Thomas Coburn

Mr. COBURN

Mr. COBURN. Mr. President, I plan to raise a point of order in a moment, but first I wish to make a statement. The emergency spending bill being considered by the Senate would provide $210 million for the 2010 Census. No strings are attached to the funding, giving the Census Bureau freedom to spend the money in any way it chooses. While the mission of the Census Bureau is vitally important because of its role in apportioning the House of Representatives and the distribution of billions of dollars in federal grants, the agency has proved to be notoriously bad at spending taxpayer money--and the last thing Congress should do is provide more. Emergency spending bills should be reserved only for true emergencies, and the 2010 Census is not one of them. The Census Bureau has spent hundreds of millions of dollars over the past 8 years preparing for the 2010 Census. Yet, even that much time and that much money has not been enough to prevent the Bureau from being woefully underprepared. One of the top priorities for the 2010 Census was modernizing the method for collecting census data so that technology would replace the traditional pen and paper method. One former Director of the Census Bureau called the modernization effort a ``significant improvement'' over the way data had been collected in the past. Modernization of the census would take two forms: First, allowing citizens to fill out census forms over the Internet, rather than on paper only. Second, equipping census workers who go door-to-door to collect information with handheld computers instead of paper forms. Two contracts were awarded to build the technology: one to Lockheed Martin for, among other things, the development of an online system and a second to the Harris Corporation for the development of the handheld computers. Unfortunately, mismanagement and incompetence forced the Census Bureau to abandon both the Internet in March 2006 and the handheld computers in April 2008 as a means of collecting data. In place of technology, the Bureau has decided to revert back to an entirely paper-based system--exactly the same way census data was collected 200 years ago. According to the Census Bureau, the reason for abandoning technology and reverting to paper was its own failure to communicate what it wanted to the contractors. The result was a great deal of confusion, schedule delays and irreversible cost overruns. According to the Government Accountability Office, the Census Bureau was warned repeatedly that problems would mount if it failed to define what it wanted the contractor to do. Instead of taking action, the Bureau kept changing its mind about what it wanted. As recently as January 16, 2008--nearly 2 years after the contract was awarded--the Census Bureau made 400 changes to the contract for handheld computers. To this day, the Census Bureau has still not finalized the handheld computer contract with the Harris Corporation and may not do so until September. The Census Bureau's mismanagement of the handheld computer contract has become the poster-child for how not to run a large information technology contract. Poor management by the Bureau has diminished the role that technology will play in the 2010 census to the point of embarrassment. Americans will take their Census by paper at the same time that more than 80 million people are filing their Federal taxes online according to the Pew Internet and American Life Project, 75 percent of all adults are actively online. That percentage increases to between 85-90 percent for adults under the age of 50. According to the Census Bureau, the impact of abandoning technology in the 2010 Census will be a $3 billion overrun. This would bring the total price tag of the 2010 Census to roughly $14.5 billion--or more than double the cost in 2000. Congress should not reward mismanagement at the Census Bureau with an additional $210 million in emergency funding for FY 2008. It is unfair that Congress would ask taxpayers to bail out the Census Bureau for its incompetence in light of the repeated warnings that cost overruns would result from its poor management. Because the problems of the Census Bureau are of its own making, any additional funding needs for fiscal year 2008 should come out of the budget of the Census Bureau or the Department of Commerce. The real ``emergency'' with the 2010 Census is the failure, mismanagement and incompetence of the Census Bureau. According to Congress' own rules, emergency spending is only allowed for needs that truly cannot wait until the next spending cycle. These rules are not difficult to understand and lay out clearly what is and what is not an emergency. There are many activities funded in the bill that are not actual emergencies according to the rules, but at the top of the list of non- emergencies is the $210 million for the 2010 Census. The 2010 Census may go down in history as one of the worst managed and most expensive of all time, primarily because it saw enormous problems on the horizon and chose to ignore them--leading to the emergency today. Problems at the Census Bureau have been obvious to auditors and to Congress for years, and the funding in this bill is nothing more than a taxpayer-subsidized bailout for a mismanaged and incompetent agency. The Senate should uphold a point of order against the $210 million included in this bill for the 2010 Census because it violates every definition of emergency spending and provides no accountability for how the money will be spent by an agency that has proven that it desperately needs accountability. According to the rules, spending can only qualify as an emergency if it meets all of the following criteria: It is a necessary expenditure--an essential or vital expenditure, not one that is merely useful or beneficial; It is sudden--coming into being quickly, not building up over time; It is urgent--a pressing and compelling need requiring immediate action; It is unforeseen--not predictable or seen beforehand as a coming need, although an emergency that is part of an overall level of anticipated emergencies, particularly when estimated in advance, would not be ``unforeseen''; and It is not permanent--the need is temporary in nature. Not only does funding for the Census fall short of meeting all of the criteria for emergency spending, it actually fails to meet any of the criteria. According to Senate Concurrent Resolution 21, any emergency funding for the Census would have to be ``necessary, essential, or vital--not merely useful or beneficial.'' The purpose of this rule is to separate true emergencies from needs that can wait for the regular appropriations process. An accurate count of the population is important for apportioning the House of Representatives, but that alone does not qualify it for emergency funding. One of the best ways to determine whether funding is ``necessary'' or ``vital'' is to ask the following basic question: ``How does the Census Bureau plan to spend $210 million?'' If funding is truly necessary then there should be a clear answer to that question in the form of a specific plan stating the emergency and how the money would be spent. So, what is the money for? The answer is: no one knows. The Census Bureau has not requested any emergency funding from the emergency supplemental appropriations bill, nor has it provided a plan for how the money would be spent if received. At a March 6, 2008, hearing of the Senate Appropriations Subcommittee on Commerce, Justice, and Science, Chairman Barbara Mikulski directly asked both the Commerce Secretary, Carlos Gutierrez, and the Census Director, Steven Murdock, whether they needed emergency funding. Sen. Mikulski gave them a deadline of April 10 to make their request, but both the Secretary of Commerce and the Director of the Census Bureau declined to request any funding. In response, the Commerce Department stated that it did not need emergency money because plenty of funding was available within the department's existing budget. On April 3, 2008--a week ahead of Sen. Mikulski's deadline--Secretary of Commerce Gutierrez instead sent Congress a request to allow the Department to reprogram the department's existing funds to cover the cost overruns at the Census Bureau. Reprogramming existing funds would force the Department of Commerce to offset an increase in Census funding and to bear the burden of its own mistakes rather than placing the burden on taxpayers. On June 9, the President sent a letter to Congress asking for an increase to its fiscal year 2009 budget request for the Census, but also provides offsetting decreases to other programs. The Administration has stated that it would like for all Census money to come from non- emergency spending, which would ensure that the Census Bureau's needs are not paid for out of deficit spending. Unfortunately, Congress has chosen deficit spending over fiscal responsibility by including $210 million in this bill for the Census. Congress would rather spend additional taxpayer money than cut existing program budgets within the Department of Commerce. Including money in this bill for the census shows little regard for taxpayers, viewing them as a source of easy money rather than as people who work hard for their income. Congress is simply playing games with the budget rules and driving up the deficit. Senate rules require that emergency spending bills be reserved only for needs that are ``sudden, urgent and unforeseen'' in nature. The United States has been conducting a census every 10 years since 1790 as required by the Constitution and therefore is never unforeseen. The Census Bureau is, however, currently facing a likely $3 billion cost overrun for the 2010 Census because of its decision to abandon the use of handheld computers and rely exclusively on paper. Only by stretching the meaning of ``sudden, urgent and unforeseen'' beyond recognition can it be said that the Census Bureau did not see this problem coming. More than 18 months ago, the Census Bureau itself recognized that abandoning the handheld computers for paper would result in a cost increase for the 2010 Census of at least $1 billion. On August 31, 2006, Former Census Director Louis Kincannon wrote a letter to the Subcommittee on Federal Financial Management with the following warning about reverting to a paper-based census: ``In addition to significant cost increases to the 2010 Census, reverting to a paper-based operation will compromise efforts to improving coverage . . . and will significantly increase the risk of operational failure during the 2010 Census.'' Even as that letter was written, the Census Bureau was being warned that its poor management of the handheld computer project could force the Bureau to revert to an all-paper census. The problems and cost overruns that are materializing today were predicted publicly for a long time, but the Census Bureau ignored the warnings and took no action to prevent the problems. Chairman Henry Waxman, of the House Oversight and Government Reform Committee, has extensively documented the warnings that were given to the Census Bureau over several years. In addition, the Census Bureau was warned repeatedly by the Government Accountability Office, the Commerce Inspector General, the MITRE Corporation and Congress about its poor planning of the 2010 Census. Each step along the way, the Bureau systematically ignored every warning, leading to the schedule delays and cost overruns being experienced today. The following chronology shows clearly that the current problems being experienced by the Census Bureau are not ``sudden, urgent or unforeseen.'' January 2004--GAG recommended that the Secretary of Commerce develop a ``single integrated project plan'' for executing the 2010 Census, including how to incorporate technology. The Census Bureau ignored the recommendation and moved forward without a plan. September 2004--The Commerce Inspector General warned that the Bureau should follow a number of key ``software engineering practices'' to avoid pitfalls with the handheld computers. These included doing a better job with ``system requirements'' and overseeing its contractor. The contract for the handhelds was awarded to the Harris Corporation with very few details about what should be produced--more than two years later the plans are still not finalized. June 2005--GAG warned the Census Bureau that the agency was ``at increased risk of not adequately managing major IT investments and is more likely to experience cost and schedule overruns and performance shortfalls.'' GAO made several recommendations aimed at improving weaknesses in the Bureau's management of information technology. The Census Bureau failed to adequately respond to these recommendations. March 2006--As the Bureau was getting ready to award the contract to the Harris Corporation, GAO warned that the agency did not have a ``full set of capabilities they need to effectively manage the acquisitions.'' Unless the problem was to be addressed, GAO warned that technology problems could lead to ``cost overruns, schedule delays, and performance shortfalls.'' The Census Bureau ignored the warnings and still has not addressed them more than two years later. June 2006--The Senate Subcommittee on Federal Financial Management held a hearing on the Census and then-Director Louis Kincannon was asked about whether there was a backup plan if the handheld computers did not work. Even as the GAO was raising concerns that technology for the 2010 Census was in jeopardy, the Director said that no backup plan was needed since the computers were guaranteed to work, and said the following: ``You might as well ask me what happens if the Postal Service refuses to deliver the census forms.'' July 2006--GAO issued a report stating that if the Census Bureau did not do more to ensure the success of the handheld computers, it would be faced with the ``possibility of having to revert to the costly paper-based census used in 2000.'' April 2007--GAO testified before Congress that ``uncertainty surrounded'' the handheld computers because the devices were not being properly tested and The Census Bureau ignored the warnings. June 2007--The Census Bureau's private, independent consultant--the MITRE Corporation--sounded a loud alarm and warned that the Bureau's continued refusal to make final specifications could put the entire census at risk of severe cost overruns. Census Bureau management dismissed the warning. July 2007--GAO testified again before a Senate subcommittee that there were ``technical problems with the handheld computing devices'' and that ``risk management activities'' were ``imperative.'' Failure to address these concerns could threaten to overtake the handheld computer project. October 2007--Once again GAO, with a rising sense of urgency, warned that the handheld contract faced ``an increased probability that decennial systems will not be delivered on schedule and within budget.'' The Census Bureau did not disagree with this assessment. November 2007--MITRE Corporation executives called an emergency meeting with the Deputy Director of the Census to recommend that he develop a backup plan for paper because the problems with the handheld computers were so severe. December 2007--In the last days of the year on December 11, the outgoing Director of the Census Bureau testified at a House hearing about the handheld computers and brushed off any concerns raised by Members. He denied that any serious problems existed or that there were any significant delays or cost overruns. For years, there were warnings raised to the Census Bureau on nearly a monthly basis at times, but those warnings were patently ignored and disdained by Census management. Not until February 2008--when the media caught wind of the true situation--did the Census Bureau acknowledge publicly that there was a serious problem with the handheld computers and that large cost overruns were likely. In testimony before the Senate Homeland Security Committee on March 5, 2008, the Secretary of Commerce, Carlos Gutierrez, took it one step further and accepted responsibility for failing to act earlier. He said: ``Clearly the problem was more significant than had been conveyed in the December 11 hearing. In testimony before the Committee on April 15, Secretary Gutierrez admitted that the Bureau was aware of problems by early 2007, when he said: ``Concerns about the [handheld computer) program grew over time and Census and Commerce officials became increasingly aware of the significance of the problems through GAO and Office of Inspector General reviews, the 2007 dress rehearsal and internal assessments.'' None of these concerns were relayed to Congress until it was too late and emergency funding was the only recourse. With this chronology of events, it is simply not possible to claim that any problems with the 2010 Census being seen today are ``sudden, urgent and unforeseen.'' They have been just the opposite: unsurprising, longstanding and predictable. Without diminishing the importance of the 2010 Census, the funding in this bill does not meet the definition of an emergency by a long shot. The problems surfacing today were not only predicted many times in the past few years, but were documented publicly in numerous congressional hearings. A vote to waive the rules on emergency spending in this situation is a vote to render the emergency spending rules meaningless. A vote to waive the rules is also a vote to reward incompetent management at the Census Bureau despite its ignoring years of repeated warnings that problems were on the horizon. In order to qualify for emergency funding, it must be proved that funding for the 2010 Census is ``temporary in nature.'' The rule is intended to ensure that needs that are long-standing or ongoing do not get funding under emergency rules. Rather, only those needs that are short-lived can qualify as an emergency. No activity of the U.S. Government has existed for a longer period of time nor has an activity of the government been as predictable as the decennial census. Article 1, Section 2 of the Constitution states that ``The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct.'' With these words, the Founding Fathers established that a census of the entire population would be taken every ten years in perpetuity. Since the birth of the Nation more than 230 years ago, a census has been taken every 10 years--few things in government are as permanent as the census. It should come as a surprise to no one that there will be a census in 2010, least of all to Congress and to the Census Bureau. $210 million in emergency spending should not be included in a bill that is intended only for measures that are ``not permanent'' or ``temporary.'' The Census Bureau finds itself today as the recipient of a bailout from Congress because it has been taught by past experience to expect a bailout whenever times get tough. The example of the 2000 Census provides an illustration of how the expectation of a congressional bailout drives up costs because it decreases concerns about getting the best price. By the late 1990s, census planners were operating under the assumption that the 2000 Census would cost $4 billion--then the most expensive of all time. At the time, the Census Bureau was planning to use a method of data collection known as ``sampling'' during the 2000 Census. On January 25, 1999, only 15 months before Census Day 2000, the Supreme Court ruled that sampling was not allowable, and that the Census Bureau would have to redesign the 2000 Census. Although the issue was highly controversial, and subject to a ruling by the Supreme Court, the Census Bureau failed to make any plans whatsoever in the event that sampling would not be allowed. In September 1999, GAO reported that: ``The bureau did not begin detailed budgeting for a nonsampling-based census until after the Supreme Court ruled that the Census Act prohibited the use of statistical sampling.'' Thus, poor planning and mismanagement forced the Census Bureau to request an additional $2.6 billion from Congress during the final year of preparations. Congress was faced with the decision to either cut $2.6 billion from existing programs or designate the new funding as an emergency. Not surprisingly, Congress chose to designate the $2.6 billion as an emergency since it allowed the funding to get around the budget rules that would have otherwise required spending cuts. It is the worst kept secret in Washington that emergency spending is nothing more than a ploy by politicians to bust through the budget caps and spend more money. Although Members of Congress were spared from having to make any difficult choices, taxpayers were not so lucky. Today, for the 2010 Census, Congress is once again facing a decision about how to come up with $3 billion. And, once again it wants to pay for it on the backs of the American people. Management at the Census Bureau is smart enough to know that Congress will never hold the agency accountable for its mismanagement of taxpayer dollars, as evidenced by the $210 million in this bill. Congress should begin holding the Census Bureau accountable today and sustain the point of order against emergency funding for the census in this bill. members of congress have repeatedly noted that census problems were a failure of management, not the result of an emergency By providing $210 million to the Census Bureau, Congress is disregarding the findings of its own committees. There have been no fewer than five committee hearings in the past 3 months detailing the long-standing failures of the Census Bureau to properly manage the 2010 Census. Several members of Congress from both parties and both houses have commented over the past several months about the poor management of the Census Bureau and the shocking indifference it showed towards those that tried to raise a warning. The following statements have been made in recent months by various Members of Congress. On March 6, the Chairman of the Senate Commerce, Justice and State Appropriations Subcommittee, Senator Barbara Mikulski, said that it was ``shocking'' that the 2010 Census will be done the same way ``we've been doing censuses for 200 years.'' Senator Mikulski also stated that ``a paper census in America borders on a scandal.'' On June 18th, the ranking member of the CJS Subcommittee, Senator Richard Shelby, said that the $3 billion cost overrun is the result of ``gross mismanagement of the Census Bureau in acquiring hand held computers.'' In March 2008, Representative Carolyn Maloney called the management of the 2010 Census a ``mess'' and said that ``what we're facing is a statistical Katrina.'' In April 2008, upon hearing that the Census Bureau decided to abandon the handheld computers, she said: ``It brings little satisfaction to have been right about this, but we've said since last year the Census was in real peril.'' Representative Henry Waxman, Chairman of the House Oversight and Government Reform Committee, blamed the cost overruns on ``serious mismanagement'' and said that ``the costly decision to return to a paper census was avoidable.'' At a hearing in March, Senator Tom Carper, Chairman of the subcommittee with jurisdiction over the Census Bureau, said that ``the Census Bureau did not heed the warnings coming from GAO and others that their handheld project was troubled.'' Representative Lacy Clay, who chairs the House Census Subcommittee said, ``This appalling failure of management oversight by both the Census Bureau and Harris Interactive, combined with ridiculous cost overruns is totally unacceptable.'' Representative Clay also said: ``[Harris] is delivering half of the hand-held computers that the Census Bureau originally ordered. The machines can't do what we wanted them to do. And yet, Harris expects the taxpayers to provide more than $700 million more to pay for their failures. That is outrageous.'' Senator Joe Lieberman said that ``it is inexcusable that the Census Bureau must still rely on paper and pencils to perform its most important function.'' Senator Susan Collins, in discussing the management of the census, said that ``there is little to applaud and much to be concerned about.'' Senator Collins went to blame agency management for a ``combination of wishful thinking, lax management, and tunnel vision.'' Even the Secretary of Commerce, Carlos Gutierrez, who is ultimately responsible for the 2010 Census, said that the problems with the handheld computers are not the result of an unexpected emergency, but is ``a management problem.'' The Census Bureau has a poor track record of using taxpayer money The Census Bureau has one of the worst track records of any federal agency when it comes to spending taxpayer money. Numerous accounts can be given to highlight the way in which the Census Bureau wastes money through negligence, mismanagement and incompetence. The $210 million in emergency funding in the bill is nothing more than rewarding bad behavior with more money and no accountability. Consider the following ways in which the Census Bureau has done a poor job of controlling the cost of the census: The cost of the census has doubled every time it has been taken since 1970. In 1970, it cost only $248 million to count 200,000 American citizens, but in 2010, it will cost nearly $15 billion to count 300,000 citizens--that means it will cost 60 times more to count 1\1/2\ times as many people. In the 1990 Census it cost $10 per person to count the population--in the 2010 Census, it will cost at least $47 per person. More recently, the Census Bureau awarded a $600 million cost-plus contract to the Harris Corporation for the development of handheld computers, which has skyrocketed above the original plan. The handheld computers were supposed to perform a number of functions, including two functions called Address Canvassing and Non-Response Follow Up: Address Canvassing is the process of plotting every American household with a GPS coordinate. Non-Response Follow Up is the process of collecting information door- to-door from households that don't respond to the census by mail. Due to mismanagement by the Census Bureau, the project has not only been severely scaled back but the cost of the contract will likely double. In April, the Secretary of Commerce decided to eliminate Non- Response Follow Up from the list of functions that the handheld computer would perform, leaving only Address Canvassing. The Harris Corporation estimated that the impact of that decision so close to the 2010 Census would increase the cost of the contract from approximately $600 million to $1.3 billion--an overrun of $700 million to be funded by taxpayers. According to estimates based on the new contract, the unit cost for each handheld computer would be $600 for a device that can do nothing more than plot homes on a map using GPS coordinates. This means that the Census Bureau will pay $600 for a custom-made handheld device that can do less than an off-the-shelf BlackBerry that costs $200 or an iPhone that costs $275. One of the most glaring examples of wasted money at the Census Bureau is seen in the recent cost overrun for a technology help-desk planned for census takers going door-to-door in 2010. The original for the help desk--before the decision was made to abandon technology for a paper census--was $36 million. After the decision to use paper only, the estimated cost of the technology help desk increased to $217 million. Some will argue that without immediate emergency funding, the Census Bureau will not be able to pull off the 2010 Census, putting apportionment and important programs in jeopardy. This is not true. The next fiscal year is only 3 months away and any funding that the Census Bureau needs can be provided then. There is no compelling argument that emergency deficit spending on the 2010 Census is needed immediately. Perhaps the reason why $210 million is being included is because the Congress--like the Census Bureau--is once again mismanaging its constitutional duties to pass appropriations bills on time. Also, as I already stated earlier, it is not clear what this money would actually be used for and so it is impossible to say it is essential. It is incomprehensible why the Census Bureau needs an extra $210 million at this point when it is planning to spend an overall amount of $14.5 billion on the 2010 Census. That is more than twice as much as the cost of the 2000 Census that was done the exact same way-- by pencil and paper. There are plenty of deficit-neutral options available to provide funding for the 2010 Census, including transferring money already available within the Department of Commerce. Or, Congress could cut or eliminate less important programs to free up money for the 2010 Census. Furthermore, some may argue that the concerns about poor management at the Census Bureau can be dealt with another time--the most important thing is getting the 2010 Census done right and without delay. I would respond by noting that this country is always in the middle of preparations for the next decennial census--if management concerns are always pushed back then they will never be addressed. Providing a bailout for the Census Bureau now is tantamount to excusing the poor management that has prevailed at the agency for the better part of a decade. Report after report by the GAO and the Inspector General have called upon the Census Bureau to improve its poor management of the 2010 Census. Each of those reports and warnings were ignored because, ultimately, the agency knew that Congress didn't care about accountability. Congress should deal with the management concerns immediately and start by withholding the bailout money in this bill. Mr. President, this is a simple point of order, but it has tremendous ramifications on whether we are going to effectively oversight the rest of the executive agencies. Three and a half years ago, Tom Carper and I started oversight hearings on the census. At that time, GAO said: They are not going to make it. They are not doing what they need to do. It was totally ignored, both by the Census Bureau as well as the Department of Commerce. Now we find that even though they have had two contracts--one with Lockheed and one with another company--to put the census online-- we are going to be the only modern country that doesn't have the census online--they have totally withheld, totally canceled that contract, and totally didn't perform. The other, to do with electronic data collection, is now a flop, and they admit the reason it is a flop is because the Census Bureau did not communicate with the contractor. In this bill is $210 million to say: Oh, we are sorry. We are going to give you more money because you didn't do it well. Secretary Gutierrez says there is plenty of money in the Commerce Department to cover this cost, and I am going to raise a point of order that it is not an emergency. There is plenty of money there, and we are sending exactly the wrong message to every other agency in this Government by allowing an agency that is going to do the census the same way it did 200 years ago because of incompetency. We are going to give them $200 million on an emergency basis, and we are going to charge the next generation because we are not going to pay for it. We are going to borrow the money, and we are going to embrace and endorse incompetence. So, Mr. President, I raise a point of order, pursuant to section 204(a)(5) of the fiscal year 2008 budget resolution, S. Con. Res. 21, against the emergency designation of $200 million for the Census Bureau in the message in the pending amendment, and I ask for the yeas and nays.

Mr. COBURN

Mr. COBURN. Madam President, I rise today to highlight the difficulties caused by neurofibromatosis, NF, the work currently being done by the Federal Government to address this difficult disease, and the importance of awareness about NF. NF is a genetic disorder of the nervous system, which causes tumors to form on the nerves anywhere in the body at any time. NF is a progressive disorder and is one of the most common genetic disorders in the United States. An estimated 100,000 Americans have a neurofibromatosis disorder. About half of those affected with NF have a prior family history of the disease. NF has two distinct forms, NF1 and NF2. NF1 is the more common version, occurring in 1 of nearly every 4,000 individuals in the U.S. It has varying manifestations and degrees of severity resulting from a mutation of the NFI gene. Symptoms include common skin abnormalities and are often evident at birth or shortly afterwards. NF1 can cause learning disorders, bone deformities, and may even be associated with cancer. NF2 is a much more rare condition, resulting from a mutation of the NF2 gene, that is most frequently associated with hearing loss and visual impairment. The National Institutes of Health, NIH, supports critical research to fight NF, investing approximately $13 million a year. At NIH, the $1.5 billion National Institute of Neurological Disorders and Stroke, NINDS, supports research and clinical trials to understand normal and abnormal development of the brain and nervous system to improve our understanding of the disease and our ability to prevent, treat, and ultimately cure the NF disorders. Researchers have been able to locate the exact NF1 gene, which they found normally works as a ``molecular brake'' to keep cells from overmultiplying, and the NF2 gene, which they found normally helps suppress tumors. It is the mutations of these genes that cause the difficulties associated with NF. According to NINDS: Understanding the molecular pathways and mechanisms that govern these key proteins and their activities will offer scientists exciting opportunities to design drugs that could replace the missing proteins in people who have neurofibromatosis and return their cell production to normal. NINDS is currently researching how NF1 can also cause abnormal fetal development that can cause learning disabilities and cognitive deficits for children. NINDS also supports research aimed at developing improved methods of diagnosing NF and identifying factors that cause the wide variations of symptoms and severity of the disorders. As a practicing physician, I am encouraged that NINDS is performing research to help doctors equip parents for their child's education by pinpointing associations between brain abnormalities and specific cognitive disabilities. This will help parents to develop and implement early intervention programs. Having treated patients with NF, I know firsthand the pain and suffering associated with the disease and the difficulties it can cause for parents. The ongoing Federal research activities though NIH are critical toward fighting NF. I also applaud the tremendous efforts of private foundations and the thousands of NF volunteers and advocates across the country. It is my sincere hope that public-private partnerships will continue to provide medical breakthroughs that can prevent, treat, and cure NF and other painful diseases.

Mr. COBURN

Mr. COBURN. Reserving the right to object, I plan on speaking longer than that, so I will ask for unanimous consent after the fact.

Mr. COBURN

Mr. COBURN. I am happy to yield to the Senator.

Mr. COBURN

Mr. COBURN. We heard some reasons we should support the Baucus doctor fix. I happen to have been practicing in 2004 when the Senate did exactly what they are doing right now. This bill is going to guarantee the doctor fix is not done by July 1. That is what is going to happen with this bill. Let me tell you, we are eventually going to fix the problem for the doctors for 18 months. There is no question. Everybody agrees to that. But what we are doing is, we are making sure we are going to add hundreds of thousands if not millions of dollars of cost in every State for every private physician that is practicing. And the reason is because the bill is not going to get changed by July 1, and they are going to be under the 10.9-percent cut. Then they are going to come back, whenever we finally get it done. They are going to have to refile all of that, and Medicare is going to have to repay all of this. So this exercise in political gamesmanship, of working only with one side of the aisle, not working with Senator Grassley, to truly get this done in a way that the President will not veto it and accomplish the purposes for which we all say we want, to eliminate the 10.9-percent cut for physicians, that is something we are going to lose grasp of, and we are going to create a hardship on every physician in this country because we are playing a political game with this rather than fixing the problem. That brings me to my next point. Why is it every 18 months the physicians in this country have to come and beg Congress not to cut their fees when we are not cutting the fees for the rest of the providers throughout the Medicare Program? What we have decided is that doctors make too much money. We have decided that when they work 80 hours a week, one and a half to two times what everybody else works in this country, they spend their time away from their families making great sacrifices, that we are going to fund increases in the care for our elderly and seniors in this country on the backs of physicians. Now, I will not dispute the fact that there are some disparities in physician pay in this country, with some physicians making too much and far too many making too little, especially primary care pediatricians, psychiatrists, and the like, those who are on the front lines. But this idea that we are going to fix temporarily, again, for 18 months, a problem that we have to fix, which is the other problem with the Baucus bill, the only thing great about Medicare that will get us out of the long-term costs is this idea of creating markets associated with choice and responsibility to give greater health care, greater choice, and greater benefits to Medicare beneficiaries through competition. I am the first to say that the Medicare Advantage Program has lots of problems. But to get the Medicare Advantage Program, which is the one thing that tries to go toward market-oriented reform in Medicare, to pay for this is ludicrous. Senator Grassley has a competing bill--we just heard the second reading objected to by the Senator from Michigan so we cannot have a side-by-side vote on it--does all of the things that the Baucus bill does except it does not gut Medicare Advantage. Well, why do we want to take the one factor in Medicare that is based on markets, that is based on transparency, that is based on some personal responsibility, and throw it out and have another program that right now every family in this country is on the hook for over $300,000 in unfunded Medicare obligations, and the Baucus bill guts the only thing that helps us solve that? So the President is right to veto this bill. Even if it passes, this bill will not be overridden. So we are ensuring the fact that doctors will experience, on July 1, a 10.9-percent cut. We do not have to do that. They know we cannot do this and have it go to the President and get it vetoed and come back and get everything else down before July 1. So by voting for the Baucus bill, what you are actually doing is ensuring that every physician in this country that cares for Medicare patients is going to spend thousands and thousands of extra dollars, and that CMS is going to spend thousands and thousands and millions, perhaps $100 million, to come back and deal with the paperwork once this is finally fixed. Nobody thinks about that around here. We are playing political games. How can you make Republicans look bad as they vote against a Baucus Medicare doctor fix? Everybody in this body wants to fix this payment system for doctors. There is one real reason we do; we want our seniors to be able to have physicians. And we know if an 11-percent cut goes through, many doctors will no longer be able to afford to care for Medicare patients, they will not be able to afford to. They cannot do it. So if you cut 11 percent of their fees on Medicare, which are already almost as low as Medicaid everywhere, which is about 40 percent less than they get paid for anything else, you are asking them to serve Medicare at half price. And what they are going to do is they are going to make a choice. They are going to say: I cannot take care of Medicare patients. So what we are going to ensure with the Baucus bill is that doctors are going to get a pay cut, maybe for a short period of time, but the inconvenience of that, the cost of that for political gamesmanship, we ought to be ashamed of what we are doing. And it is exactly the reason we have a low rating with the American people. We know Senator Grassley and Senator Baucus can work this out. We know it can happen. But the fact is, it was chosen to make it an issue, not work in a bipartisan fashion, not come up with something that the President can sign, but instead to slow down the works. And what they will do is markedly decrease availability of Medicare for seniors in this country because the doctors, when they first see this, if they see a 10.9-percent cut, some of them are going to abandon the Medicare Program, and you are ensuring, if you vote for the Baucus bill, that doctors will get a 10.9-percent cut for a short period of time. You are ensuring that, in fact, what they are going to do is, they are going to have a whole lot more overhead because they are going to get a bill from the time it starts to the time it ends and finally gets corrected, they are going to bill it twice, once for the primary at a 10.9-percent cost, then they are going to get a bill again because it is going to be retroactively fixed. They are going to have to bill it all again. That is pure waste. That is typical government. Why would we do that? What are we thinking? What we are thinking is short-term partisanship. And we ought to be ashamed of ourselves. Global Warming Now I want to spend a few minutes talking about the climate bill. I have been listening for 10 days on this issue. And I want to share some observations. It was said on the Senate floor that nobody has scientifically disputed the underlying facts associated with climate change. We cannot dispute underlying facts on climate change because climate changes. It always changes. We have a history of knowing it changes. We know that every 1,500 years we have global warming, whether we like it or not. It happens. What we do not have is common sense and scientific methods looked at. I hear my friends, even on my side of the aisle, talk about anecdotal observations that things are different. Sure they are different. As a matter of fact, we heard the leading German scientists on climate change saying we are going to have a 10-year break on global warming. So I guess that means for the next 10 years CO2 input is not going to have any effect on global warming. So we have conveniently changed the terms from global warming to climate change. Well, I want Americans to ask themselves, what is climate change? The climate changes all the time. Last week, the majority leader, on the Senate floor, said the tornados that were in this area were related to climate change. Like saying anecdotally we can prove there must be climate change because we saw tornadoes in the Washington, DC, area last week--do you know how many times there have been tornadoes in this month in Washington, DC, throughout the years? Hundreds. But now we are anecdotally, because we see something new to our experience, associating it with some phenomena. That is not science. That is ignorance. That is using science in a way that bastardizes it. The second point is, if we really want to know how we affect climate, it takes a lot of years to find that out. There are retrospective studies we can do. As a matter of fact, they have been done. We have ice core drilling that goes back about 3,500 years. We know exactly what the temperatures were in the north and in the south based on both ice core drillings and ocean sediment drillings. We know that because we know that isotopes of both oxygen and nitrogen decay at different rates. When those are measured, we can have a pattern of what the Earth's temperatures were and what the cycles of climate were. Nobody wants to embrace that. That is real science. But we ignore that. That doesn't fit with the emotion that allows us to relate a policy that we want to enact in a way that disproves it. There is so much yet to be known about climate. We can't even predict what the weather is going to be tomorrow. Yet we have this supposed settled science. The science isn't settled. The rhetoric is settled, but the science is far from settled. What do we know? Here is what we know. The most recent examples of 1,500-year cycles are these: The Roman warming started in 200 B.C. Pared with its other half, the Dark Ages, it ended in 900 A.D. We know that historically. We know there was this warming cycle that came and went. The medieval warming period, the little ice age period cycle, lasted that period of time from A.D. 900 to 1850. The modern warming cycle, which started about 1850 to present, is probably the first half of the change. What happened during the medieval warming period? The Norse populated Greenland. They fished from its coast. They had over 60,000 cattle. They raised hay on what is now majority covered with ice. So we have been there before. We don't like to look at the historical fact because it doesn't fit either our populace viewpoint or give us a reason to enact a bill which, in my estimation, is the greatest--will be, if we pass it--loss of freedom this country has ever experienced. Freedom is directly related to the level and the amount of government we have. Under the climate bill Senator Boxer has put out, you can guarantee a loss of your liberty. Anybody with any common sense knows that. We are going to put all sorts of decisionmaking in the hands of bureaucrats. They are going to be deciding for you. So when bureaucrats start deciding for you, that means you don't. If you don't like the results, you have to prove your innocence. The onus becomes on you. The unique thing about the American experience is that freedom is our basic model. Liberty is ours. When we grow the Government, through $6.4 to $6.9, all the way up to supposedly $10 trillion in a tax structure that is implemented through a great number of Government programs, Government boards, Government regulations, you can bet your freedom is going to be markedly limited. The last thing I want to talk about is the very fact that we are talking about not using resources we have. Even if you buy everything that the alarmists with climate change and global warming would have you, and let's assume they are all right, everybody agrees it is going to take us 20 to 30 years to get off of hydrocarbons as a method of energy production, as a source of energy. We know that. If we were to start building nuclear plants today, we would have every alternative energy that we had, and it would still take us 15 to 20 years to start to begin to do that. So what is it that we fear about utilizing our own energy resources? My senior Senator sitting on the floor--and I can tell you that both of us, coming from Oklahoma, love our land. We love our streams. We love our lakes. We love the wildlife that is everywhere you turn in Oklahoma. We drill all over the place. We don't contaminate our environment at all. But we have a level of ignorance about what exploration is for energy in this country. It is done in a fabulous, sophisticated way. We now drill 1 hole and create 8 to 20 wells out of 1 hole because the technology allows you to drill any direction you want at almost any depth you want. So what happens is, we allow people who are not aware of the technology of exploration to create a picture that says exploration can't be done in an environmentally friendly way. That is not true. We do it all the time in Oklahoma. Come visit. Behind my home is a gas well. It was drilled 25 years ago. When they plugged it, everything about that was remediated. Do you know what is growing there right now is the most fabulous wild blackberries you ever tasted in your life. That is exactly the opposite picture that the alarmists want you to have about energy exploration. The point I am making is, we have a hundred years, at a minimum, of hydrocarbons available to us that we could utilize in the next 5 to 10 years and not utilize foreign imported oil from people who have vowed to take away our freedoms. The fact is, that gets blocked all the time on the Senate floor on the basis of an irrationality that says you can't do it. We have two of the largest domestic natural gas producers in the world in Oklahoma. In the Gulf of Mexico, you can't even see the rigs. In 8,500 feet of water, 20,000 feet below the surface of the ocean, they are drilling oil in a platform that is floating that moves less than 8 inches based on gyroscopes. They have not once in all the years had an environmental spill when they were doing that. That is how great the technology is. Yet we have this fear that you can't do something. At the same time that we have this fear, what we are doing is embracing $4.35 gasoline. We are embracing the funding of terrorists by our purchase of oil moneys that then go to fund terrorists. We have become schizophrenic. We have lost it. When we would deny the ability to use resources in this country that would stop the upward trend on the price of oil, that would utilize oil shale to conversion for jet aviation fuel, that would utilize oil shale for heating oil, that we would not allow that, we will not allow the utilization of our own resources at our own negative benefit, what is the purpose of that? I get written to all the time by constituents from Oklahoma about gas prices. Do you know what I tell them? I say: You should blame us. You should blame the Congress. It is absolutely our fault we are in the position we are in. We didn't act. From 1995 up through this year, every time we have had a chance to increase exploration in a safe, environmentally friendly way in this country, it has been blocked. So now we sit with the hardest of the hardest hit, the poor and less fortunate, trying to make a choice of whether they can even get to work, let alone buy their groceries, because gas now and their energy needs are such a large component of their family budget. It is our fault, and we are going to sit around. We are going to dither, and gasoline is going to be $5.50 a gallon. The American public is going to react to that, and they are going to say: Maybe we ought to take another look at these good energy companies that do it environmentally well and supply us power and energy and do not fund the very people who want to take away our freedoms. It is coming. This is part of the same rumble from the American public that says we do not get it on spending. I was enlightened today on a new bill that is getting ready to be introduced that I am going to try to keep from coming to the floor that is a yearly authorization for the Coast Guard. There is a 25-percent increase in it, but of that 25 percent, 80 percent is earmarks. We almost doubled the Coast Guard when we created the Department of Homeland Security. Yet this year we are going to come close to a trillion-dollar deficit--$3,000 for every man, woman, and child--and we still do not get it. So the idea that Congress will not act to raise the level of supplies, that Congress will not take off the tariff on imported ethanol, refuses to take off the tariff on imported ethanol to protect a false economy associated with corn ethanol--when, in fact, we have a shortage, as manifested by the price of the fuels that drive our energy and yet we will not act--the American people have a right to be disgusted. We are the reason gasoline is over $4. It is not the oil companies. It is not the Middle East. It is us. Because we could have done something. We still can do something. But we heard political speeches all today because what we want to do is sue OPEC and create an excess profits tax, and eventually a Btu tax, rather than increase the supply. What we should do is increase supplies. The American people get it. Somehow we do not. My hope is that America will let us know. I think they are going to. My hope is we will listen. With that, Madam President, I yield the floor.

Mr. COBURN

Mr. COBURN. Madam President, I appreciate the cooperation of Senator Harkin and Senator Chambliss on allowing us to have some discussion on the farm bill. The attempt was made to pass this by unanimous consent. Unanimous consent means that every Senator in the body agrees with the bill, agrees it should be passed, agrees it should not be amended, and should not be debated. I will offer no amendments in working with Senator Chambliss and Senator Harkin. However, I think it is very important, especially in light of the recent WTO ruling which allows Brazil to administer approximately $5 billion in punitive penalties on American products going to Brazil because we are WTO noncompliant. I come from a farm State and I want to tell you I think this bill is not good for my farmers. As a matter of fact, I know it is not good for my farmers, especially when we think out in the distance. Input costs have more than doubled for production agriculture in this country and the assumption--not implicitly, but nevertheless in this bill is the assumption of good prices in the future. Anybody who has been around farm community for any period of time recognizes that farm prices are erratic. My thoughts are what do we have in the farm bill when corn prices are back at $3 a bushel, when wheat prices are back at $2.50 or $3 a bushel, and when soybeans are back down at $5 a bushel with input costs doubled? What we have done is we have cut $3.5 billion from the commodity title in this program. The one thing that WTO says is compliant is direct payments. We have cut them by $313 million. I don't want farmers to get anything if they don't need it, but food is important to us and I do not disagree that we will use agriculture to help us in our energy needs. But I think in the long run we have not done what we need to do for the American farmer. More importantly, and this is not to degrade the very hard work that was done by the Agriculture Committee and the conference committee, is that we have missed an opportunity to be good stewards with Americans' money. How can that be so? One is the bill extends ethanol provisions as livestock producers and consumers are struggling to pay for higher feed costs. It takes 2 pounds of feed to gain a pound of weight in a chicken. It takes 4 pounds of feed to gain a pound in a hog. So the input costs on food have risen dramatically. We didn't eliminate the import duty on ethanol. If we think ethanol is an important aspect of our freedom in terms of energy independence, why do we have an import duty on ethanol coming into this country? Why did we not fix the dollar blending for biofuels, biodiesel? Now large quantities are coming into this country. A small quantity of diesel is being blended to it, they are collecting $1 from the Federal Government and shipping the biodiesel fuel to Europe where they can get more money for it. What in fact we did not eliminate is the subsidy to European biodiesel in this bill. This is basically a food bill, it is not an agricultural bill. Madam President, 73 percent of this bill goes for food and there are absolutely no metrics on what we are doing in terms of our food programs. There is no measurement, there are no performance indicators, there are no qualifications as to are we meeting the needs? Is the money we are spending accomplishing our goal? We have no metrics in that. There are none. The bill steals money, much to the chagrin of the leaders in the Senate, for true agricultural programs and puts it into things that are not agricultural at all. We took $250 million in an earmark in this bill for the Nature Conservancy to buy land in Montana for one person. We are constructing a Chinese water garden in Washington, DC, in the Arboretum, from a gift from the Chinese--but now we are going to pay for it. We are spending $3.7 million in a noncompetitive grant for the University of the District of Columbia to upgrade agriculture and food science facilities. Granted, it is a land grant college. Why should not it have to compete? How do we know that is the best place to spend the $3.75 million? We are spending money, at a time we are going to come close to a $1 trillion deficit, on historic barn preservation? We are going to preserve falling-down barns at the time we add $3,000 per man, woman, and child in this country to their debt? We create a farm and ranch stress assistance network. After this bill they are going to need it. They are going to need it--especially if crop prices fall. The safety net is gone. We have the highest prices historically we have ever had for asparagus and yet we put $15 million for asparagus prices from 3 years ago in this bill. We have $50 million for the Sheep Industry Improvement Center that has two employees in Washington, DC. It halts a previous law that was going to privatize the center. We also have a wonderful study to study methane release from livestock operations. I would like for us to know, in the natural physiologic condition of cattle, how we are going to eliminate flatulence? How we are going to spend money? We know it is there. We know how much is there based on how many head of cattle there is. We are going to spend money to study it. More importantly, this bill offends one of the most cherished beliefs of farmers and ranchers, and that is property rights--a guaranteed right in this country is put at risk under this bill. In addition to the $250 million for the Nature Conservancy to buy more land, this bill authorizes the Community Enforced and Open Space Conservation Program, which will give grants to local governments--Federal money; we don't have it but we are going to give grants--and tribes, to buy up private forest land and put it into the hands of the Government. We are not going to have an option. We are going to let the Government agency give grants and we are going to take land away from private landowners. That is what we are going to do. That is ultimately what will happen. We added 100 million acres in Government land in the last 5 years in this country. We added 100 million acres. What was the purpose for this? The guise of protecting water supply, hunting opportunities and, in the bill itself, preventing obesity. We are going to prevent obesity by buying land. Finally, the bill fails to rein in the USDA. It is the fifth largest corporation in the world. It has 115,000 employees--11,000 here in DC. We are still going to have a top-heavy bureaucracy and we are going to spend money on the bureaucracy instead of on the production of food, efficiency in the farm, and guaranteeing that Americans will have a safe and secure food supply. This is not to denigrate my colleagues. Most of this they didn't agree with. They had to trade to keep a half-way commonsense bill, so I don't want Senator Harkin or Senator Chambliss to think--and I know through my conversations with them that this is stuff they had to swallow, coming out of a conference committee. This bill was never going to be easy. Yet after nearly 2 years of debate, Congress is going to pass a bill that fails to prioritize agricultural spending in any meaningful way and what I believe, and it is my opinion, that what in the future will be is life very much more difficult for the American farmer and rancher.

Mr. COBURN

Mr. COBURN. Mr. President, Medicare and Medicaid cost the American taxpayers a combined $770 billion in 2007; Medicare costing $432 billion and Medicaid $338 billion. In 2007, the Federal Government's share of Medicaid expenditures was $190 billion and is expected to be $402 billion by 2017. Medicare expenditures alone account for 3.2 percent of GDP. Over the next 75 years these expenditures are expected to explode to almost 11 percent of GDP. Every American household's share of Medicare's unfunded obligation is like a $320,000 IOU. The Medicaid Program, because of the promise of a generous Federal match of State Medicaid dollars, has given States heavy incentive to increase their State Medicaid spending. Medicaid spending now accounts for 26.3 percent of state budgets, up from just 6.7 percent in 1970. In some States, as much as half of all new revenues will go to Medicaid in the coming years. We have heard a lot of talk about bi-partisan commissions on entitlement reform come out of the Budget Committee, but the least that we can do is to stop blatant fraud and abuse in the mean time. Eliminating waste, fraud, and abuse is a baby step in addressing entitlements. The Centers for Medicare and Medicaid Services, CMS, has worked over the last 5 or so years to curb waste, fraud, and abuse. They have done work on a State-specific basis and also by promulgating detailed regulations so that States have the clarity they need. Over the years, Medicaid has proven to be a program susceptible to fraud, waste, and abuse. Many States have pushed the limits of what should be allowed to maximize the Federal dollars sent to them. The Government Accountability Office, GAO, put Medicaid on its ``high risk'' report a few years back because of questionable financing and the lack of accountability. According to the Wall Street Journal: The GAO and other federal inspectors have copiously documented these ``creative financing schemes'' going back to the Clinton Administration. New York deposited its proceeds in a Medicaid account, recycling federal dollars to decrease its overall contribution. So did Michigan. States like Wisconsin and Pennsylvania fattened their political priorities. Oregon funded K-12 education during a budget shortfall. According to the Wall Street Journal: The right word for this is fraud. A corporation caught in this kind of self-dealing--faking payments to extract billions, then laundering the money--would be indicted. In fact, a new industry of contingency-fee consultants has sprung up to help states find and exploit the ``ambiguities'' in Medicaid's regulatory wasteland. All the feds can do is notice loopholes when they get too expensive and close them, whereupon the cycle starts over. No one really knows how much the state grifters have already grabbed, though the Congressional Budget Office estimates that the Administration remedies would save $17.8 billion over five years and $42.2 billion over 10. We realize this is considered a mere gratuity in Washington, but Medicaid's money laundering is further evidence that Congress isn't serious about spending discipline. Examples of fraud in the Medicaid Program are plentiful. One dentist billed medicaid 991 procedures in a single day. According to the New York Times, a former State investigator of Medicaid abuse estimated that as much as 40 percent $18 billion of New York's Medicaid budget was inappropriate. New York spent $300 million of its Medicaid money on transportation. In 2005, Congressional testimony showed that 34 States hired contingency-fee consultants to game Federal Medicaid payments. Medicaid regulations by CMS are efforts to provide clear guidance in critical areas where there have been well-documented problems and result from years of work on the part of CMS and myriad reports by the GAO and the Office of the Inspector General, OIG, at the Department of Health and Human Services, HHS. When CMS doesn't know how a State is billing for a service and States don't have clear guidance for how they should, neither Medicaid beneficiaries nor the taxpayers are well served. The Medicaid regulations fix that problem. According to the Congressional Budget Office, CBO, the regulations would save the Medicaid Program $17.8 billion over 5 years and $42.2 billion over 10 years by eliminating wasteful and fraudulent Federal payments to the program. The Federal Government will spend $1.2 trillion over the next 5 years on Medicaid, so the regulations save only about 1 percent of Federal spending on Medicaid. If Congress is afraid of taking on these very modest changes to Medicaid, does it really have the will to take on the special interests that is necessary to truly address entitlement reform? The very purpose of these regulations is to build accountability into the Medicaid Program that is long overdue. The proposed delay is a budgetary gimmick to avoid paying for the real costs of delaying the Medicaid regulations. CBO estimates that delaying the rules until April 1, 2009 would cost $1.65 billion. However, if the rules were withdrawn or permanently delayed--as it is likely they would be under the next administration-- the CBO estimates a 5-year year cost of $17.8 billion and a 10-year cost of $42.2 billion. Even if the regulations should be delayed, a war supplemental is the wrong place to include Medicaid policy changes. The war supplemental is given expedited consideration procedures because funding our troops is an urgent matter. The Medicaid regulations have been considered for years, and Congress has already put one 6-month delay on them. This isn't a new or urgent issue that justifies inclusion in a war supplemental. If ensuring that America's safety net programs are adequately funded is such an important issue, it deserves the full debate and consideration of the Senate. Burying a flat-out moratorium of Medicaid regulations on a war supplemental appropriations bill isn't being honest with the American people. Congressional leaders put a moratorium on the Medicaid regulations last year and are poised to do so again. If Congress truly opposes the regulations, then it should repeal them instead of pretending to ``study them'' a little longer. However, Congress is avoiding that kind of honesty because it will cost ten times the amount of a moratorium. Instead of blaming the Bush administration, Congress needs to decide for itself how it will address waste, fraud, and abuse in the Medicaid Program. The Bush Administration has taken its turn and taken a stand to protect the integrity of one of our largest entitlement programs. Now it is Congress's turn. This is no longer about the Bush administration. This is now about Congress. Congress needs to decide whether or not it will ignore years of GAO and HHS OIG reports. Congress needs to decide whether it will listen to their State Medicaid directors and Governors or whether it will safeguard taxpayer dollars. States have had their turn and demonstrated that they will take advantage of loopholes, ambiguities, and lack of clarity. Congress is the one ultimately responsible for these programs. Congress is elected to set policy and fund priorities. By imposing another moratorium, Congress is failing to live up to its responsibilities. Congress is running away from them. Congress has closed its eyes and ears to the abuses that have been going on. By stopping the regulations from going into effect, Congress is simply giving more sugar to a diabetic. It may feel good for a moment, but it is not good in the long run. Congress doesn't really need another year to deal with these issues. These abuses have been going on for a long time. The GAO and the OIG have been issuing audits and reports on the abuses for years. Problems with the regulations themselves warrant a conversation not a moratorium. There have been very few substantive policy disagreements with the administration's regulations. The Finance Committee hasn't engaged the administration on specific problems with the regulations. There have been no hearings over the last 6-month delay. The only ``hearing'' that has occurred is the parade of Governors and providers pleading to not turn off the funding. The rule to impose a cost limit on government providers--CMS-2258--is commonsense and good government. The cost rule saves $9 billion over five years and $22 billion over 10 years by ending creative State financing schemes. First, it requires that providers, like hospitals and nursing homes and physicians, receive and retain the total computable amount of their Medicaid payments for the services they provided. Why would Congress object to that? It seems simple that if you provided a service, you should get to keep the money. During the 1990s, States figured out creative ways to pass off their obligations to providers. That was wrong and unfair. Each time Congress stopped one financing practice, a new financing scheme popped up. In 1991, Congress cracked down on loopholes in provider taxes. States opened up new loopholes. In 1997, Congress cracked down on abuses in the disproportionate share hospital, DSH, payments program. In 2000, it tried to stop the abuses in upper payment limits, though it failed to close them completely. In 2003, the Bush administration put new emphasis on ending these schemes through the State plan amendment review process. This strategy proved to be effective and many States ended their ``recycling'' arrangements. But some States complained to Congress. In July 2004, Senator Baucus wrote the Administrator of CMS: As you know, and as I indicated to you in those conversations, I feel strongly that any new CMS policy on intergovernmental transfers (IGTs) must be implemented in a manner that is transparent, that is applied equally to all states, and that responsibly takes into account the potentially serious financial consequences of eliminating a source of state funding on which some states have a longstanding reliance. Based on my understanding of current law and practice, with respect to IGTs, and on my interest in promoting public confidence in government decision-making judgment that a rulemaking or legislative process is warranted in these circumstances. Accordingly, I urge you to develop rules or a legislative proposal as soon as possible on this issue. The current chairman of the Finance Committee requested Medicaid regulations nearly 4 years ago. The administration has responded to that request by promulgating regulations. As soon as the regulations left the desk of the CMS Administrator, Congress blocked them from going into effect LAST year. What has Congress done since then in the way of hearings or conversations with CMS? Nothing. What is Congress doing now? Trying to delay them again. Chairman Baucus is right about treating States equally; Congress needs to let CMS do so. It is ironic that hospitals are telling Members to stop the Medicaid rules. The policy of the cost rule is that providers should get to keep the full amount of Medicaid reimbursement paid for the services they deliver. Why should hospitals or other types of providers be forced to send part of their payment for services back to the State or local government? It is not their responsibility to fund the State's share of the cost of Medicaid. That is the responsibility of the State and local governments. Another major part of the cost rule seeks to limit government providers to cost. This has been a recommendation of GAO dating back to 1994. Under this provision, government providers would receive 100 percent of their costs for delivering services to a Medicaid recipient. But they would be limited to cost, they simply could not charge a ``profit'' to the Federal taxpayers. A government entity shouldn't bill the taxpayer for more than the cost of delivering a service. That is nothing more than Medicaid subsidizing non-Medicaid activities. If State and local officials decide not to fund a program, that doesn't mean the Federal taxpayer should pick up the tab. Congress may have heard pressure from their States about how the cost rule will ``shred the safety net.'' If Congress really cared about hospitals, shouldn't Congress be supporting the policy that they get paid in full? When this type of policy was put in place in California, revenues to hospitals increased by 12 percent. If Congress really cared about providers, there are other tax-relief policies that would be helpful to them. Provider taxes on hospitals, nursing homes, and others totaled $12 billion in 2007. The estimated savings for the cost rule for 2008 and part of 2009 is about $770 million. If you accept the argument that all providers in the entire country will ``lose'' $770 million if the cost rule goes into effect, consider that the hospitals in New York alone paid $2 billion in provider taxes. The hospitals in Illinois paid $747 million in provider taxes. If Congress really cared about them, what about a little tax relief instead? The real story is that States are using creative ``provider taxes'' to forego paying their share of the Medicaid Program. A few years back, Congress gave a special deal to Illinois supposedly to support the Cook County Hospital system worth about $350 million per year. The hospital is forfeiting more than $300 million in order to generate supplemental payments back to the State for this. If you add provider taxes and what Cook County Hospital is forfeiting, it totals a billion dollars per year impact on Hospitals in Illinois. Instead of addressing that blatant example of taxpayer money abuse, these rules are an easier target. Senator Baucus is right that the States should be treated equally. The Senate should instruct the Finance Committee to identify all of the special treatment situations and report legislation to get rid of them. The school-based administrative costs and transportation rule--CMS- 2287--ensures that Medicaid money goes for medical care--not school buses. First, those individuals and groups who have been scaring parents of a child with a disability that this rule will end their child's treatment need to hear the truth about what this rule does. Schools are required to provide such services and if a child is on Medicaid, Medicaid will continue to pay for medically necessary services. This rule ensures that Medicaid pays only for medical and medically necessary services. Medicaid administrative claiming among schools varies widely among States. There are many States that do not bill Medicaid for administrative activities at all. Much of the funding is concentrated in a small group of States. Abuses in administrative claiming have been well documented. Comments on the rule confirm that schools are simply using Medicaid as a source of revenue to support activities that are related to education, not health care. Medicaid reimbursement has been used for a wide variety of unrelated purposes such as instructional materials and equipment or to fund staff positions. Schools use funds to attend workshops and purchase educational technology and materials, even to support after school activities, arts and music programs. There is no problem with those types of programs, but there is a problem when Medicaid is paying for them. If citizens at the local level decline to raise their property taxes for education, that doesn't mean that Federal taxpayers should have to pick up the tab. If State legislators increase funding for transportation rather than education, Medicaid shouldn't be the means of easing the impact of their decision. Allowing schools access to open-ended funding of Medicaid with virtually no accountability will erode the decision making process of every school board, State legislature as well as the Federal Government. Another rule--(CMS-2279) would stop the use of Medicaid dollars-- intended for low-income people--going to fund training for doctors. There is no question that training the next generation of physicians in this country is important. However, it should be paid for out in the open. There needs to be accountability as to where the dollars go and for whom they are used. Under Medicaid's graduate medical education, GME, funding, there is no obligation on the part of physicians who are trained with Medicaid dollars to serve Medicaid patients once the physicians graduate. In contrast both the military and the public health service corps require time commitments as repayments for help with medical school. There is no authority in the Medicaid statute to pay for GME. It is not there. Congress and CMS don't even know the exact fiscal impact of this rule because states are not required to report expenditures as GME. If Congress wants to fund a training program for doctors serving poor people, it should be done out in the open with real program accountability. I understand concerns that CMS shouldn't just abruptly end the Medicaid GME program without a transition plan in place, but at the same time the Administration is right in questioning how this money is spent. If we are going to fund residency training, we should do it right and out in the open. The Targeted Case Management--CMS-2237--rule targets scarce Medicaid dollars. In the Deficit Reduction Act of 2005, Congress appropriately acted to end state abuses. The rule promulgated by CMS is designed to be person-centered, comprehensive, and demand accountability. CMS has been accused of overstepping its authority because it is applying the criteria across the board however case management is delivered. In other words, states cannot get around the rules by hiding under administrative claiming rather than actual services. And that applies to home and community based service waivers as well as State plan amendments. So the complaint is really this--CMS did not leave any loopholes open. There are generally three provisions that have drawn the most complaints about this rule. First, there is a complaint about charging Medicaid only for a single case manager. The message of this requirement is simple and sensible--if you are the case manager for a person with mental illness, you should be capable and qualified to deal with all sorts of issues like housing and employment as well as health care needs. Why should Medicaid pay for four or five different case managers? Case management by qualified professionals should lead to better outcomes for the individual and lower costs in the long run. If one case manager is too few, then let the Finance Committee figure out if it should be two or three or four. We don't need a 1-year moratorium to figure that out. This provision does not take effect for another year--without the moratorium--so there is no immediate impact on states. They have plenty of time to come into compliance. The second complaint is based on another accountability provision-- billing in 15-minute increments. This will help ensure that rates are appropriately set and that there is an audit trail. If 15 minutes isn't appropriate, then we can change the time allotment. We don't need an all-out moratorium on the rule to figure that out. The third common complaint is about limiting the period of time for which case managers can bill for transitioning an individual from an institution into the community. The rule provides that the transition period is the last 60 days of an institutional stay that is 180 days or longer. If 60 days is too short, then let us have the Finance Committee tell us what the right number is. The targeted case management rule was published December 4, 2007, nearly 6 months ago. That certainly is plenty of time for the committee to tell us how these three policies in this rule should be different. Delaying and delaying through a series of moratoriums only succeeds in throwing taxpayer dollars out the window. This rule is intended to fix another example of how States had incentives to transfer their obligations to the Medicaid Program's funding stream. States used Medicaid case management to fund their foster care systems, juvenile justice programs, and adult protective services. The State of Washington had used Medicaid to fund non-Medicaid activities. The State legislature has now done the right thing and appropriated $17 million to replace the reduced Medicaid funding after the TCM regulation was published. If the State legislators in Washington can live up to their obligations, why should we not expect that of the other States? Medicaid has become well known as the budget filler for States. If funding was short, find someway to call it Medicaid and State costs will be cut at least in half. This is a dangerous path. If Medicaid keeps picking up the tab for schools or foster care or the correctional system, then we are simply inviting even larger raids on the Federal Treasury in the future. A provision that will prevent health coverage for low-income children doesn't belong in a bill to provide funding for American troops. Hidden in a bill intended to provide funding for our troops at war is an unrelated provision that would have the effect of denying health care to low-income children. The provision would impose a moratorium on a CMS directive which requires that States cover low- income children before expanding their State Children's Health Insurance Programs SCHIP to higher income levels. This commonsense initiative, implemented in an August 17 letter from CMS to State health officials, ensures that children's health resources are targeted towards those children and families who need help the most. The result of the moratorium will be that States will be able to ignore the needs of low-income children and instead direct resources to families with higher incomes who are more likely to have existing health insurance coverage. SCHIP should focus on low-income children first. SCHIP was designed to cover low-income children between 100-200 percent FPL. Even though studies have shown that a significant number of children below these income levels remain uninsured, States have tried to expand coverage to higher income levels without first taking steps to make sure that they have covered as many low-income children as possible. Health coverage of low-income children must remain the number one goal of SCHIP. The CMS August 17 letter implemented reasonable steps to ensure that States focus on low-income children before expanding their program. The letter explains the steps that States must take to ensure that their SCHIP programs cover low-income children before expanding to higher income levels. The letter only applies to those States that wish to expand their SCHIP programs above 250 percent of the federal poverty level (FPL). CBO reported that fewer than 20 states offer coverage above this income threshold. Additional, on May 7 CMS issued a letter clarifying the August 17 letter and specifying that current enrollees would not be impacted and that the agency would work with States to show they are meeting the requirements. CBO showed that covering families at higher income levels is an inefficient use of taxpayer dollars. The CBO has repeatedly stated its views that expanding SCHIP to families at higher income levels will result in a ``crowd-out'' rate of up to 50 percent. That is, for every 100 children who gain coverage as a result of SCHIP, there is a corresponding reduction in private coverage of up to 50 children. The CBO estimates that 77 percent of children living in families with incomes between 200 and 300 percent of the FPL have private coverage, as do 89 percent of children in families with incomes between 300 and 400 percent of FPL. It is wrong to take away seniors' choices in hospitals, and it is wrong to do that on a war supplemental so it can't be debated out in the open. Americans enjoy the highest per capita GDP among large nations mainly because we have the highest rate of productivity gains. The hospital sector sorely needs productivity-enhancing innovations like specialty hospitals. U.S. health care costs are the world's highest at 16 percent of GDP, creating major problems for Americans and their employers. For example, General Motors' financial woes are exacerbated by $1,500 of health care costs per car, which exceeds their cost of steel. Hospitals are the largest component of our health care costs, accounting for over one-third of our $2.2 trillion health care system. They are also the major reason for the growth in costs. According to a recent article in Forbes Magazine, 1 in 200 patients who spend a night or more in a hospital will die from medical error. The same article continues: 1 in 16 will pick up an infection. Deaths from preventable hospital infections each year exceed 100,000, more than those from AIDS, breast cancer and auto accidents combined. Specialty hospitals have consistently offered high-quality health care with high-quality outcomes. Risk-adjusted 30-day mortality rates were significantly lower for specialty hospitals than for community hospitals, according to a 2006 Health Affairs article. There are 200 specialty hospitals in the U.S. out of the 6,000 hospitals overall, often delivering better, safer services at lower costs. According to a recent University of Iowa study, Medicare patients who receive hip or knee replacement at specialty orthopedic hospitals have a 40 percent lower risk of complications after surgery--(bleeding, infections, or death) compared to Medicare patients at general hospitals. A 2006 study funded by Medicare found that patients of all types are four times as likely to die in a full-service hospital after orthopedic surgery as they would after the same procedure in a specialty hospital. McBride Clinic in Oklahoma City is Oklahoma's best hospital for overall orthopedic services, according to the Tenth Annual HealthGrades Hospital Quality in America Study released last month. McBride has 5- star ratings in joint replacement, total knee replacement, hip fracture repair, spine surgery, and back and neck surgery. The hospital received HealthGrades' 2008 Orthopedic Surgery Excellence Award, and is the only Oklahoma hospital among the top five percent in the Nation for overall orthopedic services. When it comes to specialization, the question is not whether to specialize, but rather how to do it. Everyone agrees that the health care system should provide focused, integrated care--especially for the victims of chronic diseases and disability who account for 80 percent of costs. For example, Duke Medical Center tried an integrated, supportive program for congestive heart failure. The approach resulted in better patient outcomes, increased patient compliance with their doctors' recommendations, and a 32 percent drop in costs per patient. Hospital admissions and lengths of stay dropped and visits to cardiologists increased nearly sixfold. Some contend that physicians who invest in specialty hospitals have a conflict of interest that may lead to overutilization. But a recent study published in Health Affairs found that most physicians refer patients to specialty hospitals for reasons totally unrelated to profits. The Medicare Payment Advisory Commission, MedPAC, has also found no evidence that overall utilization rates in communities with specialty hospitals rise more rapidly than the utilization rates in other communities. MedPAC and the Centers for Medicare and Medicaid Services, CMS, have found no evidence that physicians who have an ownership interest in a specialty hospital inappropriately refer patients to that hospital or have increased utilization. The connection between corporate ownership and performance is a bulwark of our economy. Adam Smith argued in 1776: The directors of . . . [joint-stock] companies, . . . being the managers rather of other people's money than of their own, it cannot well be expected, that they should watch over it with the same anxious vigilance with which the partners in a private copartnery frequently watch over their own. Negligence and profusion, therefore, must always prevail . . . One CEO of an orthopedic surgery practice said: Orthopedists . . . in a hospital . . . work in the same operating room [as] general surgery and obstetrics. Orthopedics is nuts-and-bolts equipment intensive. It drives them crazy to have a staff that's not familiar with a tray of multi-size screws and nuts and bolts. Some object to specialty hospitals by arguing that they only select the most profitable cases in their area and leave the other hospitals with less profitable services--burn units, trauma centers, et cetera. MedPAC has recommended changing the payments for all acute care hospitals to reduce the incentives in the overall inpatient payment system that some believe fueled the growth of specialty hospitals. Based on those MedPAC recommendations, CMS has just implemented major In-patient Prospective Payment System reforms. There is also an abundance of evidence that community hospitals are making record profits. A recent news article reported: Profits for U.S. general acute-care hospitals hit a record high of $35.2 billion in 2006--a one-year jump of more than 20%--on net revenue of $587.1 billion for a margin of 6%. We should resist efforts to bind our health care system in regulatory straightjackets. Both the hospitals' and economy's problems could be solved if we allow the market, rather than insurance bureaucrats, to set prices. If the Members of the Senate really believe that specialty hospitals are harmful, then there shouldn't be earmarks protecting the specialty hospitals in home States of certain members of the Appropriations Committee. According to a recent Congressional Quarterly, CQ, article, during the committee process, four Democrats on the Senate Appropriations Committee made language changes to the underlying ban on new growth of physician-owned hospitals that happen to protect the specialty hospitals that are located in their home States. According to CQ: A spokesman for [one Appropriations Member] confirmed that [that Member] had sought the changes, to protect a physician- owned hospital in [their state]: Wenatchee Valley Medical Center. A loosening of the grandfather clause will allow the Wenatchee's physician-owners to maintain their 100 percent stake in the hospital, as opposed to being forced to sell part of it. According to CQ, spokesmen for [two other Appropriations members] confirmed their Senators' roles in getting the language changes. One Senator's spokesman claimed: We were concerned that forced divestiture would cripple the marketplace. In Michigan, the home State of another appropriator, physician-owned Aurora BayCare Medical Center would benefit from the looser rules passed by the Appropriations Committee. If Congress really believes specialty hospitals are harmful, why are they not harmful in the home States of four appropriators? The Congressional Budget Office needs to get its story straight on the budgetary impact of killing specialty hospitals. Congress has heard from the hospital association groups about the potential cost savings from eliminating the potential for new specialty hospitals. That argument is untenable when the Congressional Budget Office can't even get their story right on the budget impact. If 3 years ago, eliminating specialty hospitals barely saved anything how can it save billions of dollars today? During the drafting of the Deficit Reduction Act of 2005, the Senate reconciliation bill contained a similar provision to curtail specialty hospitals. At that time, the Congressional Budget Office, CBO, projected less than minimal savings to the Medicare Program resulting from that provision. Subsequently, CBO scored a similar provision in the Children's Health and Medicare Protection Act of 2007. This time they changed their story and projected Medicare savings of $700 million over 5 years and $2.9 billion over 10 years, with the bulk of the projected savings attributed to the assumption that Medicare spends more for outpatient services for patients treated in physician-owned hospitals. In December of 2007, CBO changed its story again and attributed the savings from restricting specialty hospitals to a presumed shift of services to ambulatory surgical centers, admitting that the use of fewer outpatient services accounts for only a small portion of the estimated savings. This bill has troops fighting to keep birth control prices low for Ivy League students and profits high for Planned Parenthood clinics and drug companies. Congressional leaders are using the war supplemental appropriations bill to expand preferential governmental drug pricing policies to university based clinics and more Planned Parenthood clinics than currently allowed under the Medicaid statute and regulations. To have their products available in the Medicaid Program, drug manufacturers must pay rebates to the Federal Government and States. The rebates are calculated as the difference between the manufacturer's average price and the ``best price''--lowest--at which their drugs are sold. A tiny provision tucked away in a war supplemental will allow drug manufacturers to avoid counting these deeply discounted drugs sold to certain types of clinics when calculating how much they will owe the Medicaid Program in rebates, thereby protecting their profits. If the provision becomes law, the clinics could receive cheaper drugs--like RU-486 and birth control--from manufacturers which they can sell to their customers at a higher price, thereby making a profit. Manufacturers previously offered high volume clinics the discounts as a marketing tool to attract long-term loyal customers so long as they could avoid the Medicaid rebate. Taxpayers were in effect subsidizing these clinics by forfeiting Medicaid rebates. In the Deficit Reduction Act of 2005, DRA, Congress limited the types of health care clinics that can benefit from this special arrangement, providing the preferential treatment only to certain safety net clinics. Not convinced by arguments that college campus health clinics are serving ``vulnerable populations,'' the Bush administration refused to add them and additional Planned Parenthood clinics to the list of providers designated by Congress. The Deficit Reduction Act didn't prevent drug manufacturers from selling their products at lower acquisition costs to any health clinic regardless of the DRA. They would not, however, be able to avoid counting those discounts when paying States and the Federal Government their respective Medicaid rebates. Auditors in California found two Planned Parenthoods had overbilled the Medicaid Program in excess of $5 million based on the difference between their customary fees and acquisition costs. This suggests that restoring these subsidies nationwide is likely worth hundreds of millions of dollars over just a few years. The current congressional leadership's usual approach towards drug companies is to get higher rebates from them. However, that's not the case when it comes to forfeiting rebates for the Medicaid Program in order to make certain frat boys and sorority sisters get cheap drugs-- including birth control--and the clinics that provide them get bigger profits. Instead of debating the merits of such a policy change in the open, the leaders in Congress are using funding for our troops to slip this through.

Mr. COBURN

Mr. COBURN. First of all, let me compliment the chairman and ranking member on this bill. They have made some tremendous strides in trying to fix this program. The one thing we have not done is we have not asked people in this country, who are in flood-prone areas, to actually be responsible. We are going to get about $17 billion and charge it to our grandkids because we have to get rid of some debt because the insurance program had not done in the past what we intended it to do. I believe you have fairly well fixed that for the future--my hope is that you have. I am not convinced of that yet. What this amendment does is requires FEMA and the Small Business Administration to withhold any Federal flood disaster payments and assistance to people who have not purchased flood insurance. These are people who reside in a 100-year flood plain zone, meaning that catastrophic flooding is expected to occur once every 100 years. These are known as special flood hazard areas. Owners of properties in these flood-prone areas are already required by law to have flood insurance. Yet what we have seen is, time and time again, they do not have it. So, in effect, even though there is a requirement for flood insurance to be there, they do not have it, so the cost, in terms of disasters, goes up for the Federal Government. The whole purpose behind this bill in the first place, when it was first initiated, was to lessen the cost of the American taxpayer in terms of disasters so owners of properties in these flood-prone areas are required by law to purchase flood insurance if they have a federally backed loan. This amendment would simply ensure that the law is enforced. I know this is a hard amendment because what we think about is what about those bad actors, what about those who do not--what we are doing to them. But actually we ought to think in the positive, that if, in fact, you are supposed to have flood insurance and you do not, how do we ever force everybody to do that unless there is a consequence? The consequence ought to be, if you did not follow the rules of purchasing flood insurance when you lived in a 100-year flood plain zone, a high- risk area, then you are asking the rest of the taxpayers not only to rebuild your home but to also give you the benefit of not paying a premium on flood insurance. Those people in those areas are actually taking advantage of the rest of the American taxpayers if, in fact, they do not follow the law. So this is simply saying: OK, here is the law. You have a federally backed mortgage. Your mortgagor is supposed to require that--as a matter of fact, it was fixed in 1994, I believe, that if you do not, they would. What we have seen in the last disasters is the owner did not, and the mortgage backer did not. Consequently, we had a large number of people who had no flood insurance. Now, all this amendment says is, OK, we are putting you on notice right now, if you have a federally backed mortgage and you are in a flood plain zone and you do not have flood insurance, you do not get the disaster relief. You do not get the grant. You do not get what everybody who follows the rules gets. The problem with not accepting this amendment is we will undermine the rest of the flood insurance program, the very good work that the chairman and ranking member did on this bill, because if there is no consequence to not following the law, not buying insurance, why will anybody buy the insurance? In other words, if we are still going to pony up the money, what is the incentive to get them to do that? I know the chairman and the ranking member are concerned about that. Some statistics are real important. On the repetitive loss properties, what we know is that 1 percent of the properties in this country over the last 15 years account for about 34 percent of all of the expenditures. In other words, they have been damaged time and time again. And the chairman and the ranking member have done a good job in terms of addressing how we fix that in the outyears. But when one-third of the money goes for 1 percent of the homes, something is very wrong. All this amendment is designed to do is to bring them forward so we lessen this amount. More than 50,000 of these repetitive loss properties have flood coverage right now but 61,000 do not; 61,000 of the repetitive loss properties have no flood insurance right now. So how do we make them do it? Where is the teeth to make them do it, other than to know that next time, unless they have flood insurance, they are not going to get the benefit the rest of the American taxpayers get in terms of helping them out of a jam. Ultimately, what this does is it incentivizes us to have people take risks that would not otherwise take risks because they know we have their back. All this amendment says is, be an adult; participate in carrying some of the risk. So when over 50 percent of the repetitive loss properties have no flood insurance, I would like to know how we are going to get them to get it under this bill if there is no teeth to make them do it. Now, I have every intention, as I have spoken to the chairman and the ranking member, of withdrawing this amendment. But my hope would be that in conference you would address this incentive issue because I believe right now there is a large incentive not to insure their property because we have their back and there is no hard penalty to do that. If in fact I have a home and it is one of the repetitive loss properties and I do not buy flood insurance, we have a hurricane or a storm and it is damaged and I know I can still get it fixed, why am I going to buy the flood insurance? Especially, let's say, I do not have a loan on it. Let's say I am down there. I am in a very high risk area. I do not have any loan on it and, to me, I know if I get a flood, no problem; the Government is going to back me up. So what we are doing is sending a signal to the people basically who have no mortgage: The rest of the American people are going to insure you for your flood. And I do not think that is right. I will ask unanimous consent to withdraw the amendment. I think the amendment would markedly strengthen what this bill is trying to accomplish. My hope would be that in conference, if you do not like my language, you at least put something into the bill that will have some teeth that forces good behavior and forces those who own the properties to actually have some responsibility for the properties. I am not against us helping to create an insurance market. I am not sure this is the best way to do it. But we have certainly made big strides to improve the bill. Amendment No. 4716 Withdrawn I ask unanimous consent to withdraw the amendment.

Mr. COBURN. I want the record to show I voted against the last supplemental because it was not paid for. No. 2, it had $27 billion of extraneous spending that was not paid for either that was offered by the Appropriations Committee. It has to start somewhere. I am OK with it starting with me. I don't earmark anything back to Oklahoma. I look at every appropriations bill and see if it is wise. So consequently, I vote for few appropriations bills because they are not wise, with the waste that is in the Federal Government. One final point. According to GAO, IGs, and the Congressional Research Service, we have $300 billion of waste a year in the Federal Government. The Congress didn't do anything about it. We have plenty of ways to pay for the war, pay for this, and do other things, if we do the hard work of oversight and make the hard choices about prioritizing what is important. But we find that very difficult to do as a body. I am worried that we find that because we are not thinking long term. We are thinking short term. I yield the floor and suggest the absence of a quorum.

Mr. COBURN. Mr. President, this is a great choice. We can prove to the American people we either really care about the budget or not. This violates pay-go rules. We shouldn't send $30 billion to our grandkids. We ought to take it from some of the excess we have today. I agree Senator Dodd and Senator Shelby have done a good job on this, but I don't think our grandchildren ought to pay because we designed a program in 1977 and modified it in 1994 and it still doesn't work and then have them pay $40 billion. We ought to enforce the pay-go rules, and we ought to come up with another way to pay for this money. I thank the Chair. I yield the floor.

Mr. COBURN. Mr. President, I thank Senator Dodd. I think when you fixed this in 1994 or 1997 is when you required the banks on the mortgage to have a notice and pay it and then add to it. But it obviously was not enough teeth to get us up to where we need to be. So I think we need something stronger than that. Overall--and this is no reflection on the good work that has been done on this bill but we have to ask ourselves--we are talking about $30 billion with this bill. That is going to actually go against the Treasury. We are going to have $17 billion that we are going to kiss off. We are going to say the people who are living in these flood-prone areas, because their insurance did not truly reflect--we did not have it spread broadly enough, $17 billion of it we cannot pay back, so we are going to forgive that. Well, what does forgiving that mean? What that means is we are going to take the money from the Treasury, we are not going to charge it to the National Flood Insurance Program, but someone is going to have to pay that off. And who is going to pay that off? It is going to be our kids. And there is almost $9 billion in interest that is going to be not paid off, so we are going to charge that to our kids. Then there is another $3 billion still, I understand, to come from the Katrina-Rita- related storms in terms of payments that are also going out. So what we are going to have is $30 billion, because the program was not actuarially sound in the past, that now we are saying to our kids and grandkids we are going to make actuarially sound, and they are going to pay. So what we are doing with this bill--and, again, it is not an indictment. You made a lot of headway, but there has to be another way to fix this rather than charge it to our kids. So when you take this $30 billion, on top of the 10 we have now and the $74 trillion that is coming, we have a significant debt in terms of being fair to the next generation. This bill underlies and forgives all the debt to the Treasury, and it translates into roughly $30.2 billion. That is how poorly the program worked in the past. Again, I think we have made major improvements to the bill. But I believe it is important enough for us to vote on whether we want to send another $30 billion toward our kids rather than make people who have homes in flood-prone areas who are getting the benefit from it pay for a portion of the cost. Mr. President, I make a point of order that the substitute amendment violates section 201 of S. Con. Res 21 of the 110th Congress and ask for the yeas and nays associated with that, according to however the chairman would like to schedule votes. I know he will make a motion to waive the point of order. That is expected. But I would like to have a vote on that, if I could.

Mr. COBURN. I ask unanimous consent that amendment be set aside and amendment 4716 be called up.

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

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

Mr. COBURN. What is the pending business of the Senate?

Mr. COBURN. I would like to make one more point. Politics is politics, but in the realm of politics the long term is what is getting ready to happen in this country because we are on an unsustainable course. I believe we have to be guardians for the future. And I believe in waiving the pay-go rules we are not doing that; that we are not a guardian for the future. If you think about $30 billion, you are asking every person in this country this year to pay an extra $100 because this program was not funded and arranged properly. What we also ought to consider is making sure we never do this again. And I would hope that when and if this budget point of order is waived the chairman and ranking member will put something in the bill that prohibits us from going back and ever waiving debt for this program again. He wants it actuarially sound, I know that. I know the ranking member wants it actuarially sound. But it is truly unfair, when we spend $28,500 per household at the Federal Government level and the median income in this country is $42,000 and we are already spending 70 percent of that at the Federal Government level and a third of it we are not paying for, we are borrowing from our children, to add on another $30 billion. What we are talking about is opportunity. We don't want to be tough enough now to not take opportunity away from our kids. So the choice is, can we have what we want now and it not hurt our children. The fact is, we can't. We are hurting our kids when we borrow, when we forgive this money. What we should be charging this money to is to the people who have benefited from the coverage. That is who ought to be paying for it. That is who got the flood insurance at a falsely low rate. My hope is that we think long term, not short term. I know you have done that to a great extent in the bill. But my hope is that somehow when you are in conference, that you might put some type of prohibition of ever waiving the debt again, to force the program to always be actuarially sound. If we could do that, we would not ever get to this point again. I know the chairman doesn't want us to get to where we are waiving this debt again, which will force the flood insurance program to be on the same footing as every other insurance company. I thank the chairman and ranking member for taking two of my amendments, one a study on reinsurance. The reinsurance we have right now is the American taxpayer. That is who is going to do the reinsurance this time of $30 billion. I am appreciative that they considered this and accepted it. I yield the floor.

Mr. COBURN. Mr. President, I suggest the absence of a quorum.

Mr. COBURN

Mr. COBURN. Mr. President, I ask unanimous consent that I be recognized following the Senator from Washington.

Mr. COBURN. May I inquire how much longer the Senator is going to be?

Mr. COBURN. Are you aware of the thousands of studies that have already been written on this subject?

Mr. COBURN. Mr. President, reserving the right to object.

Mr. COBURN. I am objecting not solely for myself. I am happy to work on trying to put together a proposal with the administration that would make a difference and then bring it to the floor.

Mr. COBURN. Two weeks.

Mr. COBURN. Mr. President, there is $38 billion worth of fraud in Medicaid. We are on an unsustainable course as a nation. We have $74 trillion worth of unfunded liabilities. When we talk about controlling spending and earmarks, we always hear it is a mandatory program. Finally, not all of what the administration has done do I absolutely agree with but on key points I do. These rules will make a difference. If we are interested in fraud, let's write the regulations to get out the fraud. That hasn't been the offer. All we are willing to do as a body is say to the administration you have ideas that will get rid of $42 billion worth of fraud over 5 years, but we don't like it because we are feeling pressure from the State Medicaid directors, when we know States game Medicaid. A great example: There is nothing in this to stop any Medicaid Program from taking a child from school to the doctor, but it does stop the 500-some-odd million dollars being spent on transporting schoolchildren back and forth to school who don't have a medical appointment. So what we have is a system that has been gamed. We have allowed it. Now the administration put something forward which we don't like and which we ought to negotiate with them to change, rather than saying you are not going to do any of it. The fact is the unfunded liabilities associated with the Medicaid Program are about $12 trillion. We are going to do something--just forget it. I applaud the administration for making an effort to try to fix some of this. But to say you cannot do any of it, when some of it is very badly needed, is wrong. So unfortunately, Mr. Leader, I have to object again.

Mr. COBURN. Mr. President, I wish to spend a few minutes answering the question as to why would one Senator, in the light of all the other Senators who have cosponsored this bill, stand and block a bill that 60 some Senators want to see passed? I think it is a great time for us to define what is wrong in our country today. What is wrong is we think about the next election far off and more often than we think about the next generation. I want us to cure breast cancer as badly as anybody else. The point Senator Reid did not tell you is we are already spending $100 million on this very subject, the environmental connection to breast cancer. We are also spending more on breast cancer research than we are any other cancer, and yet it is not the leading cause of death. We are going to have 160,000 people die this year from lung cancer, the same number who are going to die from breast cancer, 40,000 of which have no relationship to smoking, but you do not see anybody on the floor telling the NIH to do a study between the environmental effects and nonsmoking-related lung cancer. The reason it is important is a little example of penicillin. It is a great example. We stumbled onto that through the science of microbiology, but we would never have gotten there if we had told the NIH: Study scarlet fever and find a cure; study strep tonsillitis and find a cure; study syphilis and find a cure; study gonorrhea, and we had gone four or five different ways. The point I am making is basic research is what we ought to be doing. In the mid-nineties, I was one of the strong advocates for increasing the size of the NIH budget. It ought to be twice what it is today. The reason it is not $60 billion a year instead of $29 billion is because we will not fix the waste in Medicaid of $42 billion over 5 years, we will not fix the $90 billion in fraud in Medicare, we will not fix the $8 billion that was paid out by the Pentagon for performance bonuses that nobody earned last year, we will not fix the $50 billion that is associated with waste within the Pentagon. Nobody will fix it. We had one wheelchair that was sold multiple times for $5 million to Medicare in Florida alone--one wheelchair. We will not do the hard work that creates the long-term best interest for our country, but we will certainly respond to--granted, very real issues, but in an inappropriate way that does not get us where we want to go. The NIH budget spends more on breast cancer research than any other research. We are going to spend $100 million on research on the link between breast cancer and the environment. Plus, the Defense Department is going to spend another $138 million, and the Centers for Disease Control and Prevention combined is greater than $1 billion. There is not any other disease we do that on right now. Yet we are going to tell them to do more of the same they are already doing, and we are never going to think about the other people with other diseases, the other 2,037 diseases that are not as well organized and have nowhere close to the same investment at NIH. The point is, the hardcore, heavy-duty, peer-reviewed science ought to guide us, not emotion, not my poor cousin Sharon Wetz who died 6, 7 years ago of breast cancer, not my sister who has breast cancer, not my sister-in-law who has breast cancer. What we ought to be doing is what is in the best overall good for this country as a whole. And if we need to spend more money on breast cancer, then the way to do that is to get rid of some of the waste and double NIH, but any dollar we spend on breast cancer is a dollar we are not going to spend on colon cancer, it is a dollar we are not going to spend on thyroid cancer, it is a dollar we are not going to spend on lymphoma, because we are going to take it away. In this bill, it says this should not interfere with peer-reviewed research. If that is the case, then this will never get appropriated. So either this bill is about doing research or it is about a press event for a politician. I will tell you, I think it is the latter. In 2006, we modernized the NIH to keep exactly this thing from not happening. We took away all the silos. We gave the Director the power and the authority to start making great decisions based on what the raw science was telling him so when we invest in raw science, we magnify the potential benefits that come from it. Now we are going to go back and say we are going to start picking diseases; we are going to start managing it. Why do we need a staff at NIH? Let's let the Senate pick every disease and how much we are going to spend on every one of them; we obviously are qualified. We are not qualified. I find it amazing--I do not doubt Senator Reid's story, but as a surgical resident in 1984, I was doing cystoscopies and diagnosing interstitial cystitis. We didn't think it was psychosomatic. We knew it was a real disease 3 years before Senator Reid came to the Senate. The question politicians ought to be asking is what is NIH doing? Where is the oversight on what they are doing? Find out what they are doing. How does their work rank in comparison to the other disease initiatives at NIH? We have not had a hearing on that issue. The HELP Committee has had hearings on multiple speciality disease bills. So we are back into answering a real need, but maybe it is not the best priority. What if we spent the same money we are going to spend on this disease and we got a breakthrough that cured all cancers, but because we decided we were going to reconnect with one specific aspect of one potential risk for one cancer, we missed it? The wisdom of this body has to be to think in the big picture and in the long term. I have diagnosed breast cancer over 500 times in my medical practice. It is a gut-wrenching, life-changing disease. Fortunately, we have had great improvements in it and our diagnostic skills are getting better, especially with digital MRI on breast examination. Early diagnosis has an impact, but what we do and how we do it is going to matter. I will put forward that Senator Reid can bring this bill to the floor, and if he brings it and we take the time--and I am more than happy to take 4 or 5 days to talk about how we should work at NIH, and I am happy to do that--and the bill will pass, but then are we going to do the same thing with every other disease the HELP Committee brought out? There are about eight other bills just like this bill. We are going to tell NIH: You have to spend this money here, you have to do it here. Regardless of what the raw molecular science says, regardless of what the peer-reviewed literature says, we are going to tell them what to do. Consequently, we are going to delay scientific discovery. My opposition is not that I don't want to cure breast cancer. My opposition is not that I don't want us to find a cure. I want to find a cure for all of them. I am a two-time cancer survivor. I would love to prevent colon cancer. I don't like walking around with half a colon. There are a lot of consequences to it. I don't like having melanoma and having half my neck taken away. I don't like it, but I don't want colon cancer to displace possible cures for everybody and in the best interest of this country. Will I object? Every time I come to the floor I will object because I think the ultimate underlying policy is wrong. The way we solve breast cancer in this country is double the NIH funding and let science drive the way we need to go. The way we double NIH funding is get rid of the $300 billion waste, fraud, and abuse that is in the discretionary budget every year which most of us don't have the courage to attack because it might gore somebody's ox. To those who have breast cancer, as a physician and somebody who has been through cancer, I know your fear. I have been there. I have experienced the questions. I have experienced the chemotherapy. I have experienced the losing of 30 or 40 pounds. I have experienced the nausea and vomiting that is persistent with you for 4 or 6 months. Most of all, what I have experienced is, we have a great health care system and great research in this country that is saving a lot of lives. If we will get our hands out of it as politicians, they will be able to save a whole lot more lives than when we put our hands into it and tell them what they must and shall do. I thank the good Lord for the time he has given me. I am 5 years out this month from colon cancer. There is no guarantee, but while I am alive, I am going to do things that are in the best long-term interest of our research for health care, that give us the most life for the dollars that we invest. If that is pleasing politically, great. If it is displeasing politically, it is OK too. What is important is we are good stewards--not just with the money but with the direction to allow science to lead us to cures. I yield the floor. Mr. President, I suggest the absence of a quorum.