Max Baucus

Mr. BAUCUS

Mr. BAUCUS. Mr. President, I ask unanimous consent that Daniel Barlava, an intern in Senator Dodd's office, be granted the privilege of the floor for the remainder of today's session.

Mr. BAUCUS

Mr. BAUCUS. Madam President, it has been more than a month since the majority leader moved to proceed to the health care bill before us today. This bill will provide real reform for our Nation's flawed health care system. This bill is the product of years of hard work, study, and deliberation in both the Finance Committee and the HELP Committee--and I mean years--all transparent, all aboveboard, all out in the open. In fact, in the Finance Committee, we initiated a new requirement that all amendments to the bill would have to be posted in advance on the Internet so everybody could know what they were, the same with the bill itself. The mark was on the Internet for a couple 3 days before we even went to markup. It is unprecedented how open and transparent the process has been. The same is true in the HELP Committee. The culmination of these efforts has been the weeks of debate on this bill in the Senate. These provisions have been in the public domain for a long time. It is true there could be minor changes here and there, but most of this has been in the public domain for a long time. We have considered numerous amendments. We have engaged in a full and healthy discussion. The bill before us is fully paid for. It is important to keep reminding colleagues over and over again: This is fully paid for. Don't take my word for it. That is what the CBO said. The American people trust and realize, according to the Congressional Budget Office, a nonpartisan organization, that this bill is fully paid for. It does not add one thin dime to the deficit. You are going to hear others who don't have their own proposals just want to be negative, want to try to shoot holes in this, try to say it adds to the deficit. That is their opinion. That is not the opinion of the CBO. CBO says it does not add one thin dime. This bill will also reduce the Federal deficit in the short term and over the long term. It reduces the Federal deficit. We are so very concerned about deficits. We in the Congress are and the country is. We have to begin as soon as we can to start getting those deficits down and the national debt lowered. This health care reform bill not only provides health insurance coverage and reforms the insurance industry dramatically, it also takes the steps of lowering the deficit and lowering the long-term debt. Let me quote from the Congressional Budget Office letter of yesterday: CBO and [Joint Committee on Taxation] estimate that, on balance, the direct spending and revenue effects of enacting the Patient Protection and Affordable Care Act incorporating the managers' amendment would yield a net reduction in federal deficits of $132 billion over the [10-year] period. A net reduction of $132 billion. That is even better than the merged bill was just before we included the managers' amendment. That was a $130 reduction in the national deficit. With the managers' amendment, according to the CBO, there is a net reduction in the Federal deficit of $132 billion over the 10-year period. What about later? Often people say: Gee, I hear you, Senator, you are taking care of things in the short term, but you are enacting legislation that will have an adverse long-term effect. That is what you guys do back there. You hear that often. Let me disclose what the Congressional Budget Office says about that. This legislation will reduce the deficit markedly in the outyears. Here is what the CBO says in a letter released today: All told, the [Congressional Budget Office] expects that the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law--with a total effect during that decade that is in the broad range [of] between one-quarter and one-half percent of GDP. What are they saying? They are saying that in the second 10 years, the deficit will be reduced between one-quarter and one-half percent of GDP. That is between $630 billion and $1.3 trillion. That is real money. We are going to reduce the Federal deficit by this legislation alone. Let's take the between $630 billion and $1.3 trillion--roughly, $1 trillion in the next decade. That is important. That is significant. That is a good start. The legislation before us will extend insurance coverage to more than 30 million Americans. Think of that, 30 million Americans who today do not have insurance will get health insurance. That is so important. I have forgotten the exact figure, but I remember there was a Harvard study that concluded that 45,000 Americans die every year because they have no health insurance. Obviously, people without health insurance die earlier, at an earlier age. Just for the sake of their own health, it is good those people get health insurance, let alone the benefit to hospitals by reducing uncompensated care. This legislation will increase insurance coverage to more than 30 million Americans. I have just been passed a note that people have a 40-percent higher chance of dying without health insurance. We are saying to those folks, those 31 million Americans, we are going to figure out a way so you have health insurance so you do not have that 40-percent higher risk of death. Here is what CBO says about coverage: By 2019, the CBO and [Joint Committee on Taxation] estimate that the number of nonelderly people who are uninsured will be reduced by about 31 million. CBO goes on to say: Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from 83 percent currently to about 94 percent. That is 94 percent of the folks in our country, excluding seniors, because they have insurance under Medicare, excluding them and excluding the unauthorized, the total number of Americans who have health insurance will rise from the current number of 83 percent to about 94 percent. This legislation will drive down premium costs for virtually all of us. It will drive down premium costs for virtually all. In an earlier letter, the CBO indicated premiums would go down for roughly 93 percent of Americans under the underlying bill. Premiums would go down about 93 percent for Americans. I was going to put a table in the record, but our rules don't allow us to put tables in, so I summarized. The conclusion of that summary is 93 percent of Americans will experience lower premiums--not dramatic for some folks but nevertheless down, and down is better than not down. Insurance costs would go down significantly for those receiving tax credits in the new insurance exchanges. It will protect consumers from harmful insurance company practices. This is so important. As you know, no longer will insurance companies be able to deny coverage for those with preexisting conditions. It is an outrage how much insurance companies deny coverage based on preexisting conditions. We all hear stories many times, if not from direct family members, from friends of family who run into this. It is so common, especially in the individual market as people buy insurance for themselves. Insurance companies deny coverage, deny giving health insurance to somebody because of a preexisting condition. It is wrong. No longer will insurance companies be able to drop coverage for those who are sick. That is very important too. Companies often rescind willy-nilly. They found something in the background of the person, you didn't tell us about that so we are rescinding your policy. That is not right. That is just not right. We prevent that from happening in this legislation. It will also improve choice and competition in the insurance market. We talk a lot about choice and competition. This legislation provides more choice in choosing policies and more competition in the insurance market. It will also create a true marketplace where plans compete on cost and quality rather than on their ability to cherry-pick the healthiest among us. It will represent the largest tax cut for American families that Congress has passed since 2001. This legislation includes the largest tax cut for American families that Congress has passed since that tax cut bill in 2001, the largest. It is the tax credits people will receive to help them buy insurance. That totals up, I think, to $440 billion. I have forgotten the exact figures. But this is the largest tax cut for American families since 2001. It will provide billions of dollars in tax credits to help families, workers, and small businesses to buy quality, affordable health care insurance. The managers' amendment makes this good bill even better. It will provide even more consumer protections against harmful insurance industry practices. For example, it will hold companies accountable for excessive premium rate increases. It will require them to spend more on consumer benefits and less on administrative costs and profits. That is new. That is even better consumer protection compared with the underlying bill. It will restrict the ability of health plans to impose annual limits on benefits. That is new, restricting the ability of health plans to impose annual limits on benefits. It is wrong if you have an insurance policy that, lo and behold, the company says: We didn't know you were going to be that sick so we stopped the benefits you can get, annually and also lifetime. We do both. We restrict the ability of health plans to impose not only annual limits but also lifetime limits on benefits. This managers' package will ensure that companies cannot discriminate against children with preexisting conditions and do so right away, beginning with plans that become effective midyear next year. The preexisting condition restriction would ordinarily not take effect for a couple years, but for children the preexisting condition prohibition will take effect right away. There are other provisions to help people between now and 2014. There is high-risk pooling, for example, lots of different provisions in this bill which will help people get good benefits and protection very quickly. This legislation will provide tax credits to even more small businesses. The managers' amendment will provide even more tax credits than the underlying bill. These benefits will now be available right away, in 2010. It is also a concern when will the tax credits for small business go into effect--shouldn't they go into effect earlier. Under this managers' amendment, these benefits will be available in 2010. This will also provide more health insurance choices through a new multistate option. That option offers consumers the same health insurance Congress has today--no small matter. It will extend extra funding for the Children's Health Insurance Program for 2 additional years. We are all very concerned about kids' health care. The children's health care program has done a pretty good job. This has been extended, under the managers' amendment, for an additional 2 years. It will do even more to control rising health care costs and reward even more providers for providing quality care to seniors through the Medicare Program. It will invest $10 billion in community health centers. They are so important, community health centers, for folks who need help right away and don't have insurance, just need the care right away. Especially in rural communities, it will provide access to critical care where often that care is most needed. These are the reforms which Americans have been waiting for, for decades. Americans are waiting for these changes. They are waiting for these reforms and have been for a long time. Decades may be an understatement. Our health insurance system just doesn't do what it should for Americans, the people we represent. Finally, we are taking a very significant first step to providing those reforms. These are reforms American families, workers, and businesses desperately need. They are reforms on which our economic stability depends. That is no small matter either. If we get our insurance costs under control, that is more economic stability for everyone. It is not just for families who don't know what the insurance company is or is not going to do, it is for small businesses that don't know whether premiums will be up or by how much next year. Why? It is more economic stability for families and small businesses and soon more economic stability for budgets, State budgets, our Federal budget. We need to get a little more control over all the excessive costs that are going up, and also the volatility, the yo-yo effect that premiums have and out-of-pocket cost impositions have on people. This will help them very significantly. So by and large, to be honest--I know this sounds a little naive, perhaps--I do not know why this bill does not get an overwhelming endorsement. This is a big vote on both sides of the aisle. Then we can, next year, keep going from there; add new provisions that need to be added, correct mistakes that probably this legislation is going to have, but work together because most Americans want us to work together back here. They do not like us being partisan or political. I must say, this place is getting a little more partisan over the last couple years than it was earlier. It is not what the American people want. They want us to do our job, do what is right. This bill clearly is in the bounds of reasonableness of what is right and what is the right thing to do to get control of our health care system. Again, I hope we can get this passed by a large margin. It will pass. But I would like it passed by a large margin. Madam President, I now yield 20 minutes to the Senator from Rhode Island, Mr. Whitehouse.

Mr. BAUCUS. Mr. President, I yield 15 minutes to the Senator from Oregon.

Mr. BAUCUS. Mr. President, I wish to thank the Senator from Oregon for many reasons, one of which is his kind words, which are really appreciated but, much more important than that, his long dedication to health care reform. He even worked for the Gray Panthers way back before he came here. I remember the name Ron Wyden, Gray Panthers, a good number of years ago. Then, lo and behold, both Houses of Congress together--we worked together on reforming Medigap coverage. It was an outrage. Today we talk about medical loss ratios of maybe 80 percent, 85 percent, up to 90 percent, and so forth. I can remember back when it was an outrage, the degree to which Medigap insurance coverage had medical loss ratios of not 80 percent, not 70 percent, not 60 percent; it would be below 50 percent. Insurance companies were selling insurance to seniors trying to cover that gap between what Medicare would and would not cover, and just tragically low, embarrassingly low, outrageously low medical loss ratios. Senator Wyden and I got together and got legislation passed to reform the Medigap market--to make Medigap insurance plans more fair. They were ripping seniors off, there was no doubt about it, and we got that changed. Now, on health care reform, an ardent advocate of more competition, more choice in our health care system--it is clear we need more competition. It is clear we need more choice. On the competition side, in many of our States we find there is only one or two insurance companies that dominate the entire State. That is very true around our country. There is just not the competition there should be. In addition, there is not the choice. A lot of employees would like to have more choice among insurance companies in their kinds of policies, and so on and so forth. We have a system where most employees are tied to their employer; it is pretty much insurance coverage the employer offers. If we were starting from scratch maybe 20, 30, 40, 60, maybe 80 years ago, we may not have had such an employer-based system as we have today. Our current Tax Code also tends to encourage excessive insurance coverage because of our employer-based system. Anyway, I am digressing. Senator Wyden got us thinking a lot earlier about the problems that caused, and, frankly, I think he is right. I think a lot of Americans think he is right. You can only take things a step at a time here, and we are probably not going nearly as far as the Senator from Oregon wishes to go. But I thank him. He is there, he is dogged, and he works hard on behalf of seniors. He is an advocate of American consumers, respected by health insurance companies, not letting the companies take advantage of citizens. I thank the Senator for that. I do not see any Senators on the floor on our side. If there were, it would be a good time for them to speak. Pending the arrival of the Democratic Senators, let me say a few things about small business. Clearly, one of the goals of health care reform is to ensure that employees of small businesses have good, quality, affordable health care options. We all know that is clear. I have talked to small businesspeople. I will never forget a conversation I had with a logger who has four or five or six people working for him. It was about 2 or 3 years ago. I asked him if he had health insurance. He said, yes, for his family--his wife and himself. I asked: How about your employees? He said, no; he didn't. You could tell he wanted to, and he wasn't just blowing smoke. He clearly wanted to provide insurance for his employees, but it just pained him because it was too expensive. We all hear stories like that; they are legion. I can remember talking to another small businessman in my State of Montana, a contractor, who has 5, 6, 8, 10, people working for him. He is just beside himself because the insurance company told him his premiums are going to go up 40 percent next year. He said: Max, I can't deal with that. I asked: Why are they going up 40 percent? He said: Well, they found a preexisting condition with respect to one of my employees. He said: Max, I was beside myself. I can't afford a 40-percent increase. They said it would only be a 20-percent increase if I let him go. But he has been with me 15, 20 years and is one of my best employees. I can't let him go. He found another carrier and kept his employee. So he did find another insurance carrier, but he had to pay about a 20-percent increase in premiums. He was able to keep his employee, but that is just wrong. It is so hard for small businesses to provide health insurance to their employees. I know it is a trite thing to say, but most jobs in our country are created by small businessmen. That is where most of the jobs are, and it is where most of the creativity is. That is, in many cases, where the greatest need is to help encourage entrepreneurism, American ingenuity, and where a small businessperson can do a good job with the service he is providing. Last year, 62 percent of small businesses did offer health insurance to their employees. Compare that with other companies that have, say, 200 employees. Among all companies in America that have 200 or more employees, 99 percent of them have offered their employees health insurance. Contrast 62 percent of small businesses offer health insurance and 99 percent of businesses with more than 200 employees offer health insurance. Among the very small businesses in our country it is lower, lower than 69 percent. Now it is only 49 percent--a very small number of employees--that have health insurance through their small business employer. There are clearly very significant reasons for that. There are barriers that prevent small businesses from finding affordable health insurance options. What are they? Small businesspeople tell us the main reason--at least one of them-- is that the premiums are just too high. I mentioned an example of the contractor I talked with in my State, who said they are going to charge a 40-percent increase in premiums as further evidence that premiums are too high. It is understandable that is one of the main reasons small businesses can't get health insurance. In the past 10 years, premiums have risen 82 percent for single workers and 93 percent for families employed by small business-- virtually doubled premiums in the last 10 years if you are a single person and work for a very small business. That is not true for big business. As health care costs rise, small businesses are forced to make workers pay a greater portion of these expensive premiums. In 2008, for example, employees at small businesses that did provide health insurance paid more than twice what they paid just 8 years earlier-- twice as much. The low rate of offering and higher cost-sharing responsibilities for employees in small businesses often limit the ability of small businesses to attract and retain employees. That is why the health care bill before us includes many provisions to make quality coverage for small business more affordable not only for the businesspeople but for their employees. Before the managers' amendment, the bill did include $24 billion in tax credits to help small businesses and charitable organizations purchase health insurance for their employees. The managers' amendment dedicates additional billions to providing tax credits to small businesses to make health insurance more affordable. The Congressional Budget Office and the Joint Committee on Taxation, which I know is near and dear to the heart of the Presiding Officer--after all, they are an independent arbiter. They can tell us with objectivity what this legislation is or is not--they estimate that the tax credit for small businesses will provide $40 billion in tax relief to small businesses over their first 10 years. In addition, we start the tax credits a year early; that is, we start them in 2010. In the earlier bill, it was 2011. In the managers' amendment, we start in 2010, right away. This means that in just over a week, after the legislation is passed and signed into law, eligible small businesses will be able to receive tax credits to help them buy health insurance for their employees. This expansion of the tax credits means eligible small businesses will now be able to receive up to 6 years of tax credits. So now starting in 2010, eligible small businesses will receive tax credits worth up to 35 percent of the employer's contribution to employee health insurance plans--35 percent. Then in 2014, it is even better. Eligible small businesses will receive tax credits worth up to 50 percent of the employer's contribution to employee health insurance plans purchased in health insurance exchanges. The employer would get 50 percent of the cost of the health insurance, that would be available for credit; that is, the employer can credit 50 percent, subtract from his income taxes 50 percent of the cost of insurance. What do you have to do to qualify? Businesses must cover at least 50 percent of employee premium costs. If you cover half the employee costs, you get to subtract your half from your income taxes. The value tax credit is based on the size of the business and the average wage paid to its employees. The managers' amendment strengthens the assistance to small businesses by expanding the small business tax credit. In the managers' amendment, the tax credit will be available to small businesses with fewer than 25 employees and less than $50,000 average annual wages. And the full value of the tax credit is now available to small businesses with 10 or fewer employees and $25,000 or less in average annual wages. It moved up from $20,000 to $25,000 so more small businesses can qualify and take advantage of that tax credit. By expanding the wage thresholds, which I just described, more small businesses will be able to claim the tax credits. And tax credits will phase out more slowly as wages increase. This was a high priority for small businesses. We recognized that and responded to it. The small business tax credit will help make insurance affordable for many small businesses. In 2011, 4.2 million Americans will be covered by quality, affordable health coverage; 4.2 million Americans will be able to take advantage of this. On average, small businesses across the country would receive a new tax credit of about $4,900 to help them purchase insurance. That is per employee, $4,900 to help them purchase insurance for their employees. The CBO estimates that the small business tax credit will help lower insurance costs by 8 to 11 percent for the employees of small businesses receiving the credit. Let me say that again. CBO estimates that the small business credit will help lower insurance costs by 8 to 11 percent for the employees of small businesses who receive their credit. Without the small business tax credit, many people would have to buy insurance through the exchange on their own without the benefit of a contribution from their employer. One of the reasons many small businesses are currently unable to afford health insurance is because small businesses lack the buying power larger companies have to negotiate affordable group rates. The Senate bill creates small business insurance exchanges, known as SHOP exchanges, where small businesses can band together and pool their risks, which will enhance their choice and buying power. These State- based exchanges will be a critical tool to help small businesses with fewer than 100 employees shop for health insurance plans and determine their eligibility for tax credits to buy health insurance. Small businesses that prosper and grow beyond 100 employees would be allowed to continue shopping through the exchanges--pooling. The insurance plans sold in SHOP exchanges would be subject to the same transparency requirements and consumer protections, so small businesses can feel confident they are purchasing high-quality plans that will provide quality, affordable coverage for their workers. The legislation also institutes reforms in the insurance market that will protect individuals and small businesses purchasing plans both inside and outside these SHOP exchanges. These reforms will stop insurance companies from denying coverage based on a person's preexisting health condition or increasing a person's health insurance premiums based on health status or on gender and occupation--a practice that just has to be stopped. These new regulations are essential to helping small businesses keep health care costs predictable from year to year. That is one of the big problems. Small businesses face this sea of chaos, of volatility, uncertainty, unpredictability in knowing what their insurance costs will or will not be. That is why insurance companies cherry-pick and take advantage for themselves to maximize their profits, but it has the opposite effect on small businesses. This will help, frankly, to buy a lot more certainty that we desperately need. The changes in the managers' amendment will go the extra step and ensure this bill provides small businesses with the help they so desperately need. Passing health care reform is critical to small businesses. Without reform--this is no small matter; I am not blowing smoke here--without reform, many small businesses will be forced to drop their health insurance coverage they may already have because they can no longer afford it. They cannot afford the increase in premiums. This will leave many employees to fend for themselves in the individual market. We know without this bill passing how unfair the individual market is to people. Many of the provisions in this bill were designed with small businesses in mind. The bill gives small businesses access to a reformed marketplace where they will have improved buying power to negotiate rates. And the Senate bill provides tax credits to help small businesses buy health insurance for their employees. Data from CBO tells us that these reforms will make coverage more affordable for millions of small business employees. The small business tax credit will help reduce health care costs for small businesses and their employees. As a result of the larger health reform proposals in the bill, there will be an increase in the percentage of small firms that offer health insurance coverage. We must act to help small businesses access to quality, affordable health care options for their employees. Too many small businesses around the country are waiting.

Mr. BAUCUS. Will the Senator yield for one brief minute?

Mr. BAUCUS. I thank the Senator.

Mr. BAUCUS. Reserving the right to object.

Mr. BAUCUS. Reserving the right to object, and I will object, we have been----

Mr. BAUCUS. I object.

Mr. BAUCUS. Mr. President, clearly this is a stunt. I object.

Mr. BAUCUS. Reserving the right to object, this is the fourth time today Senators on the other side----

Mr. BAUCUS. I object.

Mr. BAUCUS. For the fifth time, I object.

Mr. BAUCUS. Will the Senator yield so I can show him?

Mr. BAUCUS. He doesn't----

Mr. BAUCUS. For the sixth time we are engaged in this stunt, so I object.

Mr. BAUCUS. Mr. President, just a couple, three points here, and I see the Senator from Ohio wishes to speak. Several times during this afternoon, Senators on the other side of the aisle, in my judgment, put on a little demonstration of trying to offer amendments. They repeatedly asked consent to suspend the normal working of the cloture rule to offer amendments. Earlier, I note for the Record, they slow-walked the process when an amendment was in order. They wanted the whole amendment read. And now they are trying to offer amendments, again, to slow down the process. This is clearly a tactic to slow the process. It is not part of the regular order. That is clearly what is going on here. Those were not, despite the protestations to the contrary, serious amendments. Normally, when a Senator offers a unanimous consent request, they allow the other side to speak briefly on the subject, at least on the reservation of the right to object. That was not allowed here. My colleagues did not allow me that courtesy earlier today, to comment with a reservation of the right to object. So I want to take a moment now to explain what they are really up to. I could not because they would not give me the courtesy to say any words during the reservation. That is why I made that statement. I heard one Senator from the other side of the aisle complain that the majority is holding tonight's vote at 1 a.m. in the morning on the cloture motion. Let me set the record straight. The majority would be happy to have this vote earlier. We would be happy to have this vote maybe in 10 or 15 minutes from now. We would be happy to have this vote at a decent time. It does not have to be at 1 a.m. tomorrow. It is the other side which is insisting that vote be at 1 a.m. in the morning. So it is they who are insisting on enforcing the letter of the Senate rules. It is their right, but it is also they who are insisting on delay. I also want to put to bed some of the assertions that they claim this bill does not do real health care reform. Let me mention a few health care reform provisions in this bill. Mr. President, I do not know if you or any of my colleagues have read this second article in the New Yorker magazine by Atul Gawande. The first article talks about two towns in Texas, basically. The second is basically looking to see whether this bill does reform health care and whether it does cut down health care costs. It is an article I highly recommend to all of my colleagues in a recent issue of the New Yorker magazine. But, basically, Dr. Gawande concludes this bill includes all of the constructive provisions health care economists, stakeholders, and people who have studied this issue suggest should be part of health care reform. That is his conclusion anyway. I am happy he said that because we worked mightily to make sure we have all the provisions we can here to help constrain health care costs. What are they? Well, one--although some may disagree with the policy--is an excise tax on high-cost plans, so-called Cadillac plans. It is a bit debatable. Last night I saw a TV ad where a group was advocating passage of this bill: But just not my high-cost plan. Pass the bill, but just not my high-cost plan. I understand the tenor and import of that TV ad, but the main point is, we do have to begin to limit to some degree the excessive cost of some plans, and I think we are very fair and modest here in proposing an excise tax on those high- cost plans. The trick is to set the level at the proper level, not too high, not too low. I think this bill does that. In addition, all the delivery system reforms this bill enacts with respect to Medicare are so important to improving quality and reducing excess costs. We all know through history that when we reform Medicare and make changes in Medicare, the private sector follows. So the private commercial market will follow whatever Congress does with respect to Medicare; and that is, make good, positive changes. Why? Because Medicare is such a large provider of care, it tends to have a real effect on what other providers do. What are some of those? Well, basically, we start to change the way we pay doctors and hospitals; that is, we start to pay on the basis of value rather than volume, that is quality rather than quantity. The paradox of that is, when people stop to think about it, we are going to both cut down costs and increase value at the same time because we will be focused on quality. When you focus on quality--not just quantity, not the whole volume of services, but, rather, focus on quality--you are going to get better quality, but your costs are going to go down because you are not reimbursing things such as excessive MRIs, excessive CAT scans, excessive high-cost procedures that do not, in many cases, get to the quality of health care but, rather, are very expensive, and Medicare pays for them. So we are moving more toward reimbursing based on quality and value than quantity. What else is reform of the health care industry? One is bundled payments and the shared-savings program, which we refer to as accountable care organizations. This allows hospitals and groups to get together to cut down costs. We have bundling in here, which is another idea that moves along the same lines. I might add, too, the CMS Innovation Center and the Independent Payment Advisory Board suggest some of these. The bill makes it easier for employers to offer workplace wellness programs. We give employers greater flexibility to offer premium discounts for workers who are committed to leading healthier lifestyles. There is a lot of emphasis here on wellness and lifestyles. We give incentives to employers to have wellness programs and preventive programs, which will help, obviously, the worker, but, in addition to that, cut down costs. There are other provisions here. This bill keeps getting stronger. The so-called freshmen package, led by Senator Warner, will give the Secretary additional authority to expand delivery system reforms. It expands the scope of the Medicare board to the private sector. There are many other provisions in here. The Nation's employers, through the leadership of the BRT, played an important role in developing that package. And the manager's amendment included a provision that will provide greater access to Medicare data to measure performance. It is no exaggeration to say that this bill will revolutionize health care. But don't take my word for it. The 23 economists who wrote to the President agree. Mr. President, I ask unanimous consent that letter from these economists be printed in the Record.

Mr. BAUCUS. The CMS Actuary agrees that this bill bends the cost curve. The folks at the Commonwealth Fund say the bill will save families $2,000 per year. Mr. President, I ask unanimous consent that an excerpt from Dr. Gawande's article from the New Yorker be printed in the Record.

Mr. BAUCUS. Mr. President, the Senator from Oklahoma at one point questioned the constitutionality of the mandate to buy health insurance. I might say, we thoroughly studied this issue. I believe there is ample authority for Congress to enact such a provision under the Commerce Clause, and also under the congressional authority to tax and spend for the general welfare provided for in the Constitution. I might also add, Prof. Mark Hall of Wake Forest University has done an excellent survey article on this subject. Mr. President, I ask unanimous consent that the conclusion of Professor Hall's article, found at www.oneillinstitute.org, be printed in the Record.

Mr. BAUCUS. I might also say, Mr. President, the Senator from Oklahoma said the independent Medicare advisory board would ration care. In fact, he even accused us in the Congress--myself included--of voting against a prohibition on rationing. But, I might say, I am not for rationing care in the sense that the Senator from Oklahoma talked about. I do not think anybody in this Congress is. We have to find a system that starts to control costs in a fair way, that increases quality but also cuts costs. That is the underlying premise of the delivery system reforms in this bill. But do not just take my word for it. Right here in the bill, on page 1004, the bill says, with regard to the advisory board: The proposal shall not include any recommendation to ration health care. I chuckle a little bit when I say that because the Senator from Oklahoma is very concerned about using the word ``shall.'' If he does not like ``shall,'' then I suppose he means the board would have discretion. But we say ``shall not include any recommendation to ration health care.'' That is on page 1004 of the bill. It is right there in black and white letters. Read the bill. The prohibition against rationing of health care is right there. Mr. President, I see the Senator from Ohio, who wishes to speak.

Mr. BAUCUS. Mr. President, I yield 10 minutes to the Senator from Colorado, Mr. Udall.

Mr. BAUCUS. Mr. President, I yield 10 minutes to the senior Senator from Michigan.

Mr. BAUCUS. I yield 10 minutes to the Senator from Illinois.

Mr. BAUCUS. Will my colleague yield on that point?

Mr. BAUCUS. I wish to ask my colleague, who knows the Senate procedures so very well, why are we having a 1 a.m. vote? Isn't it possible it could be a different time?