Michael Enzi

Mr. ENZI

Mr. ENZI. Reserving the right to object, neither of these requests are the requests I was just talked to about a minute and a half ago, so I object.

Mr. ENZI. Mr. President, in the weeks this has been sequestered without us being able to review it and now having something that is not understandable in the short period of time we have to do it here, I have to object.

Mr. ENZI. Mr. President, in light of some of the trust problems and transparency problems we have, and while it appears to lead to greater transparency, we can also see ways that this can limit the ability for the minority to offer amendments. Therefore, I object.

Mr. ENZI. Mr. President, I was hoping I would have a chance to comment on the things I had to object to so I can give a more full explanation. I am happy to wait.

Mr. ENZI. Mr. President, I cannot be brief on what just happened here. I will let the Senator go ahead. Frankly, I am a little upset about what has happened--combining a couple of unanimous consent agreements so that part of it would be acceptable and part would not be, leaving out the most important one, which is that we wouldn't take Medicare money from Medicare, and then not having much time to consider, or to rewrite, or to do anything with those. I have a lot of comments I wish to make on that, plus a general statement on the bill, which fits in with what just happened. I will defer to the Senator from Maryland.

Mr. ENZI. Mr. President, as I mentioned earlier following the unanimous consent requests the leader made--who then introduced Senator Mikulski so that she could do her amendment, which kept me from commenting on the unanimous consent requests he made--I have to say I think those unanimous consent requests would have to be put in the category of a stunt. Unanimous consent usually means the two leaders have gotten together and negotiated some kind of agreement that we would abide by during this time. There was no agreement on this. Yet they went ahead and did the unanimous consent request solely so they could get the objection. Nobody here, I am sure, wants to use Social Security money for anything except Social Security. So the real key to the stunt was the second one, which is the net savings generated by the CLASS program. That is a long-term care program that wound up in the Health, Education, Labor, and Pensions Committee bill. The flaw with that particular amendment was that it collected money for 10 years without spending any and then it wound up with a huge liability. So we put in a little provision that it had to be actuarially sound because, quite frankly, it is not very good accounting to collect $70 billion in exchange for a $2 billion--excuse me, $2 trillion--I get the b's and the t's mixed up here, because we are talking about real money here--a $2 trillion bill. That is how much we are going to have to pay out over the next 10 years to cover the $70 billion we accept in payments for this new kind of insurance that would be provided. That kind of insurance is provided--it is provided in the private sector--but for considerably more than what they were providing for in the CLASS Act. So that was to bring a little more attention to it, and I want to bring a little more attention to it because I want people to take a closer look at the way that winds up. It is a good idea that is not paid for, and it is not paid for in such a way that it winds up, once again, adding to the deficit but in some cagey ways. As for having the amendments posted on the Web site before they are given, I hope the initial version is posted on the Web site by everybody before they do it. But one of the things that happens on this floor is that occasionally a good idea can be built on by somebody from the other side or even somebody from your own party, and when that happens you can modify the amendment. I am not sure that agreement wouldn't have prohibited any modifications to amendments, which is kind of what we ran into in the Finance Committee when we were trying to do amendments. So good ideas--they need a lot more work. And to just throw those out at the beginning and to have about 1\1/2\ minutes' notice that they are going to be thrown out--I just don't think that is the right way to go about this whole process. I have been working on the Nation's broken health care system ever since I entered the Senate more than 12 years ago, and I had high hopes this would be the year the Democrats and the Republicans of the Senate would work together to provide health insurance to every American. I urged my colleagues to start with a blank piece of paper and develop a bipartisan bill that up to 80 Members of the Senate could support. Unfortunately, the majority leadership had other ambitions, because the bill being debated today is a testament to a partisan ideological vision. It appears that the drafters of this bill took to heart the sentiments expressed by the Speaker of the House, who earlier this year said, ``We won the election, we write the bills.'' And for a number of weeks, the majority leader closed his door and wrote this bill on his own terms without any input from many of his colleagues or anybody on this side of the aisle. This is a deeply flawed bill that fails to address the real needs of the American people. Americans overwhelmingly want reforms that will help lower their health care costs. Instead, this bill will spend $2.4 trillion when it is fully implemented and contains numerous provisions that will actually drive up the costs millions of Americans pay for their health care. It is important to understand how we got here. At the beginning of this process, the majority staff of the HELP Committee decided they were going to draft a partisan bill based on the reforms that had recently been adopted in Massachusetts. Republicans were shut out of the process during the drafting of the HELP Committee bill. Rather than working to resolve the difficult issues, the drafters of the bill included over 200 separate instances where the bill gave the Secretary of Health and Human Services the authority to make important decisions about the types of health care plans millions of Americans can receive. Rather than confronting and debating these important policies--getting to the details, and the devil is always in the details--the majority empowered unelected government bureaucrats to make decisions that will affect the health care of every single American. As a result of this partisan process, we were forced to file hundreds of amendments. The chairman and other Democratic members of the committee have repeatedly commented on the numerous amendments accepted by the majority during the markup. At the same time, they ignored the reality that most of these amendments were merely technical corrections which were necessary because the underlying bill was hastily written and filled with numerous drafting errors. Unfortunately, nearly all of the accepted Republican amendments merely tinkered around the edges. Almost all of the substantive alternative-idea amendments suffered the failing fate of the party-line vote. In 12 days of markup at HELP, we had 45 rollcall votes on Republican-sponsored amendments and only 2 prevailed. After the markup, the majority refused to release a final copy of the bill for over 2 months, denying the American people the chance to see what they had done. Once we finally got a copy of the bill, we learned that majority staff had unilaterally made numerous changes to the bill, in some cases undoing agreements that had been worked out by Members on issues such as prevention and wellness. While this was happening, there were also ongoing bipartisan negotiations, led by Senator Max Baucus. And I have to congratulate him for the process he started and got people involved in and for his persistence and the amount of time he put into it. This dwindled down to a Gang of 6. The Gang of 6 discussions were not an honest attempt to try to develop a bipartisan health care bill that would offer real solutions to the problems that face our health care system. Ultimately, these negotiations failed to produce a bipartisan bill. I do not believe the failure was due to a lack of effort on the part of the participants but, rather, we were unsuccessful because the Democratic leadership chose to impose arbitrary and unrealistic time deadlines on the process that we commented on. The deadline slipped a few times, moved up a week, and then became finalized. The decision was made that it was more important to move fast than it was to get it right, and the decision ultimately doomed our efforts. This, in turn, led to another partisan markup where the Finance Committee rejected most GOP health reform ideas. Proposals such as medical liability reform were rejected on jurisdictional grounds, while the chairman unilaterally included Democratic provisions that were clearly within the jurisdiction of other committees. Republican amendments were voted on and then unilaterally changed at the eleventh hour--actually, 1:30 in the morning--by amendments offered by the chairman. The two bills were then merged, merged in secret, with no input from the many Republicans who want to enact a bipartisan health bill. We now have a 2,074-page bill that reflects many of the worst provisions from both the HELP and the Finance Committee bills. We did not need to end up here today with Republicans opposing a partisan health care reform bill. The Senate should develop legislation that will impact one-sixth of our Nation's economy and affect the health of every American. The former chairman of the Senate Finance Committee, Daniel Patrick Moynihan, a Democrat from New York, once provided the following perspective on how the Senate should consider major policy changes. He said: Never pass major legislation that affects most Americans without real bipartisan support. It opens the doors to all kinds of political trouble. Chairman Moynihan noted that absent such bipartisan support, the party that didn't vote for it would feel free to take shots at the resulting program whenever things go wrong and a large segment of the public would never accept it unless it was an overwhelming success. Chairman Moynihan understood a partisan legislative process guarantees that any glitches that occur in implementing the bill would provide ammunition for future attacks; thereby, further undermining public support of the new policies. There will, unfortunately, be plenty of glitches if this bill is ever enacted. The Reid bill will impose $493 billion in new taxes, and many of them go into effect immediately. At same time, most Americans will not see any insurance reforms or other potential benefits from this bill until at least 2014. That leads to some interesting accounting. The Reid bill will kill jobs and cut wages. The Congressional Budget Office has told us the employer mandates in this bill will likely result in lower wages and higher unemployment. These job and wage cuts would hit low-income workers, women, and minorities the hardest. It is hard to believe that with unemployment at a generational high, Democrats would even consider putting more jobs on the chopping block. The Reid bill mandates that Washington bureaucrats ration care. The bill lays the groundwork for a government takeover of health care, giving Washington bureaucrats the power to prevent patients from seeing the doctor they choose and obtaining new and innovative medical therapies. I think that is attested to by the first amendment we have, the amendment by the Senator from Maryland, because her amendment preempts the provision in the bill that allows the U.S. Preventive Services Task Force to determine what preventive services should be covered. This amendment recognizes the problems associated with government bureaucrats determining what benefits should be covered. The majority realized it had a political problem when the U.S. Preventive Services Task Force said that women aged less than 50 years old should not have annual breast screening exams. This amendment doesn't do anything to protect patients who might be denied access to preventive tests in the future, such as prostate exams, colonoscopies, Pap smears, and so on, if bureaucrats decide to deny access. This bill also shows how this will never be a truly science-based process. Bureaucrats will always have to respond to political pressure for powerful constituencies. I guess we are part of the powerful constituencies. If we decide something should or should not be in there, that eliminates the science-based part of it. I understand what they are trying to do. In the HELP Committee, when we were doing the markup, we did numerous amendments around this clinical effectiveness research, to see what it was supposed to eliminate from the health care for the person, separating them from their doctor by making these science-based decisions. We did a series of amendments and found there, evidently, are a lot of things they are hoping will be precluded from people being able to get. I invite people to take a look at those amendments. We may have to try those again to see exactly where this process is going. I appreciate the Senator from Maryland making an attempt to solve a part of the problem, but I am having a little trouble with the reading of the amendment itself. At any rate, enough of that. The Reid bill spends millions--billions. There is that word again. The Reid bill spends billions of taxpayer dollars on new pork-barrel spending. The bill would build new sidewalks, jungle gyms, and farmers' markets and creates a $15 billion slush fund for additional pork-barrel projects, a real deviation from what the Appropriations Committee has ever allowed. This bill also fails to achieve the commonsense goals Republicans and Democrats share. This bill even breaks many of the promises President Obama has made about health care reform. President Obama repeatedly called for a health care bill that will reduce costs. This bill will actually drive up health care costs for millions of Americans as a result of new mandates and taxes. President Obama has also said that if Americans like the insurance they have, they can keep it. Under the bill, millions of Americans will lose their employer-provided health insurance. President Obama promised not to raise taxes on individuals earning less than $250,000 per year. The bill would impose several new taxes on people who make considerably less than $250,000 a year. President Obama said the health care reform would not increase the deficit. This bill will not increase the deficit only if you believe certain things. This bill will not increase the deficit if you believe Medicare payments to physicians will be cut by 40 percent over the next decade. I don't think anybody believes that. The bill would reduce the deficit only if you believe Medicare payments to other providers will be slashed to levels that endanger patients' ability to get the care they need. No one believes that. The bill will also reduce the deficit if you believe Congress will allow a massive new tax to be imposed on middle-class tax payers. I hope no one believes that. If you don't believe Congress will allow all these things to happen, then you can't believe this bill will reduce the deficit. President Obama, in his remarks to the American Medical Association this summer, acknowledged the need to address our out-of-control medical liability. Rather than addressing this issue, this partisan bill preserves the costly, dangerous, duplicative medical malpractice system. President Obama finally said no Federal dollars will go to pay for abortion. According to the National Right to Life and the Conference of Catholic Bishops, the Reid bill fails this requirement as well. Despite all these failures, it is still not the worst health care bill in Congress. The Wall Street Journal got it right when they described the House-passed bill as the worst bill in America. Even if the Senate passed the bill before us today, it would still have to go to conference with the House bill and any final bill would have to move toward several provisions in the House bill and poll after poll suggests that the American people are opposed to this bill, let alone the wild one from the House. If we cannot defeat this partisan bill and get back to work for the American people and write a bill that garners the support of both parties, doing it step by step so we can assure, for instance, the seniors that Medicare money will only be spent on Medicare--that is one of the pieces that ought to have been in that unanimous consent I started talking about. That is not going to happen, though. They are going to take a bunch of money out of there. I think this legislation fails to meaningfully address these goals and will stick the American people with a bill we cannot afford. I believe we can do better, and we owe it to the American people to do so. I yield the floor.

Mr. ENZI. Madam President, I thank the Senator from Pennsylvania for his comments. I certainly hope no one who is listening thinks that anybody wants to make any child worse off. That is a basic premise, and I appreciate his pointing out the way the House makes some children potentially worse off. I want to constrain my comments to the Medicare amendment because I think that is one of the key parts of this whole bill. The Senator from Pennsylvania mentioned that there wasn't a Republican bill. Actually, there are four Republican bills, and there is one bipartisan bill out there that meets all of the goals the President put out. When we were going through the HELP Committee amendment process, we put one of those out, and it was voted down with one vote. We said: That didn't work very well. There were a lot of good ideas in there. They ought to have to consider every one of those. We have been putting our ideas out one at a time so that hopefully the other side will glean something out of the amendment that will be worthwhile to be a part of the bill. All the good ideas couldn't be on one side of the aisle. We began the day with kind of a stunt which, of course, was to have the leader propose a unanimous consent. He proposed that the Social Security money ought to stay with Social Security. I don't think there was any problem with that. But then he proposed that CLASS Act money ought to stay with the CLASS Act. That is a fund that isn't even actuarially sound to begin with. It is just a piece of the bill that is already in existence around here. He left out what he should have put in that unanimous consent request. He should have said Medicare money should be reserved for Medicare. That would have relaxed a lot of seniors. But it would have been untrue and impossible to pass this bill if that were the UC, because Medicare money is going to expansion of new programs outside of Medicare. That is what is upsetting seniors. And it ought to. Medicare, as everybody has said, is going broke. That is a government option that is going broke. Well, never mind. But Medicare is going broke. We all agree on that. So why would we take $464 billion out of Medicare to use on other programs and then recognize that Medicare is going broke and throw in a special commission that will come to us once a year and suggest cuts to Medicare? That is not a bad idea, but some side deals have been made in this whole thing that keep that from being a very realistic option either. The hospitals can't be cut any more. The doctors, we are going to have to fix that, and that is where some of the phony accounting comes in. The pharmaceuticals, the little deal they made for the doughnut hole, that will provide extra help to seniors through the doughnut hole, but it has to be on brand name products. We know that generics are a lot less expensive and a lot of seniors switch to generics, especially when they get to the doughnut hole and have to make decisions on their own and they want to save a few dollars. But that will not be a possibility under this bill because of the deal that was made with the pharmaceuticals. They are going to pay their percentage on brand name products only. Why would they do that? If they can get you to use brand name products through the doughnut hole, when the government starts paying again, you will still use the brand name. One of the ideas with health care is to get a little skin in the game with everybody so people are making good choices on health care. How much of a good choice are you going to make if you don't have to make a choice and you can keep on doing what you have been doing, whether it is the best choice for you, whether it is even what the doctor agrees with, and whether it is a whole lot more expensive for the government to keep Medicare going? I rise to support the McCain motion to commit this bill and eliminate its Medicare cuts. Senator Reid's bill cuts $464 billion from the Medicare Program. These cuts will eliminate benefits for Medicare patients. They will make it harder for them to see doctors and other providers and will threaten the survival of hospitals, nursing homes, and home health agencies. Don't take my word for it. The administration's own chief actuary recently reviewed the House bill with its similar levels of Medicare payment cuts and reached the same conclusion I just said. Richard Foster, chief actuary at the Centers for Medicare and Medicaid Services, CMS, wrote that if these cuts were to take effect, many providers ``could find it difficult to remain profitable and might end their participation in the program.'' He also noted that this could jeopardize Medicare beneficiaries' access to care. I have heard similar messages from doctors, home health aides, and nursing home owners back in Wyoming. They are all concerned about the one-half trillion dollars in Medicare cuts and what it will do to their ability to treat Medicare patients. I have heard from folks at the Baggs Senior Center, the Star Valley Senior Citizens, the Southwest Sublette County Pioneers Senior Citizen Center, and from other Wyoming nursing homes about how the $15 billion in Medicare cuts to nursing home payments will devastate their ability to provide care for seniors in Wyoming. Many of these nursing homes are small businesses. They struggle to make payroll every month and deal with an ever increasing burden of government regulations. We have never cut those back. They tell me how their Medicare payment rates have already been reduced and how the additional cuts in the bill could force them to close their doors. Connie Jenkins, executive director of the Star Valley Senior Center, recently wrote to me about the important role nursing homes play in rural towns in Wyoming. She noted that ``in a rural state such as ours, closure of nursing homes would mean families travelling farther to visit [their] loved ones and in some cases loss of access altogether.'' In rural States--and we are about as rural as you can get; we have the least population in the Nation, and we have a lot of land mass-- there is a lot of distance between towns. If the nursing home in your town closes down, it is a long way to the next nursing home. The Reid bill would also cut $135 billion in Medicare payments to hospitals. In a State such as Wyoming, with an older population, between 40 to 50 percent of our hospital revenue comes from Medicare. Medicare already pays a fraction of what private insurers pay, and the cuts in this bill will undermine those hospitals' ability to continue to operate. I have heard from several Wyoming hospital executives that because of the payment cuts in this bill, they are going to need to ask their people to work fewer hours and take pay cuts. They also said they may need to lay some folks off and to find ways to scale back the services they offer to their patients. They do not want to compromise the care they provide, but the payment cuts in this bill will not leave them a choice. The Reid bill also cuts nearly $8 billion in payments to hospice care. Hospice care helps to relieve the suffering of people who are dying from diseases such as cancer. These are terminal patients, terminal patients who, of course, are not going to be cured. But the hospice is intended to help manage the pain and other symptoms of the patients with the terminal illness, and working with the families, much on a volunteer basis. According to National Hospice and Palliative Care Organization, the cuts in the Reid bill, combined with prior regulatory cuts, would reduce Medicare payments to hospice providers by 14.3 percent through 2019. According to a June 2008 report from the Medicare Payment Advisory Commission, hospices already operate with narrow profit margins that average just 3.4 percent. Smaller nonprofits and hospices in rural areas such as Wyoming already operate with negative profit margins. Many depend on charitable fundraising to keep their doors open and to enable them to keep treating patients. Yet the Reid bill would further cut their Medicare payments by $8 billion. This will force many hospices to close, which will threaten dying seniors' access to that type of care. The Reid bill also cuts more than $40 billion in Medicare payments to home health agencies. According to the analysis done by one industry association, this level of cuts could put nearly 70 percent of all home health agencies at risk of having to close their doors. I want to say that again. The $40 billion in Medicare cuts to home health agencies, according to an analysis done by one industry association, could put nearly 70 percent of all home health agencies at risk of having to close their doors. There are a lot of people who are out of nursing homes because they are getting home health care. If we eliminate home health care, we drive up the cost of care. If the Senate passes this bill, it will mean that Medicare patients may not be able to get the skilled nursing care, the physical and speech therapy, and the assistance that home health aides provide with many daily activities, such as dressing, bathing, helping patients live more fully with a disability. The Medicare cuts in the Reid bill are not limited to slashing payments to hospitals and other providers. The bill also cuts $120 billion from the 11 million seniors on Medicare Advantage. These cuts make a mockery out of President Obama's promise that if you like what you have, you can keep it. As a result of these cuts, millions of Medicare beneficiaries will lose the benefits currently provided by Medicare Advantage plans. Supporters of Senator Reid's bill have tried to gloss over the impact these Medicare Advantage cuts will make, arguing they will only result in a loss of ``extra benefits.'' For the seniors who have come to rely on Medicare Advantage plans to provide things such as flu shots, eyeglasses, hearing aids, and protections against catastrophic costs, these are not extra benefits but items and services they depend on. We all agree Medicare needs to be strengthened and reformed. Its financing is unsustainable. The Hospital Insurance Trust Fund, which pays for hospital services, will be insolvent in 2017. The physician payment formula, which calls for Medicare payments to doctors to be cut by more than 40 percent over the next 10 years, is fundamentally broken. We know that. We even had a vote on that in this Chamber. We said it had to be paid for. Let's see, $464 billion coming out of Medicare. Medicare is what is being affected by the doctors' payments. Why wouldn't we use some of that? But it is a lot of money. It is a lot of money, but it is not as much money as we are taking out of Medicare. Unfortunately, the Reid bill does nothing to fix these problems. Instead, it cuts one-half trillion dollars from Medicare to create a brandnew entitlement program for the uninsured. This approach fails to address the real problem facing Medicare; and that is the physician formula. Instead, it uses the same gimmick that Congress has repeatedly used to fix this problem and provides a temporary fix in 2010, which will actually lead to steeper cuts in subsequent years. Physicians have grown increasingly frustrated by Congress's repeated failure to replace the current payment formula. We kind of like to keep them hanging on a year at a time. I think it is a little bit of a hostage situation, but that is the way Washington works. It should not be that way. We should redo the formula. If we do not address this problem soon, many more physicians are going to decide it is not worth it to continue to treat Medicare patients. The Congressional Budget Office has estimated that truly fixing the physician payment formula could cost upwards of $250 billion, yet the Reid bill does not address this problem. Spiraling costs associated with medical liability lawsuits directly increase Medicare costs. These costs are calculated directly into payment formulas for providers such as physicians. In addition, physicians and hospitals order billions of dollars in extra tests and procedures to protect themselves from the threat of potential lawsuits. We know that enacting commonsense medical liability reforms directly reduces the liability insurance premiums doctors pay. We have seen the results in States such as Texas, where physicians liability insurance premiums have decreased every year since the State-enacted reforms, with average liability rates dropping a total of 27 percent. The Reid bill does nothing to address the problems of medical liability. Instead of including reforms that would help reduce Medicare costs and extend the solvency of the program, the only thing the Reid bill does is include a meaningless sense-of-the-Senate resolution on liability reform. That will not pay the bills. We owe it to the 43 million people who depend on Medicare to reject the arbitrary cuts in the Reid bill. We need to come up with better solutions that will not endanger their ability to see a doctor or to get care at a hospital or a nursing home. Yes, if we do not pay the doctors, the doctors will not take them because in Medicaid they already will not take 40 percent of the patients; and in Medicare it is 20 percent already. A lot of people are being asked, when they call a doctor, if they are a Medicare patient. It is my contention if you cannot see a doctor, you do not have any kind of insurance at all. We do not take care of that problem, so we do need to come up with a better solution that will not endanger their ability to see a doctor or to get care at a hospital or a nursing home or to have home health care. I believe we can do better. If the Senate passes this motion to commit, we can develop bipartisan reforms that will eliminate the unsustainable payment cuts and address the underlying problems facing the Medicare Program. I yield the floor.

Mr. ENZI. Madam President, I suggest the absence of a quorum.

Mr. ENZI

Mr. ENZI. Mr. President, as morning broke over our Nation today, millions of Americans woke to a typical, crisp fall day. It seemed ordinary as shop-owners opened their local grocery stores; children filled soccer fields and families made preparations for Thanksgiving holiday. It seemed ordinary. But today is anything but ordinary in the life of our Nation. We have all heard the phrase and repeated it so many times, that we have almost grown numb to it--America is facing the worst economic crisis since the Great Depression. Think about that for a minute. What that really means is that for every single legislator in this Senate, we are in unchartered territory. We have never been here before and recent signs of a slow, unsteady and jobless recovery are troubling. And, the American people know it. In a survey from this past week, 82 percent of Americans said that our Nation's economic conditions are poor. Consider the news reports from just yesterday that 14 percent of all mortgage loans--meaning 7.4 million households--were delinquent or in foreclosure in the last quarter. That is the highest number since the mortgage bankers industry began this survey in 1972. Consider the unemployment rate--it reached a 26-year high of 10.2 percent in October. We lost 190,000 jobs in just the month of October alone. And, according to the Department of Labor's broadest measure, some 17.5 percent of Americans are without a job entirely or underemployed. We have shed 3.5 million jobs since January of this year and the average work-week is now down to 33 hours for the American worker. It is against this backdrop that the Senate majority leader has chosen to bring up this health care bill. Health reform is a huge undertaking. Every one of the 2,074 pages in this bill will have a dramatic impact on the health care of every American. I have to tell you, that is a bridge. This is a bigger problem than anyone can imagine because it will affect every single American. This bill represents a massive government intrusion into the medical care of every American. Under this bill, the government will review every employer health insurance plan in the Nation to determine if it satisfies all of the government mandated benefit requirements. If it does not, the government will then tax many of those employers. The government will also now determine whether it believes your health insurance costs too much. It will decide what benefits should be covered and what preventive services you should receive. Earlier this week, the U.S. Preventive Services Task Force recommended that women under age 50 should not receive annual mammograms. Anyone who was concerned about this decision needs to understand that this bill empowers a task force just like that to determine which preventive services should be covered by every health plan in America. As one of the only Members of the Senate to sit on both committees of health care jurisdiction, I understand the complexities at work in comprehensive health care legislation. And I understand that this bill gets it wrong. Instead of taking a step-by-step approach to health reform, identifying consensus reforms where we can fix what is broken and leave what works, the majority leader has chosen a different approach. Without Republican support and without the approval of a growing majority of the American people, Senator Reid has chosen to shake nearly 20 percent of our economy in its foundation in attempting to jam through a strictly partisan bill. This bill will increase our health care costs, do nothing to improve the quality of our care, it will increase our Nation's debt and deficit and it will harm our Nation's tenuous job market. There is no credible study and there will be no serious, unbiased economist who will say that this bill will create jobs or strengthen our economy. And that is what the people in the most recent election said was mot important. Recently, in an op-ed in the Wall Street Journal, the dean of Harvard Medical School Dr. Jeffrey Flier gave the current health reforms a ``failing grade.'' Dean Flier wrote about the reform bills being debated in Congress, that ``there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.'' Dean Flier went on to write: In discussions with dozens of health care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. I ask unanimous consent that this editorial be printed in its entirety in the Record at the conclusion of my statement.

Mr. ENZI. With ratings of failed reform like the dean of the Harvard Medical School, why are we talking about taking the time to tweak a failure of ideas so we can say we did something. We are not fooling the American people. The voices of August are still echoing and coming from a vast majority. Other experts have weighed in on the provisions in the Reid bill and their potential impact on jobs. One such provision is the job-killing tax of $28 billion that will disproportionately fall on the backs of small business employers in the form of a mandate on employers to provide Washington government-approved insurance. This job-killing tax has been studied by the non-partisan score keepers at the Congressional Budget Office as well as nationally recognized economists and health experts. These experts have said that the costs of this new tax will ultimately be paid by the American working men and women. Businesses that cannot afford to provide health insurance will pass the costs of these new penalties on to their workers in the form of lower wages, reduced hours and jobs cut. Yes, this so-called health reform bill will threaten your jobs and if this vote is successful we will spend weeks debating this bill. And just like committee work so far, the majority will reject real solutions just like they have through the two amendment processes that have been merged to make this flawed bill. According to one recent study by the Heritage Foundation, this new job-killing tax in the Reid bill will place more than 5 million low- income workers at risk of losing their jobs or having their hours reduced and an additional 10 million workers could see lower wages and reduced benefits. At a time of unprecedented economic peril, the majority has chosen to bring a bill to the Senate that will threaten our Nation's jobs and our economic growth. This bill will also increase our Nation's growing debt and deficit. Currently, our Nation's debt is greater than $112 trillion and our deficit for fiscal year 2009 was greater than $1.4 trillion. As a percentage of the economy, our deficit is 10 percent of GDP--the highest it has been since the Second World War. Once again, we are not debating this bill in a vacuum. Rather, we are debating this bill at a time when our credit card is maxed out. I worry about the country that I am leaving for my children and grandchildren. Our Nation is being buried under a mountain of debt, which poses a deadly threat to the future of our Nation. The Federal Government will spend $1.4 trillion more than it receives in revenue this year. The government will make up that deficit by borrowing more money, mostly from China and other foreign governments. These levels of debt are not sustainable and, our foreign creditors are beginning to recognize this fact. As our creditors grow more concerned about our ability to pay our debt obligations, the interest rates we pay will grow. That means that it will soon cost us considerably more to allow Washington to continue to borrow the money it needs to fund its current spending binge. With our current and growing debt, Congress should be concerned. Think about it--our most fundamental duty as Members of Congress is to wisely manage the power of the purse for our Nation. The Framers wisely put in place a process of appropriations that would be annually checked by the representatives of the American people here in Washington. In this bill we create yet another stream of mandatory spending in perpetuity--or until it runs out--that is not reviewed by Congress on an annual basis. I remind my colleagues that our Federal deficit is nearly nine times the size of the deficit just 2 years ago. During the same 2-year period, our Nation lost 8 million private sector jobs. Our total Federal debt is now around 85 percent of GDP. According to David Walker, the former head of the Government Accountability Office, at the end of the fiscal year 2000, the Federal Government had about $20.4 trillion in total liabilities and commitments and unfunded promises for just Social Security and Medicare. That number rose to $56.4 trillion at the end of fiscal year 2008. That is a 176-percent increase in only 8 years. By the end of this year, that number is expected to rise to $63 trillion. With these staggering statistics, it is astonishing we are even debating the creation of a new entitlement obligation forever. A couple days ago, Majority Leader Reid stated that this bill will be deficit neutral, but you have to understand what that means. First, the true cost of this bill is hidden by implementing the massive middle- class tax increases and Medicare cuts in the first year and pushing the massive costs in health care subsidies out to the fifth year. Republican Leader McConnell referred to this gimmick as being akin to paying a mortgage for 4 years before actually moving into the house. I wish to emphasize that a little bit. It is a gimmick. You collect the money to begin with, but you don't provide the benefits until further down the road. Then you say: We covered all those costs. But when you extend it on out, it will not continue to cover those costs. So disaster. As the only accountant in the Senate, I am shocked to see that what would constitute as fraud in the accounting world seems to be reason to hold a press conference to do a hollow boast. The gimmicks in this bill are stunning, whether it comes to implementation of the tax on so- called Cadillac health plans or the increased taxes or the $464 billion in Medicare cuts--Medicare cuts. We are already having a problem with Medicare solvency. It is going to go broke. We are going to take $464 billion from Medicare. Then we are going to form a special commission and this commission will be able to tell us, on an annual basis, where we can make cuts in Medicare so it doesn't go broke. But let's see, there is a deal with the hospitals that they are not going to be touched. There is a deal with the doctors that they will not be touched; in fact, theirs is going to be increased. There is a deal with PhRMA where they will not be touched. Who does that leave? That means cutting benefits for seniors. They and home health care and nursing homes are the only places you can cut it, if you let those other people off the hook. That is what the bill does. When it comes to the long-term care provisions in this bill that Budget Committee Chairman Conrad has referred to as a Ponzi scheme, you have to be a little bit worried. If Washington accounting had to come under the same laws as private business, the administration and Congress would be in jail. To attempt to claim the mantle of fiscal responsibility, the majority leader has jammed 10 pounds of entitlement spending into a 5-pound sack. Again, entitlement means the payments automatically go on forever with no further review or constraint. That is not fiscal responsibility and the American people are not buying it. They know, evidently better than we do, what we are talking about. A large majority of Americans believe their prescription drug costs will go up under this bill and that the cost of their premiums will go up. They are right. What the CBO score doesn't provide us with and can't provide us with is the cost of this bill to each and every one of us. But we know that cost will be great. The CBO evaluation says it is going to be paid for. Paid for? That is an evaluation of whether it is going to cost the government anything. It is not an evaluation of whether it is going to cost the people anything. The only place to get that money is from the people or, in this case, also stealing it from Medicare. In order for this bill to reduce the deficit, the majority leader has to assume that the Medicare payments to physicians will be cut by 21 percent next year. He also has to assume these payments will be annually cut another 5 percent for the next 9 years. In order for this bill to reduce the deficit, the majority leader also has to assume that more and more middle-class Americans will pay this new tax on high-cost health insurance plans. According to the Congressional Budget Office, 84 percent of the revenue collected by this new tax will come from Americans earning less than $200,000 in 2019. This reminds me of another tax which was originally intended to target just 155 individuals who made more than $200,000 and did not pay any income tax. Today the alternative minimum tax now hits millions of middle-class Americans, and every year Congress has to enact legislation to prevent it from hitting millions more. This bill is drafted that same way. It will creep up there and catch everybody in increased taxes. In order to believe that this bill will reduce the deficit, its sponsors must believe that future Congresses will allow millions of middle-class Americans to be subject to these new taxes. While the majority leader claims all these things will happen, the American public isn't fooled. In this morning's Washington Post, the dean of Washington journalists, David Broder, not a politically conservative columnist and someone often cited by the other side, pointed out that a recent survey found that less than one-fifth of the American people believe that health care reform will be deficit neutral over the next 10 years. By a 16-point margin, the majority in this poll said they opposed the legislation moving through Congress. Mr. Broder called this legislation a ``budget- buster in the making.'' It is difficult to quantify the scope of this bill. I have heard some of my colleagues talk about how many years would elapse in 2\1/2\ trillion seconds. I heard some of my colleagues talk about how many cars $2.5 trillion would buy or how many school districts it would fund or how many decades it would fund State budgets across America. I don't think people are understanding how comprehensive this bill is that entails 100 percent of the people. That is the difficulty we in the Gang of 6 had coming to any conclusion because it is so big that as we get into one area and scratch the surface and find out what we don't know, it takes a lot of research time to get there to be able to make basic decisions. But it was easy to cram into a bill and say: This solves it, solves it for $1 trillion. We should never say $1 trillion because that sounds like one, and one is not a very big number. It is $1,000 billion. We don't know what 1 billion is either, but 1 billion is 1,000 million. So we are talking about a lot of money here. Perhaps the best way to quantify this bill is, it keeps me up nights and, more importantly, these issues we are debating keep our constituents up at night. I am sure everybody has been hearing from their constituents. We worry immensely about the cost and the obligations we are passing on to our children and grandchildren. Where is this bill taking our country, and will we have the courage in our time to preserve and protect our Nation's great strengths for future generations? These are the questions that keep me up at night, and I know these concerns are shared on the other side of the aisle. I sense it in conversations I have had with the senior Senator from Delaware and the senior Senator from Nebraska. I sensed it in my work over the summer with the chairman of the Budget Committee. I know they share these concerns on the other side. That is why I believe passionately that we must defeat the motion to proceed on this bill. I am sometimes an optimist, and I still hope we can start over and get to work on a bipartisan bill that has the trust and support of the American people. Any major piece of legislation that has gone through this body has done so in a bipartisan way. It has been necessary to get the confidence of the American people. They don't have confidence in Congress right now. This bill is not helping. We say we are spending our children and grandchildren's money. Actually, we are doing that plus spending seniors' money. When you take that Medicare money, that is what you are doing. The seniors have figured it out. That is why it was so raucous in August and ever since. They have been concerned about their future and the promises made to them. We have a system that is going broke, and then we are going to take money from it. We ought to back up and make sure Medicare money goes to Medicare. I know part of that is listed as fraud and abuse. I am always fascinated when government talks about fraud and abuse because we talk about it, but if we have known that these billions of dollars of fraud and abuse were out there, why haven't we been collecting that money? Once we turn it over to the government to do that, it is no longer needed. Well, it is needed to pay the bills, but it is no longer that much of a care because the paid-for has already been taken care of. There ought to at least be a separate account set up that you have to actually collect the fraud and abuse money before you can spend it, but we are not going to do that. Every senior can tell you some instances of fraud and abuse that they think are happening, and we have passed those on. I see some effort to collect that but not a lot. As many of my colleagues know, before I came to the Senate, I was a small business owner. My wife and I owned three small shoestores in Wyoming and Montana. When I was showing someone a shoe and he or she said they didn't like it or couldn't afford it, I didn't try to give them a sales pitch. I knew it was time to try to find another shoe, one they liked and could afford. There is a lesson from this in this health care bill. The people of America are complaining, and we are showing them the shoe we want to show them. They don't want to see that shoe. They said: We thought you were going to lower my costs. Every person out there thought they were going to have the benefit of reduced costs, and they are not seeing it in this bill. They wanted to help out other people, and some of that is in here, to a limited extent. But that isn't the main thing that they expected to have happen from this. Small businesses out there are particularly hurting, and this will react on small businesses, those shoestores all over the United States, the grocery stores, the dry cleaners. This is even going to affect doctors. They are small businesses, for the most part. So there is a lesson in this story when it comes to reforming health care. It is time to listen to the customers and find the alternative they expected, that they wanted, and they can afford. Probably the biggest help to me in legislating has been the experience of working in a shoestore. The people tell you what they want, and they have told us what they want. We haven't listened. If you want to make the sale, you better listen. You better see how your inventory matches what they want. We haven't checked the inventory or we have said: We don't have anything in here that you need, but we have some things to take care of other people. That is not going to sell. We have a big decision to make tonight. It will have a lasting effect on our country, a lasting effect in that if the motion to proceed passes, we are going to debate it for a long time. A bill this size deserves a lot of time. It is necessary. And it is more comprehensive than we are going to be able to get into, no matter how long we debate it. So the American people are going to be surprised at the time we waste when we could be solving jobs and the economy, which is their biggest concern at the present time. Mr. President, I yield the floor. Exhibit 1 Health ``Reform'' Gets a Failing Grade (By Jeffrey S. Flier) As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I'd give it a failing grade. Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama's agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health-- not politics--have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial. Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care. Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that's not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost--and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform. In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value. Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern. In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system--now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all. There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but--despite initial predictions--increased total spending. A ``Special Commission on the Health Care Payment System'' recently declared that the Massachusetts healthcare payment system must be changed over the next five years, most likely to one involving ``capitated'' payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health- care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change--necessitated by skyrocketing costs and a desire to improve quality--are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required. Yet it's entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law. Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation. So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit. We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

Mr. ENZI

Mr. ENZI. Mr. President, I ask unanimous consent that the Republican Senators, during their hour, be permitted to engage in a colloquy with fellow Republican colleagues.

Mr. ENZI. Mr. President, I rise to talk about the health care reform bill. This country needs health care reform. The status quo in health care is unacceptable. Health care costs are skyrocketing, insurance premiums are increasing, and too many small businesses can no longer afford to offer health insurance to their workers. No one on either side of the aisle denies we need health care reform. We need to enact reforms to bring down costs so everyone will have access to quality, affordable health care. We need to take a step-by- step approach to reduce health care costs and lower insurance premiums for individuals and employers. We need to eliminate discrimination based on preexisting conditions and ensure that people can take their insurance with them from job to job. I support commonsense reforms that would achieve all these goals. Unfortunately, this 2,074-page Reid bill fails to address these issues. Instead, this bill would raise taxes by $493 billion. It would cut another $464 billion from the Medicare Program. The bill would reduce wages and eliminate the jobs of millions of Americans. It would actually drive up health insurance premiums for many more Americans and still leave 24 million people without insurance coverage. We need to do better than that, and I think we can. Our country currently faces one of the worst economies in a generation. Our unemployment rate is 10.2 percent, which means there are 15.7 million Americans without jobs. At the same time, the bill we are debating, or will be debating when we actually get to the real thing, would impose $28 billion in new taxes on employers. This new tax will eliminate millions of American jobs and reduce wages for millions of American workers. When employers struggle with extra costs, workers and their families feel the impact. American workers depend on a strong economy to create jobs that help them feed their families and build their dreams. Unfortunately, the policies being pushed by the majority will only make it more difficult for America's businesses to hire workers or pay current employees more. The Congressional Budget Office, health researchers, and nationally recognized economists all agree that Senator Reid's new job-killing, employer tax will mean one thing: More Americans will be out of work if this bill becomes law. As I mentioned, this bill will raise taxes by $\1/2\ trillion--$\1/2\ trillion. The authors of the bill truly believe the greatest problem in our health care system is that we do not pay enough taxes for our health care. Under this flawed bill, if you take a prescription drug, you will pay a new tax. If you use any medical devices or equipment, ranging from walkers to wheelchairs, you will pay a new tax. If you do not have health insurance, you will pay a new tax. If you do have health insurance, you will also pay a new tax. If the government decides your health insurance is too expensive, there will be a new tax for that as well. The problem with our current health system is not that we don't pay enough taxes. Americans actually want to lower their health care costs--that is the message--not just pay more taxes to the Federal Government. All these taxes will only increase costs, making health care even more unaffordable. The third major problem with this bill is it will actually increase the cost of health insurance for millions of Americans. The bill mandates that insurance premiums for younger, healthier workers be tightly tied to the costs for older, sicker individuals. This will immediately drive up costs for the young, healthy individuals who, coincidentally, make up a significant portion of our current uninsured population. The bill also eliminates consumer choices, requiring Americans to buy richer types of plans that cover more of the deductibles and cover more out-of-pocket expenses. These plans typically have much higher premiums. Taken together, these insurance changes will increase costs for millions of Americans. In looking at more modest provisions included in the Senate Finance bill, nationally recognized accounting and business consulting firms found these changes would increase insurance premiums by 20 to 50 percent. The practical effect of this bill is, Washington could dictate to every single American, even those who have insurance they now like, the coverage they would need to purchase. Washington will tell you what is good enough coverage. The bill does not give people affordable options, and it penalizes those who do not purchase high-end, expensive plans, regardless of what they want, need or can afford. Before I was a Senator, I was a small businessman. My wife and I owned three shoe stores. When I was showing someone a shoe and he said he did didn't like it or couldn't afford it, I didn't try another sales pitch. I knew it was time to find another shoe, one he liked and could afford. If the customer is complaining, get something else to show. The customers are complaining. The voices of August are still out there, and they know this bill is just more of the same. There is a lesson in that story when it comes to reforming health care. It is time to listen to our customers and find an alternative they want and can afford. The intensity of the country's disapproval is apparent in townhall meetings, letters to newspaper editors, citizen protests, constituent calls, and letters from all across the Nation. I received some of those that said: My Senator is not listening but you are. I wish to find solutions. Ask most of my colleagues and they will tell you, time and time again, I have been known to work across the aisle on commonsense reforms on all kinds of issues. I have fought for years to enact commonsense reforms that will help slow health care cost growth and make the insurance market work better for small businesses. I worked closely with Senator Ben Nelson from Nebraska on a bill that would allow small businesses to combine their purchasing power across State lines, even nationwide, and collaboratively buy health insurance at discounted rates. I worked closely with the late Senator Ted Kennedy on a bill to reform the drug approval process at the Food and Drug Administration. I worked closely with then-Senator Clinton on a bill to save lives and decrease costs by promoting greater use of electronic medical records. Time after time, I have advocated that we set partisan differences aside and work on the 80 percent of the issue that will make a difference for most people. Unfortunately, rather than working with Republicans to develop a commonsense solution, the majority drafted a flawed bill that spends too much, does too little to cut health care costs, and puts seniors' benefits on the chopping block. The White House and Democratic leaders should have responded to these concerns with alternative ideas that actually address the health care issues that most Americans care about--their cost. Unfortunately, they decided to simply try a more aggressive sales pitch. As a result, opposition to it will only continue to grow. If this bill continues to move forward, in spite of what most Americans are telling us, I am going to keep offering amendments geared to bringing down health care costs for American families, scaling back total health care spending, and protecting seniors. I yield the floor to my colleague from Wyoming who has copies of the bills.

Mr. ENZI. Absolutely and not just townhall meetings. That is how the letters, e-mails, and phone calls are coming in, greatly in response to what they anticipated they were going to get, which was going to be lower costs. They don't mind helping other people to have insurance and subsidizing that insurance or in some cases providing it for free. But they expected to get something out of it themselves. We miss the mark on this. You can tell they missed the mark. The bill that has been brought up to be voted on is just a little 2-page bill. Why didn't they put up the House bill? Because they couldn't get 60 votes for the House bill. They know that is wrong. This is a whole lot different from the House bill. It is different. I give them some credit for that. They couldn't put this bill up because they can't get 60 votes, and they have to get 60 votes to move on to debate. They brought up the Service Members Home Ownership Tax Act of 2009, which is actually two pages and a summary. So there is not much to that bill. Their hope is they can get the 60 votes and people will not concentrate on the fact of what is in this bill. I appreciate all the efforts of the Senator from Wyoming. He has been involved in the health care industry as a provider for a long time and a real student of what is in these bills. He has looked at these bills in detail, so he knows a lot of the flaws. I appreciate him taking the time to point those out.

Mr. ENZI. I would like to comment on that, in some way, unprecedented action by a committee. We agreed in committee on some amendments. Then when the bill was actually printed, which was not done for 2 months-- which was, I think, so people couldn't actually look at it during the August recess, during that 2 months--when it was finally printed, some of the things that were agreed to were left out. One of the big ones was an actual wellness program, one that worked for Safeway, that helped cut their cost in the first year by 8 percent. Have you heard of anybody cutting their costs in health care? Their program did. Since that time it has been held level because of what they were able to do with wellness programs. We got that wellness program approved. We didn't get much approved when we were doing that bill, but we got that approved. But when the bill was printed, that was left out. Staff, without talking to any one of the Members, had taken it out. I think that is unprecedented around here. But that was not the only instance either. I would like to direct the attention of Senators to the costs on this bill, which the Senator from Wyoming has mentioned. As an accountant, I look at those. They say they are going to reduce the deficit in the first 10 years and even more in the second 10 years. There are two ways they can do that. One of them is to raise taxes. The other is to steal money from other people, which is what they are doing from Medicare. That, maybe, means they are overtaxing? So that might mean they want to stick in some other things that will be spending. Is there anybody out there who thinks you can do a $1 trillion new program and it will not cost a dime? I hope people are taking a look at matters such as the Wednesday editorial by the president of Harvard who made some comments about how things are working. I hope everybody reads that. This is a good way for our Nation to go broke. We are not in very good shape right now, but that is a good way to go broke, and there are a lot of gimmicks in this bill too. I appreciate the Senator from Wyoming pointing that out, and I assume the Senator from New Hampshire, who is the chairman--ranking member on the Budget Committee now--and has a handle on a lot of these gimmicks will share some of those too.

Mr. ENZI

Mr. ENZI. Mr. President, I wish to thank the two doctors for their comments. I have been enthralled with what they have been saying. They have been doing a series of programs to help people understand what we could do with health care and how health care is being done. I am glad they point out that vast difference. Obviously, it was a very effective program. It was so effective that the other side decided to have a show too. They put up the two lawyers, and it shows one of the problems. When the President did speak to us at the joint session, he talked about medical malpractice reform and how he was going to do it the next day. The only problem is what he was referring to was a bill I did with Senator Baucus that was ignored in the HELP Committee and it was ignored in the Gang of 6 and it was ignored in the Finance Committee, something that would have gotten some medical malpractice reform going. I think that only saves about $54 billion. That is still a lot of money to me. It is a lot of money even in this bill, although this is a $1 trillion bill. I appreciate the doctors. I particularly appreciate my colleague from Wyoming who has been here all day adding comments from his medical background and making a substantial contribution to having the people of America understand this bill. But the people of America understand the bill better than the people in this Chamber. That is the problem. In August there were town meetings and people were appalled at the number of people who wanted to go to those town meetings and the way they wanted to speak, and they explained to us why this method won't work. It wasn't because anybody organized them. If Republicans were that good at organization, we would still be in the majority. These were people who were concerned about health care and where it was going. They had read a lot about what had been said, and they are still reading about it, and they are still mad. This isn't where they want to go. The average person in America thought we were going to cut their health care costs or at least keep them from escalating. That isn't what this bill does. This bill builds a whole bunch of new programs and taxes people and steals from Medicare. That is not where the country wants to go. I know that is not where the seniors want to go. I have been surprised at the AARP endorsing the bill. Their members don't think so. Their members are appalled at what is in here and how it is going to affect Medicare. But my real intent tonight is to discuss this bill and how the increase in health care costs raises taxes and particularly affects small businesses. It makes them less competitive. Small businesses across America are the engine of the economy. I don't know how many times I hear that around here--the engine of the economy. If small business is growing, the economy is growing. If small business is stagnant, people are still losing jobs in big businesses, and it is usually the ones who lose the jobs in big businesses that eventually get absorbed into the small businesses. It is a shift of a brain trust and it makes the small businesses grow and they stay the engine in the economy. As many of my colleagues know, before I came to the Senate I was a small business owner. My wife and I owned three small shoe stores in Wyoming and Montana. When I talk about small business, I don't talk about it in the vacuum of the Senate floor; I speak from my life experience. I know what it is like to manage a small business, to keep the books, to pay the vendors, and always to serve your customers. In the Small Business Committee I like to remind them that even though the Federal definition of small business is 500 employees or less, the real engines of the economy are much smaller than that. Some of them are the ones that are just starting, where the owner of the business sweeps the sidewalk, cleans the toilets, waits on customers, and does the books, and definitely not in that order. That is the small business. That is a small business growing. Those are the kinds of businesses that becomes the big businesses. A lot of them fail. A lot of them know they are taking a risk, but thank goodness they are willing to take that kind of risk. They never expect the government to add to their risk, but they know it does. I faced the challenges of making payroll and trying to negotiate good, affordable benefits for my employees. I have had that experience of sitting bolt upright in the middle of the night and saying, Tomorrow is payroll. How am I going to meet payroll? Sometimes you do it without paying yourself, but the business keeps going. I have to say in a small business the employees are very close to the business. They understand how tenuous it is. They work and they participate and in the good businesses, they are all like family. So they don't have some of the same choices that the big, flexible companies do. I see where a company in Virginia is about to lay off-- America On Line is about to lay off 2,500 people. The person who lays them off, do you think they know those 2,500 people? No, they won't know those 2,500 people. I suppose that makes it a lot easier. But in small business, they know their people. They want to do whatever they can to keep that brain trust, that skill, that ability around, and they sacrifice a lot to get to do that. As a former small business owner, I also understand that if we pass this bill, it will harm the engine of economic growth, and it will be a disaster for millions of Americans. This bill will impose $493 billion in new taxes, and those fall disproportionately on the backs of small business men and women. For instance, the new $54 billion increase in the Medicare payroll tax will hit approximately one-third of the small business owners across the country. These are the same businesses that employ over 30 million Americans. So why would this affect them? Do they make that much money? Well, that much money shows up on their books. Most of them are Subchapter S corporations, which means that every dollar of profit becomes their own income, even though they have to take most of it and put it back into the business in order to keep the business going and to grow the business. But some of them look like they make a lot of money. There are some businessmen in Gillette, WY, and they started a restaurant. They now have six restaurants. I happened to be in one of their restaurants in Casper. Sanford's is the name of it. It is a brandnew restaurant, and when I was there, the owner happened to be there and he recognized me and he came over and visited. He knew we were working on this. He said, You know, they keep piling stuff on us. They think we are rich. Sometimes the things we have to file with the government because of our Subchapter S corporation make us look rich and cost us a lot in taxes. We are helping them to keep this government going, but we don't get to put it in our pocket. He said, When we started that first business, we each had $200 in our pocket and we were able to borrow enough money to start that restaurant. Each restaurant that we built has been a little fancier and a little nicer. The one you are sitting in right now cost $500 million to build. He said, You know, me and my partner still only have $200 bucks in our pocket. The rest of it we have had to plow back into the business. And when we plow it back into the business, it creates more jobs. There are more people working. I will tell you, those are good jobs, too. I don't understand at a time when small business owners are struggling to pay their bills and to keep the lights on, the majority leader has decided we ought to increase their taxes. These businesses are fighting for their very survival. This bill makes it harder for them. Small business owners are also health care consumers like the rest of us. They take prescription drugs to treat diseases such as cholesterol and hypertension from the stress they are under, and they might also use a pacemaker or have a hip or a knee replaced. If this bill is passed, the prices they pay for all of those items will increase. They increase for the employees they have too who have those same things done. This bill contains over $40 billion in new fees for prescription drugs and medical devices. The nonpartisan Joint Commission on Taxation has said these types of fees will ultimately be passed through--to whom? To the consumer, meaning that the small business owner is going to pay more for his health care and for the health care of his employees. Many small businesses still manage to provide health insurance coverage for their employees, despite the ever-increasing cost of health insurance. I understand how hard it is to pay those ever- increasing costs. That is why I fought for years to help small businesses band together so they would be able to get the same kind of discounts that insurers typically provide for the large employers. How would that work? Businesses would be able to band together through their associations across State lines, even nationwide, and build a big enough pool that they could effectively negotiate with the insurance companies or with the providers. I have to tell you, when I proposed that, the insurance companies didn't like it. We went ahead with it anyway. I got it through committee. I brought it here to the floor of the Senate, and I understand how hard it is to get health care reform done. I had a bill that was filibustered on the motion to proceed. I got 55 votes. I had three people who would have voted for it who weren't here. I got 55 votes. That wasn't enough. You have to have 60 in order to move on. Here is the real irony. Olympia Snowe was ready to do the amendment that probably would have taken care of 80 percent of the concerns of the people, but because we couldn't do the motion to proceed, we couldn't offer that amendment. We couldn't finish the bill. As a result, there are no small business health plans that cross State lines. Yes, there are small business health plans. Ohio is the laboratory that I used to work the idea. Ohio already had this kind of thing within its State boundaries. There is a lot of population in Ohio. Wyoming doesn't have much population so we can't form these big pools, but Ohio could. I looked at what they had done and it was marvelous. It saved money. It gave more benefits than most of the insurance plans in the State. You know what they said to me? We could do better if we could cross that State line. If we could go nationwide or even across to one more State, we could do better for every one of our people, because we would have a little bigger pool and we could save more money. They said, in the initial phase of this, you know where most of the money is saved? I said, No, where? They said, In administrative costs. Each of those little businesses having to do their own buying, figuring, paying, costs a lot of money, about 38 percent of health care. That doesn't show up in premiums; that is a cost. Do you know what the Ohio small businesses were able to save? Twelve percent. Twelve percent. That is a huge savings, just in administrative costs. But, no, we weren't able to pass that on to these small businesses. Instead, we are coming up with a way to tax them more, regulate them more, which is not exactly my idea of how to fix health care. Rather than lowering the costs, this Reid bill will actually increase the cost of insurance by creating a new $60 billion tax on insurers. Just like the new taxes on drugs and devices, the cost of the new insurance tax will be passed through to the consumers, meaning that small businesses will see their health insurance premiums go up even more. The damage this bill will do to small business is, unfortunately, not limited to the new taxes it creates. The bill will also impose expensive new mandates and requirements on insurance that will have the effect of dramatically increasing costs for small employers. One of the worst provisions dealing with insurance market reform is the so-called shared responsibility for employers. What the authors of the bill are trying to hide behind and what sounds harmless is a $28 billion job- killing tax on employers. Under the bill, if an employer doesn't provide health insurance benefits to any employee eligible for the new insurance subsidies, which includes families making up to $90,000 a year, then the employer has to pay a fine. The penalty is equal to $750 per employee for all the employees. Let me say that again. If an employer doesn't provide benefits to an employee eligible for the new insurance subsidies, which includes families making up to $90,000 a year, that employer has to pay a fine. The penalty is equal to $750 per employee for all the employees, not just the one eligible for a subsidy. The nonpartisan scorekeepers at the CBO plus nationally recognized economists have said the costs of this new tax bill will ultimately be paid by workers. Businesses that cannot afford to provide health insurance will pass the costs of these new penalties on to their workers in the form of stagnant or lower wages, reduced hours, and eliminated jobs. According to one recent study by the Heritage Foundation, this new job-killing tax will place more than 5 million low-income workers at risk of losing their job, or having their hours reduced, and an additional 10 million workers could see lower wages and reduced benefits. That is what they have to do to stay in business. The bill contains a narrow exemption for small businesses with 50 or fewer employees. Similar to many of the other poorly conceived provisions of the bill, even this exemption is likely to create unintended and harmful consequences. What is the likelihood that a small employer with 50 employees right now will agree to expand their business if by adding that single extra employee they expose themselves to this new job-killing tax? Small businesses are the engine of economic growth. I cannot say that enough. They create the jobs in this country. But this provision will discourage the creation of new jobs. Fifteen million Americans are currently unemployed and 19 percent of small businesses have reported that they reduced employment in their firms in the last 3 months. If this bill is passed, the Reid job- killing employer tax will mean that more Americans will lose their jobs. We ought to be concentrating on jobs. Instead, we are focusing on something that will kill jobs. The Reid bill will also impose sweeping new regulations over the health insurance marketplace. Similar to most new regulatory schemes imposed on small businesses, this one will also mean increased costs for small businesses. Small business owners know the current market for health insurance is not sustainable. According to a recent Kaiser Family Foundation report, costs for small businesses, those with less than 200 employees, rose by 5 percent from 2008 to 2009, and they are expected to rise again next year. We all agree the status quo for health insurance is not acceptable. Equally unacceptable, however, should be any proposals that make the current situation worse. Unfortunately, that is exactly what the Reid bill will do. The nonpartisan Congressional Budget Office, the administration's own actuaries, the National Association of State Insurance Commissioners, and at least six other private studies have all looked at provisions similar to what is in the Reid bill, and they all found that these provisions will drive up health insurance costs. Actuaries at the consulting firm Oliver Wyman, which did one of the studies, estimated these provisions will increase premiums for small businesses by at least 20 percent. Last year, they had an increase of 5 percent. This is going to do 20 percent. I suspect most small businessmen will notice that, and they will also know where the blame lies. WellPoint, the largest Blue Cross/Blue Shield plan in the Nation, looked at their actual claims experiences in the 14 States in which they operate and concluded that the premiums for healthier small businesses will increase in all 14 States--in Nevada by as much as 108 percent. The bill also eliminates consumer choices, requiring Americans to buy richer types of plans that cover more deductibles and out-of-pocket expenses. These plans typically have much higher premiums. That is right. Washington is going to tell you what kind of insurance you have to have, even if it is a lot better than what you have now and you like what you have now. That is not good enough. Washington knows better for you what you need in the way of health insurance. They are going to see that you get it. Boy, are you going to get it. These plans typically have much higher premiums. We have looked at the studies to see how many people have the quality of insurance we are talking about at the lowest acceptable level. If you don't do that, you get fined. OK. Well, these new mandates will make it more difficult for small businesses to adopt new, affordable, high-deductible health plans. These plans, when combined with health savings accounts, have been enormously successful in recent years in helping small businesses control health care costs. I know a secret here in the Senate. There are quite a few employees--particularly the younger ones--who did a little evaluation, because in the Senate everybody has the same choices and everybody gets to buy from the private market and everybody can pick how much they want to pay in premiums compared to deductibles. You can pay more premium, less deductible, or less premium and more deductible. The two balance out. People know that. Some of the astute kids in my office took a look at buying the insurance as opposed to doing the high deductible and putting it in a health savings account. They found out they could take the money it would cost for the regular plan and, instead, buy this high deductible and take the difference and put it in a savings account. The savings account grows tax free. It has to be used for health care, but it pays for health care things as they come up. In less than 3 years, the one putting in the least covered the entire deductible. So for the rest of the time, she would not have to put any more into that savings account. But she is smart. She said: I am putting that in there tax free, and someday I will need it. So she is continuing to grow that. We have decided that is a bad deal. I will tell you, people around here are smarter than us. They are figuring out how to save money on health insurance already. I don't think they are going to like that. Another thing you can do as an employee here is have a flexible savings account. That happens in a lot of businesses across the country. If you have company insurance, you can do a flexible savings account. This bill is going to do away with that too. That is the way to do it if you know you are going to have health expenses the next year that don't fall within your policy. You can put that money in the bank tax free and use it as those bills come due. We are going to limit that, and that limit isn't going to have any fluctuation dealing with inflation, so in 2 or 3 years that program is gone. I don't know why these ones that encourage people to save and plan for the future are such bad ideas. According to the Kaiser Family Foundation, 11 percent of small business employees are enrolled in HSAs. Average HSA premiums for small businesses are 20 percent lower than the traditional PPO plans, and the number of employers offering HSAs has nearly doubled over the last 3 years. If you work for Starbucks, that is one of the small companies--not really. But Starbucks provides insurance to their people. They do it through HSAs. We are talking about getting rid of that, saying it is not good enough. There are going to be upset people. The new mandates in the bill will prevent some high-deductible health plans from being sold because they do not provide a rich enough benefit. Small businesses are not just purchasers of health care, they are also providers. Doctors, home health aides, and nursing home owners are all small business owners. They have a significant stake in how this bill turns out. You can tell from the two practitioners we have here who understand and had small businesses, they understand how this works. That is without even getting into the fact that the government, in Medicaid and Medicare, cuts what they pay so it is below their cost. You know how hard it is to run a business below cost? It is impossible. You have to shift the cost somewhere else so the people under private insurance pick up the costs. I am reminded of some farmers who decided they could make a killing and drive the truck over to North Dakota and buy some eggs for just 24 cents a dozen. They could bring them back to their home State and they could sell them for a lot more. Of course, when they sold them and figured in the expense of picking them up, they found out they were only getting 20 cents a dozen for them. If that is the case, you cannot just buy a bigger truck and solve the problem. That is what doctors are finding. They are saying: I cannot afford to take Medicaid patients or Medicare patients. If you cannot see a doctor, you don't have any insurance at all. That is where we are driving this thing. Unfortunately, a number of the provisions in the Reid bill will devastate these small health provider businesses. The bill cuts over $460 billion from Medicare over the next 10 years, slashing Medicare payments to hospitals, nursing homes, and home health agencies. The Reid bill will cut over $15 billion in Medicare payments to the nursing homes. In a rural State such as mine, this level of cut will destroy many small business nursing homes and force the closure of the facilities that currently provide nursing home care to hundreds of Medicare patients. Connie Jenkins, the executive director of the Star Valley Senior Center, south of Jackson, WY--a lot of people know where Jackson is, over on the western side of the State; it is the home of the Grand Teton National Park, below Yellowstone National Park. The director recently wrote to me about the important role nursing homes play in rural small towns in Wyoming. She noted that many small communities depend on nursing facilities to provide a large portion of the available jobs. She wrote that ``in a rural State, such as ours, closing of nursing homes would mean families traveling further to visit loved ones and, in some cases, loss of access altogether.'' It is important to be near the people who are in a nursing home. We have great distances and very small towns. The Reid bill would also cut more than $40 billion in Medicare payments to home health agencies. According to the analysis done by one industry association, this level of cuts could put nearly 70 percent of all home health agencies at risk of having to close their doors. Home health agencies provide valuable assistance to disabled individuals, allowing them to receive their care in their home. It is a lot cheaper than a nursing home. If these cuts are enacted and these agencies are forced to close, the patients will have to go back into institutional facilities to receive their care. In addition to devastating these small businesses, this proposal would clearly break the President's promise to protect Medicare beneficiaries and not reduce their benefits. Many doctors, such as my colleague, John Barrasso, who has been on the Senate floor all day, have also been small business owners. Doctors are currently facing a 21-percent reduction in Medicare payments that is slated to go into effect in January. Despite cutting $460 billion from the Medicare Program, the Reid bill does nothing to fix the Medicare payment formula for physicians. Since 40 percent of doctors will not take Medicaid patients, that is now moved into Medicare, and I think 20 percent will not take Medicare patients. How would you like asking for an appointment and they say: Are you Medicare? And if you are, we are not taking you. It can happen. That is not health insurance at all. Also, it is fascinating that Medicare doesn't have catastrophic coverage. We will talk about that. Unlike the Federal Government, small business owners cannot lose money on every Medicare patient and then hope to make it up on volume. A 21-percent payment cut is not sustainable, and it highlights why we need to fix the broken Medicare physician payment formula. Rather than stealing $460 billion from Medicare to create a new entitlement program for the uninsured, we should use those moneys to strengthen and improve Medicare. Medicare is going broke. You saw the charts over there earlier. It is going broke. We are going to take $460 billion from it. Oh, but don't worry. The bill has a little provision in there where we are going to form a commission that, every year, will give us suggestions on how we ought to cut Medicare so that it stays solvent. I don't know any other way you can put that: Cut Medicare to stay solvent. We had to form a commission to do that after we steal $460 billion from the program. It cannot afford to have that taken out. Another interesting thing on that commission is they already made a deal with the hospitals, and they cannot cut them, and the doctors were supposed to have a deal, although I think the deal has been broken because the low payments did not get fixed and the medical malpractice did not get included as they were promised. So I don't know if they are still in there. In exchange, they were supposed to not get any cuts. The pharmaceutical companies were not supposed to get any cuts. I would love to have the time to explain the deal they have. Do you know whom that leaves? That leaves the nursing homes, the home health, and the Medicare patients themselves. They are going to pick up those costs that are each year prescribed to us to pass to save Medicare. Medicare money should go to Medicare. The Reid bill also drives up health care costs for small businesses by its massive expansion of Medicaid. This bill includes the largest expansion of the Medicaid Program since it was created in 1965. In addition to trapping 15 million low-income Americans in the worst health care program in America, this Medicaid expansion will also increase costs for many small businesses. Medicaid uses government price controls to set private rates far below what private insurers pay, often below the cost of what it costs to provide the care. According to one estimate, Medicaid pays only 60 percent of the rates paid by private insurers. This forces doctors to make up for their losses on Medicaid patients by increasing their costs to other purchasers. According to a recent estimate by the accounting firm Milliman, inadequate Medicaid payment rates resulted in physicians shifting $23.7 billion in costs onto private sector purchasers. Enrolling 15 million more Americans into the broken Medicaid Program will only worsen this cost shift. That means if this bill is enacted, small business owners will see their health care costs increase as physicians and hospitals struggle to make up for inadequate payments for many more Medicaid patients. In addition to doctors and hospitals, States also cannot afford to pay for this expansion of the Medicaid Program. The Reid bill imposes approximately $25 billion in new unfunded Medicaid costs on State budgets at a time when the States are facing a worse economic crisis in general than perhaps our economic crisis because they cannot just print the money. When we were working with the Gang of 6, we had a table that showed how the $25 billion was distributed among the different States. The CBO estimate of the $25 billion never changed. But every day, we got a new sheet and the different States paid different amounts. Did you know that finally New York and Nevada got theirs down to what they thought was a workable level? I don't know if that is actually the way it will come out if people are just jimmying the numbers. What this will mean for small businesses will be even higher taxes and fees, as States struggle to close the estimated $22 billion budget shortfall they will face in fiscal year 2011. According to the National Association of State Budget Officers, States have already enacted $23.8 billion in new taxes and fees in the current fiscal year. These numbers are only expected to increase as States see no end in sight to their current fiscal crisis. Increased State and Federal taxes, higher health care costs, and Medicare payment cuts are the results small businesses are most likely to see if the Senate passes the Reid health care reform bill. While these would never be welcome changes, the Senate will be debating these policies at a time when small businesses face their most severe economic challenges since the Great Depression. As I mentioned, unemployment is already at 10.2 percent. Even that number, which is the worst we have seen in 26 years, may actually understate the severity of the situation. The government estimates that up to 17.5 percent of the population may be entirely without a job or underemployed. Other economic indicators paint a grim picture for a potentially jobless recovery. In October, new housing starts fell 10.6 percent, which is 30 percent lower than 1 year ago. Federal Reserve Chairman Ben Bernanke recently noted that the ongoing financial crisis has led to the reduction or elimination of bank credit lines for many small businesses. He also noted that the fraction of small businesses reporting difficulty in obtaining credit is near a record high, and these conditions are expected to tighten further. Small businesses are the engine of economic growth that can lead this Nation out of its current economic crisis. Unfortunately, the Reid bill will have the effect of sand being poured into the gears of that engine. The recent statement of the National Federation of Retail Businesses does the best job of summarizing the impact of the Reid bill on small businesses. They said: We oppose the Patient Protection and Affordable Care Act due to the amount of new taxes, the creation of new mandates, and the establishment of new entitlement programs. There is no doubt all these burdens will be paid for on the backs of small business. It's clear to us that at the end of the day, the costs to small business more than outweigh the benefits they may have realized. I see I have run a few minutes over. I apologize to the Chair.

Mr. ENZI

Mr. ENZI. Mr. President, I am very pleased to have this opportunity to acknowledge one of our great success stories--the Congressional Awards--on the occasion of their 30th anniversary. This is a great milestone in the history of a program that has served to inspire and encourage countless young people across the country since it was first signed into law in 1979. Thirty years ago, Senator Malcolm Wallop of Wyoming and Congressman James Howard of New Jersey joined forces to establish and promote the Congressional Awards and provide this great opportunity to young people all across the Nation. Today this program is achieving results throughout the United States far beyond what anyone could have ever expected. One by one, students are rolling up their sleeves and getting to work, establishing personal goals as well as goals for community service. Their dedication has made it possible for them to make a great difference in the world right where it should always start--in their own backyard. The Congressional Awards program has deep Wyoming roots because Malcolm Wallop helped to provide the leadership that led to its creation. It has deep roots in Wyoming because it has inspired our young people to a truly remarkable degree. The popularity of this program extends from one corner of my home State to the other and it continues to spark the imagination and encourage the enthusiastic participation of another group of participants every year. Because of the great work this program makes possible, I try to attend as many award ceremonies as I possibly can. I enjoy having the opportunity to recognize the achievements of those who have earned these awards almost as much as the award winners enjoy receiving the recognition of the Congress for their efforts. Every time I take part in one of these special ceremonies, I can see the excitement and sense of satisfaction that the award represents to each recipient because they have earned it by accomplishing what they set out to do. The Congressional Awards are open and available to young people from about age 14 to 23. They honor those who have done something to improve themselves by expanding their horizons as to what they believe is possible for them to achieve. Working with adult mentors, they dedicate themselves to achieving a set of goals in four areas--public service, personal development, physical fitness, and the exploration of the world around them. Because of their enthusiasm, it is no surprise that they have been able to achieve such great results in their lives. There are three levels of awards offered by the program--Bronze, Silver and Gold. The Gold Award is the most difficult of the three to earn because it requires the most in terms of both time and effort. Over the years, the number of Wyoming Congressional Award winners at each level has been impressive. However, because of the good example Malcolm Wallop worked so hard to provide, we have had a remarkable number of Gold Medal award winners in my State. That is a remarkable achievement for a State with a comparatively small population. It underscores the determination of Wyoming's young people to always finish what they set out to do. That is why our award winners have been getting noticed and the word has been getting around about how much it means to each award winner to have earned such a special prize. That has inspired others to try to do the same and it has kept the line of program participants going strong. Malcolm Wallop understood the importance of that message and the need for our young people to hear it--and hear it clearly. Thanks to him and his efforts, kids in Wyoming and throughout the nation understand that there is something better for them to do than to complain about what's wrong with the world. They now know that if there is a problem in the community or down the street you can do something about it. It's more than positive thinking; it's a call to action. It's a lesson learned that will then encourage our young people to apply the same determination that helped them to earn their Congressional Award to the other goals they have set for themselves so they can achieve the same kind of success in every area of their lives. Although Malcolm accomplished a great deal during his three terms of service in the United States Senate, I have always believed the Congressional Awards had to be one of his favorite achievements, something special that will continue to last as part of his Senate legacy that will serve to inspire present and future generations to continue to work to make great changes in the world around them. That will mean, in the years to come, when we look to the young people of Wyoming, the West and the United States to take their place as our leaders on the local, State and national level, thanks in part to the experience of the Congressional Awards program, they will be ready.

Mr. ENZI

Mr. ENZI. Mr. President, I rise today to introduce legislation to extend for 1 year the Ensuring Continued Access to Student Loans Act of 2008, ECASLA. Without this extension, hundreds of thousands of students may not have access to student loans for the 2010-2011 academic year. Since 1965, the Federal Family Education Loan, FFEL, program has successfully helped millions of Americans realize the dream of a college education. Today, it continues to provide student loans for nearly 70 percent of America's college students at over 3,400 schools. However, during the credit crisis of 2008 many private, non-profit FFEL lenders encountered difficulty raising the necessary capital to make student loans, and others left the FFEL program. Congress responded by passing the bipartisan, cost-neutral Ensuring Continued Access to Student Loans Act of 2008. ECASLA preserved liquidity in the student loan market by giving the Secretary of Education temporary authority to purchase student loans made under the FFEL program. It has been a resounding success--it has preserved liquidity in the student loan market, it has been cost neutral, in fact it has generated revenue and, most importantly, it has maintained student access to FFEL loans. However, while it was meant to be temporary, serious problems persist in the financial markets and many private, non-profit FFEL lenders are again considering leaving the FFEL program when ECASLA expires on July 1, 2010. The potential consequences could be catastrophic for America's college students, many of whom will be unable to secure student loans for 2010-2011 academic year without a functioning FFEL program. Given this predicament, the solution is simple--extend ECASLA for an additional year. Unfortunately, instead of working with Congress to pass a clean, bipartisan, one-year extension of ECASLA, the Department of Education is pursuing yet another government takeover and placing undue pressure on FFEL-participating schools to switch to the government-run Direct Loan, DL, program. Some schools will make this choice, but most do not want to because the FFEL program provides a product and services that meet individual student needs rather than the one-size-fits-all approach of the government-run DL program. Moreover, schools begin making financial aid determinations in January--just seven weeks from now. Given that it can take 4 months to make the switch to the government-run DL program, most schools do not have the time, staff, resources or capacity to make the switch while at the same time attending to the financial aid needs of current and enrolling students. Furthermore, making the switch is not simply a matter of ``flipping a switch,'' as the Department of Education asserts. Among other things, schools must install new computer software, hire and train financial aid personnel, and receive substantial technical assistance from the Department of Education. While the Department has been able to successfully assist the several hundred schools that have made the switch over the past year, thousands will need assistance over the next 7 months. The Department simply does not have the resources to devote the necessary time and attention to all of these schools, which will frantically be trying to switch before ECASLA expires on July 1, 2010. At this point, the only responsible course of action for Congress is to pass a clean, one-year extension of ECASLA. This will ensure that students have access to student loans, and will give Congress the time needed to have a serious and well thought discussion about the future of the Federal student loan program. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ENZI

Mr. ENZI. Mr. President, I rise today to introduce legislation to extend for 1 year the Ensuring Continued Access to Student Loans Act of 2008, ECASLA. Without this extension, hundreds of thousands of students may not have access to student loans for the 2010-2011 academic year. Since 1965, the Federal Family Education Loan, FFEL, program has successfully helped millions of Americans realize the dream of a college education. Today, it continues to provide student loans for nearly 70 percent of America's college students at over 3,400 schools. However, during the credit crisis of 2008 many private, non-profit FFEL lenders encountered difficulty raising the necessary capital to make student loans, and others left the FFEL program. Congress responded by passing the bipartisan, cost-neutral Ensuring Continued Access to Student Loans Act of 2008. ECASLA preserved liquidity in the student loan market by giving the Secretary of Education temporary authority to purchase student loans made under the FFEL program. It has been a resounding success--it has preserved liquidity in the student loan market, it has been cost neutral, in fact it has generated revenue and, most importantly, it has maintained student access to FFEL loans. However, while it was meant to be temporary, serious problems persist in the financial markets and many private, non-profit FFEL lenders are again considering leaving the FFEL program when ECASLA expires on July 1, 2010. The potential consequences could be catastrophic for America's college students, many of whom will be unable to secure student loans for 2010-2011 academic year without a functioning FFEL program. Given this predicament, the solution is simple--extend ECASLA for an additional year. Unfortunately, instead of working with Congress to pass a clean, bipartisan, one-year extension of ECASLA, the Department of Education is pursuing yet another government takeover and placing undue pressure on FFEL-participating schools to switch to the government-run Direct Loan, DL, program. Some schools will make this choice, but most do not want to because the FFEL program provides a product and services that meet individual student needs rather than the one-size-fits-all approach of the government-run DL program. Moreover, schools begin making financial aid determinations in January--just seven weeks from now. Given that it can take 4 months to make the switch to the government-run DL program, most schools do not have the time, staff, resources or capacity to make the switch while at the same time attending to the financial aid needs of current and enrolling students. Furthermore, making the switch is not simply a matter of ``flipping a switch,'' as the Department of Education asserts. Among other things, schools must install new computer software, hire and train financial aid personnel, and receive substantial technical assistance from the Department of Education. While the Department has been able to successfully assist the several hundred schools that have made the switch over the past year, thousands will need assistance over the next 7 months. The Department simply does not have the resources to devote the necessary time and attention to all of these schools, which will frantically be trying to switch before ECASLA expires on July 1, 2010. At this point, the only responsible course of action for Congress is to pass a clean, one-year extension of ECASLA. This will ensure that students have access to student loans, and will give Congress the time needed to have a serious and well thought discussion about the future of the Federal student loan program. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ENZI

Mr. ENZI. Mr. President, I am pleased to have this opportunity to join my colleague from Maryland, Senator Mikulski, in introducing Rosa's law. I would like to thank her for her leadership and her commitment on this issue. Simply put, this legislation will make an important change in the words we use to refer to those with intellectual disabilities. It is a much needed change in the law that is fully deserving of our support. For far too long we have used words like ``mental retardation'' in our Federal statutes to refer to those with intellectual disabilities. This has been unfortunate because when we use such a term we send a message throughout our society that someone ``is'' their disability, instead of someone like us who is facing a challenge in their life. Such a term creates the unwanted impression that growth is impossible and their disability will lock them into a certain lifestyle forever. As an example, imagine a friend with cancer. When you refer to him or her you would probably say they have cancer, or are going through cancer treatment. You wouldn't say they ``are'' cancer like this term says that someone ``is'' their disability. It's a distinction that makes a big difference for anyone facing such a difficult period of their lives. This is not a unique situation. Historically, this and other unfortunate terms have been used to refer to people with disabilities of all kinds for many years. Prior to the 1960's, people who were viewed as having intellectual limitations were shunned from society and placed in institutions. The American dream of self-determination, independent living, and the pursuit of freedom and happiness was thought to be impossible for them to achieve. We let the limitations we helped to create with our words and our attitudes slowly take away their hopes and dreams for a better life and a brighter future. We know now that words have meaning, sometimes far beyond what we intend. Therefore, we must be very careful about the way we describe the people we see every day, including those with disabilities, or those who are undergoing treatment for a variety of health issues. Unfortunately, the Federal Government has not dropped this term from our laws and it still appears in the regulations and statutes that come before our legislative bodies and our courts. With this legislation we are taking a giant step forward, as we acknowledge that times have changed and we live in a much different world. Clearly this term was not developed from malice. It came from a lack of understanding of what it was like to be labeled with such a term and then left virtually alone in the effort to overcome it. Over the years, Congress has made it known that community living, educational opportunities that lead to success in the workplace, and equal opportunity without discrimination will be available to people who are living with intellectual limitations under appropriate Federal statutes. That was a good start. Unfortunately, several key Federal disability statutes, including the Individuals with Disabilities Education Act, the Rehabilitation Act, the Developmental Disabilities Act, and the Genetic Information Nondiscrimination Act, still use the outmoded term. It is time for Congress to be proactive and join the States of New Hampshire, Maryland, and my home State of Wyoming by ending the use of this pejorative term and replacing it with a more carefully chosen word. To paraphrase a quote I have heard about cancer, a disability is a word, not a sentence. We have put that philosophy into practice over the years for other disabilities. It is time we adapted it to provide support to those living with intellectual disabilities as well. Some will ask if we are being overly sensitive, or if we are just trying to make a change to be politically correct. The answer to that question is clearly ``no.'' It is no secret. When we put a ``label'' like that on someone we often find ourselves dealing with the label as if it is not a description of the challenges someone faces in their lives but a reflection of who that person really is. That puts them in a group with a label for a name and tells them that they are not worthy of being treated as an individual, with individual needs and interests. I have heard from people with intellectual disabilities over the years. They have asked us to put an end to the use of that outdated term. Self-advocacy groups such as Self-Advocates Becoming Empowered and local People First Organizations as well as organizations such as the Arc of the United States, Special Olympics International, and others have already stopped using this archaic terminology and dropped the term from their agency names. The American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, has already voted to use the term ``Intellectual Disability'' in the next publication of their manual. I have always believed that the law is a great teacher. That is why we need to join in this effort and express our support for the efforts of those with disabilities of all kinds to live to their full potential. We can do that by eliminating the use of negative archaic terms to refer to those with intellectual limitations. Such an action on our part starts with this bill that uses the term intellectual disability in laws that are in the jurisdiction of the Senate Committee on Health, Education, Labor and Pensions. This bill makes our intent clear throughout our Nation that this term will never again be used in Congress or in any Federal office. When I came to the Senate 13 years ago, my staff and I met almost immediately to work on our mission statement. When it was completed, one of the most important clauses we had written was our commitment that we would treat others not as we would wish to be treated, but as they would wish to be treated. There is a difference. Today, with the passage of this important legislation, we are reaching out to those with intellectual disabilities to assure them that their government will treat them as they would wish to be treated. By so doing, we will also be directing our staffs and the staffs of federal offices throughout the U.S. that the best way for them to refer to those with disabilities or to anyone who comes into their office is by the term they have carried with them throughout their lives--their name.

Mr. ENZI

Mr. ENZI. Madam President, I would like to engage my friend, the Senator from Washington and the chairman of the Subcommittee on Employment and Workplace Safety, with whom I have been pleased to work on many initiatives on behalf of America's workforce, in a conversation about the bill she has just introduced. I would like to take this opportunity to clarify the treatment of workers contained in the Flight Crew Technical Corrections Act before us today that pertains to flight crews. Is it the Senator's understanding that her legislation resolves a problem unique to flight crews--meaning flight attendants and pilots--and that no other group of workers is addressed under this bill?

Mr. ENZI. In other words, is it the Senator's understanding that the bill should not be construed to apply to other occupational groups that operate under reserve systems such as health care, railway, and emergency services to seek similar treatment?

Mr. ENZI. The Senator mentioned the FMLA's legislative history. Is it the Senator's further understanding that this is the only group of employees which was intended to be included with an alternative eligibility standard?

Mr. ENZI. I would like to thank the Senator from Washington and the former Senator from New York for the deliberative process they both utilized while drafting this legislation. As the Senator knows, I am a frequent advocate for following Senate committee process so as to create the opportunity for all affected stakeholders to be included in the process. In this case, the Senator has done an admirable job of vetting the legislation with most stakeholders and produced a better product.

Mr. ENZI

Mr. ENZI. Madam President, I ask unanimous consent to speak as in morning business.

Mr. ENZI. Madam President, I would like to talk about health care as well, and I brought a few pages that the American people would be interested in. This stack closest to the podium is actually the House bill, the 2,000-page House bill. On this side is what we are working off of so far on the Senate side because what has been put together has been put together behind closed doors, and it has not been released yet. I assume that is because they do not know the cost and what adjustments will have to be made in order to meet the cost requirements, although it is an extension of cost of probably $1 trillion. I wonder if there is anybody in America who believes we can expand programs by $1 trillion and it will not cost a dime for the rest of us. But at any rate, the stacks over here are the ones from the Senate side. The little bottom stack down there is the Senate HELP bill. Then this is the Senate Finance bill, the 1,600-page bill, although when we were actually debating this bill in committee, we did not know how big the bill would be because we worked off a 220-page summary and did summary amendments. So this is the first time we have actually got to look at a final product. What is interesting about doing a summary bill is that the amendments are done in summary. If an amendment does happen to pass by the minority, then it is written by the majority, and the devil is always in the details. So we are very anxious to see, although there were not a lot of amendments that we got passed there. What I mostly want to talk about today is the impact on small business. The status quo in health care is unacceptable. Health care costs are skyrocketing, insurance premiums are increasing, and too many small businesses can no longer afford to offer health insurance to their workers. While I agree we need to change our current system, the approach reflected in the current health reform bills is the wrong answer. That is these bills. Quite a stack of papers. Very encompassing. Very comprehensive. This is going to affect every single American. We have never had a bill that affected every single American, and that is why it is so complicated. That is why it is so large. That is why it is so hard to deal with. That is why there will be so many mistakes as we go through a pile like that trying to make a few amendments that will improve the bill. They need a lot of amendments that will improve the bill. So while I agree we need to change our current system, the approach reflected in the current health reform bills is the wrong answer. I object to the current health care reform bills not because I support the status quo but because the bills do nothing to address the problems of increasing costs and premiums. These bills will not reduce health care costs and will actually increase insurance premiums for most Americans. I have fought for years to enact commonsense reforms that would help slow health care cost growth and make the insurance market work better, particularly for small businesses. Before I entered politics, my wife and I ran a small business. We had shoe stores. We know firsthand how hard it is to meet payroll and provide meaningful benefits to employees. I understand how the current insurance market fails to meet the needs of many small businesses. That is why I fought for real reforms that will actually help small businesses. In 2006, I introduced a small business health plan bill that would have saved the taxpayers about $1 billion and would have provided health insurance to almost 1 million people. The bill would have made commonsense reforms to the insurance market and given more leverage to small businesses to help them negotiate lower insurance premiums. The insurance industry, working closely with many of my Democratic colleagues fought to defeat my bill. Unfortunately, they were successful. We could not pass the cloture motion to proceed; we were short about three votes. Had we been able to get those three votes, we would have been able, with one amendment, to clear up the objections that were made during the cloture debate. Since 2006, little has changed in the insurance marketplace. Health care costs and premiums continue to spiral upwards. The Kaiser Family Foundation reports that costs for small businesses with less than 200 employees--I consider that to be a pretty big business--rose by 4.7 percent from 2006 to 2007, 2.2 percent from 2007 to 2008, 5 percent from 2008 to 2009, and they are expected to rise next year. Small businesses cannot continue to sustain these types of price increases. They need and want reform and Congress should deliver reform. Congress should pass a bill that decreases the cost of health care and reduces insurance premiums across the board, not just for the poor, not just for the uninsured. Unfortunately, the bills that Speaker Pelosi and Leader Reid and President Obama are pushing through Congress will do little to address spiraling health care costs and will actually increase the insurance premiums most Americans pay for their health care. Even worse, increases in premiums will come at a time of rising unemployment. The 2,000-page Pelosi bill and the 1,500-page Senate Finance bill will drive up costs, increase taxes, and expand the size of government. The nonpartisan Congressional Budget Office, the administration's own official actuaries, the National Association of State Insurance Commissioners, and at least six other private studies have all reported that the Democratic leadership bills will drive up costs. Actuaries at the consulting firm, Oliver Wyman, which did one of the studies, estimated these bills will increase premiums for small business by at least 20 percent. WellPoint, the largest Blue Cross Blue Shield plan in the Nation, looked at their actual claims experience in the 14 States in which they operate and concluded that premiums for healthier small businesses will increase in all 14 States; in Nevada by as much as 108 percent. Even the Congressional Budget Office has said: Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market. Let me say again what the Congressional Budget Office said: Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market When the 85 percent of Americans who already have health insurance hear the term ``health care reform,'' they want Washington to do something that lowers the cost of their health insurance premiums. Unfortunately, the bills Congress has developed will do the exact opposite. Our economy can't take the higher taxes, higher unemployment, and higher mandates these bills impose. Taken together, the new taxes, mandates, and regulations in these bills will cumulatively increase health insurance premiums for millions of Americans who currently have health insurance. These higher taxes, higher premiums, and higher costs are not the change the American people voted for. Unemployment is higher than it has been in decades. The housing market is in distress, and more and more middle-class Americans are feeling squeezed by irresponsible decisions being made in Washington. We all agree the health insurance market is broken and needs to be fixed. Everyone who wants health insurance should be able to get it. They should not have to spend all of their hard-earned savings to do so. No American should be denied health insurance because they have cancer, diabetes, or some other preexisting condition. No one should be denied health insurance, period. These reforms are very important and long overdue. We also need to enact commonsense reforms similar to the reforms I advocated in 2006 with small business health plans and then in 2007 and 2008 with my plan for 10 steps to transform health care in America. That was a step-by-step process that would get us to where all the promises are being made. It is on my Web site. I urge the Democratic leadership to go back to the drawing board to develop bipartisan health care solutions that will actually reduce costs and make health insurance more affordable for small businesses and most Americans. I yield the floor.