Kent Conrad

Mr. CONRAD

Mr. CONRAD. Mr. President, I call up the Conrad-Gregg amendment.

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

Mr. CONRAD. I thank my colleagues for this opportunity to present our amendment.

Mr. CONRAD

Mr. CONRAD. I ask for the yeas and nays.

Mr. CONRAD

Mr. CONRAD. Mr. President, I wish to begin by recognizing the work on this legislation of Leader Reid, Chairman Baucus, Chairman Harkin, and Chairman Dodd. I believe, when the history of this bill is written, it will be recognized what a remarkable job of leadership Senator Reid has provided, bringing together a disparate caucus around extraordinarily complex issues to accomplish something that will be seen in the future as a leap forward for America in reforming the health care system in this country. Chairman Baucus--no one has made a deeper, more committed, personal sacrifice than Senator Baucus in advancing this legislation. His commitment to getting this bill done and getting it done right will stand the test of history. Chairman Harkin, who succeeded Chairman Kennedy, made major contributions on the wellness provisions. Chairman Dodd, who filled in for Chairman Kennedy and continued in the role of handling this legislation, even while being chairman of the Banking Committee, provided an example of legislative leadership that is unmatched. The four of them have done a superb job in putting together the pieces of the bill that I believe will lead the way to a dramatically improved health care system in our country. If we reflect, objectively, on the package before us, it is an entirely reasonable and responsible approach. There is no government takeover of health care, no rationing, no cuts to guaranteed Medicare benefits, no benefits for illegal immigrants, and the bill sets a goal of no taxpayer funding for abortion beyond the Hyde amendment provisions in current law. In fact, this bill does much of what Republicans said they want in a health care plan. It is fully paid for, and it reduces deficits in both the short and the long term. It expands coverage and provides assistance to help families and small businesses afford health insurance. It sets new rules to stop insurance company abuses. It reforms the delivery system to control costs and improve quality. It allows for the sale of insurance across State lines. It supports medical malpractice reforms. Those are facts. Every one of those elements is in this bill. This is an approach that Senators on both sides of the aisle, who want solutions rather than slogans, should embrace. The need to act is clear. The status quo is simply unsustainable. Health care costs are crushing families, businesses, and even the government. The premiums for individuals and families are rising three times as fast as wages. You can see where we are headed. It is as clear as it can be. Without action, families will see average health care premiums rise to $22,000 a family by 2019--$22,000, on average, for family health care premiums in 2019, unless we act. It does not stop there. Premiums, as I have indicated, are skyrocketing, and national health care costs are skyrocketing right along with them. Without action, total health care spending will equal 38 percent of the gross domestic product of the country by 2050. Thirty-eight percent of the gross domestic product for health care? That would be one in every two and half dollars in this economy. Already, we are consuming one in every six in this economy on health care, and that is an unsustainable course. These costs are driving our long-term fiscal imbalances, threatening our future economic prosperity. Without action, Federal spending on Medicare and Medicaid will reach 12.7 percent of GDP by 2050. This chart I have in the Chamber makes it very clear. In 1980, the two programs were consuming 2 percent of gross domestic product, but on the current trend line, by 2050, these two-- Medicare and Medicaid--will consume more than 12 percent of our GDP-- one in every eight dollars in our economy. The growth in health care costs threatens to bankrupt Medicare. Medicare went cash negative last year. Without action, Medicare will be bankrupt in 2017. The trustees have just told us that will happen. That is 2 years earlier than forecast just last year. Again, Medicare went cash negative already. That means more money is going out than is coming in, in the Medicare accounts, and it will be insolvent--broke-- in 8 years. This legislation extends its life by 9 years. These health care costs are hurting our competitive position in the world. We are spending far more than other countries on health care, leaving less money for research and development, investment, and higher wages for Americans. In fact, as a percentage of our gross domestic product, we spend twice as much as most other advanced countries. Here it is, as shown on this chart. We are now even higher than 16 percent of our GDP. The latest numbers indicate we have gone to 17 percent of our GDP for health care. That is one in every six dollars. Look at other countries. Japan and the United Kingdom are half as much; Belgium, Germany, Switzerland, France, a little over half as much as we are paying. But even with the fact that we are spending more, we are actually performing worse on virtually every metric on health care outcomes. We are ranked 19th in preventable deaths, 22nd in infant mortality, 24th in life expectancy; and we still leave 46 million people without insurance. Continuing the status quo is not an option. America can do better, and this bill proves it. The bill before us is fiscally responsible. The nonpartisan Congressional Budget Office--the official scorekeeper, relied on by both sides of the aisle--tells us the bill reduces the deficit by $130 billion over the first 10 years. Now, those aren't my numbers, those aren't the numbers of the chairman of the Finance Committee, those aren't the Democratic leader's numbers. Those are the numbers of the nonpartisan Congressional Budget Office. They say this bill will reduce the deficit by $130 billion over the first 10 years. The savings in the following decade are even more impressive: between $650 billion and $1.3 trillion. The Congressional Budget Office says: All told, CBO expects that the legislation, if enacted, would reduce Federal budget deficits over the decade after 2019 relative to those projected under current law--with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of gross domestic product. One-quarter and one-half percent of GDP for that second 10 years is $650 billion to $1.3 trillion. Shame on those who get up on the other side and say this is going to increase the deficit. Where is their evidence, other than claims, other than assertions? We are talking about the considered judgment of the Congressional Budget Office that is nonpartisan and is the official scorekeeper for the Congress of the United States. The bill bends the cost curve for the Federal commitment to health care in the long term. In its December 19 estimate, CBO reports that the proposal would generate a reduction in the Federal budgetary commitment to health care during the decade following the 10-year budget window. So, yes, it bends the cost curve for the Federal expenditure during that period. This legislation also reforms the insurance market. We have all heard the horror stories. I have loads of letters in my office from constituents telling me about what has happened to them: being dropped because they got sick, even after paying years of premiums; being denied coverage because of preexisting conditions, in many cases preexisting conditions that had nothing to do with the illness for which they now need assistance; and being denied even though they have paid the premiums. This is serious business. This bill puts a stop to these abuses. It prohibits insurers from denying coverage for preexisting conditions on new policies. It prohibits insurers from rescinding coverage when people become sick after they have paid premiums for years on new plans. It bans insurers from lifetime caps and annual limits on health care benefits, and it prevents insurers from charging more based on health status. It also expands choice and competition. The bill before us builds on our current market-based system and makes it better. It is not government-run health care. Instead, it embraces choice and competition. It sets up a new health exchange where consumers can shop for the best value. It creates consumer-run, co-op health plans not government-run plans but plans run by the members. It allows for insurance sales across State lines to further increase competition. The managers' amendment also creates a new national plan. The Office of Personnel Management, the same agency that currently oversees health plans for all Federal employees, including Members of Congress, would select private health insurance carriers to offer plans that would be available nationwide. These plans would provide new competition for State-based health plans, particularly in areas where just one or two insurers currently dominate the market. At least one multistate plan would have to be a not-for-profit insurer, such as one of the newly created co-ops. I am particularly excited by this development. When we look around the world at the countries with the best outcomes and the lowest cost, one feature stands out: these countries rely on primarily not-for-profit insurance. Germany, France, Switzerland, Belgium, Japan, all have adopted this model. They don't have government-run health care, but they do have universal coverage. They do have extremely high-quality health care outcomes and much lower costs than we do. So I believe the not-for-profit national plans and the co-op option may, in the long run, play a key role in transforming our system into a more efficient, higher quality system. This legislation also expands coverage. According to the Congressional Budget Office, it covers 94 percent of the American people. It creates State-based exchanges for individuals and small businesses. It provides $476 billion in tax credits to help working Americans and small businesses buy coverage. You don't hear that much from the other side about this $467 billion of tax assistance for people to afford better health care coverage. It also reforms the delivery system to focus on quality and not quantity. The bill before us slows cost growth while improving quality. The sad fact is that 30 percent of current health care spending does nothing to improve health care outcomes. We are wasting about $750 billion a year on unnecessary and counterproductive procedures. Again, that is not a congressional estimate; that comes from a Dartmouth nationwide survey that concluded 30 percent of health care expenditure in this country is wasted. This bill reforms the delivery system in a fundamental way. It contains every delivery system reform health care experts believe is needed to provide better care while slowing cost growth. This proposal also extends the solvency of Medicare. Medicare's actuary says the Senate bill extends the life of Medicare by 9 years. Some on the other side say that because Medicare is heading toward insolvency, we can't have Medicare savings. What? What are they talking about? Perhaps the oddest thing I have seen in this debate is the contrast with the last year of the Bush administration. The previous administration sent up a proposal to have nearly $500 billion in savings under Medicare, and we didn't hear one peep from the other side, not one. In fact, they all said it was critically important to do. Now all of a sudden it is the death of Medicare. What is even more bizarre about their argument is that now there is an offset for the savings from Medicare providers. The offset is they are going to get 30 million new customers, 30 million Americans who haven't had insurance who will now have it so their uncompensated care costs will go down, making it more affordable for providers to provide these savings. Most of these savings have been negotiated with providers. Why have they been willing to agree to savings--hospitals, nursing homes, and home health care? It is because they know they are going to get substantially expanded business--30 million customers with insurance who previously did not. This is important legislation. These Medicare reforms don't hurt seniors. Some on the other side have said you can't reduce the growth in Medicare costs without taking benefits away from seniors. That is just scare tactics. The Medicare savings provisions lower cost growth without harming beneficiaries. This legislation also helps my State. I am proud to say it. Some have said the Medicare changes will hurt North Dakota providers. Clearly, they haven't read the bill. Right now, we get paid way below the average for Medicare reimbursement. In fact, we are the second or third lowest State in the country in Medicare reimbursement. North Dakota providers get $5,000 a year per Medicare beneficiary. In Miami, they get three times as much, more than $16,000 a year to take care of seniors there. Now I would be the first to say it may cost more to provide medicine in Miami than it does in Minot, but it doesn't cost three times as much. The fact is, moving to a system that is based on outcomes rather than procedures will benefit, not hurt, a State such as North Dakota. In addition, this legislation includes the frontier States provision that Senator Dorgan and I offered as an amendment. Our provision puts a floor under payments to North Dakota providers and in other States like ours that are rural States that have not received fair levels of reimbursement. It will mean an additional $66 million a year in Medicare payments to my State. Overall, this bill is a win for North Dakota, a win for the Nation. It reduces the deficit, it controls costs, it saves Medicare--or at least extends its life for at least 9 years--it embraces choice for American consumers and competition and expands coverage. It reforms the insurance industry, and it rewards quality and efficiency. This legislation is an excellent start. I urge my colleagues to allow it to continue because we all know this isn't the last step. Next we go to the conference committee where we will have a chance to write the final legislation. No doubt this bill will be further improved as it has been at every step of the process. Again, let me conclude as I began by thanking the leadership who has made this bill a possibility: Senator Reid, who has done a remarkable job of bringing people together; Senator Baucus, who has spent more than a year and a half in as dedicated an effort as I have ever seen by a committee chairman in this body to bring major legislation to conclusion; Senator Dodd, who filled in for Senator Kennedy on a pinch hit basis but worked so hard to produce a result in that committee; and Senator Harkin, the new chairman of the committee, for all of his assistance in getting the job done. When the history of this legislation is written, those four will be recognized as producing something that was critically important for this country. We should salute them. I thank the Chair and yield the floor.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 301(a) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, aggregates, and other appropriate levels and limits in the resolution, and make adjustments to the pay-as-you-go scorecard, for legislation that is deficit-neutral over 11 years, reduces excess cost growth in health care spending, is fiscally responsible over the long term, and fulfills at least one of eight other conditions listed in the reserve fund. I have already made two adjustments pursuant to section 301(a). The first adjustment was on November 21, for S.A. 2786, the Patient Protection and Affordable Care Act, an amendment in the nature of a substitute to H.R. 3590. The second adjustment was on December 1, for S.A. 2791, an amendment to S.A. 2786 to clarify provisions relating to first dollar coverage for preventive services for women. The Senate today adopted S.A. 3276, an amendment to S.A. 2786 to improve the bill. I find that in conjunction with S.A. 2786, as modified, that this amendment also satisfies the conditions of the deficit-neutral reserve fund to transform and modernize American's health care system. Therefore, pursuant to section 301(a), I am further revising the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Finance Committee. Along with those adjustments, I have also adjusted the aggregates and committee allocation to reflect changes to the original score of S.A. 2786 as a result of a provision included in H.R. 3326, the Department of Defense Appropriations Act, 2010. That provision uses savings also counted in the score of S.A. 2786. In total, as a result of Congress clearing H.R. 3326 on December 19, the amount of savings in S.A. 2786 is $1 billion lower over the 2010-2014 period. I ask unanimous consent to have printed in the Record the following revisions to S. Con. Res. 13.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, permits the Chairman of the Senate Budget Committee to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974, and aggregates for legislation making appropriations for fiscal years 2009 and 2010 for overseas deployments and other activities by the amounts provided in such legislation for those purposes and so designated pursuant to section 401(c)(4). The adjustment is limited to the total amount of budget authority specified in section 104(21) of S. Con. Res. 13. For 2009, that limitation is $90.745 billion, and for 2010, it is $130 billion. The Senate is considering H.R. 3326, the Department of Defense Appropriations Act, 2010. That legislation includes amounts designated pursuant to section 401(c)(4). Since this is the last of the 12 regular appropriations bills for 2010, I am revising previous adjustments made to the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays to reflect the final amount of designations made pursuant to section 401(c)(4). When combined with all previous adjustments, the total amount of adjustments for 2010 is $130 billion in discretionary budget authority and $101.178 billion in outlays. In addition, I am also further revising the aggregates for 2010 consistent with section 401(c)(4) to reconcile the amount of outlays estimated by the Congressional Budget Office for designated funding with the amount originally assumed in the 2010 budget resolution. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, was there a time reserved for a colloquy between myself and the Senator from New Hampshire?

Mr. CONRAD. Mr. President, the reason we are here on the floor is our understanding was we had time reserved at 10:30 for a colloquy between the Senator from New Hampshire and myself.

Mr. CONRAD. Do the Republicans have 10 minutes remaining for Senator Gregg?

Mr. CONRAD. I thank the Chair. I thank our colleagues. I especially thank our colleague, the Senator from Wyoming, and our colleague from Connecticut. Thank you for your courtesy. We appreciate it very much. Mr. President, this is a headline from Newsweek, December 7. In fact, it was the cover story: ``How Great Powers Fall. Steep Debt, Slow Growth, High Spending Kill Empires--and America Could Be Next.'' If you go to the story--by the way, interestingly enough, this was on December 7, Pearl Harbor day. If you go into the story that is in the magazine, it says: This is how empires decline. It begins with a debt explosion. It ends with an inexorable reduction in the resources available for the Army, Navy, and the Air Force. If the United States doesn't come up soon with a credible plan to restore the Federal budget to balance over the next 5 to 10 years, the danger is very real that a debt crisis could lead to a major weakening of American power. All we have to do is look at the facts. This shows the debt of the United States from 2001 projecting to 2019. Obviously, the first half of this chart is not a projection. It has already happened. We are approaching a debt that is 100 percent of the gross domestic product of the United States, the highest the debt has been since after World War II and the only time in our Nation's history it has been that high. The projection is by 2019 the debt will be high. The projection is by 2019 the debt will be 114 percent of the gross domestic product of the United States. More alarming, the long-term outlook of the Congressional Budget Office says we will have a debt that will reach 400 percent of the gross domestic product of the United States by 2050 on the current trend line. No one believes that is a sustainable circumstance. We have had testimony from the head of the General Accounting Office, the Congressional Budget Office, the Secretary of the Treasury, and the Chairman of the Federal Reserve all saying this is a completely unsustainable circumstance. The Congressional Budget Office said this in June of 2009: The difficulty of the choices notwithstanding, CBO's long- term budget projections make clear that doing nothing is not an option. Doing nothing is not an option. The National Journal, in an article entitled ``The Debt Problem is Worse Than You Think'' said this in a story just weeks ago: Simply put, even alarmists may be underestimating the size of the debt problem, how quickly it will become unbearable, and how poorly prepared our political system is to deal with it. I hope people are listening. I hope they are paying attention. I hope our colleagues are. Yesterday a group of us introduced legislation to confront this debt threat head on. There are now 31 cosponsors of that legislation: 19 Republicans, 12 Democrats. This legislation offers the following: to address the unsustainable long-term fiscal imbalance; that a task force should be created with everything on the table. It would consist of 18 Members: 8 Republicans from the Congress, 8 Democrats from the Congress, and 2 representatives of the administration. All task force members must be currently serving in Congress or the administration so they are accountable to the public. If 14 of the 18 Members could agree on a report, that report would come to Congress for a vote. There would be no filibustering, a straight up-or-down vote on the recommendations. The report would be submitted after the 2010 election to insulate it from politics. And, the vote would be designed to occur before the end of the 111th Congress. It would receive fast-track consideration in the Senate and the House. There would be no amendments. It would be a straight up-or-down vote. A supermajority of the House and the Senate would have to vote for it, and the President would retain his ability to veto. This is legislation that is designed to get to the floors of the House and the Senate, legislation to deal with our long-term debt threat, to face up to it. All of us know that with a problem, the sooner you deal with it, the less draconian the solutions need to be. For those who say this poses a threat to Social Security and Medicare, the opposite is true. A failure to act is what threatens Social Security and Medicare. The trustees of Medicare have told us Medicare will go broke in 8 years. They have also told us Medicare is cash negative today. That means more money is going out than is coming in. The same is true of Social Security today. It is cash negative. Now is the time. We are the ones who have an opportunity to help our country face up to a critical threat to the economic security of America. Some suggest the bill before us on health care is an example that the regular order will deal with this problem. Again, I believe the reverse is true. I believe the health care bill before us does modestly deal with the deficit and debt--modestly. But it doesn't come close to dealing with the debt bomb I have outlined. In fact, the reality is, we are on a course that is absolutely unsustainable. It is our responsibility to face up to it. In our past, we have chosen special processes, commissions, a summit, or some other special process to deal with fiscal challenges because we have learned, in our history, that going through the regular process and regular order is simply not going to succeed. I have been here 23 years. I am on the Finance Committee. I am chairman of the Budget Committee. I have been on those committees for many years. If there is one thing that is absolutely clear to me, it is the regular order cannot and will not face up to a crisis of this dimension. It is going to take a special process, a special commitment of the Members and representatives of the administration to develop a plan that gets us back on track. It is going to take a special process to bring that plan to this floor for a vote up or down. That holds, I believe, the best prospects for success. I believe this is a defining moment for this Chamber, for this Congress, for this administration. It is imperative that we find a way to deal with this debt threat. It poses one of the most dramatic challenges to American economic strength that we have confronted in the history of this country. It is time to stand and be counted. Thirty-one of us have sent forward a proposal--a bipartisan proposal--that would assure a vote on a plan to bring America back from the brink. Let's give it a chance. I thank the chair, and I especially thank the ranking member, Senator Gregg, for his energy, his commitment, and his devotion to facing up to, I believe, one of the greatest challenges confronting America. I yield the floor.

Mr. CONRAD. Mr. President, how much time remains of the 20 minutes?

Mr. CONRAD. How much on my side?

Mr. CONRAD. Let me sum up by saying this: I have been here 23 years. We saw the debt double in the previous 8 years. We know the debt is scheduled to more than double over the next 8 years if we fail to act. That will be a debt, as I indicated earlier, of well over 100 percent of the gross domestic product of the United States. The Congressional Budget Office tells us, on the current trend line, we are headed for a debt that will be 400 percent of the gross domestic product of the United States. That is absolutely beyond the pale. We know, from every serious expert who advises the Congress of the United States, we can't go there. We can't possibly be on a course to have a debt that is 400 percent of the gross domestic product of the country. The question is, What do we do about it? There are some who say: Well, you stick with the status quo approach. It hasn't worked so far. Why is there any reason to believe it will work now? I would say the health care legislation before us is a perfect example. The President had a health care summit; he had a fiscal responsibility summit. At those summits, it was asserted--and I think it was well intended--that health care reform would deal with a major part of the debt projection facing us. Well, here we are. My belief is, this bill does modestly reduce the deficit in the short- and long-term. But it in no way deals with the trajectory that is headed for a debt of this country of 400 percent of the GDP, because when you are in this circumstance, the regular legislative process cannot face up to short-term pain in exchange for long-term gain. It will not do it. This is our opportunity. We must act. I thank the Chair.

Mr. CONRAD

Mr. CONRAD. Madam President, I thank the distinguished chairman and I thank the Acting President pro tempore. I come to the floor to respond to some of the things I have heard over the last several days with respect to the legislation before us and to try to give--in some cases--the other side of this story because I am increasingly concerned, as I listen to this debate, that people have started to create their own facts, and that is never useful in a debate. Let me start with an ad that is running--a full-page ad--back in my home State of North Dakota, with the headline: Isn't Senator Conrad Supposed to be a ``Deficit Hawk?'' It starts by saying some nice things about me. It says: Senator Kent Conrad has a long, admirable record as a deficit hawk. For years, he has advocated for fiscal sanity and smaller deficits, and he has served North Dakota well. I wish they would have just ended the ad there. That would have been a very good ad. But they go on to say: Now, federal spending is totally out of control: And they give some examples. Then they say: On top of all this, Congress is considering a new $900 billion health care entitlement, with some estimates saying it could actually cost more than $2 trillion! Well, the $2 trillion number is a number that somebody has concocted. That is not the 10-year cost of this bill. The 10-year cost of this bill is between $800 billion and $900 billion, as the ad says. Then they go on to conclude: America can't afford it. And North Dakotans can't afford it. Of course, this ad is not paid for by North Dakotans. But they are clear that: ``North Dakotans can't afford it.'' Senator Conrad: how can you even consider this? ``How can you even consider this?'' Well, because I have read the bill, and this bill does not increase the deficit; this bill reduces the deficit. That is not my opinion as chairman of the Budget Committee. That is what the Congressional Budget Office--which is nonpartisan, which is the objective scorekeeper--they are the ones we look to for analysis of legislation before Congress. Objective analysis--not made up analysis. Here is their conclusion. This is the Congressional Budget Office estimate of the Senate health plan, the legislation that is before us now. It reduces the deficit over the budget period by $130 billion. It does not increase the deficit, despite all the speeches that have been given. It reduces the deficit by $130 billion. Our colleagues get different numbers because they come out here and say: Well, if this part of the bill were not included, it would increase the deficit. But that is not the bill. The bill before us has been analyzed by the Congressional Budget Office, and they say the bill before us--the one we will be voting on--reduces the deficit by $130 billion in the first budget window. In the second budget window--the second 10 years--the Congressional Budget Office says: CBO expects that the bill, if enacted, would reduce federal budget deficits over the ensuing decade [beyond 2019] relative to those projected under current law--with a total effect during that decade that is in a broad range around one-quarter percent of [gross domestic product]. What is one-quarter of 1 percent of gross domestic product in the second decade? It is $650 billion. If you take, then, in total what the Congressional Budget Office is telling us to 2019--the first 10 years-- it reduces the deficit by $130 billion. In the second 10 years, it reduces the deficit by one-quarter of 1 percent of GDP, which is equal to $650 billion. So to my friends who ran this ad in every newspaper in my State, wondering why a deficit hawk might support this legislation, it is because this legislation reduces the deficit, both in the first 10 years and in the second 10 years, according to the Congressional Budget Office. That record should be clear. Do we have a problem long term? Absolutely, we do. As this chart shows, Medicare and Medicaid combined are going from 2 percent of GDP, back in 1980, to 12.7 percent of GDP on the current trend line by 2050, and that is an unsustainable course. I think we all understand that. Medicare and Medicaid are increasing very dramatically as a share of our gross domestic product, and they are a key reason we are seeing the gross Federal deficit expand, and expand dramatically. We now project the gross Federal debt to be 114 percent of the gross domestic product in 2019. That is almost as high as it was after World War II, which is the previous record in this country. Already we are approaching 100 percent of GDP with the economic downturn and with all the pressures that exist with two wars and a very sharp reduction in revenue in this country. The reality is, for those who say we do not have to do anything, Medicare is going broke. It is already cash negative; that is, more money is going out from Medicare than is coming in under the revenue sources of Medicare. The trustees tell us it will be insolvent by 2017--2 years earlier than forecast just last year. So those who say we do not have to do anything--just steady as she goes, the status quo is fine--are detached from any financial reality. The bill before us has significant Medicare savings: provisions that lower cost growth without harming beneficiaries. Let me give some examples. In the legislation before us, we reduce overpayments to private Medicare Advantage plans. We reform the health care delivery system. By the way, this is the provision that most experts say is the single most important component of this legislation, and it has gotten almost no attention in this debate. It has gotten almost no attention in the media--reforming the delivery system so instead of paying for procedures, we pay for quality outcomes. We incentivize those integrated systems such as the Mayo Clinic, such as the Cleveland Clinic, such as Geisinger in Pennsylvania and Intermountain Healthcare out in Utah that have much lower cost and the highest quality outcomes. We are going to, for the first time, provide major incentives for other systems to adopt their good practices. This is what health care reformers say are really the most important parts of the legislation. We also improve payment accuracy, crack down on fraud and waste, which we all know is significant in Medicare, perhaps as much as $70 billion a year. We are going to beef up very substantially the moves to go after those who are committing fraud in this system. It also slows the growth in reimbursements to providers, many of whom will benefit from over 30 million newly insured people. So people ask: How is this bill paid for? One of the biggest ways of paying for it is to go to the providers and say: Your future increases will not be as large as previously indicated. You are not going to have growth as much as you had previously thought in your level of reimbursements. These groups have, by and large, agreed to that prospect. Why? Because, No. 1, they know there are savings to be accrued. No. 2, they know that with over 30 million more people being covered, they will have a big increase in business, and they will have a sharp reduction in uncompensated care. So that is why the hospitals have agreed to more than $150 billion in savings over ten years and that is why nursing homes and home health care have agreed to significant savings and why the pharmaceutical industry has as well. Let me say, before we are done, I believe that what is in the bill for nursing homes will be further modified so it is not as much of a reduction in their increases as was anticipated. Because if you look at who has put up how much, there is rough agreement from these providers to take these reductions in their increases. They are not cuts in the sense of getting less next year than they got the year before, it is getting less of an increase. Interestingly enough, an argument made by Republicans when they were advocating reductions and savings out of Medicare were far higher, far bigger than anything that is in this bill. This is an amusing point for those who have been listening to this debate. Our Republican colleagues are now decrying savings out of Medicare which just a year ago they themselves were advocating. They had their President come forward with a proposal with much bigger savings than those in this bill. We will get to that in a minute. Here is what some of my colleagues have been saying on deficit and debt because the rhetoric coming from our colleagues on the other side has been interesting, and the difference between their rhetoric and their amendments is striking. Here is what they have said. This is Senator McConnell, the Republican leader: We're heading down a dangerous road. It's long past time for the administration and its allies in Congress to face the hard choices that Americans have had to face over the past several months. No more spending money we don't have on things we don't need. No more debt. That is Leader McConnell. Senator Kyl, again, a member of the Republican leadership: We have got to reduce deficit spending to manageable levels and ultimately learn to live within our means, and the sooner the better. Senator McCain, who offered the first Republican amendment: This staggering deficit threatens our children's and grandchildren's future and simply cannot be sustained. I call on my colleagues on both sides of the aisle to chart a different course toward real change and fiscal responsibility. Well, that is what they have said in their speeches. What have they done with their amendments with respect to debt? This is curious. Every major amendment they have offered was to increase the debt, to increase deficits. After all the brave speeches about how important it was to be fiscally responsible, what amendments have they offered? Well, Senator McCain offered the first one to eliminate the Medicare savings. That would increase the deficit and increase the debt by $441 billion. So much for the brave speeches. The Hatch amendment was to continue overpayments to Medicare Advantage plans, increasing the deficit and debt by $120 billion. So much for the brave speeches. The Johanns amendment to eliminate the home health care savings would increase the deficit and debt by $42 billion. So far our Republican colleagues, who have given such strong speeches about the need to reduce deficits and debt, every single major amendment they have offered have been to increase deficits and debt and so far the running total is over $440 billion that our colleagues on the other side would increase the deficit and debt by, if their amendments had been adopted. The good thing is, there are other people watching, other people who are listening to the speeches and comparing the speeches to the amendments and comparing the speeches to the policy prescriptions of our colleagues on the other side. Here is what the American Association of Retired Persons said on November 20: Opponents of health care reform won't rest. They are using myths and misinformation to distort the truth and wrongly suggesting that Medicare will be harmed. After a lifetime of hard work, don't seniors deserve better? On November 18, the American Association of Retired Persons said this: The new Senate bill-- Talking about the bill before us-- makes improvements to the Medicare program by creating a new annual wellness benefit, providing free preventive benefits, and--most notably for AARP members--reducing drug costs for seniors who fall into the dreaded Medicare doughnut hole, a costly gap in prescription drug coverage. The Federation of American Hospitals, on November 20, said: Hospitals always will stand by senior citizens. The American Medical Association said, on that same day: We are working to put the scare tactics to bed once and for all and inform patients about the benefits of health reform. On November 16, the Catholic Health Association of the United States said: The possibility that hospitals might pull out of Medicare is very, very unfounded. Catholic hospitals would never give up on Medicare patients. Again, from the National Committee to Preserve Social Security and Medicare on November 19: We are . . . very well aware of the positive impact health reform can have on the future of the Medicare program and its beneficiaries. One of the things that is most striking to me in listening to our friends on the other side is they are trying to scare people into thinking that the savings in Medicare are going to disadvantage Medicare beneficiaries. What is most remarkable is, the last time our friends on the other side offered a budget, it was offered in the Bush administration. Their savings out of Medicare in that budget were $481 billion over 10 years, far larger than the savings in this bill. Interestingly enough, I never heard a single Republican colleague say one peep about those savings out of Medicare. There was no suggestion it threatened grandma. There was no suggestion this was going to ruin Medicare. There was no suggestion these savings out of Medicare were going to undermine Medicare beneficiaries. That was their budget. That was their President's budget, to save $481 billion out of Medicare. Let's compare it to the savings in Medicare in this bill. The Bush administration, the last budget they offered, had $481 billion in 10- year savings out of Medicare. The net reduction in this bill is $380 billion. I would ask my colleagues on the side opposite: What is the bigger number? Is $481 billion bigger or is $380 billion bigger? They didn't say one word in opposition to Medicare savings from the previous administration, their administration, when it was $481 billion, but now this administration has savings of $380 billion on a net basis, all of a sudden the sky is falling and it is the end of the world. I would say the hypocrisy meter is on tilt when I listen to these speeches from the opposite side. Medicare Advantage plans. I have heard so many speeches here about Medicare Advantage. Medicare Advantage was originally put in place to save money for Medicare. In fact, it was capped at 97 percent of traditional fee-for-service Medicare. What has happened? Is it saving money? No. On average, it is costing 114 percent of traditional fee- for-service Medicare. In fact, there are plans in Medicare Advantage that are costing 150 percent of traditional fee-for-service Medicare. We have a runaway train. We have a program in Medicare Advantage--at least some elements of it, to be fair, because some of them are working fine--some elements of it are a runaway deficit train, costing 150 percent of traditional fee-for-service Medicare. These are the hard realities Medicare Advantage is contributing to Medicare's fiscal problem. This is the MedPAC report from March of 2009: In 2009, payments to Medicare Advantage plans continue to exceed what Medicare would spend for similar beneficiaries in traditional fee-for-service. Medicare Advantage payments per enrollee are projected to be 114 percent of comparable fee- for-service spending for 2009. . . . This added cost contributes to the worsening long-range financial sustainability of the Medicare program. In plain English, it is contributing to Medicare heading for insolvency, and this bill does something about it. It moves Medicare Advantage to a more sound and sustainable course. By the way, interestingly enough, the estimates by the Congressional Budget Office are, there will be more people in Medicare Advantage after this bill passes. After this bill passes, there will still be more people in Medicare Advantage than have been in the past. So Medicare Advantage will go forward, but the abuses will be run out of the system, the overpayments will be reduced, and that will help extend the solvency of Medicare. Question: Does this bill that is before us extend the solvency of Medicare or does it reduce the years of solvency of Medicare? What is the right answer? The correct answer is, this legislation extends the solvency of Medicare by at least 4 years and perhaps 5. We know the House bill has been scored. It extends Medicare solvency, according to the CMS actuaries, 5 years. The bill that came out of the Finance Committee extended solvency of Medicare by at least 4 years, and most estimates are, the bill before us does somewhat better. Back on the question of Medicare Advantage: Taxpayers pay 50 percent more for beneficiaries enrolled in Medicare Advantage plans in some areas. I asked CBO last year: Is Medicare Advantage saving money which was its original intention? They came back and said not only is it not saving money: It is on average costing 14 percent more, or 114 percent of traditional fee-for-service Medicare and, in some places, the Medicare Advantage pricing benchmarks currently range from 100 percent to over 150 percent of local per capita spending in the fee-for-service traditional Medicare sector. Facts are stubborn things. The fact is, this bill reduces the deficit by $130 billion over the first 10 years and by as much as $650 billion over the second 10 years. Those are facts, according to CBO, not facts made up by colleagues on the floor, for one purpose or another. This bill extends the solvency of Medicare by at least 4 years and perhaps as long as 5 years. That is not all that needs to be done, but it is a beginning. Those who want to oppose it and vote against it will have to explain why they don't want to extend the solvency of Medicare, why they don't want to achieve savings, why they don't want to go after the fraud and abuse that exists in the system. Let me say with respect to the Gregg amendment, I have enormous respect for Senator Gregg, but his amendment is designed to kill this bill. Let's just be clear. That is the purpose of the amendment. If you want to kill the bill that reduces the deficit, the bill that will reduce premiums for a significant majority of the American people; if you want to kill the bill that begins the critically important process of reform, then you ought to vote for the Gregg amendment. If you want this bill to be able to advise and deliver on the promises made to the American people about what must be done to solve Medicare--not to solve it but to extend its solvency; if you want to have legislation that begins the critically important process of reform, then reject the Gregg amendment. I yield the floor.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 301 of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, aggregates, and other appropriate levels and limits in the resolution, and make adjustments to the pay-as-you-go scorecard, for legislation that is deficit-neutral over 11 years, reduces excess cost growth in health care spending, is fiscally responsible over the long term, and fulfills at least one of eight other conditions listed in the reserve fund. I have already made one adjustment pursuant to section 301(a) on November 21, for S.A. 2786, the Patient Protection and Affordable Care Act, an amendment in the nature of a substitute to H.R. 3590. I now file further changes to S. Con. Res. 13 pursuant to section 301(a) for S.A. 2791, an amendment to clarify provisions relating to first dollar coverage for preventive services for women. I find that that in conjunction with S.A. 2786, this amendment also satisfies the conditions of the deficit-neutral reserve fund to transform and modernize American's health care system. Therefore, pursuant to section 301(a), I am further revising the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Finance Committee. I ask unanimous consent to have the following revisions to S. Con. Res. 13 printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 301(a) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, aggregates, and other appropriate levels and limits in the resolution, and make adjustments to the pay-as-you-go scorecard, for legislation that is deficit-neutral over 11 years, reduces excess cost growth in health care spending, is fiscally responsible over the long term, and fulfills at least one of eight other conditions listed in the reserve fund. I find that the Patient Protection and Affordable Care Act of 2009, an amendment in the nature of a substitute to H.R. 3590, fulfills the conditions of the deficit-neutral reserve fund to transform and modernize America's health care system. Therefore, pursuant to section 301(a), I am adjusting the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Finance Committee. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I thank the Senator from Iowa, Mr. Harkin, and I commend him for the outstanding work he did on the HELP Committee, especially on the prevention provision. I don't think there is anyone in the Senate who has been more dedicated to moving us from a sickness system to a wellness system than the Senator from Iowa. He did outstanding work on the prevention provisions in the Health Committee bill, many of which now are in the bill before us. I applaud him for his leadership because in many ways those are the most important provisions. If we can encourage people to lead healthy lifestyles and have an emphasis on wellness, we can change the quality of millions of people's lives. I personally think the provisions Senator Harkin authored that are part of this legislation are in many ways the most important pieces of this bill. What is interesting is they have received very little attention in the public debate. In fact, many of the most important provisions in this bill have very little attention in the public debate. Hopefully, over the next weeks that will change and people will learn what is really in this bill versus the rumors of what is in this bill. They are very different things. I again thank the Senator from Iowa for his leadership. It made a real difference to the quality of this bill. Why are we here? We are here because we face a completely unsustainable situation in health care in this country. Medicare is going broke, premiums are rising 3 times as fast as wages, 46 million people have no health insurance, spending is twice as much per person in our country as in almost any other country in the world, and the outcomes of our system for our people are not as good as they should be. So it is very clear: The status quo is unacceptable. Doing nothing is not an option. Failure is not an option. It is critically important that we reform the health care system in this country. If we do not, our families' budgets will be threatened, our businesses will be threatened, and the Government itself is threatened. That is the reality. I want to praise Leader Reid for putting together a responsible package and a really very good first step. I also want to praise Senator Baucus for his leadership in the Finance Committee. He did an outstanding job. I have never seen, in my 23 years, any committee chairman have as diligent and focused an effort as Senator Baucus gave this in the Senate Finance Committee over a 2-year period. Our group of 6 alone met 61 times, and there were dozens and dozens of other hearings, meetings, forums, roundtables. Senator Baucus organized a health care summit last year, and that was a model of how Congress ought to approach an issue. So I give high praise to Senator Baucus. Senator Dodd, who was called in at the eleventh hour to replace Senator Kennedy because of Senator Kennedy's illness, deserves enormous credit, enormous praise for picking up the ball at a critical juncture and carrying it across the line in the HELP Committee as well. Senator Reid had the very difficult task of bringing together the Finance Committee bill and the HELP Committee bill, combining them into a vehicle for consideration here. This bill is not perfect. No work of humans ever is. Certainly more needs to be done to control cost. That is what I believe. But this is a very good beginning. This bill makes an important contribution to improving health care. Those who labored for months and months to produce it deserve our thanks and praise. I am somewhat taken aback by speeches I have heard from colleagues over the last several days acting as though this vote tomorrow is the end of the story. Anybody who understands Senate procedure even a little bit knows this is the beginning of the story. This is the beginning of the debate. This is the beginning of a process to amend and improve the bill. This is the beginning of the discussion on the floor of the Senate about legislation to reform the health care system. I don't know of a single credible reason to vote against going to consideration of legislation to reform the health care system in this country. This isn't about the final result. This is about beginning the discussion and the debate. Who would want to prevent a discussion and debate? Who would want to prevent Senators from being able to offer amendments to improve the legislation? If people are dissatisfied with the product at the end of the process, that is when they can vote no. They can vote no against cloture. They can vote no against the package. There are lots of opportunities to oppose it if you are unhappy with the final result. But being unwilling to even discuss the subject strikes me as a preposterous position. This plan meets key health care reform benchmarks. It is fully paid for. In fact, according to the Congressional Budget Office--not controlled by Republicans or Democrats; it is strictly nonpartisan-- this measure reduces the deficit by $130 billion over the first 10 years. That is their judgment. In the second 10 years, they say this legislation will reduce the deficit by $650 billion. When people come out here and say this increases the deficit, this increases the debt, I don't know what legislation they are talking about. It is not the legislation before us. They are, of course, free to make up whatever numbers they want, but the official evaluation of this legislation by the nonpartisan CBO, the Congressional Budget Office, is that this bill reduces the deficit in both the short and long terms. It also expands coverage, according to the CBO, to 94 percent of Americans. It contains critical insurance market reforms and, perhaps even more important, delivery reforms. We will get into those in a minute. Let's talk about the need for action. This chart shows what is happening to premiums for health insurance coverage. Premiums are projected to continue to rise on American families. In 1999, premiums averaged $6,050. In 2009, they increased by 117 percent. What the experts are telling us is, from 2009 to 2019, they will go up another 71 percent to average premiums in 2019 of $22,440 to an American family for health care premiums. How many families will be able to afford premiums of $22,440? At the same time we see employer-based health care coverage--and the vast majority of our people receive coverage at their place of employment--is in decline, from 68 percent to 62 percent in 2008. In 2000, 68 percent of companies were offering health care coverage. That is down to 62 percent in 2008. At the same time we know 46 million fellow citizens do not have health insurance. That is projected to increase, by 2019, to 54 million who will not have health insurance. It is interesting because every other industrialized country in the world has universal coverage. They have figured out a way to provide health insurance to every family in their countries. France, Germany, Great Britain, Japan, every other major industrialized country has figured out a way to provide health insurance for every one of their citizens. It is time for America to do the same. That is a moral issue. That is not just a financial issue; it is a moral issue. What kind of country are we going to be? This is a letter I received from a constituent in September. I wanted to share it with my colleagues. Dear Senator Conrad, I am 51 years old and have never given much thought to writing a Senator until now. Three days ago, we received some of the worst news a person can get. My husband has been diagnosed with bladder cancer. He does not have health insurance. We are self-employed. Our income is low but we do own some property which makes us ineligible for most assistance programs. A few years ago we both dropped our Blue Cross Blue Shield because the premiums were too high. I re-applied and got my insurance back but my husband was denied due to his weight. (He quit smoking 4 years ago and put on weight gradually since then.) We are stunned by the diagnosis and are terrified by the uncertainties of his prognosis. We already owe $2,000 just for emergency room costs and he has surgery scheduled for September 22 with at least an overnight stay in the hospital. The medical bills will be astronomical. If the cancer is not localized, he will be referred to oncology and will begin chemotherapy/radiation treatment and possibly even more surgery. We will have to sell almost everything we own to pay [the] bills. Please, sir, consider our story when thinking about health care reform. Any change will happen too slowly to help us but others will benefit. Don't give up. We are counting on you to make a difference. To that woman, I make this pledge: I am not going to give up. I think enough of my colleagues will not be giving up so that we can at least begin the debate on whether there should be health care reform in this country. I repeat, I can't think of a single credible reason why somebody would vote against beginning the debate, to have a chance to amend. If you don't like the product as it has come to the floor, that is what legislating is about, the opportunity to amend, the opportunity to improve, the opportunity to convince colleagues that we need to move in a different direction. I don't know what could be more clear than that we have to move in a different direction on health care. We are now spending 17 percent of our gross domestic product on health care. That is $1 in every $6 in this economy. The experts tell us by 2050, we will be spending 38 percent of our gross domestic product on health care, if we stay on the current trend line. That would be more than $1 in every $3 in this economy on health care. That would be a disaster for the American economy, a disaster for the budgets of families and businesses. That simply cannot be the result for our Nation. On Medicare and Medicaid spending, in 1980, if you put the two together, Medicare and Medicaid consumed 2 percent of our gross domestic product; $1 in every $50 in this economy was going to Medicare and Medicaid. In 2010, we are up to almost 6 percent of GDP for Medicare and Medicaid, three times as much as a share of our economy. But look where we are headed. By 2050, again on the current trend line, we would be spending 12.7 percent of gross domestic product just on Medicare and Medicaid, six times as much as back in 1980. If we look at the indebtedness of the country, there is no bigger contributor than Medicare. It is the 800-pound gorilla: $37.8 trillion of unfunded liability in Medicare. The comparable number for Social Security is $5.3 trillion. We can see the unfunded liability in Medicare is seven times the unfunded liability in Social Security. For those who say, let's not even go to a debate, let's not even go to a discussion on reforming health care, what is their proposal? Are they afraid to offer one? Do they not have one? Is their answer do nothing? Is their answer really to do nothing in the face of a crisis of this magnitude? Their answer is: Let's not even debate it; let's not have even have a chance to amend it? That is not a credible position. It is not a responsible position. It is not a serious position. That is a position of obstruction, pure and simple. If we look at our system, we have had a review by Dartmouth Medical School. They concluded: Although many Americans believe more medical care is better care, evidence indicates otherwise. Evidence suggests that states with higher Medicare spending levels actually provide lower quality care. They went on to say: We may be wasting perhaps 30% of U.S. health care spending on medical care that does not appear to improve our health. As a country, we are spending almost $2.5 trillion a year on health care. If 30 percent of that money is being wasted, is not contributing to better health, 30 percent of $2.5 trillion is $750 billion a year. The answer by some of our colleagues is, let's not even debate it. Let's not even discuss it. Let's not even attempt to address it. That is a remarkable position to take. If we look at our country versus others around the world, we see we are spending far more as a share of our income than they are. If we look country by country: Japan is spending 8 percent of GDP; the United Kingdom, 8.4; Belgium, 10 percent; Germany, about 10; Switzerland, almost 11; France, 11; and we are at 16 percent. That is as of 2007. We have gone up to 17 percent of GDP in 2009 on health care. We are spending as a share of the economy almost twice as much as any other major industrialized country in the world. Yet we still have 46 million people without any health insurance. Under the British model, they have universal coverage. Under the so- called Bismarck model, countries of Germany, France, Japan, Switzerland, and Belgium have universal coverage. Yet if we remember their costs, we see even though they are providing universal coverage in these other countries, their costs are much lower than ours. If we look further at the quality of health care outcomes, quite an interesting story emerges. Those countries have universal care, lower costs. And if we look at quality outcomes, they do better than we do. On preventable deaths, the Commonwealth Fund, which is very distinguished and nonpartisan, looked at preventable deaths around the world. They found the United States came in nineteenth. But other countries that have much lower costs and have universal coverage, for example France and Japan, are ranked 1 and 2. With much lower costs and universal coverage, they are getting better results. And some do not even want to debate going to health care? They are going to have a tall order to explain why they do not even want to discuss it. On infant mortality, the United States is ranked 22nd, again, according to the Commonwealth Fund. Again, these are countries that have universal coverage, with much lower costs than we do. Ranked No. 1 was Japan. France was No. 5. Germany was No. 9. From my earlier chart, you will remember each of those countries has universal coverage and much lower costs than we do, and yet they are getting, on these metrics, better outcomes than we are. It does not stop there. Here is life expectancy, as shown on this chart. The United States is ranked 24th. This is according to the OECD, the international scorekeeper. Again, Japan, Switzerland, France-- universal coverage, much lower costs--still ranked much higher than we do on that metric. Japan, with universal coverage, much lower cost than we have--in fact, half as much as ours--yet they were No. 1. Switzerland, No. 2-- they have universal coverage, with much lower cost than we have, and yet they rank No. 2. France, with universal coverage, much lower cost, is ranked sixth in the world. It would seem to me we ought to look to evidence, and evidence shows us there is a better way, and that is what this legislation seeks to find. It seeks to find a better way to expand coverage, to improve quality, and to contain exploding costs. The key elements of this Senate health care reform plan are these: One, it reduces both short- and long-term deficits. I noticed in one of the newspapers circulated on the Hill today a full-page ad asking: How can Senator Conrad, who is a deficit hawk, be for this bill? Well, because I have read the CBO analysis, the Congressional Budget Office analysis, that says clearly and unequivocally this bill lowers the deficit. It lowers it by $130 billion over the first 10 years. It lowers it by $650 billion over the second 10 years, according to the Congressional Budget Office. So when somebody asks, How can a deficit hawk like Senator Conrad be for this bill? It is because this bill lowers the deficit. That is not my analysis. That is the official analysis of the Congressional Budget Office which is nonpartisan. This bill also expands coverage to 94 percent of the American people. It promotes choice and competition. It reforms the insurance market. It improves the quality of care. All of these issues are at the heart of what reform must be. The Senate health plan reduces short- and long-term deficits. It extends Medicare solvency. Medicare is going to go broke in 8 years. This bill extends the life of Medicare by 4 to 5 years. It extends the solvency of Medicare by 4 to 5 years. It includes reforms to improve delivery of care and reduces costs. It curbs overpayments to Medicare Advantage plans. Some Medicare Advantage plans are now costing 150 percent of traditional fee-for- service Medicare. Medicare Advantage was started on the basis it would save money. In fact, it was initially capped at 97 percent of traditional fee-for-service Medicare. It was supposed to save money. Now there are Medicare Advantage plans that cost 150 percent of traditional fee-for-service Medicare. It is not saving money, it is costing much more money. And it will break Medicare if we do not reform it. That is clear. This bill also creates an Independent Medicare Advisory Board to make recommendations on how we can have further savings to extend further the solvency of Medicare. It also includes an excise tax on insurers offering Cadillac plans. Virtually every analyst who came before the Finance Committee said one of the most important things we could do was to start with a levy on Cadillac health insurance plans to reduce overutilization and to begin to control the exploding costs. When I say this bill reduces the deficit, that is not my assertion or the work of the Senate Budget Committee. That is the judgment of the official scorekeeper here, the nonpartisan Congressional Budget Office. Here is a page from their report, and it shows very clearly, from 2010 to 2019, this legislation reduces the deficit by $130 billion. I have heard colleagues come to the floor and give all kinds of speeches about how this increases the deficit. They have every right to come here and make up any numbers they want to make up. They can make any claim they want. But let's be clear, the official analysis of this bill by the agency we have all empowered to give us objective analysis has concluded that this bill reduces the deficit by $130 billion over the first 10 years, and $650 billion over the second 10 years. The Congressional Budget Office on the Senate health plan and reducing long-term deficits: . . . CBO expects that the bill, if enacted, would reduce federal budget deficits over the ensuing decade [beyond 2019] relative to those projected under current law--with a total effect during that decade that is in a broad range around one-quarter percent of gross domestic product. Gross domestic product over that second 10-year period is forecast to be $260 trillion. One-quarter of 1 percent of $260 trillion is $650 billion. . . . CBO anticipates that the legislation would probably continue to reduce budget deficits relative to those under current law in subsequent decades. . . . In other words, it would continue to reduce deficits beyond the first 20 years. The excise tax, which virtually every analyst has said needs to be part of a package if you are going to be serious about controlling the explosion of costs, will target plans that have a value of more than $23,000 a year. The average premium in 2013 is projected to be $15,740. So these Cadillac plans are plans that would have a value of more than $23,000 a year. There are very few people in the country who have plans of that value today, and there will be very few who will have plans of that value in 2013. The Senate health care plan also expands coverage. According to the Congressional Budget Office, it covers 94 percent of the American people by building on our existing employer-based system. It creates State-based exchanges for individuals and small businesses. It provides tax credits to help individuals and small businesses buy insurance. In fact, there is more than $400 billion of tax credits here. Somebody said: Well, this is a big tax increase. It is a big tax increase. Well, they must have left out the $400 billion of tax credits. They must not have gotten to that page in the bill. It expands Medicaid eligibility with assistance to States so they are able to afford it. The Senate health plan also promotes choice and competition. It creates a public option to compete with private plans, but not one based on Medicare levels of reimbursement. I think many of my colleagues know I strongly resisted a public option tied to Medicare levels of reimbursement because that would work a real hardship in my State. But in this plan, there is no tie of a public option to Medicare levels of reimbursement. And States can opt out. It also provides seed money for nonprofit cooperatives--member-run, member-controlled cooperatives--to compete with private plans. This chart shows the Medicare reimbursement per enrollee for 2006. You can see, New York was getting nearly $10,000; North Dakota, though, $6,000. That is the kind of disparity that exists in Medicare reimbursement. It is even more dramatic if you look at institution to institution. In fact, for many years, I was shown a hospital in Devils Lake, ND--Mercy Hospital--that would get one-half as much as Lady of Mercy Hospital in New York City to treat the exact same illnesses--one-half as much. That is all based on formulas based on historic costs. That is why many of us believe it would be unfair to tie a public option to Medicare levels of reimbursements. That disparity across the country would work an extreme hardship on low reimbursement States such as mine. The cooperative plan allows for not-for-profit co-ops to provide an affordable, accountable, transparent alternative to private insurance. The mission is to provide the best value for consumer members. It could operate at a State, regional, or national level. They are self-governed by members with an elected board--not controlled by the Federal Government--subject to the same State and Federal rules and regulations as private plans. There would be $6 billion in startup funding for capitalization by the Federal Government. And that would be the end of the Federal Government role. The Senate plan also reforms the insurance market. It prohibits insurers from denying coverage for preexisting conditions. It prohibits insurers from rescinding coverage when people become sick after they have paid premiums for years. It bans insurers from lifetime caps and unreasonable annual limits on health care benefits. And it prevents insurers from charging more based on health status. This plan also improves the quality of care. It covers preventive services. It provides incentives for healthy lifestyles. It promotes adoption of best practices in comparative effectiveness research, and includes delivery system reforms to encourage quality over quantity of care. When we look at the major reforms that are in this bill on the delivery system and compare them to the House bill, we see that the Senate has accountable care organizations; the House a pilot. Both have primary care payment bonuses. Both have readmissions reforms. Only the Senate has hospital value-based purchasing. Both have comparative effectiveness research. Both have CMS innovation centers. Only the Senate has an Independent Medicare Advisory Board. And only the Senate has a full platform for bundling. The House just has a pilot. Debunking the myths: There is no government takeover of health care here. The public option, according to CBO, would get 2 percent of the American people--2 percent. That is hardly a government takeover. And there is no tying of the public option to Medicare levels of reimbursements. There is no cut in the guaranteed benefits for seniors. There is no coverage for illegal immigrants. There are no ``death panels.'' And there is no expansion of Federal funding for abortion services. To conclude, if we look at the Senate Democratic plan and the only Republican plan, and compare them, the Senate Democratic plan contains delivery system reforms. There are none in the Republican proposal. The Senate Democratic proposal reduces the number of uninsured by 31 million people. The Republican plan makes no progress on that front. The Senate Democratic plan reforms the insurance industry, banning preexisting conditions and rescissions of coverage and health status ratings and lifetime benefit limits. The Republican plan has no similar provisions. The Senate Democratic plan improves rural Medicare reimbursement. The Republican plan does not.

Mr. CONRAD. Mr. President, I ask unanimous consent for 30 seconds.

Mr. CONRAD. The Senate Democratic plan extends Medicare solvency by 4 to 5 years. The House Republican plan has no extension of Medicare solvency. And, finally, the Senate Democratic plan reduces the deficit, according to CBO, by $130 billion--twice as much as the Republican plan from the House. I thank the Chair. I thank my colleagues.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the Record, the Budget Committee's official scoring of S. 1407, Military Construction and Veterans Affairs and Related Agencies Appropriations Act for fiscal year 2010. The bill, as reported by the Senate Committee on Appropriations, provides $78.1 billion in discretionary budget authority for fiscal year 2010, which will result in new outlays of $48.4 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the bill will total $77.7 billion. An amendment has been adopted to designate $1.4 billion in budget authority in the bill as being for overseas deployment and other activities. Pursuant to section 401(c)(4) of the 2010 budget resolution, adjustments to the Appropriations Committee's section 302(a) allocation and to the 2010 discretionary spending limits were made for that amount and for the outlays flowing therefrom. The bill matches the subcommittee's revised allocation for budget authority and for outlays. The bill is not subject to any budget points of order. I ask unanimous consent that the table displaying the Budget Committee scoring of the bill be printed in the Record.

Mr. CONRAD

Mr. CONRAD. I ask for the yeas and nays.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the section 401(b) discretionary spending limits, allocations pursuant to section 302(a) of the Congressional Budget Act of 1974, and aggregates for legislation making appropriations for fiscal years 2009 and 2010 for overseas deployments and other activities by the amounts provided in such legislation for those purposes and so designated pursuant to section 401(c)(4). The adjustment is limited to the total amount of budget authority specified in section 104(21) of S. Con. Res. 13. For 2009, that limitation is $90.745 billion, and for 2010, it is $130 billion. On July 7, 2009, the Senate Appropriations Committee reported S. 1407, the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2010. The reported bill contains $1.399 billion in funding that the Senate Appropriations Committee intends to designate for overseas deployments and other activities pursuant to section 401(c)(4). An amendment has been offered that provides a designation consistent with section 401(c)(4). The Congressional Budget Office estimates that the $1.399 billion in budget authority will result in $145 million in new outlays in 2010. As a result, I am revising both the discretionary spending limits and the allocation to the Senate Committee on Appropriations for discretionary budget authority and outlays by those amounts in 2010. When combined with previous adjustments made pursuant to section 401(c)(4), $129.999 billion has been designated so far for overseas deployments and other activities for 2010. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, section 306(f) of S. Con. Res. 13, the 2010 budget resolution, permits the chairman of the Senate Budget Committee to adjust the allocations of a committee or committees, aggregates, and other appropriate levels in the resolution for legislation that reduces the unemployment rate or provides assistance to the unemployed, particularly in the States and localities with the highest rates of unemployment, or improves the implementation of the unemployment compensation program. In addition, section 306(b) permits the chairman to adjust the allocations of a committee or committees, aggregates, and other appropriate levels for legislation providing tax relief or refundable tax relief. These adjustments to S. Con. Res. 13 are contingent on the legislation not increasing the deficit over either the period of the total of fiscal years 2009 through 2014 or the period of the total of fiscal years 2009 through 2019. I find that S.A. 2712, an amendment in the nature of a substitute to H.R. 3548, the Unemployment Compensation Extension Act of 2009, fulfills the conditions of the deficit-neutral reserve fund for unemployment mitigation. Therefore, pursuant to sections 306(f) and 306(b), I am adjusting the aggregates in the 2010 budget resolution, as well as the allocation to the Senate Finance Committee. I ask unanimous consent that the following revisions to S. Con. Res. 13 be printed in the Record.

Mr. CONRAD

Mr. CONRAD. Mr. President, I rise to offer for the record, the Budget Committee's official scoring of the conference report to accompany H.R. 2892, the Department of Homeland Security Appropriations Act for fiscal year 2010. The conference report provides $42.8 billion in discretionary budget authority for fiscal year 2010, which will result in new outlays of $25.5 billion. When outlays from prior-year budget authority are taken into account, discretionary outlays for the conference report will total $46.6 billion. The conference report includes $242 million in budget authority designated as being for overseas deployments and other activities for the Coast Guard. Pursuant to section 401(c)(4) of S. Con. Res. 13, the 2010 budget resolution, an adjustment to the 2010 discretionary spending limits and the Appropriations Committee's 302(a) allocation has been made for this amount in budget authority and for the outlays flowing therefrom. The conference report matches its section 302(b) allocation for budget authority and is $2 million below its allocation for outlays. The conference report includes provisions that make changes in mandatory programs that result in an increase in direct spending in the 9 years following the 2010 budget year. These provisions are subject to a point of order established by section 314 of S. Con. Res. 70, the 2009 budget resolution. The conference report is not subject to any other budget points of order. I ask unanimous consent that the table displaying the Budget Committee scoring of the conference report be printed in the Record.