Richard Burr

Mr. BURR

Mr. BURR. If you ask any veteran about the areas that need reform, I believe they would tell Chairman Sanders, just like they would tell me: Yes, there are a lot of places that need reform. To suggest that should not be part of this debate is ludicrous. I look forward to the next several days, and I urge my colleagues to support getting on this bill and to vote yea when they come to the floor for this next vote. I thank the Chair and yield the floor. Cloture Motion

Mr. BURR. Madam President, I thank my colleague from Illinois, and I should have told him I was going to come out to be recognized. Let me thank him because he has raised a very important issue on caregivers. I also want to thank him for the interest he took in Eric Edmundson, who is from North Carolina. I might add to the story, for my colleagues, there was not a caregiver program when Eric Edmundson's dad took over his care. He did what I think parents have a tendency to do. He said: It can be better for my son if I take control of it--and he ended up in Illinois at his dad's request. Although he has not made a full recovery, he has made a spectacular recovery from the prognosis. I know my good friend from Illinois has to go, but I appreciate him highlighting that. Let me just say that I think all Members of the Senate would like to expand the caregivers program. I wrote the caregivers program. Senator Akaka, who was then the chairman, came to the floor and it was passed. As written, section 303 would expand the caregivers program to veterans of all eras. Let me say that again: Veterans of all eras we would extend the caregivers program to if the Sanders bill was passed. I have the alternative bill, which is in the process of being filed. It does not expand the caregivers program--a program I am passionate about. I wrote it. It does not do it for a reason, and I want to turn to Senator Akaka's comments on the Senate floor when we passed this bill, where Senator Akaka, the chair of the Senate Veterans' Affairs Committee, said this: [O]ne, the needs and circumstances of the newest veterans in terms of the injuries are different--different--from those of veterans from earlier eras; two, the family situation of the younger veterans is different from that of older veterans; and three, by targeting this initiative on a specific group of veterans, the likelihood of a successful undertaking is enhanced. To me, the most important of these reasons mentioned by Senator Akaka was the belief that the VA would not be able to implement a program of that magnitude. That is why caregivers was crafted to be a program that we ramped up over time. It was targeted at a very specific population, and we envisioned that as the VA got more proficient at actual training and implementation of this program, it would be ramped up. The VA has proven us right. They have had trouble in implementing this program in what is a very limited program. Their rollout and management of the program has been flawed in several areas and has been a disservice to those veterans in need of these critical services. Since the start of the program 2\1/2\ years ago, several problems have been brought to my attention. These problems include decisions regarding eligibility for the program which are inconsistent across the country--no quality assurance program to monitor the quality, consistency and timeliness of those decisions, and no formal process to appeal the decisions of eligibility for caregiver assistance. Let me highlight the issues with this program. I want to share some stories of veterans' experiences. A veteran applied to the program at the VA in Colorado. His application was denied. Yet, after moving from Colorado to Florida, he applied again using the exact same information he had previously submitted in Colorado. The VA in Florida granted his application. How can this happen? It is because we have an agency that has yet to draw on the consistency needed to apply equally to our veterans. Another veteran in Florida suffered from multiple gunshot wounds resulting in paraplegia. VA denied him entry into the program because he did not require assistance with at least one activity of daily living or ADL. He was being compensated through an aid and assistance or A & A program. I find it interesting that this veteran did not qualify for caregivers. He was actually compensated under the aid and assistance program because what he needs is ADL services, not just the one required under the caregiver program. In addition, I have also heard many veterans and their caregivers were treated rudely by the VA staff when applying to these programs for a PTSD diagnosis. VA staff have told them that PTSD--get this--that PTSD is not a disability that requires assistance with ADLs or activities of daily living. Assistance with the activities of daily living is only one of the four criteria needed as having a serious injury. Under the law, a veteran needs to meet one of the four. Even the appeals process does not seem to be well thought through. You see, we can write the laws, but it is the agency's regulations that they write that dictate how these programs are run. VA says that they have an appeals process. However, it is vastly different from the appeals process at VBA, the Veterans Benefit Administration. It leaves Veterans Service Officers or VSOs at a disadvantage to help veterans and their caregivers. VSOs have been told that VA considers it a medical decision and they cannot question the denial. The only recourse veterans and their caregivers have is to appeal to the medical center director. The problem with this is that it was the medical center director who denied the appeal in the first place. I am going to go on as the days go on, describing the things in this program that we would all like to embrace, things that I think every Member of the Senate says: Yes, we ought to do this for veterans. Here is the problem. If we have a broken system, jamming more people into it is actually the worst thing we can do. As I said earlier, there is nothing in the Sanders bill to fix the things that are broken at VA. There is nothing in the alternative bill to fix things in the VA. But the one thing that I do not do in the alternative bill is I do not jam millions more veterans into the system. Caregivers should be expanded as VA perfects how to implement it, to educate the caregivers, to be able to address the concerns, and, more importantly, the intent of why we wrote the program. Enrollment or access to VA should only open if we have the health care professionals or the facilities to handle them, but not to crowd out those current veterans who leave the battlefield today and need the services that only the VA can provide. So, even though in everybody's wish list we would like to expand to every veteran, in the caregiver program we would like to expand to everybody who wants to care for a loved one, the truth is, we do the ones who are in the system an injustice if we are not prepared to be able to implement it, to handle it. That is the difference between the Sanders bill and my alternative. We simply look at the things that have bipartisan support, but do not necessarily grow the problem worse than it is today. I said earlier, my regret--and I see my colleague from South Carolina is here. My regret in this debate is that we are not on the Senate floor debating reforms to the Veterans' Administration. I think the presiding officer would agree that there are areas--these are areas that do not have a partisan leaning. When we look at our Nation's veterans, we do not see one side of the aisle or the other. We see a promise we made to them and a commitment we have got to fulfill. To ignore the things that need reform really is a mistake. To talk about expanding the population without reforming these areas, quite frankly, is disingenuous to the veterans to whom we owe so much. I yield the floor.

Mr. BURR. Mr. President, may I inquire how much time exists on both the majority and minority sides?

Mr. BURR. I thank the Chair, and I thank my colleague for his comments on the Affordable Care Act. I am actually excited to be here having a debate about veterans and about the promises we have made to those who are reliant on not only the VA but on this institution to actually look at the programs and the services provided, and when we, as a body, see deficiencies, reforming them, fixing them, so our customer--who is that person who made that ultimate sacrifice, who put on that uniform and, in many cases, now has a lifetime disability because of it--can count on that health care system to be there. I would have expected we would be on the floor debating in a bipartisan way those fixes that were needed to make sure that veterans with disability claims didn't have to wait hundreds of days to determine whether they were going to have a disability that was signed off on and, if so, what the percentage was and that percentage then provided them income. I thought we would focus on the challenges the Senate has to reform how the appeals process works. Because when a veteran is denied a disability claim or he gets less than he thinks he should have been awarded, then he has the opportunity to appeal that to the court of appeals. The time now for the appeals decision has grown to years. It shouldn't be like this. It is absurd that the Congress of the United States, much less the Veterans' Administration, is content with the deficiencies we have in this broken system. Instead of being here to look at fixes provided under the Sanders bill, we are here looking at how to expand the population of coverage. We are here on programs that have had little to no hearings. We are here without understanding the intended or the unintended consequences. Let me share the knowledge I have of North Carolina where we have the largest growing veterans population in America. I don't have the facilities today to handle that veterans population in the timeframe Americans are used to being delivered health care. I could go out and start construction tomorrow, if my good friend the Presiding Officer would allocate me the money, since he sits on the Appropriations Committee, and build facilities, and I still couldn't meet the facilities requirement needed to provide that level of care. As a matter of fact, we have about $14 billion worth of construction currently underway in the country, and on an annual basis, this body-- the Congress of the United States--allocates about $1 billion in facilities construction and maintenance money. We have 14 years of backlog right now and we are not even anticipating what the effects are going to be of our current warriors who have come out of Iraq, who will leave Afghanistan, who might enter Syria or who might be in a conflict down the road. No, we are here debating in the Sanders bill a massive expansion in who is provided benefits in the VA. So who is that? It is veterans who have no service-connected disability. It is veterans who are above the means-testing threshold. Let me put that in layman's terms. These are not people who are low income and these are not people who have a service-connected disability. We are going to have days to debate this bill, and I will introduce an alternative. I will openly confess, upfront, that I don't get into fixes, because to do fixes there has to be bipartisanship. To reform programs in the Federal agencies, Republicans and Democrats have to come together. We are here today because there was no outreach to attempt to put together a compromise bill. If the conversation we had about a day before we left a week ago, where my colleague said, this is what I am going to do, why don't you sign on, but he wasn't willing to talk about changes--if that was compromise, then he did that. But I don't consider that to be compromise. I don't consider it to be good-faith negotiation. But that is behind us. We now have this bill to consider, and it is a massive expansion. And what does it do? It basically says to those warriors who have service-connected disabilities, those individuals who are low income--and this is where they get their service, their health care--you are going to have to wait in a bigger line. You are going to have to get behind more people. So what veterans expect, which is that the most needy will receive the services they need, is not what this bill does. It is not at all what it does. As a matter of fact, section 301 of the Sanders bill would expand eligibility of the VA health care system. It would qualify to enroll in the VA health care as priority 8 veterans if they do not have access to health insurance except through a health exchange and do not qualify for higher priority. Before getting into my concerns about this affected section and what impact it would have on VA, I wish to comment on how this section has been drafted. The section says: If a veteran qualifies as a priority 8 veteran and has no other option but the health exchange under the Affordable Care Act, they could enroll in the VA. Let me read that again: If a veteran qualifies as a priority 8 veteran and has no other option but the health exchange under the Affordable Care Act, they can enroll in the VA. We have just mandated that everybody in this country--except when the President delays the mandate--has to be under the Affordable Care Act and they are part of the health exchange. Here we are saying to priority 8 veterans, if your only option is the health exchange, we will let you opt into the VA. Well, if the health exchange is that good, why would we dare risk all other veterans who have service- connected disabilities or low incomes having to wait behind people who were provided health care out of the health exchange? Some priority 8 veterans may even qualify for a subsidy under the exchange, something they would not receive if they were to enroll in VA health care. I don't know, are they concerned these veterans will be unable to find a plan that meets their needs? Everybody else in America was shoved into it. Why should we be concerned about them? My intention today isn't to open a health care debate. I do have serious concerns about this expansion. Expanding eligibility could stress an already overburdened system. There is a reason why the priority 8 veterans program was halted. The VA found they could not provide timely access to services while sustaining a high level of care. And judging by the well over 30 health care inspectors reports issued by the Office of Inspector General in this Congress alone, the VA is having trouble with the limited group they currently serve. Here are some examples of the IG's health care inspections report released since January 2013: 1. Three deaths in Atlanta because of delays in mental health care; 2. Two reports regarding delays in GI consults and issues with facilities operating services in Columbia, SC; 3. Emergency department patient death at the Memphis VA center; 4. Two reports on the inappropriate use of insulin pens at both the VA Western New York Healthcare System and the Salisbury VA Medical Center; and 5. Two reports on Legionnaires' disease at VA Pittsburgh and a review of Legionnaires' disease prevention at VHA facilities. If we expand enrollment, if we expand the coverage, it would surely require an increase in funding at the VA. When we increase the number of patients entering the system, we certainly need to hire additional staff and to provide more space to treat the new veterans. I have already talked about the 14-year backlog we have on facilities now. Without followthrough on secondary cost, we only frustrate veterans when their expectations aren't met, not satisfy them. I truly believe if we expand government programs we need to do it responsibly. We need to understand the intended consequences and plan for the unintended consequences. We should explore whether the VA can manage the implementation of this expansion. We should explore what impact this will have on the VA's ability to treat combat veterans and veterans with limited incomes and find out what new needs, both in staffing and space, would be created by this expansion. Unfortunately, we don't know the answers to these questions, because in preparation for this section the majority didn't hold an oversight hearing looking specifically at the consequences--intended or unintended--to expand enrollment of priority 8 veterans. In fact, the only hearing on this subject was a hearing on legislation pending before the committee on October 30, 2013. At that hearing we heard testimony on three dozen bills--clearly, not enough time to examine the details of any of the 30 bills. From their testimony at the hearing, the VA obviously agrees with me. Dr. Robert Jessie, Principal Deputy Under Secretary for Health, indicated that expanding enrollment of priority 8 veterans ``presents many potential complications and uncertain effects on VA's enrollment system.'' That comes from a guy pretty high up within the Veterans' Administration. They are not necessarily for this. Finally, I want to address a comment my colleague from Vermont made at a press conference a few weeks ago. He said: We're not going to bring one new person in without making absolutely certain that the VA has the resources to accommodate those people. As I read the bill, there is nothing in this provision or in the bill itself that would restrict implementation in that way. However, I would gladly support an amendment which would delay this provision until GAO reports that the VA could manage this additional population of veterans. Mr. President, you might be thinking, as others who are listening might, what does all this cost? How is it paid for? Is the funding recurring or is it one-time funding? Is it permanent expansion? Let me try to answer some of that for you. The way the Sanders bill is paid for is with money out of the overseas contingency operations. That is more money we were going to spend that we haven't spent, that we never had because we were borrowing it, and now we are going to use it to expand this. It is one-time funding for a permanent program. Let me say that again. It is one-time funding for a permanent program. It is not as though we are going to fund this expansion of priority 8s, and all of a sudden, when OCO money is gone, we say: Oops, we didn't mean it; we are going to pull it back. No, these are going to be in the system regardless of the impact, regardless of the consequences. So who is adversely affected? Today's warriors. The same warriors who are waiting in line to get health care services are now going to compete for a limited number of slots to be seen by people who might have had private insurance, by people who might have been in the health care exchange, by individuals who are not low income and who have no service-connected disability. Who else? Those veterans with disability claims who are waiting for a determination. I mean these veterans are going to be impacted by this because we will have such an influx of people within the system. Veterans are waiting for disposition of their disability claims, their appeals. Those who have gone back and have waited, they have finally gone through hundreds of days for a claim to be determined only to find out they have to appeal it. Now they are going to go through hundreds of days of appeal, and we are saying we are going to have to start using some of these people to administer new services which far exceed and are outside of priority 8 which I focused on. But we will talk about the entirety of this bill as the next several days go on. The last one, and I will stop for this afternoon: Who is adversely affected? Our kids, our grandchildren, the ones who sit at home today hoping the decisions we make about future obligations take into account that they are paying the tab. They are the ones who will be here years from now keeping the promises we make, and they are hoping we only make the ones we can keep. Mr. President, how much time is remaining on our side?

Mr. BURR. I will tell a personal story about a trip to one of our military cemeteries abroad. We were in the country of Belgium. I was there for a Memorial Day service. Much to my amazement, there were probably 4,000 to 5,000 individuals. We got through with the formalities of a very well-constructed Memorial Day celebration. As I wandered through the graves, I found a Belgium couple with their two young children at the headstone of an American soldier from World War II. I asked them one simple question: Why are you here? The Belgium father, younger than I, looked at me and he said: Sir, I inherited this grave from my father. My father took the responsibility for this grave to always make sure it was just like it was the day he got it. I have now inherited that from my father, and my children will inherit that responsibility from me. I know there are a lot of veterans organizations who hope Senator Sanders' bill becomes law, but I think there are a lot of veterans who are hoping it doesn't: the veterans who need the VA system and count on it for their mental health treatment, for their substance abuse treatment, for their primary care. They count on it for diabetes maintenance, they count on it to stay alive, and we promised it to them. I am sure future generations will look at the decisions we make this week and will belly up to the bar for whatever it costs, but I think it is important for us to remember our obligations stretch long past our service here. Although it seems somewhat easy to spend somebody else's money, our kids want us to reform this, our veterans want us to reform this, the VA wants us to reform this. Once we reform it, we can talk about expansion. Until then, it is irresponsible for the Congress of the United States--for the Senate of the United States--to talk about dumping more people into a broken system, to ask those who have already waited so long to wait longer because of our actions. I yield the floor.

Mr. BURR. Mr. President, I ask for an additional 30 seconds.

Mr. BURR. Mr. President, I thank my colleague, the chairman of the committee. He is right when he said we have a lot of agreements. As a matter of fact, about 80 percent of the policies in his bill are in my alternative bill, but I have a big problem with the other 20 percent. I have a problem with the cost. I have a problem with the unintended consequences. I wish we could figure out the intended consequences, but we cannot because there has not been much time to do it. I look forward to the next several days. I believe the chairman made a plea that the amendments be limited to VA issues. That might be possible if the minority had the opportunity to amend legislation in this institution. I think we have had four votes on Republican amendments since July. To suggest that Iran is not important is, in fact, turning a blind eye on the world. In my bill I have a piece of legislation that is cosponsored by 59 Senators, and it is bipartisan. My legislation is the Iran sanctions bill. Why? Because it is the only way we can get this to the floor. We have been denied the opportunity to deal with this issue in any other way. This is important to the American people, and it is important to our friends and allies around the world. I am sure it will dominate part of the debate. Make no mistake about it, the one matter the chairman didn't point to was what we are fixing. We are adding a lot of stuff, but we are not fixing anything. Ask any veteran.

Mr. BURR

Mr. BURR. Madam President, I came to the floor last week and for 45 minutes I pulled this file out of my desk. It was my notes that I talked about in 2009 about the Affordable Care Act before it became law. I talked about the increases that were projected in premiums and deductibles. I talked about the networks that were changed, the doctors that would not be available. I was not a prophet. I was reporting what people such as the Chief Actuary at CMS were saying at the time. Hospitals were going to close, doctors were not going to take patients under the new plan. More important, the premiums and deductibles were going to become unaffordable, not affordable. I am tonight going to read a letter from Donna Hulcher from Clemmons, NC, right in the middle of the State. We own a small automotive repair shop and have had continuous health insurance coverage our entire life, either through our company or for the past several years on the individual market. We learned that our high deductible plan with an HSA was not grandfathered into the Affordable Care Act about 4 months ago. Of course at that time, no pricing was available. We were paying 679.00 per month, and felt that we were protected from catastrophic sickness/injury, and we liked the flexibility the HSA provided in meeting our other expenses like dental and optical. We checked with Blue Cross once the cost for the new silver plans they are mapping us to was available, and it is going to cost 1379 per month. What a shock to the system and I am not at all sure it has as much coverage as what we are losing. I am pretty much a deer in the headlights, not knowing where we are going to turn, afraid to get onto the ACA website and give my information because I don't trust its security. It is totally foreign to me to apply for government subsidies for something we have always paid for and never depended on the government to help us. This goes against everything we believe in as being hard working, independent people. There are problems with health care and with costs, no doubt but this is not making it more affordable and from what I am hearing, doctors are retiring early or not taking this new policy. I feel like I am spinning the wheels of my brain trying to find out what is the right way to go. This has pulled the rug from under our family! We are now within 3 days of what was the cutoff. We have now extended the enrollment period to the end of March. But insurers are required, April 1 to April 27 of 2014, to submit their pricing for 2015. I have heard the folks talk about this is only about 8 percent of the American people that this applies to in 2014. In 2015 it is all of the American people. It is big business, it is small business. You know what is going to happen when they price this product with no experience of the risk pool this year. Prices are going to go up. Deductibles are going to go up. If you think it is unaffordable this year, wait until you see what hits the 90 percent of the American people in 2015. It is time for us to change this. It is time for us to fix it. It is time for us to get an affordable health care policy in place in this country. I yield the floor.

Mr. BURR

Mr. BURR. I rise to address the nomination of Cornelia Pillard to the DC Circuit Court. This nomination is a good example of government overreach that has led to things such as the ObamaCare debacle. Let me say to my colleagues who have been on the floor speaking about Newtown, I had an opportunity to spend an hour with parents of Newtown children. It is a compelling personal story that they shared. No parent should have to watch a child die. No parent should have to live and a child die. My heart still goes out to those who lost children at Newtown. Today, with the Affordable Care Act fresh on my mind, I venture back to think about when I came to the floor in 2009 and said in front of my colleagues of the Senate and the American people--I wish to spend the balance of this second half of the hour rehashing some of the things I came to the floor to talk about. There were numerous opportunities before the legislation was passed. I remember it was very close to Christmas in December of 2009. I said premiums will increase for younger and healthier individuals because of the new federally mandated rating rules. Over 40 percent of the uninsured are ages 18 to 34, the same group that will be hit with the highest increases if this bill passes. What do we hear Americans are focused on today? Young people. Are they going to join? Today their insurance is three times lower than what it will be in January of 2014. Why? Because of the Affordable Care Act. No. 2, premiums will increase because of new federally mandated insurance standards. Experts estimate many of the health plans purchased today by individuals and small businesses will not meet the minimum requirements mandated by this bill, which means that all Americans will be forced to buy richer plans. Let me remind those who are listening that this was in 2009 on the Senate floor. Listening to the comments of those today who say we never anticipated some of these things would happen--if they didn't anticipate, it is not because people weren't on the Senate floor. It wasn't because we made this up. It is because people who were experts, CMS actuaries, CBO administrators, were sharing with us what would happen if this legislation became law. Premiums will increase because of new federally mandated benefit packages. The bill empowers the Secretary of Health and Human Services to decide which benefits are covered and which benefits are not. What are Americans learning every single day? When they can get on the exchange, they are finding that they are 65 years old and they have to have maternity coverage. I turned 58 and my wife has pretty much informed me we are not going to have more children, but I can't buy coverage without maternity coverage. Why? Because they want to charge me more to shift that cost. We didn't have health care reform. We just changed where we are shifting the cost from. Now we are embedding the premium versus charging more at the delivery point of health care and shifting it within the delivery system. We are shifting it within the population by charging those of us who are a little bit older more--because we mandate that we have to have services we are never going to use--and younger people who are healthy who probably are never going to need to go to the doctor. I hope they do because prevention is actually one of the most beneficial things we can promote. Now we are going to charge them three times what they were paying, and we believe they will take it? Premiums will increase because of the new excise tax on medical devices. Innovation is what saves health care dollars. Yet in the Affordable Care Act, or what some call ObamaCare, we actually put new taxes on medical devices. Every time we have a stent that is inserted, every time a medical device is used on a person, their health care bill goes up because we have now taxed the device they are using. If the device price goes up, and the reimbursement goes up, the premium goes up. It is starting to make some sense. Again, this was in 2009 before we passed the bill. Premiums will increase because of a new excise tax on health plans. We actually taxed the same health plans that are in the exchange that we told everybody would save them money. Premiums will increase because of the new excise tax on prescription drugs. Wait a minute. I thought we were bringing down the cost of health care. In 2009, again, new taxes on devices, new taxes on health plans, new taxes on prescription drugs, these were all things that we all knew. The President knew it. My colleagues who voted for the plan knew it, but everybody seems to have amnesia today: Oh, my gosh. How could the costs go up? I never knew this was going to require people to buy a health insurance policy that had benefits they would never use. Premiums will increase because of a new fee to sell plans in the mandated exchanges. This phenomenal exchange market that created competition, we now created a new fee on the part of insurers to enter the exchange. Premiums will increase because of a new tax for comparative effectiveness. Comparative effectiveness means we are trying to bring new generics, whether they are in pharmaceuticals or biologics to the marketplace. We have decided to tax that process. Premiums will increase because the bill forces 15 million more Americans to enroll in Medicaid. Why is that happening? It happens because doctors are paid so little on Medicaid that they have to charge more for everybody else. We are cost shifting when we purchase the premium, and all of a sudden we are learning we are cost shifting even when the service is delivered. Reform? No. In 2009, again I came to the floor and I talked about the Affordable Care Act, ObamaCare. Zero times did it mention provisions prohibiting the rationing of health care--zero. Nine times it mentioned new taxes created in the bill. Thirteen pages are in the table of contents. The bill weighed 20.88 pounds and it took 36 pages for the CBO to estimate the pricetag of ObamaCare; 70 government programs authorized by the bill, and 1,697 times in the Affordable Care Act the Secretary of Health and Human Services was given the authority to create, determine, and define things in the bill. This is a bureaucrat whom we allowed 1,697 times to determine what Congress's intent was in the legislation through almost 3,000 pages; 3,609 times the word ``shall,'' not ``may,'' was in the bill. It cost $6.8 million to taxpayers per word. Let me remind you. This is what I came to the floor and talked about in 2009 before the Senate passed this legislation in the dark of night. Twenty-four million people left without health care. This is the bill that was supposed to insure everybody. Twenty-four million people without health insurance; a $1.2 billion cost to the taxpayer per page, and $5 billion to $10 billion of additional funding needed for the IRS' implementation of the bill. In other words, we are going to fund $5 billion to $10 billion for the IRS to chase down people who owe a penalty because they made the determination they couldn't afford or they didn't need health care insurance. There are $8 billion in taxes levied on uninsured individuals. There is a way to make health care affordable--tax people who don't have it. So $25 billion of additional Medicaid mandates placed on States; $28 billion in new taxes on employers not providing the government-approved plans; $100 billion estimated annually of fraud in Medicare and Medicaid; $118 billion in cuts in Medicare Advantage--to seniors all across this country who found this product to be the one that provided the most security and benefits for them; $465 billion in cuts to Medicare--cuts to Medicare. This was the health care system that was at that time projected to be insolvent by 2017. There are $494 billion in revenues from new taxes, fees, levied on American families and businesses; a $2.5 trillion cost for full implementation of the legislation. At that time we had a $12 trillion debt. Today, we have a $17 trillion debt. Health care was supposed to be more affordable because we reformed it. We didn't reform it. We took it over. The Federal Government took it over. Let me go to another process I talked about in 2009. This is all marked up. It has been in my desk drawer since then. It is a word search of the bill. There are 4,677 times where the legislation said shall, must or require; 899 times it said tax, fee or revenue; 470 times it said agency, department, commission, panel or bureau; 196 times it said regulate or regulation; 134 times it mentioned treatment; 180 times it mentioned prevention; 40 times it mentioned choice; 25 times it mentioned innovation; and 13 times it mentioned competition. If we listen to those who are out selling this awful plan today, what are the three words we hear? Choice, innovation, competition--those things that are mentioned the least in the almost 3,000 pages of health care legislation in 2009. This bill wasn't reform. This bill spent trillions of dollars at a time of record deficits and debt. When fully implemented, I said then, this bill is projected to cost $2.5 trillion over 10 years. CBO said at the time that this bill will increase Federal health costs, not lower it. What have we heard from the President? It is going to lower health costs. It is going to bring it down. It is going to be more affordable. Middle class, this is the greatest deal for you. The bill raised taxes by more than $500 billion at a time of record unemployment. The bill violated the President's own pledge to protect the middle class. Who gets taxed in this bill? Again, this is from 2009 on the Senate Floor, right here, before the vote. Uninsured Americans, insured Americans, families with high-value insurance plans, high health costs, small business, individuals who need medicines or medical devices, and employers that provide retiree drug coverage. Employers that provide retiree drug coverage, we tax them. The bill cut $466 billion in Medicare to fund new government programs. Medicare faced at that time a $38 trillion underfunded liability and insolvency that was projected to occur in 2017. Instead of fixing those problems, this bill raided Medicare to start a new government entitlement. The bill cut Medicare Advantage. It cut hospitals, it cut nursing homes, it cut home health, and it cut hospice. Nobody in the administration can go out today and say: Oh my gosh, we didn't know this was going to happen. We talked about it right here day after day after day. These are not things we made up. If we did, we would be prophets, because they are all coming true. Everything is aligning with what we said. The bill would increase premiums, making care more expensive, not less. I mean let's get past what was the easy part, and that was setting up the exchange, setting up the Web site. Or at least it should have been. New taxes in this bill will get passed on to consumers, increasing yearly premiums--this is what I said then; listen to this--by $488 a year, according to some estimates. The average premium would increase by $2,100 for a family policy in the individual market. There are individuals who are seeing $488 a month in increase, and in addition to that a deductible they have never had applied to them before. This bill imposed costly new burdens on struggling States. The bill threatens health care choices millions now enjoy with a tangled web of new rules, regulations, and government-run plans. The government will require you to purchase insurance or face a fine and will tell you what kind of insurance you have to have, even if you like what you currently have. I am not a prophet. I was going by what the experts said in reading the bill. So for everybody who went out and said: If you like your insurance, you can keep it; if you like your doctor, you can keep him; if you like your hospital, you can keep it--we were on the Senate Floor saying: That is not what the bill says. It is not going to happen. This bill cut $135 billion from hospitals, $120 billion from 11 million seniors on Medicare Advantage, nearly $15 billion from nursing homes, nearly $40 billion from home health agencies, nearly $7 billion from hospice. Cutting Medicare to fund a new government program in my book is not reform. It is ignorance. The CMS Office of the Actuary--let me tell you, the Actuary is like the gold standard. The CMS Actuary is like the guy who puts that stamp of approval on it, and there is nobody higher from the standpoint of what the actuary says. He says the bill increases national health expenditures. National health expenditures under this bill would increase by an estimate of a total of $234 billion, 0.7 percent, during 2010 and 2019. That is exactly the opposite of what everybody is out saying today. Despite promises that reform would reduce health care spending growth, the bill actually bends the health care curve upward. According to the analysis, the national health expenditure as a share of GDP is projected to be 20.9 in 2019, compared to 20.8 percent under current law. How could you go out and make a claim this was bending the cost curve down? How could you promise the American people it was going to be cheaper? The total number of persons with employer coverage in 2019, according to the CMS Actuary pre-2009, when the bill was passed, was projected to be 5 million lower under the reform package than under current law. Let me say that again. The CMS Actuary told us in 2009, before we passed this bill, that employer-based coverage would drop by 5 million individual covered lives. I might say that some estimates are coming in at 100 million employees losing their health care under employer plans right now. The new fees for drugs, devices, and insurance plans in the bill will increase prices and health insurance premium costs for consumers, and this will increase the national health expenditure by approximately $11 billion per year. The bill funds $930 billion in new Federal spending by relying on Medicare payment cuts which are unlikely to be sustainable or permanent. As a result, providers could find it difficult to remain profitable; and absent legislative intervention, they might end their participation in the Medicare program, possibly jeopardizing the care to beneficiaries. See, it wasn't Republicans who talked about rationing, it was the Actuary at CMS in his analysis of the Affordable Care Act. He said: Here is what is going to happen. It is seniors who are going to get hosed on it because they are not going to have access to the doctors anymore. The bill is especially likely to result in providers being unwilling to treat Medicare and Medicaid patients, meaning that a significant portion of the increased demand for Medicaid services would be difficult to meet. How could anybody listen or read what the CMS Actuary said and remotely go out and tell the American people: Geez, this is going to increase coverage for everybody. The CMS Actuary noted that the Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. He also found that roughly 20 percent--20 percent--of all Part A providers--hospitals, nursing homes, et cetera--would become unprofitable within the next 10 years as a result of these cuts, meaning they are going to go out of business. You know, pretty soon it is not going to be the network the insurance provider put together, it is going to be the fact the hospital went out of business because they couldn't withstand what this bill has done to them. The CMS Actuary found further that reductions in Medicare growth rates through the actions of the Independent Medicare Advisory Board-- now, that is going to sound a little odd to some because prior to the bill passing it was called the Independent Medicare Advisory Board, but it is now called the Independent Payment Advisory Board--IPAB--an entity that when set up and it is kicked in--16 members picked by the President--will determine reimbursements and scope of coverage. It is not the Congress of the United States. If we don't legislatively do something with their recommendation, it becomes law. It goes into effect. The bill would cut payments to Medicare Advantage plans by approximately $110 billion over 10 years resulting in less generous benefit packages and decreasing enrollment in Medicare Advantage plans by about 33 percent. So 33 percent of seniors would lose their Advantage plan. Again, this is 2009. This is not today. The President, in 3,000 pages said it would reduce costs. The chief actuary says that is not the case. Let me read a letter I got in the last couple of weeks from Lori Perez from Willow Springs, NC. I am a divorced mom of three. I received insurance through my employer. My rate has increased $100 a month. This is a huge difference that will have to be budgeted by reducing groceries and foregoing my son's braces I had planned for 2014. I looked into dropping my company provided insurance to join an exchange but I do not qualify to receive a subsidy because my insurance rate is less than 9\1/2\ percent of my income. It is 9 percent. My yearly income qualifies. Apparently, Obama thinks I can afford an additional $1,200 a year. I am considering dropping my insurance, paying out of pocket as needed for health care, and paying the fine at the end of the year. It would be less expensive. This is ridiculous. What can we do? What do you say to Lori? Oops. That is the law. Here is somebody who was 100 percent satisfied, an employer doing the right thing, and the Federal Government has now put her in a situation where she is considering just giving up her health care, doing away with it. Why? Because she can't afford it. This is a woman with a job. She is thinking about giving up her groceries and delaying her son's braces. Why? Because of ObamaCare. Where are we today? Let me speed forward. I said we have the health care exchange, the healthcare.gov Web site. There are companies every day that get Web sites set up. This one is complicated. They had 3 years to do it. It still is not right today. But I am convinced they will get it right. For the first time the American people are getting on the Web site and they are able to look at the health care options they have. And what are they finding? They are finding that the premium costs for something equal to what they had are two times, three times more expensive per month. They are finding this new thing they have never had before called deductibles. And I am not talking about a $100 deductible that you pay before you get participation in a doctor's visit or an emergency room visit; I am talking about $1,000, $3,000, $5,000. I have heard from friends who have now signed up for plans and have a $15,000 deductible. I say to my colleagues--especially my colleague from Florida--it sounds like a health savings account, doesn't it? You have insurance, but you are responsible for the first $15,000. The guy who shared that with me, his premium is $1,444 a month with a $15,000 deductible. I don't think he is going to drop it, but sticker shock is rampant. Benefit package. How many people have come up to me and said: I am not going to have any more children, but I have to have maternity coverage. Something is wrong. They are right--something is wrong. How many kids would like to have a scaled-down version that allows them to have a set of benefits, and they are willing to roll the dice, and if something bad happens, they will pay out of pocket? No, they don't get that option. The choice does not exist--unless it is a choice of the things created in the Affordable Care Act. Networks. This is one the American people haven't gotten to yet, and I can't wait until it happens. I have gone through getting on the DC exchange and going through the process of trying to figure out whether my doctor in North Carolina is available in this plan or that plan. Wait until the American people go onto healthcare.gov and they start picking a plan and look to see: Is my primary doctor on there? Is my hospital on there? Is the specialist I see on there? Are the drugs that I take on this plan? This is incredibly complicated. The American people were used to calling their insurance broker and saying: Here is how much coverage I want, here is how much I have to spend, and here is my health condition. And they designed a program to meet their health condition, their income, and their age. Now we penalize you for your age--if you are old or young--and we force everybody to take the same benefit package regardless of whether they can afford it, and we say: If you don't get it, we are going to charge you this year a 1-percent penalty on your income, and that goes up to 2\1/2\ percent at the end of the transition period. We are going to get past this period which I call the enrollment plan period. Next, we get to the part the President delayed. We never understood that something that was in statute, the executive branch could just decide, no, it is not going to go into effect. But for large and small employers, they had a 1-year delay. All of a sudden, in 2015, their employees are going to be in the same marketplace that we are. What makes that particularly difficult is we extended the enrollment period for individuals in healthcare.gov until March 31, 2014. They can still enroll. Well, April 1, 2014, through April 27, 2014, insurers will have to decide what their premium cost will be in 2015. So given that they have no real experience on what the mix of ages and health conditions in their plan is, what are they going to do? They are going to err on the side of higher premiums; that is, higher than we will see in 2014, which a majority of the American people say are higher than they can afford. Imagine what it is going to be like in 2015. And in that group is the 80 percent of America, not the 5 to 10 percent who are provided for by employers today. I see my colleague here, and I am infringing on his hour, but I do want to stress one last thing. I mentioned only once the Independent Payment Advisory Board, IPAB. At the end of the day, mark my word, everything that I commented on I read from my 2009 notes--notes that I came to the floor then and said: This bill shouldn't become law, and here is why. I spent 5 minutes talking about that today. But I am going to make this statement, and I will come back to the floor 2 years from now when IPAB is up and running and the benefit packages have been cut down and the reimbursements have been cut to doctors and hospitals, and I will point to the statement that I made here that picking a 16-member advisory panel that has the authority and the power to set the scope of coverage and, more importantly, the reimbursements will have a most devastating effect on health care in this country. It will ration health care because of the doctors who choose not to participate in plans that participate in the exchange. It will force hospitals out of accepting plans that participate in the exchange. And for those of us forced by government to be in the exchange and to choose, our choices will be gone. Our costs will go up. We will get care--when we are queued in line or at the emergency room or from a doctor we don't know or don't trust or from a hospital we have to drive to. It is not going to be reassuring to that mother who now has maternity coverage but no obstetrician and no local hospital to deliver a child because, you see, we didn't reform health care. We didn't do anything to liability. We just changed the pocket we pay out of. We taxed everybody we could find to pay for it. And still--as I said in 2009 and I believe will be true today--at the end of the process, there will be 24 million people without health insurance. Why? Because of ObamaCare. Because of the choice--or the lack of choice--we gave them. I yield the floor.

Mr. BURR

Mr. BURR. Mr. President, we worked to ensure that the Drug Quality and Security Act achieves a balanced approach to strengthen the safety, security and accountability of our Nation's pharmaceutical drug supply chain. This legislation establishes a uniform electronic unit-level system over the next decade that will increase security and ensure a safer pharmaceutical drug supply chain from manufacturers to dispensers. The charitable distribution of prescription drugs from the manufacturer to patients through patient assistance programs, PAPs, is a valuable and unique approach to providing American patients access to critical, lifesaving medicines. As this legislation is implemented, the varied and unique approaches of PAPs should be taken into consideration to ensure patients who access needed treatments through these effective programs are able to continue accessing the prescription drug medications provided through PAPs.

Mr. BURR

Mr. BURR. Mr. President, I recently received a letter from Kathleen Stephan of Fletcher, NC, who wrote to describe her experience with the Affordable Care Act and the impact on her health care. I wish to read her letter versus paraphrasing it. Dear Senator Burr: I recently received a notice from Blue Cross Blue Shield of North Carolina that my health insurance policy will be cancelled effective January 1, 2014 because it does not meet all of the mandates under ObamaCare. My current premium is $418 per month. The replacement policy being recommended to me will cost $928 per month--a 122 percent increase, and I do not qualify for subsidies. I have had continuous coverage with Blue Cross Blue Shield for many years, and I like the plan I currently have. I'm a 62 year old woman, and will not benefit from the mandatory additions to my plan, such as maternity coverage, newborn and pediatric care. In the past, having continuous coverage provided a sense of security that my rates could not be raised based on a change in my health status. I experienced such a change in 2012 when I was diagnosed with breast cancer and underwent seven months of treatment. Now my rates are more than doubling, and the security is gone, not because of the change in my health, but because of ObamaCare. When President Obama was selling the Affordable Care Act to the American people, he repeatedly promised that if you like your health care plan, you can keep your health care plan. Period. I'm writing to you today to tell you that I do like my plan and I want to keep it. I'm asking for fairness for myself and the estimated millions of other Americans who will have their plans taken away by ObamaCare. Sincerely, Kathleen Stephan. How do I answer Kathleen's letter? I yield the floor.

Mr. BURR

Mr. BURR. We have heard about horror stories. I want to talk about another one, the bill that is in front of the Senate today, the Drug Quality and Security Act. The Senate has an important opportunity to advance balanced bipartisan legislation on behalf of our Nation's patients. The Drug Quality and Security Act will respond to the tragic events surrounding last year's meningitis outbreak and will strengthen and improve our national pharmaceutical supply chain. Last year's unfortunate compounding meningitis outbreak has reminded us that had the early warning signs been heeded, we might have been able to prevent or mitigate the crisis in the first place. In light of what Congress has learned since the outbreak first occurred last fall, this bipartisan legislation includes provisions that respond to and take a big step toward addressing the issues which led to the unfortunate pharmaceutical compounding tragedy over 1 year ago. America's patients expect and deserve the peace of mind that medicines they take are safe and effective. FDA's repeated warnings of counterfeited drugs making their way into our prescription drug supply chain and the increased number of pharmaceutical thefts are the early warning signs of a potential and growing threat that could significantly compromise or endanger the health and well-being of patients across our Nation. In recent years, States have responded by putting new requirements in place. At a time when we should be working to lower the cost of health care, this increasing patchwork of State and regulatory requirements is, instead, driving up the cost of health care in America. For more than 1 year I have worked with Senator Michael Bennet and my colleagues on the Senate Health, Education, Labor and Pensions Committee on bipartisan legislation to address these problems and to strengthen the safety, security, and accountability of our Nation's pharmaceutical drug supply chain. The Drug Quality and Security Act, which we have before us today, includes provisions that will establish strong, uniform prescription drug-tracing standards that reflect today's realities and ensure a safer and more secure pharmaceutical drug supply chain. The Drug Quality and Security Act establishes a uniform electronic unit-level system over the next decade that will increase the security and ensure a safer pharmaceutical drug supply chain from manufacturers all the way to dispensers. This legislation will require trading partners to be authorized to pass and receive information as part of their transactions. It raises the wholesale distribution licensing standard. It establishes licensure standards for third-party logistics providers and requires suspect and illegitimate products to be appropriately handled. I would like to thank Chairman Harkin and Ranking Member Alexander for their leadership on this very important bipartisan bill. I especially would like to recognize Senator Bennet, who has been a strong partner throughout the crafting of this legislation. For more than 1 year we have worked together on this bipartisan legislation with our colleagues and have finally achieved an important balance with this bill. I might add we were told this couldn't be done. We were told this was too difficult. But for 1\1/2\ years we have tackled this objective. Congress has the opportunity to proactively put in place uniform, workable standards that will allow stakeholders greater regulatory certainty and give patients the confidence they deserve in the safety and security of our Nation's pharmaceutical drug supply chain. Congress's opportunities are twofold because this legislation is also our chance to respond to a crisis that impacted the lives of hundreds of patients nationwide, and I hope my colleagues will join me in supporting the Drug Quality and Security Act. Health Care To follow up the conversations on today's bill, I listened to my good friend Senator Blunt talk about Aaron, one of those Americans caught in the crosshairs of the Affordable Care Act and its unintended consequences. I was home this weekend and I was stopped by five individuals--five individuals--with practically the identical story. They came up and said: Richard, I was covered. I had insurance. I have no preexisting conditions, nor does anybody in my family. I had a $10,000 deductible insurance policy that cost me about $450 a month, and I had the security of knowing it was there. I just got my new notice and my insurance went to a $15,000 deductible and my monthly premium is $1,440. These are five individuals--five different families--but with a similar story. I think of the yearlong debate we had on the Affordable Care Act and the claims that were made: reduced premiums, bring down health care costs, provide coverage for those who don't have it. Today what do we see? Today's snapshot, and this may change: dysfunctional Web site, 5 million people who have been notified they have lost their insurance, a very tepid enrollment of individuals, and what has gotten lost in reality is that there are hundreds of thousands of Americans just like the five who came up to me this weekend. They are still getting insurance, but their deductible went up to $15,000 and their premium went up to $1,440 a month. Tell me, where in that scenario is this affordable? Tell me, where in this process did they get a better plan than they had before? Their deductible went up $5,000. That means the first $15,000 of their health care is coming right out of their pocket and they are paying $1,440 a month to have the security of knowing there is insurance after that. Clearly, these are five Americans who would tell me this falls woefully short of the promises made to them. I would be willing to bet in every State, in every House district around the country, we are going to continue to hear stories about this. We will, I am sure, debate heavily where we move to from here. But don't forget that under this bill, now that we have extended the enrollment period to March 31, under the law every insurer who bids to be in the exchange, starting April 1 of next year through April 27, has to submit their bids for 2015. Let me repeat that. For every insurer that wants to be in the exchange, starting April 1 of next year through April 27, they will have to submit their premium bids for 2015. They are going to do that having no experience with the pool of insured lives because we have extended until March 31 the enrollment. That assumes the Web site gets fixed and that people are going to enroll. With little actuarial history, these insurance companies are going to have to bid for 2015. Imagine what the premium cost is going to be in 2015 when it is not 5 percent of the American people now in the exchange but it is 100 percent--it is all the employers that are impacted by 2015 prices. I have always been taught there are signs you should pay attention to. When five people come to you and say: Listen, my deductible went from $10,000 to $15,000 and my premium went from $450 to $1,440, that is a warning sign. We ought to listen to it. We still have a chance to fix this. Most important, as Senator Blunt talked about, it means when you have a high-risk pool in Missouri and North Carolina, you let them keep the high-risk pool. We can manage it much better on a State level than we can in nationalizing and doing top-down health care in this country. This will not be the end of the conversation on the Affordable Care Act. The American people deserve better and this Congress must produce it. I yield the floor.

Mr. BURR

Mr. BURR. Mr President, today I wish to congratulate and offer my support and encouragement to the people and government of Azerbaijan. On October 9 Azerbaijanis overwhelmingly reelected President Aliyev to a third five year term in only their fifth Presidential election since Azerbaijan gained its independence in 1991. I, along with several of my colleagues, met privately with President Aliyev in Baku several months ago to discuss the great challenges facing Azerbaijan, the United States, and our allies in the region. I took this opportunity to personally thank President Aliyev, his government, and the Azerbaijani people for their unwavering support for the United States government and its people. President Aliyev was among the first few foreign leaders to call President Bush immediately after the attacks on 9/11 to offer his country's prayers and tangible support at a time of great crisis in our Nation. The United States and Azerbaijan share many common strategic interests. Azerbaijan plays a vital role in efforts ranging from counter-terrorism, energy security, to the transit of U.S. and NATO supplies to and from Afghanistan. As an important partner in the region, Azerbaijan is an active participant in NATO's Partnership for Peace program and was among the first nations to militarily support American led efforts in Iraq and Afghanistan. Azerbaijan's stability and prosperity in the South Caucasus, along with its continued commitment to democratic reforms, will serve as an important beacon of hope in a complex region.

Mr. BURR

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

Mr. BURR. Mr. President, a lot has been said in the last few days. I guess the issue is not everybody has said it. I am not sure that two people have been closer to the progress and the process of the Affordable Care Act than Dr. Tom Coburn and myself. We were in it in committee along with other Members. The fact that I am not embracing a strategy to close down the government is real important. It is because at the end of the day and we open the government, the way the statute is, there is the Affordable Care Act. It is still there. I did not come to Washington to embrace strategies that do not achieve solutions. I came to find solutions to big issues so the next generation can benefit from them. Do not misunderstand me. There is no bigger critic in Washington, DC, than the Senator from North Carolina. As a matter of fact, in the committee, I counted 58 votes on 58 amendments where we voted to kill the health care bill. I think my record stands for being opposed to this legislation. Senator Coburn and I have introduced more health care proposals than the rest of the Congress combined--options, replacements. We have stood on this floor hour after hour on the Affordable Care Act and shared with the American people why this was a bad move. We have quoted individuals who lead the Centers for Medicare and Medicaid Services. Their Chief Actuary told us, before we passed this bill in this body, that this will close community hospitals, it would increase premiums, it would deprive people of health care. But the Congress of the United States and the President of the United States signed this law into statute. There is only one way to kill a law once a law is in statute; that is, to pass a bill that is signed by a President that reverses that. To some degree, this is civics 101. It is an understanding of the legislative process. It was not the first time I disagreed with something this body had done. Let me assure you, it will not be the last time. But I also understand the way that we change this. It is not the way we are attempting to do it right now. So what have we seen in the short period that we have gone through this? As we move up to October 1 and these new exchanges are rolled out, we have seen premiums go up. We have seen doctors retire. We have seen health care professionals move from rural America to urban areas. We have seen the health care infrastructure scared to death of what is around the corner. We have seen premiums rise. If there is anything that is wrong, it is the title of the bill, the Affordable Care Act. We have made health care less affordable for more Americans. Let me say that again. This act has made health care less affordable for more Americans. It has tripled, at a minimum, the cost of a health care premium for somebody 30 years or under--tripled, at a minimum. This is a group who is targeted for enrollment. They would not enroll when the premium was one-third of the cost it is today. We have heard people say that Members of Congress are trying to protect their own subsidy. Members of Congress are not going to take the subsidy. We passed legislation, but at the end of the day, the public pressure will be such that no one up here will take the subsidy. But if we are going to treat Federal workers one way, then treat all of them the same way. Do not pick and choose who--the ones who work on the Hill, the ones who work in our offices, not ones who are in committees, not ones who work at the FDA, the EPA or whatever. Let's include everybody. If we want an exchange to work, then we have to enroll as many people and we have to have robust competition. The way this is set up we are going to have low enrollment. The way insurers have responded to the exchanges--in my State, we have one insurer that has entered the exchange to insure the entire State and one insurer that is representing 10 counties out of 100. That is not competition. That is almost a monopoly. I do not blame the one that is in all by themselves. I blame what we designed, where we did not empower States to actually design things that fit their health care infrastructure and their State, where individuals could buy insurance based upon their age and their income and their health condition. We said, no, if you do not buy this plan, then you are going to pay a penalty. We have heard a lot of debate about the process, but we have not heard as much debate about the specifics of this legislation. It is bad for the American people. Regardless of the outcome of tomorrow's votes, this legislation is still going to be in statute. It is still going to be implemented on October 1. I hope all of the thousands and hundreds of thousands of people who have responded to the request to call--and they don't always know why, except they do not like this health care plan--when tomorrow's vote is over, do not go away. The pressure has to be on this institution to make the changes. Most Americans do not know that we are going to start taxing--or we are already taxing the manufacturers of medical devices 1.5 percent. They pay a surcharge to fund ObamaCare. We are going to charge, in the exchanges, at 2.3 percent, I believe, a health insurance premium tax for every person who purchases health insurance. We have to ask ourselves: If we are going to tax devices and we are going to tax the insurance premiums, how in the world can the price of health care go down? It cannot. This is common sense and math matched up. It has to force health care costs up. That is, in fact, what every American sees. Even your employer's insurance, if you are lucky enough to still have an employer that is providing it, your health care premium is going up next year. If you are in an exchange, your premium cost is going up next year. Who does it benefit? It benefited maybe people who had preexisting conditions and they could not purchase insurance. You know what the first act of the Affordable Care Act was? It was to create a national pool of individuals with preexisting conditions and they would all be offered insurance. What happened? When about 20-some-percent of them got enrolled, the fund ran out of money and the one population that this bill was sold to protect, almost 80 percent of them, were left out in the cold with no options. It has failed since the first step. What I hope is that American people will not leave this debate and say we have done our best. We have not done our best. The Nation is betting on us to continue on this. Our children deserve whatever it takes for us to accomplish it. But as I started, let me say to the body, our strategy to get here was flawed. I know it sounded good, but it does not work. The only way to eliminate a bill that is in statute is to pass a bill and have it signed by a President that reverses that statute. I am glad we have had this debate. I am glad the American people are now engaged in it. I do not think this will be the last discussion we have on the Affordable Care Act. I will assure you that as I have been before, I will be again on this floor debating my colleagues as aggressively and fairly as I can about what is wrong with this bill and why it should be reversed and why it should be replaced. I thank my colleague from Alaska. I yield the floor.

Mr. BURR

Mr. BURR. Mr. President, I would like to be recognized on the student loan bill. The time can come out of the Manchin-Burr amendment. I am not sure exactly how we are allocating time. Let me take this opportunity to thank the cosponsors of the bill: Senator Alexander, Senator Coburn, Senator Carper, Senator King, and Senator Manchin. Without this bipartisan approach, we would not be here today. It has not been lost on me that four of the six cosponsors are former Governors. They recognize the importance of education. They recognize the importance of students having access to that education. I think all of them are stalwarts as it relates to good education, and I think they recognize, as do Senator Coburn and I, that this is a good bill. It is good policy, the Manchin-Burr-King-Alexander-Coburn-Carper bill. Let me take a minute to share with my colleagues or remind my colleagues where we are today. Senator King just did it. Under current law we are at 6.8 percent for all undergraduate students. It is higher for graduate students. It is higher for PLUS loans. A month ago, we had a bifurcated system where some undergraduates paid 6.8 percent and other undergraduates, who were considered subsidized, paid 3.4 percent. I would suggest that is morally wrong. I think collectively what we did was we said: How can we come up with a system that shows the equity we believe in and that provides a financial benefit to all students who participate? So I say to my colleagues, I want to point out the single most important part of this bipartisan bill or nonpartisan bill is the fact that for two students seated side by side--one whose parents have a different income level than the other one's parents--we treat them both the same. For the one who has a lower income level, as Senator King said, they qualify for Pell grants, for education tax credits, for loan forgiveness, for a lot of different things. But from the standpoint of the rate the Federal Government charges them to borrow money to go to school, we treat them the same. I think that is what we are supposed to do. If we did not treat them the same--let me back up for a second--and we were treating this one at 3.4 percent and this one at 6.8 percent, understand that this one can only borrow $3,500 at a subsidized rate. Well, you are not going to enter any college today for $3,500. It is not going to happen. So you are going to have to borrow a little more. If you borrowed the maximum you can get, it is $5,500 in your freshman year. So you are going to get $3,500 over here, and you are going to get $2,000 over here but you are going to pay 6.8 percent. What the bipartisan or nonpartisan bill does is it provides every undergraduate with, this year, 3.86 percent. In the case of the subsidized student, they are not, as before, borrowing at a lower rate for some money and a higher rate for other money, actually subsidizing themselves. And for the undergraduate who is not subsidized, they are not paying way more than they should for their college loan. So what did we do? We used the 10-year bond, with market forces. I am not sure there is a fairer way to do it--fairer for the student, fairer for the institution, fairer for the American taxpayer. We tied it to the 10-year bond, and we got an add-on which is reflective of the cost to run the program and the risk of the loan. We hope every student pays it back, but that does not always happen. What we tried to be is good fiduciaries for the American taxpayer. Within that, as Senator King said, they are capped. If you are an undergraduate, it is capped at 8.25 percent. It came out a little higher than that. But the tradeoff for doing that, in comparison to what my colleagues in the House have done, is that when you take out a loan this year at 3.86 percent, that is your interest rate for the life of the loan. We do not readjust it on an annual basis. This is like getting a 15- or 30-year amortized loan for a home mortgage. We are not going to come in and change the rules on you and say: Well, the United States wants more interest in the future. But it does mean, just like in a home mortgage purchase, if you buy one this year, the likelihood is, the one you buy next year might have a different interest rate because the market has changed. I think the American people can deal with that because it is predictable. It brings with it some certainty. You can calculate it on your own. As my colleague said, the last to set rates is the Congress of the United States. We should not be in that business. It should be market forces. With this legislation, it will be. I sat over here trying to think of just the one phrase I would say to my colleagues is the primary reason they should support this bill and provide this benefit for the American people. I wrote down two words: financially sustainable. You see, in 2007, Congress created the current student loan program rate. A year ago--after we had extended the program because it ran out for 2 years--we said: Well, we are going to fix it. We are going to have a long-term solution. Then, all of a sudden, we did a 1-year extension. The Senator from West Virginia was the most vocal person. He said: What happened? We were going to fix it. We did not fix it. Thank goodness that is why, when it came up this year, there was such outcry over the fact that now is the time to fix it if we are going to do it. Let's go ahead and fix it. Well, what is the test of: Did we fix it? I would suggest to my colleagues, it is financial sustainability. Can this withstand the test of time? Today we need that certainty from the standpoint of Federal spending, from the standpoint of the American taxpayer. But we also need it from the standpoint of America's children. We are speaking as much to the 10-year-old as we are to the 18-year- old. The 18-year-old may be a freshman next year. The 10-year-old has aspirations, down the road 8 more years, that they are going to have the ability to go to college. We want to provide them with the certainty that there is going to be a student loan program out there that is equitable and fair that they can participate in and not question whether, in fact, it will exist. I think with the option we have on the table, we will be able to say that from one generation to the next. I know we will consider this afternoon a couple of different options. I want to urge my colleagues. I think there will be two options from the standpoint of plans you can choose. If you believe equitable treatment is right, then the bipartisan bill is the one you need to support. If you believe financial sustainability is important, then the bipartisan bill is the one you need to support. I think if you tick down all the things you probably ought to look at--what makes it most affordable; what is best for the students--I think what you will find is it is the bipartisan bill. There has been a lot of work put into making it a long-term solution. I want to urge my colleagues. Congress changes every 2 years. That is the length of ``long term.'' But let's not put into law a sunset on this in 2 years. That is the other amendment. Why would we say we have come up with a great plan, one that sort of passes the test of equitability and sustainability, and then turn around and say: But we are going to sunset it in 2 years? Congress has the ability, with every new Congress, to look at any piece of legislation and change it. Let's make that the function of what we learn from this and not prejudge it and say: Let's cut it off in 2 years. I am going to conclude because my colleagues are here to speak on the program as well. I thank the cosponsors--the four Governors and Senator Coburn. Without their help we would not be to this point. I thank the leadership on both sides of the institution--the majority leader and the minority leader and those who have brokered the ability for us to be here today. Without them, we would not be considering what I think is the best piece of legislation to address the challenges we have for students in need of loans for college this year and future years. With that, I yield the floor.

Mr. BURR

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

Mr. BURR. The most significant part is for the undergraduates who were not subsidized, they would go from 6.8 to 3.6.

Mr. BURR. That is correct.

Mr. BURR. I am happy to yield.

Mr. BURR. That is correct.

Mr. BURR. The Senator is correct. I might add to my good friend, this chart shows exactly what we talked about. Under the plan on which we will vote at 12, because of the need for students in the subsidized category to borrow additional money at 6.8 percent, at the end of their process, they owe $78 a month, where under the bipartisan bill, where every undergraduate is treated the same, they owe $75. It is actually cheaper, even for the undergrads who are subsidized.

Mr. BURR. Mr. President, I come to the floor today to talk about the future of student loans for America's students. When I say students, I have to define who that is because, as we know, today we have students of all ages. We have a category of students where a financial impact requirement is applied, such as for a 19-year-old who has entered their freshman year, and depending upon where the income of their family is, under the current system they may get a subsidized loan. The maximum they can receive under that subsidized loan as an undergraduate is $3,500. I would be willing to bet the President pro tempore and I both can't pick an institution in any of our States where the tuition on an annual basis is $3,500. It doesn't happen today, and that is the reality that has been left out of the debate so far. This debate has been all about politics and it has not been about students and how to apply affordability as broadly as we can in the marketplace. Let me describe where we are today. Between 1965 and 1992 the cap on the student loan program in this country was 10 percent--10 percent. In the mid-2000s, Congress, very politically, said: You know what. We are going to adjust it, and subsidized loans are going to be at 3.4 percent and nonsubsidized loans are going to be at 6.8 percent, graduate loans are going to be at 7.9 percent, and if you are a parent borrowing, you are going to have an even higher rate, in the 8-plus percent range. That strikes me as incredibly unfair. We are taking two undergraduates--two 19-year-old freshmen--entering the same institution with the same financial obligation and we are saying to one: We are going to give you a rate on your student loan that is half of the person who sits in the seat next to you--half. In this chair, the student will pay 3.4 percent, and the student sitting in the chair next to him will pay 6.8 percent. Understand, the parents of the person sitting in this chair, depending upon the cost of the institution, may have an income over $100,000. Yet they may qualify for a Federal subsidy. Let me suggest to you that the marketplace is the thing that ought to dictate and decide what the rate is. That is the only thing that is fair to the taxpayers in this country--the predictability of knowing it is tied to something. Let me suggest that the bill we are going to take up--and we are going to vote on a motion to proceed at 12 noon today--is a bill that was created in the 2000s. Two years ago we kicked the can down the road and said we are going to extend this inequitable student loan program at 3.4 percent for some, 6.8 percent for others, 7.9 percent, and 8- plus percent for parents. Why? Because we are overcharging some to subsidize others. Let me say that again. We are overcharging some--we are overcharging some 19-year-old undergraduate freshmen in college--at 6.8 percent so they will subsidize the 3.4 percent we are charging on the subsidized loans. Let me point to a chart I have here which shows undergraduates under the student loan program. This is a comparison. Actually, let me move to a different chart, because this one best displays what I am talking about. Twenty-six percent of our Nation's kids are undergraduates and are subsidized, and 55 percent of the eligible students are either undergraduates or graduate students who fall under a 6.8-percent interest rate. So when the Senate majority leader came to the floor and said some were upstairs trying to negotiate a deal, he was 100-percent accurate. But the reality is we are still only going to have a vote on one plan at 12 o'clock. There is no option for Members of Congress. What I would suggest is that this displays why, at best, there should be two options and, at worst, we ought to vitiate the motion to proceed and see if we can come up with another bipartisan agreement. You see, another option--the Manchin bill--is a bipartisan approach. It is Democrats and Republicans coming together and saying we can agree on something that we think is fair and equitable and financially sustainable. But this is the plan we are going to have a vote on at 12. Fifty-five percent of the population of students, quite frankly, are being screwed. They are overpaying. They are paying 6.8 percent for interest, when a home mortgage for 15 years is 3.8 percent. Yet we are charging students 6.8 percent, and we are saying that to go to this is an injustice to our students, where all of a sudden we take 64 percent of the kids and we treat them all alike and we charge them 3.66 percent. Something is inherently wrong in the debate we are having. If this is about kids and about affordability, this is the plan on which we should be having the motion to proceed, not this one. This plan merely kicks the can down the road for 12 more months. Let me say this plan wasn't created by Joe Manchin or Richard Burr or Tom Coburn or Senator King or Senator Alexander. This plan was created by the Congressional Budget Office. The Congressional Budget Office in their March 2011 report to Congress came up with the idea of tying the interest rate to the 10-year Treasury bond, except the CBO says it should be the 10-year Treasury bond plus 3 percent. That is what Senator Coburn and I introduced. When Senator Manchin, Senator King, Senator Alexander, Senator Carper, and others got involved, we decided what we needed to do was continue to have a blended rate. We all agreed that an undergraduate student shouldn't face an interest rate schedule that is not equitable to all undergraduates. So instead of applying it to 26 percent, we applied it to 100 percent of the undergraduates. We said: If you are an undergraduate in college, we are going to give you the best rate, which is the 10-year bond plus 1.85. It is fair. It is understandable. It is predictable. It is consistent. One year in advance you know exactly what your rate is going to be because it is determined on the 10-year bond every May. My good friend Senator Harkin, whom I have great affection for, came to the floor and said we were balancing the budget on the back of the student loan program. The student loan program is a $1.3 trillion program. Based upon the CBO score on this bill, it had a 0.7-percent surplus. By Washington standards, in a $1 billion program, 0.7 would be a rounding error. This is a $1.3 trillion program. Let me assure the President and my colleagues, this is a rounding error. I can't look everybody in the face and say it might not cost us $100 billion. It might save us $100 billion. But we are certainly not balancing a $17 trillion deficit debt on the back of the student loan program. Let me assure you of that, and for any who suggest we are, that is, in fact, disingenuous. This is the first time I have been accused of balancing the budget on the backs of our kids. But in 2010, as part of the health care reform act, Democrats ended the Federal Family Education Loan Program, FFEL, at a savings of $61 billion. Of that, the Democrats directed $19 billion to deficit reduction and the rest to help pay for ObamaCare, the Affordable Care Act. If I am being accused of balancing the budget on 0.7 percent, determined by CBO, and in 2010 the Democrats voted to eliminate the FFEL Program and save $61 billion and applied $19 billion to deficit reduction and the rest to help the Affordable Care Act, then they plowed this ground long before I did. As a matter of fact, in 2007, as part of the College Cost Reduction and Access Act, the Democrats found $21 billion in savings and spent a good amount of it on new programs--and then directed $1 billion to deficit reduction. I said earlier, I have great affection for Senator Harkin. Senator Harkin said this should be part of the Higher Education Reauthorization Act--that may or may not happen next year. We made changes to the interest rate on student loans outside of the higher education reauthorization in 2012 with a 1-year extension of the 3.4 percent. We did it in 2010 with the elimination of the FFEL Program. We did it in 2005 under the CCRAA, the Deficit Reduction Act. Senator Harkin's Appropriations Committee has made changes to the eligibility rules for Pell grants each of the past several years outside of the higher education authorization, including the elimination of summer eligibility, ability to benefit, and lowering of the automatic enrollment for low-income students. It is not fair to come and say to me that I am doing it outside of higher education reauthorization when there is continually a track record of the person who accused us of doing it of doing it himself.

Mr. BURR. I would be happy to yield.

Mr. BURR. If it influences the Senator from Iowa at all, I will allow my 2 minutes to go to him, if the Senator wouldn't object to him having 3 additional minutes.