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Pdf, and Submitted Electronically, Either on a Disk to Accompany the Signed Statement, Or by E-Mail to the Official Reporters of Debates at ‘‘Record@Sec.Senate.Gov’’

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, TUESDAY, DECEMBER 22, 2009 No. 198 House of Representatives The House was not in session today. Its next meeting will be held on Wednesday, December 23, 2009, at 11:30 a.m. Senate TUESDAY, DECEMBER 22, 2009

The Senate met at 7 a.m. and was Eternal Spirit, whom we seek in vain and stress, and let their ordered lives called to order by the Honorable ED- without unless first we find You with- confess the beauty of Your peace. Fill WARD E. KAUFMAN, a Senator from the in, may the hush of Your presence fall them so full of Your goodness that State of Delaware. upon our spirits, quiet our minds, and they will know how to discern Your allay the irritations that threaten our best for their decisions. Make them PRAYER peace. Breathe through the heat of our faithful leaders by Your standard of The Chaplain, Dr. Barry C. Black, of- desires Your coolness and balm. fered the following prayer: Strengthen the Members of this righteousness. Let us pray. body. Take their spirits from strain We pray in Your Holy Name. Amen.

NOTICE If the 111th Congress, 1st Session, adjourns sine die on or before December 26, 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.

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S13713

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00001 Fmt 0637 Sfmt 8633 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13714 CONGRESSIONAL RECORD — SENATE December 22, 2009 PLEDGE OF ALLEGIANCE time for any personal attacks or any- cuts to Medicare. This is a time when The Honorable EDWARD E. KAUFMAN thing that is acrimonious. It is time to we should not be increasing taxes. led the Pledge of Allegiance, as follows: figure out a way to leave here in a Small businesses are burdened already. peaceful nature. We have the Christ- This adds to their burden. Families are I pledge allegiance to the Flag of the United States of America, and to the Repub- mas holiday coming, and we know how trying to make ends meet. They are lic for which it stands, one nation under God, important that is to families. I hope trying to pay their mortgage so they indivisible, with liberty and justice for all. everyone will work toward getting us will not be thrown out of their homes. They are trying to pay their bills. They f out of here and back to our families as quickly as we can. are trying to find jobs in the highest APPOINTMENT OF ACTING I designate the time the Democrats level of unemployment in our country PRESIDENT PRO TEMPORE have remaining to Senator DURBIN, the since World War II, and we are going to The PRESIDING OFFICER. The majority whip. heap taxes and burdens on them starting as early as next year—in 2 weeks. clerk will please read a communication f to the Senate from the President pro This is not a time to raise taxes. We tempore (Mr. BYRD). RESERVATION OF LEADER TIME don’t need a tax burden increase, we The legislative clerk read the fol- The ACTING PRESIDENT pro tem- don’t need Medicare cuts, and we do lowing letter: pore. Under the previous order, the need health care reform that would lower the cost of health care. This is U.S. SENATE, leadership time is reserved. PRESIDENT PRO TEMPORE, going to do the opposite. We are going f Washington, DC, December 22, 2009. to increase taxes and lower the service To the Senate: SERVICE MEMBERS HOME for Medicare in our country. Under the provisions of rule I, paragraph 3, OWNERSHIP TAX ACT OF 2009 I remember reading some of the his- of the Standing Rules of the Senate, I hereby tory and the anecdotes about the vote appoint the Honorable EDWARD E. KAUFMAN, The ACTING PRESIDENT pro tem- on the constitutional amendment to a Senator from the State of Delaware, to pore. Under the previous order, the allow women the right to vote. There perform the duties of the Chair. Senate will resume consideration of was a Congressman from Tennessee ROBERT C. BYRD, H.R. 3590, which the clerk will report. President pro tempore. who was wavering. He said what finally The legislative clerk read as follows: made up his mind—and he was the Con- Mr. KAUFMAN thereupon assumed A bill (H.R. 3590) to amend the Internal gressman who made the difference— the chair as Acting President pro tem- Revenue Code of 1986 to modify the first-time was that his mother wrote him a letter pore. homebuyers credit in the case of members of the Armed Forces and certain other Federal and said: Vote for ratification. f employees, and for other purposes. What is going to be said about this bill that changes health care policy for RECOGNITION OF THE MAJORITY Pending: LEADER every American? What is going to be Reid amendment No. 2786, in the nature of written about how the votes were The ACTING PRESIDENT pro tem- a substitute. brought together to have a bill that pore. The majority leader is recog- Reid amendment No. 3276 (to amendment would tax our American people $1⁄2 tril- nized. No. 2786), of a perfecting nature. Reid amendment No. 3277 (to amendment lion and take Medicare as the pay-for f No. 3276), to change the enactment date. for this program is that there will be SCHEDULE Reid amendment No. 3278 (to the language essential protection for seniors in Flor- proposed to be stricken by amendment No. ida and New York to prevent them Mr. REID. Mr. President, following 2786), to change the enactment date. from suffering the cuts to Medicare Ad- leader remarks, the Senate will resume Reid amendment No. 3279 (to amendment vantage but no other State. Insurance consideration of the health care legis- No. 3278), to change the enactment date. companies in only two States, Ne- lation. The time until 7:18 this morning The ACTING PRESIDENT pro tem- braska and Michigan, are exempt from is equally divided and controlled be- pore. Under the previous order, the the taxes that will take effect on insur- tween the two leaders or their des- time until expiration of cloture on ance companies, raising the premiums ignees. The Senate will then proceed to amendment No. 3276 shall be equally for every insured person in this coun- a series of three rollcall votes—they divided and controlled between the two try. Changes to the language restrict- will be stacked—in relation to the Reid leaders or their designees. ing physician ownership of medical fa- motion to table the Reid amendment The Senator from Texas is recog- cilities appear only to benefit a single No. 3278, the Reid-Baucus-Dodd-Harkin nized. medical center in Nebraska, and addi- amendment No. 3276, and a motion to Mrs. HUTCHISON. Mr. President, I tional Federal payments to Louisiana, invoke cloture on the Reid substitute will be taking the leader time on our Massachusetts, Nebraska, and Vermont No. 2786. If cloture is invoked, the ma- side. How much time is there? to expand Medicaid will cost taxpayers jority leader will then be recognized, The ACTING PRESIDENT pro tem- in every other State in America over $1 and then the time until 9:30 will be pore. Six minutes. billion. This is part of the deal that equally divided and controlled between Mrs. HUTCHISON. I thank the Chair. was brokered to make sure 60 votes the two leaders or their designees. Be- Mr. President, today we are taking would pass this bill. The people of Ne- ginning at 9:30 a.m. and until 5:30 p.m. another step toward passing a bill that braska will never pay a dime for Med- today, the time will be controlled in al- has not seen the light of day for very icaid increases, whereas my State of ternating 1-hour blocks of time, with long. It is a bill that is going to change Texas will carry a new burden of over the Republicans controlling the first health care policy in this country for- $9 billion, and every other State in hour. The Senate will recess from 12:30 ever if it is finally coming to enact- America will eventually take the bur- until 2:30 p.m. today for the weekly ment. It will take effect in 2014. The den of the Medicaid increases but not conferences. reason we are talking about this bill Nebraska, not ever. Even the Governor f and trying to let people know what is of Nebraska has said he does not think in it is because we hope there is still a that is fair. CHRISTMAS PEACE chance this bill will not become law. So I think we can do better. We can Mr. REID. Mr. President, tensions This bill was drafted behind closed do better in this country than having have been high because of this legisla- doors without Republican input. The the history of the overhaul of our tion which has been on the floor for a votes are 60 to 40. Sixty Democrats and health care system that is going to af- considerable period of time. I hope ev- 40 Republicans make up the Senate, fect the quality of life and the tax bur- eryone understands that this part of and that is what is providing cloture den on every American. I think we the session is winding down, and I hope on this bill. should have a better history. everyone will go out of their way to be This bill increases taxes by over $1⁄2 So I am asking my colleagues to thoughtful and considerate to those on trillion over a 10-year period—that is think about this vote. We could change both sides of the aisle. This is not the over $500 billion—and $1⁄2 trillion in one vote, one person who says: I don’t

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00002 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13715 want the Senate to do something this Republican Senator would vote for it. to millions of others that you have way. I want the Senate to rise to the Senator COBURN of Oklahoma offered coverage that will not be there when level that we know has been the tradi- and had accepted 38 amendments to you need it—we have to bring that to tion of this Senate for all of the years this bill and wouldn’t vote for it. Other an end. of our Republic, and that is that we Senators were the same. They had As Senator HARKIN said the other day would have an open, transparent proc- their chance, and they didn’t use their in closing the debate, this is a real de- ess; that we would have bipartisan chance. In fact, the record shows now bate over whether health care will be a input; that a Republican amendment— that after almost a year of delibera- right or a privilege in America. If you one might have passed; that what we tions, we have one Republican Con- believe it is a privilege for those who offer is what we promised the Amer- gressman from New Orleans, LA, who are wealthy and well off, then, of ican people: lower costs in health voted for the House health care reform course, you will vote against this. If care—— proposal, and one Republican Senator, you believe it is a right that should be The ACTING PRESIDENT pro tem- Ms. SNOWE of Maine, who voted for the extended to more Americans, I hope pore. The Senator’s time has expired. Finance Committee proposal. To say you will join us in supporting it. Mrs. HUTCHISON.—and a way for the Republicans have been actively en- I yield the floor. people to have more affordable access. gaged in this process is a Mr. REID. Mr. President, has all time We still have a chance. That is why misstatement. expired? we are here today. And I hope we can Here is why we have to go forward, The ACTING PRESIDENT pro tem- turn away from this process and share even if we have to meet at 7 in the pore. Forty seconds remain. the light of day with our colleagues morning or even if we have to meet Mr. REID. I yield back that time. and with America. this Christmas week. When this bill is The ACTING PRESIDENT pro tem- Thank you, Mr. President. I yield the passed, we know from the CBO several pore. The time is yielded back. floor. things will occur. First, 30 million Mr. REID. Mr. President, I move to The ACTING PRESIDENT pro tem- Americans who currently don’t have table amendment No. 3278, and I ask pore. The deputy majority leader is health insurance will have the peace of for the yeas and nays. recognized. mind of knowing they have health in- The ACTING PRESIDENT pro tem- Mr. DURBIN. Mr. President, a fa- surance. Secondly, we know 94 percent pore. Is there a sufficient second? mous Washington figure once wrote a of the American people will finally be There is a sufficient second. book entitled ‘‘Slouching Towards Go- insured—the highest percentage in the The question is on agreeing to the morrah.’’ If you were to describe what history of the United States. We know amendment. is happening in the Senate proce- the rates for health insurance pre- The clerk will call the roll. durally, we would call it lurching to- miums will start to come down, as they Mr. KYL. The following Senator is ward cloture. The cloture rules in the must, so businesses and individuals can necessarily absent: the Senator from Senate require 30 hours between votes, afford it. We know that, finally, con- Oklahoma (Mr. INHOFE). and as a consequence we find ourselves sumers across America will be able to The PRESIDING OFFICER (Mr. in the early morning hours trying to stand and fight back when health in- WHITEHOUSE). Are there any other Sen- finish this bill before the Christmas surance companies turn them down in ators in the Chamber desiring to vote? holiday, and it calls for the Senate to their moments of need. The result was announced—yeas 60, convene at extraordinary times, as we We say in this new amendment we nays 39, as follows: did this morning, but it is for a good are going to say to health insurance [Rollcall Vote No. 386 Leg.] purpose. companies: You cannot deny coverage YEAS—60 This is to bring to a close a debate to anybody under 18, any child, for a Akaka Franken Mikulski which has gone on for more than 3 preexisting condition. That is going to Baucus Gillibrand Murray weeks. You have noticed more and bring peace of mind to millions of Bayh Hagan Nelson (NE) more Republican Senators now coming American families who understand Begich Harkin Nelson (FL) Bennet Inouye Pryor to the floor with ideas and amend- that without this they couldn’t get the Bingaman Johnson Reed ments, and the obvious question we health insurance they absolutely need Boxer Kaufman Reid have to ask is, Where have you been? for their children. Brown Kerry Rockefeller For the first 21 days of debate on this Let me address quickly this notion Burris Kirk Sanders Byrd Klobuchar Schumer bill, the Republicans offered four sub- that this is somehow a mystery amend- Cantwell Kohl Shaheen stantive amendments. They offered six ment. This amendment has now been Cardin Landrieu Specter motions to take the bill off the floor, before the American public for at least Carper Lautenberg Stabenow Casey Leahy Tester send it back to committee, and quit 70 hours on the Internet. The bill itself Conrad Levin Udall (CO) the deliberations, but only four sub- has been before the American public Dodd Lieberman Udall (NM) stantive amendments. Now they say now for more than 3 weeks on the Dorgan Lincoln Warner they are just brimming with all of Internet. You can find it not only on Durbin McCaskill Webb Feingold Menendez Whitehouse these notions and ideas that can im- the Democratic Senate Web site, you Feinstein Merkley Wyden prove this bill. They had the chance. In can find it on the Republican Web site. fact, they had more than a chance. They put our bill on their Web site be- NAYS—39 They were invited into this process cause they don’t have a comprehensive Alexander Crapo Lugar Barrasso DeMint McCain early on. health care reform bill. They put ours Bennett Ensign McConnell I would say to the Senator from up for people to read. There has been Bond Enzi Murkowski Texas, she knows that 3 of her col- ample opportunity for people to read, Brownback Graham Risch leagues met over 61 times with their Bunning Grassley Roberts dissect, and to be critical of it and Burr Gregg Sessions Democratic counterparts trying to raise questions about it. Before our Chambliss Hatch Shelby come up with a bipartisan approach, final vote, America will have had its Coburn Hutchison Snowe and they couldn’t. We also know that chance to read and understand the im- Cochran Isakson Thune Collins Johanns Vitter in the Health, Education, Labor, and port of this effort and this effort is sub- Corker Kyl Voinovich Pensions Committee, the Republicans stantial. Cornyn LeMieux Wicker came and engaged in more than 50 days This is something we have built up to NOT VOTING—1 of deliberations in that committee and for decades. To finally put the Senate offered and had accepted more than 150 on record as to whether we are endors- Inhofe Republican amendments to this bill. ing the current health care system in The motion was agreed to. We were not excluding Republicans America that is unaffordable, discrimi- The PRESIDING OFFICER. The ma- from the process; they excluded them- nates against people, and leaves so jority leader. selves. When it came time for a final many behind, a system that currently AMENDMENT NO. 3277 WITHDRAWN vote in the Health, Education, Labor, rations care and says to 50 million Mr. REID. Mr. President, it is my un- and Pensions Committee, not a single Americans you have no coverage, and derstanding that the second-degree

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00003 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13716 CONGRESSIONAL RECORD — SENATE December 22, 2009 amendment has been withdrawn; is Nelson, Mark Begich, Sheldon The PRESIDING OFFICER. Without that right? Whitehouse, Roland W. Burris, Kirsten objection, it is so ordered. The PRESIDING OFFICER. Under E. Gillibrand, Ron Wyden. (The amendment is printed in the previous order, amendment No. 3277 is The PRESIDING OFFICER. By unan- RECORD of Thursday, December 3, 2009 withdrawn. imous consent, the mandatory quorum under ‘‘Text of Amendments.’’) AMENDMENT NO. 3276 call has been waived. Mr. REID. I ask for the yeas and Mr. REID. Mr. President, I ask for The question is, Is it the sense of the nays. the yeas and nays on amendment No. Senate that debate on amendment No. The PRESIDING OFFICER. Is there a 3276. 2786, as amended, offered by the Sen- sufficient second? The PRESIDING OFFICER. The yeas ator from Nevada, Mr. REID, to H.R. There is a sufficient second. and nays were previously ordered. 3590, the Service Members Home Own- The yeas and nays were ordered. The question is on agreeing to ership Tax Act of 2009, shall be brought AMENDMENT NO. 3292 TO AMENDMENT NO. 2878 amendment No. 3276. to a close? Mr. REID. I now ask the clerk to re- The clerk will call the roll. The yeas and nays are mandatory port amendment No. 3292. The assistant legislative clerk called under the rule. The PRESIDING OFFICER. The the role. The clerk will call the roll. clerk will report. Mr. KYL. The following Senator is The legislative clerk called the roll. The assistant legislative clerk read necessarily absent: the Senator from Mr. KYL. The following Senator is as follows: Oklahoma (Mr. INHOFE). necessarily absent: the Senator from The Senator from Nevada [Mr. REID] pro- The PRESIDING OFFICER. Are there Oklahoma (Mr. INHOFE). poses an amendment numbered 3292 to any other Senators in the Chamber de- The PRESIDING OFFICER (Mr. DUR- amendment No. 2878. siring to vote? BIN). Are there any other Senators in The amendment is as follows: The result was announced—yeas 60, the Chamber desiring to vote? (Purpose: To change the effective date) nays 39, as follows: The result was announced—yeas 60, At the end of the amendment, insert the [Rollcall Vote No. 387 Leg.] nays 39, as follows: following: YEAS—60 [Rollcall Vote No. 388 Leg.] This section shall become effective 5 days after enactment. Akaka Franken Mikulski YEAS—60 Baucus Gillibrand Murray Akaka Franken Mikulski Mr. REID. Mr. President, it is my un- Bayh Hagan Nelson (NE) Baucus Gillibrand Murray derstanding—Senator MCCONNELL and I Begich Harkin Nelson (FL) Bayh Hagan Nelson (NE) have agreed—I should not say I under- Bennet Inouye Pryor Begich Harkin Nelson (FL) Bingaman Johnson Reed Bennet Inouye Pryor stand—we have agreed that the time Boxer Kaufman Reid Bingaman Johnson Reed until 9:30 will be equally divided and Brown Kerry Rockefeller Boxer Kaufman Reid controlled between the two leaders, Burris Kirk Sanders Brown Kerry Rockefeller and at 9:30 we will go, as we have Byrd Klobuchar Schumer Burris Kirk Sanders Cantwell Kohl Shaheen Byrd Klobuchar Schumer worked in recent days, into having Cardin Landrieu Specter Cantwell Kohl Shaheen blocks of time until our caucuses, until Carper Lautenberg Stabenow Cardin Landrieu Specter 12:30. Casey Leahy Tester Carper Lautenberg Stabenow The PRESIDING OFFICER. The ma- Conrad Levin Udall (CO) Casey Leahy Tester Dodd Lieberman Udall (NM) Conrad Levin Udall (CO) jority leader is correct. Under the pre- Dorgan Lincoln Warner Dodd Lieberman Udall (NM) vious order, until 9:30 the time is Durbin McCaskill Webb Dorgan Lincoln Warner equally divided and controlled between Feingold Menendez Whitehouse Durbin McCaskill Webb Feinstein Merkley Wyden Feingold Menendez Whitehouse the leaders or their designees, and Feinstein Merkley Wyden under the previous order the time until NAYS—39 NAYS—39 5:30 today will be divided into 1-hour Alexander Crapo Lugar alternating blocks of time, the major- Barrasso DeMint McCain Alexander Crapo Lugar Bennett Ensign McConnell Barrasso DeMint McCain ity controlling the first block. Bond Enzi Murkowski Bennett Ensign McConnell Mr. REID. Mr. President, I ask every- Brownback Graham Risch Bond Enzi Murkowski one to acknowledge that we have our Bunning Grassley Roberts Brownback Graham Risch regular weekly caucuses at 12:30. We Burr Gregg Sessions Bunning Grassley Roberts Chambliss Hatch Shelby Burr Gregg Sessions will come back at 2:30, and we will be Coburn Hutchison Snowe Chambliss Hatch Shelby going back to blocks of time until 5:30 Cochran Isakson Thune Coburn Hutchison Snowe this evening. Collins Johanns Vitter Cochran Isakson Thune Corker Kyl Voinovich Collins Johanns Vitter The PRESIDING OFFICER. Without Cornyn LeMieux Wicker Corker Kyl Voinovich objection, it is so ordered. Cornyn LeMieux Wicker NOT VOTING—1 Mr. REID. Mr. President, I said when the Senate opened today and I will say Inhofe NOT VOTING—1 Inhofe again, because of the long hours we The amendment (No. 3276) was agreed have spent here for weeks now, there is to. The PRESIDING OFFICER. On this a lot of tension in the Senate. Feelings CLOTURE MOTION vote the ayes are 60, the nays are 39. are high, and that is fine. Everybody The PRESIDING OFFICER. Pursuant Three-fifths of the Senators duly cho- has very strong concerns about every- to rule XXII, the Chair lays before the sen and sworn having voted in the af- thing we have done and have to do. But Senate the following cloture motion firmative, the motion is agreed to. I hope everyone would go back to their which the clerk will report. The majority leader is recognized. gentlemanly ways. I was trying to fig- The assistant legislative clerk read AMENDMENT NO. 2878 ure out how to say this—gentlemanly as follows: Mr. REID. Mr. President, I ask the ways. We used to say in the House gen- CLOTURE MOTION clerk to call and report amendment No. tlewomen, so I guess it is the same We, the undersigned Senators, in accord- 2878. here. ance with the provisions of rule XXII of the The PRESIDING OFFICER. The Anyway I hope everyone has—I have Standing Rules of the Senate, hereby move clerk will report. said to a number of people—Rodney to bring to a close debate on the Reid sub- The assistant legislative clerk read King—let’s all just try to get along. stitute amendment No. 2786 to H.R. 3590, the as follows: That is the only way; we need to do it. Service Members Home Ownership Tax Act The Senator from Nevada [Mr. REID], for This is a very difficult time in the next of 2009. Mr. CARDIN, proposes an amendment No. day or so. Let’s try to work through Christopher J. Dodd, Richard Durbin, 2878. Paul G. Kirk, Jr., Max Baucus, Claire this. McCaskill, Jon Tester, Maria Cantwell, Mr. REID. I ask unanimous consent For those of the Christian faith we Barbara A. Mikulski, Mark Udall, the reading of the amendment be have the most important holiday, and Sherrod Brown, Arlen Specter, Bill waived. that is Christmas.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00004 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13717 I would hope everyone would keep in cussed are very much the principles would have to go without. The fact is mind that this is a time when we re- upon which the Finance Committee that CBO says, and I quote: flect on peace and the good things in built its bill. The principles that we The share of legal nonelderly residents life. I would hope everyone would kind discussed are very much the principles with insurance coverage would rise from of set aside all the personal animosity, reflected in the bill before us today. about 83 percent currently to about 94 per- if they have any in the next little bit, Our work began much earlier than I cent. and focus on the holiday. have indicated. We met all the pre- Nothing that Senators on the other The PRESIDING OFFICER. The mi- ceding year, held about ten hearings in side of the aisle have proposed would nority leader. the Finance Committee working to- come close. CBO estimated that the Mr. MCCONNELL. Mr. President, let ward health care reform. We also fin- Republican substitute offered in the me add, to my good friend the majority ished a white paper in November 2008. I House of Representatives would have leader, he and I have an excellent rela- say with trepidation that basically extended coverage to just 3 million tionship. We speak a number of times that is the foundation from which al- people. The fact is that CBO says of in the course of every day and have no most all ideas in health care reform that plan, and I quote: animosity whatsoever. We are working emanated. To be fair, the ideas in that The share of legal nonelderly residents on an agreement that will give cer- paper had been floating around, prin- with insurance coverage in 2019 would be tainty to the way to end this session. ciples from the Massachusetts health about 83 percent, roughly in line with the Hopefully, the two of us together can care reform, for example. Most policy current share. be recommending something that experts and health care economists I would cite the facts about the Re- makes sense for both sides in the not- who had been working on reform pub- publican substitute in the Senate. But too-distant future. lished their ideas. We sought the best, the fact is that there is no Republican The PRESIDING OFFICER. Who compiled them, and put together that substitute. yields time? white paper published in November of Some on the other side of the aisle The Senator from Montana. last year. assert that they simply prefer a more Mr. BAUCUS. What is the regular From the debate that the Senate has modest reform of health care. order? conducted this past month, you would The fact is that the Republicans con- The PRESIDING OFFICER. The time not know it. During this debate, some trolled the Senate from 1995 to 2001 and until 9:30 is equally divided between on the other side of the aisle have from 2003 to 2006. The fact is that be- the leaders or their designees. mischaracterized the bill before us. fore they took control, in 1994, 36 mil- The Senator from Montana. Some on the other side of the aisle lion Americans, 15.8 percent of non- Mr. BAUCUS. Mr. President, it has have set about a systematic campaign elderly Americans were without health been more than a month since the ma- to demonize this bill. insurance coverage. In the last year of jority leader moved to proceed to the Through bare assertion alone, with their control, in 2006, nearly 47 million health care reform bill before us today. the thinnest connection to fact, they Americans, 17.8 percent of non-elderly At long last, the Senate is now in the have sought to vilify our work. If one Americans were without health insur- final throes of passing this historic leg- listened to their assertions alone, one ance coverage. The legacy of Repub- islation. would not recognize the bill before us. lican control was 10 million more From the beginning, this Senator has And so, let me, quite simply, state Americans uninsured. sought out what Abraham Lincoln the facts. Some on the other side of the aisle called ‘‘the better angels of our na- Some on the other side of the aisle say that we are moving too fast. The fact is that it was 1912, when ture.’’ That is the way this Senator has assert that this bill is a government former President Theodore Roosevelt always sought to legislate. takeover of health care. A year and a half ago, I convened a The fact is that the nonpartisan Con- first made national health insurance bipartisan retreat at the Library of gressional Budget Office says that this part of the Progressive Party’s cam- Congress. Half a year ago, I convened bill would reduce the government’s fis- paign platform. The fact is that people three bipartisan roundtables with cal role in health care. Just 3 days ago, of good will have been working at this health care experts. Half a year ago, CBO wrote, and I quote: for nearly a century. the Finance Committee conducted The fact is, health care reform for CBO expects that the proposal would gen- America is now within reach. The fact three bipartisan walk-throughs of the erate a reduction in the federal budgetary major concepts behind the bill before commitment to health care during the dec- is, the most serious effort to control us today. ade following the 10-year budget window. health care costs is now within reach. We went the extra mile. I reached out Some on the other side of the aisle The fact is, life-saving health care cov- to my good friend, the ranking Repub- assert that this bill would add to our erage for 31 million Americans is now lican member of the Finance Com- Nation’s burden of debt. within reach. Let us, at long last, grasp that result. mittee. I reached out to the ranking The fact is that the nonpartisan Con- Let us, this time, not let this good Republican member of the HELP Com- gressional Budget Office says that this thing slip through our hands. And let mittee. bill would reduce the deficit by $132 bil- us, at long last, enact health care re- We sought to craft a bill that would lion in the first 10 years and by be- form for all. appeal to the broad middle. We sought tween $650 billion and $1.3 trillion in I suggest the absence of a quorum to craft a bill that could win the sup- the second 10 years. The fact is that and ask unanimous consent that the port of Republicans and Democrats this is the most serious deficit reduc- time be charged equally to each side. alike. tion effort in more than a decade. The PRESIDING OFFICER (Mr. We met, a group of six of us, three Some on the other side of the aisle WHITEHOUSE). Without objection, it is Democrats and three Republicans. We assert that this bill would harm Medi- so ordered. met more than 30 times. We met for care. The clerk will call the roll. months, encouraged by the President The fact is that Medicare’s inde- The legislative clerk proceeded to to do so. Our group met with the Presi- pendent actuary says that this bill call the roll. dent several times. The President en- would extend the life of Medicare by 9 Mrs. HUTCHISON. I ask unanimous couraged us to keep pursuing our nego- years. The fact is that this is the most consent that the order for the quorum tiations, hoping to reach bipartisan responsible effort to shore up Medicare call be rescinded. agreements. in more than a decade. The PRESIDING OFFICER. Without No, we did not reach a formal agree- Some on the other side of the aisle objection, it is so ordered. ment. The leadership on the other side assert that this bill does not do enough Mrs. HUTCHISON. Mr. President, are of the aisle went to great lengths to to ensure the uninsured. we now in a period where we go back stop us from doing so. The fact is that the nonpartisan Con- and forth without limit? But even though we did not reach a gressional Budget Office says that this The PRESIDING OFFICER. We are. formal agreement, we came very close bill would extend access to health care Mrs. HUTCHISON. Mr. President, I to doing so. The principles that we dis- to 31 million Americans who otherwise ask to be notified after 5 minutes, after

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But there is tion of the 10th amendment. should prevail. But not in this bill. another issue I think, looking down the I want to talk about another area My State of Texas will have almost a road, we are going to need to pursue. that I think is a stretch in this bill; $10 billion increase in its State’s share We have talked about how that is, apparently the individual man- of Medicaid because of the expansion in groundbreaking this bill is. In fact, the date is being justified by the commerce this bill. But there are States that are majority calls it historic, and it is his- clause of our Constitution. Now, the exempted from the increases and one toric. We believe it is historic in the commerce clause basically says no State that is exempted forever because bad precedents it is setting, both in State may impede interstate com- of a deal made to get that 60th vote to process and in substance. I think some merce. You may say, out in America: I pass this bill. of these precedents are going to be don’t see the connection. I am going to I think people are looking at this tested under the Constitution of the be mandated to buy health insurance issue in America today and saying: United States. or be fined if I don’t because States What has gotten into the people in I wish to start by talking about a cannot impede interstate commerce? Congress who are voting for this bill? couple of those. No. 1, in the effort to Well, I would agree with people out So, Mr. President—— get the last vote, clearly there were there that seems like a disconnect be- The PRESIDING OFFICER. The deals made. There were deals that af- cause, apparently, using the commerce Chair apologizes. The Chair did not no- fect individual States and even one clause, the majority is saying the Fed- tify the Senator at 5 minutes. The that affects two insurance companies eral Government has the right to man- Chair forgot. The Senator’s 5 minutes that will have a different treatment age insurance, and that a requirement has passed. from all the other insurance companies of an individual mandate is part of the Mrs. HUTCHISON. Mr. President, in America. It is said there will be two Federal capability to manage insur- thank you for the notification. Nebraska insurance companies that ance in this country, and you cannot I think there are issues now that will will not have to pay the tax increases impede that right by the Federal Gov- be raised going forward in the future, of the insurance companies that will be ernment because you cannot impede and there is still time for one Senator levied on all the other health insurance interstate commerce. in the 60 to change the vote. Therefore, companies. This is an issue that must I think this whole individual man- I hope one will hear from his or her be raised under the Constitution, the date issue is going to be a center for constituents enough that that person equal protection clause of the Con- discussion, debate, and opposition to will say: It is time to slow this bill stitution. To take a set of companies in the bill that is clearly moving down a down. I am going to change my vote so an industry, competitors—and we value track that we are trying to stop, but people can see all the effects that we the free market system and the free en- that train is moving. I think we are have not talked about yet, and let’s do terprise system—to pluck out two com- going to have to talk about the indi- this right. petitors and say: You will be treated vidual mandate. People are saying to We can lower the cost of health care, differently because we need your vote me: How can the Federal Government we can provide more access to more to pass this bill should be tested under tell me I have to buy insurance? I people to have health care coverage, the Constitution of the United States. think they have a point. which should be the goal of this legisla- It is my hope some insurance com- You have to buy automobile insur- tion, this massive reform of a health pany that has standing to bring this ance because, but that comes with the care system that is working for many suit will be able to test this precedent. right to drive. So you get the right, li- and has provided the best quality of It is a very bad precedent, and it is cer- censed by the State, to drive your car, health care in the world. We have a tainly bad policy to start passing laws and in exchange for that a State may chance to keep it by slowing this bill that distinguish some parts of an in- require that you have collision insur- down. That is why we are fighting. dustry versus other parts of an indus- ance on your automobile, and many That is why we are still here talking 3 try that would be treated in a different States do. But when you say you have days before Christmas. We want to stop way. I hope we will do that. to buy an insurance policy, I think this bill and do it right. Doing it right No. 2, I believe there is a 10th amend- that crosses a line where a person has is more important than doing it fast, ment issue. Here is my concern. Many a right to say: I am not going to buy and I think the American people be- States, including my State of Texas, insurance if I guarantee that I am not lieve that too. have self-insurance plans for State em- going to be a burden to the Federal Thank you, Mr. President. I yield the ployees. States with large numbers of Government or to the State govern- floor. State employees find that self-insur- ment or to any other taxpayer. I think The PRESIDING OFFICER. The Sen- ance is a better way to go than private you should have that right, but that is ator from Louisiana. insurance programs. In this bill, every not the way this bill is written. Mr. VITTER. Mr. President, how insurance company that plans to in- The bill is a Federal mandate that much time remains on the minority crease its premiums must get approval every person in America has to have side before 9:30 a.m.? from the Department of Health and health insurance or be fined if they do The PRESIDING OFFICER. There is Human Services first. not. So at least if we were going to 24 minutes remaining on the minority Now, my State of Texas, with its self- write such a provision, to keep the side. insurance plan, then, has to go to the right of an individual not to have a Mr. VITTER. Thank you, Mr. Presi- Secretary of Health and Human Serv- mandate under the commerce clause of dent. ices to ask permission to increase the the Constitution, at least you ought to Mr. President, since this latest premiums on their State self-insured say that a person would have to sign version of comprehensive health care insurance plan. That is a violation of something that says: I will give you a reform was unveiled a few days ago—a the 10th amendment, as I see it. promissory note if I do not choose to 2,733-page bill—I have been looking at I am very concerned that a State buy insurance. But that is not the way it very carefully, particularly, of that has State employees who accept a this bill is written. course, with the Louisiana perspective, self-insurance plan would then be able So I think this, along with the State and I want to share my strong concerns to be told by the Federal Government mandate on Medicaid—which, again, I with that Louisiana perspective with that they cannot increase their pre- think is an equal protection issue, and my colleagues today. miums to cover the cost and keep the maybe that is a stretch—but that one Of course, we have all heard this Sen- sound system that they have in place. State will not have to ever pay the ate health care reform bill referred to

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00006 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13719 as the ‘‘Louisiana purchase’’ because of gressional Budget Office, nonpartisan— meaningful ways, subsidize abortion. the special $300 million provision in it this bill cuts Medicare $466 billion. Louisiana is one of the most proudly related to our Medicaid match rate. Medicare now is already facing insol- pro-life States in the Nation, so that is Quite frankly, I do not much like vency by 2017. So instead of fixing that particularly offensive. Everyone who that nickname for two reasons. First of in a real way, the bill steals almost $1⁄2 cares about life, who has followed this all, the fact that we in Louisiana have trillion from Medicare and uses it not issue, whether it is the Catholic to pay a higher Medicaid match rate within Medicare but to help pay for a Bishops, National Right to Life, and under present law because of the hurri- brand-new entitlement. other organizations have said, clearly, canes is a real inequity, which I sup- Mr. BAUCUS. Mr. President, will the the language in this bill doesn’t pro- port fixing. It is a shame the merits of Senator yield for a question? tect against taxpayer-funded abortion. that fix, which are very real, have been Mr. VITTER. I will not at this time. The language in this bill does not completely lost in this debate because I will be happy to yield after my pres- honor the Hyde amendment, which has of the way this Louisiana fix has been entation. been Federal law since 1977. The lan- used and abused, quite frankly, in try- That means real cuts in terms of hos- guage in this bill crosses an important ing to pass this megabill. pitals, home and hospice, nursing line, does not offer the conscience pro- But, secondly, I do not like the homes, and Medicare Advantage. There tections we have depended on for years. phrase because it suggests that Lou- are over 151,000 Louisiana seniors on So this sets radical new precedent in isiana in general would fare very well Medicare Advantage. They are going to terms of taxpayer and Federal Govern- under the bill overall, and nothing be particularly hard hit. They like that ment support of abortion. That is a big could be further from the truth. This choice now. They will not have that Louisiana concern as well. bill overall sells Louisiana short. It choice as it exists now under this bill. So what do we have? We have a 2,733- sells Louisiana out. In fact, rather How about Louisiana taxpayers? I am page bill, mega health care reform, than the ‘‘Louisiana purchase,’’ I think also very concerned about Louisiana with all these very serious problems for the bill could be very accurately called taxpayers. Again, according to the non- Louisiana and important Louisiana the ‘‘Louisiana sellout.’’ partisan Congressional Budget Office, groups and important Louisiana citi- What are those costs and those seri- the bill contains $518 billion of tax in- zens, including seniors, small business, ous problems for Louisiana I am talk- creases nationwide—over $1⁄2 trillion of taxpayers, and the State budget, which ing about? tax increases. As for that oft repeated is already facing serious cuts and chal- Let’s start with Medicaid, the pro- promise that no one who earns under lenges. gram for the poor. Let’s start with that $200,000 will be affected, well, again, If we want to put Louisiana first con- $300 million fix. It is certainly true think again. The Joint Committee on sidering all these costs, we have to say that fix is there—a $300 million benefit Taxation—nonpartisan—has said 42.1 no to this bill. If we want to put Amer- to the State under our Medicaid Pro- million Americans earning below ica first considering all these gram—but that is not all of the pic- $200,000 will get a tax increase over the unsustainable costs, we have to say no ture. It is not even all of the Medicaid next several years—42.1 million. That to this bill. But we can and we should picture because besides that fix, in the means hundreds of thousands of Lou- say yes to the right kind of health care bill overall there is a dramatic expan- isiana taxpayers will be hit, will get a reform. This isn’t a debate about yes or sion of Medicaid—a huge expansion— tax increase—I am talking about folks no, health care reform or not; this is a and the Louisiana State government who earn well below $200,000—will also debate about what the right kind of and Louisiana taxpayers have to help pay more in the form of higher insur- health care reform is. pay for that expansion. That extra cost ance premiums because, again, the To me, we need to start over with to the State government, to the State nonpartisan Congressional Budget Of- that right kind of reform. To me, that taxpayer, is way more than the $300 fice has said this bill increases overall would mean something such as starting million benefit. health care costs. It does not decrease by passing five bills. Each one doesn’t By very conservative estimates by those costs. need to be longer than 25 pages. Each the Louisiana Department of Health Well, what about Louisiana small one would be focused like a laser beam and Hospitals, it is at least $1.3 billion businesses? Surely, this bill protects on a real problem that affects real over 10 years of full implementation. them in the midst of this serious reces- Louisianans, real Americans, offering a So, sure, a $300 million benefit but, at sion. Well, not exactly. The biggest im- real, concrete, focused solution. My least, minimum, a $1.3 billion cost— pact on businesses is a brandnew man- five bills would be this: Cover pre- extra cost—to the State. date in the bill. Most businesses have existing conditions. That is a real prob- Now, three things are important to either provide a government-defined lem in Louisiana. That is a real prob- about these figures. One is obvious: health insurance benefit or they have lem in America. Let’s have a focused $300 million is a whole lot less than $1.3 to pay a new tax to the government. bill that does that. billion. But, secondly, this $1.3 billion NFIB, the National Federation of Secondly, allow buying insurance over 10 years of full implementation is Small Business, says that is going to across State lines. That would dra- a very conservative estimate from the cost the Nation 1.6 million jobs. Trans- matically expand competition in the Louisiana Department of Health and lated to Louisiana, that is tens of thou- marketplace. That would lower pre- Hospitals. And, No. 3, while this sands of additional lost jobs on top of miums. That would give all folks want- money, the $300 million, is one time, our current high unemployment. ing health insurance dramatically de- this other goes on forever. This $1.3 bil- Again, we are in the middle of a serious creased costs than they have now. lion is the first decade cost, but it goes recession. This will cost us jobs on top Third: Let’s do something real about on forever from there; and every 10 of that. prescription drug prices. Let’s not sell years, this grows and is repeated. There is also another big problem, out to PhRMA and cut a special deal So what does that mean? That means which is an incentive for businesses to with the pharmaceutical industry, as in the first 10 years of full implementa- drop coverage. I mentioned that the White House has. Let’s pass re- tion, the net impact on the State is brandnew mandate: Either you provide importation and pass real generics re- very negative, at least $1 billion, and it a government-defined health benefit or form. goes on from there. you pay a new tax to the Federal Gov- Fourth: Let’s pass tort reform and I am very concerned about a lot of ernment. The other problem with that take all that unnecessary cost out of other groups in Louisiana, not just the is, for a lot of business, it is going to be the system. That doesn’t provide better State government and State budget. I cheaper to drop coverage and pay the health care for anyone. It doesn’t do am particularly concerned about Lou- new tax. So many employees who have anything positive for anyone except isiana seniors. Of course, Louisiana coverage now that they are reasonably wealthy trial lawyers. Let’s pass tort seniors, like seniors everywhere, de- satisfied with are going to lose it, and reform. pend on Medicare. They have paid into that is a big concern as well. And fifth: Let’s allow small business it their whole lives. This bill—it is a Just for good measure, the bill forces to pool across State lines to form larg- simple fact; it is confirmed by the Con- pro-life taxpayers to, in many very er pools of insurance across State lines

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00007 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13720 CONGRESSIONAL RECORD — SENATE December 22, 2009 and gain from that extra buying power. these misstatements and they are not reforms will have kicked in and the an- Why shouldn’t a restaurant in Baton based at all on fact. nual limits, the lifetime limits will Rouge that may only have seven or In fact, what we need to do around have been repealed. It will be a heck of eight people to cover in health insur- here is get more and more institutions a lot better insurance. So maybe their ance, why shouldn’t they be able to to objectively analyze policy so we premiums will go up a little bit, but pool through the National Restaurant know what the facts are. It is pretty they will get a heck of a lot better buy Association, create a pool of millions hard to argue the facts. The CBO does for what they are getting. It is similar nationwide and enjoy the same buying a pretty good job. The Joint Com- to buying a new car instead of a used power Apple Computers or Toyota has mittee on Taxation does a pretty good car—hopefully, a good new car. All in and get the same benefit in the insur- job. But if somehow this country could all, in a very real sense, all Americans ance marketplace through that in- turn to an organization or organiza- are going to find his or her premiums creased buying power and increased tions to find the facts—just the facts— will go down. Seven percent will find competition? I think it would help a little bit be- them go up a little bit, but they will So I urge all my colleagues to put cause it is hard to argue the facts. If get a heck of a lot better insurance for their State first and vote no, to put our you have good facts, you generally can the premiums they will be paying. Nation first and vote no, and to start create good policy. The previous speaker is wrong when anew with the right sort of focused re- Back to premiums. CBO says 93 per- he says it will increase premiums. The form as I have outlined. cent of premiums go down. Actually, Joint Committee on Taxation says it I thank the Chair. I yield the floor. for about five-sixths of those insured— will not. I didn’t hear him quote the The PRESIDING OFFICER. The Sen- that is, those who work for larger com- Joint Committee on Taxation saying ator from Montana. panies, it is called the large group mar- premiums will go up. If you look at the Mr. BAUCUS. Mr. President, I just kets—premiums will go down not a lot actual analysis by the Joint Com- have a couple statements to make, but a little. According to CBO, it is up mittee on Taxation, they find the pre- points to make, in view of the last to a 3-percent reduction in premiums. miums will go down. statement, to correct some They look at the year 2016 as a bench- Seeing nobody who wishes to speak, I misimpressions given by the last state- mark year, so CBO says that for those, wish to address the question of the con- ment. about 70 percent of Americans who stitutionality of the individual man- The last speaker said Medicare cuts work for large markets, premiums will date. Let me read into the RECORD an apply and this is going to cut Medicare. actually go down 3 percent. analysis by Mark Hall, prepared by the The fact is—I wish the previous speak- What about 13 percent of Americans O’Neill Institute. Basically, he says the er would stay on the floor, but he is who work for small groups, small com- following: fleeing the floor because he knows I am panies? Basically, CBO and the Joint Health insurance mandates have been a going to mention facts in total refuta- Committee on Taxation say those component of many recent health care re- tion to the assertions he is making. He could go up 1 percentage point as well form proposals. Because a Federal require- leaves the floor. He will not stay with as down 2 percentage points. It is about ment that individuals transfer money to a me to talk about what is going on. He private party is unprecedented, a number of even. It is difficult to tell. But those makes statements that are misrepre- legal issues must be examined. This paper who get credits in the small group mar- sentations and then he leaves the floor. analyzes whether Congress can legislate a Let me talk about some of the things ket will find their premiums down by health insurance mandate and the potential he said which are incorrect. One, he ba- about 8 to 11 percent. Those who work legal challenges that might arise given such sically says Medicare is going to be for small companies will find their pre- a mandate. The analysis of legal challenges to health insurance mandates applies to fed- hurt by these huge cuts to Medicare. miums go down 8 to 11 percent. What about the nongroup market— eral individual mandates, but can also apply The fact is, we are helping the Medi- to a federal mandate requiring employers to care trust fund with this legislation. individuals. Well, basically, if you compare today’s insurance premiums with purchase health insurance for their employ- The fact is, the Chief Actuary at HHS ees. There are no constitutional barriers for has said this legislation before us will what it might be in the future, the pre- Congress to legislate a health insurance increase the solvency of the Medicare miums will go down 14 to 20 percent, mandate as long as the mandate is properly trust fund another 9 years. That is a but because of better benefits, pre- designed and executed as discussed below. fact. miums could go up 10 to 13 percent for This paper also considers the likelihood of Second, he is trying to say there are 7 percent of Americans. As I mentioned any change in the current judicial approach a lot of big tax increases here. He is earlier, 93 percent will find their pre- to these legal questions. miums go down. For 7 percent they will Potential solutions. Congress’s Authority trying to direct the public away from to Regulate Commerce: The federal govern- what the fact is. The fact is, the Joint go up, but for those 7 percent, they are ment has the authority to legislate a health Committee on Taxation says there are going to have a lot better coverage, a insurance mandate under the Commerce $436 billion of tax cuts in this legisla- lot better insurance in 2016. All the in- Clause of the United States Constitution. A tion, reductions in taxes; $436 billion in surance market reforms will have federal mandate to purchase health insur- tax cuts in the form of tax credits for kicked in: denial of preexisting condi- ance is well within the breadth of Congress’s people who purchase insurance in the tions, market status, health status and power to regulate interstate commerce. Con- exchange. It is a tax cut of $436 billion so on and so forth. gress can avoid legal challenges related to the 10th Amendment and states’ rights by of tax cuts in the exchange. I might Get this: For the nongroup market, 17 percent of Americans who buy insur- preempting state insurance laws and imple- say $40 billion of that is small business menting the mandate on a Federal level. If tax cuts. They are not increases, they ance through the nongroup market, 10 Congress wants states to implement a fed- are tax cuts for small business and the percent of that 17 percent, because of eral mandate, it has the following two op- tax cuts for individuals is $436 billion. tax credits, will find their premiums go tions: Frankly, I wish I had a lot of the down by—guess how much—56 to 59 Conditional Spending: Congress may condi- data before me. I don’t have it right percent. Once more: 17 percent of tion federal funding, such as that for Med- now to refute other points he made. He Americans buy insurance individually. icaid or public health, on state compliance talked about premiums going up. The Of those 17 percent, 10 percent of them with federal initiatives. Conditional Preemp- tion: Congress may allow states to opt out of Congressional Budget Office basically will find their premiums will be re- complying with direct federal regulation as says 93 percent of Americans will find duced 56 to 59 percent. That is accord- long as states implement a similar regula- their premiums will come down being to the Joint Committee on Tax- tion that meets Federal requirements. cause of this legislation, and for a cer- ation. Only one small group, according Congress’s Authority to Tax and Spend for tain class of individuals—those in the to the Joint Committee on Taxation, the General Welfare: Congress also has the individual market and the small group will find an increase in 2016. That is 7 authority to legislate a health insurance market will get very significant reduc- percent of Americans in 2016, but that mandate under its Constitutional authority to tax and spend. tions in premiums on account of this will be compensated with a lot better There are no plausible Tenth Amendment bill. insurance, high-quality insurance. No and states’ rights issues arising from It irritates me, frankly, when Sen- more rescissions. No more denial based Congress’s taxing and spending power. How- ators come to the floor and make all on preexisting conditions. The rating ever, Congress’s taxation power cannot be

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00008 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13721 used in a way that burdens a fundamental ‘‘And in midterm elections, we’ll get voted the courts to promptly consider any right recognized in the Constitution’s Bill of in!’’ constitutional challenge to the Fi- Rights and judicial interpretations by the They knew regular folks need help right this nance Committee bill. He chose the U.S. Supreme Court. Since there is no funda- second— same language that was put into the mental right to be uninsured, no funda- But fundraisers, lobbyists and politics beck- mental right challenge exists. oned. bipartisan Campaign Reform Act. Un- Other Relevant Constitutional Rights: So, try as they might, Democrats could not fortunately, the amendment was Challenges under the First and Fifth Amend- win deemed nongermane. ments relating to individual rights may rise, Because their majority was simply too thin. I am seriously concerned that the but are unlikely to succeed. The federal gov- Then, across every State there arose such a Democrats’ health care reform bill vio- ernment should include an exemption on re- clatter ligious grounds to a health insurance man- lates the Constitution of these United The whole Senate rushed out to see what was States. As part of comprehensive date as an added measure of protection from the matter! legal challenges based on religious freedom. All sprang up from their desks and ran from health care reform, the Democrats In the alternative, the federal government the floor would require every single American can simply exempt a federal insurance man- Straight through the cloakroom, and right citizen to purchase health insurance. date from existing federal legislation pro- out the door. Americans who fail to buy health in- tecting religious freedom. And what in the world could be quite this surance that meets the minimum re- Considerations: To avoid a heightened raucous? level of security in any judicial review, the quirements would be subject to a finan- But a mandate for change! From the Demo- cial penalty. This provision can be federal government should articulate its sub- cratic caucus! stantive rationale for mandating health in- found in section 1501 of the Democrats’ The President, the Speaker, and of course surance during the legislative process. Leader Reid health care reform bill. It is called the It goes on, and it is probably too Had answered the call in our hour of need. ‘‘requirement to maintain minimal es- lengthy to read. Professor Hall wrote More rapid than eagles the provisions they sential coverage.’’ this. He is a professor at Wake Forest came, While this is a constitutional point of University. And they whistled, and shouted, and called order, I feel it is important to note I will read the conclusion: them by name: that in the Declaration of Independ- The Constitution permits Congress to leg- ‘‘Better coverage! Cost savings! A strong ence, America’s Founding Fathers pro- public plan! islate a health insurance mandate. Congress vided that: can use its Commerce Clause powers or its Accountable options? We said ‘yes we can!’ taxing and spending powers to create such a ‘‘No exclusions or changes for pre-existing We hold these truths to be self-evident, mandate. Congress can impose a tax on those conditions! Let’s pass a bill that re- that all men are created equal, that they are who do not purchase insurance, or provide stores competition!’’ endowed by their Creator with certain tax benefits to those that do purchase insur- The Democrats all came together to fight for unalienable rights, that among these are life, ance. . . . If Congress would like the States the American people, that Christmas liberty, and the pursuit of happiness. to implement an insurance mandate, it can Eve night. What happened to life, liberty, and avoid conflicts with the anti-commandeering And then, in a twinkle, I heard under the dome—the rollcall was closed! It was the pursuit of happiness? I guess Amer- principle by either preempting state insur- icans can only have them if they com- ance laws or by conditioning federal funds on time to go home. State compliance. A federal employer man- Despite the obstructionist tactics of some, ply with this new bill and buy a bronze, date for state and local government workers the filibuster had broken—the people silver, gold, or platinum health insur- may be subject to a challenge; however, such had won! ance program. a challenge is unlikely to be successful. Indi- A good bill was ready for President Obama, America’s Founders and subsequent vidual rights challenges under the First ready to sign, and end health care generations fought dearly for the free- drama. Amendment’s Free Exercise Clause or RFRA doms we have today. are unlikely to succeed, although a federal And Democrats explained, as they drove out insurance mandate should include a state- of sight: ‘‘Better coverage for all, even I question the appropriateness of this ment that RFRA does not apply or provide our friends on the right!’’ bill and specifically the constitu- for a religious exemption. Fifth Amendment And I say to all of my colleagues: In tionality of this individual mandate. Is Due Process and Takings Clause challenges this season, Merry Christmas and a it really constitutional for this body to are also unlikely to be successful. A legal tell all Americans they must buy analysis presented is likely to endure, as the happy, happy New Year. Mr. President, I yield the floor. health insurance coverage? If so, what Supreme Court’s current position and ap- is next? What personal liberty or prop- proach to interpreting relevant constitu- The PRESIDING OFFICER. The Sen- tional issues appear to be stable. ator from Nevada. erty will Congress seek to take away The PRESIDING OFFICER. The Sen- Mr. ENSIGN. Mr. President, in a lit- from Americans next? Will we consider ator from Illinois. tle while, I will be making a constitu- legislation in the future requiring Mr. BURRIS. Mr. President, as this tional point of order against the sub- every American to buy a car, to buy a debate draws to a close and my col- stitute amendment. I won’t make that house, or to do something else the Fed- leagues and I prepare to vote on a now because we are working on an eral Government wants? health care reform bill, I recognize agreement on when we can have that My friend and colleague, Senator that long hours and tense negotiations vote. HATCH, raised similar questions during have left some nerves and tempers I want to start talking about the rea- the debate in the Finance Committee. frayed. That is why I come to the floor. son I believe this substitute amend- In fact, he raised the following ques- Although our work keeps us away ment is unconstitutional—the indi- tion: from our family and friends for much vidual mandate contained in it. I will If we have the power simply to order Amer- of this holiday season, I see no reason be speaking for about 10 minutes now, icans to buy certain products, why did we why we cannot share good cheer with and then I will resume my remarks at need a cash for clunkers program, or the up- one another right here in Washington. 9:30, after one of the Democrats comes coming program providing rebates for pur- So in the spirit of the season, I would down and uses their 15 minutes. chasing energy efficient appliances? We can like to share my own version of a clas- If this constitutional point of order is simply require Americans to buy certain sic holiday story with my good friends rejected and the health care reform bill cars, dishwashers, or refrigerators. on both sides of the aisle. is passed, I believe the Court should re- Where do we draw the line? Will we It goes something like this: ject it on constitutional grounds. even draw one at all? The Constitution ‘Twas the night before Christmas and all Some of my colleagues may not be draws that line. It is called the enu- through the Senate aware of the Finance Committee’s de- merated powers. I don’t think Congress The Right held up our health bill, no matter bate on the constitutionality of this has ever required Americans to buy a what was in it. health care reform bill. During the product or service, such as health in- The people had voted—they mandated re- committee markup of its version of the surance, under penalty of law. I doubt form— Congress has the power to do that in But Republicans blew off the gathering bill, Senator HATCH raised some storm. thought-provoking constitutional ques- the first place. ‘‘We’ll clog up the Senate!’’ they cried with tions. He offered an amendment, which As the CBO explained during the a grin, I supported, to provide a process for 1990s:

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00009 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13722 CONGRESSIONAL RECORD — SENATE December 22, 2009 A mandate requiring all individuals to pur- care providers—doctors and hospitals— purchase a service or enter into a con- chase health insurance would be an unprece- who provide free or uncompensated tract. Similarly, Congress cannot rely dented form of Federal action. The govern- care to the uninsured, shift the cost to on its power to tax to justify imposing ment has never required people to buy any the insured or paying patients. The the individual mandate. good or service as a condition of lawful resi- hospital or doctor then shifts the cost dence in the United States. In addition to being beyond the scope of that unpaid care to the insured pa- of Congress’ enumerated powers, this Yet that is exactly what this health tient in the form of higher charges in individual mandate also amounts to a care bill would do. This bill would re- order to cover the cost of uninsured pa- taking under the fifth amendment quire Americans to buy a product tients. takings clause. I would like to take a many of them do not want or simply I understand this concept, but I am moment to read the relevant parts of cannot afford. incredibly concerned that the indi- the fifth amendment. It says in part: Some individuals have raised the ex- vidual mandate provision takes away ample of car insurance in the context No person shall be . . . deprived of life, lib- too much freedom and choice from Ne- erty, or property, without due process of law; of this debate. But requiring someone vadans and from Americans across the nor shall private property be taken for pub- to have car insurance for the privilege country. lic use, without just compensation. of being able to drive is much different I have read and studied multiple arti- Let me repeat the part of the fifth from requiring someone to have health cles by scholars on the constitu- amendment that applies to the issue at insurance. As Senator HATCH pointed tionality of the individual mandate. I hand. It says: out, people who do not drive do not believe the individual mandate provi- have to buy car insurance. Senator . . . nor shall private property be taken for sion in this health care reform bill public use, without just compensation. HATCH is right. If you live in New York calls into question several provisions of The bill before us today would re- City, you probably rely on subways or the Constitution. I think the Congress quire an American citizen to devote a some other form of mass transit. You does not have the authority, under the probably do not own a car, so you have enumerated powers, to enact such a portion of income—his or her private no reason to buy car insurance and you mandate. property—to health insurance cov- are not forced to do so. Yet this health I know the supporters of the indi- erage. There is an exception, of course, care reform bill requires Americans to vidual mandate have claimed the com- for religious reasons and for financial buy health insurance whether or not merce clause and the taxes and general hardships. they ever visit a doctor, get a prescrip- welfare clause in article I, section 8 of If one of my constituents in Nevada tion, or have an operation. the Constitution provide authority for does not want to spend his or her hard- Under this bill, if you do not buy Congress to enact such a mandate. I earned income on health insurance cov- health insurance coverage, you will be wholeheartedly disagree with that as- erage and would prefer to spend it on subject to a penalty. Let’s call this sessment. something else, such as rent or a car penalty what it really is—a tax. Even According to the Constitution, the payment, this requirement could be a worse, this penalty operates more like Federal Government only has limited taking of private property under the a taking than an ordinary tax. If an powers. Although the Supreme Court fifth amendment. American chooses not to buy minimal has upheld some far-reaching regula- As noted in a recent article coau- essential health coverage, he or she tions of economic activity—most nota- thored by Dennis Smith and the former will face rapidly increasing taxes—up bly in Wickard v. Filburn and Gonzales Deputy General Counsel of the Depart- to $750 or 2 percent of taxable income, v. Raich—neither case supports enactment of Health and Human Services, whichever is greater, by the year 2016. ing the independent health insurance Peter Urbanowicz, requiring a citizen There is no penalty for Americans who mandate based on the commerce to purchase health insurance ‘‘could be qualify for hardship or religious ex- clause. In these cases, the court held considered an arbitrary and capricious emptions. There is also no penalty for that Congress was allowed to regulate ‘taking’ no matter how many hardship illegal immigrants or prisoners. intrastate economic activity as a exemptions the federal government Americans typically pay taxes on a means to regulate interstate commerce might dispense.’’ product or service they buy or on in- in fungible goods. The mandate to pur- Some of my colleagues may also be come they earn. For example, if you chase health insurance, however, is not familiar with David B. Rivkin and Lee fill up your car at the pump, you pay a proposed as a means to regulate inter- A. Casey. They are attorneys, based in gas tax. If you earn income, you pay an state commerce, nor does it regulate or Washington, DC, who served in the De- income tax. Yet this bill creates a new prohibit activity in either the health partment of Justice during the Reagan tax on Americans who choose not to insurance or the health care industry. and Bush administrations. In Sep- buy a service. It is very counterintu- The mandate to purchase health in- tember, Rivkin and Casey published an itive. This bill taxes Americans for not surance does not purport to regulate or op-ed in the Wall Street Journal enti- doing anything at all, other than just prohibit activity of any kind, whether tled: ‘‘Mandatory Insurance is Uncon- existing. This penalty is assessed economic or noneconomic. Instead, the stitutional.’’ I urge my colleagues to through the Internal Revenue Code. individual mandate provision regulates read this article and many others I will Senator HATCH made the following no action. It purports to regulate inac- be submitting for the RECORD. statement: tivity by converting the inactivity of Mr. President, I ask unanimous con- not buying insurance into commercial If this is a tax at all, it is certainly not an sent to have printed in the RECORD at excise tax. Instead, it is a direct tax. While activity. In effect, advocates of the in- the conclusion of my remarks this Wall the Constitution requires that excise taxes dividual mandate contend that under Street Journal by David B. Rivkin, Jr., must be uniform throughout the United congressional power to ‘‘regulate com- and Lee A. Casey. States, it requires that direct taxes must be merce . . . among the several states’’ The PRESIDING OFFICER. Without apportioned among the States by population. Congress may reach the doing of noth- objection, it is so ordered. Just as the excise tax on high premiums is ing at all. (See exhibit 1.) not uniform, this direct tax on individuals In recent years, the Supreme Court Mr. ENSIGN. In the op-ed, Rivkin who do not purchase health insurance is not has invalidated two congressional stat- and Casey argue that the health insur- apportioned. utes that attempted to regulate non- ance mandate: I recognize that the authors of this economic activities. To uphold the in- . . . would expand the federal government’s health reform bill included an indi- dividual mandate based on the com- authority over individual Americans to an vidual mandate in this bill based on merce clause, the Supreme Court would unprecedented degree. It is also profoundly the idea that health care costs would have to concede that the commerce unconstitutional. be spread among all Americans and clause provides unlimited authority to Continuing the quote: would ultimately reduce their health regulate. This is a position that the Making healthy young adults pay billions insurance costs. The claim is, insur- Supreme Court has never affirmed and of dollars in premiums into the national ance costs will be lowered because cost that it rejected in recent cases. health-care market is the only way to fund shifting will be reduced. This cost shift Congress lacks the authority to regu- universal coverage without raising substan- arguably takes place because health late the individual’s decision not to tial new taxes.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00010 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13723 In effect, this mandate would be one more Americans simply because they are there. A long line of Supreme Court cases estab- giant, cross-generational subsidy—imposed Significantly, in two cases, United States v. lishes that Congress may regulate three cat- on generations who are already stuck with Lopez (1995) and United States v. Morrison egories of activity pursuant to the commerce the bill for the federal government’s prior (2000), the Supreme Court specifically re- power. These categories were first summa- spending sprees. jected the proposition that the commerce rized in Perez v. United States, and most re- A ‘‘tax’’ that falls exclusively on anyone clause allowed Congress to regulate non- cently reaffirmed in Gonzalez v. Raich. First, who is uninsured is a penalty beyond economic activities merely because, through Congress may regulate the channels of inter- Congress’s authority. If the rule were other- a chain of causal effects, they might have an state or foreign commerce such as the regu- wise, Congress could evade all constitutional economic impact. These decisions reflect ju- lation of steamship, railroad, highway or air- limits by ‘‘taxing’’ anyone who doesn’t fol- dicial recognition that the commerce clause craft transportation or prevent them from low an order of any kind. is not infinitely elastic and that, by enumer- being misused, as, for example, the shipment As the fourth Chief Justice of the Su- ating its powers, the framers denied Con- of stolen goods or of persons who have been gress the type of general police power that is preme Court, John Marshall, stated: kidnapped. Second, the commerce power ex- freely exercised by the states. tends to protecting ‘‘the instrumentalities of The power to tax involves the power to de- Mr. President, to read further from interstate commerce,’’ as, for example, the stroy. the article in the Washington Post: destruction of an aircraft, or persons or Unfortunately, this could certainly Like the commerce power, the power to things in commerce, as, for example, thefts be true in the context of this health tax is the Federal Government’s vast author- from interstate shipments. Third, Congress bill. ity over the public, and it is well settled that may regulate economic activities that ‘‘sub- We in Congress must zealously defend Congress can impose a tax for regulatory stantially affect interstate commerce.’’ Under the first prong of its Commerce our citizens’ rights and prevent this rather than purely revenue-raising purposes. Yet Congress cannot use its power to tax Clause analysis, the Court asks whether the from happening. I believe the legisla- class of activities regulated by the statute tion before us violates the greatest po- solely as a means of controlling conduct that it could not otherwise reach through the falls within one or more of these categories. litical document in the history of the commerce clause or any other constitutional Since an individual health insurance man- world, the Constitution of the United provision. In the 1922 case Bailey v. Drexel date is not even arguably a regulation of a States. Furniture, the Supreme Court ruled that channel or instrumentality of interstate I urge my colleagues to think very Congress could not impose a ‘‘tax’’ to penal- commerce, it must either fit in the third cat- carefully about the constitutional ize conduct (the utilization of child labor) it egory or none at all. . . . The Senate bill as- could not also regulate under the commerce serts (erroneously) that: ‘‘[t]he individual re- issues I have raised. I know most peo- sponsibility requirement . . . is commercial ple around here do not like to talk clause. Although the court’s interpretation of the commerce power’s breadth has and economic in nature, and substantially about whether something is constitu- changed since that time, it has not repudi- affects interstate commerce. . . . The re- tional. We just want to do what feels ated the fundamental principle that Con- quirement regulates activity that is com- good because we think we are helping gress cannot use a tax to regulate conduct mercial and economic in nature: economic people. But our Founders set forth in that is otherwise indisputably beyond its and financial decisions about how and when the enumerated powers limits on what regulatory power. health care is paid for, and when health in- this body and this Federal Government Of course, these constitutional impedi- surance is purchased.’’ could do. ments can be avoided if Congress is willing That is within the bill. to raise corporate and/or income taxes Continuing to quote: As Members of Congress, one of our enough to fund fully a new national health most important responsibilities is to system. Absent this politically dangerous— The second prong of the Court’s Commerce protect, to defend, and preserve the and therefore unlikely—scenario, advocates Clause analysis requires a determination Constitution of the United States. In of universal health coverage must accept that a petitioner has in fact engaged in the that light, it is not only appropriate Congress’ power, like that of the other regulated activity, making him or her a but essential for this body to question branches, has limits. These limits apply remember of the regulated class. In its modern gardless of how important the issue may be, Commerce Clause cases, the Supreme Court whether it is constitutional for the rejects the argument that a petitioner’s own Federal Government to require Ameri- and neither Congress nor the president can take constitutional short cuts. The genius of conduct or participation in the activity is, cans to buy health insurance coverage. our system is that, no matter how convinced by itself, either too local or too trivial to We should also question whether it is our elected officials may be that certain have a substantial effect on interstate com- constitutional for the Federal Govern- measures are in the public interest, their merce. Rather, the Court has made clear ment to tell Americans what kind of goals can be accomplished only in accord that, ‘‘where the class of activities is regu- health insurance coverage they have to with the powers and processes the Constitu- lated and that class is within the reach of purchase. So not only does this bill tell tion mandates, processes that inevitably federal power, the courts have no powers ‘to excise, as trivial, individual instances’ of the them they have to buy health insur- make them accountable to the American people. class.’’ Thus, for example, a potential chal- ance, it tells Americans what kind of lenger of the proposed mandate could not health insurance must be purchased. I want to read from another article argue that because her own decision not to Americans also deserve to know how that was written by Randy Barnett, purchase the required insurance would have the bill will impact their ability to Nathaniel Stewart, and Todd Gaziano. little or no effect on the broader market, the choose the health insurance coverage This article is entitled, ‘‘Why the Per- regulation could not be constitutionally ap- that best fits their needs. That is ex- sonal Mandate to Buy Health Insur- plied to her. The Court will consider the ef- actly why I will raise this constitu- ance is Unprecedented and Unconstitu- fect of the relevant ‘‘class of activity,’’ not tional.’’ that of any individual member of the class. tional point of order. Freedom and To assess the constitutionality of a claim Members of Congress have the responsi- choice are very precious rights. Let’s of power under the Commerce Clause, the bility, pursuant to their oath, to determine not bury our heads in the sand and primary question becomes, ‘‘what class of ac- the constitutionality of legislation independ- take away freedom and choice from tivity is Congress seeking to regulate?’’ Only ently of how the Supreme Court has ruled or when this question is answered can the Court American citizens. We need to think may rule in the future. But Senators and assess whether that class of activity sub- about this individual mandate very Representatives also should know that, de- stantially affects interstate commerce. Sig- carefully. spite what they have been told, the health nificantly, the mandate imposed by the I have several articles, and I would insurance mandate is highly vulnerable to pending bills does not regulate or prohibit challenge because it is, in truth, unconstitu- like to read a couple of quotes from the economic activity of providing or admin- tional. And all other considerations aside, these articles. The first one is from the istering health insurance. Nor does it regu- the highest obligation of each Member of Washington Post. The article is enti- late or prohibit the economic activity of pro- Congress is fidelity to the Constitution. tled, ‘‘Illegal Health Reform.’’ It is viding health care, whether by doctors, hos- written by David Rivkin and Lee A. I ask unanimous consent to have pitals, pharmaceutical companies, or other Casey. It says: printed in the RECORD, following my entities engaged in the business of providing a medical good or service. Indeed, the health The otherwise uninsured would be required remarks, the articles I have before me. care mandate does not purport to regulate or to buy coverage, not because they were even The PRESIDING OFFICER. Without prohibit activity of any kind, whether eco- tangentially engaged in the ‘‘production, dis- objection, it is so ordered. nomic or noneconomic. To the contrary, it tribution or consumption of commodities,’’ (See exhibit No. 2.) purports to ‘‘regulate’’ inactivity. but for no other reason than people without Mr. ENSIGN. Continuing to quote, health insurance exist. The federal govern- Mr. President, from the Barnett, Stew- In other words, not buying health in- ment does not have the power to regulate art, and Gaziano article: surance. Continuing once again:

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00011 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13724 CONGRESSIONAL RECORD — SENATE December 22, 2009 Proponents of the individual mandate are cross-generational subsidy—imposed on gen- can favor one industry or course of action contending that, under its power to ‘‘regu- erations who are already stuck with the bill over another, but a ‘‘tax’’ that falls exclu- late commerce . . . among the several for the federal government’s prior spending sively on anyone who is uninsured is a pen- states,’’ Congress may regulate the doing of sprees. alty beyond Congress’s authority. If the rule nothing at all! In other words, the statute Politically, of course, the mandate is es- were otherwise, Congress could evade all purports to convert inactivity into a class of sential to winning insurance industry sup- constitutional limits by ‘‘taxing’’ anyone activity. By its own plain terms, the indi- port for the legislation and acceptance of who doesn’t follow an order of any kind— vidual mandate provision regulates the ab- heavy federal regulations. Millions of new whether to obtain health-care insurance, or sence of action. To uphold this power under customers will be driven into insurance-com- to join a health club, or exercise regularly, its existing doctrine, the Court must con- pany arms. Moreover, without the mandate, or even eat your vegetables. clude that an individual’s failure to enter the entire thrust of the new regulatory This type of congressional trickery is bad into a contract for health insurance is an ac- scheme—requiring insurance companies to for our democracy and has implications far tivity that is ‘‘economic’’ in nature—that is, cover pre-existing conditions and to accept beyond the health-care debate. The Constitu- it is part of a ‘‘class of activity’’ that ‘‘sub- standardized premiums—would produce dys- tion’s Framers divided power between the stantially affects interstate commerce.’’ functional consequences. It would make lit- federal government and states—just as they Never in this Nation’s history has the com- tle sense for anyone, young or old, to buy in- did among the three federal branches of gov- merce power been used to require a person surance before he actually got sick. Such a ernment—for a reason. They viewed these who does nothing to engage in economic ac- socialization of costs also happens to be an structural limitations on governmental tivity. essential step toward the single payer, na- power as the most reliable means of pro- Let me repeat that. ‘‘Never in this tional health system, still stridently sup- tecting individual liberty—more important ported by large parts of the president’s base. Nation’s history has the commerce even than the Bill of Rights. The elephant in the room is the Constitu- Yet if that imperative is insufficient to power been used to require a person tion. As every civics class once taught, the prompt reconsideration of the mandate (and who does nothing to engage in eco- federal government is a government of lim- the approach to reform it supports), then the nomic activity.’’ ited, enumerated powers, with the states re- inevitable judicial challenges should. Since Let me close with this because I see taining broad regulatory authority. As the 1930s, the Supreme Court has been reluc- the senior Senator from Utah is on the James Madison explained in the Federalist tant to invalidate ‘‘regulatory’’ taxes. How- Senate floor, and he has argued elo- Papers: ‘‘[I]n the first place it is to be re- ever, a tax that is so clearly a penalty for membered that the general government is quently on the unconstitutionality of failing to comply with requirements other- not to be charged with the whole power of wise beyond Congress’s constitutional power this particular provision. making and administering laws. Its jurisdic- Again, I am quoting: will present the question whether there are tion is limited to certain enumerated ob- any limits on Congress’s power to regulate Today, even voting is not constitutionally jects.’’ Congress, in other words, cannot reg- individual Americans. The Supreme Court mandated. But if this precedent is estab- ulate simply because it sees a problem to be has never accepted such a proposition, and it lished— fixed. Federal law must be grounded in one is unlikely to accept it now, even in an area That is the precedent in this bill is of the specific grants of authority found in as important as health care. the Constitution. established— These are mostly found in Article I, Sec- EXHIBIT 2 Congress would have the unlimited power tion 8, which among other things gives Con- [From the Washington Post, Aug. 22, 2009] to regulate, prohibit, or mandate any or all gress the power to tax, borrow and spend ILLEGAL HEALTH REFORM activities in the United States. Such a doc- money, raise and support armies, declare (By David B. Rivkin, Jr. and Lee A. Casey) trine would abolish any limit on federal war, establish post offices and regulate com- power and alter the fundamental relation- merce. It is the authority to regulate foreign President Obama has called for a serious ship of the national government to the and interstate commerce that—in one way or and reasoned debate about his plans to over- states and the people. For this reason it is another—supports most of the elaborate fed- haul the health-care system. Any such de- highly doubtful that the Supreme Court will eral regulatory system. If the federal govern- bate must include the question of whether it uphold this assertion of power. ment has any right to reform, revise or re- is constitutional for the federal government to adopt and implement the president’s pro- Mr. President, I reserve the remain- make the American health-care system, it must be found in this all-important provi- posals. Consider one element known as the der of my time, and I yield to the sen- ‘‘individual mandate,’’ which would require ior Senator from Utah. sion. This is especially true of any mandate that every American obtain health-care in- every American to have health insurance, if EXHIBIT 1 surance or face a penalty. not through an employer then by individual [From the Wall Street Journal, Sept. 18, The Supreme Court construes the com- purchase. This requirement would particu- 2009] merce power broadly. In the most recent larly affect young adults, who often choose to save the expense and go without coverage. MANDATORY INSURANCE IS UNCONSTITUTIONAL Commerce Clause case, Gonzales v. Raich (2005), the court ruled that Congress can even Without the young to subsidize the old, a (By David B. Rivkin, Jr. and Lee A. Casey) regulate the cultivation of marijuana for comprehensive national health system will Federal legislation requiring that every personal use so long as there is a rational not work. But can Congress require every American have health insurance is part of all basis to believe that such ‘‘activities, taken American to buy health insurance? the major health-care reform plans now in the aggregate, substantially affect inter- In short, no. The Constitution assigns only being considered in Washington. Such a man- state commerce.’’ limited, enumerated powers to Congress and date, however, would expand the federal gov- But there are important limits. In United none, including the power to regulate inter- ernment’s authority over individual Ameri- States v. Lopez (1995), for example, the Court state commerce or to impose taxes, would cans to an unprecedented degree. It is also invalidated the Gun Free School Zones Act support a federal mandate requiring anyone profoundly unconstitutional. because that law made it a crime simply to who is otherwise without health insurance to An individual mandate has been a hardy possess a gun near a school. It did not ‘‘regu- buy it. perennial of health-care reform proposals late any economic activity and did not con- Although the Supreme Court has inter- since HillaryCare in the early 1990s. Presi- tain any requirement that the possession of preted Congress’s commerce power expan- dent Barack Obama defended its merits be- a gun have any connection to past interstate sively, this type of mandate would not pass fore Congress last week, claiming that unin- activity or a predictable impact on future muster even under the most aggressive com- sured people still use medical services and commercial activity.’’ Of course, a health- merce clause cases. In Wickard v. Filburn impose the costs on everyone else. But the care mandate would not regulate any ‘‘activ- (1942), the court upheld a federal law regu- reality is far different. Certainly some unin- ity,’’ such as employment or growing pot in lating the national wheat markets. The law sured use emergency rooms in lieu of pri- the bathroom, at all. Simply being an Amer- was drawn so broadly that wheat grown for mary care physicians, but the majority are ican would trigger it. consumption on individual farms also was young people who forgo insurance precisely Health-care backers understand this and— regulated. Even though this rule reached because they do not expect to need much like Lewis Carroll’s Red Queen insisting that purely local (rather than interstate) activ- medical care. When they do, these uninsured some hills are valleys—have framed the ity, the court reasoned that the consumption pay full freight, often at premium rates, mandate as a ‘‘tax’’ rather than a regulation. of homegrown wheat by individual farms thereby actually subsidizing insured Ameri- Under Sen. Max Baucus’s (D., Mont.) most would, in the aggregate, have a substantial cans. recent plan, people who do not maintain economic effect on interstate commerce, and The mandate’s real justifications are far health insurance for themselves and their so was within Congress’s reach. more cynical and political. Making healthy families would be forced to pay an ‘‘excise The court reaffirmed this rationale in 2005 young adults pay billions of dollars in pre- tax’’ of up to $1,500 per year—roughly com- in Gonzales v. Raich, when it validated miums into the national health-care market parable to the cost of insurance coverage Congress’s authority to regulate the home is the only way to fund universal coverage under the new plan. cultivation of marijuana for personal use. In without raising substantial new taxes. In ef- But Congress cannot so simply avoid the doing so, however, the justices emphasized fect, this mandate would be one more giant, constitutional limits on its power. Taxation that—as in the wheat case—‘‘the activities

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regulated by the [Controlled Substances Act] EXECUTIVE SUMMARY: WHY THE PERSONAL Act, which regulated gender-motivated vio- are quintessentially economic.’’ That simply MANDATE TO BUY HEALTH INSURANCE IS UN- lence. Because the Court found the regulated would not be true with regard to an indi- PRECEDENTED AND UNCONSTITUTIONAL activity in each case to be noneconomic, it vidual health insurance mandate. (By Randy Barnett, Nathaniel Stewart, and was outside the reach of Congress’s Com- The otherwise uninsured would be required Todd F. Gaziano) merce power, regardless of its effect on to buy coverage, not because they were even As the Congressional Budget Office ex- interstate commerce. tangentially engaged in the ‘‘production, dis- plained: ‘‘A mandate requiring all individ- To uphold the insurance purchase man- tribution or consumption of commodities,’’ uals to purchase health insurance would be date, the Supreme Court would have to con- but for no other reason than that people an unprecedented form of federal action. The cede that the Commerce Clause has no lim- without health insurance exist. The federal government has never required people to buy its, a proposition that it has never affirmed, government does not have the power to regu- any good or service as a condition of lawful that it rejected in Lopez and Morrison, and late Americans simply because they are residence in the United States.’’ Yet, all of from which it did not retreat in Raich. Al- there. Significantly, in two key cases, the House and Senate health-care bills being though Congress may possibly regulate the United States v. Lopez (1995) and United debated require Americans to either obtain operations of health care or health insurance States v. Morrison (2000), the Supreme Court or purchase expensive health insurance, esti- companies directly, given that they are eco- specifically rejected the proposition that the mated to cost up to $15,000 per year for a typ- nomic activities with a substantial effect on commerce clause allowed Congress to regu- ical family, or pay substantial tax penalties interstate commerce, it may not regulate late noneconomic activities merely because, for not doing so. the individual’s decision not to purchase a through a chain of causal effects, they might The purpose of this compulsory contract, service or enter into a contract. have an economic impact. These decisions coupled with the arbitrary price ratios and If Congress can mandate this, then it can reflect judicial recognition that the com- controls, is to require some people to buy ar- mandate anything. Congress could require merce clause is not infinitely elastic and tificially high-priced policies as a way of every American to buy a new Chevy Impala that, by enumerating its powers, the framers subsidizing coverage for others and an indus- every year, or a pay a ‘‘tax’’ equivalent to its denied Congress the type of general police try saddled with the costs of other govern- blue book value, because such purchases power that is freely exercised by the states. ment regulations. Rather than appropriate would stimulate commerce and help repay This leaves mandate supporters with few funds for higher federal health-care spend- government loans. Congress could also re- palatable options. Congress could attempt to ing, the sponsors of the current bills are at- quire all Americans to buy a certain amount condition some federal benefit on the acqui- tempting, through the personal mandate, to of wheat bread annually to subsidize farm- sition of insurance. States, for example, usu- keep the forced wealth transfers entirely off ers. ally condition issuance of a car registration budget. Even during wartime, when war production on proof of automobile insurance, or on a siz- This takes congressional power and control is vital to national survival, Congress has able payment into an uninsured motorist to a strikingly new level. An individual man- never claimed such a power, nor could it. No fund. Even this, however, cannot achieve date to enter into a contract with or buy a farmer was ever forced to grow food for the universal health coverage. No federal pro- particular product from a private party is troops; no worker was forced to build tanks. gram or entitlement applies to the entire literally unprecedented, not just in scope but And what Congress cannot do during war- population, and it is difficult to conceive of in kind, and unconstitutional either as a time, with national survival at stake, it can- a ‘‘benefit’’ that some part of the population matter of first principles or under any rea- not do in peacetime simply to avoid the po- would not choose to eschew. sonable reading of judicial precedents. litical cost of raising taxes to pay for desired government programs. The other obvious alternative is to use THE COMMERCE CLAUSE Congress’s power to tax and spend. In an ef- Advocates of the individual mandate have OTHER CONSTITUTIONAL PROBLEMS fort, perhaps, to anchor this mandate in that claimed that the Supreme Court’s Commerce Senators and Representatives should also power, the Senate version of the individual Clause jurisprudence leaves ‘‘no doubt’’ that know that: mandate envisions that failure to comply the insurance requirement is a constitu- There are four constitutionally relevant would be met with a penalty, to be collected tional exercise of that power. They are differences between a universal federal man- by the IRS. This arrangement, however, is wrong. date to obtain health insurance and the state not constitutional either. Although the Supreme Court has upheld requirements that automobile drivers carry Like the commerce power, the power to some far-reaching regulations of economic liability insurance for their injuries to oth- tax gives the federal government vast au- activity, most notably in Wickard v. Filburn ers on public roads; thority over the public, and it is well settled and Gonzales v. Raich, neither case supports A review of the tax provisions in the House that Congress can impose a tax for regu- the individual health insurance mandate. In and Senate bills raises serious questions latory rather than purely revenue-raising these cases, the Court held that Congress’s about the constitutionality of using the tax- purposes. Yet Congress cannot use its power power to regulate the interstate commerce ing power in this manner; and to tax solely as a means of controlling con- in a fungible good—for example, wheat or Since there literally is no legal precedent duct that it could not otherwise reach marijuana—as part of a comprehensive regu- for this decidedly unprecedented assertion of through the commerce clause or any other latory scheme included the power to regulate federal power, it is highly unlikely that the constitutional provision. In the 1922 case or prohibit the intrastate possession and pro- Supreme Court would break new constitu- Bailey v. Drexel Furniture, the Supreme duction of this good. In both cases, Congress tional ground to save an unpopular personal Court ruled that Congress could not impose was allowed to reach intrastate economic ac- mandate. a ‘‘tax’’ to penalize conduct (the utilization tivity as a means to the regulation of inter- Members of Congress have a responsibility, of child labor) it could not also regulate state commerce in goods. pursuant to their oath, to determine the con- under the commerce clause. Although the Yet, the mandate to purchase health insur- stitutionality of legislation independently of court’s interpretation of the commerce pow- ance is not proposed as a means to the regu- how the Supreme Court has ruled or may er’s breadth has changed since that time, it lation of interstate commerce; nor does it rule in the future. But Senators and Rep- has not repudiated the fundamental principle regulate or prohibit activity in either the resentatives also should know that, despite that Congress cannot use a tax to regulate health insurance or health care industry. In- what they have been told, the health insur- conduct that is otherwise indisputably be- deed, the health care mandate does not pur- ance mandate is highly vulnerable to chal- yond its regulatory power. port to regulate or prohibit activity of any lenge because it is, in truth, unconstitu- Of course, these constitutional impedi- kind, whether economic or noneconomic. By tional. And all other considerations aside, ments can be avoided if Congress is willing its own plain terms, the individual mandate the highest obligation of each Member of to raise corporate and/or income taxes provision regulates no action. To the con- Congress is fidelity to the Constitution. enough to fund fully a new national health trary, it purports to ‘‘regulate’’ inactivity by The PRESIDING OFFICER. The Sen- system. Absent this politically dangerous— converting the inactivity of not buying in- ator from Utah is recognized. and therefore unlikely—scenario, advocates surance into commercial activity. Pro- Mr. HATCH. Mr. President, I rise to of universal health coverage must accept ponents of the individual mandate are con- that Congress’s power, like that of the other tending that, under its power to ‘‘regulate support the constitutional point of branches, has limits. These limits apply re- commerce . . . among the several states,’’ order raised against the legislation be- gardless of how important the issue may be, Congress may reach the doing of nothing at fore us by the distinguished Senator and neither Congress nor the president can all! from Nevada. I applaud the senior Sen- take constitutional short cuts. The genius of In recent years, the Court invalidated two ator from Nevada for taking this step our system is that, no matter how convinced congressional statutes that attempted to so that all Senators can take a position our elected officials may be that certain regulate non-economic activities. In United on whether this legislation is constitu- measures are in the public interest, their States v. Lopez (1995), it struck down the tional, or whether this legislation is goals can be accomplished only in accord Gun-Free School Zones Act, which at- with the powers and processes the Constitu- tempted to reach the activity of possessing a consistent with the Constitution each tion mandates, processes that inevitably gun within a thousand feet of a school. In of us is sworn to protect and defend. make them accountable to the American United States v. Morrison (2000), it invali- The Senator from Nevada serves with people. dated part of the Violence Against Women me on the Senate Finance Committee,

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00013 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13726 CONGRESSIONAL RECORD — SENATE December 22, 2009 and he will remember that I started viduals to purchase health insurance is I was amazed to learn that when raising constitutional questions and the power to regulate interstate com- President Franklin D. Roosevelt chose objections against this legislation merce. Since the 1930s, the Supreme Frances Perkins as his Secretary of more than 3 months ago during the Court has expanded this to include reg- Labor, they discussed social policy leg- committee markup, and so has he. ulation of activities that substantially islation including health insurance. As This body has spent its time debating affect interstate commerce. But the Secretary Perkins later described it, the policy of this legislation. This is a key word is activities. Congress has they agreed that such legislation would terrible piece of legislation that will never crossed the line between regu- pose ‘‘very severe constitutional prob- raise insurance premiums, raise taxes, lating what people choose to do and or- lems,’’ including fundamentally alter- and limit access to care. dering them to do it. The difference being federal-state relationships. That is Mr. President, I ask unanimous con- tween regulating and requiring is lib- why the Social Security Act relies on sent that an editorial from yesterday’s erty. I agree with the 75 percent of the payroll tax. Even the Roosevelt ad- Wall Street Journal, titled ‘‘Change Americans who believe that the insur- ministration, which oversaw the most Nobody Believes In,’’ be printed in the ance mandate is unconstitutional be- dramatic expansion of Federal power in RECORD following my remarks. cause Congress’s power to regulate our Nation’s history, would not go as The PRESIDING OFFICER. Without interstate commerce does not include far as the legislation before us today objection, it is so ordered. telling Americans what they must buy. would go. (See exhibit 1.) Second, the financial penalty enforc- Should this legislation become law, Mr. HATCH. From the standpoint of ing the insurance mandate is just that, there would be nothing that the federal policy, Mr. President, we should not a penalty. It is not a tax and, there- government could not do. Congress pass this bill. Perhaps more impor- fore, it is constitutional only if the in- would be remaking the Constitution in tantly, from the standpoint of the Con- surance mandate it enforces is con- its image, rather than abiding by the stitution, we may not pass it. stitutional. If it is a tax, it is a direct Constitution’s limits as liberty re- Much has changed since the founding tax on individuals rather than an ex- quires. There must come a time when of this great country, but one thing has cise tax on transactions and, therefore, we say that the political ends cannot not: The liberty we love requires limits it violates article I, section 9, of the justify the constitutional means, that on government. It requires limits on Constitution which requires that direct the Constitution and the liberty it pro- government. It always has and it al- taxes be apportioned according to pop- tects are more important than we won- ways will. America’s founders knew ulation. derful Members of Congress are. That that and built limits into the system of Third, the excise tax on high-cost in- time is now, and that is why we will government they established. Those surance plans, which applies dif- vote to sustain this constitutional limits come primarily from a written ferently in some states than in others, point of order. Constitution that delegates enumer- is unconstitutional because it is not I wish to personally thank and con- ated powers to the Federal Govern- uniform throughout the United States gratulate the distinguished Senator ment. We must point to at least one— as required by article I, section 8. The from Nevada for his work on this issue, at least one—of those powers as the Supreme Court has said that to be uni- for his work on the committee, because basis for any legislation we pass. form as the Constitution requires, an he was one of the more energetic and The Constitution and the limits it excise tax must have the same force more capable people on the committee imposes do not mean whatever we want and effect wherever the subject of the in raising some of these very important them to mean. tax is found. Not only is this not the issues such as this constitutional set of This legislation brings America into case with this tax, which makes it issues we have been discussing over completely uncharted political and plainly unconstitutional, but that is this short period of time today. I am legal waters and I will not be at all sur- exactly the design and intention of grateful for him, I am grateful he has prised if there is litigation challenging those who drafted this legislation. raised it, and I am grateful to be able it on constitutional and other grounds. Fourth, the legislation orders states to be here on the floor to support him In the Finance Committee, I offered an to establish health benefit exchanges in his raising of this constitutional amendment to add a procedure for the which will require states to pass legis- point of order when he chooses to do courts to handle constitutional chal- lation and regulations. If they do not, so. lenges in an expedited fashion. The Fi- or even if the Secretary of Health and I yield the floor. nance Committee chairman ruled that Human Services believes they will not EXHIBIT 1 amendment out of order so that it by a certain date, the Secretary will [From the Wall Street Journal, Dec. 21, 2009] could not even be considered. That was literally step into each state and estab- CHANGE NOBODY BELIEVES IN his decision, but that means that any lish and operate this exchange for And tidings of comfort and joy from Harry future challenges will be handled the them. This is a direct violation of the Reid too. The Senate Majority Leader has old fashioned way, even if that means division between federal and state gov- decided that the last few days before Christ- an extended, rather than an expedited, ernment power. The Supreme Court mas are the opportune moment for a narrow process. could not have been clearer on this majority of Democrats to stuff ObamaCare I ask unanimous consent that a point, ruling over and over that Con- through the Senate to meet an arbitrary memo prepared by the Conservative gress may regulate individuals but may White House deadline. Barring some extraor- not regulate states. Congress has no dinary reversal, it now seems as if they have Action Project be printed in the the 60 votes they need to jump off this cliff, RECORD following my remarks. Its sig- authority to order states, in their ca- with one-seventh of the economy in tow. natories include former U.S. Attorney pacity as states to pass legislation. We Mr. Obama promised a new era of trans- General Edwin Meese; former Congress- have encouraged states to pass legisla- parent good government, yet on Saturday man David McIntosh; Karen Kerrigan, tion, we have bribed them, we have morning Mr. Reid threw out the 2,100–page President of the Small Business and even extorted them by threatening to bill that the world’s greatest deliberative Entrepreneurship Council; and Brian withhold federal funds. But this legis- body spent just 17 days debating and relation simply commandeers states and placed it with a new ‘‘manager’s amend- McManus of the Council for Affordable ment’’ that was stapled together in covert Health Insurance. makes them little more than subdivi- partisan negotiations. Democrats are barely The PRESIDING OFFICER. Without sions of the federal government. In even bothering to pretend to care what’s in objection it is so ordered. 1997, the Supreme Court held ‘‘state it, not that any Senator had the chance to (See Exhibit 2.) legislatures are not subject to Federal digest it in the 38 hours before the first clo- Mr. HATCH. Let me briefly repeat direction’’ and reaffirmed ‘‘categori- ture vote at 1 a. m. this morning. After pro- the constitution objections I have been cally’’ its earlier holding that ‘‘the fed- cedural motions that allow for no amend- raising for the past few months and eral government may not compel the ments, the final vote could come at 9 p.m. on which the Senator from Nevada care- states to enact or administer a federal December 24. Even in World War I there was a Christmas fully raised this morning. First, the regulatory program.’’ That should be truce. only enumerated power that conceiv- clear enough for Senators to under- The rushed, secretive way that a bill this ably can support the mandate for indi- stand here in this body. destructive and unpopular is being forced on

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The White House was volved into the raw exercise of political drug-coated stents are driving costs too able to, er, persuade the likes of the AMA power for the single purpose of permanently high, though patients and their physicians and the hospital lobbies because the Federal expanding the American entitlement state. might disagree. government will control 55% of total U.S. An increasing roll of leaders in health care ‘‘The Senate isn’t hearing those of us who health spending under ObamaCare, according and business are looking on aghast at a bill are closest to the patient and work in the to the Administration’s own Medicare actu- that is so large and convoluted that no one system every day,’’ Brent Eastman, the aries. can truly understand it, as Finance Chair- chairman of the American College of Sur- Others got hush money, namely Nebraska’s man Max Baucus admitted on the floor last geons, said in a statement for his organiza- Ben Nelson. Even liberal Governors have week. The only goal is to ram it into law tion and 18 other speciality societies oppos- been howling for months about ObamaCare’s while the political window is still open, and ing ObamaCare. For no other reason than unfunded spending mandates: Other budget clean up the mess later. ideological animus, doctor-owned hospitals priorities like education will be crowded out Health costs. From the outset, the White will face harsh new limits on their growth when about 21% of the U.S. population is on House’s core claim was that reform would re- and who they’re allowed to treat. Physician Medicaid, the joint state-federal program in- duce health costs for individuals and busi- Hospitals of America says that ObamaCare tended for the poor. Nebraska Governor Dave nesses, and they’re sticking to that story. will ‘‘destroy over 200 of America’s best and Heineman calculates that ObamaCare will ‘‘Anyone who says otherwise simply hasn’t safest hospitals.’’ result in $2.5 billion in new costs for his read the bills,’’ Mr. Obama said over the Blowing up the federal fisc. Even though state that ‘‘will be passed on to citizens weekend. This is so utterly disingenuous Medicare’s unfunded liabilities are already through direct or indirect taxes and fees,’’ as that we doubt the President really believes about 2.6 times larger than the entire U.S. he put it in a letter to his state’s junior Sen- it. economy in 2008, Democrats are crowing that ator. The best and most rigorous cost analysis ObamaCare will cost ‘‘only’’ $871 billion over So in addition to abortion restrictions, Mr. was recently released by the insurer the next decade while fantastically reducing Nelson won the concession that Congress WellPoint, which mined its actuarial data in the deficit by $132 billion, according to CBO. will pay for 100% of Nebraska Medicaid ex- various regional markets to model the Sen- Yet some 98% of the total cost comes after pansions into perpetuity. His capitulation ate bill. WellPoint found that a healthy 25- 2014—remind us why there must absolutely ought to cost him his political career, but year-old in Milwaukee buying coverage on be a vote this week—and most of the taxes more to the point, what about the other the individual market will see his costs rise start in 2010. That includes the payroll tax states that don’t have a Senator who’s the by 178%. A small business based in Richmond increase for individuals earning more than 60th vote for ObamaCare? with eight employees in average health will $200,000 that rose to 0.9 from 0.5 percentage ‘‘After a nearly century-long struggle we see a 23% increase. Insurance costs for a 40- points in Mr. Reid’s final machinations. Job are on the cusp of making health-care reform year-old family, with two kids living in Indi- creation, here we come. a reality in the United States of America,’’ anapolis will pay 106% more. And on and on. Other deceptions include a new entitle- Mr. Obama said on Saturday. He’s forced to These increases are solely the result of ment for long-term care that starts col- claim the mandate of ‘‘history’’ because he ObamaCare—above and far beyond the status lecting premiums tomorrow but doesn’t start can’t claim the mandate of voters. Some 51% quo—because its strict restrictions on under- paying benefits until late in the decade. But of the public is now opposed, according to writing and risk-pooling would distort insur- the worst is not accounting for a formula National Journal’s composite of all health ance markets. All but a handful of states that automatically slashes Medicare pay- polling. The more people know about have rejected regulations like ‘‘community ments to doctors by 21.5% next year and ObamaCare, the more unpopular it becomes. rating’’ because they encourage younger and deeper after that. Everyone knows the pay- The tragedy is that Mr. Obama inherited a healthier buyers to wait until they need ex- ment cuts won’t happen but they remain in consensus that the health-care status quo pensive care, increasing costs for everyone. the bill to make the cost look lower. The needs serious reform, and a popular Presi- Benefits and pricing will now be determined American Medical Association’s priority was dent might have crafted a durable com- by politics. eliminating this ‘‘sustainable growth rate’’ promise that blended the best ideas from As for the White House’s line about cutting but all they got in return for their year of both parties. A more honest and more costs by eliminating supposed ‘‘waste,’’ even ObamaCare cheerleading was a two-month thoughtful approach might have even done Victor Fuchs, an eminent economist gen- patch snuck into the defense bill that passed some good. But as Mr. Obama suggested, the erally supportive of ObamaCare, warned last over the weekend. Democratic old guard sees this plan as the week that these political theories are overly The truth is that no one really knows how culmination of 20th-century liberalism. simplistic. ‘‘The oft-heard promise ‘we will much ObamaCare will cost because its as- So instead we have this vast expansion of find out what works and what does not’ sumptions on paper are so unrealistic. To federal control. Never in our memory has so scarcely does justice to the complexity of hide the cost increases created by other unpopular a bill been on the verge of passing medical practice,’’ the Stanford professor parts of the bill and transfer them onto the Congress, never has social and economic leg- wrote. federal balance sheet, the Senate sets up islation of this magnitude been forced Steep declines in choice and quality. This government-run ‘‘exchanges’’ that will sub- through on a purely partisan vote, and never is all of a piece with the hubris of an Admin- sidize insurance for those earning up to 400% has a party exhibited more sheer political istration that thinks it can substitute gov- of the poverty level, or $96,000 for a family of willfulness that is reckless even for Wash- ernment planning for market forces in deter- four in 2016. Supposedly they would only be ington or had more warning about the con- mining where the $33 trillion the U.S. will offered to those whose employers don’t pro- sequences of its actions. spend on medicine over the next decade vide insurance or work for small businesses. These 60 Democrats are creating a future should go. As Eugene Steuerle of the left-leaning of epic increases in spending, taxes and com- This centralized system means above all Urban Institute points out, this system mand-and-control regulation, in which bu- fewer choices; what works for the political would treat two workers with the same total reaucracy trumps innovation and transfer class must work for everyone. With formerly compensation—whatever the mix of cash payments are more important than private private insurers converted into public utili- wages and benefits—very differently. Under investment and individual decisions. In ties, for instance, they’ll inevitably be the Senate bill, someone who earned $42,000 short, the Obama Democrats have chosen banned from selling products like health sav- would get $5,749 from the current tax exclu- change nobody believes in—outside of them- ings accounts that encourage more cost-con- sion for employer-sponsored coverage but selves—and when it passes America will be scious decisions. $12,750 in the exchange. A worker making paying for it for decades to come. Unnoticed by the press corps, the Congres- $60,000 would get $8,310 in the exchanges but EXHIBIT 2 sional Budget Office argued recently that the only $3,758 in the current system. Senate bill would so ‘‘substantially reduce For this reason Mr. Steuerle concludes CONSERVATIVE ACTION PROJECT flexibility in terms of the types, prices, and that the Senate bill is not just a new health The Conservative Action Project, chaired number of private sellers of health insur- system but also ‘‘a new welfare and tax sys- by former Attorney General Edwin Meese, is ance’’ that companies like WellPoint might tem’’ that will warp the labor market. Given designed to facilitate conservative leaders need to ‘‘be considered part of the federal the incentives of these two-tier subsidies, working together on behalf of common goals. budget.’’ employers with large numbers of lower-wage Participation is extended to leaders of With so large a chunk of the economy and workers like Wal-Mart may well convert groups representing all major elements of medical practice itself in Washington’s them into ‘‘contractors’’ or do more out- the conservative movement—economic, so- hands, quality will decline. Ultimately, ‘‘our sourcing. As more and more people flood into cial and national security. capacity to innovate and develop new thera- ‘‘free’’ health care, taxpayer costs will ex- Edwin Meese, former Attorney General; pies would suffer most of all,’’ as Harvard plode. Steven G. Calabresi, Professor, Northwestern Medical School Dean Jeffrey Flier recently Political intimidation. The experts who Law School; Mathew D. Staver, Founder & wrote in our pages. Take the $2 billion an- have pointed out such complications have Chairman, Liberty Counsel; Curt Levey, Ex- nual tax—rising to $3 billion in 2018—that been ignored or dismissed as ‘‘ideologues’’ by ecutive Director, Committee for Justice; will be leveled against medical device mak- the White House. Those parts of the health- Marion Edwyn Harrison, Past President, ers, among the most innovative U.S. indus- care industry that couldn’t be bribed out- Free Congress Foundation; Kenneth tries. Democrats believe that more advanced right, like Big Pharma, were coerced into ac- Klukowski, Senior Legal Analyst, American

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Civil Rights Union; Wendy Wright, Presi- The Commerce Clause requires an actual FOR ADDITIONAL INFORMATION ON THE UNCON- dent, Concerned Women for America; J. Ken- economic effect, not merely a congressional STITUTIONALITY OF THE HEALTH CARE MAN- neth Blackwell, Visiting Professor, Liberty finding of an economic effect. When the DATE, PLEASE VISIT THESE WEBSITES School of Law; Grover Norquist, President, Court struck down the Violence Against http://www.washingtonpost.com/wpdyn/ Americans for Tax Reform; William Wilson, Women Act in United States v. Morrison content/article/2009/08/21/ President, Americans for Limited Govern- (2000), the Court noted that although the AR2009082103033.html ment; Matt Kibbe, President, Freedom statute made numerous findings regarding http://www.politico.com/news/stories/1009/ Works; Jim Martin, President, 60 Plus Asso- the link between such violence and inter- 28463.html ciation; David McIntosh, former Member of state commerce, it held that those findings http://www.politico.com/news/stories/1009/ Congress, Indiana; Colin A. Hanna, Presi- did not actually establish an economic ef- 28620.html dent, Let Freedom Ring; Tony Perkins, fect. Therefore the various interstate-com- http://www.politico.com/news/stories/1009/ President, Family Research Council; Brent merce findings in the Senate version of the 28787.htm1 Bozell, President, Media Research Center; ‘‘Obamacare’’ legislation do not make the http://www.foxnews.com/opinion/2009/10/30/ Brian McManus, Council for Affordable bill constitutional. ken-klukowski-open-letter-pelosi-gibbs-con- Health Insurance; Karen Kerrigan, Presi- The individual mandate is not authorized stitution-individual-mandate/ dent, Small Business & Entrepreneurship under the General Welfare Clause. The Su- http://www.washingtontimes.com/news/2009/ Council; T. Kenneth Cribb, former Counselor preme Court made clear in United States v. nov/02/beware-the-health-insurance-police/ to the U.S. Attorney General; Richard Butler (1936) and Helvering v. Davis (1937) http://www.heritage.org/Research/ Viguerie, Chairman, ConservativeHQ.com; that the General Welfare Clause only applies LegalIssues/1m0049.cfm Alfred Regnery, Publisher, American Spec- to congressional spending. It applies to http://blogs.abcnews.com/politicalpunch/ tator. money going out from the government; it 2009/11/interview-with-the-president-jail- MEMO FOR THE MOVEMENT does not confer or concern any government time-for-those-without-health-care-insur- The Individual Mandate in ‘‘Obamacare’’ is Un- power to take in money, such as would hap- ance.html constitutional pen with the individual mandate. Therefore http://hatch.senate.gov/public/index.cfm? Re: The mandate under the Obama-Pelosi- the mandate is outside the scope of the Gen- FuseAction=PressReleases.Detail&Press Reid healthcare legislation requiring Amer- eral Welfare Clause. Releaselid=097a758af3–1b78–be3e-e03a- ican citizens to purchase health insurance The individual mandate is not authorized c0eea6d515c.5 violates the U.S. Constitution. under the Taxing and Spending Clause or In- The PRESIDING OFFICER. The Sen- Action: We urge you to make this point to come Tax. The Constitution only allows cer- ator from Nevada is recognized. members of the U.S. Senate—and if a bill tain types of taxation from the federal gov- Mr. ENSIGN. Mr. President, I know ernment. passes the Senate to impress upon members we are waiting for the chairman of the of both chambers of Congress—that the key The Article I Taxing and Spending Clause provision in the healthcare legislation vio- permits duties, imposts, excises and capita- Finance Committee to come. I ask lates the U.S. Constitution. tion taxes—duties, imposts and excises are unanimous consent to speak in the Issue: Mandating that individuals must ob- taxes on purchases. A capitation tax is a tax meantime, in these few seconds. tain health insurance, and imposing any pen- that every person must pay, and the Con- I thank the senior Senator from alty—civil or criminal—on any private cit- stitution’s apportionment rule requires that Utah. He is one of the best constitu- izen for not purchasing health insurance is every person in each state must pay exactly tional scholars we have here in the not authorized by any provision of the U.S. the same amount. The Obamacare mandate Senate. I appreciate his words and Constitution. As such, it is unconstitutional, is imposed on people who are making no pur- and should not survive a court challenge on chase, and is a tax that some people in a analysis on why this bill is unconstitu- that issue. Supporters of the legislation have state would pay, but others do not. tional. I think his words this morning incorrectly contended that the legal jus- The Sixteenth Amendment allows an in- were eloquent. I appreciate his support tification for the mandate is authorized by come tax. An income tax is imposed only on as I raise this constitutional point of the Commerce Clause, the General Welfare earnings, but people would have to pay this order. Clause, or the Taxing and Spending Clause. tax even if they had no income. I yield to the Senator from Montana, Given that this mandate provision is essen- Therefore it cannot be any of these con- the chairman of the Finance Com- stitutionally-permitted taxes. tial to Obamacare; its unconstitutionality mittee. renders the entire program untenable. The individual mandate is unconstitu- The individual mandate is unconstitutional regardless of whether there are crimi- The PRESIDING OFFICER. The Sen- tional unless there is a specific constitu- nal penalties involved. There is no distinc- ator from Montana is recognized. tional provision that authorizes it. The fed- tion between criminal and civil penalties for Mr. BAUCUS. Mr. President, I have a eral government is a government of limited determining the constitutionality of legisla- unanimous consent request that I un- jurisdiction. It has only enumerated powers. tion, and the penalty imposed in Wickard v. derstand has been cleared by both Therefore unless a specific provision of the Filburn (1942) was not a criminal penalty. sides. Constitution empowers a particular law, Therefore even if the criminal sanctions I ask unanimous consent that after then that law is unconstitutional. There is were removed from the legislation, the impo- Senator ENSIGN raises the point of no such authorization for the mandate. sition of any penalty or consequence for not The individual mandate is not authorized purchasing insurance renders the mandate order that the Reid substitute amend- by the Commerce Clause. Most of those advo- unconstitutional. ment No. 2786 is in violation of the cating the Democrats’ bill say that Congress The individual mandate cannot be properly Constitution, the point of order be set can pass this legislation pursuant to its compared to requiring auto insurance. Presi- aside to recur on Wednesday, December power to regulate interstate commerce. That dent Obama said in a Nov. 9 interview on 23, at a time to be determined by the argument is incorrect, because there is no ABC television that requiring people to buy majority and Republican leaders. interstate commerce when private citizens health insurance and penalizing those that The PRESIDING OFFICER. Is there do not purchase health insurance. do not buy is acceptable because people are The Commerce Clause only covers matters required to buy car insurance. That state- objection? Without objection, it is so where citizens engage in economic activity. ment is untrue. ordered. The last time the Supreme Court struck Only state governments can require people The Senator from Nevada is recog- down a law for violating the Commerce to get car insurance. While the federal gov- nized. Clause, in United States v. Morrison (2000), ernment is limited to the powers enumerated Mr. ENSIGN. Mr. President, I rise to the Court did so on the grounds that the ac- in the Constitution, the states have a gen- make a constitutional point of order tivity in question was not an economic ac- eral police power. The police power enables against this bill on the grounds that it tivity. state governments to pass laws for public violates Congress’ enumerated powers The Commerce Clause only extends to per- safety and public health. The federal govern- sons or organizations voluntarily engaging ment has no general police power, and therein article I, section 8 and that it vio- in commercial activity. Government can fore could not require car insurance. lates the fifth amendment of the Con- only regulate economic action; it cannot co- States do not require people to purchase stitution. I ask for the yeas and nays. erce action on the part of private citizens car insurance. Driving a car is a privilege, The PRESIDING OFFICER. Pursuant who do not wish to participate in commerce. not a right. States require people to get in- to the unanimous consent, the point of In the most expansive case for Congress’ surance only as a condition for those people order shall be set aside until a time to- power to regulate interstate commerce, who voluntarily choose to drive on the pub- morrow to be determined by the major- Wickard v. Filburn (1942), the Court upheld lic roads. If a person chooses to use public ity leader and the minority leader. the agricultural regulation in question transportation, or use a bicycle instead of a against a wheat farmer who earned his entire car, or operate a car only on their own prop- Is there a sufficient second? There living from growing and selling wheat, mak- erty, they are not required to have car insur- appears to be a sufficient second. The ing him a willing participant in interstate ance, and cannot be penalized for lacking in- yeas and nays are ordered on the point commerce. surance. of order.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00016 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13729 Mr. ENSIGN. Mr. President, I suggest We estimate that the aggregate net sav- under the PPACA) and to extend the trust the absence of a quorum. ings to the Part A trust fund under the fund. . . . The PRESIDING OFFICER. The PPACA— All right. You got it? Let’s go back clerk will call the roll. That is the health care reform bill— and leave out the parentheses: The legislative clerk proceeded to would postpone the exhaustion of the trust . . . the improved Part A financing cannot call the roll. fund assets by 9 years—that is from 2017 be simultaneously used to finance other Fed- Mr. SESSIONS. Mr. President, I ask under current law to 2026 under the proposed eral outlays . . . and to extend the trust unanimous consent that the order for legislation. fund, despite the appearance of this result the quorum call be rescinded. Great. That is not a bad result. But from the respective accounting conventions. The PRESIDING OFFICER. Without then he goes on. I think he was simply So they got CBO to score it as if the objection, it is so ordered. asked: If you reduce spending in Medi- money is going into the new health Mr. SESSIONS. Mr. President, I care by effecting these cuts and reduc- care reform, and they got CMS to score would like to share some thoughts on a tions in Medicare, will it extend the it as if it is saving Medicare. central issue to this health care reform life? And he said it would. However, I Now, I was a Federal prosecutor for a legislation. It is something that has think he felt he might have been used, long time. I know the responsibilities gotten away from us. I do not believe and so he didn’t leave it right there. I placed on presidents of corporations. If we fully comprehended it. It is a crit- think he believed there was something the president of a corporation were to ical issue. else afoot in this deal. He goes on to issue a prospectus and ask people to in- It seems to me we are double-count- say this: vest money in his company and support ing the money. We are counting money In practice, the improved Part A financ- his program, his agenda, and he said: I twice—maybe the largest amount of ing— have $400 billion or $400,000 I am going money ever having been counted twice That is what he is talking about, to spend in it, and he knew the money in the history of the world. It is very was being spent on something else and dangerous with regard to the financial these cuts— . . . the improved Part A financing cannot be he did not really have that money, that viability of the legislation we are look- is a criminal offense, and people would ing at today. simultaneously used to finance other Federal outlays (such as the coverage expansions go to jail for it. It was promised by the President under the PPACA)— I am worried about it; I really am. that this legislation would not add one This is unbelievable. So we are going to dime to the national debt. He said yes- The health care bill— get to the bottom of this. If I am terday that this legislation would and to extend the trust fund, despite the ap- wrong, I would like to see where the strengthen Medicare. This is his quote: pearance of this result from the respective accounting conventions. money is coming from. So my question . . . and Medicare will be stronger and its solvency extended by nearly a decade. Maybe I am wrong about this. I am to my colleagues is—and apparently this has been asked by staff for weeks I don’t think that is accurate. We happy to have a lot of people look at it. and they have never gotten a straight have had other Members of the Demo- Wait a minute, we have the President answer—where do you get this $871 bil- cratic leadership say that. of the United States yesterday saying What we know is we have, I think it that Medicare will be stronger and its lion? How much of that are you count- is about $460 billion in tax increases solvency extended for nearly a decade. ing coming from savings in Medicare; and $490 billion in tax increases and a We have Senator DURBIN and I think and where, precisely, are you getting it little less than that, $400-and-some-odd Senator BAUCUS and others saying the from Medicare? If you are going to billion in savings to Medicare, and that same thing. We are talking about $400 spend it on the new program, how are accounts for the $871 billion the bill is billion. you going to say it is going to supposed to cost in the first 10 years. So I would think this Congress can strengthen Medicare as to its insol- Of course, that is not an accurate ulti- get a straight answer somewhere. vency problem? mate cost since most of the benefits in Don’t you? Well, I have been asking You cannot count the money twice, the bill do not start until the fifth staff, and they say it is double count- and I believe that is what Mr. FOSTER year. So when you go the first full 10 ing. was suggesting; that you cannot simul- years of the bill, it costs $2.5 trillion. I said: What do you mean it is double taneously count the money ‘‘despite But, regardless, let’s take this first 10 counting? the appearance of this result from the years. The assertion is that Medicare Well, Senator GREGG, the ranking respective accounting conventions.’’ can be improved and that we can take Republican on the Budget Committee— What he is saying is, CBO is following money from it and that this is going to former chairman of the Budget Com- proper accounting conventions for make Medicare stronger and that mittee—said it is double accounting. their scoring and CMS is doing it their somehow this is going to extend the He offered an amendment, a simple way and it gives the appearance that solvency of Medicare, which is going amendment that said any money that you have some money that can be insolvent by 2017. That is because more is saved in Medicare stays in Medicare. spent twice. But he said you cannot si- and more people are retiring and people Did that pass? No. They voted that multaneously use the same money. are living longer, among other reasons. down. That should be a signal, I sub- Now, isn’t that true? But in this body, So the cost of Medicare goes up. mit. That should be a red flag. I do not know. I guess what I am framing now is So now I am looking at this really, What is another fundamental matter what I believe to be a matter of the really hard because the way I see the of budgetary importance that goes greatest importance. The argument is financial accounting of the bill, per- with it? The President has repeatedly that somehow, by cutting benefits in haps the largest bogus part of it is to said that not one dime will be added to Medicare by almost $1⁄2 trillion, we are say that the money that is being saved the national debt, and it should not be. somehow strengthening Medicare. That from Medicare is going to create this We cannot continue to do that. So would be true if the money that was new program and, at the same time, when this legislation started, the idea taken out of Medicare Programs and saying the savings in Medicare are was we needed to reform a lot of prob- benefits and providers who are pro- going to be used to extend the life of lems in our health care situation. viding the benefits—if that money were Medicare. You cannot do both. One of the problems everybody recog- maintained in Medicare. That is what Mr. FOSTER said in his nized was that the doctors are not get- They go to the CMS, the institution letter of December 10: ting paid in a proper fashion for the that keeps up with Medicare costs, the In practice, the improved Part A financ- work they do. Under the Balanced Center for Medicare and Medicaid Serv- ing— Budget Act of 1997, we effected rules on ices, the Chief Actuary there, Mr. Rich- He is talking about the improved how much doctors should be paid, and ard Foster, and they ask him: Won’t Part A financing of Medicare by these if those rules went into effect today, these reductions in Medicare expenses cuts— doctors would have a 21-percent pay extend the life of Medicare? And he the improved Part A financing cannot be si- cut on all Medicare work. Already said yes. OK. He said yes. He writes multaneously used to finance other Federal Medicare physicians are leaving the this: outlays (such as the coverage expansions practice because they get paid much

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00017 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13730 CONGRESSIONAL RECORD — SENATE December 22, 2009 less from the Federal Medicare Pro- fix of their payments. ‘‘Doctors, we are horrible for them. What happens to the gram than they do from private health going to take care of it. We’ll just pass individual market? Under the Reid bill, insurance. So they would rather do pri- it, and every penny of this will add to their premiums would go up 7.77 per- vate work than Medicare. But they do the debt.’’ cent per year. They would go up more Medicare—most doctors do—but if you Well, 13 Democrats would not swal- than the others. What about if we took them another 21 percent down, low that, and I think every Republican didn’t do anything? How much would they would not. opposed it, and it went down. So now I their bills go up then, their insurance Every year, they come here and ask think we have a 2-month fix. Two bills? Only 5.51 percent. Theirs go up the Congress to waive this cut, and months is where we are working from more than 2 percent. Congress—as part of the duplicity of today, so we would not have a slashing So I am just saying this legislation this body that has gone on under both of payments to physicians by failure to may have a great vision, it may have a parties, but each year it gets worse and fix it. great idea about trying to make the worse—we fix it, and we do not execute So they just took it out, and I as- system work better, but it doesn’t. the cut. But we only do it for 1 year. So sume we are going to have some other These are huge costs. It is not finan- when we have a budget, it assumes a gimmick to hide that $250 billion. So if cially sound. It is not going to reduce 10-year budget. As President Obama you put the $250 billion cost into our premiums. It is going to increase submitted it to us, it assumes in the health care reform, you end up with a the percentage of wealth in America first year you pay the physicians and $120 billion deficit right off the bat. going to health care instead of reduc- you do not cut their pay. Then for 9 Then, when you get into this double ac- ing it as I thought we were supposed to years you assume they get a 21-percent counting of $450 billion, you have real- do from the beginning. reduction. It is a gimmick because you ly got a mess. They are estimating $871 I see my colleague, Senator KYL, cannot cut the physicians 21 percent; billion in income for the first 10 years here. I would just leave it at that. I and we know that. If we budgeted for of this plan. As I analyze it, you have thank my colleagues. But if I am cor- the full amount, we are going to have a $250 billion hole from not paying the rect about these numbers, we shouldn’t to pay physicians, and we are going to doctors, and then you have a $400-plus vote for the bill. People should change pay physicians, then there would be a billion double accounting—the savings their vote. If I am in error, I would like big hole because we do not have the from Medicare. to be informed of how I am in error. I yield the floor. money and we either have to cut some- So it is just not good. I am telling The PRESIDING OFFICER (Mr. thing else, raise taxes, or raise the you, we only have one President. He has a lot of things on his mind, and it BURRIS). The Senator from Arizona. debt. What we have been doing is pay- Mr. KYL. Mr. President, I listened is very frustrating. But I will say one ing for it with more debt. carefully to what my colleague said, more thing he said at that press con- Well, each year, the doctors get all and as a member of the Finance Com- ference. He said, and he has repeatedly upset because they are staring at a 21- mittee, I can tell him that he is not in stated: It is going to reduce health care percent pay cut. All their representa- error. What he said about premiums premiums for your insurance. Right? tives in the AMA and everybody come going up under this legislation is true. up every year and tell us: Don’t cut our This was yesterday, after this bill The promise was that premiums would pay, and we do not—1 year at a time. passed. He says he is tired of people not go up. Well, they continue to go up. This is a misrepresentation. It hides carping about the cost of the bill. Re- In fact, in the case of the individual the financial precariousness of our po- member him saying that—tired of market, the legislation itself causes sition. It is not good. It should never these carpers? I guess he is talking them to go up between 10 and 13 per- continue. It needs to be permanently about me because I have been carping cent. My colleague is not in error. fixed, and that was supposed to be part about the cost of it for some time be- If the Reid bill has a motto, it is ‘‘in of health care reform from the begin- cause the numbers do not add up. government we trust.’’ With the turn of ning. The President said that is what All right. They claim the legislation every page, it is no exaggeration to say he was going to do. The leadership on will reduce insurance costs. This is the the Reid bill creates a Washington the other side said that is what they score of the CBO about small busi- takeover of health care, to wit, $2.5 were going to do. nesses. What about insurance pre- trillion in new government spending; But what happened—when they met miums? If you are small businesses, the $494 billion in new taxes; $465 billion in in their secret rooms, and they all average premiums today for a family is Medicare cuts; 70 new government pro- wheeled and dealed and tried to add up $13,300. If the Reid bill passes, by 2016 grams; and higher health insurance these numbers and see how they could the premiums will be $19,200. Is that premiums for individuals, families, and manipulate numbers and scores and ac- cutting premiums? Well, yes, it is be- businesses. It is packed with new Fed- counting to make it add up so they cause under the Reid bill it would in- eral requirements and mandates that could say it would not add one penny crease, on average, 5.38 percent. But if amount to a stunning assault on lib- to the debt—they could not get around we did not pass any bill at all, it would erty. Even in the absence of a govern- the $250 billion it takes to pay the doc- increase it 5.46 percent. So it saved ment-run insurance plan, this bill tors. They could not do it. money; it reduced your premium. It would give the government virtually They say, under this bill, there is a will be $19,200 instead of $19,300. That is total control over health care. The bill $130 billion surplus over the first 10 for small businesses. itself is the government option. years. But it does not fix the doctor What about for large businesses? Michael Cannon, a health policy ex- payments for Medicare in health care Does it cut insurance premiums there? pert at the Cato Institute, warns that work, Medicaid. It does not fix it. So For large business plans, under the the bill’s linchpin, the requirement when you fix it, it costs $250 billion. Reid bill, the increase, if we pass this that all individuals buy a government- There is no dispute about that. We legislation, would be 5.41 percent per approved insurance plan, would be ‘‘the have analyzed that. The accounting year in your premiums. If you do not most sweeping and dangerous measure numbers are clear: $250 billion. pass the bill at all, it would be 5.56 per- in any of the bills before Congress.’’ So what the Democrats tried to do— cent. Is that a savings? Very little. In- Of course, if Congress mandates that it was a clever—Senator ENSIGN re- stead of $21,100, under the Reid bill you every American purchase health insur- ferred to it the other day as a shell would pay $20,300. ance, then Congress gets to define ex- game. They moved the doctor fix out of Then, finally, the individual mar- actly what that health insurance en- the health care reform—just took it ket—this is the people who already are tails. Welcome to the future, where bu- out—and so, therefore, you do not have the ones who are getting hurt because reaucrats and politicians know what is the $250 billion hole and you just put it they are not in group plans; they don’t best for families, small businesses, and over here. They thought they would be have employers paying a third, a half, seniors. For example, under this legis- clever, they would just pass it, and we or whatever, for insurance; they don’t lation the government would set new would add it all to the debt. They tried get the same tax breaks. They are get- Federal rating rules. Rating rules dic- to do so, so they could tell the doctors ting killed. Barbers, individual people tate how insurers may calculate pre- they tried to vote to have a permanent who can’t get into group plans, it is miums, which experts estimate would

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00018 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13731 increase premiums by a whopping 72 comparative effectiveness research. sources, and the government inevitably percent in my home State of Arizona. This research, which is already done in interferes in your ability to access They would determine the coverage the private sector, compares the effec- care. That is rationing, and it is wrong. benefits for all plans regardless of con- tiveness of two or more health care This is not what Americans want or ex- sumer preferences or health care needs. services or treatments, and, of course, pected from health care reform. Yet it The government would limit insurers it is used to provide doctors with infor- is precisely the path Congress is tak- to offering only four plans. You have to mation as to what works best in most ing. Perhaps that is why 61 percent of offer two; you can’t offer any more cases. The goal is to provide patients Americans disapprove of this bill. than four. They would prohibit individ- and doctors with better information re- Nothing in the Reid bill would pro- uals over the age of 30 from enrolling garding the risks and benefits of a hibit the Federal Government from in a catastrophic health care plan. And drug, let’s say, for example, versus sur- using comparative effectiveness re- to highlight the magnitude of govern- gery in a particular kind of case. The search, just as it has done in Britain, ment interference and micromanage- question before us is not as to the mer- as a tool to delay or deny coverage of ment, the bill even dictates the number its of the research but, rather, whether a health care treatment or service. The of pages—by the way, it is no more the research should be used by the gov- bill actually empowers the Secretary than 4—and the font size—no smaller ernment to determine the treatments of Health and Human Services to use than 12 point—of the summary of bene- and services covered by insurance. comparative effectiveness research fits. These are just a few examples of In a recent interview, President when making coverage determinations. the heavyhanded government controls. Obama said: For example, on page 1,684 of the origi- Indeed, the word ‘‘shall’’ appears 3,607 What I think the government could do ef- nal bill, it says: times in the Reid bill. I haven’t had a fectively is to be an honest broker in assess- The Secretary may only use evidence and chance yet to count how many more ing and evaluating treatment options. findings from research conducted under sec- times it appears in the almost 400-page tion 1181 to make a determination regarding The President believes the govern- coverage . . . amendment that has been now filed. ment should assess and evaluate health In my view, however, the most dan- And so on. care treatments, and certainly that is As the Washington Examiner notes: gerous consequence of the Washington how health care works in other coun- Health and Human Services Secretary takeover of health care is the inevi- tries such as Great Britain. For exam- table rationing that will result in the Kathleen Sebelius would be awarded unprec- ple, there, they have the National In- edented new powers under the proposal, in- delay and denial of care. Ensuring ac- stitute for Health and Clinical Excel- cluding the authority to decide what medical cess to the highest quality care and lence; the acronym is NIHCE. NIHCE care should be covered by insurers as well as protecting the sacred doctor-patient routinely uses comparative effective- the terms and conditions of coverage and relationship should be the fundamental ness research to make cost-benefit cal- who should receive it. The Reid legislation goals of any health reform effort. culations. They don’t even attempt to lists 1,697 times where the Secretary is given These intangibles are the cornerstones the authority to create, determine, or define hide it. On its Web site, NIHCE says: things in the bill. of U.S. health care, the very things With the rapid advancement in modern Americans value most, that the Reid I know my colleagues will point to medicine, most people accept that no pub- language that says: Well, the Secretary bill puts in jeopardy. Don’t look for the licly funded health care system, including words ‘‘ration’’ or ‘‘withhold coverage’’ the National Health Service, can possibly can’t make these decisions on ration- or ‘‘delay access to care’’ in the bill. pay for every new medical treatment which ing care solely on the basis of compara- Obviously, they are not there. Instead, becomes available. The enormous costs in- tive effectiveness research. Whoopee. I contemplate the inevitable result of volved mean that choices have to be made. am not sure if that is a word we can new Federal rules that aim to reduce Choices are made, and this is the use on the Senate floor, but big deal. health care costs but will inevitably re- key: They are made by the govern- You can’t make it solely on that basis, sult in delayed or denied tests, treatment, not by patients and doctors. but you can use comparative effective- ments, and procedures deemed to be The National Health Service, which ness research to ration care. That is too expensive. For example, the Reid runs Britain’s health care system, has wrong, and that is what this bill per- bill would establish a Medicare Com- issued guidance known as the Liver- mits. And despite numerous times to mission. This is an unelected body of pool Care Pathway whereby a doctor get a simple amendment I offered to bureaucrats with the task of finding, can withdraw fluids and drugs from a say no comparative effectiveness re- and I am quoting here, ‘‘sources of ex- patient if the medical team diagnoses search can be used by a Federal agency to deny care or treatment—simple—the cess cost growth,’’ meaning, of course, that the patient is close to death. other side says: No, we already have it tests and treatments that are allegedly Many are then put on continuous seda- covered. It is good enough. Our lan- too expensive or whose coverage would tion so that they die free of pain. Doc- guage is fine. You don’t need that sim- mean too much government spending tors warn that some patients are being ple statement that would prevent this on seniors. The Commission’s decisions wrongly put on the pathway, which is research from being used in that fash- will result in the delay and denial of creating a self-fulfilling prophecy that ion. I think it is pretty clear that the care. they would die because sedation often Medicare already delays more med- masks the signs of improvement. attempt here is to be able to do it. During the Finance Committee, I ical claims than private insurers do, Also, due to excessively long waiting asked the majority counsel why they but this bill would redistribute Medi- periods, the National Health Service didn’t bar the Federal Government launched what they call an End Wait- care payments to physicians based on from using comparative effectiveness ing, Change Lives campaign. The goal how much they spend treating seniors. research as a tool to ration care. The here was to reduce patients’ waiting It would rely on recommendations staff replied: from the U.S. Preventive Services Task times to 18 weeks from referral to The reason why we did not include an ex- Force—the entity, by the way, that re- treatment—18 weeks. That is supposed press prohibition is we did not want to limit 1 cently recommended against mammo- to be a good thing? That is 4 ⁄2 months the institute from considering areas of grams for women under the age of 50— for an appointment. This is why many science that have a budgetary impact, if you to set preventive health care benefits, Europeans and Canadians visit the will. and it would authorize the Federal United States each year, places such as That is, of course, precisely the prob- Government to use comparative effec- the Mayo Clinic in Arizona, for access lem. Americans do not want the Fed- tiveness research when making cov- to the treatments that are denied to eral Government using this research as erage determinations. It is this last them in their own countries. a cost-cutting tool. issue—comparative effectiveness re- These are the dangers of a govern- Regina Herzlinger, a professor at search—that I wish to discuss in more ment-run health care system. The gov- Harvard Business School, warns: CER detail. ernment, not the patients and doctors, could easily morph into an instrument The Reid bill would create a new en- makes the health care decisions. The of health care rationing by the Federal tity called the Patient-Centered Out- government decides if your health care Government without the appropriate comes Research Institute to conduct is an effective use of government re- safeguards.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00019 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13732 CONGRESSIONAL RECORD — SENATE December 22, 2009 That is why earlier this year I joined That has been their philosophy for dec- colleagues on the other side of the aisle Senator MCCONNELL and Senator ROB- ades. That is not the philosophy of the want. That is not what I want. ERTS and Senator CRAPO in introducing Democratic Party. We believe in a pub- Small businesses are struggling to re- the PATIENTS Act, and it creates this lic-private partnership. We believe in a main competitive and to turn a profit. firewall to prevent the use of research level playing field. We believe in giving In the face of highly unstable and un- for rationing. We filed it as an amend- people the opportunity to earn their predictable health care costs this is ment, but, of course, we are not going way, with fair rules in place. That getting harder and harder. As chair of to be able to vote on it now that clo- party has never believed that, and that the Small Business Committee, I have ture has been invoked. This is the third is at great issue in the underlying de- held 23 hearings and roundtables just time this year we have tried to insti- bate. They can continue to fabricate this year, and several of them have tute this pro-patient firewall, but obvi- myths and lies about this bill, but been focused on how the current health ously we are not going to be able to those of us who support it will proudly care system and volatile health care vote on it, as I said. continue to tell the truth about it. costs are hurting our Nation’s small From the very beginning of the I have served in public office for 30 businesses. health care reform debate, I have be- years as a State legislator, State treas- Today, small businesses are seeing lieved that any bill should be rooted in urer, and now as a United States Sen- their health care costs increase faster a simple yet fundamental principle: ator. But it doesn’t take 30 years to than the prices of the products and that very American should be able to know the health care system our citi- services they sell four times faster choose the doctor, hospital, and health zens live under and live with today is than the rate of inflation since 2001. plan of his or her choice. No Wash- expensive, wasteful, and painfully inef- Premiums for single policies increased ington bureaucrat should interfere ficient. by 74 percent for small businesses in with that right or substitute the gov- From my visits with doctors and the last eight years, according to a 2009 ernment’s judgment for that of a physi- nurses, to seniors on Medicare, to re- Kaiser Family Foundation survey. Na- cian. There is nothing more important cent college graduates struggling to af- tionally, 40 percent of small businesses to Americans, other than maybe their ford coverage, to dozens and dozens of say that health care costs have had a freedom, than the health of their fam- small business owners who are fright- negative impact on other parts of their ily—and that does, by the way, include ened to death that they are not going business. What are we supposed to do, stand an element of freedom, obviously, the to be able to continue in their business here and do nothing? No—that is why freedom to do what you think is best because of the rising cost of health acting now is so important. That is for your family. We would all do any- care, it has become clear to me that why this bill is so important, because thing we could to help a loved one. We the time for reform is now. the status quo is unsustainable. It is don’t want Washington impeding our In Louisiana, the average family unsustainable for our government and ability to do so. spends more than $12,000 each year for it is unsustainable for small busi- Maybe that is why this new Wash- health insurance. That is almost 100 nesses. ington Post-ABC poll ‘‘finds the public percent of the earnings of a person who is working 40 hours a week at the min- Even though families, businesses, and generally fearful that a revamped sys- government budgets are being squeezed imum wage. Think about that. Only in tem would bring higher costs while by unsustainable costs, Senate Repub- one developed country in the world worsening the quality of their care.’’ licans are doing everything they can to would we have a system that says if Even, they say, those without insur- argue for the status quo. Why? I don’t you go to work 40 or 50 hours a week, ance are evenly divided on the question know. Each day, they find a new excuse you have the privilege of taking all of whether their care would be better if for their obstruction. I wish they had that money and having to purchase the system were overhauled. put the same amount of passion, en- health care in the system that my col- The American people get it. The bill ergy, and creative thinking into con- leagues on the other side want to advo- itself is the government option, but in tributing policies and ideas to this de- cate for. That is wrong. We must drive government, they do not trust. bate as they have into their delaying The PRESIDING OFFICER. The Sen- down the cost to the government, to tactics. Every amendment they offered ator from Louisiana is recognized. businesses, and to families. This bill was to send the bill backward, not for- Ms. LANDRIEU. Mr. President, I will begin to do that. ward. They seem hell-bent on defeating come to the floor today in support of Since 2000, the amount that working and not improving this bill, contrary the Patient Protection and Afford- families are charged for health insur- to their statements on the floor. ability Act, and I wish to give some of ance has increased by 91 percent. That The Republicans have charged that the reasons why I am supporting this doesn’t seem to concern my colleagues we are rushing in to vote for this bill. important piece of legislation. on the other side of the aisle. If this That is simply not true. We have been Before my colleague leaves the floor, Congress stood by and did nothing, debating this issue on and off for the I would like to respond to his last com- those costs would nearly double in the last 87 years. ment. One of the reasons the American next 6 years, with economists pre- Republican President, Theodore Roo- people are having difficulty believing dicting that families in my State will sevelt, made national health insurance the government can do anything right pay a whopping $23,000 for insurance in a plank in his party platform when he is that he and his colleagues have spent 2016—an 85-percent increase. To say sought the Presidency in 1912. Presi- the last several decades convincing that a different way, that means that if dent Harry Truman, in 1945 and then them that the government is the prob- we do nothing, the average family in again in 1948, called on Congress to lem and that the government can’t do Louisiana will be paying 60 percent of pass reform legislation to expand qual- anything right. their income for health care—if they ity health care coverage to more Amer- Even in the face of strong evidence can find it and if they can get around icans. President Truman believed we that suggests otherwise, they continue a preexisting condition—leaving only needed a stronger system and that the that worn-out, tired mantra. People in 40 percent of their wages to cover food, federal government must play a role in my State and around the Nation are education, children, housing, transpor- establishing a more robust system of getting tired of it because they know tation, and everything else families care. His critics called his approach that government must stand some- need their funds for. ‘‘socialized medicine.’’ Sound familiar? times to protect them from abusive These skyrocketing costs are bur- Only in Washington would 87 years be practices in the private marketplace, dening families not just in Louisiana considered rushing! abusive practices of insurance compa- but in every State. We don’t have a This has been a debate that has gone nies, to try to level the playing field choice but to change. We cannot con- on with particular intensity for the and set the rules. Of course, those on tinue to rely just on the private mar- last 2 years, as our Presidential can- the other side don’t believe in a level ket without reform, without guide- didates took to the airwaves in debate playing field and rules. They believe lines, and without incentives to after debate—Republican and Demo- citizens in our country should be at the change. Our people will be priced out of cratic—outlining their ideas for re- whim and mercy of the private market. the market. Maybe that is what my form. This hasn’t sprung up in the last

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00020 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13733 2 weeks. This hasn’t sprung up in the That same poll showed that pro- lutely, I am for a public-private part- last 2 months. viding subsidies for families that make nership. Millions of Americans went to the up to $88,000 a year is favored by 67 per- The American people elected Presi- polls, understanding, in large measure, cent of Americans. Additional regula- dent Obama to bring about change. A what we needed to do to change the tions on insurance companies, such as big part of the change President Obama system. Despite the rhetoric from the banning denial of coverage for those and Democrats promised during the other side, that is the reality, and the with preexisting conditions are favored campaign was improving health care record will reflect that. Instead of com- by 60 percent of the American people. for all Americans. Thanks to the Presi- ing to the table and working with I am one of the Democrats who didn’t dent’s leadership and the leadership of Democrats to write a bipartisan bill, want to eliminate insurance compa- Senator REID and many others, we are Republicans chose to put partisan nies. I believe in private markets. But taking several meaningful steps toward party politics first. I listened to my there have to be certain rules and regu- fulfilling that promise. friend, MAX BAUCUS, this morning. I, lations in order for the private market With the exception of two colleagues, myself, who thought I had followed to work for everyone, and not just for Republicans have failed to negotiate in good faith. I want to say how much I carefully the work of the Senate Fi- those with wealth or those with the in- respect our two colleagues from Maine, nance Committee, was actually moved side scoop on how private markets Senator SNOWE and Senator COLLINS. I to hear the number of meetings—doz- work. have been in dozens of meetings with ens and dozens, maybe hundreds and So we are incentivizing a healthier both of them and know that they hundreds of meetings—he attempted to insurance industry—not coddling it but have in a bipartisan way months ago, struggled mightily to find a way to encouraging it to be competitive and to work with us and to support this bill. I years ago, with Republicans. Then, at provide services and coverage for more some point, they decided they thought have not spoken with them in the last people in our country. few days, so I will not discuss their rea- that politics was more important than A recent poll by the Mellman Group policy. I think they made the wrong sons for withholding their support. I shows that support for this bill exists am sure they will express those on the choice. in all States. In my home State of Lou- They fabricated death panels, dis- floor. But I can say that they are the isiana, when the provisions of the bill exception to the rule. I know Senator torted Medicare cuts, and undermined were actually read to voters, 57 percent and disrespected the role of govern- GRASSLEY, Senator GRAHAM, Senator of Louisianians supported the bill, with BENNETT, and a few others engaged ment in protecting its citizens. They 43 percent strongly supporting the re- have engaged in a relentless misin- early on. I want to acknowledge them form effort. And most importantly, 62 and I appreciate their good will. But, formation campaign, aimed solely at percent of Louisianians oppose using using fear to sway public opinion unfortunately, the leadership of the the filibuster to stop health care re- Republican Party chose politics over against this bill. form. Recently—just yesterday—Senator policy. I am disappointed that not a I will read the language used in the JOHN MCCAIN, our colleague from Ari- single Republican could support an end zona, claimed that the American peo- poll because people say you can say to the filibuster. I suppose it is easy to ple are opposed to reform, and he anything in polls, which is true. If poll- stay unified when the only word in speaks about the will of the majority. sters are not reputable, they can twist your vocabulary is NO. Although I remind my colleague from Arizona and distort. I will read the language Democrats did not initially agree on that the will of the majority spoke used by the poll to describe the plan: exactly how to get there, we were loud and clear last year when they The plan would require every American united in saying yes to the common elected President Obama to be Presi- citizen to have health insurance and require goal of delivering meaningful health dent and decided not to elect him. The large employers to provide coverage to their care reform to America’s families and President is carrying out the will of employees. It would require insurance com- small businesses. It has been difficult. panies to cover those with pre-existing con- the majority of the people by trying to ditions and prevent them from dropping cov- Some of us come from very conserv- provide for them hope and opportunity erage for people who get sick, while pro- ative States. Some of us come from lib- in an area that has eluded us for 87 viding incentives for affordable preventive eral States. We have diverse popu- years. care. Individuals and small businesses that lations in our States that have dif- This is a good effort, a strong effort, do not have coverage would be able to select ferent needs and different views. It has and I most certainly believe that the a private insurance plan from a range of op- not been pretty, but it has been a prac- will of the American people is being tions sold on a National Insurance Exchange. tical and hopefully a positive exercise heard. The other side has tried to paint Lower and middle income people would re- that will bring comfort, support, and a picture of a nation opposed to health ceive subsidies to help them afford this in- strength to the American people and to care reform. Recent polls show other- surance, while those individuals who like the coverage they already have will be able to our economy. wise. When we cut through the misin- keep their current plan. I do hold out hope that when we take formation and scare tactics, when our vote on final passage, Republicans Americans hear what is in the bill, This is a very accurate description of will recognize this historic opportunity they overwhelmingly support it. this bill before us—the Patient Protec- and vote in favor of this bill that will According to a recent CNN poll, 73 tion and Affordable Care Act. It is not reduce costs and increase access to percent of Americans support expand- a government takeover. There is no health care for millions of Americans. ing Medicaid for the poor. Americans public option. There is a national plan Last month, I stood here on the floor know what most of us know: Most peo- available now to every American, just of the Senate to announce my inten- ple on Medicaid are the working poor. like the Members of Congress and the tion to vote in favor of bringing Sen- These are people who wake up early in Federal employees have. There will be ator REID’s melded bill to the floor. At the morning, work hard all day, and exchanges—similar to shopping cen- the time, I was very clear that my vote they go back home at night, often by ters—and Americans will be go to the was not an indication that I supported taking public transportation because exchanges and choose from a number of that particular version of the bill. My they don’t have an automobile. They insurance options. The prices will be vote was to bring that bill to the floor work hard. They are American citizens. more transparent. Administrative so that we could do the legislative But they don’t have enough money to costs will be lowered. You will not need work the American people sent us here spend 60 percent or 80 percent of their a Ph.D. to be able to read these poli- to do. income on health insurance in a bro- cies—they will be written in plain After weeks of floor debate and ken, unbridled, unfixed private market. English. amendments and round-the-clock nego- So we join together with our States to Again, this is not a government take- tiations, that work has been com- provide them access to care through over, as the other side claims. That is pleted. We produced a health care bill the Medicaid system. I support that. why 57 percent of people in Louisiana, that is significantly improved from the And in this bill, the Federal Govern- when given the right information, one that came to the floor. I would like ment will pick up a large share of the without the rhetoric, without the rail- to share a few thoughts about why, in cost of expanding coverage. ing, without the distortions, say: Abso- my view, it is improved.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00021 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13734 CONGRESSIONAL RECORD — SENATE December 22, 2009 Through tough negotiations, Senate must be in the bill for me to give my credit available immediately to help Democrats have developed a consensus final support. small businesses afford health insur- that blends the best of public and pri- We have also created administrative ance for their employees, and improve vate approaches to reduce costs, ex- savings through insurance exchanges, the tax credits for small businesses. pand coverage, and increase choice and and during Senate consideration of the This means that small businesses who competition for Americans and have bill we strengthened the Independent want to offer quality health insurance done so without a government-run pub- Medicare Advisory Board to find more to their employees will get tax breaks lic option. ways to reduce cost growth and im- right away, rather than waiting until Since I continue to hear distortions prove quality. 2011. I also worked with Senator LIN- from my colleagues on the other side, The final Senate bill includes a sub- COLN to expand the number of small let me be clear: there is no govern- stantial investment in community businesses that will be eligible for tax ment-run public option in this bill. In- health centers and will provide funding credits so that more small businesses stead, we reached an agreement to pro- to expand access to health care in rural get help in offering health insurance vide private health insurance plans to communities and under-served urban coverage for their employees—allowing be sold nationwide. The Office of Per- areas as well. In Louisiana, federally- more small business workers to ben- sonnel Management will negotiate supported health clinics have saved the efit. In all, these changes bring an ad- lower premiums, just as they negotiate state over $354 million in emergency ditional $13 billion in tax relief—on top the plans currently available to Fed- room visits by the uninsured. The leg- of the $27 billion already in the bill—to eral employees and to Members of Con- islation also expands access by increas- small businesses. gress. Importantly, we ensured that at ing funding for rural health care pro- If you own a small business of 25 or least one nonprofit plan will be offered viders and training programs for physi- less employees here is how reform will in every State exchange and that the cian and other health care providers. help you: Businesses with 25 or less em- States cannot opt out at the whim of There are many parts of the current ployees whose average annual wages every Governor and legislature. For bill that I am proud to have fought for. are less than $50,000 will get immediate the first time in our Nation’s history, The bill creates health insurance ex- help through a three-year bridge cred- Americans will have an opportunity to changes that will provide individuals, it. The creation of exchanges and a 2 have the same kind of insurance that families, and small businesses with a year exchange tax credit will lift the federal employees, including Members wide variety of affordable choices and burden of excessive paperwork admin- of Congress, have. ensure that they will always have cov- istrative costs. The exchanges will cre- In addition, there has been a lot of erage, whether they change jobs, lose a ate more stable, secure choices for talk about the cost of this bill to the job, move or get sick. These state- your employees In Louisiana, more than 50,000 small government and to taxpayers. There based exchanges will enable consumers businesses could be helped by this have been a number of false claims to comparison shop online for health small business tax credit proposal! about how this bill will add to the def- insurance which will drive down costs This will help small business owners icit and be a burden to our children and by increasing choice and competition. such as Mary Noel Black and her hus- The exchange will help the uninsured grandchildren. The fact is, this bill is band, who own a UPS franchise store in obtain needed coverage and will also completely paid for and it will reduce Baton Rouge. They offer their four em- help the more than 200,000 Louisiana the deficit by $132 billion over the next ployees group coverage and are willing 10 years and as much as $1.3 trillion in residents who currently do not have in- to pay half the cost, but the premium the following 10 years. surance through their employer to get rates have gone up so much that nei- Based on our efforts, the Congres- quality coverage at an affordable price. ther the workers nor the business can sional Budget Office and the Nation’s Many of these Louisianians in the ex- afford to pay the $3,600 a year per em- premier economists have confirmed change will qualify for a tax credit to ployee for insurance. To help Mary pay that premiums will go down over time help them purchase the insurance of for the health insurance of each em- or remain stable so that wages for mil- their choice. ployee, beginning in 2011, Mary could lions of Americans can increase. When For example, in Calcasieu Parish, the get a $1,260 bridge credit per employee this bill is passed, 3l million uninsured median household income is $39,713. In under this bill for 3 years. Then, in Americans will have access to quality the exchange created by this bill, the 2014, if she purchases coverage through health coverage. average family in Calcasieu would re- the exchange, her business is eligible This bill is a big step toward fiscal ceive an affordability credit that limits for an exchange credit of $1,800 per em- responsibility and a stronger economy. what they spend on their premium to ployee for an even more generous tax It aims to achieve these goals by around 5.6% of their income or $2,225. credit for another 2 years. This savings streamlining the health insurance mar- Considering, right now the average could mean the difference between of- ket, ensuring efficiency, and limiting Louisiana family is spending up to 28% fering insurance or dropping coverage insurance company administrative of their income on health care, this is because instead of costing her business costs, and to some degree, their profits. a huge improvement. $14,400 a year now for her four employ- It also imposes an excise tax on in- This version of the bill that we im- ees—a cost that is just unaffordable— surance companies with high-cost proved on the Senate floor now in- the tax credit could initially bring her plans. This will encourage employers cludes additional much-needed help for cost down to $9,360 and later to $7,200. to be more value-conscious purchasers small business owners, led by Senator Through our work on the Senate of health insurance. Employers are ex- LINCOLN, Senator STABENOW, myself, floor during this public debate, we have pected to choose cheaper plans, and as and other members of my committee. made this good bill better for small less capital is spent on health care, Senator SHAHEEN, Senator CARDIN, business. Not only have we extended wages will go up for hard-working fam- Senator HAGAN, Senator BAYH, and and expanded the small business tax ilies. Economists predict that this others worked very diligently on these credits, the legislation includes several could give American workers a $223 bil- provisions. amendments I authored to ensure lion pay raise, amounting to $660 per While small businesses make up 74 small businesses continue to have a household. percent of Louisiana’s businesses, only seat at the table once this bill is imple- I strongly urge that this provision be 37 percent of them offered health cov- mented. included in the final legislation. I erage benefits in 2008. Of those, 62 per- The bill requires that small busi- know that there is fierce opposition to cent say they are struggling to do so. nesses receive information regarding this on the House side. But—and the Of the 64 percent who don’t provide in- reinsurance for early retirees, small President has said this publicly and surance, 87 percent say they can’t af- business tax credits, and other issues privately to us—this is one of the most ford it. specifically for small businesses re- significant provisions that will help I worked closely with Senator garding affordable health care options. drive down costs for the entire health STABENOW to improve affordability and It lists Small Business Administra- care system. It cannot be jettisoned at choices for small businesses and tion resource partners as eligible re- this point in the debate. This provision amended the bill to make the bridge cipients of exchange public awareness

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00022 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13735 grants and will include all Small Busi- nearly $90 in additional Medicare pre- When this legislation is signed into ness Administration partners in the miums next year to subsidize these pri- law, insurance companies will not be program, including Women’s Business vate plans. able to drop children for preexisting Centers, SCORE, Minority Business Our bill extends the life of the Medi- conditions beginning immediately. Centers, Veteran Business Centers, and care Trust Fund by 9 years and lays the This is crucial for families with chil- others. groundwork for a more sustainable dren who have battled cancer or diabe- The bill now requires the Govern- health system. Thanks to these reform tes. When a parent loses a job, they ment Accountability Office to specifi- efforts, there will be no additional cost may struggle to get insurance when cally review the impact of exchanges for preventive services under the Medi- they find new employment. Once this on access to affordable health care for care program. This includes a free bill becomes law, no insurance com- small businesses to ensure that ex- wellness visit and personalized preven- pany will be able to deny a child with changes are indeed making a difference tion plan designed to help give bene- preexisting conditions. for small business owners. ficiaries the resources they need to This health care reform bill holds in- It also clearly states that agencies take better care of themselves in these surance companies’ feet to the fire to cannot waive the Federal acquisition important years. ensure they are accountable to their regulation, which requires them to re- This legislation puts taxpayers’ dol- customers. By 2014, insurers will not be port small business contracting num- lars above insurance company profits able to deny coverage due to pre- bers and meet small business con- by forcing insurers to bid competi- existing conditions. That means they tracting goals of 23 percent. tively for the business of Medicare will not be allowed to drop you from There is a provision that modifies the beneficiaries and makes changes to the coverage if you get sick or are in an ac- definition of a full-time employee to Medicare Advantage payment struc- cident. take into account fluctuation in em- ture that will give insurers an incen- Because of the good work of my col- ployee hours, and reduce the impact of tive to deliver more value. leagues Senator ROCKEFELLER and Sen- employer responsibility requirements Another critical aspect of the bill is ator BEN NELSON, this bill requires infor industries with high turnover and that it increases the amount of cov- surance companies to disclose the pric- that rely on part-time employees. erage Medicare Part D beneficiaries re- ing of their benefits to ensure that pre- The bill eliminates penalties for busi- ceive before they begin to pay out of miums are spent on health benefits not nesses that wait up to 60 days to pro- pocket for their prescriptions. Right profits and gives consumers rebates, vide health insurance to their full-time now, roughly 116,000 Medicare bene- putting the insurance companies’ ex- employees. ficiaries in Louisiana hit a wall in cessive profits back into your pockets. Finally, the Patient Protection and Medicare Part D drug coverage that It contains new requirements ensuring Affordable Care Act establishes a na- will cost some of them an average of that insurers and health care providers tional workforce commission to gather $4,080 per year. This reform legislation report on their performance, empow- information on the health care work- will provide a 50 percent discount for ering patients to make the best pos- force and better coordinate and imple- brand-name drugs. sible decisions. Under this bill, a health ment workforce planning and analysis. Some of the bill’s most important insurer’s participation in the ex- The managers’ amendment ensures provisions will benefit the most impor- changes will depend on its perform- that small businesses and the self-em- tant population—children. ance. Insurers that jack up their pre- ployed will be represented on the com- The underlying bill includes a provi- miums before the exchanges begin will mission. sion allowing children to remain on be excluded—a powerful incentive to These are important considerations their parents’ plans up until the age of keep premiums affordable. for small businesses and I was proud to 26. I have children. I would like to Finally, I was also proud to work ensure these concerns were addressed think that by 22 or 23, they will be on with Leader REID and Finance Com- through the amendment process. their own, they will be gainfully em- mittee Chairman MAX BAUCUS to ad- Despite claims from opponents of the ployed and off my payroll. But any of dress an inequity in the formula that bill, we have taken important steps to us who have raised children know that determines the federal match of Med- strengthen Medicare, not weaken it. sometimes it takes a little more time icaid dollars. As we all know, in 2005 The Senate health care reform bill cre- to launch our children. I see Senator Hurricanes Katrina and Rita ravaged ates an independent Medicare advisory SHAHEEN, who is nodding. She has done the Gulf Coast and destroyed homes, board to find ways to reduce cost this herself. It takes a little time to neighborhoods, and even full commu- growth and improve quality and moves launch them. According to the latest nities throughout South Louisiana. In to a system that rewards quality over data from the Census Bureau, in 2007 an effort to aid the recovery, Congress quantity. It reduces payments for pre- there were an estimated 13.2 million approved a much-needed aid package ventable hospital readmissions in uninsured young adults. So the bill infor Louisianians that infused grant dol- Medicare, and cuts waste, fraud and cludes this important provision to lars and direct assistance to speed our abuse by enhancing oversight, identi- allow kids to stay on their parents’ in- recovery. fying areas prone to fraud and requir- surance for a bit longer as they transi- Some of the necessary one-time re- ing Medicare and Medicaid providers tion into adulthood. covery dollars were calculated into our and suppliers to establish compliance But my question was, where do the state’s per capita income. In addition, programs. young people who age out of the foster labor and wage costs increased because As much as our Republican col- care system sign up, because they do there was heightened recovery activity leagues have tried to scare seniors into not have parents? I was proud to work and a constriction in the market. Con- opposing this bill, the fact is that Lou- on a provision that Leader REID in- sequently, Louisiana’s per capita in- isiana’s 650,000 Medicare beneficiaries cluded in this bill to ensure that every come was abnormally inflated and put stand to gain from this health care re- young person who ages out of the foster us in a category with richer states. form bill. The AARP and many seniors’ care system will be able to stay on The result is that our federal match organizations are continuing to sup- Medicaid until the age of 26 starting in for Medicaid is scheduled to drop pret- port this bill because they know it im- 2014. Almost 30,000 young people age ty dramatically. I worked with my col- proves care for our seniors. out of the foster care system every leagues to correct this formula. I never The bill lowers premiums by reducing year, having never been adopted or re- asked for special treatment for Lou- Medicare’s overpayments to private unified with their birth parents. The isiana, but only for understanding of plans. All Medicare beneficiaries pay fact that they aged out is our failure as our state’s unique situation. We only the price of excessive overpayments government. We have failed them once wanted to be treated fairly and not to through higher premiums—even the 78 and we just can’t fail them twice. We get penalized because we have been percent of seniors in Louisiana who are must support their transition to adult- forced to rebuild following the worst not enrolled in a Medicare Advantage hood, and guaranteeing access to qual- natural disaster in the United States’ plan. Without reform a typical couple ity health care will help with that history. Our federal Medicaid match in traditional Medicare would pay transition. rates should reflect that the reality on

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00023 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13736 CONGRESSIONAL RECORD — SENATE December 22, 2009 the ground in Louisiana, not the cold The PRESIDING OFFICER. The Sen- country are going to benefit from this calculations of inflexible federal for- ator from New Hampshire. legislation. We heard Senator mulas. Mrs. SHAHEEN. Mr. President, I ask LANDRIEU talk about many of the pro- An important note is that this Med- unanimous consent that the remaining visions she worked on—and many of icaid funding fix was supported by Democratic time be divided equally be- which I cosponsored—to help improve every Member of our Congressional tween myself, Senator STABENOW, and the legislation for small business. The Delegation, and specifically and re- Senator BINGAMAN. fact is, the steep annual increases in peatedly requested by our Republican The PRESIDING OFFICER. Without the cost of health insurance have been Governor Bobby Jindal. Some politi- objection, it is so ordered. forcing more and more businesses to cians in my state may run and hide Mrs. SHAHEEN. Mr. President, I make the very difficult decision to ei- when the heat gets turned up, but wish to begin by congratulating Sen- ther drop coverage for their workers or that’s not the way I was raised. I never ator LANDRIEU and thanking her for all to increase their employees’ contribu- have and never will run from what I the hard work she has done on this tion to the point that too many work- think is right. I was sent here to fight bill—first of all for small business. I ers have had to decline coverage. for my state and that is exactly what think we have significantly, with her I have heard from a number of I’m doing. leadership, improved this legislation businesspeople in New Hampshire, and Those who have dubbed this provi- for small business so that many of the I wish to read what a couple of them sion the ‘‘Louisiana Purchase’’ know small businesses in this country—many have said. little about lawmaking and even less in my home State of New Hampshire— A young woman named Adria about my views on health care reform. will now be able to get help as they try Bagshaw testified this summer at a This Medicaid fix alone would not have to cover their employees for health Small Business Committee field hear- been enough to earn my vote on this care. I also wish to congratulate her ing we held in New Hampshire. Adria legislation. This was one of literally a for all her good work to help children and her husband Aaron own the W.H. dozen priorities I had as the Senate in the foster system. It is significant Bagshaw Company. It is a fifth-genera- considered health care reform. I am they will be able to get health insur- tion small manufacturing company in voting for this bill because it achieves ance once they age out of the foster Nashua, NH. There aren’t a lot of those the goals I laid out at the beginning of system and, of course, to help those, as fifth-generation companies left that this debate: it drives down costs and she has pointed out, who have children are owned by the same family. They expands affordable health care choices who are in their early twenties and offer health insurance to their 18 em- for millions of families and small busi- who are still trying to get settled in a ployees and cover anywhere between 10 nesses in Louisiana and around the na- profession. to 25 percent of their monthly pre- tion. Any claim to the contrary, is a My daughter was fortunate enough to mium. But now the premiums are $1,100 pathetic lie meant to derail this bill, a have health insurance last year in her per month per family, and Adria is tactic that was all too common during first job out of college. But now she is afraid she will have to cut back on the this debate. going to a new job that doesn’t have quality of their health insurance plan Today, we stand on the verge of his- health insurance, and so she will be or the amount the company covers to tory, with an opportunity to support a able to be covered once this legislation make ends meet. The sad thing is that bill that will provide health insurance is passed under our plan. As Senator she says right now they are spending to 31 million more Americans, reducing LANDRIEU points out, it is going to more on health insurance than they the deficit by $132 billion over the next make a real difference for families and are for raw materials to make their ten years. for small business. products. The bill is not perfect. It is not the I am very pleased to be here today to I also heard from a man named John exact health care bill that I would have support this legislation and also to try Colony, who is a small business owner written. I think the same could be said to dispel some of the myths we have in the small, very picturesque town of for each of my colleagues. It was a heard from our colleagues on the other Harrisville, NH. He e-mailed me say- long, difficult process and during the side of the aisle about what is actually ing: in this legislation. Despite what many course of completing this landmark The cost of health insurance is the biggest bill there were a lot of twists and of our colleagues may want us to be- problem that our small business faces. turns. But, as former President Clinton lieve, passing this bill is the fiscally responsible thing to do. Our current He has 24 employees. He went on to was fond of saying, we should never let say: the perfect become the enemy of the health care system is a threat to the good. security of our families, our small busi- The present system is expensive, ineffi- nesses, and the entire economy of this cient and broken. I can’t tell you how the 20 And through hard work and good to 35 percent annual rate increases depress faith and tough negotiations and keep- Nation. The costs of health care in us all and there is no end in sight. Over the ing our eye on the ball, Senate Demo- America make up almost 18 percent of past five years, most of our employees have crats have actually crafted, in my our economy—our gross domestic prod- had to drop coverage because they simply view, an extraordinary piece of legisla- uct. That is more than any other indus- can’t afford to pay their share of the pre- tion that will go a long way to pro- trialized country. Health care costs are mium. I really believe that the time has viding comfort and security to the rising three times faster than wages. come to put the existing system out of its American people who elected us to do The leading cause of about two-thirds misery. so. of the bankruptcies in America is med- Well, I am happy to tell John we are It will provide comfort and security ical bills. Our current health care sys- about to do that, because under this for the local grocery store owner in tem is simply not sustainable. legislation, beginning next year, we Jennings, the 22-year-old in Lake The Patient Protection and Afford- provide significant tax credits for Charles who has just left the foster able Care Act moves us in a new direc- small businesses to help them pay for care system, the single mother of three tion—a direction that is fiscally re- the cost of coverage for their workers. in Monroe, the 9-year-old boy in sponsible because this bill is fully paid This bill contains a number of signifi- Natchitoches who was just diagnosed for. In fact, according to the Congres- cant measures to rein in runaway with diabetes, and the 70-year-old sional Budget Office, the Patient Pro- health care costs—measures such as Medicare beneficiary in Houma who tection and Affordable Care Act would creating a new pathway for biologic worked for three decades in the off- reduce our Federal deficit by $132 bil- drugs so we can get biologic generic shore oil industry. lion over the next 10 years. In fact, this drugs to the market and help lower The Patient Protection and Afford- legislation represents one of the larg- costs for people. There are measures in able Care Act will make a difference in est deficit-reduction measures we have this bill that will eliminate waste, these lives and millions more across seen certainly in many years and pos- fraud, and abuse—something that America, and I urge my colleagues to sibly ever. takes too big a chunk out of our health support it. Small businesses in my home State care dollar. There are also measures in I yield the floor. of New Hampshire and across this here that will get rid of the subsidies

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00024 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13737 the government pays to insurance com- tually are able to offer health insur- know realtors have struggled for years panies for Medicare Advantage plans. ance. So less than half our small busi- because they haven’t been able to buy These are all commonsense actions nesses are able to offer health insur- through a large insurance pool. That is that will save the government and ance, which is why we are focused on what this reform is all about. That is health care consumers money over small businesses in this reform bill. what this legislation is all about, to time. The majority of people in this coun- help small businesses, people who are In addition, this bill makes signifi- try who don’t have insurance are actu- working out of their homes, who are cant improvements to our health care ally working. The majority of us— self-employed, as well as people who delivery system. That is the way we about 60 percent—have insurance have lost their job and then lost their provide health care for people. It in- through our employers. We have about insurance. That is what this is all jects more competition into the health another 20 percent or so who receive about. care marketplace. Controlling health their insurance through Medicare or When we look at this legislation, ac- care spending is critical to address the Medicaid or the Veterans’ Administra- cording to the Small Business Major- fiscal health of this Nation—no pun in- tion or some other public entity and ity, without health insurance reform tended. This legislation takes a very then 15 to 20 percent of the people over- that is in this legislation the annual important first step in slowing down all in America who don’t have insur- costs of health benefits will more than the growth. ance are predominantly small busi- double in less than a decade. They will I am sure every Member of the Sen- nesses—people working for small busi- more than double. We know, because ate—Republican and Democratic nesses or they are self-employed or we have seen the statistics, that when alike—has heard heartbreaking stories they are working one, two, or three we talk about doubling health care from our constituents about health part-time jobs just to try to hold costs for businesses in the next 10 care—stories about being denied health things together. So that is a major years, it is estimated to equal another insurance, about having to stay at a focus of the health care reforms that 3.5 million jobs. job they do not like because of the fear are in the legislation that is before us. We cannot afford to lose another 3.5 of losing coverage, about frustration I am very pleased we have been able million jobs because of the doubling of over the lack of choice and who pro- to put together a package that has $40 health care costs in America. We are vides their health insurance or a lack billion in direct tax cuts—$40 billion in focused on creating more jobs. We need of understanding about their plan’s direct tax cuts—for small businesses to be laser focused—certainly, I am, limits until it is too late and they are across America to help them afford coming from Michigan—on creating facing financial peril. Well, this bill health insurance going forward, rather jobs not losing jobs. According to the will, I am happy to say, change that. than waiting for the new insurance economic analysis of the Small Busi- Not only do we ensure coverage for an pooling—the exchange—which will pro- ness Majority, health insurance reform additional 31 million people—— vide additional help for small busi- could save up to 72 percent of small The PRESIDING OFFICER. The Sen- nesses. This help, this tax cut, starts business jobs otherwise lost to a con- ator’s time has expired. right away. We will see 3.6 million tinuing rise in health care costs. We Mrs. SHAHEEN.—but we eliminate small businesses that could qualify for need those jobs. the abuses of the insurance companies. the tax cuts in this bill that will begin Again, health insurance reform is all I will be back to talk about some of next year. about saving lives, saving money, sav- these other areas. In my State, that means over 109,000 ing Medicare, and it is certainly about I thank the Chair, and I yield the small businesses that could be helped saving jobs. That is why I am so floor. by the small business tax cuts that will pleased we have made small businesses The PRESIDING OFFICER. The Sen- make premiums more affordable. So I a major priority in this legislation— ator from Michigan is recognized. am very pleased to be part of a group of both through $40 billion in tax cuts for Ms. STABENOW. Mr. President, first, Members who came together and small businesses, creating the new in- I wish to thank my friend from New worked very hard to focus on the fast- surance pool through which small busi- Hampshire for her advocacy on health est growing part of the economy, which nesses can get the same kind of deal, care reform in general, but specifically are our small businesses. have the same kind of clout as a large working together on the areas that af- I will just share one story, and this business today in being able to nego- fect small business, I very much appre- was from Crain’s Detroit, a highly re- tiate with private companies, and ciate, and we are so pleased to have her spected business publication in Michi- other provisions that are in the bill as in the Senate. gan. Mark Hodesh, who is the owner of well. I come to the floor to join my col- an Ann Arbor home and garden store, There are many reasons to support leagues. I know the chair of the Small said he has seen his health insurance health insurance reform. Standing up Business Committee, Senator premiums go up more than 300 percent for small businesses is certainly at the LANDRIEU, has been here and others since 1997. In 1996, he paid $132 in top of the list. will be here—Senator LINCOLN, who has health care premiums a month per em- I yield the floor. played such a critical role in putting ployee; and this year, regular premium The PRESIDING OFFICER (Mrs. together the small business provisions increases have led him to pay upward GILLIBRAND). The Senator from New in the bill. of $375 per month for each employee. Mexico is recognized. I am very pleased to have authored So that is a 300-percent increase. He Mr. BINGAMAN. Madam President, one of the provisions in the managers’ says: over the past few weeks we have heard amendment that will guarantee that I have been in small business for 40 years, a lot of heated debate about this health small businesses get immediate help and my conclusion is that without health care proposal. Much of it has con- starting next year—tax cuts to help care reform, these increasing costs will put centrated on a few key issues: whether them pay for the cost of health insur- me out of business. there should be a public option, wheth- ance. Michigan has close to 200,000 That is the reality for businesses er there should not be. Of course, much small employers that represent about across this country. I do believe health of that debate was on the Democratic 96 percent of the employers in our care reform is directly tied to jobs, side among Members with strongly State. whether it is large businesses com- held views on both sides of the issue. Most folks who think of Michigan peting internationally that make a de- The question of whether we should think of large employers, large manu- termination to move their facility be- try to allow people 55 and older to buy facturers. But, in fact, the majority of cause of health care costs, whether it is into Medicare was also debated. There our employers, as in the majority of small businesses going out of business were strongly held views on that issue. each of our States, are small busi- or having to decide if they keep people It is clear now we have a bill before nesses. That is where the majority of working or pay for health insurance or us that will do neither one of those the new jobs are being created. We whether it is the self-employed person things but which I think will accom- have just 41 percent of our firms that out on their own, in their own enter- plish very major health care reform for have fewer than 50 employees who ac- prise—maybe it is local realtor. We the country. I want to just concentrate

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00025 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13738 CONGRESSIONAL RECORD — SENATE December 22, 2009 for a few minutes on some of the other private insurance, as well as refundable reduction in the cost of nongroup in- policies that are contained in this leg- tax credits to ensure that the coverage surance in that State. In fact, the aver- islation that have received much less they need is affordable. These new age individual premium in Massachu- attention but which clearly are very health insurance exchanges will help setts fell from $8,537 at the end of 2006 constructive proposals that will dra- improve the choices that are available to $5,142 in mid-2009. That is a 40-per- matically improve the health care de- to Americans by allowing families and cent reduction in premium for that livery system in the country. businesses to easily compare insurance coverage. This was at a time when the I can remember when we started plans and prices and the performance rest of the Nation was seeing a 14-per- these discussions early in the spring of those plans. This will put families cent increase. and summer and had many meetings rather than insurance companies or in- Finally, much of the debate on and hearings and workshops both in surance bureaucrats or government bu- health care reform has focused on in- the HELP Committee and in the Fi- reaucrats in charge of health care. surance coverage. It is important to nance Committee, there were state- These exchanges will help people to de- recognize that as we expand coverage ments made that—on the Democratic cide which quality, affordable insur- to include more Americans, the de- and Republican side—we can agree ance option is right for them. mand for health care services is going upon maybe 80, maybe 85 percent of the On the issue of cost, the nonpartisan to increase as well. A strong health changes we ought to embrace in health Congressional Budget Office forecasts care workforce is, therefore, essential care reform. The question is, What that this legislation would not add to for successful health reform. Within about the other 15 to 20 percent? I the Federal deficit. In fact, the latest this country, approximately 25 percent think we need to spend more time fo- estimate they have given us is that it of the counties are designated as cused on that 80 to 85 percent, and let would reduce the deficit by $132 billion health professional shortage areas. me do that for just a minute. by 2019 and well over $1 trillion in the That is a measure that indicates that This Patient Protection and Afford- second 10-year period; that is, the pe- there are insufficient medical staff to able Care Act which Senator REID and riod from 2020 to 2029. properly serve that geographic area. others have introduced and is in the On the subject of premium costs, This problem is even more apparent House legislation as well, both pieces which all of us care about, all Ameri- in rural States such as mine, such as of legislation do contain very impor- cans care about, CBO has also found New Mexico. For example, 32 out of the tant policies. Let me talk a minute that in the individual market the 33 counties in our State—we have just about some of those. amount that subsidized enrollees would 33 counties—32 of those counties have First, this act before us includes long pay for coverage would be roughly 56 this shortage designation—health pro- overdue reforms to increase the effi- percent to 59 percent lower, on average, fessional shortage area designation. As ciency and the quality of the U.S. than the premiums they are expected a result, New Mexico ranks dead last health care system while holding down to be charged when this law takes ef- compared to all other States with re- the growth in costs. For example, the fect in the individual market under gard to both access to health care and legislation includes payment reforms— current law. the ability to utilize preventive medi- I have championed those for a long Among enrollees in the individual cine. time; others in this body have cham- market who would not receive new sub- This Patient Protection and Afford- pioned them as well—to shift from a sidies, average premiums would in- able Care Act also contains key provi- fee-for-service payments system to a crease by less than 10 to 13 percent— sions to improve access and delivery of bundled payments system. This will re- this, again, according to the Congres- health services throughout the Nation. shape our health care reimbursement sional Budget Office. The legislation These provisions include increasing the supply of physicians and nurses and system to reward better care and not would have smaller effects on pre- other health care providers, enhancing simply more care as the system cur- miums for employment-based coverage. workforce education and training, pro- rently does. Its greatest impact would be on small- viding support for the existing work- The legislation also includes broad er employers qualifying for new health force—health care workforce, increas- expansion of quality reporting and pay- insurance tax credits. For these busi- ing the support for community health for-performance reforms that will fur- nesses and their employees, the Con- centers. ther incentivize quality and efficiency. gressional Budget Office predicts that I applaud Senator REID and Senator The legislation also puts in place the premiums would decrease by some- BAUCUS and Senator DODD and Senator framework for a national quality strat- where between 8 and 11 percent, com- HARKIN and many other colleagues in egy and several new key Federal over- pared with the costs that they would the Senate who worked so hard on this sight bodies to allow both providers have to pay under current law. bill. The legislation represents major and consumers to have unbiased infor- These estimates by the Congressional health care reform. It is time for the mation about whether health care Budget Office are consistent with the Senate to enact this critical and long treatments and devices and pharma- estimates of the impact in my home overdue legislation. There will be ceuticals are effective and efficient. State of New Mexico, where average chances and opportunities to improve We have heard a lot of charges made families may see a decrease in pre- on this legislation in the future. I hope that trying to find out what is effective miums of as much as 60 percent from to participate in some of those. and efficient is objectionable somehow what they might otherwise have to Nothing that is passed into law in because it might lead to rationing of pay. This is families, I am talking this Congress or any Congress that I care. There is no rationing of care con- about, who would be eligible for these have served in is what it should be in templated in this legislation. But how advance refundable tax credits. all respects. But this legislation is ex- anyone could come to the Senate floor In addition, about two-thirds of the tremely important and significant and argue against providing good, sci- people in my State of New Mexico health care legislation. It will do a tre- entifically based information both to would potentially be able to qualify for mendous amount of good for a vast providers and the consumers about subsidies or for Medicaid. In fact, a number of Americans and it will do which treatments, which devices, quarter of our population in New Mex- that ‘‘good’’ in a very responsible way. which pharmaceuticals are effective ico is at an income level that would I urge my colleagues to support pas- and useful is hard for me to under- allow them to qualify for near full sub- sage of this legislation so we can get on stand. sidies if they bought insurance through with a conference with the House of Second, this Patient Protection and an insurance exchange or for Medicaid Representatives and finally settle on a Affordable Care Act includes a broad itself. bill that could be sent to President new framework to ensure that all An overall decrease in premium costs Obama for his signature. Americans have access to quality and also is consistent with the experience I yield the floor. affordable health insurance. It includes that the State of Massachusetts had The PRESIDING OFFICER. The Sen- the creation of new health insurance after they enacted similar reform to ator from Oklahoma. exchanges which will provide Ameri- what is now being considered in the Mr. COBURN. Madam President, I cans a centralized source of meaningful Senate. There has been a substantial know our leader is coming to speak,

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00026 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13739 but prior to him coming, I will take a This legislation will reshape our Na- In this new health care bill— portion of my time that has been allot- tion in ways its supporters will come been in effect two years ago. No government ted to me by my side. to regret. But they cannot say they agency could possibly have understood I sat here with great interest listen- were not warned. The verdict of the Chloe’s unique needs or her extremely rare ing to the Senator from New Mexico. American people has been clear for condition. After a perfectly healthy childhood, my He referenced the State of Massachu- months: They do not want it. seventeen-year-old showed me that her left setts. I entered into the RECORD yester- Madam President, I thank my friend arm was twitching and wouldn’t stop. Within day the 21 percent of the people under from Oklahoma, and I yield the floor. weeks, the entire left side of her body was the plan who could not get care in Mas- The PRESIDING OFFICER. The Sen- jerking constantly, every waking moment of sachusetts because they could not af- ator from Oklahoma. every day. Her MRI revealed more than one ford the copay and the deductible. This Mr. COBURN. Madam President, I periventricular heterotrophic nodule— is basically a copy or model off of that. would just follow with one comment to That is a growth around the ventric- He also discussed the fact that this my leader as far as his comments. ular system, the fluid system of the shows a $132 billion savings over the In 2007, we passed a bill called the brain— next 10 years. That is provided you do Honest Leadership and Open Govern- but her first two neurologists weren’t sure not think you are going to allow any ment Act of 2007. That act requires the there was a connection between the [changes increase in doctor payments and you posting of any earmarks or direct bene- in her movement and the movement disorder fits for Senators in any bill. It has to and the symptoms and the nodules]. They are not going to reverse the 21-percent certainly had nothing useful to offer in cut. be posted. We have not seen that with terms of treatment. But I made the rash Madam President, my leader is here, this bill, though we know there are nu- promise to my daughter that someone, some- and I will be happy to yield to him at merous and sundry specific earmarks where, knew what to do, and that we would this time. for Members. not stop looking until we found that person. The PRESIDING OFFICER. The Re- So my hope is that sometime during Unlike mothers in a government run system, publican leader is recognized. this process, we will take up the viola- I was free to research the options and apply tion of this very law by the leader of where I wanted. Our search took less than Mr. MCCONNELL. Madam President, three months. I thank my friend from Oklahoma. I this Chamber in terms of ignoring it Chloe’s pediatric movement disorder spe- will be very brief. and flaunting it. What he said, when we cialist at Mayo Clinic called her condition Madam President, Americans woke passed it, was it was a needed change, ‘‘unique’’ and unclassifiable. He had to de- up yesterday stunned to read that and now we see it ignored as they bring bate her case with his neurology team, but Democrats had voted to end debate on this bill to the floor. in the end they were willing to try an un- the latest version of this massive bill Mr. MCCONNELL. I thank my friend precedented series of brain surgeries. Chloe from Oklahoma. was desperate to live a normal life again, so while they were sleeping. They will be my husband and I agreed, though perhaps stunned again when they learn about One thing about rushing, not only is you can imagine what an excruciating deci- this second early-morning vote to ad- there a potential violation of the provision that was. Today, Chloe twitches a little, vance a bill that most of them oppose. sion the Senator from Oklahoma men- but anyone who didn’t know her history Americans are right to be stunned be- tioned, but we are learning more about would think she is just fidgeting. She is an cause this bill is a mess. And so was this bill every day as we scrub it and honors linguistics student at OU, and she the process that was used to get it over try to understand it and figure out even takes dance lessons. She recently start- what all is in it. All of that, of course, ed driving again. She said once, ‘‘Mom, with- the finish line. out the surgery, I would be strapped into a Americans are outraged by the last- is made more possible by rushing wheelchair now. minute, closed-door, sweetheart deals things through in sort of an expedited, I know that Chloe would never have had that were made to gain the slimmest hurried fashion to get it by the Amer- the unique care she needed, if we had been margin for passage of a bill that is all ican people before Christmas in the required to petition a government agency for about their health care. Once the Sun hopes they will not notice. permission. A less dedicated person than her Mr. COBURN. I thank the leader. subspecialist would have tried to classify her came up, Americans could see all the condition and restrict her to known treat- deals that were tucked inside this grab I want to spend my time this morning kind of talking about how you con- ments. In fact, other subspecialists wanted bag, and they do not like what they are to make those same restrictions. Chloe’s finding. After all, common sense dic- trol health care costs in our country. doctor learned how to treat her by spending tates that anytime Congress rushes, My experience, just from my qualifica- a great deal of time with her, by talking to Congress stumbles. It is whether Sen- tions—I have 9 years of experience in her and to us for hours at a time, and by ob- ator so-and-so got a sweet enough deal manufacturing medical devices. I did serving her in multiple contexts. I fear for to sign off on it. Well, Senator so-and- that as a young man, had hundreds of the next mother whose child has an unclassifiable condition, and whose treat- so might have gotten his deal, but the employees and a fairly large business. I left that business to become a physi- ment is planned by a faraway committee American people have not signed off. with a diagnostic manual open on the table. Public opinion is clear. What have we cian. The call of my life was to help Chloe won’t be in that manual. people directly rather than indirectly become as a body if we are not even lis- The thing that keeps people from through my medical device associa- tening to the people we serve? What getting health care in America today is tion. have we become if we are more con- the cost of health care. We have had all So I want to lay out the two different cerned about a political victory or sorts of attempts of, how do we do ways, the two different arguments for some hollow call to history than we are that? We have had the Massachusetts how we control health care costs be- about actually solving the problems model, and, as entered into the RECORD cause everybody in this Chamber wants the American people sent us here to ad- yesterday, they have insurance reform. to control health care costs. All the dress? This bill was supposed to make Almost everybody in Massachusetts is Democrats and all the Republicans do. health care less expensive. It does not. covered. Yet last year 21 percent of We have 11 studies that say premiums Incredibly, it makes it more expensive. those people who were covered could are going to rise and one that says they Few people could have imagined that not get care because they could not af- this is how this debate would end—with are not under this bill. So that is not ford the deductibles and copays. So ex- a couple of cheap deals hidden in the going to control costs. panding insurance and expanding the But I want to read a story that a lady folds of this 2,700-page bill and rushed model does not solve it. early-morning votes. But that is where from my district wrote me because I So you can either approach control- we are. Americans are asking them- think it is very important in us consid- ling costs or you can ration care. What selves: How did this happen? How did a ering which way we go. has happened in this bill, as it comes great national debate that was sup- Dr. COBURN, through, is we have chosen to ration posed to lead to a major bipartisan re- I hope you don’t mind a personal story, but as I listen to the health care debate, I can’t care. My colleagues are going to dis- form lead to a bag full of cheap legisla- help but think constantly of my middle pute that, but I want to offer signifi- tive tricks inside a $2.3 trillion, 2,733- daughter. I am convinced that Chloe would cant evidence to offset that and discuss page bill that actually makes health have lost her chance for a normal life, had what is in the bill and to also discuss care costs go up? these policies— what is not in the bill.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00027 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13740 CONGRESSIONAL RECORD — SENATE December 22, 2009 What is not in the bill is a prohibi- effectiveness, are we going to reverse are going to eliminate the heart of tion against rationing, which all of my it? We are not. So there is another medicine, which is the combination of colleagues on both the Finance Com- proof that we are, in fact, going to use vast experience, gray hair, long years mittee and the HELP Committee voted the rationing of care to control costs. of training, family history, clinical his- against, which means you are for ra- Mr. BURR. Madam President, will tory and physical exam and we are tioning if you vote against, a prohibi- my colleague yield for a question? going to say: No, it doesn’t matter. We tion. The leader denied an amendment Mr. COBURN. I would be happy to. are going to say: Here is the way you on the floor of the Senate to eliminate Mr. BURR. If, in fact, the Congress are going to do it. rationing, so we do not get to see did reverse the decision of an advisory Who uses comparative effectiveness where everybody stands. But we under- board, what does that do to the budget research? Well, several countries do. stand the intent. So there is no ques- deficit? And what does it do to the When I share with my colleagues the tion that the way we are going to con- claims that this current bill being con- stories about how it is used, you are trol costs is to limit your access by ra- sidered is paid for? going to get a real vision of what is Mr. COBURN. I am not sure I can an- tioning health care. coming with this bill—a real vision. The other side of controlling costs is swer the question. But it would make This bill creates a new agency called to incentivize the prevention of disease it less effective in terms of supposed the Patient-Centered Outcomes Re- and incentivize payments for good out- claims. search Institute to perform compara- Mr. BURR. So if the authors of this comes when we manage chronic disease tive effectiveness research. I have al- bill never intended to make cuts, then that is there in an efficient and effec- ready said the idea behind it is good. I it blows the budget neutrality that is tive way. That is not in the bill. That strongly support medical research. I portrayed in this bill. But if they use is not anywhere in the bill. What we strongly support helping doctors and all the mechanisms that are in place to have to do is incentivize an insurance their patients choose the best research make sure reimbursements are cut or and the best treatment. The problem company to invest in the management the scope of coverage is affected by a is, this bill doesn’t do that. On the con- of chronic disease rather than to pay decision to limit one’s care, then we trary, this bill will empower the gov- for the consequences of the chronic dis- could see prevention cut, wellness pro- ernment to decide which treatments ease. That is not in the bill either. grams cut, or even the preventive diag- So we get two choices. you can have and which ones you can- nosis such as for breast cancer limited Now, what do we find in this bill? We not have. That is what this does. This find a Medicare advisory commission. to a much smaller group. Mr. COBURN. I think the Senator removes the judgment of the doctor They actually dropped the name from North Carolina is really going to and replaces it with the judgment of ‘‘Medicare’’ from it, but we find an ad- where I am going to get to later; that the bureaucracy in Washington. It is visory commission that is going to tell is, what is the motivation for the deci- not a hypothetical concern, it is a real- us how much money we have to cut sionmaking? I think my colleagues on world problem. from Medicare, and we either have to the other side of the aisle are well in- In Britain, they control health care cut that amount or make some cuts tended, but I don’t think they are well costs by denying or delaying access to somewhere else. informed about the consequences of expensive therapies. That is one of the We have the U.S. Preventive Services their intentions. reasons this country has one-third bet- Task Force, and we have already seen So if you set up the Task Force for ter survival for every cancer you can during the debate on this bill when Preventive Health Services and say imagine over Great Britain because we they do something that is based on you are going to rely on it, but we don’t do that. As a two-time cancer cost alone—not clinical; breast cancer know they are going to make the deci- survivor I am acutely aware as a pa- screening for women between the ages sions based on cost-effectiveness, not tient, not as a doctor, in that I want to 40 to 50—when they do something on clinical effectiveness, what we are make sure for my family and my pa- the basis of cost instead of clinical, we going to see is the American Cancer tients they have the best alternatives, run in and jump and say no, but we are Society coming again and again and not the cheapest, because the cheapest going to pass a bill that is going to to- again because what we are going to do alternatives are the ones that take tally empower that. Seventeen times in is we are going to cover those where it years away from your life. this bill is the U.S. Preventive Services is cost-effective but not clinically ef- I am going to go through some exam- Task Force referenced in what it is fective. For 80 percent of Americans, ples. Nobody can dispute this is what is going to tell us what to do, and it is they are not going to notice the dif- happening now and what will happen not going to tell us just in Medicare ference, but one out of five Americans under our program. To Senator BAU- and Medicaid, it is going to tell us in is going to notice the difference. CUS’s credit, he had a bill that wasn’t every area what we are going to do. The second area, which I wish to cost comparative effectiveness; he had But because there was such a reaction spend some time on because we have one based on clinical comparative ef- to the first recommendation based on actually modeled it after England, is fectiveness. That is not in here. What cost—and let me explain what that cost comparative effectiveness. We is in here is cost comparative effective- was. They said that if you are age 50 ought to talk about what is compara- ness. Senator BAUCUS knew you don’t and over, the incidence of finding tive effectiveness research because want to use cost as the main thing; you somebody with breast cancer is 1 in there is nothing wrong with the re- want to use clinical outcomes as the 1,470 people, but if you are between the search. It is health care research com- No. 1 deciding agent in how we ap- ages of 40 and 50, it is only 1 in 1,910 paring various drugs, devices, and proach health care—not cost—because people; therefore, it is not cost-effec- treatments head to head, and the whole if you only look at cost, nobody in this tive. So it does not matter if you have goal of that is to find out what works country would get a mammogram be- breast cancer between the ages of 40 best and what costs the least. tween 40 and 50. But this bill is dif- and 50, we do not think the government The assumption in this bill is, we can ferent from what Senator BAUCUS had ought to be paying for your mammo- have 24 or 36 people in Washington de- offered in his Finance Committee gram and we do not think anybody cide that. In the Framingham studies markup. ought to have one. Well, that is fine for they have been running for over 50 There is an agency in Great Britain all those people who do not have breast years on heart disease, we still don’t called the National Institutes for cancer. It is terrible for the people who have the answers and we have been Health and Clinical Excellence. It is do have breast cancer and it could be studying it for 50 years. But we are pronounced NIHCE. Here are some of found early with a mammogram. going to be making decisions on cost, the decisions of NIHCE in the most re- So we rushed in here and we offset not on clinical effectiveness, which is cent years. They have a problem in what that task force did. But they are going to limit your ability to have England with cost, too, and they have going to be doing it time and time what you and your doctor think you a single-payer, government-run sys- again. And is the Congress going to need. tem. They have the government run- truly—every time they make a decision So we are going to pull out clinical ning it, but they still can’t control based on cost-effectiveness, not clinical experience of individual physicians. We their costs, so what have they done?

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00028 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13741 They have repeatedly denied breast heimer’s disease. Well, those are the 200,000 employees at Safeway and what cancer patients breakthrough drugs. only ones they work effectively on. One they have been able to do in using their They have forced patients with mul- hundred thousand Alzheimer’s patients incentive systems to pay for preven- tiple sclerosis to wait 21⁄2 years to re- a year were denied treatment that tion, to use competitive purchasing to ceive new innovative treatments that could have slowed the progress of their reconnect the employee with the pur- people in this country are getting as disease. The British Alzheimer’s Soci- chase of health care. soon as they are available. They have ety said this decision was disgraceful I understand my colleague from Ne- denied early stage Alzheimer’s patients and victimized the most vulnerable in braska is here, and I will yield to him medication, requiring their condition our society. because I understand he was a unani- to worsen before they give them the Brain cancer. Gliadel and Temodal mous consent request. medicine. What do we know about the were not cost-effective for treating The PRESIDING OFFICER. The Sen- medicine? It works best when you have brain tumors and severely restricted ator from Nebraska is recognized. the slightest symptoms of Alzheimer’s, their access to them. A 47-year-old Mr. JOHANNS. Madam President, I not when you get worse. But that is the woman sold her house to buy the drug appreciate the courtesy extended by bureaucratic thinking: We will save the government refused to provide. the Senator from Oklahoma. money rather than practice good medi- They have been held as the biggest I ask unanimous consent that the cine. breakthroughs in treating brain tu- pending substitute amendment be They deny life-prolonging treatments mors in the last 30 years. Finally, in modified to delete the following special to kidney cancer patients. They denied April of the year before last, they fi- carve-outs: eliminating or reducing the new medicine to all but a small per- nally relented and allowed brain cancer Medicaid unfunded mandate on Ne- centage of patients with osteoporosis patients to have the drugs that were braska, Vermont, Massachusetts; ex- and then only as a last resort. In other available on the market. empting certain health insurance com- words, you have to about have your Erbitux, very effective in resistant panies in Nebraska and Michigan from bones breaking by standing before you colon cancers. In 2006, denied. Seven- taxes and fees; providing automatic get medicine for osteoporosis in Great teen thousand Britons a year get the Medicare coverage for anyone in Libby, Britain. In this country, we have pre- sort of advanced colon cancer that MT; earmarking $100 million for a vented millions of hip fractures Erbitux is designed for. Yet they can’t health care facility, reportedly, in Con- through effective medicines to restore have it. necticut; giving special treatment to the calcium and bone matrix in sen- Mr. BURR. May I ask a question of Hawaii’s disproportionate share of hos- iors’ bones. But we have Medicare now my colleague? Listening to this list of pitals; boosting reimbursement rates saying you are doing too many tests to products that have been denied people for certain hospitals in Michigan and check on that, so you can only do it in Great Britain, and certainly this is Connecticut; and mandating special every 2 years. So we are going to use true in some other countries, makes treatment for hospitals in frontier rationing, and we are. me look at the Medicare population in States such as Montana, South Da- They denied access to the only drugs this country with the realization that kota, North Dakota, and Wyoming. available to treat aggressive brain tu- the way Medicare was constructed, a The PRESIDING OFFICER. Is there mors. They denied effective drugs to senior can’t pay out of pocket because objection? bowel cancer patients, colon cancer. no provider can receive a payment Mr. BAUCUS. Madam President, I ap- Macular degeneration is something from a senior. If for some reason this preciate the Senator’s desire to want that affects a large number of people in bill were passed and you took part of to cut the payments to his own State, this country. That is where the the arsenal of drugs away from seniors but I object. macula—the area that actually allows or procedures away from seniors, how The PRESIDING OFFICER. Objec- you to see and concentrate your vi- can a senior get a benefit if no provider tion is heard. sion—as we age, we have what is called can receive an out-of-pocket payment Mr. JOHANNS. Thank you. I yield to cystoid macular degeneration or dry from a senior? the Senator from Iowa. degeneration. That is a disease of the Mr. COBURN. That is the problem The PRESIDING OFFICER. The Sen- eye where it causes vision loss. NIHCE with our system today. What we are ator from Iowa. required patients suffering from going to hear them say is the insurance Mr. GRASSLEY. Madam President, macular degeneration to go blind in companies do this now. At first, for we had a very early vote, and it brings one eye before they could have the new treatments, until they are proven the health care reform bill obviously medicine that almost every American effective, most insurance companies one step closer to final passage—at who has macular degeneration in this don’t cover them, but they cover them least it looks obvious that is going to country has. She had to go blind first much sooner than Medicare does today. happen. Regardless of whether the in one eye before you could ever get Today, Medicare is the last to approve other side has 60 votes, my friends on the medicine. That is a bureaucrat the drugs. the other side still have a problem they making this decision or a bureaucratic We are going to hear that is not any want to not have the public con- committee because it was cost-effec- different than the limitations from in- centrate on; that is, that the pending tive to allow you to live with one eye. surance. That is true. We need to bill still raises taxes on middle-income Elderly patients went to court to fight change that. But the fact is, we are Americans. The Reid modification did for drugs to keep them from going getting ready to put all these people nothing to reverse this fact. blind. Twenty-two thousand Britains into insurance programs, and then we I will take a few moments to illus- became totally blind through that rul- are going to have the Federal Govern- trate the winners and losers under the ing by the NIHCE. In one case, an 88- ment, which is just as bad or worse bill. We start with a question: If a per- year-old World War II veteran and than the insurance company, making son is not receiving a subsidy for former Air Force pilot sold his house to those decisions. health insurance under the bill, then pay for the drug after the government I wish to finish my point on cost. We how can the person receive a tax cut? said they weren’t going to pay for it. get two ways for fixing cost because This is a relevant question because the The Royal National Institute of Blind that is what is keeping people from White House and the majority leader- People said that as a result of NIHCE’s getting access. We can either ration ship continue to proclaim that the bill decision, countless people have either it—and there are three methods to ra- is a ‘‘net tax cut’’ for middle-class been stripped of their sight or stripped tioning in this bill which will be used— Americans. For example, on Wednes- of their life savings to pay for private or we can incentivize outcomes and we day, December 16, a senior White House treatment. can incentivize prevention and we can aide wrote: For Alzheimer’s, they ruled that pay, based on the transparency of out- The bill being considered represents a sub- three drugs, common to many people comes and quality. We haven’t done stantial net tax cut for middle income fami- who are listening today—Aricept, any of that in this bill. We have said lies. Reminyl, and Exelon—were not cost-ef- we have, but when you look at how do So I think that statement begs more fective for patients with early Alz- you prevent it—and the model is the questions. Who do you believe? The

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00029 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13742 CONGRESSIONAL RECORD — SENATE December 22, 2009 White House, on the one hand, or on lion Americans under $200,000-a-year ally increase health insurance pre- the other hand, the nonpartisan inde- income. Finally, when we identify miums. Premiums will go up because pendent experts upon whom we on Cap- those Americans who get no benefit the companies are paying increased itol Hill rely for judgment—the people under this bill, and those Americans taxes under this bill. For insurance who are not political, the Joint Com- who see a tax increase, we find that premiums to go up, under a title of a mittee on Taxation? there are 73 million individuals, fami- bill that encompasses health care re- This committee tells us that in 2019, lies, and single parents under the form, that is going in the wrong direc- a little more than 13 million individual $200,000 category. That is this group. tion. Also, for argument’s sake, let’s families and single parents would re- I want to close by referring to a final assume my Democratic colleagues are ceive the government subsidy for help- chart that illustrates the winners and correct and this so-called hidden tax ing people under 400 percent of poverty losers under the Reid bill. What we see that results from uncompensated care buy health insurance. The Joint Com- is that there is a group of Americans equals $1,000. The pending health care mittee also tells us that the number of who clearly benefit under the bill from reform bill still leaves a large number tax filers in 2019 will be 176 million peo- the government subsidy for health in- of Americans uninsured. Specifically, ple. If people are wondering why we surance. This group, however, is rel- the Reid bill leaves 23 million out of 54 talk about 2019, it is the budget window atively small—8 percent of Americans, million without health insurance at from now until the end of the 10-year if you look at those earning less than the end of this budget window, 2019. So, period of time that we call a ‘‘budget $200,000. at best, the Democrats’ reform cuts the window.’’ That means out of—com- There is another much larger group hidden tax in half—in this case, to paring this 13 million to the 176 million of Americans who are seeing their about $500 a family. taxpayers, 13 million people receiving taxes go up. This group is not bene- To add insult to injury, however, the the subsidy and 176 million tax filers— fiting from the government subsidy, bill adds new hidden taxes. These taxes that means out of that 176 million indi- this group on the chart. There is an- are the fees imposed on health insur- viduals, families, and single parents, other group of taxpayers who are gen- ance. CBO and the Joint Committee on only 13 million of them would receive a erally unaffected, this 82 million here. Taxation—two respected organiza- government subsidy for health insur- The Joint Committee on Taxation tells tions—say this will increase costs. If ance. That is only 7 percent of the tax us this group may be affected by tax you check the report, no one can dis- filers. It is pretty important to under- increases that are not included in this pute that. These fees go into effect in stand that only 7 percent of Americans study, like the cap on flexible savings 2011—still 3 years before any of the will benefit from the subsidy for health accounts and the individual mandate major reforms under the pending bill insurance. tax that people are going to pay if they kick in. We have a pie chart so people can see That means this hidden tax will in- don’t buy health insurance. exactly what I am talking about. This crease premiums in 2011, 2012, and 2013. The bottom line is this: My friends says 176 million taxpayers, with 13 mil- That is before there is any government on the other side of the aisle, first, can- lion receiving the subsidy. This means assistance for health insurance being not say that all taxpayers receive a tax 163 million families, individuals, and provided to families that need it. The cut; two, they cannot say the Reid bill single parents—or 93 percent of all tax- new hidden tax is also created as a re- does not raise taxes on middle-income payers—will receive no government sult of the Medicaid expansion on the Americans because we have the profes- benefit under the Reid bill. What does one hand, and Medicare cuts on the that mean? It means there is a small sionals who are nonpolitical at the other hand, a major cost shift in health beneficiary class under the Reid bill—7 Joint Committee telling us differently. care derived from government pro- percent. Thirteen million people will No one can dispute that data. grams—Medicare and Medicaid—which receive benefits under the Reid bill. A I yield the floor and suggest the ab- reimburse providers at rates roughly 20 very large nonbeneficiary class—93 per- sence of a quorum. percent to 40 percent lower than pri- cent—will not benefit. The PRESIDING OFFICER. The vate providers. This nonbeneficiary class is affected clerk will call the roll. President Obama understands that in other ways. Yes, while one group of The legislative clerk proceeded to paying doctors below market rates Americans in this class would be unaf- call the roll. leads to cost shift. This is what he said fected, another group of Americans will Mr. GRASSLEY. Madam President, I at a townhall meeting on health care see their taxes go up. This group would ask unanimous consent that the order reform: not have a tax benefit to offset the new for the quorum call be rescinded. If they are only collecting 80 cents on the tax liability. That means these Ameri- The PRESIDING OFFICER. Without dollar, they have to make that up someplace cans will be worse off under the Reid objection, it is so ordered. else, and they end up getting it from people bill. Mr. GRASSLEY. Madam President, who have private insurance. It is legitimate to ask, for these 93 my friends on the other side of the The Medicare and Medicaid cost shift percent of the people, what happened aisle continue to argue that the Reid will be increased significantly under to their net tax cut? What they will see bill eliminates the so-called hidden the pending health care reform bill. instead is a net tax increase. Based on tax. They argue that this would reduce According to the CBO estimate, Med- the Joint Committee’s data, in 2019 42 the cost of health care. For example, icaid will be increased by more than 40 million individuals, families, and sin- on Wednesday, December 16, a senior percent, from 35 million to 50 million gle parents with incomes under $200,000 White House aide wrote: people. Additionally, the bill includes will see their taxes go up. This is even Even if you believe that some of the tax on almost $1⁄2 trillion in Medicare cuts after taking into account the subsidy insurance companies is passed along, it that will result in lower payments to for health insurance. Again, this is on would be more than outweighed by the bene- providers. a net basis. fits middle-class families would get from re- Increasing the current Medicare and If we were to identify those Ameri- ducing the hidden tax they currently pay for Medicaid cost shift as a result of the cans who are not eligible to receive the the uninsured. Democrats’ health reforms would add tax credit and those whose taxes go up I don’t believe the fees on health in- even more costs to a family’s health in- before they see some type of tax reduc- surance companies will be passed surance policy. The easier cost shift to tion from the subsidy, this number will through to the policyholders. I think it address would be the $1,700 cost shift climb to 73 million Americans. The is just idiotic not to think they would from defensive medicine. The Demo- first bar on the chart illustrates what not be passed through. crats do not address the cost shift from we have already established but looks I want to flatout state I know they defensive medicine which former CMS at Americans earning less than are going to be passed through. My au- Director Mark McClellan has esti- $200,000. Right here, 13 million families thority for this is the Congressional mated adds $1,700 in additional cost per and single parents and individuals Budget Office and the Joint Committee average family. would receive the subsidy. on Taxation telling us that fact. The Addressing this reform alone could The middle bar on the chart shows CBO and the Joint Committee on Tax- save more than covering all of the un- the net tax increase number of 42 mil- ation told us that these fees will actu- insured in America.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00030 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13743 So, you see, my friends on the other These provisions are important to our I point out that support in Congress side say their bill will eliminate the so- economy—not only because they help create for extending the biodiesel tax credit, I called hidden tax. My friends seem to jobs, but also because they are used to ad- think, has been and still is robust, bi- dress pressing national concerns. We under- partisan, and bicameral, and that it come up short on that one. Also, they stand that the expiration of these provisions add new hidden taxes that will burden creates uncertainty and complexity in the has not been extended prior to January middle-class Americans. tax law. 1, 2010, due solely to issues unrelated to I think in the present situation, the Taxpayers need notice of the availability the merits of the biodiesel tax credit. legislation before us and the language of these provisions to fully and effectively I want everybody to know that I used by debaters on the other side, utilize the intended benefits. We hope to ad- agree with Chairman BAUCUS that the they should be transparent when they dress this issue as soon as possible to cause expiration of these tax provisions cre- are talking about getting rid of the the fewest disruptions and administrative ates uncertainty and complexity in the problems for taxpayers and also generate the tax law. I also agree that the taxpayers hidden tax. The pending health care re- greatest economic and social benefit. form bill makes things from these Sincerely, need notice that these tax provisions three perspectives work. MAX BAUCUS, will be in place so they can plan their Madam President, I will be happy to Chairman, Senate personal and business affairs to fully yield the floor for a minute for the pur- Committee on Fi- and efficiently use the intended tax in- pose of a colloquy with Senator BAUCUS nance. centives. on another subject. CHUCK GRASSLEY, In addition, extending the tax provi- The PRESIDING OFFICER. The Sen- Ranking Member, Sen- sions as early as possible in 2010, as we ate Committee on Fi- intend to do, will minimize the admin- ator from Montana. nance Mr. BAUCUS. Madam President, I istrative problems created for the In- would like to address a colloquy with Mr. BAUCUS. Madam President, the ternal Revenue Service. letter states our intention to work to- Senator GRASSLEY, as he said, on an- I look forward to working with gether to get the extenders done as other subject that is not related to this Chairman BAUCUS to retroactively ex- quickly as possible in the new year. bill. tend these provisions as soon as pos- Senator GRASSLEY and I both under- The PRESIDING OFFICER. Without sible when the Senate reconvenes in stand that expiration of these provi- objection, it is so ordered. 2010. sions creates uncertainty and com- Mr. BAUCUS. Madam President, I EXPIRING TAX PROVISIONS plexity in the tax law. Taxpayers need thank the Senator for his statement. I Mr. BAUCUS. Madam President, the notice of the availability of these pro- look forward to working with him and Senate is wrapping up legislative busi- visions to fully and effectively utilize other Senators so we can pass this leg- ness shortly, but there are a few expir- their intended benefits. Finally, we islation as soon as possible next year. ing tax provisions that have unfortu- must act quickly to cause the least dis- Again, I commend my colleague and nately not been extended. These provi- ruptions and administrative problems friend. It is true that much more often sions include tax benefits for individ- for the Internal Revenue Service. than not we are working on the same uals and businesses. These provisions I hope when the Senate convenes side of an issue. Even on the few occa- would help teachers who purchase sup- early in 2010, we can address these ex- sions when we are on the opposite side, plies for their classrooms and families piring provisions as soon as possible. I I do say we do it agreeably. I wish more with college students. wonder if that is also the intention of of the Senate would act the same way. Further, a great number of U.S. busi- the my good friend from Iowa, Senator Mr. HARKIN. Madam President, I nesses rely on important tax benefits, GRASSLEY. thank the Senators. The delay in the such as the research and development The PRESIDING OFFICER. The Sen- passage of the Tax Extenders Act of tax credit and the active financing ex- ator from Iowa. 2009 will cause problems for a wide va- ception, both of which expire at the Mr. GRASSLEY. Madam President, I riety of groups, as the distinguished end of this year. The energy industry would like to add to what Senator BAU- Senators from Montana and Iowa have also relies on several provisions that CUS said by speaking positively on this outlined. I believe the negative impact expire on December 31. Unfortunately, issue and to remind my colleagues who of our failure to act this year will be this is not the first time we have al- maybe have been watching in the last 3 felt first, and felt most strongly, by lowed important tax benefits to expire. weeks and have seen Senator BAUCUS manufacturers of biodiesel. Without As soon as the Senate reconvenes next and I on opposite sides of the issue of the immediate passage of legislation to year, my intention is that we take up health care reform—it is extend the biodiesel tax credit, a large legislation to extend these important uncharacteristic for us to have dif- number of biodiesel manufacturing provisions. ferent points of view on legislation. In plants are likely to close down because That is why Senator GRASSLEY and I the 10 years he and I have been leaders they do not have the resources to oper- have written a letter to the Senate of the Finance Committee, most of the ate without the financial benefit of the leadership. I ask unanimous consent to issues coming out of our committee credit. have this letter printed in the RECORD. have been very bipartisan. What he Biodiesel is a key part of our Na- There being no objection, the mate- just talked about and what I am going tion’s success in biofuels. These rial was ordered to be printed in the to respond to is one of those issues. biofuels, produced here in our own RECORD, as follows: I agree with Chairman BAUCUS that country, are helping to reverse our U.S. SENATE, we should retroactively extend the ex- near-total dependence on petroleum for COMMITTEE ON FINANCE, piring tax provisions as soon as pos- transportation in this country. The Washington, DC, December 22, 2009. sible after Congress reconvenes in 2010. hard truth is that we get about 70 per- Hon. HARRY REID, As chairman of the Finance Com- cent of our petroleum from other coun- Majority Leader, U.S. Senate, Washington, DC. mittee in 2005, I worked with then- tries, and many of those countries are Hon. MITCH MCCONNELL, Ranking Member BAUCUS, and we au- unstable or are unfriendly to the Republican Leader, U.S. Senate, Washington, DC. thored the biodiesel tax credit. United States or both. So biodiesel is DEAR MAJORITY LEADER REID AND REPUB- The biodiesel tax credit is a tax cred- helping us restore national energy se- LICAN LEADER MCCONNELL: We write to in- it that is needed to be extended before curity. form you that early in the next year, we in- the end of the year to prevent the U.S. Biodiesel is made from vegetable oils tend to address the extension of various tax biodiesel market from grinding to a or animal fats. The biodiesel industry provisions expiring on or before December 31, halt on January 1, 2010. This tax credit employed over 50,000 workers and added 2009. We intend to extend the provisions differs from other tax provisions in over 600 million gallons of biobased without a gap in coverage, just as the House that the price of biodiesel will be $1 fuel last year to help power the diesel did on December 9th of this year. The legis- higher on January 1, 2010, as a result of lation will extend several important tax ben- engines across our Nation and through- efits to individuals and businesses. The legis- the tax credit not being extended be- out the economy. lation will also extend a number of energy fore that date. That means people will However, this is still a very small tax provisions, including the biodiesel tax simply buy petroleum diesel rather and struggling industry. It is abso- credit, and natural disaster relief. than biodiesel come January 1, 2010. lutely dependent on continuation of

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00031 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13744 CONGRESSIONAL RECORD — SENATE December 22, 2009 the biodiesel tax credit. Without this current levels. If the 2009 rules are An individual becomes eligible for credit, most of the biodiesel plants in retroactively applied, then only ap- the CLASS program after paying pre- this country will simply be forced to proximately 6,000 estates would pay the miums for just 5 years. If a person pays shut down, thus idling important do- estate tax each year; however, if the premiums of $2,880 per year for 5 years, mestic fuels production capacity as estate tax expires, then it is estimated they would have paid a total of $14,400 well as putting as many as 20,000 em- that 61,000 estates could be hit with the in premiums for that program. That ployees out of work. We can’t let that capital gains tax. It is critical that we person can then begin collecting a ben- happen. And, if for any reason the cred- extend the estate tax under the 2009 pa- efit of $1,500 per month. In 10 months, it was not made retroactive, bank- rameters to protect small businesses the person will have recouped their 5 ruptcy would in a good number of in- and family-owned farms, continue the years’ worth of premiums. stances be a quick result. incentive that the estate tax provides This simple explanation should make I do appreciate the efforts by the for charitable giving, and provide cer- it crystal clear why the CLASS Act is chairman and ranking member to move tainty for the heirs of farm and busi- a fiscal disaster waiting to happen, not forward with this badly needed legisla- ness estates. based on our determination but based tion at the first opportunity. During one of the most challenging on the determination of the Chief Ac- Ms. STABENOW. Madam President, economic times our country has faced, tuary. The premium will be too expen- as we work toward economic recovery, dragging our feet on these tax extensive to entice young, healthy people to it is imperative that we act quickly to sions could have a substantial impact participate. The benefit payout is very extend critical tax provisions sched- on our Nation’s businesses and families enticing for people who know they will uled to expire this year that promote at a time when we should be doing all need the benefit. Healthy people do not research and development, spur com- we can to help them succeed. I look participate; sicker people will. This ad- munity development, support the de- forward to working with Chairman verse selection problem will send the ployment of alternative vehicles and BAUCUS and Ranking Member GRASS- program into the classic insurance fuels, and provide certainty for busi- LEY to retroactively extend expiring death spiral. nesses and families. tax credits expeditiously when we re- The Chief Actuary concluded on page Knowing these tax provisions are in turn next year. 14 of his report with this one sentence: place allows Americans to plan for the Mr. GRASSLEY. Madam President, I There is a very serious risk that the prob- upcoming year. The longer we wait to suggest the absence of a quorum. lem of adverse selection would make the pass this legislation, the more uncer- The PRESIDING OFFICER. The CLASS program unsustainable. tainty we place on businesses during a clerk will call the roll. If the CLASS Act becomes law, the time when they are starting to recover. Mr. GRASSLEY. Madam President, I Federal taxpayers are at very serious Many of these tax provisions encourage ask unanimous consent that the order risk of paying a price to clean up the investment, the development of new for the quorum call be rescinded. fiscal disaster when the CLASS Act technologies, and business growth, The PRESIDING OFFICER. Without fails. which allow our companies to be com- objection, it is so ordered. I yield the floor and suggest the ab- petitive in a global marketplace. Mr. GRASSLEY. Madam President, sence of a quorum. Delaying the extension of the re- there was a report released recently by The PRESIDING OFFICER. The search credit could put more than the Chief Actuary, Rick Foster. I hope clerk will call the roll. 100,000 jobs and billions of dollars in this report will once and for all put an The assistant legislative clerk pro- economic activity and Treasury rev- end to any serious consideration of the ceeded to call the roll. enue expected in 2010 in jeopardy, ac- CLASS Act. The CLASS Act is going to Mr. BAUCUS. Madam President, I cording to estimates from be in the bill, if this bill passes Con- ask unanimous consent that the order TechAmerica. If the credit is renewed, gress. But it should not be in it, and we for the quorum call be rescinded. the association estimates that 120,000 should have had a long discussion on The PRESIDING OFFICER. Without jobs would be generated and/or sus- this provision because it is simply fis- objection, it is so ordered. tained, there would be an additional $16 cally unsustainable. Mr. BAUCUS. Madam President, this billion in additional research and de- The information the Chief Actuary’s chart shows very graphically—this is velopment and other economic activity letter provides is ample evidence of data put together by the Joint Com- and $13 billion in Federal tax revenue why the CLASS part of this bill cannot mittee on Tax, combining all the var- over the course of 2010. However, for work. Quoting from page 13 of the Chief ious provisions in the bill. Basically, it every day that the credit is left ex- Actuary’s letter: shows that in 2015—that is the bar on pired, there is the potential to lose 331 We estimate that an initial average pre- the far left—there will be a $26.8 billion jobs, $45 million in economic activity, mium level of about $240 per month would be net tax cut for individuals—net tax and $37 million in tax revenue. required to adequately fund CLASS program cut. Two years later in 2017—that is the Another important tax provision set costs for this level of enrollment, middle vertical bar—there is a net tax to expire this year allows businesses to antiselection, and premium inadequacy for cut of $40 billion for all Americans—a write off the expenses of cleaning up students and low income participants. net tax cut. Not for all Americans. brownfields, industrial land that would So who would enroll in the CLASS Some will not get it, but most Ameri- otherwise continue to be a blight on program? An American making 300 per- cans by far will. Then, of course, 2 our communities and harm our envi- cent of poverty has a gross income of years later in 2019, there is a net tax ronment. In my home State of Michi- $32,490. If the CLASS premium is, as cut of $40.8 billion. gan, these credits will be needed more the Chief Actuary predicts, $240 per I wanted to make it clear that there than ever to address the brownfields month—that is $2,880 per year—and an is a net tax cut in this bill, according that have been left behind as a result individual at 300 percent of poverty to Joint Tax. This is the distribution of the restructuring of the automotive would have to commit 8.9 percent of over 3 different years—2015, 2017, and industry. Revitalization of these their income to join the program. That 2019. That is information prepared by brownfields will be critically impor- is simply not possible, nor is it plau- the Joint Committee on Tax. I want tant to communities throughout the sible to argue that young, healthy per- Americans to know there are tax cuts State and the Midwest. sons will commit almost 9 percent of in this bill, and they are very signifi- It is also imperative that we restore their income to long-term care insur- cant. the estate tax retroactively to January ance policy. 1, 2010. I am extremely disappointed The people who will enroll then are Madam President, I yield the floor. that an extension was blocked and that those who have real expectations of f the estate tax will be allowed to expire using the long-term care benefit. Peo- in 2010. Contrary to Republicans’ ple who join the CLASS program with RECESS claims, more heirs of farm and business the expectation of needing the benefit The PRESIDING OFFICER. Under estates will be hit with a tax increase become the Bernie Madoffs of the the previous order, the Senate stands than if we extended the estate tax at CLASS Act Ponzi scheme. in recess until 2:30 p.m.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00032 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13745 Thereupon, the Senate, at 12:30 p.m., erage, and every day we remain here Health insurance reform will offer recessed until 2:30 p.m. and reassem- delaying this measure, 14,000 more Rhode Islanders access to stable and af- bled when called to order by the Pre- Americans will lose their coverage. We fordable health insurance coverage. siding Officer (Mr. WEBB). have to, I think, reverse that trend and Here are some of the changes that will f begin to fix our broken health care sys- happen immediately with the enact- tem. ment of this bill: SERVICE MEMBERS HOME Since 1999, Rhode Island’s uninsured Insurance coverage for the uninsured OWNERSHIP TAX ACT—Continued population has nearly doubled, growing with preexisting conditions will be pro- The PRESIDING OFFICER. The Sen- from 6.1 percent to 11.8 percent in 2008, vided through a high-risk pool within 6 ator from Montana is recognized. and it has soared up to about 15 percent months of this bill being signed into Mr. BAUCUS. Mr. President, I have today in the wake of unprecedented law. In my State, one plan already acts control of the Democratic block of economic issues. But while some of us as the insurer of last resort and pro- time, and I yield 25 minutes to the have made this debate about trying to vides coverage for those who have pre- good Senator from Rhode Island. fix a broken health care system, others existing conditions. This bill will sup- Mr. REED. Mr. President, I thank the have made it clear their real intention port their efforts. And, all insurers will chairman for yielding me the time and was to use this issue to ‘‘break Presi- be prevented from denying coverage to also thank him for his great effort on dent Obama’’ and make health reform children immediately due to a pre- this legislation. his ‘‘Waterloo.’’ Partisanship must not existing condition. It is a profound privilege to have the come before providing access to life- There will be no lifetime limits on opportunity to serve the people of saving health care to children, fami- coverage for all new policies. This Rhode Island and in that capacity to lies, and seniors. means no one will exhaust their cov- support the legislation before us. This I also don’t understand how some erage plan, no matter how sick they effort has been decades in the making. party loyalists who spent the past 8 become. Every year that passes without health years helping George W. Bush drive our There will be restrictions on annual insurance reform has made the task economy into the ground and inflate limits for all new policies. Insurance more difficult and, the need for reform, the deficit to record levels are now ob- companies will have more difficulty de- more essential. structing every reasonable effort to fix nying care in the middle of treatment. Rhode Islanders have seen their these problems. How could they help All new policies sold will cover chil- health care costs double in just the last George W. Bush double our national dren up to the age of 26. This is par- decade. In 2000, the average employer- deficit, running it up more in 8 years ticularly helpful since graduates from sponsored family health insurance pol- than all 42 Presidents before him, and college often—particularly in this icy cost about $6,700. In 2008, the same then turn around and claim President economy—have a hard time finding plan cost nearly $12,700. Without re- Obama isn’t doing enough to control employment with health care benefits. form, by 2016, that family will pay over it? Insurers will no longer be able to re- $24,000 in premiums, consuming 45 per- How could they say this $800 billion scind coverage upon illness—when cent of their projected median income. insurance reform bill—which is fully treatments, checkups, screenings, and Such a course is unsustainable by the paid for and reduces costs to con- medication are absolutely critical. Insurance companies will be required families of Rhode Island. sumers—is too expensive, but the $1.2 to cover—free of charge—preventive Soaring health care costs are hurting trillion prescription drug bill they passed—which was financed through care for new policyholders. family budgets, small businesses, and Beginning next year, in 2011, small the national economy. In 1980, Ameri- deficit spending and amounted, in many respects, to a giveaway to drug businesses will be eligible for a tax cans spent $253 billion on medical bills. credit to purchase insurance for em- Today, we are paying $2.5 trillion on companies—was somehow good policy? How can they rail against health care ployees. medical bills. That pressure is pushing reform right after overseeing the larg- Then, in 2014, after allowing the Medicare toward collapse and 750,000 est expansion of our government in States a time to design and develop Americans into bankruptcy each year. decades? How will they change their and prepare themselves, our bill will This legislation will help contain approach when, through hard work, we extend affordable coverage to over 30 health costs, extend insurance to mil- do, in fact, extend coverage and reduce million uninsured Americans through a lions, and give health consumers more cost and begin to deal with the deficit new health insurance exchange which protection against discriminatory in- that has to be dealt with in the years promises to expand choice, increase surance practices. By shifting the bal- ahead? competition, and rein in cost. ance of power from insurance compa- Health insurance reform hasn’t al- Rhode Islanders without a job will be nies to consumers, we will make health ways been this partisan. Indeed, many able to purchase insurance on a newly care more affordable for individuals Republicans have said they support a established and government-regulated and businesses and provide families great deal of what is in this bill but, health insurance market. Many will re- with greater health care access and for whatever reason, they refuse to ceive Federal support for the purchase stability. support it. Indeed, by my count, this of coverage. This bill is fiscally responsible. It is bill increases competition, which Re- Rhode Islanders employed by a com- fully paid for. We trimmed wasteful publicans said they wanted. Indeed, by pany that does not provide insurance— programmatic spending and imposed my count, this bill lowers cost, which or inadequate insurance—will be able new fees on drugmakers, reined in enti- Republicans said they wanted. Indeed, to purchase insurance on this new mar- tlement spending, and imposed taxes by my count, this bill does not contain ket exchange. on things such as tanning beds, which a public option. I regret that, but that Small business owners will be able to lead to health care costs. But we also is the position I think most of the Re- easily compare the cost of insurance provided every American family with publicans—not all—supported. And, in- coverage offered by a multitude of greater health care stability and ex- deed, this bill provides Americans with plans through a new health insurance tended affordable health insurance to tax credits to purchase insurance, exchange, and it will allow small busi- 30 million more of our fellow citizens. which Republicans said they wanted. ness owners to pick the coverage that The nonpartisan, independent Con- So the bill we will pass seeks to tear fits the needs and budget of their em- gressional Budget Office—the CBO—es- down the inefficiencies in the current ployees. timates this bill will reduce the deficit system, curb the cost, and reduce the Rhode Islanders on Medicare will no by $132 billion over the next decade and waste and abuse Rhode Islanders and longer have to pay out of pocket for $1.2 trillion over the following 10 years. Americans experience every day. important preventive services and no We need urgent action. The delay It is our responsibility to enact longer spend portions of the year in the tactics and the procedural obstacles meaningful health reform. Just saying so-called doughnut hole without paid employed by the other side are hurting no may be a powerful political weapon, drug coverage. our fellow citizens. Every day, 14,000 but this country is built on hope and a Low-income adults, without children, more Americans lose their health cov- better future, not fear. will have access to Medicaid, which

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00033 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13746 CONGRESSIONAL RECORD — SENATE December 22, 2009 will provide them with insurance at businesses. Every year, these business to drive down costs, as more people reasonable costs. owners face increasing premiums of 15 shop effectively for health care insur- Having access to health insurance is to 20 percent. They do not have much ance. important. Individuals, employers, em- choice. Two companies control 80 per- Third, there will be lower adminis- ployees, and families will have access cent of the market in Rhode Island, trative overhead and greater sim- to new insurance options after reform, and you either accept what is offered plification of insurance as a result of which is important. However, afford- or you go without insurance. Every this legislation. ability—the amount a family has to year, they see double-digit increases. Under the proposal we are consid- pay—is also critically important. Again, this is not sustainable, not only ering, premiums for small businesses We have examples of States that over the long term but over the next will stop the never-ending trend of in- have already enacted insurance reform several years. crease after increase and will begin to that covers their entire population, Starting a business and finding the come down. Making health insurance and what we found is, premiums have right personnel is a challenging and ex- more affordable for small business gone down significantly since this re- pensive proposition. Innovation and en- owners will help them by defraying form was enacted. We have learned a trepreneurship is risky. Often startup their startup costs and ensuring indi- lot from their efforts, and Federal re- companies have difficulty hiring quali- viduals can seek employment regard- form will improve upon those efforts fied individuals because the business less of the benefit options. It will foster innovation and put for the rest of the country. owners can’t face these increasing companies in a situation where they As I suggested before, the average costs of health insurance. In Rhode Is- have an edge over foreign competitors premium for a Rhode Island family is land, these kinds of pressures have led and can win in the global marketplace. $12,700. If we don’t do something, ex- to the loss of employer-sponsored American companies today are com- perts predict this premium will double health care or reduction in premium peting against nations around the in just 6 or 7 years. Rhode Islanders assistance from employers. globe that either have a national sys- will be looking at health insurance What has happened over the last sev- tem, which does not directly affect bills—just the bills of annual pre- eral years is, real wages have been flat their balance sheet in terms of health miums—of over $25,000. Again, that is because health care has been taking all insurance costs, or they have no health not sustainable. It will literally bank- the extra money that in other times insurance at all, and as a result, that is rupt the families of Rhode Island, and would have gone to increased wages. As not on the balance sheet of these com- they will make a very difficult choice: a result, if you are a middle-income panies. Every one of our businesses is, paying this much money—which for American and you look around through in some way or another, competing many, if not most, is extraordinarily all the struggle and all the work you against other countries that heavily difficult—or not having insurance or are doing and you have this sense that subsidize their insurance, that provide doing other things, such as limiting you haven’t made a lot of real progress an advantage, a competitive advan- the access their children have for colin terms of additional wealth or addi- tage. We want to in some small way di- lege or not saving for their retirement. tional money put aside, it is no won- minish—in fact, in a large way at least We can change that today by moving der. You have been paying the indirect begin to diminish that advantage. forward with this legislation. costs of an ineffective, inefficient While there have been many ill- The Congressional Budget Office has health care system. The money is founded claims about the reform pack- also analyzed the effect of this bill on going into health care. The money is age, the simple fact is that the tax the premiums that Rhode Islanders going into—in many respects—health credits provided in this bill is the larg- pay, and they expect premiums to de- care that is not efficient or effective est health tax credit bill that has ever crease anywhere from 14 to 20 percent. and it is not going into the paycheck of been considered in Congress. Over $400 CBO found these decreases will result working Americans. billion in tax credits will be provided from an influx of enrollees with below- The reforms set forth in the Patient to Americans in order to increase af- average spending for health care. Protection and Affordable Care Act fordability. One of the problems we have in the will strengthen the employer-sponsored Since health insurance reform will health care system today is, healthy, health insurance market. There has provide Rhode Islanders access to af- young people—unless they are offered been some suggestion that this is going fordable health coverage, our providers health insurance through their em- to create no opportunities or options should no longer face the financial ployer—don’t typically purchase it. for employers to continue to provide pressure from uncompensated care. They are the classic free riders. If they health insurance for their workers. Hospitals will care for patients with in- get hurt in an accident, they will go to But, according to the CBO, 83 percent surance, and doctors will be able to the emergency room and be treated for of the privately insured Americans will prescribe preventive measures to pa- free. They will not have paid into the be insured through their employers. tients so they do not become ill. system that cares for them. The whole That is a dramatic change, nearly dou- Today, it is estimated that of all the principle of insurance is spreading risk ble the total of Americans insured private insurance premiums we pay in across the largest population to reduce through their employer today. Rhode Island, at least $1,000 dollars of cost. That is precisely what we are What we are going to see is not a de- those premiums is to pay for uncom- doing. This is fundamental to any increase in employer insurance but an in- pensated care in our hospitals, in our surance program. crease. I think this is something that clinics throughout the State. When we So this approach will actually lower will match the best aspects of our have a significant number—95, 94-plus the cost, as the CBO has reported. Ad- economy—individual business men and percent—of Rhode Islanders covered, ditionally, the bill will provide perma- women making judgments about what those uncompensated costs won’t be nent tax credits for Rhode Islanders to plan is best for them and providing uncompensated. There will be an insur- purchase insurance. that benefit in a cost-effective way to ance program behind these individuals, Depending on income, individual their employees. It will occur because so they can seek preventive care and Rhode Islanders can expect a $500 to of a few simple changes: they can pay for emergency care and $3,000 break on their insurance costs First, as I mentioned, small business pay for regular care. because of these tax credits. Rhode Is- owners will actually receive a tax cred- Each one of the hospitals in my state land families can expect to save much it to purchase insurance for employees, is contributing in our efforts to insure more—$1,400 to $8,500—on their insur- should they choose, beginning next more Americans and doing so with the ance through these credits. Everyone year, 2011. I will repeat, small busi- knowledge that they can potentially should recognize the insurance reforms nesses will get a tax credit, a tax break benefit from the fact that people will in this bill will mean people will get which they are not getting now, to help not be showing up in their emergency better coverage at lower costs. provide insurance for their workers. rooms without insurance but will bring The bill also mitigates the costs fac- Second, individuals will have the op- their insurance card, and the support ing small businesses, which in my tion of finding affordable insurance on their card ensures, to the emergency State accounts for 95 percent of all their own with increased competition room.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00034 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13747 In addition, the safety net providers cause they profit very handsomely The PRESIDING OFFICER. Without throughout the country, our commu- from Medicare Advantage. They spent objection, it is so ordered. nity health centers, will find great sup- months telling seniors health reform (The remarks of Mr. KIRK are printed port in this legislation. will take away their coverage. These in today’s RECORD under ‘‘Morning There will be direct improvements claims are inaccurate. Business.’’) for physicians in Rhode Island. The We will eliminate excessive overpay- Mr. REID. Mr. President, I suggest looming 21 percent Medicare payment ments to private insurance companies. the absence of a quorum. reduction will be eliminated, as it is In my State, Medicare Advantage plans The PRESIDING OFFICER (Mr. impending. We will continue to look are paid over 20 percent more per bene- UDALL of Colorado). The clerk will call for permanent solutions, not only to ficiary than traditional Medicare fee- the roll. this issue of Medicare payments but for-service. This overpayment is par- The legislative clerk proceeded to also a payment formula used to pay ticularly astounding given the fact call the roll. Mr. REID. Mr. President, I ask unan- doctors in a more equitable and more that the Government Accountability imous consent that the order for the appropriate way. Office found that 19 percent of Medi- I am also pleased that we have taken quorum call be rescinded. care Advantage beneficiaries pay more The PRESIDING OFFICER. Without steps to improve and enhance training than traditional Medicare for home objection, it is so ordered. of a new generation of primary care health care and 16 percent pay more for Mr. REID. Mr. President, I ask unan- physicians who will be necessary to fill inpatient services. Seniors should be imous consent that all postcloture the increased demand. These improve- angry and upset at insurance compa- time be considered expired on H.R. 3590 ments will help our overall efficiency. nies, that they continue to profit from at 8 a.m., Thursday, December 24, if This bill will also provide seniors the Medicare system while simulta- cloture is invoked, and that imme- with an improved Medicare Program. neously taking more money from sen- diately the bill, as amended, be read a Nearly one-fifth of my State is on iors’ pocketbooks as they charge extra third time, and the Senate vote on pas- Medicare; over 180,000 Rhode Islanders for these services. This was not the in- sage; that after passage of H.R. 3590, as rely on Medicare. Seniors have paid tent of the program. In fact, the intent amended, the Senate then proceed to into Medicare during their lifetime. of the program—the argument the in- the immediate consideration of Cal- They deserve a program that will pro- surance companies made is: Give us the endar No. 245, H.R. 4314, an act to per- vide comprehensive coverage at the flexibility to manage Medicare pa- mit continued financing of government lowest cost without risk of coverage tients, and we will lower costs. Very operations; that no amendments be in being terminated. However, that is not shortly after that, it became clear that order; that the bill be read a third the Medicare coverage Rhode Islanders they were not managing the costs that time, and the Senate then proceed to always receive today. Here is what well. vote on passage; that passage require Medicare does today. Medicare fre- Of course, the bill is going to target an affirmative 60-vote threshold; and if quently allows the same test for the waste, fraud, and abuse. For every $1 that threshold is achieved, then the same complaint to be performed mul- we spend in this effort—and you have motion to reconsider be considered tiple times. This costs money, but it to invest in this fraud detection—we made and laid upon the table; further, doesn’t necessarily improve patient expect to recover $17. that on Wednesday, January 20, 2010, at care. Medicare leaves over 31,000 Rhode Our efforts will improve health care a time to be determined by the major- Islanders without prescription drug of seniors and will stabilize Medicare. ity leader, following consultation with coverage for parts of the year. This Also, we should note that we will be the Republican leader, the Finance costs them money. And Medicare today doing significant amounts with respect Committee be discharged of H.J. Res. is on the path toward insolvency in to children. I particularly applaud Sen- 45, increasing the statutory limit on just 8 short years, which will affect ator BOB CASEY’s amendment to ensure the public debt and the Senate then every senior in Rhode Island. that Rhode Islanders on Rite Care will proceed to the measure; that imme- Instead of allowing Medicare to go not have to fear losing their safety net diately after the joint resolution is re- bankrupt, the comprehensive health re- coverage. ported, the majority leader or his des- form bill we are currently debating Finally, it is important to note, as I ignee be recognized to offer a sub- would extend Medicare solvency for at mentioned before, that these reforms stitute amendment and that the fol- least 5 additional years. Some predict are paid for. This is a stark contrast to lowing be the only first-degree amend- it will be extended for nearly a decade. others. We voted on the Medicare pre- ments in order to the joint resolution: This is important for seniors enrolled scription bill in 2003, which I opposed. Thune, TARP; Murkowski, endanger- in the program today and those who It was unpaid for, and it was more cost- ment EPA regs; Coburn, rescissions will soon enroll in the program. ly than the amendment which was package; Sessions, spending caps; Solvency is extended by reforming originally presented to us. McConnell, relevant to any on the list; the system. Seniors in my State will We voted on countless measures out- Reid, one relevant to any on the list; not have to make multiple trips to side the normal process of budgeting to Reid, pay-go; Baucus, three relevant to their doctors’ offices for the same test fund the wars in Iraq. We voted tax cut any on the list; Conrad-Gregg, fiscal for the same complaint because we will after tax cut for the wealthy, which task force; that each of the listed eliminate unnecessary duplication and has left my State not prosperous and amendments be subject to an affirma- tests and services. They will not fear wealthy but 13 percent of my State un- tive 60-vote threshold and that if any being readmitted to a hospital after employed and 15 percent of my neigh- achieve that threshold, then they be discharge because we will encourage bors are uninsured. agreed to and the motion to reconsider care coordination after discharge. And We are moving forward to reduce the be laid upon the table; that if they do they will not put off important preven- deficit with this bill, to provide valu- not achieve the 60-vote threshold, then tive care because the out-of-pocket able coverage, to ensure the promise of they be withdrawn; that upon disposi- costs are just too great because the health care in the United States is ful- tion of all amendments, the substitute cost-sharing component for preventive filled, not denied. amendment, as amended, if amended, care will be eliminated. I yield the floor. be agreed to, the joint resolution, as Many of my seniors are on the Medi- Mr. BAUCUS. Mr. President, pending amended, be read a third time and the care Advantage Program, which is a a potential unanimous consent request Senate then proceed to vote on pas- privatized version of traditional Medi- by the two leaders, I now yield such sage; further, that passage also be sub- care. Over 65,000 seniors in my State time as the Senator from Massachu- ject to an affirmative 60-vote thresh- have elected to enroll in this option, setts desires. old; further, as in executive session, I and there has been an effort to charac- The PRESIDING OFFICER. The Sen- ask unanimous consent that on terize the changes to this program as ator from Massachusetts is recognized. Wednesday, January 20, 2010, after a pe- undermining that program. The private Mr. KIRK. I ask unanimous consent riod of morning business, the Senate insurance companies have been saying to speak as in morning business, the proceed to executive session to con- that for over a month now. Why? Be- time to be counted postcloture. sider Calendar No. 421, the nomination

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00035 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13748 CONGRESSIONAL RECORD — SENATE December 22, 2009 of Beverly Martin to be a U.S. circuit Mr. CONRAD. Mr. President, I wish It does not stop there. Premiums, as judge for the Eleventh Circuit; that to begin by recognizing the work on I have indicated, are skyrocketing, and there be 60 minutes of debate with re- this legislation of Leader REID, Chair- national health care costs are sky- spect to the nomination, with the time man BAUCUS, Chairman HARKIN, and rocketing right along with them. With- equally divided and controlled between Chairman DODD. out action, total health care spending Senators LEAHY and SESSIONS or their I believe, when the history of this bill will equal 38 percent of the gross do- designees; that upon the use or yield- is written, it will be recognized what a mestic product of the country by 2050. ing back of time, the Senate then pro- remarkable job of leadership Senator Thirty-eight percent of the gross do- ceed to vote on confirmation of the REID has provided, bringing together a mestic product for health care? That nomination; that upon confirmation, disparate caucus around extraor- would be one in every two and half dol- the motion to reconsider be considered dinarily complex issues to accomplish lars in this economy. Already, we are made and laid upon the table, no fur- something that will be seen in the fu- consuming one in every six in this ther motions be in order, the President ture as a leap forward for America in economy on health care, and that is an be immediately notified of the Senate’s reforming the health care system in unsustainable course. These costs are action, and the Senate then resume this country. driving our long-term fiscal imbal- legislative session. Chairman BAUCUS—no one has made ances, threatening our future economic The PRESIDING OFFICER. Is there a deeper, more committed, personal prosperity. objection? sacrifice than Senator BAUCUS in ad- Without action, Federal spending on The Republican leader is recognized. vancing this legislation. His commit- Medicare and Medicaid will reach 12.7 Mr. MCCONNELL. Mr. President, re- ment to getting this bill done and get- percent of GDP by 2050. This chart I serving the right to object, and I will ting it done right will stand the test of have in the Chamber makes it very not be objecting, I wish to make sure history. clear. In 1980, the two programs were the Senate is aware of an under- Chairman HARKIN, who succeeded consuming 2 percent of gross domestic standing the majority leader and I Chairman Kennedy, made major con- product, but on the current trend line, have that the substitute amendment tributions on the wellness provisions. by 2050, these two—Medicare and Med- referred to in paragraph 1 will be lim- Chairman DODD, who filled in for icaid—will consume more than 12 per- ited to an actual amount when it is of- Chairman Kennedy and continued in cent of our GDP—one in every eight fered. the role of handling this legislation, dollars in our economy. Mr. REID. That is right. And if there even while being chairman of the The growth in health care costs are any amendments here that pass, of Banking Committee, provided an ex- threatens to bankrupt Medicare. Medi- course, they would automatically be ample of legislative leadership that is care went cash negative last year. part of it. unmatched. Without action, Medicare will be bank- The PRESIDING OFFICER. The Sen- The four of them have done a superb rupt in 2017. The trustees have just told ator from Montana. job in putting together the pieces of us that will happen. That is 2 years Mr. BAUCUS. Mr. President, reserv- the bill that I believe will lead the way earlier than forecast just last year. ing the right to object, I wish to in- to a dramatically improved health care Again, Medicare went cash negative al- quire whether, under that consent re- system in our country. ready. That means more money is quest that is being propounded, sec- If we reflect, objectively, on the going out than is coming in, in the ondary amendments would be in order package before us, it is an entirely rea- Medicare accounts, and it will be insol- to any of the first-degree amendments sonable and responsible approach. vent—broke—in 8 years. This legisla- on that list. There is no government takeover of tion extends its life by 9 years. Mr. REID. No. health care, no rationing, no cuts to These health care costs are hurting Mr. BAUCUS. I do not object. guaranteed Medicare benefits, no bene- our competitive position in the world. The PRESIDING OFFICER. Hearing fits for illegal immigrants, and the bill We are spending far more than other no objection, without objection, it is so sets a goal of no taxpayer funding for countries on health care, leaving less ordered. abortion beyond the Hyde amendment money for research and development, The Republican leader is recognized. provisions in current law. investment, and higher wages for THANKING SENATE PAGES MARTIN CHARBONEAU In fact, this bill does much of what Americans. In fact, as a percentage of AND MIKHAILA FOGEL Republicans said they want in a health our gross domestic product, we spend Mr. MCCONNELL. Mr. President, I care plan. It is fully paid for, and it re- twice as much as most other advanced wish to recognize two young pages who duces deficits in both the short and the countries. are actually on the floor with us today. long term. It expands coverage and pro- Here it is, as shown on this chart. We Martin Charboneau and Mikhaila Fogel vides assistance to help families and are now even higher than 16 percent of are the pages who energetically volun- small businesses afford health insur- our GDP. The latest numbers indicate teered to stay until the Senate ad- ance. It sets new rules to stop insur- we have gone to 17 percent of our GDP journs and actually have sacrificed ance company abuses. It reforms the for health care. That is one in every six some of their Christmas vacation. Also, delivery system to control costs and dollars. Look at other countries. Japan they both volunteered their service improve quality. It allows for the sale and the United Kingdom are half as over the weekend before the Thanks- of insurance across State lines. It sup- much; Belgium, Germany, Switzerland, giving break. ports medical malpractice reforms. France, a little over half as much as we We typically have seven pages at a Those are facts. Every one of those are paying. time on each of the sides, the Demo- elements is in this bill. This is an ap- But even with the fact that we are cratic side and the Republican side, but proach that Senators on both sides of spending more, we are actually per- both Martin and Mikhaila marvelously the aisle, who want solutions rather forming worse on virtually every met- have worked hard and dutifully, on than slogans, should embrace. ric on health care outcomes. We are both sides of the floor—both the Demo- The need to act is clear. The status ranked 19th in preventable deaths, 22nd cratic side and the Republican side—to quo is simply unsustainable. Health in infant mortality, 24th in life expect- make a 14-person job work with just care costs are crushing families, busi- ancy; and we still leave 46 million peo- two people. nesses, and even the government. The ple without insurance. One can imagine how hard a task it premiums for individuals and families Continuing the status quo is not an must be for just two individuals to pre- are rising three times as fast as wages. option. America can do better, and this pare for the numerous speeches we You can see where we are headed. It is bill proves it. The bill before us is fis- have had over the course of the past as clear as it can be. cally responsible. The nonpartisan Con- week. I know Senator REID joins me in Without action, families will see av- gressional Budget Office—the official thanking them for their gracious and erage health care premiums rise to scorekeeper, relied on by both sides of impeccable service to the Senate. $22,000 a family by 2019—$22,000, on av- the aisle—tells us the bill reduces the The PRESIDING OFFICER. The Sen- erage, for family health care premiums deficit by $130 billion over the first 10 ator from North Dakota is recognized. in 2019, unless we act. years.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00036 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13749 Now, those aren’t my numbers, those sales across State lines to further in- proposal to have nearly $500 billion in aren’t the numbers of the chairman of crease competition. savings under Medicare, and we didn’t the Finance Committee, those aren’t The managers’ amendment also cre- hear one peep from the other side, not the Democratic leader’s numbers. ates a new national plan. The Office of one. In fact, they all said it was criti- Those are the numbers of the non- Personnel Management, the same agen- cally important to do. Now all of a sud- partisan Congressional Budget Office. cy that currently oversees health plans den it is the death of Medicare. They say this bill will reduce the def- for all Federal employees, including What is even more bizarre about icit by $130 billion over the first 10 Members of Congress, would select pri- their argument is that now there is an years. vate health insurance carriers to offer offset for the savings from Medicare The savings in the following decade plans that would be available nation- providers. The offset is they are going are even more impressive: between $650 wide. These plans would provide new to get 30 million new customers, 30 mil- billion and $1.3 trillion. The Congres- competition for State-based health lion Americans who haven’t had insur- sional Budget Office says: plans, particularly in areas where just ance who will now have it so their un- All told, CBO expects that the legislation, one or two insurers currently dominate compensated care costs will go down, if enacted, would reduce Federal budget defi- the market. At least one multistate making it more affordable for pro- cits over the decade after 2019 relative to plan would have to be a not-for-profit viders to provide these savings. those projected under current law—with a insurer, such as one of the newly cre- Most of these savings have been ne- total effect during that decade that is in a ated co-ops. I am particularly excited gotiated with providers. Why have they broad range between one-quarter percent and by this development. been willing to agree to savings—hos- one-half percent of gross domestic product. When we look around the world at pitals, nursing homes, and home health One-quarter and one-half percent of the countries with the best outcomes care? It is because they know they are GDP for that second 10 years is $650 bil- and the lowest cost, one feature stands going to get substantially expanded lion to $1.3 trillion. Shame on those out: these countries rely on primarily business—30 million customers with in- who get up on the other side and say not-for-profit insurance. Germany, surance who previously did not. this is going to increase the deficit. France, Switzerland, Belgium, Japan, This is important legislation. These Where is their evidence, other than all have adopted this model. They don’t Medicare reforms don’t hurt seniors. claims, other than assertions? We are have government-run health care, but Some on the other side have said you talking about the considered judgment they do have universal coverage. They can’t reduce the growth in Medicare of the Congressional Budget Office that do have extremely high-quality health costs without taking benefits away is nonpartisan and is the official score- care outcomes and much lower costs from seniors. That is just scare tactics. keeper for the Congress of the United than we do. So I believe the not-for- The Medicare savings provisions lower States. profit national plans and the co-op op- cost growth without harming bene- The bill bends the cost curve for the tion may, in the long run, play a key ficiaries. Federal commitment to health care in role in transforming our system into a This legislation also helps my State. the long term. In its December 19 esti- more efficient, higher quality system. I am proud to say it. Some have said mate, CBO reports that the proposal This legislation also expands cov- the Medicare changes will hurt North would generate a reduction in the Fed- erage. According to the Congressional Dakota providers. Clearly, they eral budgetary commitment to health Budget Office, it covers 94 percent of haven’t read the bill. Right now, we get care during the decade following the 10- the American people. It creates State- paid way below the average for Medi- year budget window. So, yes, it bends based exchanges for individuals and care reimbursement. In fact, we are the the cost curve for the Federal expendi- small businesses. It provides $476 bil- second or third lowest State in the ture during that period. lion in tax credits to help working country in Medicare reimbursement. This legislation also reforms the in- Americans and small businesses buy North Dakota providers get $5,000 a surance market. We have all heard the coverage. You don’t hear that much year per Medicare beneficiary. horror stories. I have loads of letters in from the other side about this $467 bil- In Miami, they get three times as my office from constituents telling me lion of tax assistance for people to af- much, more than $16,000 a year to take about what has happened to them: ford better health care coverage. It care of seniors there. Now I would be being dropped because they got sick, also reforms the delivery system to the first to say it may cost more to even after paying years of premiums; focus on quality and not quantity. The provide medicine in Miami than it does being denied coverage because of pre- bill before us slows cost growth while in Minot, but it doesn’t cost three existing conditions, in many cases pre- improving quality. The sad fact is that times as much. The fact is, moving to existing conditions that had nothing to 30 percent of current health care spend- a system that is based on outcomes do with the illness for which they now ing does nothing to improve health rather than procedures will benefit, not need assistance; and being denied even care outcomes. We are wasting about hurt, a State such as North Dakota. though they have paid the premiums. $750 billion a year on unnecessary and In addition, this legislation includes This is serious business. counterproductive procedures. Again, the frontier States provision that Sen- This bill puts a stop to these abuses. that is not a congressional estimate; ator DORGAN and I offered as an amend- It prohibits insurers from denying cov- that comes from a Dartmouth nation- ment. Our provision puts a floor under erage for preexisting conditions on new wide survey that concluded 30 percent payments to North Dakota providers policies. It prohibits insurers from re- of health care expenditure in this coun- and in other States like ours that are scinding coverage when people become try is wasted. This bill reforms the de- rural States that have not received fair sick after they have paid premiums for livery system in a fundamental way. It levels of reimbursement. It will mean years on new plans. It bans insurers contains every delivery system reform an additional $66 million a year in from lifetime caps and annual limits health care experts believe is needed to Medicare payments to my State. on health care benefits, and it prevents provide better care while slowing cost Overall, this bill is a win for North insurers from charging more based on growth. Dakota, a win for the Nation. It re- health status. This proposal also extends the sol- duces the deficit, it controls costs, it It also expands choice and competi- vency of Medicare. Medicare’s actuary saves Medicare—or at least extends its tion. The bill before us builds on our says the Senate bill extends the life of life for at least 9 years—it embraces current market-based system and Medicare by 9 years. Some on the other choice for American consumers and makes it better. It is not government- side say that because Medicare is head- competition and expands coverage. It run health care. Instead, it embraces ing toward insolvency, we can’t have reforms the insurance industry, and it choice and competition. It sets up a Medicare savings. What? What are they rewards quality and efficiency. new health exchange where consumers talking about? This legislation is an excellent start. can shop for the best value. It creates Perhaps the oddest thing I have seen I urge my colleagues to allow it to con- consumer-run, co-op health plans not in this debate is the contrast with the tinue because we all know this isn’t government-run plans but plans run by last year of the Bush administration. the last step. Next we go to the con- the members. It allows for insurance The previous administration sent up a ference committee where we will have

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00037 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13750 CONGRESSIONAL RECORD — SENATE December 22, 2009 a chance to write the final legislation. has been created by the skyrocketing Katerina’s, more choices. That means No doubt this bill will be further im- premiums and unlocking the potential instead of just having one choice when proved as it has been at every step of for new health care careers. It is about she is laid off, which was to purchase the process. supporting the doctors and the nurses, high-priced COBRA, Katerina will be Again, let me conclude as I began by the hospitals and the clinics that work able to compare the price and perform- thanking the leadership who has made every day to take care of you. It is ance of plans and make a decision for this bill a possibility: Senator REID, about helping you or your father or her family with the benefit of true op- who has done a remarkable job of your mother, your grandfather or your tions. bringing people together; Senator BAU- grandmother, by increasing benefits, That will increase stability and keep CUS, who has spent more than a year cutting waste, and strengthening the insurance companies accountable. and a half in as dedicated an effort as Medicare on which you depend. And it Never again will insurance companies I have ever seen by a committee chair- is about Katerina. be able to drop a family’s plan simply man in this body to bring major legis- Katerina is a woman from Redmond, because somebody got sick. No longer lation to conclusion; Senator DODD, WA, and she is one of my more than will losing your job mean losing access who filled in for Senator Kennedy on a 10,000 constituents from my home to affordable coverage, and no longer pinch hit basis but worked so hard to State who have sent me their stories will people such as Katerina have to produce a result in that committee; about their experiences with our bro- choose between food, clothing, and and Senator HARKIN, the new chairman ken health care system. Katerina is a health care for herself and her child. of the committee, for all of his assist- single mom. She has a good education, It will also keep families secure by ance in getting the job done. she told me, and she has a good job and ensuring that all insurance plans offer When the history of this legislation a solid middle-class lifestyle. But like an adequate level of coverage, includ- is written, those four will be recognized a lot of Americans this year, struggling ing free preventive care that will keep as producing something that was criti- in the toughest economy since the them healthy and ensure that minor, cally important for this country. We Great Depression, she was laid off from inexpensive medical issues can be should salute them. her job, and she lost her employer-pro- treated before they become major, ex- I thank the Chair and yield the floor. vided health care. She was able to pensive medical problems. Mr. BAUCUS. Mr. President, I very scrape enough money together to pay Our plan will increase options, en- much thank my good friend from North for COBRA coverage, but she told me hance security and stability, and it Dakota for his generous statements. As she didn’t dare go to the doctor be- will reduce costs for people such as he knows, this is all teamwork. We are cause she knew she wouldn’t be able to Katerina by providing credits and pre- all in this together, all Senators, espe- afford the copays. So though she was mium assistance. So families will no cially on this side of the aisle, with the technically covered right now, in prac- longer have to worry about their cov- President, to get health care reform fi- tice, neither she nor her child have ac- erage if they lose a job, switch jobs, nally passed for all Americans. Teddy cess to true health care or preventive move, or get sick. Roosevelt started this many years ago, services. She found that living that Mr. President, that is what this plan and many Presidents since have been way had some real consequences. is about. It is about Katerina, it is unable to get health care reform Last month she told me she got an about her child, and it is about the mil- passed. I think finally this time we are eye infection and eventually had to go lions of Americans in similar situa- going to do it, and it is a moment of to the doctor for treatment. She said tions. which we are all very proud. after all of her out-of-pocket costs and If the status quo wins out, things will Mr. President, I yield the remainder still with no job and no income, she only get worse. If some of my col- of my time to the Senator from Wash- had to make some very serious and leagues continue to play politics with ington. I don’t know how much that is, very tough choices about her family’s this issue, Katerina will continue to but whatever it is, it is all hers. food and clothing budget. Who knows struggle. The PRESIDING OFFICER. The Sen- what would have happened if Katerina If we continue to have delay and dis- ator from Montana has 71⁄2 minutes re- or her child got seriously ill. traction and obstruction, families will maining. Our broken health insurance system pay more for less, they will lose cov- The Senator from Washington is rec- is failing Katerina, and she is not erage, and they will be denied treat- ognized. alone. Millions of people have lost jobs ment and continue to have to fight in- Mrs. MURRAY. Mr. President, I in this current recession. surance company redtape to get the thank my colleague from Montana, the Millions of families have been tossed care they deserve. chairman of the Finance Committee, out of their employers’ plans—families That is what this is all about. I am who, I remember, months ago, with a who had health care, who felt secure, going to continue to stand up and tell smile on his face, said we can get this all of a sudden understand how broken the stories of families and small busi- done. We are on the verge, and we owe the system really is and how few op- ness owners from Washington because him a huge debt of gratitude. So I tions they actually have today for af- they are counting on us to fix this bro- thank the Senator very much. fordable care. That is why we need ken system. I urge my colleagues to As this debate now moves forward, it health insurance reform for Katerina focus on their States’ families and join has become apparent that some of our and millions of Americans in similar with us to pass true health insurance colleagues are losing sight of what we situations and the hundreds of millions reform. are working on. What should be a ro- of Americans who may switch jobs or Before I yield, I want to take this op- bust debate about a critical issue that move or start small businesses or who portunity to make an additional point. is facing all of our families and busi- just want more options for high-qual- As everybody knows, we have been nesses is being bogged down by distrac- ity affordable health care. working incredibly demanding sched- tions and political gimmicks and ob- Mr. President, let me talk for a ules in recent weeks. Senators have structions and a lot of delay while minute about how this bill will specifi- seen this floor at every conceivable American families watch and wait and cally help Katerina and many others. hour—late at night, early in the morn- wonder where they exactly fit into this Our plan sets up a market where people ing, in the face of a blizzard. Far too conversation. So I want to be clear can shop for and purchase insurance, frequently, we forget that every time with my colleagues and with Ameri- where insurance companies would have we are here, there are literally hun- cans across the country today: This to compete for your business, and dreds of staff forced to be here along bill is about you. It is about your loved where people such as Katerina would be with us. In fact, they are often here ones. It is about the people just like able to choose a plan that fits her fam- long before we arrive and long after we you across the country to bring down ily best from among a range of options leave. This body could not function your premiums, expand your options, in an open marketplace. without the tireless dedication of these and increase your stability. It would inject competition into the men and women. It is about helping our economy and insurance market, it will lower costs, Many of them are here now: the creating jobs by reducing the drag that and it will give families, such as clerks, Parliamentarians, cloakroom

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00038 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13751 staff, doorkeepers, Capitol Police offi- There being no objection, the mate- established by our courts, by prior acts cers, and the maintenance workers. rial was ordered to be printed in the of Congress and by the history of They work very long hours, nights, RECORD, as follows: American democracy. The legislative mornings, and weekends—with no re- history of this important measure gard to a government closure, dan- CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL should leave no doubt with respect to gerous snowstorms, or the need to com- YEAR 2010—S. CON. RES. 13; FURTHER REVISIONS TO the constitutionality of our actions. plete their holiday shopping. If we are THE CONFERENCE AGREEMENT PURSUANT TO SECTION The Constitution of the United here, they are here. They deserve our 301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANS- States begins with a preamble that sets thanks. FORM AND MODERNIZE AMERICA’S HEALTH CARE SYS- forth the purposes for which ‘‘We the I want to express my gratitude to TEM People of the United States’’ ordained every one of them and to my own staff [In billions of dollars] and established it. Among the six pur- as well. It hasn’t been an easy time. poses set forth by the Founders was Section 101 that the Constitution was established You should all know we are deeply ap- (1)(A) Federal Revenues: preciative of your service. FY 2009 ...... 1,532.579 to ‘‘promote the general Welfare.’’ It is I, for one, am strongly supportive of FY 2010 ...... 1,614.258 hard to imagine an issue more funda- FY 2011 ...... 1,936.811 mental to the general welfare of all bringing this debate to a close so that FY 2012 ...... 2,140.785 each one of you can be home with your FY 2013 ...... 2,321.087 Americans than their health. families enjoying some well-deserved FY 2014 ...... 2,563.018 The authority and responsibility for time off for the holidays. (1)(B) Change in Federal Revenues: taking actions to further this purpose FY 2009 ...... 0.008 is vested in Congress by article I of the I yield the floor. FY 2010 ...... ¥51.728 FY 2011 ...... ¥151.820 Constitution. In particular article I, f FY 2012 ...... ¥219.608 section 8, sets forth several of the core FY 2013 ...... ¥194.250 powers of Congress, including the ‘‘gen- FURTHER CHANGES TO S. CON. FY 2014 ...... ¥70.640 eral welfare clause,’’ the ‘‘commerce RES. 13 PURSUANT (2) New Budget Authority: FY 2009 ...... 3,675.736 clause’’ and the ‘‘necessary and proper Mr. CONRAD. Mr. President, section FY 2010 ...... 2,905.487 clause.’’ These clauses form the basis 301(a) of S. Con. Res. 13, the 2010 budget FY 2011 ...... 2,845.236 for Congress’s power, and include au- FY 2012 ...... 2,835.568 resolution, permits the chairman of the FY 2013 ...... 2,988.308 thority to reform health care by con- Senate Budget Committee to adjust FY 2014 ...... 3,206.647 taining spiraling costs and ensuring its the allocations of a committee or com- (3) Budget Outlays: availability for all Americans. The nec- mittees, aggregates, and other appro- FY 2009 ...... 3,358.952 FY 2010 ...... 3,017.021 essary and proper clause of the Con- priate levels and limits in the resolu- FY 2011 ...... 2,965.551 stitution provides that ‘‘The Congress tion, and make adjustments to the pay- FY 2012 ...... 2,867.235 shall have Power . . . To make all Laws as-you-go scorecard, for legislation FY 2013 ...... 2,993.112 which shall be necessary and proper for FY 2014 ...... 3,184.357 that is deficit-neutral over 11 years, re- carrying into Execution the foregoing duces excess cost growth in health care Powers, and all other Powers vested by spending, is fiscally responsible over CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL this Constitution in the Government of the long term, and fulfills at least one YEAR 2010—S. CON. RES. 13; FURTHER REVISIONS TO the United States or in any Depart- of eight other conditions listed in the THE CONFERENCE AGREEMENT PURSUANT TO SECTION ment or Officer thereof.’’ reserve fund. 301(a) DEFICIT-NEUTRAL RESERVE FUND TO TRANS- Any serious questions about congres- I have already made two adjustments FORM AND MODERNIZE AMERICA’S HEALTH CARE SYS- sional power to take comprehensive ac- pursuant to section 301(a). The first ad- TEM tion to build and secure the social safe- justment was on November 21, for S.A. [In millions of dollars] ty net have been settled over the past 2786, the Patient Protection and Af- century. According to article I, section Current Allocation to Senate Finance Committee: fordable Care Act, an amendment in FY 2009 Budget Authority ...... 1,178,757 8, ‘‘The Congress shall have Power To the nature of a substitute to H.R. 3590. FY 2009 Outlays ...... 1,166,970 lay and collect Taxes, Duties, Imposts The second adjustment was on Decem- FY 2010 Budget Authority ...... 1,249,836 and Excises, to pay the Debts and pro- ber 1, for S.A. 2791, an amendment to FY 2010 Outlays ...... 1,249,342 FY 2010–2014 Budget Authority ...... 6,824,817 vide for the common Defense and gen- S.A. 2786 to clarify provisions relating FY 2010–2014 Outlays ...... 6,818,925 eral Welfare of the United States.’’ to first dollar coverage for preventive Adjustments: This clause has been the basis for ac- services for women. FY 2009 Budget Authority ...... 0 tions by Congress to provide for Ameri- FY 2009 Outlays ...... 0 The Senate today adopted S.A. 3276, FY 2010 Budget Authority ...... ¥5,220 cans’ social and economic security by an amendment to S.A. 2786 to improve FY 2010 Outlays ...... ¥6,670 passing Social Security, Medicare and the bill. I find that in conjunction with FY 2010–2014 Budget Authority ...... 20,950 Medicaid. Those landmark laws provide S.A. 2786, as modified, that this amend- FY 2010–2014 Outlays ...... 3,720 Revised Allocation to Senate Finance Committee: the well-established foundation on ment also satisfies the conditions of FY 2009 Budget Authority ...... 1,178,757 which Congress builds today by seeking the deficit-neutral reserve fund to FY 2009 Outlays ...... 1,166,970 to provide all Americans with access to transform and modernize American’s FY 2010 Budget Authority ...... 1,244,616 quality, affordable health care. FY 2010 Outlays ...... 1,242,672 health care system. Therefore, pursu- FY 2010–2014 Budget Authority ...... 6,845,767 The Supreme Court settled the de- ant to section 301(a), I am further re- FY 2010–2014 Outlays ...... 6,822,645 bate on the constitutionality of Social vising the aggregates in the 2010 budget Security more than 70 years ago in resolution, as well as the allocation to Mr. LEAHY. Mr. President, the ur- three 1937 decisions. In one of those de- the Senate Finance Committee. Along gent need for comprehensive reform of cisions, Helvering v. Davis, Justice with those adjustments, I have also ad- our health care system has not stopped Cardozo wrote that the discretion to justed the aggregates and committee opponents from launching spurious at- determine whether a matter impacts allocation to reflect changes to the tacks. I understand that the junior the general welfare ‘‘is not confided in original score of S.A. 2786 as a result of Senator from Nevada recently raised a the courts’’ but falls ‘‘within the wide a provision included in H.R. 3326, the constitutional point of order against range of discretion permitted to the Department of Defense Appropriations the pending health care reform bill. As Congress.’’ Turning then to the ‘‘na- Act, 2010. That provision uses savings chairman of the Senate Judiciary Com- tion-wide calamity that began in 1929’’ also counted in the score of S.A. 2786. mittee, I would like to respond to those of unemployment spreading from State In total, as a result of Congress clear- who have called into question whether to State throughout the Nation, leaving H.R. 3326 on December 19, the Congress has the authority under the ing older Americans without jobs and amount of savings in S.A. 2786 is $1 bil- Constitution to enact health insurance security, Justice Cardozo wrote of the lion lower over the 2010–2014 period. reform legislation. The authority of Social Security Act: ‘‘The hope behind I ask unanimous consent to have Congress to act is well-established by this statute is to save men and women printed in the RECORD the following re- the text and the spirit of the Constitu- from the rigors of the poor house as visions to S. Con. Res. 13. tion, by the long-standing precedent well as from the haunting fear that

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00039 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13752 CONGRESSIONAL RECORD — SENATE December 22, 2009 such a lot awaits them when journey’s reform. We can debate whether to con- which are not prohibited, but con- end is near.’’ trol costs by having all Americans be sistent with the letter and spirit of the The Supreme Court reached its deci- covered by health insurance. In fact, Constitution, are constitutional.’’ sions upholding Social Security after we have been having that debate for In seeking to discredit health care re- the first Justice Roberts—Justice months and months in this Congress, form, the other side relies on a res- Owen Roberts—in the exercise of good through extensive public markups in urrection of long-discredited legal doc- judgment and judicial restraint began two committees in the Senate, as well trines used by courts a century ago to voting to uphold the key New Deal leg- as in the House of Representatives, and tie Congress’s hands by substituting islation. He was not alone. It was Chief now for weeks on the Senate floor. We their own views of property to strike Justice Hughes who wrote the Supreme have considered untold numbers of down laws such as those guaranteeing Court’s opinion in West Coast Hotel v. amendments in committees and several a minimum wage and outlawing child Parrish upholding minimum wage re- before the Senate. That is what Con- labor. They have to rely on such cases quirements as reasonable regulation. gress is supposed to do. We consider of unbridled conservative judicial ac- The Supreme Court also upheld a Fed- legislation, debate it, vote on it and tivism as Lochner v. New York, eral farm bankruptcy law, railroad act in our best collective judgment to Shechter Poultry Corporation v. labor legislation, a regulatory tax on promote the general welfare. Some United States, Reagan v. Farmers Loan firearms and the Wagner Act on labor Senators will agree and some will dis- and Trust and the infamous Dred Scott relations in National Labor Relations agree, but it is a matter for the full case. Those dark days are long gone Board v. Jones & Laughlin Steel Cor- Senate to decide. I wish we could do so and better left behind. The Constitu- poration. The Supreme Court aban- by a majority but Senate Republicans tion, Supreme Court precedent, our doned its judicially created veto over abhor majority rule now that they are history and congressional action all congressional action with which it dis- not in control. So it will take an ex- stand on the side of Congress’s author- agreed on policy grounds and rightfully traordinary majority for the Senate’s ity to enact health care legislation in- deferred to Congress’s constitutional will to be done. cluding health insurance reform. authority. Tomorrow, we will vote on a point of Under article I, section 8, Congress Congress has woven America’s social order challenging the pending bill’s has the power ‘‘to regulate Commerce safety net over the last three score and constitutionality. The fact that Senate with foreign Nations, and among the 12 years. Congress’s authority to use Republicans disagree with the major- several States.’’ Since at least the time its power and its judgment to promote ity’s effort to help hardworking Ameri- of the Great Depression and the New the general welfare cannot now be in cans obtain access to affordable health Deal, Congress has been understood doubt. America and all Americans are care does not make it unconstitu- and acknowledged by the Supreme the better for it. Growing old no longer tional. As Justice Cardozo wrote in up- Court to have power pursuant to the means growing poor. Being older or holding Social Security, ‘‘whether wis- commerce clause to regulate matters poor no longer means being without dom or unwisdom resides in the scheme with a substantial effect on interstate medical care. These developments are of benefits set forth . . . it is not for us commerce. The Supreme Court has all due to congressional action. to say. The answer to such inquiries long since upheld laws like the Fair These Supreme Court decisions and must come from Congress, not the Labor Standards Act against commerce the principles underlying them are not courts.’’ I agree. Justice Cardozo un- clause challenges, ruling that Congress in question. As dean Erwin derstood the separation of powers en- had the authority to outlaw child Chemerinsky of the University of Cali- shrined in the Constitution and the Su- labor. The days when women and chil- fornia Irvine School of Law wrote in a preme Court’s precedent. In 1803, our dren could not be protected, when the recent op-ed in The Los Angeles Times: greatest Chief Justice, John Marshall, public could not be protected from sick ‘‘Congress has broad power to tax and upheld the constitutionality of the Ju- chickens infecting them, when farmers spend for the general welfare. In the diciary Act in Stuart v. Laird noted could not be protected and when any last 70 years, no federal taxing or that ‘‘there are no words in the Con- regulation that did not guarantee prof- spending program has been declared to stitution to prohibit or restrain the ex- its to corporations are long past. The exceed the scope of Congress’ power. ercise of legislation power.’’ That is reach of Congress’s commerce clause The ability in particular of Congress to true here, where Congress is acting to authority has been long established tax people to spend money for health provide for the general welfare of all and well settled. coverage has been long established Americans. Even recent decisions by a Supreme with programs such as Medicare and I believe that Congress can and Court dominated by Republican-ap- Medicaid.’’ I will ask that this article should decide whether the problems of pointed justices have affirmed this rule be printed in the RECORD following my the lack of availability and afford- of law. In 2005, the Supreme Court remarks. ability of health care, and the rising ruled in Gonzales v. Raich that Con- The right-wing opponents of health health care costs that burden the gress had the power under the com- care reform are so intent on partisan American people, is a problem, ‘‘plain- merce clause to prohibit the use of warfare that they are even calling into ly national in area and dimensions,’’ as medical marijuana even though it was question the constitutionality of Justice Cardozo wrote of the wide- grown and consumed at home, because America’s established social safety net. spread crisis of unemployment and in- of its impact on the national market They would leave American workers security during the Great Depression. I for marijuana. Surely if that law without the protections their lifetime believe that it is right for this Con- passes constitutional muster, of hard work have earned them. They gress to determine that it is in the gen- Congress’s actions to regulate the would turn back the clock to the hard- eral welfare of the Nation to ensure health care market that makes up one- ships of the Great Depression, and that all Americans have access to af- sixth of the American economy meets thrust modern American back into the fordable quality health care. But the test of substantially affecting com- conditions of Dickens’ novels. That is whether other Senators agree or dis- merce. Conservatives cannot have it what some extremists will be urging agree with me, none should argue that both ways. They cannot ignore the set- another Justice Roberts—Chief Justice we should take steps that turn back to tled meaning of the Constitution as John Roberts—to do. That path should clock to the Great Depression when well as the authority of the American be rejected now, just as it was when an- conservative activist judges prevented people’s elected representatives in Con- other inspiring President led the effort Congress from exercising its powers to gress. to confront the economic challenges make that determination. As Chief The regulation of health insurance facing Americans. To strike down prin- Justice Marshall wrote in his landmark clearly meets the test from Raich, ciples that have been settled for nearly decision in McCulloch v. Maryland: whether the activities ‘‘taken in the three quarters of a century would be ‘‘Let the end be legitimate, let it be aggregate, substantially affect inter- wrong and damaging to the Nation. within the scope of the Constitution, state commerce.’’ Addressing these For months now, we have been debat- and all means which are appropriate, problems is at the core of Congress’s ing whether or not to pass health care which are plainly adopted to that end, powers under the commerce clause. In

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00040 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13753 fact, the Supreme Court expressly ad- ruptcy and disaster with every illness. Los Angeles Times op-ed to which I re- dressed this issue 65 years ago, ruling Americans who work hard their whole ferred. in 1944 that insurance was interstate life should not be robbed of their fam- There being no objection, the mate- commerce and subject to Federal regu- ily’s security because health care is too rial was ordered to be printed in the lation. Congress responded to this deci- expensive. During the New Deal we RECORD, as follows: sion in 1945 with the McCarran-Fer- charted a path for America where [From the Los Angeles Times, Oct. 6, 2009] guson Act, which gave insurance com- growing old did not mean being poor, THE CONSTITUTIONALITY OF HEALTHCARE panies an exemption from antitrust or being without health care. Ameri- (By Erwin Chemerinsky) laws unless Federal regulation was cans should not lose their life savings Are the healthcare bills pending in the made explicit under Federal law. It is because they have the misfortune of House and Senate unconstitutional? the immunity from Federal antitrust losing a job or getting sick. That is not That’s what some of the bills’ critics have law enacted in McCarran-Ferguson America. alleged. Their argument focuses on the fact that I have been working to overcome The success of the last century was that most of the major proposals would re- with my Health Insurance Industry the establishment of a social safety net quire all Americans to obtain healthcare coverage or pay a tax if they don’t. Those Antitrust Enforcement Act of 2009 and for which all Americans can be grateful too poor to afford insurance would have their the amendment I have sought to offer and proud. Through Social Security, health coverage provided by the state. to the current health insurance reform Medicare and Medicaid, Congress es- Although the desirability of this approach legislation. Why would this exemption tablished some of the cornerstones of can be debated, it unquestionably would be have been necessary if insurance was American security. They are within constitutional. not interstate commerce? I strongly the constitutional authority of the Those who claim otherwise make two argu- believe that the exemption in Congress just as health insurance re- ments. First, they say the requirement is beyond the scope of Congress’ powers. And sec- McCarran-Ferguson is wrongheaded form is. No conservative activist court ond, they say that people have a right to be but would anyone seriously contend should overstep the judiciary’s role by uninsured and that requiring them to buy that it is unconstitutional? Of course seeking to turn back the clock and health insurance violates individual liberty. not. That is why I am working so hard deny a century of progress. The author- Neither argument has the slightest merit to pass legislation to repeal it. ity of Congress is well settled and well from a constitutional perspective. The legislation and amendment I established by the Constitution, judi- Congress has broad power to tax and spend have sponsored will prohibit the most cial precedent, and our history of legis- for the general welfare. In the last 70 years, egregious anticompetitive conduct— no federal taxing or spending program has lation promoting the general welfare been declared to exceed the scope of Con- price fixing, bid rigging and market al- and protecting the economic security gress’ power. The ability in particular of locations—conduct that harms con- and health of Americans. Congress to tax people to spend money for sumers, raises health care costs, and The cumulative economic effects on health coverage has been long established for which there is no justification. Sub- the Nation of the rising costs of health with programs such as Medicare and Med- jecting health and medical malpractice care are significant, with those costs icaid. insurance providers to the Federal making up a large percentage of our Congress has every right to create either a antitrust laws will enable customers to economy and with American businesses broad new tax to pay for a national healthcare program or to impose a tax only feel confident that the price they are struggling to provide benefits to their on those who have no health insurance. being quoted is the product of a fair employees. As set forth in a paper by The reality is that virtually everyone will, marketplace. The lack of affordable Georgetown University and the O’Neill at some point, need medical care. And, if a health insurance plagues families Institute for National and Global person has certain kinds of communicable throughout our country, and my Health Law, the requirement for indi- diseases, the government will insist that he amendment would take a step toward viduals to purchase health insurance or she be treated whether they are insured or ensuring competition among health in- would address the problem of free rid- not. A tax on the uninsured is a way of pay- surers and medical malpractice insurers, millions of Americans who refuse ing for the costs of their likely future medical care. ers. The need for Congress to repeal the to buy health insurance and then rely Another basis for the power of Congress to out of date Federal antitrust law ex- on expensive emergency health care impose a health insurance mandate is that emption only further demonstrates the when faced with medical problems. the legislature is charged with regulating tremendous impact of health care on This shifts the costs of their health commerce among the states. The Supreme our economy and congressional power care to people who do have insurance, Court has held that this means Congress has to act. which in turn has a significant effect the ability to regulate activities that have a The third clause of article I, section on the costs of insurance premiums for substantial effect on interstate commerce. A 8, to which I have referred, is the nec- few years ago, for example, the court held covered Americans and on the economy that Congress could prohibit individuals essary and proper clause, as a basis for as a whole. A requirement that all from cultivating and possessing small congressional action. This clause gives Americans have health insurance—like amounts of marijuana for personal medicinal Congress the power ‘‘to make all Laws requirements to be vaccinated or to use because marijuana is bought and sold in which shall be necessary and proper for have car insurance or to register for interstate commerce. carrying into Execution the foregoing the draft or to pay taxes—is within The relationship between healthcare cov- Powers and all other Powers vested by congressional power if Congress deter- erage and the national economy is even this Constitution in the United clearer. In 2007, healthcare expenditures mines it to be essential to controlling amounted to $2.2 trillion, or $7,421 a person, States.’’ The Supreme Court settled spiraling health care costs. Requiring and accounted for 16.2% of the gross domes- the meaning of the necessary and prop- that all Americans have health insur- tic product. er clause 190 years ago in Justice Mar- ance coverage, and preventing some The claim that individuals have a constitu- shall landmark decision in McCullough from depending on expensive emer- tional ‘‘right’’ to not have health insurance v. Maryland, during the dispute over gency services in place of regular is no stronger than the objection that this the National Bank. Justice Marshall health care, can and will help reduce would exceed Congress’ powers. It is hard to wrote that ‘‘the clause is placed among even articulate the constitutional right that the cost of health insurance premiums would be violated by requiring individuals to the powers of Congress, not among the for those who already have insurance. have health insurance or pay a tax. limitations on those powers.’’ The nec- Whether Senators agree or not on the Since the 19th century, the Supreme Court essary and proper clause goes hand in necessity to reform our health care has consistently held that a tax cannot be hand with the commerce clause to en- system and health insurance, I trust challenged as an impermissible taking of pri- sure congressional authority to regu- that all Senators, Republican, Demo- vate property for public use without just late activity with a significant eco- cratic and Independent, agree that it is compensation. All taxes, of course, are a tak- nomic impact. our responsibility to act and within ing of private property for public use, and a We face a health care crisis, with Congress’s constitutional authority to tax to pay for health coverage—whether imposed on all Americans or just the unin- millions of Americans uninsured and legislate for the general welfare of all sured—is certainly something Congress could with uncertainty and high costs for Americans. impose. Americans who are insured. We need to Mr. President, I ask unanimous con- The claim that an insurance mandate ensure that Americans not risk bank- sent to have printed in the RECORD the would violate the due process clause is also

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00041 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13754 CONGRESSIONAL RECORD — SENATE December 22, 2009 specious. Most states have a requirement for court. New Hampshire regulators were will give the newly created insurance mandatory car insurance, and every chal- able to reduce a proposed 100 percent exchanges better information. lenge to such mandates has been rejected. rate increase to 12.5 percent. Under the amendment, the Secretary More important, since 1937, the Supreme But in other States, including Cali- of Health and Human Services, and the Court has constantly held that government regulations of property and the economy will fornia, insurance commissioners do not relevant insurance commissioner, will be upheld as long as they are reasonable. have this ability. recommend to exchanges whether a Virtually every economic regulation and tax And Some states have laws like this company should be permitted to par- has been found to meet this requirement. A on the books, but do not have suffi- ticipate in the exchanges. mandate for health coverage would meet this cient resources to review all the rate So companies should be put on no- standard, which is so deferential to the gov- changes that insurance companies pro- tice: unfair premium increases and ernment. pose. other unfair behaviors will come with a Finally, those who object to having health Consumers deserve full protection price. Millions of Americans will re- coverage on freedom-of-religion grounds also have no case. The Supreme Court has ex- from unfair rate increases, no matter ceive tax credits to purchase coverage pressly rejected objections to paying Social where they live. in the exchange beginning in 2014. In- Security and other taxes on religious The amendment I have proposed surance companies will need to dem- grounds. More generally, the Supreme Court would ensure that all Americans have onstrate that they are worthy of par- has ruled that individuals do not have a some level of basic protection. The ticipating in this new market, and re- right to an exemption from a general law on amendment will strengthen a provision ceiving Federal money to cover unin- the ground that it burdens their religion. included in the underlying bill, which sured Americans. There is much to debate over healthcare already requires insurance companies This concern about premium in- reform and how to achieve it. But those who object on constitutional grounds are making to submit justifications and explain increases stems from the fact that we are a faulty argument that should have no place creases in premiums. They must sub- the only industrialized nation that rein the debate over this important public mit these justifications to the Sec- lies heavily on a for-profit medical in- issue. retary of Health and Human Services, surance industry to provide basic Mrs. FEINSTEIN. Mr. President, I and they must make these justifica- health care. I believe, fundamentally, rise to discuss an amendment to create tions available on their Web site. that all medical insurance should be a medical insurance rate authority and I believe we must do more. not for profit. rate review process that I filed to the The amendment asks the National The industry is focused on profits, Patient Care and Affordable Choice Association of Insurance Commis- not patients. And it is heavily con- Act. sioners to produce a report detailing centrated, leaving consumers with few Unfortunately, because of the objec- the rate review laws and capabilities in alternatives when their premiums do tions of one of my colleagues, my all 50 States. The Secretary of HHS increase. amendment was not included in the will then use these findings to deter- As of 2007, just two carriers— final bill before us today. mine which States have the authority WellPoint and UnitedHealth Group— I am profoundly disappointed. I and capability to undertake sufficient had gained control of 36 percent of the would like to take a few minutes to rate reviews to protect consumers. national market for commercial health discuss why I believe this proposal is so In States where insurance commis- insurance. important and why, without it, we can sioners have authority to review rates, Since 1998, there have been more expect to see skyrocketing health in- they will continue to do so. than 400 mergers of health insurance surance premiums. In States without sufficient author- companies, as larger carriers have pur- I am very concerned that health in- ity or resources, the Secretary of HHS chased, absorbed, and enveloped small- surance companies will seek to exploit will review rates and take any appro- er competitors. the time between passage of the bill, priate action to deny unfair requests. In 2004 and 2005 alone, this industry and 2014, when reforms are fully in This could mean blocking unjustified had 28 mergers, valued at more than place. rate increases, or requiring rebates, if $53 billion. That is more merger activ- Credit card companies provide a use- an unfair increase is already in effect. ity in health insurance than in the 8 ful example. Earlier this year, Congress This will provide all American con- previous years combined. approved major credit card reform leg- sumers with another layer of protec- Today, according to a study by the islation. However, the consumer pro- tion from an unfair premium increase. American Medical Association, more tections it contains will not be fully ef- The amendment would also require than 94 percent of American health in- fective until February 2010. the Secretary of Health and Human surance markets are highly con- Credit card companies have taken Services to establish a medical insur- centrated, as characterized by U.S. De- full advantage of this interim period to ance rate authority as part of the proc- partment of Justice guidelines. This raise rates, with many card interest ess in the bill that enables her to mon- means these companies could raise pre- rates increasing 20 percent over the itor premium costs. miums or reduce benefits with little last year. The rate authority would advise the fear that consumers will end their con- I am very worried that health insur- Secretary on insurance rate review and tracts and move to a more competitive ance companies will do the very same would be composed of seven officials carrier. thing. And I believe the rate authority that represent the full scope of the In my State of California just two amendment is essential to stopping health care system including: at least companies, WellPoint and Kaiser them. two consumers; at least one medical Permanente, control more than 58 per- In some States, insurance commis- professional; and one representative of cent of the market. In Los Angeles, the sioners have the authority to review the medical insurance industry. top two carriers controlled 51 percent rates and increases and block rates The remaining members would be ex- of the market. that are found to be unjustified. Ac- perts in health economics, actuarial Record levels of market concentra- cording to a 2008 Families USA report, science, or other sectors of the health tion have helped generate a record 33 States have some form of a prior ap- care system. level of profit increases. proval process for premium increases. The rate authority will also issue an Between 2000 and 2007, profits at 10 of The same report describes several no- annual report, providing American con- the largest publicly traded health in- table successes among States that use sumers with basic information about surance companies soared 428 percent this process, including . . . regulators how insurance companies are behaving from—$2.4 billion in 2000 to $12.9 billion in North Dakota were able to reduce 37 in the market. It will examine pre- in 2007. This is Health Care for America percent of the proposed rate increases mium increases, by plan and by State, Now, Premiums Soaring in Consoli- filed by insurers. Maryland used their as well as medical loss ratios, reserves dated Health Insurance Market, May State laws to block a 46-percent pre- and solvency of companies, and other 2009, citing U.S. Securities and Ex- mium increase after a company relevant behaviors. change Commission filings. charged artificially low rates for 2 This data will give consumers better The CEOs at these companies took in years. The decision was upheld in information. But more importantly, it record earnings. In 2007, these 10 CEOs

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00042 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13755 made a combined $118.6 million. The year. We, the undersigned organizations, mending and complimenting the staff. CEO of CIGNA took home $25.8 million; support a proposed amendment by Senators That is a bipartisan sentiment for this The CEO of Aetna took home $23 mil- Feinstein, Rockefeller and others that would Christmas season. I am sure every Sen- lion; The CEO of UnitedHealth took provide greater specificity in terms of rate ator on the floor feels the same way review of increases in health insurance pre- home $13.2 million; and the CEO of miums. and expresses that appreciation to the WellPoint took home $9.1 million. The proposed amendment: hard-working staff. I am very concerned that this profit Creates a rate review authority that could I want to start off by saying there is seeking behavior will only worsen, now deny or modify unjustified rate increases or still an opportunity for this bill to be that insurance companies know that order rebates to consumers, amended to change some of the very health reform will change their busi- Defines potentially unjustified rate in- harmful ways that this will affect our ness model. creases as increases which exceed market people back home and, particularly, Insurers know that come 2014, they averages, Gives priority to rate increases that im- our State governments. will be playing by new rules: No dis- pact large numbers of consumers, I was on the Senate floor several criminating based on preexisting con- Creates market conduct studies of health days ago pointing out the objections ditions. No cherry picking and choos- insurance rate increases, that most of the State Governors have ing to cover only the healthy. No Exclude from State Exchanges insurers with regard to the Medicaid mandates. charging women or older people astro- that have a pattern of excessive premium in- I want to read from a letter dated De- nomical rates. No dropping coverage crease, low medical loss ratios or other mar- cember 10, from my Governor, Haley once someone gets sick. ket conduct, Barbour of Mississippi, who reminds Allows a State to conduct the rate reviews. Insurers know these changes are Senators that: coming. Listen to a comment made by We support the provisions of health reform which make health insurance more afford- This bill continues to place a huge un- Michael A. Turpin, a former senior ex- able for individuals and businesses. This funded mandate on States, while harming ecutive for UnitedHealth. He is now a amendment is consistent with the stated in- our small businesses and seniors through top official at an insurance brokerage tention of the ‘‘Patient Protection and Af- budget gimmicks and increased taxes. firm, and he said that insurers were fordable Care Act’’ and provides greater And he says this: specificity to the provisions on ‘‘ensuring ‘‘under so much pressure to post earn- If the current bill, which would expand that consumers get value for their dollars.’’ ings, they’re going to make hay while Medicaid up to 133 percent of the Federal The proposed amendment prevents antici- the sun is shining.’’ poverty level, were enacted into law, the patory price increases by health insurers in ‘‘Make hay while the sun is shining.’’ number of Mississippians on Medicaid would advance of full implementation of health re- increase to 1,037,606, or 1 in 3 citizens, in Mis- That means these companies will try form. Scrutiny of rate increases will have a sissippi. Over 10 years, this bill would cost to make as much money as they pos- deterrent effect on increases in premiums Mississippi taxpayers $1.3 billion. sibly can, for as long as they can. that are out of line. That is why a rate review amend- For these reasons, we support the proposed I was on the Senate floor a few days ment is so important. amendment. ago also with this map, which shows in Frankly, I wish the health reform Sincerely, red the number of States that are fac- bill before us would go further and ANGIE WEI, ing this unfunded mandate because of eliminate the for-profit health insur- Legislative Director, the increased Federal mandate for ance industry. California Labor Medicare coverage coming from this But since this bill chooses to main- Federation. MARTY MARTINEZ, bill, should it be enacted into law. I tain a for-profit industry, we must do Policy Director, Cali- was pointing out that only the two the next best thing and ensure that it fornia Pan-Ethnic States—Vermont and Massachusetts— is thoroughly regulated. Insurance Health Network. because of a formula that has been companies should not be able to take MICHAEL RUSSO, worked out, would be exempt. Every advantage of the fact that affordable Health Care Advocate other State will have to come up with health care is a basic life need. In ef- and Staff Attorney, the extra money either through cut- fect, they have the power to increase California Public ting education programs, cutting men- their prices at will, knowing that peo- Research Interest Group (CALPIRG). tal health programs or other vital serv- ple will continue to pay as long as they SONYA VASQUEZ, ices or by raising taxes. They will have can afford to do so. Policy Director, Com- to come up with the extra money under This amendment certainly will not munity Health this legislation so that half of the peo- fix all of the ills of a for-profit insur- Councils, Inc. ple covered by this new act will be cov- ance industry, but I believe it makes a GARY PASSMORE, ered by Medicaid. needed improvement in the underlying Director, Congress of I want to make an amendment to bill and will help protect consumers California Seniors. that chart today and add one other ANTHONY WRIGHT, from unfair increases. Without it, I State. I think it has become quite a worry that consumers in far too many Executive Director, Health Access Cali- well-known fact that we need to put States will see major premium in- fornia. one other State up there in yellow, and creases. BILL A. LLOYD, that is the State of Nebraska. I will continue to work to see that Executive Director, We know pursuant to an agreement this amendment is included in the final Service Employees that was made before Senator NELSON version of health reform legislation. International Union announced his support as the 60th vote Without it, too many Americans will California State for cloture on this very important leg- Council. still lack protection from unfair rate islation, a deal was cut—the minority REV. LINDI RAMSDEN, increases. leader said a cheap deal, and I agree— I ask unanimous consent that a copy Executive Director, Unitarian Univer- that the State of Nebraska would be of a support letter from California or- salist Legislative exempt in perpetuity from its require- ganizations be printed in the RECORD. Ministry Action Net- ment to pay the State match. The Fed- There being no objection, the mate- work—California. eral Government, according to this leg- rial was ordered to be printed in the The PRESIDING OFFICER. The Sen- islation that we will be asked to vote RECORD, as follows: ator from Mississippi is recognized. on in the next 2 days, will pick up all DECEMBER 17, 2009. Mr. WICKER. Mr. President, I ask of the extra expenditures for the State Hon. HARRY REID, unanimous consent that several Repub- of Nebraska. Majority Leader of the U.S. Senate, Hart Office Building, Washington, DC. lican colleagues and I be allowed to en- The poverty level in Nebraska is not Re Support of amendment to HR. 3590 to im- gage in a colloquy for the next hour. quite as bad. I don’t know how the pow- prove rate review of increases in health The PRESIDING OFFICER. Without ers that be felt they should or could insurance premiums. objection, it is so ordered. justify this expenditure, but I will tell DEAR SENATOR REID: Thank you for your Mr. WICKER. Mr. President, I thank you the people in the State of Mis- leadership in advancing health reform this my friend from Washington for com- sissippi are going to have to come up

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00043 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13756 CONGRESSIONAL RECORD — SENATE December 22, 2009 with another $1.3 billion over the next out, and the majority of the population have the same provision that Senator 10 years to pay for what we are going of this country can see where they NELSON, according to these reports, in- to be required to do by Congress—in its were not. They are going to pay while serted, a grandfather clause that would wisdom. those States pay less because of not allow Floridians to reserve their price How is it fair that one Senator from just their location but because they in the Medicare Advantage Program? Nebraska goes behind closed doors with happen to have been behind closed Would he accept a unanimous consent the majority leader and cuts this deal doors and cut special deals. request right now that same provision so that his citizens don’t have to pay Mr. BAUCUS. I wonder if the Senator apply to every State in America? this extra tax, and they don’t have to would yield briefly. I ask unanimous consent that the do without services in other State pro- Mr. MCCAIN. Sure. I ask that Sen- same provision that was put in for the grams to come up with the money? No ator BAUCUS be recognized. State of Florida by Senator NELSON one in this building—nobody within the Mr. BAUCUS. I am pointing out, as would apply to every State in America. sound of my voice—can come in here the Senators know, for example, under The PRESIDING OFFICER. Is there and explain why that is fair. this legislation, the Federal Govern- objection? The fact is, the majority leader need- ment pays all the costs of eligible en- Mr. BAUCUS. Reserving the right to ed that vote, and that was part of the rollees through 2016. In this legislation, object, I think it would be highly im- deal that was cut. Now citizens in Ari- we are talking about the so-called ex- prudent for me not to object, so I will zona, citizens in Wyoming, citizens in pansion population. That is those be- object to that request. I also point out Mississippi, in Arkansas, and in Lou- tween 100 percent of poverty on Med- that on average, Uncle Sam pays 90 isiana—we will have to come up with icaid and 133 percent of poverty, and percent of the Medicaid payments for the extra Federal tax money on our under the underlying statute—— this expansion of population after the part, but the Federal Government can Mr. MCCAIN. Does that mean all year 2016. cover all of the additional costs—State these States are being treated the The PRESIDING OFFICER. Objec- and Federal—in Nebraska. same? tion is heard. Mr. MCCAIN. If the Senator will Mr. BAUCUS. In 2016, all States are Mr. MCCAIN. I think the fact that an yield, on that map, I wonder should treated the same. objection was heard resolves the case. there not be a sticker for the State of Mr. MCCAIN. This happens to be 2009. Those are comforting words on the part Florida? According to a published re- What happens between now and 2016? of the Senator from Montana, whom I port by one of my favorite columnists, Mr. BAUCUS. Beginning next year, appreciate, but the fact is, there are Dana Milbank, of the Washington Post: when this goes into effect, 2010 through special deals for special people. It is Gator Aid: Senator Bill Nelson inserted a 2016, all States will get 100 percent pay- well known. It is very well known. grandfather clause that would allow Florid- ments for that expansion coverage. May I mention to my colleagues— ians to preserve their pricey Medicare Ad- Mr. WICKER. What would happen, sort of a personal privilege here—the vantage program. then, after 2016 under current legisla- Senator from Louisiana came to the So maybe we should have one of tion? floor this morning and said: those stickers for Florida there. By the Mr. BAUCUS. Afterward, under cur- Recently, just yesterday, Senator John way, that will cost my constituents rent legislation—one sentence of back- McCain, our colleague from Arizona, has more money because they will not have ground. Today, as the Senator well claimed that the American people are opposed to reform and he speaks about the will that same deal. Should there be a knows, different States receive different Federal contributions to Med- of the majority. I would like to remind, re- sticker for Montana? spectfully, my colleague from Arizona that Again, according to Dana Milbank: icaid. It varies according to States. the will of the majority spoke last year when Handout Montana: Senator Max Baucus se- The average is about 57 percent Fed- they elected President Obama to be Presi- cured Medicare coverage for anybody ex- eral. The average for all States on av- dent and they decided not to elect him, and posed to asbestos—as long as they worked in erage is 57 percent of the cost of Med- the President is carrying out the will of the a mine in Libby, Montana. icaid is paid for—— majority of the people to try to provide them Should there be a sticker there? Mr. MCCAIN. If that is the case—— hope and opportunity. Continuing, Dana Milbank says: Mr. BAUCUS. Let me finish. I say in response to that, I really did Mr. MCCAIN. If that is the case, we Iowa pork and Omaha Prime Cuts: Senator not need to be reminded. I had not for- Tom Harkin won more Medicare money for will be glad to have the same provision gotten. Sometimes I would very much low-volume hospitals of the sort commonly inserted for the State of Arizona that like to. But I appreciate the reminder. found in Iowa. . . . was inserted for the State of Florida. The fact is that the Senator from Maybe there should be a sticker for You don’t have a problem with that, do Louisiana and other Senators should that. I don’t know if you have North you? know that poll after poll, public opin- Dakota in there. Dana Milbank says: Mr. BAUCUS. Let me answer the ion, partially because of what the Sen- question. Meanwhile, Senators Byron Dorgan and ator from Mississippi is pointing out— Kent Conrad, both North Dakota Democrats, Mr. MCCAIN. Do you have a problem the latest being ‘‘U.S. Voters Oppose would enjoy a provision that would bring with that? Health Care Plan by Wide Margin.’’ A higher Medicaid payments to hospitals and Mr. BAUCUS. I can answer only one Quinnipiac poll finds 3 to 1 that the doctors in ‘‘frontier counties’’ of states such question at a time. The first question plan should not pay for abortion. And as—let’s see here—North Dakota! is from the Senator from Mississippi. it says American voters mostly dis- Should there be one for Hawaii? Mr. Then, after 2017, all States get 90 per- approve of the plan 53–36 and dis- Milbank goes on to say: cent—we are talking about expansion approve 56–38 percent President Hawaii, with two Democratic senators, of population. Obama’s handling of the health care would get richer payments to hospitals that Mr. WICKER. The Senator yielded to issue. treat many uninsured people. me the other day, and I appreciate If I can remind my friend and col- Should there be a sticker there for that. We have a number of Republicans league from Louisiana, I did carry her Michigan? Mr. Milbank says: who want to speak during our hour. State. The fact is, after 2016, every State in Michigan, home of two other Democrats, Mr. BAUCUS. The Senator carried would earn higher Medicare payments for red has to tax their own citizens and my State too. some reduced fees for Blue Cross/Blue Shield. pay their State share, except Vermont, Mr. MCCAIN. And the State of the Vermont’s Senator Bernie Sanders held out Massachusetts, and Nebraska. And I Senator from Montana. for larger Medicaid payments for his state. still challenge any colleague in this Mr. JOHANNS. If I may jump in here, (neighboring Massachusetts would get one, Senate to come before this body and probably like every Senator here, I too). say that is fair. I do not believe they read the newspapers back home every I guess there are a number of States will say that is fair. morning as I start my day. There was that maybe should have stickers on Mr. MCCAIN. My question to the Sen- an editorial in the Lincoln Journal them so that the American people can ator from Montana is this: Would the Star on December 21 that speaks to see where these special deals were cut Senator from Montana be willing to this issue of special deals. I thought it

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00044 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13757 was excellent. The Lincoln Journal Is that what we were sent here to do? Small business group say Reid health bill Star has covered me for a long time. That has never been my view of what more of the same—more taxes, mandates, big Sometimes I agree with them, some- our obligations to our citizens are, but spending, and nothing to help lower insur- times I do not. Sometimes they agree also to the citizens of this country. ance costs. with me, sometimes they do not. But I I ask my colleagues to comment. Associated Builders and Contractors have always respected the work they The PRESIDING OFFICER. The Sen- is against it. The National Association do. ator from Idaho. of Manufacturers is against it, the Here is what they said in their edi- Mr. RISCH. Mr. President, here is Independent Electrical Contractors, torial: what this has come to. In the next 48 the International Franchise Associa- hours, this 2,400-some page bill is going tion. Even the labor unions have said: Since when has Nebraska become synony- mous for cynical ‘‘what’s in it for me’’-type to pass the Senate. But how did we get Don’t tax our health care benefits. We politics? there? Was it done the way things are agree with them. We are on the side of The term ‘‘Cornhusker kickback’’ is al- usually done in this body? Not at all. the labor unions. We should not be tax- ready a favorite of television’s talking One party has been able to gather 60 ing health care benefits. heads. votes for this. Not one person from the But set all that stuff aside. These are They go on to say: other party is going to vote for it. How all people who have an ax to grind. The That’s how the rest of the country sees did they get those 60 votes? Did they American people do not want this bill. [this] deal. get it by arguing this out? They did not These people who are coming out here The editorial continues: do that. They have bluntly, boldly, and saying the American people want this on the front of virtually every news- bill, I don’t know whether they are not Under its provisions, the federal govern- paper in this country bought the votes ment would pay all additional Medicaid reading the newspapers, whether they costs for Nebraska ‘‘in perpetuity.’’ The Con- to pass this bill, to get to the 60. They are not reading their own e-mails at gressional Budget Office has estimated the bought the last handful of votes, and their office. The Quinnipiac poll that deal may be worth $100 million over 10 years. they did not even buy it with their was out this morning, Tuesday through They go on to say I think in very money, they bought it with the Amer- Sunday, says: 36 percent of the Amer- powerful language: ican people’s money. Now, that is ican public support the health care wrong. The deal is the embodiment of what is spending bill; 53 percent oppose. That wrong in Washington. The explanation I heard from the ma- is an 18-percent difference. Gallup says Instead of thoughtful, careful work on real jority leader the other day is: Well, 61 percent of the American people don’t problems, Washington lawmakers cobble to- that is the way this is done. That may want this bill. gether special deals, dubious financial ac- be the way this is done in banana re- Stop coming out here saying the counting and experimentation on a grandiose publics, that may be the way this is American people want this bill. The scale. done in Third World countries, but this American people do not want it. You They devote a paragraph to the many is America. The American people are want it, but the American people do special deals cut, and the Senator’s outraged over this. The other party not want it. Leaders in your own party chart illustrates one. ought to be outraged. do not want it. The labor unions do not Mr. MCCAIN. If the Senator will—— I heard one Member quoted as saying: want it. Nobody wants this thing, and Mr. JOHANNS. If I may finish, I say Well, I was too stupid to get any most of all small business does not to Senator MCCAIN, and then you can money for my State in there. I heard want this bill. ask me. the majority leader say: You are not I have listened to anecdote after They say this: doing your job if you don’t have some- anecdote from the other side. There are It’s time to push the reset button on thing in there for you. Where is the some very touching stories, and every- health care reform. outrage from the other side, not only body over here is empathetic with The effort has gone awry. about the process but how they are get- them. But you don’t legislate using Mr. MCCAIN. But also, doesn’t this ting snookered by some other members anecdotes because you are only hearing bring up a larger issue—I ask all my of their party? Where is the outrage? one side of the story, you are not hear- colleagues to comment on this—wheth- I watched the debate on the other ing all the facts dealing with the anec- er our job here is to do whatever we side and have seen Members come down dotes, and to then pat this 2,400-page can to just simply help our State, even and say: The American people want bill and say this will solve that, that is if it is at the expense of other States, this. Are they living in a cave? Sure, not the way you legislate, and it is cer- as the Senator from Mississippi pointed there are a handful of American people tainly not the way you argue a point. out, or is our title U.S. Senator, Ari- who want this. Let me tell you who I heard the other side come out here zona, Nebraska, Mississippi, et cetera? does not. The U.S. Conference of and pat the bill and say: When we pass My title is not Arizona Senator, U.S.; Bishops does not want it. The National this bill, 94 percent of American people it is U.S. Senator, Arizona. So of Right to Life people do not want this. will have insurance, will be covered by course I am here to represent the peo- Not one Republican wants this. The health insurance. In court, they say ple of my State. But is a U.S. Senator’s Democrats do not want it. you have to tell the truth, the whole Listen to what Howard Dean, the job to go out and do something which truth, and nothing but the truth, and former leader of the Democratic Party, would then be at the expense of the that is exactly why. You cannot pat said: citizens of another State simply by vir- this bill and say now 94 percent of the At this point, the bill does more harm than American people are going to be cov- tue of their clout and influence? Is that good. what we were sent here by our con- ered. Ask any Democratic Governor in Somebody listening to that will say: stituents to do? America. This bill transfers $25 billion Is it true what the majority leader Gosh, what a wonderful bill. What is it in costs in unfunded mandates to the said yesterday: going to cost? It costs $2.5 trillion to Governors and to their taxpayers. They ″ cover 94 percent of the American peo- I don’t know if there is a Senator that have to come up with $25 billion. They doesn’t have something in this bill that was ple. But they don’t say the bill only important to them,’’ Senate Majority Leader don’t want it. adds another 7 percent. The fact is, HARRY REID reasoned when asked at a news I have stood here and listened to the they don’t tell you that 87 percent of conference Monday about the cash-for-clo- other side say: This is wonderful for Americans are already covered by some ture accusation. ‘‘And if they don’t have small business. Small business is going kind of health insurance. So don’t say something important in it to them, then it to come out so well on this. Then why this is a grand and glorious victory be- doesn’t speak well of them.’’ does the National Federation of Inde- cause we are now going to cover 94 per- Does it speak well of us when we do pendent Business—small businesses— cent when 87 percent are already cov- something like the Senator from Mis- say: ered. sissippi pointed out, that favors Libby, The Senate bill fails small businesses. This is gimmickry at its worst, to MT, and not the rest of the country, The National Association of Whole- tax for 4 years without giving any that helps the seniors in Medicare Ad- sale Distributors. The Small Business major benefits. Giving some minor ben- vantage in Florida and not in Arizona? Entrepreneurship Council says: efits but holding off the major benefits

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00045 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13758 CONGRESSIONAL RECORD — SENATE December 22, 2009 until later is plain gimmickry. They they cut a special deal—on top of the Presumably there’s a wing where tax- say: Oh, look how wonderful this is. It tremendous national debt that we are payers can go to get their wallets removed. is not going to add to the national defi- facing, the American people are fright- The Democrats insist that their Medicare cuts will not lead to rationing. So why did, cits because we are going to collect ened. They have a right to be fright- as HotAir.com reports, Sen. Bill Nelson, D– taxes for 4 years, and only then are we ened and worried. Fla., insist on language that exempted three going to start the benefits. Mr. BARRASSO. I don’t know how heavily Democratic counties in his home What do we have here? When all is many of my colleagues have seen the state from the cuts? If those massive cuts to said and done and you strip it away, editorial in today’s Investors Business the program won’t hurt people on Medicare you have $2.5 trillion and 2,400 pages Daily. Advantage, why did Nelson fight to get ex- that most people do not understand, Mr. President, I ask unanimous con- emptions for Palm Beach, Dade and Broward higher taxes, and higher insurance present to have printed in the RECORD the counties? miums. article to which I am going to refer. After all this wheeling and dealing, we will There being no objection, the mate- still have a cost-raising tax-increasing, I can give you one fact that is the Frankenstein monster of a bill hurriedly best reason to vote against this bill; rial was ordered to be printed in the stitched together behind closed doors that that is, it cuts $1⁄2 trillion out of Medi- RECORD, as follows: will lead to doctor shortages and rationed care benefits. If you are a senior watch- LOUISIANA PURCHASE AND OMAHA STAKES care. ing, $1⁄2 trillion of Medicare benefits is Politics: Mary Landrieu’s payoff was the Mr. BARRASSO. The article is head- going to disappear. I heard the Presi- new ‘‘Louisiana Purchase.’’ Ben Nelson got lined: ‘‘Louisiana Purchase and Omaha dent say and I heard my friends on the Uncle Sam to pick up Nebraska’s future Stakes.’’ The editorial says: other side say: Look, if you like your Medicaid tab. Maybe we should just put Sen- ate votes up on eBay. Politics: Mary Landrieu was the new ‘‘Lou- program, if you like your insurance Nelson, the 60th vote in the middle-of-the- isiana Purchase.’’ Ben Nelson got the federal plan, you are going to be able to keep night Senate party line vote on health care government to pick up his state’s future it. Try to tell that to the people who reform, will go down in American political Medicaid tab. are on Medicare Advantage. It is being history as the inventor of the permanent And the article continues: stripped. It is being eliminated under earmark. His seemingly principled stand Maybe we should just put Senate votes up this bill. Indeed, if you read the rules against including federal funding for abor- on eBay. . . . Nelson won a permanent ex- and regulations under this bill, the tion evaporated like the morning dew as he emption from the state share of Medicaid ex- plan you have will not even exist when decided to take what was behind door No. 1. pansion for Nebraska—forever. The world’s The deal for Nelson includes special Med- it is done. greatest deliberative body has now become icaid funding for Nebraska, along with the most corrupt. You know, I have heard the other Vermont and Massachusetts, which has a side say: Oh, you Republicans are just special election to fill the seat of the late So Uncle Sam is taking the hit for playing on fears of the American peo- Sen. Ted Kennedy coming up in January. 100 percent of the Medicaid expansion ple. Let me tell you something. The Under the Senate bill every state is equal, for Nebraska forever. That is what this American people are frightened. They but some are more equal than others. The says. It goes on to say this is not what are afraid. It isn’t just this health care other states and their taxpayers—that legislating is about; that this is not bill, they have sat here for the last means you—will pick up this tab. compromise, rather, it is about brib- This came just three days after Sen. Bernie ery. year, and they have watched stimulus Sanders, I–Vt., said on Neil Cavuto’s Fox packages costing $1 trillion. They have Business show that he was prepared to vote Mr. President, this is horrible for us watched multibillion-dollar bailouts. against the bill after the recent decision to as a nation to have these things writ- They have seen buyouts. They have strip the public option and the Medicare buy- ten about this institution, when we seen trillion-dollar deficits running up. in provision from the legislation to get the should be way above any of these sorts They have seen the national debt now vote of Sen. Joe Lieberman, I–Conn. of claims. running into the trillions. And, yes, Nelson won a permanent exemption from I look at that map that my colleague the state share of Medicaid expansion for Ne- they are afraid. from Mississippi has up, with just Ne- braska. Uncle Sam will take the hit for 100% braska on there as the special deal, and But it isn’t us that is doing it to of the Medicaid expansion for Nebraska—for- them, it is you that have done it to ever. The world’s greatest deliberative body I do not believe that is the way legisla- them. It is you that have committed has now become the most corrupt. tion should be written. We should be the actions that have put the fear into The Congressional Budget Office (CBO) in- looking at ways to improve health care the hearts of the American people. formed lawmakers Sunday night that this for all Americans, improve the quality, Don’t do this. Stop this nonsense. You section of the manager’s amendment to the make it more affordable, make it more have the opportunity still to stop this. Senate’s health bill would cost $1.2 billion available to people, and give them the over 10 years. You can do it. The American people Nebraska actually receives the least of the access they need. don’t want this. Stop the insanity. three, some $100 million over the first 10 I brought four amendments the other I yield the floor. years. Vermont will receive $600 million over day, after Senator REID brought his Mr. WICKER. I will say to my friend, 10 years, while Massachusetts will get $500 massive amendment to the floor, and I am afraid. I am afraid for my coun- million. each was rejected. They were things try. We are going to have a vote some- Nelson, like most other senators, doesn’t that would actually improve this bill time between now and Christmas Eve know what’s really in this bill or what it and make it better for Americans. on raising the debt limit. It will just be costs, except for the scoring that involves So I stand here, looking at this, and comparing a decade of taxes with six or reading headline after headline and a short-term thing. I doubt if a single seven years of ‘‘benefits.’’ Republican will vote for that. Then we This includes gutting Medicare by half a editorial after editorial about just how will have to come back again in Feb- trillion dollars. The abortion language he ac- very bad is the way this bill is being ruary and do the same thing. cepted may not survive conference or the pushed forward. We certainly wouldn’t The debt that is piling up on our Stupak amendment supporters in the House. want any young child to know how this country is something to be frightened The Medicaid bribe he accepted will. is happening in their country, as we try about. It is something we need to fight Senate Majority Leader Harry Reid, the to get them involved in this process Boss Tweed of our time, defended how this and learn and study and feel that against and be resolute about. We are sausage was made. ‘‘You’ll find a number of not shedding crocodile tears, but I am states that are treated differently than other maybe they should become involved in frightened by this debt, and we should states. That’s what legislating is all about. this. This isn’t what legislating in be, if we want our economy to stay It’s about compromise,’’ he said. America is all about. We are better strong. The fact we are adding $2.5 tril- On the contrary, sir, it’s about bribery— than this. lion in an entitlement program, which about what has been dubbed the If you have to do these sorts of things apparently the majority has the votes ‘‘Cornhusker kickback,’’ and about politics to get a 60th vote, then the bill isn’t done the ‘‘Chicago Way.’’ good enough to pass. If the ideas aren’t for, is simply going to add to this enor- A $100 million item for construction of a mous debt. university hospital was inserted in the Sen- good enough to get the votes, then it So it is no wonder, when you add the ate health care bill at the request of Sen. shouldn’t pass. In this country, we look Medicare cuts, the taxes that most Christopher Dodd, D–Conn., who faces a dif- for bipartisan solutions to the big States are going to have to pay—unless ficult re-election campaign. issues of the day. That is what we did

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00046 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13759 in the Wyoming Legislature. Major So I would ask the Senator from Ne- parts of our State, people believe you issues passed with overwhelming num- braska: How does this go over in the seal a contract not by putting things in bers. That is what has happened in this heartland of America? How do the peo- writing but by shaking hands and giv- country throughout the course of his- ple in Nebraska, who see that they ing your word. They don’t want this tory. The big bills have come forth have gotten some kind of special deal, kind of attention. They don’t want to with large numbers of supporters, and a special provision—certainly reported be on the evening news every night that is how you get the country to fol- as so in the media—that would come at with the talking heads talking about low you, not by trying to force through the expense of other taxpayers in the ‘‘cornhusker kickback’’ or what- a vote, buying a vote here and buying America? I am curious about the reac- ever the latest terminology is. They a vote there to just squeak by with the tion the Senator from Nebraska gets. just want to be treated fairly. minimum amount of support. That is Mr. JOHANNS. It doesn’t go over. It They asked me to come here and rep- not the way to change policy that is just simply doesn’t. In every way pos- resent them as fervently as I can, to going to affect everyone in the United sible, over the last 4 or 5 days, I have try to do all I can to get fair treatment States personally and affect one-sixth been asked: Do you support this special for them. But not a single person at of our economy. That is not the way to deal for Nebraska? I don’t. I think it is any townhall I have ever had stood up do it. wrong. and said: MIKE, I disagree with that It has not been the way, it shouldn’t I could read through all the special principle. I want you to go back there be the way, and it should never be the deals because we have all got the list— and give me a special deal or get our way again. I am looking for some Dem- it is Florida, Louisiana, and Montana, State a special deal. ocrat to stand up and say: This isn’t and on and on and on. But I came to So I appreciate Senator MCCAIN ask- the way, and I am going to not vote for the floor this morning and I asked ing me the question. I feel very strongly about this. I wish the other side this bill. unanimous consent that all the special would consider my request for a unani- Mr. MCCAIN. A Senator from Colo- deals be taken out, and I listed a long rado came to the floor and proudly mous consent agreement that just list of them. Of course, there was an stated that he had not asked for any- says: Time out, everybody. Let’s pull objection to that request for unani- thing or gotten anything, and I will out the special deals, whether it is Ne- mous consent. Why? Why would we ask the Senator from Nebraska a ques- braska or Montana or whatever. It want to try to pass legislation with all tion because his State seems to be at doesn’t matter to me. Let’s pull those of this? It makes no sense to me. out and let’s take a step back and let’s the center of a lot of attention. But, But let me take a step back. We all first of all, there is a little booklet work for what Senator RISCH talks remember a few months ago there was that is put out by the Government about and the rest of us have talked a big story that Nevada was going to Printing Office that talks about how about. We can get 80 votes on a health get a special Medicaid deal. It was our laws are made. We give it to our care reform bill. I guarantee you. But right about that time that we took a constituents and send it to schools all not on this bill. few days off. I went back home, and I over America. I have never seen any- Mr. WICKER. I would echo what the did townhall meetings, as I have done thing in that little booklet—it is a Senator from Nebraska has just said. I for years and years and years. But we very interesting booklet—that says know my friend from Arizona has been really invested time and effort, and we you get behind closed doors and you one of the most outspoken critics of identified six principles of health care cut deals. special deals and special earmarks. I know we are all a little cynical which are on my Web site for people to This is not some catchall appropria- about politics and campaign promises, look at. I literally had a PowerPoint tions bill to get us through the end of but the negotiating behind closed doors presentation. I did four townhall meet- the year. This is one of the most major is especially so, particularly after your ings—Carnie, Grand Island, Lexington, pieces of legislation on which any President says during the campaign, and Lincoln. I put up these principles. Member of this Senate currently serv- time after time: I am going to have all One of the principles was no carve- ing will ever vote. This is one-sixth of the negotiations around a big table. We out. No backroom deals. No special the American economy, and the Amer- will have doctors and nurses, hospital deals. I presented that to the people ican people are learning about these administrators, insurance companies, who were at those townhall meetings. I special carve-outs where the citizens of drug companies, they will get a seat at did tons of interviews. I explained why one State will be treated differently the table. They just would not be able I felt the way I did. People were so not because of a formula, not because to buy every chair. But what we will irate at the possibility that Nevada of the poverty level, but because of po- do, we will have negotiations televised was going to get this special deal. litical power. on C–SPAN so that people can see who Since then, I think that has fallen by It would just seem to me that one is making arguments on behalf of their the wayside, but all these other things Member of the majority party, in these constituents and who is making argu- have come along. That is why I read next 2 days, might step forward and ments on behalf of the drug companies. the Lincoln Journal Star editorial. say: You are right, and I will not be a Of all people he recognized, the drug This is an editorial page that some- party to this. companies—who got the best deal of times likes what I am doing and some- Mr. MCCAIN. Let me make one addi- all? PhRMA. Who has spent the most times it does not. Over the years, they tional comment. I have seen reform go money lobbying? Who has spent the have not hesitated to take me to task. through the Congress of the United most money on advertising? PhRMA. They looked at this and they said: States. The first one I saw was when we Who is going to cost the American con- Since when has Nebraska become synony- saved Social Security—a major reform sumer $100 billion, that could have mous for cynical ‘‘what’s in it for me’’-type of Social Security. There was no back- been saved by the consumer if we had politics? room dealing. It was a straightforward been able to reimport prescription They said it is time to hit the reset proposal as to how to fix Social Secu- drugs? button. We are not getting this right at rity. We fixed welfare, it was welfare But I would ask my friend from Ne- all. We simply aren’t getting it right. reform—again, open, honest, bipartisan braska because along with the ‘‘Lou- They talked about the issues of cost negotiations and bipartisan agreement. isiana purchase’’ and probably the containment, they talked about the Welfare reform, Social Security re- Florida deal this Nebraska deal has Actuary’s report, which I had spent a form, the efforts we made at tobacco probably gotten the most publicity and little time talking to them about, and reform, at campaign finance reform, at visibility. Maybe because it was the other folks around the State. After immigration reform and many others— 60th vote. I don’t know if it is the big- looking at all of that, they just said: the Patients’ Bill of Rights. Every re- gest or not, in terms of money, because Look, this isn’t going the way it needs form I have ever been involved in has we will be finding deals in this 2,700- to go for the American people. had two major and sole components: page bill for months. For months, we Here is what I would say to all of my No. 1, it is bipartisan; No. 2, there were will be finding provisions, even though colleagues in the Senate. I love my no special favors or deals cut, provi- our staffs have carefully read it. It is State. I love the people there. They are sions in thousands of pages of legisla- not 2,700 pages for nothing. such honest, decent people. In many tion.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00047 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13760 CONGRESSIONAL RECORD — SENATE December 22, 2009 Again, we know where the train is assertion over on that side is, Medicare improve access—100 Senators want to headed. We know what is going to hap- Advantage is not Medicare. As a mat- do that. That is the goal of each and pen a short time from now, but they ter of fact, some of the leadership in every one of us here. will make history. You will make his- this very body said the booklet the We need one courageous Senator to tory. You will have rammed through Government puts out that says Medi- say it is time, time now, to take a step ‘‘reform’’ on a strictly partisan basis, care Advantage is part of Medicare back, let us go home over Christmas, without the participation of the other should be changed. Those words should let us think about this, let us talk to party, over the objections of a majority be stricken from the handout because our constituents at home, let us hear of the American people, done in closed it is not part of Medicare. The Web site what they have to say about this look- negotiations, with results that are an- the Federal Government has saying ing out for No. 1—$100 million. Dana nounced to the American people with- Medicare Advantage is part of Medi- Milbank’s column in the Washington out debate or discussion and to this care, that should be changed because it Post today, that is what we need now side without debate or discussion. is just an insurance company in the Senate. We need the kind of The American people do not like it. masquerading as Medicare. courage John Kennedy wrote about in They do not like for us to do business Let me just take a second. This is ‘‘Profiles in Courage.’’ that way. I am sure this peaceful revo- Betty. Betty represents—she is from Mr. RISCH. I say to Senator lution that is going on out there al- Louisiana. I don’t know if she was one BARRASSO, you know there are already ready—because as the Senator from of the 60 percent of Louisianans who some courageous Democrats stepping Idaho pointed out, because of the in- voted for Senator MCCAIN in Louisiana, up. I hope every Democrat on the other volvement of the car companies, the but she enjoys Medicare Advantage. side calls their Governor and says: stimulus, the bonus, the generational She was told during the election that if Governor, what do you think about theft we are committing, this, all on you like your coverage, under any plan this? Help me out here. I am in caucus, top of that, is going to give great fuel that the Obama administration would they bought enough votes to get to the to the fire that is already burning out approve, you get to keep that coverage. 60. But I have to tell you I don’t like there, where they want real change, She gets hearing aids, vision coverage, the way they did it, No. 1; and, No. 2, real change which they were promised dental care, and she likes her Medicare what about the rest of us? We didn’t in the last Presidential campaign and Advantage. get the $300 million. We didn’t get the certainly did not get. If Betty is 1 of the 150,000 seniors in X number of million. Help me out, Gov- Mr. RISCH. I say to Senator MCCAIN, the State of Louisiana who enjoy this ernor. They say they are going to shift probably one of the great ironies of all benefit, she is at risk of losing it. But $25 billion to the States that you are this is going to be at 8 o’clock on De- if she happens to be in the State of going to have to come up with. What cember 24—when this bill passes with Florida, in any of these counties with do you think? Do you think I ought to the 60 votes, all Democrats—imme- the $100 million carve-out, she is fortu- vote for this—or maybe if one of us diately following that vote is going to nate enough to be able to keep her steps forward and says I am going to be a vote, again all 60 Democrats and Medicare Advantage. vote no and I want to set the reset but- only Democrats, raising the national In other words, it may not be guaran- ton and I want to put people back to debt. What an irony, to put $2.5 trillion teed, but she sure likes it. Obviously, the table and say let’s do this right, we in spending of a new social entitlement one of the Senators from Florida be- can do this right. program, adding it to the three already lieves his constituents like it—again, a We are Americans. We know how to huge entitlement programs that are in carve-out so this nonguaranteed, non- do this. We are the most innovative the process of bankrupting America, Medicare benefit that is not very good, people in the world. All we have to do adding this to it and then turning right they can keep it in Florida. That is in is get together and do it. But to jam around and increasing the debt ceiling. the bill and no one can deny that spe- this down the throats of the American When they increase it, it is going to cial treatment is given to that one people—and make no doubt about it, be—nobody knows exactly how much it State under Medicare Advantage. this is being jammed down the throats is going to be, hundreds of billions. But Again, I challenge any American to of the American people on the eve of that is only in the last 2 months. They come onto the floor of this Senate and Christmas, in the middle of the night, are going to have to come back again tell me how that is fair. in the face of poll after poll that says in February and increase the national Mr. BARRASSO. It is not. There have don’t do this to us. debt ceiling again. What irony. been a number of references to our That is what is happening. There are Mr. MCCAIN. Of course, this legisla- friend and colleague, the late Senator courageous Democrats out there. Not tion turns everything we know about Ted Kennedy. Let’s take a look at the one of them is sitting here. budgeting on its head, although it has book his brother, John Kennedy, wrote, Mr. WICKER. Let me tell my friend been done before and it has been done ‘‘Profiles in Courage.’’ As we have seen from Idaho about some courageous by Republicans, to our shame. Today, all this, it is time for one courageous Democrats. When the House version of if you go out and buy an automobile, Democrat to stand and say: This is this was being considered at the other you can drive it for a year before you about our country. This is about our end of this building, a number of Demo- have to pay for it. Under this bill, it is country, not about a kickback. This is crats stepped forward and said: I can’t the opposite. You pay the taxes, you about health care, not about a hand in vote for this. It was very close. They have the reductions in benefits, and the cookie jar. have a huge majority, 40 votes over then 4 years later you start having That is what we need. We need one there. As a matter of fact, one Member whatever benefits would accrue from courageous Democrat to stand and say: of the House today basically said: I this legislation. So for 4 years small I don’t want to be part of this editorial can’t take any more. He switched par- businesspeople, people all over Amer- that talks about the Louisiana Pur- ties. A Member from Alabama is now ica, will see their health care costs in- chase and Omaha Stakes. I don’t want joining the Republican conference. But creased before there is a single, tan- to be a part of this that says this, the there are a number of loyal Democrats gible result from it—remarkable. world’s greatest deliberative body, has who have no intention of switching Mr. WICKER. The Senator mentioned now become corrupt. I don’t want to be parties and they have stepped forward the Florida carve-out. Perhaps I should a part of this that says this is about and said: I can’t vote for it. Don’t have it on my map. The reason I did bribery. count me in on this. not is it involves Medicare Advantage It needs one courageous Democrat, 1 BART STUPAK is a Representative, a and not Medicaid. The map was about out of 60, to stand and say: I am going courageous pro-life Representative Medicaid, but he makes a good point to vote no; we need to back up; we need from Michigan. He did vote for the bill. about the Florida carve-out. to think about this. We have 100 Mem- I do not impugn his motives. He did I had a discussion with some of the bers of the Senate who want to reform what he thought was right. But before leadership on the Democratic side on health care in this country, who want he voted for it, he made sure legisla- the floor of the Senate the other day to get the costs under control, who tion was included in the House version about Medicare Advantage. The strong want to improve quality, who want to to make sure the Hyde language, which

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00048 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13761 has been the law of the land for almost ured this out. It is going to be one of Mr. WICKER. Unless my colleagues two decades, was included. the great historic mistakes—not his- want to join in, I thank them for join- Here is what Representative STUPAK toric—but historic mistakes made by ing us and certainly thank Senator said yesterday or the day before yester- the Congress of the United States. MCCAIN, one of the most distinguished day about this so-called pro-life com- Mr. MCCONNELL. If I may say to my public servants, someone who sac- promise that was included in the friend from Arizona, he is absolutely rificed for his country and who has version we will have to vote on in the right. I have had an opportunity to ob- been on this floor hour after hour. Senate. He said it is ‘‘not acceptable serve Senator Kennedy over the years. The bill we will be asked to vote for . . . a dramatic shift in Federal policy That is exactly the way he operated. on Christmas Eve by the administra- that would allow the Federal Govern- If I may, just to make a point with tion’s own Chief Actuary increases ment to subsidize insurance policies regard to the observation of the Sen- health care costs, threatens access to with abortion coverage.’’ ator from Mississippi about Congress- care for seniors, forces people off their That is a release actually on Decem- man STUPAK, as I understand it, Con- current coverage, and actually in- ber 19. gressman STUPAK was not asking for creases the amount of the gross domes- I appreciate the courage of someone some special deal for Michigan in re- tic product that will be spent on health from a Democratic State, from a dis- turn for his vote. He was, rather, try- care rather than decreasing it. These trict that has long been Democratic, ing to establish a principle that would are not statements I have made; these who is a member—chairman of a com- apply to all Americans. Is that not the are assessments made by the Chief Ac- mittee and a member of the leadership case? tuary for the Obama administration. over there—stepping forward and say- Mr. WICKER. That is exactly correct. There is still time. Even if this bill ing: I can’t go this far. Unless this lan- I commend my former House colleague passes, we will go home for Christmas, guage is changed—and we are told by for taking that principled stand. for the holidays. We will hear from our Mr. MCCONNELL. Could not be same Members of the Senate there better not constituents. I hope we listen to that thing be said for our colleague, Senator be much of a conference. What we vote over 60 percent of Americans who say: LIEBERMAN from Connecticut? I am on, on Christmas Eve, it better sort of We advise you not to vote for this leg- sorry he ended up voting for this 2,700- stay like it is or it will not be passed islation. by the Senate when it comes out of page monstrosity, but you have to Mr. BARRASSO. It is time for a new stay, as I understood his position—and conference. chapter to be written in ‘‘Profiles in Senator MCCAIN certainly knows him BART STUPAK is stepping forward and Courage.’’ One of the Members of this very well—his position was, if the gov- saying, if that is the case, then I am body can be that profile. All they have ernment goes into the insurance busi- switching from a yes to a no. I appre- to do is stand up and say: No, I will not ness, I can’t support this bill, not: I am ciate that kind of courageous Demo- be part of what has been called corrup- open for business and what you can you crat. tion in the Senate. I will not be part of do for Connecticut. Mr. MCCAIN. Can I say, I appreciate what has been called, in the editorials, Mr. MCCAIN. There may be on the the Senator from Mississippi bringing floor a unanimous consent request to bribery in the Senate. I will be that this important aspect to this issue and remove the Nebraska Medicaid deal. I courageous person and vote no. It is continuing to do so. would hope, if there is any unanimous time for a new chapter in ‘‘Profiles in I would like to pick up on what Dr. consent agreement at any time, that Courage.’’ BARRASSO mentioned about the Ken- the whole bill will be fixed, which I yield the floor. nedy family. It is well known I had a means every special provision would be The PRESIDING OFFICER. It is the very close relationship, developed over removed, whether it be from Nebraska understanding of the Chair that the the years, with Senator Ted Kennedy or any other State. We still have the Senator from Mississippi had the floor. and that we worked together on a vari- Louisiana Purchase of $300 million. We Mr. WICKER. I yield the floor. ety of issues. So there is a great irony The PRESIDING OFFICER. The Sen- still have the Florida Medicare grand- ator from Montana. in the constant, over there on the father clause, $25 to $30 billion. The list Mr. BAUCUS. Mr. President, I have other side of the aisle, references to goes on and on. The Connecticut hos- several points to make. First, as a mat- Senator Kennedy, who always began pital—I guess it is the Connecticut hos- ter of personal privilege, on behalf of legislation by getting bipartisan, by pital. It is always in legislation, so you the people of Libby, MT, the Senator getting Members of the other side of have to do research to see who quali- from Arizona made it sound as if the the aisle committed and working to- fies. I would hope we could have, again, gether—whether it be on immigration agreement that all these special provi- folks in Libby were getting some kind reform, whether it be on health care re- sions that affect certain specific States of a sweetheart deal. I wish the Sen- form, whether it be on one of the great would be removed as well. That would ator would not leave so he can hear achievements of President Bush 2, No go over rather well with the American what is actually going on. I think the Child Left Behind. people. Senator from Arizona would agree with In other words, every dealing I ever I want to say to my colleagues, me that he would not want his con- had with Senator Kennedy was to thank you for your passion. I know a stituents to suffer an environmental reach out, establish a fundamental lot of people don’t watch our pro- calamity. He would not want his con- base for agreement, and then move for- ceedings on the floor. It has played a stituents to not get some redress be- ward with legislation in a bipartisan role in educating the American people cause of a declaration of public emer- fashion, which I think was one of the as to what we are facing. The media gency due to contamination of asbes- major reasons why he had such an im- played a role, advocacy groups, grass- tos. I assume the Senator from Arizona pressive legislative record. roots organizations all over America. would very much stand up for his con- How did the other side do it? Without But I have had the great privilege of stituents. a bit of serious negotiation, without engaging in these colloquies with my Let me explain. Congress passed a bringing anyone on board before mov- colleagues. To me, it has been both law in 1980 called CERCLA. That legis- ing forward—no one—which ends up, helpful to my constituents, and, frank- lation said that whenever there was a now, with a 60-to-40 vote, which is a ly, it has also been helpful to me to declaration of a public emergency be- pure partisan vote and outcome when work with people who have been in- cause of contamination at a Superfund there has never been, in history, a sin- volved in these issues, former Gov- site, the government has an oppor- gle reform that was not bipartisan. ernors and others. We have made some tunity to declare a public emergency That is why the American people are kind of contribution, which I think is and help those people get medical care rejecting this. That is why the Amer- what we are all sent here for. because of contamination of asbestos; ican people are seeing through it. To Mr. WICKER. How much time rein this case especially, something hear the constant refrain that the mains? called tremolite, which causes even American people want this: Read any The PRESIDING OFFICER (Mr. greater damage than ordinary asbestos. poll. It is just a matter of difference ROCKEFELLER). The Senator has 2 min- I would assume the Senator from Ari- because the American people have fig- utes. zona would want his constituents to

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00049 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13762 CONGRESSIONAL RECORD — SENATE December 22, 2009 get some help from contamination faith. They were in good faith. They talked to those Senators many times. from asbestos. wanted to mutually work together to That is not what happened. I will tell Mr. MCCAIN. May I respond? pass health care reform. They asked you what did happen. Your leadership Mr. BAUCUS. Absolutely. good questions. Senator ENZI from Wy- pressured them, pressured them, pres- Mr. MCCAIN. All the Senator had to oming, for example, asked very good sured them not to work together. do was have it authorized, bring it up questions. Senator SNOWE asked very There was no European-style effort in on the floor as an appropriation, and I good questions. Senator GRASSLEY that room. That is a totally untruthful am sure the Senator’s arguments asked very good questions. We worked statement—a totally untruthful state- would have been far more cogent than to get health care reform. ment. None whatsoever. We are passing jamming it into a bill which has to do But do you know what happened? I a bill here that is a uniquely American with health care reform, the policy of could feel it happening. One by one by solution. It provides competition. It health care reform. one, they started to drift away. They helps the doctor-patient relationship. This legislation and this cause of the wanted to pass health care reform. That assertion of working toward a Eu- Senator from Montana has been turned They wanted to act in a bipartisan ropean solution is entirely untrue. It is back several times on other grounds. basis. But they were pressured—pres- entirely false. Mr. BAUCUS. This is health care. Re- sured from their political party not to The fact is, those Senators did not claiming my right to the floor. do it, not to do it, not to do it. Why want to work with us. It is regrettable. Mr. MCCAIN. I am responding. were they pressured not to do it? Un- It is highly regrettable. One of the big- Mr. BAUCUS. I reclaim my right to fortunately, they gave in to the pres- gest travesties here is there was not a the floor because he doesn’t want to sure because their leadership wanted to good-faith effort on that side of the deal in good faith with this issue. make a political statement. One of the aisle to come up with a constructive, My second point. It is disrespectful, Senators on the floor here said: Let’s comprehensive alternative to the it is unseemly for Senators in this body make health care Obama’s Waterloo. Democratic version of health care re- to invoke the names of Ted Kennedy They did not want to work with us, form. If there had been a constructive, and Jack Kennedy in opposition to this that side of the aisle. They did not honest, alternative health care reform, bill. It is disrespectful and unseemly. I, want to work with us because they we could have had a really good debate. frankly, am very much surprised that thought it was better to make a polit- What is the better approach to solving Senators would go to that level and in- ical statement: Attack the bill, attack the health care problem? That did not voke the names of Ted Kennedy and the bill, attack the bill, attack the bill ever happen. It did not ever happen at Jack Kennedy in opposition to this leg- in order to make political points for all. Rather, they didn’t have anything. islation. Talk about profiles in cour- the 2010 election. That is what they They didn’t have a health care bill. age. I hear Senators on the other side were trying to do. None whatsoever. say: Where is the courage of one Sen- I ask, where is the courage? Where is The only one that came up a little ator to stand up and vote against the courage? Where is the Republican bit was over in the House. Because of health care reform? That is what I Senator who will stand up and say: all the criticism about Republicans not keep hearing. Where is the courage? Boy, let’s work together to pass health having an alternative, finally the Re- Where is the courage of one Senator on care reform. Where is the Senator who publicans in the House came up with the Democratic side to stand up and will stand up and say: We want to work an alternative. It was very small. vote against health care reform? together to pass health care reform. There wasn’t much to it. To be honest, Mr. President, I want to turn that This Senator tried mightily to get bi- the CBO said it would hardly increase around. ‘‘Profiles in Courage’’—Jack partisan support. Ask Senator GRASS- any coverage whatsoever. It was not Kennedy and Ted Kennedy were Sen- LEY from Iowa, with whom I have been really a comprehensive health care re- ators who worked to try to find resolu- working for a long, long time. They form bill. And there has been none in tions to agreements. They wanted to were pulled away. Senator GRASSLEY— the U.S. Senate on the Republican side, compromise. They wanted to work to- I don’t want to speak for him, but I no alternative for a comprehensive gether to get just results. know he wanted to get health care re- health care reform bill. I ask, where is the Senator on that form passed on a bipartisan basis. I I want the public to know we worked side of the aisle who has the courage to know that is the case. Frankly, he got very hard to get a bipartisan bill. That break from their leadership, break pressured, pressured, and he just side of the aisle started without work- from the partisanship they are exer- couldn’t do it. I have the highest re- ing with us, but gradually they began cising on their side of the aisle to work spect and regard for him, but he just to believe that politically they would together to pass health care reform? I couldn’t do it. have a better chance in the 2010 elec- ask, where is the courage? Where are Mr. WICKER. Will the Senator yield tions by just not working with us but the Senators who have the courage on briefly? just attack, attack, attack, attack, that side of the aisle to stand up and Mr. BAUCUS. Absolutely. trying to score political points to de- work together on a bipartisan basis to Mr. WICKER. I think the Senator has feat any honest effort to get health get health care reform passed? Where? really answered his own question. As a care reform. We on this side reached out our matter of fact, Senator GRASSLEY and I now yield such time as he would hands for bipartisan agreement on Senator ENZI met for hours and hours, like to the Senator from Nebraska. health care reform, probably to a fault. weeks upon weeks with my friend from The PRESIDING OFFICER. The Sen- I say ‘‘to a fault’’ because for months Montana in good faith, hoping to come ator from Nebraska is recognized. and months this Senator, anyway, ex- up with a program that could get that Mr. NELSON of Nebraska. Thank tended the hand to work with other 80-vote support we usually get on mat- you, Mr. President. Senators on a bipartisan basis. I know ters of—— Well, this has been quite an enlight- the current occupant of the chair Mr. BAUCUS. That is how they start- ening experience on the floor this past knows that. He watched this. He saw it ed out, that is true. 30 or 40 minutes. It shows how emotion- happen in the Finance Committee. Mr. WICKER. And then eventually, it ally charged this body has become over Senator GRASSLEY and I worked very dawned on them that my friends on the this issue and perhaps other issues as hard to get Senators on both sides of other side of the aisle wanted to well. But the challenge is, we are all the aisle to work to pass health care Europeanize the health care system of entitled to our own opinions. We are reform, very hard. Then after a while the United States of America. just not entitled to our own set of we had to work toward another ap- Mr. BAUCUS. Reclaiming my time. facts. proach. The Group of 6—3 Republicans, The PRESIDING OFFICER. The Sen- I would like to take a moment to ex- 3 Democrats—worked for months on a ator from Montana has the floor. plain the so-called Medicaid fix for the bipartisan basis to get health care re- Mr. WICKER. I thank the Senator for State of Nebraska. Now, it has been de- form passed. Do you know what hap- yielding. scribed as the ‘‘Omaha Stakes fix.’’ I pened? I watched it happen. Those Sen- Mr. BAUCUS. That is not what hap- take issue—and I only wish my col- ators in the room were acting in good pened. I was in the room constantly. I league from Nebraska had stayed on

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00050 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13763 the floor to hear this. I take issue with the issues you have raised. Under my pro- tally segregated. They just did not like one of the premier businesses in the posal, if Nebraska prefers not to opt in to a the language. State of Nebraska used in a manner of reformed health care system, it would have Well, if in the conference the Stupak- derision to outline something that is that right. Nelson-Hatch-Casey language passes, I factually incorrect on the basis of how My colleague and others know this is will be happy, and so will Congressman they are presenting it. the case. They know this is the case, STUPAK, and so would, I would imagine, You can twist and you can turn and but they choose to ignore it. They those who signed on to that legislation. you can try to distort what happens, choose to ignore the facts. It is unfortunate, though, to continue but it does not change the underlying On December 20, I again wrote to the to distort and misrepresent what hap- facts. The underlying facts are, this Governor and shared with him my con- pens in the body of the Senate. It is dif- was pursued initially as an opt-in or cern about this unfunded mandate, and ficult enough to have comity. It is dif- opt-out for all States. It was impos- I pointed out that: ficult enough to have cooperation. It is sible to do that at the present time, Within hours after the amendment was difficult enough to have collegiality. and so as a matter of fix, there was, in filed, [my colleague from Nebraska] objected When politics are put above policy and fact, the extension of the Federal dol- to the inclusion of these funds. As a result, productivity, this is what we get. lars from the year 2017 on, well into the I am prepared to ask that this provision be Mr. President, I am very dis- removed from the amendment in conference appointed, somewhat disillusioned, by future, as a marker to lay down so that if it is [the Governor’s] desire. every State could object to this man- the use of this method and this ap- ner of unfunded mandates. I got a letter back on the day after, proach that would undermine the good As a Governor—and my colleague is a on December 21, talking about this as a name of a company in Nebraska, as former Governor—we fought against special deal. It is not a special deal for well as the name of the State of Ne- Federal unfunded mandates. As a Sen- Nebraska. It is, in fact, an opportunity braska, by associating it with some- ator back here, I have also fought to get rid of an unfunded Federal man- thing that has not been done, was not against unfunded and underfunded Fed- date for all the States. Let me repeat intended, and did not result. eral mandates. This was, in fact, ex- that: for all the States. There is noth- Mr. President, with that, I yield the actly that. While we were not able to ing special about it, and it is fair. floor. get in this legislation an actual opt-out What we have done is we have drawn The PRESIDING OFFICER. Who or opt-in for a State-based decision, a line in the sand and said: This is un- seeks recognition? what we did get is at least a line, if you acceptable, and it is unacceptable for Mr. BAUCUS. Mr. President, I yield will, so that in the future other States all States as well. I cannot believe that 15 minutes to the Senator from Dela- are going to be able to come forward this sort of a situation would continue. ware. and say: Hey, either the Federal Gov- There is no misunderstanding here. I The PRESIDING OFFICER. The Sen- ernment pays for that into the future think it is just an opportunity to mis- ator from Delaware. or the State will have the opportunity lead, distort, and, unfortunately, con- Mr. CARPER. Mr. President, let me to decide not to continue that so that fuse the American public all the more, just express my thanks for those 17 we do not have an unfunded Federal and to use the State of Nebraska and minutes. mandate. the name of a good company for par- I would ask the Chair to please ad- So I am surprised. I am shocked. tisan political purposes on the other vise me when I have used 15 of those Well, actually, I am not shocked. I am side of the aisle. minutes. disappointed this would be used and My colleagues know I am not a deep- The PRESIDING OFFICER. The misused in this fashion, not only deri- ly partisan person and that I rarely Chair will do so. sively against a great company in Ne- come to the floor to speak, and that Mr. CARPER. Mr. President, listen- braska—the Nebraska Steaks—I am when I come to the floor, it is for some- ing to the debate today reminds me of, also surprised my colleague would par- thing like this, to take exception with among others, a famous quotation from ticipate in a colloquy that would use the misuse of information for partisan Winston Churchill, who, I believe, said: the name of that company in such a purposes. That is exactly what has ‘‘The worst system devised by wit of manner. been done with this situation. man’’—he was talking about democ- I am surprised this colloquy went on I am prepared to fight for the State racy. He said it was the worst form of without understanding the facts of of Nebraska, and I hope my colleague is government devised by wit of man, and what this so-called carve-out—which is as well. Obviously, the Governor was then he added ‘‘except for all the rest.’’ not a carve-out—truly consisted of. prepared to fight for the State of Ne- We like to sort of lecture the Iraqis There is no carve-out. Each State be- braska by bringing it to my attention. and Afghanis on how to run a democ- tween now and 2017—two-thirds-plus of But I am not prepared to fight to get a racy, and we still struggle with it after a decade—will have an opportunity to special deal for the State of Nebraska. more than 200 years. In the 8 or 9 years come back in and get this bill changed. I did not, and I refuse to accept that I have been here, I have never seen us Governors asked for relief. As Gov- kind of responsibility or that kind of a struggle as much as we have on the ernors, we asked for relief against suggestion from anyone on that side of issue of health care. Part of the reason these continuing unfunded mandates. the aisle or anyone else. is because it is just enormously com- Time and time again, we fought Then, as it relates to abortion, I plex, and it is just confusing. against them. This was one more op- think my colleagues know that we in- As to the people who are following portunity to fight. As a matter of fact, troduced legislation that is comparable the debate, if you listen to folks on the the Governor of Nebraska spotted this to the Stupak legislation in the House political left, mostly in our party, and wrote me a letter on December 16 dealing with barring the use of Federal what you hear is: No public option, no and said, among other things: funds for elective abortions. We intro- Medicare buy-in, we are not doing The State of Nebraska cannot afford an un- duced it over here, and it was bipar- enough to make health care affordable. funded mandate and uncontrolled spending tisan. It was Nelson-Hatch-Casey, and What you hear from the right, mostly of this magnitude. it did not pass. So I began the process on the other side of the aisle, is, this is He goes on to say a number of other of trying to find other solutions that I government run, this is government things about the bill. But he makes the thought equally walled off the use of funded, this is a government takeover. point that this is an unfunded Federal Federal funds and made it clear that no So you have the two extremes out mandate and wanted me to do some- Federal funds would be used. here trying to take shots at one an- thing about it. Now, apparently I did not say ‘‘moth- other. Those of us in the middle are So I sent him back a letter on the er may I’’ in the process of writing that sort of collateral damage or road kill. same date, saying: language because others took issue But at the end of the day, a lot of Thank you. . . . with it, even though they cannot con- times when you find neither the left Please be advised that I have proposed that structively point out how it does not nor the right are entirely pleased with the Senate bill be modified to include an prohibit the use of Federal funds or the outcome, sometimes that suggests ‘‘opt-in’’ mechanism to allow states to avoid wall off those funds or keep them to- that the outcome is not all that bad.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00051 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13764 CONGRESSIONAL RECORD — SENATE December 22, 2009 I am not saying this is a perfect bal- bankrupt because they cannot compete about 3 percent for every premium dol- ance, but it is not a bad balance. For with foreign competitors because of the lar. That is a lot lower than folks who those, especially in our party, who feel price of our health care; and that is try to go out and buy it on their own as though we should have done more, I true with a lot of smaller companies as in the open market. They may pay 33 am sure in 1965, when Lyndon Johnson well. percent of their premium dollar for signed into law the Medicare legisla- The idea of doing nothing is, to my their administrative costs. They are tion, there were probably some who did mind, not a very smart thing to do. We not paying 3 percent. We are going to not vote for it—and I am told it was have to do a number of things to ac- try to replicate that. We do it in the mostly Democrats who voted for it, not complish three goals: No. 1, rein in the exchange. so much our Republican friends—but I growth of health care costs. This idea There may be 50 exchanges through- am not sure how many Democrats who of two, three times the rate of inflation out the country, some regional ex- voted for Medicare at the time said: It in the growth of health care costs is changes as well. So we do exchanges as does not do enough for our senior citi- not sustainable. Frankly, if we do not well. When States create interstate zens. It does not provide for hospice rein in the growth of health care costs, compacts across State lines, such as care. It does not provide for home neither will be sustainable the cov- Delaware with New Jersey or maybe health care. It does not provide for dis- erage we extend to people who do not Delaware and Maryland or Delaware ability benefits for those who are under have it today. and Pennsylvania, maybe all four of us, the age of 65. There is no prescription The third thing we try to work on in insurance sold in any of those four drug program. There is nothing for out- this legislation, to the extent we can— States can be sold across State lines patient surgery. None of those things a lot of interesting things are going on and introduce new competition, addi- were in the original Medicare legisla- in the private sector, very interesting tional competition for business and for tion. Over time, they have been added, things going on in the private sector, the folks looking for coverage for those and I think the Medicare legislation, regarding how to instill personal re- two or three or four States. the Medicare law, has been improved to sponsibility in employees, and how to Another thing that works is the de- make it a better program. get better transparency and better livery system, delivery of health care Now we face a day when the Medicare costs through the health care delivery in outfits such as the Cleveland Clinic Program is literally running out of system. That is going to be a part of and the Mayo Clinic, Geisinger in money. One of the less-told secrets in this as well. But we have to figure out Pennsylvania, not far from where we the legislation that is before us is that a way to get better outcomes, and are in Delaware, Intermountain Health the life of the Medicare trust fund—life there are a lot of good examples for out in Utah, and Kaiser Permanente in that has been down to about 7 or 8 doing that. California. years—I understand, thanks to the re- I want to take the remaining time I I actually went with Rachuel Russell, forms that are in this legislation, have today to just mention some a member of my staff, to the Cleveland should be pretty much doubled. That is things that are in the legislation that Clinic about 3 months ago. What we not good enough, but we are going to I think make sense because they are found was the Cleveland Clinic and the stretch by about 100 percent the useful based and founded on what works. And Mayo Clinic and Geisinger and all remaining life of the Medicare Pro- as an old Governor—and Senator NEL- these others pretty much all have the gram. SON has already spoken from Ne- same template. They focus on primary Another fact that is sort of lost in all braska—we are used to focusing on care. They focus on prevention and the debate, all the tumult, is what this what works and trying to replicate wellness. They coordinate the care of does with respect to our budget defi- what works, steal ideas from other folks who are receiving treatment. All cits. I am told by—not us, not Demo- States and try to work them in our of their patients have electronic health crats or Republicans—the neutral Con- own State. I want to mention a couple records. gressional Budget Office, which is nei- things we have taken that work. We Medical malpractice coverage is pro- ther Democratic nor Republican—non- are trying to grow them and, in some vided by the entity itself, the Mayo partisan—that the legislation, if we cases, on a national level. Clinic, Cleveland Clinic, and all the adopt it in its current form, will reduce One of things Senator BAUCUS and his docs are on salary. They have gone the deficit over the next 10 years by staff in the Finance Committee focused after what we call not just defensive about $130 billion, and by as much as on, I think, is maybe the best idea in medicine but fee-for-service, and they maybe $1 trillion, $1.3 trillion in the the health care legislation, something have done a very good job reducing the second 10 years beyond that. In terms of what is going to happen called an exchange. problems that flow out of fee-for-serv- When I was a naval flight officer, we as to the cost of premiums, we are told, ice which lead to more utilization and again, by the nonpartisan Congres- used to go to the exchange on the base unnecessary utilization of time, tests, sional Budget Office that rather than which was a place to buy stuff. It was technology. They get better outcomes spiking premiums, we are actually like a little department store. The ex- and they spend less money. going to see people get somewhat bet- change in health care delivery, which What we are trying to do with this ter coverage for, frankly, not more will open in January 2014—I hope we legislation is to take those health care money in terms of their premiums. can actually stand up the exchanges delivery ideas from those nonprofits In terms of those of us who just love and open the exchanges sooner—but and instill them into the delivery of the health insurance we have—we are that is going to be a place for people to health care, particularly through Medi- delighted with the coverage and the go and buy health care coverage. When care but also in other ways too. amount we pay for it—I would just re- people do that, they will become part I like to shop for groceries. We have mind all of us of a couple things: One, of a purchasing pool in their State or a bunch of good grocery stores in Dela- we have spent more money by far than maybe in a couple of States to sort of ware. One of the places I shop for gro- any nation on Earth for health care— band together and form a regional pur- ceries occasionally when I am in my about 11⁄2 times more than the next chasing pool. State is a place called Safeway, in closest country. We do not get better Why is a purchasing pool important? Dover. A guy named Steve Burd is the results. In many cases, we get worse re- Well, because we are part of one, and CEO of the company, and they have sults. we know that with 8 million people in really helped inform our decision- We have about 14,000 people who our purchasing pool—Federal employ- making in this debate in ways that are woke up with health care coverage who ees, Federal retirees, all of our depend- pretty remarkable by virtue of the way will wake up tomorrow morning and ents—we get a lot of competition. A lot they provide coverage to their employ- they will not have it; they will have of private sector companies want to ees. It is not just Safeway. It is not lost it. Over 40 million people in our offer us products to choose from. We just Pitney Bowes. There are a number country have no health care coverage don’t get cheap insurance, but we get of companies that are figuring out how at all. pretty good prices. With 8 million peo- to get better results for less money, Finally, we have big companies such ple in a purchasing pool, we really and we are borrowing some of their as GM and Chrysler that have gone drive down administrative costs to ideas.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00052 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13765 One of the ways we are borrowing is of the cost. But once a person’s pre- think in the future it will be a very im- to say, how does Safeway provide—lit- scription costs reach $2,500 up to about portant addition. erally flattening out for the last 4 or 5 $5,500, for most people Medicare doesn’t Lastly, I want to build on a proposal years—health care coverage for their pay anything and the individual pays it offered again by Senator BAUCUS with employees? They haven’t reduced their all. That $2,500 to $5,500 gap is called Senator ENZI, and the issue is defensive benefits. One of the things they have the doughnut hole. It has nothing to do medicine. done is to incentivize their employees, with doughnuts, but that is the name The ACTING PRESIDENT pro tem- use financial incentives to get employ- we have given to it. pore. The Senator has used 15 minutes. ees to—if they are overweight, to con- In the legislation that is before us— Mr. CARPER. Thank you. trol their weight, get their weight again, I give a lot of credit to our The issue is defensive medicine. The down, and if they do that, their pay- chairman and others who have nego- issue is medical malpractice. There ments are reduced. If they are smokers, tiated this—we are going to fill the have been a couple of amendments of- they get rewarded for stopping smok- doughnut hole. We are going to basi- fered by friends across the aisle for us ing. If they have high cholesterol or cally cover people who are in that gap to try to deal with the incidence of high blood pressure, they get rewarded of the $2,500 to $5,500 so that people will medical malpractice lawsuits, the de- by reduced premiums for reducing their be able to continue to take the medi- fensive medicine that sort of flows cholesterol and blood pressure. cine they need to take. They won’t from there where doctors prescribe What we have done with our legisla- stop. They will have the availability to really too many tests and too many tion—and I thank the chairman and medicine. procedures and maybe too many of the my colleagues for their support, Demo- They will also have access to some- wrong kinds of medicine just in an ef- cratic and Republican, for supporting thing called primary care. I am at the fort to reduce the likelihood they are an amendment by Senator ENSIGN and tender age of 62, and I think my Pre- going to be sued. What we have done myself where employers would be able siding Officer, also from Delaware, is here is to take an idea from the States. to provide a 30-percent discount to em- just about the same age as I. When peo- The States have done some very in- ployees who do the right thing for their ple in this country end up being old teresting stuff with respect to trying own health. By doing that, they will enough for Medicare, they get a one- to make sure we reduce the incidence reduce health care costs for not just time-only Medicare physical. That is of medical malpractice lawsuits, that their employer but for others in the it—one time. If they live to be 105, they we reduce the incidence of defensive group in which they are covered. never get another one, at least not paid medicine, and we actually improve There is another piece in the legisla- for by Medicare. health care outcomes. We are going to tion that really borrows from an idea In terms of borrowing good ideas take those ideas, one called Sorry that is popping up in a couple of cities from the nonprofits, the Cleveland Works that they were using up in and maybe a State or two around the Clinics and the Mayo Clinics, we are Michigan where people have an oppor- country, and that is, Why don’t we bet- going to say you get more than just tunity—doctors have an opportunity to ter inform people? We are interested in one physical. You get it when you are apologize and offer a financial settle- personal responsibility, people taking 65 and 66 and 67 and 68, and if you live ment to people and patients who have charge of their own health and reduc- to be 105, God bless you, you will get it been harmed by that doctor; an idea ing their health care liability. Why every year up until then; finding out called panels of certification like we don’t we do a better job of ensuring what is right with people, what is have in Delaware where before I can that—when I go into a restaurant or wrong with people, and what they need sue my doctor I have to go before a anybody goes into a restaurant, we to do more of or less of. That is a smart panel to find out if my suit has any look at the menu board of a chain res- idea, and it is part of the reforms in basis in fact. We are going to take taurant and we know right then and the legislation. ideas like safe harbor. If a doctor does there what the calories are in what we In terms of going back to medicine, all the things by the book, everything are drinking or eating, for an entree, we want to make sure people have good by the book, should that doctor receive for a salad or dessert. I know it right access to primary care, annual some kind of expectation that maybe there by looking at the menu board if physicals if they are on Medicare, so they are safe from lawsuits or reduced it is a chain restaurant. If it is a menu, their doctor can find out what is wrong exposures to lawsuits? We think there not a board, they have to have that in- with them, if they need to exercise, should be some of that. There is the formation on the menu. They have to stop smoking, control their weight, idea of health courts, where there are have on site additional information on whatever that might be, but also to folks on the court, like the bankruptcy 10 other items, including fats, trans learn if there are some medicines they courts, folks who are the experts, and fats, cholesterol, sodium, and on and ought to be taking, and second, to before a suit can actually go into a on. make sure they can afford them. Third, court, that health court would actually The idea is to make us better in- our legislation actually improves their sit in determination of whether a doc- formed consumers. As we try to fight lives in terms of if medicines are pre- tor or a hospital or a nurse has really obesity in this country—about a third scribed, they will actually be taken messed up. Those are all ideas that are of our country is obese or overweight, and used the way they are prescribed. being talked about, experimented with. and adults are worse than kids. Kids There is a little piece in this legisla- We are going to make sure they are are catching up with their parents, un- tion that Senator RON WYDEN deserves robustly tested. States are going to fortunately. That is one of the things a lot of credit for called personalized apply for grants to test those ideas and that is in the legislation. We call it the medicine. The idea is that if there are maybe others to accomplish three Lean Act. The idea is to try to provide certain people who, because of their ge- things: one, reducing medical mal- personal information so people can as- netic makeup, the way God made them, practice lawsuits; two, reducing the in- sume personal responsibility. they have a particular condition and cidence of defensive medicine; and Speaking of what we should eat or the medicine is not going to help three, and most importantly, improv- not eat, I wish to mention doughnuts, them—if the same group of people have ing health care outcomes. and I will do it in the context of some- the same problem—or if a different Those ideas build on what works. thing called the doughnut hole. Folks group of people have a different genetic They are not Democratic ideas. They who are Medicare eligible have prob- makeup and the medicine will help one are not Republican ideas. I think they ably heard this term before because group and not the other, we want to are just smart ideas for the most part. under the Medicare prescription drug make sure we spend the money on the They are ideas that, as time goes by, program, when people’s out-of-pocket folks who will be helped and not waste people will find out if they really do costs reach about—when their cost for money on the folks who will never be the trick in helping to rein in health medicines, their prescription medi- helped because of their genetic make- care costs so the coverage we extend cines, reach about $2,500, the first up—literally, the way the Good Lord can be sustained. $2,500, Medicare pays 75 percent of the made them. That is called personalized I will just close with this, if I could. cost and the individual pays 25 percent medicine, and it is in this legislation. I For the folks in this country who are

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00053 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13766 CONGRESSIONAL RECORD — SENATE December 22, 2009 totally confused by all this, for the several days have been scratching our [FROM THE LOS ANGELES TIMES, OCT. 6, 2009] people who are scared that we are heads just trying to figure out what we THE CONSTITUTIONALITY OF HEALTHCARE doing something really foolish and it is can do to avoid this next year. Hope (By Erwin Chemerinsky) going to be a disaster for our country, springs eternal. Are the healthcare bills pending in the let me just say that when all the nega- I know this Senator and I know the House and Senate unconstitutional? tive ads sort of stop being funded, when occupant of the chair want to try to That’s what some of the bills’ critics have folks have actually had a chance to un- find ways for this body to be much alleged. Their argument focuses on the fact derstand some of the things I have more civil. We are not just blowing that most of the major proposals would re- talked about here today and a lot of smoke here. We really mean it. I thank quire all Americans to obtain healthcare coverage or pay a tax if they don’t. Those the aspects of the bill that really will very much the Senator from Delaware too poor to afford insurance would have their improve outcomes, that really will rein for raising that point. It is needed, and health coverage provided by the state. in the growth of cost, that really will I do think this country is in trouble if Although the desirability of this approach extend coverage, I think they really we don’t find some solution to handle can be debated, it unquestionably would be will be pleasantly surprised. this excessive partisanship which is constitutional. In closing, I am the guy who came certainly hurting our country. Those who claim otherwise make two argu- here always believing that Democrats On another matter, some of my col- ments. First, they say the requirement is be- and Republicans should work together. leagues on the other side of the aisle yond the scope of Congress’ powers. And second, they say that people have a right to be I know our chairman tried mightily in have asserted that the penalty that is uninsured and that requiring them to buy the Finance Committee to do that, and proposed under the bill before us for health insurance violates individual liberty. I commend him and others for their ef- failing to maintain health coverage is Neither argument has the slightest merit fort. When we come back, we can’t unconstitutional. One Senator has from a constitutional perspective. have another 12 months of this or 12 raised a point of order—Senator EN- Congress has broad power to tax and spend years of this. Our country is in trouble SIGN—on that subject, and that is now for the general welfare. In the last 70 years, if this is the way we are going to be pending. no federal taxing or spending program has Those of us who voted to proceed to been declared to exceed the scope of Con- doing business in the future. Our coun- gress’ power. The ability in particular of try is in trouble. the health reform bill and who voted Congress to tax people to spend money for My hope is that we will get this done, for cloture on the substitute amend- health coverage has been long established we will get it behind us, we will im- ment take seriously our oath to defend with programs such as Medicare and Med- prove the bill in conference, and the the Constitution. Every Senator here icaid. President will provide a signature for takes that oath of office very seriously. Congress has every right to create either a us, and we will go back to work on im- We have seriously looked at this broad new tax to pay for a national plementing this. Just like Medicare. question as well and have concluded healthcare program or to impose a tax only that the penalty in the bill is constitu- on those who have no health insurance. Just like Medicare. The key isn’t just The reality is that virtually everyone will, to stop; the key is to make it better tional. at some point, need medical care. And, if a and to build on this as a foundation. I Those who study constitutional law person has certain kinds of communicable am committed to doing that. I know as a line of work have drawn that same diseases, the government will insist that he my colleagues on this side of the aisle conclusion. Most legal scholars who or she be treated whether they are insured or are committed to doing that. My hope have considered the question of a re- not. A tax on the uninsured is a way of pay- and prayer is that our friends on the quirement for individuals to purchase ing for the costs of their likely future med- other side will want to join us in that health care coverage argue forcefully ical care. that the requirement is within Another basis for the power of Congress to effort. impose a health insurance mandate is that Again, I commend our chairman of Congress’s power to regulate interstate the legislature is charged with regulating the Finance Committee, our leader- commerce. commerce among the states. The Supreme ship, Senator REID, and others. I com- Take Professor Erin Chemerinsky, a Court has held that this means Congress has mend my friend OLYMPIA SNOWE, who renowned constitutional law scholar, the ability to regulate activities that have a showed a lot of courage during the author of four popular treatises and substantial effect on interstate commerce. A course of this debate in committee and casebooks on constitutional law and few years ago, for example, the court held here on the floor. She was under enor- the dean of the University of California that Congress could prohibit individuals mous pressure, as were some of our Re- Irvine School of Law. Professor from cultivating and possessing small Chemerinsky has gone so far as to say amounts of marijuana for personal medicinal publican colleagues on the Finance use because marijuana is bought and sold in Committee whom I am convinced that those arguing on the other side of interstate commerce. would like to have been with us, and I the issue do not have ‘‘the slightest The relationship between healthcare cov- believe we would have had an even bet- merit from a constitutional perspec- erage and the national economy is even ter bill if the pressure from within tive.’’ clearer. In 2007, healthcare expenditures their own party had allowed them to be In arguing that a requirement to amounted to $2.2 trillion, or $7,421 a person, more fully participative. But that have health care coverage falls within and accounted for 16.2% of the gross domes- Congress’s power to regulate interstate tic product. wasn’t the case this time. It has to be The claim that individuals have a constitu- the next. commerce, Professor Chemerinsky tional ‘‘right’’ to not have health insurance On that happy note, I say to my col- compares health care reform to the is no stronger than the objection that this leagues, we will gather again after the case of Gonzales v. Raich—often cited would exceed Congress’ powers. It is hard to holidays and get this job done and look by the other side. In that case, the Su- even articulate the constitutional right that forward to working on a host of other preme Court held that the Federal Gov- would be violated by requiring individuals to issues. None will be more important ernment’s commerce clause powers ex- have health insurance or pay a tax. than this one. None will be more im- tend to the cultivation and possession Since the 19th century, the Supreme Court of small amounts of marijuana for per- has consistently held that a tax cannot be portant than this one. challenged as an impermissible taking of pri- I yield the floor. sonal use. Professor Chemerinsky notes vate property for public use without just The ACTING PRESIDENT pro tem- that the relationship between health compensation. All taxes, of course, are a tak- pore. The Senator from Montana. care coverage and the national econ- ing of private property for public use, and a Mr. BAUCUS. Mr. President, I want omy is even clearer than the cultiva- tax to pay for health coverage—whether im- to begin by saying I agree with my col- tion and possession involved in Gon- posed on all Americans or just the unin- league from Delaware. This partisan- zalez v. Raich. sured—is certainly something Congress could ship has to stop. It is just too much. It Mr. President, I ask unanimous con- impose. is ironic, it is bittersweet that we are sent that Professor Chemerinsky’s Los The claim that an insurance mandate reaching a high point because we are would violate the due process clause is also Angeles Times article be printed in the specious. Most states have a requirement for going to pass health care reform legis- RECORD. mandatory car insurance, and every chal- lation, but we are reaching a low point, There being no objection, the mate- lenge to such mandates has been rejected. too, in terms of partisanship. It is very rial was ordered to be printed in the More important, since 1937, the Supreme unfortunate. Many of us over the last RECORD, as follows: Court has constantly held that government

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00054 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13767 regulations of property and the economy will sumers to the health insurance mar- cent endorsements. Rather, these are be upheld as long as they are reasonable. ket, increasing the supply and demand statements of support from these orga- Virtually every economic regulation and tax for health care services. nizations. Some totally support it, and has been found to meet this requirement. A Under existing health and labor laws, some say there are very good features mandate for health coverage would meet this the Federal Government has a signifi- standard, which is so deferential to the gov- in it. As far as I know, none of these ernment. cant role in regulating health insur- groups totally oppose this legislation. Finally, those who object to having health ance. Some would like to see some changes, coverage on freedom-of-religion grounds also Other prominent legal scholars have but they favor the legislation. have no case. The Supreme Court has ex- also said that Congress has the con- The American Association of Retired pressly rejected objections to paying Social stitutional authority to impose a re- People supports this legislation. That Security and other taxes on religious quirement on individuals to maintain is the largest seniors group. They grounds. More generally, the Supreme Court health coverage. think this is good—I am sure for a lot has ruled that individuals do not have a Jonathan Adler, a professor of law at right to an exemption from a general law on of reasons, but it extends the solvency Case Western Reserve University to the Medicare trust fund for another the ground that it burdens their religion. School of Law, stated: There is much to debate over healthcare 5 years. reform and how to achieve it. But those who In this case, the overall scheme would in- The Business Roundtable supports object on constitutional grounds are making volve the regulation of ‘‘commerce’’ as the this legislation. They say: a faulty argument that should have no place Supreme Court has defined it for several decades, as it would involve the regulation of On behalf of the members of Business in the debate over this important public Roundtable, I want to commend you for your issue. health care markets. And the success of such a regulatory scheme would depend upon re- efforts to improve the health care reform Mr. BAUCUS. Mr. President, as a sec- quiring all to participate. legislation currently being considered by the ond example, I refer my colleagues to United States Senate. The proposed legisla- Doug Kendall of the Constitutional tion is a step toward our shared goal of pro- an article by Mark Hall, a law pro- Accountability Center similarly con- fessor at Wake Forest University. His viding high quality, affordable health care cluded: for all Americans. . . . As we understand it, article is a comprehensive peer-re- The fundamental point behind pushing peo- the proposed legislation now will include viewed analysis of the constitu- ple into the private insurance market is to provisions to accelerate and enhance the tionality of a Federal individual re- make sure that uninsured individuals who process for delivery reform for the Medicare sponsibility requirement. can pay for health insurance don’t impose system. . . . It strengthens the match be- In this article, Professor Hall con- costs on other taxpayers. tween the insurance reforms and the indi- cludes that there are no plausible 10th Professor Michael Dorf of the Cornell vidual obligation. . . . We will continue to amendment or States’ rights issues University Law School also noted: work with you, the Congress and the Admin- arising from the imposition by Con- istration to ensure we achieve the goals we [T]he individual mandate is ‘‘plainly all set when this process began. gress of an individual responsibility to adapted’’ to the undoubtedly legitimate end maintain health coverage. of regulating the enormous and enormously The American Diabetes Association Professor Hall notes further that important health care sector of the national also supports this bill. They say it is health care and health insurance both economy. It is therefore constitutional. ‘‘long overdue improvements to our affect and are distributed through Robert Shapiro, a professor of law at broken health care system.’’ interstate commerce, and that gives Emory University School of Law, stat- The Small Business Majority also be- Congress the power to legislate a cov- ed: lieves the managers’ amendment ‘‘in- erage requirement using its commerce When everyone thinks of the wisdom of an cludes new provisions essential for clause powers. individual mandate, or of health care reform small business protection and sur- Professor Hall notes that the Su- generally, it would be surprising if the Con- vival.’’ preme Court indicated in its decision stitution prohibited a democratic resolution Doctors for America supports passage of the issue. Happily, it does not. in U.S. v. Morrison and U.S. v. Lopez— of this bill. two other cases relied on by the other Thus, Mr. President, the weight of The National Hospice and Palliative side—that the noneconomic, criminal authority is that health care and insur- Care Organization strongly supports nature of the conduct in those cases ance represent interstate commerce. this legislation. There has been confu- were central to the Court’s decisions in The individual responsibility require- sion as to whether they did. But they those cases that the government had ment to maintain coverage would be strongly support it, saying: not appropriately exercised power within Congress’s power to regulate On behalf of hospice and palliative care under the commerce clause. interstate commerce. providers and the more than 1.5 million pa- Mr. President, in the last hour, sev- tients, and their families . . . would like to Health insurance, on the other hand, eral Senators on the other side listed express our strong support for the national does not deal with criminal conduct. many organizations they claim oppose effort to enact health care reform. We ac- Health insurance is commercial and the bill before us. I will indicate many knowledge the enormity and complexity . . . economic in nature and, to reiterate, and we applaud your recognition of the im- organizations that favor the health substantially affects interstate com- portance of various provisions. . . . care reform bill. merce. I will begin with the American Med- Families USA supports this legisla- Health insurance and health care ical Association. That is the major doc- tion. I already mentioned AARP, which services are a significant part of the tors association that supports this leg- also supports it. Community Catalyst national economy. National health islation. In fact, the incoming presi- is another organization that supports spending is 17.6 percent of the econ- dent, the president-elect of AMA, at a it. U.S. PIRG supports it. The Center omy, and it is projected to increase press conference yesterday, made that for American Progress supports it. from $2.5 trillion in 2009 to $4.7 trillion statement very clear. Medco Health, Microsoft, a big com- in 2019. In addition, the American Heart As- pany in the United States, makes a Private health insurance spending is sociation supports the legislation. strong statement approving the meas- projected to be $854 billion in 2009. It They believe the many patient-cen- ure we are considering here. covers things such as medical supplies, tered provisions are a significant step Many organizations support this leg- drugs, and equipment that are shipped toward meaningful health care. islation. I am sure there are more, but in interstate commerce. The American Hospital Association this is an example of a few. Health insurance is sold by national supports passage of the legislation. How much time remains on our side? or regional health insurance carriers. The American Cancer Society Action The ACTING PRESIDENT pro tem- Thus, health insurance is sold in inter- Network supports it. pore. There is 10 minutes remaining. state commerce. As well, claims pay- The Federation of American Hos- Mr. BAUCUS. Mr. President, I yield ments flow through interstate com- pitals also supports it. 10 minutes to the Senator from Penn- merce. The National Puerto Rican Coalition sylvania. The individual responsibility require- supports this legislation. The ACTING PRESIDENT pro tem- ments, together with other provisions Mr. President, it would be unfair to pore. The Senator from Pennsylvania in the act, will add millions of new con- say that these are all totally 100 per- is recognized.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00055 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13768 CONGRESSIONAL RECORD — SENATE December 22, 2009 Mr. CASEY. Mr. President, I com- into a high-risk pool to get help right notified when I have 2 minutes remain- mend the work of our Finance Com- away. ing, I would appreciate that. mittee chairman, MAX BAUCUS, for so It improves care to older citizens, as The ACTING PRESIDENT pro tem- many things in this debate. First, for I mentioned, and lowers prescription pore. The Chair is unaware of any re- helping us get health care legislation drug costs. strictions. There is 1 hour for the Sen- moving in 2009 and now at the point of It reduces costs for small businesses ator’s side. getting close to passing the bill. I am through tax credits. Mr. LEMIEUX. OK. If I can be noti- grateful for his leadership. There are Fourth, it extends coverage for fied when I have spoken for 20 minutes. some highlights of the bill I want to young adults—young adults 25, 26 years The ACTING PRESIDENT pro tem- note in the remaining moments of our old, who may be living under difficult pore. The Chair will so notify the Sen- time. circumstances and don’t have insur- ator. First, there has been a lot of debate ance coverage. Preventive care—we Mr. LEMIEUX. Mr. President, I rise over the last couple of days and preached and talked about that for today to talk about this health care weeks—but even over months—about years, and we point to studies and good bill. I have spoken about it before. I cost and care. Fortunately, we are able practices, but we have never made it feel obligated on behalf of my State of to report that with this bill coming out part of our overall health care bill. Florida to explain why I, unfortu- of the Senate, we will have more care This bill does it. nately, will not be able to support this bill on final passage. I think, in doing and less costs. The deficit will be cut We eliminate lifetime limits on the so, it is important to talk about why by $132 billion over 10 years as a result amount of coverage a person may receive—a terrible problem for families. we are here and how we got here. of this bill; $1.3 trillion will be cut in I am sure the American people think The message from our system has been the deficit in the second decade. that in this process of debating health It will provide coverage for 94 percent that we can cure you, but we have to care over the past weeks and months, of the American people. This has not limit the kind of care we are going to this has been a process where both been talked about much, but the bill is provide for you. sides, Republicans and Democrats, Three more points in this area: What a net tax cut for the American people. have worked together, sat in an open are the immediate benefits in 2010? It We are going to crack down on insur- room and gave ideas back and forth; prohibits discrimination based upon ers’ practices that have gone on too that there has been give-and-take and salary, gender, or illness. We make in- long, were allowed to go on for too compromise so that we could come to surance plans more transparent and many years: ending preexisting condi- the plan that is before us today. I am tion discrimination, and discrimina- competitive. sure the American people believe that Finally—and this is a rather new tion based upon gender, providing pro- amendments were offered, that each change—it prohibits insurance compa- tection from exorbitant out-of-pocket Senator could come to the floor and costs, something we hear about all the nies from denying children coverage offer amendments and that his and her time. due to a preexisting condition. colleagues were allowed to hear about That has moved up in the bill, so to Just with regard to older citizens those amendments and vote them up or across our country, one, the bill will speak, to an immediate benefit for down. I also believe the American peo- extend the solvency of Medicare; two, children. So at least in the short term ple think we do not just come to this it makes prescription drugs more af- for children, there will be no more de- Chamber and give monologs. They fordable by filling the so-called dough- nying them coverage due to a pre- probably think this room is not empty nut hole and helping people with those existing condition—a tremendous and that there are just two of my dis- costs; cutting waste, fraud, and abuse breakthrough for a child, for his or her tinguished colleagues here but that we in Medicare; ensuring Medicare funding family, and for our economy and for all sit here and listen to each others’ to improving care for seniors not to in- our health care system, to protect chil- arguments and decide what is best for surance companies. dren in a very substantial way. Wheth- the American people. Small businesses—if there was one er it is cutting the deficit, providing Unfortunately, that is not the case sector of our economy we have heard better quality of care, providing oppor- with this bill. This bill was designed from over and over about the crushing tunities for great prevention which will and crafted by the Democratic leader- burden of health care costs, it is small lead to a healthier outcome, protecting ship, without the input of the col- businesses. I know that tens of thou- people so they do not have to go bank- leagues from this side of the aisle. sands of small businesses in Pennsyl- rupt to get the care they need, and es- There was no give-and-take. There was vania, for example, will benefit from pecially for protecting older citizens no back-and-forth in a conference room this legislation. and children, this bill moves forward in with C–SPAN in the room, as the Presi- There are two points with regard to a way we have never had an oppor- dent told us he would ensure when he the bill and small business. First, the tunity to move our system forward in a ran for the Office of the Presidency. bill provides tax credits to small busi- very positive way. And we did not have the opportunity to nesses to make employee coverage I again commend Chairman BAUCUS offer amendments to make this bill more affordable. on his work and our majority leader, better. Second, tax credits of up to 50 per- HARRY REID, and all those who made it I know that seems hard to believe, cent of premiums will be available to possible to move this bill forward and that we would not have the ability to eligible firms that choose to offer cov- to have it passed through the Senate offer amendments to make this bill erage—a tremendous breakthrough for and move it to enactment. better, but I can prove it to you. people out there who are creating most I yield the floor. I have an amendment at the desk. It of the jobs in Pennsylvania and most of The ACTING PRESIDENT pro tem- is amendment No. 3225. What this the jobs nationally. pore. The Senator from Montana. amendment does is it takes a piece of One of the more unreported or under- Mr. BAUCUS. Mr. President, I see no legislation I filed shortly after coming reported aspects of the bill is what hap- Senator seeking recognition. I ask to the Senate in September of this pens immediately. A lot of folks say: unanimous consent that the next block year—the legislation is called the Pre- We like your bill. We like what is going of time begin immediately. vent Health Care Fraud Act of 2009. to happen. But a lot of it won’t take ef- The ACTING PRESIDENT pro tem- This legislation has 11 cosponsors. It fect for at least several years, until pore. Without objection, it is so or- has bipartisan support. 2014. dered. What the bill does is basically three A good part of the bill takes effect in The Senator from Florida. things: 2010. A quick summary of those provi- Mr. LEMIEUX. Mr. President, I First, it creates the chief health care sions: First, it provides affordable cov- thank the chairman of the Senate Fi- fraud prevention officer of the United erage to the uninsured with preexisting nance Committee for his courtesy. I ap- States. It would be the No. 2 person at conditions. If there is an insurance preciate the opportunity to be here. Health and Human Services. Their only company that excludes you because of I understand, Mr. President, I have a job would be to ferret out health care a preexisting condition, you can go certain allotment of time. If I can be fraud.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00056 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13769 Second, it would use and take a page preserve and protect the program’s in- bill done. But it is my concern with from the private sector to go after tegrity. The bill does a lot to protect this measure and with the other meas- fraud. There is an industry out there fraud. ures in the bill that we could have right now that does an excellent job of I might say, I know this is on his worked together. stopping fraud. That industry is about time, but this procedure has been un- Mr. President, I say to the chairman, the same size as the health care indus- usual. I appreciate the indulgence of I am new to the Chamber. But this is try. It is the credit card business. It is the Chair, as well as the indulgence of not the way businesses work. It is not about a $2 trillion business. Health the Senator from Florida. the way American families work. It is care is about a $2 trillion business. In You will not believe the number of not the way even State legislators health care and in Medicare alone, esti- amendments that were offered on a bi- work, which I have experience with in mates are that $1 out of every $7 in partisan basis in the Finance Com- Florida. Medicare is fraud. In the credit card mittee, as well as in the HELP Com- I wish we could have talked about business, it is pennies on the hundreds mittee. They were adopted in both that amendment and offered it. I wish of dollars. committees. It was very transparent, my colleagues were here to debate it up How does the credit card business do open, bipartisan. Unfortunately, by the or down. Let’s talk about where we are it? We have all had this experience. time the bill got to the floor, it became instead. Let’s talk about what this bill You go to purchase something in a apparent we were facing less than the does and why I cannot, unfortunately, store, and when you leave, you get an nature of legitimate amendments, support it as a Senator from Florida. e-mail or a phone call and your credit more message amendments. So the ma- We know this bill cuts Medicare by 1 card company says to you: Did you jority leader resorted to a procedure to nearly $ ⁄2 trillion. We know this bill 1 really mean to purchase that good or move this bill expeditiously. raises taxes by nearly $ ⁄2 trillion. And service? Guess what. If you say no, I am taking advantage of the Sen- we know it does not accomplish the they don’t pay. The way we do things ator’s time to explain all this. That is fundamental goal the President put in Medicare and Medicaid is we do pay- not the proper procedure. There are forward when we embarked on this de- and-chase. We pay, and then when we strong antifraud provisions in this leg- bate about health care reform. The American people are beginning think there is fraud, we try to go after islation, and very respectfully I must to realize and if they have not realized it. object. yet will be shocked to hear that this This model stops the fraud before it The ACTING PRESIDENT pro tem- bill is not going to cut the cost of starts. A group here in Washington, pore. Objection is heard. health care for people who have insur- DC, has evaluated this legislation and Mr. LEMIEUX. Mr. President, I ance already. That is the very reason says that it might save as much as $20 thank the distinguished chairman of this debate was embarked upon, not billion a year in Medicare alone. We the Finance Committee. Sure, there just access for people who do not have think there is $60 billion in fraud in are things in this bill that he pointed health care insurance but to bring the out to go after fraud. But I would like Medicare—$1 out of every $7. costs down. Health care has gone up 130 This proposal that we put forward to inform the Senate of a report that percent in the past 10 years. This bill also would require background checks came out evaluating this new bill, the will not address that. In fact, estimates for every health care provider in Amer- managers’ amendment. show that for some folks, the cost of ica to make sure they are not a crimi- I have a table which evaluates how health care will go up. nal. Florida, my State, unfortunately much will be saved from the waste, There are basically five reasons why is ground zero for health care fraud. We fraud, and abuse provisions which are I cannot support this measure as a Sen- have the worst health care fraud in in this bill. It is $.9 billion. The pro- ator from Florida. America. Just this past weekend, and I posal that I have, one group—and, I am concerned, first of all, about ac- sent this letter around to my col- again, it is not the CBO—one group has cess and quality of care for our seniors. said it might save $20 billion a year. leagues—a $61 million Medicare fraud When you take $1⁄2 trillion out of Medi- scheme out of Florida and some other Putting aside our differences, I sure care, my fear is that it is going to di- States. wish we could talk about my amend- minish the quality of care for seniors My bill, this proposal which has bi- ment today, I say to my colleague. I in Florida. partisan support, could save $20 billion hope we can revisit it after this is over It is said on the other side that we a year. We have fashioned this bill into because we should be able to agree, and are not going to take away benefits, an amendment to this health care bill. it does have bipartisan support. I wish that we are just going to take money Mr. President, I ask unanimous con- we could amend the bill today. I hear away from providers. It was said on the sent that the pending amendment be the objection, and I will move on. I other side that the new insurance will set aside to call up my amendment. It hope we can talk about this. take care of uncompensated care, so is amendment No. 3225. Mr. BAUCUS. I ask the Senator if he that the cuts to hospitals and to other The ACTING PRESIDENT pro tem- might yield using time on our side. I providers will not really hurt seniors in pore. Is there objection? fully agree with the Senator. It is un- the end. I think that is a tremendously Mr. BAUCUS. Reserving the right to fortunate we cannot proceed at this risky experiment. object, and I hope my colleague will let moment. But I pledge my support next I cannot believe, at the end of the me say a word or two in my reserva- year to work aggressively with very day, when we pay providers less, it is tion, the underlying bill, while cer- strong oversight to boost our antifraud not going to affect benefits. Right now, tainly objective, was crafted with the measures even more than they are in studies show that 24 percent of seniors guidance of CMS, the Office of the In- this bill. on Medicare trying to find primary spector General, HHS, and the Justice There will be an awful lot of over- care physicians cannot find one. I get Department for stronger antifraud. It sight necessary when the bill is passed letters from seniors in Florida who say would give CMS new screening author- to make sure all the provisions that they cannot find a doctor who will take ity to provide resources to CMS for are intended come true. In fact, we their Medicare. We know in Medicaid it new screening authority. It also limits think we are working hard to get it is worse. We know in Medicaid that if providers in other ways but more over- passed; frankly, I think we have to you are just going into the program sight when fraud is suspected, such as work harder next year to make sure and trying to find a physician, almost limiting durable medical equipment the provisions work. I pledge my sup- 40 percent of the physicians will not providers because we know it is fraught port to work aggressively in that area. take you. In metropolitan areas for with fraud. We also require providers Mr. LEMIEUX. I thank the chairman. specialists, it is up to 50 percent who to have compliance programs, make I wish we could do it before we had to will not take Medicaid. sure providers know the rules. There rush to judgment on this bill. I wish we I fear that if we take nearly $1⁄2 tril- are increased penalties for fraudulent had more time. I wish we did not have lion out of a program that is already in activity in the bill as well. Most impor- to be backed up against a wall before financial trouble, a program that in tantly, we will give CMS, HHS, OIJ, Christmas. I understand colleagues on the next 7 years is going to be in seri- and DOJ more tools at their disposal to the other side have a desire to get this ous financial trouble and not be able to

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00057 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13770 CONGRESSIONAL RECORD — SENATE December 22, 2009 meet its obligations, that it is going to the payments to the providers for bene- to work. That is why health care costs hurt seniors. fits—are going to decline 5 percent a aren’t going down for the 170 million I have heard this discussion about year. That is on pages 895 through 897. Americans who have health insurance. how we are prolonging the life of Medi- So it is an off-ramp. Every year, less In fact, for some, they are going to go care. The distinguished chairman just payments. Every year, less benefits. up. That is not health care reform. spoke about it. But when you look at I talked to one provider down in Fourth, this is a budget-busting bill. what the Actuary at HHS has said Miami that many Senators in this It is not deficit neutral. Let me explain about that assumption, the assumption Chamber have visited. He runs a very why. You will hear reports this is going is that we are not going to restore the successful Medicare Advantage Pro- to cut more than $100 billion from the 21-percent decrease in physician pay- gram. He said these cuts would be dev- deficit over the next 10 years. Only in ments which, of course, as soon as we astating. So while it might not be an Washington, DC, could you come to get back in the new year, we are going exit for Florida right away, it is cer- this calculation. It is funny math. We to have before us. tainly going to be an off-ramp that one have this Congressional Budget Office, You cannot take money out of Medi- day ends up being an exit. which is sort of the arbiter of all things care and pay for a new program and Let’s remember that many of the financial here in Washington. You send shore up Medicare. You do not need an folks on the other side of the aisle who them a proposal and they give you an actuary or an evaluation or an analyst are proposing these cuts to Medicare answer. But it is not a thinking an- to tell you that. It is common sense. Advantage didn’t vote for Medicare Ad- swer; it is an analytical answer, and it You cannot get blood from a stone. If vantage to start with. They don’t like gets gamed. What you send them deter- the doctor is not in, it is not health it. They don’t like the private sector mines what you get back. They only care reform. being involved. They don’t like these look at a 10-year period—what it is I have received a letter, as many of extra benefits being provided. It goes going to cost in the next 10 years. If my colleagues have, from an organiza- against what they philosophically be- you bring in more money than you tion called 60 Plus which represents 5.5 lieve. But I know Floridians like it. Be- spend in the next 10 years, then it will million seniors. James Martin, the cause this bill cuts it, I can’t be for it. cut the budget. It will cut the deficit. president of 60 Plus, writes: No one can guarantee to me that in the That is what they say back to you. Cutting half a trillion dollars from Medi- next 10 years Medicare Advantage in So what was done in this bill in order care while adding 31 million more to the Florida will be as robust as it is today. to get something that would fulfill the health care rolls is an outrage. I am concerned also about the home President’s promise to be a budget cut 60 Plus strongly supports health care re- health care payments. I am concerned or at least deficit neutral? We have 10 form but first we should do no harm to a sys- about what it is going to do to the years of taxes and 6 years of benefits. tem serving so many so well. . . . Make in- small business home health care pro- Most of the benefits don’t start until cremental changes that do not bankrupt a viders in Florida. I talked to the larg- 2014, yet the taxes start in 2 weeks—in system already teetering on insolvency. est provider of home health care serv- January. That is akin to you going to I want to talk a minute about Medi- ices in Florida, and he said: We will be buy a home and saying: I am going to care Advantage. There are more Florid- fine, but the small businesses—the live here for 10 years, and they say: ians in Medicare Advantage than any mom and pops who do this—will go out That is great, start paying today and other State. A lot has been said about of business. That is disconcerting in a you can move in in 2014. this program. We have had amend- State with 111⁄2 percent unemployment. It is funny math. This is a $2.5 tril- ments to try to stop the cuts. Mr. The second reason I can’t support lion new entitlement program we can’t President, 950,000 Floridians—Medicare this bill is this is going to have a dev- afford. We can’t afford the programs we Advantage is a great program, and peo- astating effect on our State budget in have, let alone the programs the ma- ple in Florida enjoy it. Seniors enjoy it Florida. We talked today to the head of jority in this Chamber want. We have a because they get more than regular the Florida health care system, the $12 trillion deficit. We have $30-some care; they get eye care, hearing care, Agency for Health Care Administra- trillion in unfunded entitlement def- wellness, diabetic supplies, and other tion, and these increases in Medicaid, icit. We have hundreds of thousands of things that add to the quality of life of raising Medicaid from 100 percent of dollars of debt for every family in seniors and help their entire health poverty to 133 percent, are going to America, and no plan to pay for it. We care. These Medicare Advantage pro- cost Florida an estimated $31⁄2 billion spend more than we take in. We spent viders are actually working hard to over the next 10 years. That is $31⁄2 bil- $1.4 trillion—we have a $1.4 trillion def- make sure their senior customers are lion Florida can’t afford to pay. icit this year—just the debt this year. happy, not a concept you hear a lot Our budget has gone from $73 billion That is more than the past 4 years about when the government is in to $66 billion in a short period of time combined. charge. with the economic decline. Unlike this The American people are on to this There is a fix for Florida, as has been Chamber, which spends money it and they are angry about it and they talked about, but I wish to talk about doesn’t have, Florida has to balance its should be. what that fix is, as I understand it. It budget. So what happens when you The ACTING PRESIDENT pro tem- is an off-ramp. For the rest of the have less money? You have to cut pro- pore. The Senator has used 20 minutes. country, it is going to be somewhat of grams. But when you have a Federal Mr. LEMIEUX. Fifth and finally, the an exit. For Florida, it is an off-ramp. mandate, you can’t cut that. So what reason I can’t support this bill is it First of all, we don’t know what will do you cut? You cut education and doesn’t lower the cost of health insur- happen in conference. The Senate cuts teachers. You cut law enforcement— ance for Americans. $120 billion; the House cuts $170 billion. not good for Florida. This is a burden The Congressional Budget Office has I don’t know if the Florida fix will still Florida can’t afford to pay. That is said the majority of Americans would be there. But in talking to experts and why all the Governors in the country— see the same increases as they cur- reading the bill myself—specifically virtually Republican and Democratic rently get under the current system. around page 895 through about 901 of alike—including our Governor, Charlie For some people, individual policies, the original Reid bill—there is this Crist, are against this unfunded man- for example, they will receive a 10- to grandfathering in for folks in Florida, date. 13-percent increase. and other areas, but part of Florida is The third reason I can’t support this I am going to conclude by saying covered. Of the 950,000 people, the ex- bill is because it raises taxes—$518 bil- this, and this will probably be the final perts think 150,000 to maybe as many lion. What happens when the drug com- time I will speak before we have final as 250,000 will not get this grand- pany that makes your medicine or the passage on this bill. I long for what fathering in. They are going to get the medical device company that makes could have been. We could have worked cuts to Medicare Advantage. So this is the lifesaving implement for you gets together. We could have had an 80-vote not good for them. Then, for the oth- taxed? They are going to pass it along bill. We could have had a bill that ers, say, 700,000 people or so, every to you. They are going to put it right would say insurance companies can’t year, starting in 2013, their benefits—or in the bill. That is the way it is going drop you if you are sick, insurance

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00058 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13771 companies can’t deny you if you have a an opportunity to spend a lot of time and this is a concern that was raised by preexisting condition, insurance com- checking to see what people are saying the Anchorage homebuilders and the panies can compete across State lines, when they are contacting our office. Alaska State Home Building Associa- set up an exchange, give a tax credit to The volume of correspondence, whether tion. They have pointed out that as an the American people, put money in in e-mails or faxes or phone calls, com- industry, the homebuilders industry, their pocket, let them be consumers ing in from Alaskans during this time they are being unfairly singled out in who go out and buy health insurance has been absolutely unprecedented. this bill. and drive the cost down because the I think, typically, in the legislative We have talked about the employer market economy would, once again, calendar about this time—several days mandate that is contained in this legis- work in health care. before Christmas—you don’t see con- lation, and that mandate applies to This bill doesn’t solve the problem. It stituents contacting their Senators those businesses with 50 or more em- perpetuates it and makes it worse. At and pounding the drum. Well, let me ployees. But there is a zing in this leg- the same time, it cuts health care for tell you, the people in Alaska are islation to homebuilders who are now seniors and doesn’t lower the cost of pounding the drum. In just the past 24 responsible for providing federally ap- health insurance for most Americans. hours, we have gotten probably close to proved health benefits if they have five For more and more seniors, the doctor about 500 health care e-mails that have or more employees. will not be in. That is not reform. For come in. Overwhelmingly these are e- Look at what is going on throughout those reasons, respectfully, for that mails from constituents saying: No, this country in terms of industries that lost opportunity, I will not be able to this is not good. You must do what you have taken a real hit with this eco- support this bill. can to prevent this reform package, as nomic downturn and this recession. I yield the remainder of my time to you call it, from moving forward. The homebuilding industry has suf- my friend and colleague from Alaska. It seems the longer the people from fered incredibly during this downturn. The ACTING PRESIDENT pro tem- Alaska, the longer the people from On top of depressed house prices and pore. The Senator from Alaska is rec- around this country have to look at increases in home foreclosures, now we ognized. what is contained in this 2,000-plus are now going to punish them with an Ms. MURKOWSKI. Mr. President, I page bill, the more they realize the employer mandate that treats them wish to acknowledge the very eloquent negative impacts, the consequences to worse than any other employer. In and articulate comments of my friend them and their families and their busi- other words, if you have five or more from Florida. We recognize that his nesses and they are no longer silent. I employees as a homebuilder, you need time in the Senate has been relatively have had so many calls and letters to know that your industry is the one, short, but in terms of an individual coming from people saying: I have the only one that will be subject to the jumping in with both feet and embrac- never weighed in with you before, employer mandate of $750 per em- ing the challenges we clearly have in never weighed in with my delegation, ployee. front of us and representing the con- but this is something I can’t keep si- In Alaska, we checked to see how stituents of the State of Florida in the lent on. many individuals are homebuilders manner he has, I think that deserves When you look at some of the ones within the State. We have about 250 public recognition, and I thank the that have come in, these are just to- homebuilders in Alaska. But when you Senator for his leadership. day’s. This is one from a woman in An- look to see how many individuals they We have had occasion to talk about chorage who says: Yesterday on the TV employ, that is about 3,078 employees, the similarities between Alaska and news I heard about the sweetheart deal it is about 12 employees to every build- Florida. You might not think there Senator NELSON made regarding the er. So the total homebuilding industry would be much in relationship there— rest of us paying Nebraska’s Medicare that would be impacted is about 800 my being from the North and the cold bill forever. To say I am angry is put- employers in my State. versus the sunny South in Florida. But ting it mildly. Yesterday, there was a letter sent to when it comes to our senior popu- There is a gentleman in Fairbanks Members of the Senate. This is from lations, this is where we truly have a who writes in: I am very skeptical the homebuilding industry as well as shared interest. Florida has probably about this mandatory health insurance many other associated industries—the the largest number of seniors per cap- that apparently everyone will have to air-conditioning contractors, the build- ita, and in my State of Alaska, we are buy in. ers and contractors, the electrical con- the State that has the fastest growing Here is one from a fellow in Anchor- tractors. I wish to mention some of the population of seniors per capita. age also. He says: You are moving a statements that are contained in this One might not think of Alaska as health care bill that can’t be under- letter. Again, it is written yesterday. being a retirement haven, but more stood unless a person has a law degree. They say: and more we are becoming so, and we Another individual, and this is an in- We are writing to express our strong oppo- share the same problems when it comes teresting one. He and his family appar- sition to language contained in the man- to access. When you can’t get in to see ently own four indoor tanning busi- agers’ amendment which excludes the con- a provider, when that insurance card is nesses in Alaska. We need to get a lit- struction industry from the small business all we have given you, then we haven’t tle sunshine, even if it is not what God exemption contained in the bill. The fact done anything to provide for a level of has provided us. But these are good that the managers’ amendment was made care to improve the situation for the businesses, and he says: When did this public less than 2 days before the first vote on the matter has increased the difficulty of residents of Florida or the residents of go from a 5-percent tax increase for playing a constructive role in the legislative Alaska. So what we are doing today— cosmetic surgery to 10 percent for in- process. as we move toward final passage on door tanning anyway? And he adds: I will take a little detour from the legislation that I would concur with Adding another 10-percent tax hike on letter. This is part of the problem. You the Senator from Florida does not fix small businesses, like indoor tanning, have these organizations and groups, the problem—we are not dealing with will likely drive many families, just and there is a list of about a dozen of how we appropriately and adequately like mine, into bankruptcy. them here, that have signed on to this provide for access to quality health I could go on and on in terms of the letter. They had literally hours before care. We have much work remaining stacks of correspondence and phone we were forced to vote on the man- before us. calls we have gotten, but suffice it to agers’ amendment. They did not know We have had some time these past say, the more people understand what what was in the bill and how it im- couple days—actually these past couple is in this legislation, the greater their pacted them. They go on to say: weeks—as we have spent a considerable concerns are and the greater their out- amount of time in our offices waiting The managers’ amendment singles out the rage as they learn what is contained in construction industry by altering the exemp- for votes at 1 in the morning or votes it. tion so it applies only to firms with fewer at 7 o’clock in the morning, and I have One of the things I learned just yes- than 5 employees. This is an unprecedented had a chance to go through some terday, which I don’t think we have assault on our industry. It is unreasonable to things on my desk, but I have also had gotten the focus or the attention on— presume that small business owners can bear

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This is how we are paying for the simply because Congress mandates that they taxes on small businesses for the indi- bill. do so. viduals, the families, the health bene- CBO and CMS told us the taxes on They go on to conclude in the letter: fits of the police, the firefighters, other medical devices—whether they are We are unaware of any data or evidence public protective service people who tongue depressors or x-rays or blood that suggests that the needs and struggles of put their lives on the line for so many. sugar meters—these are going to be a construction contractor with fewer than 50 These are the things about which, un- passed on to the individuals so you are employees are so different from those of going to be taxed for vital medications small business owners in other industries, fortunately, we might not be getting and absent such convincing evidence, we are the full picture. and other health products. The ques- left to assume that this specific provision is Our colleagues on the other side have tion you then have to ask yourself: OK, merely a political payoff to satisfy the de- claimed that health care coverage will so do these hidden costs actually go sires of a small constituency. be expanded. Again, let’s go to our non- away? Those are some pretty strong words partisan entities—the CBO and the I suppose they do because they are no there toward the end. But it does cause Joint Committee on Taxation. The av- longer hidden. What we will have done you to wonder why, in this legislation, erage premium per person, if you pur- is we will have raised your premiums, we are going to require that busi- chase in the individual market, is we will have increased the penalties on nesses—only businesses in excess of 50 going to be 10 to 13 percent higher in those earning more than $37,500 who employees are going to be subject to 2016 than the average premium under did not buy into health insurance, and this mandate. Why this unprecedented current law. That tells you if these we will have taxed your tongue depres- assault on the homebuilders? I don’t Federal scorekeepers are correct, your sors and x-rays to pay for the bill. get it. But what it does cause me to get premiums are going to go up under this In addition, the smallest of the small is that there is a heck of a lot more out health bill if you buy insurance your- businesses are going to be taxed if they there that, the more we read it, the self. do not provide insurance for their em- more we sit down and we connect the In Alaska, according to ISER—again, ployees, and individuals and couples dots, the more we realize this fish we the Institute for Social and Economic earning over $200,000, they are going to have set out on the front porch is going Research—you have about 28,000 Alas- be penalized because they are the high- to continue to stink. kans who would pay 12 percent more er income earners. It stuns me. We have the home- for their premiums. It is going to cost The Democrats are also telling you builders up in Alaska who are beside an individual in my State an extra that as Medicare patients, they are themselves, saying: Can you take a $1,100 per year and a family in my going to get some good, positive look at this and let me know how the State nearly $3,000 more per year for things. They will get free preventive Senators feel. What are you going to do the coverage by 2016. services. This is good. This is abso- about this, LISA, is the question I have Again, you have to ask the question: lutely great. We should be encouraging received. Is health care expanding? This bill preventive services. This is something we all have to forces you to purchase federally ap- But as my colleague from Florida reckon with. proved health care; otherwise, you was explaining, as I mentioned, after Madam President, at the conclusion have to pay the penalty of $750 or 2 per- this bill passes, are any of the 13—I of my remarks, I ask unanimous con- cent of your income if you earn more think we are down to only 12 now—pri- sent that a copy of the letter be print- than $37,500. mary care doctors in Alaska, in the ed in the RECORD. If you look at Alaska’s population, Anchorage area anyway, accepting new The PRESIDING OFFICER (Mrs. this is going to bring in more than 50 Medicare patients? We are saying we SHAHEEN). Without objection, it is so percent of Alaska’s population who are are going to provide this service to you ordered. going to be penalized if they fail to at no cost. But, again, if you can’t get (See Exhibit 1.) have health insurance. Again, you ask anybody who will take you as a pa- Ms. MURKOWSKI. I am going to the question: Is health care coverage tient, how are we helping you? We have speak a little bit about how aspects of going to be expanded? heard from a doctor in Anchorage. In this legislation have impact specifi- Since the law we are advancing is fact, I have an opinion piece that was cally on my State. As a rural State, going to require that you buy federally published just this week in the Anchor- sometimes the impacts we see are dif- approved health insurance, and then we age Daily News. She indicates she is ferent than you have in more urban are going to penalize you if you do not dropping out of Medicare and she is States. Our geography is different, our buy it, then what you have is the heavy doing it because of this legislation. lack of providers, our high senior popu- hand of the Federal Government that I ask unanimous consent that be lation, our extremely expensive costs, forces you to buy health insurance, printed in the RECORD. there are a lot of dynamics at play that which is going to cost about 12 percent There being no objection, the mate- cause real issues and real concerns. more once this bill is enacted—12 per- rial was ordered to be printed in the There have been many words that cent more than it would today. RECORD, as follows: have been exchanged on this floor The Democrats will also talk about [From the Anchorage Daily News, Dec. 18, about what this bill doesn’t do or what the hidden tax on families and how 2009] it does do. I find it helpful to go to the that will go away because once this bill OPINION: DOCTORS AND PATIENTS, NOT FEDS, experts, the think tank in my State, passes, under this bill, everyone is KNOW BEST and ask them flat out. We have an in- going to have coverage. Alaskans and (By Ilona Farr, M.D.) stitution at the University of Alaska all Americans who do not get federally I have made the heart-wrenching decision called the Institute of Social Economic approved health insurance that the as a physician to opt out of Medicare. I do so Research. I take what they have to say Federal Government is going to require after working with Sen. Stevens, Sen. Mur- very seriously. that you have, they are going to be kowski and Rep. Young for a decade in hopes I also take very seriously what our fined $750, 2 percent of your taxable in- we could ensure seniors would be able to con- Congressional Budget Office has to say, come, and what the Democrats will not tinue to receive medical services in Alaska. On a visit costing $115, Medicare pays $40, what the CMS Actuary has to say, be- tell you when they say health care cov- secondary insurance pays $7, and the rest— cause, as my colleague from Florida erage is going to be expanded or the $68—is a loss, not a tax write-off. It takes six pointed out, these are the independent hidden tax is going to go away is, those insurance paying patient visits to offset arbiters. These are the guys whose job with income greater than $37,500— losses from one Medicare or Medicaid pa- it is to work the numbers. I would like again, affecting over 50 percent of the tient. to discuss some of the findings from people in my State—are going to be The House health care bills, HR3590/ the University of Alaska and also try taxed a full 2 percent of their house- HR3962, increase the number of people not paying their share of the costs and will lead to inject a little bit of common sense hold income, once the bill is fully doctors to opt out of Medicare or retire into the debate as to what it means for phased in, if they do not get health in- early. Alaska, how it increases their pre- surance. It is this penalty that is going Anchorage has 75 family physicians, down miums, how it raises that cost curve on to raise $15 billion to help pay for this from 180. Physician shortages like these are

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00060 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13773 caused by government interference in the that will bankrupt us as individuals and as a dividual market, they are going to see free market. Government artificially keeps nation. their premiums go up an extra $1,160 reimbursement rates low, forcing other pa- Ms. MURKOWSKI. It is no secret, in per year for a family—nearly $3,000 tients, and insurance companies, to pick up my State of Alaska and in far too more in 2016. the additional costs. Family practice Alaska is defined as a high-cost residencies are filled with foreign medical many States around this country, we graduates because of high costs (more than do not have enough providers that will State. If you are a small business that $200,000) associated with medical school. Low take these individuals. ISER has said can afford to pay good health and den- physician reimbursement rates make it dif- seniors in low payment Medicare tal benefits for your employees and ficult to repay loans. States will be forced to wait in line. those benefits amount to $8,500 per in- Medicare and Medicaid auditors are paid Alaska is one of two States—we are, I dividual or $23,000 per family, in a high- on commission, can fine us $2,000 to $50,000 think, second to last in terms of Medi- cost State such as Alaska, you look to for one charting mistake or billing error, and be hit with a 40-percent excise tax be- then extrapolate this over the practice and care payments and where we stack up drive us out of business . . . all for one minor in relation to the reimbursement. ISER cause you basically want to provide mistake. There is fraud, but this system that goes on to state: your employees with good benefits. penalizes us severely for simple errors is un- Independent of the doc fix, in Alaska the Again, according to ISER: tenable. remainder of seniors are at risk of long lines Alaska is a high cost state and thus, In these bills malpractice reform is re- to see a primary care doctor and overflowing roughly 50 percent of health plans in Alaska stricted, health savings accounts (which help to community health center and hospital will be subject to the tax by 2016, compared reduce costs and fraud) are essentially elimi- emergency rooms where existing capacity is to only 19 percent average in the Lower 48. nated, and taxes and fees on insurance and highly likely to be quickly overwhelmed and Again, by 2016, 50 percent of the plans medical services are increased. There are no long wait times become increasingly com- in my State will be subject to this 40- Medicare/Medicaid rate, rule, or audit re- mon. percent excise tax. forms, or tax write-offs for business losses. ISER has also said that additional One section in Sen. Harry Reid’s bill says I ask unanimous consent to have Medicare will no longer pay for home health new insured patients are going to hurt printed in the RECORD a letter we re- services, durable medical goods, and possibly Medicare beneficiaries, and they state: ceived from the municipality of An- labs, X-rays, prescriptions or other services Federal healthcare reform applied to Alas- chorage, Police and Fire Retiree Med- written by providers who have opted out of ka likely will exacerbate an already very ical Trust. Medicare. Many talented physicians have challenging situation for Alaska’s seniors as There being no objection, the mate- had to opt out of Medicare (and by this law baby boomers age into Medicare and finding rial was ordered to be printed in the must opt out of Medicaid and the military’s themselves waiting in line behind a rapidly RECORD, as follows: Tricare also) to stay in business. People will expanding line of better paying private no longer be able to see these physicians be- plans. MUNICIPALITY OF ANCHORAGE, PO- cause of government financial restrictions or LICE & FIRE RETIREE MEDICAL We are told 5 years from now our TRUST, will be forced to pay all medical bills associ- Medicare population is going to in- ated with these visits themselves. December 15, 2009. Bills under consideration cut Medicare crease by 50 percent. We cannot accom- PLAN ADMINISTRATOR REPORT spending by $460 billion, raise fees on med- modate those who are Medicare-eligi- At the November 24, 2009 PFRMT board ical services, increase physicians’ adminis- ble now. Our boom is not sustainable. meeting I brought to your attention a health trative burdens, promote electronic medical The CMS Actuary has said: care bill, HR 3590as—Patient Protection and records with mandated reporting of out- The Reid bill reduces payments to health Affordable Care Act, being considered in the comes data, and increase business costs so it care providers, which is unlikely to be sus- US Senate that contains provisions that if will be impossible for small practices to sur- tainable on a permanent basis. As a result, implement into law would require that the vive. providers could find it difficult to remain Municipality of Anchorage (MOA) and the My decision to withdraw from Medicare profitable and absent legislative interven- Trust to make changes to their current busi- was also precipitated by U.S. Preventive tion, might end their participation in the ness practices. S 1796—America’s Healthy Services Task Force’s recommendation that Medicare program. Future Act of 2009 also contains these breast cancer screening mammograms It is happening. Doctors, providers, changes and could become effective January should only be done on women between age 1, 2010. 50 and 74. Approximately 48 percent of my physicians are making those decisions Three provisions in the bill that are of par- patients with breast cancer developed it be- as we speak. They are opting out. So ticular concern are: fore age 50. Up to 1.2 percent of my practice, this is not some theoretical approach 1. Inclusion of health care benefits as tax- mostly young mothers, could have died if to the problem. This is happening. able income to employees. Not only will this this were a national guideline. Madam President, how much time do increase the employee’s taxable income but The Senate bill has this task force and we have on our side? the MOA’s payroll taxes will also increase. other committees determining what tests SEC. 9002. INCLUSION OF COST OF EM- will be covered for patients. I am concerned The PRESIDING OFFICER. The Sen- PLOYER-SPONSORED HEALTH COV- that penalties may be imposed on insurance ator has 17 minutes. ERAGE ON W–2. (p. 1996) companies, and maybe providers, for going Ms. MURKOWSKI. If I may ask my (b) EFFECTIVE DATE—The amendments against these guidelines. The Hippocratic colleague from Kansas, do I understand made by this section shall apply to taxable Oath compels us to protect the health of all the Senator is seeking about 10 min- years beginning after December 31, 2010. humans throughout life, and many provi- utes? 2. Taxation of MOA health care plans. This sions in these health care bills would cause Mr. BROWNBACK. Yes. tax will be imposed on the employer. The us to violate that oath. Ms. MURKOWSKI. Madam President, current MOA health plan design is apt to be Physicians and patients (not government) considered to have an ‘‘excess benefit’’. This should decide the best, most cost-effective I want to speak about small businesses would make it subject to a 40% excise tax. medical treatment for patients. Government because we have all been talking about There is also an aggregation rule for the should not dictate to insurance companies or the impact to small businesses. Under value of employee coverage with multiple providers which tests can or cannot be cov- this bill, as we know, small businesses employers or retiree medical (example, vet- ered. Medicine is changing too rapidly for are going to be penalized $750 per em- erans and rehired police officers and fire guidelines to be made at a national level. ployee if even one of their employees fighters). If a retiree would purchase MOA I have worked in government medical fa- seeks governmental health care Health Insurance that is considered exces- cilities and in private practice for the last 26 through Medicaid or through Federal sive, the 40% excise tax would be incurred by years. Physicians provide timelier, less cost- the general fund of the Medical Trust. One ly and more patient-oriented care if not subsidies. So if you have 50 or more may argue that the tax is a tax to the em- overseen by hordes of non-producing govern- employees, you can be expected to pay ployer. The argument can also be made that ment administrators. fines in an amount of $750 per em- the Trust is an integral part of the Munici- I am in favor of reform, but current bills ployee, which amounts to over $37,000 pality. This was a conclusion determined in before Congress will collapse our health care or $3,000 for that individual employee. IRS PLR–06164–96. Thus the tax would be system and work against the freedoms we I think we need to put it into per- payable from the Trust general fund assets. are guaranteed under the Constitution. Gov- spective in terms of who these busi- SEC. 9001. EXCISE TAX ON HIGH COST ernment should not be allowed to force peo- EMPLOYER-SPONSORED HEALTH COV- ple to purchase health insurance, mandate nesses are. These are the solo-practi- ERAGE. (P. 1979) what health care services you are allowed, or tioners, like the one-lawyer office or ‘‘any excess benefit with respect to cov- increase our taxes astronomically to support the small doctor’s office. If these indi- erage, there is hereby imposed a tax equal to a huge government health care bureaucracy viduals purchase health care in the in- 40% of the excess benefit.’’

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00061 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13774 CONGRESSIONAL RECORD — SENATE December 22, 2009 (d) (1) (E) GOVERNMENTAL PLANS IN- nicipality. Thus the tax would be payable Medicare/Medicaid rate, rule, or audit re- CLUDED from the Trust general fund assets. forms, or tax write-offs for business losses. IRS PLR–06164–96 Because the Trust is an Their third point is: One section in Sen. Harry Reid’s bill says integral part of the Municipality, it is not Current municipal employees are able to Medicare will no longer pay for home health required to file an annual federal income tax be reimbursed tax free from money they services, durable medical goods, and possibly return. (p.5) have placed in their flexible spending ac- labs, X-rays, prescriptions or other services 3. Current Municipal employees are able to written by providers who have opted out of be reimbursed tax free from money that they count for over the counter medicine. Retired police officers and firefighters also currently Medicare. Many talented physicians have have placed in their flexible spending ac- had to opt out of Medicare (and by this law count for over the counter (OTC) medicine. are allowed this reimbursement as part of their medical benefit. Under the rules of this must opt out of Medicaid and the military’s Retired police officers and fire fighters also Tricare also) to stay in business. People will currently are allowed this reimbursement as bill, these reimbursements would no longer be allowed. This is a reduction in employee no longer be able to see these physicians be- part of their medical benefit. Under the rules cause of government financial restrictions or of this bill, these reimbursements would no benefits. It is also likely to encourage an increase [in] the utilization of more expensive will be forced to pay all medical bills associ- longer be allowed. This is a reduction in em- ated with these visits themselves. ployee benefits. It is also likely to encourage non-OTC prescriptions, as they are a covered expense. Bills under consideration cut Medicare an increase the utilization of more expensive spending by $460 billion, raise fees on med- non-OTC prescriptions, as they are a covered There are about 400 members that are ical services, increase physicians’ adminis- expense. part of the Police and Fire Retiree trative burdens, promote electronic medical SEC. 9003. DISTRIBUTIONS FOR MEDI- Medical Trust. When they find out, as records with mandated reporting of out- CINE QUALIFIED ONLY IF FOR PRE- I am sure they will, that essentially comes data, and increase business costs so it SCRIBED DRUG OR INSULIN. (p. 1997) they are going to be taxed on their will be impossible for small practices to sur- This bill contains expenses that should be vive. considered and planned for accordingly. A plan—I think most of these firefighters My decision to withdraw from Medicare December 2009 press release from Mercer, an and police officers don’t view them- was also precipitated by U.S. Preventive HR consultancy stated, selves as having access to a Cadillac Nearly two-thirds (63 percent) of employers plan. They are just firefighters and po- Services Task Force’s recommendation that in a recent survey by Mercer say they would breast cancer screening mammograms lice officers. But this is coming from should only be done on women between age cut health benefits to avoid paying an excise their trust fund, expressing great con- tax included in the Senate’s Patient Protec- 50 and 74. Approximately 48 percent of my cern over what we have in front of us. patients with breast cancer developed it be- tion and Affordable Care Act, unveiled No- I have mentioned that we have re- vember 18. Mercer estimates that one in five fore age 50. Up to 1.2 percent of my practice, employers offer health coverage that would ceived a copy of an opinion piece from mostly young mothers, could have died if be deemed ‘‘too generous’’ and thus be sub- a primary care provider in Anchorage this were a national guideline. ject to the Act’s 40 percent non-deductible who has outlined why she is opting out The Senate bill has this task force and tax on the excess value. of the Medicare system in Alaska. other committees determining what tests Two letters have been sent to the MOA in- I ask unanimous consent to have her will be covered for patients. I am concerned that penalties may be imposed on insurance forming them of these matters. The dates of letter printed in the RECORD. these letters were November 25 and Decem- There being no objection, the mate- companies, and maybe providers, for going against these guidelines. The Hippocratic ber 5, 2009. Since then, Larry Baker, Senior rial was ordered to be printed in the Policy Advisor, in the Mayor’s Office in- Oath compels us to protect the health of all RECORD, as follows: formed me that the MOA’s benefit consult- humans throughout life, and many provi- ant, The Wilson Agency, affirmed that the [From the Anchorage Daily News, Dec. 18, sions in these health care bills would cause current MOA health plans are going to be 2009] us to violate that oath. subject to the 40% excise tax. They are con- OPINION: DOCTORS AND PATIENTS, NOT FEDS, Physicians and patients (not government) tacting Senator Begich but beyond that he KNOW BEST should decide the best, most cost-effective did not specify what the course of action was (By Ilona Farr, M.D.) medical treatment for patients. Government going to be. I have made the heart-wrenching decision should not dictate to insurance companies or I recommend two points of action. Bring as a physician to opt out of Medicare. I do so providers which tests can or cannot be cov- the PFRMT membership up to date of this after working with Sen. Stevens, Sen. Mur- ered. Medicine is changing too rapidly for situation. And contact Senator Begich to in- kowski and Rep. Young for a decade in hopes guidelines to be made at a national level. form him of the negative impact that these we could ensure seniors would be able to con- I have worked in government medical fa- bills will have on our retired police officers’ tinue to receive medical services in Alaska. cilities and in private practice for the last 26 and fire fighters’ medical benefit. On a visit costing $115, Medicare pays $40, years. Physicians provide timelier, less cost- Sincerely, secondary insurance pays $7, and the rest— ly and more patient-oriented care if not LORNE BRETZ, $68—is a loss, not a tax write-off. It takes six overseen by hordes of non-producing govern- Plan Administrator. insurance paying patient visits to offset ment administrators. Ms. MURKOWSKI. The city of An- losses from one Medicare or Medicaid pa- I am in favor of reform, but current bills tient. before Congress will collapse our health care chorage is the largest city in Alaska. The House health care bills, HR3590/ system and work against the freedoms we We received this letter last week. In HR3962, increase the number of people not are guaranteed under the Constitution. Gov- the letter, they cite specifically three paying their share of the costs and will lead ernment should not be allowed to force peo- provisions in the bill that are of par- doctors to opt out of Medicare or retire ple to purchase health insurance, mandate ticular concern—No. 1, inclusion of early. what health care services you are allowed, or health care benefits as taxable income Anchorage has 75 family physicians, down increase our taxes astronomically to support from 180. Physician shortages like these are a huge government health care bureaucracy to employees. caused by government interference in the It states: that will bankrupt us as individuals and as a free market. Government artificially keeps nation. Not only will this increase the employee’s reimbursement rates low, forcing other pa- taxable income but the [Municipality of An- tients, and insurance companies, to pick up Ms. MURKOWSKI. One of the things chorage’s] payroll tax will also increase. the additional costs. Family practice we don’t have in this legislation is a The second point is the taxation of residencies are filled with foreign medical provision that relates to medical mal- the municipality’s health care plans. graduates because of high costs (more than practice. It has been stated that, in This tax will be imposed on the employer. $200,000) associated with medical school. Low Alaska, you tried medical malpractice The current [municipality] health plan de- physician reimbursement rates make it dif- reform and we haven’t seen the posi- sign is apt to be considered to have ‘‘an ex- ficult to repay loans. tive impacts. Medicare and Medicaid auditors are paid cess benefit.’’ This would make it subject to on commission, can fine us $2,000 to $50,000 I ask unanimous consent to have a 40% excise tax. for one charting mistake or billing error, and printed in the RECORD a statement They go on to say: then extrapolate this over the practice and from the Alaska State Medical Asso- There is also an aggregation rule for the drive us out of business . . . all for one minor ciation, along with an article that was value of employee coverage with multiple mistake. There is fraud, but this system that published in Alaska Medicine in Sep- employers or retiree medical. If a retiree penalizes us severely for simple errors is un- tember of 2009 entitled ‘‘Malpractice would purchase [the municipality’s] Health tenable. Relief, Lower Premiums, Tort Reform In these bills malpractice reform is re- Insurance that is considered excessive, the Add to Alaska’s Appeal.’’ 40% excise tax would be incurred. stricted, health savings accounts (which help One may argue that the tax is a tax to the reduce costs and fraud) are essentially elimi- There being no objection, the mate- employer. The argument can also be made nated, and taxes and fees on insurance and rial was ordered to be printed in the that the Trust is an integral part of the Mu- medical services are increased. There are no RECORD, as follows:

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ALASKA PHYSICIANS’ GROUP: SENATOR ERRED those paid by internists in the five highest providers. The result was a limit of $250,000 ON TORT REFORM states; surgeons here pay roughly 25 percent, in all cases except when damages are award- ANCHORAGE, ALASKA (Dec. 21, 2009)—The and obstetrician/gynecologists pay about 31 ed for wrongful death or a severe permanent Alaska State Medical Association (ASMA), percent. (The top five states vary by spe- physical impairment that is more that 70 which represents physicians throughout cialty.) Some of the difference in cost may percent disabling. For those, the limit is Alaska and is primarily concerned with the be societal, but part of it has to do with the $400,000. health of all Alaskans, is taking issue with tort reforms that have passed, or not passed, Since then, Alaska has enjoyed a stable Sen. Mark Begich’s stance on medical liabil- in each state. malpractice climate, with both of its major ity reform. In Alaska, our history is similar to many insurance carriers reducing rates and/or re- In an interview with Fox News on Dec. 7, states where the costs are lower. It’s a state turning profits through dividend distribu- 2009, Alaska’s junior senator opined that tort with an active medical society (the Alaska tions. reform in his home state has not worked. State Medical Association), an engaged The caps make a big difference. For exam- ASMA asserts that Begich did not accurately membership, a broad coalition of providers ple, NORCAL Mutual, which writes policies portray the facts in that nationally broad- and an enlightened legislative body that rec- in Alaska and California, also does business cast interview and that medical liability re- ognizes the connection between malpractice in Rhode Island, which does not limit non- form in Alaska serves as a shining example costs and access to care. economic damages in malpractice cases. for the other 49 states. In 1975, Alaskan physicians suddenly were ‘‘Most rates for physicians with at least ‘‘Alaska’s physicians have worked hard for confronted with a disappearing market for three years’ practice experience (mature at least the last 35 years to achieve meaning- medical malpractice insurance. The Legisla- rates) in Rhode Island are at least double the ful and equitable liability reform measures,’’ ture stepped in and created the Medical In- mature rates for physicians in Alaska,’’ ASMA President Brion J. Beerle, MD, wrote demnity Corporation of Alaska (MICA), a NORCAL Marketing and Communications today in a letter to Sen. Begich. ‘‘Those ef- quasi-state agency funded with state money Manager Brent Samodurov wrote in an e- forts have resulted in a stable marketplace but run by a private board of directors ap- mail to Alaska Medicine. ‘‘For several med- for insurers that provide medical profes- pointed by the governor. At the same time, ical specialties NORCAL Mutual’s rates for sional liability coverage to Alaska’s physi- the Legislature modified the law governing Rhode Island are nearly triple those for Alas- cians at rates that are competitive.’’ medical malpractice claims. Among the key ka.’’ More than 90% of medical liability cov- changes: MPL CARRIERS erage in Alaska is provided by two, not-for- The burden of proof was codified, making There are two major MPL insurers in Alas- profit insurers—MIEC and NORCAL—that it clear that a practitioner could only be ka: MIEC and NORCAL. Both companies are are owned by their policyholders (mutual in- judged against those in the same field or spe- owned by their policyholders (mutual insur- surers) and overseen by boards of governors, cialty. ers) and are overseen by a board of governors Res ipso loquitur, a legal doctrine that all of whom are physicians, with representa- consisting of physicians. switched the burden of proof to the health- tion on those boards by Alaska physicians. MIEC came to Alaska in 1978 and is spon- care provider in certain instances, was abol- ‘‘The cumulative result of the Alaska phy- sored by ASMA. NORCAL became active in ished. sicians’’ advocacy has been a success for phy- 1991 after it purchased MICA. The law required that juries be told that sicians and their patients,’’ Beerle wrote. According to data published by the Na- injury alone does not raise a presumption of ‘‘For example, according to the Medical Li- tional Association of Insurance Commis- negligence or misconduct. ability Monitor Survey, 2008 premiums paid sioners, MIEC wrote 69.7 percent of all med- Plaintiffs were prohibited from filing in- by Alaska’s internists average just 24% of ical malpractice premiums for physicians in flammatory pleadings asking for millions of those paid by the interests in the five most the state during 2008 and NORCAL wrote 23.4 dollars. expensive states; general surgeons pay about percent. Ten other carriers shared the re- 25%; and obstetricians/gynecologists pay The law of informed consent was codified. The law prohibited claims that a health- maining 6.9 percent of the market. about 31%. According to that same 2008 sur- Typical of these types of policyholder- care provider had orally agreed to achieve a vey, the premiums for those same specialties owned companies, both MIEC and NORCAL specific medical result. are in the lowest quartile of all states plus Plaintiffs were prohibited from obtaining a have a long history of returning profits to the District of Columbia. recovery for sums that had been paid by col- policyholders through dividend distributions: ‘‘MIEC also has returned excess earnings NORCAL’s Alaska clients have received lateral sources, except for a select few fed- to its policyholders in 16 of the last 19 years; dividends in 12 of the past 18 years, the most eral programs that must, by law, seek reim- and NORCAL policyholders received divi- recent amounting to 12 percent of each eligi- bursement. dends in 12 of the last 18 years. MIEC has, in During the 1970s and ’80s physicians en- ble policyholder’s premium as of Sept. 30, addition, reduced its rates by 5% in 2009 and countered rising and falling malpractice 2008, according to Samodurov. He noted: also for 2010,’’ the ASMA president added. costs as the insurance cycle reacted to ‘‘Dividends declared are directly related to Writing on behalf of the association he changing claim experience in Alaska and the company’s loss experience in each leads, Beerle noted that because of tort re- elsewhere, culminating in the departure of state.’’ form, premiums Alaska’s physicians pay for MIEC has a similar record of returning several medical professional liability (MPL) liability coverage is generally not signifi- profits to its Alaska members. MIEC policy- insurers in the late 1990s. cant in the cost of operating a medical prac- In the mid-1990s, the Alaska State Medical holders have received dividends in 16 of the tice. Association and several MPL insurers joined past 19 years in amounts that average 28.8 ‘‘The factor that does have a material ef- with the Alaska State Hospital and Nursing percent of basic premiums (for $1 million/$3 fect is the cost of practicing defensive medi- Home Association, Providence Hospital and million limits) in each one of the past 19 cine,’’ he wrote. the business community to press for addi- years. The American Medical Association has es- Ms. MURKOWSKI. The bottom line is timated that the annual cost of the practice tional tort reforms. The result was the 1997 of defensive medicine in the United States Tort Reform Act. from the Alaska State Medical Asso- Among its achievements was a cap on non- ranges from $99 billion to $179 billion. ciation: ‘‘Until medical liability reforms similar to economic damages of $400,000 except in cases The cumulative result of Alaska physi- those enacted in Alaska are adopted nation- of severe disfigurement or severe permanent cians’ advocacy has been a success for physi- wide, the additional costs of the practice of impairment, in which the cap rises to $1 mil- cians and their patients. defensive medicine will continue to be a lion. Punitive damages were limited, and the Again, we have seen the positive im- driver in the cost of health care in Alaska standards for awarding them were tightened. pact in Alaska because of the laws we and throughout the country,’’ Beerle con- Prejudgment interest was tied to the federal cluded. have passed. It is unfortunate that we discount rate—Alaska’s current rate is 3.25 didn’t take that opportunity as we [From Alaska Medicine, Sept. 2009] percent. Joint and several liability was abol- dealt with health care reform these ished in favor of comparative fault, in which MALPRACTICE RELIEF past many months. each party is responsible only for its per- I yield the floor. (By Andrew Firth and Roger Holmes) centage share of the total fault. And parties It is seemingly a universal truth that were prohibited from using experts in med- EXHIBIT 1 wherever one practices in the United States, ical malpractice cases unless the expert is li- DECEMBER 21, 2009. malpractice insurance costs too much. But censed, trained and experienced in the same U.S. Senate, in Alaska, the average medical malpractice discipline or school of practice as the physi- Washington, DC. premiums are lower than at least 35 other cian and certified by a recognized board. DEAR SENATOR: We are writing to express states, a national survey shows. A coalition called Alaskans for Access to our strong opposition to language contained Physicians in Alaska pay much less than Health Care—comprising ASMA, Alaska in the Manager’s Amendment to H.R. 3590, their colleagues in the nation’s five most Physicians & Surgeons, the hospital associa- which excludes the construction industry costly states, according to the Medical Li- tion and Providence—went back to the Leg- from the small business exemption contained ability Monitor Survey, 2008. Premiums paid islature in 2005 and argued for an even lower in the bill. We regret that this is our first op- by Alaska’s internists average 24 percent of non-economic damage cap for health-care portunity to address this issue, though the

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00063 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13776 CONGRESSIONAL RECORD — SENATE December 22, 2009 fact that the Manager’s Amendment was This is what you are going to get. This some of those expenses out of this. made public less than two days before the was in the New York Times today. This That would be one way to cut back first vote on the matter has increased the is where I sit or this is what is going to some of the expenses. But in the House difficulty of playing a constructive role in happen to me in this overall system. It the legislative process. bill, they included Stupak language In recognition of the negative impact that is no wonder the American public which continued the Hyde tradition a mandate to provide health insurance will doesn’t want this. They are not excited and law of the land that the govern- have on employers, H.R. 3590 exempts em- about this. They are not excited about ment will not pay for abortions other ployers with fewer than 50 employees from what it is going to do to the budget— than cases of rape, incest, and life of the fines levied on those who cannot afford $2.5 trillion. That is about $700 million the mother. Except now buried in the to provide their employees with the federal a day, if you are counting in millions a Senate bill, in the Reid amendment, is minimum standard of health insurance. How- day as one way to look at it. ever, the Manager’s Amendment singles out the public funding of abortion, which There are some interesting things we haven’t done for years. the construction industry by altering the ex- hidden within the bill. One of the emption so that it applies to only those Yesterday I talked to both Congress- firms with fewer than 5 employees. things I want to point out is the trans- man STUPAK and Senator NELSON. They This narrowly focused provision is an un- fer of wealth from young people to old. both agree that the Stupak language is precedented assault on our industry, and the One of the things that has really far superior. It doesn’t publicly fund men and women who every day make the bugged me about what we have done in abortions, whereas what is in this bill bold decision to strike out on their own by so many of the government systems now does. You don’t need to take my starting a business. Our members’ benefit here—it has been a wealth transfer packages reflect the reality of their business word. Here is what others have said. from younger people to older. The U.S. Conference of Catholic models, and they proudly offer the best Several of my children are students health insurance coverage that they can af- Bishops, who want a health care bill ford. It is unreasonable to presume that and working part-time jobs, and they but are opposed to the public funding small business owners can bear the increased are paying payroll taxes. They say: of abortion and opposed to abortion, cost of these new benefits simply because What is this payroll tax going to? I say: say: Well, talk to your grandparents Congress mandates that they do so. The bill is morally unacceptable unless and In the real world, where the rhetoric sur- and tell them to say thank you to you. until it complies with longstanding current rounding this legislation will meet the stark These are funds collected that are laws on abortion funding such as the Hyde reality of the employer struggling to make going to pay for their retirement funds. amendment. payroll, this special interest carve out is They do, and the grandparents say simply another bill to pay in an industry We voted on this floor for the Nelson- that, with an unemployment rate exceeding thank you. But it doesn’t seem to be Hatch amendment which is now not in 18% and more than $200 billion in economic satisfying to them because they are the bill. activity lost in the past year, already is saying: Why aren’t I putting this in You don’t have to take that. You can struggling to survive. something I am saving money for me take BART STUPAK, Democrat from And, we would be remiss if we failed to so that I can have something later on Michigan, who voted for the bill in the question the justification for singling out instead of this sort of, OK, I am paying House. He says: the construction industry to bear such a bur- and they are getting. What is going to den. We are unaware of any data or evidence It is now not acceptable. A dramatic shift be there when I get there? in Federal policy that would allow the Fed- that suggests that the needs and struggles of That sort of wealth transfer from a construction contractor with fewer than 50 eral Government to subsidize insurance poli- employees are so different from those of young people to old people continues in cies with abortion coverage. small business owners in other industries, this bill. Look at this wealth transfer. The American public doesn’t want and absent such convincing evidence, we are Younger workers will pay more for that either. The latest poll of Decem- left to assume that this specific provision is health insurance premiums so that ber 22 shows that 72 percent of Ameri- merely a political payoff to satisfy the de- older workers can pay less. Their cost cans oppose using any public money in sires of a small constituency. at age 25 will go up 25 percent for As Congress moves forward in the legisla- the health care overhaul to pay for health insurance premiums. If you are abortion, including 54 percent of Demo- tive process for H.R. 3590, we strongly en- 64, it will go down 20 percent for health courage you to address this onerous provi- crats and 74 percent of Independents. sion that needlessly singles out small con- care. This is another one of the wealth That is where they are. That is where struction industry employers. transfers that take place. It isn’t right. the public is. Sincerely, It is taking from the kids. It is taking National Right to Life, which is the Air Conditioning Contractors of America, from the grandkids. It should not be gold standard on standing up for life, American Institute of Architects, Associated continued. It is continued in this bill. says: Builders and Contractors, Associated Equip- You can look at it another way: Sub- The Reid managers amendment requires ment Distributors, Associated General Con- sidies in this bill go disproportionately tractors, Association of Equipment Manufac- that all enrollees in an abortion covering to older Americans. Average subsidies plan make a separate payment into an ac- turers, Independent Electrical Contractors, for the 55-year-olds are nearly 10 times National Association of Home Builders. Na- count that will pay for abortions. The bill tional Federation of Independent Business, that of a 25-year-old. A 25-year-old gets also contains language that is intended to National Lumber and Building Material a subsidy of $458, a 55-year-old gets a prevent or discourage any insurer from ex- Dealers Association, National Ready-Mixed subsidy of $4,427—another wealth trans- plaining what this surcharge is to be used Concrete Association, National Roofing Con- fer from younger to older. for. Moreover, there is nothing in the lan- tractors Association, National Utility Con- Then you can look at the claims in guage to suggest that payment of the abor- tractors Association, Plumbing-Heating- this bill that there are going to be tax tion charge is optional for any enrollee. Cooling Contractors-National Association, cuts for the middle class. That is if you This base bill has another thing in it: Small Business & Entrepreneurship Council, are in the lucky group. For every low- It takes the individual opt-out and U.S. Chamber of Commerce. to-middle-income family with a tax moves to it a State opt-out. So while The PRESIDING OFFICER. The Sen- cut, three low-to-middle-income fami- let’s say Kansas may opt out of the ator from Kansas. lies have a tax increase in this bill by abortion funding in the bill, they still Mr. BROWNBACK. Madam President, the structure of this bill, by this struc- have to pay their taxes that go to an- I am glad to join my colleagues in ture, this convoluted, difficult-to-navi- other State to pay for abortions there talking about the health care bill. If gate, hard-to-understand, expensive, which are equally offensive to my peo- you looked in the New York Times $2.5 trillion structure. ple or other States that don’t want to today, there was a full-page ad describ- That is where we stand. Likely to see this funding take place. ing the bill. I am putting it up here, pass this body and then go to the House It doesn’t address the issue of having the same thing that was in the New of Representatives where there is a preventive services include abortion. York Times today. It starts with the major issue that is still brewing, dif- There was discussion that we are not question, I want to receive care from ficult, and must be dealt with, and that going to include preventive services in my doctor. This, on one page, puts the is the issue of public funding of abor- it, but that is not in the language. 2,600 pages in kind of what you are tion that is in this bill. There was discussion. We tried an going to see with this bill. It is con- If you want to cut some of the cost amendment. That is not there. It can voluted. It is difficult. It is expensive. out of this thing, why don’t you take still be defined. Now it may ultimately

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00064 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13777 unwind the entire bill based upon the we have the bill to be able to look at. efiting from the very large subsidy. funding of abortion that is in the Sen- If people of good faith on the other side This is because, in general, this group ate bill. It will be up to House Mem- want to get these addressed, there are isn’t even eligible for the subsidy. bers, a number of whom are very con- ways, and we have the language on how It comes back to this: a small group cerned and quite fired up about this to address it. It is called the Stupak of Americans benefit under this bill. particular piece, to take this out. I language. It has already passed the Another group of Americans pay higher know Congressman STUPAK is working House of Representatives. It is called taxes. These Americans include mid- to do that, wants to see that done, the Nelson-Hatch amendment that was dle-income individuals and families. agrees with Senator NELSON that his debated here, although it was not Mr. HATCH. Madam President, I rise language is far superior, actually does passed. We can do that. It is important to speak on my amendment to the Reid that. It is supported by the Catholic that it get done. health care bill that would add an ex- Bishops, the National Right to Life, This bill is not supported by the pedited judicial review provision to the and other pro-life groups that say the American public, and particularly this legislation. It would provide a mecha- way to go is the Stupak language. funding piece that is so offensive to so nism for the courts expeditiously to It is not what is in the Senate bill. many Americans. We can debate about handle any future constitutional chal- The Senate bill will actually fund abor- abortion, but the government should lenges to this legislation. tions. Then we go through the spe- not be funding it, and that is agreed to Make no mistake. I strongly oppose cifics, as I have in here, of the various by over 70 percent of the American this Federal takeover of our health places that it has. I met with Senator public. care system. I do so for a host of im- NELSON about those specifics. I have I just ask my colleagues on the other portant and serious policy reasons. I addressed a number of those concerns. side, as you move on forward with believe it is bad for our country, but I I know he continues to work on it, but this—if this bill passes here—take this also oppose it because I believe some of at the end of the day this is one of piece out. We know what language is its core provisions are unconstitu- those babies you cannot split. You need agreed to and works. This piece can be tional, undermining the Constitution to have the Stupak language in this taken out. It can be taken out yet. And and the liberty that it makes possible. bill. I am afraid at the end of the day I think the whole bill may unwind if it I have argued for months that the that is not going to be in there. I know is not taken out—unwind because of a constitutional problems with this leg- Congressman STUPAK is pushing very number of Democrats who voted for the islation include the requirement that hard for its inclusion, and I wish him bill on the House side who want the individuals obtain a certain level of all the best. Stupak language, and they do not want health insurance and the differential If this legislation passes this body, it the inferior language that was put in State-by-State taxation of high cost is going to be up to the House of Rep- on the Senate side that will actually insurance plans. Other scholars and resentatives to put in that Stupak lan- allow and start the funding of abortion, commentators have argued that re- guage. And they can do it. It is my that we have not done for 30 years. strictions on the ability of insurance hope they will do it. I do not think the Madam President, I thank my col- providers to make risk-adjusted deci- overall bill should be passed, but cer- leagues and yield the floor. sions about coverage and premiums tainly you should not have this piece of Mr. GRASSLEY. Madam President, amount to a taking of private property funding in this bill, in breaking the My Friend, Senator CASEY, just a few in violation of the fifth amendment. longstanding work we have had in the moments ago repeated the frequent Others have said that requiring States Hyde agreement, in the Hyde language. claim made by members on the other to pass legislation creating health ben- Thank you very much, Madam Presi- side of the aisle that the health care efit exchanges exceeds Congress’s dent. How much time do we have re- bill provides a $40 billion net tax cut. power in our Federal-State system. maining on our side? As I demonstrated in a speech earlier I do not necessarily believe that each The PRESIDING OFFICER. One today, this claim is inaccurate and of these constitutional arguments is as minute. does nothing to address the fact that substantive or as persuasive as the Mr. BROWNBACK. Madam President, millions of middle-class Americans will in that concluding minute, what I next. Some may agree with this one or see a tax increase. that one, all of them, or none at all. would like to briefly speak about is the I have consistently given my Demo- overall process. These and other arguments, however, cratic friends credit for providing a sig- are real, substantive, and many of I think there are people in this body nificant benefit to help people buy in- who did not want to include things them are as yet untested by the courts surance. because this legislation goes so far be- such as abortion funding in the bill. This beneficiary class, however, is yond anything the Federal Government But when you operate in a closed proc- small. ess like this, these sorts of things end At the same time there are 78 million has ever attempted. These and other up happening because the people who individuals, families, and single par- issues very well may be the basis for work on these issues are excluded. I ents who will see a tax increase. litigation against this legislation. certainly was not consulted. I am not Seventy-three million of them are Therefore, I think it is in everyone’s saying anyone said: Well, look, we are below $200,000. interest to provide a mechanism for fu- not going to get your vote anyway, so It is only because the subsidy for this ture constitutional challenges to be we do not need to have it. But if you do small group is so large—and refund- handled expeditiously by the courts. not want to have abortion funding in able—that there is a net tax benefit. The supporters of this legislation, it, one should look past that and say: For example, the average subsidy is those who are so confident that no con- Let’s get the people who understand close to $8,000. Around 13.2 million indi- ceivable constitutional argument has and work on this issue—and we agree, viduals and families receive this sub- any merit whatsoever, should be the we should not have it in there; that is sidy. strongest supporters of this amend- what President Obama said; it should But the data also shows that there is ment. More than anyone, they would not be in there—and let’s see what lan- a group of 73 million middle-class want to eliminate as quickly as pos- guage passes by their muster. Americans who will pay on average sible anything that could delay or pre- That was not done. Unfortunately, $710 more in taxes. vent full implementation of this legis- that is part of what has happened in My Democratic colleagues want to lation. Frankly, I am surprised that this process. I think it is tragic that it say that since the cost of providing an they are not the ones offering this has happened that way in this process. average tax benefit of $8,000 to 13.2 mil- amendment and I hope they will sup- I think it is wrong. I think it builds a lion individuals and families is greater port it. bill that then people are not satisfied than the revenue raised by raising the Madam President, I now wish to with, and certainly a process they do taxes on 73 million individuals and speak about my amendment No. 3294. not agree with that takes place in this families by $710 there is a net tax de- My amendment would ensure that all overall bill. crease. Americans would be able to keep the It is still not too late. There is still The truth is individuals who are see- health care coverage they already time to address these issues, now that ing a tax increase are not actually ben- have.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00065 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13778 CONGRESSIONAL RECORD — SENATE December 22, 2009 My amendment is simple. If adopted, obtain their medications. Sometimes which individuals in each State will be it would ensure that the implementa- community pharmacies are the only deemed ‘‘newly eligible’’ for Medicaid. tion of the Democrat’s health care bill health care providers for many miles. It is my understanding that the Fed- shall be conditioned on the Secretary So, it is important that we perma- eral Government will provide 100 per- of Health and Human Services certi- nently fix in this health care reform cent of the funds to cover this group of fying to Congress that this legislation bill the problems for pharmacies newly eligibles from 2014 to 2016 and would not cause more than 1,000,000 caused by the severe reimbursement that States will be provided with their Americans to see higher premiums as cuts from the Deficit Reduction Act of current law FMAP rates, which are compared to projections under current 2005. below 100 percent, for individuals al- law. Mrs. LINCOLN. I thank my colleague ready covered. Is this correct? and agree with him. That is why I ask This amendment would ensure that Mr. BAUCUS. I thank the Senator for him the purpose behind the language in this $2.5 trillion tax-and-spend bill the question. Yes, that is correct, and the bill that would establish the Fed- would not go into effect if the Sec- it is my understanding of the legisla- eral upper limit for generics at no less retary of Health and Human Services tion as well. finds that it would actually raise than 175 percent of the weighted-aver- health insurance premiums for more age average manufacturer price. I Mr. FEINGOLD. I thank the Senator. than 1 million Americans compared to know this amount is less than the As the Senator knows, to be considered projections under current law contrary chairman originally proposed in the ‘‘newly eligible’’ under this bill, indi- to the promise made by President Medicaid Fair Drug Payment Act from viduals must not be eligible under the Obama that health care reform would last Congress, which I cosponsored. State plan or under a waiver of the result in average savings of $2,500 per However, in what cases would it be the plan for full benefits or for benchmark family. intent of the intent of the chairman coverage as described in section 1937 of One of the major reasons for enacting that the Federal upper limit would be the Social Security Act. Two of the health care reform is to ensure that we set at more than 175 percent? I am par- benefits that must be incorporated into control rising health care costs that ticularly concerned about my small benchmark coverage under section 1937 continue to put increasing pressure on independent pharmacies in Arkansas of the Social Security Act are mental American families and small busi- that fill a significant number of Med- health and substance use disorder serv- nesses. However, according to the non- icaid prescriptions. Would it be the in- ices, and prescription drug coverage. If partisan Congressional Budget Office, tent to set a higher rate for these phar- these two benefits are not offered at the premiums under this bill would ac- macies? Would it be the intent to set a all, then the coverage will not count as tually rise for Americans purchasing higher rate for generics that might be benchmark coverage. insurance on their own by as much as in short supply or for which there are Mr. KOHL. As my two colleagues are 13 percent and will continue to rise at availability problems to encourage aware, Wisconsin currently provides double the rate of inflation for both the more manufacturers to make them? coverage for a number of individuals small group and large group markets. Mr. BAUCUS. I would say to my col- under a Medicaid waiver, but this cov- Spending $2.5 trillion of hard-earned league that the language indicating erage does not meet the requirements taxpayer dollars on a system that al- that the Secretary could set the Fed- for benchmark or benchmark-equiva- ready spends almost $2.2 trillion a year eral upper limit at no less than 175 per- lent coverage under the Social Secu- without any impact on controlling cent the weighted average average rity Act. The Centers for Medicare & health care premiums should be unac- manufacturer price could be used in Medicaid Services, the Federal agency those types of circumstances. It would ceptable to every American. that oversees Medicaid, has confirmed give the Secretary flexibility to set the Madam President, I also wish to this for us. Senator FEINGOLD and I un- Federal upper limits in cases where speak to my amendment No. 3296 to derstand that, because of this, the indi- there is a need to provide states with a H.R. 3590, the health care reform legis- viduals in Wisconsin who do not re- higher match in order to assure that lation. This amendment isn’t com- ceive benchmark or benchmark-equiva- appropriate payment is made to phar- plicated. It would prevent the provi- lent coverage will be considered newly macies to encourage the use of generic sions of the bill from taking effect in eligible, and therefore Wisconsin will the event that it imposes unfunded drugs. Mrs. LINCOLN. I thank the chairman receive 100 percent Federal funds for mandates on the States. As we all those individuals in 2014, 2015, and 2016. know, this legislation imposes signifi- for his insights into this provision and his work on behalf of our Nation’s com- Is this the Senator’s understanding of cant new burdens on the States and the the legislation as well? proposed funding for this program is, in munity pharmacies. WISCONSIN S MEDICAID PROGRAM Mr. BAUCUS. Yes. I thank the Sen- some cases, likely to fall short. Simply ’ Mr. KOHL. Madam President, I rise ator. put, the Congress should not impose to discuss language in the Reid sub- upon the States new Federal policy re- stitute amendment to H.R. 3590 that f quirements without ensuring they are would have a dramatic effect on Wis- adequately reimbursed. In the event consin’s Medicaid Program. I would RELIGIOUS CONSCIENCE that Congress does not provide full like to converse about this with two of funding for these programs, my amend- EXEMPTION my distinguished colleagues—the other ment would ensure that none of the Senator from my home State of Wis- Mr. CASEY. May I ask the Senator new mandates will be binding on the consin, Senator FEINGOLD, and Senator from Iowa to yield for a question about States. BAUCUS, chairman of the Senate Fi- the managers’ amendment, amendment MEDICAID PHARMACY REIMBURSEMENT nance Committee. 3276, to amendment 2786 to H.R. 3590? Mrs. LINCOLN. I would like to en- I commend Senator BAUCUS’s long Mr. HARKIN: Of course. gage my colleague, the distinguished and hard work in crafting this histor- Mr. CASEY. Chairman HARKIN, the Senate Finance Committee chairman, ical piece of legislation, and today, I in a short colloquy regarding the Med- managers’ amendment includes a reli- seek clarification of one piece of this gious conscience exemption from the icaid pharmacy reimbursement provi- bill. sions in the Senate health care reform individual requirement to maintain Mr. FEINGOLD. I also seek clarifica- minimum essential coverage in section bill. tion of this piece of the Patient Protec- Mr. BAUCUS. I would be happy to en- 1501. Is it the intent of the managers tion and Affordable Care Act, specifi- that this exemption apply to an indi- gage Senator LINCOLN in a colloquy. I cally in section 2001, regarding the defi- commend her for all her leadership vidual who is a member of recognized nition of individuals that would be con- religious sect described in Internal over the years on this issue, because sidered newly eligible under Medicaid. she recognizes that it is important to Mr. BAUCUS. I thank the Senator. I Revenue Code section 1402(g) regardless reimburse pharmacies adequately for would be pleased to enter into a col- of employment status? the generic medications they dispense loquy with the Senators from Wis- Mr. HARKIN. Yes, the intent of the to Medicaid patients. In rural States consin on this subject. religious exemption is to focus on an like ours, Medicaid patients need ac- Mr. KOHL. I thank the Senator. Sec- individual who is a member of a reli- cess to their community pharmacies to tion 2001 of the legislation describes gious

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00066 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13779 sect described in 1402(g) and who is an The bill clerk proceeded to call the the years, he attracted some wonderful adherent of the teachings of that sect roll. people to work with him, as he fought notwithstanding his or her employ- Mr. DODD. Madam President, I ask year in and year out to bring us to the ment status. unanimous consent that the order for moment we are about to enjoy; and Mr. CASEY. I thank the chairman. the quorum call be rescinded. that is, to see some national health So, for example, an Amish person The PRESIDING OFFICER. Without care legislation adopted for the very working in a factory or store for a non- objection, it is so ordered. first time. Amish employer and meeting the f Michael Myers had worked on this 1402(g) requirements would not be re- issue for a number of years for Senator HEALTH CARE REFORM quired to obtain insurance coverage Kennedy, and still is here working with against his or her religious convic- Mr. DODD. Madam President, I want Senator HARKIN now as part of the tions? to take a few minutes, if I may, this Health, Education, Labor, and Pen- Mr. HARKIN. The Senator is correct. evening to speak about what this sions Committee. The managers’ amendment creates a health care bill means to my constitu- Mark Childress, again, worked for clear bright line exemption for individ- ents in Connecticut. I say to the Pre- the majority leader, worked for Tom uals described in 1402(g). This religious siding Officer, the benefits to our Daschle, has worked for others in this conscience exemption applies whether States are very similar in many ways, body, and has just done a fantastic job. one is unemployed, a self-employed but, obviously, we like to point out He stayed on at my request and the re- Amish person, an Amish person work- what this particularly means in our quest of Leader REID to help us work ing for an Amish employer, or an own respective jurisdictions that we on this issue. He was involved with the Amish person working for a non-Amish represent. White House as well, and really under- employer. But before doing so, I want to take a stood the substance of this bill as well Mr. CASEY. I thank the Senator for few minutes, if I could, because, again, as the political navigation that was that clarification. tomorrow will be a short day, and then necessary to bring us to this moment. The PRESIDING OFFICER. The ma- there are the votes, apparently, that I thank Pam Smith as well for her jority leader is recognized. we are going to have Thursday, and fine work for Senator HARKIN. Jenelle then we will be leaving the Senate for f Krishnamoorthy made a wonderful con- a number of weeks before we return in tribution. She worked closely with ORDERS FOR WEDNESDAY, mid-January, and it might not be pos- Senator HARKIN, and I want to thank DECEMBER 23, 2009 sible tomorrow or in the very early her. Connie Garner was responsible, for Mr. REID. Madam President, I ask hours of Christmas Eve to say a special many years, working on the CLASS unanimous consent that when the Sen- thanks to the people who work with Act, which is a part of our bill. Portia ate completes its business today it ad- our offices in this Chamber, both on Wu and David Bowen did a remarkable journ until 9:45 a.m., Wednesday, De- the minority side and the majority job. John McDonough and Topher cember 23; that following the prayer side, who rarely get the kind of rec- Spiro, as well, are individuals who cer- and pledge, the Journal of proceedings ognition they deserve. tainly made a significant contribution be approved to date, the morning hour I have tried periodically over the to our product her. be deemed expired, the time for the two years to make sure that as to the con- Senator BAUCUS’s staff: Liz Fowler, leaders be reserved for their use later sideration of every major bill we talk Bill Dauster, Russ Sullivan, Cathy in the day, and the Senate resume con- about the staff and what they have Koch, Yvette Fontenot, David sideration of H.R. 3590, the health care done. So I want to take a couple min- Schwartz, Neleen Eisinger, Chris Dawe, reform legislation, with the time fol- utes and identify people with whom I Shawn Bishop, and Kelly Whitener—I lowing any leader remarks and until 10 have worked. This not an inclusive list. want to thank them for their efforts as a.m. equally divided and controlled be- There are many more people who work well. tween the two leaders or their des- for individual Senators who have done Again, we could give separate re- ignees; that at 10 a.m. and until 2 p.m. outstanding work. Our floor staff here, marks about each of these individuals the time be controlled in alternating 1- both on the majority side and the mi- and their contributions. hour blocks of time, with the majority nority side, do a remarkable job and In my office, again, like others, I controlling the first hour; further that have great patience with all of us. I am have been blessed with some wonderful the remaining time until 2:13 p.m. be very grateful to them, as well as for people. Jim Fenton is my legislative equally divided and controlled between the jobs they perform. director and has done a terrific job. the two leaders, with the majority I want to take a few minutes and rec- Tamar Magarik Haro, who is sitting leader controlling the final half. ognize the people I have worked very with me on the floor this evening—I The PRESIDING OFFICER. Without closely with over the last—well, in- know we are not supposed to recognize objection, it is so ordered. tensely—over the last almost year now people other than Members—along f on this issue. with Jeremy Sharp, they have just Certainly in Senator REID’s office, done a wonderful, wonderful job, and I PROGRAM the majority leader’s office, Kate know all of my colleagues have gotten Mr. REID. Madam President, Sen- Leone, Carolyn Gluck, Jacqueline to know both of them because of their ators should expect a series of rollcall Lampert and Randy Devalk deserve a work. votes, maybe as many as five, to begin great deal of credit. All of us know Monica Feit, Joe Caldwell, Bryan at approximately 2:13 tomorrow after- them and how much they have been in- DeAngelis, Andy Barr, Lia Lopez, Dan- noon. volved in this issue. iel Barlava, and Rachael Holt all have f And for those of us who serve in our made wonderful contributions as well. caucus, we have listened to Kate Leone Senate legislative counsel, with spe- ORDER FOR ADJOURNMENT on numerous occasions go over the de- cial thanks to Bill Baird, who was Mr. REID. Madam President, if there tails of these bills, answer the ques- present throughout the entire HELP is no further business to come before tions Members have raised about the Committee consideration, has gone the Senate, I ask unanimous consent importance of the legislation. So to the way above and beyond. And legislative that it adjourn under the previous members of Senator REID’s staff—and, counsel never gets the kind of recogni- order, following the remarks of Sen- obviously, there are a lot more people tion they deserve. ator DODD of Connecticut. in his office who deserve recognition— They do a tremendous job in drafting The PRESIDING OFFICER. Without but I want to particularly recognize the actual legislation. Once these ideas objection, it is so ordered. these four individuals with whom we are developed, then they require legis- Mr. DODD. Madam President, I sug- have worked very closely. lative language to be written. gest the absence of a quorum. Senator Kennedy, as we all know, From the administration, Nancy Ann The PRESIDING OFFICER. The was such a lion of this institution and DeParle, whom all of us have gotten to clerk will call the roll. cared so deeply about this issue. Over know very well; Jeanne Lambrew—I

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00067 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13780 CONGRESSIONAL RECORD — SENATE December 22, 2009 want to give a special thanks to they weren’t able to get that health consumer price gouging in the next few Jeanne. She has been just incredible in care coverage—not because their em- years. That is going to be critically im- terms of her encyclopedic knowledge of ployer didn’t want to give it to them portant. For the more than half mil- the issues, working very closely with but because that small employer just lion seniors in Connecticut, this bill our staffs. Again, individuals who may could not afford to do so and stay in protects Medicare, keeping it solid into not be well known to the public, but business. Even those who are healthy the future. Nearly 100,000 seniors in my when this bill becomes law, these are in my State, who have insurance, there State hit what is called the doughnut the individuals who deserve special is that worry as well. hole in the prescription drug benefit credit for their tremendous work. What I have described is not an irra- area, costing them an average of more Mike Hash, Lauren Aronson, Sec- tional fear they have that someone in than $4,000 annually. retary Sebelius, Kathleen Sebelius, their family will lose their job that This bill we are about to adopt takes who left the governorship of Kansas to provides the coverage as I just de- the first critical step toward closing come here to be head of the Health and scribed, worrying about that child who that doughnut hole, and Connecticut Human Services agency and has done a may develop an illness not covered by seniors should know that I and Chair- magnificent job in her new capacity; their policies, or worrying about no man BAUCUS, along with majority lead- Jim Messina, who worked with MAX matter how much they pay in pre- er HARRY REID, have committed to BAUCUS for years up here and has been miums their insurance doesn’t allow completing that job in conference, and the Deputy Chief of Staff at the White them to be sure of anything at all. we will do so. House and has done a tremendous job. The residents of my State understand Meanwhile, in Connecticut, seniors Phil Schilliro and Shawn Maher both the status quo is no longer sustainable will see their Medicare premiums go worked to represent the administration because the so-called status quo down. They will see major improve- and their Legislative Affairs Office and threatens the basic economic security ments in the quality of care they re- they do a great job; Dana Singiser as of every family in my State, as it does ceive, resulting in as many as 29,000 well, for her work. across this country. They and their fel- hospital readmissions being prevented. We will make this list available for low Americans in all 50 States sent us In my State of Connecticut, 3 in 10 the RECORD. I wanted to thank these here to take action, and it is action Connecticut residents have not had a individuals again for their fine work. that we shall take. colorectal cancer screening. I wish to speak, if I can today, not in When this bill becomes law, the peo- One in six women over the age of 50 my capacity as a senior member of the ple of my State will begin to reap the have not had a mammogram in the Health, Education, Labor, and Pen- benefits right away. One in four of my past 2 years. These are important sions Committee nor in my capacity as constituents have high blood pressure. screenings. They and other wellness one of the coauthors of the underlying One in four teens suffers from diabetes programs will be provided at no cost to legislation, but rather in my capacity, in Connecticut. Today, insurance com- people in my State as well as others as I said at the outset, as a Senator panies can use these preexisting condi- across the country. Beginning in 2011, representing 3.5 million residents of tions, along with many others, as an seniors will be able to get a free annual the State of Connecticut. Our neigh- excuse to deny these people coverage. checkup so they can stay well instead boring State, my good friend and col- Immediately, young people in our of simply receiving care when they get league, the Senator from New Hamp- State and across the country will be sick. That annual free checkup can shire, the Presiding Officer, represents protected against these preexisting make such a difference. I am a living New England. conditions to receive the coverage they example of that where—because under If you travel my State, you will meet need. Beginning 90 days after this bill our health care plan, I can have a free some of the world’s most talented and becomes law, every uninsured resident medical checkup once a year. As a re- dedicated health care professionals. of my State who has been denied cov- sult of that, I discovered that I had You will tour some of the Nation’s fin- erage because of a preexisting condi- prostate cancer, and what a difference est hospitals where patients get world- tion will be able to find the affordable that made to be able to discover that, class treatment. But you will also hear coverage they need to treat that condi- to get through the surgery, and to some heartbreaking stories from peo- tion. know that I have a bright future ahead ple in my State who come from middle- Small businesses make up more than of me, not one that I would discover class families who have lost every- three and four businesses in the State later on when the kind of surgery I re- thing—their homes, their life’s savings, of Connecticut, but today only one-half ceived might have been worthless and their hope for the future—just because of them are able to offer health bene- pointless. someone in their family got sick. They fits to their workers. Beginning in 2010, So these are the kinds of annual needed special care. You will meet next year, some 37,000 small businesses physicals Members of Congress get hard-working men and women who in my State, as well as others across under our health care plans, and our have seen their insurance premiums the nation, will be eligible for tax cred- fellow citizens ought to be able to as skyrocket over the last decade from its to make those benefits more afford- well, particularly our seniors. around $6,000 for a family of four to able. A 50-percent tax break, $40 billion In addition, there are some 255,000 over $12,000 annually for that same in this bill, is provided specifically for Connecticut residents between the ages family, and they wonder how much that purpose: to assist the 37,000 small of 55 and 64 who will need home health longer they will be able to continue to businesses in Connecticut, and others services after they turn 65 because of afford the coverage they have. You will across the country, to get a tax credit, an illness or an injury. These services, meet small business owners facing an as much as 50 percent, to allow them to whether they involve installing a hand- impossible choice between cutting off defer or reduce the cost of health insur- icap shower or hiring a home health health care benefits to their employees ance for their employees. care aide, will help these older Ameri- or laying off those workers. Small business owners throughout cans live in their homes in dignity and I have talked specifically about con- Connecticut have experienced per- with independence. But today these stituents of mine, small businesspeople sistent annual increases in premiums. services are not always covered by who literally have been faced with that In recent years—and this is true across Medicare or private insurance. Rather choice or who have had employees who the country, but certainly true in my than having to impoverish themselves dreaded having to leave the job they State—it is not uncommon for small so they can qualify for Medicaid by had because there were no health care business owners to be told they have to transferring all of their wealth and as- benefits. They took reductions in pay pay 20 percent or more for the same in- sets to a family member or rely on the because they just couldn’t stay given surance they had the previous year. full-time help of loved ones, these sen- the health conditions of their family. So the bill we are about to pass will iors will be able to take advantage of a Having to leave a job they had for 20 empower the State insurance ex- new voluntary program called the years or more to find new work where changes such as the one we will have in CLASS Act—authored by Senator Ken- there was health care coverage; leaving Connecticut in 2014 to deny insurers ac- nedy years ago and which is now a part a job they loved for less pay because cess to the exchange if they engage in of this bill—that will provide a cash

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00068 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13781 benefit to be used on these services and young doctors to stay in primary care, home than to cast my vote as 1 of 100 supports, totally paid for by the indi- which we all know is critically impor- in this body for health care reform in vidual themselves. Not a nickel, not a tant. our Nation, so long overdue, so long penny of Federal money is in that pro- Today, 9 percent of Connecticut resi- waited for. And on this Christmas Eve gram. It is totally based on the con- dents can’t access a primary care phy- it will become an accomplished feat of tribution that people make to that pro- sician because there aren’t enough doc- the U.S. Senate. gram. tors to go around. This bill makes an With that, I yield the floor and note So when I hear people talk about this investment in our medical workforce the absence of a quorum. as if it was some great robbery from and a $10 billion investment in commu- The PRESIDING OFFICER. The the Federal Treasury, it doesn’t in- nity health centers and the National clerk will call the roll. volve the Federal Treasury at all. As Health Service Corps, which begins The legislative clerk proceeded to the bill takes effect, the health insur- taking effect immediately in 2010. It call the roll. ance exchanges are set up and health will be phased in over 5 years. That is Mr. DODD. Mr. President, I ask unan- insurance will become a buyer’s mar- going to expand dramatically the imous consent that the order for the ket for people in my State as well. availability of patient care with our quorum call be rescinded. More than 350,000 Connecticut resi- community health care system. The PRESIDING OFFICER (Mr. dents who today do not have insurance As more uninsured people gain cov- UDALL of Colorado). Without objection, will finally have affordable options to erage, Connecticut will no longer have it is so ordered. choose from. Nearly a quarter of a mil- to subsidize the $383 million it spends Mr. DODD. Mr. President, there were lion people in my State would be eligi- in uncompensated care our providers a number of other people I wished to ble for premium credits to help take deliver each year—important at a time mention. I will not go through the list care of the cost of insurance. That when my State is already, like every of all the staff involved in this effort in doesn’t go into effect until 2014, but in State—almost every State—in serious the Senate. I am sure I would miss 2010, next year, insurance companies budget trouble. some people. It is a lengthy list of will be prohibited from imposing life- I have just recited a long list of sta- those who played such an important time caps on the amount of care you tistics showing how my State will ben- role. I was fearful I wouldn’t have a can receive. efit from this bill—in many instances, chance between now and the actual Insurance companies will be prohib- benefit immediately. Some will take a vote on Thursday morning, Christmas ited next year from taking away your little longer, but many of these provi- Eve, to express my deep gratitude as coverage, and they will be prohibited sions go into effect in the next year. one Member who benefited tremen- from discriminating based on gender or More important than any statistic will dously from the participation of my income in the year 2014. The insurance be what you will see when you tour my staff, two of whom are seated with me industry will be forced to spend more State, or any other State for that mat- this evening. I know that is probably a of your premium dollars on your health ter, after this bill takes effect—or more violation of Senate rules to recognize care, not on bureaucrats hired to come accurately, what you will not see. You them, but I want my constituents at up with reasons to deny you the care will not see 100 people losing their in- home and the American public to know you need. This is called the so-called surance, their health insurance every how many dedicated people there are medical loss ratios which require that single day, finding themselves cast into whose names they never know, faces resources be spent on patient care and uncertainty and fear—100 people every they will never see. needs of the policyholder rather than day—that will no longer be the case. I ask unanimous consent that a list on profits or administrative costs. You will not see families paying an of staff be printed in the RECORD. The industry will also be required to extra $1,100 a year in health insurance There being no objection, the mate- offer an appeal if your claim is denied, premiums, the so-called hidden tax rial was ordered to be printed in the and each State will set up its own inde- paid by everyone with insurance as a RECORD, as follows: pendent appeals process to keep the in- result of the nearly 50 million unin- REID dustry honest. Next year the industry sured Americans. You will not see sen- Kate Leone, Carolyn Gluck, ard Randy will be forced to provide more details iors facing the loss of their Medicare DeValk. about their policies so that you can benefits because overpayments to pri- HARKIN/KENNEDY shop for health insurance the same way vate insurance companies have ren- Michael Myers, Mark Childress, Pam you shop for anything else, armed with dered the program insolvent. You will Smith, Jenelle Krishnamoorthy, Connie Gar- enough information to be a smart con- not see parents laying awake at night ner, Portia Wu, David Bowen, John sumer. praying that their child’s cough goes McDonough, Topher Spiro, Stacey Sachs, All of these insurance items will take away because they can’t afford to take Tom Kraus, Terri Roney, Craig Martinez, Taryn Morrissey, Andrea Harris, Sara effect at least by 2014, many of them him or her to see a doctor. You will not Selgrade, Lee Perselay, Caya Lewis, Steph- next year, as I have just mentioned. see people losing their homes, their anie Hammonds, Andrew Garrett, Joe It is not just consumers who will ben- life’s savings, losing their economic se- Hutter, Lauren McFerran, Jeff Teitz, Kate efit. Connecticut’s 15,000 physicians curity, all because they got sick or a Cyrul, Dan Goldberg, Caroline Fichtenberg, will also benefit. Today these physi- child or a spouse did. You will not see Bill McConagha, Lory Yudin, and Evan cians spend, on average, 140 hours and people dying, as 45,000 do every year in Griffis. $68,000 every year just dealing with bu- our country, because they couldn’t af- BAUCUS reaucrats at the health insurance com- ford access to the health care system. Liz Fowler, Bill Dauster, Russ Sullivan, panies. Let me repeat that: 140 hours So as a senior member of the Health, Cathy Koch, Yvette Fontenot, David and roughly $68,000 every year just Education, Labor and Pensions Com- Schwartz, Neleen Eisinger, Chris Dawe, dealing with bureaucrats at the insur- mittee, and a close and dear friend of Shawn Bishop, Kelly Whitener, Tony Clapsis, ance companies. That is 2.1 million our departed colleague, Senator Ted Diedra Henry-Spires, Tom Reeder, Bridget Mallon, Tiffany Smith, and Catherine Dratz. hours and $1 billion in costs overall, Kennedy, who led this fight for so long, time and money wasted in my State it will be my honor—a deep honor in- DODD alone. That is going to end. deed, one of the highest honors I would Jim Fenton, Tamar Magarik Haro, Jeremy This bill cuts down on bureaucratic Sharp, Monica Feit, Joe Caldwell, Bryan have had in the 30 years I have served DeAngelis, Andy Barr, Lia Lopez, Daniel redtape and needless paperwork. Doc- here—to cast a vote in favor of this Barlava, and Rachael Holt. tors will be able to spend their time landmark legislation. Senate Legislative Counsel, with special caring for patients, not fighting with As one of two Senators whose job it thanks to Bill Baird, who, along with Stacy the insurance industry. Meanwhile, is to look out for the people of my Kern-Scheerer, was present throughout the more than 5,000 Connecticut primary home State of Connecticut, supporting entire HELP Committee and has gone above care physicians will qualify for the new this bill is nothing short of my duty, and beyond. 5- to 10-percent payment bonus. That and I intend to fulfill it with great OBAMA ADMINISTRATION happens next year in 2010. New pro- pride at 8 a.m. on Christmas Eve. What NancyAnn DeParle, Jeanne Lambrew, grams will incentivize many more better gift could I give to my folks at Mike Hash, Lauren Aronson, Secretary

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Mr. President, let me say you checked with Barbs?’’ I know how for 47 years and to me for these few im- this to the minority staff as well. proud Ted would be that this tribute portant and historic months, I add my While we have disagreed, and while honoring Barbara’s extraordinary ex- own personal heartfelt thanks to her, they didn’t vote for the bill, there are ample of public service to our Senate, especially for the blessings of her people I admire immensely on the mi- our Commonwealth and our country is friendship, support, and counsel over nority staff. On our committee, there taking place this day. the many decades, and I wish her a were wonderful suggestions and con- I first met Barbara Souliotis when I well-deserved happy and healthy retire- tributions that came from the Repub- joined Senator Kennedy’s staff in 1969– ment in the many years to come. lican side of the aisle. While they 40 years ago. I could see right away Thank you, Barbs. We love you. Hit didn’t support the bill, I think they that behind Barbara’s modest de- ’em long and hit ’em straight! made it a better bill because of their meanor was a remarkable woman who contributions. I want to add their would never let Senator Kennedy down. f Why? names as well. MIKE ENZI of Wyoming, NOMINATION OF ERROLL Because she had learned that his val- the ranking member—and I worked SOUTHERS with every Republican minority mem- ues and his commitment to making a ber of the HELP Committee—offered positive difference in peoples lives was Mr. DURBIN. Mr. President, it is amendments that were included. While the very reason she wanted to work for only fitting that during this travel- they may not want to admit it or ac- him in the first place. As I have heavy holiday season, we urge our col- knowledge it, they made a contribution thought about public service through leagues on the other side of the aisle to to this bill that makes it stronger and the years, it has become clear that the work with us in confirming the nomi- a better piece of legislation. I add their best of our Nation was built on the la- nation of Erroll Southers as Assistant names as well for their efforts. bors of loyalty and love of unsung pub- Secretary for the Transportation Secu- lic heroines like Barbara Souliotis. rity Administration. f It was once said that ‘‘Loyalty means The Transportation Security Admin- MORNING BUSINESS nothing unless it has at its heart—the istration is tasked with ensuring the Mr. DODD. Mr. President, I ask unan- absolute principle of self sacrifice’’. If security and safety of travelers using imous consent that the Senate proceed that is the standard of loyalty, I can our transportation network. Most to a period of morning business, with tell you this,—there is no more loyal often associated with security at air- Senators permitted to speak therein United States Senate staffer than Sen- ports, TSA responsibilities also include for up to 10 minutes each. ator Kennedy’s own ‘‘Barbara highway, rail, port, bus, and mass tran- The PRESIDING OFFICER. Without Souliotis’’. sit security. The agency grew out of She embodies the admirable quality objection, it is so ordered. the aftermath of 9/11, a somber re- of loyalty no matter the cir- minder of the need for vigilant atten- f cumstances. Barbs planned to retire tion to transportation security. TRIBUTE TO BARBARA A. years ago, but her loyalty to Senator Erroll Southers is the chief of home- SOULIOTIS Kennedy and her leadership position on land security and intelligence for the Mr. KIRK. Mr. President, I know all his staff kept her with him to the end. Los Angeles International Airport po- my colleagues share an indebtedness to Just as she had throughout his storied lice force. He is ready for this job. He the many staff members who work so career, she worked unfailingly for Sen- has nearly three decades working in (skillfully and) tirelessly behind the ator Kennedy through the difficult public safety, homeland security, and scenes each day. They assist us in serv- months of his illness and during his intelligence. Chief Southers has ing the public and responding to the final days. worked as a Santa Monica police offi- After Senator Kennedy passed away needs of our constituents. Today, I am cer, special agent for the Federal Bu- in August, Barbara continued her re- honored to pay particular tribute to reau of Investigation, and as a top offi- markable life’s work of service as the cer with the Los Angeles International the contributions of one truly out- director of my Boston office. This Airport, assisting in the management standing member of the Senate staff. woman I had known as a colleague of the largest U.S. airport police force. She will retire at the end of this ses- came, once again, to the aid of a friend. Unfortunately, without Chief sion of Congress after 47 years of im- As one who was appointed to, among Southers in the position he has been pressive service to the citizens of Mas- other things, continue constituent nominated to, TSA is without the lead- sachusetts. services for the people of Massachu- ership necessary to move forward. The Barbara Souliotis worked on Senator setts, I knew I could keep that pledge— President nominated Chief Southers in Edward M. Kennedy’s first campaign because Barbara Souliotis volunteered for the Senate in 1962. She was the first to stay on to lead the Kennedy team September, and the nomination has employee in Senator Kennedy s office during these last few months. been reported favorably to the Senate in November of that year And from the Barb’s loyalty, integrity and com- by both the Homeland Security and moment he joined this body until the mitment are legendary. She is the true Commerce Committees, it is being held end of his life, Barbara served as a noble public servant, the tireless and up by Senate Republicans. member of his staff and for the last 23 compassionate friend, the unassuming At the same time Senate Republicans years, she was the State director of his aid to all around her. are insisting on expanding the role and Boston office. If public service is Barb’s vocation, responsibility of TSA by requiring guns ‘‘Barbs’’ recalls that on her first day sports is her avocation. There is no to be allowed on Amtrak, they block at work here in Washington, she spilled more avid fan of the Boston Red Sox, and delay the permanent leadership a glass of Coca Cola on Senator Ken- the Boston Bruins, the Boston Celtics, necessary to implement these new poli- nedy. When she started to apologize, he and the New England Patriots than cies. smiled his iconic smile and said ‘‘Bar- Barbara Souliotis. And what is the justification for de- bara, you and I are going to get along And she’s also an outstanding golfer laying Chief Southers’ confirmation? It just fine.’’ who plays without a handicap and who is not his qualifications, his past ac- And they did. She served him bril- has at least one hole-in-one on her tions or experience. These are gen- liantly throughout his entire Senate score card. In Massachusetts, sports erally accepted to be outstanding. No, career—the only member to run the and politics are our passion. And Barbs it is instead an unreasonable demand full race as a ‘‘staffer’’, though many of has scored literally thousands of holes- that he predetermine if TSA employees us have reported back in whenever Bar- in-one for the constituents of Massa- should be allowed to form unions. In- bara sent out the call. chusetts. A lifelong resident of Haver- stead of bending to political pressure, Senator Kennedy considered ‘‘Barbs’’ hill, she has travelled tens of thou- Chief Southers has taken the stance to be his most indispensable assistant. sands of miles through the years serv- that this decision should be made with If anyone ever had a question relating ing the people of our Commonwealth. the input of all stakeholders, using

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New Jersey mandated duties. Chief Southers is an 60 Senators that caucus with the has 2 facilities. There is 1 facility in excellent candidate to lead the Trans- Democrats, so they can pass anything North Dakota. portation Security Administration, if they vote together. It rings hollow to Only 6 of the 50 States do not have and he should be in place at the agency place the blame on Republicans for some biodiesel production. They are today. In the midst of the heaviest failing to enact the tax extenders pack- Alaska, Delaware, Maine, New Hamp- travel period of the year, it is irrespon- age before the end of the year when the shire, Vermont, and Wyoming. The sible that the Senate has left this post Democrats hold a supermajority of 60 other 44 States have some biodiesel unfilled. I urge my colleagues to sup- Senators, an overwhelming majority in presence. port the confirmation of Chief the House, and the Presidency. So workers in 44 States will be nega- Southers. The House, waiting until the last tively affected by the inaction of this month of the year, finally passed a tax Congress to extend the tax credit. f extenders bill. However, the House usu- You don’t have to take my word for ally passes an extenders bill prior to BIODIESEL TAX CREDIT it. On November 25, I received a letter the last month of the year. from the Iowa Renewable Fuels Asso- Mr. GRASSLEY. Mr. President, the For example, in 2008 the House passed ciation. biodiesel tax credit will expire on De- a tax extenders bill on September 26, The letter outlined the economic and cember 31, 2009. I am speaking today to 2008, and in 2007 the House passed a tax job ramifications of allowing the tax set the record straight about why the extenders bill on November 9, 2007. This credit to expire, even if it is a short- biodiesel tax credit will not be ex- year, the House passed an extenders term expiration. I would like to read tended before the end of the year. bill that they knew the Senate would directly from that letter. Some have suggested that Repub- not accept. And then they left town for It states in part: licans are to blame for not getting the the year. This is called a dump and biodiesel tax credit extended before the run. Simply put, if the biodiesel tax incentive is allowed to expire—even for a brief period of end of the year. This is simply inac- The House dumped a tax extenders time—the Iowa biodiesel industry will cease curate. bill that they knew the Senate would production and many plants will likely not The bottom line is that the Senate not agree to, and left town before the reopen under current ownership. Democratic leadership decided they Senate could have any chance to nego- If the biodiesel tax incentive expires, bio- were going to attach the tax extender tiate a tax extenders bill that both the diesel blends will be priced out of the mar- package to a controversial estate tax House and Senate could agree to. ketplace and our customers—the oil compa- bill in an attempt to get moderate The House also had a choice to make nies—will stop purchasing biodiesel. In reality, we already cannot book any first quar- Democrats and Republicans to vote for regarding whether they wanted to pass a tax extenders bill this year by simply ter sales for next year. an estate tax bill that does not provide No retroactive action on the tax credit sufficient estate tax relief. attaching a noncontroversial version of sometime next year will undo the harm If the Senate Democratic leadership the tax extenders bill, which both the caused by the lost sales and shuttered plants had not chosen to hold the tax ex- House and Senate could agree on, to over the holidays. tender package hostage in an attempt the House Department of Defense bill, Quite frankly, the biodiesel industry is fac- to force moderate Democrats and Re- without attaching either the con- ing shutdowns that would certainly lead to a publicans to vote for an estate tax bill troversial estate tax bill or the in- much longer—and unpaid—Christmas break crease of the debt limit on the Defense than anticipated for the hundreds of workers that lacks support, the tax extender at Iowa biodiesel plants. package would have easily passed sepa- bill. However, the House chose not to do so. But there are long-term impacts poten- rately. tially even more far-reaching. After more Therefore, this should set the record The tax extenders bill could have than a year of mainly breakeven or negative straight. The Democratic leadership in passed as a stand-alone bill easily at margins, most of Iowa’s biodiesel plants sim- the House and the Senate, and not Re- any time during this whole year. In ply do not have the cash reserves to with- publicans, are responsible for the fail- fact, the Senate Democratic leadership stand even a two or three month shutdown. ure to pass a tax extenders bill before So, even if the biodiesel blenders’ tax cred- could simply bring up a noncontrover- the end of this year. it is retroactively enacted, several of Iowa’s sial version of the tax extenders bill This failure has very serious con- biodiesel plants are unlikely to reopen under and pass it by unanimous consent like sequences to the U.S. biodiesel indus- the current local-ownership. Please do not we have done in the past. We wouldn’t try, which will grind to a halt as of let the Iowa-owned biodiesel industry dis- even need to be talking about the tax appear on your watch. January 1, 2010. I remind my colleagues extenders package in relation to the of the economic challenges faced by I would ask unanimous consent that Department of Defense funding bill. this industry. In 2008, the biodiesel in- the entire letter from the Iowa Renew- However, because the Senate Demo- dustry supported more than 52,000 able Fuels Association to which I re- cratic leadership failed to act on the green jobs. ferred be printed in the RECORD. tax extenders package this entire year, Because of the downturn in the econ- The dire situation reflected in this one of the only legislative vehicles left omy, the biodiesel industry has already letter applies to all 173 biodiesel plants to pass the tax extenders package was lost 29,000 green jobs in 2009. The indus- around the country. The expiration of the Department of Defense funding bill. try is poised to lose another 23,000 jobs this tax credit on December 31, 2009, Instead of just adding to the Defense if nothing is done on the tax incentive will affect all 23,000 workers in this bill a noncontroversial tax extenders or regulatory delays at the Environ- green energy sector. package that both Republicans and mental Protection Agency. It is unfortunate that we have to be Democrats could agree on, the Senate So where are these jobs? Some might faced with the loss of 23,000 green jobs Democratic leadership instead decided think they are all in the Midwest, but because of inaction on the extension of that they would also try to attach the they are not. These green jobs are in 44 the biodiesel tax credit. I hope this ex- controversial estate tax bill and a con- of the 50 States. I would like to list the planation makes clear who is respon- troversial increase in the debt limit. 13 largest biodiesel-producing States in sible for this terrible situation. They could have instead just in- the country. There being no objection, the mate- cluded a noncontroversial tax extend- There are 24 facilities in Texas. There rial was ordered to be printed in the ers package with the Defense bill, and are 15 facilities in Iowa. There are 6 fa- RECORD, as follows:

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00071 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13784 CONGRESSIONAL RECORD — SENATE December 22, 2009 IOWA RENEWABLE FUELS ASSOCIATION, ‘‘eventually’’—is an easy way to maintain tion the facilities staff who have kept November 25, 2009. hundreds of jobs in Iowa and thousands the Capitol Building clean and warm, Hon. CHARLES E. GRASSLEY, around the country. Failure to extend the replenishing wood for the fireplaces Hart Senate Office Building, biodiesel tax credit will undoubtedly add to nonstop. Washington, DC. the jobless rolls. DEAR SENATOR GRASSLEY: First, thank you We thank you for your support of the Iowa I want to thank the staff of the Ar- for taking the time to meet with Iowa Re- biodiesel industry, and we encourage you to chitect of the Capitol, led by Acting newable Fuels Association members on No- do all you can to ensure that the biodiesel Architect Stephen Ayers, and the vember 17, 2009. At that meeting, we dis- tax incentive is extended as soon as possible. many, many folks who have worked cussed the absolute necessity of extending We are not trying to be alarmist. Rather, we around the clock from Ted Bechtel and the biodiesel blenders’ tax credit prior to the want you to have a clear picture of the pros- the Capitol Grounds crew who have end of this year. With this letter, we want to pects facing the Iowa biodiesel industry as been removing snow from the road, reinforce the economic and job ramifications the tax credit expiration comes closer each of allowing the tax credit to expire—even for day. Please do not let the Iowa-owned bio- sidewalks, and parking lots of the Cap- a couple of months. diesel industry disappear on your watch. itol Complex, to Robin Morey and his As a longtime supporter of Iowa biodiesel, Sincerely, staff who have kept the Senate build- you know that the biodiesel tax incentive, MONTE SHAW, ings clean and warm throughout these which allows blenders to claim a $1 excise Executive Director. long, long weeks. I truly appreciate the tax credit for each gallon of biodiesel blend- f extra hours of work provided by these ed with diesel, is set to expire on December individuals. 31, 2009. Simply put, if the biodiesel tax in- THANKING STAFF I want to thank the Secretary of the centive is allowed to expire—even for a brief Mr. NELSON of Nebraska. Mr. Presi- period of time—the Iowa biodiesel industry Senate, Nancy Erickson, and her staff, will cease production and many plants will dent, I want to take a few minutes in including the legislative clerks, the likely not reopen under current ownership. the midst of this debate to acknowl- bill clerks, the enrolling clerks, the ex- With the tax credit, biodiesel blends are edge some individuals who work for us ecutive clerks, Parliamentarians, offi- very competitive in today’s marketplace. here in the Senate. As chairman of the cial reporters of debates, captioning However, if the biodiesel tax incentive ex- Legislative Branch Appropriations sub- services, journal clerks, and the staff of pires, biodiesel blends will be priced out of committee that funds these agencies, I the Daily Digest. These folks have been the marketplace and our customers—the oil have had the opportunity to get to companies—will stop purchasing biodiesel. here around the clock, under some very In reality, we already cannot book any first know these staffs and have a good un- tiring circumstances, to deliver the quarter sales for next year. Therefore, bio- derstanding of the work they do for us services that are needed to keep this diesel plants are unable to purchase feed- here in the Senate. These folks work institution running. stocks for the beginning of 2010 because tirelessly behind the scenes at all Last but not least, I want to thank there is no guarantee that a market for bio- times to keep this institution running Lula Davis and David Schiappa, our diesel will exist come January 1, 2010. As a safe and sound under any cir- floor leaders, for their tireless guid- result, many plants will likely begin to stop cumstances. ance in keeping us—the Members— operations in mid-December. We have been in session every week- No ‘‘retroactive’’ action on the tax credit where we need to be when we need to sometime next year will undo the harm end since Thanksgiving, including dur- be there. We are in your debt. caused by the lost sales and shuttered plants ing the largest December snowstorm in Mr. President, I have undoubtedly over the holidays. Quite frankly, the bio- Washington’s history, and we have left out many people in the Senate who diesel industry is facing shutdowns that worked uninterrupted thanks to the deserve to be thanked, and I hope they would certainly lead to a much longer—and dedication and hard work of these indi- know who they are and how much we unpaid—Christmas break than anticipated viduals. It is easy to take for granted appreciate them. for the hundreds of workers at Iowa biodiesel the hard work they perform on a daily f plants. basis—and we often do, but today, on That is a prospect that any industry hopes ADDITIONAL STATEMENTS to avoid. But there are long-term impacts behalf of the entire Senate I would like potentially even more far-reaching. While to say a heartfelt thank you to all of 2009 has been a rough economic year for them. many industries, the biodiesel industry has I want to start by thanking the U.S. 100TH ANNIVERSARY OF THE been hit harder than most. In fact, of Iowa’s Capitol Police Force, led by Chief Phil- HOUSE OF JACOB fifteen biodiesel refineries, only nine are cur- ip Morse and Assistant Chief Dan Nich- ∑ Mr. VOINOVICH. Mr. President, rently operating—and most of those at a se- ols. This force of 1800 officers put their today I am pleased to extend my warm- verely reduced capacity. After more than a lives on the line every day to protect est congratulations to the Supreme year of mainly breakeven or negative margins, most of Iowa’s biodiesel plants simply us and this institution, and they have Council of the House of Jacob of the do not have the cash reserves to withstand all worked a tremendous amount of United States of America as it cele- even a two or three month shutdown. overtime lately. I want to particularly brates its 100th anniversary with dele- So even if the biodiesel blenders’ tax credit mention the terrific work of Inspector gates from 41 locations from around is retroactively enacted, several of Iowa’s Sandra Coffman and her staff in the the United States travelling to biodiesel plants are unlikely to reopen under Capitol Division for all the extra hours Coshocton, OH, for services in the the current local-ownership. In fact, if recent they have worked in securing and pro- church’s newly constructed Mount history from the ethanol industry is any in- Zion Tabernacle. dication, Big Oil companies may swoop in, tecting the Capitol and the Chamber. buy the closed plants for pennies on the dol- They have gone above and beyond their For 100 years, the Supreme Council of lar and then reopen them as part of their normal duty, and we are extremely the House of Jacob of the United multi-national, vertically-integrated busi- grateful for their dedication to our States of America has invited men and ness plan. While this would be better than safety and protection. women of diverse backgrounds to wor- having the doors of these plants closed for Next I want to thank the staff of the ship God according to the teachings of good, keeping these plants in the hands of Senate Sergeant at Arms, led by Ser- Jesus Christ, advocating strong family Iowa investors provides the most benefits to geant at Arms Terry Gainer and Dep- ties, a high standard of moral values the local communities. During our meeting, there was discussion uty Sergeant at Arms Drew Willison. and civic participation. of using a tax extenders package or estate The SAA staff of nearly 900 people in- I would like to recognize Supreme tax bill as a vehicle to extend the biodiesel cludes the doorkeepers who have Bishop, Father J. Daniel Israel, J.O.G., tax credit this year. That type of decision is worked nonstop through the last and the Board of Directors of the House best left to you—we just know the extension month keeping access to the Senate of Jacob of the United States of Amer- needs to happen this year. We have also in- available for staff and visitors who ica, which make up the leadership of creasingly heard of the need for a ‘‘jobs bill’’ have traveled to Washington to witness this church. I commend the ministries this year in response to U.S. unemployment this historic debate firsthand. They and the good works under their super- surpassing ten percent. We urge you to consider the extension of the tax credit as part have kept our computer systems and vision within Ohio, and across our Na- of any ‘‘jobs bill’’ that Congress may con- overstretched telephone systems run- tion. sider. After all, extending the tax credit— ning, kept the mail moving, and the re- I encourage my fellow Ohioans, my something most people believe will happen cording studio functioning, not to men- colleagues in the Senate and the entire

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00072 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13785 Nation to recognize this memorable an- December 17, 2009; to the Committee on Fi- Mr. KYL, Mr. CASEY, Mr. GRAHAM, niversary celebration and to congratu- nance. Mr. LEVIN, Mr. BROWNBACK, and Mr. late the Supreme Council of the House EC–4149. A communication from the Chief HATCH): of Jacob of the United States of Amer- of the Publications and Regulations Branch, S. Res. 386. A resolution condemning the Internal Revenue Service, Department of the Government of Iran for restricting and sup- ica on its 100-year anniversary on the Treasury, transmitting, pursuant to law, the pressing freedom of the press, freedom of 1st day in January 2010. Also, may God report of a rule entitled ‘‘Arbitrage Treat- speech, freedom of expression, and freedom continue to bless this Church, its lead- ment of Certain Guarantee Funds’’ (Notice of assembly, and for its human rights abuses, ers and its faithful members.∑ No. 2010–5) received in the Office of the Presi- and for other purposes; considered and dent of the Senate on December 17, 2009; to agreed to. f the Committee on Finance. f MESSAGES FROM THE PRESIDENT EC–4150. A communication from the Chief of the Publications and Regulations Branch, ADDITIONAL COSPONSORS Messages from the President of the Internal Revenue Service, Department of the S. 619 United States were communicated to Treasury, transmitting, pursuant to law, the the Senate by Mrs. Neiman, one of his report of a rule entitled ‘‘Reduction in Tax- At the request of Mr. SPECTER, his secretaries. able Income for Housing Hurricane Katrina name was added as a cosponsor of S. Deplaced Individuals’’ ((TD 9474)(RIN1545– 619, a bill to amend the Federal Food, f BF14)) received in the Office of the President Drug, and Cosmetic Act to preserve the EXECUTIVE MESSAGES REFERRED of the Senate on December 17, 2009; to the effectiveness of medically important Committee on Finance. As in executive session the Presiding antibiotics used in the treatment of Officer laid before the Senate messages f human and animal diseases. from the President of the United REPORTS OF COMMITTEES S. 891 States submitting sundry nominations The following reports of committees At the request of Mr. DURBIN, the which were referred to the appropriate were submitted: name of the Senator from Pennsyl- committees. vania (Mr. CASEY) was added as a co- By Mr. ROCKEFELLER, from the Com- sponsor of S. 891, a bill to require an- (The nominations received today are mittee on Commerce, Science, and Transpor- printed at the end of the Senate pro- tation, without amendment: nual disclosure to the Securities and ceedings.) H.R. 3819. A bill to extend the commercial Exchange Commission of activities in- volving columbite-tantalite, cas- f space transportation liability regime. f siterite, and wolframite from the EXECUTIVE AND OTHER Democratic Republic of Congo, and for COMMUNICATIONS INTRODUCTION OF BILLS AND other purposes. JOINT RESOLUTIONS The following communications were S. 987 laid before the Senate, together with The following bills and joint resolu- At the request of Mr. DURBIN, the accompanying papers, reports, and doc- tions were introduced, read the first name of the Senator from North Da- uments, and were referred as indicated: and second times by unanimous con- kota (Mr. DORGAN) was added as a co- EC–4144. A communication from the Chief sent, and referred as indicated: sponsor of S. 987, a bill to protect girls of the Publications and Regulations Branch, By Mr. HATCH: in developing countries through the Internal Revenue Service, Department of the S. 2922. A bill to amend the Medicare Pre- prevention of child marriage, and for Treasury, transmitting, pursuant to law, the scription Drug, Improvement, and Mod- other purposes. report of a rule entitled ‘‘Update to Notice ernization Act of 2003 to extend the Rural S. 1076 2009–38’’ (Notice No. 2010–2) received in the Community Hospital Demonstration Pro- Office of the President of the Senate on De- gram; to the Committee on Finance. At the request of Mr. SPECTER, his cember 17, 2009; to the Committee on Fi- By Mrs. MURRAY: name was added as a cosponsor of S. nance. S. 2923. A bill to provide funding for sum- 1076, a bill to improve the accuracy of EC–4145. A communication from the Chief mer and year-round youth jobs and training fur product labeling, and for other pur- of the Publications and Regulations Branch, programs; to the Committee on Health, Edu- poses. Internal Revenue Service, Department of the cation, Labor, and Pensions. S. 1297 Treasury, transmitting, pursuant to law, the By Mr. LEAHY (for himself, Mr. report of a rule entitled ‘‘Extension of Notice HATCH, Mr. KOHL, and Mr. SESSIONS): At the request of Mr. CONRAD, the 2008–55’’ (Notice No. 2010–3) received in the S. 2924. A bill to reauthorize the Boys & name of the Senator from Georgia (Mr. Office of the President of the Senate on De- Girls Clubs of America, in the wake of its ISAKSON) was added as a cosponsor of S. cember 17, 2009; to the Committee on Fi- Centennial, and its programs and activities; 1297, a bill to amend the Internal Rev- nance. to the Committee on the Judiciary. enue Code of 1986 to encourage guaran- EC–4146. A communication from the Chief By Mr. WYDEN (for himself and Mr. teed lifetime income payments from of the Publications and Regulations Branch, CORNYN): annuities and similar payments of life S. 2925. A bill to establish a grant program Internal Revenue Service, Department of the insurance proceeds at dates later than Treasury, transmitting, pursuant to law, the to benefit victims of sex trafficking, and for report of a rule entitled ‘‘Guidance Under other purposes; to the Committee on the Ju- death by excluding from income a por- Section 409A(a) Regarding Complying with diciary. tion of such payments. Opinions Issued By the Special Master Under f S. 1927 the EESA’’ (Notice No. 2009–92) received in At the request of Mr. DODD, the name SUBMISSION OF CONCURRENT AND the Office of the President of the Senate on of the Senator from Washington (Mrs. December 17, 2009; to the Committee on Fi- SENATE RESOLUTIONS MURRAY) was added as a cosponsor of nance. The following concurrent resolutions EC–4147. A communication from the Chief S. 1927, a bill to establish a morato- of the Publications and Regulations Branch, and Senate resolutions were read, and rium on credit card interest rate in- Internal Revenue Service, Department of the referred (or acted upon), as indicated: creases, and for other purposes. Treasury, transmitting, pursuant to law, the By Mr. BURR (for himself and Mrs. S. 1939 report of a rule entitled ‘‘Extension of Dead- HAGAN): At the request of Mrs. GILLIBRAND, line to Adopt Certain Retirement Plan S. Res. 384. A resolution honoring United the name of the Senator from North Amendments’’ (Notice No. 2009–97) received States Army Special Operations Command in the Office of the President of the Senate on their 20th anniversary; to the Committee Dakota (Mr. DORGAN) was added as a on December 17, 2009; to the Committee on on Armed Services. cosponsor of S. 1939, a bill to amend Finance. By Mr. LUGAR: title 38, United States Code, to clarify EC–4148. A communication from the Chief S. Res. 385. A resolution recognizing the presumptions relating to the exposure of the Publications and Regulations Branch, great progress made by the people of Ukraine of certain veterans who served in the Internal Revenue Service, Department of the in the establishment of democratic institu- vicinity of the Republic of Vietnam, Treasury, transmitting, pursuant to law, the tions, and supporting a free and transparent and for other purposes. report of a rule entitled ‘‘2009 Cumulative presidential election on January 17, 2010; to List of Changes in Plan Qualification Re- the Committee on Foreign Relations. S. 2781 quirements’’ (Notice No. 2009–98) received in By Mr. KAUFMAN (for himself, Mr. At the request of Ms. MIKULSKI, the the Office of the President of the Senate on LIEBERMAN, Mr. MCCAIN, Mr. DODD, names of the Senator from New Jersey

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00073 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13786 CONGRESSIONAL RECORD — SENATE December 22, 2009 (Mr. LAUTENBERG) and the Senator the case of members of the Armed (9)(A) youth jobs programs benefit both from Massachusetts (Mr. KIRK) were Forces and certain other Federal em- youth and communities when designed added as cosponsors of S. 2781, a bill to ployees, and for other purposes. around principles that promote mutually beneficial programs; change references in Federal law to AMENDMENT NO. 3218 (B) youth benefit from jobs that provide mental retardation to references to an At the request of Mr. DORGAN, the them with work readiness skills and that intellectual disability, and to change name of the Senator from Connecticut help them make the connection between re- references to a mentally retarded indi- (Mr. DODD) was added as a cosponsor of sponsibility on the job and success in adult- vidual to references to an individual amendment No. 3218 intended to be pro- hood; and with an intellectual disability. posed to H.R. 3590, a bill to amend the (C) communities benefit when youth are engaged productively, providing much-need- S. 2787 Internal Revenue Code of 1986 to mod- ed services that meet real community needs. At the request of Mr. THUNE, the ify the first-time homebuyers credit in name of the Senator from Florida (Mr. the case of members of the Armed (b) REFERENCES.— Forces and certain other Federal em- (1) CERTIFICATE; CREDENTIAL.—In sub- LEMIEUX) was added as a cosponsor of ployees, and for other purposes. section (d), references to the terms ‘‘certifi- S. 2787, a bill to repeal the authority of cate’’ and ‘‘credential’’ have the meanings f the Secretary of the Treasury to ex- prescribed by the Secretary of Labor. tend the Troubled Asset Relief Pro- STATEMENTS ON INTRODUCED (2) YOUTH-RELATED REFERENCES.—In this gram. BILLS AND JOINT RESOLUTIONS Act, and in the provisions referred to in sub- S. 2847 sections (c) and (d) for purposes of this Act— By Mrs. MURRAY: (A) a reference to a youth refers to an indi- At the request of Mr. NELSON of Flor- S. 2923. A bill to provide funding for vidual who is not younger than age 14 and ida, his name was added as a cosponsor summer and year-round youth jobs and not older than age 24, and meets any other of S. 2847, a bill to regulate the volume training programs; to the Committee requirements for that type of youth; and of audio on commercials. on Health, Education, Labor, and Pen- (B) a reference to a youth activity refers to S. 2862 sions. an activity covered in subsection (d)(1) that At the request of Ms. SNOWE, the Mrs. MURRAY. Mr. President, I ask is carried out for a youth described in sub- name of the Senator from Maryland unanimous consent that the text of the paragraph (A). (Mr. CARDIN) was added as a cosponsor bill be printed in the RECORD. (c) AUTHORIZATION OF APPROPRIATIONS.— of S. 2862, a bill to amend the Small There being no objection, the text of There is authorized to be appropriated to the Business Act to improve the Office of the bill was ordered to be printed in Secretary of Labor for youth activities under International Trade, and for other pur- the RECORD, as follows: the Workforce Investment Act of 1998 (29 U.S.C. 2801 et seq.), $1,500,000,000, which shall poses. S. 2923 Be it enacted by the Senate and House of Rep- be available for the period of January 1, 2010 S. 2917 resentatives of the United States of America in through June 30, 2011, under the conditions At the request of Mr. BAUCUS, the Congress assembled, described in subsection (d). names of the Senator from Arkansas SECTION 1. SHORT TITLE. (d) CONDITIONS.— (Mrs. LINCOLN) and the Senator from This Act may be cited as the ‘‘Youth Jobs (1) USE OF FUNDS.—The funds made avail- Nebraska (Mr. JOHANNS) were added as Act of 2010’’. able under subsection (c) shall be used for cosponsors of S. 2917, a bill to amend SEC. 2. SUMMER AND YEAR-ROUND YOUTH JOBS. youth jobs and training programs, to provide the Internal Revenue Code of 1986 to (a) FINDINGS.—Congress finds that— opportunities referred to in subparagraphs modify the penalty for failure to dis- (1) a $1,500,000,000 investment in summer (C), (D), (E), and (F) of section 129(c)(2) of and year-round employment for youth, such Act (29 U.S.C. 2854(c)(2)) and, as appro- close certain reportable transactions through the program supported under this priate, opportunities referred to in subpara- and the penalty for submitting a bad section, can create up to 450,000 temporary graphs (A) and (G) of such section, except check to the Internal Revenue Service, jobs and meaningful work experiences for that no such funds shall be spent on unpaid to modify certain rules relating to Fed- economically disadvantaged youth and stim- work experiences and the opportunities may eral vendors, and for other purposes. ulate local economies; include learning described in paragraph (2) there is a serious and growing need for (3)(B). S. CON. RES. 39 employment opportunities for economically (2) LIMITATION.—Such funds shall be dis- At the request of Mr. MENENDEZ, the disadvantaged youth (including young tributed in accordance with sections 127 and name of the Senator from Oregon (Mr. adults), as demonstrated by statistics from 128 of such Act (29 U.S.C. 2852, 2853), except MERKLEY) was added as a cosponsor of the Bureau of Labor Statistics stating that, that no portion of such funds shall be re- S. Con. Res. 39, a concurrent resolution in November 2009— served to carry out 128(a) or 169 of such Act expressing the sense of the Congress (A) the unemployment rate increased to 10 (29 U.S.C. 2853(a), 2914). that stable and affordable housing is an percent, as compared to 6.8 percent in No- (3) PRIORITY.—In using funds made avail- essential component of an effective vember 2008; able under subsection (c), a local area (as de- strategy for the prevention, treatment, (B) the unemployment rate for 16- to 19- fined in section 101 of such Act (29 U.S.C. year-olds rose to 26.7 percent, as compared to 2801))— and care of human immunodeficiency 20.4 percent in November 2008; and (A) shall give priority to providing— virus, and that the United States (C) the unemployment rate for African- (i) work experiences in viable, emerging, or should make a commitment to pro- American 16- to 19-year-olds increased to 49.4 demand industries, or work experiences in viding adequate funding for the devel- percent, as compared to 32.2 percent in No- the public or nonprofit sector that fulfill a opment of housing as a response to the vember 2008; community need; and acquired immunodeficiency syndrome (3) research from Northwestern University (ii) job referral services for youth to work pandemic. has shown that every $1 a youth earns has an experiences described in clause (i) in the pri- accelerator effect of $3 on the local economy; vate sector, for which the employer involved S. RES. 158 (4) summer and year-round jobs for youth agrees to pay the wages and benefits, con- At the request of Mr. KERRY, the help supplement the income of families liv- sistent with Federal and State child labor name of the Senator from South Caro- ing in poverty; laws; and lina (Mr. GRAHAM) was added as a co- (5) summer and year-round jobs for youth (B) may give priority to providing— sponsor of S. Res. 158, a resolution to provide valuable work experience for eco- (i) work experiences combined with link- commend the American Sail Training nomically disadvantaged youth; ages to academic and occupational learning, Association for advancing inter- (6) often, a summer or year-round job pro- so that the experiences and learning provide vided under the Workforce Investment Act of opportunities for youth to earn a short-term national goodwill and character build- 1998 is an economically disadvantaged certificate or credential that has value in ing under sail. youth’s introduction to the world of work; the labor market; and AMENDMENT NO. 2995 (7) according to the Center for Labor Mar- (ii) work experiences combined with learn- At the request of Mr. SCHUMER, the ket Studies at Northeastern University, ing that are designed to encourage and maxi- name of the Senator from Oregon (Mr. early work experience is a very powerful pre- mize the likelihood of a participant’s return dictor of success and earnings in the labor to, or completion of, a program of study MERKLEY) was added as a cosponsor of market, and early work experience raises leading to a recognized secondary or postsec- amendment No. 2995 intended to be pro- earnings over a lifetime by 10 to 20 percent; ondary degree, certificate, or credential. posed to H.R. 3590, a bill to amend the (8) participation in a youth jobs program (4) MEASURE OF EFFECTIVENESS.—The effec- Internal Revenue Code of 1986 to mod- can contribute to a reduction in criminal tiveness of the activities carried out with ify the first-time homebuyers credit in and high-risk behavior for youth; and such funds shall be measured, under section

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00074 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13787 136 of such Act (29 U.S.C. 2871), only with per- authorizing Justice Department grants ‘‘(I) the growth of Boys and Girls Clubs formance measures based on the core indica- through 2015. also includes the growth of Boys & Girls tors of performance described in section We need safe havens where our Clubs on Native American land, having 136(b)(2)(A)(ii)(I) of such Act (29 U.S.C. youth—the future of our country—can grown from 0 in 1990 to 225 in 2009 serving 2871(b)(2)(A)(ii)(I)), applied to all youth learn and grow up free from the influ- 140,000 Native American youth; served through the activities. ences of drugs, gangs and crime. That ‘‘(J) investment in our school partnerships is why Boys & Girls Clubs are so impor- has positively impacted graduation rates as By Mr. LEAHY (for himself, Mr. demonstrated in recent survey of Clubs con- HATCH, Mr. KOHL, and Mr. SES- tant to our children. ducted by BGCA’s CareerLaunch career prep- I hope all Senators will support this SIONS): aration program, in which 96.68 percent of S. 2924. A bill to reauthorize the Boys bipartisan bill to provide Federal sup- participants progressed successfully to the & Girls Clubs of America, in the wake port for the Boys & Girls Clubs of next grade level at the end of the 2008-2009 of its Centennial, and its programs and America. Our greatest responsibility is school year; activities; to the Committee on the Ju- to our children, and supporting Boys & ‘‘(K) public housing projects and Native diciary. Girls Clubs is just one way in which we American land in which there is an active Mr. LEAHY. Mr. President, I am can show our commitment to their fu- Boys and Girls Club have experienced a re- pleased today to introduce legislation ture. duction in the presence of crack cocaine, and Mr. President, I ask unanimour con- a reduction in juvenile crime and gang vio- to reauthorize the Department of Jus- sent that the text of the bill be printed lence; tice grant program for Boys & Girls in the RECORD. ‘‘(L) Boys & Girls Clubs are locally run and Clubs. I thank Senator HATCH, Senator There being no objection, the text of have been exceptionally successful in bal- KOHL and Senator SESSIONS for joining the bill was ordered to be printed in ancing public funds with private sector dona- tions and maximizing community involve- me in this effort. the RECORD, as follows: I have partnered with Senator HATCH ment as evidenced by collaborations and S. 2924 for many years on issues concerning partnerships with schools, cities, counties, Be it enacted by the Senate and House of Rep- Sea Research, other youth providers such as the Boys & Girls Clubs, and this bipar- resentatives of the United States of America in tisan bill shows the commitment of Big Brothers Big Sisters, Police Athletic Congress assembled, League (PAL), Cal Ripken Sr. Foundation, both Democrats and Republicans to the SECTION 1. SHORT TITLE. Boy Scouts, Girl Scouts, 4–H, and public li- good work done by Boys & Girls Clubs This Act may be cited as the ‘‘Boys & Girls braries; and across the Nation. Clubs Centennial Reauthorization Act of ‘‘(M) further investment in Boys & Girls Children are the future of our coun- 2009’’. Clubs, which celebrated 100 years of service try, and we have a responsibility to SEC. 2. BOYS & GIRLS CLUBS OF AMERICA. in 2006 will— make sure they are safe and secure. I Section 401 of the Economic Espionage Act ‘‘(i) inure to our collective national ben- know firsthand how well Boys & Girls of 1966 (42 U.S.C. 13751 note) is amended— efit; (1) in subsection (a), by striking paragraph Clubs work, and the real impact they ‘‘(ii) continue to assist in the effort to re- (1) and inserting the following: duce crime and drug use among our Nation’s have in our communities. In my home ‘‘(1) FINDINGS.—Congress finds that— State of Vermont, we are fortunate to youth by teaching young people how to avoid ‘‘(A) for over 100 years, the Boys & Girls gangs, resist alcohol, tobacco, and other have 6 Boys & Girls Clubs operating in Clubs of America, a national organization drug use; chartered by an Act of Congress, has proven 25 locations. These clubs serve more ‘‘(iii) continue to assist in improving edu- itself as a positive force in the communities than 14,000 youth in the State. I often cational opportunities and create centers of it serves; hear from parents, educators, law en- learning in and with schools thereby reduc- ‘‘(B) Boys & Girls Clubs and the programs forcement officers and others in ing the drop out rate and helping to improve and services implemented therein by over the economy (if the national male gradua- Vermont about just how successful 50,000 professional staff, and 194,000 volun- tion rate were increased by only 5 percent, these Clubs are, and how they inspire teers promote and enhance the development the Nation would see an annual savings of youth to reach their full potential. of boys and girls by instilling a sense of com- $4,900,000,000 in crime related costs); As a senior member of the Senate Ap- petence, usefulness, belonging and influence ‘‘(iv) continue in the efforts of reducing propriations Committee, I have pushed thereby making Boys & Girls Clubs a safe childhood obesity by teaching young people place to learn and grow; for more Federal funding for Boys & about the benefits of healthy habits such as Girls Clubs. This year, I recommended ‘‘(C) the purpose of the program established by this section has been to provide eating right and being physically active; additional funding for youth mentoring ‘‘(v) continue to serve youth in rural com- programs, so that youth-serving orga- adequate resources in the form of seed money for the Boys & Girls Clubs of America munities including Native American land, by nizations like the Boys & Girls Clubs of to assist local communities to form partner- engaging and creating partnerships in those America are able to continue making a ships in a collaborative manor so education, communities; substantial and real difference in the youth development and prevention programs ‘‘(vi) continue to serve youth in urban and lives of vulnerable children. I was could be available for the youth in those suburban communities including Public pleased that Congress included $100 communities; Housing by engaging and creating partnerships in those communities; million for competitive youth men- ‘‘(D) in 1990 there were 1,810 Boys and Girls Clubs facilities throughout the United ‘‘(vii) continue to provide outdoor and en- toring grants in the recently passed vironmental education programs for kids consolidated appropriations bill. States, Puerto Rico, and the United States Virgin Islands, serving 2,400,000 youths na- that would otherwise not have those edu- The current recession has hit many tionwide; cational and enriching opportunities; organizations around the country, ‘‘(E) due to the public investment via the ‘‘(viii) continue to develop job training threatening their financial health, and program established pursuant to this sec- programs for teens; and the Boys & Girls Clubs are no different. tion, resulting congressional appropriations, ‘‘(ix) better equip communities to continue At the same time, participation in and private partnership support, there are to sustain and improve the quality of these these clubs has never been higher, and now 4,387 Boys & Girls Clubs facilities programs through effective use of existing it continues to increase. I believe fund- throughout the United States, Puerto Rico, resources, merging operations, and working collaboratively within communities to pro- ing is well spent at the community and the United States Virgin Islands, serving 4,500,000 youths nationwide; vide the highest quality programs for the level, however, where the positive im- ‘‘(F) with the assistance of the Federal youth in the Boys & Girls Clubs.’’; pact on our youth is felt most directly. Government, local communities have col- (2) in subsection (c)(1)— In the 108th Congress, Senator HATCH laborated to establish and operate the Clubs (A) by striking ‘‘2006, 2007, 2008, 2009, and and I worked together to pass a bill to in schools, parks, parks and recreation fa- 2010’’ and inserting ‘‘2011, 2012, 2013, 2014, and reauthorize and extend the programs of cilities, libraries, and community centers; 2015’’; and the Boys & Girls Clubs of America ‘‘(G) these new partnerships have resulted (B) by striking ‘‘establishing and extending through fiscal year 2009. Due in part to in 33 percent of the Boys & Girls Clubs lo- Boys & Girls Clubs facilities where needed, the support of Congress, there now cated in or on school campuses where Club with particular emphasis placed on establishing clubs in and extending services to exist over 4,300 Boys & Girls Clubs in programs enhance and enrich the learning opportunities for youth; public housing projects and distressed areas’’ all 50 states, serving more than 4.8 mil- ‘‘(H) the growth of Boys & Girls Clubs also and inserting ‘‘improving the quality of lion young people. The bill we intro- includes an increase in Clubs located in pub- youth development and educational produce today will help us continue to lic housing sites across the Nation, having grams, health, physical fitness, and preven- support these important programs by grown from 289 in 1990 to 440 in 2009; tion services for youth at existing and new

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00075 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13788 CONGRESSIONAL RECORD — SENATE December 22, 2009 Boys & Girls Clubs facilities with special em- nals—they are victims of crime. They flag them as ‘‘repeat runaways’’ who phasis on reducing high school drop out don’t need to be prosecuted. They need are at high risk of being lured into rates’’; all the help they can get to escape the prostitution. (3) in subsection (c)(2)— clutches of pimps. Sex trafficking is a complex issue (A) by striking subparagraphs (A) and (B); Unfortunately, until now, the gov- that requires the comprehensive, wrap- and (B) by redesignating subparagraphs (C) and ernment has been a step behind. Right around approach that this bill would (D) as subparagraphs (A) and (B), respec- now, it is very difficult for law enforce- deliver. As daunting as this problem is, tively; and ment officers and prosecutors to build there are bright examples of how to ad- (4) by amending subsection (e) to read as criminal cases and crack down on dress the challenge, such as the follows: pimps. The Trafficking Deterrence and achievements of Sergeant Byron ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— Victims Support Act would change Fassett of the Dallas Police Depart- ‘‘(1) IN GENERAL.—There are authorized to that. ment. Just listening to Sergeant be appropriated to carry out this section— Here is how it would work: The bill Fassett, who spoke at a recent congres- ‘‘(A) $85,000,000 for fiscal year 2011; sional briefing that I hosted, is an edu- ‘‘(B) $85,000,000 for fiscal year 2012; would establish a pilot project of 6 ‘‘(C) $85,000,000 for fiscal year 2013; block grants in locations in different cation in how to do this right. The les- ‘‘(D) $85,000,000 for fiscal year 2014; and regions of the country with significant sons he has learned in over 20 years of ‘‘(E) 85,000,000 for fiscal year 2015.’’. sex trafficking activity. The block combating sex trafficking are a primer grants would be awarded by the De- for how to get victims out of the By Mr. WYDEN (for himself and partment of Justice to State or local clutches of pimps and build cases to Mr. CORNYN): government applicants that have de- put pimps away. Sergeant Fassett is S. 2925. A bill to establish a grant veloped a workable, comprehensive not the only officer out there who’s at- program to benefit victims of sex traf- plan to combat sex trafficking. The tacking this challenge the right way. ficking, and for other purposes; to the grants would require a comprehensive, In my home town of Portland, the offi- Committee on the Judiciary. multi-disciplinary approach to address- cers on the human trafficking task Mr. WYDEN. Mr. President, I am ing trafficking problems. Applicants force are doing excellent work. But pleased to join today with my col- for the grants would have to dem- right now, they simply don’t have the league from Texas, Senator CORNYN, to onstrate they can work together with resources to crack this problem. The introduce the Trafficking Deterrence local, State, and Federal law enforce- Trafficking Deterrence and Victims and Victims Support Act of 2009. ment agencies, prosecutors, and social Support Act would deliver the training This bill addresses a serious problem service providers to achieve the goals and resources they need. that is modern day slavery, pure and the bill would set out for them. I want to also thank the many indi- simple—human sex trafficking. You Government agencies that get the viduals and organizations who attended could almost call it a war, where all grants would be required to create the briefing and participated in efforts too often, children are the casualties. shelters where trafficking victims to craft this legislation. I particularly The statistics on minors involved in would be safe from their pimps, and want to acknowledge the Polaris sex trafficking are shocking. Experts where they could start getting treat- Project and the National Center for estimate that over 100,000 children in ment for the trauma they have suf- Missing & Exploited Children, for their the U.S. are at risk for prostitution. fered. The shelters would provide coun- instrumental roles in this effort. The average age of entry into prostitu- seling, legal services, and mental and I look forward to working with Sen- tion is 12. The children at greatest risk physical health services, including ator CORNYN and other colleagues to of becoming involved in sex trafficking treatment for substance abuse, sexual move this important legislation for- are what they call ‘‘repeat run- abuse, and trauma-informed care. The ward. There are children out on the aways’’—kids who have run away over shelters would also provide food, cloth- streets tonight who shouldn’t have to and over again. They need help right ing, and other necessities, as well as wait for the help this bill can give. Let away if they are going to avoid being education and training to help victims us end this appalling war on those kids. caught by pimps. One third of run- get their lives on track. Let us give them the help they need by away children are lured into prostitu- It is going to take this kind of com- passing this piece of legislation with tion within 48 hours of leaving home prehensive plan to finally turn the ta- all the speed possible. and 75 percent of minors caught in this bles on pimps who, right now, just wait I ask unanimous consent that the web of prostitution have a pimp. for their victims to be released from text of the bill be printed in the This problem is on the rise because jail so they can put them back out on RECORD. There being no objection, the text of criminal gang members are increas- the streets to make money for them. the bill was ordered to be printed in ingly turning to pimping. Gang mem- Once those girls are out, they don’t the RECORD, as follows: bers have discovered that they are less come back to testify against their likely to get prosecuted for trafficking pimps—they’re just gone. S. 2925 a person than trafficking drugs. While This bill fixes that problem by giving Be it enacted by the Senate and House of Rep- drugs can only be sold once, a pimp can resentatives of the United States of America in the young victims a safe haven. It is Congress assembled, sell a person over and over. It is just as only by addressing the needs of these SECTION 1. SHORT TITLE. lucrative. A pimp can make $200,000 a victims that law enforcement officers This Act may be cited as the ‘‘Trafficking year on one trafficking victim. will be able to work with them to build Deterrence and Victims Support Act of This situation is horrifying and to- criminal cases against their pimps. The 2009’’. tally unacceptable. The bill I am intro- block grants will also provide for spe- SEC. 2. FINDINGS. ducing today will bring a smart strat- cialized training for law enforcement Congress finds the following: egy that will give some teeth to the ef- officers and prosecutors to help them (1) Human trafficking is modern day slav- forts law enforcement across the coun- learn how to handle trafficking victims ery. It is the fastest-growing, and second try have made to combat sex traf- largest, criminal enterprise in the world. and build trafficking cases. Human trafficking generates an estimated ficking. It will give them additional re- This bill would also strengthen re- profit of $32,000,000,000 per year, world wide. sources they need to lock up pimps and porting requirements for runaway or (2) In the United States, human trafficking sex traffickers. It will also help victims missing children, and authorize fund- is an increasing problem. This criminal en- break away from their abusers and get ing to the FBI to enhance the National terprise includes citizens of the United the treatment and services they need Crime Information Center, NCIC, data- States, many of them children, who are to take their lives back. base, which is where missing child re- forced into prostitution, and foreigners Let us be absolutely clear about ports are filed. This would give law en- brought into the country, often under false this—the pimps who prey upon vulner- forcement officers better information pretenses, who are coerced into forced labor or commercial sexual exploitation. able young people are criminals, and on the children at greatest risk of (3) Sex trafficking is one of the most lucra- they should be put behind bars. The being lured in to sex trafficking by tive areas of human trafficking. Criminal young women, girls, and sometimes being able to show a tally of how many gang members in the United States are in- boys who are trafficked are not crimi- times a child has run away, and can creasingly involved in recruiting young

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00076 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13789 women and girls into sex trafficking. Inter- escape and overcome being sexually ex- trafficking, and not less than 1 of the block views with gang members indicate that the ploited, and should also be allowed to seek grants shall be awarded to an eligible entity gang members regard working as an indi- appropriate remuneration from crime vic- with a State population of less than 5,000,000. vidual who solicits customers for a pros- tims’ compensation funds. (2) GRANT AMOUNT.—Each grant awarded titute (commonly known as a ‘‘pimp’’) to (14) The State of New York has adopted a under this section shall be in the amount of being as lucrative as trafficking in drugs, safe harbor law that establishes a presump- $2,500,000. but with a much lower chance of being crimi- tion a minor charged with a prostitution of- (3) DURATION.— nally convicted. fense is a severely trafficked person. This (A) IN GENERAL.—A grant awarded under (4) Minors in the United States are highly law allows the child to avoid criminal this section shall be for a period of 1 year. vulnerable for sexual exploitation and sex charges of prostitution and instead be con- (B) RENEWAL.—The Secretary may renew a trafficking. As many as 2,800,000 children live sidered a ‘‘person in need of supervision.’’ grant under this section for 2 1-year periods. on the streets. Of the estimated 1,600,000 The statute also provides support and serv- (c) USE OF FUNDS.— children who run away each year, 77 percent ices to sexually exploited youth who are (1) ALLOCATION.—For each grant awarded return home within 1 week. However, 33 per- under the age of 18 years old. These services under subsection (b)— cent of children who run away are lured into include safe houses, crisis intervention pro- (A) not less than 25 percent of the funds prostitution within 48 hours of leaving home. grams, community-based programs, and law- shall be used to provide shelter and services (5) National Incidence Studies of Missing, enforcement training to help officers iden- to victims of sex trafficking; and Abducted, Runaway and Throwaway Chil- tify sexually exploited youth. (B) not less than 10 percent of the funds dren, the definitive study of episodes of miss- (15) Sex trafficking is not a problem that shall be awarded by the eligible entity to a ing children, found that of the children who occurs only in urban settings. This crime ex- subcontractor with annual revenues of less are victims of non-family abduction, run- ists also in rural areas and on Indian res- than $750,000, to provide services to victims away or throwaway children, the police are ervations. Efforts to address sex trafficking of sex trafficking or training for law enforce- alerted by family or guardians in only 21 per- should include partnerships with organiza- ment and social service providers. cent of the cases. In 79 percent of cases there tions that seek to address the needs of such (2) OTHER ACTIVITIES.—Grants awarded pur- is no report and no police involvement, and under-served communities. suant to subsection (b) may be used for ac- therefore no official attempt to find the SEC. 3. SENSE OF THE SENATE. tivities such as— child. It is the sense of the Senate that— (A) providing shelter to domestic minor (6) In 2007, the Administration of Children (1) the Attorney General should implement trafficking victims, including temporary or and Families, Department of Health and changes to the National Crime Information long-term placement as appropriate; Human Services, reported to the Federal Center database in order to ensure that— (B) providing trafficking victims with Government 265,000 cases of serious physical, (A) a child entered into the database will clothing and other daily necessities needed sexual, or psychological abuse of children. be automatically designated as an endan- to keep the trafficking victims from return- (7) Experts estimate that over 100,000 chil- gered juvenile if the child has been reported ing to living on the street; dren in the United States are at risk for (C) counseling and legal services for vic- prostitution. missing not less than 3 times in a 1 year pe- tims of sex trafficking, including substance (8) Children who have run away from home riod; are at a high risk of becoming involved in (B) the database be programmed to cross- abuse treatment, trauma-informed care, and sex trafficking. Children who have run away reference newly entered reports with histor- sexual abuse or other mental health coun- multiple times are at much higher risk of ical records already in the database; and seling; not returning home and of engaging in pros- (C) the database be programmed to include (D) specialized training for law enforce- titution. a visual cue on the record of a child des- ment personnel and social service providers, (9) The vast majority of children involved ignated as an endangered juvenile in order to specific to sex trafficking issues; in sex trafficking have suffered previous sex- assist law enforcement officers in recog- (E) funding salaries, in whole or in part, ual or physical abuse, live in poverty, or nizing the child and providing the child with for law enforcement officers, including pa- have no stable home or family life. These appropriate care and services; and trol officers; detectives; and investigators; children require a comprehensive framework (2) funds awarded under subpart 1 of part E provided that the percentage of the salary of of specialized treatment and mental health of title I of the Omnibus Crime Control and the law enforcement officer paid for by funds counseling that addresses post-traumatic Safe Streets Act of 1968 (42 U.S.C. 3750 et from a grant awarded under subsection (b) stress, depression, and sexual exploitation. seq.) (commonly known as Byrne Grants) shall be no less than the percentage of the (10) The average age of entry into prostitu- should be used to provide programs relating time dedicated to working on sex trafficking tion is 12. Seventy-five percent of minors en- to sex trafficking education, training, deter- cases by the law enforcement officer; gaged in prostitution have a pimp. A pimp rence, and prevention. (F) funding salaries for State and local can earn $200,000 per year prostituting 1 traf- SEC. 4. SEX TRAFFICKING BLOCK GRANTS. prosecutors, including assisting in paying ficking victim. (a) DEFINITIONS.—In this section— trial expenses for prosecution of sex traf- (11) Sex trafficking is a complex and varied (1) the term ‘‘Assistant Attorney General’’ ficking law offenders; criminal problem that requires a multi-dis- means the Assistant Attorney General for (G) investigation expenses, including— ciplinary, cooperative solution. Reducing the Office of Justice Programs of the Depart- (i) wire taps; trafficking will require the government to ment of Justice; (ii) consultants with expertise specific to address victims, pimps, and johns; and to (2) the term ‘‘domestic minor’’ means an sex trafficking cases; provide training specific to sex trafficking individual who is— (iii) travel; and for law enforcement officers and prosecutors, (A) a citizen of the United States or a law- (iv) any other technical assistance expend- and child welfare, public health, and other ful permanent resident of the United States; itures; and social service providers. A good model for and (H) outreach and education programs to this type of approach is the Internet Crimes (B) under the age of 18 years old; and provide information about deterrence and Against Children task force program. (3) the term ‘‘eligible entity’’ means a prevention of sex trafficking, including pro- (12) Human trafficking is a criminal enter- State or unit of local government that— grams to provide treatment to men charged prise that imposes significant costs on the (A) has significant sex trafficking activity; with solicitation of prostitution in cases economy of the United States. Government (B) has demonstrated cooperation between where— and non-profit resources used to address traf- State and local law enforcement agencies, (i) a treatment program is an appropriate ficking include those of law enforcement, the prosecutors, and social service providers in alternative to criminal prosecution; and judicial and penal systems, and social serv- addressing sex trafficking; and (ii) the men were not charged with solicita- ice providers. Without a range of appropriate (C) has developed a workable, multi-dis- tion of sex with a minor. treatments to help trafficking victims over- ciplinary plan to combat sex trafficking, in- (d) APPLICATION.— come the trauma they have experienced, vic- cluding— (1) IN GENERAL.—Each eligible entity desir- tims will continue to be involved in crime, (i) the establishment of a shelter for sex ing a grant under this Act shall submit an unable to support themselves, and continue trafficking victims; application to the Assistant Attorney Gen- to require government resources rather than (ii) the provision of comprehensive services eral at such time, in such manner, and ac- being productive contributors to the legiti- to domestic minor victims; companied by such information as the As- mate economy. (iii) the provision of specialized training sistant Attorney General may reasonably re- (13) Many domestic minor sex trafficking for law enforcement officers and social serv- quire. victims are younger than 18 years old and ice providers; and (2) CONTENTS.—Each application submitted are below the age of consent. Because traf- (iv) deterrence and prosecution of sex traf- pursuant to paragraph (1) shall— ficking victims have been forced to engage in ficking offenses. (A) describe the activities for which assist- prostitution rather than willfully to com- (b) GRANTS AUTHORIZED.— ance under this section is sought; and mitting a crime, these victims should not be (1) IN GENERAL.—The Assistant Attorney (B) provide such additional assurances as charged as criminal defendants. Instead, General is authorized to award 6 block the Secretary determines to be essential to these victims of trafficking should have ac- grants to eligible entities in different re- ensure compliance with the requirements of cess to treatment and services to help them gions of the United States to combat sex this Act.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00077 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE S13790 CONGRESSIONAL RECORD — SENATE December 22, 2009 (e) EVALUATION.—The Assistant Attorney SUBMITTED RESOLUTIONS (OSCE) to have been consistent with inter- General shall, in consultation with the national election standards; Comptroller General of the United States, Whereas the United States has closely sup- enter into a contract with an academic or SENATE RESOLUTION 384—HON- ported the people of Ukraine in their bold ef- non-profit organization that has experience ORING UNITED STATES ARMY forts to pursue a free and democratic future following the declaration of their independ- in sex trafficking issues and evaluation of SPECIAL OPERATIONS COMMAND ence in 1991; grant programs to conduct an annual evalua- ON THEIR 20TH ANNIVERSARY Whereas the NATO Freedom Consolidation tion of grants made under this section to de- Mr. BURR (for himself and Mrs. Act of 2007 (Public Law 110–17; 22 U.S.C. 1928 termine the impact and effectiveness of pro- HAGAN) submitted the following resolu- note), signed into law by President George grams funded with grants awarded under tion; which was referred to the Com- W. Bush on April 9, 2007, recognized the subsection (b). mittee on Armed Services: progress made by Ukraine toward meeting the responsibilities and obligations for mem- (f) AUTHORIZATION OF APPROPRIATIONS.— S. RES. 384 bership in the North Atlantic Treaty Organi- For fiscal years 2011 through 2014, there are Whereas since the establishment of United zation (NATO) and designated Ukraine as eli- authorized to be appropriated, to carry out States Army Special Operations Command gible to receive assistance under the NATO the provisions of this section, the following (USASOC) on December 1, 1989, its personnel Participation Act of 1994 (title II of Public sums: have operated in some of the most remote Law 103–447; 22 U.S.C. 1928 note); (1) $45,000,000 to fund grants awarded under and hostile regions of the world; Whereas Ukraine has made steps toward subsection (b). Whereas the 7 components of USASOC con- integration within European institutions (2) $1,500,000 to conduct the evaluation sist of the John F. Kennedy Special Warfare through a joint European Union–Ukraine Ac- under subsection (e). Center and School, the United States Army tion Plan, as part of the European (3) $3,500,000 to the Attorney General, to Special Forces Command, the 75th Ranger Neighbourhood Policy; and design and implement improvements to the Regiment, the 160th Special Operations Avia- Whereas the United States–Ukraine Stra- NCIC database. tion Regiment, the 4th Psychological Oper- tegic Partnership Commission was inaugu- ations Group, the 95th Civil Affairs Brigade, rated by Secretary of State Hillary Clinton SEC. 5. REPORTING REQUIREMENTS. and the 528th Sustainment Brigade; and Ukrainian Foreign Minister Petro (a) REPORTING REQUIREMENT FOR STATE Whereas USASOC provides 70 percent of Poroshenko on December 9, 2009: Now, there- CHILD WELFARE AGENCIES.— special operations personnel in Central Com- fore, be it (1) REQUIREMENT FOR STATE CHILD WELFARE mand’s theater and approximately 63 percent Resolved, That the Senate— (1) recognizes the great progress made by AGENCIES TO REPORT CHILDREN MISSING OR AB- of the total overseas military commitments of the United States; the people of Ukraine in establishing demo- DUCTED.—Section 471(a) of the Social Secu- cratic institutions and carrying out peaceful rity Act (42 U.S.C. 671(a)) is amended— Whereas in the 8 years since the start of Operation Enduring Freedom and Operation election processes in 2004, 2006, and 2007; (A) in paragraph (32), by striking ‘‘and’’ Iraqi Freedom, 245 USASOC soldiers have (2) supports a free and transparent election after the semicolon; made the ultimate sacrifice; and process in the presidential election in (B) in paragraph (33), by striking the pe- Whereas Master Sergeant Brendan O’Con- Ukraine on January 17, 2010, that comports riod and inserting ‘‘; and’’; and nor, Chief Warrant Officer David Cooper, with the international election standards of (C) by inserting after paragraph (33) the Colonel Mark Mitchell, Master Sergeant the Organization for Security and Coopera- following: Donald Hollenbaugh, and Master Sergeant tion in Europe; ‘‘(34) provides that the State has in effect Daniel Briggs, all of whom have served this (3) encourages all parties to respect the procedures that require the State agency to Nation as soldiers assigned to USASOC, re- independence and territorial integrity of promptly report information on missing or ceived the Distinguished Service Cross for Ukraine, as well as the full integration of abducted children to the law enforcement actions in support of the Global War on Ter- Ukraine into the international community authorities for entry into the National rorism: Now, therefore, be it of democracies; and Crime Information Center (NCIC) database.’’. Resolved, That the Senate— (4) pledges support for the creation of a (2) REGULATIONS.—The Secretary of Health (1) commends the United States Army Spe- prosperous free market economy and the and Human Services shall promulgate regu- cial Operations Command for more than 20 strengthening of a free and open democratic lations implementing the amendment made years of dedicated service to our Nation; system in Ukraine. by paragraph (1). The regulations promul- (2) honors the more than 27,000 personnel f gated under this subsection shall include who serve in the United States Army Special provisions to withhold federal funds to any Operations Command; and SENATE RESOLUTION 386—CON- State that fails to substantially comply with (3) pledges its continued support for the DEMNING THE GOVERNMENT OF the requirement imposed under the amend- men and women of the United States Armed IRAN FOR RESTRICTING AND ment made by paragraph (1). Forces. SUPPRESSING FREEDOM OF THE (3) EFFECTIVE DATE.—The amendment f PRESS, FREEDOM OF SPEECH, made by paragraph (1) shall take effect on FREEDOM OF EXPRESSION, AND October 1, 2010, without regard to whether SENATE RESOLUTION 385—RECOG- NIZING THE GREAT PROGRESS FREEDOM OF ASSEMBLY, AND final regulations required under paragraph FOR ITS HUMAN RIGHTS (2) have been promulgated by that date. MADE BY THE PEOPLE OF UKRAINE IN THE ESTABLISH- ABUSES, AND FOR OTHER PUR- (b) ANNUAL STATISTICAL SUMMARY.—Sec- MENT OF DEMOCRATIC INSTITU- POSES tion 3701(c) of the Crime Control Act of 1990 TIONS, AND SUPPORTING A Mr. KAUFMAN (for himself, Mr. (42 U.S.C. 5779(c)) is amended by inserting ‘‘, LIEBERMAN, Mr. MCCAIN, Mr. DODD, Mr. that includes the total number of reports re- FREE AND TRANSPARENT PRESI- KYL, Mr. CASEY, Mr. GRAHAM, Mr. ceived and the total number of entries made DENTIAL ELECTION ON JANUARY LEVIN, Mr. BROWNBACK, and Mr. HATCH) to the National Crime Information Center 17, 2010 submitted the following resolution; (NCIC) database’’ after ‘‘of this title’’. Mr. LUGAR submitted the following which was considered and agreed to: resolution; which was referred to the (c) STATE REPORTING.—Section 3702 of the S. RES. 386 Crime Control Act of 1990 (42 U.S.C. 5780) is Committee on Foreign Relations: Whereas hundreds of thousands of Iranian amended in paragraph (4)— S. RES. 385 citizens have engaged in peaceful protest (1) by striking ‘‘(2)’’ and inserting ‘‘(3)’’; Whereas adherence by Ukraine to demo- since the June 12, 2009, presidential election (2) in subparagraph (A), by inserting ‘‘, and cratic, transparent, and fair election stand- in Iran; a photograph taken within the previous 180 ards has been necessary for full integration Whereas the Government of Iran has re- days’’ after ‘‘dental records’’; into the community of democracies; sponded to these protests with a concerted (3) in subparagraph (B), by striking the Whereas steps undertaken by Ukraine in campaign of intimidation, repression, and vi- ‘‘and’’ after the semicolon; recent years, including reform of election olence, including human rights abuses (4) by redesignating subparagraph (C) as laws and regulations, the development of a against Iranian citizens; subparagraph (D); and free and independent press, and the estab- Whereas there have been numerous allega- (5) by inserting after subparagraph (B) the lishment of public institutions that respect tions of torture, rape, imprisonment, and vi- following: human rights and the rule of law, have en- olence perpetrated against Iranian citizens ‘‘(C) notify the National Center for Missing hanced Ukraine’s progress toward democracy by the Government of Iran since the June 12 and Exploited Children of each report re- and enhanced prosperity; elections; ceived relating to a child reported missing Whereas elections in Ukraine in 2004, 2006, Whereas the Government of Iran has from a foster care family home or childcare and 2007 were determined by the Organiza- sought to restrict and suppress the legiti- institution; and’’. tion for Security and Cooperation in Europe mate right of the people of Iran to exercise

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freedom of speech, freedom of expression, Whereas on December 10, 2009, President SA 2786 proposed by Mr. REID (for himself, freedom of assembly, and freedom of the Barack Obama affirmed in his statement ac- Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to press; cepting the Nobel Peace Prize, ‘‘We will bear the bill H.R. 3590, to amend the Internal Rev- Whereas the Government of Iran has mon- witness to the quiet dignity of reformers. . .to enue Code of 1986 to modify the first-time itored, controlled, and censored access to the the hundreds of thousands who have marched homebuyers credit in the case of members of Internet, and has conducted a campaign of silently through the streets of Iran. It is tell- the Armed Forces and certain other Federal harassment and intimidation through the ing that the leaders of these governments employees, and for other purposes; which electronic media; fear the aspirations of their own people more was ordered to lie on the table. Whereas Freedom House assesses Internet than the power of any other nation. And it is SA 3295. Mr. HATCH submitted an amend- and digital media in Iran as ‘‘Not Free,’’ and the responsibility of all free people and free ment intended to be proposed to amendment characterizes the Government of Iran as nations to make clear to these movements SA 2786 proposed by Mr. REID (for himself, wielding ‘‘one of the world’s most sophisti- that hope and history are on their side.’’ Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to cated apparatuses for controlling the inter- Whereas, on December 18, 2009, the United the bill H.R. 3590, supra; which was ordered net and other digital technologies’’; Nations General Assembly passed a resolu- to lie on the table. Whereas the Government of Iran is en- tion calling on the Government of Iran to re- SA 3296. Mr. HATCH submitted an amend- gaged in a range of activities that interfere spect its human rights obligations, including ment intended to be proposed to amendment with, or infringe upon, the right of the peo- its obligations under its own constitution as SA 2786 proposed by Mr. REID (for himself, ple of Iran to access accurate, independent well as those of international human rights Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to law; and news and information; the bill H.R. 3590, supra; which was ordered Whereas, on December 18, 2009, the Depart- Whereas, according to Amnesty Inter- to lie on the table. ment of State issued a statement welcoming national, the Government of Iran has banned SA 3297. Mr. DEMINT submitted an amend- the passage of the United Nations resolution several newspapers, including Farhang-e ment intended to be proposed to amendment which stated, ‘‘The resolution, first adopted Ashti, Arman-e Ravabet-e Omomi, Tahlil-e SA 2786 proposed by Mr. REID (for himself, last month by the UN Third Committee, ex- Rooz, and Sarmayeh; Mr. BAUCUS, Mr. DODD, and Mr. HARKIN) to presses deep concern over the brutal re- Whereas the Government of Iran has har- the bill H.R. 3590, supra; which was ordered sponse of Iranian authorities to peaceful to lie on the table. assed, arrested, detained, imprisoned, and as- demonstrations in the wake of the June 12 saulted numerous Iranian and foreign jour- election. . .Those in Iran who are trying to f nalists, publishers, editors, photographers, exercise their universal rights should know cameramen, and bloggers; that their voices are being heard.’’: Now, TEXT OF AMENDMENTS Whereas the Government of Iran has pro- therefore, be it SA 3294. Mr. HATCH submitted an hibited Iranian and non-Iranian news serv- Resolved, That the Senate— ices from distributing reports in Farsi; amendment intended to be proposed to (1) supports the right of the people of Iran amendment SA 2786 proposed by Mr. Whereas the Government of Iran has re- to peacefully express their voices, opinions, voked and temporarily suspended the accred- and aspirations, despite intimidation, repres- REID (for himself, Mr. BAUCUS, Mr. itation of foreign journalists to report on sion, and violence; DODD, and Mr. HARKIN) to the bill H.R. current events and news developments in (2) condemns the human rights abuses 3590, to amend the Internal Revenue Iran; committed by the Government of Iran Code of 1986 to modify the first-time Whereas the Government of Iran has inter- against Iranian citizens; homebuyers credit in the case of mem- rupted short message service (SMS), pre- (3) condemns the efforts of the Government bers of the Armed Forces and certain venting text message communications and of Iran to restrict and suppress freedom of other Federal employees, and for other blocking Internet sites that utilize such the press, freedom of speech, freedom of ex- services; pression, and freedom of assembly; purposes; which was ordered to lie on Whereas the Government of Iran has par- (4) condemns online censorship, moni- the table; as follows: tially jammed shortwave and medium wave toring, intimidation, and harassment con- At the appropriate place in title I, insert transmissions of Radio Farda, the Persian ducted by the Government of Iran, including the following: language service of Radio Free Europe/Radio threats against citizens of Iran and Iranian- SEC. ll. ENSURING THE AFFORDABILITY OF Liberty; Americans living in the United States; COVERAGE. Whereas the Government of Iran has inter- (5) condemns an atmosphere of impunity in Notwithstanding any other provision of mittently jammed satellite broadcasts by Iran for those who employ censorship, in- this Act, this Act (and the amendment made Radio Farda, the Voice of America’s Persian timidation, harassment, or violence to re- by this Act) shall not take effect until the News Network (PNN), the British Broad- strict and suppress freedom of speech, free- date on which the Secretary of Health and casting Corporation (BBC), and other non- dom of expression, freedom of assembly, and Human Services certifies to Congress that Iranian government news services; freedom of the press; the implementation of this Act (and amend- Whereas the Government of Iran has (6) condemns the Government of Iran for ments) will not result in a greater increase blocked Web sites and blogs, including social violating the International Covenant on in health insurance premiums than the in- networking, content-sharing, and blogging Civil and Political Rights, done at New York crease that is otherwise projected under cur- sites, such as Facebook, Twitter, YouTube, December 16, 1966, and entered into force rent law for more than 1,000,000 Americans. Orkut, Blogger, and Persianblog; March 23, 1976, which has been ratified by Whereas the Government of Iran has tar- Iran and states, ‘‘Everyone shall have the SA 3295. Mr. HATCH submitted an geted, blocked, and limited Internet connec- right to freedom of expression; this right amendment intended to be proposed to shall include freedom to seek, receive and tions and mobile network access to thwart amendment SA 2786 proposed by Mr. communication in advance of planned dem- impart information and ideas of all kinds, onstrations, and has seized mobile phones regardless of frontiers, either orally, in writ- REID (for himself, Mr. BAUCUS, Mr. that were used to film or document the dem- ing or in print, in the form of art, or through DODD, and Mr. HARKIN) to the bill H.R. onstrations; any other media of his choice.’’; 3590, to amend the Internal Revenue Whereas the Government of Iran has mon- (7) welcomes the decision made by the De- Code of 1986 to modify the first-time itored online activities of Iranians and partment of State on December 15, 2009, to homebuyers credit in the case of mem- threatened them and their families with pu- foster and support the free flow of informa- bers of the Armed Forces and certain nitive action, including citizens of Iran and tion to Iranian citizens by recommending that the Department of the Treasury’s Office other Federal employees, and for other Iranian-Americans living in the United purposes; which was ordered to lie on States and elsewhere overseas; of Foreign Assets Control (OFAC) issue a Whereas, in November 2009, the police general license that would authorize the table; as follows: forces of the Government of Iran formed a downloads of free mass market software to At the appropriate place, insert the fol- special unit to monitor websites and ‘‘Inter- Iran necessary for the exchange of personal lowing: net crimes,’’ including political offenses; communications or sharing of information or SEC. llll. CIVIL ACTIONS BROUGHT ON CON- Whereas the Victims of Iranian Censorship both over the Internet as deemed ‘‘essential STITUTIONAL GROUNDS. Act (subtitle D of title XII of Public Law 111– to the national interest of the United (a) SPECIAL RULES FOR ACTIONS BROUGHT 84), which was signed into law on October 28, States’’; and ON CONSTITUTIONAL GROUNDS.—If any action 2009, stipulates that ‘‘it shall be the policy of (8) urges the implementation of the Vic- is brought for declaratory or injunctive re- the United States to encourage the develop- tims of Iranian Censorship Act (subtitle D of lief to challenge the constitutionality of any ment of technologies, including Internet Web title XII of Public Law 111–84). provision of this Act or any amendment sites, that facilitate the efforts of the Ira- f made by this Act, the following rules shall nian people to gain access to and share accu- AMENDMENTS SUBMITTED AND apply: rate information and exercise freedom of (1) The action shall be filed in any United speech, freedom of expressions, freedom of PROPOSED States District Court and shall be heard by a assembly, and freedom of the press, through SA 3294. Mr. HATCH submitted an amend- 3-judge court convened pursuant to section the Internet or other electronic media’’; ment intended to be proposed to amendment 2284 of title 28, United States Code.

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Such ap- (c) APPEALS.—Appeals from the decisions printed in the RECORD, with no inter- peal shall be taken by the filing of a notice of the Chair relating to any provision of this vening action. of appeal within 10 days, and the filing of a section shall be limited to 1 hour, to be The PRESIDING OFFICER. Without jurisdictional statement within 30 days, of equally divided between, and controlled by, objection, it is so ordered. the entry of the final decision. the appellant and the manager of the meas- The bill (H.R. 4284) was ordered to a (4) It shall be the duty of the United States ure. An affirmative vote of two-thirds of the third reading, read the third time, and District Court in which the action is brought Members of the Senate, present and voting, passed. and the Supreme Court of the United States shall be required to sustain an appeal of the to advance on the docket and to expedite to ruling of the Chair on a point of order raised f the greatest possible extent the disposition under this section. COMMENDING THE SOLDIERS AND of the action and appeal. f CIVILIAN PERSONNEL AT FORT (b) APPLICABILITY.— GORDON (1) INITIAL CLAIMS.—With respect to any ac- NOTICE OF INTENT TO SUSPEND tion initially filed on or before July 31, 2010, THE RULES Mr. DODD. Mr. President, I ask unan- the provisions of subsection (a) shall apply imous consent that the Committee on with respect to each action described in such Mr. DEMINT. Mr. President, I submit Armed Services be discharged from fur- section. the following notice in writing: In ac- ther consideration and the Senate now (2) SUBSEQUENT ACTIONS.—With respect to cordance with Rule V of the Standing any action initially filed after July 31, 2010, proceed to H. Con. Res. 206. Rules of the Senate, I hereby give no- The PRESIDING OFFICER. Without the provisions of subsection (a) shall not tice in writing that it is my intention apply to any action described in such section objection, it is so ordered. unless the person filing such action elects to move to suspend Rule XXII, Para- The clerk will report. such provisions to apply to the action. graph 2, for the purpose of proposing The bill clerk read as follows: and considering the following amend- A concurrent resolution (H. Con. Res. 206) SA 3296. Mr. HATCH submitted an ment, including germaneness require- commending the soldiers and civilian per- amendment intended to be proposed to ments: sonnel stationed at Fort Gordon and their amendment SA 2786 proposed by Mr. At the appropriate place, insert the fol- families for their service and dedication to REID (for himself, Mr. BAUCUS, Mr. lowing: the United States and recognizing the con- DODD, and Mr. HARKIN) to the bill H.R. SEC. ll. POINT OF ORDER. tributions of Fort Gordon to Operation Iraqi 3590, to amend the Internal Revenue (a) IN GENERAL.—It shall not be in order in Freedom and Operation Enduring Freedom Code of 1986 to modify the first-time the Senate to consider a congressionally di- and its role as a pivotal communications training installation. homebuyers credit in the case of mem- rected spending item, a limited tax benefit, bers of the Armed Forces and certain or a limited tariff benefit, if a Senator, Mem- There being no objection, the Senate other Federal employees, and for other ber, Delegate, or Resident Commissioner has proceeded to consider the concurrent conditioned the inclusion of language to pro- resolution. purposes; which was ordered to lie on vide funding for a congressional directed the table; as follows: Mr. DODD. Mr. President, I ask unan- spending item, a limited tax benefit, or a imous consent that the resolution be At the appropriate place in title I, insert limited tariff benefit in any amendment, the following: bill, or joint resolution (or an accompanying agreed to, the preamble be agreed to, SEC. ll. PROHIBITION ON UNFUNDED MAN- report) or in any conference report on a bill and the motion to reconsider be laid DATES. or joint resolution (including an accom- upon the table. Notwithstanding any other provision of panying joint explanatory statement of man- The PRESIDING OFFICER. Without this title (or an amendment made by this agers) on any vote cast by any Senator, objection, it is so ordered. title), no State or locality shall be required Member, Delegate, or Resident Commis- The concurrent resolution was agreed to comply with a requirement of this title sioner. to. (or amendment) prior to the date on which (b) WAIVER.—The provisions of this section The preamble was agreed to. funds are appropriated at the full authorized be waived or suspended only by the affirma- level as provided for in this Act (or an tive vote of two-thirds of the Members, f amendment made by this Act). present and voting. CONDEMNING THE GOVERNMENT (c) APPEALS.—Appeals from the decisions OF IRAN SA 3297. Mr. DEMINT submitted an of the Chair relating to any provision of this amendment intended to be proposed to section shall be limited to 1 hour, to be Mr. DODD. Mr. President, I ask unan- amendment SA 2786 proposed by Mr. equally divided between, and controlled by, imous consent that the Senate proceed REID (for himself, Mr. BAUCUS, Mr. the appellant and the manager of the meas- to the immediate consideration of S. ure. An affirmative vote of two-thirds of the DODD, and Mr. HARKIN) to the bill H.R. Res. 386, submitted earlier today. Members of the Senate, present and voting, 3590, to amend the Internal Revenue The PRESIDING OFFICER. Is there shall be required to sustain an appeal of the objection? Code of 1986 to modify the first-time ruling of the Chair on a point of order raised homebuyers credit in the case of mem- under this section. Without objection, it is so ordered. bers of the Armed Forces and certain The clerk will report. f other Federal employees, and for other The bill clerk read as follows: purposes; which was ordered to lie on EXTENDING GENERALIZED SYS- A resolution (S. Res. 386) condemning the the table; as follows: TEM OF PREFERENCES AND THE Government of Iran for restricting and suppressing freedom of the press, freedom of At the appropriate place, insert the fol- ANDEAN PREFERENCE ACT speech, freedom of expression, and freedom lowing: Mr. DODD. Mr. President, I ask unan- of assembly, and for its human rights abuses, SEC. ll. POINT OF ORDER. imous consent that the Senate proceed and for other purposes. (a) IN GENERAL.—It shall not be in order in to the immediate consideration of H.R. the Senate to consider a congressionally di- There being no objection, the Senate rected spending item, a limited tax benefit, 4284, received from the House and at proceeded to consider the resolution. or a limited tariff benefit, if a Senator, Mem- the desk. Mr. DODD. Mr. President, I ask unan- ber, Delegate, or Resident Commissioner has The PRESIDING OFFICER. Without imous consent that the resolution be conditioned the inclusion of language to pro- objection, it is so ordered. agreed to, the preamble be agreed to, vide funding for a congressional directed The clerk will state the bill by title. the motions to reconsider be laid upon spending item, a limited tax benefit, or a The bill clerk read as follows: the table, with no intervening action limited tariff benefit in any amendment, A bill (H.R. 4284) to extend the Generalized or debate, and that any statements re- bill, or joint resolution (or an accompanying System of Preferences and the Andean Trade report) or in any conference report on a bill lated to the resolution be printed in Preference Act, and for other purposes. or joint resolution (including an accom- the RECORD. panying joint explanatory statement of man- There being no objection, the Senate The PRESIDING OFFICER. Without agers) on any vote cast by any Senator, proceeded to consider the bill. objection, it is so ordered.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00080 Fmt 0637 Sfmt 0634 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE December 22, 2009 CONGRESSIONAL RECORD — SENATE S13793 The resolution (S. Res. 386) was that were used to film or document the dem- ing or in print, in the form of art, or through agreed to. onstrations; any other media of his choice.’’; The preamble was agreed to. Whereas the Government of Iran has mon- (7) welcomes the decision made by the De- itored online activities of Iranians and partment of State on December 15, 2009, to The resolution, with its preamble, threatened them and their families with pu- foster and support the free flow of informa- reads as follows: nitive action, including citizens of Iran and tion to Iranian citizens by recommending S. RES. 386 Iranian-Americans living in the United that the Department of the Treasury’s Office Whereas hundreds of thousands of Iranian States and elsewhere overseas; of Foreign Assets Control (OFAC) issue a citizens have engaged in peaceful protest Whereas, in November 2009, the police general license that would authorize since the June 12, 2009, presidential election forces of the Government of Iran formed a downloads of free mass market software to in Iran; special unit to monitor websites and ‘‘Inter- Iran necessary for the exchange of personal Whereas the Government of Iran has re- net crimes,’’ including political offenses; communications or sharing of information or sponded to these protests with a concerted Whereas the Victims of Iranian Censorship both over the Internet as deemed ‘‘essential campaign of intimidation, repression, and vi- Act (subtitle D of title XII of Public Law 111– to the national interest of the United olence, including human rights abuses 84), which was signed into law on October 28, States’’; and against Iranian citizens; 2009, stipulates that ‘‘it shall be the policy of (8) urges the implementation of the Vic- the United States to encourage the develop- Whereas there have been numerous allega- tims of Iranian Censorship Act (subtitle D of ment of technologies, including Internet Web tions of torture, rape, imprisonment, and vi- title XII of Public Law 111–84). sites, that facilitate the efforts of the Ira- olence perpetrated against Iranian citizens nian people to gain access to and share accu- by the Government of Iran since the June 12 rate information and exercise freedom of f elections; speech, freedom of expressions, freedom of Whereas the Government of Iran has assembly, and freedom of the press, through sought to restrict and suppress the legiti- APPOINTMENTS the Internet or other electronic media’’; mate right of the people of Iran to exercise Whereas on December 10, 2009, President The PRESIDING OFFICER. The freedom of speech, freedom of expression, Barack Obama affirmed in his statement ac- Chair, on behalf of the President pro freedom of assembly, and freedom of the cepting the Nobel Peace Prize, ‘‘We will bear tempore, pursuant to 22 U.S.C. 276n, as press; witness to the quiet dignity of reformers. . .to amended, appoints the following Sen- Whereas the Government of Iran has mon- the hundreds of thousands who have marched ator as a delegate of the U.S.-China itored, controlled, and censored access to the silently through the streets of Iran. It is tell- Internet, and has conducted a campaign of Interparliamentary Group conference ing that the leaders of these governments during the 111th Congress: The Honor- harassment and intimidation through the fear the aspirations of their own people more electronic media; than the power of any other nation. And it is able MICHAEL ENZI of Wyoming. Whereas Freedom House assesses Internet the responsibility of all free people and free The Chair, on behalf of the President and digital media in Iran as ‘‘Not Free,’’ and nations to make clear to these movements pro tempore, pursuant to 22 U.S.C. characterizes the Government of Iran as that hope and history are on their side.’’ 276n, as amended, appoints the fol- wielding ‘‘one of the world’s most sophisti- Whereas, on December 18, 2009, the United cated apparatuses for controlling the inter- lowing Senator as a delegate of the Nations General Assembly passed a resolu- U.S.-China Interparliamentary Group net and other digital technologies’’; tion calling on the Government of Iran to re- Whereas the Government of Iran is en- spect its human rights obligations, including conference during the 111th Congress: gaged in a range of activities that interfere its obligations under its own constitution as the Honorable ROLAND BURRIS of Illi- with, or infringe upon, the right of the peo- well as those of international human rights nois. ple of Iran to access accurate, independent law; and Mr. DODD. Mr. President, I yield the news and information; Whereas, on December 18, 2009, the Depart- floor. Whereas, according to Amnesty Inter- ment of State issued a statement welcoming national, the Government of Iran has banned the passage of the United Nations resolution f several newspapers, including Farhang-e which stated, ‘‘The resolution, first adopted Ashti, Arman-e Ravabet-e Omomi, Tahlil-e last month by the UN Third Committee, ex- Rooz, and Sarmayeh; presses deep concern over the brutal re- ADJOURNMENT UNTIL 9:45 A.M. Whereas the Government of Iran has har- sponse of Iranian authorities to peaceful TOMORROW assed, arrested, detained, imprisoned, and as- demonstrations in the wake of the June 12 saulted numerous Iranian and foreign jour- election. . .Those in Iran who are trying to The PRESIDING OFFICER. Under nalists, publishers, editors, photographers, exercise their universal rights should know the previous order, the Senate stands cameramen, and bloggers; that their voices are being heard.’’: Now, adjourned until 9:45 a.m. tomorrow. Whereas the Government of Iran has pro- therefore, be it There being no objection, the Senate, hibited Iranian and non-Iranian news serv- Resolved, That the Senate— at 7:06 p.m., adjourned until Wednes- ices from distributing reports in Farsi; (1) supports the right of the people of Iran Whereas the Government of Iran has re- to peacefully express their voices, opinions, day, December 23, 2009, at 9:45 a.m. voked and temporarily suspended the accred- and aspirations, despite intimidation, repres- itation of foreign journalists to report on sion, and violence; f current events and news developments in (2) condemns the human rights abuses Iran; committed by the Government of Iran NOMINATIONS Whereas the Government of Iran has inter- against Iranian citizens; rupted short message service (SMS), pre- (3) condemns the efforts of the Government Executive nominations received by venting text message communications and of Iran to restrict and suppress freedom of the Senate: blocking Internet sites that utilize such the press, freedom of speech, freedom of ex- THE JUDICIARY services; pression, and freedom of assembly; Whereas the Government of Iran has par- (4) condemns online censorship, moni- J. MICHELLE CHILDS, OF SOUTH CAROLINA, TO BE UNITED STATES DISTRICT JUDGE FOR THE DISTRICT OF tially jammed shortwave and medium wave toring, intimidation, and harassment con- SOUTH CAROLINA, VICE GEORGE ROSS ANDERSON, JR., transmissions of Radio Farda, the Persian ducted by the Government of Iran, including RETIRED. language service of Radio Free Europe/Radio threats against citizens of Iran and Iranian- RICHARD MARK GERGEL, OF SOUTH CAROLINA, TO BE UNITED STATES DISTRICT JUDGE FOR THE DISTRICT OF Liberty; Americans living in the United States; SOUTH CAROLINA, VICE HENRY M. HERLONG, JR., RE- Whereas the Government of Iran has inter- (5) condemns an atmosphere of impunity in TIRED. mittently jammed satellite broadcasts by Iran for those who employ censorship, in- DEPARTMENT OF JUSTICE Radio Farda, the Voice of America’s Persian timidation, harassment, or violence to re- WILLIAM N. NETTLES, OF SOUTH CAROLINA, TO BE News Network (PNN), the British Broad- strict and suppress freedom of speech, free- UNITED STATES ATTORNEY FOR THE DISTRICT OF casting Corporation (BBC), and other non- dom of expression, freedom of assembly, and SOUTH CAROLINA FOR THE TERM OF FOUR YEARS, VICE Iranian government news services; freedom of the press; WILLIAM WALTER WILKINS, III. KELVIN CORNEILIUS WASHINGTON, OF SOUTH CARO- Whereas the Government of Iran has (6) condemns the Government of Iran for LINA, TO BE UNITED STATES MARSHAL FOR THE DIS- blocked Web sites and blogs, including social violating the International Covenant on TRICT OF SOUTH CAROLINA FOR THE TERM OF FOUR networking, content-sharing, and blogging Civil and Political Rights, done at New York YEARS, VICE JOHNNY MACK BROWN. sites, such as Facebook, Twitter, YouTube, December 16, 1966, and entered into force IN THE COAST GUARD Orkut, Blogger, and Persianblog; March 23, 1976, which has been ratified by THE FOLLOWING NAMED INDIVIDUAL FOR APPOINT- Whereas the Government of Iran has tar- Iran and states, ‘‘Everyone shall have the MENT AS COMMANDANT OF THE UNITED STATES COAST geted, blocked, and limited Internet connec- right to freedom of expression; this right GUARD AND TO THE GRADE INDICATED UNDER TITLE 14, U.S.C., SECTION 44: tions and mobile network access to thwart shall include freedom to seek, receive and communication in advance of planned dem- impart information and ideas of all kinds, To be admiral onstrations, and has seized mobile phones regardless of frontiers, either orally, in writ- VICE ADM. ROBERT J. PAPP, JR.

VerDate Nov 24 2008 02:41 Mar 11, 2010 Jkt 089060 PO 00000 Frm 00081 Fmt 0637 Sfmt 9801 E:\RECORD09\S22DE9.REC S22DE9 mmaher on DSK69SOYB1PROD with CONG-REC-ONLINE Tuesday, December 22, 2009 Daily Digest Senate change the enactment date. (By 60 yeas to 39 nays Chamber Action (Vote No. 386), Senate tabled the amendment.) Routine Proceedings, pages S13713–S13793 Pages S13714, S13715 Measures Introduced: Four bills and three resolu- Withdrawn: tions were introduced, as follows: S. 2922–2925, and Reid Amendment No. 3277 (to Amendment No. S. Res. 384–386. Page S13785 3276), to change the enactment date. Measures Reported: Pages S13714, S13715–16 H.R. 3819, to extend the commercial space trans- Pending: portation liability regime. Page S13785 Reid Amendment No. 2786, in the nature of a Measures Passed: substitute. Pages S13714–44, S13745–51 Generalized System of Preferences and the An- Reid (for Cardin) Amendment No. 2878 (to dean Trade Preference Act Extension: Senate Amendment No. 2786), to provide for the establish- passed H.R. 4284, to extend the Generalized System ment of Offices of Minority Health. of Preferences and the Andean Trade Preference Act, Pages S13714, S13716 clearing the measure for the President. Page S13792 Reid Amendment No. 3292 (to Amendment No. Commending the Soldiers, Civilian Personnel, 2878), to change the effective date. Pages S13716–44 and Families at Fort Gordon: Committee on During consideration of this measure today, Senate Armed Services was discharged from further consid- also took the following action: eration of H. Con. Res. 206, commending the soldiers and civilian personnel stationed at Fort Gordon Reid Amendment No. 3279 (to Amendment No. and their families for their service and dedication to 3278), to change the enactment date, fell when Reid the United States and recognizing the contributions Amendment No. 3278 (to the language proposed to of Fort Gordon to Operation Iraqi Freedom and Op- be stricken by Amendment No. 2786) (listed above), eration Enduring Freedom and its role as a pivotal was tabled. Page S13714 communications training installation, and the resolu- By 60 yeas to 39 nays (Vote No. 388), three-fifths tion was then agreed to. Page S13792 of those Senators duly chosen and sworn, having Condemning the Government of Iran: Senate voted in the affirmative, Senate agreed to the motion agreed to S. Res. 386, condemning the Government to close further debate on the Reid Amendment No. of Iran for restricting and suppressing freedom of the 2786, in the nature of a substitute. Page S13716 press, freedom of speech, freedom of expression, and A unanimous-consent agreement was reached pro- freedom of assembly, and for its human rights viding that all post-cloture time be considered ex- abuses. Pages S13792–93 pired on the bill at 8 a.m., Thursday, December 24, Measures Considered: 2009, if cloture is invoked, and immediately the Service Members Home Ownership Tax Act— bill, as amended, be read a third time, and Senate Agreement: Senate continued consideration of H.R. vote on passage of the bill. Page S13747 3590, to amend the Internal Revenue Code of 1986 A unanimous-consent-time agreement was reached to modify the first-time homebuyers credit in the providing for further consideration of the bill at ap- case of members of the Armed Forces and certain proximately 9:45 a.m., on Wednesday, December other Federal employees, taking action on the fol- 23, 2009, with the time following any Leader re- lowing amendments proposed thereto: marks and until 10 a.m. equally divided and con- Pages S13714–44, S13745–51 trolled between the two Leaders, or their designees; Adopted: that at 10 a.m. and until 2 p.m. the time be con- By 60 yeas to 39 nays (Vote No. 387), Reid trolled in alternating one hour blocks of time, with Amendment No. 3276 (to Amendment No. 2786), the Majority controlling the first hour; provided fur- of a perfecting nature. Pages S13714–15, S13716 ther, that the remaining time until 2:13 p.m. be Rejected: equally divided and controlled between the two Reid Amendment No. 3278 (to the language pro- Leaders, with the Majority controlling the final half. posed to be stricken by Amendment No. 2786), to Page S13779 D1509

VerDate Nov 24 2008 04:24 Dec 23, 2009 Jkt 089060 PO 00000 Frm 00001 Fmt 5627 Sfmt 5627 E:\CR\FM\D22DE9.REC D22DEPT1 jbell on DSKDVH8Z91PROD with DIGEST D1510 CONGRESSIONAL RECORD — DAILY DIGEST December 22, 2009 Appointments: that Senate vote on passage of the joint resolution, U.S.-China Interparliamentary Group Con- as amended, that passage also be subject to an af- ference: The Chair, on behalf of the President pro firmative 60 vote threshold. Page S13747 tempore, pursuant to 22 U.S.C. 276n, as amended, Martin Nomination—Agreement: A unanimous- appointed the following Senator as a delegate of the consent-time agreement was reached providing that U.S.-China Interparliamentary Group conference dur- on Wednesday, January 20, 2010, after a period of ing the 111th Congress: Senator Burris. Page S13793 morning business, Senate begin consideration of the U.S.-China Interparliamentary Group Con- nomination of Beverly Baldwin Martin, of Georgia, ference: The Chair, on behalf of the President pro to be United States Circuit Judge for the Eleventh tempore, pursuant to 22 U.S.C. 276n, as amended, Circuit; that there be 60 minutes of debate with re- appointed the following Senator as a delegate of the spect to the nomination, with time equally divided U.S.-China Interparliamentary Group conference dur- and controlled between Senators Leahy and Sessions, ing the 111th Congress: Senator Enzi. Page S13793 or their designees; that upon the use or yielding Continued Financing of Government Oper- back of time, Senate vote on confirmation of the ations—Agreement: A unanimous-consent agree- nomination. Pages S13747–48 ment was reached providing that on Thursday, De- Nominations Received: Senate received the fol- cember 24, 2009, after passage of H.R. 3590, to lowing nominations: amend the Internal Revenue Code of 1986 to modify J. Michelle Childs, of South Carolina, to be the first-time homebuyers credit in the case of mem- United States District Judge for the District of bers of the Armed Forces and certain other Federal South Carolina. employees, as amended, Senate immediately begin Richard Mark Gergel, of South Carolina, to be consideration of H.R. 4314, an act to permit contin- United States District Judge for the District of ued financing of Government operations; that no South Carolina. amendments be in order; Senate vote on passage of William N. Nettles, of South Carolina, to be the bill; that passage require a 60 affirmative vote United States Attorney for the District of South threshold. Page S13747 Carolina for the term of four years. Increasing the Statutory Limit on the Public Kelvin Corneilius Washington, of South Carolina, Debt—Agreement: A unanimous-consent agree- to be United States Marshal for the District of South ment was reached providing that on Wednesday, Carolina for the term of four years. January 20, 2010, at a time to be determined by the Majority Leader, following consultation with the Re- 1 Coast Guard nomination in the rank of admiral. publican Leader, the Committee on Finance be dis- Page S13793 charged of H.J. Res. 45, increasing the statutory Executive Communications: Page S13785 limit on the public debt; Senate proceed to the Additional Cosponsors: Pages S13785–86 measure; that immediately after the joint resolution Statements on Introduced Bills/Resolutions: is reported, the Majority Leader, or his designee, be recognized to offer a substitute amendment; and that Pages S13786–91 the following be the only first-degree amendments Additional Statements: Pages S13784–85 in order to the joint resolution: Thune Amendment Amendments Submitted: Pages S13791–92 relative to TARP; Murkowski Amendment relative Notices of Intent: Page S13792 to Endangerment EPA regulations; Coburn Amend- ment relative to Rescissions package; Sessions Record Votes: Three record votes were taken today. Amendment relative to Spending caps; McConnell (Total—388) Pages S13715–16 Amendment relative to any on list; Reid Amend- Adjournment: Senate convened at 7:01 a.m. and ment relative to any on list; Reid Amendment rel- adjourned at 7:06 p.m., until 9:45 a.m. on Wednes- ative to pay go; three Baucus Amendments relative day, December 23, 2009. (For Senate’s program, see to any on list; and Conrad/Gregg Amendment rel- the remarks of the Majority Leader in today’s Record ative to fiscal taskforce; that each of the listed on page S13779.) amendments be subject to an affirmative 60 vote threshold; and that if any achieve that threshold, then they be agreed to; that if they do not achieve Committee Meetings the 60 vote threshold, then they be withdrawn; that upon disposition of all amendments, the substitute (Committees not listed did not meet) amendment, as amended, if amended, be agreed to; No committee meetings were held.

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Next Meeting of the SENATE Next Meeting of the HOUSE OF REPRESENTATIVES 9:45 a.m., Wednesday, December 23 11:30 a.m., Wednesday, December 23

Senate Chamber House Chamber Program for Wednesday: Senate will continue consider- Program for Wednesday: to be announced. ation of H.R. 3590, Service Members Home Ownership Tax Act, with a series of up to five rollcall votes to begin at approximately 2:13 p.m.

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