Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. President, let me reclaim my time. The fact is, this is a tremendous advantage to them compared to other businesses. They already have a program from which they get $15 million. Then they can add another $20 million. The average cost for a film is less than 100 million bucks. We are writing off $35 million out of the Tax Code immediately before this provision even begins, and we are going to add another quarter of a billion dollars this year for just 2009, which would say we are going to treat them differently than we treat everybody else in this country.

Mr. COBURN. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. COBURN. Mr. President, I wanted to respond to some comments by the chairman of the Finance Committee. The explanation of why we have a $250 million earmark for the movie industry was that when we attempted to give them this earmark before, somebody took it out, and now we are going to put it back. The consequence, however, belies the fact that we are only doing this for 1 year. If it is something they deserve and it should be equal, why wouldn't it be there every year? The second point is that the movie industry gets to take advantage of every depreciation out there that every other business has. There was some debate in the House last year on whether they were truly manufacturers. But they also now have $15 million for every movie in direct writeoffs above their depreciation if they produce 75 percent of those costs in this country. If they do it in a low employment area, they get another $20 million. To say we are righting something that was wrong before doesn't fit with common sense. If we are righting it, let's put it in forever--if that is what we are trying to do. But in this bill we do it for 2009 only. The second point I will make is that this bill is without any sacrifice. When President Obama was elected, one of the things he campaigned on was an item-by-item look at the Federal budget, to get rid of programs that don't work, get rid of lower priority programs that might work but are not efficient and are not a priority. Nowhere in this bill is there an elimination of one Government program--not one. There is no line by line. There is no attempt to do what we are asking Americans to do every day. Here is what we are asking them to do: We are in tough financial straits. Go through your budget, figure out what you cannot afford, and eliminate it. We have not done that at all with this bill. There is no attempt to make the Federal Government more efficient. This bill is filled with bloating bureaucracies, further lessening liberty and freedom by way of having bureaucracies decide what we will have to follow. I am not against the movie industry. I love the movies they produce-- the vast majority; some I abhor. But I enjoy their entertainment and the fact that they are profitable and viable. They have been very successful this last year. They had the best January in their history. For us to put a quarter of a billion dollars into an earmarked tax benefit for the movie industry at a time when Americans are struggling belies the honor and integrity of this institution. With that, I retain the remainder of my time and yield the floor.

Mr. COBURN

Mr. COBURN. As former FCC Chairman James Quello argued shortly after the policy was repealed, The fairness doctrine doesn't belong in a country that is dedicated to freedom of the press and freedom of speech. I agree and am disturbed that our likely next Attorney General apparently does not. In conclusion, after listening carefully to Eric Holder's testimony, especially regarding each of the issues I raised today, I am forced to conclude that he lacks the judgment, independence, and candor necessary to be Attorney General. I did not reach this conclusion without careful consideration. When I first came to the Senate, one of the first votes I had to make was on the nomination--to consent and advise--on Attorney General Alberto Gonzalez. I had a catch in my spirit on that nomination. I should not have cast a vote for him. I was the first Republican to suggest that he should resign because he did not display the independence, the candor, or the support for the rule of law. Although hindsight is always 20/20, I reserve my right to do the right thing on this nomination. There is no difference between the lack of independence that has been demonstrated by the testimony of Eric Holder and his past and what we saw in the lack of independence of previous Attorneys General. Oftentimes, nominees come to the Senate with nearly a blank slate. This was not the case with Eric Holder. His time in public service, specifically his stint as Deputy Attorney General for President Clinton, served as an audition for this position. His role in the pardon and commutations is very troubling. I believe, in summary, independence is lacking, candor is lacking, and judgment is lacking. President Obama deserves some degree of deference in his choices, but no President is entitled to a Cabinet member who will neglect the Constitution and his own sound judgment to facilitate a bad political decision. I regret I cannot, in good conscience, support his nomination.

Mr. COBURN. I ask unanimous consent for 3 additional minutes.

Mr. COBURN. Madam President, I thank the chairman for his graciousness, and I thank the ranking member. Last week in the Judiciary Committee, I voted against the nomination of Eric Holder. I was not, because of time constraints, offered the opportunity to express my reasoning and logic for that opposition. Today, I rise to explain my opposition and to urge others to share my concerns to do the same. I have high praise for Eric Holder as an individual and as a lawyer. I believe certain aspects, however, of his record disqualify him as serving as Attorney General. I plan on outlining those in this talk before the Senate today, specifically, his facilitation of the Marc Rich pardon, his defense as reasonable of the FALN terrorists' commutations, in addition to his views on the first amendment and second amendment, specifically his answers with respect to the fairness doctrine. Eric Holder has spent most of his distinguished career as a public servant. By all accounts, he is a brilliant lawyer. His nomination was met with high praise from both sides of the aisle. His intellect and ability have been noted throughout his career, and they were duly noted in his appearance before the Senate Judiciary Committee. Moreover, I believe him to be a man of good character. The long line of individuals who have voiced support for his nomination speaks to the high regard in which he is clearly held. In our private meeting, I found him to be personable and kind. He is undoubtedly a good man. These good qualities, however, are not enough to overcome the concerns I have with this nomination. In particular, four issues have caused me to conclude that Eric Holder should not be given the assignment as the next Attorney General of the United States. I believe these matters suggest he lacks judgment, that he lacks independence, and my concern is that he now, from his testimony, lacks candor for such an important job. Eric Holder's role in facilitating the controversial pardon of fugitive financier Marc Rich is perhaps the most notorious blight on his record. Even now, 10 years later, the condemnation of that pardon is strong. Indeed, not even Mr. Holder will defend his actions, telling the committee it was a naive mistake. Eric Holder's involvement in this unconscionable pardon suggests he has dangerously poor judgment or he has an inability to say no to powerful political pressure. As Deputy Attorney General, he orchestrated an end run around the Justice Department, ignoring the advice of prosecutors and career professionals who opposed clemency for Marc Rich. Although pardoning a fugitive was extremely rare, the candidate appeared to have no qualms with the proposition. While he acknowledges his role in this pardon as a mistake, Mr. Holder offers a curious explanation for the error. He told the committee he was not familiar with Rich's record at the time of the pardon. First of all, I find this to be unbelievable, as the facts suggest otherwise. Just a few years before the pardon, when Holder was U.S. attorney for the District of Columbia, his office sued one of Rich's companies after an extensive investigation into contract fraud. The complaint that was filed in that case and comments that were made to the press make it almost impossible to believe Eric Holder was unfamiliar with Rich at the time of the pardon. Moreover, given that Rich had been featured as one of the FBI's top 10 most wanted fugitives, it is even harder to believe Mr. Holder did not become familiar with the man in the 15 months that passed between the time he was first contacted by Rich's lawyer and the day clemency was issued. To say that this pardon was a mistake is an understatement of the worst kind. As others have pointed out, the best thing Eric Holder could have done for himself and his boss would have been to oppose the pardon and convince President Clinton not to issue it. While I readily acknowledge mistakes are inevitably made by us all, I find the excuse for this one implausible. Eric Holder is a bright and contentious lawyer. At the time of the Rich pardon, he had served for 3 years as Deputy Attorney General. In short, he should have known better. Because he allowed his good judgment to be overridden by political influence, I believe this act alone should suffice to disqualify him from higher office. Although the Marc Rich pardon may have been the best known act of controversial clemency in Eric Holder's record, the commutation of sentences for 16 FALN terrorists became an issue of equal, if not greater, concern throughout the hearing. The FALN organization had been linked to 150 bombings, threats, kidnappings, and other events which resulted in the deaths of at least six Americans and the injury of many more between 1974 and 1983. It is not hard to understand why these commutations were strongly opposed by the U.S. attorney, the FBI, the pardon attorney at the Department of Justice, as well as the victims' families. What is hard to understand is why Eric Holder chose to ignore those opinions and instead facilitate clemency for these convicted terrorists. New information discovered just before the hearing revealed that Eric Holder played an active role in securing these commutations. According to the L.A. Times, ``Holder instructed his staff at Justice's Office of the Pardon Attorney to effectively replace the department's original report recommending against any commutations, which had been sent to the White House in 1996, with one that favored clemency for at least half the prisoners.'' Unlike the Rich pardon, Holder has embraced his role in endorsing these commutations. He told Senator Sessions during our committee hearings that the decision was reasonable and has stood unapologetically by that statement, even when it was proven that he knew very little about the terrorists or their crimes at the time of the commutations. Perhaps no one is as angry about Holder's role in this incident, or about his elevation to this distinguished office, as Joseph Connor, whose 33-year-old father was murdered when the FALN bombed the New York City restaurant where he was eating lunch. Mr. Connor was 9 years old. He has written numerous editorials and gave compelling testimony at our hearing about how devastating and indefensible these commutations were. I quote him: We Americans have to make clear that we will not tolerate officials who would put our lives in jeopardy by releasing terrorists. It is a disrespectful affront to all Americans, particularly to those of us who have come face to face with their violence. Mr. Connor's testimony struck a chord with me due to my own experiences with domestic terrorism. Having dealt with the shock and the aftermath of the Oklahoma City bombing, which happened prior to the FALN commutations, I can relate to the grief and anger felt by the family member of a victim murdered senselessly by terrorists. I have seen the devastation these acts of violence inflict on a community and especially on the families they most directly impact. I have heard from the many law enforcement officers who work the scene, gather the evidence, and tend to the victims. I have witnessed the long and difficult process of prosecution, conviction, and sentencing. I know that bringing perpetrators to justice is a crucial part for these families' healing process. I cannot imagine how all those things would come undone if justice were undermined, as it was in the FALN case. The danger of commuting the sentences of terrorists responsible for the murder of American citizens and intent on killing even more is obvious. I will not recount those concerns here, but to help give a voice to Joe Connor and to the many other surviving family members of terrorist victims, I ask that our colleagues consider the effect these decisions had on them. We are accountable to each and every one. Eric Holder also raises another concern with me and that is his hostility to the second amendment. I heard our chairman speak earlier about how he said he would uphold the second amendment, but when queried directly and specifically about components of the second amendment, the answers were not forthcoming. As Deputy Attorney General, he advocated restrictive gun control legislation, such as waiting periods, an age limit, that a soldier coming back from Iraq could not own a shotgun because he wasn't 21 yet, a registration for every gun in this country, the elimination for me to be able to give my shotgun to my grandson when it is time to teach him to go hunting. All those things he has espoused limiting the second amendment. While he has advanced those restrictions as a member of the Clinton administration, working under Attorney General Janet Reno, he remained active in anti-gun advocacy after he entered the private sector. After the attacks of September 11, he authored an op-ed for the Washington Post, entitled ``Keeping Guns Away from Terrorists.'' I will not go through the details of that piece, but the details of what he purports to support would have a devastating impact on the second amendment in this country. Perhaps the most telling and unsettling aspect of Mr. Holder's anti- gun record is the signing of an amicus brief in the Supreme Court's seminal second amendment case, in which he argued that the Constitution did not protect an individual's right to bear arms. I believe he actually believes that--that we don't have the right. He now tells us that is settled with the Heller case. But on further query, we get tremendously nervous about his support for the second amendment. The Supreme Court rejected his view on the second amendment unanimously. His statement in our hearing that he respects Heller as the law of the land does not provide enough assurance on his commitment to defend the second amendment. It is neither controversial nor instructive to make such a statement. What matters are his views on specific proposals for gun control legislation and regulation. At his hearing, I used the vast amount of my time in three rounds of questioning to try and extract opinions from Eric Holder on the second amendment. In his testimony, he advocated a permanent ban on so-called assault weapons, an age restriction on handgun possession--again, many of our troops returning home and out of the military after 2 years would not be able to have a handgun because they are not 21--and closing the gun show loophole. What that means is I cannot sell a gun to one of my neighbors without a background check on my neighbor. I cannot actually sell a piece of material I have to someone without going through a gun check, or I cannot even sell it to my brother. He refused to commit to defending State right-to-carry laws. There are more than 40 States that have these laws. He was questioned over and over and would not answer affirmatively that he would use the power of the attorney to uphold the second amendment. He repeatedly testified that gun regulation was not a priority for either he or the administration. Consistently, Mr. Holder has unapologetically embraced his anti-gun views. Yet at his confirmation hearing, he would not tell us what those views were. He has been a vocal gun control advocate in the past, both in his official and individual capacities. He was not candid on the second amendment issue, an issue he has followed for years, as he was on interrogation techniques, an issue which he could not possibly have enough information to prejudge. After an extensive review of his record and his testimony, I have concluded that Eric Holder as Attorney General will not defend--not adequately defend--the second amendment. Finally, I have serious doubts as to whether Eric Holder is committed to defending the first amendment against threats such as the so-called fairness doctrine. This policy existed for decades before being abolished in 1987 and rightly so. Today, the concept has been revived and the threat of Government censorship over the airwaves is again a real possibility. At our hearing, Eric Holder was asked about his thoughts on this proposal. Specifically, he was asked whether, as a matter of public policy, the fairness doctrine should be reinstated, to which he replied: [T]hat's a toughie. I've not given an awful lot of thought to [it]. It is hard to accept that Eric Holder, a former Deputy Attorney General, somehow missed the debate over this prominent issue in our society. It is even harder to accept his answer when reviewing his past statements about media bias. This not-so-thinly-veiled attack targets the very media outlets that advocates of the fairness doctrine hope to cripple. While this may be an acceptable position for a private advocate, there is no room for this kind of bias in the Department of Justice. Unfortunately, Mr. Holder said nothing to ease concerns about his predisposition on this issue. In written responses to further questions from the committee he said this: If a law or regulation is enacted that seeks to implement some version of the fairness doctrine, I will work with other agencies in the new administration and in the Department's Office of Legal Counsel to reach a considered view about the constitutionality of the specific law or regulation under consideration. Remarkably, although Mr. Holder was given an opportunity to distance himself from the inflammatory comments he made in the 2004 speech, the best he could offer was a commitment to give a ``considered view'' of any such legislation. What I expected from a prospective Attorney General was, first and foremost, a clear and strong commitment to uphold and defend the first amendment. What Eric Holder said fell far short of my expectation. The so-called ``Fairness Doctrine'' is not a ``toughie'' issue, as it was described by the presumptive Attorney General.

Mr. COBURN. Madam President, short of 15 minutes; probably 15 minutes.

Mr. COBURN

Mr. COBURN. Mr. President, this amendment really is the amendment that is going to take care of our children. It is going to take the Medicaid stamp and SCHIP stamp off their foreheads. It is going to create access to the finest doctors, not just 40 percent of the doctors as we see in Medicaid and SCHIP. It is going to give the same care to all the children--those at the 300 percent poverty level and under-- that we give to our own kids. It does all that not spending the $70 billion in increased taxes that is in this bill and auto-enrolling children so that we don't just pick up 4 million kids, we pick up all 8.9 million kids who are not insured. To my colleagues who sponsored the Wyden bill, the Healthy Americans bill, that is exactly what is in that bill, except we are going to do it for children without increasing costs but increasing the quality, increasing the care, and increasing the outcomes. We are going to truly make children on the same level we are in terms of their access. They are going to get to choose their doctor rather than have their doctor chosen for them. They are going to get a referral to the best rather than to one who will just take them. They are going to get the same thing we get, and they deserve it, and we are not going to spend a penny more than we are spending today. We don't do away with SCHIP, we don't privatize SCHIP; what we do is say we really care about kids and we are going to give them the same thing we have. At the same time, we are going to save the American taxpayers $70 billion. I yield my time.

Mr. COBURN. Mr. President, what this amendment does is it says you have 14 percent improper payment rate in SCHIP, we have 10.6 percent improper payment in Medicaid. The average improper payment rate across the rest of the Federal Government on every agency--this amendment says that before New York can go to 400 percent, they have to bring their improper payment rates in line with the rest of the Federal Government. The improper payment rate in New York--New York alone--accounts for 50 percent of the fraud in Medicaid. Fifty percent of that is in New York State alone. So what this amendment would do is it would delay the improper payment reporting requirements and limit earmark program expansion until the Medicaid and SCHIP improper payment rates match the Federal average of improper payment rates. It is meant to help us get back on track. We just started getting improper payment rates on Medicaid, and they are out of control. We should not be delaying the onset of that, and we should put teeth into it so that where it is bad, we don't expand it and make it worse. With that, I reserve the remainder of my time.

Mr. COBURN. Mr. President, I ask for the yeas and nays.

Mr. COBURN. I agree. I withdraw my request.

Mr. COBURN. Will the Chair state what the amendment is?

Mr. COBURN. I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. COBURN. Madam President, the bill we are considering is designed to help low-income kids have coverage and have care. What do we know about the kids who are in those programs and the care they have? Here is one of the things we know: They don't have access to 60 percent of the doctors in this country because the reimbursement rates are so low they won't be seen. That is the first thing. No. 2 is they don't have access to the best drugs because a lot of Medicaid programs and SCHIP won't pay for the best drugs for those children. I got to thinking about this bill and what it does and what it is intended to do. What is in agreement in the Senate is that we want all of the kids covered. We want every child in this country to be able to have access to quality care with no limitation of their choice of who their doctor is going to be--the one the child and the parent feel the most comfortable with--because we know if that is the case, they are going to be most compliant. So we want them to have the greatest care, and we want every one of them to be able to have access to care. This bill brings up Government payments under SCHIP to 300 percent of the poverty level--60,000 bucks, essentially. Anybody making, essentially, over that wouldn't be benefited by this bill but everybody under it. It adds $70 billion worth of taxes to the American people to be able to do that. As it does it, it takes 2 million kids who are presently covered by insurance off insurance and gets 2 million out of the 8.9 million or 9.8 million kids who aren't covered today with anything. So we are going to spend $70 billion to get 4 million kids, a little less than 4 million kids covered, of which we are going to absorb the costs that are already being paid by businesses for those kids right now. By the way, I ask unanimous consent to add Senators McConnell, Enzi, Cornyn, DeMint, Johanns, Kyl, Alexander, Graham, Burr, Chambliss, Thune, and Barrasso as cosponsors of the amendment.

Mr. COBURN. So maybe it is instructive for us to look at what we are doing right now and say: What could we do with that money? Right now, we have 31 million kids in America who don't have private coverage. In other words, we have 31 million out of the 78 million kids who don't get to choose where they want to go, don't get to have the best drugs, don't get the referral to the best centers, don't get the referral to the best doctors because they are on a Government-run program. So 8.9 million kids aren't even covered by any program right now, and not all of those 8.9 million kids are in families who are at 300 percent of the poverty level or less. This is based on 2005 numbers, and we know it is greater now, but these numbers for the number of children are accurate right now. We are spending $67 billion to do that. What does that mean? That means we are spending $2,160 each to cover 22 million kids. Well, if you divided the 31 million kids who are out there into this number, you would get $2,160 available for every child at 300 percent of the poverty level who is not covered right now by their parents, and that includes Medicaid and SCHIP. So you have $2,160 to work with. Now, the average price in the individual market in this country is less than $1,200 a year. Some will say: Well, that coverage is not as good. Well, let's make it $1,700, which is $300 more than what our kids cost. Let's make it $1,700, or let's make it $1,800, or let's make it $2,160. What could we buy for $2,160 for every kid at 300 percent of the poverty level or less who is not on the program? What we could buy for all of them is a top-grade policy outside of Government-run programs that would give insurance to 100 percent of the children who don't have insurance and give them 100 percent access to every quality doctor in this country on a competitive basis and give them access to the drugs the Members of Congress' kids have access to and the same doctors to whom the Members of Congress have access. The important point is, we have a government-run program and the administrative costs and the inefficiencies of it cost more than private insurance, than if we would just go out and buy every one of these guys an FEHPB--Federal Employees Health Benefits Plan--a top- drawer plan. Why would we run it through the Government? Why would we take away choice? Why would we take away access by running it through a government-run program and one that is highly inefficient? There is another thing we should know. The rate of fraud in private insurance products is about 3 percent. The rate of fraud in Medicaid is 10.4 percent, and in SCHIP it is 14 percent. So because the Government is running the program and we can't run it well and we don't run it well, we are losing about 11 percent or 11 cents out of every dollar that we are trying to get to kids because we can't run efficient or effective programs. So wouldn't it be smarter, rather than to have all of this gobbledygook government, to make sure that every kid in this country whose parents don't make $60,000, who isn't covered with insurance today, has access to a top-drawer health insurance policy that gives them 100 percent access, gives them 100 percent quality, and gives them 100 percent access to the drugs and the physicians they want? Who is going to argue with that? As a matter of fact, several of my colleagues are cosponsors of the Healthy Americans Act, and that is exactly what it does. It is going to be very interesting to see if they are cosponsors of this bill but yet don't vote for this for kids. And that is a bipartisan bill. So if it is good enough for all of America and if it is good enough for the Members of Congress and their kids and if it is good enough for Federal employees, why can't we give that to the children of this country who don't have health insurance? Why can't we do that? We can't do it because it doesn't fit into the partisan rancor of Washington. This is a commonsense proposal that doesn't cost a penny more than what we spent in 2005. And we cover all of the kids, not just 4 million more; we cover 8.9 million more with the same amount of money. All the children have access. It is not a child's fault if their parents can't afford or don't have a job that gives them access to 100 percent of physicians or access to the best medicines or access to equal care. It is not the child's fault. So if we are going to spend this much of the American taxpayers' money, why don't we get value for it? Why don't we decide we want value for this money? So if you take all the kids out there--31 million--on what we spent in 2005, you can spend $2,160 on every one of them--every one of them-- and get them a top-drawer health insurance policy. Top drawer. Top of the line. That is almost double what the charge is for an individual policy now. So we could spend almost twice as much to get that same coverage. Why would we not do that? What is going to keep us from helping all the kids? I will tell my colleagues the other aspect of it. We are also not going to raise taxes $71 billion if we do this plan. Let me say that again. President Obama said your taxes won't be raised. This bill raises $71 billion--granted, from tobacco products, which I don't have any objection to--but let's save the $71 billion on tobacco products for something else when we can efficiently buy our kids health care and buy them a health insurance policy. Another key point: As somebody who has cared for Medicaid kids and Medicaid moms, when you have the ``Medicaid'' stamp on your forehead, it is not equivalent care. When we give all these children access to a private insurance policy of their own, it is no longer a Medicaid program, it is their insurance policy. Providers will never know how they got that policy. They will never know if it was an employment- based policy, an individually bought policy, or a policy that comes through SCHIP and Medicaid. What we do is we take the demeaning qualities and characteristics of having to be dependent through a government program, and we throw that out. So the bias goes out, the discrimination goes out, and the self- esteem goes up. What will happen if this passes? The first thing that will happen is we will save $70 billion. The second thing that will happen is not 4 million kids--actually, it is a net 2 million kids will get coverage-- 8.9 million kids will get coverage, and we will do it with the same amount of money we spent in 2005. Every child will be covered. There will be a real choice of who is going to be your provider. Right now you get hustled into whoever will take care of you in these programs. Some are great and some are not. Confidence will be restored. There will be increased quality of outcome and increased access to specialists who now today cannot afford to see a Medicaid or SCHIP patient because their overhead is so great. Finally, $70 billion--I know we are talking about $1 trillion in the stimulus package--doesn't seem like much, but $70 billion is a lot of money. If you look at it, it is about $2,000 per man, woman, and child over the next 5 years that we will save in this country. If the goal of SCHIP and all the speeches we have heard all week long is to care for kids, to make sure kids have access, to make sure they have care, if that is the goal, then anybody who is not going to vote for this amendment is not secure in saying they want to cover all the kids. This one will. This substitute allows the Secretary to develop autoenrollment. There is $100 million in this amendment so we can have outreach, trying to get kids coverage. This takes away the negative consequences of applying for Medicaid or applying for SCHIP when your parents cannot afford to get you coverage. The other thing it does is there is a compensation in terms of making sure we help people who have insurance keep their insurance by compensating to keep them on their employer's insurance, which costs a whole lot less. It costs maybe $200 or $300 a year. But the most important thing it does is it provides liberty and freedom and equal access for every child in this country. They are going to say this will not work. But notice there is not going to be a point of order filed against this amendment because this amendment does not cost any money. It saves money. It does not cost a penny. It will not cost us and will cover so many more children. My question to my colleagues, as we wrap up the SCHIP bill, is: Do you want to do it right? Do you want to do it better? Do you want to cover all the kids. Or do you want to play the games of Washington and political gamesmanship and partisanship and say: Yes, I care about the kids, but I couldn't do the right thing, the easy thing, the commonsense thing, the things that are associated with order, priority, and common sense that says: Gosh, we can buy and get better coverage for less money; why wouldn't we do that? We are going to hear all the reasons. We may not hear any because most of the amendments I offered nobody will debate them. They know they have the votes to defeat them so they will not debate. They will not come out and say why this would not be a good idea. The American taxpayers ought to think: Here is a great opportunity for us to save a ton of money and do something very good socially: cover innocent children with quality health care that they do not have access to today, with no increase in cost--with no increase in cost. Yet we are going to see a vote where they are going to say no. Then we are going to know if you care about kids and whether you care about access for kids. I will end my debate at this time and yield to my colleague from North Carolina, Senator Burr. I ask unanimous consent to add Senator Vitter as a cosponsor.

Mr. COBURN. Madam President, I ask unanimous consent to set aside the pending amendment and call up amendment No. 86.

Mr. COBURN. Mr. President, first, this does not get rid of the system, and it certainly does not privatize it. What it does is it guarantees every child in this country, all 3l million--which is something this bill does not do--all 3l million who don't have an insurance policy today will be insured with a plan equal to what we have for our children. What it doesn't get rid of is access. They only have access to 40 percent of the physicians now. It gives them access to 100 percent of all the physicians. We are defending a system that, first, is only going to enroll 4 million new kids, is still going to leave 5 million not covered and 2 million of the 4 million they enroll are from those who already have private insurance, and we are going to say we will stick with a system to take care of the ones we have now and we are not going to give real access, and with the not real access comes no choice of a physician because we limited the number of physicians who can participate because of the economics of it. I will tell you what it does get rid of. It gets rid of $70 billion of taxpayers' money that we are not going to use to cover every one of these kids. Based on the 2005 numbers, we can buy a premium health insurance policy for all 31 million kids--the 8.9 million who do not have any coverage now and the 22 million who are covered in either SCHIP or Medicaid today. We save all the administrative expense. We autoenroll them so we don't have to worry about picking up only 4 million with an additional $70 billion in taxes. To say this is privatization is a total mischaracterization of it. What it does is it guarantees that all children will not have a Medicaid stamp or SCHIP stamp on their forehead that says: Yes, we are giving you coverage but you can't see all the physicians, you can't get referrals to the best because you have a government-run program. Not only do we increase access and quality, we save tremendous amounts of money, and it will still be a government-run program because it will be administered by the Secretary in a way that guarantees these kids are autoenrolled. They will have premium health insurance coverage and we still save money, even after that. We are spending $2,160 per kid now based on 2005 numbers, and we will cover every one of these kids and not spend more money than that. To characterize this as getting rid of coverage is wrong. What it does is greatly create and increase access for children in this country to have the same access that our children have. It saves money and markedly improves quality for those children. Every American child ought to have access, and what we do is take the money we are spending now and spend it more wisely, and create a system where they all have coverage. I yield the floor.

Mr. COBURN

Mr. COBURN. Madam President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. COBURN. Madam President, this is another amendment. It is about being prudent with the taxpayers' money. It is about us doing what we are expected to do. It is about us controlling improper payments. This amendment would require that the final rule implementing the payment error rate measurement requirements under section 601(b) shall not be made later than 6 months after the date of enactment of this act. Now, the problem that we have is, the legislation, in its current form, would effectively erase this long overdue progress by placing an unnecessary moratorium on the reporting requirements for Medicaid improper payment numbers. Let me say that again. In its current form, this legislation erases this long overdue progress by placing a moratorium on the reporting requirements for Medicaid improper payment numbers. Section 601 of the bill states: The provision would prohibit the Secretary from calculating or publishing national or state-specific error rates based on

Mr. COBURN. Madam President, I call up amendment No. 49.

Mr. COBURN. Madam President, I ask unanimous consent that reading of the amendment be dispensed with.

Mr. COBURN. Madam President, this is a pretty straightforward amendment. I am having trouble understanding what we are doing. The average improper payment rate, as published by GAO and OMB, is around 3.5 percent for the programs. We, just now, after 7 years, are starting to see the improper payment rates for Medicaid and SCHIP reported. What is interesting is that the payment Medicaid error rate for fiscal 2008 is 10.5 percent. Madam President, $32 billion was improperly paid out of Medicaid this last year; $18.6 billion of that is the Federal share. The SCHIP rate was a 14.7-percent improper payment rate. This is the first time we have seen that SCHIP has reported its improper payment numbers for a full year, and it is important in this regard: The worst offender in the country is the State of New York, with an estimated 40-percent improper payment rate. The purpose of this amendment is to restore fiscal discipline by making the Medicaid and SCHIP programs more accountable and efficient and to limit earmark expansions until the programs are working at least within the range of what other Government programs work. Now, we have an earmark in this SCHIP bill for the State of New York that allows citizens in the State of New York an elevated level of access to the SCHIP program that is some $30,000 above the rest of the country. We can decide to do that. That is fine. But what we should not do is allow the worst State in terms of offense in fraud in Medicaid to be able to expend additional moneys up to 400 percent of the poverty level until, in fact, they bring their improper payment levels down. Let me refer to a 2005 New York Times article where the former State investigator of Medicaid abuse estimated that questionable claims totaled 40 percent of all Medicaid spending in New York--nearly $18 billion a year in New York alone. One dentist somehow built the State's biggest Medicaid dental practice. This dentist--she--claimed to have performed 991 procedures a day in 2003. Get that again: 991 procedures a day. Van services intended as medical transportation for patients who cannot walk were regularly found to be picking up scores of people who walked quite easily when a reporter was watching nearby. These rides cost taxpayers $50 a round trip, adding up to $200 million a year, of which a large portion of that was fraud. So what this amendment does--it does not affect existing SCHIP programs or States that wish to expand eligibility for families making up to 300 percent of the Federal poverty level. What it says is, until Medicaid and SCHIP payments reach the improved level of 3.5 percent-- the average of other Federal agencies--we should not give New York a special earmark for people making 400 percent of the Federal poverty level. First of all, it is a matter of common sense. Why would we allow the State with the worst fraud rate on Medicaid to have an additional exception over everybody else in the country, when they are the least efficient with spending their money on the people whom they are covering today? Now, I do not know if 40 percent is accurate. It may not be. But the fact is, the whole Medicaid Program and SCHIP program are three to four times what the rest of the Federal Government is in terms of fraud and abuse. I think it is important we condition the expansion and the earmark for New York State on them coming into alignment with the rest of the Federal Government in terms of its abuse. So with that, I yield the floor to the chairman. He has no comments. I will move on to another amendment. Amendment No. 50 Madam President, I call up amendment No. 50.

Mr. COBURN. I thank the chairman for his consideration.

Mr. COBURN. Madam President, the purpose of this amendment is to make sure children don't lose their private insurance and uninsured children can get access to private health insurance. This amendment would require a premium assistance approach for new Medicaid or SCHIP expansions under this act. It would cut bureaucratic redtape for States to use a premium assistance approach. I will be the first to say SCHIP was created for targeted low-income children, those families making less than 200 percent of the Federal poverty level, and I believe that is where the program should stay focused. The Department of Health and Human Services just released new numbers on the Federal poverty level. For a family of four, it is $22,050 a year. That means the current SCHIP without expansions is available to children whose families are making $44,000 a year. That is close to the national median income of $50,000. The underlying bill will expand the SCHIP program up to families making $66,000 a year or $88,000 if you are fortunate enough to live in the State of New York. I am concerned about this for a number of reasons, but there is little question the majority has the votes to pass the underlying bill and President Obama will pass it. Therefore, my amendment is not about whether to expand SCHIP; my amendment is about how to expand SCHIP. Are we going to put the majority of American kids on a government-run program? If that is our goal, then we should totally reject this amendment. Or are we going to use an approach that ensures children in America have access to market-based insurance? Let me tell my colleagues why this is important. Today, only 40 percent of the physicians will take an SCHIP or a Medicaid patient. Sixty percent would not even let them darken their door. So what we have in essence done is put a stamp on the foreheads of people in these programs that says: You get the doctors who are not busy enough so they have to take SCHIP and Medicaid. What this amendment is designed to do is, if they have an opportunity for insurance, we give them that opportunity, which takes that stamp off their foreheads. In other words, we don't relegate them to lower class health care. My amendment would require States to use a premium assistance approach to keep kids in private coverage if they want to expand their Medicaid or SCHIP under this bill. The American people know the market generally does a better job of controlling costs and improving the quality than government can. We know that because when we look at outcomes of Medicare versus private insurance, we see it. When we look at outcomes of private insurance versus Medicaid, we see it. When we look at outcomes of private insurance versus SCHIP, we see it. We know that is true. If they need a little extra help to get the private insurance, this amendment would make sure they have it. I believe parents--not government bureaucrats--should be able to make the decisions about the health care of their kids. This amendment will reduce crowdout of private insurance. Anytime the government offers to give something away for free, it is common sense that an employer or an individual will take them up on the offer. As we offer free health care to higher income children, many of whom already have coverage, we are going to see a resulting drop or crowdout in the number of employers willing to pay for private coverage. The Massachusetts Institute of Technology economist Jonathan Gruber has estimated the crowdout rate of expanding SCHIP to new eligibility groups at 60 percent. The Congressional Budget Office shows that 400,000 children will be newly covered in higher income families, and there will be a reduction in existing private insurance for another 400,000 children. That is our own Congressional Budget Office. If we send the bill as it is written to President Obama, it is going to break one of his campaign promises when he stated last fall: If you already have insurance, the only thing that will change under my plan is that we will lower your premiums. Voting in support of this amendment ensures that President Obama can keep his promise. Not only does crowdout take away the private coverage higher income children have now, it is a bad deal for taxpayers. For those new populations covered by CHIPRA 2009, the SCHIP legislation, one new child for the cost of two. CBO says the bill will cover 1.9 million SCHIP kids in 2013 at a cost of $2,160. However, because of crowdout, taxpayers will actually pay $4,430 for every newly insured kid because we are picking up the tab for those kids who already had insurance. The purpose of this amendment is to minimize that crowdout. Rather than encourage government dependence, it is to help people stay in a private insurance plan. It is also cost effective because the State will only have to subsidize the employee's share of the health insurance benefit rather than having taxpayers pay the entire benefit. This amendment also cuts bureaucratic redtape to make it easier for States to use a premium assistance approach. Current laws allow premium assistance, but the administrative requirements are so cumbersome that only a handful of States have premium assisted programs. I will note that the underlying bill permits premium assistance but would also note that the administrative burdens would once again discourage States from using this approach. According to the Kaiser Family Foundation, 55 percent of the 78.6 million children in America have employer-sponsored insurance. If that coverage is working for the majority of American kids, why can't it work for kids who are eligible for SCHIP? The answer is, it can and we have a duty to make sure it does. The premium assistance language in the underlying bill also denies parents the right to choose certain types of coverage for their children. This language gives parents the right to choose from more coverage options. Parents, not bureaucrats, know best about what fits the needs of their children. A parent should be able to use premium assistance for their share of the employer-sponsored insurance, to buy insurance in the nongroup market, or to buy a consumer-directed product. All this does is give parents that right to make individual decisions about what is best for their children, about what doctor they will have for their children. Don't forget most people in SCHIP don't get a real choice about who is going to take care of their children. They have a very limited choice. What this amendment does is ensures that a large portion of them can actually choose the doctor they want for their child. It is not about--this amendment isn't about whether we should cover American kids; it is about the best way to cover those kids. I believe keeping kids with their parents and market-based coverage is going to be better for American kids, better for our country in the long run, and I will guarantee it will give us better outcomes for the children who are covered. With that, I yield the floor.

Mr. COBURN. The Senator does not want to move on this amendment?