John Ensign

Mr. ENSIGN

Mr. ENSIGN. If the Senator will yield.

Mr. ENSIGN. As a practicing physician, isn't this what the Senator saw in his practice with HMOs?

Mr. ENSIGN. Because we have kind of an insurance center system today, to a large degree, and now we are going to make that worse. Instead of going more toward a patient center, we are going to go from an insurance center to a government center to where these government bureaucrats now start being in control of eventually what kind of care you are going to get, what is paid for, and all that. We need to put the doctor and the patient back at the center of our health care system.

Mr. ENSIGN. If my friend will yield, there is one part--actually one of the best parts in this bill--but there are so many other bad parts of this bill and the Senator from North Carolina mentioned them, and we have talked about a lot of them. The one place they actually have improved our health care system is the part that allows people to have larger discounts for healthier behaviors. Safeway was the model for this. They have done the most work on this in the last 4 years. Today, they can discount up to 20 percent of their health care premiums for people who engage in healthier behaviors--for not smoking, for being the proper body weight compared to their height, doing things such as that. If they are a nonsmoker, they get a lower premium, and if they even quit smoking, Safeway pays for the cessation products. To be fair, that is in the bill. Senator Carper and I got that in the Finance Committee. We were able to get that amendment drafted. The problem is, that is a tiny part of this bill. That should be a major focus of the bill. We should be able to buy insurance across State lines. Many of us have supported that--small business health plans, where small businesses can join together and take advantage of purchasing power. We all, on this side, almost everybody on this side of the aisle agrees with medical liability reform. The Congressional Budget Office said that would save $100 billion. The bottom line is, what we have been focused on--and I appreciate the efforts Senator Burr and Senator Coburn made in their bill last year--is trying to address the No. 1 problem we have in health care in the United States, which is costs. This bill does not address costs. As a matter of fact, you said it in your opening remarks. Total health care costs actually, according to President Obama's CMS, go up $234 billion if nothing is done. If nothing is done, we actually save money on total health care spending. But with this bill, it actually goes up by $234 billion.

Mr. ENSIGN. I see our friend from South Carolina has joined us. He has spoken eloquently about some of the sweetheart deals that have been made in this plan to ``buy'' votes. Could the Senator from South Carolina address those?

Mr. ENSIGN. I wish to ask Senator Coburn to address, in the last couple of minutes here--because he has spoken so eloquently about debt and the Congressional Budget Office saying this helps the deficit by some $100 billion--how the taxes go into effect right away and that the spending doesn't go into effect, and how that kind of smoke and mirrors happens all the time around here; how they try to hide various expenses, and what this is going to do to our debt.

Mr. ENSIGN. If the Senator will yield, though, if America does this with our health care system, where will the Canadians come for their health care when they need it? When they get it rationed up there, they usually come to the United States.

Mr. ENSIGN. But where will Americans go?

Mr. ENSIGN

Mr. ENSIGN. Will the Senator yield?

Mr. ENSIGN. So let me ask the Senator, from what I understand about the so-called doctors fix, there is around a $250 billion cost to that. In this bill, there is no fix to that, from what I understand. Is that correct?

Mr. ENSIGN. So the bill is either dishonest as far as the deficit is concerned because if you put the doctors fix in there, this thing actually hurts the deficit, or we are actually seriously hurting doctors because this bill will require a lot more doctors in the country to take care of those new people who will now have health insurance in the country. Is that correct?

Mr. ENSIGN. Will the Senator yield further?

Mr. ENSIGN. So would the Senator describe this almost as a shell game?

Mr. ENSIGN. The doctors fix would be the pea. Where are they hiding the pea? Because we know this is going to be fixed. It is always fixed. Every year, we fix the doctors' pay. And yet, to hide the true costs of the bill, then, the doctors' fix is really the pea in that little shell game and they are just hiding it. Is that correct?

Mr. ENSIGN

Mr. ENSIGN. Objection.

Mr. ENSIGN

Mr. ENSIGN. I object.

Mr. ENSIGN

Mr. ENSIGN. Will my colleague yield?

Mr. ENSIGN. Would the CBO--which is nonpartisan--score a welfare payment the same as these so-called tax credits?

Mr. ENSIGN. I would like to jump in here and ask the Senator from Idaho a question. From what I understand, the taxes go into effect-- actually, this is from yesterday, so I think it would be in 17 days from now based on the current bill before us. All of these taxes the Senator from Idaho has on his chart are all the taxes the President said he would not violate. The article yesterday said 13 taxes. We know of at least nine absolute taxes that would go into effect. But the tax subsidies, these payments to folks who do not have a tax liability, those are not received for 1,479 days; isn't that correct?

Mr. ENSIGN. I want to address one of these taxes, the so-called Cadillac tax that the Democrats have put into this bill. The problem is, they did not index it for inflation. As time goes forward, with the red line as the threshold, the Democrats indexed it for what is called the consumer price index plus 1 percent. That goes up a little bit. The problem is, medical inflation is going up much faster. What happens is--the blue line is the average plan in the United States--that is how fast it is going up. We can see that is much higher. At this point, it starts catching most of the plans in the United States. This 40-percent tax the unions are running ads against right now is going to start getting almost all Americans' plans in the future. That is the reason a lot of people do not realize this is a tax. It may not get them today, but it is going to get them eventually. What is going to happen is this tax will be passed on to them in lower benefits.

Mr. ENSIGN. I would like to ask the Senator from Idaho a question. These are the nine taxes we know for sure that are being raised: 40 percent Cadillac plan, a separate insurance tax, an employer tax, a drug tax, a lab tax, a medical device tax, a failure to buy insurance tax, the cosmetic surgery tax, and the increased employee Medicare tax. In our States, people think we will pass a sales tax, and the business will just pay the sales tax. I ask the Senator from Idaho, who actually pays the sales tax? Who have the Congressional Budget Office and the Joint Committee on Taxation, which are both nonpartisan, said are going to pay these taxes?

Mr. ENSIGN. The last thing I would like to point out goes along with the Senator's chart. This is what the Joint Committee on Taxation has said: 84 percent of all the taxes being paid in this bill are being paid by those making less than $200,000 a year. If this is not a direct violation of the President's promise not to raise one dime of their taxes, I don't know what is. I don't understand how the President can sign this bill and keep to the promise he made during the campaign.

Mr. ENSIGN. There is no question. I can answer the Senator's question: True, true, true, and true. The old saying, if it walks like a duck and it quacks like a duck, it is a duck. These taxes sometimes are called fees. The Supreme Court has ruled that a fee that acts like a tax is, in fact, a tax. Most of the provisions we talked about before, we call them a tax, and that is what they are. These nine new taxes are a tax. You are exactly right. The Joint Committee on Taxation and the CBO have said these are going to be passed on to the consumer. What they have also said--and I thought this was significant--is that 84 percent of all these taxes are going to be passed on to people who make less than $200,000 a year. That is what we have been saying. The other side says: We are just going to tax the rich. When 84 percent of that tax burden is paid by people making less than $200,000 a year and the vast majority is also paid by people making less than $100,000, the vast majority is being paid by people who make less than $100,000 a year, the same as sales taxes. The sales tax has been called a regressive tax. These are regressive taxes the Democrats are passing on to the American people.

Mr. ENSIGN

Mr. ENSIGN. Madam President, I want to address a few of the things that were mentioned on the floor just now. However, I want to start by talking about how this health care bill will affect small businesses. Small businesses are the engine that drives our economy. We know they are struggling right now. The President met with some bankers today at the White House because many of the large banks are not loaning money to small businesses. We all know that. Many small businesses are struggling to keep their doors open. One of the reasons small businesses are a little nervous right now is because they do not know if this bill goes into effect, what that massive effect is going to be on them. They are uncertain about the future. Let me tell you a few things. First of all, we all know that there is a $500 billion tax increase contained in this 2,074-page bill that is before us today. In that bill, there is also an employer mandate of $28 billion. This is what the nonpartisan Congressional Budget Office has said about that $28 billion: Not only does it fall heavily on small businesses, but the CBO goes further to say that ``workers in those firms would ultimately bear the burden of those fees'' in the form of reduced compensation. That is a direct quote. This bill also discourages small businesses from hiring folks. CBO went on to say: `` . . . the employment loss would be concentrated among low-income workers.'' Do we want to do that to folks out there who are struggling right now? We have heard across this country that record numbers of people are signing up for food stamps, welfare, unemployment insurance, and all of the various government subsidies that are out there to try to help people through a tough time. Do we want to keep them from getting a job? The Medicare payroll tax, that is $54 billion in this bill, will hit one-third of all small business owners. Those small business owners that it will hit about 30 million people in the United States. If you put a tax on somebody, especially during a recession, you are going to inhibit them from investing in their business and creating jobs. I have heard many people from the other side of the aisle say that it is not a good time to raise taxes, and yet they are raising taxes in this bill. Sometimes they call them fees, penalties, assessments, or different things, but they are taxes. This bill will also require small businesses to buy a government- approved insurance plan. So even for those small businesses that currently have a plan that they like, one that works for them and their employees, and one that is affordable and even though these small businesses have tried to do the right thing, the plan that they have selected may not quite meet the government criteria. This may be because the plan they chose was a little more of a bare-bones type of plan--in any event, this bill will require them to spend more money for a higher level of coverage than maybe they can afford. What will that do? Well, if the small business is barely getting by now, barely keeping its doors open, and the government requires it to spend more money on health insurance, some employees may be laid off or in some cases, small businesses may close and all its employees may lose their jobs. Most people in this body have never operated a small business. I built, owned, and operated two different small businesses--veterinary clinics. I understand how difficult it is for a small business owner, especially when you are just starting out and you are investing, you are putting everything you have into it, with all your hard work, and the few profits you make you plow right back into the business. You are trying to expand. You are trying to hire the next person, and you are trying to grow your business. When the government comes along and puts extra taxes and extra burdens on you, it makes it tough. That is not what we should be doing, especially during a time of recession. This bill before us also caps what are called flexible spending accounts at $2,500. Flexible spending accounts are used by a lot of small businesses, but they are also used by a lot of Federal employees. They are used by a lot of people. They are especially used by a lot of people who have serious chronic diseases. If you are a Federal employee, for instance, you can put $5,000 in a flexible spending account, and then you can pay, for instance, for approved out-of-pocket health care expenses. This bill caps that at $2,500 a year. So for somebody who has multiple sclerosis or somebody who has diabetes or somebody who has a chronic disease that requires a lot of medical attention, you are hurting those people who need that money the most. That is not something we should be doing, but that is exactly what this bill does. Let me talk about some of the general provisions in this bill and not just how it affects small businesses. We have talked about the Medicare provisions in the bill a lot on the floor. We know there is a $500 billion cut in Medicare. Folks on the floor were just talking about the doughnut hole for senior citizens in the Part D prescription drug plan under Medicare. Under this bill, Medicare Advantage will be cut by $120 billion. Most Medicare Advantage plans have no doughnut hole, yet this bill would take $120 billion out of Medicare Advantage, cutting extra services. According to CBO, there will be a 64-percent reduction in extra benefits by the year 2016 for those seniors who have Medicare Advantage. Ten million seniors in the United States today have Medicare Advantage. They have chosen it. They were not forced into it. As a matter of fact, Medicare Advantage is a relatively new program. Seniors do not like change that much, yet they saw an advantage in this program. They did not have pay to pay their Medigap insurance. They did not have a doughnut hole. Many of them get vision and dental services, yet their extra benefits are going to be cut by 64 percent because of this bill. Overall, because of the smoke and mirrors that are used, it is said this bill only costs $849 billion. But, the costs are hidden. First of all, $849 billion is a huge number. But it is actually a $2.5 trillion spending bill. The reason is because when you look at it fully implemented--right now, a lot of the benefits do not start right away but the taxes start right away--when you look at the full 10 years when taxes, benefits, and everything is implemented, it is a $2.5 trillion bill. This is a massive increase in the Federal Government. As an example, within the 2,074 pages of this bill there are almost 1,700 new places where authority is provided to the Secretary of Health and Human Services to make health care decisions for the American people. Madam President, this bill gives the Secretary of Health and Human Services the authority to make health care decisions for the American people 1,700 times. If that is not a massive government expansion into our health care field, I do not know what is. There is also about $500 billion in new taxes. I have this chart in the Chamber. This is a quote by President Obama on his health care promises. He said: Let me be perfectly clear. . . .if your family earns less than $250,000 a year, you will not see your taxes increased a single dime. I repeat: not one single dime. He said: Nothing in this plan will require you or your employer to change the coverage or the doctor that you have. Let me repeat this: nothing in our plan requires you to change what you have. And thirdly, he said: Under the plan, if you like your current health [care] insurance, nothing changes, except your costs will go down by as much as $2,500 per year. Let me focus on the first quote about the new taxes that are in this bill. The bill includes a 40-percent insurance plan tax. There is a separate insurance tax on top of the 40-percent insurance plan tax. This is the one, by the way, that several of my colleagues were talking about that the unions are all up in arms about. It is the Cadillac plans they were talking about that are going to be taxed. Most union members have a Cadillac plan, and their plans are going to be taxed at 40 percent above a certain dollar figure. Because this tax is not indexed to inflation, by the end of a decade, most Americans' plans will be subject to this 40-percent tax. There is also an employer mandate tax. But as the Congressional Budget Office said, this tax actually gets shifted down to the workers. There is a drug tax. Every time you purchase drugs, taxes are passed onto you by the drug companies, so all of us are going to be paying more for drugs. There is a laboratory tax. Every time you go in, there is a tax on lab work. All of these taxes end up raising health care premiums. There is a medical device tax. There is a failure to buy insurance tax. There is a cosmetic surgery tax. And, there is an increased employee Medicare tax. At this point, let's remember that first quote I showed where President Obama said he would not raise taxes on families making $250,000 or less, and on individuals making $200,000 a year or less. Well, 84 percent of the taxes in this bill will be paid by people making less than $200,000 a year--84 percent of the taxes. I would like to point out another problem with this bill. It contains a sense of the Senate on medical liability reform. In his September address on health care reform, the President talked about the need to do something about medical liability reform. The problem is that this bill before us today only includes a sense of the Senate on medical liability reform. Let me show you. As shown on this chart, this is how much money this health care bill saves with their sense of the Senate. Zero. However, the Congressional Budget Office said that real medical liability reform would save $100 billion in this country--between what the government spends and what the private sector spends, that is $100 billion in total. The problems with this bill are so numerous that we could go on and on discussing them, but we truly do need to start over. We need to start over and take more of a step by step approach. We need to develop an incremental approach, where both sides can agree on some of the reforms we need to do--without destroying our current health care system. We need to enact meaningful medical liability reform. We need to agree on provisions about eliminating preexisting conditions. We need to agree on an incremental approach to reward people for engaging in healthy behaviors. It is cheaper to insure people who are nonsmokers and people who are not obese. It is about $1,400 less to insure a non-smoker versus a smoker; and it is about $1,400 less to cover someone who has the proper body weight versus somebody who is obese. Encouraging individuals to engage in healthy behaviors is a good thing. We can agree on that. We also need to allow small businesses to join together to take advantage of purchasing power in the same manner that big businesses do. This is an incremental reform proposal that would not destroy the quality of our health care system and would not take the costs and put them on the backs of small businesses. This is something we should do. This is something we can do. The only way to enact these incremental reforms is to stop the bill that is before us today. The only way for us to do that is to sit down together, not as Republicans or Democrats, but to sit down together and come up with ideas that we can all agree on that will actually help the health care system in America. That is what this body should do if we want to do what is right for the American people. I yield the floor.

Mr. ENSIGN

Mr. ENSIGN. I ask unanimous consent that I be able to speak as long as I take tonight and then following my comments, the Senate stand in adjournment.