Sam Brownback

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, the Senator from North Dakota is a strong, good, talented legislator. He has a good amendment, one I have looked at. It has been around for a long time. I have to rise in opposition to it. I am ranking member on the Appropriations Subcommittee on Agriculture, Rural Development, and the Food and Drug Administration. The FDA is in the purview of our subcommittee, so I work on the issues of the FDA. If I may brag, the University of Kansas is one of the best pharmaceutical schools in the world and is often rated No. 1 as a pharmacy school. For anybody interested in that field of study or work, it is a good place to go. They are very concerned about what is in the Dorgan amendment. The United States currently has one of the safest drug supply systems in the world that allows the Federal Food and Drug Administration to monitor and regulate the manufacture and distribution of approved medicines. The legal authority to import drugs already exists in this country. However, no HHS Secretary, Democrat or Republican, has been able to certify that the importation of prescription drugs from foreign nations is safe or will lead to cost savings. None have been able to. The Dorgan amendment will allow for the importation of drugs from outside our current regulatory system, established and enforced by the FDA without certification from the Secretary of HHS or the Food and Drug Administration. Allowing drug importation from foreign nations could threaten public health and result in unsafe, unapproved, and counterfeit drugs being placed on pharmacy shelves in the United States. I want to develop that thought. The FDA has been tasked with the responsibility of safeguarding this country's prescription drug supply and has executed that responsibility quite well. But as this country and the Food and Drug Administration struggle to prevent the growing threat posed by imported, foreign-produced goods, as evidenced by recent failures to detect polluted products such as infant formula, pet food, and toothpaste, permitting the importation of drugs from foreign nations without the complete assurance from the FDA that it will not jeopardize public safety is irresponsible and threatens this Nation's safety and proven drug supply. Toward that end, I ask unanimous consent that a letter that Senator Carper received from the Health and Human Services agency, the FDA Director, be printed in the Record at the conclusion of my comments.

Mr. BROWNBACK. This letter states in particular: We commend the sponsors for their efforts to include numerous protective measures in the bill that address the inherent risks of importing foreign products and other safety products relating to the distribution system of drugs within the U.S. However, as currently written, the resulting structure would be logistically challenging to implement and resource intensive. In addition, there are significant safety concerns related to allowing the importation of non- bioequivalent products, and safety issues related to confusion in distribution and labeling of foreign products and the domestic product that remain to be fully addressed in the amendment. In other words, they don't think we can do this--importation, reimportation of drugs--without significant safety problems. There has been an explosion of illegal drug counterfeiting occurring around the world. Emergence of a multibillion-dollar international black market has proven to this Senate, current and past HHS Secretaries, and the FDA that weakening our prescription drug regulatory framework would only increase the risk of life-threatening counterfeit, contaminated, or diluted prescription drugs entering our prescription drug supply that millions of Americans rely on and trust. Prescription drug counterfeiting has become a highly profitable criminal enterprise that has been taken up by international organized crime syndicates, rogue nations such as North Korea, Syria and Iran, and developing nations such as China and Pakistan that seek to exploit ineffective or weak counterfeit enforcement frameworks around the globe. Criminals have realized that the production of counterfeit drugs is twice as profitable as the trafficking of illegal narcotics and comes with significantly less criminal penalties compared to those handed out for illegal drugs. Due to these limited and minimal criminal penalties, global counterfeiting has grown into an epidemic that reaches every country around the world. The World Health Organization estimates that tens of thousands of people are dying due to counterfeit HIV, diabetes, and tropical disease medicines. Unfortunately, in most counterfeit cases, it is not what is included in these fake drugs, it is what has been excluded that proves to be most harmful and deadly to patients. By taking counterfeit, diluted, or completely ineffective drugs, many patients fail to receive the important lifesaving medicines they need. It is just as dangerous for a person with high cholesterol to use a counterfeit drug that lacks the prescribed medicine as it is for a person to ingest a contaminated or even a poisonous pill. Due to this global counterfeit epidemic, two Secretaries of HHS, under both the Clinton and Bush administrations, have been unable to certify that the importation of prescription drugs will not pose a substantial risk to the health and safety of citizens within the United States. Current Secretary Kathleen Sebelius, from Kansas, has committed to preventing a drug importation system in the United States until it can be proven that the safety standards of the imported drugs are ``at or above American standards.'' The FDA doesn't believe they can get that done at this time. Many have argued that parallel trade in Europe has proven drug importation across nations' borders has resulted in prescription cost savings and has not increased risks to consumers or general public health. However, these cost and safety assertions do not correctly reflect the European experience with drug importation through what is called parallel trading. A study by the London School of Economics on drug importation costs concluded that savings from parallel imports benefit middlemen and third-party vendors who buy and resell the imported drugs and do not get passed on to the patients in the form of lower prices. They say this: Although the overall number of parallel imports has continued to increase, healthcare stakeholders are realizing few of the expected savings . . . profits from parallel imports accrue mostly to the benefit of the third-party companies that buy and resell these medicines. Furthermore, a report by the University of London School of Pharmacy on the safety of the parallel prescription drug trade stated this: The United Kingdom is the most vulnerable in Europe to counterfeiting owing to the high level of ``parallel importing.'' Due to parallel trade, the Medicines and Health Care Regulatory Agency in the UK has issued 10 different recalls of counterfeit drugs in the past 5 years. Drugs recalled include prescriptions to treat schizophrenia, blood pressure, and prostate cancer. The most disturbing fact of this counterfeit infiltration was that these drugs entered the United Kingdom through legitimate supply chains through parallel distribution trade, according to the MHRA, the regulator agency in the UK. In other studies, the European Commission found that the prescription drug supply chain in Europe, which includes the former Eastern bloc counties such as Latvia, Slovakia, and Bulgaria, is increasingly targeted by international criminal counterfeiters. The European Commission's Vice President, Gunter Verheugen, stated European parallel trade ``[B]rings a considerable risk for the safety of the patients'' and that the increase in counterfeit medicines ``is a very serious threat to public health and can cost lives.'' We don't want that happening to the United States, particularly with what we have seen in recent products coming in from China, not regulated under our system: things such as toothpaste, pet food, and then the problems we have here. Do we want that to happen in the drug system? No, we don't. We can't certify that we can keep these products safe. As you can see, safety concerns and the lack of savings that may result from exposing this country to the potential risk created by the importation of drugs from outside our current safety system are real threats. It is kind of interesting. In October 2004, then-Governor Rod Blagojevich of Illinois launched the I-SaveRx Program to allow residents in Illinois, and later Missouri, Vermont, Wisconsin, and Kansas, to purchase low-cost drugs from Canada. However, by 2006, the Illinois State auditor found that the program cost nearly $1 million and was used by only about 3,700 people in Illinois and 267 residents of my State of Kansas. Health and Human Services has concerns regarding the safety of importation. The Food and Drug Administration has concerns regarding the safety of importation. Given the opportunity to purchase Canadian prescription drugs, only 267 Kansans took that chance. We should not throw out the safety of our drug supply chain without safety assurances from this country's regulatory bodies. I yield the floor. Exhibit 1 Department of Health and Human Services, Food and Drug Administration, Silver Spring, MD December 8, 2009. Hon. Tom Carper, U.S. Senate, Washington, DC. Dear Senator Carper: Thank you for your letter requesting our views on the amendment filed by Senator Dorgan to allow for the importation of prescription drugs. The Administration supports a program to allow Americans to buy safe and effective drugs from other countries and included $5 million in our FY 2010 budget request for the Food and Drug Administration (FDA or the Agency) to begin working with various stakeholders to develop policy options related to drug importation. Importing non-FDA approved prescription drugs presents four potential risks to patients that must be addressed: (1) the drug may not be safe and effective because it was not subject to a rigorous regulatory review prior to approval; (2) the drug may not be a consistently made, high quality product because it was not manufactured in a facility that complies with appropriate good manufacturing practices; (3) the drug may not be substitutable with the FDA-approved product because of differences in composition or manufacturing; and (4) the drug may not be what it purports to be, because it has been contaminated or is a counterfeit due to inadequate safeguards in the supply chain. In establishing an infrastructure for the importation of prescription drugs, there are two critical challenges in addressing these risks. First, FDA does not have clear authority over foreign supply chains. One reason the U.S. drug supply is one of the safest in the world is because it is a closed system under which all the participants are subject to FDA oversight and to strong penalties for failure to comply with U.S. law. Second, FDA review of both the drugs and the facilities would be very costly. FDA would have to review data to determine whether or not the non-FDA approved drug is safe, effective, and substitutable with the FDA- approved version. In addition, the FDA would need to review drug facilities to determine whether or not they manufacture high quality products consistently. The Dorgan importation amendment seeks to address these risks. It would establish an infrastructure governing the importation of qualifying drugs that are different from U.S. label drugs, by registered importers and by individuals for their personal use. The amendment also sets out registration conditions for importers and exporters as well as inspection requirements and other regulatory compliance activities, among other provisions. We commend the sponsors for their efforts to include numerous protective measures in the bill that address the inherent risks of importing foreign products and other safety concerns relating to the distribution system for drugs within the U.S. However, as currently written, the resulting structure would be logistically challenging to implement and resource intensive. In addition, there are significant safety concerns related to allowing the importation of non- bioequivalent products, and safety issues related to confusion in distribution and labeling of foreign products and the domestic product that remain to be fully addressed in the amendment. We appreciate your strong leadership on this important issue and would look forward to working with you as we continue to explore policy options to develop an avenue for the importation of safe and effective prescription drugs from other countries. Sincerely, Margaret A. Hamburg, Commissioner of Food and Drugs.

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, I ask unanimous consent the order for the quorum call be rescinded.

Mr. BROWNBACK. Mr. President, I ask for 10 minutes to be allotted to me under the minority time.

Mr. BROWNBACK. Mr. President, in the past few months this body has been forced to stand aside as Senator Reid and a few others crafted a 2,000-page bill behind closed doors, the one we are on right now. Unfortunately, the product that was resolved at the closed-door meetings--at least the one we have now, I don't know about a future one--still raises taxes by $\1/2\ trillion. Probably under any new bill that comes out you are going to have taxes going up $\1/2\ trillion, cut Medicare by $\1/2\ trillion, raise premiums on American families, fail to bend the cost curve down, and expand government's encroachment further and further into people's health care decisions. What I want to go through is a series of charts about how inflation is going to end up being the tax collector's best friend in this overall plan and how the tax of inflation is going to be one of the key features of how the overall bill is paid for. I hope most people remember when we had inflation. A lot of people maybe don't remember when we had significant inflation. It is a cruel tax. It is a very cruel tax on people on fixed income, a very cruel tax on people in low-income status because constantly the dollars you have stay pretty stable, and everything you are buying goes up. So inflation kills you. It kills you in the pocketbook and is one of the things we have to be concerned about, particularly with the amount of money that is out in the money supply today and the likelihood of this moving forward and how it is built in to pay for this huge expansion that we can't afford in this bill. I am joining my colleagues today in speaking against the $500 billion in new taxes that are in the Democrats' proposal to levy on the American people and the job-creating small businesses this is going to be put on, in an attempt to pay for this big 2,000-page bill. This monstrous bill is flawed economic policy. I will develop that point for you as well. It fails to lower health care premiums, fails to bend the cost curve down, and will further cripple the struggling economy with massive and burdensome tax increases. This careless legislation reminds me of a cautionary tale that is still being played out in another part of the world. That is what happened in the early 1990s in Japan. Japan, a surging economic giant at the time, suffered a severe economic recession in the early 1990s, of which the effects are still lingering even today in Japan. During Japan's ``lost decade,'' from 1991 to 2003, their gross national product grew a paltry 1.4 percent annually, creating a decade of stagflation--that is where you have a stagnant overall growth but inflation in the economy--and limited economic growth. Most economists believe that Japan's economic recession would not have lasted nearly as long as it did had it not been for one fatal error that the Japanese government made. In the late 1990s, as their economy was recovering and appearing to be pulling out of its economic slump--so the economy is just getting going, starting to pull out of the economic slump--the Japanese government made a catastrophic decision to raise taxes. The result was that this one decision aborted the strong recovery the Japanese economy was starting to experience and plunged it back further into an economic downturn that lasted for many more years, the hangover from which is still on them today. What are we doing here today, discussing a $2.5 trillion government entitlement expansion that raises taxes $\1/2\ trillion, plays budget gimmicks with our $12 trillion deficit and raises health premiums and costs for all Americans in the middle of the country's economic recession? What are we even talking about, why are we doing it? That is what I get from the people back home. They say why are you talking about this while are we in this recession? Why are you talking about this with the health care situation the way it is, to raise the cost, raise the insurance premiums, cutting Medicare when Medicare needs more, not money taken out of it? Now is not the time, this is not the bill, and this is not the way the American people want to see their health care reformed. What the American people want is for this body to lower health care costs and induce an economic recovery that creates jobs, not kills them, and grows the American economy, not thwarts it. The way to do that is not to raise taxes, as is evidenced by what happened in Japan. Increased mandates, increased regulations, and increased taxes are a recipe for disaster. It is a recipe that kills jobs. In fact, President Obama's chief economic advisor, Dr. Christina Romer, stated earlier this year that as many as 5.5 million jobs could be lost due to the Democrats' new tax proposal in this 2000-page government takeover of health care. Nothing can be worse at a time when the Nation is already experiencing a 10-percent unemployment, a 26-year high. This bill will impose $28 billion in new taxes on employers that will ultimately be paid by American workers in the form of reduced wages and lost jobs. Under this burdensome legislation employees will face stunted wages and the loss of their benefits as their employers attempt to find ways to fund these newly imposed mandates. As small businesses struggle to keep their doors open, tough decisions will have to be made on whether to raise prices, cut wages, or let go workers in order to find the funds necessary to comply with the Federal mandates imposed in this bill. Furthermore, this bill will kill jobs by penalizing small businesses who are looking to grow--and small businesses are the growth engine for the country. In this bill, firms with more than 50 workers that did not offer coverage would have to pay a penalty or a tax to the Federal Government for each full-time worker if any of their workers obtain subsidized coverage through the government-run exchange. What businessman would decide to hire that 50th employee, knowing full well if he did that the government would penalize his business and slam him with a new costly tax? So now people try to stay under this limit rather than constantly looking to grow the business. Furthermore, under certain circumstances, firms with relatively few employees and relatively low average wages would be eligible for tax credits to cover portions of their health insurance premiums. That is relatively few would be eligible. I ask, what employer would decide to increase the number of employees or increase the amount of their wages if they stand to lose government handouts, supports, subsidies, or face an increased tax burden? They simply will not be willing to do it. One of the most disturbing aspects of this legislation is the use of inflation to fund it--the use of inflation, a hidden tax increase on working families, to fund it. I am the ranking member on the Joint Economic Committee and we look at these aspects a great deal. The use of inflation is built into the base of this to fund it. We know the consumer, the individual taxpayer, pays all taxes. No matter how the government claims to assess those taxes, they are paid by individuals. I have a couple of examples I want to show. First, I want to talk about: High-cost Plans Tax Hits the Middle Class. Let me talk about that. This is the tax on the so-called Cadillac health insurance plans. We know that insurance policies and benefit plans will be altered to avoid that tax. In other words, if you get an insurance plan that is up above a certain level you get taxed on that higher end, that so-called Cadillac plan. So in all probability most groups will not provide this high-quality health care because they say you are going to get taxed on it. Benefits that taxpayers with insurance currently receive on a pretax basis--right now they get it so the company is paying for it, is pretax to the individual--will gradually shift to after-tax benefits resulting in higher payroll and income taxes. So now that you have cut this Cadillac plan to get underneath it being taxed, and then the company says OK, we will pay you in wages or we will do this somewhat differently. Then you have to go around and supplement or have a lower quality of health insurance. You are going to have to pay for it with after-tax dollars. That will result in more taxes, but you don't get more benefits from this. This is a big tax hit on the middle class of people who are going to have to pay this as their higher income or their higher based insurance plans are taxed. Here is what the Joint Committee on Taxation said about the distribution impact of the high-cost tax plans: Despite the President's promises the majority claims--91 percent of taxpayers will be affected by this tax earning under $200,000. The tax will hit married filers more severely than singles; 62 percent of the high-cost plans tax impact will fall on married filers compared to 25 percent on single filers. Why are we building the marriage penalty back into the insurance? We worked a long time in this body to get rid of key portions of the marriage penalty, saying we should not tax marriage, we should support this institution. It is being built back into this plan. This bill also imposes an additional Medicare tax on wage and salary--or certain types of business incomes of single taxpayers with incomes above $200,000 and married taxpayers with incomes of more than $250,000. Right off the bat there is a new marriage penalty. People living together but unmarried making $150,000 each won't pay the tax. Two married people paying the same amount will. What is right about that? Making matters worse, the thresholds are not indexed for inflation-- no indexing for inflation. Inflation is a cruel tax and unfortunately in this situation it is not only going to be inflation, but you are going to be taxed, then, as you get inflated into these categories. From 2013 to 2019, the number of returns of people earning under $200,000 in today's dollars will rise from 75,000 to 345,000 under the current trajectory on inflation. We are making the tax man's best friend inflation. That is wrong. So you are going to move 75,000 to 345,000 for new tax revenue. Married couples will be hit hard, as I mentioned earlier. Then you are looking at inflation: 2013, 2015, 2017, 2019--the number of people growing into this taxable category affected by this Medicare tax that will increase in 2009 dollars from $75,000 to $345,000. If you want to think about this, think about when the alternative minimum tax was first put in place. The alternative minimum tax was supposed to be on very wealthy individuals. That was all it was going to be on. But it was not indexed for inflation. Now you get whole swatches of people hit by it and this body regularly tries to change that or deal with it on a 1-year basis because it was not indexed for inflation. What you build into the base of this bill is, if you want to pay for the bill, you want inflation. So you get inflation and it hurts people on fixed incomes and you get more people taxed than you started off with. You didn't tell them about it at the outset. This plan clearly should be indexed for inflation. We know that should take place. Yet this is where a major part of the money for the bill comes from--inflation. Is that something the Federal Government should be banking on, that we will get inflation to pay for this health care bill? I don't think the American public wants to see that taking place. To put this in context, let's not just look at returns under $200,000, let's look at all returns and how this tax will spread. According to the Census Bureau estimates, between 2013 and 2019, the working-age population of the country will grow by 1.6 percent. Joint Tax estimates that the number of returns that will be affected by this tax will grow by 52.6 percent and revenue collected as a result of the tax will grow by more than 54 percent. Over time, the Reid bill Medicare tax isn't just for the wealthy. Comparing the increase in taxes with growth in the working-age population, this is how many more people will be impacted. Inflation becomes the tax man's key friend. During Japan's lost decade, from 1991 to 2003, their gross national product grew a paltry 1.4 percent annually, creating a decade of stagflation and limited economic growth. It was because of policies such as this where you have inflation, where you have tax increases put in place. These are the things that caused that to take place. It should not be done. I will just add as a final note, when I am talking with people back home, all the time they raise this health care bill. They talk about it constantly. If they are small businesspeople, they are talking about not doing anything until the political environment is more stable in their estimation, about how much taxes we are talking about, about how much regulation we will be talking about. You have what is going on with a climate change debate and regulations in Copenhagen. That tells a lot of people in my area who are energy users and producers, don't do anything until this stabilizes. When you talk about tax increases or inflation being a part of this proposal, you have a bunch of people saying: Don't do anything. Just stay on the sideline. That is a prescription for no job growth. That is a prescription for killing jobs. You want people out there investing and creating jobs and opportunities. You want them to see a stable political environment where they are not worried about increasing taxes, not worried about increasing regulation but, rather, saying: This is a stable environment in which we can invest and grow. That is not what they are doing today. That is repeating the lesson the Japanese learned of raising taxes when you are coming out of a recession. It is harmful. It is the wrong economic strategy. It should not be a part of this bill. I yield the floor.

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, I ask unanimous consent that the Senate proceed to a period of morning business, with Senators permitted to speak for up to 10 minutes each.

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, I rise to speak about the recent suicide bombing in Somalia and the broader security situation in that region. While our attention is necessarily focused on the wars in Afghanistan and Iraq, this latest bombing is a stark reminder that we cannot take our eye off of the Horn of Africa. Last week, Somalis had a reason to celebrate. The graduation of several medical students from a university in Mogadishu was a welcome glimmer of hope for the future. Unfortunately, a suicide bomber intruded, blew himself up, and killed more than 20 others, including three Ministers from the fledgling Somali transitional government. There is, seemingly, no end to the violence which has plagued Somalia for a generation. Somalia continues to lack a truly functional government, and for several years, we have watched the slow but steady development of extremism there. Though we support the development of a moderate government for Somalia, success is far from assured. The transitional government lacks control of significant parts of the country and struggles to provide the most basic services to the Somali people. The most significant challenge to the transitional government comes from extremist groups such as al-Shabab, a group of Islamist terrorists with deep roots in Somalia that came to prominence after the defeat of the Islamic Courts Union 3 years ago. As we have seen throughout the world, if there is a power vacuum, violent extremists will seek to fill it, and that is what is taking place in Somalia. Somalia cannot succeed while groups such as al-Shabab grow and thrive. Al-Shabab's future depends in no small part on support from outside the country. Al-Shabab gets new recruits from all over the world, it is strengthening ties to al-Qaida and the global jihadist network, it receives support from regional actors such as Eritrea, who use al- Shabab as a proxy for its own interests. Al-Shabab will not be defeated while this outside support continues. For this reason, I hope that our administration will work hard to support and pass a draft resolution now circulating at the United Nations Security Council. Uganda, one of the Council's current rotating members, has drafted a resolution that addresses Eritrean support for Somali extremist groups, including al-Shabab. The resolution, which follows strong warnings to Eritrea from the U.S. and the African Union not to support al-Shabab, would ban weapon sales to Asmara, prohibit technical, financial and other assistance related to military activities, and freeze the assets of Eritrean political and military leaders as well as restrict their travel. Al-Shabab seeks to undermine any attempt to stabilize Somalia. A volatile Somalia jeopardizes the stability of the Horn of Africa region, which is itself important to security in Africa, the greater Middle East, and the rest of the world. Support for extremist groups such as al-Shabab is unacceptable, and as long as Eritrea provides arms to al-Shabab, there will be no chance for peace in Somalia. I hope that the Security Council can take up and pass this resolution soon, and I hope the United States will be a strong supporter of this effort. Somalia ought not be a safe haven for extremists or a playground for outside powers pursuing their own agendas. Though Somalia's future is far from clear, the Security Council should have no difficulty in agreeing on the need to take steps to cut al-Shabab's lifelines of outside support.

Mr. BROWNBACK

Mr. BROWNBACK. Will the Senator yield for a comment?

Mr. BROWNBACK. In responding to the Senator from Pennsylvania as well, I wish to quote Bart Stupak, who carried the same sort of amendment you are putting forward, only on the House side. The same sorts of questions, naturally, were coming forward, saying: OK, you are blocking abortion funding for the individual. He said this--and I am quoting directly from Representative Stupak: The Capps amendment--Which is in the base Reid bill here-- departed from Hyde in several important and troubling ways: by mandating that at least one plan in the health insurance exchange provide abortion coverage, by requiring a minimum $1 monthly charge for all covered individuals that would go toward paying for abortions and by allowing individuals receiving Federal affordability credits-- Those are Federal dollars-- to purchase health insurance plans that cover abortion. . . . In all those ways, the Capps amendment--which is in the Reid bill-- expands and does allow Federal funding of abortion that we have not done for 33 years. Going on with Representative Stupak's statement: Hyde currently prohibits direct federal funding of abortion. . . . The Stupak amendment-- Which is also the Nelson-Hatch amendment-- is a continuation of this policy-- Of the Hyde amendment-- nothing more, nothing less. I think it is important to clarify that this is a continuation of what we have been doing for 33 years that the Senator from Utah and the Senator from Nebraska are putting forward with this amendment. I thank my colleague for yielding.

Mr. BROWNBACK. Will my colleague yield?

Mr. BROWNBACK. If you are not clear about this, then abortion will be funded. If there is any of this that needs clarity one thing is for certain with the Capps language in the baseline of the Reid bill, that abortion will be funded. The Commonwealth of Massachusetts recently passed its State-mandated insurance, Commonwealth Care, without an explicit exclusion on abortion. Guess what. Abortions there were also funded immediately. In fact, according to the Commonwealth Care Web site, abortion is considered covered as outpatient medical care. That is a point about being clear with the Hyde-type language, which is the Nelson-Hatch language, which says: No, we are not going to fund this, and we are going to continue the 33-year policy. If we keep the Capps language in that funds abortion--the last time the Federal Government funded abortions was during that 3-year period after Roe, but before Hyde, and we were funding about 300,000 abortions a year. The Federal taxpayer dollars funded abortions through Medicaid. I cannot believe any of my colleagues would say: Yes, I would be willing to buy into that 300,000 abortions a year when President Obama and President Clinton said we want to make abortions safe, legal, and rare. Well, 300,000 a year would not be in that ballpark. That is the past number that happened when you didn't have Hyde language in place at the Federal level.

Mr. BROWNBACK. Madam President, I think the Catholic bishops have put it as concisely as anybody: In every major Federal program where Federal funds combine with nonfederal funds (e.g. state or private) to support or purchase health coverage, Congress has consistently sought to ensure that the entire package of benefits excludes elective abortion. For example, the Hyde amendment governing Medicaid prevents the funding of such abortions not only using federal funds themselves, but also using the state matching funds that combine with the federal funds to subsidize the coverage. A similar amendment excludes elective abortions from all plans offered under the Federal Employees Health Benefits Program, where private premiums are supplemented by a federal subsidy. Where relevant, such provisions also specify that federal funds may not be used to help pay for administrative expenses of a benefits package that included abortions. Under this policy, those wishing to use state or private funds to purchase abortion coverage must do so completely separately from the plan that is purchased in whole or in part with federal financial assistance. This is the policy that health care reform legislation must follow if it is to comply with the legal status quo on federal funding of abortion coverage. All of the five health care reform bills approved by committee in the 111th Congress violate this policy. Following the Hyde amendment principles is what we have done for 33 years, until this moment, until the Capps language in the Reid bill. Now we have flipped that on its head and are saying you can combine Federal funds with non-Federal funds to pay for elective abortions. That was the policy prior to Hyde in 1977. That funded 300,000 abortions, roughly, a year at that point in time. There is no way in this country that is a policy the American people support. They don't. They may be divided about abortion but not about Federal funding for elective abortion. There is no division about that at all. It has been very consistent policy, until we have seen the Reid bill, this particular piece of legislation. We have been quite consistent about this. It is my hope my colleagues will say: I may be pro-choice, but I have consistently supported Hyde because I think we should not be funding elective abortions. I hope they will vote for the Nelson-Hatch amendment because of that very feature. It is not about abortion, it is about the funding of elective abortions. I hope we don't go in that direction. I yield the floor.

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, I appreciate this very much. It has been a healthy debate, a big debate, and it is an unusual debate because we haven't debated Hyde around here for 20 years. So this is an unusual debate we are having. Normally, we debate about abortion but not about abortion funding because there has been an agreement in this body for 33 years about that. So this is an unusual debate, but I think it is an important one. I think it is extraneous, in many respects, to the health care bill itself. Abortion is not health care, and so why we are debating the funding of abortion in a health care bill seems odd to me. But it is in the base bill, and we need to deal with that. A lot of people are coming forward and saying: Well, OK, which way is this; is it in the bill or not on funding for abortion? I am going to go to an independent fact checker and cite this. This is an independent research and prize-winning fact checker, PolitiFact.com, and they say our opponents' characterization of this amendment was ``misleading'' and that ``the people who would truly pay all their premium with their own money, and who would not use Federal subsidies at all, not barred in any way from obtaining abortion coverage, even if they obtain their insurance from the federally administered health exchange.'' That is an independent group, PolitiFact.com, saying this doesn't limit the ability for somebody on their own to be able to purchase abortion coverage, if they want to do that, but in the base bill, what we are saying is we don't want to put Federal funds in it as the longstanding policy has been here. As the President himself has said when he spoke to a joint session of Congress, launching the health care debate: One more misunderstanding I want to clear up--under our plan, no Federal dollars will be used to fund abortions, and Federal conscience laws will remain in place. Unfortunately, in the Reid bill, this is not true. This is not true in the Reid bill. What is in the Reid bill is the so-called Capps amendment language, which allows for the Federal funding of abortion. I wish to describe--and I think a great deal of what is in here has been described, but what is taking place is the Federal subsidization of an insurance program that will have abortion funding in it. According to most groups, that is what is taking place in the Capps language, which is in the base Reid bill. I say this is an unusual debate that is taking place because we haven't debated Hyde for years around here. I wish to read to you what is our normal status on funding of abortions; that is, that we don't do Federal funding of abortions. I will read to you what the normal status is. The U.S. Conference of Catholic Bishops, which supports this base bill but does not support funding of abortions, describes it this way: In every major federal program where federal funds combined with nonfederal funds to support or purchase health coverage, Congress has consistently sought to ensure that the entire package of benefits excludes elective abortions. For example, the Hyde amendment governing Medicaid prevents the funding of such abortions not only using federal funds themselves, but also using the state matching funds that combine with the federal funds to subsidize the coverage. A similar amendment excludes elective abortions from all plans offered under the Federal Employees Health Benefits Program, where private premiums are supplemented by a federal subsidy. So there it is prohibited as well. Where relevant, such provisions also specify that federal funds may not be used to help pay the administrative expenses of a benefits package that includes abortions. Under this policy, those wishing to use state or private funds to purchase abortion coverage must do so completely separately from the plan that is purchased in whole or in part with federal financial assistance. Here I take a quick aside. That is what we are saying should be done in this bill, but it is not what is done in this bill. Going on: This is the policy that health care reform legislation must follow if it is to comply with the legal status quo on federal funding of abortion coverage. All of the five health care reform bills approved in the 111th Congress violate this policy. This is from a group, the United States Conference of Catholic Bishops, that supports health care reform but not the abortion funding in it. They say as well that this fails in the Reid bill, that there is explicit funding for abortion in this bill. I thank my colleagues, particularly on the other side of the aisle, Senators Nelson and Casey, for being major cosponsors of this amendment. They are the ones who look at this and say: I don't want this in the base bill. This should not be in the base bill. It doesn't belong in the base bill. The language should be different. I also wish to note that most people across the country don't want this in the base bill. A majority of the country is opposed to the bill overall. They don't think this is the way we should go. They think it is the wrong way. But even people who support the bill itself by and large don't want Federal funding for abortion to be in this bill. A Pew poll even showed that 46 percent of people who support health care reform want to see the radical abortion language removed, the Capps language in the Reid bill, and all pro-choice Republicans and several pro-choice Democrats supported the measure in the House that put Stupak language in that removed the Federal funding for abortion. The American people feel this way because they know that forcing Federal funding of abortion is fiscally irresponsible and morally indefensible. Those are the two central pieces we are discussing, the fiscal responsibility or irresponsibility of this and the moral indefensibility. At a time of hemorrhaging debt, the Federal Government being supportive and funding elective abortions flies in the face of trying to restrain or bend the cost curve down in this legislation. That is not us being fiscally responsible. I have shown this chart before, but I think it is so striking. Back when we did do funding for abortions, we funded about 300,000 a year. How is that extra funding going to help us be more fiscally responsible? That is why a majority of the people, pro-life and pro- choice, are saying the Federal Government should not be funding this. I don't believe that is fiscally responsible. And it is morally indefensible. Whether you are pro-choice or pro-life, we are having 300,000 children who are not going to be here that we are funding the elimination of. Under anybody's definition of looking at that, they would say that is morally indefensible for the Federal Government that has long debated abortion policy, has not debated abortion funding, that that is morally indefensible for us to do something along that line. There are many issues to debate but thankfully Hyde has not been one of them we have been debating until now. I say to my colleagues the admonition we have had many times, whether you choose this day life or death, blessing or curse, why wouldn't we choose the life route on this one? Even if you have a close call or you are questioning this, why wouldn't we choose the route that says: I am not going to fund 300,000 abortions. I want abortion to be safe, legal and rare, as some people in this body, but that is not rare, 300,000. Why wouldn't we choose the life route that says this is a controversial issue sometime way in the past, not recently. We don't fund these things. So many people in America don't want their money used to pay for abortions. Yet in this base Reid bill, it is there. I urge my colleagues to vote in favor of the Nelson-Hatch-Casey amendment that puts into Hyde language that is the status quo that there is not taxpayer funding going toward abortion and to reject those who would put the Reid language forward that would take us back decades to an era when we did fund abortion procedures. I yield the floor.

Mr. BROWNBACK

Mr. BROWNBACK. I appreciate that. I also note the Ensign amendment, instead of cutting, creates. A Robert Woods study in 2006 said caps on things such as this hold down awards in cases 20 to 30 percent and increases the supply of physicians, which is something else we need. I wish to give a better live example that we have in my State of Kansas. In the early 1980s, mid-1980s the piston engine industry of aircraft was just about dead. It had been sued--the aircraft industry, general aviation had been sued so much they were stopping making piston engine aircraft. Congress, finally, because the industry was dead, said we are going to put a 17-year statute of limitations on it so after 17 years you cannot sue the manufacturer anymore after that period of time. It brought the industry back. They are now being made. There is a new plant in Independence, KS. There is another one that is making this aircraft because there was a limitation put, a reasonable limitation on manufacturing reform. If we do this, this will create--this will help our medical industry, it will hold down costs, it will increase the number of physicians. These sorts of changes have worked. There is no reason at all not to do this in this bill.

Mr. BROWNBACK

Mr. BROWNBACK. Madam President, I wish to thank the ranking member from Iowa for his comments on the amendment. I wish to speak on the Johanns motion and its effect on the State of Kansas and the underlying bill in particular. Cuts to home health agencies of $42 billion have a huge impact in my State, and I wish to urge my colleagues to support the Johanns amendment and restore that amount of money to the home health care agencies. Years ago I did some work with the home health care agencies, and anybody who has been around them knows these groups don't operate on much of a profit margin. They are frequently not highly capitalized. They are high on people and people skills. They take care of folks in their homes. They do a great job of it. They take care of people where they want to be taken care of, which is in their homes and not in hospitals or extended stay facilities. Home health care and hospice frequently work with people in some of the most difficult times in their lives, when they are facing those difficult, often final, illnesses and they want to do it at home. They don't want to be in the hospital. They want to be at home with family and friends around comfortable surroundings. In this underlying base bill, home health care is cut $42 billion from the people who need it the most and from agencies that need it the most and are in dire straits. I have a chart up here which shows the impact on my State, particularly on home health care agencies. Roughly $240 million in cuts to home health care agencies in the State of Kansas will take place under this base bill. In this base bill, 64 percent of the home health agencies in Kansas will go broke by 2016, 64 percent by 2016. So just at the point in time where you have a lot of uptake and need for home health care for some people who are aging at that point in time, you are going to cut and you are going to cut this much, $240 million in my State, 64 percent of them go broke, and for what? Supposedly, it is to save a bunch of money, right? Well, on top of this, the CMS Office of the Actuary recently pointed out that the drastic cut to home health care will not produce savings to the Medicare Program. According to OACT, the savings from permanent annual productivity adjustments are unrealistic. Again, that just stands to reason; if you are going to force people out of their homes into a hospital for extended care because you are cutting home health care, you are not going to save money in that system. You are going to spend more money in that system. This is not going to work. It is going to hurt people overall, and it is going to be at a point in their lives when they would rather be at home than in the hospital. I think these are cruel cuts. I think it is at a terrible time. That is just for home health care, that alone, and then with the hospice. I have a letter from the Kansas Home Care Association that I wish to ask unanimous consent of the Presiding Officer to have printed in the Record at the end of my statement.

Mr. BROWNBACK. They say in this sentence, among other things: This will cause an increase in patients seeking care in more expensive institutions which will only cause more of a drain on State and Federal budgets. It is projected that over 58 percent of Kansas home health agencies will operate at a negative margin in 2010. . . . I noted to you the number that is going to go broke by 2016. This isn't a far-off prospect. This is even next year, under the current setting. Then they are going to cut another $240 million from the Kansas ones that will cause even more of them to have great difficulty and financial trouble at this point in time. I ask my colleagues to revisit this issue. Vote for the Johanns motion that supports home health care agencies. The Johanns motion is simple. It says: Look, restore this piece. Don't take these moneys from home health care agencies. For a number of us who represent a number of rural States, home health care is key. It can be expensive in a rural setting. They need the resources to be able to meet the needs of the seniors we have. On top of that, in the overall cuts that are taking place are key and major cuts to Medicare Advantage programs. Referring to the chart, there will be a 63.7-percent cut to Medicare Advantage benefits that will affect more than 1 in 10 Kansas Medicare beneficiaries. A $1.5 billion cut to Kansas hospitals is taking place and an 11.8-percent cut in hospice payments. Home health care agencies often do hospice care as well. So this is a double cut for them. Again, this is at a point in time in life where it is the most difficult. There is $124 million in cuts of skilled nursing facilities as well. This will force more people into that setting. Exhibit 1 Kansas Home Care Association, Topeka, KS, December 4, 2009. Hon. Pat Roberts, Senator from Kansas. Dear Senator Roberts: On behalf of the Home Health Care and Hospice agencies of Kansas, we would like to support the Republican Senators motions to commit back to the Senate Finance Committee the HCR bill with changes that do not include cuts in payments to both home health and hospice agencies. This bill includes cuts to home health agencies that total $42.1 billion and cuts to hospice agencies of $7.7 billion. In Kansas a number of our member agencies service both home care patients and hospice patients, so they would be hit twice with monstrous cuts. It is projected that over 58 percent of Kansas home health agencies will operate at a negative margin in 2010 and that number increases significantly in years to follow. Hospice agencies have already sustained cuts that have limited access to the Hospice benefit, particularly in rural areas, which of course is much of Kansas. Last week Governor Mark Parkinson announced a 10 percent cut to Medicaid providers in order to balance the state budget. Agencies that provide services to Medicaid clients cannot sustain such drastic cuts and access will be severely limited. This will cause an increase in patients seeking care in more expensive institutions which will only cause more of a drain on state and federal budgets. On behalf of the Kansas Home Care Association members, we applaud your efforts to block cuts to home health care and hospice benefits that the citizens of Kansas and the United States need and deserve. Sincerely yours, Jane Kelly, Executive Director.

Mr. BROWNBACK

Mr. BROWNBACK. Madam President, I rise in support of the amendment of the Senator from Alaska, and I have talked with my good friend, the Senator from Maryland, Ms. Mikulski, about a side issue in this overall debate about what is included in the definition of preventive care. The Senator from Maryland stated in a colloquy that ``there are no abortion services included in the Mikulski amendment.'' She has stated that in colloquy. I have trouble, however, because I believe a future bureaucracy could interpret it differently. So I asked my friend from Maryland if she would include clear legislative language in this saying simply: Nothing in this Act shall be construed to authorize the Secretary, or any other governmental or quasi-governmental entity, to define or classify abortion or abortion services as ``preventive care'' or as a ``preventive service.'' I think that clarifies the issue, and it would be my hope that my colleague from Maryland would include that in her language. It is not in there, even though there have been statements on the floor. But, as we all know as legislators, it is one thing to say something on the Senate floor, and it is one thing to have a colloquy, but it is far different to have it written in the base law. This is not in the base law. So I would urge my colleague, the Senator from Maryland, to include this language. Absent that, I think there is too much room for a broader definition of what preventive care means; that it could include abortion services as well, and I would urge my colleagues to vote against the Mikulski amendment if that is the case. On that ground, I think there are other issues involved, and that is why I think the approach of the Senator from Alaska is superior, while maintaining the doctor-patient privilege. I think this is a good debate for us to have, given these recent discussions. But absent this change, I think there is another issue that is involved that I would urge my colleagues to consider. Madam President, I want to yield back to maintain some time for the Senator from Wyoming to be able to speak, so I yield the floor.

Mr. BROWNBACK

Mr. BROWNBACK. Mr. President, I rise to speak in favor of the McCain motion, and I do it from the perspective of a representative of the State of Kansas. We have a number of senior citizens and hospitals that are Medicare- dependent. We have a number of providers for whom a majority of their practice is Medicare reimbursement. They are scared to death of these cuts, and the cuts are well documented--$500 billion in Medicare cuts, and for the 43 million senior citizens on a program that is already projected to go insolvent by 2017, specific cuts of $135 billion from hospitals, $120 billion from 11 million seniors in Medicare Advantage, nearly $15 billion from nursing homes, nearly $40 billion from home health agencies, and then--a cruel gesture, it seems to me--nearly $8 billion from hospice, where people are getting their final care for cancer and diseases that are killing them--$8 billion cut from hospice. What that does in a State such as mine and in many rural hospitals, it cuts the legs out from under them. They are not going to have the money they need to operate. They are going to do everything they can to continue to operate--and they will, probably. What they will try to do is tax their local citizenry, raise property taxes, in all probability, to make up for the Medicare cuts because they are going to have a hospital there and they are going to do everything they can to keep a hospital there. But what a terrible gesture on our part here, to take money that has been going into Medicare--and people have been paying into Medicare-- and then steal it for a new program that is not going to get everybody covered on top of that and from a program that is already set to go insolvent by 2017. It is like writing a big fat check on an overdrawn bank account to start something new, to buy a new motorcycle. That doesn't make sense to people. Then it seems cruel and unusual to the senior citizens that you are taking $500 billion and really gutting a lot of their care programs on a program that doesn't work. I met earlier, within the last several days, with the Kansas Association of Anesthesiologists. They are looking at these things and saying: This is really going to hurt us and our ability to provide services and care. I talked with other individuals who look at this, and they say: Wait a minute, you are going to change everything to try to get a few more people covered and you are going to gut a Medicare program that is not paying the bills now, that a number of private insurance plans are helping to subsidize Medicare and Medicaid, and you are going to cut the reimbursements that are not making things work yet? It makes no sense to individuals that this would take place. I get called by a number of individuals across the State of Kansas saying they are very scared of this bill and what it is going to do to their health care. I do telephone townhall meetings, as a number of individuals across this body do, and the individuals there whom you get on a random phone calling basis are scared and mad about this bill and the prospects of what it does to their health care. I get it from individuals. I get it from mail. I was in a meeting in Kansas the week of Thanksgiving, and I polled the audience--it was an audience that was mostly over the age of 65-- how many were in favor of the overall bill? There were about 200-some people there, and 10 were in favor. How many opposed? Everybody else, with a few saying they don't have an opinion. But it was 90 percent, 95 percent opposed to this bill, and it is because they look at it and they see what it is going to do to them, and they don't see it providing the care that is being promised--and adding, on top of that, to the deficit. One of two things is going to happen on these Medicare cuts, because we have seen, in the past, efforts to control the spending in Medicare passed by this body and then each year those cuts to try to restrain the spending on Medicare being restored. One of two things is going to happen. Either these cuts in Medicare are going to take place, and it is going to cripple the program and particularly hurt it in a number of rural areas across the country and in my State, or these cuts will never take place in Medicare and it is going to add to a ballooning deficit and debt that is taking place right now. Either choice is an irresponsible choice for this body to do. It is irresponsible for us to do for this country. Most people look at it and say: I want to get more people covered, and I want to bend down the cost curve. But let's do that on an incremental basis. Senator Kyl spoke about incremental changes that can take place, whether it is tort reform, allowing bigger pooling on health insurance, whether it is starting more community-based clinics, one that I look at as something that has worked in my State to get more people covered at an earlier phase in their health care needs. All of those are incremental, low cost, and, in some cases, ones that actually do bend down the cost curve and that can help, not a gargantuan $2.5 trillion program that takes $500 billion out of Medicare that is already headed toward insolvency in less than a decade. The bill doesn't make sense to individuals. Then to do it on top of a time period when the President, 10 days ago, comes back from China, meeting with our bankers, as most people look at it, and the bankers lecturing us on why are we spending more money which we don't have, going further and further into debt, which we should not do at this point in time, being lectured by the Chinese when we ought to be talking to them about what they are doing about human rights and currency. We are being lectured about fiscal irresponsibility, and it is because of bills such as this. If we just stop and slow down and listen to seniors and others across this country, there is a commonsense middle ground that we can go to, that doesn't cost anything along the nature of this, doesn't change health care for most people but addresses the narrow problem of getting the cost curve down, of getting more people covered. This bill with these cuts in Medicare cripples many of my providers in the State of Kansas and will make them raise property taxes to keep the hospitals open, to try to provide doctors in the community--a lot of the hospitals are going to close and a lot of providers will stop providing Medicare--or, in all probability, these cuts will never happen, and it will be added to the debt and deficit, completely irresponsible toward our kids. I urge my colleagues to vote for the McCain motion that makes sense, that is what the citizenry wants to do: send these cuts in Medicare back to communities and pull out of this bill. I yield the floor.

Mr. BROWNBACK

Mr. BROWNBACK. Madam President, I, first, thank my colleague for offering these amendments in committee. In both the HELP and Finance Committees, you said: Let's put in the Hyde language, and both times the amendments were defeated in committee. I appreciate my colleague raising it. Proponents of the Reid bill will tell us the abortion funding language is essentially the Hyde language included in the annual Labor-HHS appropriations bill. That is plain wrong. The Hyde amendment specifically removes abortion from government programs. The Reid bill specifically allows abortion to be offered in two huge new government programs. The Reid bill tries to explain this contradiction by calling for segregation of Federal dollars when Federal subsidies are used to purchase health plans. This segregation of funds, though, actually violates the Hyde amendment, which prevents funding of abortion not only by Federal funds but also by State matching funds within the same plan. Simply put, today Federal and State Medicaid dollars are not segregated, and the Reid bill specifically authorizes something the Hyde amendment specifically rejects.

Mr. BROWNBACK. Well, if I could follow up quickly on the last point, I think it is clear that if we are not going to put this in the Federal employees benefit insurance system, then we should not put it in this system. Yet this is a billing expansion that is taking place. The Democratic health bill would explicitly authorize abortion to be covered in the government option. It also mandates that there must be abortion coverage in every insurance market in the country. This is an enormous expansion, a radical departure from the 30-year policy that represents the Hyde amendment. The abortion language that was included in the bill is a huge departure from 30 years of bipartisan Federal policy prohibiting Federal tax dollars paying for elective abortions. The language in the Senate bill explicitly authorizes the Secretary of Health and Human Services to include abortion in the public option and permits government subsidies for plans that pay for abortion. The Capps language, commonly referred to in the Senate bill, contains a clever accounting gimmick that proponents say separates private and public funds for abortion coverage. However, it has been proven over and over by outside reviewers that the Capps measure would include both abortion coverage and funding in the government-run public option as well as for those plans in the insurance exchange. Representative Bart Stupak, a Democrat from Michigan, explained the issue very clearly in an op-ed he wrote yesterday. He wrote: The Capps amendment, which is the basis of the Senate language, departed from Hyde in several important and troubling ways: By mandating that at least one plan in the health insurance exchange provide abortion coverage; by requiring a minimum $1 monthly charge for all covered individuals that would go towards paying for abortions; and by allowing individuals receiving Federal affordability credits to purchase health insurance plans that cover abortion. Hyde currently prohibits direct Federal funding of abortion. The Stupak amendment is a continuation of that policy--nothing more, nothing less. I would like to ask Senator Hatch about this provision, about what we need to talk about on the exchanges and the types of plans that will be included in the exchanges and about how this is an expansion of the abortion language.

Mr. BROWNBACK. The Reid health care reform bill would require at least one health care plan to offer elective abortions in each State health insurance exchange. However, nothing in the Reid bill ensures that the one plan that must cover elective abortions be the plan that is most affordable or least affordable. In other words, if I do not wish to have a plan that covers elective abortions but all I can afford is that plan, where does that leave me? Should my constituents have to compromise their own moral code in order to receive health care; in other words, that they would have to buy a plan that covers abortion?

Mr. BROWNBACK. Today, no Federal health program requires the coverage of elective abortions. This is a clear departure from current law, and I cannot imagine us forcing people to pay for insurance that covers abortions when it is so unconscionable to so many of the American people. I also would like to make one other point perfectly clear. The Stupak-Pitts compromise amendment would not prohibit the ability of women to obtain elective abortions as long as they use their own money to purchase these policies. I think it is important we get that piece of it clear as well.

Mr. BROWNBACK. Well, I think this is a key thing for us to keep in mind, that it is true that women can purchase separately, with their own money, use their own funds to be able to provide for their own abortion coverage. But what we are saying here today is that we should not have this as part of the Federal Government. We should not have it as part of the Federal funding program. We should not be using taxpayer dollars to fund abortions, as we have not done for 30 years. That has been the longstanding bipartisan program. But it is not prohibited that an individual could go ahead and buy this service on their own.

Mr. BROWNBACK. I say to Senator Hatch, as someone who has been in this body for some years and as someone who has followed this issue courageously for many years, what we are asking for, again, is just what has been established since 1977 in this body and in the House.

Mr. BROWNBACK. I was there that evening, along with the Senator and Senator Hatch and almost all of the Senators, when the President was addressing us on health care. I remember vividly sitting there and listening to these words, the ones you just mentioned. He was very clear, very concise; there was no fudging around on it: And one more misunderstanding I want to clear up--under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place. Yes, that is specifically violated in the bill, and they had a very simple route to change it. They could have just put the Stupak language in that has already passed the House. That is the Hyde language that has been agreed to by this body and others for 30 years here. Instead, they put in this abortion-expansion language. I will show another chart here a little bit later on. The last time we funded abortions here was between 1974 and 1977, right after Roe v. Wade and before the Hyde language in 1977. Do you know how many abortions were funded annually by the Federal Government at that period of time? If we are going back to that policy, if we are looking to go back to that era where the Federal Government was funding it, Medicaid funded as many as 300,000--300,000 annually. Now, I would ask everybody, pro-choice or pro-life, do you want your taxpayer dollars to pay for 300,000 abortions a year? I do not think anybody wants to see us do that. President Clinton we all remember very clearly saying often that he wanted to make abortion safe, legal, and rare. Adding 300,000 does not do that. So the President took the time, in a carefully tailored and vetted speech that all of us were there to hear--the Presiding Officer, as well; it was nationally televised in prime time--to tell Congress the words we have quoted here today and to make that specific promise. And that promise is broken in the Reid legislation before us today. We sat there in the House Chamber and heard him say those words. Our constituents watching the speech at home heard those words. I have to believe these are the kinds of broken promises that are making our constituents lose their trust in government. But the fact is, as so many people have pointed out, abortion is very much in this health care bill. Many Democrats and Republicans acknowledge this. Mr. Stupak, whom I have quoted several times, is just one of them. If we want to do more than just pay lipservice to lowering the incidence of abortion, we need to oppose the motion to proceed, and we should have had the Stupak compromise language included in the bill in the first place since the President clearly stated he did not want Federal dollars to be used for the funding of abortion. Consider the fact that when Federal funding is not available for abortion, fewer abortions occur. When Federal funding is available, as we have seen in the past, thousands more will occur. As shown on this chart, here is why the Hyde amendment is so important. The administrators running the Medicaid Program funded, as I noted, over 300,000 per year. That is almost 1 million abortions paid for by the country's taxpayers out of their pockets when the Hyde language was not the law of the land. That was until the Hyde amendment was enacted in 1976 because the American people disagreed with being forced to pay for abortions. Whether they are pro-choice or pro-life, they did not want taxpayer dollars to go for this. One other example of government ushering abortion policy through health care legislation is when the Commonwealth of Massachusetts recently passed its State-mandated insurance, Commonwealth Care. They failed to include an explicit exclusion of abortion, like Senator Hatch tried to get in committee or like they had in the House language, the Stupak language, so abortions there were funded immediately in Massachusetts. In fact, according to the Commonwealth Care Web site, abortion is considered covered under ``outpatient medical care.'' The Federal Government should not go down this road. The President made a commitment to the American people, and the Democrat-led Senate has failed to include that commitment in this bill. They included radical language that will increase the incidence of abortion. I say to Senator Johanns, don't you think it makes sense to protect health care providers, when we look at that issue here, who have objections of conscience to abortions so they are not forced to provide abortions?