday bills to the President for his signature. spending too much. I will point out where the approval rating of Members It might be of interest to my col- that the amounts recommended in the of Congress has fallen below that of the leagues that of the 12 bills assigned to bill are below the amounts requested approval rating for used car sales- this committee, 11 were passed by the by the President and equal to the persons. I think it was at 4 percent, as end of July, many months ago. One was amount approved by the Congress in I recall the poll. I have not met any of held up at the request of the House but the Budget Committee. It has been a the 4 percent. I have not met anybody passed in mid-September. This is De- long process. Furthermore, the only who approves of what we are doing. cember. These bills have been passed. area where the committee exceeded the This exercise we are in right here, on And it might be of further interest to amount requested by the President is December 11, 2009, with a pork-laden the Senate that of the 12 bills, 9 were for military construction and for vet- Omnibus appropriations bill which passed unanimously, bipartisan, 30 to 0. erans. frivolously and outrageously spends Three passed by one objection—29 to 1. Moreover, some have criticized the their dollars when they are struggling Completing action on our annual ap- majority for resorting to an omnibus to keep their heads above water is propriations bills is our most funda- measure once again. Clearly, those who something that is going to be rejected mental responsibility. The Founding criticize are those responsible for this sooner or later by the American people. Fathers gave us the power of the purse, outcome. When the Senate needs 4 days I have warned my colleagues that the and for good reason. Our system of to pass a noncontroversial conference American people are sick and tired of checks and balances, which has served agreement on the Energy and Water this. They did not like it before. Now us so well in the last 220 years, allows appropriations bill, we know the only they are fed up with it. the executive branch to propose spend- reason can be that a few Members want We will be hearing more this after- ing initiatives that make clear to us to delay our progress. Why do they noon. their intentions and desires. But the want to do that? So they can complain So, Mr. President, I rise today to Constitution gives the Congress the ul- when the calendar has expired and we raise a point of order under rule timate decisionmaking authority, and have no time left for the regular order. XXVIII against H.R. 3288, the Omnibus it is our responsibility to fulfill this As a reminder to all of us, the Mili- appropriations bill. I do this to ensure obligation. tary Construction bill was delayed for 6 that this bloated legislation is not per- Regular order allows each Senator days of debate on this floor. It was a mitted to proceed to full consideration the opportunity to debate and to bill that was voted out of the Appro- by the Senate. amend each bill on an individual basis. priations Committee unanimously, bi- Specifically, rule XXVIII precludes Every Senator on both sides of the partisan-wise, and then delayed. But conference reports from including pol- aisle recognizes that regular order is after the delay of 6 days, this Senate icy provisions that were not related to the preferred course of action. passed it by a vote of 100 to 0. What was either the House or the Senate version The underlying Transportation, the opposition all about? What was the of the legislation as sent to conference. Housing and Urban Development bill delay all about, when everyone here Several provisions included in division will provide urgently needed funding so was in favor of it? There was not a sin- D—the Departments of Labor, Health we can keep our transportation system gle dissenting vote, so it is obvious and Human Services, and Education, safe and strong and provide much-need- there was not opposition to the bill. It and Related Agencies Appropriations ed assistance to our most vulnerable was simply that a few Members wanted Act—of this omnibus bill are out of populations. to delay the bill. scope and were never considered on the In addition, every one of the six bills Mr. President, now is December 11, floor of the Senate. we consider today was reported out by and it is nearly time to adjourn the

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00016 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.021 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12987 Senate for the year. We have not com- I think the bill could have passed Democrats presented more amend- pleted our work, and therefore we have much faster. I think it could have ments than the Republicans did. The consolidated six appropriations bills in solved a lot more problems. If it would Republicans did get two that we voted one measure. My colleagues know pre- have had the kind of bipartisanship on and passed. The Democrats had over cisely why we have reached this point, Senator DURBIN keeps describing as 30 that they presented to get passed. and it is not the fault of one member of having happened, we would already How come they even had to put in the Appropriations Committee, nor the have the bill done. Much of what he amendments? It was their bill. We are fault of the majority. It is the fault of keeps repeating—and the more times facing the same thing with the bill a handful of Members who would rather you repeat it doesn’t make it more that is on the floor here. They are put- see the responsibility for funding our true—in every speech he gives, he ting in more amendments than we are. Federal Government turned over to the makes the same comments about how Every time we put in an amendment bureaucrats and administration than long the HELP Committee worked on they have a side-by-side on it to give have the Congress exercise its constitu- this bill and how many amendments them some cover to say, well, what tional responsibility. I am a very pa- from the Republican side were auto- they said wasn’t that important. It tient person, but at times the rhetoric matically accepted into the HELP bill. wouldn’t make a difference. Besides of this debate is too much to take. We always have to come out and cor- that, we don’t want to do it, so we will With Senator COCHRAN, my vice rect that. Yes, there were a number of have something that says we voted for chairman, as my partner, we have tried amendments. That bill was put to- that concept. to move 12 individual bills only to be gether over a period of 2 weeks with a If you put the bill together, you thwarted by a few Members—just a few new committee chairman, without a shouldn’t be the ones filibustering and Members. That is why we are here and single input from Republicans. It was doing the amendments. They have a where we are today with an omnibus brought to the committee for markup. unique position here now. We have a Democratic amendment and a Demo- bill. We did have about 3 days to do amend- cratic side-by-side. I don’t remember As we look ahead to consideration of ments, and we did a lot of amendments. ever seeing that before. But we had a fiscal year 2011 appropriations bills, I They did accept some of the amend- request this morning for three Demo- hope all Members of the Senate will ments. Of course, we helped correct cratic votes and one Republican vote. learn from the frustrations of this punctuation, we helped correct spell- year. We can succeed in returning to That is real bipartisanship? Yet they ing, and we did have a few amendments want the cooperation. regular order for appropriations. We that were accepted that actually made only need a modicum of cooperation The thing that upsets me the most is a difference. they keep saying this will save money, and a recognition that delay for the After the vote, they didn’t publish sake of delay serves no one’s best inter- this bill is going to save the country the bill for the public to look at—the money, and we are in this appropria- ests, least of all the people of the amended version of the bill for the pub- United States. tions process and we ought to be inter- lic to look at. I think that was so they ested in saving the country money. But I strongly support this clean, bipar- could rip out the Republican amend- tisan bill. I urge my colleagues to sup- CBO didn’t say that. CBO did not say ments they had accepted. That has that this bill will save money, unless port it as well. never been done in committees. When I yield the floor. you use a whole bunch of phony ac- I suggest the absence of a quorum. amendments are accepted, they are left counting, and there is phony account- The PRESIDING OFFICER. The in the bill, or at least the Senator who ing in this bill. That is how they are clerk will call the roll. proposed the amendment gets to talk able to say, Oh, yes, we save money. The legislative clerk proceeded to about why maybe it should or We save money. This is going to save call the roll. shouldn’t be in there, or at least he is the American people a lot of money. The PRESIDING OFFICER. The Sen- informed that they are going to rip it No, it does not. Do not buy that story. ator from Wyoming. out. Not in this case. The bill is pub- Look at the accounting. I am the ac- Mr. ENZI. Mr. President, I ask unani- lished, we are looking for some of these countant. I have taken a look at it, but mous consent that the order for the things and find they are gone. Then I am not that good of an authority. quorum call be rescinded. they wonder why there is opposition to We just got the report from the CMS The PRESIDING OFFICER. Without the bill. chief actuary. Yes, that is the actuary objection, it is so ordered. Then he talks about the hours we who is actually in charge of Medicare Mr. ENZI. Mr. President, for several spent together working as the Group of and Medicaid and he did an analysis on weeks I have been saying, where are 6. I appreciate him mentioning the it. I am going to go into some more de- the appropriations bills? Under Federal hours, but hours don’t make any dif- tail on that analysis, because he says law, we are supposed to have those ference if ideas aren’t taken. The pur- this bill does not save money. This bill done by October 1—October 1. Let’s see. pose of the hours is to be able to ex- will cost seven-tenths of 1 percent This is December 10. We must be past press ideas that can be included in a more than if we did nothing. Is that that deadline. bill. Just getting to express them isn’t health care reform? Well, here come the bills. They are enough. To make them bipartisan, they And where is the transparency we all packed into one. There won’t be the have to be included. Anybody who were promised would happen under this debate we would get if we handled looks at the things we have on our Web administration? Transparency? They them one by one. It is fascinating to sites would understand that we did built the bill behind the closed doors me that one of them is Health and have some good ideas, some things that over on that side of the Senate Cham- Human Services. All year we have would make a change in the way we do ber and now a significant part of the heard that health is what is breaking health care in America. Are those in bill—which is called the public option, the people of this Nation, how impor- this bill? No. government option, government-run tant health care is; why we have to do This is the Reid bill. This wasn’t put program, whatever you want to call health care reforms under strict dead- together by the HELP Committee or it—has been drastically changed. The lines—strict deadlines that have shift- the Finance Committee, although sig- newspapers have written about it. Peo- ed a number of times and are irrelevant nificant parts of both of those bills, ple have seen it. But the newspapers to getting a good bill. But health care which we didn’t have input into, are a haven’t seen what is in there. The is that important, and it is one-sixth of part of it. How was that designed? That Democrats, according to Senator DUR- the Nation’s economy. So why haven’t was designed behind closed doors right BIN, the majority whip, have not seen we had the health care appropriations over there, with no Republican input that bill. The only one who has seen it debate before October 1? Why did it get whatsoever. How does that make it bi- is Senator REID and the Congressional put off until now? I guess it is because partisan? How does that even give us a Budget Office. He is not going to dis- all of the earmarks weren’t ready yet chance to make it bipartisan? Then close any of that—any of that—until or maybe it is because they thought they wonder why we have amendments. after he sees what the score is going to this bill ought to pass and solve all of Here is a fascinating thing on amend- be. That is the ultimate in trans- the problems. ments: In the HELP Committee, the parency, in my opinion. If you think

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00017 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.022 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12988 CONGRESSIONAL RECORD — SENATE December 11, 2009 you have a good idea, maybe you ought ing at unprecedented levels. I am here This Nation has had a debate about to let people see what the score is and right now to support Senator MCCAIN’s whether we should even allow abor- see what the bill is, and you ought to if rule XXVIII point of order that points tions to be legal. But we have been in you expect us to debate it in a hurry. out that the majority, the Democratic general agreement as a nation, and That is what we are under, this hurry- majority, has violated all of these so- even here in the Congress, for years up situation. Hurry up so a bill that called ethics and transparency im- that we should not force taxpayers to isn’t going to do anything until 2014 provements that they were bragging pay for abortions. That is a terrible use can be passed by Christmas. about only a year ago. We are not sup- of the power of government. This side is ready to reform health posed to take bills and in the secret of The omnibus bill reported by the care. This side is ready to stay in conferences add things that weren’t in House-Senate conference allows tax- through the weekend. We already the House or the Senate version. That payer funds to be used to pay for elec- stayed in through last weekend. We violates a specific rule, an ethics rule tive abortion in the District of Colum- will stay in until Christmas. We will that the majority trumpeted not too bia, because Congress controls DC’s en- stay in the days after Christmas. We long ago. This bill contains out-of-con- tire budget, including appropriating will stay in next year. But it has to be trol spending. It completely reverses the city’s local revenues. If this omni- right. The American public expects Congress’s traditional position on bus bill passes, Congress will be allow- this to be right. many values issues such as taxpayer- ing U.S. taxpayer dollars to fund abor- There has never been a major piece of funded abortions and needle exchanges tion on demand, when it was previously legislation passed by this body in the in the District of Columbia. It ends the prohibited. history of the United States that was DC Opportunity Scholarship Program This is a major shift in policy. We passed by one party. Not yet, there that has done so much to help a small must step back and see where our pri- hasn’t been. There is a good reason for number of disadvantaged minority stu- orities are as a nation. The values of that. It is full of flaws if just one side’s dents. It increases funding for Planned our country are at stake in this legisla- ideas are incorporated in the bill, and Parenthood, the Nation’s leading pro- tion. As we look at this, I hope no this is no exception. This has a lot of vider of abortions, and it legalizes med- American is so naive as to think that if flaws. This is a real move to the left to ical marijuana. Yet the overall funding they pass this government takeover of incorporate most of the people over levels of this bill are unconscionable at health care, no matter what we put in a time when we are in recession and so there, but they weren’t able to incor- the legislation, they will eventually many people are out of work. We have porate all of them, so now they are fund elective abortions in this country. massive debt that threatens our Na- doing a secret public option to expand It shows everywhere they pass a piece tion’s economic future and our very Medicare to distract people without of legislation that they are trying to currency itself. telling them what is in it and expect- promote abortion in this country. ing us in a few days to vote on this The bill represents a $50 billion increase or 12.5 percent over last year’s A vote for the omnibus is a vote for thing. taxpayer-funded abortion. A vote Well, I am going to share some of funding level. This is not mandated spending; this is discretionary spend- against Senator MCCAIN’s point of these numbers from the CMS chief ac- order is a vote for taxpayer-funded tuary a little later, but I see my col- ing. This is a time the President is saying we have to get a handle on our abortion. It is simple and it is clear. league is here and is actually going to Congress is responsible for the budget talk mostly on the appropriations bill. debt. Yet every bill the Democratic and the way the funds are spent. If we I will say that what I have had to say majority has pushed across this floor don’t think the government should cre- ties in directly to appropriations. It is has major increases in spending. It is ate an incentive for taking unborn spending money. We are going to spend actually nearly a $90 billion increase lives, we should not allow it in the leg- $464 billion of Medicare money from a over the year before. islation before us today. system that is going broke and we are Mr. President, what the President said he was against, which was ear- In addition to this troubling revela- going to raise taxes—that is kind of an tion, the bill contains many other egre- appropriation too—to cover the other marks, this bill has 5,224 earmarks, costing nearly $4 billion, in addition to gious reversals of longstanding policy $1⁄2 trillion in new programs that are contradicting traditional American not going to lower premiums or save the other spending. I cannot read all of values. The underlying bill legalizes the United States money, according to those, but I think people across the medical marijuana and uses Federal the CMS Chief Actuary Rick Foster. country have learned what earmarks I yield the floor. mean. Here are a few examples: funds to establish a needle exchange The PRESIDING OFFICER. The Sen- $500,000 for construction of a beach program in Washington, DC. Both en- ator from South Carolina. park promenade; six different bike courage the use of drugs. Mr. DEMINT. Mr. President, I wish to paths totaling $2.11 million; $250,000 for This is another glimpse of what is thank Senator ENZI for not just what a trail at Wolftrap Center for the Per- going to happen with government-run he said today but for what he has been forming Arts; and $250,000 for the En- health care. If this Congress is pro- doing throughout this whole debate to trepreneurial Center for Horticulture. moting the use of medical marijuana, make very complex issues much sim- I could go on and on. It makes no needle exchange programs, abortion, in pler so that people can listen in to sense to be doing this. I think maybe this funding bill, does anyone believe what is being said here and understand one of the most egregious parts of the that that won’t be a part of a govern- what we are doing. It has been a frus- bill, which I want to focus on for a few ment-run health care system? Of trating process here dealing with this minutes, goes back to those values course not. attempted government takeover of issues. It is one thing to make abortion Additionally, this bill eliminates the health care. While the majority has us legal; it is quite another thing to force successful DC Scholarship Opportunity here on the floor debating one bill, Americans who consider abortion im- Program, which aids low-income chil- they are behind a closed door over here moral, based on their beliefs, or reli- dren by giving them scholarships to at- creating a whole new bill and making gious beliefs—it is immoral to make tend private schools in Washington, periodic announcements about what them pay for it, to actually promote DC. This affects only about 1,500 chil- might be in it. It is kind of like a magi- abortion. dren. I have had a chance to meet with cian who gets you looking at one hand That is what this bill does. Every- some of them who were in schools that while the sleight of hand is actually where you turn, this administration is were not working. This small scholar- doing the magic with the other hand, promoting anti-life initiatives and ad- ship program allows disadvantaged, and that is what we see happening here vancing policies that most Americans primarily minority, students in Wash- today. The majority wants to force this find morally objectionable—namely, ington, DC, to go to a private school of major piece of legislation through be- taxpayer-funded abortions. We have their choice. Remarkably, in just a few fore Christmas while people aren’t pay- seen that throughout this health care years, the students who moved from ing attention. debate, and now in the very set of bills the government schools to the private In the middle of this, they have de- that funds our government, it is pro- schools were 2 years ahead of their cided to take a break to expand spend- moting and funding abortion. peers. It is an example of something

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00018 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.023 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12989 that is working, helping disadvantaged The DC Opportunity Scholarship Pro- done in States across the United students, and it is a good example of an gram is a voucher program, created States. Seventeen States have decided administration that is more interested more than 5 years ago. It was author- they will have State funds pay for in paying off union interests—in this ized through the Appropriations Com- abortions beyond the Hyde amend- case the teachers union—than doing mittee, not through formal authoriza- ment. It is their State’s decision, not what is good for the children in our tion. As many as 1,700 students in DC our decision in DC. We, in this bill, country. To eliminate this small, inex- ended up going to school and getting give them the same authority that the pensive program is absurd. But it re- about $7,500 a year to help pay the tui- State of South Carolina has and the veals to you—— tion for their schools. The program has State of Illinois has. No Federal funds Mr. DURBIN. Will the Senator yield diminished in size—I will concede from the government, from Congress, for a question? that—even though I tried in a debate can be spent on this exercise or use of Mr. DEMINT. No, I won’t. It reveals and negotiations to change that. It is funds for abortions beyond the Hyde to you the true motives of the major- down to about 1,300 students. It is fund- amendment. But if they choose to use ity. If we look at this bill and this ed in this bill to the tune of $13.2 mil- their own funds—just as South Caro- eventual health care bill—if we ever lion. lina and Illinois make their choice— have time to see it before they try to So for the Senator from South Caro- then they make that decision. pass it—we are beginning to see a real lina to stand up and say, as he did, that Many in Congress have a secret glimpse, a true picture of where this this program is killed, how does he ex- yearning to be mayors of the District Democratic majority is going. plain the $13.2 million in the bill? of Columbia. They want to be on the Finally, this bill increases funding Mr. DEMINT. If the Senator will city council—not just in the Senate. for title X family planning services, of yield, the President has said he is They want to make every finite deci- which Planned Parenthood is the larg- going to end this program. sion for the 500,000 or 600,000 people who est recipient. Planned Parenthood is Mr. DURBIN. Does this bill end it? live here. the Nation’s largest provider of abor- Mr. DEMINT. I will come to the floor Mr. DEMINT. Will the Senator yield? tions. Increasingly, they are what we to explain the technical aspects of why Mr. DURBIN. Not at this time. When call directed abortions. When people it is not. I finish, I will. The people who live here come to Planned Parenthood and look Mr. DURBIN. I am anxious to hear it. in DC are taxpaying citizens. They pay for advice on family planning, they are Explain all the technical aspects you their taxes and they vote for President. more often than not encouraged and would like, but the fact is that $13.2 They send their young men and women pushed toward abortion. million goes to the DC Opportunity off to war just like every State in the All around this bill, you see what is Scholarship Program. And the 1,300 Union. I think they are entitled to going on. It is a major change in pol- students currently in the program will some of the basic rights we enjoy in icy—not to make abortion available be protected and will receive the tui- each of our own States. but to make Americans pay for it and tion—a grant of $7,500 per student—in I also want to say a word about the to promote it. the coming year. That is a fact. To needle exchange program. I get nervous I, along with 34 of my colleagues in stand there and say otherwise is wrong. around needles. I don’t like to run in to the Senate, signed and sent a letter to Mr. DEMINT. You grandfather it in— the doctor and say give me another the majority leader regarding the trou- if the Senator will yield for a question, shot. So taking an issue like this on is bling anti-life policies in this omnibus does this bill fund the continuation of not a lot of fun to start with. Why are bill. Collectively, we vowed to speak the program beyond the 1,300 who are we talking about needle exchange pro- out to protect the longstanding Fed- already in it? grams in the District of Columbia? For eral funding limitations on abortion—a Mr. DURBIN. No. It limits the pro- one simple reason: The HIV/AIDS infec- belief that has enjoyed broad bipar- gram to 1,300. tion rate in the District of Columbia, tisan support for many years. Mr. DEMINT. It kills the program Washington, DC, the Nation’s Capital, For this reason, as well as a number then. is the highest in the Nation. We are liv- of other values issues that are irre- Mr. DURBIN. No. If they are why—— ing in a city with the highest incidence sponsibly addressed in this legislation, Mr. DEMINT. But the program will of needle-related HIV/AIDS and menin- I support Senator MCCAIN to raise a not continue. gitis and other things that follow. A point of order against the omnibus Mr. DURBIN. Reclaiming my time. needle exchange program says to those under rule XXVIII of the Standing What happens is this program next who are addicted: Come to a place Rules of the Senate. I urge my col- year will be up going through the Sen- where they can at least put you in leagues to do the same. ate and the House of Representatives. touch with someone who can counsel I remind my colleagues that a vote For the Senator from South Carolina you and help move you off your addic- against the McCain point of order is a to misrepresent the contents of the bill tion, and they will give you a clean vote to force American taxpayers to is not fair. needle instead of a dirty one. I hate it, promote and pay for abortions. It is Secondly, this idea of government and I wish we didn’t need it. I don’t plain and simple. I am sure there will funding abortion, let me say to the like it. But in States across the Nation be a lot of smoke and mirrors after my Senator from South Carolina, here are they make the decision that this is the talk that will try to convince you that the basic pillars on this controversial humane and thoughtful thing to do to is not true. But it is in the legislation issue in America. First, the Supreme finally bring addicts in before they in- and it will happen. We need to stop it. Court has said abortion is a legal pro- fect other people and spread this epi- I thank the Chair and yield the floor. cedure in Roe v. Wade. demic. The PRESIDING OFFICER. The Sen- Second, Congress said, through the The doctors are the ones who tell us ator from Illinois is recognized. Hyde amendment, that we will spend this works. States make the decisions Mr. DURBIN. Mr. President, I hope no Federal funds for abortion except in on it. I think the District of Columbia, the Senator from South Carolina won’t cases involving the life of the mother, facing the highest incidence of infec- leave. He would not yield for a ques- rape, and incest. tion from HIV/AIDS, should also make tion. I want to address his remarks, Third, Congress said any provider— that same decision in terms of the and some of them are not accurate. I hospital, doctor, medical professional— money they spend. The provision that don’t want him to feel that I am saying who in good conscience cannot partici- came over from the House of Rep- this outside of his presence. pate in an abortion procedure will resentatives would have limited the I ask the Senator from South Caro- never be compelled to do so. distribution of this program to vir- lina, while he has a few minutes, if he This bill doesn’t change that at all. tually a handful of places in DC. We could look in the bill and find the pro- In the Senator’s State of South Caro- said that DC can make the rules about vision in the bill that kills the DC Op- lina and in my State of Illinois, the where the safe places are for these nee- portunity Scholarship Program. Please leadership of the States—the Governor dle exchange programs. present it to me now, because it is not and the legislature—decide what they As I said, I hate to even consider the there. It is not there. will spend their State funds on. That is prospect, but I cannot blind myself to

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00019 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.025 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12990 CONGRESSIONAL RECORD — SENATE December 11, 2009 the reality that we have this high inci- Second, the buildings they teach in— Congress, could make its own deci- dence of infection in the District of Co- these DC voucher schools have to pass sions. That is my goal. I would like to lumbia, and the medical professionals the fire safety code. Is that a radical see that happen. In the meantime, I tell us this is working. We are bringing idea killing the program? If it means think we should treat the people who addicts in. We are bringing them into a closing a school that is dangerous, live here fairly, give them a chance to safer situation. We are counseling some sure, I would close that school in a sec- deal with their significant problems, of them beyond their addiction. We are ond before I would send my child or acknowledge success, as we just re- saving lives. grandchild there. ported in the public schools, and try to Am I supposed to turn my back on Third, we said, if you attend a DC help them where we can. that and say, I am sorry, it offends me voucher school, the students there This is, in fact, a great city and the to think of this concept? It offends me have to take the same tests as the DC capital of a great nation. I think the to think of people dying needlessly, Public Schools so we can compare how mayor does a good job. and that is why we have this program. you are doing. If you take a different I reserve the remainder of my time. Let me say a word about the DC Pub- test, you have different results. We are Mr. ENZI. Mr. President, what is the lic Schools. I did not ask to take this never going to have a true comparison. time situation? DC appropriations bill on. This is not I also added in here, at the sugges- The PRESIDING OFFICER. The Sen- something I ran for in the House of tion of Senator LAMAR ALEXANDER of ator from Wyoming has 8 minutes 26 Representatives or the Senate. But it Tennessee, a former Secretary of Edu- seconds. The Democrats have 7 minutes is part of my responsibility. This is a cation, that each of the DC voucher 30 seconds. great city with great problems, but schools either has to be accredited or Mr. ENZI. Mr. President, I rise to dis- there are some shining lights on the seeking accreditation. I don’t think cuss a new report on Senator REID’s horizon, and one of them is Michelle that is radical. I don’t think it closes a health care reform bill. This kind of Rhee, chancellor of the public school program. fits in with the appropriations that system in the District of Columbia. The final thing I say is, the people deal with Health and Human Services Michelle is an amazing story of a who administer this program have to that is over 2 months past due. young woman attending Cornell Uni- actually physically visit the school at Last night, we received a new anal- versity. She decided, when she grad- least twice a year. We had a hearing ysis of the Reid bill we have been dis- uated, to sign up for one of the top em- where the administrator of the pro- cussing about 11 days straight, per- ployers of college graduates in America gram was shown pictures of some of formed by the Center for Medicare and today, Teach for America. She went off these DC voucher schools and, frankly, Medicaid Services—that is CMS—which and taught in Baltimore. She took a he said: We have not been there. Maybe is under the Department of Health and hopeless classroom situation and in 2 once a year we get by. It has to be Human Services. The chief actuary, years turned it around. Kids from the more than that. We have to make sure Rick Foster—this is the guy in charge neighborhood had test scores nobody these schools are functioning and oper- of all this. He is the chief actuary. This dreamed of because of Michelle’s skill. ating. We are sending millions of Fed- is not somebody outside the system. She worked in New York, bringing non- eral dollars into them. We expect it at This is the guy who has to answer for traditional teachers into the teaching public schools, we expect it at charter all this. He serves as the independent situation and then was asked to be schools. Should we not ask the same of technical adviser to the administration chancellor here. and Congress on estimating the true She is working on an overall reform the DC voucher schools? I say this, at least those in the Arch- costs of health care reform. Some of for the DC Public Schools, which I en- diocese of Washington agreed to these the findings in this report directly con- dorse. It is a reform which will move us things and have said: For our Catholic tradict some of the claims we heard toward pay for performance, where this week about the Reid bill. those teachers who do a good job and schools, we are ready to meet these For a week now, we have heard how improve test scores are rewarded. It is standards and tests. My hat is off to the Reid bill will help slow spending a voluntary program for teachers. The them. It is a challenge, I am sure, but growth and reduce how much we as a results are starting to show. This week it is one I think they will meet. I want nation spend on health care. Mr. Fos- in the District of Columbia, they re- them to continue to do that. ter’s analysis shows that statement is ported math scores that showed dra- I did try to expand this program in false. matic improvements compared to cit- one aspect in the course of our negotia- According to this report, national ies around the Nation. tions, with Senator COLLINS’ assist- She has another responsibility: while ance, so siblings would be allowed to health expenditures will actually in- 45,000 kids are in the public schools of attend this program. I think it would crease by seven-tenths of 1 percent DC, 28,000 are enrolled in public, but be helpful. We were not successful. over the next 10 years. That is seven- independent, charter schools. The char- There are those opposed to this alto- tenths of 1 percent if we did nothing ter schools have to match the perform- gether. different. Despite promises that the ance of the public schools or improve I say the Senator from South Caro- bill would reduce health care spending upon them. It is the same for the lina has mischaracterized the DC growth, this report shows the Reid bill voucher schools, the DC opportunity voucher program. He has not fully ex- actually bends the health care cost scholarships. plained that we have not changed the curve upward. The Senator from South Carolina Hyde amendment, which prohibits Fed- We have also heard, over the past stands before us to say I eliminate the eral funds for abortion purposes, other week, how this bill will reduce health program. Where does that $13.2 million than strict narrow categories. He went insurance premiums. Again, the admin- go? It goes to the program, the DC op- on to say something about the needle istration’s own chief actuary says this portunity scholarships. I did change exchange program, which does not re- is false. The new report describes how the program. I changed the program flect the reality and the gravity of the the fees for drugs, devices, and insur- because I failed initially when I offered health crisis facing the District of Co- ance plans in the Reid bill will increase amendments. lumbia. health insurance premiums, increasing Here are some of the changes I made, This is not a radical bill. This is a national health expenditures by ap- and you be the judge as to whether bill which I think is in the mainstream proximately $11 billion per year. these are unreasonable changes. of America. It is a bill consistent with We have also heard how the Reid bill I said for the voucher schools—half of the same laws that apply in his State will reduce the deficit, extend the sol- them are Catholic schools—I said for of South Carolina and my State of Illi- vency of the Medicare trust fund, and the voucher schools, every teacher in nois and most other States across the reduce beneficiary premiums. Accord- basic core subjects has to have a col- Nation. ing to the Foster report, these claims lege degree. How about that for a rad- I wish we were not in this paternal- are all conditioned on the continued ical idea, a teacher with a college de- istic position in relation to the District application of the productivity pay- gree? It is now required. It was not be- of Columbia. I would rather this city ment cuts in the bill which the actuary fore. had home rule, had its own Members of found were unlikely to be sustainable

VerDate Nov 24 2008 04:50 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00020 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.027 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12991 on a permanent annual basis. If these most of the job of coming up with the If you compare apples to apples, this cuts cannot be sustained, one of two details of the bill we have before us. bill provides $1.2 billion less spending things will happen. Either this bill will That means actual elected officials than in fiscal year 2009. dramatically increase the deficit or would not be doing it. But this CMS ac- Some Republican Senators have beneficiaries will not be able to con- tuary says everything that has been made speeches against this omnibus tinue to see their current doctors and said by that side of the aisle is false package on account of earmarks they other health care providers. unless there is some phony accounting don’t like, even though some of them In reviewing the $464 billion in Medi- that goes into it. requested their own earmarks. In fact, care cuts in the Reid bill, the Foster I yield the floor and reserve the re- earmarks comprise a tiny fraction of report found these cuts would result in mainder of our time. the total package. providers finding it difficult to remain Mr. President, I suggest the absence Like past years, the State-Foreign profitable. of a quorum and ask unanimous con- Operations conference agreement does The report went on to note that absent that we divide the time. not contain any earmarks as defined by sent legislative intervention, these The PRESIDING OFFICER. Without the Appropriations Committee. providers might end their participation objection, it is so ordered. The clerk We do fund many programs that are in the Medicare Program. In addition, will call the roll. priorities of Democrats and Repub- if enacted, the report found that the The legislative clerk proceeded to licans, including assistance for coun- cuts would result in roughly 20 percent call the roll. tries like Afghanistan, Pakistan and of all Part A providers—that is hos- Mrs. MURRAY. Mr. President, I ask Iraq, and longstanding allies like pitals, nursing homes, et cetera—be- unanimous consent that the order for Israel, Egypt, and Jordan. coming unprofitable within the next 10 the quorum call be rescinded. In addition, the conference agree- years as a result of these cuts. The PRESIDING OFFICER. Without ment provides $5.7 billion to combat As a former small business owner objection, it is so ordered. HIV/AIDS, including $750 million for myself, I understand the impact this Mrs. MURRAY. Mr. President, I sug- the Global Fund. Funds are provided to will have on doctors, hospitals, and gest the absence of a quorum. combat other diseases, like malaria, The PRESIDING OFFICER. The other health care providers. In rural tuberculosis, and neglected tropical clerk will call the roll. areas, such as my State, these pro- The legislative clerk proceeded to diseases, viders will go out of business or have to call the roll. The agreement provides $1.2 billion refuse to take any more Medicare pa- Mr. LEAHY. Mr. President, I ask for climate change and environment tients. unanimous consent that the order for programs, including for clean energy The CMS actuary noted that the the quorum call be rescinded. programs and to protect forests. Medicare cuts in the bill could jeop- The PRESIDING OFFICER. Without The agreement provides $1.2 billion ardize Medicare beneficiaries’ access to objection, it is so ordered. for agriculture and food security pro- care. He said the Reid bill is especially Mr. LEAHY. Mr. President, Division grams, with authority to provide addi- likely to result in providers being un- F of this omnibus conference agree- tional funds. willing to treat Medicare and Medicaid ment provides funding for the State There are provisions dealing with patients. That is what we have been Department, Foreign Operations, and corruption and human rights, funding saying for about 11 days. related programs. for international organizations like the The Reid bill also forces 18 million I want to thank the ranking member United Nations, NATO and the Inter- people into the Medicaid Program. The of the subcommittee, Senator GREGG, national Atomic Energy Agency, and Foster report concluded this will mean and his very capable staff, Paul Grove to promote democracy, economic de- a significant portion of the increased and Michele Wymer, for once again velopment, and the rule of law from demand for Medicaid services will be working with me and my staff in a bi- Central America to Central Asia. difficult to meet. These are not the partisan manner to produce this con- The conference agreement provides claims made by insurance companies ference agreement. the funds to support our embassies and or anyone who might have a vested in- I also want to thank Chairwoman diplomats around the world, public di- terest in the outcome of the debate. NITA LOWEY and Ranking Member KAY plomacy and broadcasting programs, These come directly from the adminis- GRANGER, and their staffs, for working the Peace Corps, and many other pro- tration’s own independent actuary. so cooperatively with us throughout grams that promote United States in- In light of this report, why are the this process. terests. sponsors of this bill continuing to The fiscal year 2010 State Foreign I don’t support everything in this argue for a $2.5 trillion bill of new pro- Operations conference agreement pro- omnibus package any more than any- grams which will increase health care vides $48.8 billion in discretionary one else does. I had hoped, as I know spending, drive up premiums, and funding, a $3.3 billion decrease from the did Chairman INOUYE and Vice Chair- threaten the health care of Medicare President’s budget request of $52 bil- man COCHRAN, that we could have beneficiaries? lion. brought each of the bills in this omni- We can do better. We need to start The bill is $1.2 billion below the fiscal bus, including the State-Foreign Oper- over and develop a bipartisan bill that year 2009 level, including supplemental ations bill, to the Senate floor individ- will address the real concerns of Amer- funds. This is an important point that ually. ican people—develop a bipartisan bill. needs to be understood by all Senators, But a handful of Senators on the They cannot just exclude one side be- because yesterday a Senator on the other side have made clear that they cause there is a majority that won the other side of the aisle criticized this will do whatever is procedurally pos- election and gets to write the bills. We bill for being 31 percent above fiscal sible to slow down or prevent consider- get tired of hearing that told to us. year 2009. ation of these bills. Where is your comparable bill? We are That is misleading, because it does Despite that, I can say that the State not trying to have a comparable bill, not account for the billions of dollars Foreign Operations conference agree- we are trying to have input into the in fiscal year 2009 ‘‘emergency’’ supple- ment was negotiated with the full par- current bill or the current bills: Sit mental funding that was the standard ticipation of both House and Senate down, talk about the principles, find way of doing business under the pre- chairmen and ranking members. It was the actual things that fit into those vious administration. in every sense a collaborative process. principles, develop the details, and To ignore those costs to American It is a balanced agreement and have a bill that goes step by step so we taxpayers is disingenuous. President should be supported by every Senator get the confidence of the American Obama has made clear that he intends who cares about U.S. security and the people. The step we ought to start with to fund these programs on budget, not security of our allies and friends is Medicare. That is why I present this through supplemental gimmicks. That around the world. report from the actuary of CMS, which is what the Congress urged him to do, The PRESIDING OFFICER. The is part of the Department of Health and now he is being criticized for doing question occurs on agreeing to the mo- and Human Services, which is assigned so. tion to waive all applicable sections of

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00021 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.028 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12992 CONGRESSIONAL RECORD — SENATE December 11, 2009 rule XXVIII. The yeas and nays have Mr. REID. I am happy to. weekend in Washington. I won’t be been ordered. The clerk will call the Mr. MCCAIN. And the disposition of traveling the country doing any fund- roll. the pending Dorgan amendment, could raisers that people seem to be afraid of. The assistant legislative clerk called we have some idea about that? Mr. MCCONNELL. The answer to it is the roll. Mr. REID. I think my friend from Ar- that our good friend the majority lead- Mr. KYL. The following Senators are izona asks a very pertinent question. er told us on November 30 we would be necessarily absent: the Senator from We offered a consent request last here the next two weekends. He said Kentucky (Mr. BUNNING), the Senator evening—and I did again today—that again this past Monday we would be from Oklahoma (Mr. COBURN), the Sen- we would have the votes now before the here this weekend. I assumed and I ator from Texas (Mrs. HUTCHISON), and Senate in sequential order. I offered a know he certainly meant what he said. the Senator from North Carolina (Mr. unanimous consent request to do that. Our Members are here and ready to BURR). We are happy to do that. I announced work. We wish to work on health care Further, if present and voting, the there would be no more votes today. On amendments. But as a result of the Senator from Kentucky (Mr. BUNNING) Monday when we come in, we will be privileged status of the conference re- would have voted ‘‘Nay.’’ happy to do that. port that is before us, we have had that The PRESIDING OFFICER. Are there Mr. MCCONNELL. I say to my friend displaced. But I think everybody was any other Senators in the Chamber de- the majority leader, the problem with on full notice as to what the work siring to vote? that is we have been going back and schedule was going to be for last week- The result was announced—yeas 60, forth with an amendment on each side, end and this weekend. nays 36, as follows: and the agreement that you have prof- Mr. KERRY. Mr. President, if I could fered, if I understand it correctly, basi- respond, I don’t mean to assert myself [Rollcall Vote No. 372 Leg.] in any way that is inappropriate with YEAS—60 cally had two Democratic side-by- sides. Am I not correct in my under- respect to the leader, but we all know Akaka Feinstein Mikulski that in the workings of the Senate, Baucus Franken Murray standing of that? Begich Gillibrand Nelson (NE) Mr. REID. Yes, but on all amend- what we are doing is both complicated Bennet Hagan Nelson (FL) ments that we have had up to this and serious and critical to the country. Bingaman Harkin Pryor point, every side, Democrats or Repub- We are waiting for CBO to appro- Bond Inouye Reed licans, has had the opportunity to do priately, consistently—as a member of Boxer Johnson Reid the Finance Committee, we adhered to Brown Kaufman Rockefeller side-by-sides if they wanted to. In the a very strict notion that we would try Burris Kerry Sanders weeks we have worked on this, what Byrd Kirk Schumer to find the precise modeling and cost of has transpired here, I am quite sure, Cantwell Klobuchar Shaheen whatever it was we might do. It is en- Cardin has happened before. Simply stated, we Kohl Specter tirely appropriate, to have a proper de- Carper Landrieu Stabenow have been requested by Republicans to bate or discussion, that we know ex- Casey Lautenberg Tester have some votes, and we have agreed to Cochran Leahy Udall (CO) actly what the cost is of any particular have the votes. I explained in some de- Collins Levin Udall (NM) proposal. That is what we are waiting Conrad Lieberman Warner tail last evening why we can’t do it on for. So the majority leader is appro- Dodd Lincoln Webb a piecemeal basis. Procedurally, it puts Dorgan Menendez Whitehouse priately trying to move another piece us into a quagmire. Let’s clear the Durbin Merkley Wyden of legislation that is ripe, that is im- deck. There will be other amendments portant to the country. This is just a NAYS—36 after that we would certainly try to Alexander Feingold McCaskill question of courtesy to Senators and to have each side offer. their families and to the staff of the Barrasso Graham McConnell But I agree with the Senator from Bayh Grassley Murkowski Senate who have been working extraor- Bennett Gregg Risch Arizona, we should get rid of the drug dinarily hard. The question is simply, Brownback Hatch Roberts reimportation amendment one way or why, as a matter of convenience, we Chambliss Inhofe Sessions the other, in addition to the motion of- Corker Isakson Shelby couldn’t schedule a vote for today in- Cornyn Johanns Snowe fered by Senator CRAPO. stead of being scheduled for tomorrow. Crapo Kyl Thune Mr. MCCONNELL. My point was, We could do that by unanimous con- DeMint LeMieux Vitter typically a side-by-side is offered one Ensign Lugar Voinovich sent. Enzi McCain Wicker on each side. On the drug reimporta- Mr. REID. If I could have the RECORD tion issue, you have basically two NOT VOTING—4 reflect, the Republican leader is right. votes, both generated on the Demo- I said we would be in session the next Bunning Coburn cratic side, which created some confu- Burr Hutchison several weekends. But if you go back sion. But we will have to continue to and look at the RECORD, how many The PRESIDING OFFICER. The yeas talk about this and see if we can work times have I said we would be in ses- are 60, the nays are 36. Three-fifths of our way through it. sion over the weekend and, interest- the Senators duly chosen and sworn The PRESIDING OFFICER. The Sen- ingly enough, around here, magic having voted in the affirmative, the ator from Massachusetts. things happen on Thursdays and Fri- motion is agreed to. Mr. KERRY. Mr. President, I wanted days. I have had every intention, as I Mr. LEAHY. Mr. President, I move to to ask the minority leader—some of us have every time I have said it, that we reconsider the vote. are a little bit perplexed. I know the should be in on a weekend, and usually Mrs. MURRAY. I move to lay that Senate has its rules, and we try to we are able to work something out. We motion on the table. work through them. But we also at this haven’t been able to this time. I accept The motion to lay on the table was time of year often try to accommodate that. I am not complaining. But cer- agreed to. families and schedules and so forth. I tainly the question of my friend from Mr. REID. I ask unanimous consent am curious as to whether the minority Massachusetts is a pertinent one. Sen- that no further points of order be in leader might not consent to allowing ators are here now. Maybe we could order during the pendency of H.R. 3288. us or why it is that we couldn’t, since have the vote early. But it is set statu- The PRESIDING OFFICER. Without Senators are here today, schedule the torily. My unanimous consent request objection, it is so ordered. vote and agree to have the vote on the was, and I am not sure it was responded Mr. REID. It is my understanding 60-vote margin today rather than to- to, that we could have that vote at 9:30 that the next vote will be tomorrow morrow morning, requiring all staff tomorrow morning without having the morning at 9:30. We will be happy to and everybody in the Senate to come in mandatory 1-hour beforehand. come in at 8:30, but I ask unanimous on a Saturday. I heard no objection to that. We will consent if we could have that vote at Mr. REID. If I could make a comment just come in at 8:30. We will come in at 9:30. We will come in at 9, if that is OK before my friend the Republican leader 8:30 tomorrow morning and have a 9:30 with everybody. comments, everyone should under- vote. Mr. MCCAIN. Will the majority lead- stand—this should make it easier for Mr. KERRY. Mr. President, I ask er yield for a question? everybody—I am going to be home all unanimous consent that the vote

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00022 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.031 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12993 scheduled for tomorrow morning be gage in a colloquy for up to 30 minutes; Secondly, they concluded that ‘‘the held instead today at some convenient that following the conclusion of that 30 Reid bill still leaves an estimated 24 time within the next hours. minutes, Senator ALEXANDER or his million people . . . uninsured.’’ Twen- The PRESIDING OFFICER. Is there designee be recognized for up to 30 min- ty-four million people—that is almost objection? utes to engage in a colloquy with other half of the uninsured today. Why is Mr. MCCONNELL. Mr. President, remembers of the Republican caucus. that important? We were told the pur- serving the right to object—and I will The PRESIDING OFFICER. Is there pose of this health reform exercise was object—we have been told by the ma- objection? to, one, insure everybody; two, bend jority that the single most important The Senator from New Hampshire. the health care costs down; and three, thing we could do would be to work on Mr. GREGG. Mr. President, reserving make sure that if you have your own weekends and try to pass this health the right to object, I understand that is health care that you like, you do not care bill which, according to the CNN in addition to Senator WYDEN’s re- lose it. Well, on two counts, it appears poll that came out last night, the quest, which is that I should begin with the Reid bill clearly fails that test and American people oppose 61 to 36, before my first 10 minutes, then we would go gets an F—on the issue of bending Christmas. We are here. We are pre- to the Senator from Arkansas, then we health care costs down and on the issue pared to work. We would like to get would go to Senator WYDEN, and then of insuring everyone, according to back on the health care bill as rapidly we would go to the outline as rep- CMS, an independent group. as possible and vote on amendments to resented by the majority leader. Third, it says: the bill. It either is or it isn’t impor- Mr. REID. If that is OK with the Sen- The new fees for drugs, devices, and insurance plans in the Reid bill will increase— tant enough for us to be here before ator from Arkansas. Christmas. My Members are not ex- The PRESIDING OFFICER. Without Increase— pecting to take a break. We have been objection, it is so ordered. prices and health insurance premium costs told by the majority all year long this The Senator from New Hampshire is for customers. This will increase national recognized. health [care] expenditures by approximately is important. First we had to get it $11 billion per year. done before August. Then we had to get Mr. GREGG. Mr. President, thank you very much. So instead of bringing health pre- it done before Thanksgiving. Now we miums down, as was represented by the have to get it done before Christmas. Mr. President, I rise to speak a little bit about this health care bill. I know President—he said it was going to go We are here, ready to work. down by $2,100 per family—your health there has been a lot of discussion of it I object. care premiums are going to go up. already today, but I think it is impor- The PRESIDING OFFICER. Objec- What happens when health care pre- tant—very important—that as this tion is heard. miums go up? People stop giving you health care bill comes forward, we The Senator from New Hampshire. health care insurance because they Mr. GREGG. Is the Senator from Ar- know what it says. cannot afford it. Employers cannot af- kansas seeking recognition? Unfortunately, we received this 2,074- ford it. So on the third issue, will you Mrs. LINCOLN. Yes. page health care bill about 8 days ago, lose your health insurance if you like The PRESIDING OFFICER. The Sen- after it had been worked on for 8 weeks it, yes, you will. Yes, you will because ator from Arkansas. in camera, behind closed doors by the the price of your health insurance is Mr. GREGG. Mr. President, I still Democratic leadership. We have only going to go up under the Reid bill. have the floor. I was just asking a had 8 days to look at it. We now hear There are a couple other points they question. there is going to be a massive revision make which are fairly important here: The PRESIDING OFFICER. The Sen- of it—a massive revision—that is going The actuary’s analysis shows that claims ator from New Hampshire has the to involve potentially expanding Medi- that the Reid bill extends the solvency are floor. care to people who are aged 55. shaky. Mr. GREGG. Mr. President, I ask Medicare is already broke, by the They are ‘‘shaky’’—the claims that it unanimous consent to be allowed to way. It is broke. It has a $38 trillion extends the Medicare trust fund sol- speak for up to 10 minutes and then unfunded liability. And we are going to vency. that the Senator from Arkansas be rec- add another 10 million people, maybe, Quoting further: ognized, and then we will come back to into Medicare? That makes no sense at Moreover, claims that the Reid bill ex- this side. all. tends the Medicare HI Trust Fund and re- The PRESIDING OFFICER. Is there But what I think is important is that duces beneficiary premiums are conditioned objection? what we know so far has been reviewed on the continued application of the produc- by a lot of different people, but some of tivity payment adjustments in the bill, The Senator from Oregon is recog- which the actuary found were unlikely— nized. them have not been all that objective. That is their concept, ‘‘unlikely’’— Mr. WYDEN. Mr. President, reserving So there was a request made to CMS, the right to object—and I have no in- which is an arm of the administra- to be sustainable on a permanent annual basis. . . . tention of objecting—I would like to tion—therefore, one would presume it also propound a unanimous consent re- was not necessarily biased toward the So the idea that this bill somehow assists Medicare—by the way, this bill quest that after the Senator from Ar- Republican side of the aisle; in fact, cuts Medicare by $1⁄2 trillion, almost, in kansas has spoken and after the Sen- maybe just the opposite; I do not think the first 10 years. When it is fully im- ator from New Hampshire has spoken, it is biased at all, hopefully; but if plemented, it cuts Medicare by $1 tril- Senator COLLINS, I, and Senator BAYH there was bias here, it certainly would lion in a 10-year timeframe, and over be recognized for up to 30 minutes for a not be Republican—to review the pro- the next 20 years, it cuts Medicare by colloquy. posal of Senator REID. $3 trillion. The idea that this is going The PRESIDING OFFICER. Is there Let me read to you what the CMS to somehow help Medicare is fraudu- objection to the request of the Senator conclusion is—some of them—on the lent on its face, according to the Actu- from Oregon? Reid bill. ary. ‘‘Fraudulent on its face’’ is my The majority leader is recognized. According to the CMS Actuary: ‘‘The term. It is ‘‘unlikely’’ to accomplish Mr. REID. Mr. President, reserving Reid bill increases National Health Ex- that. the right to object, I would ask my penditures’’ by $234 billion during the Then it goes into this issue of the friend from Oregon if he would allow period 2010 to 2019. Why is this impor- CLASS Act, which we have heard so this modification to his unanimous tant? Well, it is pretty darn important much puffery about how wonderful this consent request. It would be as follows: because we had representations that CLASS Act is, which is basically an- consent that Senator LINCOLN be recog- the purpose of this health care reform other Ponzi scheme, as it was described nized and that she be allowed to speak was to decrease, to move down, health by the chairman of the Budget Com- for up to 10 minutes; that Senator care costs. Now we find this bill, as mittee, not myself. The Actuary said: GREGG be recognized for up to 10 min- scored by the CMS Actuary, signifi- The Reid bill creates a new long term in- utes; and then that Senators WYDEN, cantly increases the national health surance program (CLASS Act) that the CMS COLLINS, and BAYH be permitted to en- care expenditures. actuaries found faces ‘‘a very serious risk’’—

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00023 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.033 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12994 CONGRESSIONAL RECORD — SENATE December 11, 2009 This is their term, ‘‘a very serious tainable? And those conclusions are But I really come to the floor today risk’’— come to by the CMS, the independent to highlight the challenges Arkansas of becoming unsustainable as a result of ad- CMS Actuary. Why would we want to small business owners face in providing verse selection by participants. . . . put that type of program in place? Of quality, affordable health care for In other words, only people who are course, we should not. themselves, their families, and their probably going to need long-term care Listen, this 2,074 pages of bill—it was employees under the current system are going to opt into this program. So put together haphazardly. It was just and to look at what we can do to im- this plan will basically not be able to sheets of paper stuck together. It ends prove what their challenges are, what pay the costs of the benefits it is pro- up costing us $2.5 trillion overall. it is they face. posing because they will not have funds Every page costs us about $1 billion. Small businesses are our No. 1 source coming in to support the people who Obviously, it was not well thought out of jobs in Arkansas, and they are truly need it because there will be no larger because the CMS Actuary looked at it the economic engines of our local insurance pool of healthy people who and said it is not well thought out. It economies, but they are also the eco- are using the program. Only the people does not accomplish its goals. nomic engines of our national econ- who need the program will use it. So So rather than moving forward with omy, not to mention learning labora- the CLASS Act representations we the bill, why don’t we just step back tories for great ideas that will allow us have heard around here have been de- and start doing things we know are in this great Nation to be truly com- bunked by this CMS report. going to work? Why don’t we start petitive in the 21st century. This is not our side saying these doing a few things around here we Arkansas’s nearly 250,000 small busi- things. It is not our side saying that know are going to work? ness and self-employed individuals the cost of this bill will drive up the I know the Senator from Oregon is on make significant contributions to our cost of national health care. It is not the floor, and he happens to be the State’s economy and generated $7.2 bil- our side saying there are 24 million sponsor of a bill which actually would lion in 2008. Small employers account people left uninsured when this is fully make some progress in the area. Why for 97 percent of the employers in our implemented. It is not our side saying don’t we—I would be willing to step State, and I would daresay nationally premiums will go up when this bill is back and start from his bill because his it is somewhere at that same level. fully implemented. It is not our side bill at least makes sense. If it were Addressing the needs of small busi- saying the CLASS Act will be a seri- scored by the CMS Actuary, it would nesses is absolutely critical to any ously unsustainable program. It is not not come out like this. They would not health insurance reform legislation we our side saying Medicare will not be be saying that people would be unin- bring forward. benefited by this program. In fact, it sured, that the price of health care was As I mentioned before, Senator will be negatively impacted by this going to go up and that Medicare was SNOWE and I have worked together for program. It is CMS saying that, an going to go into a disastrous strait and many years to try to address these con- independent Actuary—not that inde- create an unsustainable entitlement. cerns, talking with small businesses pendent; an arm of the administration. So we have ideas around here that do and their advocacy groups to try to fig- The administration’s Actuary is saying work or are fairly close or at least have ure out what it is we can provide them, it, not our side. So I think it is legiti- the foundation to work. Why don’t we just as we provide ourselves as Federal mate to have some serious concerns use those rather than this bill? That is employees the ability to access health about this bill. my only point. This bill is ill thought insurance that has been negotiated, The CMS report goes on and says: out, and that is not my conclusion, where people have come together, The CMS actuary noted that the Medicare that is the only conclusion you can pooled the resources of all of our risks cuts in the bill could jeopardize Medicare come to when you look at the CMS Ac- as Federal employees—all 8 million of beneficiaries’ access to care. tuary’s evaluation of it. us—to really get a better deal in the Now, that is serious. That is serious. Mr. President, I appreciate the cour- marketplace. It found that roughly 20 percent of tesy of the Presiding Officer, and I es- We want to be able to allow small all Part A providers—hospitals—would pecially appreciate the courtesies of businesses to do the same, to come to- become unprofitable—20 percent of all the Senator from Arkansas. gether nationwide, pool themselves in Part A providers, such as hospitals, The PRESIDING OFFICER. The Sen- their State exchanges, and be able to would become unprofitable within the ator from Arkansas. really take advantage of sharing their next 10 years as a result of the pro- Mrs. LINCOLN. Mr. President, thank assets and their risks in the health in- posals in the Reid bill. you. And I appreciate the courtesies of surance marketplace and get the best Well, I know ‘‘profits’’ is a bad word my colleague from Oregon for allowing possible product they can. on the other side of the aisle, but the me to speak now. Those small businesses that are able simple fact is, if you do not have profit I rise today to talk a little bit about to afford health care coverage for their in a hospital, the odds are pretty good the health care concerns, particularly, employees in today’s world continue to you are going to go out of business. in our small businesses. I first wish to experience skyrocketing costs, jeopard- You are going to go out of business be- compliment and thank my colleagues, izing our States’ and our Nation’s com- cause you cannot pay the costs of oper- particularly Senator LANDRIEU, who is petitive edge, both among themselves ating that hospital. Even nonprofits chairman of the Small Business Com- nationwide domestically but also inter- have some sort of cushion in order to mittee, as well as Senator SNOWE, with nationally. We find that our small make it through. Now we have the whom I have worked for years on the businesses are finding themselves more CMS Actuary telling us that 20 percent plight of the small businesses in our and more in the situation of having to of the hospitals in this country are States and across the country—their be competitive globally to be able to do going to go into a negative cashflow need to be able to really access the the business they do and to create the and are going to become unprofitable kinds of competition and choice that jobs they need to create. as a result of what this bill proposes. allow them to make good decisions and Yesterday, I spoke with a radio sta- Well, colleagues, Senators, why spend their health care dollars more tion owner from Wynne, AR, in Cross would we vote for a bill which in- wisely and being able to do what they County, who said high costs have creases the cost of health care for the all want to do in small business, and threatened his ability to be able to pro- country and does not bend the health that is to be able to cover their em- vide coverage for his employees. Or, care cost down, which leaves half the ployees, to make sure their employees worse, skyrocketing costs are forcing people in this country who are unin- and their employees’ families are cov- business owners to consider giving up sured still uninsured, which raises the ered with reasonable and meaningful their businesses altogether, like the premium costs for Americans, which health insurance that actually covers small business owner from Malvern, puts the Medicare system at risk, what they need but is at an affordable AR, who wrote me that he was giving which will put hundreds of providers at price. So I thank those women, as well up his 17-year-old business because he risk, hospitals, and which creates a as Senator STABENOW, who I know has can no longer afford his rising health brandnew entitlement which is not sus- also been working on these issues. care insurance premiums. His wife and

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00024 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.034 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12995 his daughter each have a preexisting limiting what an insurer can charge tered this body together, and she has medical condition, and he feels pres- based on age and by banning the prac- consistently advocated on behalf of sured to find a new job that provides tices of denying coverage based on pre- small businesses, not only across Ar- affordable employer-sponsored cov- existing conditions or increasing rates kansas but across the country. We both erage for his family. when customers all of a sudden get want to reform the health care system. I heard from another small business sick. We know this has a major impact on owner in Mena who told me that at the We look at our small businesses and, small businesses. They create most of age of 65, he continued to keep himself yes, there are a lot of young entre- the new jobs in our society. So if we on his own small business’s health in- preneurs, but a lot of our small busi- care about job creation, we need to surance plan in order to ensure that he nesses are those individuals in that care about how health insurance costs could maintain providing health insur- category above 55. These are people affect businesses. They are going up ance to his employees, many with who, unfortunately, are starting to see too fast, and Senator LINCOLN has con- whom he grew up. They were friends of chronic disease challenges in their life sistently advocated for doing what we his from grade school or church and as they age. Unfortunately, they be- can to get those cost increases down community services and other places come an issue, or certainly their cov- and, in fact, lower the burden on our where he had built lifelong relation- erage becomes an issue when we talk small businesses. So this is not only a ships, not only as an employer and an about preexisting conditions. So it is health issue, it is a jobs issue. She has employee but as part of a community. critical that we make sure we change been a real leader for many years. Being able to maintain providing that the way insurers do business as usual So it is a privilege to work with the to them was so critical to him that he today and make sure they are playing Senator on these important issues. Our was willing to ante up. fair with the small business entities class is doing well. I have heard from small business out there. I also wish to say how much I am owners from all across my State who Just one more of my efforts is some- privileged to work with my friend from desperately want to offer health care thing on which we worked with Sen- Oregon, Senator WYDEN, who has been coverage for their employees, but it is ator SNOWE and Senator DURBIN, which one of the most innovative thinkers in simply not cost productive. The fact is, is to allow that there would be na- the area of health reform. Once again, so many people think small businesses tional private insurers, as there are he is leading the way on an issue I am just want to opt out, that they don’t today, but allowing them to sell going to speak to for just a second. want to provide health insurance, but multistate plans nationwide, to be able I am happy to see my colleague from they do. They do because it is impor- to sell their plans in all 50 States. It Maine is with us. It saddens me to say tant to them as a part of that commu- would be with a strong Federal admin- that, regrettably, this is one of the few nity to do something for their employ- istrator who would be able to negotiate examples of bipartisan cooperation ees who also happen to be their friends for quality and affordable coverage. where we have come together across and neighbors. They also want to make Some of this has emerged as another the aisle, Democrats and Republicans, sure their business is the best it can be, potential part of the framework for na- working together to figure out how in and in order to do that they have to tional health insurance reform that a practical way we can help solve the compete for those skilled workers. Get- can help us achieve our goals of more problem our country faces. ting the best workers means providing choices and more affordability for con- Here we have an issue of what to do good benefits, with health care being at sumers, particularly those in the small about the 7 percent of Americans who the top of that list. business marketplace. are the individual insurance market Another Arkansan asked me to So I wish to thank the Presiding Offi- but are receiving no subsidies from the please include the self-employed in my cer for the opportunity to share with government. According to the CBO, efforts to secure affordable health care. my colleagues and certainly those they are at risk of having their pre- There are many small businesses with Americans out there who are the inge- miums go up. That is not right, par- only one employee, and health care nuity and the engine of our economy. I ticularly at a time when even people under this scenario is extremely expen- know my colleague from Oregon has who are making more than $88,000 very sive. They are put in an individual talked so much about choice and com- often are struggling. So the question market where they are rated against petition. It is so important, more im- is, What can we do about it? themselves in many instances and not portant than ever in that small busi- Senator COLLINS, Senator WYDEN, given the benefit of what we enjoy as ness marketplace and in that indi- and myself focused on these individuals Federal employees; that is, pooling vidual marketplace, as well as pro- because we wanted to do what we ourselves together, adding our assets viding exchanges and the ability for could, in the words that my colleague and our risks together so that we can national insurers, private insurers to from Oregon emphasizes so often, to mitigate that risk among all 8 million be able to provide these types of prod- provide choice and encourage competi- Federal employees. ucts across all 50 States. Also, a tion to improve both price and quality. These are just a few of the stories I multistate plan gives our small busi- That is what our amendments are all have heard from Arkansans, and that is nesses and our self-employed, our indi- about. why in every Congress since 2004, I vidual marketplace, our independent I wish to read a very brief statement have introduced legislation to help contractors, such as our realtors and and then turn it over to my colleagues. small business owners afford health others, the ability to have access to When I go home to Indiana, the coverage for themselves, their employ- greater choice, greater competition in health care concern I hear the most ees, and their families. Several of my that marketplace, and, therefore, a about from ordinary Hoosiers, particu- provisions are already included in the better product—greater, more mean- larly middle-class Hoosiers, is what are health insurance reform bill currently ingful coverage at a more reasonable we going to do to make their coverage before the Senate, including the tax cost, and that is what we want to see. more affordable. Many people in my credit to help small businesses afford More importantly, that is what our State already have insurance, but they coverage, and we want to improve upon small businesses want to see. are struggling to keep up with the sky- that. Also included are insurance ex- So I thank the Presiding Officer, and rocketing increases and the cost of changes through which consumers can I yield the floor to my colleague from that care. compare insurance plans side by side so Oregon and my colleague from Indiana, We began our health care debate and that they will be able to choose the op- and the Senator from Maine as well, these deliberations in this body this tion that is best for them, allowing whom I know will have a great addi- past spring. In mid-October, months their employees to see what is avail- tion to this conversation. Thank you. into our debate, some of us were struck able to them and making sure that The PRESIDING OFFICER (Mrs. by the fact that we had not answered they are having access to all the op- SHAHEEN). The Senator from Indiana. the most basic question: How much is tions of the marketplace. There are re- Mr. BAYH. Madam President, I wish this going to cost, and what do we do forms that force insurance companies to begin by complimenting my friend to bring those costs down? So I, along to change the way they do business by and colleague from Arkansas. We en- with some others, submitted in writing

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00025 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.036 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12996 CONGRESSIONAL RECORD — SENATE December 11, 2009 that question to the Congressional choices, premium cost increases under cans don’t get a chance to benefit when Budget Office. What will this do for control, eliminating preexisting condi- they shop wisely. people in the small group markets such tions—those are the things that will As Senator BAYH noted—and as Sen- as small business owners, what will help middle-class families in my State ator COLLINS and I have noted over the this do for individuals in the large and others across the country. last few days—that is something we group markets who work for larger em- I am proud that the Wyden-Collins- ought to change. It is certainly not a ployers, and what will it do for individ- Bayh affordability package will rep- partisan idea. Senator REID and Sen- uals who are out there struggling on resent one of the few bipartisan efforts ator BAUCUS, to their credit, have their own to provide health insurance in this body. As I was saying, I regret agreed with me that there ought to be for themselves and for their loved the fact that it is one of the few, but I more choice for those folks who have ones? am proud we have come together to what, in effect, are hardship exemp- When they released their report, I work to address this important chal- tions under this legislation. There are was pleased to see that the current leg- lenge. I hope my colleagues will agree people, for example, who spend more islation before us would either contain that we have a responsibility to re- than 8 percent of their income on or lower costs for 93 percent of the strain premium costs for all American health who aren’t eligible for subsidies, American people. For 83 percent of families by encouraging consumer who have these hardship exemptions; those in small group and large group choice and robust competition in the and Senator REID, Senator BAUCUS, and plans, it is about holding even or mod- private marketplace. I hope we will I have agreed they ought to be able to estly lower. For the 17 percent in the pass these amendments because they take any help they are getting from individual marketplace, about 10 of accomplish exactly that. their employer in the form of a voucher that 17 percent get subsidies sufficient Madam President, thank you for and go into the marketplace. These to actually bring their prices down, your patience. I yield the floor. people should be able to put into their which leaves us with the 7 percent of The PRESIDING OFFICER. The Sen- pockets any savings that come about those individuals in the individual ator from Oregon. because they have shopped wisely. market who get no subsidies and may Mr. WYDEN. Madam President, I But as Senator BAYH has noted, we see serious cost increases if nothing is wish to begin my part of this colloquy have an opportunity to go further. If an done. The Wyden-Collins-Bayh amend- with Senator BAYH and Senator COL- employer in the exchange decides, on a ments accomplish just that. LINS by thanking my colleague from voluntary basis, that their workers Our first amendment promotes more Indiana. I also thank my colleague should have a choice, under the pro- health choices for both employers and from Maine because both senators have posal advanced by the Senator from In- workers who would otherwise have few, said from the very beginning of this diana, the Senator from Maine, and if any, choices. It would help individ- discussion that the bottom line for mil- myself, they would be able to do it. uals who would be forced to buy their lions of working families, for single It is the voluntary nature of our idea own insurance at higher rates than moms, for folks who are walking on an that Senator BAYH has outlined, an ap- they currently pay. It would give them economic tightrope across the country, proach that gives more options to both the option to purchase low-cost plans they are going to see this issue through employers and employees, that caused that offer essential, basic coverage. It the prism of what it means for them in our proposal to win an endorsement would ensure that Congress does not terms of their premiums and their from the National Federation of Inde- mandate that anyone buy a more ex- costs. pendent Business. pensive plan than they currently have. Over these many months, Senator I ask unanimous consent at this time Our second amendment is a market- BAYH and Senator COLLINS and I have to have printed in the RECORD that let- based reform that would pressure in- been toiling to put together some bi- ter from the National Federation of surance companies economically to partisan ideas. We have filed these Independent Businesses. lower premiums and penalize them if ideas as a package of amendments, sub- There being no objection, the mate- they try to raise rates before the new mitted them to the majority leader, rial was ordered to be printed in the exchanges are fully up and running. It Senator REID, and the chairman of the RECORD, as follows: would immediately adjust the insurer Finance Committee, Senator BAUCUS, NATIONAL FEDERATION fee in the bill to give insurance compa- and we just wanted to take a few min- OF INDEPENDENT BUSINESS, nies a strong financial incentive to utes today to talk in particular about December 10, 2009. keep premiums down. It would do this why it is so essential that there be a Hon. RON WYDEN, U.S. Senate, Dirksen Senate Office Building, by making it economically smart for bipartisan effort put together for addi- Washington, DC. companies to hold the line on overhead tional steps to contain costs. Hon. SUSAN COLLINS, and executive salaries and to root out Senator BAYH is absolutely right in U.S. Senate, Dirksen Senate Office Building, administrative inefficiencies. describing the Congressional Budget Washington, DC. Our third amendment would offer Office analysis. Certainly, many people DEAR SENATORS WYDEN AND COLLINS: On vouchers to give consumers who have were fearful the CBO report would behalf of the National Federation of Inde- health insurance but aren’t satisfied come out and say that on day one after pendent Business (NFIB), the nation’s lead- with it access to more choices to meet enactment premiums would rise into ing small business association, we are writing in support of the Wyden-Collins amend- their health care needs. It would offer the stratosphere as a result of the leg- ment (Optional Free Choice Voucher— vouchers that individuals could use to islation. Fortunately, that was not the amendment #3117), which provides vouchers shop in the new insurance exchanges case in the report for most people. as a new voluntary option for employers and we are creating. Those who prefer their We also believe there is a whole lot employees to purchase health insurance. current plan to what is offered in the more that can be done. So we have For small business, the goal of healthcare exchange could return the voucher and said, Democrats and Republicans are reform is to lower costs, increase choices and keep their existing coverage. going to try to prosecute that case. provide real competition for private insur- If we pass these amendments, we can What it comes down to is ensuring ance. The Wyden-Collins amendment achieves what we know are clear bipartisan credibly tell the American people that that, in the text of this legislation, goals in healthcare reform—expanding ac- our long efforts will have addressed ris- there is more choice and more competi- cess to coverage, increasing consumer choice ing health insurance premium costs for tion. and improving portability. everyone, and that is at the heart of The reality is, ever since the 1940s, Free choice vouchers recognize that the this effort we have undertaken. the days of the wage and price control employer-employee relationship in America In closing, I will say that Americans decisions that have done so much to has changed considerably since employer- are not looking for a Democratic solu- shape today’s health care system, most sponsored insurance began in the 1940s. They tion or a Republican solution to our Americans have not had real choice in give employees tax- advantaged resources to tailor healthcare choices and purchases to health care challenge. They are look- the health care marketplace and have their own preferences and needs. Because the ing for us to come together to pass a not been able to enjoy the fruits of a employees will be able to choose from more reform bill that works in practical competitive system. Most Americans policies, they will be more invested in their terms in their daily lives. More have little or no choice. Most Ameri- healthcare decisions. They will be better

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00026 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.036 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12997 consumers because they will be more aware bipartisan common ground, around chase one of the four types of plans of costs, and this will help ‘‘bend the cost principles the President has em- that are authorized by this bill? curve.’’ braced—choice and competition. Some would say, well, if you do that, In today’s diverse and highly mobile work- At this point, I yield whatever time you are going to have a problem where force, people change jobs every few years. Improving portability will reduce the ‘‘job she desires to our friend from Maine, a person will perhaps have a health lock’’ that currently stifles entrepreneur- who is a wonderful partner in this, savings account or a supplemental cat- ship. Since free choice vouchers would help along with Senator BAYH. Americans astrophic insurance plan and wait until make health insurance portable, employees are looking for commonsense ideas they are ill to trade up to a far better will not be locked into jobs when better op- above all else. That is what we have plan. But there is a way to stop that portunities come along. sought to do in this proposal. from happening. We have drafted our This amendment addresses the short- I yield to my friend from Maine. amendment so that if an individual comings of the existing employer-based sys- The PRESIDING OFFICER. The Sen- wished to upgrade his or her coverage, tem for small businesses. In the current system, small employers often have few options ator from Maine is recognized. he or she would have to wait until the beyond ‘‘take it or leave it.’’ This new and Ms. COLLINS. Madam President, next plan year and then could only up- voluntary option will encourage employers first, let me thank my two colleagues grade to what is known as the bronze to provide insurance coverage for employees. for their hard work on these amend- plan—the next higher level of coverage. It is the exact opposite of employer man- ments. My colleague from Oregon, Sen- That would help greatly to avoid the dates that harm struggling businesses, dis- ator WYDEN, has been working so hard problem of adverse selection and hav- courage startups and kill jobs. on health care issues for such a long ing a situation where an individual While some may claim this amendment time. My colleague from Indiana, Sen- simply waits until he or she becomes weakens employer-sponsored health insur- ator BAYH, and I have worked together ance, NFIB disagrees. The current system ill before upgrading coverage. works better for larger firms who can oper- on other issues, and I am proud of the We also wish to make sure consumers ate more efficiently and effectively, and this fact that the three of us have been able know exactly what they are buying and inequity must be addressed. Simply put, to come together, in a bipartisan way, what kind of coverage they are getting. what works for Wall Street does not work for to present to our colleagues three im- That is why we would require health Main Street. The Wyden-Collins amendment portant amendments. plans to disclose fully the terms of the works to address this by making coverage It is, as Senator BAYH has noted, so coverage to ensure that consumers more affordable for many of the nation’s job unfortunate that the debate on this bill fully understand the limitation. creators. has been so divisive and partisan. Sen- NFIB appreciates your commitment to Finally, this amendment makes clear healthcare reform and your continuous ef- ator WYDEN approached me about try- that States have the ability to impose forts to find solutions that work for small ing to find some common ground on additional requirements or conditions business. issues that would unite us. for the catastrophic plans offered under Sincerely, I should make clear the adoption of this bill. SUSAN ECKERLY, these amendments—important though The bottom line is, health care re- Senior Vice President, they are and great steps forward form should be about expanding access Public Policy. though they are—do not solve all the to affordable choices. The bill that is Mr. WYDEN. Madam President, I will problems I have with the legislation on the floor now would cause many make one last comment and then we before us. But they do improve the un- Americans in the individual market to will be happy to have our colleague derlying bill in important ways be- pay more for health care coverage than from Maine join us in this bipartisan cause they help to advance the goal of they do today. That isn’t right. If their colloquy. more affordable insurance choices for health care coverage is working well As we go forward with this legisla- consumers. Providing more choices and for them, if they are higher income and tion, I hope we will do more to look at more competition and greater afford- can bear the risk, if they have a health the exchanges, which are the new mar- ability, after all, should be major goals savings plan, if they are not getting a ketplace for American health care. We of health care reform. taxpayer subsidy, why should we dic- haven’t had that kind of approach The bill before us falls short in meet- tate, to this degree, the level of cov- since decades ago when we had a dis- ing those objectives. erage they can buy? cussion about a system that, for all Let me discuss our amendments. In I believe this amendment is simple practical purposes, tethered people to summary, our amendments would common sense. Let me explain what it one choice that was a judgment by an allow individuals, who are not receiv- would mean in my home State of employer and insurance company. I ing subsidies, to purchase lower cost Maine because I think it shows that wish to make sure, in the days ahead, plans if that coverage is more afford- one size does not fit all. In Maine, 87.5 that as many people as possible can able for them and more appropriate for percent of those purchasing coverage in keep exactly what they have today. them. the individual market have a policy That is something the President feels We are also proposing health insur- with an actuarial value of less than 60 strongly about. That is something ance vouchers that would provide more percent. The most popular individual every Member of the Senate feels options for employers and employees market policy sold in Maine costs a 40- strongly about. I also want employers alike. We are proposing incentives to year-old about $185 a month. These in- and employees to be able to say they insurers to keep their rates lower than dividuals often pair this catastrophic are going to have a broader range of they otherwise might be. coverage with a health savings ac- choices than they do now. Let me further explain our three count. I think that can be done in a way amendments. First, we would open the Under the bill we are debating, unless that does not destabilize employer- catastrophic plan—the so-called young they are grandfathered and don’t have based coverage. In fact, I believe it will invincibles plan—in the individual any change—for example, they have strengthen employer-based coverage. I market to anyone, regardless of age, not gotten married or divorced—then think that is one of the reasons the Na- who is not eligible for a subsidy under that 40-year-old would have to pay at tional Federation of Independent Busi- the bill. least $420 a month—more than twice as ness has endorsed our proposal. It is incredible to me that we are much—for a policy that would meet We have a lot of work to do. I think going to so constrain the insurance the new minimum standard. Otherwise there is a lot of good faith among Sen- choices for an individual who is receiv- they would have to pay a $750 penalty. ators on both sides to get this done. I ing no taxpayer subsidy at all. That There is an exception in the bill, but have always felt that on issues such as does not make sense. We want to en- it is only for people who are under the this, when you are talking about one- sure not only that people can keep the age of 30. What we are saying is, let’s sixth of the American economy, you insurance they have, if they like it, but broaden that, so that if you don’t re- ought to try to find as much common also that they have more options avail- ceive help from the government, if you ground as you possibly can. The three able to them. Why should we say that don’t receive a taxpayer subsidy, you, of us have come together behind a new an individual who is not receiving any too, can buy that kind of catastrophic set of amendments that does find some help—no subsidy at all—can only pur- coverage plan.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00027 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.005 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S12998 CONGRESSIONAL RECORD — SENATE December 11, 2009 A second amendment the three of us provide more choices, greater afford- I thank my colleagues. I yield the are offering would provide more ability, and more options. These should floor. choices to small businesses and to their be the goals of health care reform, and The PRESIDING OFFICER. The Sen- employees. Giving employers and em- these amendments help to advance ator from Tennessee. ployees more choices should be among those goals. Mr. ALEXANDER. Madam President, the chief goals of health care reform. Mr. WYDEN. Madam President, how I ask unanimous consent that Repub- Our amendment would allow employ- much time do we have? lican Senators be permitted to engage ers who choose to do so to offer vouch- The PRESIDING OFFICER. There is in a colloquy during our time. ers to employees so they can purchase 3 minutes 50 seconds remaining. The PRESIDING OFFICER. Without insurance on the exchange. This would Mr. WYDEN. Madam President, I objection, it is so ordered. allow them, for example, to use the em- thank my colleague from Maine for her Mr. ALEXANDER. Madam President, ployer voucher, plus tap into the sub- great statement. She summed it up so my grandfather was a Santa Fe railway sidy available because of their income well. engineer. He lived in Newton, KS. So level, and put some of their own funds To close, I will turn to Senator BAYH, far as I can tell, he was one of the most into purchasing the kind of coverage and if we have time, I will add a important men in the world. I was 5, 6, they want. As Senator WYDEN has ex- thought or two. 7 years old when I would go out there. plained, this program is completely op- Mr. BAYH. Madam President, I will He drove one of these great big steam tional. Employers could offer these be brief. I compliment Senator COLLINS locomotives. If there were as many yel- vouchers or decide to continue with on an excellent presentation. She sum- low flags and red flags along the track their employer plan. marized it very succinctly and in a way when he was driving that Santa Fe lo- Let me tell you one reason I think that was compelling. comotive as there are with the health I hope our colleagues will take note this strengthens the bill. We need more care locomotive that is going through that among the three of us, we have people buying insurance through the the Senate today, I think my grand- the east coast represented, the west exchanges, because if more people are father would have been guilty of gross coast represented, and the Midwest using the exchanges, it broadens the negligence if he did not slow it down represented. So we span the country risk pool, and the rates will be better and see what those red flags and yellow and this body. I hope that will cause for everyone. In insurance, having flags meant. more people over which to spread the our colleagues to take some note. The Senator from Maine focused on There is a lot of talk about making risk drives costs and premiums down. history with this bill, but there are a So it is not surprising to me that our the letter from the NFIB. This helps lot of different ways to make history. Nation’s largest small business group, small businesses at a time when they One of the things I hope we will be very the NFIB, has endorsed our amend- are struggling to create jobs. I hope careful to do in the Senate is not to ment. Let me read one paragraph from our colleagues will take note of this make a historic mistake with this the NFIB letter because it really sums letter. health care legislation. it up. The NFIB says: The Senator from Maine also pointed Now we have even one more red flag This amendment addresses the short- out, why should we control the health comings of the existing employer-based sys- care choices of individuals who are re- to consider. It came out last night tem for small businesses. In the current sys- ceiving no subsidies. That ought to be from Chief Actuary Richard Foster of tem, small employers often have few options up to them. We accomplish all of those the Centers for Medicare and Medicaid beyond ‘‘take it or leave it.’’ This new and things. Services. The Centers for Medicare and voluntary option will encourage employers It is a pleasure doing business with Medicaid Services is not a Republican to provide insurance coverage for employees. organization nor a Democratic organi- It is the exact opposite of employer man- Senator COLLINS. This is a practical approach to solving these problems. I zation. It is in the Obama administra- dates that harm struggling businesses, dis- tion. But it is the agency in charge of courage startups, and kill jobs. hope our colleagues will take notice. the Federal Government’s spending for I think the NFIB has said it well. The last thing I will say is, I repeatedly have people come up to me and health care, which, according to Mr. This will give more choices both to em- Samuelson, who wrote a column in ployers and to employees. say: Boy, RON WYDEN has some great Finally, let me say a few words about ideas. We need more of these ideas in Newsweek recently, was 10 percent in our proposal to modify the formula for this bill. And this is accomplishing the year 1980 and 25 percent today of the allocation of the $6.7 billion annual that. Senator WYDEN has been a true our government’s total expenditures. tax on health insurance providers. leader for many years in this area. I If we go back to the reason we start- There are a lot of problems with that am glad choice and competition is ed all this debate on health care, let’s particular tax, not the least of which is being introduced, and it is because of remember that the reason we started the gap between when the tax is im- his good work. the debate was first to see if we can posed and when the subsidies are fi- Mr. WYDEN. Madam President, to bring down the costs of health care be- nally available 4 years later. Another close, briefly, I thank my colleagues. I cause the red flags and the yellow flags problem is that the tax applies to non- don’t want to make this a bouquet- are everywhere for small businesses, profit insurers as well as for-profit in- tossing contest, but to have Senator for individuals, for our government. We surers. I am working with Senator BAYH and Senator COLLINS—they are as cannot continue to afford the increas- CARL LEVIN to try to address that prob- good of partners as it can possibly get. ing cost of health care in America. So lem. At the end of the day, Americans are our first goal here is to bring down the Here is what we are saying. The way going to watch this bill, they are going costs. the tax is designed in the bill, there is to watch it next year during the open Yet, Mr. Foster, the Chief Actuary of little to keep insurers from jacking up enrollment season when millions are the Centers for Medicare and Medicaid premiums, which is exactly the oppo- signing up for their coverage, and they Services, in a lengthy report delivered site of what we want them to do. They are going to be looking to see if we did last night on the health care bill—most are going to just pass this tax on. So everything possible to hold down their of which we have seen but some of what we propose is to give insurers an premiums. Holding down their pre- which we do not know about yet; it is incentive to keep premiums as low as miums—there is a variety of ways to still being written in the back room— possible. Under our amendment, if you go about it, but there is no better tool says that it will increase costs. Instead are an insurer that is holding down the than to bring the principles of the mar- of reducing costs, it will increase costs. cost of your premiums, you don’t pay ketplace, the principles that are used It points out the obvious, which is that as large a share of the tax. That makes in every other part of American life— the taxes in the bill will raise the pre- sense. That helps us be more fair to the choice and competition—for the chal- miums for the 180 million of us pay efficient insurer that is working hard lenge ahead. who have employer-based insurance, to keep premiums down. With the help of Senator COLLINS and and for those who have individual in- Again, I am very pleased to join with Senator BAYH, we are going to pros- surance. It talks about the millions of my two colleagues in presenting to the ecute that case. We are going to do it Americans who will be losing their em- Senate three amendments that will in a bipartisan way. ployer insurance by the

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00028 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.039 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S12999 combination of provisions in this bill, Reid bill, according to this report—this Mr. BARRASSO. My answer to that many of whom will end up in Medicaid, is not the Republican policy committee is they are objective. That is why we where 50 percent of doctors will not see but the Centers for Medicare and Med- did not get this report—I have the a new patient. But maybe the most im- icaid Services—doesn’t it say: same copy my colleague from Arizona portant finding is the most obvious The Reid bill creates a new long-term in- has. This just came out, and the reason finding, the one which we have been surance program— is because they wanted to take the suggesting to our colleagues day-in and Called the CLASS Act— time to study the bill which they got day-out. It is one we ought to pay at- that the CMS actuaries found faces ‘‘a very in the middle of November. So they tention to and one which almost every serious risk’’ of becoming unsustainable as a needed the time to actually go through American can easily understand. And result of adverse selection by participants. point by point what the implications it is this—it has to do with Medicare, The actuary found that such programs face a were. the government program on which 40 significant risk of failure and expects that The Senator talked about the one the program will result in ‘‘net Federal cost segment where they talk about they million seniors depend. This bill would in the long term.’’ cut $1 trillion—let’s start this way. ‘‘face a significant risk of failure.’’ I would like to mention two other Medicare, the program we depend on, They actually go on to say: ‘‘This will provisions to my friend from Tennessee its trustees say it is going broke in 5 eventually trigger an insurance death and Dr. BARRASSO, who is very familiar years. It is already spending more than spiral.’’ This is for people who depend not only with this center but with it brings in, and it will be insolvent be- upon Medicare for their health care. Medicare and Medicaid services. tween 2015 and 2017. Those are the There is an Associated Press story Medicare trustees telling us this. The Reid bill funds $930 billion in new Fed- out today that says this provides a eral spending by relying on Medicare pay- What does this bill do to that? sober warning—a sober warning—today ment cuts which are unlikely to be sustain- to Members of the Senate. This is a Mr. MCCAIN. Will the Senator yield able on a permanent basis. As a result— for a question? time when the Senate raised the debt According to CMS— Mr. ALEXANDER. If I may finish my limit in this country by over $1 tril- point. providers could ‘‘find it difficult to remain lion. As the old saying goes—I say to What does this bill do? It would cut profitable and, absent legislative intervention, might end their participation in the my friend who served in the Navy— $1 trillion from Medicare. I ask the Medicare program.’’ they are spending money like drunken Senator from Arizona, if the program The Reid bill is especially likely to result sailors, and yet they want to keep the is going broke and you cut $1 trillion in providers being unwilling to treat Medi- bar open longer. They want to increase out—and then it has been suggested care and Medicaid patients, meaning that a the debt at a time when our Nation over the last few days that we add sev- significant portion of the increased demand cannot afford it, when we have 10 per- eral million more people into Medi- for Medicaid services would be difficult to cent unemployment. care—what do you suppose the result meet. The folks who know Medicare the would be? They go on to say: best and can look at this objectively Mr. MCCAIN. The answer is, obvi- The CMS actuary noted that the Medicare and share with the American people ously, that I don’t know. cuts in the bill could jeopardize Medicare what their beliefs are as to what the I would like to say to the Senator beneficiaries’ access to care. He also found impact is going to be say that is going that roughly 20 percent of all Part A pro- from Tennessee—and Dr. BARRASSO is viders (hospitals, nursing homes, etc.) would to be devastating for patients who rely here as well—a lot of Americans have become unprofitable within the next 10 years on Medicare for their health care—our heard of the Congressional Budget Of- as a result of these cuts. seniors—and devastating for small fice. I am not sure many have heard of Finally, he goes on to say: community hospitals. I see the former the Centers for Medicare and Medicaid The CMS actuary found that further reduc- Governor, now Senator of Nebraska, is Services, which is part of the Depart- tions in Medicare growth rates through the here, and he knows, as I do from Wyo- ment of Health and Human Services. actions of the Independent Medicare Advi- ming, the impact on our small commu- Are they not the people whose entire sory Board— nity hospitals. focus is not on the entire budget, as Which is one of the most controver- But as the Senator from Tennessee CBO’s is, but just on Medicare and sial parts of this legislation— said, this is all being done in a back Medicaid, so that they can make deter- which advocates have pointed to as a central room. We are not privy to the newest minations as to the future and the im- lynchpin in reducing health care spending, changes, which I think are actually pact of various pieces of legislation on ‘‘may be difficult to achieve in practice.’’ going to make matters worse. The New specifically Medicare and Medicaid? Is This is a remarkable study, I say to York Times today says Democrats’ new that a correct assessment? my friend from Tennessee. ideas would be even more expensive. Mr. ALEXANDER. The Senator from Mr. ALEXANDER. I thank the Sen- Questions exist about the affordability. Arizona is exactly right. I believe I ator from Arizona for being so specific What we are dealing with is a situation have my figures right. I think Mr. about this and making it clear that that is unsustainable, and that is why Samuelson said in his column the other this is not a Republican Senator talk- the newest poll out today by CNN—cer- day that in 1980 the Federal Govern- ing, this is a Republican Senator read- tainly not biased one way or the ment was spending 10 percent of all our ing the report of the Federal Govern- other—finds that 61 percent of Ameri- dollars on health care and today it is 25 ment’s Chief Actuary for the Medicare cans oppose this bill. It is the highest percent. And this is the agency in and Medicaid Program. Senator level of opposition to date because charge of most of that massive Federal BARRASSO, a physician for 25 years in more and more people are seeing and expenditure every year. Wyoming, brought to our attention learning the truth about what is being Mr. MCCAIN. I thank my friend. Be- some of these things earlier this week proposed in the bill before the Senate. cause the findings as of December 10, when he pointed out what this also Mr. MCCAIN. This is the information 2009, which is entitled ‘‘Estimated Fi- says. on the bill as it is; correct—the origi- nancial Effects of the ‘Patient Protec- Isn’t the point that if we keep cut- nal bill? This is without the expansion tion and Affordable Care Act of 2009,’ ting Medicare, there are not going to of Medicare taken into this study, as Proposed by the Senate Majority be any hospitals and any doctors which already, as the Senator quoted Leader on November 18, 2009,’’ have around to take care of patients who from the New York Times and other some incredibly, almost shocking re- need care? health care experts, is going to in- sults, I say to my friend from Ten- Mr. MCCAIN. May I also ask, in addi- crease costs even more. As you expand nessee. tion to that question, has Dr. Medicare, among other things, you run We know the bill before us does not BARRASSO ever heard of the CMS being the risk of adverse selection, which bring costs under control. But as I unbiased or slanted in one way or an- means the people who are the sickest derstand this—and it is pretty, may I other? Isn’t it one of the most respect- immediately enroll, which then in- say, Talmudic in some ways to under- able and admired objective observers of creases the cost, and then who would stand some of the language that is in the health care situation as far as be paying the increased Medicare pay- this report, but is it not true that the Medicare and Medicaid are concerned? ments? The young and the healthy. I

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00029 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.040 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13000 CONGRESSIONAL RECORD — SENATE December 11, 2009 ask my friend from Wyoming, should There being no objection, the mate- the various tax and fee proposals or the im- we do that to the next generations of rial was ordered to be printed in the pact on income and payroll taxes due to eco- Americans? RECORD, as follows: nomic effects of the legislation. Similarly, Mr. BARRASSO. Well, we should not. the impact on Federal administrative ex- DEPARTMENT OF HEALTH & HUMAN penses is excluded. A summary of the data, We need to be fair. We need to deal SERVICES, CENTERS FOR MEDICARE assumptions, and methodology underlying with this in a realistic way. But the & MEDICAID SERVICES, OFFICE OF our estimates of national health reform pro- bill in front of us now is going to raise THE ACTUARY, posals is available in the appendix to our Oc- taxes $500 billion, it is going to cut Baltimore, MD, December 10, 2009. tober 21 memorandum on H.R. 3200. From: Richard S. Foster, Chief Actuary. Medicare by almost $500 billion for our Subject: Estimated Financial Effects of the SUMMARY seniors who depend upon it, and for ‘‘Patient Protection and Affordable Care The table shown on page 2 presents finan- people who have insurance they like, it Act of 2009,’’ as Proposed by the Senate cial impacts of the selected PPACA provi- is going to increase their premiums. Majority Leader on November 18, 2009. sions on the Federal Budget in fiscal years They are going to end up paying more The Office of the Actuary has prepared this 2010–2019. We have grouped the provisions of than if no bill was passed at all. memorandum in our longstanding capacity the bill into six major categories: That is why, across the board, more as an independent technical advisor to both (i) Coverage proposals, which include both people would rather have this Senate the Administration and the Congress. The the mandated coverage for health insurance do nothing than to pass this bill we are costs, savings, and coverage impacts shown and the expansion of Medicaid eligibility to herein represent our best estimates for the those with incomes at or under 133 percent of looking at today. They understand the Patient Protection and Affordable Care Act. the Federal poverty level (FPL); impact on this Nation and our future is We offer this analysis in the hope that it will (ii) Medicare provisions; devastating. This will cause us to lose be of interest and value to policy makers as (iii) Medicaid and Children’s Health Insur- jobs, with the taxes; it will cause us to they develop and debate national health care ance Program (CHIP) provisions other than lose care in small communities; and for reforms. The statements, estimates, and the coverage expansion; our seniors who depend upon Medicare, other information provided in this memo- (iv) Proposals aimed in part at changing they are going to throw more people randum are those of the Office of the Actu- the trend in health spending growth; ary and do not represent an official position (v) The Community Living Assistance into Medicaid, another program where of the Department of Health & Human Serv- Services and Supports (CLASS) proposal; and half the folks now can’t find a doctor ices or the Administration. who will see them. This memorandum summarizes the Office (vi) Immediate health insurance reforms. All in all, there is nothing I see about of the Actuary’s estimates of the financial The estimated costs and savings shown in this bill or any of the new changes and and coverage effects through fiscal year 2019 the table are based on the effective dates specified in the bill as released. Additionally, certainly nothing in this report that of selected provisions of the proposed ‘‘Pa- tient Protection and Affordable Care Act of we assume that employers and individuals says to the American people: Hey, you 2009’’ (PPACA). The estimates are based on would take roughly 3 to 5 years to fully might want to think about this. The the bill as released by Senate Majority Lead- adapt to the insurance coverage provisions American people have thought about er Harry Reid on November 18 as an amend- and that the enrollment of additional indi- it. This report tells the American peo- ment in the nature of a substitute for H.R. viduals under the Medicaid coverage expan- ple this is not what they want for 3590. Included are the estimated net Federal sion would be completed by the third year health care in this Nation. expenditures in support of expanded health following enactment. Because of these tran- Mr. ALEXANDER. Madam President, insurance coverage, the associated numbers sition effects and the fact that most of the of people by insured status, the changes in coverage provisions would be in effect for I ask unanimous consent to have print- Medicare and Medicaid expenditures and rev- only 6 of the 10 years of the budget period, ed in the RECORD the summary of the enues, and the overall impact on total na- the cost estimates shown in this memo- report of the Centers for Medicare & tional health expenditures. Except where randum do not represent a full 10–year cost Medicaid Services. noted, we have not estimated the impact of for the proposed legislation. ESTIMATED FEDERAL COSTS (+) OR SAVINGS (¥) UNDER SELECTED PROVISIONS OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2009 [In billions]

Fiscal year Provisions Total, 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2010–19

Total 1 ...... $16.1 ¥$1.6 ¥$18.6 ¥$35.2 $22.4 $78.1 $83.0 $76.2 $74.5 $71.0 $365.8 Coverage 2 ...... 93.8 141.1 158.3 165.8 178.6 192.3 929.9 Medicare ...... 11.5 1.3 ¥13.4 ¥24.3 ¥60.5 ¥52.0 ¥66.0 ¥80.9 ¥95.8 ¥113.3 ¥493.4 Medicaid/CHIP ...... ¥0.4 ¥0.1 ¥0.7 ¥5.3 ¥4.9 ¥4.9 ¥4.8 ¥4.9 ¥4.8 ¥4.8 ¥35.6 Cost trends ...... ¥0.0 ¥0.1 ¥0.2 ¥0.4 ¥0.6 ¥0.9 ¥2.3 CLASS program ...... ¥2.8 ¥4.5 ¥5.6 ¥5.9 ¥6.0 ¥4.3 ¥3.4 ¥2.8 ¥2.4 ¥37.8 Immediate reforms ...... 5.0 ...... 5.0 1 Excludes Title IX revenue provisions except for 9015, certain provisions with limited impacts, and Federal administrative costs. 2 Includes expansion of Medicaid eligibility. 3 I Includes estimated non-Medicare Federal savings from provisions for comparative effectiveness research, prevention and wellness, fraud and abuse, and administrative simplification. Excludes impacts of other provisions that would affect cost growth rates, such as the productivity adjustments to Medicare payment rates, which are reflected in the Medicare line.

As indicated in the table above, the provi- resulting in an overall reduction in the Fed- result of the expansion of eligibility to all sions in support of expanding health insur- eral deficit through 2019. legal resident adults under 133 percent of the ance coverage (including the Medicaid eligi- The chart shown on the following page FPL. (In addition, roughly 2 million people bility changes) are estimated to cost $930 bil- summarizes the estimated impacts of the with employer-sponsored health insurance lion through fiscal year 2019. The net savings PPACA on insurance coverage. The man- would enroll in Medicaid for supplemental from the Medicare, Medicaid, growth-trend, dated coverage provisions, which include coverage.) Another 20 million persons (most and CLASS proposals are estimated to total new responsibilities for both individuals and of whom are currently uninsured) would re- about $564 billion, leaving a net cost for this employers, and the creation of the Health ceive individual insurance coverage through period of $366 billion before consideration of Benefit Exchanges (hereafter referred to as the newly created Exchanges, with the ma- the ‘‘Exchanges’’), would lead to shifts jority of these qualifying for Federal pre- additional Federal administrative expenses across coverage types and a substantial over- mium and cost-sharing subsidies, and an es- and the increase in Federal revenues that all reduction in the number of uninsured, as timated 20 percent choosing to participate in would result from the excise tax on high-cost many of these individuals become covered the public insurance plan option. Finally, we employer-sponsored health insurance cov- through their employers, Medicaid, or the estimate that the number of individuals with erage and other revenue provisions. (The ad- Exchanges. employer-sponsored health insurance would ditional Hospital Insurance payroll tax in- By calendar year 2019, the mandates, cou- decrease overall by about 5 million, reflect- come under section 9015 of the PPACA is in- pled with the Medicaid expansion, would re- ing both gains and losses in such coverage cluded in the estimated Medicare savings duce the number of uninsured from 57 mil- under the PPACA. shown here.) The Congressional Budget Of- lion, as projected under current law, to an As described in more detail in a later sec- fice and Joint Committee on Taxation have estimated 24 million under the PPACA. The tion of this memorandum, we estimate that estimated that the total net amount of Medi- additional 33 million people who would be- total national health expenditures under this care savings and additional tax and other come insured by 2019 reflect the net effect of bill would increase by an estimated total of revenues would somewhat more than offset several shifts. First, an estimated 18 million $234 billion (0.7 percent) during calendar the cost of the national coverage provisions, would gain primary Medicaid coverage as a years 2010–2019, principally reflecting the net

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00030 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.043 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13001 impact of (i) greater utilization of health are promoting this bill don’t get that mate impact would be on health care care services by individuals becoming newly message. costs and we felt strongly we needed a covered (or having more complete coverage), Let me quote the chairman of the Fi- second opinion. So we asked that this (ii) lower prices paid to health providers for nance Committee, who today issued bill be submitted to scrutiny by CMS, the subset of those individuals who become covered by Medicaid, and (iii) lower pay- this statement relative to the CMS re- and that is what we are getting today. ments and payment updates for Medicare port the Senator has in his hand. He Twenty-four of us signed onto that. services, together with net Medicaid savings said: Madam President, I ask unanimous from provisions other than the coverage ex- The report shows that health reform will consent to have printed in the RECORD pansion. Although several provisions would ensure both the Federal Government and the the letter to the majority leader, dated help to reduce health care cost growth, their American people spend less on health care November 12, 2009. impact would be more than offset through than if this bill does not pass. There being no objection, the mate- 2019 by the higher health expenditures re- That statement is directly contrary rial was ordered to be printed in the sulting from the coverage expansions. RECORD, as follows: The actual future impacts of the PPACA to the statement in the CMS report on health expenditures, insured status, indi- that Senator ALEXANDER just ref- U.S. SENATE, vidual decisions, and employer behavior are erenced, which says: Washington, DC, November 12, 2009. Hon. HARRY REID, very uncertain. The legislation would result . . . we estimate that total national health Majority Leader, U.S. Senate, Hart Senate Of- in numerous changes in the way that health expenditures under this bill would increase fice Building, Washington, DC. care insurance is provided and paid for in the by an estimated total of $234 billion (0.7 per- DEAR MAJORITY LEADER REID: This health U.S., and the scope and magnitude of these cent) during calendar years 2010–2019. care bill will be the most significant piece of changes are such that few precedents exist Not only that, but the report says legislation that Congress considers this year for use in estimation. Consequently, the esti- that national health expenditures because it would undoubtedly affect every mates presented here are subject to a sub- American. Therefore, it is vitally important stantially greater degree of uncertainty than would increase as a percentage of GDP from $1 of every $7, which is about 16 that we do not make decisions without a is usually the case with more routine health complete and thorough analysis of the bill. care proposals. percent, to $1 out of every $5, which is One of the most important issues facing us The balance of this memorandum discusses 20 percent. as we review this legislation is its effect on these financial and coverage estimates—and What the report concludes is not only overall health care spending. The President their limitations—in greater detail. are our health care costs going to go has repeatedly stated that he believes health EFFECTS OF COVERAGE PROPOSALS ON FEDERAL up, but as the Senator from Arizona reform should control health care costs. EXPENDITURES AND HEALTH INSURANCE COV- said, 20 percent of all Part A pro- Achieving that objective, as you know, ERAGE viders—nursing homes, hospitals, home means more than simply employing draco- Federal expenditure impacts nian cuts in Medicare spending and creating health—would become unprofitable numerous new taxes to minimize the effect The estimated Federal costs of the cov- within the next 10 years as a result of erage provisions in the PPACA are provided of creating a vast new health care entitle- in table 1, attached, for fiscal years 2010 the provision in this bill relating to the ment on the federal deficit. Bending the cost through 2019. We estimate that Federal ex- Medicare cuts the Senator from Ten- curve means curbing the rate of all health penditures would increase by a net total of nessee talked about. spending. Unfortunately, the Congressional Budget $366 billion during this period—a combina- The American people do get it. That Office has been unable to produce an esti- tion of $930 billion in net costs associated is why these poll numbers the Senator mate of the effect of the bills before us on with coverage provisions, $493 billion in net from Wyoming just stated coming out overall medical spending though we note savings for the Medicare provisions, a net of CNN and why the FOX poll I saw that the CMS Actuary has provided such an savings of $36 billion for the Medicaid/CHIP this morning said 57 percent of the peo- assessment of an earlier version of the House provisions (excluding the expansion of eligi- health reform bill (HR 3200). Such an anal- bility), $2 billion in savings from proposals ple in America are opposed to this bill. The American people are getting it ysis would be invaluable to the Senate as we intended to help reduce the rate of growth in consider this important legislation. health spending, $38 billion in net savings but, for some reason, our friends on the Therefore, we request that you submit the from the CLASS proposal, and $5 billion in other side of the aisle are not. legislation to the Office of the Actuary at costs for the immediate insurance reforms. Mr. ALEXANDER. I see the Senator CMS for analysis and make the findings pub- These latter four impact categories are dis- from Nebraska is here, and we had a lic before you bring the bill to the Senate cussed in subsequent sections of this memo- conversation earlier about the attitude floor for consideration. We agree with Presi- randum. of people in Nebraska. It is very helpful dent Obama that health care legislation Of the estimated $930 billion net increase to have independent evaluators who must ‘‘bend the cost curve so that we’re not in Federal expenditures related to the cov- seeing huge health-care inflation over the erage provisions of the PPACA, about two- tell us that if you cut $1 trillion out of long term.’’ Therefore, we would specifically fifths ($364 billion) can be attributed to ex- a program that is going bankrupt and like the Office of the Actuary at CMS to de- panding Medicaid coverage for all adults who then add more people to it, doctors and termine if this legislation will bring down make less than 133 percent of the FPL and hospitals are going to go broke. We health care expenditures over the long term. all uninsured newborns. This cost reflects have heard that before from the Mayo We look forward to your response and the the fact that newly eligible persons would be Clinic, and I think Senator JOHANNS assurance that this secondary analysis will covered with a 100-percent Federal Medical has been hearing that in the State of be completed in order to provide us and the Assistance Percentage (FMAP) for the first 3 American people with the information nec- years and approximately 90 percent there- Nebraska. essary to make a well-informed vote. after; that is, the Federal government would Mr. JOHANNS. I have heard it all Sincerely, bear a significantly greater proportion of the over the State. Today, let me say, the Mike Johanns; Sam Brownback; Pat cost of the newly eligible enrollees than is fog cleared. The fog cleared and the Roberts; Robert F. Bennett; Tom the case for current Medicaid beneficiaries. Sun is shining brightly on this mam- Coburn; Richard Burr; Christopher S. Mr. ALEXANDER. I ask the Senator moth experiment with 16 percent of the Bond; Roger F. Wicker; John Barrasso; from Georgia, while this is a complex economy. This actuary says, very Michael B. Enzi; Jim Bunning; Mike document, in many ways, isn’t it a clearly—and he has no ax to grind with Crapo; Orrin G. Hatch; Lamar Alex- ander; Susan M. Collins; John Thune; matter of common sense that if you anyone—that costs are going to go up George S. LeMieux; Jim DeMint; Mitch take a program that is going broke and under this bill; that care is going to be McConnell; George V. Voinovich; John you take $1 trillion out of it and you jeopardized under this bill; that the Cornyn; James E. Risch; Kay Bailey add millions of people to it, isn’t the very linchpin, the essence of what this Hutchison; Lindsey Graham; Thad end result going to be there is not bill was supposed to be all about, can’t Cochran. going to be anyone left to take care of happen. Mr. JOHANNS. Today, we finally the patients who need help? Isn’t that If I might, I wish to refer to some- have come to grips with the fact that the logical result, just as this report thing which I will ask to be a part of all the promises made are not being says? the RECORD to gain some perspective. fulfilled by this bill; that the $2.5 tril- Mr. CHAMBLISS. Not only does that I wish to applaud my colleagues on lion that will be spent will accomplish report say that, but as you say, com- this side, and here is why. We wrote to nothing; that health care costs would mon sense ought to tell you that. Un- the majority leader back in the first not go down—they will, in fact, go up; fortunately, it is pretty obvious the part of November and we said CBO had and that people will lose their private folks on the other side of the aisle who not been able to tell us what the ulti- insurance.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00031 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.008 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13002 CONGRESSIONAL RECORD — SENATE December 11, 2009 I tell you the most heartbreaking will actually increase health care a physician is reimbursed to the physi- thing for me, and any other Senator costs? cian under Medicare. As a result of who has rural hospitals, which is just Mr. BARRASSO. It does say that. that, the younger physicians, particu- about every Senator, is that 20 percent, The President has said he wanted to larly, who are coming out of med as the Senator from Georgia points bend the cost curve down. This report school with these huge debts they have out, will be underwater. That means says, if we do these things that are in incurred as a result of the long years nursing homes that provide care for the Reid bill, costs of care will actually they are required to be in school, sim- real people, and that means hospitals go up faster than if we did nothing at ply cannot afford to take Medicare pa- that provide services for real people. I all. That means for people who buy tients and they are not taking Medi- tell you, in a State such as Nebraska, their own insurance, the cost of their care patients. Is that in fact what is when hospital care disappears in a premiums will go up faster than if this happening in the real world? And will small town, that may mean hospital Senate passed nothing at all. that not get worse under this proposal? care disappears for hundreds of miles. Mr. ALEXANDER. So if I am under- Mr. BARRASSO. It is happening. It Mr. ALEXANDER. If I could ask the standing it, we are going to cut $1 tril- will get worse under the proposal that Senator from Nebraska this question. lion, when fully implemented, out of is ahead of us. That 90-percent figure is Did a rural hospital in Nebraska or Wy- Medicare; we are going to add $1 tril- actually a high number. I know a num- oming or some State not—did I notice lion in taxes, when fully implemented; ber of physicians and hospitals, espe- in a letter from the Mayo Clinic this we are going to run up the debt, we be- cially in rural communities, that get week, they said cuts such as this or an lieve on this side; we are going to in- reimbursed less than that. The ambu- expansion of Medicare under these cir- crease premiums and costs are still lance services do not even get reim- cumstances would cause them to—well, going up? bursed enough from Medicare—these are volunteer ambulance services—to to drop Medicare, period; they lost $840 Mr. BARRASSO. For people all fill the ambulance with the gas for tak- million this year, and they are begin- across the country, costs are still going ing somebody the long distances from ning to say to some citizens from Ne- to go up. The cost of doing business where they may have fallen and hurt braska, Montana, other areas: We can’t will go up. For families who buy their own insurance, the cost of their pre- themselves, broken a hip, to get them take you if you are a Medicare patient miums will go up. For people who are all the way to the hospital. This is or if you are a Medicaid patient. on Medicare, they are going to see tre- across the board bad for America. Mr. JOHANNS. They are saying that, We say we want patients to be able to and that is what is happening because mendous cuts into that program, and they depend on that for their health get care. If you throw a whole bunch they are losing money. They are defi- more people on to this boat that is al- nitely losing money on Medicaid and care. So costs are going up for people who pay for their own and for busi- ready sinking, which is what the they are losing money on Medicare. Democratic leader is now trying to do, So what the Reid bill does is it says: nesses that try to build jobs. We know small business in this coun- it is going to make it that much harder Mr. ALEXANDER, you sell whatever— try is the engine that drives the econ- for our hospitals to stay open, espe- cars. Let’s use that as the analogy— omy, and according to the National cially in these communities where and I know you are losing $100 on every Federation of Independent Businesses, there is only one hospital providing car. But let’s just give you twice as 70 percent of all new jobs come from care—much more difficult. But with many to sell. Well, you are going to small businesses. They are going to be any young physician coming out with a lose twice as much money. That is penalized to the point they are not lot of debt, trying to hire the nurse and their solution to the health care crisis going to be able to add those new jobs. pay the rent and the electricity and in this country. The NFIB says we will lose across the the liability insurance and all of that, But what this actuary points out, country 1.6 million jobs over the next 4 these do not even cover the expenses. what the Mayo Clinic points out, and years as the government keeps col- That means they have to charge more what so many analysts now have point- lecting the taxes but doesn’t even give to the person who does have insurance, ed out is that this bill is going to put any of these health care services be- the cost shifting that occurs. hospitals under and it is going to put cause those have all been delayed for 4 As a result, for people who have in- nursing homes under. years. surance, they are going to see their Here is another point that gets lost Mr. ALEXANDER. We have about 6 rates going up. For people who rely on in this complex debate. That nursing minutes remaining in our time. I won- Medicare, it is going to be harder to home or that hospital may be the only der if the Senator from Georgia, having find a doctor. For those who are put major employer in that community. heard the comments, has any addi- onto Medicaid, with the aid for those When you lose that, you not only lose tional recommendations on the chief who need additional help, which the your medical care, but you lose those actuary’s report. Senate majority leader is trying to put jobs. I have said on the floor before Mr. CHAMBLISS. I wish to ask a more people into that area, it is going that this bill is a job killer. It is a job question or two of the Senator from to be harder for them to find care. killer. There is no way of getting Wyoming, who is a medical doctor and Across the board, there is nothing around it. Those jobs will disappear in who, prior to coming to the Senate, good with this proposal. What we have that small town, that rural area, and was an active orthopedic surgeon. seen today documented from the folks even in the big cities. I have had physicians come into my who are objective and look at the I hope our friends on the other side office by the droves and talk to me whole picture, they think it is actually study this very carefully. This is a about Medicare before we ever got into as bad—they admit it is as bad as we roundhouse blow to the Reid plan—to this health care debate, and what I have been saying it is. They say you the Reid-Obama plan. This, in my judg- heard was in reference to the reim- guys have been right, what you are ment, proves, beyond a shadow of a bursement rate under Medicare to phy- saying about the cost of care, the im- doubt, that this is going to crush sicians and to hospitals being so low. pact on health care. And their phrase- health care in our country. In fact, the American Hospital Asso- ology is such that I think they abso- Mr. ALEXANDER. I would ask the ciation has come out just in the last 24 lutely pinpoint all of the reasons that Senators from Wyoming and Georgia, hours and pointed out that hospitals the American people, now by a number who are here, to go back to the begin- across the Nation get a return of about of 61 percent, oppose this bill we are ning. When we began this debate, the 91 cents for every dollar of care pro- taking a look at. That is why the Mayo President, in his summit at the begin- vided. That is not 91 cents of the Clinic has said, in the letter from their ning of the year, very correctly—and I amount of charges from the hospital to executive director of their Health Pol- applauded him for that—all of us said Medicare, it is 91 cents of the cost of icy Center, ‘‘Expanding this system to we have to reduce health care costs— the care provided. So the return is persons 55 to 64 years old will ulti- costs to us, costs to small businesses, about 10 percent less to a hospital than mately hurt patients by accelerating and costs to our government. But the cost that the hospital has in it. the financial ruin of hospitals and doc- doesn’t this report of the chief actuary My understanding is that at least 10 tors across the country.’’ That is what of the government say the Reid bill percent less than the cost provided for we are looking at.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00032 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.045 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13003 Mr. ALEXANDER. Madam President, board of a local hospital in a rural going to be the IRS that is going to en- how much time remains? area, and you hear the word CMS, it is force this as well as CMS, which has The PRESIDING OFFICER. There re- probably not viewed in the best of con- been doing most of the enforcing. mains 11⁄2 minutes. siderations, that CMS is in charge of In Kansas, the Kansas Medical Soci- Mr. ALEXANDER. Madam President, enforcing what H2S comes down with. ety said: No, no, we are not going to go if I could conclude our time, with the So in terms of reimbursement, in terms along with this bill. I am talking about permission of the Senator from Georgia of all things—competitive bidding—and the bill we have been talking about for and Wyoming, instead of racing down I am talking about doctors, hospitals, some time. The Kansas Hospital Asso- this train track with yellow flags and nursing homes, home health care, hos- ciation was adamant. They said no. Ob- red flags flying everywhere, people pice, all of this—when they hear the viously that was because of advice they often ask us: What would you do? What word CMS a cold chill goes down the got from 128 hospitals in my State, we would do is what we think most back of their neck, more or less like saying: No, we cannot reconcile with Americans would do when faced with a expecting Lizzy Borden to come in the this because of cost, because of the ra- big problem, not try to solve it all at front door. tioning. We are only being reimbursed once but to say, What is our goal? Our So I am especially glad that the actu- at 70 percent or less, as we talk about goal is reducing cost. What are the ary, Mr. Richard Foster, the Chief Ac- it—and the doctors about 80 percent. first four or five steps we can take to tuary from CMS, has shined the light Many doctors do not serve Medicare reduce costs? Can we an agree on of truth into darkness. He has taken now in Kansas. Let me rephrase that. those? We think we can. Let’s start the original bill we have been talking Some doctors don’t serve Medicare in taking them. For example, small busi- about for some time, as my colleague Kansas. If this bill passes, a lot of doc- ness health plans to allow small busi- has pointed out, and said basically this tors simply will not serve Medicare. nesses to offer insurance to their em- bill is going to increase costs and is You can have the best plan or the best ployees at a lower rate. That legisla- going to result in rationing. It does not card in the world, it is not going to tion is prepared and before the Senate. take into consideration the latest make any difference if you can’t see a Reducing junk lawsuits against doc- iteration that we hear from the press doctor. It is not worth a dime. tors. That reduces costs. and media about including people 55 to Then I have to say the Kansas Nurs- Allow competition across State lines 65 into Medicare. It is going to be in- ing Home Association and Kansas for insurance policies. That reduces teresting, if we have enough time—al- Home Health Care folks and the Kansas costs. though I know that the distinguished Hospice folks all said: No, this is not Going step by step to re-earn the majority leader has asked for a CBO where we want to go. This is self-de- trust of the American people to reduce score—but I would sure like to know feating. This is not going to do what health care costs is the way to go, in- what Mr. FOSTER would think of that the sponsors of the bill and what every- stead of making what this new report idea. I think it would be far worse. body for health care reform hoped they from the Center for Medicare and Med- I encourage all of my colleagues who would actually see happen. icaid Services helps to show again belong to the Rural Health Care Cau- I don’t know what the word is, I am— would be a historic mistake. cus to take a very hard look at this. not overwhelmed, I am extremely glad; I yield the floor. This confirms what we have been say- I am somewhat surprised but I am ex- Mr. ROBERTS. Will the Senator ing for some time. These are not scare tremely glad that CMS again shined yield for an observation? tactics, these are actual facts. the light of truth into darkness. I com- Mr. ALEXANDER. Certainly. Let me say, too, I know when this de- mend Mr. FOSTER, the chief actuary. I Mr. ROBERTS. I thank the Senator bate first started some of the national recommend this as required reading for for yielding. organizations that represent doctors everybody who was going to vote for The PRESIDING OFFICER. The time and hospitals, perhaps nursing homes— this bill and certainly with the latest of the Senator has expired. The Sen- certainly not any home health care— iteration, where we are adding any- ator from Kansas. well, I take that back. There was a let- where from 10 to 20 to 30 million people Mr. ROBERTS. Madam President, I ter written by the home health care to Medicare, which will make the situ- will be very brief. I thank the Senator folks at one time, but certainly not ation much worse in regard to Medi- from Tennessee, not only for his state- hospices—indicating that they were care being actuarially sound and costs ment but for his constant efforts. Facts lukewarm, warm to the bill, or would going up, premiums going up, and also are stubborn things. Yet he has pointed perhaps support it. I think the message rationing, the dreaded rationing. It is out basically what this report now con- was pretty clear—come to the break- not a scare tactic but actually a fact. firms. During the last few months we fast or you won’t come to lunch. That I yield my time. have seen some commentary that says was pretty bare knuckles but they The PRESIDING OFFICER. The Sen- ‘‘scare tactics,’’ of all things. I happen hoped that at least by insuring those ator from Washington. to have the privilege of being the who have insurance, that would make Ms. CANTWELL. Madam President, I chairman of the Rural Health Care their situation better. have been on the floor now for about an Caucus. I was in the House of Rep- Then, of course, came the latest hour listening to my colleagues on the resentatives when I had the privilege of iteration to this bill of putting in peo- health care debate. Certainly I want to serving there and I am a cochairman ple 55 to 65, and the national associa- express the opinion from many people with Senator TOM HARKIN of Iowa. tion, in regard to our doctors and our in the Northwest. We know that doing There are about 30 of us who, from hospitals, said: Whoa. nothing about health care certainly time to time, will correspond and meet Let me point out in Kansas and in will guarantee that premiums will go and send messages back and forth to many States throughout the country up. We know it happened in the last 10 try to keep the rural health care deliv- there never was the support. They years; they have gone up 100 percent. ery system viable. knew exactly what would happen if we We know that doing nothing now We have been worried for some time passed this bill and CMS would come means they will go up 8 to 10 percent a in regard to what is going to happen to knocking on their door. I might add it year. We also know there is about $700 Medicare, what is going to happen in wouldn’t be CMS that would actually billion in waste in the system. regard to cost, what is going to happen do that, it would be the Internal Rev- This is about what we can do to re- in regard to rationing. Every hospital enue Service under this bill, and that form the system so we can stop the director, every hospital board in rural was one consideration where I made rise, the increase we are seeing in our America has worried about these about a 15-minute speech and obviously premiums. There are many things in things—more especially about CMS, not too many people paid attention. this legislation, changing fee-for-serv- which has been described here in detail. But all patients, all doctors, all nurses, ice systems so we are driving down the That is the Centers for Medicare and all clinical lab folks, anybody con- quantity of health care that is deliv- Medicaid Services. nected with the home health care in- ered instead of making sure that it is I have to tell you, if you are a hos- dustry or hospice or nursing homes or quality; making sure we make reforms pital administrator or if you are on the whatever, should have known it is in long-term care; making sure we give

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00033 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.046 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13004 CONGRESSIONAL RECORD — SENATE December 11, 2009 the power to States to negotiate and fore we moved off the health care legis- First of all, if the Senate is going to drive down the costs. I know my col- lation. It was a motion I raised to ob- reject a procedural maneuver, that re- league Senator COLLINS was on the ject to the tax increases on the middle fers to what is happening on the Senate floor with some of my other colleagues, class in America that are contained in floor, procedural efforts. It does not the Senators from Oregon and Indiana, the bill. refer to any substantive measure in the to discuss their ideas about how we im- The motion I have is very simple. It bill. The amendment we had pending— prove cost containment. focuses on the President’s pledge. The which this is going to be a counterpart I hope my colleagues in the next days President pledged that ‘‘no family to—specifically refers to the substance will join us in the discussion about how making less than $250,000 will see their of the bill and says the substance of we continually improve the bill to taxes increase—not your income taxes, the bill should be changed to take out drive down costs, because doing noth- not your payroll taxes, not your cap- the taxes, the hundreds of billions of ing will not get us to that point. ital gains taxes, not any of your dollars of taxes. (The remarks of Ms. CANTWELL and taxes.’’ The President pledged: You will I wonder, before we go to the next Ms. COLLINS pertaining to introduction not see any of your taxes increase one phrase, does my colleague from Wyo- of S. 2827 are located in today’s RECORD single dime. ming care to comment? under ‘‘Statements on Introduced Bills So the motion I brought was very Mr. BARRASSO. Well, I do care to and Joint Resolutions.’’) simple. It was simply to commit the comment. I care to comment that the Ms. COLLINS. Madam President, I bill to the Finance Committee to have important thing is to get the taxes out suggest the absence of a quorum. the Finance Committee go through the of the bill—not what a sense of the The PRESIDING OFFICER. The 2,074-page bill and remove from the bill Senate is, not some procedural maneu- clerk will call the roll. the taxes that are in it that apply to ver. It is the specifics of removing the The assistant legislative clerk pro- the middle class in the United States, taxes from the bill. as defined by the President here: being When the President says, ‘‘My plan ceeded to call the roll. won’t raise your taxes one penny,’’ Mr. CRAPO. Madam President, I ask those who, as a couple, are making less than $250,000 a year, or those, as an in- which was his quote, we need to be able unanimous consent that the order for dividual, who are making less than to make sure the President is telling us the quorum call be rescinded. $200,000 a year. the truth, that we need to remove The PRESIDING OFFICER. Without What we have seen is that not only these taxes from the bill. objection, it is so ordered. has there been delay on reaching that The Joint Committee on Taxation Mr. CRAPO. Madam President, I ask goal but a counterproposal to the looked at this bill—specifically looked unanimous consent to be able to enter amendment has been brought up by the at this bill—and it said that 38 percent into a colloquy with my Republican chairman of the Finance Committee, of the people earning less than $200,000 colleagues for up to 30 minutes, and Senator BAUCUS. His counteramend- a year will see a tax increase—a tax in- that following those remarks, the Re- ment says: crease under the Reid bill. publican leader be recognized, and that It is the sense of the Senate that the Sen- So we want to make sure the Presi- following his remarks Senator DURBIN ate should reject any procedural maneuver dent’s words go with what is in the bill. be recognized to speak. that would raise taxes on middle class fami- So we need to actually remove the The PRESIDING OFFICER. Without lies, such as a motion to commit the pending taxes—not just have a sense of the Sen- objection, it is so ordered. legislation to the Committee on Finance, ate. Mr. CRAPO. Thank you, Madam which is designed to kill legislation that pro- Then, when we look at the chief of President. vides tax cuts for American workers and staff of the Joint Committee on Tax- Madam President, I would like to families, including the affordability tax ation, he was asked a question at the speak on health care. The pending busi- credit and the small business tax credit. Finance Committee, and he said, when ness before the Senate right now is ac- A number of us are here today to it all ‘‘shakes out,’’ we would expect tually the Omnibus appropriations bill, talk about the fact that this sense of people who are going to be paying which the Senate moved to yesterday, the Senate is designed to provide cover taxes are going to have incomes ‘‘less after having started the debate on the for those who do not want to vote to than’’ the number the President said. health care legislation. protect American taxpayers. It is a So I want to get to the point of the My motion is the pending business on meaningless sense of the Senate. We Crapo amendment, the amendment the health care legislation, and so it is are going to go through the sense of that actually says: Get these taxes out that motion I would like to talk about. the Senate phrase by phrase. of the bill. This is a bill that is going Before I do so, I would like to again I would like to ask my colleague to raise taxes by $500 billion, and those from the State of Wyoming if he would raise objection and concern to the fact are taxes that are going to impact all like to step in on the first phrase and that we have moved off the health care Americans. comment. The first phrase says what legislation debate to the Omnibus ap- At a time when we have 10-percent the amendment is: ‘‘It is the sense of propriations bill, both because I believe unemployment, when the Senate is the Senate . . .’’ Would my friend from we should stay on the health care issue being asked to increase the debt level Wyoming like to comment on what and work it through, but also because by another almost $2 trillion, the last that means? thing we need to be spending our time we moved to an Omnibus appropria- Mr. BARRASSO. I would be happy to. tions bill that we have not had an op- on is a sense of the Senate. We need to OK, so we agree, it is the sense of the actually get to those taxes that are portunity to review carefully and that Senate. It is meaningless in terms of going to affect the people, the hard- raises the spending—I believe for these actually having the force of law. The working people of America get those seven appropriations bills that have Senator talked about the issues of the taxes out of the bill. been compiled together, the spending is spending and the taxes, so we came up So as we are looking at that Baucus raised by an average of about 12 per- with a sense of the Senate. amendment; it is very nice, but it recent. This is why we are asking people all minds me of the Bennet amendment we Once again, Congress is in a spending across the country to read the bill. The had here last week, and I think every- free fall, and whether it be the stim- sense of the Senate essentially means body voted for it. The New York Times, ulus package or the appropriations for nothing. It says we kind of agree on in their editorial, said it was a mean- our ordinary operations of government this, but there is no law applied. ingless amendment. I want an amend- or whether it be the bailouts or the tre- Mr. CRAPO. Exactly. It is very crit- ment with some teeth in it that I can mendous other aspects of spending ical to point out, a sense of the Senate vote for, and I am ready to vote right pressures and proposals, including the has no binding impact. It is just sort of now. health care legislation we have, there what we think. Mr. CRAPO. I thank my colleague seems to be no restraint in Washington Let’s go to the next phrase in the from Wyoming. with regard to spending the taxpayers’ amendment: ‘‘that the Senate should The next phrase in the amendment— dollars. reject any procedural maneuver that referring to a procedural motion—says But let’s talk for a minute about the . . . ’’ in other words, the Senate that ‘‘would raise taxes on middle class motion that was before the Senate be- should reject a procedural maneuver. families.’’

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00034 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.047 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13005 There is nobody bringing a motion to Mr. ROBERTS. That phrase that the think our friends on the other side raise taxes. My amendment says it is Senator just mentioned is, ‘‘which is would dispute that notion. Indeed, the referring the bill to the Finance Com- designed to kill legislation.’’ My ques- Democratic Party assumed control of mittee to take out the taxes on those tion has already been answered by the the White House almost a year ago, as who earn less than $200,000 or $250,000. distinguished Senator, what does it everybody knows, and seated large ma- I note that my colleague from Kansas mean, but there are no motions that jorities here in the Congress. The one has arrived. have been considered or pending, in- unmistakable distinction between the Would the Senator care to jump in at cluding the pending motion to commit parties is this: Our party has respect- this point? by the distinguished Senator—is the fully opposed—I underline the word re- Mr. ROBERTS. I will tread with motion designed to kill this spectfully—opposed numerous efforts great care, I would say to my distin- legislation? Because that is what you by the majority party to impose broad- guished friend. are going to hear on the other side, and based taxes increases on American I thank the Senator for this colloquy. that is not the case. workers and families. So one only need But you asked what it means that ‘‘the Mr. BARRASSO. Madam President, to look at the stimulus debate or the Senate should reject any procedural it seems to me that what the Senator budget debate or the cap-and-trade leg- maneuver that’’—that is in quotes— is doing with the Crapo amendment is islation, and I could go on and on and and what does that really mean? actually trying to help people, trying on, more especially with the health Well, it applies only to the Senate to help the American people by taking care debate, and the bill before us. procedural motions. By itself it would this burden of $500 billion of taxes off Don’t you follow from that general have no effect on any substantive pro- of their backs, off of their shoulders, principle? vision. That is the way it is commonly helping the American people. That is Mr. CRAPO. Absolutely. Again, I be- understood under Senate rules. It what I see he is trying to accomplish, lieve what is going on here with this means, if adopted, the amendment at a time where with a gimmick they new amendment is simply an effort to would not remove any provision that are going to start taxing immediately sort of divert attention from the real has been identified as a tax increase on and when the taxes go into play—today issue that is before the American peo- middle-class taxpayers, which is pre- is the 11th of December; in 20 days they ple, the motion that was before the cisely what the Senator is trying to do. are going to start collecting taxes for Senate, before we were forced by a pro- So basically it means nothing. services they are not going to give for cedural vote yesterday to move off the Mr. CRAPO. I think that is exactly 4 more years. So it seems to me what bill, and that is the question of the the point we are trying to point out. is going on here with the Crapo amend- taxes in the bill. The next phrase in the amendment ment is it is saving the American peo- The final phrase refers to a couple of says, ‘‘such as a motion to commit the ple by keeping dollars in their pockets, the provisions in the bill that do have pending legislation to the Committee keeping dollars in the pockets of the some support for improving the tax cir- on Finance.’’ Remember, that is refer- hard-working people of our country. cumstances for small businesses and ring to the previous phrase that refers I am not the only one who is saying the affordability tax credit, meaning to a motion to increase taxes. that. There is a new CNN poll out the tax credit that will be utilized to The only thing we need to say about today that specifically asks the ques- implement the subsidies for insurance. this phrase is, there is a motion to tion—because the President has made a Again, we can say it any number of commit the bill to the Finance Com- statement about the fact that you times, but the fact is the motion they mittee, but there is not a motion to wouldn’t see your taxes go up—Do you are trying to avoid does not deal with commit the bill to the Finance Com- think your taxes would or would not either of these provisions of the bill; it mittee to raise taxes. It is to cut taxes. increase if HARRY REID’s bill is passed, deals with those provisions in the bill The next phrase in the amendment is and 85 percent of the American people that tax the American people. to suggest that there is an effort to try in a CNN poll out today said they be- Mr. BARRASSO. I am fine with vot- to kill the legislation. lieve their taxes are going to go up; 85 ing on this, but it doesn’t mean any- Now, this is my motion. I suppose the percent of the American people. thing. I think it is absolutely meaning- implication there is, by trying to take Mr. CRAPO. I would say to my col- less, the Baucus amendment. I want to the taxes out of the bill, we are trying league from Wyoming that they are get to the heart of the matter, the to kill the legislation. What does that right, if this bill is not committed back meat of the matter, which is the Crapo mean? Well, that means if you take the to the Finance Committee to take amendment. That is the one I think taxes out of this bill, that the bill does those taxes out. makes the difference for the American not stand. I assume that is what the The next phrase in the amendment people. If I were a citizen sitting at amendment is trying to say. The rea- is—this is referring to a procedural mo- home watching C–SPAN on a Friday son that it does not stand is because tion, we call it—‘‘that provides tax afternoon saying, what is going on in they are saying the bill does not in- cuts for American workers and fami- the Senate, what do I want, what is crease the deficit. Well, the only way lies.’’ going to help me, I would say I want to you can say that the bill does not in- In other words, they don’t want to call my Senator and say: Vote for the crease the deficit is if you do not bring send it back to committee to have a Crapo motion because that is the one into consideration the nearly $500 bil- procedural motion put into place that that is actually going to help keep lion of cuts in Medicare, the nearly $500 would stop them from providing tax money in my pocket. The sense of the billion of taxes which are being put on cuts for American families. Senate? Oh, that is nice, but it is the people of this country, and the ad- Again, it is rhetoric. Read the mo- meaningless. ditional budget gimmicks that do not tion. The motion does not say to take I am ready to vote right now for the start counting the spending for 4 years, out any benefits in the bill for anybody Crapo motion because that is the one I plus a number of other budget gim- in America, unless you consider taxing think is going to help possibly save my micks. people to be a benefit to them, but it job if I am at home and working. I am So what they are saying is, you can- simply says the taxes in the bill that worried about unemployment in the not take out one of the key legs of this are imposed on people that the Presi- country, I am worried about the taxes bill, which is the way we raise all the dent identified to be in the middle and the impact that is going to have. money for this massive new spending, class and would be protected must be Because I worry if we don’t get these or else it will kill the bill. I think it is removed from the bill. taxes out of here, it is going to be a job a pretty interesting fact that they Mr. ROBERTS. Would the distin- killer for our Nation and for families have actually admitted in their own guished Senator yield for a question? all across this country, in Idaho, in amendment what kind of games are Mr. CRAPO. Yes. Wyoming, in Kansas, in Kentucky. I being played. Mr. ROBERTS. As Republicans, there think we have great concerns for the Mr. ROBERTS. Will the Senator is probably no principle that unifies us economy and the 10-percent unemploy- yield for a question? more than keeping taxes low on Amer- ment. We need to get those taxes out of Mr. CRAPO. Yes. ican workers and families, and I don’t there now.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00035 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.049 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13006 CONGRESSIONAL RECORD — SENATE December 11, 2009 Mr. CRAPO. The Senator is, in fact, believe, and have been working on this proved; the week before Gallup said 9 right. If you go back and try to get a health care bill for a long time. It is percent more disapproved than ap- little perspective on the entire debate, typical of a big, complex bill such as proved. We can see what is happening most Americans would agree that we this that it is difficult to pass, and you here: widening public opposition. need health care reform, but when they get a sense every now and then of And then CMS, the actuary, the inde- say that, they are talking about the whether it is likely to pass or unlikely pendent government employee who is need to control the skyrocketing costs to pass. This week has been a particu- an expert on this, says this bill, the of their health insurance and the costs larly difficult week for the bill. I have Reid bill, doesn’t do any of the things of medical care, and they are talking noticed the majority leader trying to it is being promoted to accomplish. So about making sure we have real, mean- create a sense of inevitability about two important messages on December ingful access to quality health care in the bill. 11 delivered from CNN and from CMS. America. But, increasingly, it seems to me, Mr. ROBERTS. Would the Senator In his statements, the President has with it becoming clear that with so yield? many times commented about different much of it being paid for by new taxes, Mr. CRAPO. Yes. Mr. ROBERTS. I wish to thank our parts of that. We remember when he and then last night the chief actuary of distinguished leader for pointing that said, If you like what you have, you the Centers for Medicare and Medicaid out. It has been a seminal event. As I can keep it. Well, we have seen that is Services saying the cost is going up, said before, I have the privilege of not true, and there will be and have premiums are going up; with the Mayo being chairman of the Rural Health Clinic saying it is beginning to not been already amendments to try to ad- Care Caucus. There are probably 30 of take Medicare patients, and the idea of dress those questions. us in a bipartisan caucus to try to pro- Remember when he said it is going to putting millions more Americans into tect and improve the rural health care drive down the cost of health care and a program already going broke which delivery system. I took that report by drive down your health care premiums? you are taking $1 trillion out of is a Mr. Foster, who is the actuary of CMS, Well, we have learned now that it bad idea; I wonder if in all—and all this and said, this is required reading. I doesn’t do that either; it actually talk about history being made and the made the point that if you mention inevitability of this bill, that the Sen- drives up the cost of health care insur- CMS to a beleaguered hospital admin- ator from Idaho might not think, look- ance and it is going to drive up the cost istrator or a member of the board or of medical care in this country. ing back over this whole debate, that any medical provider—doctor, nursing Remember when he said you will not maybe there are a lot of different ways home, home health care, hospice; even see your taxes go up? In fact, he to make it—that maybe a growing hospice is cut in regard to the cuts— pledged that if you were a member of number of Senators might be think- they know if a CMS representative is the middle class, whom he defined as ing—not saying yet—might be thinking knocking on the door, that is a lot like those making less than $250,000 as a that this bill would be an historic mis- sending a cold shiver down their spine couple or $200,000 as an individual, you take and that all the king’s horses and thinking it is Lizzie Borden. Of all of would not see your taxes go up. Well, all the king’s men are not going to be the agencies that now are shining the this motion is focused on that part of able to push this up over the top. light of truth into darkness in regard the debate. What did we see happen? Mr. CRAPO. The Senator from Ten- to the nature of this bill in increased Instead of letting us fix the bill, send nessee is right, and he has put his fin- costs, and yes, rationing—no, it is not the bill back to the Finance Com- ger on one of the key issues that is a scare tactic—CMS is that agency. It mittee to make the bill comply with going on here in the Senate that some- would be amazing if we could get CMS the President’s pledge, we saw two pro- times isn’t highlighted as closely as I to report back on, if we knew what it cedural maneuvers, one to maneuver think maybe it should be. That is, was—the media reports are how we get off the bill, to get off the bill and move while we are talking about the need to the information on this new iteration to the omnibus appropriations bill; sec- make sure this bill does not raise taxes of a bill where allegedly we are going ondly, to put up a bait-and-switch on the middle class, to make sure that to add in people from 55 years old into amendment that makes it look as the bill does not increase the cost of the Medicare system. You do that, and though there is some kind of protec- health insurance premiums, and to now all of a sudden even the national tion being put in place when, in re- make sure that we maintain quality of organizations, let alone the State pro- ality, it is nothing more than a sense health care and don’t cut Medicaid and vider associations who have been op- of the Senate relating to procedural Medicare, the real battle here is an ef- posed to this, to say, Whoa, we can’t do motions that don’t exist. I agree with fort to create a legacy to essentially that. That is going to break the sys- my colleague from Wyoming and with put the government in control of the tem. my colleague from Kansas. health care economy. That is the de- What I wish to point out and what I I see we have several of our other col- bate. That is the legacy. That is the think is another piece of information leagues joining us here now. We need to history that those who are pushing the that has sort of been overlooked, the keep the focus on health care and we bill are seeking to make, and they are CBO has estimated the cost to the In- need to keep the focus on those core seeking to make it at the expense of ternal Revenue Service to implement parts of the bill that are critical to the those on Medicare, of those of the tax- taxes and penalties and enforce them— American people. payers in America; and of the costs, I am talking about the IRS now, not Before I ask my colleague from Kan- the cost curve that they said they want CMS, but the IRS that is going to im- sas if he wishes to make any other to drive down, dealing with the cost of plement and administer and enforce comments, I will reiterate the point our health care. taxes and penalties on the bill—that that my colleague from Wyoming made I see our leader is here. cost is $10 billion estimated by CBO. with regard to the American people’s Mr. MCCONNELL. I say to my friends That would double the budget size of understanding of this issue. In that from Tennessee and Idaho, December the IRS. We have to train these people, CNN poll that I believe showed over 60 11, 2009 may be remembered as the sem- and then you have to figure out what percent—I think it was 61 percent—of inal moment in the health care debate kind of questions they are going to ask the people in this country who do not for those who are writing about what of employers and employees in regard want this bill to move forward because finally happened on this issue. There to the fines and the fees, you have to they are now understanding what it were two extraordinary messages deliv- read the fine print. The American peo- does, in that same poll, 85 percent of ered on this very day on this health ple understand this tremendous tax in- the people in this country believe that care issue. They were delivered from crease is going to be administered by this pledge of the President is broken CMS and from CNN. CNN told us how the IRS and that is not going to be a by this bill. the American people felt about it: 61 happy circumstance. But those two Mr. ALEXANDER. I wonder if I percent, as the Senator from Idaho things that the leader has brought out might ask the Senator from Idaho and pointed out, telling us please don’t pass are absolutely primary in this debate. the Senator from Kansas, both the Sen- this bill. A week ago, Quinnipiac said I think a side-by-side is a straw man. ators are on the Finance Committee, I 14 percent more disapproved than ap- I think it is very clear about that. I am

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00036 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.050 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13007 happy to comment on that further. I budget gimmicks of delaying imple- The PRESIDING OFFICER. Under wish to give others an opportunity to mentation of the bill for 4 years on the the previous order, the Republican speak. spending side, while raising taxes now, leader is recognized. Mr. ALEXANDER. If I can make a or if they raise hundreds of billions in Mr. MCCONNELL. Mr. President, this short comment, I thank the Senator taxes and cut Medicare by hundreds of follows along further with my col- from Idaho for his leadership on taxes. billions of dollars. leagues who were discussing the CMS But Senator MCCONNELL’s comment These things are starting to be un- report. about those two events on December derstood by the American people. That Americans, of course, were told the 9—the poll from CNN and the report is why I believe we are starting to see purpose of reform was to lower costs, from the Centers for Medicare and those kinds of answers in the polls. It to bend the so-called cost curve down. Medicaid Services chief actuary—made is not just the CNN poll, as the leader But the report released last night by me think about the immigration bill 2 knows. Many polls are showing the the administration’s own independent years ago, in 2007. There were a lot of American people get it. scorekeeper, as we have been dis- our best Senators working to pass com- Mr. ROBERTS. Will the Senator cussing on the floor of the Senate, prehensive immigration bill, including yield for another question? shows the Reid bill gets a failing grade. Senators MCCAIN, KENNEDY, KYL, MAR- Mr. CRAPO. Yes. The chief actuary is the person the TINEZ, Members on both sides of the Mr. ROBERTS. I would like to get administration depends on to give its aisle, who worked very hard to do it. back to the side-by-side amendment al- straightforward, unbiased analysis of There seemed to be a sense of inevi- legedly being offered by the chairman the impact the legislation would have. tability that that bill might pass. The of the Finance Committee, the Senator This is an independent expert. It is the President was even behind it. from Montana. I said straw man, and official referee, if you will. So this is But then it began to have so many that is pretty harsh, but I intend it to quite significant. problems, and the red flags began to be. We have seen how, if the language According to CMS, the Reid bill in- pop up just like they are popping up is examined, the amendment, at a min- creases national health spending. Ac- with this comprehensive health care imum, is a red herring. You can fairly cording to CMS, there are new fees for bill. There came a time, perhaps much say the amendment, rather, has no drugs, devices and insurance plans in like December 10, when the sense of in- other purpose than to facilitate a the Reid bill and they will increase evitability was replaced by a sense that strong argument. prices and health insurance premiums we were making a historic mistake, On Tuesday, when Senator CRAPO for consumers. and a bill that got on the floor with 64 laid down his amendment, the majority According to CMS, claims about the votes only had 46 to get off. didn’t show us this side-by-side amend- Reid bill extending the solvency of I have a feeling this bill, the more we ment until shortly before we thought— Medicare are based on the shakiest of learn about it, the wiser thing to do is and they thought—we were going to assumptions. to let it fall of its own weight. Then we vote. So that very limited notice According to CMS, the Reid bill cre- can start over, step by step, to reearn makes you think it may be more likely ates a new long-term insurance pro- the trust of the American people by re- to distract from or muddy the clear gram, commonly referred to around ducing health care costs. We can do question the Senator from Idaho here as the CLASS Act, that CMS actu- that. That is the sense I have. brought; that is, the motion to commit aries found faces a ‘‘very serious risk of I appreciate the Republican leader’s before the Senate. The motion was de- becoming unsustainable.’’ observation about those important signed to be to be straightforward, and The CMS found that such programs events on the 9th. the Senator did that. face a significant risk of failure. Mr. CRAPO. Mr. President, I agree A vote for the motion is a vote to The Reid bill pays for a $1 trillion with my colleagues. I think the com- send the Reid amendment and under- government expansion into health ment of our leader is very insightful. lying bill back to the Finance Com- care, with nearly $1 trillion in Medi- As you start seeing the evidence mittee. Under the motion, the Finance care payment cuts. mount, and the fact that the American Committee would report back a bill All of this, I continue to be quoting public is understanding the weight of that eliminates the tax increases on from the CMS report. this mounting evidence about this leg- middle-income taxpayers. One could The report further says the Reid bill islation, we could be at the tipping not say it anymore simply. That is is especially likely to result in pro- point right now, where it has become what the motion does. The other bill is viders being unwilling to treat Medi- so evident that the purpose behind a straw man. care and Medicaid patients, meaning a health care reform has not only been After the remarks by the distin- significant portion of the increased de- missed by this legislation, but it has guished leader, I would say this may be mands for Medicaid services would be been made worse—the objectives. a seminal event. I think that is one of difficult to meet. I point to this chart, the cost curve. the key votes where the other side The CMS actuary noted the Medicare When you talk to most Americans could start to realize this and start to cuts in the bill could jeopardize Medi- about what they believe the purpose finalize this without all the rhetoric care beneficiaries’ access to care. behind health care reform is, the vast and ideology and philosophical support The CMS actuary also found that majority say it is to control the sky- for this bill, and they could start the roughly 20 percent of all Part A pro- rocketing costs. Well, those who are road back, if you will, of doing it in a viders—that is hospitals and nursing promoting the bill say it does that, it step-by-step, thoughtful way—doing it, homes, for example—would become un- bends that cost curve. Which cost meaning real health care reform. profitable within the next 10 years as a curve? Is it the size of government? I commend the Senator. Again, this result of these cuts. As a result of That goes up $2.5 trillion in the first side-by-side is a straw man. The Sen- those Medicare cuts, 20 percent of hos- full 10 years of implementation. The ator is clear in what he wants to do. pitals and nursing homes would become cost of health care—the CMS report Under the Senator’s motion, the Fi- unprofitable within 10 years. came out, it is about the 10th report, nance Committee would report back a The CMS actuary found that further but this is from the actuary of the bill that eliminates the tax increases reductions in Medicare growth rates Medicare and Medicaid system who for middle-income taxpayers. We can through the actions of the independent analyzed this independently, and he restart the debate in a bipartisan way, Medicare advisory board, which advo- says health care costs are going to go where we can agree on many common cates have pointed to as a central up, not down. goals. I thank the Senator. linchpin in reducing health care spend- The CBO said the cost of insurance is Mr. CRAPO. I thank my colleague. ing, ‘‘may be difficult to achieve in going to go up, not down. The Federal Mr. President, how much time re- practice.’’ deficit—they say the bill doesn’t make mains? The CMS further found the Reid bill the Federal deficit go up. In fact, re- The PRESIDING OFFICER (Mr. would cut payments to Medicare Ad- garding that, the only way they can REED). Thirty minutes. vantage plans by approximately $110 claim that is if they implement their Mr. CRAPO. I thank the Chair. billion over 10 years, resulting in ‘‘less

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00037 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.054 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13008 CONGRESSIONAL RECORD — SENATE December 11, 2009 generous benefit packages’’ and de- I have an amendment I filed for this evidence-based nurse home visitation creasing enrollment in Medicare Ad- health care bill called the nurse home services—let me say those words again: vantage plans by about 33 percent. visitation Medicaid option amendment. ‘‘evidence-based.’’ This is not some the- That is a 33-percent decrease in Medi- It sounds a little complicated, but it is ory; this is not some maybe—let’s try care Advantage enrollment over 10 actually rather simple. It is part of to create a program. These programs years. what we need to do in the next couple work. The evidence is, in a word, irref- What should we conclude from this of days and weeks as we complete our utable over many years that these CMS report? The report confirms what work on health care. nurse home visitation programs work. we have known all along: The Reid One point to make initially is that We want to allow States to be reim- plan will increase costs, raise pre- we know these nurse home visitation bursed under a State Medicaid option. miums, and slash Medicare. programs work. They get results for We have about 30 years of research to That is not reform. The analysis new parents, new mothers, and have back up the following claims. Let me speaks for itself. This day, this Friday, positive benefits to a new mother and give four or five points. as we were discussing yesterday, is a her children. We start with a category for every seminal moment. We have heard from We all have had the experience, if we 100,000 families who are served by nurse CMS, the Government’s objective actu- are parents, of the anxieties of what it home visitation programs or nurse- ary, the bill fails to meet any of the ob- is like to be a new parent but espe- family partnership programs—all in jectives we all had in mind. We also cially what a new mother goes that same category. heard from CNN about how the Amer- through—all of the anxiety. It is not For every 100,000 families, 14,000 ican people feel about this package: 61 limited to one income group. No mat- fewer children will be hospitalized for percent are opposed; only 36 percent ter what income you are, no matter injuries and 300 fewer infants will die are in support. what background, it is a challenge to in their first year of life. That alone, The American people are asking us fully understand what it is like to have that number alone is worth making not to pass this, and the Center for a baby and to care for that child appro- sure States have this option. What is Medicaid Services’ actuary is telling us priately. That is one of the underlying the price of saving 300 infants a year it doesn’t achieve the goals that were concerns we have. out of 100,000 families? It is incalcu- desired at the outset. In our health care system, we have to lable. There is no value we could put on How much more do we need to hear? do everything possible to give that that kind of lifesaving as well as down How much more do we need to hear be- child a healthy start in life, and the the road saving money. fore we stop this bill and start over and best way to give a child a healthy start Let me give a couple of other exam- go step by step to deal with the cost is to make sure his or her mother—and ples. issue, which the American people hopefully both parents—is able to han- For every 100,000 families served by thought we were going to address in dle the pressures and manage the anxi- these nurse home visitation-type pro- this debate? eties that so many new parents have. grams, 11,000 fewer children will de- I suggest the absence of a quorum. The amendment I filed supports op- velop language delays by age 2. That is The PRESIDING OFFICER. The tional nurse home visits. That means a profound impact on the child—his or clerk will call the roll. that if someone chooses not to take ad- her ability to achieve in school and The bill clerk proceeded to call the vantage of this program, obviously, then his or her ability to develop a roll. they do not have to. The amendment high skill and therefore contribute Mr. CASEY. Mr. President, I ask simplifies the process for providers of positively to our economy. There is no unanimous consent that the order for nurse home visitation to seek Medicaid price one can put on 11,000 new children the quorum call be rescinded. reimbursement. Some will say there is learning more at a younger age. The PRESIDING OFFICER. Without Medicaid reimbursement now. Yes, Out of 100,000 families, 23,000 fewer objection, it is so ordered. there is, but it gets complicated to a children will suffer child abuse and ne- Mr. CASEY. Mr. President, we are in point where a lot of States are not get- glect in the first 15 years of life. Again, our discussion of health care. We have ting the full benefit of that reimburse- there is no way we can quantify that been focused on a couple of major ment. This amendment will impact the goals. The obvious goals that I think lives of Medicaid-eligible pregnant with a number or budget estimate. But are a major part of the legislation we women and their children, and the im- I would like to say we support strate- are debating are controlling costs, the pact is profound. The amendment is co- gies around here that are evidenced- based and scientifically based to make goal of providing better quality of care, sponsored by Senator GILLIBRAND of providing health care to millions of New York. It will allow States the op- sure children are not abused, that they Americans—tens of millions, really— tion to seek more adequate reimburse- live through the first couple years of who would have no chance to get that ment for nurse home visitation serv- their lives when they are at risk of kind of coverage without this legisla- ices. Again, a State is not forced to dying. tion, and also the concern we have seek greater reimbursement, but I be- One more statistic. Out of the 100,000 about not only controlling costs, but lieve a lot of States could and should families we use as a measurement, we have legislation on the floor that take advantage of this kind of an op- 22,000 fewer children will be arrested actually reduces the deficit by $130 bil- tion. and enter the criminal justice system lion and beyond the 10 years by hun- In Pennsylvania, we have been trying in the first 15 years of their lives. Just dreds of billions. to do this for years, even in the midst like the statistic about the first year of One of the concerns we have is that of having very effective nurse home life and surviving the first year of life in the midst of a health care debate visitation programs. One can just or not having in this case 23,000 more about numbers and the details of the imagine how valuable that is for a new children suffer child abuse and neglect, programs is that we also do not forget mother, that they can get advice and these are impossible to measure. In a that some parts of our health care sys- help from a nurse or another kind of sense, it is the measure itself that we tem work well but often might need an professional and get them through the save children’s lives, we make them adjustment or an amendment or a early days and weeks of being a new healthier. They and their families are change that would benefit a vulnerable parent. able to contribute more to society. population of Americans who do not I believe a State such as Pennsyl- This is the right thing to do to give have the kind of coverage or protection vania that has had a track record of our States the option—just the op- or peace of mind they should have. these kinds of programs that have a dition—of seeking greater reimburse- One of the more successful parts of rect and positive impact on children ment for these important services. I our health care system as it relates to and their families, their mothers espe- have seen it firsthand. new parents, especially new mothers cially, should be able to take advan- Many years ago—it must be at least and new children, is what is known by tage of this, as I am sure many other 10 years ago—in Pennsylvania, I actu- the broad category of nurse home visi- States. ally went to the home of a brand-new tation programs. They have been enor- The amendment helps States cut mother, a lower income mother in mously successful over many years. through the redtape and allow these northeastern Pennsylvania. We walked

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00038 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.054 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13009 in the door, with her permission, with year estimate, and I will quote what he called exchange programs. The penalty the nurse who was working with her said here. these employers pay will be much less after she left the hospital with her new Because of these transition effects and the than what they are paying now to pro- baby. There is no way to put into words fact that most of the coverage provisions vide insurance. how valuable that relationship was be- would be in effect for only 6 of the 10 years So these folks who are very happy tween a new mother and a nurse, be- of the budget period, the cost estimates with the insurance they have right now tween a new mother and a health care shown in this memorandum do not represent are not going to be very happy when professional to give her the start in a full 10-year cost for the proposed legisla- they get something substantially less tion. any circumstance but especially if a than that through the so-called ex- new mother has financial pressures The reason that is important is we change. They may like the coverage which are extraordinary and almost have been saying here for quite a long they have now, but, unfortunately, unbearable for some new mothers or time that you can’t just look at the what the President promised, that they has pressures as it relates to her hus- first 10 years in order to see the full would get to keep it, is not true. And band or boyfriend, whoever is part of impact of this legislation because for this is confirmed by what I read to you. her life. Sometimes there is violence. the first 4 years most of the benefits What about folks on Medicare Advan- Sometimes there are other pressures don’t exist. They are simply collecting tage? These are senior citizens above 65 that some of us cannot even begin to taxes and fees and revenues, and then who are on Medicare, and what they imagine, in addition to the obvious is when the benefits kick in, as a result have chosen to participate in is the pri- pressure of being a new mother, being a of which, when they say it is all in bal- vate insurance coverage component of new parent, and wanting to do the ance, it is in balance because they are Medicare called Medicare Advantage. right thing. collecting money for 10 years but they Here is the quotation. These programs, as the evidence and only have to pay for benefits for 6 of Lower benchmarks would reduce Medicare science tell us, work to give new moth- those 10 years. So the real question is: Advantage rebates to plans and thereby re- What does it cost over the first full 10 sult in less generous benefit packages. We es- ers peace of mind and to give States timate that in 2015, when the competitive the ability to directly and positively years of implementation? And it turns benchmarks would be fully phased in, enroll- impact the lives of that new mother out that is about $2.5 trillion. ment in Medicare Advantage plans would de- and her child. We have known this, and we have crease by about 33 percent. So we should give States this option, made the point. I think even the chair- Everybody has acknowledged there and that is why I urge my colleagues to man of the Finance Committee has ac- would be a reduction, but there has support the nurse home visitation Med- knowledged the $2.5 trillion if you take been little debate about how much it icaid option amendment. the first 10 years of implementation. would be. Our initial projections are Mr. President, I yield the floor and But I think it is good to actually have borne out by the CMS actuary—a de- suggest the absence of a quorum. that confirmed now by the Chief Actu- crease in enrollment in Medicare Ad- The PRESIDING OFFICER. The ary of CMS. vantage by about 33 percent. That is a clerk will call the roll. Secondly, a point I have been making third. This is important to me because The bill clerk proceeded to call the all along is that when the President 337,000 Arizonans participate in Medi- roll. said repeatedly: If you like your insur- care Advantage—almost 40 percent of Mr. KYL. Mr. President, I ask unani- ance, you get to keep it, that is not all our seniors. And a third of them, if mous consent that the order for the true; and it is not true for a variety of this works across the board, are going quorum call be rescinded. reasons under the bill, and again this to lose their plan because of this. In The PRESIDING OFFICER. Without report confirms what we have been say- any event, they are all going to lose objection, it is so ordered. ing is in fact true; namely, that a num- Mr. KYL. Mr. President, I ask unani- benefits because of ‘‘the result in less ber of workers who currently have em- mous consent that following my re- generous benefit packages.’’ ployer-sponsored insurance would lose This hasn’t been much in dispute, be- marks Senator BROWN of Ohio and then their coverage. In addition to that, sen- cause the Congressional Budget Office Senator LEMIEUX of Florida be recog- iors who are enrolled in private Medi- itself has described precisely how much nized in that order. The PRESIDING OFFICER. Without care plans, which are known as the the benefit packages will be reduced objection, it is so ordered. Medicare Advantage plans, would lose by, and it is 90-some dollars. It is from Mr. KYL. Mr. President, each day it benefits, and many of them would no 130-some dollars in actuarial value seems there is a new analysis of the longer be covered. down to 40-some dollars in actuarial Democratic proposal on health care Let me read two quotations, first rel- value, which is a huge reduction, obvi- that suggests it is not such a great ative to employer-sponsored insurance; ously. So reduction in benefits; a third idea. Today, a devastating report was and, second, people who are on Medi- of the people no longer on Medicare Ad- made public by the Obama administra- care Advantage plans. I am quoting vantage. The bottom line, whether you tion itself—the Department of Health now. are privately insured through your em- and Human Services—and their group Some smaller employers would be inclined ployer or you are a senior citizen in that is in charge of Medicare and Med- to terminate their existing coverage, and Medicare Advantage, you are not going icaid. It goes by the initials CMS. Spe- companies with low average salaries might to be able to keep the benefits and the find it to their and their employees’ advan- cifically, the Chief Actuary, Richard S. plan you like and have, notwith- tage to end their plans. The per-worker pen- standing the President’s commitment Foster, of the Centers for Medicare and alties assessed on nonparticipating employ- Medicaid Services, issued a report to the contrary. ers are very low compared to prevailing Third, Medicare cuts. We have been about the effect of the Reid legislation health insurance costs. As a result, the pen- talking a lot about Medicare cuts, and on health care as it pertains to a whole alties would not be a significant deterrent to dropping or forgoing coverage. my colleagues on the other side say: variety of things—the cost of the legis- Well, we don’t think that the Medicare What does that mean? The employer lation, the effect it is going to have on cuts are the way you describe them. under this bill has an obligation to pro- taxes, on premiums, on benefits, the Seniors are still going to have access vide insurance to his or her employees. cost with respect to Medicare and the to doctors and so on. This report is If they don’t do that, then they pay a kinds of things that will occur to bene- devastating in blowing a hole in that penalty. The problem is that the pen- ficiaries in Medicare, and so on. It is a argument. Let me quote a couple of the alty is much less than the cost of buy- complete report by a person who I things they say. ing the insurance. So what we have think all would agree is not only quali- Providers for whom Medicare constitutes a fied to speak to these things but also been saying all along, and what the substantive portion of their business could quite objective, as the chief actuary of CMS actuary confirms here, is that in find it difficult to remain profitable and, ab- CMS. He reached a number of very in- a lot of cases, small employers—and sent legislative intervention, might end teresting conclusions, and I want to particularly companies with low aver- their participation in the program (possibly briefly discuss eight of them. age salaries—will find it to their ad- jeopardizing access to care for beneficiaries). The first thing is that he noted his vantage to drop the insurance coverage This is what we have been predicting. estimates were actually not a full 10- and have their folks go into the so- If you impose extra costs and mandates

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00039 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.055 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13010 CONGRESSIONAL RECORD — SENATE December 11, 2009 on the people who are providing the are devastating for access to care or best. If we are going to provide care for care—whether it be the hospitals, the the cuts are so unrealistic they do not a group of people, we need to do it physicians, home health care, or if you go into effect, in which case the legis- right. Unfortunately, this is how ra- are taxing something such as medical lation can’t be paid for. And then I tioning begins if you don’t have enough devices—all of those impose costs on guess you are going to have to raise money to do it right. the people who are providing these taxes on the American people because Then let me conclude with this medical benefits. What the CMS actu- you aren’t able to effect the savings quotation. ary is saying here is that the combina- from Medicare. [This] possibly is especially likely in the tion of those things would potentially Here is what the actuary says: case of the substantially higher volume of jeopardize access to care for the bene- In general, limiting cost growth to a level Medicaid services, where provider payment ficiaries. There aren’t going to be as below medical price inflation alone would rates are well below average. many of these people in business to represent an exceedingly difficult challenge. And that is my point. provide care for an increasing number That is the challenge being put be- Therefore, it is reasonable to expect that a of people. fore them here—an exceedingly dif- significant portion of the increased demand Let me go on with the quotation that ficult challenge. for Medicaid would be difficult to meet, particularly over the first few years. I think will make this clear: Actual Medicare cost growth per bene- Simulations by the Office of the Actuary ficiary was below the target level in only 4 of What they are saying is that there suggest that roughly 20 percent of Part A the last 25 years, with 3 of those years imme- aren’t going to be the physicians and providers [hospitals, nursing homes, home diately following the Balanced Budget Act of the other people to care for the Med- health] would become unprofitable within 1997; the impact of the BBA prompted Con- icaid patients here and, as a result, the the 10 year projection period as a result of gress to pass legislation in 1999 and 2000 mod- the productivity adjustments. promise we have made to these people erating many of the BBA provisions. we are not going to be able to keep. In other words, 20 percent of the hos- What does that mean? In 1997, Con- Enrolling in Medicaid does not guar- pitals, home health care folks and oth- gress passed the Balanced Budget Act, antee access to care by a long shot. ers are not going to be profitable any- which drastically reduced the pay- No. 6. Again, this is something we more. They are going to be out of busi- ments to these providers in order to have been saying. This is not really too ness because of the burdens that are cut the cost of Medicare. Three out of controversial because the Congres- being placed upon them in this legisla- the four years in which the costs were sional Budget Office has said the same tion. What happens when you have the reduced, it was immediately following thing that the Actuary here says. But baby boomers going into the Medicare that legislation. But starting in 1999 it is always good to have a backup Program? Under the latest idea from and into the year 2000, Congress real- opinion. This is the tax on drugs, on the other side of the aisle, we are even ized those cuts were too deep; you were devices, and on insurance plans. We going to have 30 million potentially not going to get doctors and hospitals have all been saying of course those being able to join Medicare—the folks to continue to take care of patients if costs are passed on to the consumer in from 55 up to 65—but you are going to we continued to cut what they were the form of higher premiums or, in a reduce by 20 percent the number of paid for their services. So the cuts were couple of cases, higher taxes. That is folks to take care of them—the hos- ameliorated and, as a result, the sav- what is demonstrated: pitals and home health care and so on. ings were not achieved. Consumers will face even higher costs as a Obviously, you have a big problem. Ac- What the actuary is saying here is if result of the new taxes on the health care cess will be jeopardized, as the actuary that same thing happens again, if these sector. says. cuts are so drastic we actually don’t I might just say before I read the This is where rationing, in effect, let them go into effect because they quotation here, it doesn’t make any comes in. There simply aren’t enough would be self-defeating, then you will sense to me why, in order to pay for doctors, hospitals, and others to care not have the savings that have been this new entitlement, you would tax for the number of patients who want to promised and scored here as enabling the very people you want to take care see them. This is how it starts. First, this legislation to be so-called ‘‘budget of. Tax the doctors, insurance compa- long delays, long lines, long waiting pe- neutral.’’ It won’t be budget neutral. nies, device manufacturers that make riods before you can get your appoint- So as I said, one of two things will hap- the diabetes pump or the stent for a ment, and eventually denial of care be- pen, and both are bad. Either you have heart patient or some other device that cause there is simply nobody to take the cuts, which are devastating for sen- improves our health care these days? care of you. iors or you don’t have them and they Let’s tax them? I am saying maybe you This is exacerbated by something are devastating to taxpayers. want to tax liquor or tobacco or some- else in the legislation, which is the Five is Medicare expansion. I think thing, but why tax the things that fourth point here. The actuary talks all of us agree on both sides of the aisle make people healthier? Go figure. That about the independent Medicare advi- that Medicaid is a very vexing problem is what the bill does. sory board. What is happening is that because the States have to pay for a Here is what the Actuary says: Medicare is being cut in three different percentage of the Medicaid patients ways: one, Medicare Advantage, which We anticipate that such fees would gen- and the States are generally in very erally be passed through to the health con- I mentioned; two, the providers are poor financial shape and they do not sumers in the form of higher drug and device being slashed in the reimbursements need more people added to the Med- prices and higher insurance premiums, with that they are receiving; and three, this icaid rolls that can’t pay for them. an associated increase of approximately $11 legislation creates an independent My Governor was in town earlier this billion per year in overall national health Medicare advisory board that is sup- week, and she said: Please, please, expenditures, beginning in 2011. posed to make recommendations on don’t add people to the Medicaid rolls Remember how we were going to how to effect huge reductions in the and expect the States are going to be drive costs down with this bill? We cost of Medicare, and the primary way able to pay for them. Let me read a weren’t going to be paying as much? they will do that is by reducing the couple of the quotes from this actu- The Actuary says: amount of money paid to doctors, to arial report. We anticipate such fees would be generally hospitals, to others who take care of Providers might tend to accept more pa- passed through to the consumers in the form patients. That, obviously, will also re- tients who have private insurance (with rel- of higher drug and device prices and higher sult in less care for the senior citizens. atively attractive payment rates) and fewer insurance premiums, with an associated in- If the cuts are so drastic that Con- Medicare or Medicaid patients, exacerbating crease of $11 billion a year. gress says no, we are not going to do existing access problems for the latter group. This is going backward, not forward. them, then you don’t have the savings That latter group, of course, is the The whole idea was to reduce costs and the bill relies upon to pay for the new Medicaid group. The problem is that premiums. Instead, they are going up. entitlement. So one of two things hap- reimbursement is so low for Medicaid, No. 7. Here is another tax. We are pens, and they are both disastrous: Ei- frankly, they are the last patients a going to tax the higher premium plans. ther you have these huge cuts, which doctor sees, and their care is not the In response—this is a 40-percent tax on

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00040 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.056 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13011 these plans. What will employers do? Mr. BROWN. Mr. President, I rise to have negotiated good health benefits— According to the Actuary: speak in opposition to a provision in including dental and vision coverage— . . . employers will reduce employees’ the Patient Protection and Affordable are able to keep those benefits without health care benefits. Care Act that would impose a 40 per- punishment. That makes sense. If you are going to cent excise tax on certain health insur- I have heard many of my colleagues tax an insurance plan that has a lot of ance plans. argue that this excise tax will ‘‘bend good benefits in it, then the employer It is my strong belief that a benefits the cost curve’’ of health care costs is going to say: Rather than paying tax is the wrong way to pay for health and expenditures. that tax, I will reduce the benefits— reform legislation. However, the Commonwealth Fund precisely what CMS says. This is an- Beginning in 2013, this legislation found that ‘‘there is little empirical other case in which if you like what would impose an excise tax of 40 per- evidence that such a tax wcould have a you have, sorry, you are not going to cent on insurance companies and plan substantial effect on health care spend- get to keep it. We are going to tax it. administrations for any health insuring.’’ Then the employer is going to reduce ance plan that is above the threshold of And is makes no sense to bend the the benefits. $8,500 for singles and $23,000 for family cost curve by compromising access to Here is the quotation from CMS: plans. needed health services now—leading to In reaction to the excise tax, many em- The tax would apply to the amount higher health care costs later. ployers would reduce the scope of their of the premium in excess of the thresh- You are squeezing on a balloon, not health benefits. old. changing the long-term trajectory of This is exactly what we have been This tax would not only be imposed health spending. saying. on basic health benefits, it would be To bend the cost curve, we need to Here are seven specific ways in which imposed if the combined value of basic identify and reward the provision of the CMS Actuary, working for the benefits, dental benefits, and vision the right care, in the right settings, at Obama administration Department of benefits reaches the $8,500 limit. the right time. Health and Human Services, has In other words, Americans would be We need to target duplication, pro- verified the complaints Republicans better off without dental and vision mote best practices, and clamp down have been making about this legisla- coverage than with it. on those who overprice health insur- tion for weeks—that it will raise pre- How could a disincentive to dental ance and health care products and serv- miums, it will raise taxes, it will raise and vision coverage be a good idea? The ices—exploiting their role in ensuring costs. It will raise the cost of health answer is, ‘‘it’s not.’’ the health of the American people. care. It will raise the cost to the gov- In subsequent years, increases in the We need to give Americans more pur- ernment. It will provide fewer benefits. benefit thresholds will be tied to the chasing power and inject more com- It will result in the transition of people consumer price index plus one percent. petition into the health care market- from private insurance to the exchange What this means is that more and place. which is created in here and will result more workers and employers will be af- We don’t need to reverse the clock on in less access to care because there will fected in subsequent years. health care progress by discouraging be fewer providers to take care of more In fact, the Congressional Budget Of- Americans from having good health people. What a wonderful reform. fice, CBO, estimates that, by 2016, this coverage. This is why, when I talk about this benefits tax would affect 19 percent of There is so much that is critically legislation, I do not talk of health care workers with employer-provided health important in health reform legisla- reform. I am reminded of the line from coverage. tion—from delivery system reforms to a novel in which the individual says: CBO further projects that revenues prevention and wellness initiatives to Reform, sir? Don’t talk of reform. Things resulting from the tax would increase provisions which strengthen Medicare are bad enough already. by 10–15 percent every year in the sec- to making insurance more affordable Indeed, they are. We do have prob- ond decade after the tax takes effect. and accessible for all Americans—but lems. One of those problems is pre- And though this appears to be a tax this counterproductive tax on middle- mium costs going up. on insurance companies, we should not income Americans is not a provision I I note that my colleagues in the be fooled. can support. House of Representatives on the Re- Insurance companies are likely to That is why I have cosponsored an publican side offered an amendment pass these costs onto their customers— amendment with Senator SANDERS of which, according to calculations of the forcing employees to pay higher pre- Vermont that would eliminate this Congressional Budget Office and ac- miums or encouraging employers to benefits tax and instead impose a sur- cording to the House Republicans, cut or limit coverage. tax on the very wealthiest earners— would have actually reduced premiums Health reform legislation should not those who benefitted so much from the by $3,000 a year for the average family penalize middle-income Americans who Bush-era tax cuts. rather than increasing them. Repub- have forgone salary and wage increases Our amendment, as modified, would licans have good ideas about attacking in return for more generous health ben- replace the benefits tax on health in- the specific problems we face today. efits. surance plans with a 5.4 percent surtax What we do not need is something I remember, as the Presiding Officer on adjusted gross income for individ- under the guise of reform which is so in his leadership in the Banking Com- uals who earn more than $2.4 million a massive, so intrusive into our lives mittee remembers, during the auto dis- year and couples who earn more than and, with all due respect, not well cussions, when President Bush first $4.8 million per year. thought out in terms of its long-range moved to help the auto companies that Instead of taxing middle class Ameri- implications. were under such duress, many people cans for having good health coverage, What you end up with at the end of on the other side of the aisle saw the our amendment would help address the the day, according to CMS now, accord- legacy costs as something bad, the leg- disproportionate impact of the Bush ing to the Actuary of the U.S. Govern- acy costs the auto companies had. In tax cuts—which were outrageously tilt- ment Health and Human Services, fact, these legacy costs were benefits ed toward the wealthiest of the CMS, it raises premiums, raises taxes, negotiated by unions. Those workers wealthy. reduces access to care, increases the had been willing to give up present-day Multimillionaires and billionaires cost, and provides fewer benefits. I can- wages to have better health insurance fared far better than middle-class fami- not imagine how we could go home at and better pensions. This is the same lies under the Bush Administration. Christmastime and say to our constitu- kind of issue. Let’s not continue that tradition in ents: This is what we are giving you for And health reform legislation should this Congress. Christmas this year. not encourage the elimination of exist- The PRESIDING OFFICER (Mr. The PRESIDING OFFICER. Under ing health benefits. KIRK). The Senator from Florida. the previous order, the Senator from Instead, health reform legislation Mr. LEMIEUX. Mr. President, it is al- Ohio is recognized. should ensure that Americans who ways good to follow my colleague from

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00041 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.060 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13012 CONGRESSIONAL RECORD — SENATE December 11, 2009 Ohio. I rise to speak about the health The cost estimates shown in this memo- terminate their existing coverage. So care bill. I, specifically, wish to speak randum do not represent a full 10-year cost they will drop their health insurance. about this new report we have received of the proposed legislation. You are an employee in a small busi- from the Office of the Actuary from the It is not budget neutral. It is just a ness, they drop your health insurance. Centers for Medicare & Medicaid Serv- gimmick. Now you must go buy the Federal pro- ices. This report, unfortunately, con- The second problem the actuary gram, where you will be subsidized. firms many of the problems we already points to is, it jeopardizes access to What does that mean? It means every knew. This report comes from an inde- care for seniors. My colleagues have man and woman will be paying taxes to pendent actuary who works in the very been saying this for the past couple help pay for health care insurance, agencies that have to implement our weeks. You can’t take $1⁄2 trillion out taxes we can’t afford, spending we Federal health care programs. This ac- of Medicare and have it not hurt the can’t afford, not in a world where we tuary has reviewed the proposal before provision of health care for seniors. have a $12 trillion budget deficit. We us, the proposal that is intended to be This plan is going to gut Medicare as are just pushing the cost off on our health care reform. The review and re- we know it. It severely cuts funding for children and grandchildren. That is port of this actuary shows significant Medicare. when this deficit is going to come problems with this proposal and why In this report, it goes through all the home to roost. we must start over and take a step-by- cuts to Medicare Advantage, to home The actuary also says the excise tax on high cost employer-sponsored step approach. health, to hospice. The actuary goes health insurance is going to cause em- I had the opportunity to read this re- through all these cuts. What does the actuary conclude is going to be the re- ployers to scale back coverage. So if port this afternoon in my office, word you have one of the better health care for word, and go through it line by line. sult? Our friends on the other side of the aisle say this is not going to cut plans, the Cadillac plans, your em- I hope all my colleagues do on both ployer will not be incentivized to give sides of the aisle. There are many trou- Medicare; it is going to save Medicare. 1 you less coverage, less benefits, less ac- bling things this report shines light How do you take $ ⁄2 trillion out and save Medicare? The actuary under- cess. Is that what we thought reform upon. First, the proposal we are debat- was supposed to be? ing increases the cost of health care. stands it. He knows that doctors who provide services under Medicare for Now we also know from the actuary For Americans who are at home and we are going to raise taxes in this bill. might be watching this to see various seniors or for the poor under Medicaid aren’t going to take these reimburse- As my friend, the Senator from Ari- Senators on the floor of this great zona, was saying, we are going to tax body, they think the reason we are ments anymore. They will not see people and provide health care. So it is not device makers. We are going to tax here is to reduce the cost of health care pharmaceutical companies, the imple- and to promote more access. Those are health care reform if the doctor will not see you. ments and devices and medicines that the two big goals. That is what the save our lives. We know there is $64 bil- President told us. We are going to Right now, in this country 24 percent of doctors aren’t taking Medicare; 40 lion in penalties in this bill. The actu- lower the cost of health care. This re- ary says, on page 5, if you are a small percent are not taking Medicaid. The port shows, national health care ex- business or you are an individual and actuary says providers for whom Medi- penditures are going to go up from 16 you don’t provide the insurance, you care constitutes a substantive portion percent of the gross domestic product are going to be taxed, penalized, $64 bil- of their business could find it difficult to 20 percent. lion in penalties. to remain profitable and might end The actuary says: The chief actuary says, on page 4 of their participation in the program, pos- this report, we are going to spend $234 We anticipate that such fees would gen- sibly jeopardizing access to care for erally be passed to health consumers— billion more on health care over the beneficiaries. next 10 years. We are going to spend These are the taxes on the devices The second reason we are doing and the drugs— more on health care. We are not going health care reform, access to care, is to reduce costs. We are going to in- in the form of higher prices and higher insur- going to be hurt for seniors by this bill. ance premiums. crease costs. That is on page 9, for those who are fol- I also wish to address one point be- Moreover, the Federal Government, lowing at home. By the way, we are in its provision of health care, is going fore concluding. My friends on the going to put this report on our Web other side have been saying there are to spend $366 billion more in health site at lemieux.senate.gov. If you want care provisions. We are told this pro- not going to be any cuts to benefits be- to read it, you can read all the details. cause we will run a more efficient sys- posal is budget neutral or it actually The next thing the actuary discovers tem. There is going to be less fraud and creates less of a deficit. It cuts the def- as a problem with this bill is that for icit of the Federal budget. But as has abuse and waste. the 170 to 180 million Americans who We all want that. That makes a lot of been revealed this week—and this is have health insurance, your premiums sense. But the actuary, in evaluating just gimmickry—the taxes start before are going to go up, not down. We are this—and he talks about it on page 12— the benefits. For 4 years, we pay the not going to bend the cost curve down. finds that the cuts and the reductions taxes and the benefits don’t start until Health care will be more expensive, are negligible. In fact, he can’t even 2014. So 4 years of penalties without more expensive than if we were to do sufficiently provide evidence to know any benefits. This is similar to if you nothing and not implement this bill at what the estimates of savings might were to go buy a home and you went to all. be; at best, $2.3 billion for all the effi- buy the home and you said: We are The chief actuary says premiums for ciency and savings. Remember, this is going to live here for the next 10 years, the government-run plan, for example, a $2.5 trillion program. There is $2.3 and the real estate agent said to you: would be 4 percent higher than for pri- billion in savings, like 1 percent. So it That is fine. You are just going to pay vate insurers. So we don’t achieve that is not the efficiency that is going to for the first 4 years, but you don’t get goal. What is going to happen when we make up the cuts; it is going to be a to move in until 2014. put all this burden on businesses? Be- cut in benefits to seniors. It will be For families sitting around the cause we know that under this program higher insurance premiums for Ameri- kitchen tables, that is not how they we are going to penalize businesses if cans. That is not health care reform. balance their budgets. But that is this they don’t provide health insurance. It is why the Wall Street Journal strange world that Washington is, that We are going to penalize individuals if called this bill the worst bill ever. In you can set up this budget gimmickry they don’t provide health insurance. So talking about this new proposal to ex- in order to get it to so-called budget what are small businesses going to do pand Medicare and drop the age for neutrality. The actuary of CMS recog- who are hardly making it now? In Flor- Medicare, this morning the Wall Street nizes that. He says, on page 2, most of ida, we have 11 percent unemployment. Journal corrected itself and said that the coverage provisions would be in ef- Our small businesses are suffering. is even worse than the worst bill ever. fect for only 6 of the 10 years of the The actuary says on page 7, some Similar to the Presiding Officer, I am budget period. small employers would be inclined to new to this Chamber. I have been here

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00042 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.067 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13013 about 90 days. It is a great honor to Mr. HATCH. Mr. President, I appre- health care system or to bring about serve in the Senate, representing 18 ciate the remarks of my distinguished universal insurance coverage, but we million people from Florida, but it is colleague from Florida. People need to do take an oath to protect and defend also a little bit frustrating. The way listen to him. I am grateful to have the Constitution of the United States. the Senate works is not the real world. him in the Senate, a fine man he is and For the past 8 years, my friends on It is not like moms and dads who sit a good example to all of us. I appre- the other side of the aisle insisted that around the kitchen table and try to fig- ciate his remarks. the Constitution sets definite and ob- ure out how to make ends meet and I rise to explain why I believe the jective limits that the President must they can only spend as much money as Reid health care bill is not only bad obey. The Constitution, they said, does they take in. That is not how we work policy for this country but also under- not mean whatever the President in this institution. We don’t work in a mines the Constitution and the liberty wants it to mean. Compelling cir- reasonable way. it makes possible. I urge my colleagues cumstances or even national crises, My colleague from Utah will speak in to resist two errors that can distort they said, cannot change the fact that a minute. He was on the floor the other our judgment and lead us down the the Constitution controls the Presi- night talking eloquently about how, wrong path. Those errors are assuming dent, not the other way around. when you do real reform, you get 80 that the Constitution allows whatever It is easy to insist that the Constitu- Senators to vote on a proposal. If this we want to do and ignoring this question controls another branch of govern- bill passes, 60 Democrats will vote for tion altogether. ment, that the Constitution does not it, 40 Republicans will not. If just one We have only the powers the Con- mean whatever another branch of gov- Democrat would feel their conscience stitution grants us because liberty re- ernment wants it to mean. The real and not vote for this bill, we could quires limits on government power and test of our commitment to liberty, start over. We could work together in a we have our own responsibility to however, is our willingness to point bipartisan way and help those 45 mil- make sure we stay within those limits. that same finger at ourselves. lion Americans who don’t have health James Madison said that if men were I ask my colleagues, is the Constitu- insurance. But we wouldn’t do it by angels, no government would be nection rock solid, unchanging, and su- robbing from Medicare. We wouldn’t do essary, and if angels were to govern preme for the executive branch but it by raising taxes. We wouldn’t do it men, no limits on government would be malleable, shape-shifting, and in the by creating a $2.5 trillion new program. necessary. Because neither men nor the eye of the beholder for the legislative I have struggled to try to figure out governments they create are angelic, branch? a way to explain to the people how bad A principle applied only to others is this bill is. I know it is hard. You are government and limits on government are both necessary to protect liberty— just politics, and politics alone cannot sitting at home, around the kitchen protect liberty. We must be willing to table, trying to understand what Wash- not just government but limits on government as well. Those limits come say that there are lines we may not ington is up to. It is hard to under- cross, means we may not use, and steps stand. I have thought about cultural primarily from a written Constitution which delegates enumerated powers to we may not take. references and historical references, The Constitution empowers Congress maybe even things in pop culture that the Federal Government. Here is how the Supreme Court put it to do many things for the American I could use as an analogy to try to ex- people. Just as important, however, is plain what is going on in the Senate. just a few years ago. This is in United States v. Morrison in 2000, quoting that the Constitution also sets limits The only thing I can think of is the on our power. We cannot take the ‘‘Wizard of Oz.’’ In the ‘‘Wizard of Oz,’’ Marbury v. Madison—one of the most important decisions ever by the Su- power without the limits. Dorothy gets thrown into the tornado I want to address several constitu- in sort of an alternate reality, a place preme Court, probably the single most important decision—back in 1803: tional issues raised by this legislation. that doesn’t play by the same rules. The first is the requirement in sec- That is sort of the Congress. Dorothy Every law enacted by Congress must be based on one or more of its powers enumer- tion 1501 that individuals obtain not and the lion and the tin man and the simply health insurance but a certain scarecrow are told: Follow the yellow ated in the Constitution. ‘‘The powers of the legislature are defined and limited; and that level of insurance. Failure to meet this brick road, you will get there. All your those limits may not be mistaken or forgot- requirement results in a financial pen- answers will be solved. Everything will ten, the constitution is written.’’ alty which is to be assessed and col- be great. lected through the Internal Revenue That is sort of like this phrase we The important word there happens to hear around here: Make history, make be ‘‘limits.’’ Code. We hear a lot about how Senators on history, just get it done. Pay no atten- No one likes limits, least of all poli- this side of the aisle are supposedly de- tion to the cuts in Medicare. Pay no at- ticians with grand plans and aggressive fending the big, evil insurance compa- tention to the Medicaid you will put on agendas. It is tempting to ignore or the States that can’t afford it. Pay no forget the limits the Constitution im- nies, while those on the other side of attention to the higher taxes and the poses on us by pretending the Constitu- the aisle are defenders of American higher premiums people will have to tion means whatever we want it to families. This insurance mandate ex- suffer under. Similar to the scarecrow, mean. But we take an oath to support poses such partisan hypocrisy. who doesn’t have a brain, it is not very and defend the Constitution, not to Let me just ask you one simple ques- thoughtful to put more expenses and make the Constitution support and de- tion. Who would benefit the most from more taxes on the States with Med- fend us. The Constitution cannot limit the unprecedented mandate to pur- icaid when they can’t afford it. Similar government if government controls the chase insurance or face a penalty en- to the tin man, who doesn’t have a Constitution. forced by our friends at the Internal heart, it is not very thoughtful to take In April 1992, during a debate on wel- Revenue Service? The answer is simple. money out of health care for seniors. fare reform legislation, the senior Sen- There are two clear winners under this Similar to the lion, who has no cour- ator from New York, Mr. Moynihan, Draconian policy and neither is the age, we don’t have the courage to do with whom I served, made a point of American family. The first winner is what is right and work together in a order that an amendment offered by a the Federal Government, which could bipartisan way. When you get to the Republican Senator was unconstitu- easily use this authority to increase end of the yellow brick road and you tional. Here is what Senator Moynihan the penalty or impose similar ones to get to Oz, you find out there is nothing said: create new streams of revenue to fund behind the curtain. We do not take an oath to balance the more out-of-control spending. Second, This isn’t health care reform. We budget, and we do not take an oath to bring the insurance companies are the most need to start over, and we need to get about universal peace, but we do take an direct winners under this insurance it right. oath to protect and defend the Constitution mandate because it would force mil- I yield the floor. of the United States. lions of Americans who would not oth- The PRESIDING OFFICER. The Sen- Applying that sage advice today, we erwise do so to become their cus- ator from Utah. do not take an oath to reform the tomers. I cannot think of a bigger

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00043 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.068 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13014 CONGRESSIONAL RECORD — SENATE December 11, 2009 windfall for corporations than the Fed- ticular good or service. The Court has Whether such a requirement [to have eral Government ordering Americans never done that. health insurance] would be constitutional to buy their products. Let me mention just three of the Su- under the Commerce Clause is perhaps the Right now, States are responsible for most challenging question posed by such a preme Court’s commerce clause cases. proposal, as it is a novel issue whether Con- determining the policies that best In its very first case, Gibbons v. Ogden gress may use this clause to require an indi- meet the particular demographic needs in 1824, Thomas Gibbons had received a vidual to purchase a good or service. and challenges of their own residents. Federal license to operate a steamboat Can Congress use this clause to re- That is the States. Massachusetts, for between New Jersey and New York and quire an individual to purchase a good example, has decided to implement a wanted to compete with Aaron Ogden, or service? health insurance mandate, while Utah who had been granted a steamboat mo- One thing did change in the legal has decided not to do so. This bill nopoly by New York State. In Wickard landscape between 1994, when CBO would eliminate this State flexibility v. Filburn, Roscoe Filburn used the called the health insurance mandate so that the Federal Government may winter wheat he planted on his Ohio ‘‘unprecedented,’’ and 2009, when CRS impose yet another one-size-fits-all farm to feed his livestock and make called it ‘‘novel.’’ The Supreme Court mandate on all 50 States and on every bread for his own dinner table. In the twice found that there are limits to American. I cannot think of anything winter of 1942, he grew more wheat what Congress may do in the name of more at odds with the system of fed- than allowed under the Agricultural regulating interstate commerce. eralism that America’s Founders estab- Adjustment Act and challenged the re- In United States v. Lopez, the Court lished, a system designed to limit gov- sulting fine. And in Hodel v. Surface rejected a version of the commerce ernment and protect liberty. Mining & Reclamation Association, power that would make it hard ‘‘to I can understand why this mandate is companies challenged a Federal stat- posit any activity by an individual so attractive to those who believe in an ute regulating surface coal mining. that Congress is without power to reg- all-powerful Federal Government. These cases have two things in com- ulate.’’ After all, raising the percentage of mon. The Supreme Court upheld Fed- If there is no difference between reg- those with health insurance is easy by eral authority in each case, but each ulating and requiring what people do, if simply ordering those without insur- case involved an activity—remember there is no difference between incen- ance to buy it. But while government the word ‘‘activity’’—in which individ- tives and mandates, if Congress may may choose the ends, the Constitution uals chose to engage. There would have require that individuals purchase a determines the permissible means. been no Gibbons v. Ogden if Thomas particular good or service, why did we That is why one of the basic principles Gibbons had not chosen to operate a even bother with the Cash for Clunkers is that Congress must identify at least steamboat. Congress could regulate his Program? Why did we bother with one of our powers enumerated in the activity but could not have required TARP or other bailouts? We could sim- Constitution as the basis for any legis- that he engage in it. There would have ply require that Americans buy certain lation we ultimately pass. been no Wickard v. Filburn if Roscoe cars or appliances, invest in certain The health insurance mandate is sep- Filburn had not chosen to grow wheat. companies, or deposit their paychecks arate from the penalty used to enforce Congress could regulate his activity in certain banks. For that matter, we it. The only enumerated power that but not have required that he engage in could attack the obesity problem by re- can conceivably justify the mandate is it. And there would have been no Hodel quiring Americans to buy fruits and the power to regulate interstate com- case if companies had not chosen to vegetables and to eat only those. merce. For more than a century, the mine coal. Congress could regulate Some say that because State govern- Supreme Court treated this as meaning their activity but could not have re- ments may require drivers to buy car what it says. Congress cannot use its quired that they engage in it. insurance, the Federal Government power to regulate commerce in order to The key word in the commerce clause may require that everyone purchase regulate something that is not com- is the word ‘‘regulate,’’ and the key health insurance. That is too sim- merce. Congress cannot use its power word in every Supreme Court case plistic, that argument. Simply stating to regulate interstate commerce in about the commerce clause is the word that point should be enough to refute order to regulate intrastate commerce. ‘‘activity.’’ Regulating an activity in it. States may do many things that the In classic judicial understatement, which individuals chose to engage is Federal Government may not, and if the Supreme Court has said that ‘‘our one thing; requiring that they engage you do not drive a car, you do not have understanding of the reach of the com- in that activity is another. to buy car insurance. This legislation merce clause . . . has evolved over The Congressional Budget Office ex- would require individuals to have time.’’ Indeed, it has. Since the 1930s, amined the 1994 health care reform leg- health insurance simply because they the Supreme Court has expanded the islation which also included a mandate exist, even if they never see a doctor power to regulate interstate commerce to purchase health insurance. Here is for the rest of their lives. to include regulating activities that the CBO’s, the Congressional Budget The defenders of this health insur- substantially affect interstate com- Office’s, conclusion. This is August ance mandate must know that they are merce. That is obviously far beyond, by 1994, the Congressional Budget Office: on shaky constitutional ground. The orders of magnitude, what the com- A mandate requiring all individuals to pur- bill before us now includes findings merce power was intended to mean, but chase health insurance would be an unprece- which attempt to connect the mandate that is where things stand today, and dented form of federal action. The govern- to the Constitution. I assume they are some say it justifies this health insur- ment has never required people to buy a par- the best arguments that this unprece- ance mandate in this bill. ticular good or service. . . .Federal mandates dented and novel mandate is constitu- Using the Constitution or even the typically apply to people as parties to eco- tional. Supreme Court’s revision of the Con- nomic transactions, rather than members of Those findings fail in at least four stitution as a guide requires more than society. ways. a good intention fueled by an active That is pretty important language. First, the findings say that the re- imagination. The Supreme Court has In other words, Congress can regulate quirement to purchase health insur- certainly expanded the category of ac- commercial activities in which people ance will add millions of new con- tivities—get that word ‘‘activities’’— choose to engage but cannot require sumers to the health insurance mar- that Congress may regulate. But every that they engage in those commercial ket. I cannot dispute the observation one of its cases has involved Congress activities. that requiring more people to purchase seeking to regulate just that: activities Just a few months ago, as Congress health insurance will result in more in which people have chosen to engage. once again is considering a health in- people having health insurance. I think Even the Supreme Court has never surance mandate, the Congressional that seems quite self-evident. But the abandoned that category altogether Research Service examined the same question is not the effect of the man- and allowed Congress instead to re- issue. Here is what the Congressional date but the authority for the man- quire that individuals engage in activi- Research Service concluded. This was date. Liberty requires that the ends ties, in this case by purchasing a par- in July 2009. The CRS concluded: cannot justify the means. The findings

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00044 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.069 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13015 also fail to establish that the insurance ular than enacting legislation even if it lations of campaign financing and the need mandate is constitutional by failing to is not constitutional. for repeated ‘‘reforms.’’ Only this time, the offer a single example—a single prece- Some defenders of this legislation public is aligned against a scheme that will dent, a single case—in which Congress such as the House majority leader have require repeated unpopular votes, especially to raise taxes to compensate for the absence has required individuals to purchase a said that Congress may require individ- of the health insurance mandate. particular good or service or the courts uals to purchase health insurance be- These political considerations are beyond have upheld such a requirement. The cause it can pass legislation to pro- the scope of this paper, and the expertise of cases I described are typical, and simi- mote the general welfare. The only its authors. But Senators and Representa- lar examples are legion. Every one in- thing necessary to dismiss this argu- tives need to know that, despite what they volves—every one of those cases I have ment is to read the Constitution. Read have been told, the health insurance man- cited—the regulation of activity in the Constitution. That dismisses this date is highly vulnerable to challenge be- which individuals choose to engage. argument. Just read it. Read the Con- cause it is, in truth, unconstitutional. And political considerations aside, each legis- Requiring that the individual engage in stitution. Article I refers to general lator owes a duty to uphold the Constitution. such activity is a difference not in de- welfare as a purpose, not as a power. It Mr. HATCH. I also wish to share with gree but in kind. is a purpose that limits rather than ex- The findings also fail to answer the pands Congress’s power to tax and to my colleagues a letter I received from question by observing that States such spend. The requirement that individ- Dr. Michael Adams and attorney Car- as Massachusetts have required that uals purchase health insurance is not roll Robinson. They are on the faculty individuals purchase health insurance. an exercise of either the power to tax of the Barbara Jordan Mickey Leeland As I noted regarding the example of car or the power to spend, and so even the School of Public Affairs at Texas insurance, our Federal and State sys- purpose of general welfare is not con- Southern University. Mr. Robinson, a tem allows States to do many things nected to it at all. Needless to say, it former member of the Houston City that the Federal Government may not. makes no sense to include in a written Council, was named by the Democratic That is one of those limits on the Fed- Constitution designed to limit Federal Leadership Council in 2000 to its list of eral Government that is necessary to Government power an open-ended, ‘‘100 to Watch.’’ I ask unanimous consent their entire protect liberty. catchall provision empowering Con- letter, which is dated October 25, 2009, The findings fail to answer the ques- gress to do anything it thinks serves be printed in the RECORD following my tion by mistakenly focusing on wheth- the general welfare. er Congress may regulate the sale of If America’s Founders wanted to cre- remarks. insurance. That misses the point in ate a Federal Government with that The PRESIDING OFFICER. Without two respects. Simply because Congress much power, they could have written a objection, it is so ordered. may regulate the sale of health insur- much shorter Constitution, one that (See exhibit 1.) Mr. HATCH. Let me share just an ex- ance does not mean that the Congress simply told Congress to go for it and cerpt from these two people. This is an may require it. Simply because Con- legislate well. That is what they could excerpt from Michael Adams, Ph.D., gress may regulate the sale of health have done. They didn’t do that, thank and Carroll G. Robinson, Esquire, from insurance does not mean that Congress goodness. may regulate the purchase of health in- The Heritage Foundation has just the Barbara Jordan and Mickey Leland surance. This legislation requires you published an important paper arguing School of Public Affairs, Texas South- to believe that nonactivity is the same that this health insurance mandate is ern University: as activity; that choosing not to do both unprecedented and unconstitu- Our reading of the Constitution and Su- something is the same as choosing to tional. It is authored by Professor preme Court precedent could not identify any reasonable basis, expressed or implied, do it; that regulating what individuals Randy Barnett, the Cormack do is the same as requiring them to do for granting Congress the broad, sweeping Waterhouse Professor of Legal Theory and unprecedented power that is represented it. That notion makes no common at the George Washington Law Center; by the individual mandate requirement. In sense, and it certainly makes no con- Nathaniel Stewart, an attorney with fact, we could not find any court decision, stitutional sense. If Congress can re- the prestigious law firm of White & state or federal, that said or implied that the quire individuals to spend their own Case, and Todd Gaziano, Director of Constitution gave Congress the power to money on a particular good or service the Center for Judicial and Legal Stud- mandate citizens buy a particular good or simply because Congress thinks it is ies at the Heritage Foundation. service or be subject to a financial penalty levied by the government for not doing so. important, then the Constitution I ask unanimous consent to have the means whatever Congress says it conclusion portion of the Legal Memo- That is pretty impressive stuff. means and there are and will be no lim- randum published by the Heritage It is certainly possible to achieve the its to the Federal Government’s power Foundation printed in the RECORD. goal of greater health insurance cov- over each and every one of our lives. There being no objection, the mate- erage by constitutional means, not un- That version of Federal power will be rial was ordered to be printed in the constitutional means. I am quite cer- exactly what the Supreme Court in RECORD, as follows: tain, however, that those means are politically impossible. Lopez prohibited; namely, that there CONCLUSION Liberty requires that the Constitu- would be no activity by individuals In theory, the proposed mandate for indi- that the Federal Government may not viduals to purchase health insurance could tion trump politics, but in the legisla- control. Neither the power to regulate be severed from the rest of the 2,000–plus- tion before us, politics trumps the Con- interstate granted by the Constitution page ‘‘reform’’ bill. The legislation’s key stitution. nor the power to regulate activities sponsors, however, have made it clear that Another provision in this legislation that substantially affect interstate the mandate is an integral, indeed ‘‘essen- that is inconsistent with the Constitu- commerce granted by the Supreme tial,’’ part of the bill. After all, the revenues tion is section 9001, which imposes an Court go that far. They don’t go that paid by conscripted citizens to the insurance excise tax on high-cost employer-spon- companies are needed to compensate for the sored insurance plans differently in far. increased costs imposed upon these compa- The American people agree. A na- nies and the health care industry by the some States than in others. The legis- tional poll conducted last month found myriad regulations of this bill. lation imposes a tax equal to 40 percent that 75 percent of Americans believe The very reason why an unpopular health of benefits above a prescribed limit but that requiring them to purchase health insurance mandate has been included in raises that limit in 17 States to be de- insurance is unconstitutional because these bills shows why, if it is held unconsti- termined by the Secretaries of the Congress’s power to regulate commerce tutional, the remainder of the scheme will Treasury and Health and Human Serv- does not include telling Americans prove politically and economically disas- ices. what they must buy. By a margin of trous. Members need only recall how the Su- My colleague from Ohio, Senator preme Court’s decision in Buckley v. Valeo— more than 7 to 1, Americans believe which invalidated caps on campaign spend- BROWN, spoke against this provision on that elected officials should be more ing as unconstitutional, while leaving the policy grounds earlier. concerned with upholding the Constitu- rest of the scheme intact—has created 30 The Constitution allows Congress to tion regardless of what might be pop- plus years of incoherent and pernicious regu- impose excise taxes but requires that

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00045 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.071 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13016 CONGRESSIONAL RECORD — SENATE December 11, 2009 they be ‘‘uniform throughout the Health, Education, Labor and Pensions chase health insurance, and that Con- United States.’’ This is one of those Committee—but also the Finance Com- gress cannot tax certain health insur- provisions that will be dismissed with mittee, as well as the Judiciary Com- ance plans in some States but not in pejorative labels such as archaic by mittee that, for some reason, has some others. those who find it annoying. But it is great interest in the Constitution. I These, and the others I have men- right there in the same Constitution have never heard any justification for tioned, are only some of the constitu- that we have all sworn to uphold. We singling out certain States for different tional issues raised by this legislation. have all sworn that same oath to pro- tax treatment. Any of these, and others I have not tect and defend, and we are just as The attitude seems to be that this is mentioned, could well be the basis for bound today to obey it. what the majority wants to do, so they future litigation challenging this legis- Frankly, a good test of our commit- are going to do it no matter what the lation should it become law. ment to the Constitution is when we Constitution says. That may be politi- Writing for the Supreme Court in must obey a provision that limits what cally possible, but that does not make 1991, Justice Sandra Day O’Connor re- we want to do. it constitutionally permissible. minded us: The Supreme Court has had rel- Other legal analysts and scholars The Constitution created a Federal Gov- atively few opportunities to interpret who are examining this health care ernment of limited powers. and apply the uniformity clause, but takeover legislation are raising addi- America’s Founders, she wrote, limits cases do provide some basic prin- tional constitutional objections. Pro- ited Federal Government power to ciples which I think easily apply to the fessor Richard Epstein of the Univer- ‘‘protect our fundamental liberties.’’ legislation before us today. The Court sity of Chicago School of Law, for ex- Here is the way Justice O’Connor put has held, for example, that a Federal ample, focuses on provisions that re- it, writing for the Supreme Court in excise tax must be applied ‘‘with the strict insurance providers’ ability to New York v. United States in 1992: same force and effect in every place make their own risk-adjusted decisions But the Constitution protects us from our where the subject of it is found.’’ about coverage and premiums. He ar- own best intentions: It divides power among The Congress has wide latitude in de- gues these restrictions amount to a sovereigns and among branches of govern- termining what to tax and may tailor a taking of private property without just ment precisely so that we may resist the regional solution to a geographically compensation and in violation of the temptation to concentrate power in one loca- isolated problem, but laws drawn ex- tion, as an expedient solution to the crisis of fifth amendment. the day. plicitly in terms of State lines will re- Others have observed that the legis- That is a pretty remarkable state- ceive heightened scrutiny. By the plain lation requires States to establish ment. I could not have said it better terms of the legislation before us, in- health benefit exchanges. It does not myself. Those are either principles we surance plans providing a certain level ask, cajole, encourage, or even bribe must obey or cliches we may ignore. of benefits in one State will be taxed them. It simply orders State legisla- If the Constitution means anything while the very same plans providing tures to pass legislation creating these anymore, if it does what it was created the very same benefits in another will health benefit exchanges and says if to do by not only empowering but, not be taxed. We do not yet know what States do not do so, the Secretary of more importantly, limiting govern- States will be treated differently, but Health and Human Services will estab- ment power, then now is the time to we do know, according to this bill, that lish the exchanges for them. How stand on principle rather than to slip 17 of them will. That actually makes thoughtful. on politics. the constitutional point more clearly But as the Supreme Court said in I yield the floor. by identifying the State-based dis- FERC v. Mississippi in 1982: EXHIBIT 1 crimination more starkly. Congress This Court never has sanctioned explicitly may decide to tax insurance plans with a federal command to the States to promul- OCTOBER 25, 2009. gate and enforce laws and regulations. Hon. ORRIN G. HATCH, benefits that exceed a particular limit, U.S. Senator. but the tax must have the same force The Supreme Court reaffirmed a dec- DEAR SENATOR HATCH: We support reducing and effect wherever that subject of the ade later in New York v. United States the cost of health insurance and expanding tax is found. That is the clear meaning that ‘‘the Framers explicitly chose a access to quality, affordable prevention, of the constitutional provision and the Constitution that confers upon Con- wellness and health care services for all clear holding of the Supreme Court’s gress the power to regulate individuals, Americans. Despite our support for health precedents. Taxing the same insurance not States.’’ care reform that empowers consumers, we plans differently in one State than in In that case, the Court struck down have serious concerns about the constitu- tionality of the individual mandate require- another is the opposite of taxing them Federal legislation that would press ment being proposed by Congress. uniformly throughout the United State officials into administering a At least one scholar has argued that the States. Federal program. individual mandate requirement is constitu- I commend to my colleagues the More recently, in Printz v. United tional because Congress has unlimited au- work of Professor Thomas Colby of the States, the Supreme Court stated: thority under the Commerce Clause to regu- George Washington University Law We have held, however, that State legisla- late the economic activity of individual School, whose comprehensive work on tures are not subject to Federal direction. American citizens no matter how infinites- imal. the uniformity clause was published in Yet this legislation does what these We do not agree with that position. In volume 91 of the Virginia Law Review. cases said Congress may not do. It Philadelphia, the Framers established a fed- I asked the Congressional Research commands States to pass laws, it regu- eral government of limited powers. If Con- Service to look at this uniformity lates States in their capacity as gress has unlimited power under the Com- clause issue. Its report confirmed that States, and it attempts to make States merce Clause to regulate the economic activ- this differential tax on high-cost insur- subject to Federal direction. ity of citizens, then the Constitution is no ance plans is drawn explicitly along Let me return to the principles with longer (and never was) ‘‘a promise . . . that State lines and that a court will more which I began. Liberty requires limits there is a realm of personal liberty which the government may not enter.’’ closely scrutinize the reasons for the on government power. Those limits We believe that this promise still exists State-based distinction. It also con- come primarily from a written Con- and is not a mirage. The Supreme Court said cluded that Congress has not articu- stitution which delegates enumerated so, at least as recently as 2003. lated any justification for singling out powers to Congress. We must be able to It has also been argued that the individual certain States for different treatment. identify at least one of those enumer- mandate is constitutional because citizens I have raised this issue over and over ated powers to justify legislation, and have ‘‘no fundamental right to be uninsured’’ throughout the process of developing those powers should not mean what- or ‘‘to decline insurance.’’ These are and considering this legislation. I serve strawman characterizations intended to dis- ever we, in our delightful wisdom, want tract attention from the real constitutional on both of the Senate committees that them to mean. question: Does Congress have the power to are involved in this process. In fact, I Those principles lead me to conclude mandate citizens buy a specific good or serv- can say I have served on three: not that Congress does not have the au- ice or be subjected to a financial penalty for only the HELP Committee—the thority to require that individuals pur- not doing so?

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00046 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.072 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13017 Our reading of the Constitution and Su- Mr. BROWNBACK. Mr. President, I riage. Higher taxes, more employer preme Court precedent could not identify am delighted to follow my colleague mandates, and disincentives to job cre- any reasonable basis, expressed or implied, from Utah. I am pleased he has raised ation, productivity, and family forma- for granting Congress the broad, sweeping and unprecedented power that is represented these constitutional issues, which I tion are hardly the prescription for the by the individual mandate requirement. In think are significant to this bill. The growth our economy so desperately fact, we could not find any court decision, idea that we could have a constitu- needs right now. state or federal, that said or implied that the tional mandate to buy health insur- Both the House and the Senate bills Constitution gave Congress the power to ance, to me, is highly questionable would, for instance, increase the al- mandate citizens buy a particular good or under our rights under the role of the ready existing penalty on work faced service or be subject to a financial penalty Federal Government and under the levied by the government for not doing so. by many low-income families who re- There are cases that say Congress can tell Constitution. Senator HATCH has been ceive tax and in-kind benefits from consumers what products to buy if they on the Judiciary Committee for many government welfare programs. We al- choose to buy, but no cases that say Con- years and he understands these issues ready heard this. Health insurance sub- gress can mandate that a citizen must buy a very well. sidies in the legislation for individuals particular good or service or be fined for not We are now on our sixth iteration of and families in poverty would tack on doing so. the health care reform bill. This one an additional 12 to 20 percent to mar- The individual mandate requirement di- talks about expanding Medicare, basi- rectly burdens the fundamental meaning of ginal tax rates, which already approach being an American citizen as embodied in cally as one of the key components of 40 to 50 percent for families receiving a the Ninth Amendment reaching back solving the problem. Here is a quote variety of benefits for those with low through the Declaration of Independence to from the Mayo Clinic I found, and oth- incomes. This would result in marginal the Magna Carta and its expansion coming ers have also been cited. I found this tax rates of 50 to 60 percent for most forward from the 3/5ths Clause of Article I of interesting, succinct, and accurate: affected families. the Constitution and the Court’s Dred Scott Any plan to expand Medicare, which is the decision to the Thirteenth, Fourteenth, Fif- Government’s largest public plan, beyond its If working more hours or obtaining teenth, Nineteenth, Twenty-Fourth and current scope does not solve the Nation’s better paying jobs results in more than Twenty-Sixth Amendments as well as health care crisis, but compounds it. It is half of those additional earnings being through Supreme Court decisions related to also clear that an expansion of the price con- taken away as a result of taxes or a re- these amendments, legislation adopted pur- trol of the Medicare payment system will suant to them, the Bill of Rights and its pe- duction in benefits—if you are a low-in- not control overall Medicare spending or come individual, you are working numbra. curb costs. This scenario follows the typical The Supreme Court has ruled that freedom more, you are getting more money pattern for price control, reduced access, of speech, expression and association are compromised quality, and increasing costs coming in, but your benefits from the constitutionally protected. Our right to free- anyway. We need to address these problems, government are reduced. So if you are ly move around the country is also constitu- not perpetuate them through health reform taking 50 to 60 percent away in a reduc- tionally protected. Congress can regulate the legislation. tion of benefits or in taxes, the incen- size of political donations but has no authority to tell a citizen which political candidate That was the Mayo Clinic. It is clear- tive to work harder or to invest in an or party they can lawfully contribute to. ly not the way to go to solve the crisis education is greatly reduced. That is Like political donations, how a citizen le- or the problems. It probably hastens obvious on its face. Yet it is in this gally spends their money in the market the day Medicare goes bankrupt, which bill. place is clearly a form of expression and as- is set to happen in 2017, 7 years away. This is not the only work disincen- sociation that requires strict scrutiny, or I want to talk about the possibility heightened, protection. tive in the bill. It is common for teen- Calling the individual mandate a tax raises that this health care bill puts this very agers and college students to obtain another constitutional concern. Under the early piece of economic recovery that jobs so they can have some spending mandate, American citizens are essentially we are having at risk. The latest re- money on their own or to help with subject to a financial penalty simply for ports on unemployment provide some their educational expenses. The Senate being a citizen of the United States residing hope that our battered economy may bill penalizes the families of these in a state of the Union. It is essentially an be showing some tentative signs of eco- younger workers by including their existence fee, a fee for existing. Under the Fourteenth Amendment, the nomic recovery, as the job loss con- wages in benefit eligibility calcula- definition of citizenship does not include any tinues to slow. Most of this is based off tions. For many low-to-moderate in- requirement that Americans pay a ‘‘tax’’ of monetary policy. We are seeing some come families, the inclusion of their simply because we are citizens. In fact, the of this taking place. wages could mean a significant in- Twenty-Fourth Amendment and related Su- Consumer confidence is still low. Un- crease in their cost of health insurance preme Court decisions expressly prohibit fi- employment hovers at 10 percent, and or even in them losing thousands of nancially burdening the rights of citizens to over 7 million jobs were lost since the dollars of health insurance subsidies al- prevent them from exercising a right of citi- beginning of the recession. together. That is in the bill. zenship. Citizens have a liberty interest in It should be clear that any potential deciding when to buy a good or service and And more harmful to the economy, which to buy form the legally available op- recovery is incredibly fragile. That being the case, Congress and the ad- potentially, are the incentives directed tions. at employers. Both the House and Sen- The Supreme Court has said, ‘‘Had those ministration should focus like a laser ate bills include temporary subsidies to who drew and ratified the Due Process beam on policies that encourage eco- Clauses of the Fifth Amendment or the Four- nomic growth and put Americans back small businesses to encourage them to teenth Amendment known the components to work. That seems to be obvious. offer employer-sponsored health insur- of liberty in its manifold possibilities, they Instead, though, the administration ance. As the number of employees in- might have been more specific. They did not and the Democratic-controlled Con- crease or as salaries increase, the presume to have this insight. They knew amount of the credit provided to the times can blind us to certain truths and . . . gress have taken up crucial months with a proposed revamping of our en- business decreases. The structure of laws once thought necessary and proper in this subsidy not only discourages em- fact serve only to oppress. As the Constitu- tire health care system that will cost tion endures, persons in every generation nearly $2.5 trillion over the next 10 ployers from hiring new employees, but can invoke its principles in their own search years, to be paid for by new taxes and it also discourages them from increas- for greater freedom.’’ employer mandates, and it will impose ing employees’ salaries. We don’t want We believe that reducing the cost of health a grave risk to a sustained rebound of those sorts of disincentives in any bill. care insurance and expanding coverage can Ironically, the incentives in the bill be achieved without opening the constitu- our Nation’s economy. This hurts our tional Pandora’s Box of the individual man- economic recovery. would even work to encourage employ- date requirement. Not only that, but the Democratic ers to drop health insurance coverage Sincerely, health care bill includes some posi- for individual employees or eliminate CARROLL G. ROBINSON, Esq. tively perverse incentives that would insurance coverage altogether. The MICHAEL O. ADAMS, PhD. discourage hiring, work, saving, and Senate bill would cap employee con- The PRESIDING OFFICER. The Sen- even marriage. Again, it would discour- tributions to insurance premiums at 9.8 ator from Kansas is recognized. age hiring, work, savings, and mar- percent of their income. If an employer

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00047 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.024 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13018 CONGRESSIONAL RECORD — SENATE December 11, 2009 offered a policy that required employ- the system and in the bill. We are try- The FAH is strongly opposed to this pro- ees to pay more than this, the em- ing to take it away in the welfare proposal. A Medicare buy-in would involve ployee would be eligible to purchase in- grams, but to add another piece to low Medicare rates, would be controlled by CMS, surance through the new ‘‘health care and moderate-income couples is the and would crowd out older workers with private coverage and may choose early retire- exchanges.’’ The employer would have wrong way for us to go. ment as a result. Such a policy will further to pay a fine. Since, in many cases, That the Democratic health care leg- negatively impact hospitals. islation would set the United States on that fine is considerably less than the In my rural State, in particular, it a path to a single-payer government- additional insurance costs the em- would have a huge negative impact on ployer would incur if they retained run health insurance system of the sort a number of the hospitals in my State. coverage, many businesses concerned found in Europe and Canada is bad Mr. President, I yield the floor. about the bottom line would be enticed enough, but even more troubling is the The PRESIDING OFFICER. The Sen- by the bill to stop providing any health fact that these proposals would create ator from Illinois. insurance coverage. So they are actu- a series of perverse incentives ulti- Mr. DURBIN. Mr. President, is there ally enticed here to drop health insur- mately harmful to workers, businesses, a unanimous consent order of business? ance coverage—another thing we don’t and the entire economy. The Senate The PRESIDING OFFICER. There is want to see happen. must reject this poorly conceived, ruin- not. Furthermore, employers who offer ously expensive scheme and get back to Mr. DURBIN. Mr. President, I rise to flexible spending accounts or FSAs will the business of helping our economy re- speak as in morning business. be encouraged to stop providing these cover. I would like to say at the outset I re- tax-free medical spending accounts for I have talked to many people across spect very much my colleague from the their employees. Under the Senate the United States and particularly in State of Kansas. He and I have worked Democrats’ bill, FSA contributions Kansas, many people who are deeply on many issues together. In fact, we will be included in the total cost of em- concerned about this economy and the traveled together to Africa, a memo- ployees’ health insurance benefits for perverse things coming out of Wash- rable trip for both of us, I am sure, vis- the purpose of calculating the proposed ington. While they might start consid- iting the Democratic Republic of tax on high-cost health plans—the so- ering investing in their small business, Congo, Rwanda, and meeting a lot of called Cadillac health care plans. Add- putting some income or something out people in desperate straits. I thank him ing an FSA contribution could push to be able to grow and create jobs, peo- for that. the total cost of health benefits above ple are holding back and saying: I don’t I know he is now preparing for an- the high-cost threshold for many work- know how many more taxes you will other public career in the State of Kan- ers, which will result in the employer put on us or what the health insurance sas, with the blessing of the Kansas being liable for a portion of the 40 per- plan will look like. I don’t know what voters. But in the meantime, he con- cent high-cost plan’s tax. As more and cap and trade will do on raising energy tinues to be a very important, vital more plans become subject to the high- costs. voice in the Senate. I thank him for cost plan’s tax, it will be in the em- They are holding back. These per- that as well. ployer’s best interest to eliminate FSA verse economic signals, and the discus- We do disagree on health care reform. offerings altogether. That is another sion of them in Washington, is per- I know he has had a chance to explain disincentive we don’t want to see hap- versely affecting the economy. It is his point of view. I will say I disagree pening. hurting the economic recovery. If you with many of his conclusions about The proposed legislation would also put these pieces into place statutorily, what we are about, what we are trying create new marriage penalties across you are hurting savings, hurting hir- to accomplish. the income spectrum. We have been ing, hurting marriage formation, and This is the bill that is before us when working for some years to do away you will further hurt an already very we return to the health care reform de- with the marriage penalty. Marriage is tentative recovery from taking place. bate. It is 2,074 pages long. It is the a good and solid institution that helps This is a bad medicine for the econ- product of 1 year’s work by two major so much in this Nation. Yet it puts in omy. The idea that you would expand committees in the Senate. The House a marriage penalty, penalizes people Medicare to take care of that is a ter- of Representatives spent a similar pe- for getting married; it is built into this rible idea. You will be hurting a pro- riod of time in three different commit- legislation. These penalties can be so gram that already is not financially tees working on it to come up with large that, in some cases, couples solvent in the long term and is looking their work product, which they passed would have to forgo marriage in order at something like $30 trillion of un- just a few weeks ago. to avoid thousands of dollars in new funded obligations already on its This is historic because we have been taxes. The penalties are significant. books. That alone, if you expand it promising this and threatening this Low- and moderate-income families back to age 55, plus the provider com- and talking about this for decades. It often have limited savings as well. munity—the American Medical Asso- was Theodore Roosevelt who first Given the already significant marriage ciation and the American Hospital As- raised the question about whether penalties in low-income benefit pro- sociation are opposed to this expansion America could accept the challenge of grams, it seems ironic that the govern- of Medicare. They don’t get full reim- providing health care for every citizen. ment would create yet another pro- bursement of costs right now. With the That was over 100 years ago. Then, of gram that penalizes low-income indi- talk about bringing it back to age 55, course, Harry Truman, who, in a more viduals for getting married. you will be sweeping a large number of modern era, issued the same challenge. Currently, if they are on public as- people into Medicare, so you are sweep- He was confronted by his critics who sistance and they get married, their ing in a lot of people who are already said: He is talking about socializing combined incomes often move a couple in private insurance plans. When they medicine. Must be socialism that Harry out of the support they receive for are pulled out of private insurance Truman is proposing. The idea died. their families, whether it is health sup- which pays at the full rate to the pro- Then, again, Lyndon Johnson raised port, housing, or food support. By get- vider community, you are taking those it in the early 1960s. He was a master of ting married, they often lose their ben- resources away from the provider com- the Senate, as he has been character- efits. Instead of taking them away, we munity, from doctors and hospitals. ized in a book that has been written ought to be helping them form solid That is why you are seeing the Amer- about him. He believed he had the families. That sort of disincentive is ican Medical Association and the power to make this happen to deal with built into this health insurance plan as American Hospital Association come the health care system across the well, where you actually put in dis- out against this proposal on Medicare board in America. It turned out he incentives for low-income couples to expansion. How on Earth would it ever made a significant contribution with get married. In other words, to be able be paid for, when the program is al- the enactment of Medicare and Med- to get the health insurance subsidy, ready not on a stable financial track? icaid but could not reach the goal of they may have to forgo marriage. That The Federation of American Hos- universal health care or comprehensive is not the sort of incentive we want in pitals stated this: health care reform.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00048 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.074 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13019 This President, President Obama, that we will help you pay for your pre- We also say, when it comes to your came to us and issued the same chal- miums. The lower your income, the children—you know how it is today, lenge. He said we have reached a point more we will help pay. you learn the hard way—when your of no return. The current health care If you are making, for example, as an kids who are on the family plan reach system in America is unsustainable, it individual, less than $14,000 a year, you the age of 24, they are off. We extend is unaffordable, and the cost of health will not pay for your health care. It that to age 26, which I think is a little care goes up dramatically. Ten years will be covered by Medicaid, the pro- more peace of mind, particularly for ago, a family of four paid an average of gram that is now nationwide, and you students graduating from college look- $6,000 a year, $500 a month for health will not have to pay a premium. Then ing for jobs these days. It is not easy. care insurance. Now that is up to twice as you make more money, you will pay We want to make sure they are covered that amount, $12,000 average for a fam- a little bit of a premium with help with health insurance while they are ily of four, $1,000 a month. In 8 years, from this bill. paying off their student loans and with projected increases in costs, we The Republicans have not produced a building their career. That is in this expect that the monthly premium for plan of any kind that deals with help- bill. the family of four to go up to $2,000 a ing families of limited means, modest There is not a bill from the Repub- month, $24,000 a year. We know that means, pay for their health insurance lican side of the aisle that deals with premiums. We have. The Congressional represents 40 percent of earnings for the Patients’ Bill of Rights. In fact, it Budget Office has scored it. One of the many people. That is absolutely is a rare Senator on the other side of major provisions in this bill—and one I unsustainable. the aisle who even stands and is crit- What we have tried to do, first and think most people will identify with ical of health insurance companies in foremost, is address affordability. How quickly—is the fact that health insur- the way they are treating people in can we make health insurance protec- ance reform is included too. There is a this country. tion more affordable for more families? Patients’ Bill of Rights in this bill. It I do not know if my friends on the How can we start lessening the annual basically says we should bring an end other side of the aisle get back home to the discriminatory practices of increase in premiums and actually help enough to meet with some of these health insurance companies against people by substantially cutting the families. Surely they do. They must re- American citizens. We know what we cost of premiums for many families? It ceive mail that tells them about these are talking about. stories we have all heard about. You is a big challenge, and we have, I think, Friends of mine, a family I am closer would think they would be endorsing risen to the challenge with this bill. to than any other family in Spring- The other side of the aisle has ideas, our approach in this bill. Instead, they field, IL, has a son fighting cancer. He they have amendments, they have are critical of it from start to finish. is a young man in his forties. He has speeches, they have charts, but they do They talk a lot about taxes. I want young children in high school. He was not have a comprehensive health care you to know, under this bill, if you diagnosed with melanoma just a few reform bill. They do not have a bill have a small business with 25 or fewer years ago. His oncologist has worked employees, we actually provide tax that has been sent over to the Congres- with him with chemotherapy and radi- breaks to help you provide insurance sional Budget Office, carefully read, ation and with the kind of treatment for your employees. There are a lot of and evaluated. It took weeks to do it. and drugs and surgeries he needed. As a businesses, mom-and-pop businesses, They do not have a bill that came back result of it, he has gone through some for example, that cannot afford health from the Congressional Budget Office, tough surgeries and tough treatment. considered to be the neutral observer of His oncologist said at one point: We insurance that will have a chance now action on Capitol Hill. They do not have a drug we believe will help you. because of tax breaks here. Then, when it comes to paying for have a bill that came back from the He gave him the drug, and the drug, in premiums, I mentioned earlier, if you CBO that has been characterized as ac- fact, arrested the development of his make $80,000 or less, we provide tax tually reducing the deficit. cancer. This bill, according to the Congres- Shortly after the drug was prescribed breaks in helping you pay for it. The sional Budget Office, will reduce Amer- and administered, his health insurance cost of it in tax breaks is $440 billion ica’s deficit over the next 10 years by company that he paid into for years over 10 years. It is a huge amount of $130 billion and over the following 10 came back and said: We will not cover money we are providing to American years another $650 billion. It is not just that drug. The drug costs $12,000 a citizens to give them a chance to pay dealing with health care reform; it is month. It is impossible for him, as the for their health insurance premiums. dealing with the costs of health care to coach of a baseball team at one of our All we hear from the other side is: Oh, our government and reducing our ex- universities, to come up with that kind this bill is going to raise taxes. It does penditures by significant amounts. It is of money. His family borrowed money raise some. It raises taxes on health in- the largest deficit-reduction bill ever to pay for one of the treatments, and surance companies for what we call considered on the floor of the Senate. now they are suing the insurance com- Cadillac health care policies. Although the Republicans have many pany in the hopes that they can get We can debate for a long time wheth- ideas, they do not have anything that coverage. er that level of policy, $25,000, is a rea- matches this bill in terms of deficit re- After all those years paying in, when sonable level or should be something duction or bringing down the cost of they finally needed that coverage, they different. But the fact is, it is a tax on health care. They have not produced a turned him down. I hope he wins that the health insurance company. It will bill which will extend the reach of lawsuit. This is a very profitable insur- likely result in fewer policies that are health insurance coverage to 94 percent ance company. It is a company that that grand and that expansive being of our people in this country, which should be paying, but they are not. issued. this bill does. That is one example of thousands we I think this is a bill that moves in For the first time in the history of could talk about. the right direction. It is a bill that the United States of America, 94 per- The purpose of this bill is to make makes insurance more affordable. It is cent of our American citizens will have sure a friend of mine, his family, and a bill that does not increase the deficit, peace of mind knowing they have other families just like his have a it reduces it. It is a bill that gives peo- health insurance. Today, 50 million do fighting chance against these insur- ple a fighting chance against health in- not. This bill will take 30 million off ance companies. We say in this bill we surance companies that discriminate the uninsured rolls and put them in in- are going to provide a way for protec- against their customers. It is a bill surance plans that can protect their tion for people with a preexisting con- that extends the coverage of health in- families, and it will help them pay for dition; that if you have a history of surance of 94 percent of Americans. It the premiums. If people are making high cholesterol or high blood pressure, is a bill that looks at putting Medicare less than 400 percent of poverty—which if you have some cancer in your family, on sound footing. It adds 5 years of sol- in layman’s terms is about $80,000 a it is not going to disqualify you. You vency to Medicare—5 years. There has year in income. If your family makes are still going to be eligible for health not been a bill produced on the other $80,000 or less, we provide in this bill insurance, a policy you can afford. side of the aisle that even adds 1 year,

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00049 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.076 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13020 CONGRESSIONAL RECORD — SENATE December 11, 2009 that I am aware of. It adds 5 more that has been carefully analyzed, I Back in December of 2006, when the years of solvency. That is the reason don’t think is a responsible approach housing markets were humming along why this bill has been supported by the to the serious problem that we face and the bankers and brokers were rak- American Association of Retired Per- today. ing in money, the Center for Respon- sons. We have support of medical pro- There are real-life stories of people sible Lending published a report called fessionals, senior organizations, and who have contacted me. One of them I ‘‘Losing Ground.’’ That report, in De- consumer groups all across America. will tell you about involves a small cember of 2006, estimated that nearly 2 They know, as we do, we cannot wait business. Right now we know that one million homes would be lost to fore- any longer. sick employee of a small business can closure in the coming years due largely I also wish to make the point that drive the cost of health care for the to shoddy subprime mortgages. the Senate bill offers significant sav- whole company to limits where they Here is what the Mortgage Bankers ings for seniors. The CMS Actuary just can’t afford it. My friends, Martha Association told the Washington Post projects a net $469 billion in Medicare and Harry Burrows, whom I have met, when they heard of this study. It was and Medicaid savings over 10 years, are small business owners in Chicago, authored by the Center for Responsible slightly more than the Congressional and they have to wrestle with this Lending. Budget Office. It extends the life of the problem and try to run a successful The report is ‘wildly pessimistic’ because Medicare trust fund, according to the business at the same time. When they most homeowners have prime loans and are Office of the Actuary, by 9 years. That opened their toy store, Timeless Toys, not at financial risk. is longer than anyone has projected in 16 years ago, they promised to provide That is what a senior economist at previous forecasts, but it is a signifi- health insurance to their full-time em- the Mortgage Bankers Association said cant increase, almost doubling the life ployees. Martha Burrows said: in December of 2006. He went on to say: of the Medicare trust fund over what it Since we were covered, we wanted to offer The subprime market is a small part of the currently would be. the same benefit to our employees. overall market. Lending industry officials It reduces premiums by $12.50 a But as their health care premiums have said that regulatory action could injure month by the year 2019 or $300 per cou- have skyrocketed with leaps of more the subprime market. ple per year. Slowing Medicare growth than 20 percent at a time, the commit- When he speaks of regulatory action, will lower health care costs for seniors ment has taken its toll on their busi- he means regulating these subprime as well as younger Americans. Not only ness. Providing health insurance to markets. will there be a premium savings, but their full-time staff of seven meant On the floor of the Senate, I was in- coinsurance will fall as well. cuts not only to profits but also to the volved in a debate with a Senator from The Senate bill slows the growth of wages of their employees. In general, Texas named Phil Gramm. I offered an health care costs. The Actuary report the older employees faced even higher amendment to a bankruptcy bill which we have, for example, says, ‘‘ . . . Re- costs. We shouldn’t put our Nation’s Senator GRASSLEY and I worked on ductions in Medicare payment updates employers in a position where the which said: If you are guilty of preda- for providers, the actions of the Inde- health costs of an older worker can tory lending, you will be precluded in pendent Medicare Advisory Board, and make such a huge difference. bankruptcy from pursuing your claim. the excise tax on high-cost employer- Marcia says: That was debated on the Senate floor, sponsored health insurance would have I don’t like making decisions that way. I and debating on the other side against a significant downward impact on fu- want to base hiring decisions on the quality my amendment was Senator Phil ture health care cost growth rates.’’ of the person. Gramm of Texas, who said on the floor The bend in the health care cost The legislation on the floor, inciden- of the Senate: curve is evident. Health care costs tally, deals with the rating of premium If the Durbin amendment passes, it will de- under the Senate bill begin to decline costs for senior citizens, for example, stroy the subprime mortgage market. as cost savings begin to kick in. and makes a fairer rating system. Cur- Well, my amendment failed by one I have not mentioned this bill focuses rently, health insurance companies in vote, and the subprime mortgage mar- on prevention and wellness too. If there America are exempt from the antitrust ket continued until it collapsed just a is one thing we need, it is to encourage laws. Under a bill known as McCarran- couple of years ago. I wish I had had people to take care of themselves and Ferguson, passed in the 1940s, they are another vote for my amendment. to get a helping hand for the tests they exempt, along with organized baseball, At the time this debate took place in need to stay healthy and to monitor which means the insurance compa- December of 2006, about 25 percent of their conditions. This preventive care nies—health insurance companies and home loans were subprime. So the and wellness, though we have not been others—can literally sit down in a mortgage bankers, unfortunately, mis- credited by the Congressional Budget room and conspire, collude, agree on led the public about the state of the Office, is an important element of this prices they are going to charge. If any market at the time to wave away bill. other companies that were supposed to warnings about any crisis that might I think there is one thing on which be competing did that in America they be following, and we all know what we should all agree. The cost of health would be sued but not the insurance that has meant to this country. care, particularly for small businesses, companies. So they can set premiums I go back to that episode now because is very difficult. On the Senate floor, and agree on what the premiums will 3 years later, in 2009, we have had more both Democrats and my friends on the be, and they can divide up the market than 2 million foreclosures, something other side of the aisle have recognized for the sale of their products, sending the Mortgage Bankers Association said small businesses are struggling to pay some companies to one town and some wouldn’t happen. In fact, the Mortgage for health insurance. But there is a to another, making sure they do not Bankers Association has recently an- real difference. We have offered a solu- compete against one another. nounced that in the third quarter of tion, one that is comprehensive and That is the reality of health insur- this year, nearly one in seven families one that has been scored and carefully ance today. What we provide in this paying mortgages in this country were analyzed by the Congressional Budget bill is protection against the ratings either behind on their payments or al- Office. which discriminate against people be- ready in foreclosure—one out of seven Unfortunately, that has not happened cause they are elderly or because they people holding mortgages today. It is on the other side. Their approach is ba- are women. We put limits to the rating hard to imagine. That is the highest it sically to criticize what we have pro- differences that will be allowed in has ever been. posed but to offer no alternative. If health insurance policies. There is no The statement from the Mortgage they are happy with the current sys- bill I know of from the Republican side Bankers Association said: tem, I understand that. If they will that even considers or addresses that Despite the recession ending in mid-sum- concede that it is hard to produce a bill problem. mer, the decline in mortgage performance like this, I would understand that. But Mr. President, one of the issues that continues. merely to criticize this without alter- I have tried to focus on in the midst of Three years ago, the rosy scenario native, a comprehensive alternative this recession is our foreclosure crisis. they painted has now morphed into a

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00050 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.077 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13021 much more serious situation which One last statistic. The Wall Street the executive branch of government, they cannot ignore. I have been talking Journal ran a front-page story recently under the President of the United about this foreclosure crisis since early highlighting that one in four home- States, who says this about this reform in 2007. I stand here with some regret owners who are paying a mortgage bill—that it will cost more than the and say it is getting worse. today owes more on their mortgage status quo. The Chief Actuary of the In Illinois, foreclosure filings in the than their house is worth. One in four Centers for Medicare & Medicaid Serv- six-county region around Chicago went homeowners is making house payments ices issued a report on Senator REID’s up 67 percent in the last quarter. This on a home that is now underwater. If bill which shows that health care costs isn’t just a problem for the city of Chi- you owe more than your house is worth would go up, not down, under his bill. cago. New filings in Cook County, and have no extra cash lying around, The Chief Actuary warned that the mainly suburban areas, were down 4.6 you are really vulnerable. If there is a Democrats’ health care bill would in- percent last quarter. The problem, un- sickness in your family, a health care crease health care costs, threaten ac- fortunately, has migrated to the sub- emergency, a job loss, you could lose cess to care for seniors, and force peo- urbs. All of the so-called ‘‘collar coun- your home. If you are underwater, you ple off their current coverage. ties’’ around Chicago have experienced are likely to stay there. In other words, the administration’s massive increases in foreclosure activ- The 10.7 million families who find own Chief Actuary conclusively dem- ity. Kane County, a near-in county to their mortgages are higher than the onstrates that the Democrats’ rhetoric the city of Chicago, saw foreclosure fil- value of their homes are at serious risk does not match the reality of the bill. ings increase 97 percent in the last of foreclosure. Over 400,000 of those The cost curve would bend up, not quarter over a comparable period last families are at risk in my home State down. National health expenditures year. of Illinois. JPMorgan Chase estimates would increase from 16 percent of GDP I know the administration is working that home prices won’t hit bottom to 20.9 percent under the Reid bill. The on this. The Home Affordable Modifica- until next year, so it is going to get Chief Actuary concluded that the Fed- tion Program is helping some families. worse before it gets better. eral Government and the country I know Treasury has stepped up nam- So do we stand idly by and watch would spend $234 billion more under the ing and shaming and hoping that it this—watch people lose their life’s sav- bill than without it. The Chief Actuary will provide more data for the public ings and their homes, watch these also says that the bill ‘‘jeopardizes ac- on which banks are actually trying. boarded-up homes spring up across our cess to care for beneficiaries’’ because Some are—not much but some are. neighborhoods, around towns large and of the bill’s severe cuts in Medicare. Many are not trying at all to renego- small across America and shake our Quoting the Chief Actuary: tiate mortgages for people facing fore- Providers for whom Medicare constitutes a closure. But no matter how much the heads and say it is inevitable? We don’t have to. What we have to do is lean on substantive portion of their business could Treasury Department leans on these find it difficult to remain profitable and . . . bankers, the big banks that service these banks legally, with new laws that might end their participation in the program most of these troubled mortgages have put pressure on them to make a dif- (possibly jeopardizing access to care for simply not stepped up to the plate. ference. Don’t appeal to their better beneficiaries). Treasury reported yesterday that 3.3 nature. We have tried that, and it Then it speaks about the savings in million families are eligible for the didn’t work. We have to use the law. the bill being unrealistic. The Actuary Home Affordable Modification Pro- We have to stand up for this economy says that many of the Medicare cuts gram. Those are the families who are and putting it back on its feet, and we ‘‘are unrelated to the providers’ costs at least 2 months behind on their mort- have to make the point of saying to of furnishing services to beneficiaries.’’ gages and in serious risk of being these bankers that they have to nego- It is therefore ‘‘doubtful’’ that pro- thrown out in the street. How many tiate these mortgages. viders could reduce costs to keep up families, based on this 3.3 million fami- We need to do our part in the Senate. with the cuts. lies eligible for this program, have As we focus on health care and jobs and Then the Chief Actuary speaks about been able to get a bank to commit to a the state of the economy, let’s not lose new taxes costing consumers $11 billion permanent loan modification that will sight of this foreclosure crisis that is per year. The new taxes in the Reid bill keep them in their homes? There were devastating neighborhoods across the would increase drug and device prices 31,000 out of 3.3 million; less than one- country. The economy will struggle to and health insurance premiums for tenth of 1 percent of the families in fully recover until more families are consumers. The Actuary estimates this trouble have been able to work out a confident enough in their homes that would increase costs on consumers by permanent solution with their bankers. they are willing to go out and go shop- $11 billion per year, beginning in 2011— That is disgraceful. ping again. We must do more. that is 3 years before most benefits The big banks that created this mess Mr. President, I yield the floor. kick in. continue to stand in the way of clean- The PRESIDING OFFICER. The Sen- Then the Actuary speaks about ing it up. They are making billions of ator from Iowa. health care shortages, that these dollars while foreclosing on millions of Mr. GRASSLEY. Mr. President, I had health care shortages are ‘‘plausible American families. Shaming the banks a chance to listen to my good friend, and even probable,’’ particularly for with speeches on the floor of the Sen- the Senator from Illinois; his remarks Medicare and Medicare beneficiaries. ate isn’t going to work. We have about why the bill before the Senate is Because of the increased demand for learned the hard way that many banks going to reduce costs and pay down on health care, the Actuary says that ac- are beyond embarrassment. You can’t the national debt. Now, that is the cess-to-care problems—again these embarrass bankers who take billions of Senator from Illinois. I am the Senator words ‘‘plausible’’ and even ‘‘probable’’ taxpayer dollars to stay solvent and to from Iowa. But I would like to not under the Reid bill. The access prob- overcome their bad banking policies, refer to my judgment about this bill lems will be the worst for seniors on then turn around and pay millions out right now. What I would like to refer to Medicare and low-income people on in bonuses to the officers of the same is the judgment outlined in a report Medicaid. The Actuary says ‘‘providers banks. You can’t publicly shame bank- that was issued today from the Chief might tend to accept more patients ers into doing something when they Actuary of the Centers for Medicare & who have private insurance with rel- simply don’t care. Medicaid Services in the Department atively attractive payment rates and But let’s be clear. Congress hasn’t of Health and Human Services, a pro- fewer Medicare and Medicaid patients, done its part either. We have not done fessional person who calls it like it is. exacerbating existing access problems enough to make these banks help the That is his responsibility. for the latter group.’’ American people who need some help. I Remember, I am quoting from a re- Premiums for the government-run will continue to come to the floor to port that was just given today about plan would actually be higher than remind my colleagues that we must ad- this 2,074-page bill we have before us, under private plans. Agreeing with the dress this crisis far more aggressively and that my friend from Illinois was Congressional Budget Office, the Chief than we have, and I will continue to just speaking very favorably about. So Actuary said that because the govern- look for ways to help. I am going to talk about somebody in ment plan would not encourage higher

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00051 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.078 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13022 CONGRESSIONAL RECORD — SENATE December 11, 2009 value health care and it would attract Actuary tallied up around $493 billion wide productivity gains, are unlikely sicker people, premiums for the gov- in net Medicare cuts, and he raised to be sustainable on a permanent an- ernment-run plan would be 4 percent concerns in particular about two cat- nual basis.’’ That is right out of the re- higher than for the private insurers. egories of these Medicare cuts. port of the Actuary. Then there is a point about employ- First, the report warns about the per- The second category of Medicare cuts ers dropping coverage. The Chief Actu- manent productivity adjustments to the Chief Actuary raises concerns ary concluded that 17 million people annual payment updates. These pro- about would be imposed by the new will lose their employer-sponsored cov- ductivity adjustments ‘‘automatically independent Medicare advisory board erage. Many smaller employers would cut annual Medicare payment updates created in this 2,074-page bill. This new be ‘‘inclined to terminate their exist- based on productivity measures for the body of unelected officials would have ing coverage’’ so their workers could entire economy,’’ not just for that sec- broad authority to make even further qualify for ‘‘heavily subsidized cov- tion of health care part of the econ- cuts in Medicare. These additional cuts erage’’ through the exchange. omy. in Medicare would be driven by arbi- Then it speaks, lastly, about the The Chief Actuary confirms that trary cost growth targets based on a long-term health care part of this bill these permanent cuts would threaten blend of general economic growth and called the CLASS Act. The CLASS Act access to care. Referring to these cuts, medical inflation. This board would stands for Community Living Assist- he wrote that ‘‘. . . the estimated sav- have the authority to impose further ance Services and Support, C-L-A-S-S. ings . . . may be unrealistic’’ and ‘‘. . . automatic Medicare cuts, even absent The Chief Actuary has determined possibly jeopardizing access to care for any congressional action. that the CLASS Act long-term care in- beneficiaries.’’ The Chief Actuary gives a reality surance program faces ‘‘a significant ‘‘It is doubtful that many could im- check to this proposal. He shows how risk of failure’’ because the high costs prove their own productivity to the end tall an order the Reid bill’s target for will attract sicker people and lead to achieved by the economy at large.’’ health care cost growth actually is. low participation. Even though pre- This is a direct quote from the Chief Again quoting the Actuary: miums would be $240 a month, the pol- Actuary’s report. He goes on to say, Limiting cost growth to a level below med- icy would result in ‘‘a net Federal cost ‘‘We are not aware of any empirical ical price inflation would represent an ex- in the long term.’’ evidence demonstrating the medical ceedingly difficult challenge. I think quoting the Chief Actuary is community’s ability to achieve produc- He points out in this analysis that a very good way to bring attention to tivity improvements equal to those of Medicare cost growth was below this the shortcomings that, on this side of the overall economy.’’ target in only 4 of the last 25 years. the aisle, we have tried to discuss In other words, basically he is saying Just think—what this 2,074-page bill is about the 2,074-page bill. Members on this: If you are going to make a judg- trying to accomplish is something that this side of the aisle have shown that ment that you are going to cut health has been accomplished in only 4 out of the Reid bill will bend the health care costs and that productivity has to the last 25 years. spending curve the wrong way over the be measured by the entire economy, The Actuary also points out that the next year and that the Reid bill cuts you can’t take the entire economy and backroom deals that carved out certain Medicare by $1⁄2 trillion and jeopardizes apply it to a small segment of the types of providers would complicate seniors’ access to care. So, again, economy—health care—and expect it to this board’s effort to cut Medicare. So, quoting from the Health and Human be fair and expect that small segment to this analysis: Services Chief Actuary’s analysis con- of the economy to be as productive and The necessary savings would have to be firms the dangerous consequences of equal the productivity of the entire achieved primarily through changes affect- the 2,074-page Reid bill. U.S. economy. ing physician services, Medicare Advantage I would like to highlight some of the You have to listen to these people payments, and Part D. findings in a more encompassing way who are professionals in these areas. So providers, such as hospitals, will than I just did, quoting the Chief Actu- The Chief Actuary is a professional. In escape from this board’s cut at the ex- ary. fact, the Chief Actuary’s conclusion is pense of doctors, Medicare Advantage First, contrary to what Members on that it would be difficult for providers plans, and higher premiums imposed on the other side of the aisle claim, the to even remain profitable over time, as beneficiaries for their Medicare drug Chief Actuary’s report confirms that Medicare payments fail to keep up coverage, Part D of Medicare. If we sur- the Reid bill bends the cost curve the with the cost of caring for bene- vey the Nation’s seniors, I doubt very wrong way. According to the HHS ficiaries. much they would say that raising their Chief Actuary, over the next 10 years— Referring to this chart, ultimately, premiums for Medicare drug coverage and this chart highlights it—‘‘total na- here is the Chief Actuary’s conclusion: is what they would call health care re- tional health expenditures under this that providers who rely on Medicare form. bill would increase by an estimated might end their participation in Medi- This board, which can cut reimburse- total of $234 billion.’’ And a good por- care, ‘‘. . . possibly jeopardizing access ments, is guaranteed to have to impose tion of the increase in national health to care for beneficiaries.’’ That is right these additional Medicare cuts. In expenditures would be caused by the out of the Chief Actuary’s report, is other words, they can do it. so-called fees in this bill on medical de- where that quote comes from. According to the Chief Actuary’s vices and on prescription drugs and on He even has numbers to back up analysis of the Medicare cuts in the health insurance premiums. these statements. His office ran sim- Reid bill, even though the Medicare Here we have a chart where the Chief ulations of the effect of these drastic cuts already in the Reid bill are ‘‘quite Actuary found that ‘‘. . . fees would and permanent cuts. Here we have the substantial,’’ they would—the savings . . . be passed through to health con- quote. Based on the simulations, the ‘‘would not be sufficient to meet the sumers in the form of higher drug and Chief Actuary found that during the growth rate targets.’’ This means the device prices and higher insurance pre- first 10 years, ‘‘. . . 20 percent of Medi- board will be required by law to impose miums . . .’’ This would result in ‘‘. . . care Part A providers would become even more Medicare cuts, in addition an associated increase of approxi- unprofitable . . . as a result of produc- to the massive Medicare cuts already mately $11 billion per year in overall tivity adjustments. in the bill. national health expenditures.’’ This re- This is going to be horrible on rural This bill imposes a $21⁄2 trillion tab futes claims from the other side that America where we already have dif- on Americans. It kills jobs with taxes the so-called fees won’t be passed on to ficult times recruiting doctors and and fees that go into effect 4 years be- consumers. And this analysis clearly keeping our hospitals open. As I said, it fore the reforms kick in. refutes claims from the other side that is difficult to keep up with these pro- It kills jobs with an employer man- the Reid bill saves money. ductivity adjustments by our pro- date. It imposes $1⁄2 trillion in higher Next, the Chief Actuary also con- viders. It is for this reason that the Ac- taxes on premiums, on medical devices, firms that the Reid bill jeopardizes tuary found that ‘‘reductions in pay- on prescription drugs and more. It beneficiary access to care. The Chief ment updates . . . based on economy- jeopardizes access to care with massive

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00052 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.080 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13023 Medicare cuts. It imposes higher costs. general, these individuals and families There being no objection, the mate- It raises premiums. It bends the growth are not receiving the subsidy for health rial was ordered to be printed in the curve the wrong way; in other words, insurance. This means they have no RECORD, as follows: up instead of down. This is not what government benefit to offset their new CONGRESS OF THE UNITED STATES, people have in mind when they think tax liability. The most important point JOINT COMMITTEE ON TAXATION, about health care reform. I want to make—for the third time—is Washington, DC, December 9, 2009. There is another aspect to this bill that these tax increases fall on individ- Hon. MIKE CRAPO, that I wish to go over. I hope the third uals making more than $50,000 and fam- U.S. Senate, time is the charm. I hope this time the ilies making more than $75,000. Again, Washington, DC. DEAR SENATOR CRAPO: This letter is in re- other side of the aisle will understand I highlighted this group on the Joint that the Reid bill increases taxes on sponse to your request of December 8, 2009, Committee on Taxation chart. for information regarding the ‘‘Patient Pro- middle-income families, individuals, The Joint Committee distributed in tection and Affordable Care Act,’’ as intro- and single parents. That is because this chart three separate tax provi- duced by Senator Reid. In particular, you re- contrary to the claims made by the sions: the high-cost plan tax, the med- quested that we provide you with informa- other side of the aisle, the Reid bill ical expense deduction limitation, and tion on the provisions in the bill that would clearly raises taxes on middle-income the Medicare payroll tax. Among these increase tax liability for taxpayers with adjusted gross income (‘‘AGI’’) under $200,000 Americans. We have data, not from tax provisions, the high-cost plan tax this Senator, but as I quoted pre- ($250,000 in the case of a joint return). seems to be garnering the most atten- In previous correspondence with you, we viously the expertise of the Chief Actu- tion and also tremendous opposition. I ary, I want to quote the expertise now provided a distributional analysis of the bill. don’t have to explain who the oppo- In estimating the distributional effects of of the Joint Committee on Taxation, nents of this tax increase are. Every- the bill, we distributed items that have eco- professionals who are blind to politics, body knows. In fact, yesterday I had nomic incidence on individuals, including who judge things and call them like representatives of the Iowa Education some items that do not have statutory inci- they see them. Yesterday I pointed out Association, the teachers of Iowa, say- dence. We are enclosing a copy of that dis- how the same Joint Committee on Tax- tributional analysis for reference. Included ing they are against that high plan tax ation data led my Democratic friends in the distribution table are the following because it is going to hurt Iowa teach- to proclaim that the Reid bill provided items that would have statutory incidence as ers. So if this provision, the high-cost a net tax cut to all Americans. We have well as economic incidence on individuals plan tax, were to drop out of the Reid this distribution chart I used pre- and are likely to increase tax liabilities for bill for one reason or another—and this some taxpayers with AGI below $200,000 viously to show that that net really is bill is still being written in secret or at ($250,000 in the case of a joint return): not net. 1. Raise the 7.5 percent AGI floor on med- There is no question that the bill least changes in this 2,074-page bill are being written in secret so who knows ical expenses deduction to 10 percent; and does provide a tax benefit to a group of 2. Additional 0.5 percent hospital insurance Americans, a relatively small group. A what is going to happen to this highly tax on wages in excess of $200,000 ($250,000 much larger group, however, will see controversial thing—if it is taken out, joint). their taxes go up. Most, if not all in some Members may feel they have suc- You asked us to enumerate items that we this group, will not benefit from the cessfully shielded the middle class have not previously distributed and that we government subsidy for health insur- from a tax increase. Unfortunately, for believe could affect the tax liability of taxpayers with AGI below $200,000 ($250,000 in ance. That is part of this 2,074-page those Members who may be hopeful of this, lesser known tax provisions that the case of a joint return). Below is a list of bill. As a result, the generous subsidy the provisions that we have not previously that is in that bill that is going to a are likely to stay in the changes that come through the Democratic health distributed and that have statutory inci- small group of Americans cannot be dence on individuals, with some of those in- used by this larger group to offset their care reform product would still raise dividuals likely to have income below your increased tax liabilities. The other taxes on the middle class. threshold: side, however, wants to spread the Again, don’t take my word for it. The 1. Conform definition of medical expenses large tax benefit that is going to this Joint Committee on Taxation tells us for health savings accounts, Archer MSAs, so. Specifically, that committee sent a health flexible spending arrangements, and small group of Americans to every- health reimbursement arrangements; body; in other words, all Americans, letter to Senator CRAPO stating that tax provisions such as the cap on flexi- 2. Increase the penalty for nonqualified even among those Americans who are health savings account distributions to 20 not eligible to receive the subsidy, and ble savings accounts, the elimination percent; then somehow claim that all Ameri- of tax reimbursements for over-the- 3. Limit health flexible spending arrange- cans are receiving a tax cut. How can a counter medicines and, most impor- ments in cafeteria plans to $2,500; person receive a tax cut if they are not tantly, the individual mandate excise 4. Impose a five-percent excise tax on cos- receiving some type of tax benefit? tax penalty will increase taxes on peo- metic surgery and similar procedures; and Yes, the data shows that some will ple making less than $250,000. That 5. Impose an individual mandate penalty. receive a benefit, but the data also happens to be middle-class individual, I hope this information is helpful to you. If middle-class families, and middle-class we can be of further assistance in this mat- shows that the others will see a tax inter, please let me know. crease. I have highlighted in yellow single parents. Sincerely, these various figures, individuals and I ask unanimous consent to have THOMAS A. BARTHOLD. families who will see a tax increase. In printed in the RECORD that letter. Enclosure.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00053 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.081 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13024 CONGRESSIONAL RECORD — SENATE December 11, 2009

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00054 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.025 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE Insert offset folio 678/3 here ES11DE09.001 December 11, 2009 CONGRESSIONAL RECORD — SENATE S13025

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00055 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.025 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE Insert offset folio 678/4 here ES11DE09.002 S13026 CONGRESSIONAL RECORD — SENATE December 11, 2009 Mr. GRASSLEY. In closing, let me free flow of information. We now try to a free public library. There isn’t that turn to one more chart the Joint Tax use it in different parts of the world in Cuba, at least not a free public li- Committee has provided. This chart based on the new challenges we have. brary. They control what books might shows the effect on the medical ex- One of those places in the world in be found there. pense deduction limitation. This tax which we do this surrogate broad- So these groups try to create infor- increase is just one of the many tax in- casting is into the island of Cuba, be- mation. One of the things they do is, creases likely to stay in the new Demo- cause it has a repressive regime that again, to be able to have access—as cratic proposal. On this chart, which is will not allow the free flow of informa- shown in this picture. This is a panel for the year 2019, because that is when tion to go to its people. We have a pro- that is talking on Television Marti. this bill is fully implemented, we see gram called Radio and Television Here, in this picture, is a young child positive dollar figures. I have high- Marti. Marti is sort of like the George watching a Marti program inside of lighted these dollar figures in yellow. Washington of Cuba. It is named after Cuba. You can see the logo here of For those who may not be able to see, him. Marti TV. I will reiterate that this chart only has In 1983, Congress passed the Radio As shown in this picture, this was a positive dollar figures on it. But re- Broadcasting to Cuba Act to provide special that was broadcast into Cuba member, as I explained yesterday, the people of Cuba, through Radio and was seen in Cuba on the Reverend when we see positive dollar figures Marti, with information the Cuban Dr. Martin Luther King on the whole from the Joint Committee on Tax- Government would try to censor and issue of peaceful, nonviolent change— ation, that committee is telling us that keep from them. Subsequently in 1990, as a message to the Cuban people that, taxes for these people are going to go Congress authorized U.S. television in fact, these things could be achieved. up. That means for all of the tax re- broadcasting to Cuba through Radio Now, you can see at the bottom of turns listed on this chart, taxes will be and Television Marti to support the these pictures—it is a little hard to going up for each. And this tax in- right of the Cuban people to receive in- see—but here is the Marti logo that is crease, the medical expense deduction formation and ideas they would not seen on the bottom right-hand corner limitation, reaches as low as someone normally receive. It opened radio and on several of these photographs. making $10,000 a year. television broadcasting to Cuba, pro- This came from that Government Ac- Maybe some of these low-income in- vided a consistently reliable and au- countability Office report. A January dividuals and families who will see a thoritative source of accurate, objec- 2009 report by the Government Ac- tax increase under this provision will tive, and comprehensive news com- countability Office noted the following: receive a subsidy for health insurance. mentary and other information about The Broadcasting Board of Gov- These people may be able to offset this events in Cuba and elsewhere. It did so ernors—which is the oversight we have new tax liability. But you can bet your to promote the cause of freedom inside as the Federal Government—and the bottom dollar that a large portion of of Cuba. Office of Cuba Broadcasting and the the middle-income individuals and We know there is a long history of re- U.S. Interests Section in Havana— families are not receiving a subsidy. pressive regimes trying to block our which, in essence, is, we do not have an This means that this tax liability high- surrogate broadcasting around the Embassy there because we do not have lighted in yellow cannot be offset by world. They just don’t simply sit back relations, but we have an Interests Sec- the government benefit. and say: Send it all in. Let me accept tion there—that Cuba officials empha- My Democratic friends cannot escape whatever it is you are sending in. That sized that they face significant chal- that fact. Even if my friends drop some is not their effort. Their effort is to lenges in conducting valid audience re- of the tax provisions in the current block. And our difficulty with broad- search due to the closed nature of Reid bill, many tax provisions will casting has never been a justification Cuban society. most likely remain. And those tax pro- for cutting funding for these programs. U.S. government officials stationed visions will increase taxes on middle- We have never submitted to the propo- in Havana are prohibited by the Castro class Americans. This not only breaks sition that when a regime tries to regime from traveling outside of Ha- President Obama’s pledge, but it will block our surrogate broadcasting— vana. arbitrarily burden middle-class Ameri- whether it was Voice of America, Radio We know it is difficult to travel to cans for years to come. Free Europe, all of those efforts, there Cuba for the purpose of conducting au- I yield the floor. was always blocking taking place— dience research. We know the threat of The PRESIDING OFFICER (Mr. that that is a cause or justification for Cuban Government surveillance and re- UDALL of Colorado). The Senator from cutting funding. It should not be a dif- prisals for interviewers and respond- New Jersey. ferent standard now. ents raises concerns about respondents’ Mr. MENENDEZ. What is the pending I ask, when it comes to Cuba broad- willingness to answer sensitive ques- business before the Senate? casting, why the double standard? In tions frankly. The PRESIDING OFFICER. The con- fact, especially now when change is In this January 2009 Government Ac- ference report to accompany H.R. 3288. coming to Cuba, it is in our interest to countability Report, U.S. officials indi- Mr. MENENDEZ. I thank the Chair. have the capacity to broadcast infor- cated that research on Radio and TV I rise about a program funded in that mation to the Cuban people. Marti’s audience size faces significant conference report. It is a program that I want to show one of the charts that limitations. For example, none of the we put under the framework of Cuba may be a little difficult back at home, data is representative of the entire broadcasting. It is surrogate broad- but these are actual photographs which Cuban population. Telephone surveys casting into a closed society, a society came from a January 2009 Government are the only random data collection ef- for which the State controls all infor- Accountability Office report which fort in Cuba, but it might not be rep- mation or attempts to control all in- were provided by an organization that resentative of Cuba’s media habits for formation to its 11 million citizens. It reports on Cuban affairs. It depicts evi- several reasons. But here are two of the is a part of a long tradition of the dence of Cubans’ ability to watch Tele- main ones. United States with the Voice of Amer- vision Marti despite Cuban jamming ef- First, only adults in homes with pub- ica type of broadcasting, the effort to forts. These pictures were taken from lished telephone numbers are surveyed. try to bring a free flow of information inside of Cuba. They may not be the According to Broadcasting Board of into countries in the world which are best picture quality, although I doubt Governors documents, approximately governed by despotic rulers. We did they have digital television inside of 17 percent of Cuban adults live in this successfully in the former Soviet Cuba. But nonetheless, they have the households with published household Union. We did it successfully in East- ability to see it. numbers. That means that 83 percent ern Europe and during the changes in There are other pictures of Cubans. of the population does not have a pub- the Czech Republic, then Czecho- Here is a picture of a group of individ- lished telephone number. slovakia, Poland, the Solidarity move- uals who, in fact, are part of an effort Second, the Board of Governors and ment, and many others. We have been to create a library system, something the Office of Cuba Broadcasting offi- proud of that history of bringing the as fundamental in the United States as cials noted that because individuals in

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00056 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.082 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13027 Cuba are discouraged or prohibited by felt willing to vote to proceed with the onstrations. Especially in light of the their government from listening to and omnibus bill. events of yesterday and today, we watching U.S. international broad- One of the body’s greatest strengths know the Castro regime is a brutal to- casts, they might be fearful of respond- is the ability to freely debate issues in talitarian dictatorship that continues ing to media surveys and disclosing an open format, issues on which, in the to violate the most basic human rights, their media habits. end, we might completely disagree, but continues to crush debate and crush di- If I am told that it is illegal for me issues that need to be brought into alog. simply to watch the programming of clear focus for the American people. Yesterday, I came to the floor as part some international organization, and However, when I see my colleagues of my concerns and I spoke about this that I can go to jail for listening to drawing conclusions on their own, gentleman and his wife, as shown in that programming, then ultimately— without reasonable data to support this picture. I spoke about Jorge Luis then ultimately—am I going to be those conclusions, I feel compelled to Garcia Perez ‘‘Antunez.’’ This is a gen- truthful to some telephone survey come and present an alternative per- tleman who said, while standing in a about: Did I watch TV Marti? Did I lis- spective of the facts. plaza in his hometown, which is in the ten to Radio Marti? Why is this important to us. The center of Havana—it is not where the Mr. President, I know about this per- United States is a beacon of light of tourists go, not on the beaches of Ha- sonally. Years ago, when I was in the freedom and democracy around the vana; it is in the heart of Havana—he House of Representatives, while I had world. The promotion of democracy said what we need is the type of change an aunt who was still alive at the time, and human rights has always been one we saw in Eastern Europe. who I had asked never to acknowledge of the pillars of our foreign policy. For that simple statement, he was thrown into jail for 17 years—17 years. me as her nephew—which she agreed Yesterday was Human Rights Day, He came out a couple years ago, but he to—in my second term, however, she which is the day that marks the anni- has not changed. He has not changed was listening to me on Radio Marti, versary of the United Nations Assem- his views or his effort to create human and in a moment of pride, she said: bly’s adoption of the Universal Dec- rights. ‘‘Oh, that Menendez is my nephew.’’ laration of Human Rights in 1948. It is He issued a public letter that I read Unfortunately, she said it in front of recognized every year on December 10. yesterday, an English translation, of a some visitors who she thought were her Yesterday, in the midst of the rec- public letter he wrote to the present friends. One of them was part of El ognition of this day in Havana, we saw dictator, Raul Castro, the brother of Comite de Defensa de la Revolucion, the brutal Castro regime cracking Fidel Castro, and he said many things. which means ‘‘The Committee to De- down on people just because they were I am not going to read the whole letter fend the Revolution,’’ a block watch trying to exercise their right for peace- again, but he said things like: Let me organization in every city, in every vil- ful demonstration. We saw people beat- ask you a few questions that I think lage, in every hamlet inside Cuba, en, arrested, and forcibly detained. are important. whose only job is to go and spy on their There is a group of ladies; they call With what right do the authorities, with- neighbors and tell the state security themselves the Ladies in White. They out a prior crime being committed, detain who speaks ill or does something are mothers and sisters and friends of and impede the free movement of their citi- against the regime. jailed dissidents inside of Cuba. So zens in violation of a universally recognized Unfortunately, for that simple act of these are people of imprisoned family right? speaking out, saying to a friend: ‘‘Oh, members—their son or their daughter, The very rights that are being ob- that Menendez is my nephew,’’ my their brother or sister, their friends— served in that international Human aunt suffered serious consequences. and the only reason those people are in Rights Day of the Universal Declara- So the audience size might very well jail is because they have pursued tion of Human Rights. be larger than the survey results would peaceful means to try to create change What feelings could move a man like Cap- indicate because people are fearful to inside of their own country. They may tain Idel Gonzalez Morfi to beat my wife, a say: Yes, I am listening to Radio and have said something. They may have defenseless woman so brutally causing lasting effects to her bones for the sole act of ar- Television Marti, because I cannot do worn a white band that says ‘‘cambio,’’ riving at a radio station to denounce with that and not face the consequences of a which means ‘‘change.’’ They may have evidence the torture that her brother— regime that would arrest me. simply uttered the fact that: What we Her brother; this is his wife shown in Radio and TV Marti have a larger au- need is change inside of Cuba. the picture— dience in Cuba. Why do I say that? Be- So these Ladies in White—they dress received in a Cuban prison. cause a 2007 survey that the Office of fully in white so that, in fact, it is a I spoke about him yesterday and his Cuba Broadcasting commissioned, in- form of being noticed, but, again, a letter. What happened today, Mr. tended to obtain information on pro- peaceful form—held long-stem flowers President? gramming preferences and media hab- and miniature Cuban flags. They were Today, the day after Human Rights its, also contained data on Radio and attacked by hundreds of angry pro-gov- Day, and the day after I read his letter TV Marti’s audience size. ernment demonstrators who sought to into the RECORD, and 2 days after he While the survey was not intended to drown out their chants of ‘‘freedom’’ presented that letter to Raul Castro, measure listening rates or project audi- by yelling ‘‘this street belongs to he was arrested again by the regime ence size, this nonrandom survey of 382 Fidel.’’ and arbitrarily detained with his wife Cubans, who had recently arrived in Now, in Cuba, these groups are not and another activist. the United States—so now they were spontaneous. It is not the citizenry. It What is his crime? That I read a let- free to say what they actually did back is something called ‘‘rapid response ter in the U.S. Senate about his calls at home because they were not subject brigades.’’ They are state security for freedom and democracy? And the to being arrested simply for listening dressed as civilians, whose purpose is day after the recognition of inter- to Radio and Television Marti—found to make it seem that the populous is national human rights, he gets ar- that 45 percent of all of those respond- against the human rights activists and rested today, and his wife gets arrested ents reported listening to Radio Marti political dissidents. But, ultimately, today—or detained today. I am not and that over 21 percent reported they are state security agents who act sure. He got arrested for sure. watching TV Marti within the last 6 in a way to make it seem quite dif- TV Marti is one of the many efforts months before leaving Cuba. ferent. But they are thugs. the U.S. Government rightly invests in So I rise because I want to bring this Mr. President, the reason the regime to try to reach the Cuban people with data, this information, this perspective organizes protests in this way is so if information, to try to reach the people to the debate. you orchestrate a protest, where it who were beaten today and yesterday I am happy to see the very deep cuts looks like its citizens are protesting and, for decades, simply for trying to that were made to the Office of Cuba against each other, then the regime demonstrate peacefully, to speak their Broadcasting that contains both Radio can deny, in fact, any role in the event. mind, to walk in peace and in remem- and Television Marti have largely been However, we know very well the role brance of their loved ones they lost restored. That is one of the reasons I the Castro regime plays in these dem- under the clenched fists of this regime.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00057 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.089 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13028 CONGRESSIONAL RECORD — SENATE December 11, 2009 I feel badly that the day after I spoke after that. Would you not want some- tunity Scholarship Program is not about Mr. Antunez, he ends up in jail. one somewhere in the world to be being terminated is yet another act of So we need to have a spotlight, just as standing and speaking for you? I deception on their part to the Amer- we did for Aleksandr Solzhenitsyn in would, and that is what I try to do on ican people. The President, who him- the Soviet Union; just as we did for this floor. self is a recipient of a K–12 educational Vaclav Havel as he was trying to cre- With that, I yield the floor. scholarship, has refused to stand up for ate change for the Czech Republic; just Mr. FEINGOLD. Mr. President, the children in our Nation’s Capital and as we did with Lech Walesa when he massive, unamendable spending bill be- fight for the same educational opportu- was having the Solidarnosc Movement fore the Senate includes three bills nities afforded to him and his family— inside Poland. that the Senate never had a chance to a right he exercises now as he practices For some reason, I can’t get anybody consider, and is chock-full of earmarks. school choice with his own children. to come to this floor and talk about At a time of record budget deficits, we Mr. JOHNSON. Mr. President, work- the human rights violations inside should be showing our constituents ing families are struggling to pay the Cuba. I hear a lot about: Let’s trade that we are serious about fiscal respon- costs of health care in this country. As with Cuba, let’s do business with Cuba, sibility. Instead of controlling spend- the debate over health care reform pro- let’s travel to Cuba but, God, I never ing, this bill represents business as gresses, we must keep in mind that hear anyone talking about these usual in Congress. Americans need and deserve quality, human rights activists like the Lech Mr. DEMINT. Mr. President, I rise affordable health care. All too often Walesas, the Vaclav Havels, the Alek- today to address a question submitted families learn that the plan they could sandr Solzhenitsyns of that other time. to me from the good Senator from Illi- afford was not adequate when they This man got arrested today simply nois as to whether the DC Opportunity needed it most. because yesterday we made his letter Scholarship Program will in fact end I recently heard from Cory and Erin public. That is the Castro regime that after this year. In order to respond to in Lake Herman, SD. They shared the I know, not the romanticism of what my colleague, I would like to highlight story of their daughter’s birth and how they discovered the inadequacies of some people have about what goes on a particular section of the Financial their seemingly affordable health in- at that island. Services and General Government Ap- So I am pleased the Office of Cuba propriations Act of 2010 that funds the surance policy. When Cory and Erin’s Broadcasting has made efforts over the District of Columbia’s budget. daughter Katarzyna was born in 2006, last year to reevaluate the programs In title IV, which explains how the Cory was working as an English and they are carrying out and carefully District of Columbia is funded, it math teacher. At the time, the family states that $13.2 million will indeed be consider creative ways to reach the health insurance plan available to him provided for opportunity scholarships through the school district cost nearly Cuban people. They have done this for existing students in the DC Oppor- 50 percent of his monthly salary. Cory with Television Marti. They will con- tunity Scholarship Program. However, chose instead to buy a catastrophic, tinue to do this with other programs. I the very next line clearly states that high-deductible policy on the indi- would expect nothing less. The kind of the funds are to ‘‘remain available vidual market for just over 10 percent evaluation should continue. We should until expended,’’ which means that the of his income. Cory and Erin were constantly strive to tailor our pro- program will eventually be phased out healthy adults and had no major med- grams so our investments are reaching and terminated once the funding for ical issues until the birth of their those who truly need our help, invest- current students is exhausted. Stu- daughter. Their insurance policy did ments that are advancing U.S. foreign dents in the program will slowly be not cover prenatal or maternity care. policy interests, the national interests phased out over time, unable to avail Wanting to be smart health care con- of the United States, and the national themselves of future educational op- sumers, Cory and Erin shopped around security interests of the United States. portunities currently given to them for the best and most affordable hos- I have a declaration that came out of through this program. pital to welcome the birth of their first Cuba of over 100 human rights activists The DC Opportunity Scholarship Pro- child and decided on their nearby com- inside Cuba who are in support of the gram, which has the overwhelming sup- munity hospitial. However, when efforts of the United States as it report of DC residents, parents, Mayor Katarzyna was born, she had a lung in- lates to the surrogate broadcasting Adrian Fenty, Chancellor Michelle fection that required immediate ac- that goes into Cuba from Radio and Rhee, former Mayor Anthony Williams, tion. Exhausted and worried for the Television Marti. This broadcasting and a majority of the DC City Council, health of their new baby girl, Cory and provides some free flow of information has now been mandated a slow death Erin had only moments to decide of what is happening in the rest of the by House and Senate appropriators. whether to airlift Katarzyna to a hos- world, as well as what is happening in- This scholarship program, which gives pital with specialized care. At that mo- side Cuba. Because that is part of what students of Washington, DC’s poorest ment, the last thing they could think we help here, to let those who other- families a chance at a quality edu- about was the cost. wise would not know because of a cation, has now effectively been termi- Katarzyna spent 3 nights in the Natal closed society and a dictatorship that nated since there is only funding avail- Intensive Care Unit of one of the rules with an iron fist what is hap- able for existing scholarships and exist- State’s largest hospitals, where she re- pening even inside their own country, ing students, and not for future schol- ceived top-notch care and survived the what is happening to people such as arships and future students. near-fatal pneumonia. The total cost Mr. Antunez, what is happening to the By funding this program in such a came to $24,000, of which Cory and ladies in white who are protesting manner in the omnibus, Congress is ul- Erin’s high-deductible insurance policy peacefully about their loved ones in timately signaling the beginning of the covered only $12,000. For the next sev- jail. end for this scholarship program. By eral months, the family faced not only Mr. MENENDEZ. With that letter of disallowing future students to take the challenges of a new baby but sig- over 100 human rights activists is the part, the size of the program will nificant debt and a drawn-out struggle recognition that we will not let up for shrink year after year, and will deny with their insurance company. They Mr. Antunez and the recognition that entry to siblings of existing partici- found a mistake with nearly every bill there are voices who will continue to pants—punishing many who have been they received. Since this experience, speak out for the human rights. waiting in line for this tremendous op- Cory and Erin have purchased a new The last point I wish to make, imag- portunity. Additionally, the federal policy but worry that the insurance ine if you were sitting in a gulag some- evaluation of this program will be com- they can afford is not adequate in the where, if you were beaten simply be- promised as the numbers of partici- face of another unforeseen medical cause you had a few words to say about pants diminishes, making it difficult emergency. creating change peacefully in your own for administrators to evaluate the ef- Like many Americans, Cory and Erin country; imagine if you could be swept fectiveness of the program. have health insurance. Despite their away by security police and taken to The fact that this administration limited income, they took the respon- some jail and maybe not seen for years continues to claim that the DC Oppor- sibility to buy their own policy and

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00058 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.083 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13029 tried to be smart health care con- The PRESIDING OFFICER. Without Mr. Doll showed his respect for his sumers. Their experience, however, il- objection, it is so ordered. customers with the motto, ‘‘I believe lustrates the vulnerability of Ameri- f that a successful law firm must empha- cans who purchase insurance on the in- size and create the delivery of prompt TRIBUTE TO CAROL BORNEMAN dividual market, as well as the limits and exceptional legal service to the cli- to which it is possible for Americans to Mr. MCCONNELL. Mr. President, ent—we must remember that the client be informed health care consumers. today I would like to recognize an out- is king.’’ One of the great successes of The health care market does not standing Kentuckian for her talented his career was helping to bring the function like other consumer markets. efforts to entertain and educate the Toyota plant to Scott County. He also Ask your neighbor what a gallon of public about the Cumberland Gap Na- served as the president of the Louis- milk costs and they could tell you. Ask tional Historic Park. Ranger Carol ville Bar Foundation. In 1986, Mr. Doll them how much it costs to have a baby Borneman is the recipient of the 2009 was named Lawyer of the Year by the and you would likely get a variety of Freeman Tilden Award for the south- Louisville Bar Association. answers, based entirely on their own east region of the National Park Serv- Bob was also active in his commu- experience with this important life ice. Ranger Carol, as she is commonly nity, as he served as president of the event. The fact is the cost of having a known from her television show, ‘‘Wild Greater Louisville YMCA board of di- baby depends. It depends on how much Outdoor Adventures with Ranger rectors and maintained a leading role you pay for health insurance, what Carol,’’ has been with the Cumberland in the Boy Scouts of America. Phillip your insurance policy will cover and Gap National Historical Park for over Scott, the current firm chairman of how much of that cost is your share. It 15 years and serves as the park’s super- Greenebaum, Doll & McDonald, stated depends on where you live, what com- visory interpreter. that ‘‘Mr. Doll was not just a great plications may arise and whether the The Cumberland Gap, through the lawyer, but a great man and great lead- Cumberland Mountains and near the hospital nearby is equipped to handle er. He was a progressive leader who Kentucky-Virginia border, was Amer- an emergency. made Greenebaum the firm it is today. ica’s historical gateway to the West. The Patient Protection and Afford- We deeply value the friendship, ideals Ranger Carol’s stories bring to life the able Care Act will guarantee families and character he bestowed upon on us, travel experiences of America’s earliest access to affordable health insurance and we’ll miss him greatly.’’ western settlers in a way that is both and coverage for essential benefits, in- As a leader in his community, Bob educational and memorable. cluding prenatal and maternity care. Doll was a man of integrity who made New health insurance exchanges in There is no doubt that it is Ranger Carol’s love for the park that keeps her a real positive impact in the Common- every State will provide a menu of wealth. His devotion for creating and quality, affordable health insurance stories entertaining. Mark Woods, Su- perintendent of the Cumberland Gap maintaining a client-focused business plans for the self-employed and those shows he always cared about serving who can’t afford the coverage offered National Historical Park, stated that ‘‘she truly has a passion for the work the community first. He will be missed by their employer. Families who need by all who had the pleasure of knowing assistance will be eligible for tax cred- that she does and it definitely comes him, and I ask that my colleagues join its to make the plan of their choice af- through on the show. . . . You cannot me in paying tribute to the wonderful fordable. Most importantly, families watch the show without being cap- life of Mr. A. Bob Doll. like Cory, Erin and Katarzyna’s will tivated by Carol’s knowledge, dedica- have health insurance that covers life’s tion, and sheer enthusiasm.’’ f essential needs. The birth of a child The Freeman Tilden Award is the EL SALVADOR most prestigious award given in the should not be a time to worry about Mr. LEAHY. Mr. President, I want to what your health insurance will pay field of interpretation and education within the National Park Service. briefly discuss a subject that should infor or whether you can afford the treat- terest all Senators concerning the ment you need. Health care reform will Borneman is not new to such an honor; in fact, this is the second time she has country of El Salvador, which recently give American families one less thing elected a new President and last month to worry about with the security of received it. It is with great pride that I rise today to ask my colleagues to suffered extensive loss of life and dev- quality, affordable health care. astating property damage as a result of Mr. MENENDEZ. Mr. President, I ask join me in congratulating Ranger Carol torrential rains caused by Hurricane unanimous consent that after any lead- Borneman on receiving the Freeman Ida. er remarks on Saturday, December 12, Tilden Award, and for her outstanding First, I congratulate the people of El the Senate then resume consideration efforts to keep important Kentucky Salvador on the election, which was of the conference report to accompany history alive for future generations to historic in that President Funes is the H.R. 3288, and that at 9:30 a.m., the enjoy. country’s first President since the end Senate proceed to vote on the motion f of the civil war who is a member of the to invoke cloture on the conference re- REMEMBERING A. ROBERT DOLL FMLN, which after the 1992 Peace Ac- port, with the time until 9:30 a.m. cords evolved from an armed insur- equally divided and controlled between Mr. MCCONNELL. Mr. President, gency into a political party. I am en- the leaders or their designees; further, today I would like to reflect on the life couraged by what I have heard about that if cloture is invoked, then of a dear friend, the late A. Robert postcloture time continue to run dur- Doll. Bob, as he was affectionately President Funes’ policies and wish him ing any recess, adjournment, or period known, was a well-known lawyer, lead- the best. Second, the destruction caused by of morning business; that on Sunday, er, and volunteer in his beloved Louis- Hurricane Ida was extensive. Excep- December 13, all postcloture time be ville community. His passing is a great considered expired at 2 p.m., and the loss, but his legacy lives on in the busi- tionally heavy and constant rain fell Senate proceed to vote on the adoption ness and organizations he so dearly on November 7 and 8, resulting in of the conference report to accompany loved. flooding and landslides that killed 192 H.R. 3288. Mr. Doll was a founding member of people. Another 80 were reported miss- The PRESIDING OFFICER. Is there the law firm Greenebaum, Doll & ing, and more than 14,295 others were objection? McDonald in Louisville. He joined the displaced from their homes. Thousands Without objection, it is so ordered. firm in the 1950s after receiving his law of homes, as well as roads, bridges, and degree from the College of William and f other public buildings, were damaged Mary. During his 50-plus years with or destroyed. MORNING BUSINESS Greenebaum, Doll & McDonald, Bob On November 10, U.S. Charge´ d’Af- Mr. MENENDEZ. Mr. President, I ask helped the firm grow from a mere 20 faires Robert Blau declared a disaster unanimous consent that the Senate lawyers to a firm with multiple offices in response to the damage, and the U.S. proceed to a period of morning busi- and 120 lawyers. When Bob was just 30 Agency for International Development ness, with Senators permitted to speak years old, he argued and won a case be- has so far allocated some $280,851 in hu- for up to 10 minutes each. fore the U.S. Supreme Court. manitarian aid. An assessment of the

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00059 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.065 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13030 CONGRESSIONAL RECORD — SENATE December 11, 2009 total damage is underway, but it is ex- cially since it identifies a number of I have long called for action to ad- pected to be in the hundreds of mil- concrete steps through which U.N. dress the armed exploitation of Congo’s lions, if not billions, of dollars. member states can address the finan- minerals, which fuels this conflict. I Congressman JIM MCGOVERN and I cial and support networks that fuel the was pleased to join with Senators have urged the administration to pro- violence in eastern Congo. BROWNBACK and DURBIN earlier this vide additional aid. We remember how This new Group of Experts report year to introduce the Congo Conflict the U.S. Government all but forgot particularly focuses on the FDLR, the Minerals Act, S. 891, which would com- about El Salvador after the war ended, armed group comprising many former mit the United States to address this and this is a time to help the Salva- Rwandan ge´nocidaires that is at the issue comprehensively. And I was glad doran people recover from this tragedy. heart of the instability in eastern that Secretary Clinton spoke about Third, an issue that has deeply con- Congo. It documents how this group this issue during her visit to Congo in cerned me for many years is the prob- continues to benefit from ‘‘residual but August. As the Group of Experts report lem of corruption and impunity in El significant support’’ from top com- makes clear, armed groups will con- Salvador. The police and the courts manders of the Congolese military. It tinue to exploit the region’s rich min- lack the training and resources they also documents how this group is sup- eral base as long as it is profitable. The need, crimes are rarely solved and per- ported by a far-reaching international Group of Experts recommends that petrators are rarely punished. Violent Diaspora network. Based on records of member states take necessary meas- satellite phones, the Group of Experts crime and corruption have become en- ures to clarify the due diligence obliga- found that the FDLR commanders fre- demic. El Salvador’s democratic and tions of companies under their respec- quently communicate with people in economic development will continue to tive jurisdictions that operate with twenty-five different countries in Eu- be impeded by a justice system that is these minerals. The Group also calls incapable of enforcing the rule of law, rope, North America and Africa. The report also mentions credible reports for the Congolese government to estab- and in which the Salvadoran people and testimony that the FDLR is using lish an independent monitoring team, and foreign investors have little con- Burundi ‘‘as a rear base’’ for regroup- with international support, to conduct fidence. ing and recruitment purposes. spot checks of mines and mineral trad- One of the courageous Salvadorans To address these continued support ing routes. who is trying to change this is Ms. networks, the Group of Experts rec- I am glad that there is increasing Zaira Navas, inspector general of the ommends that U.N. member states di- outrage about what is happening in National Police. She has a woefully in- rect their respective law enforcement eastern Congo. It is the single deadliest adequate budget and too few staff. But and security agencies to conduct inves- conflict since the Second World War despite that, from everything I have tigations and share relevant informa- and millions have been displaced from heard she is doing an outstanding job tion on FDLR Diaspora members pro- their homes, forced to live in squalid for justice and the people of El Sal- viding material support to the group. conditions. Countless women and girls vador. The Group also calls on member states and some men and boys in the Congo I mention Ms. Navas because of the to prosecute violations of the sanctions have endured rape and sexual violence. critical importance of the job she is regime by their nationals or leaders of But our outrage means little unless it doing, and because she has recently re- armed groups that are currently resid- translates into concrete actions to fun- ceived death threats and I am con- ing within their countries. The report damentally change the situation in cerned for her safety. I urge officials at cites three such leaders who have re- Congo. We need to finally get serious the U.S. Embassy to discuss with sided in France and Germany. With re- about addressing the underlying issues President Funes what steps can be gard to the Congolese military, the that make this war profitable and taken immediately to provide her the Group recommends that the Security allow it to persist. The Group of Ex- security she needs, and to increase the Council require member states to no- perts has provided a clear picture of budget of her office. tify and get approval from the Sanc- some of those issues as well as specific El Salvador is a small country but tions Committee for all deliveries of ways that U.N. member states can ad- one with which the U.S. has a long his- military equipment and provision of dress them, including within our own tory. We both have newly elected presi- training to Congo. This would help en- national jurisdictions. I applaud the dents, and I am hopeful that we will sure that international assistance is Group for its courageous work. I see a renewed effort to work together not contributing to abusive behavior or strongly hope that the Security Coun- to broaden our relations. Nothing, in going to units of the military believed cil will pursue the report’s rec- my view, is more important than to be colluding with armed groups. ommendations, and I urge the Obama strengthening the rule of law and sup- Building on its previous reports, the administration to lead the way in this porting people like Ms. Navas, but we Group of Experts report also shows how respect. should also expand our collaboration in the FDLR and other armed groups con- health, education and exchanges, the tinue to benefit from the exploitation f environment, trade and investment, of natural resources. According to this RECOGNIZING WREATHS ACROSS science and technology, the arts and Group’s investigations, the FDLR con- AMERICA culture. tinues to get millions of dollars in di- f rect financing from gold and cas- Ms. SNOWE. Mr. President, today I siterite reserves in eastern Congo. The pay tribute to Wreaths Across America CONGO report illustrates how gold from east- and Morrill and Karen Worcester, Mr. FEINGOLD. Mr. President, last ern Congo is smuggled out to Uganda whose outstanding vision of a nation- month, the United Nations Group of and Burundi, and then travels on to the wide effort to extol America’s fallen Experts on the Democratic Republic of United Arab Emirates and ultimately heroes is now in its 18th year! Congo presented its latest report to the international markets. Similarly, the Nothing could be more central to the U.N. Security Council. Over the years, report documents how former rebels of Wreaths Across America organiza- the Group of Experts has conducted the CNDP—who have ostensibly be- tion—which counts among its many critical investigations into violations come part of the Congolese military— tremendous volunteers and partners, of the sanctions and the U.N. arms em- continue to control and exploit min- The Maine State Society of Wash- bargo toward Congo as well as human eral-rich areas. In fact, two of the most ington, DC, the Civil Air Patrol, the rights abuses and the linkages between lucrative mining sites are reportedly Patriot Guard Riders, and members of natural resource exploitation and the controlled by units of the Congolese The American Legion and Veterans of financing of illegal armed groups. Yet, military that are composed almost ex- Foreign Wars—than its noble mission too often, the Group of Experts’ reports clusively of former CNDP units. This is to remember those who made the ulti- and recommendations have not re- especially worrying in the context of mate sacrifice, honor those who serve, sulted in action by the Security Coun- the CNDP’s integration into the Congo- and teach our children that today’s cil and/or U.N. member states. I hope it lese military, which is still extremely freedoms have been won at a great will be different with this report, espe- fragile. price. And how fitting it is that

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00060 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.020 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13031 Mainers across our State ushered in Before joining the Senate, lstSgt A lot has changed in the past year for this week of solemn events and wreath- Bradley Simmons served in Kuwait our office, and for lstSgt Bradley Sim- laying ceremonies sponsored by with the 3rd Assault Amphibian Bat- mons as well. First Sergeant Simmons Wreaths Across America, the culmina- talion. He also participated in the ini- came to my office as a gunnery ser- tion of which will be the delivery of as tial attack and continuing operations geant. many as 16,000 wreaths for placement in Iraq. At his promotion ceremony a few at Arlington National Cemetery on De- His heroic service as an AAV section weeks back, his superiors explained cember 12 as well as observances in leader during that time earned him the that the Marine Corps does not base more than 400 participating locations Navy and Marine Corps Commendation promotion in rank on previous per- nationwide, including 24 overseas vet- Medal and a combat distinguishing de- formance and accomplishment. erans cemeteries. Indeed, I could not vice for valor. Instead, promotion is based on a can- have been more gratified to join Sen- 1stSgt Bradley Simmons’ strength, didate’s innate capability and potential ator COLLINS in introducing legisla- dedication, and firsthand experience to do the job well and the rank of first tion, designating December 12, 2009, as overseas made him an invaluable re- sergeant justice. ‘‘Wreaths Across America Day’’ which source for my staff and our Nation’s Like his superiors, I am as confident passed the Senate unanimously on the service members and veterans. that he will succeed in anything he at- first of this month. Understanding of the difficult transi- tempts and that he demonstrates the What an inexpressible source of pride tion for returning service members and courage and commitment that we rec- it is that tomorrow, on the morning of veterans, lstSgt Bradley Simmons ognize in him. the 12th, a convoy of Mainers is sched- reached out to help them and their His humility belies his dedicated uled to arrive at Arlington National families in tangible ways. service to our Nation. It provides great Cemetery to lay Maine-made balsam From helping Ohio veterans with comfort knowing that hundreds of ma- wreaths at the grave sites of our Na- their VA claims; to assisting a wound- rines will have the opportunity to tion’s fallen heroes. The Patriot Guard ed service member during rehabilita- work, live, learn, and serve with First Riders will continue their tradition of tion; to meeting and speaking with the Sergeant Simmons. escorting tractor-trailers filled with families whose loved ones are overseas, He is a testament to the Marines, to wreaths donated by Worcester Wreath lst Sgt Bradley Simmons demonstrated our Nation, to his family, and to his Company in Harrington, ME, to Arling- an unequivocal commitment to his fel- home State of Kansas. ton National Cemetery. On a personal low service members. And to Karen, his wife, thank you for note, I well recall the Worcester’s initi- His tireless work on the Visions your support and sacrifice while your ating the Arlington Wreath Project in Scholars Act of 2009 will help ensure husband serves this Nation. I enjoyed December of 1992, when Morrill called that veterans suffering from eye inju- meeting you and I know that lstSgt my office to ask if he could place his ries would not also suffer from the cur- Bradley Simmons can do what he does excess wreaths on the graves at Arling- rent nationwide shortage of visions because of your love and support. ton National Cemetery. I never could specialists at the VA. After having the privilege of working have imagined that what occurred then The Vision Scholars Act of 2009 with First Sergeant Simmons over the would someday evolve into a nation- passed the Senate last month with past year and seeing the lasting mark wide expression of unfailing gratitude great assistance from Sergeant Sim- he has left on my office, I am honored to our troops. to have someone of his caliber and The enduring legacy of our bravest mons. But lstSgt Bradley Simmons has commitment representing our Nation. and finest for whom service above self Thank you, 1stSgt Bradley G. Sim- and country above self-interest is been more than a trusted adviser. He’s been a teacher and a friend. As mons, for your distinguished service to woven into the fabric of our greatness First Sergeant Simmons likes to say, the people of Ohio and for your contin- is a powerful reminder that freedom is ued commitment to protecting our Na- not free, especially as the indelible he has been running a full-scale Marine Corps familiarization program in my tion and the prosperity of all Ameri- memories of those heroes who, in the cans. immortal words of President Lincoln office for the past year. ‘‘gave the last full measure of devo- With a story-telling talent that left f tion,’’ are etched forever in our minds you laughing, with a moment of con- MESSAGES FROM THE PRESIDENT and upon our hearts. We also owe an templation on the life of a marine, or with a little PT encouragement for the Messages from the President of the enormous debt of gratitude to the men United States were communicated to and women extraordinary enough to deskbound, First Sergeant Simmons made us appreciate the leadership the Senate by Mrs. Neiman, one of his wear the uniform who are currently secretaries. serving in harm’s way and placing qualities that are found throughout the f their lives on the line on our behalf, es- ranks of the Marine Corps, but espe- pecially in Iraq and Afghanistan. In- cially in him. EXECUTIVE MESSAGES REFERRED From interns in my office to con- deed, what a fitting remembrance this As in executive session the Presiding stituents in the State, to all of my annual gesture of reverence and grate- Officer laid before the Senate messages staff in Ohio and Washington, he suc- fulness by Wreaths Across America from the President of the United ceeded in educating us about the represents, especially during this joy- States submitting sundry nominations honor, tradition, and sacrifices readily ous season of giving, for those who which were referred to the appropriate made by our Marines and our military have bequeathed this great land so committees. forces. much, and for whom we are truly (The nominations received today are He made us better at our jobs and grateful. printed at the end of the Senate pro- better citizens in our communities. ceedings.) f He accompanied me to Walter Reed TRIBUTE TO FIRST SERGEANT to visit troops recovering from combat f BRADLEY G. SIMMONS injuries and later assisted in helping a MESSAGES FROM THE HOUSE Mr. BROWN. Mr. President, I rise to few of them transition to life as a civil- At 10:47 a.m., a message from the honor 1stSgt Bradley G. Simmons, U.S. ian, or on active duty in the guard or House of Representatives, delivered by Marine Corps, for his year of service to reserve. Mrs. Cole, one of its reading clerks, an- the U.S. Senate and for his continuing He invited my staff to the Pentagon nounced that the House has passed the service to our Nation and the Marine to a welcome home those recently in- following bill, in which it requests the Corps. jured in Iraq and Afghanistan. concurrence of the Senate: During this past year, First Sergeant For the past year, lstSgt Bradley H.R. 4017. An act to designate the facility Simmons has worked in my office and Simmons taught us about the deter- of the United States Postal Service located served the people of Ohio as the first mination and commitment of the men at 43 Maple Avenue in Shrewsbury, Massa- enlisted Marine fellow in the U.S. Sen- and women who give honor to the Ma- chusetts, as the ‘‘Ann Marie Blute Post Of- ate. rine Corps. fice’’.

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00061 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.042 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13032 CONGRESSIONAL RECORD — SENATE December 11, 2009 At 3:00 p.m., a message from the EC–3984. A communication from the Chief EC–3992. A communication from the Acting House of Representatives, delivered by of the Publications and Regulations Branch, Chairman, Equal Employment Opportunity Mrs. Cole, one of its reading clerks, an- Internal Revenue Service, Department of the Commission, transmitting, pursuant to law, Treasury, transmitting, pursuant to law, the the Semiannual Report of the Inspector Gen- nounced that the House has passed the report of a rule entitled ‘‘New Qualified eral for the period from April 1, 2009, through following joint resolution, in which it Plug-in Electric Drive Motor Vehicle Credit’’ September 30, 2009; to the Committee on requests the concurrence of the Senate: (Notice No. 2009–89) received in the Office of Homeland Security and Governmental Af- H.J. Res. 62. Joint resolution appointing the President of the Senate on December 4, fairs. the day for the convening of the second ses- 2009; to the Committee on Finance. EC–3993. A communication from the Assist- sion of the One Hundred Eleventh Congress. EC–3985. A communication from the Assist- ant Deputy Associate Administrator for Ac- The message further announced that ant Secretary, Bureau of Legislative Affairs, quisition Policy, General Services Adminis- tration, Department of Defense and National pursuant to section 1238(b)(3) of the Department of State, transmitting, pursuant to the Arms Export Control Act, the certifi- Aeronautics and Space Administration, Floyd D. Spence National Defense Au- cation of a proposed manufacturing license transmitting, pursuant to law, the report of thorization Act for Fiscal Year 2001 (22 agreement for the export of defense articles, a rule entitled ‘‘Federal Acquisition Regula- U.S.C. 7002), as amended by division P including, technical data, and defense serv- tion; Federal Acquisition Circular 2005–38’’ of the Consolidated Appropriations ices to Japan relative to the design and man- received in the Office of the President of the Resolution, 2003 (22 U.S.C. 6901), the ufacture of propellant actuated devices for Senate on December 9, 2009; to the Com- Minority Leader re-appoints the fol- F–15J Aircraft; to the Committee on Foreign mittee on Homeland Security and Govern- mental Affairs. lowing members on the part of the Relations. EC–3986. A communication from the Assist- EC–3994. A communication from the Chief House of Representatives to the United ant Secretary, Bureau of Legislative Affairs, Human Capital Officer, Small Business Ad- States-China Economic and Security Department of State, transmitting, pursuant ministration, transmitting, pursuant to law, Review Commission, effective January to the Arms Export Control Act, the certifi- a report relative to a vacancy in the position 1, 2010: Mr. Peter T.R. Brookes of Vir- cation of a proposed amendment to a manu- of Chief Counsel for Advocacy, received in ginia and Mr. Daniel M. Slane of Ohio. facturing license agreement for the export of the Office of the President of the Senate on December 8, 2009; to the Committee on Small f defense articles, including, technical data, and defense services to Mexico relative to Business and Entrepreneurship. MEASURES REFERRED the design and manufacture of Military f Flexible Printed Circuit Board Assemblies The following bill was read the first REPORTS OF COMMITTEES and the second times by unanimous (Flex Circuits) in the amount of $50,000,000 or more; to the Committee on Foreign Rela- The following reports of committees consent, and referred as indicated: tions. were submitted: H.R. 4017. An act to designate the facility EC–3987. A communication from the Assist- By Mr. LEAHY, from the Committee on of the United States Postal Service located ant Secretary, Bureau of Legislative Affairs, the Judiciary, with an amendment in the na- at 43 Maple Avenue in Shrewsbury, Massa- Department of State, transmitting, pursuant ture of a substitute: chusetts, as the ‘‘Ann Marie Blute Post to the Arms Export Control Act, the certifi- S. 448. A bill to maintain the free flow of ″ Office ; to the Committee on Homeland Se- cation of a proposed amendment to a manu- information to the public by providing condi- curity and Governmental Affairs. facturing license agreement for the export of tions for the federally compelled disclosure f defense articles, including, technical data, of information by certain persons connected and defense services to Japan relative to the with the news media. MEASURES PLACED ON THE design, manufacture, and repair of the Japan f CALENDAR PATRIOT Product Improvement Program in The following bill was read the first the amount of $50,000,000 or more; to the INTRODUCTION OF BILLS AND and second times by unanimous con- Committee on Foreign Relations. JOINT RESOLUTIONS EC–3988. A communication from the Assist- sent, and placed on the calendar: ant Secretary, Bureau of Legislative Affairs, The following bills and joint resolu- H.R. 1506. An act to provide that claims of Department of State, transmitting, pursuant tions were introduced, read the first the United States to certain documents re- to the Arms Export Control Act, the certifi- and second times by unanimous con- lating to Franklin Delano Roosevelt shall be cation of a proposed technical assistance sent, and referred as indicated: treated as waived and relinquished in certain agreement for the export of defense articles, By Mr. CARPER (for himself, Mr. AL- circumstances. including, technical data, and defense serv- EXANDER, Mr. BYRD, Mr. LIEBERMAN, f ices to Israel relative to the design, manu- Mr. VOINOVICH, Mr. WARNER, and Mr. facture, and delivery of tactical computers WEBB): EXECUTIVE AND OTHER and data processing and communications S. 2872. A bill to authorize appropriations COMMUNICATIONS systems in the amount of $50,000,000 or more; for the National Historical Publications and The following communications were to the Committee on Foreign Relations. Records Commission through fiscal year laid before the Senate, together with EC–3989. A communication from the Assist- 2014, and for other purposes; to the Com- ant Secretary, Bureau of Legislative Affairs, mittee on Homeland Security and Govern- accompanying papers, reports, and doc- Department of State, transmitting, pursuant uments, and were referred as indicated: mental Affairs. to the Arms Export Control Act, the certifi- By Mr. BEGICH: EC–3981. A communication from the Con- cation of a proposed technical assistance S. 2873. A bill to amend the Internal Rev- gressional Review Coordinator, Animal and agreement for the export of defense articles, enue Code of 1986 to deny the deduction for Plant Health Inspection Service, Department including, technical data, and defense serv- direct to consumer advertising expenses for of Agriculture, transmitting, pursuant to ices to Canada to support the sale of C–130J prescription pharmaceuticals and to provide law, the report of a rule entitled ‘‘National Hercules Aircraft in the amount of a deduction for fees paid for the participa- Veterinary Accreditation Program’’ (Docket $100,000,000 or more; to the Committee on tion of children in certain organizations No. APHIS–2006–0093) received in the Office Foreign Relations. which promote physical activity; to the of the President of the Senate on December EC–3990. A communication from the Assist- Committee on Finance. 10, 2009; to the Committee on Agriculture, ant Secretary, Bureau of Legislative Affairs, By Ms. LANDRIEU: Nutrition, and Forestry. Department of State, transmitting, pursuant S. 2874. A bill to designate the facility of EC–3982. A communication from the Con- to the Arms Export Control Act, the certifi- the United States Postal Service located at gressional Review Coordinator, Animal and cation of a proposed technical assistance 2000 Louisiana Avenue in New Orleans, Lou- Plant Health Inspection Service, Department agreement for the export of defense articles, isiana, as the ‘‘Ray Rondeno, Sr. Post Office of Agriculture, transmitting, pursuant to including, technical data, and defense serv- Building’’; to the Committee on Homeland law, the report of a rule entitled ‘‘Swine ices to the United Kingdom relative to the Security and Governmental Affairs. Health Protection; Feeding of Processed design and manufacture of Wing Trailing By Mr. FEINGOLD: Product to Swine’’ (Docket No. APHIS–2008– Edge Panels and Flap Hinge Fairings for the S. 2875. A bill to establish the Commission 0120) received in the Office of the President C–17 Globemaster III Transport Aircraft in on Measures of Household Economic Secu- of the Senate on December 10, 2009; to the the amount of $100,000,000 or more; to the rity to conduct a study and submit a report Committee on Agriculture, Nutrition, and Committee on Foreign Relations. containing recommendations to establish Forestry. EC–3991. A communication from the Sec- and report economic statistics that reflect EC–3983. A communication from the Chair- retary, Department of Agriculture, transmit- the economic status and well-being of Amer- man, Board of Governors of the Federal Re- ting, pursuant to law, the Semiannual Re- ican households; to the Committee on Home- serve System, transmitting, pursuant to law, port of the Inspector General for the period land Security and Governmental Affairs. a report relative to the Buy American Act; from April 1, 2009, through September 30, By Ms. LANDRIEU: to the Committee on Banking, Housing, and 2009; to the Committee on Homeland Secu- S. 2876. A bill to amend the Internal Rev- Urban Affairs. rity and Governmental Affairs. enue Code of 1986 to clarify the capital gain

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00062 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.016 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13033 or loss treatment of the sale or exchange of S. 1524 research, development, demonstration, mitigation credits earned by restoring wet- At the request of Mr. KERRY, the and commercial application in vehicle lands, and for other purposes; to the Com- name of the Senator from Nebraska technologies at the Department of En- mittee on Finance. (Mr. JOHANNS) was added as a cospon- ergy. By Ms. CANTWELL (for herself and sor of S. 1524, a bill to strengthen the S. 2852 Ms. COLLINS): S. 2877. A bill to direct the Secretary of the capacity, transparency, and account- At the request of Mr. BEGICH, the Treasury to establish a program to regulate ability of United States foreign assist- name of the Senator from Florida (Mr. the entry of fossil carbon into commerce in ance programs to effectively adapt and NELSON) was added as a cosponsor of S. the United States to promote clean energy respond to new challenges of the 21st 2852, a bill to establish, within the Na- jobs and economic growth and avoid dan- century, and for other purposes. tional Oceanic and Atmospheric Ad- gerous interference with the climate of the S. 1589 ministration, an integrated and com- Earth, and for other purposes; to the Com- At the request of Ms. CANTWELL, the prehensive ocean, coastal, Great Lakes, mittee on Finance. and atmospheric research, prediction, By Mrs. GILLIBRAND: names of the Senator from Missouri S. 2878. A bill to prevent gun trafficking in (Mr. BOND) and the Senator from Illi- and environmental information pro- the United States; to the Committee on the nois (Mr. BURRIS) were added as co- gram to support renewable energy. Judiciary. sponsors of S. 1589, a bill to amend the S. 2869 By Mr. ROCKEFELLER (for himself, Internal Revenue Code of 1986 to mod- At the request of Ms. LANDRIEU, the Mrs. HUTCHISON, Mr. KERRY, Ms. ify the incentives for the production of names of the Senator from Massachu- SNOWE, Mr. PRYOR, and Mr. WARNER): setts (Mr. KERRY), the Senator from S. 2879. A bill to direct the Federal Com- biodiesel. Connecticut (Mr. LIEBERMAN), the Sen- munications Commission to conduct a pilot S. 1790 ator from New Hampshire (Mrs. program expanding the Lifeline Program to At the request of Mr. DORGAN, the SHAHEEN) and the Senator from North include broadband service, and for other pur- name of the Senator from Connecticut Dakota (Mr. DORGAN) were added as co- poses; to the Committee on Commerce, (Mr. DODD) was added as a cosponsor of sponsors of S. 2869, a bill to increase Science, and Transportation. S. 1790, a bill to amend the Indian f loan limits for small business concerns, Health Care Improvement Act to revise to provide for low interest refinancing ADDITIONAL COSPONSORS and extend that Act, and for other pur- for small business concerns, and for poses. S. 605 other purposes. S. 1859 At the request of Mr. KAUFMAN, the S. CON. RES. 20 name of the Senator from Utah (Mr. At the request of Mr. ROCKEFELLER, At the request of Mr. BYRD, the name BENNETT) was added as a cosponsor of the name of the Senator from New of the Senator from North Carolina S. 605, a bill to require the Securities York (Mrs. GILLIBRAND) was added as a (Mr. BURR) was added as a cosponsor of and Exchange Commission to reinstate cosponsor of S. 1859, a bill to reinstate S. Con. Res. 20, a concurrent resolution the uptick rule and effectively regulate Federal matching of State spending of authorizing the last surviving veteran abusive short selling activities. child support incentive payments. of the First World War to lie in honor S. 730 S. 1932 in the rotunda of the Capitol upon his At the request of Mr. ENSIGN, the At the request of Mr. BENNET, the death. name of the Senator from New York name of the Senator from Missouri AMENDMENT NO. 2790 (Mr. SCHUMER) was added as a cospon- (Mrs. MCCASKILL) was added as a co- At the request of Mr. CASEY, the sor of S. 730, a bill to amend the Har- sponsor of S. 1932, a bill to amend the names of the Senator from Hawaii (Mr. monized Tariff Schedule of the United Elementary and Secondary Education AKAKA), the Senator from Alaska (Mr. States to modify the tariffs on certain Act of 1965 to allow members of the BEGICH) and the Senator from New footwear, and for other purposes. Armed Forces who served on active York (Mr. SCHUMER) were added as co- duty on or after September 11, 2001, to sponsors of amendment No. 2790 in- S. 812 be eligible to participate in the Troops- tended to be proposed to H.R. 3590, a At the request of Mr. BAUCUS, the bill to amend the Internal Revenue name of the Senator from South Da- to-Teachers Program, and for other purposes. Code of 1986 to modify the first-time kota (Mr. JOHNSON) was added as a co- homebuyers credit in the case of mem- sponsor of S. 812, a bill to amend the S. 2776 bers of the Armed Forces and certain Internal Revenue Code of 1986 to make At the request of Mr. ALEXANDER, the other Federal employees, and for other permanent the special rule for con- name of the Senator from Virginia (Mr. purposes. tributions of qualified conservation WARNER) was added as a cosponsor of S. AMENDMENT NO. 2827 contributions. 2776, a bill to amend the Energy Policy At the request of Mr. TESTER, the S. 1067 Act of 2005 to create the right business environment for doubling production of name of the Senator from Colorado At the request of Mr. BROWNBACK, the (Mr. UDALL) was added as a cosponsor name of the Senator from California clean nuclear energy and other clean energy and to create mini-Manhattan of amendment No. 2827 intended to be (Mrs. FEINSTEIN) was added as a co- proposed to H.R. 3590, a bill to amend sponsor of S. 1067, a bill to support sta- projects for clean energy research and development. the Internal Revenue Code of 1986 to bilization and lasting peace in northern modify the first-time homebuyers cred- S. 2777 Uganda and areas affected by the it in the case of members of the Armed At the request of Ms. SNOWE, the Lord’s Resistance Army through devel- Forces and certain other Federal em- opment of a regional strategy to sup- name of the Senator from Maine (Ms. ployees, and for other purposes. COLLINS) was added as a cosponsor of S. port multilateral efforts to success- AMENDMENT NO. 2878 2777, a bill to repeal the American Re- fully protect civilians and eliminate At the request of Mr. CARDIN, the covery Capital loan program of the the threat posed by the Lord’s Resist- names of the Senator from Massachu- Small Business Administration. ance Army and to authorize funds for setts (Mr. KERRY) and the Senator from humanitarian relief and reconstruc- S. 2833 Alaska (Mr. BEGICH) were added as co- tion, reconciliation, and transitional At the request of Mr. REED, the name sponsors of amendment No. 2878 in- justice, and for other purposes. of the Senator from Illinois (Mr. tended to be proposed to H.R. 3590, a S. 1389 BURRIS) was added as a cosponsor of S. bill to amend the Internal Revenue At the request of Mr. NELSON of Ne- 2833, a bill to provide adjusted Federal Code of 1986 to modify the first-time braska, the name of the Senator from medical assistance percentage rates homebuyers credit in the case of mem- Utah (Mr. BENNETT) was added as a co- during a transitional assistance period. bers of the Armed Forces and certain sponsor of S. 1389, a bill to clarify the S. 2843 other Federal employees, and for other exemption for certain annuity con- At the request of Ms. STABENOW, the purposes. tracts and insurance policies from Fed- name of the Senator from Indiana (Mr. AMENDMENT NO. 2879 eral regulation under the Securities BAYH) was added as a cosponsor of S. At the request of Mr. CARDIN, the Act of 1933. 2843, a bill to provide for a program of name of the Senator from Wisconsin

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00063 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.019 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13034 CONGRESSIONAL RECORD — SENATE December 11, 2009 (Mr. KOHL) was added as a cosponsor of buyers credit in the case of members of STATEMENT ON INTRODUCED amendment No. 2879 intended to be pro- the Armed Forces and certain other BILLS AND JOINT RESOLUTIONS posed to H.R. 3590, a bill to amend the Federal employees, and for other pur- By Mr. CARPER (for himself, Mr. Internal Revenue Code of 1986 to mod- poses. ALEXANDER, Mr. BYRD, Mr. ify the first-time homebuyers credit in AMENDMENT NO. 3101 LIEBERMAN, Mr. VOINOVICH, Mr. the case of members of the Armed At the request of Mr. FRANKEN, the WARNER, and Mr. WEBB): Forces and certain other Federal em- name of the Senator from Wisconsin SA 2872. A bill to authorize appro- ployees, and for other purposes. (Mr. FEINGOLD) was added as a cospon- priations for the National Historical AMENDMENT NO. 2904 sor of amendment No. 3101 intended to Publications and Records Commission At the request of Ms. SNOWE, the be proposed to H.R. 3590, a bill to through fiscal year 2014, and for other name of the Senator from Louisiana amend the Internal Revenue Code of purposes; to the Committee on Home- (Ms. LANDRIEU) was added as a cospon- 1986 to modify the first-time homeland Security and Governmental Af- sor of amendment No. 2904 intended to buyers credit in the case of members of fairs. be proposed to H.R. 3590, a bill to the Armed Forces and certain other Mr. CARPER. Mr. President, I rise amend the Internal Revenue Code of Federal employees, and for other pur- today with my colleagues to introduce 1986 to modify the first-time home- poses. an important and bipartisan piece of buyers credit in the case of members of AMENDMENT NO. 3102 legislation that will help protect our the Armed Forces and certain other Nation’s history for future generations. At the request of Mr. DURBIN, the Federal employees, and for other pur- Our bill reauthorizes the National name of the Senator from New York poses. Historical Publications and Record (Mr. SCHUMER) was added as a cospon- AMENDMENT NO. 2909 Commission, or NHPRC for short, sor of amendment No. 3102 intended to which was first established by Congress At the request of Mr. NELSON of Flor- be proposed to H.R. 3590, a bill to ida, the name of the Senator from in 1934. The Commission is the grant- amend the Internal Revenue Code of making body of the National Archives Pennsylvania (Mr. SPECTER) was added 1986 to modify the first-time home- as a cosponsor of amendment No. 2909 and Records Administration and is buyers credit in the case of members of comprised of representatives from the intended to be proposed to H.R. 3590, a the Armed Forces and certain other bill to amend the Internal Revenue President of the United States, the Federal employees, and for other pur- U.S. Senate and House of Representa- Code of 1986 to modify the first-time poses. homebuyers credit in the case of mem- tives, the Federal judiciary, the De- AMENDMENT NO. 3112 bers of the Armed Forces and certain partments of State and Defense, the Li- other Federal employees, and for other At the request of Ms. CANTWELL, the brary of Congress, and six national, purposes. name of the Senator from Florida (Mr. professional associations of archivists. NELSON) was added as a cosponsor of Since 1964, the Commission has funded AMENDMENT NO. 2924 amendment No. 3112 intended to be pro- projects that locate, preserve, and pro- At the request of Mr. CASEY, the posed to H.R. 3590, a bill to amend the name of the Senator from New York vide public access to some our nation’s Internal Revenue Code of 1986 to mod- most precious historical resources that (Mr. SCHUMER) was added as a cospon- ify the first-time homebuyers credit in sor of amendment No. 2924 intended to otherwise would be lost and destroyed. the case of members of the Armed For example, some of the history be proposed to H.R. 3590, a bill to Forces and certain other Federal em- that has been preserved by the NHPRC amend the Internal Revenue Code of ployees, and for other purposes. over the years has helped award-win- 1986 to modify the first-time home- ning historian David McCullough write buyers credit in the case of members of AMENDMENT NO. 3114 his biography of John Adams and Pul- the Armed Forces and certain other At the request of Mr. GRASSLEY, the itzer Prize-winner Ron Chernow write Federal employees, and for other pur- names of the Senator from Nevada (Mr. his biography of Alexander Hamilton. poses. REID) and the Senator from Montana Further, the NHPRC has helped estab- AMENDMENT NO. 2938 (Mr. TESTER) were added as cosponsors of amendment No. 3114 intended to be lish or modernize public records pro- At the request of Mrs. GILLIBRAND, grams in cities all across America such the names of the Senator from Min- proposed to H.R. 3590, a bill to amend the Internal Revenue Code of 1986 to as the cities of Seattle, Boston, and nesota (Mr. FRANKEN), the Senator San Diego. The NHPRC also has been from Massachusetts (Mr. KIRK) and the modify the first-time homebuyers credit in the case of members of the Armed the key federal body to help preserve Senator from Pennsylvania (Mr. the oral histories of many Native CASEY) were added as cosponsors of Forces and certain other Federal employees, and for other purposes. American tribes such as the Seneca, amendment No. 2938 intended to be pro- Blackfoot, Sioux, Navajo, Apaches, and AMENDMENT NO. 3119 posed to H.R. 3590, a bill to amend the dozens more. Internal Revenue Code of 1986 to mod- At the request of Mr. WARNER, the Further, I am proud to say that the ify the first-time homebuyers credit in names of the Senator from Delaware NHPRC recently sped up and digitized the case of members of the Armed (Mr. CARPER), the Senator from Maine over 5,000 documents left behind by our Forces and certain other Federal em- (Ms. SNOWE) and the Senator from Con- Nation’s founding fathers that were ployees, and for other purposes. necticut (Mr. LIEBERMAN) were added previously unpublished. Congress AMENDMENT NO. 3011 as cosponsors of amendment No. 3119 passed legislation last year that I was At the request of Ms. LANDRIEU, the intended to be proposed to H.R. 3590, a honored to co-author with our former name of the Senator from Mississippi bill to amend the Internal Revenue colleague, Senator John Warner from (Mr. WICKER) was added as a cosponsor Code of 1986 to modify the first-time Virginia, requiring the NHPRC to work of amendment No. 3011 intended to be homebuyers credit in the case of mem- with the groups publishing the volumes proposed to H.R. 3590, a bill to amend bers of the Armed Forces and certain so that the documents could be made the Internal Revenue Code of 1986 to other Federal employees, and for other available online at no charge to any modify the first-time homebuyers cred- purposes. student of history. Before, they were it in the case of members of the Armed AMENDMENT NO. 3132 walled-up behind the doors of large li- Forces and certain other Federal em- At the request of Mrs. MCCASKILL, braries and expensive to access. To put ployees, and for other purposes. the name of the Senator from Virginia that into context, the NHPRC has AMENDMENT NO. 3037 (Mr. WEBB) was added as a cosponsor of saved anyone who needs to view the At the request of Mr. JOHNSON, the amendment No. 3132 intended to be pro- letters of John Adams thousands of name of the Senator from New York posed to H.R. 3590, a bill to amend the dollars, which would have been the tra- (Mr. SCHUMER) was added as a cospon- Internal Revenue Code of 1986 to mod- ditional cost of a complete set of pub- sor of amendment No. 3037 intended to ify the first-time homebuyers credit in lished letters. be proposed to H.R. 3590, a bill to the case of members of the Armed Lastly, the bill I am introducing amend the Internal Revenue Code of Forces and certain other Federal em- today removes an artificial profit cap 1986 to modify the first-time home- ployees, and for other purposes. that Congress put in place a few years

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00064 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.021 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13035 ago that prevents the National Ar- and recommendations of the National His- of income to include the value of bene- chives and Records Administration torical Publications and Records Commis- fits programs such as health insurance from operating its regional facilities sion, may make grants to States, colleges and retirement plans; the percentage of and universities, museums, libraries, and Americans who are covered by both more like a business. For example, genealogical associations to preserve records there are times at the end of the year and establish electronically searchable data- employer-provided and individual when the revolving fund that pays for bases consisting of local records of servitude, health care plans and the extent of cov- the operation and maintenance of the emancipation, and post-Civil War recon- erage per dollar paid by both employers regional archival facilities earns a struction. and employees; the savings rate, in- profit. Instead of incentivizing the Na- ‘‘(b) MAINTENANCE.—Any database estab- cluding both standard savings plans tional Archives to save the excess prof- lished using a grant under this section shall and pension plans; the disparity in in- be maintained by appropriate agencies or income distribution over time and be- it for long-term capital investments, stitutions designated by the Archivist of the the cap incentivizes regional facilities United States.’’. tween different demographic and geo- to spend the money on short term graphic groups; and the breakdown of projects that they may not be needed. By Mr. FEINGOLD. household expenditures between such This simply does not make sense for S. 2875. A bill to establish the Com- categories as food, shelter, medical ex- the National Archives or for the tax- mission on Measures of Household Eco- penses, debt servicing, and energy. payer. nomic Security to conduct a study and In addition, the Commission will con- I look forward to working with my submit a report containing rec- sider the relevance of certain non-mar- colleagues to get this important and ommendations to establish and report ket activities, like household produc- necessary bill enacted before it’s too economic statistics that reflect the tion, education, and volunteer services late. I think everyone can agree that economic status and well-being of that affect the economic well-being of one of the things our democracy relies American households; to the Com- households but are not measured or on is educated citizenry. The NHPRC is mittee on Homeland Security and Gov- valued in currently reported economic the principle body that helps make ernmental Affairs. statistics. As Robert F. Kennedy fa- that happen. Mr. FEINGOLD. Mr. President, our mously said, some of our economic in- Mr. President, I ask unanimous con- government agencies collect and report dicators measure ‘‘everything in short, sent that the text of the bill be printed a range of economic information but except that which makes life worth- in the RECORD. much of what we see or hear is most while.’’ We need to make an effort to There being no objection, the text of suited to describing the general state value more than just our gross domes- the bill was ordered to be printed in of the country’s economy. This infor- tic product and sales receipts. We need the RECORD, as follows: mation does not reflect what is hap- to better measure and understand what pening in and what matters most to matters to American households. S. 2872 This effort to improve how we meas- Be it enacted by the Senate and House of Rep- our families and the quality of our lives. For example, our national unem- ure what matters in our economy is resentatives of the United States of America in very much in the Wisconsin tradition Congress assembled, ployment figures don’t tell us that of accountable good government. It SECTION 1. AUTHORIZATION OF APPROPRIA- those who are employed may not have TIONS THROUGH FISCAL YEAR 2014 benefits, or that they are working two was Senator Robert LaFollette, Jr. FOR NATIONAL HISTORICAL PUBLI- or three jobs to earn the income that who, in 1932, introduced a resolution CATIONS AND RECORDS COMMIS- requiring the U.S. Government to es- SION. they report, or that their mortgage debt and college loans are jeopardizing tablish a more scientific, specific and Section 2504(g)(1) of title 44, United States accurate set of measures of the health Code, is amended— their ability to repay their credit card (1) in subparagraph (R), by striking ‘‘and’’; debt or their medical bills. By knowing of the U.S. economy. From his request, (2) in subparagraph (S), by striking the pe- and reporting this kind of information Simon Kuznets, a University of Penn- riod and inserting ‘‘; and’’; and we can not only more accurately re- sylvania economics professor, devel- (3) by adding at the end of the following: flect what our families are experi- oped the first set of national accounts ‘‘(T) $13,000,000 for fiscal year 2010, encing economically, we can better in- which form the basis for today’s meas- $13,500,000 for fiscal year 2011, $14,000,000 for ure of GDP and other economic indica- fiscal year 2012, $14,500,000 for fiscal year form policymakers about what matters most to people and the steps that need tors. Kuznets won the 1971 Nobel Prize 2013, and $15,000,000 for fiscal year 2014.’’. in Economics ‘‘for his empirically to be taken to address household eco- SEC. 2. INCREASED FLEXIBILITY FOR ARCHIVIST founded interpretation of economic IN THE RECORDS CENTER REVOLV- nomic needs and concerns. ING FUND. To address this need I am re-intro- growth which has led to new and deep- Subsection (d) under the heading ‘‘RECORDS ducing the Commission on Measures of ened insight into the economic and so- CENTER REVOLVING FUND ’’ in title IV of the Household Economic Security Act of cial structure and process of develop- Independent Agencies Appropriations Act, 2009. The bill would establish a bipar- ment’’. His work was the basis for 2000 (Public Law 106-58; 113 Stat. 460; 44 much of the New Deal reform policies. U.S.C. 2901 note), is amended— tisan congressional commission of 8 economic experts to look at existing Yet Kuznets specifically acknowledged (1) in paragraph (1), by striking ‘‘not to ex- that his measures were incomplete and government economic data and iden- ceed 4 percent’’ and inserting ‘‘determined did not go far enough to measure what by the Archivist of the United States’’; and tify the possible need for new informa- may really matter. In his 1934 report to (2) in paragraph (2), by striking ‘‘Funds in tion, more accurate methodologies and the Senate on his compilation of statis- excess of the 4 percent at the close of each better ways to report these economic tics associated with Gross National fiscal year’’ and inserting ‘‘Any unobligated measures to give a more accurate and Product he concluded: ‘‘The welfare of and unexpended balances in the Fund that reliable picture of the economic well the Archivist of the United States deter- a nation can . . . scarcely be inferred being of American households. As part mines to be in excess of those needed for cap- from a measurement of national in- of their effort, the Commission will be ital equipment or a reasonable operating re- come as [so] defined. . . .’’ This bill is asked to meet with representative serve’’. intended to advance these earlier ef- SEC. 3. GRANTS FOR ESTABLISHMENT OF STATE groups of the public so that their views forts to make our economic statistical AND LOCAL DATABASES FOR are taken into account in the Commis- RECORDS OF SERVITUDE, EMANCI- measures more reflective of the welfare sion’s recommendations. of our families and our nation. PATION, AND POST-CIVIL WAR RE- In doing this, the Commission will CONSTRUCTION. The cost of this commission will be Section 8 of the Presidential Historical look at such things as the current debt fully covered by amounts already au- Records Preservation Act of 2008 (44 U.S.C. situation of American individuals and thorized and appropriated to the Bu- 2504 note) is amended to read as follows: households, including categories of reau of Labor Statistics. I urge my col- ‘‘SEC. 8. GRANTS FOR ESTABLISHMENT OF STATE debt such as credit card debt, edu- leagues to support my legislation. AND LOCAL DATABASES FOR cation related loans and mortgage pay- RECORDS OF SERVITUDE, EMANCI- ments; the movement of Americans be- PATION, AND POST-CIVIL WAR RE- By Ms. CANTWELL (for herself CONSTRUCTION. tween salaried jobs with benefits to and Ms. COLLINS): ‘‘(a) IN GENERAL.—The Archivist of the single or multiple wage jobs with lim- S. 2877. A bill to direct the Secretary United States, after considering the advice ited or no benefits with a comparison of the Treasury to establish a program

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00065 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.015 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13036 CONGRESSIONAL RECORD — SENATE December 11, 2009 to regulate the entry of fossil carbon ture huge energy spikes. If we do that, comprehensive long-term actions that into commerce in the United States to we are going to leave to the next gen- will stabilize gas and oil prices, help to promote clean energy jobs and eco- eration a better situation. We will prevent energy shortages, avoid those nomic growth and avoid dangerous in- leave the planet Earth in better shape. spikes when we are held hostage to for- terference with the climate of the But most importantly, we are going to eign oil, and achieve national energy Earth, and for other purposes; to the take the U.S. economy, struggling to independence. This effort will require a Committee on Finance. move ahead, and we are going to create stronger commitment to renewable en- Ms. CANTWELL. Mr. President, I thousands of jobs in the short term and ergy sources such as wind energy, as send to the desk legislation on my be- millions of jobs in the next several well as energy efficiency and conserva- half and Senator COLLINS’, the Senator years. That is good news, to think that tion. from Maine, dealing with putting a the United States could become a lead- The development and implementa- market signal on carbon so we can get er in energy technology, that we are tion of these new approaches to envi- off of carbon and move forward on a not going to be as dependent upon the ronmental stewardship and energy green energy economy that will create Chinese for battery technology of the independence will also provide a power- millions of jobs in America. future as we are right now on Middle ful stimulus to our economy and the I know we are still on health care so East oil. creation of green jobs. Like my col- I am not going to take a lot of time I introduce this legislation with the league, I want the United States to right now to talk about this because most respect for my colleagues, Sen- lead the way on green technology, not we in the next several weeks and ators BOXER and KERRY, LIEBERMAN lose our edge to China, for example. months ahead are going to have a lot of and MCCAIN, many of my colleagues In addition to advancing these goals, time to talk about this issue. But I do have been involved in this issue for the CLEAR Act is the fairest climate want to say for my colleagues, as we many decades, but to work across the change approach from the perspective are introducing this legislation: The aisle. If health care shows us anything, of consumers. It would rebate 75 per- American people have been on a roller we have to cut down the amount of cent of the proceeds generated by the coaster ride with energy prices. I know time it takes to move these important cap on carbon emissions directly to the Presiding Officer knows this be- pieces of legislation by working to- citizens. That is a tremendous advan- cause she comes from the Northeast gether in an effort to show that we do tage of this bill over alternative ap- and knows what home heating oil costs understand the needs of the American proaches such as the cap-and-trade bill. have done to her State and surrounding public. We have to drive down their I also share the concerns of my col- States. I know my colleague from costs, not just on health care but on league from Washington State about Maine knows this as well. That is part fuel as well. We have to give them eco- the abuses we have seen in energy and of her motivation in joining me in this nomic opportunity for the future. agricultural markets, when speculators cause, I am sure. The American public Sending this market signal is the best are allowed to participate in the mar- cannot sustain having oil prices wreak way to create jobs and help protect ket. That is why in our bill, which im- havoc on our economy for the next 30 consumers for the future. poses an upstream cap on carbon, only years. The PRESIDING OFFICER. The Sen- the producers are allowed to partici- We know from economists that some- ator from Maine. pate in the trading. That is a far better time in the next 5 to 30 years we will be Ms. COLLINS. Mr. President, I am approach that will guard against mar- at peak oil, and once we are at peak pleased to join my colleague from ket manipulation and excessive specu- oil, the cost to the U.S. economy will Washington State, Senator CANTWELL, lation. be even more extravagant. The Amer- in introducing what I believe to be In the United States alone, emissions ican people want to know what we are landmark legislation, the Carbon Lim- of the primary greenhouse gas carbon going to do to transition off of that and its and Energy for America’s Renewal, dioxide have risen more than 20 percent do so in a respectable way. What they or CLEAR Act. Let me commend the since 1990. Clearly climate change is a are not so interested in is a proposal Senator for her leadership on this im- daunting environmental challenge, but that would have Wall Street come up portant issue. we must develop solutions that do not with a funding source by doing specula- One of the most appealing parts of impose a heavy burden on our econ- tive trading to continue the games this bill is it takes a fresh look at the omy, particularly during these difficult that have been played for the last year issues facing our country in the area of economic times. That is why I am or 2 years on various commodities that developing alternative energy, pro- pleased to join as the lead cosponsor of drove the economy into the ditch. moting energy independence, and ad- the CLEAR Act. Climate change legis- I find it interesting that today in the dressing climate change and the need lation must protect consumers and in- newspapers coming from Copenhagen, for more green jobs in the economy. In- dustries that could be hit with higher now they have decided that up to 90 deed, this bill addresses the most sig- energy prices. We must recognize that percent of all market activity in the nificant energy and environmental many of our citizens are struggling to European trading markets was related challenges we face. It would help to re- afford their monthly energy bills now to fraudulent activity. That tells us duce our dependence on foreign oil, and cannot afford dramatically higher that trading markets already existing promote alternative energy and energy prices. We also must produce legisla- on carbon futures have had great deals conservation, and advance the goal of tion that would provide predictability of problems with manipulation. I don’t energy independence for our Nation. in the price of carbon emissions so that think we need to repeat that. What we The cost of gas and oil imposes a businesses can plan, invest, and create want to do instead is say, we are going great burden on many Americans, par- good jobs. Climate change legislation to make sure that consumers get a ticularly those living in large rural should encourage the adoption of en- check back to help them with their en- States such as the State of Maine. High ergy efficiency measures and the fur- ergy bills. We want to say we are going gasoline prices have a disproportionate ther development of renewable energy. to protect them from the skyrocketing impact on Mainers who often have no I am very excited about the possibili- prices of energy, but we are going to choice but to travel long distances to ties for the State of Maine because of transition off of fossil fuels and onto their jobs, grocery stores, and doctors its immense potential to develop off- new sources of energy, of biofuels, of offices. This lessens the amount of shore wind energy. Estimates are that alternatives such as wind and solar, of money they have to spend on other ne- the development of 5 gigawatts of off- things such as plug-in electric vehicles, cessities. shore wind in Maine would be enough of an electricity grid that can be more In addition, 80 percent of Mainers to power more than 1 million homes for efficient and a smart two-way commu- heat their homes with home heating a year. It could attract $20 billion of in- nications system. oil. That is one of the highest percent- vestment to the State of Maine and In the end, our economy is going to ages in the Nation. The State of Maine create more than 15,000 green energy be better. We are going to create more is one of the States most dependent on jobs, jobs that are desperately needed jobs. We are going to make sure that foreign oil of any State in the Nation. in our State. The CLEAR Act would consumers are not held hostage by fu- Our Nation must work together on help to achieve all of those goals.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00066 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.028 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13037 I could not support the bill that was Officer and I live, as well as the North- sonable solutions to reduce our carbon passed to deal with climate change by west. It makes sense. It is a common- emissions. the House of Representatives. Let me sense approach. I hope my colleagues I have personally observed the dra- read a couple of the descriptions of will consider joining the Senator from matic effects of climate change and that bill. The New York Times de- Washington and me on this important had the opportunity to be briefed by scribed it as ‘‘fat with compromises, legislation. the preeminent experts, including Uni- carve-outs, concessions, and out-and- Again, I commend Senator CANT- versity of Maine professor and National out gifts.’’ The Washington Post in an WELL’s leadership. She has done a great Academy of Sciences member George editorial described it as having pollu- deal of work to come up with this ap- Denton. In 2006, on a trip to Antarctica tion credits and revenue that were proach, and I am excited to be joining and New Zealand, for example, I saw ‘‘divvied up to the advantage of politi- her in this effort. sites in New Zealand that had been cally favored polluters.’’ To reiterate, today I am pleased to buried by massive glaciers at the be- I do not believe this bill, which is a join my colleague from Washington, ginning of the 20th century, but are 2,000-page monstrosity, can garner the Senator CANTWELL, in introducing now ice free. Fifty percent of the gla- necessary 60 votes to proceed in the landmark legislation, the Carbon Lim- ciers in New Zealand have melted since Senate. The CLEAR Act, by contrast, its and Energy for America’s Renewal, 1860—an event unprecedented in the would help to move a stalled debate or CLEAR, Act. last 5,000 years. It was remarkable to forward by offering a fairer, a more ef- This bill addresses the most signifi- stand in a place where some 140 years ficient, and a straightforward ap- cant energy and environmental chal- ago, I would have been covered in tens proach. lenges facing our country. It would or hundreds of feet of ice, and then to You have only to look at our bill. It help reduce our dependence on foreign look far up the mountainside and see is 39 pages long compared to 2,000 pages oil, promote alternative energy and en- how distant the edge of the ice is of the House-passed bill. ergy conservation, and advance the today. My full statement goes into detail on goal of energy independence for our Na- The melting is even more dramatic in how the bill would work. I hope my col- tion. the Northern Hemisphere. In the last 30 leagues will look closely at it. But let The costs of gas and oil impose a years, the Arctic has lost sea ice cover me talk about one part. That is in the great burden on many Americans, par- over an area ten times as large as the CLEAR Act, 75 percent of the carbon ticularly those living in large, rural State of Maine, and at this rate will be auction revenues would be returned to States like Maine. High gasoline prices ice free by 2050. In 2005 in Barrow, AK, consumers as tax free rebates. They have a disproportionate impact on I witnessed a melting permafrost that wouldn’t be lost to speculation or to Mainers who often have to travel long is causing telephone poles, planted $1⁄2 billion of fees every year to invest- distances to their jobs, doctors’ offices, years ago, to lean over for the first ment firms on Wall Street. No, 75 per- and grocery stores, which lessens the time ever. cent of those revenues would be re- amount of money they have available I also learned about the potential im- turned on a per capita basis to con- to spend on other necessities. Also, 80 pact of sea level rise during my trips to sumers. That means that 80 percent of percent of Mainers heat their homes these regions. If the west Antarctica Americans would incur no net new cost with home heating oil, one of the high- ice sheet were to collapse, for example, under the CLEAR Act. The average est percentages in the Nation. Our Na- sea level would rise 15 feet, flooding Mainer would stand to actually gain tion must work together on com- many coastal cities. In its 2007 report, $102 per year from the CLEAR Act. I prehensive, long-term actions that will the IPCC found that even with just can tell you, Mainers would welcome stabilize gas and oil prices, help to pre- gradual melting of ice sheets, the aver- that. It would help them winterize vent energy shortages, and achieve na- age predicted sea level rise by 2100 will their homes, meet their energy bills, tional energy independence. This effort be 1.6 feet, but could be as high as 1 invest in energy conservation and effi- will require a stronger commitment to meter, or almost 3 feet. In Maine a 1 ciency, or have a little more money to renewable energy sources, such as wind meter rise in sea level would cause the get by. energy, and energy efficiency and con- loss of 20,000 acres of land, include 100 By contrast, under the House-passed servation. acres of downtown Portland, including cap-and-trade bill, the average citizen The development and implementa- Commercial Street. Already in the past in this country would experience a net tion of these new approaches to envi- 94 years, a 7-inch rise in sea level has cost increase of $175 per year. That is a ronmental stewardship and energy been documented in Portland. big difference and a big advantage of independence will also provide a power- The solutions to these problems must the Cantwell-Collins approach. ful stimulus for our economy and the not impose a heavy burden on our What about the other 25 percent of creation of ‘‘green’’ jobs. economy, particularly during these dif- the auction revenues? What we would In addition to advancing the goal of ficult economic times. That is why I propose is that those would go to a energy independence and creating am pleased to be the lead cosponsor of trust fund to fund energy efficiency green jobs, the CLEAR Act is the fair- the CLEAR Act. programs and renewable energy re- est climate change approach for con- While we must take meaningful ac- search and development, to provide in- sumers. It would rebate 75 percent of tion to respond to climate change, it centives for forestry and agriculture the proceeds generated by the cap on must be a balanced approach. Climate practices that sequester carbon, to en- carbon directly to citizens. change legislation must protect con- courage practices that reduce other According to recent reports from the sumers and industries that could be hit greenhouse gases, to help energy-effi- Intergovernmental Panel on Climate with higher energy prices. We must cient, energy-intensive manufacturers, Change, increases in greenhouse gas recognize that many of our citizens are and to assist low-income consumers. emissions have already increased glob- struggling just to pay their monthly That fund would be called the Clean al temperatures, and likely contributed energy bills and cannot afford dramati- Energy Reinvestment Trust, the CERT to more extreme weather events such cally higher prices. Such legislation fund. It would be subject to the annual as droughts and floods. These emis- also must provide predictability so appropriations process so that Con- sions will continue to change the cli- that businesses can plan, invest, and gress could adapt assistance for climate, causing warming in most regions create jobs. mate-related activities on an annual of the world, and likely causing more Climate change legislation should en- basis rather than being locked into a droughts, floods, and many other prob- courage adoption of energy efficiency complicated allocation scheme that lems. measures and the further development may well favor special interests. In the United States alone, emissions of renewable energy, which could spur I am excited about this bill. It offers of the primary greenhouse gas, carbon our economy and job creation. For ex- us a way forward to a green economy. dioxide, have risen more than 20 per- ample, Maine has immense potential to It will help create jobs. It will alleviate cent since 1990. Climate change is the develop offshore wind energy. Esti- the burden on consumers, particularly most daunting environmental chal- mates are that development of 5 in New England, where the Presiding lenge we face, and we must develop rea- gigawatts of offshore wind in Maine—

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00067 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.062 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13038 CONGRESSIONAL RECORD — SENATE December 11, 2009 enough to power more than 1 million tion and speculation to drive up carbon are among the least likely to subscribe homes for a year—could attract $20 bil- prices that exists in the House bill. Fi- to broadband. At the same time, busi- lion of investment to the State and nancial experts estimate that under nesses and educational institutions, create more than 15,000 green energy the House bill, carbon permit trading among others, have migrated many es- jobs that would be sustained over 30 could create a $3 trillion commodity sential services and opportunities to years. market by 2020. Do we really want to the Internet. The result is that people The CLEAR Act achieves all of these have energy consumers subsidizing without broadband, particularly in goals, whereas the bill passed by the Wall Street traders? rural areas, are being left behind. House of Representatives earlier this In the CLEAR Act, 75 percent of the Today, 77 percent of Fortune 500 com- year has been characterized by the Bos- carbon auction revenues would be re- panies only accept job applications on- ton Globe as ‘‘providing cushions for turned to consumers as tax-free re- line. Seventy-eight percent of students industry;’’ ‘‘fat with compromises, bates. Nationwide, this means 80 per- regularly use the Internet for class- carve-outs, concessions and out-and- cent of Americans would incur no net room work. Similarly, State, and local out gifts,’’ a New York Times article costs under the CLEAR Act. The aver- government agencies, as well as vital by John Broder, June 30, 2009; and hav- age Mainer would stand to gain $102 per healthcare services, are increasingly ing pollution credits and revenue that year from the CLEAR Act. By contrast, migrating online, especially as budget were ‘‘divvied up to the advantage of under the House-passed cap and trade cuts reduce the availability and qual- politically favored polluters,’’ from the bill, the average citizen would experi- ity of offline services. Washington Post editorial, June 26, ence a net cost increase of $175 per All of this means that the children of 2009. This House bill could not garner year. families without broadband lose access the necessary 60 votes in the Senate. The other 25 percent of the auction to learning opportunities. Qualified The CLEAR Act will help to move a revenues generated under CLEAR workers lose access to jobs. Low-in- stalled debate forward by offering a would go into a trust fund to fund en- come Americans waste precious time— more efficient, straightforward ap- ergy efficiency programs and renew- sometimes even having to take off proach. able energy research and development, from their jobs—in government offices, Let me discuss how our bill would to provide incentives for forestry and waiting for services that are otherwise work. The CLEAR Act places an up- agriculture practices that sequester available online. stream cap on carbon entering the carbon, to encourage practices that re- This income-based digital divide is economy. The upstream cap on carbon duce other greenhouse gases, to help stark. Americans who earn less than would capture 96 percent of all carbon energy-intensive manufacturers, and to $30,000 per year have a 50 percent lower dioxide emissions, 93 percent of total assist low-income consumers. The fund, rate of broadband adoption than those annual U.S. greenhouse gas emissions called the Clean Energy Reinvestment who earn $100,000 annually. What by weight, and 82 percent of total an- Trust, CERT Fund, would be subject to makes it worse is that, in some ways, nual U.S. greenhouse gas emissions by the annual appropriations process. This low-income consumers are the ones global warming potential. would allow Congress to adapt assist- who stand to benefit the most from af- The initial annual carbon budget ance for climate-related activities on fordable broadband access. Online job under the cap would be set based on the an annual basis, rather than being information and educational opportu- amount of fossil carbon likely to be locked into a complicated allocation nities can provide low-income con- consumed by the U.S. economy in 2012, scheme that favors special interests. sumers with critical means to improve the year in which the CLEAR Act regu- I applaud the leadership of my col- their lives and the lives of their chil- lations would begin, based on projec- league from Washington for developing dren. tions by the Energy Information Ad- this straightforward, effective and fair Like basic telephone service, ministration. For the first 2 years, the climate bill. I urge all my colleagues to broadband is quickly becoming a neces- cap would stay at the 2012 level to give consider joining us on this important sity. Consumers without access are at companies time to adapt to the system. legislation. risk of becoming second class citizens Starting in 2015, the carbon budget in a growing digital world. The original would be reduced annually along a By Mr. ROCKEFELLER (for him- Lifeline program recognized that tele- schedule designed to achieve nearly an self, Mrs. HUTCHISON, Mr. phone service was a critical part of ev- 80 percent reduction in 2005 level emis- KERRY, Ms. SNOWE, Mr. PRYOR, eryday life and that low-income Ameri- sions by 2050. and Mr. WARNER): cans needed to be connected to the The cap will recognize voluntary re- S. 2879. A bill to direct the Federal world around them. What was true for gional efforts like the Regional Green- Communications Commission to con- telephony then is true for broadband house Gas Initiative, RGGI. RGGI is a duct a pilot program expanding the now. That is why the Lifeline program cooperative effort by 10 northeast and Lifeline Program to include broadband at the FCC should be expanded to sup- mid-Atlantic States to limit green- service, and for other purposes; to the port broadband access for low-income house gas emissions. These 10 States Committee on Commerce, Science, and households. have capped CO2 emissions from the Transportation. The legislation we introduce today power sector and will require a 10-per- Mr. ROCKEFELLER. Mr. President, I creates a two-year pilot program to ex- cent reduction in these emissions by rise today to introduce legislation that pand the FCC’s Lifeline program by 2018. will enable more low-income house- supporting broadband service for eligi- Coal companies, oil and gas pro- holds to receive broadband and its ben- ble low-income households. It also asks ducers, and oil and gas importers would efits. the FCC to provide Congress with a re- have to buy permits or ‘‘allowances’’ Broadband has fundamentally port on expanding the Link-Up pro- for the carbon in their products. They changed the way Americans live their gram to assist with the costs of secur- would buy the permits in a monthly daily lives. It has changed how we do ing equipment, such as computers, auction in which those companies business, get information, find jobs, needed to use broadband service. would be the only ones allowed to par- learn, communicate, and interact with We must make sure that we act now ticipate. One hundred percent of the al- Federal, State, and local governments. to bridge the divide that threatens to lowances would be auctioned; no free Over the next few years, we can only make low-income consumers second- allowances are provided to special in- expect more innovation and more class citizens. For this reason, I urge terests. Thus, the CLEAR Act does not broadband applications that open doors my colleagues to join me and support provide special favors like the House to new opportunities and provide even this legislation. more benefits to consumers. bill. f Unlike the House bill, in the CLEAR While broadband has been more Act, only the companies directly regu- quickly deployed and adopted in pre- AMENDMENTS SUBMITTED AND lated by the legislation would partici- dominantly urban areas, availability PROPOSED pate in the auction. This avoids the and adoption in rural areas has lagged SA 3164. Mr. CASEY submitted an amend- huge potential for market manipula- behind. Low-income rural households ment intended to be proposed to amendment

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00068 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.031 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13039

SA 2786 proposed by Mr. REID (for himself, HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered the bill H.R. 3590, to amend the Internal Rev- SA 3178. Mr. GRASSLEY submitted an to lie on the table. enue Code of 1986 to modify the first-time amendment intended to be proposed to SA 3193. Mr. ENZI submitted an amend- homebuyers credit in the case of members of amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment the Armed Forces and certain other Federal (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, employees, and for other purposes; which HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to was ordered to lie on the table. was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered SA 3165. Mr. BINGAMAN submitted an SA 3179. Mr. GRASSLEY submitted an to lie on the table. amendment intended to be proposed to amendment intended to be proposed to SA 3194. Mr. ENZI submitted an amend- amendment SA 2786 proposed by Mr. REID amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment EID (for himself, Mr. BAUCUS, Mr. DODD, and Mr. (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. R (for himself, Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to HARKIN) to the bill H.R. 3590, supra; which HARKIN) to the bill H.R. 3590, supra; which was ordered to lie on the table. was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered SA 3166. Mr. BINGAMAN submitted an SA 3180. Mr. GRASSLEY (for himself and to lie on the table. SA 3195. Mr. ENZI submitted an amend- amendment intended to be proposed to Mr. ROBERTS) submitted an amendment in- ment intended to be proposed to amendment amendment SA 2786 proposed by Mr. REID tended to be proposed to amendment SA 2786 SA 2786 proposed by Mr. REID (for himself, (for himself, Mr. BAUCUS, Mr. DODD, and Mr. proposed by Mr. REID (for himself, Mr. BAU- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to CUS, Mr. DODD, and Mr. HARKIN) to the bill HARKIN) to the bill H.R. 3590, supra; which the bill H.R. 3590, supra; which was ordered was ordered to lie on the table. H.R. 3590, supra; which was ordered to lie on to lie on the table. SA 3167. Mr. BINGAMAN submitted an the table. SA 3196. Mr. ENZI submitted an amend- amendment intended to be proposed to SA 3181. Mr. GRASSLEY submitted an ment intended to be proposed to amendment amendment SA 2786 proposed by Mr. REID amendment intended to be proposed to SA 2786 proposed by Mr. REID (for himself, (for himself, Mr. BAUCUS, Mr. DODD, and Mr. amendment SA 2786 proposed by Mr. REID Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to HARKIN) to the bill H.R. 3590, supra; which (for himself, Mr. BAUCUS, Mr. DODD, and Mr. the bill H.R. 3590, supra; which was ordered was ordered to lie on the table. HARKIN) to the bill H.R. 3590, supra; which to lie on the table. SA 3168. Mr. CASEY (for himself and Mrs. was ordered to lie on the table. SA 3197. Mr. ENZI submitted an amend- GILLIBRAND) submitted an amendment in- SA 3182. Mr. GRASSLEY submitted an ment intended to be proposed to amendment tended to be proposed to amendment SA 2786 amendment intended to be proposed to SA 2786 proposed by Mr. REID (for himself, proposed by Mr. REID (for himself, Mr. BAU- amendment SA 2786 proposed by Mr. REID Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to CUS, Mr. DODD, and Mr. HARKIN) to the bill (for himself, Mr. BAUCUS, Mr. DODD, and Mr. the bill H.R. 3590, supra; which was ordered H.R. 3590, supra; which was ordered to lie on HARKIN) to the bill H.R. 3590, supra; which to lie on the table. the table. was ordered to lie on the table. SA 3198. Mr. CORNYN (for himself and Mr. SA 3169. Mr. CORNYN (for himself and Mr. SA 3183. Mr. BAUCUS submitted an amend- LEMIEUX) submitted an amendment intended COBURN) submitted an amendment intended ment intended to be proposed by him to the to be proposed to amendment SA 2786 pro- to be proposed to amendment SA 2786 pro- bill H.R. 3590, supra; which was ordered to lie posed by Mr. REID (for himself, Mr. BAUCUS, posed by Mr. REID (for himself, Mr. BAUCUS, on the table. Mr. DODD, and Mr. HARKIN) to the bill H.R. Mr. DODD, and Mr. HARKIN) to the bill H.R. SA 3184. Mr. CASEY submitted an amend- 3590, supra; which was ordered to lie on the 3590, supra; which was ordered to lie on the ment intended to be proposed to amendment table. table. SA 2786 proposed by Mr. REID (for himself, f SA 3170. Mr. PRYOR (for himself and Mr. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to BAYH) submitted an amendment intended to the bill H.R. 3590, supra; which was ordered TEXT OF AMENDMENTS be proposed to amendment SA 2786 proposed to lie on the table. SA 3164. Mr. CASEY submitted an by Mr. REID (for himself, Mr. BAUCUS, Mr. SA 3185. Mr. BROWN submitted an amend- amendment intended to be proposed to DODD, and Mr. HARKIN) to the bill H.R. 3590, ment intended to be proposed to amendment amendment SA 2786 proposed by Mr. supra; which was ordered to lie on the table. SA 2786 proposed by Mr. REID (for himself, REID (for himself, Mr. BAUCUS, Mr. SA 3171. Mr. PRYOR submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to ment intended to be proposed to amendment the bill H.R. 3590, supra; which was ordered DODD, and Mr. HARKIN) to the bill H.R. SA 2786 proposed by Mr. REID (for himself, to lie on the table. 3590, to amend the Internal Revenue Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3186. Mr. BROWN submitted an amend- Code of 1986 to modify the first-time the bill H.R. 3590, supra; which was ordered ment intended to be proposed to amendment homebuyers credit in the case of mem- to lie on the table. SA 2786 proposed by Mr. REID (for himself, bers of the Armed Forces and certain SA 3172. Mr. BROWN submitted an amend- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to other Federal employees, and for other ment intended to be proposed to amendment the bill H.R. 3590, supra; which was ordered purposes; which was ordered to lie on SA 2786 proposed by Mr. REID (for himself, to lie on the table. the table; as follows: Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 3187. Mr. WYDEN (for himself and Mr. On page 330, strike lines 7 through 11 and the bill H.R. 3590, supra; which was ordered CRAPO) submitted an amendment intended to to lie on the table. be proposed to amendment SA 2786 proposed inserting the following: ‘‘individual is— SA 3173. Mr. MERKLEY (for himself and by Mr. REID (for himself, Mr. BAUCUS, Mr. ‘‘(i) a member of a recognized religious Mr. FRANKEN) submitted an amendment in- DODD, and Mr. HARKIN) to the bill H.R. 3590, tended to be proposed to amendment SA 2786 supra; which was ordered to lie on the table. sect or division thereof which is described in proposed by Mr. REID (for himself, Mr. BAU- SA 3188. Ms. CANTWELL submitted an section 1402(g)(1), and CUS, Mr. DODD, and Mr. HARKIN) to the bill amendment intended to be proposed to ‘‘(ii) an adherent of established tenets or H.R. 3590, supra; which was ordered to lie on amendment SA 2786 proposed by Mr. REID teachings of such sect or division as de- the table. (for himself, Mr. BAUCUS, Mr. DODD, and Mr. scribed in such section. SA 3174. Ms. SNOWE submitted an amend- HARKIN) to the bill H.R. 3590, supra; which Mr. BINGAMAN submitted ment intended to be proposed to amendment was ordered to lie on the table. SA 3165. SA 2786 proposed by Mr. REID (for himself, SA 3189. Mr. ENZI submitted an amend- an amendment intended to be proposed Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to ment intended to be proposed to amendment to amendment SA 2786 proposed by Mr. the bill H.R. 3590, supra; which was ordered SA 2786 proposed by Mr. REID (for himself, REID (for himself, Mr. BAUCUS, Mr. to lie on the table. Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to DODD, and Mr. HARKIN) to the bill H.R. SA 3175. Mr. SPECTER (for himself, Mr. the bill H.R. 3590, supra; which was ordered 3590, to amend the Internal Revenue BROWN, and Mr. CASEY) submitted an amend- to lie on the table. Code of 1986 to modify the first-time ment intended to be proposed to amendment SA 3190. Mr. ENZI submitted an amend- homebuyers credit in the case of mem- SA 2786 proposed by Mr. REID (for himself, ment intended to be proposed to amendment bers of the Armed Forces and certain Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SA 2786 proposed by Mr. REID (for himself, the bill H.R. 3590, supra; which was ordered Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to other Federal employees, and for other to lie on the table. the bill H.R. 3590, supra; which was ordered purposes; which was ordered to lie on SA 3176. Mr. GRASSLEY submitted an to lie on the table. the table; as follows: amendment intended to be proposed to SA 3191. Mr. ENZI submitted an amend- On page 1395, strike line 11 and all that fol- amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment lows through ‘‘SEC. 778.’’ on line 15 and in- (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, sert the following: HARKIN) to the bill H.R. 3590, supra; which Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to SEC. 5314. FELLOWSHIP TRAINING IN PUBLIC was ordered to lie on the table. the bill H.R. 3590, supra; which was ordered HEALTH. SA 3177. Mr. GRASSLEY submitted an to lie on the table. Part B of title III of the Public Health amendment intended to be proposed to SA 3192. Mr. ENZI submitted an amend- Service Act (42 U.S.C. 243 et seq.) is amended amendment SA 2786 proposed by Mr. REID ment intended to be proposed to amendment by inserting after section 311 the following: (for himself, Mr. BAUCUS, Mr. DODD, and Mr. SA 2786 proposed by Mr. REID (for himself, ‘‘SEC. 311A.

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00069 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.033 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13040 CONGRESSIONAL RECORD — SENATE December 11, 2009 SA 3166. Mr. BINGAMAN submitted homebuyers credit in the case of mem- is otherwise insufficient to determine eligi- an amendment intended to be proposed bers of the Armed Forces and certain bility. to amendment SA 2786 proposed by Mr. other Federal employees, and for other (c) REQUIREMENTS RELATING TO ELIGIBILITY REID (for himself, Mr. BAUCUS, Mr. purposes; which was ordered to lie on BASED ON DATA EXCHANGES.— DODD, and Mr. HARKIN) to the bill H.R. the table; as follows: (1) DEVELOPMENT OF SECURE INTERFACES.— 3590, to amend the Internal Revenue Strike section 1413 and insert the fol- Each State shall develop for all applicable Code of 1986 to modify the first-time lowing: State health subsidy programs a secure, elec- homebuyers credit in the case of mem- SEC. 1413. STREAMLINING OF PROCEDURES FOR tronic interface allowing an exchange of bers of the Armed Forces and certain ENROLLMENT THROUGH AN EX- data (including information contained in the CHANGE AND STATE MEDICAID, application forms described in subsection other Federal employees, and for other CHIP, AND HEALTH SUBSIDY PRO- (b)) that allows a determination of eligibility purposes; which was ordered to lie on GRAMS. for all such programs based on a single appli- the table; as follows: (a) IN GENERAL.—The Secretary shall es- cation. Such interface shall be compatible On page 816, after line 20, insert the fol- tablish a system meeting the requirements with the method established for data of this section under which residents of each lowing: verification under section 1411(c)(4). State may apply for enrollment in, receive a SEC. 3115. GAO STUDY AND REPORT ON MEDI- (2) DATA MATCHING PROGRAM.—Each appli- determination of eligibility for participation CARE BENEFICIARY ACCESS. cable State health subsidy program shall in, and continue participation in, applicable (a) STUDY.—The Comptroller General of participate in a data matching arrangement State health subsidy programs. Such system the United States (in this section referred to for determining eligibility for participation shall ensure that if an individual applying to as the ‘‘Comptroller General’’) shall conduct in the program under paragraph (3) that— a study on the ability of Medicare bene- an Exchange, to a State Medicaid program under title XIX of the Social Security Act, (A) provides access to data described in ficiaries to fully access available health care paragraph (3); services during the 5-year period following or to a State children’s health insurance program (CHIP) under title XXI of such Act, is (B) applies only to individuals who— enactment of this Act. Such study shall in- (i) receive assistance from an applicable clude the following: found to be ineligible for the program to which the individual applied, the individual State health subsidy program; or (1) A detailed analysis regarding levels of (ii) apply for such assistance— access to health care services for different shall be screened for eligibility for all other potentially applicable such programs and (I) by filing a form described in subsection groups or populations of Medicare bene- (b); or ficiaries, including a breakdown— shall be enrolled in the program for which (II) notwithstanding section 1411(b), by re- (A) by location, including rural areas (as the individual qualifies. (b) REQUIREMENTS RELATING TO FORMS AND questing a determination of eligibility and defined in section 1886(d)(2)(D) of the Social NOTICE.— authorizing disclosure of the information de- Security Act), health professional shortage (1) REQUIREMENTS RELATING TO FORMS.— scribed in paragraph (3) to applicable State areas (as designated under section 332 of the (A) IN GENERAL.—The Secretary shall de- health coverage subsidy programs for pur- Public Health Service Act), medically under- velop and provide to each State a single, poses of determining and establishing eligi- served communities (as defined in section streamlined form that— bility; and 799B(6) of such Act), and medically under- (i) may be used to apply for all applicable (C) is consistent with standards promul- served populations (as defined in section State health subsidy programs within the gated by the Secretary, including the pri- 330(b)(3) of such Act); State; (B) by type of health care service, includ- vacy and data security safeguards described (ii) may be filed online, in person, by mail, ing physician services and primary care serv- in section 1942 of the Social Security Act or or by telephone; ices; and that are otherwise applicable to such pro- (iii) may be filed with an Exchange or with (C) by any other measure determined ap- grams. State officials operating one of the other appropriate by the Comptroller General. (3) DETERMINATION OF ELIGIBILITY.— plicable State health subsidy programs; and (2) A summary that identifies— (A) IN GENERAL.—Each applicable State (iv) is structured to maximize an appli- (A) any groups or populations of Medicare health subsidy program shall, to the max- cant’s ability to complete the form satisfac- beneficiaries that lack adequate access to imum extent practicable— torily, taking into account the characteris- health care services; and (i) establish, verify, and update eligibility tics of individuals who qualify for applicable (B) any types of health care services that for participation in the program using the State health subsidy programs. are not fully accessible to Medicare bene- data matching arrangement under paragraph (B) STATE AUTHORITY TO ESTABLISH FORM.— ficiaries. (2); and A State may develop and use its own single, (b) REPORT.— (ii) determine such eligibility on the basis streamlined form as an alternative to the (1) INTERIM REPORT.—Not later than 30 of reliable, third party data, including infor- months after the date of enactment of this form developed under subparagraph (A) if the mation described in sections 1137, 453(i), and Act, the Comptroller General shall prepare alternative form is consistent with standards 1942(a) of the Social Security Act, obtained and submit an interim report to Congress promulgated by the Secretary under this sec- through such arrangement, provided that if that contains the preliminary results of the tion. such data do not establish an individual’s study conducted under subsection (a), to- (C) SUPPLEMENTAL ELIGIBILITY FORMS.—The eligibility for medical assistance under title gether with recommendations for such legis- Secretary may allow a State to use a supple- XIX of the Social Security Act, the rules de- lation and administrative action as the mental or alternative form in the case of in- scribed in section 1902(e)(14)(H) of such Act Comptroller General determines appropriate. dividuals who apply for eligibility that is not shall apply to such individual. determined on the basis of the household in- (2) FINAL REPORT.—Not later than 60 (B) EXCEPTION.—This paragraph shall not months after the date of enactment of this come (as defined in section 36B of the Inter- apply in circumstances with respect to which Act, the Comptroller General shall prepare nal Revenue Code of 1986). the Secretary determines that the adminis- and submit a final report to Congress that (D) RELEVANCE.—The forms described in trative and other costs of use of the data contains the results of the study conducted subparagraphs (A) and (B) shall not require matching arrangement under paragraph (2) under subsection (a), together with rec- the applicant to answer any questions that outweigh its expected gains in accuracy, effi- ommendations for such legislation and ad- are irrelevant to establishing eligibility for ciency, and program participation. applicable State health subsidy programs. ministrative action as the Comptroller Gen- (4) SECRETARIAL STANDARDS.—The Sec- eral determines appropriate. The Secretary shall establish procedures retary shall, after consultation with persons that avoid any need for such requirements, (c) MEDICARE BENEFICIARY.—In this sec- in possession of the data to be matched and tion, the term ‘‘Medicare beneficiary’’ means which shall include determining the amounts representatives of applicable State health an individual entitled to benefits under part expended for medical assistance that are de- subsidy programs, promulgate standards scribed in subsection (y)(1) of section 1905 of A of title XVIII of the Social Security Act, governing the timing, contents, and proce- the Social Security Act (as added by section enrolled under part B of such title, or both. dures for data matching described in this 2001(a)(3) of this Act) through the use of the (d) AUTHORIZATION OF APPROPRIATIONS.— subsection. Such standards shall take into post-enrollment procedures described in sec- There are authorized to be appropriated such account administrative and other costs and tion 1903(u)(1)(C) of the Social Security Act. sums as are necessary to carry out this sec- the value of data matching to the establish- (2) NOTICE.—The Secretary shall provide tion. ment, verification, and updating of eligi- that an applicant filing a form under para- bility for applicable State health subsidy graph (1) shall receive notice of eligibility SA 3167. Mr. BINGAMAN submitted programs. an amendment intended to be proposed for an applicable State health subsidy pro- (d) ADMINISTRATIVE AUTHORITY.— to amendment SA 2786 proposed by Mr. gram without any need to provide additional information or paperwork unless such infor- (1) AGREEMENTS.—Subject to section 1411 REID (for himself, Mr. BAUCUS, Mr. mation or paperwork is specifically required and section 6103(l)(21) of the Internal Rev- DODD, and Mr. HARKIN) to the bill H.R. by law when information provided on the enue Code of 1986 and any other requirement 3590, to amend the Internal Revenue form is inconsistent with data used for the providing safeguards of privacy and data in- Code of 1986 to modify the first-time electronic verification under paragraph (3) or tegrity, the Secretary may establish model

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00070 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.045 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13041

agreements, and enter into agreements, for and educational achievement, or reducing ‘‘(1) LIMITATION ON CONTRIBUTIONS TO the sharing of data under this section. dependence on public assistance.’’. HEALTH FLEXIBLE SPENDING ARRANGEMENTS.— (2) AUTHORITY OF EXCHANGE TO CONTRACT (b) EFFECTIVE DATE.—The amendments For purposes of this section,’’, and OUT.—Nothing in this section shall be con- made by this section shall apply to services (2) by adding at the end the following new strued to— furnished on or after January 1, 2010. paragraph: (A) prohibit contractual arrangements (c) CONSTRUCTION.—Nothing in the amend- ‘‘(2) ALLOWANCE OF CARRYOVER OF UNUSED through which a State medicaid agency de- ments made by this section shall be con- AMOUNTS IN HEALTH FLEXIBLE SPENDING AR- termines eligibility for all applicable State strued as affecting the ability of a State RANGEMENTS.— health subsidy programs, but only if such under title XIX or XXI of the Social Security ‘‘(A) IN GENERAL.—For purposes of this agency complies with the Secretary’s re- Act to provide nurse home visitation serv- title, a plan or other arrangement shall not quirements ensuring reduced administrative ices as part of another class of items and fail to be treated as a cafeteria plan solely costs, eligibility errors, and disruptions in services falling within the definition of med- because under the plan or arrangement a coverage; or ical assistance or child health assistance participant is permitted access to any un- (B) change any requirement under title under the respective title, or as an adminis- used amounts attributable to salary reduc- XIX that eligibility for participation in a trative expenditure for which payment is tion contributions under such plan or ar- State’s medicaid program must be deter- made under section 1903(a) or 2105(a) of such rangement in the manner provided under mined by a public agency. Act, respectively, on or after the date of the subparagraph (B). (e) APPLICABLE STATE HEALTH SUBSIDY enactment of this Act. ‘‘(B) CARRYOVER OF UNUSED AMOUNTS.—A PROGRAM.—In this section, the term ‘‘appli- plan or arrangement may permit a partici- cable State health subsidy program’’ SA 3169. Mr. CORNYN (for himself pant in a health flexible spending arrange- means— and Mr. COBURN) submitted an amendment to elect to carry over so much of the (1) the program under this title for the de- ment intended to be proposed to unused amounts attributable to salary re- termination of eligibility for premium tax amendment SA 2786 proposed by Mr. duction contributions under such plan or ar- credits under section 36B of the Internal REID (for himself, Mr. BAUCUS, Mr. rangement as of the close of any calendar Revenue Code of 1986 and cost-sharing reduc- DODD, and Mr. HARKIN) to the bill H.R. year as does not exceed $1,000 to the imme- tions under section 1402; 3590, to amend the Internal Revenue diately succeeding calendar year. (2) a State medicaid program under title ‘‘(C) AMOUNTS NOT DEFERRED COMPENSA- XIX of the Social Security Act; Code of 1986 to modify the first-time TION.—No amount shall be treated as de- (3) a State children’s health insurance pro- homebuyers credit in the case of mem- ferred compensation for purposes of this title gram (CHIP) under title XXI of such Act; and bers of the Armed Forces and certain by reason of any carryover under this para- (4) a State program under section 1331 es- other Federal employees, and for other graph. tablishing qualified basic health plans. purposes; which was ordered to lie on ‘‘(D) COORDINATION WITH CONTRIBUTION the table; as follows: LIMIT.—The maximum amount which may be SA 3168. Mr. CASEY (for himself and contributed to a health flexible spending ar- Strike section 6001. Mrs. GILLIBRAND) submitted an amend- rangement under paragraph (1) for any cal- ment intended to be proposed to SA 3170. Mr. PRYOR (for himself and endar year to which an unused amount is carried over under this paragraph shall be re- amendment SA 2786 proposed by Mr. Mr. BAYH) submitted an amendment in- REID (for himself, Mr. BAUCUS, Mr. duced by such amount.’’. tended to be proposed to amendment (b) EFFECTIVE DATE.—The amendments DODD, and Mr. HARKIN) to the bill H.R. SA 2786 proposed by Mr. REID (for him- made by this section shall apply to calendar 3590, to amend the Internal Revenue self, Mr. BAUCUS, Mr. DODD, and Mr. years beginning after December 31, 2010. Code of 1986 to modify the first-time HARKIN) to the bill H.R. 3590, to amend homebuyers credit in the case of mem- the Internal Revenue Code of 1986 to SA 3172. Mr. BROWN submitted an bers of the Armed Forces and certain modify the first-time homebuyers cred- amendment intended to be proposed to other Federal employees, and for other it in the case of members of the Armed amendment SA 2786 proposed by Mr. REID (for himself, Mr. BAUCUS, Mr. purposes; which was ordered to lie on Forces and certain other Federal em- DODD, and Mr. HARKIN) to the bill H.R. the table; as follows: ployees, and for other purposes; which 3590, to amend the Internal Revenue On page 466, between lines 5 and 6, insert was ordered to lie on the table; as fol- Code of 1986 to modify the first-time the following: lows: SEC. 2305. OPTIONAL COVERAGE OF NURSE homebuyers credit in the case of mem- HOME VISITATION SERVICES. On page 828, between lines 3 and 4, insert bers of the Armed Forces and certain (a) IN GENERAL.—Section 1905 of the Social the following: other Federal employees, and for other Security Act (42 U.S.C. 1396d), as amended by SEC. 3130. RESTORING STATE AUTHORITY TO WAIVE THE 35-MILE RULE FOR MEDI- purposes; which was ordered to lie on sections 2001(a)(3), 2006, and 2301(a)(1), is the table; as follows: amended— CARE CRITICAL ACCESS HOSPITAL DESIGNATIONS. (1) in subsection (a)— On page 18, between lines 15 and 16, insert Section 1820(c)(2)(B)(i)(II) of the Social Se- (A) in paragraph (28), by striking ‘‘and’’ at the following: curity Act (42 U.S.C. 1395i–4(c)(2)(B)(i)(II)) is the end; ‘‘SEC. 2713A. COVERAGE OF CERTAIN CARE. amended by inserting ‘‘or on or after the (B) by redesignating paragraph (29) as ‘‘A group health plan and a health insur- date of enactment of the Patient Protection paragraph (30); and ance issuer offering group or individual and Affordable Care Act’’ after ‘‘January 1, (C) by inserting after paragraph (28) the health insurance coverage shall provide cov- 2006,’’. following new paragraph: erage for wound-care supplies that are medi- ‘‘(29) nurse home visitation services (as de- cally necessary for the treatment of SA 3171. Mr. PRYOR submitted an epidermolysis bullosa and are administered fined in subsection (z)); and’’; and amendment intended to be proposed to (2) by inserting after subsection (y) the fol- under the direction of a physician.’’. amendment SA 2786 proposed by Mr. lowing new subsection: Mr. MERKLEY (for himself ‘‘(z) The term ‘nurse home visitation serv- REID (for himself, Mr. BAUCUS, Mr. SA 3173. ices’ means voluntary home visits that are DODD, and Mr. HARKIN) to the bill H.R. and Mr. FRANKEN) submitted an provided by trained nurses to a family with 3590, to amend the Internal Revenue amendment intended to be proposed to a first-time pregnant woman, or a child Code of 1986 to modify the first-time amendment SA 2786 proposed by Mr. (under 2 years of age), who is eligible for homebuyers credit in the case of mem- REID (for himself, Mr. BAUCUS, Mr. medical assistance under this title, but only, bers of the Armed Forces and certain DODD, and Mr. HARKIN) to the bill H.R. to the extent determined by the Secretary other Federal employees, and for other 3590, to amend the Internal Revenue based upon evidence, that such services are Code of 1986 to modify the first-time effective in achieving 1 or more of the fol- purposes; which was ordered to lie on the table; as follows: homebuyers credit in the case of mem- lowing: bers of the Armed Forces and certain ‘‘(1) Improving maternal or child health On page 1999, between lines 20 and 21, insert and pregnancy outcomes or increasing birth the following: other Federal employees, and for other purposes; which was ordered to lie on intervals between pregnancies. SEC. 9005A. ANNUAL ROLLOVER OF HEALTH FSA ‘‘(2) Reducing the incidence of child abuse, BALANCES. the table; as follows: neglect, and injury, improving family sta- (a) IN GENERAL.—Subsection (i) of section On page 354, between lines 2 and 3, insert bility (including reduction in the incidence 125 of the Internal Revenue Code of 1986, as the following: of intimate partner violence), or reducing added by section 9005(a)(2), is amended— (D) APPLICATION TO CONSTRUCTION INDUSTRY maternal and child involvement in the (1) by striking all matter before ‘‘if a ben- EMPLOYERS.—In the case of any employer the criminal justice system. efit’’ and inserting the following: substantial annual gross receipts of which ‘‘(3) Increasing economic self-sufficiency, ‘‘(i) SPECIAL RULES APPLICABLE TO HEALTH are attributable to the construction indus- employment advancement, school-readiness, FLEXIBLE SPENDING ARRANGEMENTS.— try—

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00071 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.047 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13042 CONGRESSIONAL RECORD — SENATE December 11, 2009 (i) subparagraph (A) shall be applied by correspondence, memoranda, papers, docu- to amendment SA 2786 proposed by Mr. substituting ‘‘who employed an average of at ments, tapes, and materials as the Com- REID (for himself, Mr. BAUCUS, Mr. least 5 full-time employees on business days mittee considers advisable. DODD, and Mr. HARKIN) to the bill H.R. during the preceeding calendar year or whose (2) REPORTS AND RECOMMENDATIONS.—The 3590, to amend the Internal Revenue annual payroll expenses exceed $250,000 for Committee may issues reports and findings such preceeding calendar year’’ for ‘‘who em- as it deems appropriate, including offering Code of 1986 to modify the first-time ployed an average of at least 50 full-time em- suggestions for legislation to improve the re- homebuyers credit in the case of mem- ployees on business days during the quirements and activities under this Act (in- bers of the Armed Forces and certain preceeding calendar year’’, and cluding the amendments made by this Act). other Federal employees, and for other (ii) subparagraph (B) shall be applied by (3) ISSUANCE AND ENFORCEMENT OF SUB- purposes; which was ordered to lie on substituting ‘‘5’’ for ‘‘50’’. POENAS.— the table; as follows: (A) ISSUANCE.—Subpoenas issued under SA 3174. Ms. SNOWE submitted an On page 816, after line 20, insert the fol- paragraph (1) shall bear the signature of the lowing: amendment intended to be proposed to Chairperson of the Committee and shall be SEC. 3115. EXCLUSION OF CUSTOMARY PROMPT amendment SA 2786 proposed by Mr. served by any person or class of persons des- PAY DISCOUNTS EXTENDED TO REID (for himself, Mr. BAUCUS, Mr. ignated by the Chairperson for that purpose. WHOLESALERS FROM MANUFACTUR- DODD, and Mr. HARKIN) to the bill H.R. (B) ENFORCEMENT.—In the case of contu- ER’S AVERAGE SALES PRICE FOR 3590, to amend the Internal Revenue macy or failure to obey a subpoena issued PAYMENTS FOR DRUGS AND under paragraph (1), the United States dis- BIOLOGICALS UNDER MEDICARE Code of 1986 to modify the first-time trict court for the judicial district in which PART B. homebuyers credit in the case of mem- the subpoenaed person resides, is served, or Section 1847A(c)(3) of the Social Security bers of the Armed Forces and certain may be found may issue an order requiring Act (42 U.S.C. 1395w–3a(c)(3)) is amended— other Federal employees, and for other such person to appear at any designated (1) in the first sentence, by inserting after purposes; which was ordered to lie on place to testify or to produce documentary ‘‘prompt pay discounts’’ the following: the table; as follows: or other evidence. Any failure to obey the ‘‘(other than, for drugs and biologicals that are sold on or after January 1, 2011, and be- At after title IX, insert the following: order of the court may be punished by the court as a contempt that court. fore January 1, 2016, customary prompt pay TITLE X—HEALTH CARE REFORM (4) WITNESS ALLOWANCES AND FEES.—Sec- discounts extended to wholesalers, but only OVERSIGHT COMMITTEE tion 1821 of title 28, United States Code, shall to the extent such discounts do not exceed 2 SEC. 10001. HEALTH CARE REFORM OVERSIGHT apply to witnesses requested or subpoenaed percent of the wholesale acquisition cost)’’; COMMITTEE. to appear at any hearing of the Committee. and (a) ESTABLISHMENT.—There is established a The per diem and mileage allowances for (2) in the second sentence, by inserting committee to be known as the Health Care witnesses shall be paid from funds available after ‘‘other price concessions’’ the fol- Reform Oversight Committee (referred to in to pay the expenses of the Committee. lowing: ‘‘(other than, for drugs and this section as the ‘‘Committee’’), for the (5) INFORMATION FROM FEDERAL AGENCIES.— biologicals that are sold on or after January purpose of maintaining close oversight of the The Committee may secure directly from 1, 2011, and before January 1, 2016, customary implementation of the requirements of this any Federal department or agency such in- prompt pay discounts extended to whole- Act (including the amendments made by this formation as the Committee considers nec- salers, but only to the extent such discounts Act), including with regard to the afford- essary to carry out this Act. Upon request of do not exceed 2 percent of the wholesale ac- ability criteria set forth in this Act, the im- the Chairperson of the Committee, or of an- quisition cost)’’. pact of this Act on small businesses, and other member of the Committee rep- pricing trends resulting from implementa- resenting a majority vote, the head of such SA 3176. Mr. GRASSLEY submitted tion of this Act. department or agency shall furnish such in- an amendment intended to be proposed (b) MEMBERSHIP.—The Committee shall be formation to the Committee. to amendment SA 2786 proposed by Mr. composed of 12 members, selected by the (6) POSTAL SERVICES.—The Committee may REID (for himself, Mr. BAUCUS, Mr. President pro tempore of the Senate and the use the United States mails in the same DODD, and Mr. HARKIN) to the bill H.R. Speaker of the House of Representatives, in manner and under the same conditions as consultation with the majority and minority 3590, to amend the Internal Revenue other departments and agencies of the Fed- Code of 1986 to modify the first-time leaders of the Senate and of the House of eral Government. Representatives, from among members of homebuyers credit in the case of mem- (7) GIFTS.—The Committee may accept, the public experienced in health care admin- use, and dispose of gifts or donations of serv- bers of the Armed Forces and certain istration, tax policy, small business, actu- ices or property. other Federal employees, and for other arial science, health insurance plan design or (h) COMPENSATION OF MEMBERS.— purposes; which was ordered to lie on sales, or a profession that would lend credi- (1) IN GENERAL.—Each member of the Com- the table; as follows: bility to the work of the Committee. Not mittee who is not an officer or employee of more than 3 members of the Committee may On page 334, between lines 18 and 19, insert the Federal Government shall be com- the following: be Federal employees. pensated at a rate equal to the daily equiva- HAIRPERSON.—The Committee shall se- ‘‘(E) SPECIAL RULE FOR INDIVIDUALS BE- (c) C lent of the annual rate of basic pay pre- lect a Chairperson from among its members. TWEEN THE AGES OF 55 AND 64.— scribed for level IV of the Executive Sched- (d) MEETINGS.—The Committee shall meet ‘‘(i) IN GENERAL.—In the case of an applica- ule under section 5315 of title 5, United at the call of the chairperson, or as voted by ble individual who has attained the age of 55 States Code, for each day (including travel 7 members, as is necessary to maintain close but has not attained the age of 65 before the time) during which such member is engaged oversight of the implementation of the re- beginning of a calendar year, this paragraph in the performance of the duties of the Com- quirements of this Act (including the amend- shall be applied to such individual for mittee. All members of the Committee who ments made by this Act), to address specific months during such calendar year by sub- are officers or employees of the United problems raised by such implementation, or stituting ‘5 percent’ for ‘8 percent’ in sub- States shall serve without compensation in to address constituent concerns. paragraphs (A) and (D). addition to that received for their services as (e) QUORUM.—A quorum shall consist of a ‘‘(ii) USE OF INCREASED FEDERAL FUNDS.— total of 7 members of the Committee, except officers or employees of the United States. ‘‘(I) IN GENERAL.—The amount available for that a total of 5 members shall be present to (2) TRAVEL EXPENSES.—The members of the any calendar year for expenditure under the conduct hearings, unless such requirement Committee shall be allowed travel expenses, early retiree reinsurance program under sec- that 5 members be present to conduct hear- including per diem in lieu of subsistence, at tion 1102 of the Patient Protection and Af- ings is waived by a majority of the Com- rates authorized for employees of agencies fordable Care Act shall be increased by the mittee. under subchapter I of chapter 57 of title 5, amount the Secretary of Health and Human (f) DUTIES OF THE COMMITTEE.—The Com- United States Code, while away from their Services estimates under subclause (II) for mittee shall provide close oversight of all as- homes or regular places of business in the the calendar year. Notwithstanding section pects of the requirements of this Act, includ- performance of services for the Committee. 1102(a)(1) of such Act, amounts made avail- ing the amendments made by this Act. (i) TERMINATION OF THE COMMITTEE.—The able under this subclause for any calendar (g) POWERS OF THE COMMITTEE.— Committee shall terminate 5 years after the year after 2014 may be used to make pay- (1) HEARINGS.—The Committee may, for date of enactment of this Act. ments under such reinsurance program. the purpose of carrying out this section— (j) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(II) ESTIMATES.—The Secretary of Health (A) hold such hearings, sit and act at such There is authorized to be appropriated such and Human Services, in consultation with times and places, take such testimony, re- sums as may be necessary to carry out this the Secretary, shall estimate for each cal- ceive such evidence, administer such oaths; section. endar year after 2013 the net increase (if any) and in Federal revenues, and the net decrease (if (B) require, by subpoena or otherwise, the SA 3175. Mr. SPECTER (for himself, any) in Federal outlays, by reason of the ap- attendance and testimony of such witnesses Mr. BROWN, and Mr. CASEY) submitted plication of clause (i). The sum of such and the production of such books, records, an amendment intended to be proposed amounts (expressed as a positive number)

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00072 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.046 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13043 shall be the amount taken into account (I) the President, Vice President, each timates under subclause (II) for the calendar under subclause (I). The Secretary shall ad- Member of Congress, each political ap- year. Notwithstanding section 1341(b)(4) of just the estimate for any calendar year to pointee, and each Congressional employee such Act, amounts made available under this correct any errors in an estimate for any shall be treated as a qualified individual en- subclause for any calendar year after 2018 preceding calendar year. titled to the right under this paragraph to may be used to make payments under any enroll in a qualified health plan in the indi- reinsurance program of a State in the indi- SA 3177. Mr. GRASSLEY submitted vidual market offered through an Exchange vidual market in effect during such calendar an amendment intended to be proposed in the State in which the individual resides; year. to amendment SA 2786 proposed by Mr. and ‘‘(II) ESTIMATES.—The Secretary of Health REID (for himself, Mr. BAUCUS, Mr. (II) any employer contribution under such and Human Services, in consultation with chapter on behalf of the President, Vice the Secretary, shall estimate for each cal- DODD, and Mr. HARKIN) to the bill H.R. President, any Member of Congress, any po- endar year after 2013 the net increase (if any) 3590, to amend the Internal Revenue litical appointee, and any Congressional em- in Federal revenues, and the net decrease (if Code of 1986 to modify the first-time ployee may be paid only to the issuer of a any) in Federal outlays, by reason of the ap- homebuyers credit in the case of mem- qualified health plan in which the individual plication of clause (i). The sum of such bers of the Armed Forces and certain enrolled in through such Exchange and not amounts (expressed as a positive number) other Federal employees, and for other to the issuer of a plan offered through the shall be the amount taken into account purposes; which was ordered to lie on Federal employees health benefit program under subclause (I). The Secretary shall ad- the table; as follows: under such chapter. just the estimate for any calendar year to (ii) PAYMENTS BY FEDERAL GOVERNMENT.— correct any errors in an estimate for any On page 336, between lines 16 and 17, insert The Secretary, in consultation with the Di- preceding calendar year. the following: rector of the Office of Personnel Manage- ‘‘(6) COLLEGE STUDENTS.— ment, shall establish procedures under ‘‘(A) IN GENERAL.—Any applicable indi- which— SA 3180. Mr. GRASSLEY (for himself vidual for any month which occurs within an (I) the employer contributions under such and Mr. ROBERTS) submitted an amend- academic period during which the individual chapter on behalf of the President, Vice ment intended to be proposed to is a student (whether full-time or part-time) President, and each political appointee are amendment SA 2786 proposed by Mr. who meets the requirements of section determined and actuarially adjusted for age; REID (for himself, Mr. BAUCUS, Mr. 484(a)(1) of the Higher Education Act of 1965 and (20 U.S.C. 1091(a)(1)) at an institution of (II) the employer contributions may be DODD, and Mr. HARKIN) to the bill H.R. higher education (including a community made directly to an Exchange for payment 3590, to amend the Internal Revenue college or trade school) described in such to an issuer. Code of 1986 to modify the first-time section. For purposes of the preceding sen- (iii) POLITICAL APPOINTEE.—In this sub- homebuyers credit in the case of mem- tence, any month between 2 consecutive aca- paragraph, the term ‘‘political appointee’’ bers of the Armed Forces and certain demic periods shall be treated as occurring means any individual who— during an academic period. other Federal employees, and for other (I) is employed in a position described purposes; which was ordered to lie on ‘‘(B) USE OF INCREASED FEDERAL FUNDS.— under sections 5312 through 5316 of title 5, ‘‘(i) IN GENERAL.—The amount available for United States Code, (relating to the Execu- the table; as follows: any calendar year for expenditure under the tive Schedule); reinsurance program under section 1341 of On page 1053, between lines 2 and 3, insert (II) is a limited term appointee, limited the following: the Patient Protection and Affordable Care emergency appointee, or noncareer ap- Act shall be increased by the amount the pointee in the Senior Executive Service, as SEC. 3403A. PROTECTING SENIORS FROM HIGHER Secretary of Health and Human Services es- defined under paragraphs (5), (6), and (7), re- PREMIUMS, REDUCED BENEFITS, timates under clause (11) for the calendar spectively, of section 3132(a) of title 5, United AND RATIONING OF LIFE-SAVING year. Notwithstanding section 1341(b)(4) of CARE UNDER MEDICARE PARTS C States Code; or AND D. such Act, amounts made available under this (III) is employed in a position in the execu- subclause for any calendar year after 2018 tive branch of the Government of a confiden- Section 1899A(c)(2)(A) of the Social Secu- may be used to make payments under any tial or policy-determining character under rity Act, as added by section 3403, is amend- reinsurance program of a State in the indi- schedule C of subpart C of part 213 of title 5 ed— vidual market in effect during such calendar of the Code of Federal Regulations. (1) in clause (ii), by striking ‘‘under section year. (iv) CONGRESSIONAL EMPLOYEE.—In this 1818, 1818A, or 1839’’; and ‘‘(ii) ESTIMATES.—The Secretary of Health subparagraph, the term ‘‘Congressional em- (2) by striking clause (iv). and Human Services, in consultation with ployee’’ means an employee whose pay is dis- the Secretary, shall estimate for each cal- bursed by the Secretary of the Senate or the endar year after 2013 the net increase (if any) Clerk of the House of Representatives. SA 3181. Mr. GRASSLEY submitted in Federal revenues, and the net decrease (if an amendment intended to be proposed any) in Federal outlays, by reason of the ap- SA 3179. Mr. GRASSLEY submitted to amendment SA 2786 proposed by Mr. plication of subparagraph (A). The sum of an amendment intended to be proposed REID (for himself, Mr. BAUCUS, Mr. such amounts (expressed as a positive num- to amendment SA 2786 proposed by Mr. ber) shall be the amount taken into account DODD, and Mr. HARKIN) to the bill H.R. under clause (i). The Secretary shall adjust REID (for himself, Mr. BAUCUS, Mr. 3590, to amend the Internal Revenue the estimate for any calendar year to correct DODD, and Mr. HARKIN) to the bill H.R. Code of 1986 to modify the first-time any errors in an estimate for any preceding 3590, to amend the Internal Revenue homebuyers credit in the case of mem- calendar year. Code of 1986 to modify the first-time bers of the Armed Forces and certain homebuyers credit in the case of mem- other Federal employees, and for other Mr. GRASSLEY submitted SA 3178. bers of the Armed Forces and certain purposes; which was ordered to lie on an amendment intended to be proposed other Federal employees, and for other the table; as follows: to amendment SA 2786 proposed by Mr. purposes; which was ordered to lie on REID (for himself, Mr. BAUCUS, Mr. the table; as follows: Beginning on page 909, strike line 21 and DODD, and Mr. HARKIN) to the bill H.R. On page 334, between lines 18 and 19, insert all that follows through page 910, line 19. 3590, to amend the Internal Revenue the following: Code of 1986 to modify the first-time ‘‘(E) SPECIAL RULE FOR INDIVIDUALS UNDER homebuyers credit in the case of mem- AGE 30.— SA 3182. Mr. GRASSLEY submitted bers of the Armed Forces and certain ‘‘(i) IN GENERAL.—In the case of an applica- an amendment intended to be proposed other Federal employees, and for other ble individual who has not attained age 30 to amendment SA 2786 proposed by Mr. before the beginning of a calendar year, this REID (for himself, Mr. BAUCUS, Mr. purposes; which was ordered to lie on paragraph shall be applied to such individual the table; as follows: DODD, and Mr. HARKIN) to the bill H.R. for months during such calendar year by sub- 3590, to amend the Internal Revenue On page 156, beginning with line 4, strike stituting ‘5 percent’ for ‘8 percent’ in sub- all through page 157, line 7, and insert the paragraphs (A) and (D). Code of 1986 to modify the first-time following: ‘‘(ii) USE OF INCREASED FEDERAL FUNDS.— homebuyers credit in the case of mem- (D) PRESIDENT, VICE PRESIDENT, MEMBERS ‘‘(I) IN GENERAL.—The amount available for bers of the Armed Forces and certain OF CONGRESS, POLITICAL APPOINTEES, AND CON- any calendar year for expenditure under the other Federal employees, and for other GRESSIONAL STAFF IN THE EXCHANGE.— reinsurance program under section 1341 of purposes; which was ordered to lie on (i) IN GENERAL.—Notwithstanding chapter the Patient Protection and Affordable Care the table; as follows: 89 of title 5, United States Code, or any pro- Act shall be increased by the amount the vision of this title— Secretary of Health and Human Services es- At the end, add the following:

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00073 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.048 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13044 CONGRESSIONAL RECORD — SENATE December 11, 2009 TITLE X—ENSURING THAT SAVINGS FROM (C) the large number of health care pro- hedonic damages, injury to reputation, and MEDICAL CARE ACCESS PROTECTION viders who provide items or services for all other nonpecuniary losses of any kind or ARE USED TO REDUCE THE COVERAGE which the Federal Government makes pay- nature. Such term includes economic dam- GAP UNDER MEDICARE PART D ments. ages and noneconomic damages, as such Subtitle A—Reducing the Coverage Gap (b) PURPOSE.—It is the purpose of this sub- terms are defined in this section. Under Medicare Part D title to implement reasonable, comprehen- (5) CONTINGENT FEE.—The term ‘‘contin- sive, and effective health care liability re- gent fee’’ includes all compensation to any SEC. 10001. REDUCING THE COVERAGE GAP. forms designed to— person or persons which is payable only if a Section 1860D–2(b) of the Social Security (1) improve the availability of health care recovery is effected on behalf of one or more Act (42 U.S.C. 1395w–102(b)), as amended by services in cases in which health care liabil- claimants. section 3315, is further amended— ity actions have been shown to be a factor in (6) ECONOMIC DAMAGES.—The term ‘‘eco- (1) in paragraph (3)(A), by striking ‘‘and the decreased availability of services; nomic damages’’ means objectively (7)’’ and inserting ‘‘, (7), and (8)’’; (2) reduce the incidence of ‘‘defensive medi- verifiable monetary losses incurred as a re- (2) in paragraph (7), by striking subpara- cine’’ and lower the cost of health care li- sult of the provision of, use of, or payment graph (C); and ability insurance, all of which contribute to for (or failure to provide, use, or pay for) (3) by adding at the end the following new the escalation of health care costs; health care services or medical products, paragraph: (3) ensure that persons with meritorious such as past and future medical expenses, ‘‘(8) INCREASE IN INITIAL COVERAGE LIMIT IN health care injury claims receive fair and loss of past and future earnings, cost of ob- SUBSEQUENT YEARS.— adequate compensation, including reason- taining domestic services, loss of employ- ‘‘(A) IN GENERAL.—For plan years begin- able noneconomic damages; ment, and loss of business or employment ning on or after January 1, 2011, the initial (4) improve the fairness and cost-effective- opportunities. coverage limit described in paragraph (3)(B) ness of our current health care liability sys- (7) HEALTH CARE GOODS OR SERVICES.—The otherwise applicable shall be increased by an tem to resolve disputes over, and provide term ‘‘health care goods or services’’ means amount which the Chief Actuary of the Cen- compensation for, health care liability by re- any goods or services provided by a health ters for Medicare & Medicaid Services deter- ducing uncertainty in the amount of com- care institution, provider, or by any indi- mines is equal to the estimated amount of pensation provided to injured individuals; vidual working under the supervision of a savings during the plan year as a result of and health care provider, that relates to the di- the provisions of the Medical Care Access (5) provide an increased sharing of informa- agnosis, prevention, care, or treatment of Protection Act of 2009. tion in the health care system which will re- any human disease or impairment, or the as- ‘‘(B) CONSIDERATIONS.—In determining the duce unintended injury and improve patient sessment of the health of human beings. amount of the increase under subparagraph care. (8) HEALTH CARE INSTITUTION.—The term (A) for a plan year, the Secretary shall take ‘‘health care institution’’ means any entity into account— SEC. 10103. DEFINITIONS. licensed under Federal or State law to pro- ‘‘(i) any increase under such paragraph In this subtitle: vide health care services (including but not during the preceding year or years; and (1) ALTERNATIVE DISPUTE RESOLUTION SYS- limited to ambulatory surgical centers, as- ‘‘(ii) any estimated increase in utilization TEM; ADR.—The term ‘‘alternative dispute sisted living facilities, emergency medical as a result of the application of this para- resolution system’’ or ‘‘ADR’’ means a sys- services providers, hospices, hospitals and graph. tem that provides for the resolution of hospital systems, nursing homes, or other ‘‘(C) APPLICATION.—The provisions of sub- health care lawsuits in a manner other than entities licensed to provide such services). paragraph (B) of paragraph (7) shall apply to through a civil action brought in a State or (9) HEALTH CARE LAWSUIT.—The term the application of subparagraph (A) of this Federal court. ‘‘health care lawsuit’’ means any health care subparagraph in the same manner as such (2) CLAIMANT.—The term ‘‘claimant’’ liability claim concerning the provision of provisions apply to the application of sub- means any person who brings a health care health care goods or services affecting inter- paragraph (A) of paragraph (7).’’. lawsuit, including a person who asserts or state commerce, or any health care liability claims a right to legal or equitable contribu- Subtitle B—Medical Care Access Protection action concerning the provision of (or the tion, indemnity or subrogation, arising out failure to provide) health care goods or serv- SEC. 10101. SHORT TITLE. of a health care liability claim or action, and ices affecting interstate commerce, brought This subtitle may be cited as the ‘‘Medical any person on whose behalf such a claim is in a State or Federal court or pursuant to an Care Access Protection Act of 2009’’ or the asserted or such an action is brought, wheth- alternative dispute resolution system, ‘‘MCAP Act’’. er deceased, incompetent, or a minor. against a health care provider or a health SEC. 10102. FINDINGS AND PURPOSE. (3) COLLATERAL SOURCE BENEFITS.—The care institution regardless of the theory of (a) FINDINGS.— term ‘‘collateral source benefits’’ means any liability on which the claim is based, or the (1) EFFECT ON HEALTH CARE ACCESS AND amount paid or reasonably likely to be paid number of claimants, plaintiffs, defendants, COSTS.—Congress finds that our current civil in the future to or on behalf of the claimant, or other parties, or the number of claims or justice system is adversely affecting patient or any service, product or other benefit pro- causes of action, in which the claimant al- access to health care services, better patient vided or reasonably likely to be provided in leges a health care liability claim. care, and cost-efficient health care, in that the future to or on behalf of the claimant, as (10) HEALTH CARE LIABILITY ACTION.—The the health care liability system is a costly a result of the injury or wrongful death, pur- term ‘‘health care liability action’’ means a and ineffective mechanism for resolving suant to— civil action brought in a State or Federal claims of health care liability and compen- (A) any State or Federal health, sickness, Court or pursuant to an alternative dispute sating injured patients, and is a deterrent to income-disability, accident, or workers’ resolution system, against a health care pro- the sharing of information among health compensation law; vider or a health care institution regardless care professionals which impedes efforts to (B) any health, sickness, income-disability, of the theory of liability on which the claim improve patient safety and quality of care. or accident insurance that provides health is based, or the number of plaintiffs, defend- (2) EFFECT ON INTERSTATE COMMERCE.—Con- benefits or income-disability coverage; ants, or other parties, or the number of gress finds that the health care and insur- (C) any contract or agreement of any causes of action, in which the claimant al- ance industries are industries affecting group, organization, partnership, or corpora- leges a health care liability claim. interstate commerce and the health care li- tion to provide, pay for, or reimburse the (11) HEALTH CARE LIABILITY CLAIM.—The ability litigation systems existing through- cost of medical, hospital, dental, or income term ‘‘health care liability claim’’ means a out the United States are activities that af- disability benefits; and demand by any person, whether or not pursu- fect interstate commerce by contributing to (D) any other publicly or privately funded ant to ADR, against a health care provider the high costs of health care and premiums program. or health care institution, including third- for health care liability insurance purchased (4) COMPENSATORY DAMAGES.—The term party claims, cross-claims, counter-claims, by health care system providers. ‘‘compensatory damages’’ means objectively or contribution claims, which are based upon (3) EFFECT ON FEDERAL SPENDING.—Con- verifiable monetary losses incurred as a re- the provision of, use of, or payment for (or gress finds that the health care liability liti- sult of the provision of, use of, or payment the failure to provide, use, or pay for) health gation systems existing throughout the for (or failure to provide, use, or pay for) care services, regardless of the theory of li- United States have a significant effect on health care services or medical products, ability on which the claim is based, or the the amount, distribution, and use of Federal such as past and future medical expenses, number of plaintiffs, defendants, or other funds because of— loss of past and future earnings, cost of ob- parties, or the number of causes of action. (A) the large number of individuals who re- taining domestic services, loss of employ- (12) HEALTH CARE PROVIDER.— ceive health care benefits under programs ment, and loss of business or employment (A) IN GENERAL.—The term ‘‘health care operated or financed by the Federal Govern- opportunities, damages for physical and provider’’ means any person (including but ment; emotional pain, suffering, inconvenience, not limited to a physician (as defined by sec- (B) the large number of individuals who physical impairment, mental anguish, dis- tion 1861(r) of the Social Security Act (42 benefit because of the exclusion from Fed- figurement, loss of enjoyment of life, loss of U.S.C. 1395x(r)), registered nurse, dentist, po- eral taxes of the amounts spent to provide society and companionship, loss of consor- diatrist, pharmacist, chiropractor, or optom- them with health insurance benefits; and tium (other than loss of domestic service), etrist) required by State or Federal law to be

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00074 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.050 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13045 licensed, registered, or certified to provide sion in the failure to bring an action on be- (4) if separate awards are rendered for past health care services, and being either so li- half of the injured minor. and future noneconomic damages and the censed, registered, or certified, or exempted (d) RULE 11 SANCTIONS.—Whenever a Fed- combined awards exceed the limitations de- from such requirement by other statute or eral or State court determines (whether by scribed in subsection (b), the future non- regulation. motion of the parties or whether on the mo- economic damages shall be reduced first. (B) TREATMENT OF CERTAIN PROFESSIONAL tion of the court) that there has been a vio- (d) FAIR SHARE RULE.—In any health care ASSOCIATIONS.—For purposes of this subtitle, lation of Rule 11 of the Federal Rules of Civil lawsuit, each party shall be liable for that a professional association that is organized Procedure (or a similar violation of applica- party’s several share of any damages only under State law by an individual physician ble State court rules) in a health care liabil- and not for the share of any other person. or group of physicians, a partnership or lim- ity action to which this subtitle applies, the Each party shall be liable only for the ited liability partnership formed by a group court shall impose upon the attorneys, law amount of damages allocated to such party of physicians, a nonprofit health corporation firms, or pro se litigants that have violated in direct proportion to such party’s percent- certified under State law, or a company Rule 11 or are responsible for the violation, age of responsibility. A separate judgment formed by a group of physicians under State an appropriate sanction, which shall include shall be rendered against each such party for law shall be treated as a health care provider an order to pay the other party or parties for the amount allocated to such party. For pur- under subparagraph (A). the reasonable expenses incurred as a direct poses of this section, the trier of fact shall (13) MALICIOUS INTENT TO INJURE.—The result of the filing of the pleading, motion, determine the proportion of responsibility of term ‘‘malicious intent to injure’’ means in- or other paper that is the subject of the vio- each party for the claimant’s harm. tentionally causing or attempting to cause lation, including a reasonable attorneys’ fee. SEC. 10106. MAXIMIZING PATIENT RECOVERY. physical injury other than providing health Such sanction shall be sufficient to deter (a) COURT SUPERVISION OF SHARE OF DAM- care goods or services. repetition of such conduct or comparable AGES ACTUALLY PAID TO CLAIMANTS.— (14) NONECONOMIC DAMAGES.—The term conduct by others similarly situated, and to (1) IN GENERAL.—In any health care law- ‘‘noneconomic damages’’ means damages for compensate the party or parties injured by suit, the court shall supervise the arrange- physical and emotional pain, suffering, in- such conduct. ments for payment of damages to protect convenience, physical impairment, mental SEC. 10105. COMPENSATING PATIENT INJURY. against conflicts of interest that may have anguish, disfigurement, loss of enjoyment of (a) UNLIMITED AMOUNT OF DAMAGES FOR AC- the effect of reducing the amount of damages life, loss of society and companionship, loss TUAL ECONOMIC LOSSES IN HEALTH CARE LAW- awarded that are actually paid to claimants. of consortium (other than loss of domestic SUITS.—In any health care lawsuit, nothing (2) CONTINGENCY FEES.— service), hedonic damages, injury to reputa- in this subtitle shall limit the recovery by a (A) IN GENERAL.—In any health care law- tion, and all other nonpecuniary losses of claimant of the full amount of the available suit in which the attorney for a party claims any kind or nature. economic damages, notwithstanding the lim- a financial stake in the outcome by virtue of (15) PUNITIVE DAMAGES.—The term ‘‘puni- itation contained in subsection (b). a contingent fee, the court shall have the tive damages’’ means damages awarded, for (b) ADDITIONAL NONECONOMIC DAMAGES.— power to restrict the payment of a claim- the purpose of punishment or deterrence, and (1) HEALTH CARE PROVIDERS.—In any health ant’s damage recovery to such attorney, and not solely for compensatory purposes, care lawsuit where final judgment is ren- to redirect such damages to the claimant against a health care provider or health care dered against a health care provider, the based upon the interests of justice and prin- institution. Punitive damages are neither amount of noneconomic damages recovered ciples of equity. economic nor noneconomic damages. from the provider, if otherwise available (B) LIMITATION.—The total of all contin- (16) RECOVERY.—The term ‘‘recovery’’ under applicable Federal or State law, may gent fees for representing all claimants in a means the net sum recovered after deducting be as much as $250,000, regardless of the num- health care lawsuit shall not exceed the fol- any disbursements or costs incurred in con- ber of parties other than a health care insti- lowing limits: nection with prosecution or settlement of tution against whom the action is brought or (i) 40 percent of the first $50,000 recovered the claim, including all costs paid or ad- the number of separate claims or actions by the claimant(s). vanced by any person. Costs of health care brought with respect to the same occurrence. (ii) 331⁄3 percent of the next $50,000 recov- incurred by the plaintiff and the attorneys’ (2) HEALTH CARE INSTITUTIONS.— ered by the claimant(s). office overhead costs or charges for legal (A) SINGLE INSTITUTION.—In any health (iii) 25 percent of the next $500,000 recov- services are not deductible disbursements or care lawsuit where final judgment is ren- ered by the claimant(s). costs for such purpose. dered against a single health care institu- (iv) 15 percent of any amount by which the (17) STATE.—The term ‘‘State’’ means each tion, the amount of noneconomic damages recovery by the claimant(s) is in excess of of the several States, the District of Colum- recovered from the institution, if otherwise $600,000. bia, the Commonwealth of Puerto Rico, the available under applicable Federal or State (b) APPLICABILITY.— Virgin Islands, Guam, American Samoa, the law, may be as much as $250,000, regardless of (1) IN GENERAL.—The limitations in sub- Northern Mariana Islands, the Trust Terri- the number of parties against whom the ac- section (a) shall apply whether the recovery tory of the Pacific Islands, and any other tion is brought or the number of separate is by judgment, settlement, mediation, arbi- territory or possession of the United States, claims or actions brought with respect to the tration, or any other form of alternative dis- or any political subdivision thereof. same occurrence. pute resolution. SEC. 10104. ENCOURAGING SPEEDY RESOLUTION (B) MULTIPLE INSTITUTIONS.—In any health (2) MINORS.—In a health care lawsuit in- OF CLAIMS. care lawsuit where final judgment is ren- volving a minor or incompetent person, a (a) IN GENERAL.—Except as otherwise pro- dered against more than one health care in- court retains the authority to authorize or vided for in this section, the time for the stitution, the amount of noneconomic dam- approve a fee that is less than the maximum commencement of a health care lawsuit ages recovered from each institution, if oth- permitted under this section. shall be 3 years after the date of manifesta- erwise available under applicable Federal or (c) EXPERT WITNESSES.— tion of injury or 1 year after the claimant State law, may be as much as $250,000, re- (1) REQUIREMENT.—No individual shall be discovers, or through the use of reasonable gardless of the number of parties against qualified to testify as an expert witness con- diligence should have discovered, the injury, whom the action is brought or the number of cerning issues of negligence in any health whichever occurs first. separate claims or actions brought with re- care lawsuit against a defendant unless such (b) GENERAL EXCEPTION.—The time for the commencement of a health care lawsuit spect to the same occurrence, except that individual— shall not exceed 3 years after the date of the total amount recovered from all such in- (A) except as required under paragraph (2), manifestation of injury unless the tolling of stitutions in such lawsuit shall not exceed is a health care professional who— time was delayed as a result of— $500,000. (i) is appropriately credentialed or licensed (1) fraud; (c) NO DISCOUNT OF AWARD FOR NON- in 1 or more States to deliver health care (2) intentional concealment; or ECONOMIC DAMAGES.—In any health care law- services; and (3) the presence of a foreign body, which suit— (ii) typically treats the diagnosis or condi- has no therapeutic or diagnostic purpose or (1) an award for future noneconomic dam- tion or provides the type of treatment under effect, in the person of the injured person. ages shall not be discounted to present review; and (c) MINORS.—An action by a minor shall be value; (B) can demonstrate by competent evi- commenced within 3 years from the date of (2) the jury shall not be informed about the dence that, as a result of training, education, the alleged manifestation of injury except maximum award for noneconomic damages knowledge, and experience in the evaluation, that if such minor is under the full age of 6 under subsection (b); diagnosis, and treatment of the disease or in- years, such action shall be commenced with- (3) an award for noneconomic damages in jury which is the subject matter of the law- in 3 years of the manifestation of injury, or excess of the limitations provided for in sub- suit against the defendant, the individual prior to the eighth birthday of the minor, section (b) shall be reduced either before the was substantially familiar with applicable whichever provides a longer period. Such entry of judgment, or by amendment of the standards of care and practice as they relate time limitation shall be tolled for minors for judgment after entry of judgment, and such to the act or omission which is the subject of any period during which a parent or guard- reduction shall be made before accounting the lawsuit on the date of the incident. ian and a health care provider or health care for any other reduction in damages required (2) PHYSICIAN REVIEW.—In a health care institution have committed fraud or collu- by law; and lawsuit, if the claim of the plaintiff involved

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00075 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.050 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13046 CONGRESSIONAL RECORD — SENATE December 11, 2009

treatment that is recommended or provided (1) FACTORS CONSIDERED.—In determining Act does not apply, then this subtitle or oth- by a physician (allopathic or osteopathic), an the amount of punitive damages under this erwise applicable law (as determined under individual shall not be qualified to be an ex- section, the trier of fact shall consider only this subtitle) will apply to such aspect of pert witness under this subsection with re- the following: such action. spect to issues of negligence concerning such (A) the severity of the harm caused by the (b) SMALLPOX VACCINE INJURY.— treatment unless such individual is a physi- conduct of such party; (1) IN GENERAL.—To the extent that part C cian. (B) the duration of the conduct or any con- of title II of the Public Health Service Act (3) SPECIALTIES AND SUBSPECIALTIES.—With cealment of it by such party; establishes a Federal rule of law applicable respect to a lawsuit described in paragraph (C) the profitability of the conduct to such to a civil action brought for a smallpox vac- (1), a court shall not permit an expert in one party; cine-related injury or death— medical specialty or subspecialty to testify (D) the number of products sold or medical (A) this subtitle shall not affect the appli- against a defendant in another medical spe- procedures rendered for compensation, as the cation of the rule of law to such an action; cialty or subspecialty unless, in addition to case may be, by such party, of the kind caus- and a showing of substantial familiarity in ac- ing the harm complained of by the claimant; (B) any rule of law prescribed by this sub- cordance with paragraph (1)(B), there is a (E) any criminal penalties imposed on such title in conflict with a rule of law of such showing that the standards of care and prac- party, as a result of the conduct complained part C shall not apply to such action. tice in the two specialty or subspecialty of by the claimant; and (2) EXCEPTION.—If there is an aspect of a fields are similar. (F) the amount of any civil fines assessed civil action brought for a smallpox vaccine- (4) LIMITATION.—The limitations in this against such party as a result of the conduct related injury or death to which a Federal subsection shall not apply to expert wit- complained of by the claimant. rule of law under part C of title II of the nesses testifying as to the degree or perma- (2) MAXIMUM AWARD.—The amount of puni- Public Health Service Act does not apply, nency of medical or physical impairment. tive damages awarded in a health care law- then this subtitle or otherwise applicable SEC. 10107. ADDITIONAL HEALTH BENEFITS. suit may not exceed an amount equal to two law (as determined under this subtitle) will (a) IN GENERAL.—The amount of any dam- times the amount of economic damages apply to such aspect of such action. (c) OTHER FEDERAL LAW.—Except as pro- ages received by a claimant in any health awarded in the lawsuit or $250,000, whichever vided in this section, nothing in this subtitle care lawsuit shall be reduced by the court by is greater. The jury shall not be informed of shall be deemed to affect any defense avail- the amount of any collateral source benefits the limitation under the preceding sentence. to which the claimant is entitled, less any able, or any limitation on liability that ap- (c) LIABILITY OF HEALTH CARE PROVIDERS.— plies to, a defendant in a health care lawsuit insurance premiums or other payments made (1) IN GENERAL.—A health care provider by the claimant (or by the spouse, parent, or action under any other provision of Fed- who prescribes, or who dispenses pursuant to eral law. child, or legal guardian of the claimant) to a prescription, a drug, biological product, or SEC. 10111. STATE FLEXIBILITY AND PROTEC- obtain or secure such benefits. medical device approved by the Food and (b) PRESERVATION OF CURRENT LAW.— TION OF STATES’ RIGHTS. Drug Administration, for an approved indica- Where a payor of collateral source benefits (a) HEALTH CARE LAWSUITS.—The provi- has a right of recovery by reimbursement or tion of the drug, biological product, or med- sions governing health care lawsuits set subrogation and such right is permitted ical device, shall not be named as a party to forth in this subtitle shall preempt, subject under Federal or State law, subsection (a) a product liability lawsuit invoking such to subsections (b) and (c), State law to the shall not apply. drug, biological product, or medical device extent that State law prevents the applica- (c) APPLICATION OF PROVISION.—This sec- and shall not be liable to a claimant in a tion of any provisions of law established by tion shall apply to any health care lawsuit class action lawsuit against the manufac- or under this subtitle. The provisions gov- that is settled or resolved by a fact finder. turer, distributor, or product seller of such erning health care lawsuits set forth in this SEC. 10108. PUNITIVE DAMAGES. drug, biological product, or medical device. subtitle supersede chapter 171 of title 28, (a) PUNITIVE DAMAGES PERMITTED.— (2) MEDICAL PRODUCT.—The term ‘‘medical United States Code, to the extent that such (1) IN GENERAL.—Punitive damages may, if product’’ means a drug or device intended for chapter— otherwise available under applicable State humans. The terms ‘‘drug’’ and ‘‘device’’ (1) provides for a greater amount of dam- or Federal law, be awarded against any per- have the meanings given such terms in sec- ages or contingent fees, a longer period in son in a health care lawsuit only if it is prov- tions 201(g)(1) and 201(h) of the Federal Food, which a health care lawsuit may be com- en by clear and convincing evidence that Drug and Cosmetic Act (21 U.S.C. 321), re- menced, or a reduced applicability or scope such person acted with malicious intent to spectively, including any component or raw of periodic payment of future damages, than injure the claimant, or that such person de- material used therein, but excluding health provided in this subtitle; or liberately failed to avoid unnecessary injury care services. (2) prohibits the introduction of evidence that such person knew the claimant was sub- SEC. 10109. AUTHORIZATION OF PAYMENT OF FU- regarding collateral source benefits. stantially certain to suffer. TURE DAMAGES TO CLAIMANTS IN (b) PREEMPTION OF CERTAIN STATE LAWS.— (2) FILING OF LAWSUIT.—No demand for pu- HEALTH CARE LAWSUITS. No provision of this subtitle shall be con- nitive damages shall be included in a health (a) IN GENERAL.—In any health care law- strued to preempt any State law (whether ef- care lawsuit as initially filed. A court may suit, if an award of future damages, without fective before, on, or after the date of the en- allow a claimant to file an amended pleading reduction to present value, equaling or ex- actment of this Act) that specifies a par- for punitive damages only upon a motion by ceeding $50,000 is made against a party with ticular monetary amount of compensatory or punitive damages (or the total amount of the claimant and after a finding by the sufficient insurance or other assets to fund a damages) that may be awarded in a health court, upon review of supporting and oppos- periodic payment of such a judgment, the care lawsuit, regardless of whether such ing affidavits or after a hearing, after weigh- court shall, at the request of any party, monetary amount is greater or lesser than is ing the evidence, that the claimant has es- enter a judgment ordering that the future damages be paid by periodic payments in ac- provided for under this subtitle, notwith- tablished by a substantial probability that standing section 10105(a). cordance with the Uniform Periodic Pay- the claimant will prevail on the claim for (c) PROTECTION OF STATE’S RIGHTS AND ment of Judgments Act promulgated by the punitive damages. OTHER LAWS.— National Conference of Commissioners on (3) SEPARATE PROCEEDING.—At the request (1) IN GENERAL.—Any issue that is not gov- of any party in a health care lawsuit, the Uniform State Laws. erned by a provision of law established by or trier of fact shall consider in a separate pro- (b) APPLICABILITY.—This section applies to under this subtitle (including the State ceeding— all actions which have not been first set for standards of negligence) shall be governed by (A) whether punitive damages are to be trial or retrial before the effective date of otherwise applicable Federal or State law. awarded and the amount of such award; and this subtitle. (2) RULE OF CONSTRUCTION.—Nothing in this (B) the amount of punitive damages fol- SEC. 10110. EFFECT ON OTHER LAWS. subtitle shall be construed to— lowing a determination of punitive liability. (a) GENERAL VACCINE INJURY.— (A) preempt or supersede any Federal or If a separate proceeding is requested, evi- (1) IN GENERAL.—To the extent that title State law that imposes greater procedural or dence relevant only to the claim for punitive XXI of the Public Health Service Act estab- substantive protections (such as a shorter damages, as determined by applicable State lishes a Federal rule of law applicable to a statute of limitations) for a health care pro- law, shall be inadmissible in any proceeding civil action brought for a vaccine-related in- vider or health care institution from liabil- to determine whether compensatory dam- jury or death— ity, loss, or damages than those provided by ages are to be awarded. (A) this subtitle shall not affect the appli- this subtitle; (4) LIMITATION WHERE NO COMPENSATORY cation of the rule of law to such an action; (B) preempt or supercede any State law DAMAGES ARE AWARDED.—In any health care and that permits and provides for the enforce- lawsuit where no judgment for compensatory (B) any rule of law prescribed by this sub- ment of any arbitration agreement related damages is rendered against a person, no pu- title in conflict with a rule of law of such to a health care liability claim whether en- nitive damages may be awarded with respect title XXI shall not apply to such action. acted prior to or after the date of enactment to the claim in such lawsuit against such (2) EXCEPTION.—If there is an aspect of a of this Act; person. civil action brought for a vaccine-related in- (C) create a cause of action that is not oth- (b) DETERMINING AMOUNT OF PUNITIVE DAM- jury or death to which a Federal rule of law erwise available under Federal or State law; AGES.— under title XXI of the Public Health Service or

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00076 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.050 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13047 (D) affect the scope of preemption of any year in which the taxable year begins, deter- (A) Section 24(b)(3)(B) of such Code is other Federal law. mined by substituting ‘calendar year 2008’ amended by striking ‘‘23,’’. SEC. 10112. APPLICABILITY; EFFECTIVE DATE. for ‘calendar year 1992’ in subparagraph (B) (B) Section 25(e)(1)(C) of such Code is This subtitle shall apply to any health care thereof. amended by striking ‘‘23,’’ both places it ap- lawsuit brought in a Federal or State court, If any amount as increased under the pre- pears. or subject to an alternative dispute resolu- ceding sentence is not a multiple of $10, such (C) Section 25A(i)(5)(B) of such Code is tion system, that is initiated on or after the amount shall be rounded to the nearest mul- amended by striking ‘‘23, 25D,’’ and inserting date of the enactment of this Act, except tiple of $10. ‘‘25D’’. that any health care lawsuit arising from an ‘‘(2) INCOME LIMITATION.—In the case of a (D) Section 25B(g)(2) of such Code is injury occurring prior to the date of enact- taxable year beginning after December 31, amended by striking ‘‘23,’’. ment of this Act shall be governed by the ap- 2002, the dollar amount in subsection (E) Section 26(a)(1) of such Code is amend- plicable statute of limitations provisions in (b)(2)(A)(i) shall be increased by an amount ed by striking ‘‘23,’’. effect at the time the injury occurred. equal to— (F) Section 30(c)(2)(B)(ii) of such Code is ‘‘(A) such dollar amount, multiplied by amended by striking ‘‘23, 25D,’’ and inserting SA 3183. Mr. BAUCUS submitted an ‘‘(B) the cost-of-living adjustment deter- ‘‘25D’’. amendment intended to be proposed by mined under section 1(f)(3) for the calendar (G) Section 30B(g)(2)(B)(ii) of such Code is him to the bill H.R. 3590, to amend the year in which the taxable year begins, deter- amended by striking ‘‘23,’’. (H) Section 30D(c)(2)(B)(ii) of such Code is Internal Revenue Code of 1986 to mod- mined by substituting ‘calendar year 2001’ for ‘calendar year 1992’ in subparagraph (B) amended by striking ‘‘sections 23 and’’ and ify the first-time homebuyers credit in thereof. inserting ‘‘section’’. the case of members of the Armed (I) Section 36B of such Code, as so redesig- If any amount as increased under the pre- nated, is amended— Forces and certain other Federal em- ceding sentence is not a multiple of $10, such (i) by striking paragraph (4) of subsection ployees, and for other purposes; which amount shall be rounded to the nearest mul- (b), and was ordered to lie on the table; as fol- tiple of $10.’’. (ii) by striking subsection (c). lows: (2) ADOPTION ASSISTANCE PROGRAMS.— (J) Section 137 of such Code is amended— (A) IN GENERAL.—Paragraph (1) of section At the appropriate place, insert the fol- (i) by striking ‘‘section 23(d)’’ in subsection 137(b) of the Internal Revenue Code of 1986 lowing: (d) and inserting ‘‘section 36B(d)’’, and (relating to dollar limitation) is amended by SEC. ll. PROTECTING MIDDLE CLASS FAMILIES (ii) by striking ‘‘section 23’’ in subsection striking ‘‘$10,000’’ and inserting ‘‘$15,000’’. FROM TAX INCREASES. (e) and inserting ‘‘section 36B’’. (B) CHILD WITH SPECIAL NEEDS.—Paragraph It is the sense of the Senate that the Sen- (K) Section 904(i) of such Code is amended (2) of section 137(a) of such Code (relating to ate should reject any procedural maneuver by striking ‘‘23,’’. $10,000 exclusion for adoption of child with that would raise taxes on middle class fami- (L) Section 1016(a)(26) is amended by strik- special needs regardless of expenses) is lies, such as a motion to commit the pending ing ‘‘23(g)’’ and inserting ‘‘36B(g)’’. amended— legislation to the Committee on Finance, (M) Section 1400C(d) of such Code is amend- (i) in the text by striking ‘‘$10,000’’ and in- which is designed to kill legislation that pro- ed by striking ‘‘23,’’. serting ‘‘$15,000’’, and vides tax cuts for American workers and (N) The table of sections for subpart A of (ii) in the heading by striking ‘‘$10,000’’ and families, including the affordability tax part IV of subchapter A of chapter 1 of such inserting ‘‘$15,000’’. credit and the small business tax credit. Code of 1986 is amended by striking the item (C) CONFORMING AMENDMENT TO INFLATION relating to section 23. ADJUSTMENT.—Subsection (f) of section 137 of SA 3184. Mr. CASEY submitted an (O) Paragraph (2) of section 1324(b) of title such Code (relating to adjustments for infla- amendment intended to be proposed to 31, United States Code, is amended by insert- tion) is amended to read as follows: ing ‘‘36B,’’ after ‘‘36A,’’. amendment SA 2786 proposed by Mr. ‘‘(f) ADJUSTMENTS FOR INFLATION.— (P) The table of sections for subpart C of REID (for himself, Mr. BAUCUS, Mr. ‘‘(1) DOLLAR LIMITATIONS.—In the case of a part IV of subchapter A of chapter 1 of the DODD, and Mr. HARKIN) to the bill H.R. taxable year beginning after December 31, 2009, each of the dollar amounts in sub- Internal Revenue Code of 1986 is amended by 3590, to amend the Internal Revenue inserting after the item relating to section Code of 1986 to modify the first-time sections (a)(2) and (b)(1) shall be increased by an amount equal to— 36A the following new item: homebuyers credit in the case of mem- ‘‘Sec. 36B. Adoption expenses.’’. bers of the Armed Forces and certain ‘‘(A) such dollar amount, multiplied by ‘‘(B) the cost-of-living adjustment deter- (c) EXTENSION OF CREDIT AND ADOPTION AS- other Federal employees, and for other mined under section 1(f)(3) for the calendar SISTANCE PROGRAMS.— purposes; which was ordered to lie on year in which the taxable year begins, deter- (1) IN GENERAL.—Section 36B of the Inter- the table; as follows: mined by substituting ‘calendar year 2008’ nal Revenue Code of 1986, as redesignated by At the appropriate place in title IX, insert for ‘calendar year 1992’ in subparagraph (B) subsection (b), is amended by adding at the the following: thereof. end the following new subsection: ‘‘(i) TERMINATION.—This section shall not If any amount as increased under the pre- Subtitle—Expansion of Adoption Credit and apply to expenses paid or incurred in taxable ceding sentence is not a multiple of $10, such Adoption Assistance Programs years beginning after December 31, 2014.’’. amount shall be rounded to the nearest mul- SEC. l01. EXPANSION OF ADOPTION CREDIT AND (2) IN GENERAL.—Section 137 of the Internal tiple of $10. ADOPTION ASSISTANCE PROGRAMS. Revenue Code of 1986 is amended by adding ‘‘(2) INCOME LIMITATION.—In the case of a (a) INCREASE IN DOLLAR LIMITATION.— at the end the following new subsection: taxable year beginning after December 31, (1) ADOPTION CREDIT.— ‘‘(g) TERMINATION.—This section shall not (A) IN GENERAL.—Paragraph (1) of section 2002, the dollar amount in subsection apply to expenses paid or incurred in taxable 23(b) of the Internal Revenue Code of 1986 (re- (b)(2)(A) shall be increased by an amount years beginning after December 31, 2014.’’. lating to dollar limitation) is amended by equal to— (3) SUNSET FOR MODIFICATIONS MADE BY striking ‘‘$10,000’’ and inserting ‘‘$15,000’’. ‘‘(A) such dollar amount, multiplied by EGTRRA TO ADOPTION CREDIT REMOVED.—Title (B) CHILD WITH SPECIAL NEEDS.—Paragraph ‘‘(B) the cost-of-living adjustment deter- IX of the Economic Growth and Tax Relief (3) of section 23(a) of such Code (relating to mined under section 1(f)(3) for the calendar Reconciliation Act of 2001 shall not apply to $10,000 credit for adoption of child with spe- year in which the taxable year begins, deter- the amendments made by section 202 of such cial needs regardless of expenses) is amend- mined by substituting ‘calendar year 2001’ Act. ed— for ‘calendar year 1992’ in subparagraph (d) EFFECTIVE DATE.—The amendments (i) in the text by striking ‘‘$10,000’’ and in- thereof. made by this section shall apply to taxable serting ‘‘$15,000’’, and If any amount as increased under the pre- years beginning after December 31, 2009. (ii) in the heading by striking ‘‘$10,000’’ and ceding sentence is not a multiple of $10, such inserting ‘‘$15,000’’. amount shall be rounded to the nearest mul- SA 3185. Mr. BROWN submitted an (C) CONFORMING AMENDMENT TO INFLATION tiple of $10.’’. amendment intended to be proposed by ADJUSTMENT.—Subsection (h) of section 23 of (b) CREDIT MADE REFUNDABLE.— Mr. REID (for himself, Mr. BAUCUS, Mr. such Code (relating to adjustments for infla- (1) CREDIT MOVED TO SUBPART RELATING TO DODD, and Mr. HARKIN) to the bill H.R. tion) is amended to read as follows: REFUNDABLE CREDITS.—The Internal Revenue 3590, to amend the Internal Revenue ‘‘(h) ADJUSTMENTS FOR INFLATION.— Code of 1986 is amended— Code of 1986 to modify the first-time ‘‘(1) DOLLAR LIMITATIONS.—In the case of a (A) by redesignating section 23, as amended homebuyers credit in the case of mem- taxable year beginning after December 31, by subsection (a), as section 36B, and 2009, each of the dollar amounts in sub- (B) by moving section 36B (as so redesig- bers of the Armed Forces and certain sections (a)(3) and (b)(1) shall be increased by nated) from subpart A of part IV of sub- other Federal employees, and for other an amount equal to— chapter A of chapter 1 to the location imme- purposes; which was ordered to lie on ‘‘(A) such dollar amount, multiplied by diately before section 37 in subpart C of part the table; as follows: ‘‘(B) the cost-of-living adjustment deter- IV of subchapter A of chapter 1. On page 553, between lines 14 and 15, insert mined under section 1(f)(3) for the calendar (2) CONFORMING AMENDMENTS.— the following:

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00077 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.050 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13048 CONGRESSIONAL RECORD — SENATE December 11, 2009

SEC. 2721. INCREASED PAYMENTS FOR PEDI- (b) INCREASED FMAP.—Section 1905 of such On page 828, between lines 3 and 4, insert ATRIC CARE UNDER MEDICAID. Act (42 U.S.C. 1396d), as amended by sections the following: (a) IN GENERAL.— 2006 and 4107(a)(2), is amended SEC. 3130. MEDICARE CRITICAL ACCESS HOS- (1) FEE-FOR-SERVICE PAYMENTS.—Section (1) in the first sentence of subsection (b), PITAL PROVISIONS. 1902 of the Social Security Act (42 U.S.C. by striking ‘‘and’’ before ‘‘(4)’’ and by insert- (a) FLEXIBILITY IN THE MANNER IN WHICH 1396b), as amended by section 2001(b)(2), is ing before the period at the end the fol- BEDS ARE COUNTED FOR PURPOSES OF DETER- amended— lowing: ‘‘, and (5) 100 percent (for periods be- MINING WHETHER A HOSPITAL MAY BE DES- (A) in subsection (a)(13)— ginning with 2010) with respect to amounts IGNATED AS A CRITICAL ACCESS HOSPITAL (i) by striking ‘‘and’’ at the end of subpara- described in subsection (cc)’’; and UNDER THE MEDICARE PROGRAM.— graph (A); (2) by adding at the end the following new (1) IN GENERAL.—Section 1820(c)(2)(B) of the (ii) by adding ‘‘and’’ at the end of subpara- subsection: Social Security Act (42 U.S.C. 1395i– graph (B); and ‘‘(cc) For purposes of section 1905(b)(5), the 4(c)(2)(B)) is amended— (iii) by adding at the end the following new amounts described in this subsection are the (A) in clause (iii), by inserting ‘‘(or 20, as subparagraph: following: determined on an annual, average basis)’’ ‘‘(C) payment for pediatric care services ‘‘(1)(A) The portion of the amounts ex- after ‘‘25’’; and (as defined in subsection (hh)(1)) furnished pended for medical assistance for services de- (B) by adding at the end the following flush by physicians (as defined in section 1861(r)) scribed in section 1902(a)(13)(C) furnished on sentence: (or for services furnished by other health or after January 1, 2010, that is attributable care professionals that would be pediatric ‘‘In determining the number of beds for pur- to the amount by which the minimum pay- care services under such subsection if fur- poses of clause (iii), only beds that are occu- ment rate required under such section (or, by nished by a physician) at a rate not less than pied shall be counted.’’. application, section 1932(f)) exceeds the pay- 80 percent of the payment rate that would be (2) EFFECTIVE DATE.—The amendments ment rate applicable to such services under applicable if the adjustment described in made by this subsection take effect on Janu- the State plan as of the date of enactment of subsection (hh)(2) were to apply to such serv- ary 1, 2010. the Patient Protection and Affordable Care ices under part B of title XVIII (or, if there (b) CRITICAL ACCESS HOSPITAL INPATIENT Act. is no payment rate for such services under BED LIMITATION EXEMPTION FOR BEDS PRO- ‘‘(B) Subparagraph (A) shall not be con- part B of title XVIII, the payment rate for VIDED TO CERTAIN VETERANS.— the most comparable services, as determined strued as preventing the payment of Federal (1) IN GENERAL.—Section 1820(c) of the So- by the Secretary in consultation with the financial participation based on the Federal cial Security Act (42 U.S.C. 1395i–4(c)) is Medicaid and CHIP Payment and Access medical assistance percentage for amounts amended by adding at the end the following Commission established under section 1900 in excess of those specified under such sub- new paragraph: and adjusted as appropriate for a pediatric paragraph.’’. ‘‘(3) EXEMPTION FROM BED LIMITATION.—For population) for services furnished in 2010, 90 (c) EFFECTIVE DATE.—The amendments purposes of this section, no acute care inpa- percent of such adjusted payment rate for made by this section shall apply to services tient bed shall be counted against any nu- such services furnished in 2011, and 100 per- furnished on or after January 1, 2010. merical limitation specified under this sec- cent of such adjusted payment rate for such tion for such a bed (or for inpatient bed days services furnished in 2012 and each subse- SA 3186. Mr. BROWN submitted an with respect to such a bed) if the bed is pro- quent year;’’; and amendment intended to be proposed to vided for an individual who is a veteran and (B) by adding at the end the following new amendment SA 2786 proposed by Mr. the Department of Veterans Affairs referred subsection: REID (for himself, Mr. BAUCUS, Mr. the individual for care in the hospital or is ‘‘(hh) INCREASED PAYMENT FOR PEDIATRIC DODD, and Mr. HARKIN) to the bill H.R. coordinating such care with other care being CARE.—For purposes of subsection (a)(13)(C): 3590, to amend the Internal Revenue provided by such Department.’’. ‘‘(1) PEDIATRIC CARE SERVICES DEFINED.— (2) EFFECTIVE DATE.—The amendment The term ‘pediatric care services’ means Code of 1986 to modify the first-time made by paragraph (1) shall apply to cost re- evaluation and management services, with- homebuyers credit in the case of mem- porting periods beginning on or after the out regard to the specialty of the physician bers of the Armed Forces and certain date of the enactment of this Act or hospital furnishing the services, that are other Federal employees, and for other procedure codes (for services covered under purposes; which was ordered to lie on SA 3188. Ms. CANTWELL submitted title XVIII) for services in the category des- the table; as follows: an amendment intended to be proposed ignated Evaluation and Management in the Beginning on page 729, strike line 21 and to amendment SA 2786 proposed by Mr. Healthcare Common Procedure Coding Sys- all that follows through line 13 on page 730, REID (for himself, Mr. BAUCUS, Mr. tem (established by the Secretary under sec- and insert the following: DODD, and Mr. HARKIN) to the bill H.R. tion 1848(c)(5) as of December 31, 2009, and as ‘‘(xv) Promoting— subsequently modified by the Secretary) and 3590, to amend the Internal Revenue ‘‘(I) improved quality and reduced cost by that are furnished to an individual who is en- Code of 1986 to modify the first-time developing a collaborative of high-quality, rolled in the State plan under this title who homebuyers credit in the case of mem- low-cost health care institutions that is re- has not attained age 19. Such term includes bers of the Armed Forces and certain sponsible for— procedure codes established by the Sec- ‘‘(aa) developing, documenting, and dis- other Federal employees, and for other retary, in consultation with the Medicaid seminating best practices and proven care purposes; which was ordered to lie on and CHIP Payment and Access Commission methods; the table; as follows: established under section 1900, for services ‘‘(bb) implementing such best practices On page 2074, after line 25, add the fol- furnished under State plans under this title and proven care methods within such insti- lowing: to individuals who have not attained age 19 tutions to demonstrate further improve- and for which there is not an a procedure SEC. lll. TREATMENT OF HRAS. ments in quality and efficiency; and code (or a procedure code that the Secretary, For purposes of the provisions of, and ‘‘(cc) providing assistance to other health in consultation with such Commission, de- amendments made by, this Act, and the pro- care institutions on how best to employ such termines is comparable) established under visions of any other law, funds from a health best practices and proven care methods to the Healthcare Common Procedure Coding reimbursement arrangement used in whole improve health care quality and lower costs. System. or in part by an individual to purchase an in- ‘‘(II) improved quality and reduced cost by ‘‘(2) ADJUSTMENT.—The adjustment de- dividual or family health benefits plan shall developing a similarly focused collaborative scribed in this paragraph is the substitution not be considered or construed as an em- of pediatric providers and institutions of 1.25 percent for the update otherwise pro- ployer contribution and such individual or through the Medicaid and CHIP programs.’’. vided under section 1848(d)(4) for each year family plan shall not be considered or con- beginning with 2010.’’. strued as a group health benefits plan. SA 3187. Mr. WYDEN (for himself and (2) UNDER MEDICAID MANAGED CARE PLANS.— Section 1932(f) of such Act (42 U.S.C. 1396u– Mr. CRAPO) submitted an amendment SA 3189. Mr. ENZI submitted an 2(f)) is amended— intended to be proposed to amendment amendment intended to be proposed to (A) in the heading, by adding at the end SA 2786 proposed by Mr. REID (for him- amendment SA 2786 proposed by Mr. the following: ‘‘; ADEQUACY OF PAYMENT FOR self, Mr. BAUCUS, Mr. DODD, and Mr. REID (for himself, Mr. BAUCUS, Mr. PEDIATRIC CARE SERVICES’’; and HARKIN) to the bill H.R. 3590, to amend DODD, and Mr. HARKIN) to the bill H.R. (B) by inserting before the period at the the Internal Revenue Code of 1986 to 3590, to amend the Internal Revenue end the following: ‘‘and, in the case of pedi- modify the first-time homebuyers cred- Code of 1986 to modify the first-time atric care services described in section it in the case of members of the Armed homebuyers credit in the case of mem- 1902(a)(13)(C), consistent with the minimum payment rates specified in such section (re- Forces and certain other Federal em- bers of the Armed Forces and certain gardless of the manner in which such pay- ployees, and for other purposes; which other Federal employees, and for other ments are made, including in the form of was ordered to lie on the table; as fol- purposes; which was ordered to lie on capitation or partial capitation)’’. lows: the table; as follows:

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00078 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.052 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13049 On page 1053, between lines 2 and 3, insert DODD, and Mr. HARKIN) to the bill H.R. SEC. 4403. PROHIBITION ON THE USE OF FUNDS the following: 3590, to amend the Internal Revenue FOR THE CONSTRUCTION OF SIDE- WALKS, PLAYGROUNDS, OR JUNGLE SEC. 3404. AUTHORITY TO VARY THE AMOUNT OF Code of 1986 to modify the first-time GYMS. THE MEDICARE PART B PREMIUM FOR NEW BENEFICIARIES THAT homebuyers credit in the case of mem- Notwithstanding any other provision of SMOKE AND BENEFICIARIES THAT bers of the Armed Forces and certain this Act (or an amendment made by this MAKE HEALTHY CHOICES. other Federal employees, and for other Act), no funds appropriated under this Act Section 1839 of the Social Security Act (42 purposes; which was ordered to lie on (or an amendment made by this Act) shall be U.S.C. 1395r) is amended— the table; as follows: allocated to pay for the construction of side- (1) in subsection (a)(2), by striking ‘‘and walks, playgrounds, or jungle gyms. (i)’’ and inserting ‘‘(i), and (j)’’; and On page 1266, between lines 17 and 18, insert (2) by adding at the end the following new the following: SA 3195. Mr. ENZI submitted an subsection: SEC. 4403. TERMINATION OF PROGRAMS. amendment intended to be proposed to ‘‘(j) AUTHORITY TO VARY THE AMOUNT OF Notwithstanding any other provision of amendment SA 2786 proposed by Mr. this Act (or an amendment made by this THE PREMIUM FOR BENEFICIARIES THAT SMOKE REID (for himself, Mr. BAUCUS, Mr. AND BENEFICIARIES THAT MAKE HEALTHY Act), the Secretary of Health and Human DODD, and Mr. HARKIN) to the bill H.R. CHOICES.—With respect to the monthly pre- Services shall terminate a program estab- mium amount for individuals who enroll lished under this title if the Secretary of 3590, to amend the Internal Revenue under this part after the date of the enact- Health and Human Services determines that Code of 1986 to modify the first-time ment of the Patient Protection and Afford- such program has not reduced health care homebuyers credit in the case of mem- able Care Act, the Secretary shall vary the costs for the Federal government and bene- bers of the Armed Forces and certain amount of such premium for such an indi- ficiaries under such program. other Federal employees, and for other vidual if the individual smokes or makes purposes; which was ordered to lie on healthy choices to improve health outcomes SA 3192. Mr. ENZI submitted an the table; as follows: (as defined by the Secretary).’’. amendment intended to be proposed to On page 101, between lines 19 and 20, insert amendment SA 2786 proposed by Mr. the following: SA 3190. Mr. ENZI submitted an REID (for himself, Mr. BAUCUS, Mr. amendment intended to be proposed to (3) INCLUSION OF HIGH DEDUCTIBLE HEALTH DODD, and Mr. HARKIN) to the bill H.R. PLANS.—If a health plan is a high deductible amendment SA 2786 proposed by Mr. 3590, to amend the Internal Revenue health plan (as defined in section 223(c)(2) of REID (for himself, Mr. BAUCUS, Mr. Code of 1986 to modify the first-time the Internal Revenue Code of 1986) that DODD, and Mr. HARKIN) to the bill H.R. homebuyers credit in the case of mem- meets all requirements under such section to 3590, to amend the Internal Revenue bers of the Armed Forces and certain be offered in connection with a health sav- Code of 1986 to modify the first-time other Federal employees, and for other ings account— homebuyers credit in the case of mem- (A) such plan shall be treated as a qualified purposes; which was ordered to lie on health plan under this section, and as min- bers of the Armed Forces and certain the table; as follows: other Federal employees, and for other imum essential coverage under section 5000A On page 356, between lines 19 and 20, insert of such Code, for purposes of this Act and the purposes; which was ordered to lie on the following: amendments made by this Act; the table; as follows: ‘‘(f) LIMITATION.—If in any calendar year (B) no requirement imposed by any provi- On page 245, between lines 14 and 15, and the national unemployment rate (as deter- sion of, or any amendment made by, this Act insert the following: mined by the Bureau of Labor Statistics) ex- shall apply with respect to the plan or issuer (B) SPECIAL RULE FOR CERTAIN INDIVIDUALS ceeds 6 percent, then, notwithstanding any thereof. ELIGIBLE FOR MEDICAID.—If a taxpayer is an other provision of law, this section shall not individual described in section 1902(k)(3) of apply for the remainder of such calendar SA 3196. Mr. ENZI submitted an the Social Security Act who elects, in ac- year.’’. amendment intended to be proposed to cordance with procedures established by a amendment SA 2786 proposed by Mr. State under that section, to enroll in a quali- SA 3193. Mr. ENZI submitted an REID (for himself, Mr. BAUCUS, Mr. fied health plan and whose household income amendment intended to be proposed to DODD, and Mr. HARKIN) to the bill H.R. does not exceed 100 percent of an amount amendment SA 2786 proposed by Mr. 3590, to amend the Internal Revenue equal to the poverty line for a family of the REID (for himself, Mr. BAUCUS, Mr. size involved, the taxpayer shall— Code of 1986 to modify the first-time DODD, and Mr. HARKIN) to the bill H.R. (i) for purposes of the credit under this sec- homebuyers credit in the case of mem- tion, be treated as an applicable taxpayer 3590, to amend the Internal Revenue bers of the Armed Forces and certain and the applicable percentage with respect Code of 1986 to modify the first-time other Federal employees, and for other to such taxpayer shall be 2.0 percent; and homebuyers credit in the case of mem- purposes; which was ordered to lie on (ii) for purposes of reduced cost-sharing bers of the Armed Forces and certain the table; as follows: under section 1402 of the Patient Protection other Federal employees, and for other On page 54, between lines 19 and 20, insert and Affordable Care Act, shall be treated as purposes; which was ordered to lie on having household income of more than 100 the following: the table; as follows: (g) USE OF FUND.—Notwithstanding any percent but less than 150 percent of the pov- other provision of this Act (or an amend- erty line (as so defined) applicable to a fam- On page 1142, strike lines 8 through 16 and ment made by this Act), the Secretary shall ily of the size involved. insert the following: On page 404, between lines 13 and 14, insert (c) USE OF FUND.—Notwithstanding any allocate amounts appropriated under sub- the following: other provision of this Act (or an amend- section (e) to the high risk pool program ‘‘(3) The State shall establish procedures to ment made by this Act), the Secretary shall under section 1101 and the reinsurance pro- ensure that any individual eligible for med- allocate amounts in the Fund to the high gram for individual and small group markets ical assistance under the State plan or under risk pool program under section 1101 and the in each State under section 1341, in order to a waiver of the plan (under any subclause of reinsurance program for individual and lower health care premiums for Americans. subsection (a)(10)(A) or otherwise) who is not small group markets in each State under elderly or disabled may elect to enroll in a section 1341, in order to lower health care SA 3197. Mr. ENZI submitted an qualified health plan through an Exchange premiums for Americans. amendment intended to be proposed to established by the State under section 1311 of amendment SA 2786 proposed by Mr. the Patient Protection and Affordable Care SA 3194. Mr. ENZI submitted an REID (for himself, Mr. BAUCUS, Mr. Act instead of enrolling in the State plan amendment intended to be proposed to DODD, and Mr. HARKIN) to the bill H.R. under this title or a waiver of the plan. An amendment SA 2786 proposed by Mr. 3590, to amend the Internal Revenue individual making such an election shall REID (for himself, Mr. BAUCUS, Mr. Code of 1986 to modify the first-time waive being provided with medical assist- DODD, and Mr. HARKIN) to the bill H.R. homebuyers credit in the case of mem- ance under the State plan or waiver while 3590, to amend the Internal Revenue bers of the Armed Forces and certain enrolled in the qualified health plan. In the Code of 1986 to modify the first-time case of an individual who is a child, the other Federal employees, and for other child’s parent may make such an election on homebuyers credit in the case of mem- purposes; which was ordered to lie on behalf of the child. bers of the Armed Forces and certain the table; as follows: other Federal employees, and for other Strike the matter proposed to be inserted SA 3191. Mr. ENZI submitted an purposes; which was ordered to lie on and insert the following: amendment intended to be proposed to the table; as follows: SECTION 1. SHORT TITLE. amendment SA 2786 proposed by Mr. At the end of subtitle E of title IV, insert This Act may be cited as the ‘‘Small Busi- REID (for himself, Mr. BAUCUS, Mr. the following: ness Health Plans Act of 2009’’.

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00079 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.053 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13050 CONGRESSIONAL RECORD — SENATE December 11, 2009 TITLE I—ENHANCED MARKETPLACE tions, or other organizations composed of in- fully or with gross negligence incomplete or POOLS dividuals and groups which may have little inaccurate. SEC. 101. RULES GOVERNING ENHANCED MAR- or no association with employment, provided ‘‘SEC. 804. REQUIREMENTS RELATING TO SPON- KETPLACE POOLS. however, that such alternative market pool- SORS AND BOARDS OF TRUSTEES. (a) IN GENERAL.—Subtitle B of title I of the ing organizations meet, and continue meet- ‘‘(a) SPONSOR.—The requirements of this Employee Retirement Income Security Act ing on an ongoing basis, to satisfy standards, subsection are met with respect to a small of 1974 is amended by adding after part 7 the rules, and requirements materially equiva- business health plan if the sponsor has met following new part: lent to those set forth in this part with re- (or is deemed under this part to have met) spect to small business health plans; the requirements of section 801(b) for a con- ‘‘PART 8—RULES GOVERNING ENHANCED ‘‘(3) conduct periodic verification of such tinuous period of not less than 3 years end- MARKETPLACE POOLS compliance by alternative market pooling ing with the date of the application for cer- ‘‘SEC. 801. SMALL BUSINESS HEALTH PLANS. organizations, in consultation with the Sec- tification under this part. ‘‘(a) IN GENERAL.—For purposes of this retary of Health and Human Services and the ‘‘(b) BOARD OF TRUSTEES.—The require- part, the term ‘small business health plan’ National Association of Insurance Commis- ments of this subsection are met with re- means a fully insured group health plan sioners, except that such periodic spect to a small business health plan if the following requirements are met: whose sponsor is (or is deemed under this verification shall not materially impede ‘‘(1) FISCAL CONTROL.—The plan is oper- part to be) described in subsection (b). market entry or participation as pooling en- ated, pursuant to a plan document, by a ‘‘(b) SPONSORSHIP.—The sponsor of a group tities comparable to that of small business board of trustees which pursuant to a trust health plan is described in this subsection if health plans; agreement has complete fiscal control over such sponsor— ‘‘(4) assure that consistent, clear, and regu- the plan and which is responsible for all op- ‘‘(1) is organized and maintained in good larly monitored standards are applied with erations of the plan. faith, with a constitution and bylaws specifi- respect to alternative market pooling orga- ‘‘(2) RULES OF OPERATION AND FINANCIAL cally stating its purpose and providing for nizations to avert material risk-selection periodic meetings on at least an annual CONTROLS.—The board of trustees has in ef- within or among the composition of such or- fect rules of operation and financial con- basis, as a bona fide trade association, a ganizations; trols, based on a 3-year plan of operation, bona fide industry association (including a ‘‘(5) the expedited and deemed certification adequate to carry out the terms of the plan rural electric cooperative association or a procedures provided in section 805(d) shall and to meet all requirements of this title ap- rural telephone cooperative association), a not apply to alternative market pooling or- plicable to the plan. bona fide professional association, or a bona ganizations until sooner of the promulgation ‘‘(3) RULES GOVERNING RELATIONSHIP TO fide chamber of commerce (or similar bona of regulations under this subsection or the PARTICIPATING EMPLOYERS AND TO CONTRAC- fide business association, including a cor- expiration of one year following enactment TORS.— poration or similar organization that oper- of this Act; and ‘‘(A) BOARD MEMBERSHIP.— ates on a cooperative basis (within the mean- ‘‘(6) make such other appropriate adjust- ‘‘(i) IN GENERAL.—Except as provided in ing of section 1381 of the Internal Revenue ments to the requirements of this part as the clauses (ii) and (iii), the members of the Code of 1986)), for substantial purposes other Secretary may reasonably deem appropriate board of trustees are individuals selected than that of obtaining medical care; to fit the circumstances of an individual al- from individuals who are the owners, offi- ‘‘(2) is established as a permanent entity ternative market pooling organization or cers, directors, or employees of the partici- which receives the active support of its category of such organization, including but pating employers or who are partners in the members and requires for membership pay- not limited to the application of the mem- participating employers and actively partici- ment on a periodic basis of dues or payments bership payment requirements of section pate in the business. necessary to maintain eligibility for mem- 801(b)(2) to alternative market pooling orga- ‘‘(ii) LIMITATION.— bership; nizations composed primarily of church- or ‘‘(I) GENERAL RULE.—Except as provided in ‘‘(3) does not condition membership, such faith-based membership. subclauses (II) and (III), no such member is dues or payments, or coverage under the ‘‘SEC. 803. CERTIFICATION OF SMALL BUSINESS an owner, officer, director, or employee of, or plan on the basis of health status-related HEALTH PLANS. partner in, a contract administrator or other factors with respect to the employees of its ‘‘(a) IN GENERAL.—Not later than 6 months service provider to the plan. members (or affiliated members), or the de- after the date of enactment of this part, the ‘‘(II) LIMITED EXCEPTION FOR PROVIDERS OF pendents of such employees, and does not applicable authority shall prescribe by in- SERVICES SOLELY ON BEHALF OF THE SPON- condition such dues or payments on the basis terim final rule a procedure under which the SOR.—Officers or employees of a sponsor of group health plan participation; and applicable authority shall certify small busi- which is a service provider (other than a con- ‘‘(4) does not condition membership on the ness health plans which apply for certifi- tract administrator) to the plan may be basis of a minimum group size. cation as meeting the requirements of this members of the board if they constitute not Any sponsor consisting of an association of part. more than 25 percent of the membership of entities which meet the requirements of ‘‘(b) REQUIREMENTS APPLICABLE TO CER- the board and they do not provide services to paragraphs (1), (2), (3), and (4) shall be TIFIED PLANS.—A small business health plan the plan other than on behalf of the sponsor. deemed to be a sponsor described in this sub- with respect to which certification under ‘‘(III) TREATMENT OF PROVIDERS OF MEDICAL section. this part is in effect shall meet the applica- CARE.—In the case of a sponsor which is an ‘‘SEC. 802. ALTERNATIVE MARKET POOLING OR- ble requirements of this part, effective on association whose membership consists pri- GANIZATIONS. the date of certification (or, if later, on the marily of providers of medical care, sub- ‘‘(a) IN GENERAL.—The Secretary, not later date on which the plan is to commence oper- clause (I) shall not apply in the case of any than 1 year after the date of enactment of ations). service provider described in subclause (I) this part, shall promulgate regulations that ‘‘(c) REQUIREMENTS FOR CONTINUED CERTIFI- who is a provider of medical care under the apply the rules and standards of this part, as CATION.—The applicable authority may pro- plan. necessary, to circumstances in which a pool- vide by regulation for continued certifi- ‘‘(iii) CERTAIN PLANS EXCLUDED.—Clause (i) ing entity other (hereinafter ‘Alternative cation of small business health plans under shall not apply to a small business health Market Pooling Organizations’) is not made this part. Such regulation shall provide for plan which is in existence on the date of the up principally of employers and their em- the revocation of a certification if the appli- enactment of the Small Business Health ployees, or not a professional organization or cable authority finds that the small business Plans Act of 2009. such small business health plan entity iden- health plan involved is failing to comply ‘‘(B) SOLE AUTHORITY.—The board has sole tified in section 801. with the requirements of this part. authority under the plan to approve applica- ‘‘(b) ADAPTION OF STANDARDS.—In devel- ‘‘(d) EXPEDITED AND DEEMED CERTIFI- tions for participation in the plan and to oping and promulgating regulations pursu- CATION.— contract with insurers. ant to subsection (a), the Secretary, in con- ‘‘(1) IN GENERAL.—If the Secretary fails to ‘‘(c) TREATMENT OF FRANCHISES.—In the sultation with the Secretary of Health and act on an application for certification under case of a group health plan which is estab- Human Services, small business health this section within 90 days of receipt of such lished and maintained by a franchiser for a plans, small and large employers, large and application, the applying small business franchisor or for its franchisees— small insurance issuers, consumer represent- health plan shall be deemed certified until ‘‘(1) the requirements of subsection (a) and atives, and state insurance commissioners, such time as the Secretary may deny for section 801(a) shall be deemed met if such re- shall— cause the application for certification. quirements would otherwise be met if the ‘‘(1) adapt the standards of this part, to the ‘‘(2) CIVIL PENALTY.—The Secretary may franchisor were deemed to be the sponsor re- maximum degree practicable, to assure bal- assess a civil penalty against the board of ferred to in section 801(b) and each anced and comparable oversight standards trustees and plan sponsor (jointly and sever- franchisee were deemed to be a member (of for both small business health plans and al- ally) of a small business health plan that is the sponsor) referred to in section 801(b); and ternative market pooling organizations; deemed certified under paragraph (1) of up to ‘‘(2) the requirements of section 804(a)(1) ‘‘(2) permit the participation as alternative $500,000 in the event the Secretary deter- shall be deemed met. market pooling organizations unions, mines that the application for certification For purposes of this subsection the terms churches and other faith-based organiza- of such small business health plan was will- ‘franchisor’ and ‘franchisee’ shall have the

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00080 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.059 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13051 meanings given such terms for purposes of ‘‘(ii) provides that the sponsor of the plan scribed by the applicable authority by regu- sections 436.2(a) through 436.2(c) of title 16, is to serve as plan sponsor (referred to in sec- lation. Code of Federal Regulations (including any tion 3(16)(B)). ‘‘(b) ABILITY OF SMALL BUSINESS HEALTH such amendments to such regulation after ‘‘(B) DESCRIPTION OF MATERIAL PROVI- PLANS TO DESIGN BENEFIT OPTIONS.—Nothing the date of enactment of this part). SIONS.—The terms of the health insurance in this part or any provision of State law (as ‘‘SEC. 805. PARTICIPATION AND COVERAGE RE- coverage (including the terms of any indi- defined in section 514(c)(1)) shall be con- QUIREMENTS. vidual certificates that may be offered to in- strued to preclude a small business health ‘‘(a) COVERED EMPLOYERS AND INDIVID- dividuals in connection with such coverage) plan or a health insurance issuer offering UALS.—The requirements of this subsection describe the material benefit and rating, and health insurance coverage in connection are met with respect to a small business other provisions set forth in this section and with a small business health plan from exer- health plan if, under the terms of the plan— such material provisions are included in the cising its sole discretion in selecting the spe- ‘‘(1) each participating employer must be— summary plan description. cific benefits and services consisting of med- ‘‘(A) a member of the sponsor; ‘‘(2) CONTRIBUTION RATES MUST BE NON- ical care to be included as benefits under ‘‘(B) the sponsor; or DISCRIMINATORY.— such plan or coverage, except that such bene- ‘‘(C) an affiliated member of the sponsor, ‘‘(A) IN GENERAL.—The contribution rates fits and services must meet the terms and except that, in the case of a sponsor which is for any participating small employer shall specifications of part II of subtitle A of title a professional association or other indi- not vary on the basis of any health status-re- XXIX of the Public Health Service Act (re- vidual-based association, if at least one of lated factor in relation to employees of such lating to lower cost plans), as added by title the officers, directors, or employees of an employer or their beneficiaries and shall not II of the Small Business Health Plans Act of employer, or at least one of the individuals vary on the basis of the type of business or 2009. who are partners in an employer and who ac- industry in which such employer is engaged, ‘‘(c) DOMICILE AND NON-DOMICILE STATES.— tively participates in the business, is a mem- subject to subparagraph (B) and the terms of ‘‘(1) DOMICILE STATE.—Coverage shall be ber or such an affiliated member of the spon- this title. issued to a small business health plan in the State in which the sponsor’s principal place sor, participating employers may also in- ‘‘(B) EFFECT OF TITLE.—Nothing in this clude such employer; and title or any other provision of law shall be of business is located. ‘‘(2) all individuals commencing coverage construed to preclude a health insurance ‘‘(2) NON-DOMICILE STATES.—With respect to under the plan after certification under this issuer offering health insurance coverage in a State (other than the domicile State) in part must be— connection with a small business health plan which participating employers of a small ‘‘(A) active or retired owners (including that meets the requirements of this part, business health plan are located but in which self-employed individuals), officers, direc- and at the request of such small business the insurer of the small business health plan tors, or employees of, or partners in, partici- health plan, from— in the domicile State is not yet licensed, the pating employers; or ‘‘(i) setting contribution rates for the following shall apply: ‘‘(B) the dependents of individuals de- small business health plan based on the ‘‘(A) TEMPORARY PREEMPTION.—If, upon the scribed in subparagraph (A). claims experience of the small business expiration of the 90-day period following the ‘‘(b) INDIVIDUAL MARKET UNAFFECTED.—The health plan so long as any variation in such submission of a licensure application by such requirements of this subsection are met with rates for participating small employers com- insurer (that includes a certified copy of an respect to a small business health plan if, plies with the requirements of clause (ii), ex- approved licensure application as submitted under the terms of the plan, no participating cept that small business health plans shall by such insurer in the domicile State) to employer may provide health insurance cov- not be subject, in non-adopting states, to such State, such State has not approved or erage in the individual market for any em- subparagraphs (A)(ii) and (C) of section denied such application, such State’s health ployee not covered under the plan which is 2912(a)(2) of the Public Health Service Act, insurance licensure laws shall be tempo- similar to the coverage contemporaneously and in adopting states, to any State law that rarily preempted and the insurer shall be provided to employees of the employer under would have the effect of imposing require- permitted to operate in such State, subject the plan, if such exclusion of the employee ments as outlined in such subparagraphs to the following terms: from coverage under the plan is based on a (A)(ii) and (C); or ‘‘(i) APPLICATION OF NON-DOMICILE STATE health status-related factor with respect to ‘‘(ii) varying contribution rates for partici- LAW.—Except with respect to licensure and the employee and such employee would, but pating small employers in a small business with respect to the terms of subtitle A of for such exclusion on such basis, be eligible health plan in a State to the extent that title XXIX of the Public Health Service Act for coverage under the plan. such rates could vary using the same meth- (relating to rating and benefits as added by ‘‘(c) PROHIBITION OF DISCRIMINATION odology employed in such State for regu- the Small Business Health Plans Act of 2009), AGAINST EMPLOYERS AND EMPLOYEES ELIGI- lating small group premium rates, subject to the laws and authority of the non-domicile BLE TO PARTICIPATE.—The requirements of the terms of part I of subtitle A of title State shall remain in full force and effect. this subsection are met with respect to a XXIX of the Public Health Service Act (re- ‘‘(ii) REVOCATION OF PREEMPTION.—The pre- small business health plan if— lating to rating requirements), as added by emption of a non-domicile State’s health in- ‘‘(1) under the terms of the plan, all em- title II of the Small Business Health Plans surance licensure laws pursuant to this sub- ployers meeting the preceding requirements Act of 2009. paragraph, shall be terminated upon the oc- of this section are eligible to qualify as par- ‘‘(3) EXCEPTIONS REGARDING SELF-EMPLOYED currence of either of the following: ticipating employers for all geographically AND LARGE EMPLOYERS.— ‘‘(I) APPROVAL OR DENIAL OF APPLICATION.— available coverage options, unless, in the ‘‘(A) SELF EMPLOYED.— The approval of denial of an insurer’s licen- case of any such employer, participation or ‘‘(i) IN GENERAL.—Small business health sure application, following the laws and reg- contribution requirements of the type re- plans with participating employers who are ulations of the non-domicile State with referred to in section 2711 of the Public Health self-employed individuals (and their depend- spect to licensure. Service Act are not met; ‘‘(2) information regarding all coverage op- ents) shall enroll such self-employed partici- ‘‘(II) DETERMINATION OF MATERIAL VIOLA- tions available under the plan is made read- pating employers in accordance with rating TION.—A determination by a non-domicile ily available to any employer eligible to par- rules that do not violate the rating rules for State that an insurer operating in a non- ticipate; and self-employed individuals in the State in domicile State pursuant to the preemption ‘‘(3) the applicable requirements of sec- which such self-employed participating em- provided for in this subparagraph is in mate- tions 701, 702, and 703 are met with respect to ployers are located. rial violation of the insurance laws (other the plan. ‘‘(ii) GUARANTEE ISSUE.—Small business than licensure and with respect to the terms health plans with participating employers of subtitle A of title XXIX of the Public ‘‘SEC. 806. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS, CONTRIBUTION who are self-employed individuals (and their Health Service Act (relating to rating and RATES, AND BENEFIT OPTIONS. dependents) may decline to guarantee issue benefits added by the Small Business Health ‘‘(a) IN GENERAL.—The requirements of this to such participating employers in States in Plans Act of 2009)) of such State. section are met with respect to a small busi- which guarantee issue is not otherwise re- ‘‘(B) NO PROHIBITION ON PROMOTION.—Noth- ness health plan if the following require- quired for the self-employed in that State. ing in this paragraph shall be construed to ments are met: ‘‘(B) LARGE EMPLOYERS.—Small business prohibit a small business health plan or an ‘‘(1) CONTENTS OF GOVERNING INSTRU- health plans with participating employers insurer from promoting coverage prior to the MENTS.— that are larger than small employers (as de- expiration of the 90-day period provided for ‘‘(A) IN GENERAL.—The instruments gov- fined in section 808(a)(10)) shall enroll such in subparagraph (A), except that no enroll- erning the plan include a written instru- large participating employers in accordance ment or collection of contributions shall ment, meeting the requirements of an in- with rating rules that do not violate the rat- occur before the expiration of such 90-day pe- strument required under section 402(a)(1), ing rules for large employers in the State in riod. which— which such large participating employers are ‘‘(C) LICENSURE.—Except with respect to ‘‘(i) provides that the board of trustees located. the application of the temporary preemption serves as the named fiduciary required for ‘‘(4) REGULATORY REQUIREMENTS.—Such provision of this paragraph, nothing in this plans under section 402(a)(1) and serves in other requirements as the applicable author- part shall be construed to limit the require- the capacity of a plan administrator (re- ity determines are necessary to carry out ment that insurers issuing coverage to small ferred to in section 3(16)(A)); and the purposes of this part, which shall be pre- business health plans shall be licensed in

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00081 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.059 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13052 CONGRESSIONAL RECORD — SENATE December 11, 2009 each State in which the small business nate stating that such termination is in- coverage in the small group market (as de- health plans operate. tended and the proposed termination date; fined in section 2791(e)(5) of the Public ‘‘(D) SERVICING BY LICENSED INSURERS.— ‘‘(2) develops a plan for winding up the af- Health Service Act) is regulated by such Notwithstanding subparagraph (C), the re- fairs of the plan in connection with such ter- State. quirements of this subsection may also be mination in a manner which will result in ‘‘(8) MEDICAL CARE.—The term ‘medical satisfied if the participating employers of a timely payment of all benefits for which the care’ has the meaning provided in section small business health plan are serviced by a plan is obligated; and 733(a)(2). licensed insurer in that State, even where ‘‘(3) submits such plan in writing to the ap- ‘‘(9) PARTICIPATING EMPLOYER.—The term such insurer is not the insurer of such small plicable authority. ‘participating employer’ means, in connec- business health plan in the State in which Actions required under this section shall be tion with a small business health plan, any such small business health plan is domiciled. taken in such form and manner as may be employer, if any individual who is an em- ‘‘SEC. 807. REQUIREMENTS FOR APPLICATION prescribed by the applicable authority by ployee of such employer, a partner in such AND RELATED REQUIREMENTS. regulation. employer, or a self-employed individual who ILING EE ‘‘(a) F F .—Under the procedure pre- ‘‘SEC. 809. IMPLEMENTATION AND APPLICATION is such employer (or any dependent, as described pursuant to section 802(a), a small AUTHORITY BY SECRETARY. fined under the terms of the plan, of such in- business health plan shall pay to the applica- ‘‘The Secretary shall, through promulga- dividual) is or was covered under such plan ble authority at the time of filing an application and implementation of such regulations in connection with the status of such indi- tion for certification under this part a filing as the Secretary may reasonably determine vidual as such an employee, partner, or self- fee in the amount of $5,000, which shall be necessary or appropriate, and in consulta- employed individual in relation to the plan. available in the case of the Secretary, to the tion with a balanced spectrum of effected en- ‘‘(10) SMALL EMPLOYER.—The term ‘small extent provided in appropriation Acts, for tities and persons, modify the implementa- employer’ means, in connection with a group the sole purpose of administering the certifi- tion and application of this part to accom- health plan with respect to a plan year, a cation procedures applicable with respect to modate with minimum disruption such small employer as defined in section small business health plans. changes to State or Federal law provided in 2791(e)(4). ‘‘(b) INFORMATION TO BE INCLUDED IN AP- this part and the (and the amendments made ‘‘(11) TRADE ASSOCIATION AND PROFESSIONAL PLICATION FOR CERTIFICATION.—An applica- by such Act) or in regulations issued thereto. ASSOCIATION.—The terms ‘trade association’ tion for certification under this part meets and ‘professional association’ mean an entity the requirements of this section only if it in- ‘‘SEC. 810. DEFINITIONS AND RULES OF CON- STRUCTION. that meets the requirements of section cludes, in a manner and form which shall be 1.501(c)(6)–1 of title 26, Code of Federal Regu- prescribed by the applicable authority by ‘‘(a) DEFINITIONS.—For purposes of this part— lations (as in effect on the date of enactment regulation, at least the following informa- of this Act). tion: ‘‘(1) AFFILIATED MEMBER.—The term ‘affiliated member’ means, in connection with a ‘‘(b) RULE OF CONSTRUCTION.—For purposes ‘‘(1) IDENTIFYING INFORMATION.—The names of determining whether a plan, fund, or pro- and addresses of— sponsor— ‘‘(A) a person who is otherwise eligible to gram is an employee welfare benefit plan ‘‘(A) the sponsor; and which is a small business health plan, and ‘‘(B) the members of the board of trustees be a member of the sponsor but who elects an affiliated status with the sponsor, or for purposes of applying this title in connec- of the plan. tion with such plan, fund, or program so de- ‘‘(2) STATES IN WHICH PLAN INTENDS TO DO ‘‘(B) in the case of a sponsor with members which consist of associations, a person who termined to be such an employee welfare BUSINESS.—The States in which participants benefit plan— is a member or employee of any such asso- and beneficiaries under the plan are to be lo- ‘‘(1) in the case of a partnership, the term ciation and elects an affiliated status with cated and the number of them expected to be ‘employer’ (as defined in section 3(5)) in- the sponsor. located in each such State. cludes the partnership in relation to the PPLICABLE AUTHORITY ‘‘(3) BONDING REQUIREMENTS.—Evidence ‘‘(2) A .—The term ‘applicable authority’ means the Secretary of partners, and the term ‘employee’ (as defined provided by the board of trustees that the in section 3(6)) includes any partner in rela- bonding requirements of section 412 will be Labor, except that, in connection with any exercise of the Secretary’s authority with re- tion to the partnership; and met as of the date of the application or (if ‘‘(2) in the case of a self-employed indi- later) commencement of operations. spect to which the Secretary is required under section 506(d) to consult with a State, vidual, the term ‘employer’ (as defined in ‘‘(4) PLAN DOCUMENTS.—A copy of the docu- section 3(5)) and the term ‘employee’ (as de- ments governing the plan (including any by- such term means the Secretary, in consultation with such State. fined in section 3(6)) shall include such indi- laws and trust agreements), the summary vidual. ‘‘(3) APPLICABLE STATE AUTHORITY.—The plan description, and other material describ- ‘‘(c) RENEWAL.—Notwithstanding any pro- term ‘applicable State authority’ means, ing the benefits that will be provided to par- vision of law to the contrary, a participating ticipants and beneficiaries under the plan. with respect to a health insurance issuer in employer in a small business health plan a State, the State insurance commissioner ‘‘(5) AGREEMENTS WITH SERVICE PRO- shall not be deemed to be a plan sponsor in or official or officials designated by the VIDERS.—A copy of any agreements between applying requirements relating to coverage the plan, health insurance issuer, and con- State to enforce the requirements of title renewal. tract administrators and other service pro- XXVII of the Public Health Service Act for ‘‘(d) HEALTH SAVINGS ACCOUNTS.—Nothing viders. the State involved with respect to such in this part shall be construed to create any ‘‘(c) FILING NOTICE OF CERTIFICATION WITH issuer. mandates for coverage of benefits for HSA- STATES.—A certification granted under this ‘‘(4) GROUP HEALTH PLAN.—The term ‘group qualified health plans that would require re- part to a small business health plan shall not health plan’ has the meaning provided in sec- imbursements in violation of section 223(c)(2) be effective unless written notice of such tion 733(a)(1) (after applying subsection (b) of of the Internal Revenue Code of 1986.’’. certification is filed with the applicable this section). (b) CONFORMING AMENDMENTS TO PREEMP- State authority of each State in which the ‘‘(5) HEALTH INSURANCE COVERAGE.—The TION RULES.— small business health plans operate. term ‘health insurance coverage’ has the (1) Section 514(b)(6) of such Act (29 U.S.C. ‘‘(d) NOTICE OF MATERIAL CHANGES.—In the meaning provided in section 733(b)(1), except 1144(b)(6)) is amended by adding at the end case of any small business health plan cer- that such term shall not include excepted the following new subparagraph: tified under this part, descriptions of mate- benefits (as defined in section 733(c)). ‘‘(E) The preceding subparagraphs of this rial changes in any information which was ‘‘(6) HEALTH INSURANCE ISSUER.—The term paragraph do not apply with respect to any required to be submitted with the applica- ‘health insurance issuer’ has the meaning State law in the case of a small business tion for the certification under this part provided in section 733(b)(2). health plan which is certified under part 8.’’. shall be filed in such form and manner as ‘‘(7) INDIVIDUAL MARKET.— (2) Section 514 of such Act (29 U.S.C. 1144) shall be prescribed by the applicable author- ‘‘(A) IN GENERAL.—The term ‘individual is amended— ity by regulation. The applicable authority market’ means the market for health insur- (A) in subsection (b)(4), by striking ‘‘Sub- may require by regulation prior notice of ance coverage offered to individuals other section (a)’’ and inserting ‘‘Subsections (a) material changes with respect to specified than in connection with a group health plan. and (d)’’; matters which might serve as the basis for ‘‘(B) TREATMENT OF VERY SMALL GROUPS.— (B) in subsection (b)(5), by striking ‘‘sub- suspension or revocation of the certification. ‘‘(i) IN GENERAL.—Subject to clause (ii), section (a)’’ in subparagraph (A) and insert- ‘‘SEC. 808. NOTICE REQUIREMENTS FOR VOL- such term includes coverage offered in con- ing ‘‘subsection (a) of this section and sub- UNTARY TERMINATION. nection with a group health plan that has sections (a)(2)(B) and (b) of section 805’’, and ‘‘A small business health plan which is or fewer than 2 participants as current employ- by striking ‘‘subsection (a)’’ in subparagraph has been certified under this part may termi- ees or participants described in section (B) and inserting ‘‘subsection (a) of this sec- nate (upon or at any time after cessation of 732(d)(3) on the first day of the plan year. tion or subsection (a)(2)(B) or (b) of section accruals in benefit liabilities) only if the ‘‘(ii) STATE EXCEPTION.—Clause (i) shall not 805’’; board of trustees, not less than 60 days be- apply in the case of health insurance cov- (C) by redesignating subsection (d) as sub- fore the proposed termination date— erage offered in a State if such State regu- section (e); and ‘‘(1) provides to the participants and bene- lates the coverage described in such clause in (D) by inserting after subsection (c) the ficiaries a written notice of intent to termi- the same manner and to the same extent as following new subsection:

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00082 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.059 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13053 ‘‘(d)(1) Except as provided in subsection SEC. 103. EFFECTIVE DATE AND TRANSITIONAL as the Secretary may reasonably determine (b)(4), the provisions of this title shall super- AND OTHER RULES. necessary or appropriate, and in consulta- sede any and all State laws insofar as they (a) EFFECTIVE DATE.—The amendments tion with a balanced spectrum of effected en- may now or hereafter preclude a health in- made by this title shall take effect 12 tities and persons, modify the implementa- surance issuer from offering health insur- months after the date of the enactment of tion and application of this title to accom- ance coverage in connection with a small this Act. The Secretary of Labor shall first modate with minimum disruption such business health plan which is certified under issue all regulations necessary to carry out changes to State or Federal law provided in part 8. the amendments made by this title within 6 this title and the (and the amendments made ‘‘(2) In any case in which health insurance months after the date of the enactment of by such Act) or in regulations issued thereto. coverage of any policy type is offered under this Act. ‘‘Subtitle A—Market Relief a small business health plan certified under (b) TREATMENT OF CERTAIN EXISTING ‘‘PART I—RATING REQUIREMENTS HEALTH BENEFITS PROGRAMS.— part 8 to a participating employer operating ‘‘SEC. 2911. DEFINITIONS. (1) IN GENERAL.—In any case in which, as of in such State, the provisions of this title ‘‘In this part: the date of the enactment of this Act, an ar- shall supersede any and all laws of such ‘‘(1) ADOPTING STATE.—The term ‘adopting State insofar as they may establish rating rangement is maintained in a State for the State’ means a State that, with respect to and benefit requirements that would other- purpose of providing benefits consisting of the small group market, has enacted small wise apply to such coverage, provided the re- medical care for the employees and bene- group rating rules that meet the minimum quirements of subtitle A of title XXIX of the ficiaries of its participating employers, at standards set forth in section 2912(a)(1) or, as Public Health Service Act (as added by title least 200 participating employers make con- applicable, transitional small group rating II of the Health Insurance Marketplace Mod- tributions to such arrangement, such ar- rules set forth in section 2912(b). rangement has been in existence for at least ernization and Affordability Act of 2007) ‘‘(2) APPLICABLE STATE AUTHORITY.—The (concerning health plan rating and benefits) 10 years, and such arrangement is licensed term ‘applicable State authority’ means, are met.’’. under the laws of one or more States to pro- with respect to a health insurance issuer in (c) PLAN SPONSOR.—Section 3(16)(B) of such vide such benefits to its participating em- a State, the State insurance commissioner Act (29 U.S.C. 102(16)(B)) is amended by add- ployers, upon the filing with the applicable or official or officials designated by the ing at the end the following new sentence: authority (as defined in section 808(a)(2) of State to enforce the insurance laws of such ‘‘Such term also includes a person serving as the Employee Retirement Income Security State. Act of 1974 (as amended by this subtitle)) by the sponsor of a small business health plan ‘‘(3) BASE PREMIUM RATE.—The term ‘base under part 8.’’. the arrangement of an application for cer- premium rate’ means, for each class of busi- (d) SAVINGS CLAUSE.—Section 731(c) of such tification of the arrangement under part 8 of ness with respect to a rating period, the low- Act is amended by inserting ‘‘or part 8’’ after subtitle B of title I of such Act— est premium rate charged or that could have ‘‘this part’’. (A) such arrangement shall be deemed to been charged under a rating system for that be a group health plan for purposes of title I (e) CLERICAL AMENDMENT.—The table of class of business by the small employer car- contents in section 1 of the Employee Retire- of such Act; rier to small employers with similar case ment Income Security Act of 1974 is amended (B) the requirements of sections 801(a) and characteristics for health benefit plans with by inserting after the item relating to sec- 803(a) of the Employee Retirement Income the same or similar coverage. Security Act of 1974 shall be deemed met tion 734 the following new items: ‘‘(4) ELIGIBLE INSURER.—The term ‘eligible with respect to such arrangement; insurer’ means a health insurance issuer ‘‘PART 8—RULES GOVERNING SMALL BUSINESS (C) the requirements of section 803(b) of HEALTH PLANS that is licensed in a State and that— such Act shall be deemed met, if the arrange- ‘‘(A) notifies the Secretary, not later than ‘‘801. Small business health plans. ment is operated by a board of trustees 30 days prior to the offering of coverage de- ‘‘802. Alternative market pooling organiza- which has control over the arrangement; scribed in this subparagraph, that the issuer tions. (D) the requirements of section 804(a) of intends to offer health insurance coverage ‘‘803. Certification of small business health such Act shall be deemed met with respect to consistent with the Model Small Group Rat- plans. such arrangement; and ing Rules or, as applicable, transitional ‘‘804. Requirements relating to sponsors and (E) the arrangement may be certified by small group rating rules in a State; boards of trustees. any applicable authority with respect to its ‘‘(B) notifies the insurance department of a ‘‘805. Participation and coverage require- operations in any State only if it operates in nonadopting State (or other State agency), ments. such State on the date of certification. not later than 30 days prior to the offering of ‘‘806. Other requirements relating to plan The provisions of this subsection shall cease coverage described in this subparagraph, documents, contribution rates, to apply with respect to any such arrange- that the issuer intends to offer small group and benefit options. ment at such time after the date of the en- health insurance coverage in that State con- ‘‘807. Requirements for application and re- actment of this Act as the applicable re- sistent with the Model Small Group Rating lated requirements. quirements of this subsection are not met Rules, and provides with such notice a copy ‘‘808. Notice requirements for voluntary ter- with respect to such arrangement or at such of any insurance policy that it intends to mination. time that the arrangement provides coverage offer in the State, its most recent annual ‘‘809. Implementation and application au- to participants and beneficiaries in any and quarterly financial reports, and any thority by Secretary. State other than the States in which cov- other information required to be filed with ‘‘810. Definitions and rules of construction.’’. erage is provided on such date of enactment. the insurance department of the State (or SEC. 102. COOPERATION BETWEEN FEDERAL AND (2) DEFINITIONS.—For purposes of this sub- other State agency); and STATE AUTHORITIES. section, the terms ‘‘group health plan’’, ‘‘(C) includes in the terms of the health in- Section 506 of the Employee Retirement ‘‘medical care’’, and ‘‘participating em- surance coverage offered in nonadopting Income Security Act of 1974 (29 U.S.C. 1136) is ployer’’ shall have the meanings provided in States (including in the terms of any indi- amended by adding at the end the following section 808 of the Employee Retirement In- vidual certificates that may be offered to in- new subsection: come Security Act of 1974, except that the dividuals in connection with such group ‘‘(d) CONSULTATION WITH STATES WITH RE- reference in paragraph (7) of such section to health coverage) and filed with the State SPECT TO SMALL BUSINESS HEALTH PLANS.— an ‘‘small business health plan’’ shall be pursuant to subparagraph (B), a description ‘‘(1) AGREEMENTS WITH STATES.—The Sec- deemed a reference to an arrangement re- in the insurer’s contract of the Model Small retary shall consult with the State recog- ferred to in this subsection. Group Rating Rules and an affirmation that nized under paragraph (2) with respect to a TITLE II—MARKET RELIEF such Rules are included in the terms of such small business health plan regarding the ex- SEC. 301. MARKET RELIEF. contract. ercise of— The Public Health Service Act (42 U.S.C. ‘‘(5) HEALTH INSURANCE COVERAGE.—The ‘‘(A) the Secretary’s authority under sec- 201 et seq.) is amended by adding at the end term ‘health insurance coverage’ means any tions 502 and 504 to enforce the requirements the following: coverage issued in the small group health infor certification under part 8; and surance market, except that such term shall ‘‘(B) the Secretary’s authority to certify ‘‘TITLE XXIX—HEALTH CARE INSURANCE not include excepted benefits (as defined in small business health plans under part 8 in MARKETPLACE MODERNIZATION section 2791(c)). accordance with regulations of the Secretary ‘‘SEC. 2901. GENERAL INSURANCE DEFINITIONS. ‘‘(6) INDEX RATE.—The term ‘index rate’ applicable to certification under part 8. ‘‘In this title, the terms ‘health insurance means for each class of business with respect ‘‘(2) RECOGNITION OF DOMICILE STATE.—In coverage’, ‘health insurance issuer’, ‘group to the rating period for small employers with carrying out paragraph (1), the Secretary health plan’, and ‘individual health insur- similar case characteristics, the arithmetic shall ensure that only one State will be rec- ance’ shall have the meanings given such average of the applicable base premium rate ognized, with respect to any particular small terms in section 2791. and the corresponding highest premium rate. business health plan, as the State with ‘‘SEC. 2902. IMPLEMENTATION AND APPLICATION ‘‘(7) MODEL SMALL GROUP RATING RULES.— which consultation is required. In carrying AUTHORITY BY SECRETARY. The term ‘Model Small Group Rating Rules’ out this paragraph such State shall be the ‘‘The Secretary shall, through promulga- means the rules set forth in section domicile State, as defined in section 805(c).’’. tion and implementation of such regulations 2912(a)(2).

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00083 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.059 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13054 CONGRESSIONAL RECORD — SENATE December 11, 2009

‘‘(8) NONADOPTING STATE.—The term ‘non- under the rating system for that class of ‘‘(iii) The small employer carrier provides adopting State’ means a State that is not an business, shall not vary from the index rate coverage to one or more association groups adopting State. by more than 25 percent of the index rate that meet the requirements of this title. ‘‘(9) SMALL GROUP INSURANCE MARKET.—The under clause (ii). ‘‘(C) LIMITATION.—A small employer car- term ‘small group insurance market’ shall ‘‘(iv) INCREASES FOR NEW RATING PERIODS.— rier may establish up to 9 separate classes of have the meaning given the term ‘small The percentage increase in the premium rate business under subparagraph (B), excluding group market’ in section 2791(e)(5). charged to a small employer for a new rating those classes of business related to associa- ‘‘(10) STATE LAW.—The term ‘State law’ period may not exceed the sum of the fol- tion groups under this title. means all laws, decisions, rules, regulations, lowing: ‘‘(D) LIMITATION ON TRANSFERS.—A small or other State actions (including actions by ‘‘(I) The percentage change in the new employer carrier shall not transfer a small a State agency) having the effect of law, of business premium rate measured from the employer involuntarily into or out of a class any State. first day of the prior rating period to the of business. A small employer carrier shall ‘‘(11) VARIATION LIMITS.— first day of the new rating period. In the case not offer to transfer a small employer into or ‘‘(A) COMPOSITE VARIATION LIMIT.— of a health benefit plan into which the small out of a class of business unless such offer is ‘‘(i) IN GENERAL.—The term ‘composite var- employer carrier is no longer enrolling new made to transfer all small employers in the iation limit’ means the total variation in small employers, the small employer carrier class of business without regard to case char- premium rates charged by a health insurance shall use the percentage change in the base acteristics, claim experience, health status issuer in the small group market as per- premium rate, except that such change shall or duration of coverage since issue. mitted under applicable State law based on not exceed, on a percentage basis, the change ‘‘(b) TRANSITIONAL MODEL SMALL GROUP the following factors or case characteristics: in the new business premium rate for the RATING RULES.— ‘‘(I) Age. most similar health benefit plan into which ‘‘(1) IN GENERAL.—Not later than 6 months ‘‘(II) Duration of coverage. the small employer carrier is actively enroll- after the date of enactment of this title and ‘‘(III) Claims experience. ing new small employers. to the extent necessary to provide for a grad- ‘‘(IV) Health status. ‘‘(II) Any adjustment, not to exceed 15 per- uated transition to the minimum standards ‘‘(ii) USE OF FACTORS.—With respect to the cent annually and adjusted pro rata for rat- for premium variation as provided for in sub- use of the factors described in clause (i) in ing periods of less then 1 year, due to the section (a)(1), the Secretary, in consultation setting premium rates, a health insurance claim experience, health status or duration with the National Association of Insurance issuer shall use one or both of the factors de- of coverage of the employees or dependents Commissioners (NAIC), shall promulgate scribed in subclauses (I) or (IV) of such of the small employer as determined from State-specific transitional small group rat- clause and may use the factors described in the small employer carrier’s rate manual for ing rules in accordance with this subsection, subclauses (II) or (III) of such clause. the class of business involved. which shall be applicable with respect to ‘‘(B) TOTAL VARIATION LIMIT.—The term ‘‘(III) Any adjustment due to change in non-adopting States and eligible insurers op- ‘total variation limit’ means the total vari- coverage or change in the case characteris- erating in such States for a period of not to ation in premium rates charged by a health tics of the small employer as determined exceed 3 years from the date of the promul- insurance issuer in the small group market from the small employer carrier’s rate man- gation of the minimum standards for pre- as permitted under applicable State law ual for the class of business. mium variation pursuant to subsection (a). based on all factors and case characteristics ‘‘(v) UNIFORM APPLICATION OF ADJUST- ‘‘(2) COMPLIANCE WITH TRANSITIONAL MODEL (as described in section 2912(a)(1)). MENTS.—Adjustments in premium rates for SMALL GROUP RATING RULES.—During the ‘‘SEC. 2912. RATING RULES. claim experience, health status, or duration transition period described in paragraph (1), ‘‘(a) ESTABLISHMENT OF MINIMUM STAND- of coverage shall not be charged to indi- a State that, on the date of enactment of ARDS FOR PREMIUM VARIATIONS AND MODEL vidual employees or dependents. Any such this title, has in effect a small group rating SMALL GROUP RATING RULES.—Not later than adjustment shall be applied uniformly to the rules methodology that allows for a vari- 6 months after the date of enactment of this rates charged for all employees and depend- ation that is less than the variation provided title, the Secretary shall promulgate regula- ents of the small employer. for under subsection (a)(1) (concerning min- tions establishing the following Minimum ‘‘(vi) PROHIBITION ON USE OF CERTAIN CASE imum standards for premium variation), Standards and Model Small Group Rating CHARACTERISTIC.—A small employer carrier shall be deemed to be an adopting State if Rules: shall not utilize case characteristics, other the State complies with the transitional ‘‘(1) MINIMUM STANDARDS FOR PREMIUM than those permitted under paragraph (1)(C), small group rating rules as promulgated by VARIATIONS.— without the prior approval of the applicable the Secretary pursuant to paragraph (1). ‘‘(A) COMPOSITE VARIATION LIMIT.—The State authority. ‘‘(3) TRANSITIONING OF OLD BUSINESS.— composite variation limit shall not be less ‘‘(vii) CONSISTENT APPLICATION OF FAC- ‘‘(A) IN GENERAL.—In developing the transi- than 3:1. TORS.—Small employer carriers shall apply tional small group rating rules under para- ‘‘(B) TOTAL VARIATION LIMIT.—The total rating factors, including case characteris- graph (1), the Secretary shall, after consulta- variation limit shall not be less than 5:1. tics, consistently with respect to all small tion with the National Association of Insur- ‘‘(C) PROHIBITION ON USE OF CERTAIN CASE employers in a class of business. Rating fac- ance Commissioners and representatives of CHARACTERISTICS.—For purposes of this para- tors shall produce premiums for identical insurers operating in the small group health graph, in calculating the total variation groups which differ only by the amounts at- insurance market in non-adopting States, limit, the State shall not use case character- tributable to plan design and do not reflect promulgate special transition standards with istics other than those used in calculating differences due to the nature of the groups respect to independent rating classes for old the composite variation limit and industry, assumed to select particular health benefit and new business, to the extent reasonably geographic area, group size, participation plans. necessary to protect health insurance con- rate, class of business, and participation in ‘‘(viii) TREATMENT OF PLANS AS HAVING sumers and to ensure a stable and fair tran- wellness programs. SAME RATING PERIOD.—A small employer car- sition for old and new market entrants. ‘‘(2) MODEL SMALL GROUP RATING RULES.— rier shall treat all health benefit plans ‘‘(B) PERIOD FOR OPERATION OF INDE- The following apply to an eligible insurer in issued or renewed in the same calendar PENDENT RATING CLASSES.—In developing the a non-adopting State: month as having the same rating period. special transition standards pursuant to sub- ‘‘(A) PREMIUM RATES.—Premium rates for ‘‘(ix) REQUIRE COMPLIANCE.—Premium rates paragraph (A), the Secretary shall permit a small group health benefit plans to which for small business health benefit plans shall carrier in a non-adopting State, at its op- this title applies shall comply with the fol- comply with the requirements of this sub- tion, to maintain independent rating classes lowing provisions relating to premiums, ex- section notwithstanding any assessments for old and new business for a period of up to cept as provided for under subsection (b): paid or payable by a small employer carrier 5 years, with the commencement of such 5- ‘‘(i) VARIATION IN PREMIUM RATES.—The as required by a State’s small employer car- year period to begin at such time, but not plan may not vary premium rates by more rier reinsurance program. later than the date that is 3 years after the than the minimum standards provided for ‘‘(B) ESTABLISHMENT OF SEPARATE CLASS OF date of enactment of this title, as the carrier under paragraph (1). BUSINESS.—Subject to subparagraph (C), a offers a book of business meeting the min- ‘‘(ii) INDEX RATE.—The index rate for a rat- small employer carrier may establish a sepa- imum standards for premium variation pro- ing period for any class of business shall not rate class of business only to reflect substan- vided for in subsection (a)(1) or the transi- exceed the index rate for any other class of tial differences in expected claims experi- tional small group rating rules under para- business by more than 20 percent, excluding ence or administrative costs related to the graph (1). those classes of business related to associa- following: ‘‘(4) OTHER TRANSITIONAL AUTHORITY.—In tion groups under this title. ‘‘(i) The small employer carrier uses more developing the transitional small group rat- ‘‘(iii) CLASS OF BUSINESSES.—With respect than one type of system for the marketing ing rules under paragraph (1), the Secretary to a class of business, the premium rates and sale of health benefit plans to small em- shall provide for the application of the tran- charged during a rating period to small employers. sitional small group rating rules in transi- ployers with similar case characteristics for ‘‘(ii) The small employer carrier has action States as the Secretary may determine the same or similar coverage or the rates quired a class of business from another small necessary for a an effective transition. that could be charged to such employers employer carrier. ‘‘(c) MARKET RE-ENTRY.—

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00084 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.059 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13055

‘‘(1) IN GENERAL.—Notwithstanding any ‘‘SEC. 2914. CIVIL ACTIONS AND JURISDICTION. consistent with the List of Required Benefits other provision of law, a health insurance ‘‘(a) IN GENERAL.—The courts of the United and Terms of Application in a nonadopting issuer that has voluntarily withdrawn from States shall have exclusive jurisdiction over State; providing coverage in the small group mar- civil actions involving the interpretation of ‘‘(B) notifies the insurance department of a ket prior to the date of enactment of the this part. nonadopting State (or other applicable State Small Business Health Plans Act of 2009 ‘‘(b) ACTIONS.—An eligible insurer may agency), not later than 30 days prior to the shall not be excluded from re-entering such bring an action in the district courts of the offering of coverage described in this sub- market on a date that is more than 180 days United States for injunctive or other equi- paragraph, that the issuer intends to offer after such date of enactment. table relief against any officials or agents of health insurance coverage in that State con- ‘‘(2) TERMINATION.—The provision of this a nonadopting State in connection with any sistent with the List of Required Benefits subsection shall terminate on the date that conduct or action, or proposed conduct or ac- and Terms of Application, and provides with is 24 months after the date of enactment of tion, by such officials or agents which vio- such notice a copy of any insurance policy the Small Business Health Plans Act of 2009. lates, or which would if undertaken violate, that it intends to offer in the State, its most ‘‘SEC. 2913. APPLICATION AND PREEMPTION. section 2913. recent annual and quarterly financial re- ‘‘(a) SUPERSEDING OF STATE LAW.— ‘‘(c) DIRECT FILING IN COURT OF APPEALS.— ports, and any other information required to ‘‘(1) IN GENERAL.—This part shall supersede At the election of the eligible insurer, an ac- be filed with the insurance department of the any and all State laws of a non-adopting tion may be brought under subsection (b) di- State (or other State agency) by the Sec- State insofar as such State laws (whether en- rectly in the United States Court of Appeals retary in regulations; and acted prior to or after the date of enactment for the circuit in which the nonadopting ‘‘(C) includes in the terms of the health in- of this subtitle) relate to rating in the small State is located by the filing of a petition for surance coverage offered in nonadopting group insurance market as applied to an eli- review in such Court. States (including in the terms of any indi- gible insurer, or small group health insur- ‘‘(d) EXPEDITED REVIEW.— vidual certificates that may be offered to in- ance coverage issued by an eligible insurer, ‘‘(1) DISTRICT COURT.—In the case of an ac- dividuals in connection with such group including with respect to coverage issued to tion brought in a district court of the United health coverage) and filed with the State a small employer through a small business States under subsection (b), such court shall pursuant to subparagraph (B), a description health plan, in a State. complete such action, including the issuance in the insurer’s contract of the List of Re- ‘‘(2) NONADOPTING STATES.—This part shall of a judgment, prior to the end of the 120-day quired Benefits and a description of the supersede any and all State laws of a non- period beginning on the date on which such Terms of Application, including a descrip- adopting State insofar as such State laws action is filed, unless all parties to such pro- tion of the benefits to be provided, and that (whether enacted prior to or after the date of ceeding agree to an extension of such period. adherence to such standards is included as a enactment of this subtitle)— ‘‘(2) COURT OF APPEALS.—In the case of an term of such contract. ‘‘(A) prohibit an eligible insurer from offer- action brought directly in a United States ‘‘(3) HEALTH INSURANCE COVERAGE.—The ing, marketing, or implementing small Court of Appeal under subsection (c), or in term ‘health insurance coverage’ means any group health insurance coverage consistent the case of an appeal of an action brought in coverage issued in the small group, indi- with the Model Small Group Rating Rules or a district court under subsection (b), such vidual, or large group health insurance mar- transitional model small group rating rules; Court shall complete all action on the peti- kets, including with respect to small busi- or tion, including the issuance of a judgment, ness health plans, except that such term ‘‘(B) have the effect of retaliating against prior to the end of the 60-day period begin- shall not include excepted benefits (as de- or otherwise punishing in any respect an eli- ning on the date on which such petition is fined in section 2791(c)). gible insurer for offering, marketing, or im- filed with the Court, unless all parties to ‘‘(4) LIST OF REQUIRED BENEFITS.—The term plementing small group health insurance such proceeding agree to an extension of ‘List of Required Benefits’ means the List coverage consistent with the Model Small such period. issued under section 2922(a). Group Rating Rules or transitional model ‘‘(e) STANDARD OF REVIEW.—A court in an ‘‘(5) NONADOPTING STATE.—The term ‘non- small group rating rules. action filed under this section, shall render a adopting State’ means a State that is not an ‘‘(b) SAVINGS CLAUSE AND CONSTRUCTION.— judgment based on a review of the merits of adopting State. ‘‘(1) NONAPPLICATION TO ADOPTING STATES.— all questions presented in such action and ‘‘(6) STATE LAW.—The term ‘State law’ Subsection (a) shall not apply with respect shall not defer to any conduct or action, or means all laws, decisions, rules, regulations, to adopting states. proposed conduct or action, of a nonadopting or other State actions (including actions by ‘‘(2) NONAPPLICATION TO CERTAIN INSUR- State. a State agency) having the effect of law, of ERS.—Subsection (a) shall not apply with re- ‘‘SEC. 2915. ONGOING REVIEW. any State. spect to insurers that do not qualify as eligi- ‘‘Not later than 5 years after the date on ‘‘(7) STATE PROVIDER FREEDOM OF CHOICE ble insurers that offer small group health in- which the Model Small Group Rating Rules LAW.—The term ‘State Provider Freedom of surance coverage in a nonadopting State. are issued under this part, and every 5 years Choice Law’ means a State law requiring ‘‘(3) NONAPPLICATION WHERE OBTAINING RE- thereafter, the Secretary, in consultation that a health insurance issuer, with respect LIEF UNDER STATE LAW.—Subsection (a)(1) with the National Association of Insurance to health insurance coverage, not discrimi- shall not supercede any State law in a non- Commissioners, shall prepare and submit to nate with respect to participation, reim- adopting State to the extent necessary to the appropriate committees of Congress a re- bursement, or indemnification as to any pro- permit individuals or the insurance depart- port that assesses the effect of the Model vider who is acting within the scope of the ment of the State (or other State agency) to Small Group Rating Rules on access, cost, provider’s license or certification under ap- obtain relief under State law to require an and market functioning in the small group plicable State law. eligible insurer to comply with the Model market. Such report may, if the Secretary, ‘‘(8) TERMS OF APPLICATION.—The term Small Group Rating Rules or transitional in consultation with the National Associa- ‘Terms of Application’ means terms provided model small group rating rules. tion of Insurance Commissioners, determines under section 2922(a). ‘‘(4) NO EFFECT ON PREEMPTION.—In no case such is appropriate for improving access, ‘‘SEC. 2922. OFFERING AFFORDABLE PLANS. shall this part be construed to limit or affect costs, and market functioning, contain legis- ‘‘(a) LIST OF REQUIRED BENEFITS.—Not in any manner the preemptive scope of sec- lative proposals for recommended modifications 502 and 514 of the Employee Retirement later than 3 months after the date of enact- tion to such Model Small Group Rating ment of this title, the Secretary, in con- Income Security Act of 1974. In no case shall Rules. this part be construed to create any cause of sultation with the National Association of ‘‘PART II—AFFORDABLE PLANS action under Federal or State law or enlarge Insurance Commissioners, shall issue by in- or affect any remedy available under the ‘‘SEC. 2921. DEFINITIONS. terim final rule a list (to be known as the Employee Retirement Income Security Act ‘‘In this part: ‘List of Required Benefits’) of covered bene- of 1974. ‘‘(1) ADOPTING STATE.—The term ‘adopting fits, services, or categories of providers that ‘‘(5) PREEMPTION LIMITED TO RATING.—Sub- State’ means a State that has enacted a law are required to be provided by health insur- section (a) shall not preempt any State law providing that small group, individual, and ance issuers, in each of the small group, indi- that does not have a reference to or a con- large group health insurers in such State vidual, and large group markets, in at least nection with State rating rules that would may offer and sell products in accordance 26 States as a result of the application of otherwise apply to eligible insurers. with the List of Required Benefits and the State covered benefit, service, and category ‘‘(c) EFFECTIVE DATE.—This section shall Terms of Application as provided for in sec- of provider mandate laws. With respect to apply, at the election of the eligible insurer, tion 2922(b). plans sold to or through small business beginning in the first plan year or the first ‘‘(2) ELIGIBLE INSURER.—The term ‘eligible health plans, the List of Required Benefits calendar year following the issuance of the insurer’ means a health insurance issuer applicable to the small group market shall final rules by the Secretary under the Model that is licensed in a nonadopting State and apply. Small Group Rating Rules or, as applicable, that— ‘‘(b) TERMS OF APPLICATION.— the Transitional Model Small Group Rating ‘‘(A) notifies the Secretary, not later than ‘‘(1) STATE WITH MANDATES.—With respect Rules, but in no event earlier than the date 30 days prior to the offering of coverage de- to a State that has a covered benefit, serv- that is 12 months after the date of enact- scribed in this subparagraph, that the issuer ice, or category of provider mandate in effect ment of this title. intends to offer health insurance coverage that is covered under the List of Required

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00085 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.060 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13056 CONGRESSIONAL RECORD — SENATE December 11, 2009 Benefits under subsection (a), such State ployers of small business health plans, the conduct or action, or proposed conduct or ac- mandate shall, subject to paragraph (3) (con- requirements of this part shall apply begin- tion, by such officials or agents which vio- cerning uniform application), apply to a cov- ning on the date that is 15 months after the lates, or which would if undertaken violate, erage plan or plan in, as applicable, the date of enactment of this title. section 2923. small group, individual, or large group mar- ‘‘(e) UPDATING OF LIST OF REQUIRED BENE- ‘‘(c) DIRECT FILING IN COURT OF APPEALS.— ket or through a small business health plan FITS.—Not later than 2 years after the date At the election of the eligible insurer, an ac- in such State. on which the list of required benefits is tion may be brought under subsection (b) di- ‘‘(2) STATES WITHOUT MANDATES.—With re- issued under subsection (a), and every 2 rectly in the United States Court of Appeals spect to a State that does not have a covered years thereafter, the Secretary, in consulta- for the circuit in which the nonadopting benefit, service, or category of provider man- tion with the National Association of Insur- State is located by the filing of a petition for date in effect that is covered under the List ance Commissioners, shall update the list review in such Court. of Required Benefits under subsection (a), based on changes in the laws and regulations ‘‘(d) EXPEDITED REVIEW.— such mandate shall not apply, as applicable, of the States. The Secretary shall issue the ‘‘(1) DISTRICT COURT.—In the case of an ac- to a coverage plan or plan in the small updated list by regulation, and such updated tion brought in a district court of the United group, individual, or large group market or list shall be effective upon the first plan year States under subsection (b), such court shall through a small business health plan in such following the issuance of such regulation. complete such action, including the issuance State. ‘‘SEC. 2923. APPLICATION AND PREEMPTION. of a judgment, prior to the end of the 120-day ‘‘(3) UNIFORM APPLICATION OF LAWS.— ‘‘(a) SUPERSEDING OF STATE LAW.— period beginning on the date on which such N GENERAL ‘‘(A) I .—With respect to a State ‘‘(1) IN GENERAL.—This part shall supersede action is filed, unless all parties to such pro- described in paragraph (1), in applying a cov- any and all State laws insofar as such laws ceeding agree to an extension of such period. ered benefit, service, or category of provider relate to mandates relating to covered bene- ‘‘(2) COURT OF APPEALS.—In the case of an mandate that is on the List of Required Ben- fits, services, or categories of provider in the action brought directly in a United States efits under subsection (a) the State shall per- health insurance market as applied to an eli- Court of Appeal under subsection (c), or in mit a coverage plan or plan offered in the gible insurer, or health insurance coverage the case of an appeal of an action brought in small group, individual, or large group mar- issued by an eligible insurer, including with a district court under subsection (b), such ket or through a small business health plan respect to coverage issued to a small busi- Court shall complete all action on the peti- in such State to apply such benefit, service, ness health plan, in a nonadopting State. tion, including the issuance of a judgment, or category of provider coverage in a manner ‘‘(2) NONADOPTING STATES.—This part shall prior to the end of the 60-day period begin- consistent with the manner in which such supersede any and all State laws of a non- ning on the date on which such petition is coverage is applied under one of the three adopting State (whether enacted prior to or filed with the Court, unless all parties to most heavily subscribed national health after the date of enactment of this title) in- such proceeding agree to an extension of plans offered under the Federal Employee sofar as such laws— such period. Health Benefits Program under chapter 89 of ‘‘(A) prohibit an eligible insurer from offer- ‘‘(e) STANDARD OF REVIEW.—A court in an title 5, United States Code (as determined by ing, marketing, or implementing health in- action filed under this section, shall render a the Secretary in consultation with the Di- surance coverage consistent with the Benefit judgment based on a review of the merits of rector of the Office of Personnel Manage- Choice Standards, as provided for in section all questions presented in such action and ment), and consistent with the Publication 2922(a); or shall not defer to any conduct or action, or of Benefit Applications under subsection (c). ‘‘(B) have the effect of retaliating against proposed conduct or action, of a nonadopting In the event a covered benefit, service, or or otherwise punishing in any respect an eli- State. category of provider appearing in the List of gible insurer for offering, marketing, or im- ‘‘SEC. 2925. RULES OF CONSTRUCTION. Required Benefits is not offered in one of the plementing health insurance coverage con- ‘‘(a) IN GENERAL.—Notwithstanding any three most heavily subscribed national sistent with the Benefit Choice Standards. other provision of Federal or State law, a health plans offered under the Federal Em- ‘‘(b) SAVINGS CLAUSE AND CONSTRUCTION.— health insurance issuer in an adopting State ployees Health Benefits Program, such cov- ‘‘(1) NONAPPLICATION TO ADOPTING STATES.— or an eligible insurer in a non-adopting State ered benefit, service, or category of provider Subsection (a) shall not apply with respect may amend its existing policies to be con- requirement shall be applied in a manner to adopting States. sistent with the terms of this subtitle (con- consistent with the manner in which such ‘‘(2) NONAPPLICATION TO CERTAIN INSUR- cerning rating and benefits). coverage is offered in the remaining most ERS.—Subsection (a) shall not apply with re- ‘‘(b) HEALTH SAVINGS ACCOUNTS.—Nothing heavily subscribed plan of the remaining spect to insurers that do not qualify as eligi- in this subtitle shall be construed to create Federal Employees Health Benefits Program ble insurers who offer health insurance cov- any mandates for coverage of benefits for plans, as determined by the Secretary, in erage in a nonadopting State. HSA-qualified health plans that would re- consultation with the Director of the Office ‘‘(3) NONAPPLICATION WHERE OBTAINING RE- quire reimbursements in violation of section of Personnel Management. LIEF UNDER STATE LAW.—Subsection (a)(1) 223(c)(2) of the Internal Revenue Code of ‘‘(B) EXCEPTION REGARDING STATE PROVIDER shall not supersede any State law of a non- 1986.’’. FREEDOM OF CHOICE LAWS.—Notwithstanding adopting State to the extent necessary to subparagraph (A), in the event a category of TITLE III—HARMONIZATION OF HEALTH permit individuals or the insurance depart- INSURANCE STANDARDS provider mandate is included in the List of ment of the State (or other State agency) to Covered Benefits, any State Provider Free- obtain relief under State law to require an SEC. 301. HEALTH INSURANCE STANDARDS HAR- MONIZATION. dom of Choice Law (as defined in section eligible insurer to comply with the Benefit Title XXIX of the Public Health Service 2921(7)) that is in effect in any State in which Choice Standards. Act (as added by section 201) is amended by such category of provider mandate is in ef- ‘‘(4) NO EFFECT ON PREEMPTION.—In no case adding at the end the following: fect shall not be preempted, with respect to shall this part be construed to limit or affect that category of provider, by this part. in any manner the preemptive scope of sec- ‘‘Subtitle B—Standards Harmonization ‘‘(c) PUBLICATION OF BENEFIT APPLICA- tions 502 and 514 of the Employee Retirement ‘‘SEC. 2931. DEFINITIONS. TIONS.—Not later than 3 months after the Income Security Act of 1974. In no case shall date of enactment of this title, and on the ‘‘In this subtitle: this part be construed to create any cause of first day of every calendar year thereafter, ‘‘(1) ADOPTING STATE.—The term ‘adopting action under Federal or State law or enlarge the Secretary, in consultation with the Di- State’ means a State that has enacted the or affect any remedy available under the rector of the Office of Personnel Manage- harmonized standards adopted under this ment, shall publish in the Federal Register a Employee Retirement Income Security Act subtitle in their entirety and as the exclu- description of such covered benefits, serv- of 1974. sive laws of the State that relate to the har- ices, and categories of providers covered in ‘‘(5) PREEMPTION LIMITED TO BENEFITS.— monized standards. that calendar year by each of the three most Subsection (a) shall not preempt any State ‘‘(2) ELIGIBLE INSURER.—The term ‘eligible heavily subscribed nationally available Fed- law that does not have a reference to or a insurer’ means a health insurance issuer eral Employee Health Benefits Plan options connection with State mandates regarding that is licensed in a nonadopting State and which are also included on the List of Re- covered benefits, services, or categories of that— quired Benefits. providers that would otherwise apply to eli- ‘‘(A) notifies the Secretary, not later than ‘‘(d) EFFECTIVE DATES.— gible insurers. 30 days prior to the offering of coverage de- ‘‘(1) SMALL BUSINESS HEALTH PLANS.—With ‘‘SEC. 2924. CIVIL ACTIONS AND JURISDICTION. scribed in this subparagraph, that the issuer respect to health insurance provided to par- ‘‘(a) IN GENERAL.—The courts of the United intends to offer health insurance coverage ticipating employers of small business States shall have exclusive jurisdiction over consistent with the harmonized standards in health plans, the requirements of this part civil actions involving the interpretation of a nonadopting State; (concerning lower cost plans) shall apply be- this part. ‘‘(B) notifies the insurance department of a ginning on the date that is 12 months after ‘‘(b) ACTIONS.—An eligible insurer may nonadopting State (or other State agency), the date of enactment of this title. bring an action in the district courts of the not later than 30 days prior to the offering of ‘‘(2) NON-ASSOCIATION COVERAGE.—With re- United States for injunctive or other equi- coverage described in this subparagraph, spect to health insurance provided to groups table relief against any officials or agents of that the issuer intends to offer health insur- or individuals other than participating em- a nonadopting State in connection with any ance coverage in that State consistent with

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00086 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.060 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13057

the harmonized standards published pursu- ‘‘(B) EX OFFICIO MEMBER.—A representative ‘‘(ii) Timeframes for filings to be reviewed ant to section 2933(d), and provides with such of the Secretary shall serve as an ex officio by a State if review is required before they notice a copy of any insurance policy that it member of the Board. are deemed approved. intends to offer in the State, its most recent ‘‘(3) ADVISORY PANEL.—The Secretary shall ‘‘(iii) Timeframes for an eligible insurer to annual and quarterly financial reports, and establish an advisory panel to provide advice respond to State requests following its re- any other information required to be filed to the Board, and shall appoint its members view. with the insurance department of the State after considering the recommendations of ‘‘(iv) A process for an eligible insurer to (or other State agency) by the Secretary in professional organizations representing the self-certify. regulations; and entities and constituencies identified in this ‘‘(v) State development of form and rate ‘‘(C) includes in the terms of the health in- paragraph: filing templates that include only non-pre- surance coverage offered in nonadopting ‘‘(A) Two representatives of small business empted State law and Federal law require- States (including in the terms of any indi- health plans. ments for eligible insurers with timely up- vidual certificates that may be offered to in- ‘‘(B) Two representatives of employers, of dates. dividuals in connection with such health which one shall represent small employers ‘‘(vi) Procedures for the resubmission of coverage) and filed with the State pursuant and one shall represent large employers. forms and rates. to subparagraph (B), a description of the har- ‘‘(C) Two representatives of consumer or- ‘‘(vii) Disapproval rationale of a form or monized standards published pursuant to ganizations. rate filing based on material omissions or section 2933(g)(2) and an affirmation that ‘‘(D) Two representatives of health care violations of non-preempted State law or such standards are a term of the contract. providers. Federal law with violations cited and ex- ‘‘(3) HARMONIZED STANDARDS.—The term ‘‘(4) QUALIFICATIONS.—The membership of plained. ‘harmonized standards’ means the standards the Board shall include individuals with na- ‘‘(viii) For States that may require a hear- certified by the Secretary under section tional recognition for their expertise in ing, a rationale for hearings based on viola- 2933(d). health finance and economics, actuarial tions of non-preempted State law or insurer ‘‘(4) HEALTH INSURANCE COVERAGE.—The science, health plans, providers of health requests. term ‘health insurance coverage’ means any services, and other related fields, who pro- ‘‘(B) MARKET CONDUCT REVIEW.—Market coverage issued in the health insurance mar- vide a mix of different professionals, broad conduct review standards shall be developed ket, except that such term shall not include geographic representation, and a balance be- which provide for the following: excepted benefits (as defined in section tween urban and rural representatives. ‘‘(i) Mandatory participation in national 2791(c). ‘‘(5) ETHICAL DISCLOSURE.—The Secretary databases. ‘‘(5) NONADOPTING STATE.—The term ‘non- shall establish a system for public disclosure ‘‘(ii) The confidentiality of examination adopting State’ means a State that fails to by members of the Board of financial and materials. enact, within 18 months of the date on which other potential conflicts of interest relating ‘‘(iii) The identification of the State agen- the Secretary certifies the harmonized to such members. Members of the Board cy with primary responsibility for examina- standards under this subtitle, the har- shall be treated as employees of Congress for tions. monized standards in their entirety and as purposes of applying title I of the Ethics in ‘‘(iv) Consultation and verification of com- the exclusive laws of the State that relate to Government Act of 1978 (Public Law 95–521). plaint data with the eligible insurer prior to the harmonized standards. State actions. ‘‘(6) DIRECTOR AND STAFF.—Subject to such ‘‘(6) STATE LAW.—The term ‘State law’ ‘‘(v) Consistency of reporting requirements review as the Secretary deems necessary to means all laws, decisions, rules, regulations, with the recordkeeping and administrative assure the efficient administration of the or other State actions (including actions by practices of the eligible insurer. Board, the chair and vice-chair of the Board a State agency) having the effect of law, of ‘‘(vi) Examinations that seek to correct may— any State. material errors and harmful business prac- ‘‘(A) employ and fix the compensation of tices rather than infrequent errors. ‘‘SEC. 2932. HARMONIZED STANDARDS. an Executive Director (subject to the ap- ‘‘(a) BOARD.— ‘‘(vii) Transparency and publishing of the proval of the Comptroller General) and such ‘‘(1) ESTABLISHMENT.—Not later than 3 State’s examination standards. other personnel as may be necessary to carry months after the date of enactment of this ‘‘(viii) Coordination of market conduct out its duties (without regard to the provi- title, the Secretary, in consultation with the analysis. sions of title 5, United States Code, gov- NAIC, shall establish the Health Insurance ‘‘(ix) Coordination and nonduplication be- erning appointments in the competitive Consensus Standards Board (referred to in tween State examinations of the same eligi- service); this subtitle as the ‘Board’) to develop rec- ble insurer. ‘‘(B) seek such assistance and support as ommendations that harmonize inconsistent ‘‘(x) Rationale and protocols to be met be- State health insurance laws in accordance may be required in the performance of its du- fore a full examination is conducted. with the procedures described in subsection ties from appropriate Federal departments ‘‘(xi) Requirements on examiners prior to (b). and agencies; beginning examinations such as budget plan- ‘‘(C) enter into contracts or make other ar- ‘‘(2) COMPOSITION.— ning and work plans. rangements, as may be necessary for the ‘‘(A) IN GENERAL.—The Board shall be com- ‘‘(xii) Consideration of methods to limit posed of the following voting members to be conduct of the work of the Board (without examiners’ fees such as caps, competitive appointed by the Secretary after considering regard to section 3709 of the Revised Stat- bidding, or other alternatives. the recommendations of professional organi- utes (41 U.S.C. 5)); ‘‘(xiii) Reasonable fines and penalties for zations representing the entities and con- ‘‘(D) make advance, progress, and other material errors and harmful business prac- stituencies described in this paragraph: payments which relate to the work of the tices. ‘‘(i) Four State insurance commissioners Board; ‘‘(C) PROMPT PAYMENT OF CLAIMS.—The as recommended by the National Association ‘‘(E) provide transportation and subsist- Board shall establish prompt payment stand- of Insurance Commissioners, of which 2 shall ence for persons serving without compensa- ards for eligible insurers based on standards be Democrats and 2 shall be Republicans, and tion; and similar to those applicable to the Social Se- of which one shall be designated as the chair- ‘‘(F) prescribe such rules as it deems nec- curity Act as set forth in section 1842(c)(2) of person and one shall be designated as the essary with respect to the internal organiza- such Act (42 U.S.C. 1395u(c)(2)). Such prompt vice chairperson. tion and operation of the Board. payment standards shall be consistent with ‘‘(ii) Four representatives of State govern- ‘‘(7) TERMS.—The members of the Board the timing and notice requirements of the ment, two of which shall be governors of shall serve for the duration of the Board. Va- claims procedure rules to be specified under States and two of which shall be State legis- cancies in the Board shall be filled as needed subparagraph (D), and shall include appro- lators, and two of which shall be Democrats in a manner consistent with the composition priate exceptions such as for fraud, non- and two of which shall be Republicans. described in paragraph (2). payment of premiums, or late submission of ‘‘(iii) Four representatives of health insur- ‘‘(b) DEVELOPMENT OF HARMONIZED STAND- claims. ers, of which one shall represent insurers ARDS.— ‘‘(D) INTERNAL REVIEW.—The Board shall that offer coverage in the small group mar- ‘‘(1) IN GENERAL.—In accordance with the establish standards for claims procedures for ket, one shall represent insurers that offer process described in subsection (c), the Board eligible insurers that are consistent with the coverage in the large group market, one shall identify and recommend nationally requirements relating to initial claims for shall represent insurers that offer coverage harmonized standards for each of the fol- benefits and appeals of claims for benefits in the individual market, and one shall rep- lowing process categories: under the Employee Retirement Income Se- resent carriers operating in a regional mar- ‘‘(A) FORM FILING AND RATE FILING.—Form curity Act of 1974 as set forth in section 503 ket. and rate filing standards shall be established of such Act (29 U.S.C. 1133) and the regula- ‘‘(iv) Two representatives of insurance which promote speed to market and include tions thereunder. agents and brokers. the following defined areas for States that ‘‘(2) RECOMMENDATIONS.—The Board shall ‘‘(v) Two independent representatives of require such filings: recommend harmonized standards for each the American Academy of Actuaries who ‘‘(i) Procedures for form and rate filing element of the categories described in sub- have familiarity with the actuarial methods pursuant to a streamlined administrative fil- paragraph (A) through (D) of paragraph (1) applicable to health insurance. ing process. within each such market. Notwithstanding

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00087 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.060 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13058 CONGRESSIONAL RECORD — SENATE December 11, 2009 the previous sentence, the Board shall not ommendations to the Secretary pursuant to shall not supersede any State law of a non- recommend any harmonized standards that subsection (d)(1). adopting State to the extent necessary to disrupt, expand, or duplicate the benefit, ‘‘(f) ONGOING REVIEW.—Not earlier than 3 permit individuals or the insurance depart- service, or provider mandate standards pro- years after the termination of the Board ment of the State (or other State agency) to vided in the Benefit Choice Standards pursu- under subsection (e), and not earlier than obtain relief under State law to require an ant to section 2922(a). every 3 years thereafter, the Secretary, in eligible insurer to comply with the har- ‘‘(c) PROCESS FOR IDENTIFYING HARMONIZED consultation with the National Association monized standards under this subtitle. STANDARDS.— of Insurance Commissioners and the entities ‘‘(4) NO EFFECT ON PREEMPTION.—In no case ‘‘(1) IN GENERAL.—The Board shall develop and constituencies represented on the Board shall this subtitle be construed to limit or recommendations to harmonize inconsistent and the Advisory Panel, shall prepare and affect in any manner the preemptive scope of State insurance laws with respect to each of submit to the appropriate committees of sections 502 and 514 of the Employee Retire- the process categories described in subpara- Congress a report that assesses the effect of ment Income Security Act of 1974. In no case graphs (A) through (D) of subsection (b)(1). the harmonized standards applied under this shall this subtitle be construed to create any section on access, cost, and health insurance ‘‘(2) REQUIREMENTS.—In adopting standards cause of action under Federal or State law or under this section, the Board shall consider market functioning. The Secretary may, enlarge or affect any remedy available under the following: based on such report and applying the proc- the Employee Retirement Income Security ‘‘(A) Any model acts or regulations of the ess established for certification under sub- Act of 1974. National Association of Insurance Commis- section (d)(2)(B), in consultation with the ‘‘(c) EFFECTIVE DATE.—This section shall National Association of Insurance Commis- sioners in each of the process categories de- apply beginning on the date that is 18 sioners and the entities and constituencies scribed in subparagraphs (A) through (D) of months after the date on harmonized stand- represented on the Board and the Advisory subsection (b)(1). ards are certified by the Secretary under this Panel, update the harmonized standards ‘‘(B) Substantially similar standards fol- subtitle. through notice and comment rulemaking. lowed by a plurality of States, as reflected in ‘‘SEC. 2934. CIVIL ACTIONS AND JURISDICTION. ‘‘(g) PUBLICATION.— existing State laws, relating to the specific ‘‘(a) IN GENERAL.—The district courts of ‘‘(1) LISTING.—The Secretary shall main- process categories described in subpara- the United States shall have exclusive juris- tain an up to date listing of all harmonized diction over civil actions involving the inter- graphs (A) through (D) of subsection (b)(1). standards certified under this section on the ‘‘(C) Any Federal law requirement related pretation of this subtitle. Internet website of the Department of ‘‘(b) ACTIONS.—An eligible insurer may to specific process categories described in Health and Human Services. subparagraphs (A) through (D) of subsection bring an action in the district courts of the ‘‘(2) SAMPLE CONTRACT LANGUAGE.—The (b)(1). United States for injunctive or other equi- Secretary shall publish on the Internet table relief against any officials or agents of ‘‘(D) In the case of the adoption of any website of the Department of Health and standard that differs substantially from a nonadopting State in connection with any Human Services sample contract language conduct or action, or proposed conduct or ac- those referred to in subparagraphs (A), (B), that incorporates the harmonized standards or (C), the Board shall provide evidence to tion, by such officials or agents which vio- certified under this section, which may be lates, or which would if undertaken violate, the Secretary that such standard is nec- used by insurers seeking to qualify as an eli- essary to protect health insurance con- section 2933. gible insurer. The types of harmonized stand- ‘‘(c) DIRECT FILING IN COURT OF APPEALS.— sumers or promote speed to market or ad- ards that shall be included in sample con- At the election of the eligible insurer, an ac- ministrative efficiency. tract language are the standards that are tion may be brought under subsection (b) di- ‘‘(E) The criteria specified in clauses (i) relevant to the contractual bargain between rectly in the United States Court of Appeals through (iii) of subsection (d)(2)(B). the insurer and insured. for the circuit in which the nonadopting ‘‘(d) RECOMMENDATIONS AND CERTIFICATION ‘‘(h) STATE ADOPTION AND ENFORCEMENT.— State is located by the filing of a petition for BY SECRETARY.— Not later than 18 months after the certifi- review in such Court. ‘‘(1) RECOMMENDATIONS.—Not later than 18 cation by the Secretary of harmonized stand- ‘‘(d) EXPEDITED REVIEW.— months after the date on which all members ards under this section, the States may ‘‘(1) DISTRICT COURT.—In the case of an ac- of the Board are selected under subsection adopt such harmonized standards (and be- tion brought in a district court of the United (a), the Board shall recommend to the Sec- come an adopting State) and, in which case, States under subsection (b), such court shall retary the certification of the harmonized shall enforce the harmonized standards pur- complete such action, including the issuance standards identified pursuant to subsection suant to State law. of a judgment, prior to the end of the 120-day (c). ‘‘SEC. 2933. APPLICATION AND PREEMPTION. period beginning on the date on which such ‘‘(2) CERTIFICATION.— ‘‘(a) SUPERSEDING OF STATE LAW.— action is filed, unless all parties to such pro- ‘‘(A) IN GENERAL.—Not later than 120 days ‘‘(1) IN GENERAL.—The harmonized stand- ceeding agree to an extension of such period. after receipt of the Board’s recommenda- ards certified under this subtitle and applied ‘‘(2) COURT OF APPEALS.—In the case of an tions under paragraph (1), the Secretary as provided for in section 2933(d)(3), shall su- action brought directly in a United States shall certify the recommended harmonized persede any and all State laws of a non- Court of Appeal under subsection (c), or in standards as provided for in subparagraph adopting State insofar as such State laws re- the case of an appeal of an action brought in (B), and issue such standards in the form of late to the areas of harmonized standards as a district court under subsection (b), such an interim final regulation. applied to an eligible insurer, or health in- Court shall complete all action on the peti- ‘‘(B) CERTIFICATION PROCESS.—The Sec- surance coverage issued by a eligible insurer, tion, including the issuance of a judgment, retary shall establish a process for certifying including with respect to coverage issued to prior to the end of the 60-day period begin- the recommended harmonized standard, by a small business health plan, in a non- ning on the date on which such petition is category, as recommended by the Board adopting State. filed with the Court, unless all parties to under this section. Such process shall— ‘‘(2) NONADOPTING STATES.—This subtitle such proceeding agree to an extension of ‘‘(i) ensure that the certified standards for shall supersede any and all State laws of a such period. a particular process area achieve regulatory nonadopting State (whether enacted prior to ‘‘(e) STANDARD OF REVIEW.—A court in an harmonization with respect to health plans or after the date of enactment of this title) action filed under this section, shall render a on a national basis; insofar as they may— judgment based on a review of the merits of ‘‘(ii) ensure that the approved standards ‘‘(A) prohibit an eligible insurer from offer- all questions presented in such action and are the minimum necessary, with regard to ing, marketing, or implementing health in- shall not defer to any conduct or action, or substance and quantity of requirements, to surance coverage consistent with the har- proposed conduct or action, of a nonadopting protect health insurance consumers and monized standards; or State. maintain a competitive regulatory environ- ‘‘(B) have the effect of retaliating against ‘‘SEC. 2935. AUTHORIZATION OF APPROPRIA- ment; and or otherwise punishing in any respect an eli- TIONS; RULE OF CONSTRUCTION. ‘‘(iii) ensure that the approved standards gible insurer for offering, marketing, or im- ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.— will not limit the range of group health plan plementing health insurance coverage con- There are authorized to be appropriated such designs and insurance products, such as cata- sistent with the harmonized standards under sums as may be necessary to carry out this strophic coverage only plans, health savings this subtitle. subtitle. accounts, and health maintenance organiza- ‘‘(b) SAVINGS CLAUSE AND CONSTRUCTION.— ‘‘(b) HEALTH SAVINGS ACCOUNTS.—Nothing tions, that might otherwise be available to ‘‘(1) NONAPPLICATION TO ADOPTING STATES.— in this subtitle shall be construed to create consumers. Subsection (a) shall not apply with respect any mandates for coverage of any benefits ‘‘(3) APPLICATION AND EFFECTIVE DATE.— to adopting States. below the deductible levels set for any health The standards certified by the Secretary ‘‘(2) NONAPPLICATION TO CERTAIN INSUR- savings account-qualified health plan pursu- under paragraph (2) shall apply and become ERS.—Subsection (a) shall not apply with re- ant to section 223 of the Internal Revenue effective on the date that is 18 months after spect to insurers that do not qualify as eligi- Code of 1986.’’. the date on which the Secretary certifies the ble insurers who offer health insurance cov- harmonized standards. erage in a nonadopting State. SA 3198. Mr. CORNYN (for himself ‘‘(e) TERMINATION.—The Board shall termi- ‘‘(3) NONAPPLICATION WHERE OBTAINING RE- and Mr. LEMIEUX) submitted an nate and be dissolved after making the rec- LIEF UNDER STATE LAW.—Subsection (a)(1) amendment intended to be proposed to

VerDate Nov 24 2008 06:01 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00088 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.060 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13059 amendment SA 2786 proposed by Mr. with data in the system of records of the sums as may be necessary to carry out this REID (for himself, Mr. BAUCUS, Mr. Secretary, so long as the requirements of section. DODD, and Mr. HARKIN) to the bill H.R. subparagraphs (A) and (B) of paragraph (3) are met, in order to determine— SEC. 3. MONTHLY VERIFICATION OF ACCURACY 3590, to amend the Internal Revenue OF CLAIMS FOR PAYMENT FOR PHY- ‘‘(I) whether a beneficiary under the pro- SICIANS’ SERVICES. Code of 1986 to modify the first-time gram under title XVIII, XIX, or XXI is dead, homebuyers credit in the case of mem- imprisoned, or otherwise not eligible for ben- (a) IN GENERAL.—Section 1893 of the Social bers of the Armed Forces and certain efits under such program; and Security Act (42 U.S.C. 1395ddd) is amended— other Federal employees, and for other ‘‘(II) whether a provider of services or a (1) in subsection (b), by adding at the end purposes; which was ordered to lie on supplier under the program under title the following new paragraph: the table; as follows: XVIII, XIX, or XXI is dead, imprisoned, or ‘‘(7) The monthly verification of the accu- otherwise not eligible to furnish or receive racy of claims for payment for physicians’ Strike all after the first word and insert payment for furnishing items and services services under the system under subsection the following: under such program; and (i).’’; and 1. SHORT TITLE. ‘‘(ii) include in such agreement safeguards (2) by adding at the end the following new This Act may be cited as the ‘‘Seniors and to assure the maintenance of the confiden- subsection: Taxpayers Obligation Protection Act of tiality of any information disclosed and pro- ‘‘(i) MONTHLY VERIFICATION OF ACCURACY 2009’’. cedures to permit the Secretary to use such OF CLAIMS FOR PAYMENT FOR PHYSICIANS’ SEC. 2. REQUIRING THE SECRETARY OF HEALTH information for the purpose described in SERVICES.— AND HUMAN SERVICES TO CHANGE clause (i). ‘‘(1) SYSTEM.— THE MEDICARE BENEFICIARY IDEN- ‘‘(B) Information provided pursuant to an ‘‘(A) IN GENERAL.—Not later than 1 year TIFIER USED TO IDENTIFY MEDI- agreement under this paragraph shall be pro- after the date of the enactment of this sub- CARE BENEFICIARIES UNDER THE vided at such time, in such place, and in such MEDICARE PROGRAM. section, the Secretary shall establish and manner as the Commissioner determines ap- implement a system to verify (electronically (a) PROCEDURES.— propriate. or otherwise, taking into consideration the (1) IN GENERAL.—Not later than 1 year after ‘‘(C) Information provided pursuant to an the date of enactment of this Act, in order to agreement under this paragraph shall in- administrative burden of such verification protect beneficiaries from identity theft, the clude information regarding whether— on physicians and group practices) on a Secretary of Health and Human Services (in ‘‘(i) the name (including the first name and monthly basis that the claims for payment this section referred to as the ‘‘Secretary’’) any family name or surname), the date of under part B for physicians’ services fur- shall establish and implement procedures to birth (including the month, day, and year), nished in high risk areas are— change the Medicare beneficiary identifier and social security number of an individual ‘‘(i) for physicians’ services actually fur- used to identify individuals entitled to bene- provided to the Commissioner match the in- nished by the physician or the physician’s fits under part A of title XVIII of the Social formation contained in the Commissioner’s group practice; and Security Act or enrolled under part B of such records, and ‘‘(ii) otherwise accurate. title so that such an individual’s social secu- ‘‘(ii) such individual is shown on the ‘‘(B) NO DETERMINATION OF MEDICAL NECES- rity account number is not used. records of the Commissioner as being de- SITY.—In no case shall any verification con- (2) MAINTAINING EXISTING HICN STRUC- ceased.’’. ducted under the system established under TURE.—In order to minimize the impact of (2) INVESTIGATION BASED ON CERTAIN INFOR- subparagraph (A) include a determination of the change under paragraph (1) on systems MATION.—Title XI of the Social Security Act the medical necessity of the physicians’ that communicate with Medicare beneficiary (42 U.S.C. 1301 et seq.) is amended by insert- service. eligibility systems, the procedures under ing after section 1128F the following new sec- ‘‘(2) VERIFICATION.—Under the system, the paragraph (1) shall provide that the new tion: Secretary, at the end of each month, shall Medicare beneficiary identifier maintain the ‘‘SEC. 1128G. ACCESS TO CERTAIN DATA AND IN- provide the physician or the group practice existing Health Insurance Claim Number VESTIGATION OF CLAIMS INVOLV- with a detailed list of such claims for pay- structure. ING INDIVIDUALS WHO ARE NOT ELI- ment that were submitted during the month (3) PROTECTION AGAINST FRAUD.—The proce- GIBLE FOR BENEFITS OR ARE NOT in order for the physician or the group prac- dures under paragraph (1) shall provide for a ELIGIBLE PROVIDERS OF SERVICES tice to review and verify the list. In pro- process for changing the Medicare bene- OR SUPPLIERS. viding the detailed list, the Secretary shall ‘‘(a) DATA AGREEMENT.—The Secretary ficiary identifier for an individual to a dif- use the provider number of the physician or shall enter into an agreement with the Com- ferent identifier in the case of the discovery the group practice. missioner of Social Security pursuant to sec- of fraud, including identity theft. ‘‘(3) AUDITS.—The Secretary shall conduct tion 205(r)(9). (4) PHASE-IN AUTHORITY.— audits of the review and verification by phy- ‘‘(b) INVESTIGATION OF CLAIMS INVOLVING N GENERAL sicians and group practices of the detailed (A) I .—Subject to subparagraphs CERTAIN INDIVIDUALS WHO ARE NOT ELIGIBLE (B) and (C), the Secretary may phase in the FOR BENEFITS OR ARE NOT ELIGIBLE PRO- list provided under paragraph (2). Such au- change under paragraph (1) in such manner VIDERS OF SERVICES OR SUPPLIERS.— dits shall assess whether the physician or as the Secretary determines appropriate. ‘‘(1) IN GENERAL.—The Secretary shall, in group practice conducted such review and (B) LIMIT.—The phase-in period under sub- the case where a provider of services or a verification in a fraudulent manner. In the paragraph (A) shall not exceed 10 years. supplier under the program under title case where the Secretary determines such re- (C) NEWLY ENTITLED AND ENROLLED INDIVID- XVIII, XIX, or XXI submits a claim for pay- view and verification was conducted in a UALS.—The Secretary shall ensure that the ment for items or services furnished to an in- fraudulent manner, the Secretary shall re- change under paragraph (1) is implemented dividual who the Secretary determines, as a coup any payments resulting from the fraud- not later than January 1, 2010, with respect result of information provided pursuant to ulent review and verification and impose a to any individual who first becomes entitled such agreement, is not eligible for benefits civil money penalty in an amount deter- to benefits under part A of title XVIII of the under such program, or where the Secretary mined appropriate by the Secretary on the Social Security Act or enrolled under part B determines, as a result of such information, physician or group practice who conducted of such title on or after such date. that such provider of services or supplier is the fraudulent review and verification. The (b) EDUCATION AND OUTREACH.—The Sec- not eligible to furnish or receive payment for provisions of section 1128A (other than sub- retary shall establish a program of education furnishing such items or services, conduct an sections (a) and (b)) shall apply to a civil and outreach for individuals entitled to, or investigation with respect to the provider of money penalty under the previous sentence enrolled for, benefits under part A of title services or supplier. If the Secretary deter- in the same manner as such provisions apply XVIII of the Social Security Act or enrolled mines further action is appropriate, the Sec- to a penalty or proceeding under section under part B of such title, providers of serv- retary shall refer the investigation to the In- 1128A(a). ices (as defined in subsection (u) of section spector General of the Department of Health ‘‘(4) HIGH RISK AREAS DEFINED.—In this sub- 1861 of such Act (42 U.S.C. 1395x)), and sup- and Human Services. section, the term ‘high risk area’ means a pliers (as defined in subsection (d) of such ‘‘(2) ASSESSMENT OF IMPLEMENTATION AND county designated as a high risk area under section) on the change under paragraph (1). EFFECTIVENESS BY THE OIG.—The Inspector subsection (j)(1). (c) DATA MATCHING.— General of the Department of Health and ‘‘(5) REPORT BY THE SECRETARY.—Not later (1) ACCESS TO CERTAIN INFORMATION.—Sec- Human Services shall test the implementa- than 1 year after implementation of the sys- tion 205(r) of the Social Security Act (42 tion of the provisions of this section (includ- tem established under paragraph (1), the Sec- U.S.C. 405(r)) is amended by adding at the ing the implementation of the agreement retary shall submit a report to Congress on end the following new paragraph: under section 205(r)(9)) and conduct such pe- the progress of such implementation. Such ‘‘(9)(A) The Commissioner of Social Secu- riod assessments of such implementation as report shall include recommendations— rity shall, upon the request of the Sec- the Inspector General determines necessary ‘‘(A) on how to improve such implementa- retary— to determine the effectiveness of such imple- tion, including whether the system should be ‘‘(i) enter into an agreement with the Sec- mentation.’’. expanded to include verification of claims retary for the purpose of matching data in (d) AUTHORIZATION OF APPROPRIATIONS.— for payment under part B for physicians’ the system of records of the Commissioner There are authorized to be appropriated such services furnished in additional areas; and

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00089 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.061 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13060 CONGRESSIONAL RECORD — SENATE December 11, 2009 ‘‘(B) for such legislation and administra- check conducted under subparagraph (A), in- graph, the Secretary shall establish proce- tive action as the Secretary determines ap- cluding whether— dures to require carriers, prior to paying a propriate.’’. ‘‘(i) a fingerprint check is necessary; claim for payment for durable medical equip- (b) AUTHORIZATION OF APPROPRIATIONS.—To ‘‘(ii) a background check shall be con- ment, prosthetics, orthotics, and supplies carry out the amendments made by this sec- ducted with respect to additional employees, under this title, to confirm with the Na- tion, there are authorized to be appropriated board members, contractors or other inter- tional Supplier Clearinghouse— such sums as may be necessary for each of ested parties of the supplier; and ‘‘(i) that the National Provider Identifier fiscal years 2010 through 2014. ‘‘(iii) any additional national background of the physician or practitioner prescribing SEC. 4. DETECTION OF MEDICARE FRAUD AND checks regarding exclusion from participa- or ordering the item or service is valid and ABUSE. tion in Federal programs (such as the pro- active; (a) IN GENERAL.—Section 1893 of the Social gram under this title, title XIX, or title ‘‘(ii) that the Medicare identification num- Security Act (42 U.S.C. 1395ddd), as amended XXI), adverse actions taken by State licens- ber of the supplier is valid and active; and by section 3, is amended— ing boards, bankruptcies, outstanding taxes, ‘‘(iii) that the item or service for which the (1) in subsection (b), by adding at the end or other indications identified by the Inspec- claim for payment is submitted was properly the following new paragraph: tor General of the Department of Health and identified on the CMS–855S Medicare enroll- ‘‘(8) Implementation of fraud and abuse de- Human Services are necessary. ment application. tection methods under subsection (j).’’; ‘‘(D) EXPANDED IMPLEMENTATION.—Not ‘‘(B) ONLINE DATABASE FOR IMPLEMENTA- (2) in subsection (c), by adding at the end later than 24 months after the date of enact- TION.—Not later than 18 months after the of the flush matter following paragraph (4), ment of this subsection, the Secretary shall date of enactment of this paragraph, the Sec- the following new sentence ‘‘In the case of an establish procedures for the implementation retary shall establish an online database activity described in subsection (b)(8), an en- of such fraud and abuse detection methods similar to that used for the National Pro- tity shall only be eligible to enter into a con- under this title with respect to items and vider Identifier to enable providers of serv- tract under the Program to carry out the ac- services furnished by all providers of services ices, accreditors, carriers, and the National tivity if the entity is selected through a and suppliers, including those not in high Supplier Clearinghouse to view information competitive bidding process in accordance risk areas designated under paragraph (1). on specialties and the types of items and with subsection (j)(3).’’; and ‘‘(3) COMPETITIVE BIDDING.—In selecting en- services each supplier has indicated on the (3) by adding at the end the following new tities to carry out this subsection, the Sec- CMS–855S Medicare enrollment application subsection: submitted by the supplier. ‘‘(j) DETECTION OF MEDICARE FRAUD AND retary shall use a competitive bidding process. ‘‘(C) NOTIFICATION OF CLAIM DENIAL AND RE- ABUSE.— SUBMISSION.—In the case where a claim for ‘‘(1) ESTABLISHMENT OF SYSTEM TO IDENTIFY ‘‘(4) REPORT TO CONGRESS.—The Secretary shall submit to Congress an annual report on payment for durable medical equipment, COUNTIES MOST VULNERABLE TO FRAUD.—Not prosthetics, orthotics, and supplies under later than 6 months after the date of enact- the effectiveness of activities conducted under this subsection, including a descrip- this title is denied because the item or serv- ment of this subsection, the Secretary shall ice furnished does not correctly match up establish a system to identify the 50 counties tion of any savings to the program under this title as a result of such activities and with the information on file with the Na- most vulnerable to fraud with respect to tional Supplier Clearinghouse— items and services furnished by providers of the overall administrative cost of such activities and a determination as to the ‘‘(i) the National Supplier Clearinghouse services (other than hospitals and critical shall— access hospitals) and suppliers based on the amount of funding needed to carry out this subsection for subsequent fiscal years, to- ‘‘(I) provide the supplier written notifica- degree of county-specific reimbursement and tion of the reason for such denial; and analysis of payment trends under this title. gether with recommendations for such legislation and administrative action as the Sec- ‘‘(II) allow the supplier 60 days to provide The Secretary shall designate the counties the National Supplier Clearinghouse with ap- identified under the preceding sentence as retary determines appropriate.’’. (b) AUTHORIZATION OF APPROPRIATIONS.—To propriate certification, licensing, or accredi- ‘high risk areas’. tation; and ‘‘(2) FRAUD AND ABUSE DETECTION.— carry out the amendments made by this section, there are authorized to be appro- ‘‘(ii) the Secretary shall waive applicable ‘‘(A) INITIAL IMPLEMENTATION.—The Sec- requirements relating to the time frame for retary shall establish procedures for the im- priated— (1) such sums as may be necessary, not to the submission of claims for payment under plementation of fraud and abuse detection this title in order to permit the resubmission methods under this title with respect to exceed $50,000,000, for each of fiscal years 2010 through 2014; and of such claim if payment of such claim would items and services furnished by such pro- otherwise be allowed under this title.’’. viders of services and suppliers in high risk (2) such sums as may be necessary, not to SEC. 7. STRATEGIC PLAN FOR THE DEVELOP- areas designated under paragraph (1) (and, exceed an amount the Secretary determines appropriate in the most recent report sub- MENT OF A SERIAL NUMBER TRACK- beginning not later than 18 months after the ING SYSTEM FOR DURABLE MED- date of enactment of this subsection, with mitted to Congress under section 1893(j)(4) of ICAL EQUIPMENT. respect to items and services furnished by the Social Security Act, as added by sub- Section 1834(a) of the Social Security Act such providers of services and suppliers in section (a), for each subsequent fiscal year. (42 U.S.C. 1395m(a)), as amended by section areas not so designated) including the fol- SEC. 5. USE OF TECHNOLOGY FOR REAL-TIME 6(a), is amended by adding at the end the following: DATA REVIEW. lowing new paragraph: ‘‘(i) In the case of a new applicant to be a Title XVIII of the Social Security Act (42 ‘‘(23) STRATEGIC PLAN FOR THE DEVELOP- supplier, a background check, a pre-enroll- U.S.C. 1395 et seq.) is amended by adding at MENT OF A SERIAL NUMBER TRACKING SYSTEM ment site visit, and random unannounced the end the following new section: FOR DURABLE MEDICAL EQUIPMENT.— site visits after enrollment. ‘‘SEC. 1899. USE OF TECHNOLOGY FOR REAL-TIME ‘‘(A) IN GENERAL.—Not later than 1 year ‘‘(ii) Not less than 5 years after the date of DATA REVIEW. after the date of enactment of this para- enactment of this subsection, in the case of ‘‘(a) IN GENERAL.—The Secretary of Health graph, the Secretary shall develop a stra- a supplier who is not a new applicant, re-en- and Human Services shall establish proce- tegic plan for the development and imple- rollment under this title, including a back- dures for the use of technology (similar to mentation of a serial number tracking sys- ground check and a site-visit as part of the that used with respect to the analysis of tem for durable medical equipment. application process for such re-enrollment, credit card charging patterns) to provide ‘‘(B) SERIAL NUMBER TRACKING SYSTEM FOR and random unannounced site visits after real-time data analysis of claims for pay- DURABLE MEDICAL EQUIPMENT.—The plan de- such re-enrollment. ment under the Medicare program under veloped under subparagraph (A) shall include ‘‘(iii) Data analysis to establish prepay- title XVIII of the Social Security Act to mechanisms to ensure that an item of dura- ment claim edits designed to target the identify and investigate unusual billing or ble medical equipment which has not been claims for payment under this title for such order practices under the Medicare program issued a unique identifier under the unique items and services that are most likely to be that could indicate fraud or abuse. device identification system established fraudulent. ‘‘(b) COMPETITIVE BIDDING.—The procedures under section 519(f) of the Federal Food, ‘‘(iv) Prepayment benefit integrity reviews established under subsection (a) shall ensure Drug, and Cosmetic Act bears a unique iden- for claims for payment under this title for that the implementation of such technology tifier, unless the Secretary already requires such items and services that are suspended is conducted through a competitive bidding an alternative placement or provides an ex- as a result of such edits. process.’’. ception for a particular item or type of dura- ‘‘(B) REQUIREMENT FOR PARTICIPATION.—In SEC. 6. EDITS ON 855S MEDICARE ENROLLMENT ble medical equipment under such section no case may a provider of services or sup- APPLICATION. 519(f). plier who does not meet the requirements Section 1834(a) of the Social Security Act ‘‘(C) PROVISION OF UNIQUE IDENTIFIER TO under subparagraph (A) (including, in the (42 U.S.C. 1395m(a)) is amended by adding at THE SECRETARY.—The plan developed under case of a supplier, the requirement of a back- the end the following new paragraph: subparagraph (A) shall include appropriate ground check) participate in the program ‘‘(22) CONFIRMATION WITH NATIONAL SUP- mechanisms for manufacturers of items of under this title. PLIER CLEARINGHOUSE PRIOR TO PAYMENT.— durable medical equipment to submit to the ‘‘(C) BACKGROUND CHECKS.—The Secretary ‘‘(A) IN GENERAL.—Not later than 1 year Secretary unique identifiers issued under shall determine the extent of the background after the date of enactment of this para- subparagraph (B) or such section 519(f) with

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00090 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.061 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13061 respect to such items. The plan shall include from the supplier that the item of durable Burkard, a detailee from the Govern- mechanisms for the Secretary to provide for medical equipment has been returned by 1 ment Accountability Office to the Ap- the storage of such unique identifier in ac- beneficiary and is now being used by another propriations Committee, be granted cordance with subparagraph (F)(i). beneficiary, no payment shall be made under the privilege of the floor during consid- ‘‘(D) REQUIREMENTS FOR MANUFACTURERS this part for such item of durable medical AND WHOLESALERS.—The plan developed equipment unless the Secretary has verified eration of the consolidated appropria- under subparagraph (A) shall include mecha- that the beneficiary has received such item tions bill. nisms for manufacturers of items of durable in accordance with subclause (IV). The PRESIDING OFFICER. Without medical equipment, or, in the case where a ‘‘(IV) VERIFICATION.—The plan developed objection, it is so ordered. wholesaler provides an item of durable med- under subparagraph (A) shall include provi- f ical equipment to suppliers, wholesalers, to— sions for the Secretary to conduct any ‘‘(i) upon issuing an item to a supplier, de- verification required under subclause (II) or ORDERS FOR SATURDAY, velop a product description for the item (III) within 30 days after receipt by the Sec- DECEMBER 12, 2009 which includes— retary of the relevant claim form. In the ‘‘(I) the unique identifier of the item; case where such verification is not com- Mr. MENENDEZ. Mr. President, I ask ‘‘(II) the specific Healthcare Common Pro- pleted within such time period, the Sec- unanimous consent that when the Sen- cedure Coding System (HCPCS) code for the retary shall pay such claim, complete the ate completes its business today, it ad- item; verification, and, in the case where the Sec- journ until 9 a.m., Saturday, December ‘‘(III) the name of the supplier the item retary has entered into a contract with an was shipped to; and 12; that following the prayer and entity for the conduct of such verification, pledge, the Journal of proceedings be ‘‘(IV) the supplier’s Medicare identification recover any payments that would not have number; and been made if the verification had been com- approved to date, the morning hour be ‘‘(ii) submit the product description devel- pleted within such time period from such en- deemed expired, the time for the two oped under clause (i) to the Secretary for tity. leaders be reserved for their use later storage in the unique identifier database in ‘‘(iii) QUALITY CONTROL AUDITS.—The plan in the day, and the Senate resume con- accordance with subparagraph (F)(i). developed under subparagraph (A) shall in- sideration of the conference report ac- ‘‘(E) REQUIREMENTS FOR SUPPLIERS.—The clude a requirement that the Secretary con- companying H.R. 3288, the consolidated plan developed under subparagraph (A) shall duct quality control audits to identify un- include mechanisms to ensure that suppliers appropriations bill, as provided for usual billing patterns with respect to items under the previous order. of items of durable medical equipment— of durable medical equipment for which pay- ‘‘(i) upon issuing the item to a beneficiary, ment is made under this part and may pro- The PRESIDING OFFICER. Without note the unique identifier of such item on— vide that the Secretary conduct unan- objection, it is so ordered. ‘‘(I) the claim form submitted for such nounced site visits or commission other f item; and agencies to conduct such site visits as part ‘‘(II) when appropriate or otherwise re- of such quality control audits. PROGRAM quired, the detailed product description of ‘‘(iv) NO USE AS A PRECERTIFICATION MECHA- the item; Mr. MENENDEZ. Mr. President, at NISM.—The plan developed under subpara- ‘‘(ii) in the case where the item is issued to 9:30 a.m., the Senate will proceed to a graph (A) shall include mechanisms to en- a beneficiary on a rental basis, designate the sure that in no case shall a unique identifier cloture vote on the consolidated appro- unique identifier with an ‘R’ after the num- issued under subparagraph (B) or section priations conference report. If cloture ber to indicate that the item was rented, and 519(f) of the Federal Food, Drug, and Cos- is invoked, the Senate will proceed to not purchased, by the beneficiary; and metic Act be used as a precertification ‘‘(iii) upon return of the item to the sup- vote on the adoption of the conference mechanism for the supply of an item of dura- plier, notify the Secretary— report at 2 p.m. on Sunday. ble medical equipment or the payment of a ‘‘(I) before reissuing that item and resub- claim for such an item under this part.’’. f mitting that number on such a claim form; or SEC. 8. GAO STUDY AND REPORT ON EFFECTIVE- ORDER FOR ADJOURNMENT ‘‘(II) upon resubmitting that number on NESS OF SURETY BOND REQUIRE- MENTS FOR SUPPLIERS OF DURA- Mr. MENENDEZ. Finally, I ask unan- such a claim form. BLE MEDICAL EQUIPMENT IN COM- ‘‘(F) RESPONSIBILITIES FOR THE SEC- imous consent that following the re- BATING FRAUD. marks of the distinguished Senator RETARY.— (a) STUDY.—The Comptroller General of ‘‘(i) MAINTENANCE OF DATABASE OF SERIAL the United States shall conduct a study on from Nevada, Senator ENSIGN, the Sen- NUMBERS.—The plan developed under sub- the effectiveness of the surety bond require- ate adjourn under the previous order. paragraph (A) shall include the responsi- ment under section 1834(a)(16) of the Social The PRESIDING OFFICER. Without bility of the Secretary to establish and Security Act (42 U.S.C. 1395m(a)(16)) in com- objection, it is so ordered. maintain a database containing the unique bating fraud. Mr. MENENDEZ. Mr. President, I identifiers submitted by manufacturers of (b) REPORT.—Not later than 18 months yield the floor. items of durable medical equipment under after the date of enactment of this Act, the subparagraph (C). Comptroller General shall submit to Con- The PRESIDING OFFICER. The Sen- ‘‘(ii) PAYMENT.— gress a report containing the results of the ator from Nevada. ‘‘(I) LIMITATION.—Subject to subclause (II), study conducted under subsection (a), to- Mr. ENSIGN. I ask unanimous con- the plan developed under subparagraph (A) gether with recommendations for such legis- sent that I be able to speak as long as shall include mechanisms to ensure that lation and administrative action as the I take tonight and then following my payment may only be made for an item of Comptroller General determines appropriate. comments, the Senate stand in ad- durable medical equipment if the unique f journment. identifier on the claim form submitted for such item matches the unique identifier sub- NOTICE OF HEARING The PRESIDING OFFICER. Without objection, it is so ordered. mitted by the manufacturer of such item Mr. BINGAMAN. Mr. President, I Mr. ENSIGN. Mr. President, first, I under subparagraph (C). would like to announce for the infor- ‘‘(II) EXCEPTION TO LIMITATION AFTER wish to say to my friend from New Jer- mation of the Senate and the public VERIFICATION OF RECEIPT.—The plan devel- sey, I appreciate the remarks he has that a business meeting has been oped under subparagraph (A) shall include made. I have stood with the Cuban peo- mechanisms to ensure that in the case where scheduled before Committee on Energy and Natural Resources. The business ple and especially with the dissidents the unique identifier is not on the claim down there for years, many times with form submitted for such item or does not meeting will be held on Wednesday, De- match the unique identifier submitted by the cember 16, 2009, at 11:30 a.m., in room my friend from New Jersey. I appre- manufacturer of such item under subpara- SD–366 of the Dirksen Senate Office. ciate the issue he is bringing up and graph (C), no payment shall be made under The purpose of the business meeting fighting for those folks. this part for the item of durable medical is to consider pending legislation. There have been those cases over the equipment until the Secretary has verified For further information, please con- years where American voices have that the beneficiary has received such item tact Sam Fowler at (202) 224–7571 or reached all the way into those gulags, in accordance with subclause (IV). Amanda Kelly at (202) 224–6836. whether it was the old Soviet Union or ‘‘(III) DUPLICATIVE UNIQUE IDENTIFIERS.— North Korea or wherever it may be. The plan developed under subparagraph (A) f America being the beacon of hope for shall include mechanisms to ensure that in PRIVILEGES OF THE FLOOR the case where a unique identifier is sub- so many people around the world, it is mitted on more than 1 claim form submitted Mrs. MURRAY. Mr. President, I ask critical that Members of this body, as for such an item and there is no indication unanimous consent that Richard well as the President of the United

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00091 Fmt 0624 Sfmt 0634 E:\CR\FM\A11DE6.061 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13062 CONGRESSIONAL RECORD — SENATE December 11, 2009 States, speak out for freedom and ered responsible spending during the My friends on the other side of the speak out for those people to give them economic times we are in. There are aisle have made it a habit to come hope that there are people in America over 5,000 earmarks in this omnibus down to the Senate floor and say: Well, who are listening and who are paying bill, this mini bus bill, whatever you where were Republicans when Presi- attention to them, so they will keep want to call it, that is before us dent Bush was in office, adding to the fighting for freedom in their own coun- today—5,000 earmarks. debt, increasing the deficit? Well, I was try. So I appreciate the comments the Not surprisingly, with all this spend- right here saying many of the same Senator from New Jersey made to- ing, the majority in Congress must in- things I am saying today. Not only did night. crease the debt limit. The debt limit is I vote against many of the spending OMNIBUS APPROPRIATIONS the limit set by Congress of how much bills that were passed during the pre- I rise tonight, though, to speak about debt our country can take on. This is vious administration, but I would have the legislation that is before the Sen- similar, if you think about it, to your liked to have seen President Bush put ate. It is the Consolidated Appropria- credit card limit. Right now, the debt his foot down and veto some of these tions Act or, as some people call it, the limit is set at a little over $12 trillion— bills and force Congress to cut back on mini bus. This is a $447 billion bill. trillion. Let me take a little side note. out-of-control spending. Around here, that seems like a small We speak about trillions of dollars any- If President Obama is worried about number. I believe this spending bill more as though it is nothing. Well, to the debt that his children and grand- represents yet another step in the put $1 trillion in a little bit of perspec- children are going to inherit, he has a wrong direction for our country. I be- tive—I have said this on this floor be- hard time showing it. It seems to me lieve this legislation is only more of fore—if you spend $1 million a day, 7 the President is in denial regarding the the same old recipe of fiscal irrespon- days a week, 365 days a year, to get to fiscal train wreck that is taking place sibility that guides the majority in $1 trillion, you would have had to start in this country. Congress. In a time of sky-high budget spending that $1 million a day every In July of this year, President Obama deficits and staggering debt, the Amer- day from the time Jesus was born, said he understands the concern about ican people are now demanding a better spend it until now, and you still the debt and admitted his recovery way forward. wouldn’t be at your first $1 trillion. plan has added to the growing debt. I wish to make it clear for the record Yet our country already has $1 trillion But he stated at the time that now is what this legislation does. As a Senate in debt. not the time to tighten our belt and Budget Committee analysis shows, this Anyway, the majority is raising the stop spending. bill increases spending by 12 percent debt limit. This would be akin to tak- In November, however, President over last year’s fiscal year for the six ing your credit card and maxing it out Obama said: spending bills that are wrapped up in but then going to the bank and saying: I think it is important, though, to recog- this legislation. When we look at each By the way, can I increase my credit nize that if we keep adding to the debt, even of these bills separately, the numbers limit by 20 percent? Oh, by the way, I in the midst of the recovery, that at some are even more shocking. The State De- have no idea how I am going to pay it point, people could lose confidence in the partment received a 33-percent in- back, except maybe my children will be U.S. economy in a way that could actually crease over last year. Transportation, able to pay it back someday. That is lead to a double-dip recession. Housing, and Urban Development re- exactly what this Congress is doing. We First, the President says we must ceived a 23-percent increase over last are saying: We can’t pay this debt keep spending, even during the reces- year. Keep in mind that these accounts back. There is no way we can pay this sion. Then he says that continued together received more than $60 billion debt back. Maybe our children, maybe spending and increasing the debt dur- of increase in the stimulus bill that our grandchildren can pay it back. ing the recession could lead to a lack of was signed earlier this year. Americans across the country are confidence in the U.S. economy by the When we look at the gritty details, going through tough times and they American people and by people around for example, at individual programs, are doing what many in this body are the world. the numbers are just as bad. The bill unwilling to do. They are tightening The President remains in his state of increases the Corporation for National their belts and cutting back on spend- denial because before us is a $447 bil- Community Service by 30 percent and ing. According to the Federal Reserve, lion bill that he will likely sign into includes a 41-percent increase for bilat- household debt has been reduced by law. eral economic assistance. There is also $351 billion in the last quarter. This is I challenge President Obama to show a 9-percent increase in Amtrak, and the largest quarterly decline in our Na- leadership and veto this bill. Say to the keep in mind that Amtrak got a $1.3 tion’s history. That is right. American Senate and the House of Representa- billion extra amount of money in the families see the danger of fiscal irre- tives: Get your fiscal house in order. It stimulus bill this year. sponsibility and they are cutting back is time we show responsibility to our These spending increases are set on borrowing the money they may children and grandchildren. Spending against a dire economic picture. Ac- have trouble paying back. State gov- this year has added up a little bit. The cording to the nonpartisan Congres- ernments, local governments, busi- TARP—an additional $350 billion was sional Budget Office, in fiscal year 2010, nesses are doing the same as American added to the TARP program this year. the deficit will be $1.4 trillion. Right families: They are cutting back. This has now become a slush fund. The now, American families are hurting. I We also have interest we must pay on stimulus bill was $787 billion. It was know my home State of Nevada has ex- this debt. Just like the interest you supposed to not allow the unemploy- perienced some of the highest unem- pay on your credit card when you carry ment rate to go over 8 percent. We now ployment levels in the country—13 per- a balance, Americans pay interest on know the unemployment rate is 10 percent, according to the Department of the debt this country continues to ac- cent. There were supposed to be mil- Labor. In talking to constituents back cumulate. CBO estimates today the an- lions of jobs saved or created. That cer- home, I can guarantee my colleagues it nual interest on this Nation’s debt last tainly doesn’t appear to be the case. In is actually much higher. We have a sit- year was around $179 billion—a big this stimulus bill, we see that $6 mil- uation where because people quit look- number, $179 billion. A lot of good lion will go to a PR firm whose head is ing for jobs, the unemployment rate is could be done with that if we weren’t a former pollster for a high-ranking understated. In my State is probably just spending that, paying the interest member in the Obama administration. closer to 20 percent. on the debt. Well, that $179 billion by Again, that was for $6 million. That Democrats expect this bloated spend- the year 2019 is projected to go to al- was to educate folks on what it means ing bill to receive what has become a most $800 billion, not including any of to go from analog television to digital. customary rubberstamp when it comes the new spending programs that are I don’t know if anybody watched TV to spending in this town. But I don’t being proposed out there—$800 billion a this last year, but the cable companies, see how a $300,000 earmark to Carnegie year. As much as we are spending on the broadcasters, spent tens and tens of Hall in New York City or $250,000 for a our national defense will just be inter- millions of dollars to tell folks about bike path in Michigan can be consid- est on our debt. the transition and what it meant to

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00092 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.086 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13063 transition from analog to digital. League Poll found that almost 70 per- David Martinez, whose daughters, Walmart and other companies that cent of DC residents support this edu- Brenda and Katherine, already attend were selling the converter boxes were cation funding. Sacred Heart through the scholarship telling people about it. The govern- Although the Chancellor of Public program, wanted his youngest daugh- ment didn’t need to spend this money. Schools, Michelle Rhee, has made ter, Heidi, to enroll as well. The private sector was handling it just much progress reforming DC’s public David writes: fine. schools, there is still much work to do. I wanted my 5-year-old daughter, Heidi, to That is just one small example of the The statistics paint a grim picture. attend a private school, as well. I was over- wasteful spending that was part of the According to the Department of Edu- joyed when we received a letter—telling us stimulus bill. My State has a 13-per- cation’s National Assessment of Edu- that the scholarship had been granted. Then, cent unemployment rate, as I men- cation, DC ranked last in the Nation two weeks later—because President Obama, based on fourth and eighth grade read- the Congress, and Education Secretary Arne tioned before. So the stimulus bill cer- Duncan sided against my daughter—we re- tainly doesn’t seem to have helped my ing assessments. In 2007, only 14 percent of fourth ceived another letter. This letter said that State. Heidi wouldn’t receive her scholarship. We I want to show you what we are fac- graders—14 percent—were proficient in were devastated when we read the letter. reading and math in DC schools. DC’s ing with this debt. Under the Presi- Patricia Williams writes of her son overall performance on SATs is not dent’s budget that was passed earlier Fransoir. Before the program, she wor- much better. Reading scores are 32 this year, the debt will double within 5 ried how she could help Fransoir get a years, and it will actually triple within points below the national average, while math scores are 60 points below good education and make sure he was 10 years. The debt that this country is safe and supervised. Patricia hopes taking on will double within 5 years the national average. DC has some of the highest levels of that all her children attend college in and triple within 10 years. the future. Now we are going to add a $2.5 tril- per-pupil spending in the Nation. Un- fortunately, this large investment is Despite the fact that the parents and lion health care bill, which is what the students involved in the DC Oppor- spending will be when it is fully imple- bearing little fruit. The biggest tragedy of all is that a tunity Scholarship have pleaded with mented. The other side of the aisle has quality education represents the best lawmakers to preserve the program, said that it actually decreases the def- chance for most of these children to es- Democrats continue to advocate elimi- icit. That is part of the smoke and mir- cape the cycle of poverty that so many nating the opportunity for more than rors. You get all of the tax increases of their families are in today. For 1,700 students to continue attending and the Medicare cuts in the first few many, the DC Opportunity Scholarship private schools. years, but the actual benefits don’t Program provides that chance. When you look close at the data on start until 2014. So if you look at a true The average household income of par- DC schools, it is no wonder that the DC 10-year picture, the spending in the bill ticipating families that get these Opportunity Scholarship parents are so is about $2.5 trillion. scholarships is $22,000 a year for a fam- vocal about keeping the program alive. On top of that, the bill I am talking ily of four. All participating students Per-pupil expenditures in the District about today, the $447 billion ‘‘minibus’’ come from families below 185 percent public schools are more than $14,000 per of appropriations bills, is a 12-percent of the poverty line. Nearly 100 percent pupil per year, and DC class size is one increase from last year to this year. of the participating students are mi- of the lowest, 14 to 1 student-teacher When are we going to get the message norities. ratio. Yet reading scores continue to from the American people? In the past, Eighty-six percent of the scholarship languish at or near the bottom in every it doesn’t seem like they cared that students would otherwise be assigned national assessment. much about the debt and deficit. We to attend a DC public school that did Recent data shows that 69 percent of are hearing about it all across the not meet the ‘‘adequate yearly fourth graders are reading below basic country today. That is the reason progress’’ standards in 2006 and 2007 levels, as defined by the Department of you’re seeing in poll after poll that it and are in need of improvement, cor- Education in Washington, DC. is one of the big things the American rective action, or restructuring. DC students in DC public schools people are concerned about now. I am Unfortunately, many of the Demo- rank last in the Nation in both SAT happy they are finally paying atten- crats in this body continue to put poli- and ACT scores. tion. I just hope this body starts pay- tics ahead of a program that is helping Beyond the low performance in the ing attention to what the American to ensure low-income children have the classrooms, DC schools are often vio- people are saying. ability to attend safe and effective lent and dangerous. A Federal Govern- Mr. President, now I want to turn my schools. ment study found that 12 percent of DC attention to the DC Opportunity Schol- Some opponents of the DC Oppor- students were threatened or injured by arship Program and how the bill that is tunity Scholarship say the program a weapon on school property during a before us would eliminate this vital isn’t effective. They say it doesn’t recent school year—well above the na- and successful program. work and only diverts money from DC tional average. This omnibus bill would accomplish public schools. I simply disagree, and I Would most Americans put up with this by restricting the enrollment of believe the facts paint a very different those kinds of statistics, or would they any new students and lead to the end of picture, a more accurate representa- fight for change? This body has to fight the program. As many of you know, the tion of the success of the scholarship for the students and the parents in DC Opportunity Scholarship Program program. Washington, DC. is part of a comprehensive strategy de- According to Dr. Patrick Wolf at the According to the Washington Post, signed to provide a quality education University of Arkansas, the principal Anacostia High School alone saw 61 for every child in the District, regard- investigator studying the scholarship violent offenses, including 3 sexual as- less of income or neighborhood. program, this program is working. saults and 1 instance of the use of a The District roundly supports this DC opportunity scholarship recipi- deadly weapon. program. DC’s mayor, Adrian Fenty, ents show the largest achievement im- Perhaps these facts are why Presi- testified in favor of the program. He pact in reading of any education policy dent Obama has chosen to enroll both has sent letters of support to Members program yet evaluated in a randomized of his daughters in a private school in of Congress regarding the scholarship control trial. These randomized trials Washington. program. are the gold standard when it comes to Clearly, we can do better, and the DC Other DC leaders have also expressed figuring out whether a program works. Opportunity Scholarship Program is a their support, including City Council While the numbers paint an encour- means to achieve better results for Chairman Vincent Gray, DC Public aging picture, I think 90 percent of par- low-income children in Washington. School Chancellor Michelle Rhee, and ents of children in the program who There are promising signs that this former Mayor Anthony Williams. say that the scholarship program gives program works. My colleagues, includ- The residents support the program their child a chance at a quality and ing Senators on both sides of the too. A Greater Washington Urban safe education is a better measure. aisle—Senators LIEBERMAN, COLLINS,

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00093 Fmt 0624 Sfmt 0634 E:\CR\FM\G11DE6.087 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13064 CONGRESSIONAL RECORD — SENATE December 11, 2009

EINSTEIN OINOVICH YRD LEX IRMIE KEELER BLANTON III, OF GEORGIA DEBORAH R. MARCUS F , V , B , and A - CHELAN J. BLISS, OF WASHINGTON ELEANOR C. NAZARSMITH ANDER—have joined in a bipartisan bill DAVID SEAN BOXER, OF VIRGINIA DEAN L. PRENTICE ALEXIA MCNEAL BRANCH, OF CALIFORNIA JAMES E. REINEKE to improve and extend this successful RAVI FRANKLIN BUCK, OF MISSOURI THERESA D. RODRIGUEZ program. MATTHEW BUSHELL, OF CONNECTICUT LISA A. SCHMIDT OMAR CARDENTEY, OF FLORIDA ROBIN L. SCHULTZE This program should not see its DANIEL C. CARROLL, OF HAWAII KAREN L. SCLAFANI death through the appropriations proc- ANDREW N. CARUSO, OF VIRGINIA JULIA G. STOSHAK MICHAEL P. CASEY, OF VIRGINIA CHRISTINE S. TAYLOR ess. BENJAMIN COCKBURN, OF GEORGIA MARY M. WHITEHEAD In conclusion, what this ‘‘minibus’’— JOANNE ILENE COSSITT, OF CONNECTICUT PATRICK J. WILLIAMS ROCCO COSTA, OF MARYLAND the bill before us today—is doing is CHRISTOPHER B. CREAGHE, OF COLORADO THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT rolling over the future of this country. ROBIN S. CROMER, OF SOUTH CAROLINA TO THE GRADE INDICATED IN THE UNITED STATES AIR FORCE UNDER TITLE 10, U.S.C., SECTION 624: Call it what you want—minibus, omni- GAETAN DAMBERG-OTT, OF MINNESOTA JESSICA RENEE DANCEL, OF COLORADO To be colonel bus, or 18 wheeler—it is carrying a load SCOTT B. DARGUS, OF WASHINGTON PETER JOHN DAVIDIAN, OF OHIO DAVID W. BOBB of debt and wasteful spending and gov- REBEKAH E. DAVIS, OF THE DISTRICT OF COLUMBIA CHARLES R. CARLTON, JR. ernment irresponsibility. It is a re- JASON DYER, OF NEW MEXICO CRAIG J. CHRISTENSON MARCUS GEORGE FALION, OF TENNESSEE DAVID COHEN minder to the American people that GAIL HEGARTY FELL, OF NEW YORK JAMES H. DIENST while they balance their budgets and JOSEPH ANTON FETTE, OF CALIFORNIA BRIDGET C. GREGORY AARON ELLIOTT GARFIELD, OF CALIFORNIA SAMUEL D. HALL III scrape to pay their bills and try to save PHILLIP M. GATINS, OF FLORIDA ALVIS W. HEADEN III something for the future, the Federal SARAH GJORGJIJEVSKI, OF VIRGINIA STEVEN R. HINTEN SAMUEL EVERETT GOFFMAN, OF ILLINOIS DOUGLAS C. HODGE Government continues its reckless DANIEL ROSS HARRIS, OF CALIFORNIA BAILEY H. MAPP shopping spree and just prints the NOEL HARTLEY, OF THE DISTRICT OF COLUMBIA DANIEL E. REISER JANEL MARGARET HEIRD, OF MICHIGAN LONDON S. RICHARD money. This is not what we are sent PEPIJN M. HELGERS, OF THE DISTRICT OF COLUMBIA ERIC A. SHALITA here to do. I hope the President sees CHRISTOPHER D. HELMKAMP, OF VIRGINIA MARK E. SMALLWOOD WILLIAM N. HOLTON, JR., OF ILLINOIS BRIAN K. STANTON that and vetoes this irresponsible legis- TRAVIS A. HUNNICUTT, OF VIRGINIA JAY M. STONE lation. DONNA J. HUSS, OF INDIANA ROBERT W. WISHTISCHIN MOUNIR E. IBRAHIM, OF NEW YORK THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT I yield the floor. AMENAGHAMWON IYI-EWEKA, OF WISCONSIN TO THE GRADE INDICATED IN THE UNITED STATES AIR DANA MARIE JEA, OF FLORIDA FORCE UNDER TITLE 10, U.S.C., SECTION 624: f JOANNA TRACY KATZMAN, OF NEW JERSEY JENNIFER ANNE KELLEY, OF THE DISTRICT OF COLUM- To be colonel ADJOURNMENT UNTIL 9 A.M. BIA TOMORROW CRAIG S. KENNEDY, OF GEORGIA RANDALL M. ASHMORE THOMAS D. KOHL, OF FLORIDA ADAM G. BEARDEN The PRESIDING OFFICER. Under JACK C. LAMBERT, OF OREGON SCOTT T. BROWN BRENT JOSEPH LAROSA, OF MARYLAND MICHAEL S. BURKE the previous order, the Senate stands ALEXI LEFEVRE, OF FLORIDA HEATHER M. CARTER adjourned until 9 a.m. tomorrow. IAN MACKENZIE, OF MASSACHUSETTS ROBERT R. EDWARDS, JR. JUAN D. MARTINEZ, OF NEW YORK KURTIS W. FAUBION There being no objection, the Senate, KELLY JEAN MCANERNEY, OF PENNSYLVANIA D. SCOTT GUERMONPREZ at 7:44 p.m., adjourned until Saturday, MAUREEN A. MCNICHOLL, OF ILLINOIS JASON T. HALL GREGORY MEIER, OF CALIFORNIA SCOTT J. HILMES December 12, 2009, at 9 a.m. MARC A.J. MELINO, OF WASHINGTON THOMAS M. HUNTER MATAN MEYER, OF FLORIDA JEFFERY F. JONES f BENJAMIN J. MILLS, OF NEW MEXICO ELMO J. ROBISON III SEAN P. MOFFATT, OF MARYLAND R. BRUCE ROEHM NOMINATIONS CHARLES VINCENT MURPHY, OF CALIFORNIA HERBERT C. SCOTT LINDA A. NEILAN, OF NEW JERSEY JAMES A. SPERL Executive nominations received by EMILY YASMIN NORRIS, OF MASSACHUSETTS THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT the Senate: ELIZABETH CURRAN O’ROURKE, OF ILLINOIS TO THE GRADE INDICATED IN THE UNITED STATES AIR MARY LILLIAN PELLEGRINI, OF NEW HAMPSHIRE FORCE UNDER TITLE 10, U.S.C., SECTION 624: TENNESSEE VALLEY AUTHORITY LISA MARIE PETZOLD, OF MASSACHUSETTS KATHRYN STANSBURY PORCH, OF MARYLAND To be colonel MARILYN A. BROWN, OF GEORGIA, TO BE A MEMBER OF MARIA DEL PILAR QUIGUA, OF MASSACHUSETTS SEAN W. DIGMAN THE BOARD OF DIRECTORS OF THE TENNESSEE VALLEY RYAN M. QUINN, OF WISCONSIN LARRY J. EVANS AUTHORITY FOR A TERM EXPIRING MAY 18, 2012, VICE SCOTT RULON RASMUSSEN, OF WASHINGTON TOMMY D. FISHER SUSAN RICHARDSON WILLIAMS, TERM EXPIRED. LEA PALABRICA RIVERA, OF NEW YORK MICHAEL E. FULTON TANYA ELAINE ROGERS, OF TEXAS ALLEN J. HEBERT, JR. NUCLEAR REGULATORY COMMISSION SUSAN ROSS, OF NEW YORK GERALD P. KABAN ZACHARY R.S. ROTHSCHILD, OF THE DISTRICT OF CO- WILLIAM CHARLES OSTENDORFF, OF VIRGINIA, TO BE ANGELA M. MONTELLANO LUMBIA A MEMBER OF THE NUCLEAR REGULATORY COMMISSION JACOB E. PALMA LAUREN C. SANTA, OF THE DISTRICT OF COLUMBIA FOR THE REMAINDER OF THE TERM EXPIRING JUNE 30, HYEKYUNG HELENA PAE PARK TODD BENSON SARGENT, OF VERMONT 2011, VICE DALE KLEIN, RESIGNED. PHILLIP C. PORTERA MONICA A. SLEDJESKI, OF NEW YORK ROGER E. PRADELLI DEPARTMENT OF DEFENSE MATTHEW BOUTON STANNARD, OF CALIFORNIA ROBERT V. REINHART, JR. MATTHEW M. STEED, OF CALIFORNIA DAVID L. ROBINSON SHARON E. BURKE, OF MARYLAND, TO BE DIRECTOR OF DAVID S. STIER, OF NEW YORK OPERATIONAL ENERGY PLANS AND PROGRAMS. (NEW ANNA STINCHCOMB, OF THE DISTRICT OF COLUMBIA THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT POSITION) CASSIE COADY SULLIVAN, OF NEW YORK TO THE GRADE INDICATED IN THE UNITED STATES AIR FOREIGN SERVICE VIOLETA TALANDIS, OF MARYLAND FORCE UNDER TITLE 10, U.S.C., SECTION 624: DANIEL J. TARAPACKI, OF NEW YORK THE FOLLOWING-NAMED PERSONS OF THE AGENCIES TIMOTHY TRANCHILLA, OF THE DISTRICT OF COLUMBIA To be colonel INDICATED FOR APPOINTMENT AS FOREIGN SERVICE OF- GREGORY J. VENTRESCA, OF NEW YORK ALBERT H. BONNEMA FICERS OF THE CLASSES STATED. DOMINGO J. VILLARONGA, OF NEW YORK MARK J. BROOKS FOR APPOINTMENT AS FOREIGN SERVICE OFFICER OF NICHOLAS VON MERTENS, OF NEW HAMPSHIRE MARY T. BRUEGGEMEYER CLASS THREE, CONSULAR OFFICER AND SECRETARY IN DARREN WANG, OF CALIFORNIA JAMES H. BURDEN, JR. THE DIPLOMATIC SERVICE OF THE UNITED STATES OF THOMAS CHARLES WEBER, OF TEXAS BRET D. BURTON AMERICA, JOHN NOEL WINSTEAD, OF WYOMING THOMAS N. CHEATHAM WILLIAM QIAN YU, OF WASHINGTON DEPARTMENT OF STATE NICOLA A. CHOATE IN THE AIR FORCE BRANDON D. CLINT SEAN J. MCINTOSH, OF NEW YORK CHARLES D. CLINTON THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT MARK R. COAKWELL FOR APPOINTMENT AS FOREIGN SERVICE OFFICER OF TO THE GRADE INDICATED IN THE UNITED STATES AIR MARCUS M. CRANSTON CLASS FOUR, CONSULAR OFFICER AND SECRETARY IN FORCE UNDER TITLE 10, U.S.C., SECTION 624: BRIAN K. CROWNOVER THE DIPLOMATIC SERVICE OF THE UNITED STATES OF To be colonel ERIC W. FESTER AMERICA: DAVID GARRETT, JR. DEPARTMENT OF STATE NOEMI ALGARINLOZANO PHILIP L. GOULD CAROL ANN BARCLA ANDREWS PAUL E. GOURLEY JILLIAN FRUMKIN BONNARDEAUX, OF VIRGINIA SUSAN F. BALL NABIL M. HABIB LYNDA J. HINDS, OF CALIFORNIA SUSAN E. BASSETT BENJAMIN A. HARRIS YOLANDA D. BLEDSOE KAREN A. HEUPEL THE FOLLOWING—NAMED MEMBERS OF THE FOREIGN KEVIN J. BOHAN JAMES L. JABLONSKI II SERVICE TO BE CONSULAR OFFICERS AND SECRETARIES KAREN L. CHURCH WILMER T. JONES III IN THE DIPLOMATIC SERVICE OF THE UNITED STATES OF STEPHEN K. DONALDSON JAMES A. KEENEY AMERICA: CAROLE A. FARLEY MICHAEL R. KOTELES DEPARTMENT OF STATE ANNETTE S. GABLEHOUSE JOHN P. LYNCH VIRGINIA A. GARNER DEBRA L. MALONE RYAN AIKEN, OF UTAH DANIEL E. GERKE RANDY O. MAUFFRAY R. ANDREW ALLEN, OF GEORGIA PENELOPE F. GORSUCH RANDALL R. MCCAFFERTY NATALIA ALMAGUER, OF FLORIDA VIVIAN C. HARRIS KENT D. MCDONALD LAURA AYLWARD, OF WASHINGTON MADELINE D. HOWELL WILLIAM F. MOORE JENNIFER AZARI, OF NEW JERSEY AMELIA L. HUTCHINS PAUL H. NELSON KARA B. BABROWSKI, OF FLORIDA BILLYE G. HUTCHISON MARRINER V. OLDHAM ZACHARY BAILEY, OF VIRGINIA DENISE R. IRIZARRY TIMOTHY R. PAULDING JUDITH E. BAKER, OF MASSACHUSETTS ALETA P. JEFFERSON GARY A. PEITZMEIER ESTHER F. BELL, OF RHODE ISLAND GUYLENE D. KRIEGHFLEMING TODD W. POINDEXTER

VerDate Nov 24 2008 05:30 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00094 Fmt 0624 Sfmt 9801 E:\CR\FM\G11DE6.088 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE December 11, 2009 CONGRESSIONAL RECORD — SENATE S13065

MICHAEL G. RAPPA TODD P. HUHN AARON T. KRANCE TODD E. RASMUSSEN JON R. JACOBSON JAE S. LEE ROCKY R. RESTON JOEL W. JENNE LOUIS JOSEPH MARCONYAK, JR. JOANN Y. RICHARDSON DAVID S. JONES AMY G. MASON EDGAR RODRIGUEZ LOREN M. JONES SHAWN P. MCMAHON LOWELL G. SENSINTAFFAR THOMAS E. KIBELSTIS BRENT A. MILNE STACY A. SHACKELFORD PAUL KLIMO, JR. TAMARA A. MURRAY TERESA M. SKOJAC MICHELE L. KNIERIM LOSCAR N. PEREZVELEZ LEIGH A. SWANSON JANA S. KOKKONEN COURTNEY A. SCHAPIRA MICHAEL S. TANKERSLEY JAMES B. KOPP NICHOLAS D. SCHULTE GRANT P. TIBBETTS ELLA B. KUNDU NATHAN T. SCHWAMBURGER DEREK K. URBAN NIRVANA KUNDU JELENA C. SEIBOLD SCOTT A. VANDEHOEF ALEX J. LEE LORA R. SKEAHAN BRYAN M. VYVERBERG JEFFREY D. LEWIS DRAGOS STEFANDOGAR GEORGE A. WADDELL KARYN C. LEWIS JAMES R. VANDRE LESLIE A. WILSON KEEGAN M. LYONS LANCE R. WASHBURN RAWSON L. WOOD DANIEL S. MADSEN DENNIS J. WEBER II JON B. WOODS CHARLES G. MAHAKIAN RACHEL A. WEBER SCOTT D. ZALESKI MARIA I. MARTINO GIANNA R. ZEH PHILLIP E. MASON THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT DEREK A. MATHIS TO THE GRADE INDICATED IN THE UNITED STATES AIR THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT EDWARD L. MAZUCHOWSKI II FORCE UNDER TITLE 10, U.S.C., SECTION 624: TO THE GRADE INDICATED IN THE UNITED STATES AIR HOWARD J. MCGOWAN To be major FORCE UNDER TITLE 10, U.S.C., SECTION 624: DONALD J. MCKEEL To be lieutenant colonel MICHAEL D. MICHENER ERIC E. ABBOTT QUINTESSA MILLER ERIK L. ABRAMES ERIC R. BAUGH, JR. BRIAN A. MOORE VAN W. ADAMSON DORON BRESLER PAUL M. MORTON JASON M. ALLEN STEPHEN H. CHARTIER SAMUEL B. MUNRO MICHAEL A. AROCHO JILL A. CHERRY DANIEL H. MURRAY ANGELE J. ARTHUR ORLANDO L. COLONCONCEPCION HAFEZ A. NASR JOSEPH R. BABER FREDERICK A. CONNER BRETT R. NISHIKAWA MICAH J. BAHR GREGORY A. CONNER WILLIAM C. OTTO CARRIE G. BAKER MARVIN CONRAD SARAH M. PAGE ERIK A. BAKER JONATHAN D. EVANS WESLEY D. PALMER TROY W. BAKER DANIEL B. GABRIEL GILBERTO PATINO KEVIN J. BALDOVICH MICHAEL T. GARDNER JUDITH E. PECK JEREMY W. BALDWIN CECILIA I. GARIN ALYSSA C. PERROY JAMES R. BALES DAVID E. HALL TIMOTHY M. PHILLIPS RYAN A. BARENCHI DENNIS M. HOLT BRIAN J. PICKARD ROBERT T. BARIL DAVID M. JONES ROBERT R. PORCHIA CHRISTOPHER W. BATES MIKELLE L. KERNIG TONYA S. RANS GAIL C. BATES JAMES DALE KISER, JR. NATALIE L. RESTIVO CLAIRALYN L. BAUCOM KELLI C. MACK MARK G. RIEKER TIMOTHY S. BAUMGARTNER ROBERT K. MCGHEE ERIC M. RITTER ELIZABETH A. BEAL KATHERINE R. MORGANTI JENNIFER M. RIZZOLI AMY S. BECK BARRY F. MORRIS MARK O. ROBINSON SCOTT J. BENTLEY JESSE MURILLO KYLE M. ROCKERS WILLIAM A. BETHEA JEANLUC G. C. NIEL GEOFFREY T. SASAKI CHARLES A. BEVAN III KYLE W. ODOM STEPHANIE A. SAVAGE DAVID K. BIGELOW INAAM A. A. PEDALINO CHRIS A. SCHEINER BRANDON J. BINGHAM KYLE E. PELKEY STEPHEN E. SCRANTON CHRISTOPHER D. BLACK AIDA M. SOLIVANORTIZ JIFFY C. SETO KWABENA L. BLANKSON YOUNG K. SUNG ANDREA D. SHIELDS CALE WALTER BONDS JOHN A. THOMAS DANIEL A. SHOEMAKER KEVIN S. BORCHARD JAMES R. THOMPSON REBECCA W. SHORT ERNEST E. BRAXTON WILLIAM K. TUCKER TERESA A. SIMPSON HEATHER K. BRIGHT GEORGE S. TUNDER, JR. ROMMEL B. SINGH PAMELA J. BRODERICK KARYN E. YOUNG JOHN HWA SLADKY AMY N. BROWN KEVIN E. STEEL DANIEL J. BROWN THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT ELIZABETH DOKFA P. STEWART MICHAEL J. BUYS TO THE GRADE INDICATED IN THE UNITED STATES AIR MARK A. SUMMERS SUSAN J. CARBOGNIN FORCE UNDER TITLE 10, U.S.C., SECTION 624: DEENA E. SUTTER MICHAEL H. CARPENTER To be lieutenant colonel LON J. TAFF KATRINA CARTER PATRICK J. THOMPSON DAVID J. CASSAT ADAM M. ANDERSON RAMONE A. TOLIVER ELISE M. CHAMBERS BRETT C. ANDERSON MARK S. TOPOLSKI NATALIE G. CHAN ROBERT S. ANDREWS EDDIE H. UY MICHAEL J. CLEGG DAVID E. ANDRUS JOSEPH D. VILLACIS NATHAN F. CLEMENT MARIA M. ANGLES KIRSTEN R. VITRIKAS TIMOTHY J. COKER MARY CATHERINE ARANDA DANIEL R. WALKER JASON A. COMPTON JORGE ARZOLA DAVID T. WANG TARA L. CONNER SHAWN M. BAKER YUANHONG WANG JAMES R. COONEY KIMBERLY M. BALOGH JOHN C. WHEELER GEOFFREY J. COOPER ANTHONY S. BANKES PATRICK F. WHITNEY SUSANNAH C. COOPER JEFFREY W. BARR MAUREEN N. WILLIAMS CHRISTINA L. CRISTALDI PETRAN J. BEARD LEE T. WOLFE SPENCER J. CURTIS RICHARD W. BENTLEY GRAND F. WONG AUGUSTA L. CZYSZ JEFFREY J. BIDINGER ROGER A. WOOD DANIEL F. DAVENPORT JAMES A. BLEDSOE HENRY ALLEN WOODS, JR. AMY M. DAVIS DENNIS F. BOND II JOSHUA L. WRIGHT JESSICA M. DAVIS CRAIG D. BOREMAN JOY C. WU RICHARD P. DAVIS STACEY L. BRANCH SHAHID A. ZAIDI JONATHAN A. DAY BRETT D. BRIMHALL AUTUMN N. DEAN SCOT E. CAMPBELL THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT MELISSA J. DOOLEY FRANCIS R. CARANDANG TO THE GRADE INDICATED IN THE UNITED STATES AIR BRANDEN G. DUFFEY GABRIELLA CARDOZAFAVARATO FORCE UNDER TITLE 10, U.S.C., SECTION 624: SPENCER G. DUNCAN DAVID H. CARNAHAN To be major STEPHEN T. ELLIOTT BRYCHAN K. CLARK JONATHAN E. ELLIS DAREN S. DANIELSON BRIAN J. ALENT JOEL B. ELTERMAN PAUL BARTOLOMEO DIDOMENICO AYMAN M. ALI MICHELLE M. ENGELKEN GEORGE M. DOCKENDORF ZACHARY D. ALLMAND JOSEPH K. ERBE JAMISON W. ELDER ELIZABETH A. BOWMAN WILLIAM R. ERRICO ANN S. FENTON JEFFREY R. BURROUGHS DONALD S. EULER, JR. COLLEE FITZPATRICKWEISBROD JAN R. CARLSON ROGER N. EWONKEM JAY T. FLOTTMANN BENJAMIN T. CLARK TIMOTHY D. FAGEN SARAH O. FORTUNA JEFFREY E. CULL SHANNON D. FARAG CURTIS M. FOY SHONNA R. CURRY DAVID D. FARNSWORTH DOUGLAS S. FRENIA JESSICA N. DEAN MELINDA G. FIERROS KELLY D. GAGE DAVID M. DENNISON COREY D. FINCH JOSEPH P. GALLAGHER JENNIFER M. DEPEW AUSTIN D. FINDLEY MICHAEL S. GARRETT RYAN M. DIEPENBROCK CARRIE E. FLANAGAN VERONICA M. GONZALEZ MATTHEW J. EDWARDS STACY F. FLETCHER THERESA B. GOODMAN JEFFREY D. FLEIGEL III FREDERICK L. FLYNT, JR. WADE T. GORDON DANIEL D. FRIDMAN CRISTINA L. FRANCHETTI NOAH H. GREENE BENJAMIN J. GANTT RYAN D. FREELAND LOUIS Q. GUILLERMO LANNY J. GIESLER SHAWN K. FRENCH ERIC S. HALSEY PHILLIP J. HARVEY SCOTT H. FRYE DERRICK A. HAMAOKA CYNTHIA HERNANDEZFALU DANIEL L. GALLO MATTHEW P. HANSON SHAWNA N. HOFFERT JOHN G. GANCAYCO KARIN N. HAWKINS LAQUANIS S. HOOKER RYAN F. GIBBONS BRET D. HEEREMA LAWERENCE S. HORNE GUY N. GIBSON ERIC J. HICK HANLING H. JOSWICK SHAUN M. GIFFORD JAMES M. HITCHCOCK NEIL C. KESSEL PHILLIP J. GOEBEL CRYSTAL L. HNATKO JONGSUNG KIM MICHELLE NICOLE GONZALEZ KYLE B. HUDSON JERED B. KING JASON C. GOODWIN SCOTT W. HUGHES KRISTEN B. KNODEL ZACHARY P. GORAL

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00095 Fmt 0624 Sfmt 9801 E:\CR\FM\A11DE6.036 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE S13066 CONGRESSIONAL RECORD — SENATE December 11, 2009

JOSE B. GOROSPE KATHRYN R. OUBRE HEATHER J. FAGAN MARIA E. GOROSPE JEREMY W. OWENS DANIEL M. FROEHLICH ERIC S. GRAJKOWSKI CHI NA PAK DEON M. GREEN GIOVI GRASSOKNIGHT BRET L. PALMER JOHN A. HAMNER II BRIAN J. GROAT BRUCE M. PALMER JAMES G. HARWOOD FREDERICK P. GROIS III BENJAMIN J. PARK TIMOTHY P. HAYES, JR. AJIT GUBBI ROGER T. PARK KEVEN J. KERCHER MICHELLE S. GUCHEREAU JASON D. PASLEY MAUREEN A. KOHN MICHAEL S. HAMPTON JOSHUA B. PEAD RODNEY R. LEMAY TRISTAN E. HANDLER CANDACE S. PERCIVAL ERIC D. MAGNELL BRENT S. HARLAN SERAFIM PERDIKIS ROBERT L. MANLEY III CORTNEY ELIZABETH HARPER SARA LYNN PETERSONSCHRADER ANDRAS M. MARTON JEFFREY N. HARRIS ANDREW J. PETERSON SEAN T. MCGARRY NOAL I. HART KRISTINE K. PIERCE OREN H. MCKNELLY WILLIAM A. HAYES II DARREN S. PITTARD MICHAEL D. MIERAU, JR. KEVIN F. HEACOCK BRANDON W. PROPPER RUSSELL N. PARSON SARAH M. HEDRICK JAMIE M. RAND KELLI L. PETERSEN JASON A. HIGEY PHILLIP J. REDD EMILY C. SCHIFFER JASON H. HINES ANDREW G. REES THOMAS E. SCHIFFER THAO T. B. HO SUSAN L. REESE CHRISTINE M. SCHVERAK DIANE C. HOMEYER CHRISTOPHER A. REGNIER DAVID T. SCOTT JACOB G. HOOVER STEVEN REGWAN KARIN G. TACKABERRY WILLIAM R. HOWARTH AMANDA B. RICHARDS NELSON J. VANECK JUSTIN C. HUANG TIGHE C. RICHARDSON AARON A. WAGNER ISAAC P. HUMPHREY JONATHAN M. RICKER CHARLES W. WALLACE KYLE F. JARNAGIN JILL E. ROTH SCOTT D. WALTERS TAUNYA M. JASPER JUSTIN P. ROWBERRY MARTIN N. WHITE KEVIN N. JENSEN JAIME RUIZ PEREZ ERIC W. YOUNG JULIE C. JERABEK PETER R. SABATINI D004179 ASHLEY B. JOHNSON DERICK A. SAGER COLLEEN N. JOHNSON STEPHEN C. SAMPLE IN THE MARINE CORPS SARA KAY LUTTIO JOHNSTONE RICHARD J. SAXEN FRANCES J. JONES THE FOLLOWING NAMED OFFICER FOR TEMPORARY RANDAL S. SCHOLMA LASONYA D. JONES APPOINTMENT TO THE GRADE INDICATED IN THE KARA S. SCHULTZ OSCAR B. JONES UNITED STATES MARINE CORPS UNDER TITLE 10, U.S.C., ROSS A. SCHUMER ROBERT J. JONES, JR. SECTION 6222: REBEKAH A. SENSENIG KEVIN KALWERISKY TRISTAN L. SEVDY ALEXANDER P. KELLER IV To be major JONATHAN B. SHAPIRO JARED C. KELSTROM BRIAN J. DIX TIMOTHY P. KENNARD CHARLOTTE A. SHEALY MEHDI C. SHELHAMER KEIRON T. KENNEDY IN THE AIR FORCE SARA S. KERLEY MARK E. SHEPHERD JONATHAN R. KEVAN GREGORY A. SKOCHKO THE FOLLOWING NAMED OFFICER FOR APPOINTMENT JEREMY P. KILBURN CLARISA I. SMITH IN THE RESERVE OF THE AIR FORCE TO THE GRADE INDI- DANNY S. KIM TRIMBLE L. SPITZER CATED UNDER TITLE 10, U.S.C., SECTION 12203: JEFFREY D. KISER TRAVIS A. STEPHENSEN DAVID A. KLEIN HEATHER L. STEWART To be brigadier general NORMAN E. STONE III ELIZABETH A. KLEWENO COL. DIXIE A. MORROW SHANNON F. KLUMP STEPHEN T. D. STOREY JOSHUA H. KNOWLES LISA E. STRICKLAND THE FOLLOWING NAMED OFFICER FOR APPOINTMENT JAMES B. KOCH SARAH J. STRINGER IN THE RESERVE OF THE AIR FORCE TO THE GRADE INDI- KATHERINE A. KOCZAN JAMIE M. SWARTZ CATED UNDER TITLE 10, U.S.C., SECTION 12203: CALEB E. KROLL ROBERT C. SWIFT THOMAS J. KRYZAK RAMON N. THOMAS To be brigadier general ROGER S. THOMAS BRIAN D. LARSON COL. PAUL S. DWAN JOSHUA L. LATHAM GINA M. THOMASON ZHI V. LAU KATHERINE S. TILLE THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT RANDY A. LEACH PAUL A. TILTON IN THE UNITED STATES AIR FORCE TO THE GRADE INDI- CHRISTOPHER C. LEDFORD JAMES R. TOWNLEY CATED UNDER TITLE 10, U.S.C., SECTION 624: RYAN S. LEE PETER T. TRAN JADE A. LHEUREUX TIM P. TRAN To be brigadier general JOHN LICHTENBERGER III RONALD J. URTON ANDREW R. W. VACLAVIK COL. DANIEL B. FINCHER APRIL LIGATO COL. DAVID C. WESLEY PEICHUN LIN FLORA P. VARGHESE DOUGLAS R. VILLARD SCOTT R. LINK THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT ADAM P. VOSSEN NANCY W. LO IN THE RESERVE OF THE AIR FORCE TO THE GRADE INDI- TERENCE E. WADE GUSTAVO A. LOPES CATED UNDER TITLE 10, U.S.C., SECTION 12203: WILLIAM N. LUTHIN DENNIS D. WALKER DUSTIN O. LYBECK ANDREW L. WALLS To be brigadier general MEIKEL P. MAJOR YANG WANG COLONEL GARY C. BLASZKIEWICZ LOU ROSE M. MALAMUG JEREMIAH R. WATKINS COLONEL ARTHUR C. HAUBOLD JELRIZA C. B. MANSOURI LARISSA F. WEIR COLONEL MICHAEL D. KIM DAVID J. MARTINEZ CHRISTINA M. WELCH COLONEL LINDA S. MARCHIONE AMELITA A. MASLACH DALIA J. WENCKUS COLONEL RICHARD O. MIDDLETON II JOEL G. MASSEY JENNIFER L. WHATLEY COLONEL ROBERT N. POLUMBO JAMIE A. MASSIE BRAD E. WHEELER COLONEL JANE C. ROHR RENEE I. MATOS CALEN N. WHERRY COLONEL PATRICIA A. ROSE MICHAEL J. MATSUURA BENJAMEN H. WILLIAMS COLONEL PETER SEFCIK, JR. MICHAEL J. MATTEUCCI PHILIP A. WIXOM COLONEL JAMES F. SMITH JEFFREY C. MCCLEAN EMILY B. WONG COLONEL EDMUND D. WALKER MARC D. MCCLEARY AARON F. WOODWARD COLONEL WILLIAM O. WELCH RISPBA N. MCCRAYGARRISON JEFFREY S. WOOLFORD BRIAN W. WRITER TORREE M. MCGOWAN IN THE NAVY RYAN S. MCHUGH DUOJIA XU CHRISTOPHER C. MEDINA ETHAN EVERETT ZIMMERMAN THE FOLLOWING NAMED OFFICER FOR APPOINTMENT WAYNE J. MERBACK IN THE ARMY IN THE UNITED STATES NAVY TO THE GRADE INDICATED BRADLEY R. MEYER WHILE ASSIGNED TO A POSITION OF IMPORTANCE AND LISA R. MICHELS THE FOLLOWING NAMED OFFICERS FOR APPOINTMENT RESPONSIBILITY UNDER TITLE 10, U.S.C., SECTION 601: CHARLES B. MILLER TO THE GRADE INDICATED IN THE UNITED STATES ARMY SHANNA M. MOLINA JUDGE ADVOCATE GENERAL’S CORPS UNDER TITLE 10, To be vice admiral U.S.C., SECTIONS 624 AND 3064: JEREMY D. MOLL VICE ADM. DAVID ARCHITZEL TYLAN A. MUNCY To be lieutenant colonel BRIAN H. NEESE IN THE MARINE CORPS COURTNEY R. NELSON OLGA M. ANDERSON SHERWIN P. NEPOMUCENO DAVID O. ANGLIN THE FOLLOWING NAMED OFFICER FOR APPOINTMENT KHANG H. NGUYEN JASON M. BELL IN THE UNITED STATES MARINE CORPS TO THE GRADE JOSEPH D. NOVAK ROSEANNE M. BENNETT INDICATED UNDER TITLE 10, U.S.C., SECTION 5046: VALERIE C. OBRIEN DEIRDRE G. BROU To be major general KEVIN L. OLSON MARY E. CARD ROBERT M. ORE JONATHAN E. CHENEY COL. VAUGHN A. ARY

VerDate Nov 24 2008 03:56 Dec 12, 2009 Jkt 089060 PO 00000 Frm 00096 Fmt 0624 Sfmt 9801 E:\CR\FM\A11DE6.039 S11DEPT1 jbell on DSKDVH8Z91PROD with SENATE