Chuck Grassley

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, today I am introducing the Clean Renewable Energy Advancement Tax Extension Jobs Act of 2009, or the CREATE Jobs Act of 2009 for short. This is a bill to help all kinds of businesses create jobs and continue pushing ahead on the development of clean renewable energy. My bill extends the tax credit for the production of electricity from wind and open-loop biomass through December 31, 2016. It increases the amount of bond authority for new clean renewable energy bonds to incentivize more clean renewable energy projects and the jobs created by these projects. For all businesses, my bill extends bonus depreciation for 1 year, so that businesses are able to deduct half of the value of any property placed in service in 2010. This tax cut for businesses that invest in new property in 2010 will spur investment in clean energy projects, as well as other new projects, and that will create badly needed jobs. I urge my colleagues to help me in getting this important legislation enacted into law as soon as possible. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, today I am introducing the Clean Renewable Energy Advancement Tax Extension Jobs Act of 2009, or the CREATE Jobs Act of 2009 for short. This is a bill to help all kinds of businesses create jobs and continue pushing ahead on the development of clean renewable energy. My bill extends the tax credit for the production of electricity from wind and open-loop biomass through December 31, 2016. It increases the amount of bond authority for new clean renewable energy bonds to incentivize more clean renewable energy projects and the jobs created by these projects. For all businesses, my bill extends bonus depreciation for 1 year, so that businesses are able to deduct half of the value of any property placed in service in 2010. This tax cut for businesses that invest in new property in 2010 will spur investment in clean energy projects, as well as other new projects, and that will create badly needed jobs. I urge my colleagues to help me in getting this important legislation enacted into law as soon as possible. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, on Monday the Congressional Budget Office sent a letter to the Senator from Indiana, Mr. Bayh, that provides a very comprehensive analysis of what health insurance premiums will look like as a result of this 2,074-page bill before us, introduced by Senator Reid. Listening to that discussion, I am starting to wonder if anyone actually read the letter. I hear a lot of people saying this letter proves that premiums will go down under the Reid bill, even though that is not what the letter says. I am here to tell my colleagues what the letter really says. The letter makes it very clear that premiums will increase on average by 10 to 13 percent for people buying coverage in the individual market. Since it seems to fly by everybody what this letter actually said about increasing premiums, I brought down a chart to show everyone in case they missed it. The letter from the CBO says very clearly that for the individual market, premiums are going to go up 10 to 13 percent. My colleagues keep saying premiums are going to go down, conveniently forgetting, then, to mention this 10- to 13-percent increase. They prefer to talk about the 57 percent of Americans in the individual market who are getting subsidies. It is true that government is spending $500 billion in hard-earned taxpayer money to cover up the fact that this bill drives up premiums faster than current law. So we might as well repeat it: Premiums will go up faster under this bill. Supporters of this bill are covering this increase in cost how? By handing out subsidies. If you are one of the 14 million who doesn't happen to get a subsidy, you are out of luck. You are stuck with a plan that is 10 to 13 percent more expensive and also, simultaneous with it, an unprecedented new Federal law that mandates that you purchase insurance. If you don't purchase insurance, you are going to pay a penalty to the IRS every time you file your income tax. Some may say this is just the individual market. It only accounts for a small portion of the total market. If you are comfortable with 14 million people paying more under this bill than they would under current law, let's look at the employer-based market. The Congressional Budget Office analysis says this bill maintains the status quo in the small group and large group insurance market. Is that something to be celebrating? Are expectations so low at this point that my friends on the other side of the aisle are celebrating that this bill will increase premiums for some and maintain the status quo for everyone else? I am being generous in using the phrase ``status quo'' because this bill actually makes things worse for millions of people. This bill is so bad that my friends on the other side of the aisle are trying to convince the American people that this is just more of the same, when that doesn't happen to be the case. Whatever happened to bending the growth curve? If that is too Washingtonese for people, the goal around here of a bill at one time was to make sure the inflation in insurance didn't continue to go up so much that it would go the other way. Then what about the President's promise that everyone would save $2,500? According to the Congressional Budget Office, almost every small business will pay between 1 percent more to 2 percent less for health insurance. That means, of course, that compared to what businesses would have paid under current law, this bill will either raise premiums 1 percent or decrease them a whopping 2 percent. It doesn't sound like this bill is providing any real relief or, for sure, not providing $2,500 savings for every American, as President Obama repeatedly pledged during the campaign. Larger businesses will pay the same or up to 3 percent less for health insurance. Once again, that doesn't sound like relief; it sounds like more of the same. In fact, the Congressional Budget Office has confirmed that between now and 2016, premiums will continue to grow at twice the rate of inflation. I thought Congress was considering health reform to put an end to unsustainable premium increases. So this bill cuts Medicare by $500 billion, raises taxes by $500 billion, restructures 17 percent of our economy, and spends $2.5 trillion. Yet some of my colleagues on the other side of the aisle are celebrating that they have achieved the status quo when, in fact, the situation will be worse. I always thought the status quo was unacceptable. I thought businesses could not afford the status quo. I thought the status quo was killing American businesses, killing jobs, and making this country less competitive. But Member after Member keeps coming down to the floor to celebrate spending $2.5 trillion on the status quo. We could have done that for free. Am I missing something? Did people really read the same letter I did from the CBO? When President Obama visited Minneapolis in September, he didn't sound as though he was celebrating maintaining the status quo. On the contrary, I have a chart with one of his quotes: I will not accept the status quo. Not this time. Not now. . . . Some Members seem to disagree. Some Members are celebrating that they are making things worse for millions of Americans and maintaining the status quo for everyone else. Here is what Vice President Biden said: The status quo is simply unacceptable. Let me say that again--the status quo is simply unacceptable. Rising costs are crushing us. That doesn't sound like a call for more of the same. Once again, Members on the other side of the aisle seem quite comfortable investing $2.5 trillion in more of the same. That is taxpayer dollars we are talking about. If I asked most Iowans how they would feel about government spending $2.5 trillion and premiums would still increase as fast or faster, they would say that was a pretty bad investment. Well, I will not argue with what our constituents would say on that point. I agree with them. This Congressional Budget Office letter tells me that we are debating a pretty bad investment. Our constituents want lower costs. That is their main concern. But this bill fails to address that concern because it raises premiums. Despite offering new ideas throughout the committee process and on the floor of the Senate, Republicans are being accused of supporting the status quo. CBO has spoken, and it is pretty clear that my colleagues are not only OK with the status quo, they are OK with making things worse: higher taxes, higher premiums, increased deficit, less Medicare. They are celebrating that they spent $2.5 trillion to raise premiums for 14 million people, not bending the growth curve of inflation in health care, and not cutting costs. Don't take my word for it. Read the letter. Read the letter from the Congressional Budget Office. I have copies I will pass out if anybody wants them. I have this chart that demonstrates that point. I also wish to take a few minutes at this time to correct some inaccurate comments made earlier by some of my colleagues. When we are talking about 17 percent of the economy and something that touches the lives of every single American, I want to make sure we have an honest and accurate debate. This morning I heard at least three Members on the other side of the aisle say that Medicare Advantage is not part of Medicare. This is totally false. But don't take my word for it. I would like to have Members turn to page 50 of the handbook,''Medicare and You.'' Presumably it has the date of 2010 on it. It is sent out every year. In fact, I think I have two copies of this in my household. If anybody wants to save paper and not waste taxpayer money, they can get on the Internet and tell them only to send one to their house next year. I have done that. This book says, for those who say Medicare Advantage is not part of Medicare: A Medicare Advantage plan is another health coverage choice that you may have as part of Medicare. I repeat, despite what Members were saying earlier, the ``Medicare and You'' handbook says very clearly: Medicare Advantage Plans are part of Medicare. So if you are cutting Medicare Advantage benefits, you are, in fact, cutting Medicare benefits. Next, I hear a lot of Members talking about guaranteed benefits versus statutory benefits. I can't speak for my other 99 colleagues, but the seniors in Iowa who have come to rely upon the free flu shots, eyeglasses, and dental care that Medicare Advantage provides don't care if they are guaranteed or if they are statutory. Seniors in Iowa just want to know they will still have these benefits after health reform is passed. The Senator from Connecticut challenged any Member to come down to the Senate floor and point out where this bill will cut benefits. He even read a section from page 1,004 of this 2,074-page bill that talks about how the Medicare Commission cannot cut benefits or ration care. I have read page 1,004. What Senator Dodd failed to mention is that this section only refers to Parts A and B of Medicare. It fails to provide any protection to Medicare Part D, the prescription drug benefit, or the Medicare Advantage Program that covers 11 million seniors. Are we now going to start hearing that Medicare Part D is not part of Medicare either? In fact, on page 1,005, it specifically says the Medicare Commission can ``[i]nclude recommendations to reduce Medicare payments under parts C and D.'' I have asked CBO, and they have confirmed this authority could result in higher premiums and less benefits to seniors. In fact, this is what Congressional Budget Office Director Elmendorf said, and we have that on a chart for you to see the quote I am going to read: ``A reduction in subsidies to [Part D] would raise the cost to beneficiaries.'' Lastly, I wish to raise an issue about access to care. I keep hearing my friends on the other side of the aisle talk about how these cuts will not affect seniors. They say they are just overpayments to providers. Well, in my opinion, if you cannot find a doctor or if you cannot find a home health provider or a hospice provider to deliver care, then that tends to be a very big problem. I would even consider that a cut in benefits or hurting access to care. But, once again, do not take my word for it. In talking about similar cuts to Medicare in the House bill, the Office of the Actuary at the Centers for Medicare & Medicaid Services said providers that rely on Medicare might end their participation, ``[p]ossibly jeopardizing access to care for beneficiaries.'' So let's be accurate and let's be honest. Medicare Advantage is part of Medicare, and this bill cuts benefits seniors have come to rely upon. The Medicare Commission absolutely has authority to cut benefits and to raise premiums, and this bill will jeopardize that access to care. Those are all facts. They are not my facts but facts taken directly from the language of this 2,074-page bill and from reports of the Congressional Budget Office and the Office of the Actuary at the Centers for Medicare & Medicaid Services. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, as I said yesterday when I spoke on this very same bill, the excesses of the Reid bill appear willfully ignorant of what is going on in the rest of the economy outside of health care. I believe the reason people have objected to the health care bill so quickly after the summer was that there was a rude awakening on a lot of other things the Congress has done to put this country further into debt, and then they heard us talking about $1.3 trillion and $1.6 trillion for health care, and they thought Congress had gone bananas. So everything seemed to focus on health care reform at that particular time. People were concerned about the economy as a whole. I think the health care issue in and of itself was what people came out for, but health care was kind of the straw that broke the camel's back and brought attention to everything else--the debt and things that weren't working. At the same time, they saw the auto industry going into bankruptcy and, of course, being bailed out or nationalized, as it is. They have seen banks go under. Then they wondered about health care being nationalized as well. We have seen our Federal debt skyrocket by $1.4 trillion since this President took office. I say ``since this President took office'' because I acknowledge there was a trillion-dollar debt in last year's budget. Just with the addition, it comes out to $11,500 per household. So our Federal debt exceeds $12 trillion for the first time in history. Already, foreign holdings of U.S. Treasuries stand at nearly $3.5 trillion or 46 percent of the Federal debt held by the public. There doesn't appear to be light at the end of the tunnel. Don't just take my word for it. We have the nonpartisan CBO and the White House Office of Management and Budget which have intellectually honest people working there who aren't politically motivated who tell us really what is what. This is what they have to say. Both have stated that within 5 years, the Obama administration's policies will more than double the amount of debt held by the public. Both have stated that by 2019 these policies will more than triple the national debt. In this context, you would expect Congress to be considering a bill that would create jobs and prevent the country from being burdened with a bigger and more unsustainable Federal budget. Instead of working to bring the Federal budget under control, we have in this Congress--the majority of it, by 60 being Democratic--putting forward a bill, this 2,074-page bill before us that will cost $2.5 trillion when fully implemented. Instead of addressing the budget crisis, this bill will bend the Federal spending curve the wrong way by over $160 billion over the next 10 years. I remember during the summer that the Gang of 6, under the leadership of Senator Baucus--I was part of that bipartisan group--said there are two things we need to accomplish: We need to make sure that what we have comes out balanced, and we also need to make sure we do not have inflation of health care continuing to go up, that we would eventually bring it down. These bills don't do either. I know people say we do have the 10-year window balance. Yes, that is technically right. But when you have 10 years of income and 6 years of policy expenditure, it is easy to do almost anything you want to in that 10-year window. But you have to look beyond that 10-year window, and then you have questions about that. So instead of addressing this budget crisis, this bill adds to the Federal burden with enormous costs from the biggest Medicaid expansion in history and unfunded liabilities from the new program. Instead of addressing this budget crisis, we are now considering this 2,074-page bill that cuts Medicare by $\1/2\ trillion and threatens seniors' access to care. After the bailouts of Wall Street and Detroit, a stimulus bill that has led to the highest unemployment in 26 years, and the Federal Reserve System shoveling money out the door without any accountability--they even object to having the GAO check on them--the health care reform agenda the Democratic leadership put forward is, once again, kind of the straw that broke the camel's back. We have the Senator from Arizona offering a motion to send this bill back to the Finance Committee with instructions to report a bill without the drastic, arbitrary Medicare cuts that are in this bill. I support the Senator's motion because it is an opportunity to fix the bill and then come back to the full Senate with a better bill. Anything that comes back to the Senate floor should not have the drastic and arbitrary Medicare cuts. I am hearing this from seniors: I have paid into this Medicare for all these years. I am in retirement, and now Congress wants to take that money and establish a new entitlement program for somebody else other than seniors. So to a lot of seniors it just doesn't add up. This bill, as written, now permanently cuts all annual Medicare provider payment updates in order to account for the supposed increases in productivity by health care providers. The productivity measure used to cut provider payments in this bill does not represent productivity for a specific type of provider, such as nursing homes. You would think that if Medicare is going to reduce your payments to account for increases in productivity, it would at least measure your productivity, not an entire group of productivity or not somebody else's productivity but yours, and you would be rewarded according to that productivity or, if it wasn't productive, be harmed because of it because you are not doing the best job you can. But that is not the case. Instead, these reform bills would make the payment cuts based on measures of productivity for the entire economy. So if the productivity of the economy grows because computer chips and other products are made more efficiently, then health care providers see their payments go down. What is the relationship? These permanent cuts threaten beneficiary access to care. The Chief Actuary at the U.S. Department of Health and Human Services recently identified this threat to beneficiary access to care. He confirmed this in an October 21 memorandum analyzing the House of Representatives' bill and again in a November 13 memorandum. Both the House bill and the Senate bill propose the same type of permanent Medicare productivity cuts. We have a chart here. Here is what Medicare's own Chief Actuary had to say about these productivity cuts. Referring to these cuts, he wrote: The estimated savings . . . may be unrealistic. In their analysis of these provisions, Medicare's own Chief Actuary said: It is doubtful that many could improve their own productivity to the degree achieved by the economy at large. The Actuary goes on to say: We are not aware of any empirical evidence demonstrating the medical community's ability to achieve productivity improvements equal to those of the overall economy. So you have a $14 trillion economy today. You have $2.3 trillion of that, or one-sixth, related to health care, and you are going to try to do something to the health care aspect, productivity measure, harm or benefit, based upon what happens to the entire $14 trillion economy? That doesn't make sense. The Chief Actuary's conclusion is that it would be difficult for providers to even remain profitable over time as Medicare payments fail to keep up with the cost of caring for the beneficiaries. Going back to my chart again, ultimately here is the Chief Actuary's conclusion--that providers who rely on Medicare might end their participation in Medicare, ``possibly jeopardizing access to care for beneficiaries.'' This bill also cuts $120 billion from the Medicare Advantage Program, which provides health coverage to 11 million seniors, including the 64,000 seniors in my State of Iowa. These drastic Medicare cuts would reduce Medicare payments for those 11 million beneficiaries by close to 50 percent. Just like a lot of people, seniors are struggling financially right now, and these Medicare Advantage cuts will only make it harder for them to afford vision care, chronic-care management, dental care, and other benefits they have come to rely on, of their own choosing, because they decided to go to Medicare Advantage instead of staying in traditional Medicare. And what they are going to lose if they don't want to stay in Medicare Advantage and they are not going to get the benefits they got out of it, they go over to traditional Medicare, are these sorts of benefits which will not be included in traditional Medicare. During the campaign, the President said that if you like what you have, you can keep it. Well, that won't be true for Medicare Advantage people. They will either pay more, which is contrary to what the President said in his September speech to the joint session of Congress, they are going to pay more or lose benefits. Another problem is that this bill creates a new body of unelected officials with broad authority to make even further cuts in Medicare. Ironically, this body has been renamed the ``Independent Medicare Advisory Board,'' but it is not really advisory. I would hardly describe this group that way when its so-called recommendations can automatically go into effect, even absent congressional action--absent Congress going after it. I want to go to the chart again. The Wall Street Journal has a more appropriate name for this group. They call it the ``rationing commission.'' They described it as ``the unelected body that will dictate future medical decisions.'' These additional cuts in Medicare will be driven by arbitrary spending targets and automatic Medicare cuts written into law by this bill. This bill, unwisely, makes this board permanent. This bill requires this board to continue making even more cuts to Medicare and to do that forever. If you want to stop it, it will take another act of Congress to do it. Of course, this kind of sounds like the sustainable growth rate, or SGR, that impacts doctors every year. We always have to correct the mistakes that were made by passing the sustainable growth rate, SGR, first set in place probably 20 years ago, because this SGR formula set arbitrary spending targets. These targets turned out to be unrealistic. Now that flawed formula will cause an automatic 21-percent cut in Medicare physician payments on January 1 if Congress doesn't intervene by the end of the year. We all know the challenges Congress faces every year in trying to prevent these Medicare physician cuts that are supposed to take place because spending targets have been exceeded, so automatic payment cuts are then to automatically kick in. We have all heard from physicians in our States about the challenges in providing care to Medicare beneficiaries while these payment cuts loom above. This permanent board would cause the same problem for the entire Medicare Program, not just as SGR does for physician payments. This is a far bigger threat to the Medicare Program. It will jeopardize access to health care for our Nation's seniors on a much bigger scale. If this bill is enacted with this permanent board, we will be hearing from other providers, in addition to doctors, about how they cannot afford to treat Medicare patients. What is more alarming is that special back-room deals were cut to exempt some providers. This forces then, because of these special exemptions that were made, even greater cuts to fall directly on the remaining providers. Also, the Congressional Budget Office has confirmed that the board structure requires it to take focus on its Budget Act on premiums that seniors pay for Part D prescription drug coverage and for Medicare Advantage. I have already spoken about Medicare Advantage but just think: One of the things we hear about this time of the year all the time from seniors is prescription drug costs are going up, premiums on Part D are going up. Then you want to give this advisory commission--that is not advisory--authority to increase premiums that seniors pay for Part D prescription drug coverage? That means higher premiums for some of our most vulnerable populations. Another issue that cannot be ignored is the pending insolvency of the Medicare Program. The Medicare hospital insurance fund started going broke last year. That means more money is going out than is coming in from the payroll tax. The Medicare trustees--you remember, they report yearly and they look ahead 75 years--the Medicare trustees have been warning all of us for years that this trust fund is in terrible trouble and, by a certain date, 2017, we bust it. But rather than work to bridge Medicare's $37 trillion in unfunded liabilities--and that $37 trillion is that 75-year figure the trustees give us once a year, each spring, as they update it--so instead of working to bridge that $37 trillion of unfunded liabilities, this bill does what? It cuts $\1/2\ trillion from the Medicare Program to fund yet another unsustainable health care entitlement program. Medicare has a major problem with physician payments that could cost more than $250 billion to fix, but this bill ignores the problem. Instead, the proposed legislation assumes the government would implement the 23-percent Medicare cut scheduled to go against doctors in January 2011, as well as additional cuts that are scheduled for future years under that SGR. By pretending the physician payment issue does not exist, this bill would leave future Congresses virtually no way to restructure Medicare that would fix this problem. Instead, this bill diverts Medicare resources elsewhere and ignores major problems such as that one. Besides ignoring major problems, such as the physician payment issue, this bill also ignores the predictions of experts that Medicare cuts, such as are in this bill, will jeopardize access to care of Medicare beneficiaries. There are no fail-safes in this bill that would automatically kick in if these drastic cuts caused limited provider access or worsened quality of care. Instead, Congress would have to step in. Congress can always step in, but will it step in. We know how impossible it is to undo this kind of damage. By making this board a permanent program and requiring permanent productivity cuts, they become part of the baseline in the next decade. They go on cutting, cutting, cutting forever. If Congress ever wants to shut off those cuts, then this is the problem Congress faces: We have to come up with offsets to do it. The administration can cut and cut and cut or add and add and add. They do not have to do that. But the budget laws require us to have these offsets or to do the famously impossible thing to do--get a 60-vote margin to overcome it. The Congressional Budget Office has projected that these Medicare cuts keep increasing by 10 to 15 percent each year over the next decade. You heard me right. Medicare cuts keep growing 10 to 15 percent each year beyond the year 2019. Those are some pretty substantial cuts in a program that 43 million seniors and people with disabilities rely on for their health coverage. Provisions, such as the productivity adjustments and the Medicare independent advisory board, would drive the increased cuts to the program. This gives us an idea of the damage these bills will do to health care. This is an example of the challenge Congress will face in the next decade if this bill--this 2,074-page bill--becomes law. The few years of extended life this bill would give to the Medicare hospital insurance trust fund is a pyrrhic victory because the drastic and permanent Medicare cuts in this bill will worsen health care quality and access. This bill is the wrong way to address a big and unsustainable budget. You simply cannot slash Medicare payments, spend those funds to start up another new unsustainable government entitlement program, and then turn a blind eye toward the effect on access and quality. That is why I will support the motion of the Senator from Arizona to commit this bill and develop a bill without these Medicare cuts. I urge my colleagues to do the same. The reason I urge my colleagues to do the same is because we have an opportunity to step back just a little ways, go back to the drawing board on bipartisanship and maybe come up with something that fits in with the health care issues affecting the lives of 306 million Americans and, secondly, restructuring one-sixth of our economy. That is something I have heard people on both sides of the aisle say ought to be done on more of a consensus basis than the partisan road this is going down. It was a road that, for the first 6 months of this year, looked very doable, but it never turned out that way. I get back to this bottom line: If you are having a coffee club meeting in some restaurant Saturday morning in Delaware, Illinois or Iowa, and they are talking about health care reform and I go in to explain that what we are discussing right now on the floor of the Senate is going to raise taxes, it is going to raise premiums, it is going to not do anything about the inflation of health care costs, and we are going to take almost $\1/2\ trillion out of the Medicare fund to fund a new entitlement program, I would say that unanimously people would say: This is not health care reform. There has to be something else. But we throw away the word ``reform'' when we are not accomplishing the kind of goals we set out to accomplish the first 6 months of this year. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, I thank the Senator from Montana for his kind remarks. He does describe the situation very well, particularly one where there was a very close working relationship during the summer and up until the middle of September, when people in this body felt we were not moving fast enough to get a product before the body, and so some of us were shoved to the side, not by Senator Baucus but by other people in this body. I also compliment Senator Dodd from this standpoint--that as I look at this 2,074-page bill we call health care reform, that as he described parts of this bill, I think you get a broad consensus that the things he talked about should be done. But that does not describe everything in this bill and it does not describe the opposition that comes to a certain part of this bill now, not only by Members of the body, but if you follow polls and town meetings around the country, you find a lot of the people are having second thoughts about the words ``health care reform.'' I would suggest to you, if you were in a coffee shop in any small town of the United States and they were talking about health care reform, and I came into that coffee meeting and I said: The bill before the U.S. Senate is going to raise premiums, it is going to raise taxes, it is going to take hundreds of billions of dollars out of Medicare, and it is not going to do anything about the inflation of health care, I will bet you that people at the end of that would say: Well, that doesn't sound like health care reform to me. Even though Senator Dodd describes a lot of things that are neither Democratic nor Republican nor even bipartisan, there is kind of a consensus that these things ought to be done. He describes it accurately. But, still, a lot of goals that were sought by those of us who were negotiating these things over a period of several months--that we ought to have it be revenue neutral--and on the 10-year budget window, it is revenue neutral. But, remember, that is 10 years of increased taxes and 6 years of program to make that happen. So you raise the question, if it was 10 years of expenditures and 10 years of income, would it be revenue neutral? Well, obviously not. And it does not do anything about health care inflation. Those are two goals that were sought over a long period of time. This 2,074-page bill does not do that. I believe the people of the United States think our country has the best doctors and nurses in the world. But as Senator Dodd pointed out, there is widespread agreement that the health care system in America does have problems. Costs are rising three times the rate of inflation. Americans are uninsured. Millions more fear losing their insurance in a weak economy and because of preexisting conditions. Doctors are ready to close their doors over high malpractice costs and low government reimbursement. So everybody says we need health care reform. Everybody agrees on that very much. But, today, the Senate begins debate on a bill--2,074 pages--that would make a bad situation worse. It is unfortunate that early efforts to reach bipartisan solutions in Congress deteriorated into leadership- driven, partisan exercises. The bills in Congress slide rapidly down the slippery slope to more and more government control of health care. They contain the biggest expansion of Medicaid since it was created 43 years ago. They impose an unprecedented Federal mandate for coverage, backed by enforcement authority of the Internal Revenue Service. They increase the size of government by $2.5 trillion when fully implemented. They give the Secretary of Health and Human Services extraordinary powers to actually define benefits for every private health plan in America and to redefine those benefits annually. They create dozens of new Federal bureaucracies and programs to increase the scope of the Federal Government's role in health care. That is a lot of power over people's lives, and it is concentrated here in Washington, DC, in the Federal Government. The excesses of the bill appear willfully ignorant of what is going on in the rest of the economy outside of health care. These excesses make the bill far worse than doing nothing. At this point in our Nation's history, we are a nation facing very challenging economic times--some people would say the great recession, not quite the Great Depression; other people would say the worst recession we have had since 1982. What have we seen? We have seen the auto industry go into bankruptcy. We have seen banks shutter their doors. I have a chart that is up. We call it the wall of debt chart. The Federal debt has increased by $1.4 trillion just since inauguration. This chart shows the growing amount of debt the Federal Government is taking on. The amount of increased debt added just since the inauguration is $11,500 per household. It now exceeds $12 trillion for the first time in history. Within 5 years, the Obama administration's policies will more than double the amount of debt held by the public, and by 2019 it will more than triple the debt. That is not according to this Senator but according to the Congressional Budget Office and the White House Office of Management and Budget. Already, foreign holdings of U.S. Treasurys stands at nearly $3.5 trillion or 46 percent of the Federal debt held by the public. In other words, people outside of this country are holding 46 percent of our Federal debt. At the beginning of this debate, one of the key promises of health care reform was--and I said this previously, but I will repeat it now-- that it would bring down Federal health costs. This needs to be done before health spending sinks the Federal budget and saddles the taxpayer. I have another chart, a health spending chart or, more accurately, a Federal health spending chart. As this chart illustrates, this bill bends the Federal spending curve further upward by $160 billion over the next decade. The red area of this chart, emphasizing the red area of the chart, shows net additional Federal health spending--again, not according to this Senator but according to the Congressional Budget Office. Americans have rightly lost faith when, in the face of the current economic crisis--the ``great recession''--Congress thinks this $2.5 trillion restructuring of our health care system is a good idea. The Reid bill also includes a government-run plan. A government-run plan would drive private insurers out of business and lead to a government takeover of the health care system. From rationing health care to infringing on doctor-patient relationships, a government-run system would guarantee U.S. taxpayers a staggering tax burden for generations to come. The government cannot be a regulator, a funder, and a competitor at the same time without doing a great deal of damage to what the private sector has been doing for 60-some years. A government-run plan is not necessary for health care reform unless perchance the goal is to put in place the power of the Federal Government to drive down costs by--how? Not just driving them down but the consequences of that: rationing care and slashing payments to providers. These problems are bad enough, but much worse is that this bill--this bill--fails to solve the fundamental problems in health care. None of them take serious steps to reduce costs in health care. The bills will cause health care premiums for scores of people to go up, not down. An analysis just released this very day by the Congressional Budget Office confirms our worst fears about the impact this bill will have on people's health insurance premiums. According to the Congressional Budget Office, the new benefit mandates and regulatory changes will actually increase costs of nongroup health insurance for individuals and families by 10 to 13 percent. That means millions of people who are expecting lower costs as a result of health care reform will end up paying more in the form of higher premiums. For large and small employers that have been struggling for years with skyrocketing health insurance premiums, the Congressional Budget Office concludes this bill will do little, if anything, to provide relief. In fact, they cover their increased premiums they cause by spending even more on subsidies because of the increased premiums. So what happens? They do this by handing over close to $500 billion in hard- earned taxpayer dollars directly to health insurance companies. That sure doesn't sound as though this bill is actually reforming the market. The nonpartisan Congressional Budget Office analysis makes clear the Reid bill is not fixing the problem. The Reid bill also imposes new fees and taxes that will be pushed directly to the consumer. These new fees and taxes will total about one-half trillion dollars over the next few years. On the front end, these fees and taxes will cause premium increases beginning next year when they go into effect, and those new fees increase premiums--for 4 years; they are there for 4 years--before most of the reforms take effect in 2014. Then after forcing health premiums to go up, the legislation makes it mandatory to buy health insurance. Let's think about mandatory health insurance. The Federal Government is a government of limited powers under the 10th amendment. To my knowledge--and I think I know a lot about U.S. history--never in 225 years has the Federal Government said you had to buy anything. You don't have to buy--you buy what you want to buy in America, but not when this 2,054-page bill goes into effect. Then you will buy health insurance. Somebody is going to throw at us: Well, the States make you buy car insurance, and probably most States do. My State of Iowa does. But under the 10th amendment, the State governments have a lot of power the Federal Government doesn't have. The Reid bill also makes problematic changes to Medicare. It imposes higher premiums for prescription drug coverage on seniors and the disabled. The Reid bill creates a new independent Medicare board with broad authority to make further cuts in Medicare, and this bill makes that commission permanent. The damage this group of unelected people could do to Medicare is, in fact, unknown. What is more alarming is that so many providers got exempted--they have political power, so they got exempted from the cuts this board would make--that it forces the cuts. Then what happens? They fall directly and disproportionately on seniors and the disabled. Sooner or later, it has to be acknowledged that by making this board permanent, those savings are coming more and more--are going to bring more and more cuts to Medicare. That is a good example of the philosophical differences between the two sides in this body, and as the country divides itself more against this 2,054-page bill than for it, but still a large number of people in America support going in this direction. So those are philosophical differences between the two sides. There are alternatives. Some of us want to reduce the overall cost of the legislation. We want to try to reduce the pervasive role of government, make it harder for undocumented workers to get benefits, allow alternatives to the individual mandate and harsh penalties, and add medical malpractice reforms. I bring a little bit of emphasis to medical malpractice reform because at my town meetings throughout this past year and particularly during the month of August people would say: Why don't you first try to save money in health care costs by taking on the lawyers and doing medical malpractice reform? But, instead, the prevailing view is to move millions of people from private coverage into public coverage and create new government programs that cover families making close to $90,000. Yet, even with all of these changes, after raising one-half trillion dollars in new taxes, cutting one-half trillion dollars in Medicare, imposing stiff new penalties for people who don't buy insurance, and increasing costs for those who do--after all of these changes, the Congressional Budget Office says there are still 24 million people who will not have health insurance under the Reid bill. I don't think this is what the American people had in mind when the President and the Congress promised to fix the health care system. It is not too late for bipartisan legislation, so I have the hope that Senator Baucus just expressed before I spoke that builds on common ground to improve coverage, affordability, increased quality, and decreased costs. So here are some more alternatives. I have worked for years on bipartisan legislation that would transform Medicare from paying for volume of services provided to the quality of care delivered. There is also widespread support for stronger rules on insurance companies to make coverage more affordable and accessible, especially for small businesses and for people who aren't offered coverage by their employers, and for reforms to stop denials of coverage due to preexisting conditions. Tort reform would reduce abusive lawsuits that drive up costs and surely limit access to doctors. The nonpartisan Congressional Budget Office estimates that comprehensive medical liability reform would reduce Federal budget deficits by roughly $54 billion over the next 10 years. It would save even more when nonfederal health spending is taken into account. That would mean lower premiums for individuals and families. So far the Democratic leaders in Congress have little interest in creating an environment where doctors don't have to engage in defensive medicine just to keep their practices open because somebody might sue them. The medical community should continue to make the case for reasonable reforms that will cut down on unnecessary medical tests that serve no purpose except to reduce malpractice premiums and to protect against frivolous lawsuits. On several occasions, Republicans tried to take the legislative substance in a whole different direction. We tried to ensure the President's pledge not to tax middle-income families, seniors, and veterans was carried out. However, we were rebuffed at every step of the way. Republicans' efforts to provide consumers with a lower cost benefit option were consistently defeated. That means despite the promise, a lot of people are not actually going to be able to keep what they have as they were promised in the last Presidential campaign. The Democratic leaders in Congress are advancing their extremist health care reform bills with a bare minimum of votes to do the job. I disagree with that approach. Health care is one-sixth of the economy. That is as large as the entire British economy. The legislation Congress is considering will affect every American at every level of health and at every stage of employment. When the debate began last year--in fact, it was just this month of November that I remember 8 or 10 of us from different committees met with a solemn pledge. We were going to work together in a bipartisan way to get this job done. We met again for the next 6 months several times, but it just didn't work out. But when that debate began last year, interested legislators of both parties set benchmarks that were no-brainers: Health care reform should lower the cost of premiums. It should reduce the deficit. It should bend the growth curve in health care the right way--downward. The Reid bill doesn't do any of these things. It is not too late to start over. I guess Senator Baucus has put forth that invitation. I hope it materializes. If both sides can set aside some philosophical differences, and if the Democratic leaders are willing to refocus on the principles that brought us to the table months ago, I believe we can produce health care reform that improves the quality of life for Americans who are suffering under the current health care system and doesn't degrade the quality of life for everyone else. But it is not the entirety of this 2,074-page bill. These issues can be addressed without upending the entire health care system, with the result of higher taxes, higher insurance premiums, and deficits and debt that will get in the way of opportunities that result from the ingenuity and productivity and industry of the American people. I get back to that coffee shop meeting, where people are discussing health care reform. As I walk into that coffee meeting and I tell them that this 2,074-page bill increases taxes, increases premiums, takes 400 or more billion dollars out of Medicare, and it doesn't do anything about controlling costs, according to the Congressional Budget Office, that group again will say: That doesn't sound like health care reform to me. As we start this debate this week, I urge my colleagues to listen to the American people. The Reid bill is in the wrong direction. I yield the floor.

Mr. GRASSLEY. Madam President, I am not in favor of doing nothing. The previous Democratic speaker, Senator Casey, said if we do nothing, costs will go up. I think the fact is, if you look at CBO's analysis, it says costs will go up even more if this bill, this 2,074-page bill, passes. So I want to spend some time because there has been some obfuscation on what this Congressional Budget Office letter to Senator Bayh means. This morning, the nonpartisan Congressional Budget Office sent a letter to Senator Bayh providing a very detailed analysis of what health insurance premiums will look like as a result of this 2,074-page bill. I have the letter from the Congressional Budget Office right here, if anybody wants to read it in detail. Like many of us, Senator Bayh wants to know if the Reid bill is addressing our constituents' No. 1 priority: costs. I think if you were to have a Saturday morning coffee club meeting in almost any of the small towns of America, and they were discussing health care reform-- and emphasis upon the word ``reform''--and I walked into that meeting, and if I told them under this 2,074-page Reid bill that costs were not going to be brought under control, taxes were going to go up, premiums were going to go up, and we were taking $400 billion out of Medicare to set up a new health care program, they would probably unanimously respond: Well, that does not sound like health care reform to me. A lot of Senators are concerned about costs because that is what we are hearing from the grassroots of America. Everyone, from the dean of Harvard's Medical School to even the New York Times, has said this bill does not sufficiently address the rising cost of health care. But before today, we were still all anxiously waiting to hear what the Congressional Budget Office has now said about that issue of rising costs. Well, today, CBO has spoken loudly and clearly. The Reid bill not only fails to bring down costs, it will actually raise costs for millions of Americans. I think that bears repeating. The Reid bill will make health insurance more expensive. Families will end up paying 10 to 13 percent more as a result of this 2,074-page bill. Some proponents of the bill are trying to spin this, what they consider unfortunate news, and tell the American people that taxpayer- funded subsidies will actually offset these cost increases. In fact, tonight some Members have already been saying that this CBO analysis shows costs will come down. But I want to make it very clear CBO says that is not the case. Well, this may be true; if you take $500 billion of taxpayers' hard-earned money and give it out in subsidies directly to insurance companies, sure, some people may end up paying less for health insurance. But this argument fails to recognize two big underlying problems. First, most Americans will not qualify for any subsidies. They will end up paying higher premiums. In fact, 160 million Americans who stay in employer-based plans will not see any help. In fact, despite all the rhetoric about how employers cannot afford the status quo, CBO says this bill does little, if anything, to lower costs for employers. Maybe that is why the National Federation of Independent Businesses, the U.S. Chamber of Commerce, and a host of other business groups, oppose this 2,074-page bill. The nonpartisan Congressional Budget Office goes on to say that 14 million people who cannot get coverage through an employer will not get any help either, but they will see a 10- to 13-percent increase in premiums. And, of course, an intrusive new insurance mandate will be enforced by the IRS if you do not do what has never been done in the 225-year history of America. Never has the Federal Government said any American had to buy anything. Now you have to buy insurance. If you do not buy it, pay the IRS more money. Some people are going to say: Well, you have to buy car insurance. But under the tenth amendment, the State governments have any powers that are not prohibited by the Federal Constitution to them. So families who would have paid $13,100 under current law will actually pay more than $15,000 as a direct result of this 2,074-page bill. And people in employer-based coverage will be paying more than $20,000 a year for health insurance in 2016. The second big problem is this: Health insurance premiums are still more expensive in the Reid bill than they would be under current law. The government is cutting Medicare and raising taxes to offset the increases. So instead of addressing the underlying issue of cost, as was promised, this bill enacts policies that drive up costs by close to 30 percent, and then hands over close to $500 billion in hard-earned taxpayer dollars directly to health insurance companies to offset the increases. Well, you might not believe the spin. In fact, you better not believe the spin because the nonpartisan Congressional Budget Office has confirmed it. This bill fails to drive down the cost of health insurance premiums. It simply drives up prices with a bunch of arbitrary regulatory reforms, very cutely shifting the cost on to the American people in the form of higher taxes and massive Medicare cuts. So, once again, don't take my word for it. Read what the nonpartisan Congressional Budget Office says. They have confirmed what we have been hearing for months: The Democratic leadership bill means higher costs for millions of Americans. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I wish to be notified when I have spoken 20 minutes, please.

Mr. GRASSLEY. Mr. President, on November 10, former President Clinton visited the Democratic Senate caucus. It has been widely reported that his message to Senate Democrats was that on health care reform, the worst thing to do is to do nothing. With all due respect to the former President, that is simply wrong. Mr. Clinton, the worst thing we can do is pass this bill. This is not something I say lightly because there are serious problems with our health care system. There are important steps we need to take to fix the problems in our system. But the excesses of this bill appear willfully ignorant of what is going on outside health care. Those things deal with our economy. Those excesses make this bill far worse than doing nothing. We are a nation facing challenging economic times. We have seen the auto industry go into bankruptcy. We have seen banks shutter their doors. I want to refer to a chart of our national debt. The Federal debt has increased by $1.4 trillion since inauguration. This chart shows the growing amount of debt the Federal Government is taking on. The amount of increased debt added since the inauguration is $11,535 per household. The national debt now exceeds $12 trillion for the first time in history. I wish to show a chart on Federal health spending. As this chart illustrates, this bill bends the Federal spending curve further upward by $160 billion over the next decade. The red area of this chart is that net additional Federal health spending, not according to this Senator but according to the nonpartisan Congressional Budget Office. Americans have rightly lost faith when in the face of the current economic crisis Congress thinks this $2.5 trillion restructuring of the health care system happens to be a good idea. Perhaps one of the biggest warning signs that this bill will saddle taxpayers with more spending and debt is the fact that the budget fail- safe mechanism was dropped from the bill behind closed doors in the Capitol where this bill was written--and I emphasize ``closed doors.'' The Grassley budget fail-safe mechanism was cut from the bill and lots of budget gimmicks were added. Former Congressional Budget Office Director Douglas Holtz-Eakin wrote in yesterday's Wall Street Journal that this bill is ``fiscally dishonest'' and that it uses ``every budget gimmick and trick in the book . . . leave out inconvenient spending, back-load spending to disguise the true scale, front-load tax revenue, let inflation push up tax revenues, promise spending cuts to doctors and hospitals that have no record of materializing,'' and so on. This bill is simply irresponsible. It is worse than doing nothing. Let's talk about some of the excesses in the bill. It increases the size of government by a staggering $2.5 trillion when fully implemented. It imposes $\1/2\ trillion in new fees and taxes. Imposing these new fees and taxes as the economy is struggling to recover is worse than doing nothing. This $\1/2\ trillion in new taxes will hurt small businesses and destroy job creation. It breaks President Obama's campaign promise by increasing taxes on individuals and families making less than $250,000 per year. Adding insult to injury, these fees and taxes will also cause health care premiums to go up beginning next year. But I don't want you to take my word for it. Both the nonpartisan Committee on Taxation and the Congressional Budget Office have confirmed these taxes and fees will be passed through to the consumers in the form of higher health insurance premiums, and these taxes and fees will start increasing premiums 4 years before most of the reforms in this bill take effect in 2014. Let's take a look at what happens to Medicare and Medicaid in this bill. Both of these health care entitlement programs are already on perilous financial footing. Both are facing a financial meltdown. This bill adds to that burden. First of all, the Medicare trust fund started going broke last year. In the year 2008, the Medicare Program began spending more out of the trust fund than was coming in. The Medicare trustees have been warning all of us for years that the trust fund is going broke. They now predict it will go broke right around the corner, about 2017. But rather than work to bridge Medicare's $37 trillion in unfunded liabilities, this bill cuts $\1/2\ trillion from that Medicare Program to fund yet another unsustainable health care entitlement program. Medicare has a major problem with physician payments that will cost more than $250 billion to fix. But this bill ignores that problem by pretending the problem does not exist. This bill would leave future Congresses virtually no way to restructure Medicare to do the doctors fix. By diverting Medicare resources elsewhere and ignoring major problems such as that one, this bill does worse than nothing. Then there is Medicaid. The Medicaid Program serves 59 million low- income children and families. It is our health care safety net and it, too, is on very shaky financial ground. The Government Accountability Office has reported to Congress that States are reaching a financial and budgetary crisis with Medicaid. Like Medicare, Medicaid is essentially going broke. The Government Accountability Office models predict that State spending on Medicaid will grow faster than State revenues for at least the next 10 years. Here is what the Government Accountability Office has said about this situation: Since most State and local governments are required to balance their operating budgets, the declining fiscal conditions shown in our simulation suggest that, without intervention, these governments would need to make substantial policy changes to avoid growing fiscal imbalances. But this bill does not fix this problem either. Here again, this bill makes the problem worse. This bill adds another $374 billion in spending to the Medicaid Program. It adds 15 million people to the rolls of the worst delivery system in health care. It increases State spending by $25 billion, and that happens to be a hidden tax increase because States will be forced to raise taxes to pay for this increased cost--another unfunded mandate. By dropping the equivalent of a 10,000- pound weight through to our frayed Medicaid safety net, this bill does worse than nothing. This bill also compounds these long-term entitlement spending problems by creating yet another new entitlement program called the CLASS Act. This one is a voluntary Federal program for long-term care insurance. I devoted several years of effort to improving long-term care support, particularly for the disabled and the elderly. I understand the issues that supporters of the CLASS Act want to address. But the CLASS Act is simply not viable in its current form. The CLASS Act is almost certain to attract people who are most likely to need it. This is known as adverse selection. That will cause premiums to increase and healthier people to drop out of the program. It is a classic insurance death spiral. On November 13, the administration's own chief actuary confirmed this. The chief actuary issued a dire warning in a report on the CLASS Act in the House bill, which is virtually identical to the Senate version. Quoting the chief actuary: There is a significant risk the problem of adverse selection would make the CLASS program unsustainable. For the first 10 years, the CLASS Act saves money. It saves money at the beginning because it collects premiums before benefits start getting paid out. But some time afterwards, it starts to lose money. We all know what happens from there. It will become the taxpayers' responsibility to rescue the program as it fails. Look at financial struggles of Social Security. Look at Medicare. Look at Medicaid. Now go home and look at your children and grandchildren. Creating an unsustainable CLASS Act is not a responsible thing to do for our children and grandchildren. By adding the ticking time bomb of yet another unfunded liability to our children and grandchildren through the CLASS Act, this bill, again, does worse than nothing. Health care is one-sixth of the economy. The American people do not want a bill that makes the economy worse. The nonpartisan Congressional Budget Office, the Committee on Taxation, and even the Office of the Actuary of the U.S. Department of Health and Human Services have told us what the American people already knew: These massive partisan health care reform bills are going to make the problem worse when it comes to the cost of health insurance. According to a September 22 letter from the Congressional Budget Office to Chairman Baucus about the Finance Committee bill, CBO wrote: Premiums in new insurance exchanges would tend to be higher than the average premiums in the current law individual market. So according to CBO, after these bills spend $1 trillion, many of the people struggling to afford their premiums today will actually end up paying more if this bill moves forward and is enacted. By increasing costs when people desperately need Congress to lower costs, this bill does worse than nothing. It does not have to be this way. When the debate began last year, interested legislators of both parties set forth benchmarks that were no-brainers. Health care reform should lower the cost of premiums. It should make health care more affordable. It should do so without Medicare cuts that jeopardize access to care for seniors. It should do so without overloading the Medicaid safety net until it rips. It should do so without adding to the already unsustainable, unfunded liabilities by creating yet another unsustainable entitlement program. It should have done all those things. That is what we intended to do when we started out. Instead, this bill threatens the economic recovery. It is $\1/2\ trillion of new taxes hurting small business and destroying job creation. It calls for an even bigger and more unsustainable Federal budget. It adds to that burden with a massive new government-run health plan. It makes health care more unaffordable and lowers quality. I know some people believe we should get on to the bill and try to fix it by amendment. But this 2,000-page bill has many more problems than can be fixed by amendment on the Senate floor. If you want to improve it, it should be stopped right now and get back together where we were at one time. Democratic leaders and the White House have put together one extreme health care plan after another. After the bailouts for Wall Street and Detroit, a stimulus bill that led to the highest unemployment in 26 years, and the Fed shoveling money out the door without any accountability, this health care reform bill is the straw that broke the camel's back. What Senate Republicans are trying to say tonight, with tonight's vote, is we don't support reform just for the sake of reform. Changes to the health care system must be responsible and not break the backs of the taxpayers and the job-creating engine in America, small business. It doesn't make any sense to make major new unsustainable commitments to entitlement spending. Already, Medicare's solvency is in jeopardy and the Reid bill would make things worse for Medicare. Seniors are in a tough situation today with the way the economy has hit their retirement savings. We have to step back and remember it is not our money, it is their money. It is the taxpayers' money we are talking about--$2\1/2\ trillion of taxpayers' dollars over the decade when this bill is fully implemented. Generations of hard-working Americans will be forced to pay the costly price for this bill if it moves forward. It is irresponsible for Democratic leaders to use their filibuster-proof majority in the Senate and their control of the House and the White House to push through such massive legislation, reshaping one-sixth of the American economy. The unintended consequences of this legislation could have a destabilizing effect at just the wrong time as America's economy struggles to recover and working families are doing everything in their power just to hold on. The late Senator Moynihan often warned about the perils of a majority party pushing through major bills and changes in a partisan way. It is a well-founded warning that Democratic leadership has not heeded--this time, at least. If a bill like this one cannot get support more broadly, then something is wrong with it. Moreover, grassroots America has spoken out against this legislation. It is alarming how those voices have been disregarded by congressional leaders. President Andrew Jackson made it clear that our duty is to tune in to the common sense of the American people who sent us here. I quote President Jackson: Our Government is founded upon the intelligence of the people. I, for one, do not despair of the republic. I have great confidence in the virtue of the great majority of the people, and I cannot fear the result. Listen to what President Jackson said. Listen to the concerns of the people. They are telling us to reconsider this massive, complicated legislation and take a path that leads to less spending, less taxes, and less debt. Instead of continuing to mortgage the future of our children and grandchildren, we need to get back to basics. Congress should pass commonsense medical malpractice reform to stop wasting so much money on defensive medicine. Congress should empower consumers to shop around for health care and lower costs with competition just like with other services the consumers buy. Congress should make market reforms that help small businesses and the self-employed have greater access to health insurance at an affordable rate. These issues can be addressed without upending the entire health care system with the result of higher taxes, higher insurance premiums, and deficits and debts that will get in the way of the opportunity that results from the ingenuity and industry of the American people. If we were sitting around a coffee shop in Springfield, IL, or Little Rock, AR, and we were discussing health care reform and I told them we are talking about a bill that is going to raise taxes, cut Medicare, raise premiums, and not do anything about costs, they would say that is not health care reform. I encourage my colleagues to listen to the American people and to send this bill back to the drawing board. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, today I have introduced a bill to extend deadlines by one year for three provisions in the Heartland Disaster Tax Relief Act of 2008. The Heartland Disaster Tax Relief Act has been critical in rebuilding the lives and communities of those affected by the terrible floods and tornadoes from last year. Because of delays in Federal funding and tighter credit conditions, many homeowners affected by the 2008 floods and storms will be unable to meet the deadline for the tax relief intended to help with recovery. It is only fair to extend the deadline and give these homeowners the chance to recover and rebuild. A lot of people are still trying to fix their ruined homes or move on to new housing. A house is ruined in a few minutes, but banks and governments take what seems like an eternity. The first provision is a one-year extension of the provision allowing disaster victims with damage to their primary residence to use their own assets to buy a new home or repair an existing home by withdrawing money from their retirement plans without tax penalties. The second provision is a one-year extension of a provision allowing disaster victims that have borrowed from their retirement account for disaster recovery to repay their own account without penalty. The final provision is a 1-year extension of a provision allowing disaster victims whose banks cancel mortgage debt to not have the cancelled debt counted as taxable income. I urge my colleagues to help me in getting this important legislation enacted into law as soon as possible. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, today I have introduced a bill to extend deadlines by one year for three provisions in the Heartland Disaster Tax Relief Act of 2008. The Heartland Disaster Tax Relief Act has been critical in rebuilding the lives and communities of those affected by the terrible floods and tornadoes from last year. Because of delays in Federal funding and tighter credit conditions, many homeowners affected by the 2008 floods and storms will be unable to meet the deadline for the tax relief intended to help with recovery. It is only fair to extend the deadline and give these homeowners the chance to recover and rebuild. A lot of people are still trying to fix their ruined homes or move on to new housing. A house is ruined in a few minutes, but banks and governments take what seems like an eternity. The first provision is a one-year extension of the provision allowing disaster victims with damage to their primary residence to use their own assets to buy a new home or repair an existing home by withdrawing money from their retirement plans without tax penalties. The second provision is a one-year extension of a provision allowing disaster victims that have borrowed from their retirement account for disaster recovery to repay their own account without penalty. The final provision is a 1-year extension of a provision allowing disaster victims whose banks cancel mortgage debt to not have the cancelled debt counted as taxable income. I urge my colleagues to help me in getting this important legislation enacted into law as soon as possible. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. GRASSLEY

Mr. GRASSLEY. Madam President, we have been waiting for many weeks while the Democratic leadership worked behind closed doors to write a new health care reform bill. Rather than trying to build consensus for a bill that could get broad-based support, they toiled in secret, but at long last this new health care reform plan is finally public. They have come forward to at last reveal the legislative language for a health care reform bill that the Democrats intend to bring to the floor. We know where they started. We know the changes they made along the way. Those in this Chamber will recall that we worked for months in the Senate Finance Committee on health reform. Senator Baucus and I worked very carefully in committee to try to develop a bipartisan reform plan. Health care, as everybody knows, is one-sixth of the economy. If that economic fact is obscure to people, $1 out of every $6 in the United States is spent on health care. We are, of course, to spend upward of $33 trillion on health care in this country over the next decade--$33 trillion. Already our health care system is on an unsustainable path. Our current health care entitlement programs, at least the two, Medicare and Medicaid, are both on very unsound financial footing. Not only are both programs in jeopardy financially, but the magnitude of the problem is a real threat to the Federal budget. Starting in 2008, the Medicare Program began spending more out of the hospital insurance trust fund than it is taking in. That deficit spending at the trust fund is the beginning of the end of Medicare unless Congress steps in and does something to maintain that trust fund. The Medicare trustees have been warning us for years that the hospital insurance fund--the trust fund, that is--is going to go broke. They now predict that year of going broke is 2017. To keep Medicare going for future retirees means finding a way to bridge the gap for the $75 trillion of unfunded liability, and this must be done in a manner that does not worsen the health care quality or access for beneficiaries. Likewise, the Medicaid Program, which serves 59 million low-income pregnant women as well as children and the families, is on a very shaky financial ground. We have the Government Accountability Office reporting to Congress that States--meaning the 50 States--are reaching a crisis with their part of the Medicaid Program. The Government Accountability Office models predict that State spending will grow faster than State revenues for at least the next 10 years. The impact of declining revenues is very clear. I quote what the GAO has said about this situation: Since most state and local governments are required to balance their operating budgets, the declining fiscal conditions shown in our simulations suggest that, without intervention, these governments would need to make substantial policy changes to avoid growing fiscal imbalances. This, too, is the crisis facing the Medicaid Program today. So both of the two major Federal health care programs are in very serious trouble. These are major problems with some of the most significant implications for our entire country and the 300 or more million people who live here. If reforms to health care are not done carefully--and I say ``carefully'' because I am not saying they should not be done--this is going to make the situation far worse, not better. Anyone listening would have no doubt of the ability of Congress to make it worse. These dire economic implications are not the only thing at stake with health care reform. Besides the significant economic implications of health care reform, this is a bill that affects everyone in another very important way. It affects everyone's health by changing the way we get health care in this country. It touches the lives of every family, every senior, every child, every student. In plain language, it affects everybody: the 306 million people who live here now and the many more people who will be living here in the future. It makes changes to health care that will be nearly impossible to undo. The reforms these bills contemplate will make long lasting changes to our health care system. These are changes all of us will have to live with for decades to come. Health reform presents this Chamber with a bill that has significant economic implications at a time when all eyes are focused on the economy, so focused on the economy that it almost reminds me of how President Clinton got elected on the campaign slogan, ``It's the economy, stupid.'' This health care reform bill is a bill that will make permanent changes to our system of health care. For all of these reasons, it makes it all the more important that changes of this magnitude be done with broad-based support in this Chamber and across the country. This broad-based support was something Senator Baucus and I focused on in our work on the Finance Committee, as we were trying to bring forth a bill that would be bipartisan. In the Finance Committee, we believed strongly that a bill of such significance should be done with broad-based support; in other words, health care is a life-or-death issue for every American, and it affects $1 out of every $6 spent in America. Because it is so big, that is the basis for that statement ``broad-based support.'' Under the leadership of Senator Baucus, chairman of the Finance Committee, we started last year with a bipartisan health care reform summit. We held 20 hearings. We held three public forums this year on options for financing, coverage, and delivery system reform. We invited in experts from across the country. We invited anyone to submit input to the committee on those options, and we received over 600 sets of comments on the option papers. Senator Baucus and I developed the broad outlines of what we believed would be a good reform package. That broad outline reflected the input we had from that very open and public process. We took that outline, and we sat down with four other leaders on the issue of health care in this very Chamber. That group soon became known as the group of six. That group began meeting in June to take that framework and finish the important details. We met for untold hours. We consulted with experts at the Congressional Budget Office and the Joint Committee on Taxation. We invested a tremendous amount of time and effort to develop a bipartisan package. Then what happens around here too often? People get impatient. In this case, the Democratic leaders got impatient. They wanted the reform bill to be finished faster. They were more concerned with health care reform getting done right now rather than getting done right. We said we needed to give the process the time it needed. We said we were not going to be bound by arbitrary deadlines. We wanted to get the job done right. But when the first of September rolled around, they were not willing to give the group of six any more time. As a result, the Democratic leaders pulled the plug on that bipartisan work, and the hope for a bill with broad bipartisan support ended at that point. Ultimately, the Finance Committee reported out a bill that did not have that broad bipartisan support, the support we had hoped for earlier in the year. The bigger and far more liberal agenda driven by the White House and the Democratic leadership went beyond where the true consensus on reform exists. Now the next step in this process has been to merge together the bills from the HELP Committee and the Finance Committee. That job fell to the Democratic leader and the chairmen of the two committees. But, ultimately, their leader even excluded the chairmen from the process. That process began on October 2. So the rest of the Senate has been waiting ever since that time to see what would emerge from behind closed doors just across the hall. But then people started to complain about how long it was taking to develop the merged bill. When that happened, lo and behold, we started to hear from the Democratic leader what the group of six had been saying. That leader, too, started saying he was not going to be bound by any artificial timeline. He, too, started saying he was going to take whatever time he needed. Imagine our shock and dismay when we heard this. All the impatience we heard about how long our bipartisan process was taking, the criticism we took. So they pulled the plug on that effort out of impatience. My suspicion is that only now is there a realization of how hard it is to assemble a comprehensive health care reform plan. Now at long last, that merged bill is before us. Now we know what is in it. The bill has undergone many changes since the Democrats decided to do a partisan bill. They are not positive. They have moved more and more to not only a partisan agenda, they have moved to an extreme agenda. It is an agenda so extreme, they are having difficulty finding votes among Democratic Members. They have 60-vote control of this body. They have an overwhelming majority in the House. Yet they are trying to blame Republicans for slowing down the process. Surely they don't expect 100 Senators to get this done faster than it took a leader behind closed doors to get the bill done, to put together the two bills between the Finance Committee and the HELP Committee, what we have before us or will eventually have before us. But it is not Republicans who are slowing this down. It is not because of Republicans that it took so long to merge these two Senate bills. It is not because of Republicans that it took the House so long after July to finally vote on the bill. The reason for the difficulties is that their leftwing is driving the health reform agenda so far to the extreme left. It is so far to the left that they are having trouble getting everyone on their side to support that agenda? In the other body, 39 Democrats voted against Speaker Pelosi's plan, and you can be sure that we would have seen a bill in the Senate much sooner than now if all Democrats were lined up behind this effort. But this is where we are. Now let's look at what has been produced, what changes have been made to produce the merged bill. I will highlight a few of the changes I find most disturbing. As I highlight these issues, it will be clear that this bill is already sliding rapidly down the slippery slope to more and more government control of health care. It still has the biggest expansion of Medicaid since the program was created in 1965. It still imposes an unprecedented and intrusive Federal mandate for coverage backed by the enforcement authority of the Internal Revenue Service. It still increases the size of the government by $2.5 trillion when fully implemented. It has gotten even more expensive since the Finance Committee started. It still gives the Secretary of Health and Human Services the power to set prices and define benefits for private health plans. That is a lot of government power in Washington over people's lives. It still will cause health care premiums for millions to go up. As I said when this process started, the bill released by the Finance Committee was an incomplete but comprehensive, good-faith attempt to reach bipartisan agreement. But ever since that moment, the bill has moved further and further away from that approach on several key issues. Now we can see clearly that the bill continues its march leftward. It continues to take shape into an extreme agenda driven by the far left. This far left partisan change is precisely what my party feared would occur at later stages in the legislative process. Today we see these fears were legitimate and justified. Nevertheless, I still hold out hope that at some point the doorway for bipartisanship will again open. I hope at some point the White House and leadership will want to correct the mistakes they made by ending our collaborative, bipartisan work of 3 months during the summer. I hope at some point they will want to let that bipartisan work begin again. Then they need to back that effort and give it the time needed to get it right rather than getting it done right now. It is clear that today is not the day that is going to happen. I yield the floor.

Mr. GRASSLEY

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

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, I ask unanimous consent for Randoe Dice, a detailee on my staff, Ben Bremen, Anne Pick, and Joseph Moon, interns on my staff, be granted the privileges of the floor during debate of H.R. 3590.

Mr. GRASSLEY

Mr. GRASSLEY. I thank my friend, the Senator from Kansas, for his kind remarks. I am very happy to join him in sounding an alarm about the role of the Internal Revenue Service in America's health care choices. The various health care bills being considered before Congress would task the IRS with administering several new and very controversial provisions. This would include things such as the individual mandate-- or another way to say that is a government-run insurance mandate, a government-required insurance mandate. It would also affect the employer free rider penalty. The IRS would be involved with the premium subsidy for low-income individuals. It would be involved with the small business tax credit. The IRS would be involved in working with exchanges to verify income information, and it would be involved in figuring out how to calculate and collect several new fees, which are in fact excise taxes. Senator Roberts has just explained some of this. Also, during debate in the Finance Committee--when the Senate Finance Committee bill was up in that committee, some people joked that CMS stands for ``it's a mess.'' The same could be said of the IRS. As many of us know all too well, the tax gap is a very serious problem. The hundreds of billions of dollars owed that the IRS isn't collecting suggests that the IRS isn't effective at executing its primary mission: the enforcement of our revenue laws. The IRS is just now starting to increase its enforcement efforts, which had declined significantly after the restructuring of that agency a decade ago. But just like many other Federal agencies, it is facing a human resource crisis because more than 50 percent of its workforce is expected to retire in the near future. So it doesn't have the resources it needs to do its presently described job, never mind a whole new one, such as administering health care reform--or at least helping administer health care reform. One independent report after another highlights IRS's enforcement problems. Senator Roberts mentioned the recent reports on the Making Work Pay credit, home buyer tax credit, and the IRS's financial statements. In addition to those, we have problems with the earned- income tax credit and the health coverage tax credit. In February, the Treasury Inspector General for Tax Administration issued a report on fraud in the earned-income tax credit. Then today, the administration reports that waste of taxpayer dollars from improper payments has increased from $72 billion in 2008 to $98 billion in 2009. Over $12 billion--almost 12 percent--of the $98 billion in improper payments was because of the earned-income tax credit. In another tax inspector general report from earlier this month on the health coverage tax credit, that inspector general reviewed a valid sample of individuals who claimed this credit on their 2006 Federal tax return. The tax inspector general found that 72 percent did not have the required documentation to get that credit. In addition, the inspector general states that the IRS does not effectively identify or prevent individuals from erroneously claiming the health credit on their Federal tax return. The inspector general identified over 1,200 individuals who appeared to have wrongly claimed $1.8 million of these credits on their Federal tax returns. This report is particularly relative since the premium subsidy in the Finance Committee health reform bill is modeled after this credit. The earned-income tax credit, the health coverage tax credit, and the making work pay tax credit are all examples of social welfare programs that presently are being administered by the Internal Revenue Service, and this despite the fact that we have a whole separate agency--the Department of Health and Human Services--that is supposed to be concerned with social welfare. In a recent interview with tax analysts about current health reform proposals, a former IRS Assistant Commissioner had this to say about IRS' role in the health reform issue: These kinds of programs require social welfare expertise. IRS agents are not recruited or trained to do that. . . . The IRS record is mixed and sometimes abysmal with regard to effectively administering these kinds of programs. I couldn't have said it better myself. Aside from the costs and the problems with enforcing these types of credits, there are opportunity costs associated with requiring the IRS to administer programs outside its expertise. The Government Accountability Office and the tax inspector general issued reports discussing the IRS' poor performance in providing telephone customer service during the 2009 filing season because of stimulus legislation. That was passed in February of this year. The reports state that customer service declined significantly, despite the fact that collection employees were assigned to staff the phones. So honest and diligent taxpayers do not get the help they need when they need it, and tax cheats and tax evaders increasingly get away with not paying their fair share, and the tax gap widens. From a tax administration perspective, the provisions in the various health reform bills will create infinite new problems for the Internal Revenue Service. The Internal Revenue Service is likely to be tasked with implementing provisions for which it actually must go out and collect new data--data that is unrelated to the taxpayer's tax liability. In addition to the provisions Senator Roberts highlighted, the Internal Revenue Service would have to develop new processes and procedures for insurance companies and employers to challenge and appeal the calculations of the high-cost premiums tax and the employer free rider excise tax, both new provisions in the Senate Finance Committee bill. Both these taxes are calculated by a third party, other than the IRS or the individual taxpayer. The IRS would have to develop a method for calculating the new excise taxes on medical devices and pharmaceuticals, also a new provision in that bill, the basis for which is unprecedented. In light of these issues, I think it is fair to consider a couple questions. Assuming that an individual mandate is constitutional, do we want the IRS checking up on whether everyone has health insurance? Another question: Do we want to facilitate the dissemination of tax information to third parties, such as employers or an insurance exchange? We have always been very cautious about maintaining the privacy of individual tax returns. Another question: Shouldn't we be providing more resources to the Department of Health and Human Services to ensure that it can receive and process the necessary data if this bill is going to be implemented instead of having the IRS do it? My Democratic colleagues in the Congress and the administration have many ideas for new and complex ways to tax individuals and, of course, tax small businesses as well, to fund all sorts of new spending. It would seem wise to make sure the IRS can enforce the tax laws before being charged with administering new social programs created because of health reform. I ask my colleagues on the other side of the aisle to consider these questions as we debate the health care reform bill over the next several weeks. I yield the floor, and I suggest the absence of a quorum.

Mr. GRASSLEY

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

Mr. GRASSLEY. Mr. President, I oppose the nomination of Judge David Hamilton to be a Seventh Circuit Appeals Court judge. I have serious concerns about this nomination and will be voting not to confirm him. During his time as a Federal judge on the U.S. District Court for the Southern District of Indiana, Judge Hamilton has issued a number of highly controversial rulings and, more importantly, has been reversed in some very prominent cases. In my opinion, these decisions strongly indicate that Judge Hamilton is an activist judge who will ignore the law in favor of his own personal ideology and beliefs. For example, in one case, Judge Hamilton succeeded in blocking enforcement of an informed consent law for 7 years. In that case, called A Woman's Choice v. Newman, Judge Hamilton struck down an Indiana law requiring that certain medical information be given to a woman in person before an abortion can be performed. The Seventh Circuit overruled Judge Hamilton's decision, stating: For 7 years, Indiana law has been prevented from enforcing a statute materially identical to a law held valid by the Supreme Court in Casey, by this court in Karlin, and by the Fifth Circuit in Barnes. No court anywhere in the country (other than one district judge in Indiana) has held any similar law invalid in the years since Casey . . . Indiana (like Pennsylvania and Wisconsin) is entitled to put its law into effect and have that law judged by its own consequences. That was the circuit court overturning Judge Hamilton. It seems to me that Judge Hamilton went out of his way to make his finding and actually block the Indiana law. That is not the proper role of a judge. In addition, Judge Hamilton has shown hostility against the expression of religion in the public square. In two prominent cases, he ruled against public prayer in the State legislature and religious displays in public buildings, and in both cases he was reversed. In the case of Hinrichs v. Bosma, Judge Hamilton enjoined the speaker of the Indiana house of representatives from permitting sectarian prayer. Judge Hamilton ruled that the Indiana State legislature was prohibited from starting its session with prayers, specifically those that expressly mentioned Jesus Christ, but that it would be permissible for a prayer to mention Allah. The Seventh Circuit overturned Judge Hamilton's decision in Hinrichs, and subsequently the Indiana house passed a resolution 85-to-0 opposing Judge Hamilton's ruling. Then in Grossbaum v. Indianapolis-Marion County Building Authority, Judge Hamilton ruled that a county could prohibit the display of a menorah in a nonpublic forum. The Seventh Circuit unanimously reversed Judge Hamilton, noting that the judge disregarded relevant Supreme Court precedent to reach his ruling and that he failed to recognize a rabbi's first amendment right to display the menorah as symbolic religious speech. Judge Hamilton also ignored clear statutory mandate so he could impose his own personal beliefs when sentencing criminal defendants. Example: In the 2008 case U.S. v. Woolsey, Judge Hamilton disregarded an earlier conviction in order to avoid imposing a life sentence on a repeat drug offender. The Seventh Circuit reversed the decision, admonishing Judge Hamilton, specifically stating that he was ``not free to ignore'' prior conviction because ``statutory penalties for recidivism . . . are not optional, even if the court deems them unwise or an inappropriate response to repeat drug offenders.'' In another case, U.S. v. Rinehart, Judge Hamilton used his court opinion to request clemency for a police officer who pled guilty to two counts of producing child pornography. In this case, the police officer had engaged in and videotaped ``consensual'' sex with two teenagers. In addition, in writings and speeches, Judge Hamilton has indicated that he approves of the concept that judges should make policy from the bench. For example, he has embraced President Obama's empathy standard, a standard so radical that even the new Supreme Court Justice Sotomayor had to rebuke it at her confirmation hearings. In response to written questions for his confirmation hearing, Judge Hamilton answered this way: Federal judges take an oath to administer justice without respect to persons, and to do equal right to the poor and to the rich. Empathy--to be distinguished from sympathy--is important in fulfilling that oath. Empathy is the ability to understand the world from another person's point of view. A judge needs to empathize with all parties in cases--plaintiff and defendant, crime victims and accused defendant--so that the judge can better understand how the parties came to be before the court and how legal rules affect those parties and others in similar situations. To empathize with the parties is not the proper role of a judge. Rather, the proper role of a judge is to apply the law to the facts in an impartial manner, and that is what we refer to as blind justice. Further, in a 2003 speech, Judge Hamilton endorsed the idea that the role of a judge includes ``writing footnotes to the Constitution'' through evolving case law. He said: Judge S. Hugh Dillin of this court has said that part of our job here as judges is to write a series of footnotes to the Constitution. We all do that every year in cases large and small. Oddly enough, the last time I checked, it was the role of Congress to write laws, not the judicial branch. Judge Hamilton's personal bias has been noted by lawyers who practice before him. In fact, statements of local practitioners in the Almanac of the Federal Judiciary described Judge Hamilton as ``the most lenient of any judges in the district.'' Another quote: ``One of the more liberal judges of the district.'' Another quote: ``Goes out of his way to make the defendant comfortable.'' Another quote: ``He is your best chance for downward departures.'' Lastly, ``in sentencing, he tends to be very empathetic to the downtrodden, or to those who commit crimes due to poverty.'' Contrary to how the White House has tried to characterize Judge Hamilton, I believe that the record amply demonstrates that Judge Hamilton is an activist judge. He has taken radical positions, and a number of his rulings indicate that Judge Hamilton will impose his own personal beliefs and values in cases. We should not promote an individual whose track record clearly demonstrates that he will carry out an outside-of-the-mainstream personal agenda on the Federal appeals court. For these reasons, I will oppose the nomination of Judge Hamilton to the Seventh Circuit. If he was going to serve on a circuit, as many times as he has been overruled, it would be more appropriate for him to be on the Ninth Circuit, where a lot of those decisions on appeal are overturned by the Supreme Court--about 9 times out of 10. I yield the floor.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, in 2008, Medicare accounted for about $470 billion of the $2 trillion spent on health care in the U.S.. Conservative estimates are that as much as $60 billion of that Medicare spending is lost to fraud, waste, and abuse each year. News reports today tell us that the Medicare payment error rate for fiscal year 2009 is going to be 12.4 percent. To put it in a different way, last year, Medicare made 47 billion dollars in improper payments. $47 billion of taxpayer money that by all accounts was wasted by Medicare on payments that shouldn't have been made. As Medicare spending continues to skyrocket, so will the dollars lost to fraud, waste and abuse. That problem is bad enough. But it is even worse because it turns out that a rule in the law today makes it easier for crooks to cheat the system and steal money from Medicare. A recent 60 Minutes segment highlighted how the law as written contributes to the problem and drives this growing danger to the American taxpayer and public coffers. In this segment, we saw a medical supply company that billed Medicare, $2 million this past July--despite being empty and having apparently no staff. Federal agents described the problem as far bigger than the drug business in Miami now. They were told it has pushed aside cocaine as the biggest criminal enterprise there. According to those interviewed by 60 Minutes, an entire health care fraud industry exists today that is committed to doing nothing except finding ways to rip off the Medicare program. Many of these suppliers don't exist. There is no office that exists and nobody who works there. They recruit doctors and patients and use stolen patient lists, and do nothing but figure out how to steal from Medicare. One man interviewed said he was waking up every day making $20,000- $40,000 every day. It was like winning the lottery he said. He was running a fake medical supply company that didn't actually sell any medical equipment to anyone. He says he stole at least 20 million dollars from Medicare. He said it was, quote ``real easy.'' All he says he needed was someone pretending to run the office and then he just had to check his bank account every day to see how much money he had made. All he did was fill out forms to Medicare and in 15 to 30 days he would have the money in his bank account. Even more alarming, he says that there are about 2,000 to 3,000 more fake medical suppliers just in Miami billing Medicare fake claims. They are able to do this because Federal law puts Medicare in a position of having to ``pay and chase'' health care fraudsters. this is because federal law requires that Medicare pay providers promptly regardless of any risk of fraud, waste, or abuse. The prompt payment requirement in current law requires payment for a ``clean'' claim within 14 to 30 days. And that is not enough time for the limited number of Medicare auditors to determine if the claim is legitimate before the payment has to be made. The result is that this ``prompt payment rule'' requires that Medicare pay fraudsters first, and ask questions later. This requirement in current law doesn't make any sense. I am here today to introduce a bill to fix it. This legislation, the Fighting Medicare Payment Fraud Act of 2009 Act, would provide the government with an important new tool to fight fraud, waste and abuse in Medicare. This bill will stop the cycle of ``paying and chasing.'' This legislation would protect Federal taxpayer dollars from being wasted on suspicious payments that are required to be made because of the prompt payment rule. Today, the prompt payment rule applies to all payments regardless of the risk that those payments would be to fly-by-night operators. But this legislation ends the policy of pay first and ask questions later. This legislation gives the Secretary of Health and Human Services the authority to ask questions first and then and ONLY then to make the payment if the health care provider and the payment for services check out. This bill accomplishes that by extending the time period in which payments must be made under the prompt payment rule in cases where the Secretary determines there is a likelihood of fraud, waste or abuse. For categories of providers or suppliers, the payment time period can be extended to up to one year. For individual providers or suppliers, the Secretary would be required to take whatever time is necessary to engage in more in-depth reviews to determine that the claims are supposed to be paid in the first place. With this additional time, the Secretary would be required to conduct more detailed reviews of suspicious claims to make sure they are supposed to be paid. This would help ensure that Medicare dollars are in fact going to bona fide providers, instead of fraudsters with empty strip mall medical supply companies. Finally, this legislation requires the experts in the Office of Inspector General to recommend, on at least an annual basis, categories of providers or suppliers that warrant additional time before payments are made under the prompt payment rule. To make sure there is action on these recommendations, the Secretary would be required to provide a response to the Inspector General on these recommendations. With this new authority to fight health care fraud, the Federal Government will be in a better position to protect taxpayer dollars and catch health care crooks. Crooks are taking advantage of Medicare's prompt payment requirement. They know they can bill Medicare, get their payment, and be gone before they get caught. And Federal law enables it to happen. That has got to end. This legislation takes that step.

Mr. GRASSLEY

Mr. GRASSLEY. Mr. President, in 2008, Medicare accounted for about $470 billion of the $2 trillion spent on health care in the U.S.. Conservative estimates are that as much as $60 billion of that Medicare spending is lost to fraud, waste, and abuse each year. News reports today tell us that the Medicare payment error rate for fiscal year 2009 is going to be 12.4 percent. To put it in a different way, last year, Medicare made 47 billion dollars in improper payments. $47 billion of taxpayer money that by all accounts was wasted by Medicare on payments that shouldn't have been made. As Medicare spending continues to skyrocket, so will the dollars lost to fraud, waste and abuse. That problem is bad enough. But it is even worse because it turns out that a rule in the law today makes it easier for crooks to cheat the system and steal money from Medicare. A recent 60 Minutes segment highlighted how the law as written contributes to the problem and drives this growing danger to the American taxpayer and public coffers. In this segment, we saw a medical supply company that billed Medicare, $2 million this past July--despite being empty and having apparently no staff. Federal agents described the problem as far bigger than the drug business in Miami now. They were told it has pushed aside cocaine as the biggest criminal enterprise there. According to those interviewed by 60 Minutes, an entire health care fraud industry exists today that is committed to doing nothing except finding ways to rip off the Medicare program. Many of these suppliers don't exist. There is no office that exists and nobody who works there. They recruit doctors and patients and use stolen patient lists, and do nothing but figure out how to steal from Medicare. One man interviewed said he was waking up every day making $20,000- $40,000 every day. It was like winning the lottery he said. He was running a fake medical supply company that didn't actually sell any medical equipment to anyone. He says he stole at least 20 million dollars from Medicare. He said it was, quote ``real easy.'' All he says he needed was someone pretending to run the office and then he just had to check his bank account every day to see how much money he had made. All he did was fill out forms to Medicare and in 15 to 30 days he would have the money in his bank account. Even more alarming, he says that there are about 2,000 to 3,000 more fake medical suppliers just in Miami billing Medicare fake claims. They are able to do this because Federal law puts Medicare in a position of having to ``pay and chase'' health care fraudsters. this is because federal law requires that Medicare pay providers promptly regardless of any risk of fraud, waste, or abuse. The prompt payment requirement in current law requires payment for a ``clean'' claim within 14 to 30 days. And that is not enough time for the limited number of Medicare auditors to determine if the claim is legitimate before the payment has to be made. The result is that this ``prompt payment rule'' requires that Medicare pay fraudsters first, and ask questions later. This requirement in current law doesn't make any sense. I am here today to introduce a bill to fix it. This legislation, the Fighting Medicare Payment Fraud Act of 2009 Act, would provide the government with an important new tool to fight fraud, waste and abuse in Medicare. This bill will stop the cycle of ``paying and chasing.'' This legislation would protect Federal taxpayer dollars from being wasted on suspicious payments that are required to be made because of the prompt payment rule. Today, the prompt payment rule applies to all payments regardless of the risk that those payments would be to fly-by-night operators. But this legislation ends the policy of pay first and ask questions later. This legislation gives the Secretary of Health and Human Services the authority to ask questions first and then and ONLY then to make the payment if the health care provider and the payment for services check out. This bill accomplishes that by extending the time period in which payments must be made under the prompt payment rule in cases where the Secretary determines there is a likelihood of fraud, waste or abuse. For categories of providers or suppliers, the payment time period can be extended to up to one year. For individual providers or suppliers, the Secretary would be required to take whatever time is necessary to engage in more in-depth reviews to determine that the claims are supposed to be paid in the first place. With this additional time, the Secretary would be required to conduct more detailed reviews of suspicious claims to make sure they are supposed to be paid. This would help ensure that Medicare dollars are in fact going to bona fide providers, instead of fraudsters with empty strip mall medical supply companies. Finally, this legislation requires the experts in the Office of Inspector General to recommend, on at least an annual basis, categories of providers or suppliers that warrant additional time before payments are made under the prompt payment rule. To make sure there is action on these recommendations, the Secretary would be required to provide a response to the Inspector General on these recommendations. With this new authority to fight health care fraud, the Federal Government will be in a better position to protect taxpayer dollars and catch health care crooks. Crooks are taking advantage of Medicare's prompt payment requirement. They know they can bill Medicare, get their payment, and be gone before they get caught. And Federal law enables it to happen. That has got to end. This legislation takes that step.

Mr. GRASSLEY

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

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

Mr. GRASSLEY. Mr. President, last week, we learned that the Nation's unemployment rate has risen to 10.2 percent. That is 1 out of every 10 working Americans being out of a job. But the real number is even higher than that. It is really closer to 1 in 6 workers. When you add in people who are underemployed or have stopped looking for work, the unemployment number is almost 17 percent. According to a weekend article in the New York Times, that is the highest this country has seen in unemployment since 1982. The Times also noted: ``If statistics went back so far, the measure would almost certainly be at its highest level since the Great Depression''--the Great Depression 80 years ago. After all the bailouts and a $1 trillion stimulus bill, there are still 16 million of our constituents who want to work but are unemployed. In fact, despite the White House's fuzzy math, the real statistics show that the unemployment rate has more than doubled since the President signed the stimulus bill in February. And, you remember, that bill was supposed to be passed very quickly so the unemployment rate would not exceed 8 percent, and here we are today at 10.2 percent the way it is officially reported, but taking all the other people into consideration, 17 percent. So people kind of wonder why there is some question about all the debt we are piling on our future generations through the national debt. Particularly, it is a legitimate question when people were told the stimulus bill had to be passed ``right now'' or unemployment, then under 8 percent, might exceed 8 percent. So there are a lot of questions out there, and some of it carries over into the health care reform issues before Congress right now because it is kind of like people were not really concerned about health care legislation in the Congress of the United States even costing $1 trillion or more until they found out all these other trillions of dollars that were being spent to get us out of a recession were not working. Then it is kind of like the health care reform was kind of the straw that broke the camel's back to cause people to lose confidence in Congress using its own good judgment to solve this problem of the recession. So we have 10.2 percent unemployment officially, more otherwise. That equates to about 7 million lost jobs since the stimulus bill was passed, and despite the stimulus bill's failings, the White House is pinning its hopes on yet another trillion-dollar effort. Now they are using their ``back of the envelope'' calculations to say health care reform is going to save the economy. This picked up about 6 months ago, back in March, when the White House chose to focus on health care reform rather than the economic crisis. I would like to quote President Obama: Healthcare reform . . . is a fiscal imperative. If we want to create jobs and rebuild our economy, then we must address the crushing cost of healthcare this year, in this administration. That is a quote from President Obama. I want to say, to some extent I agree with him. It is true health care costs are rising at twice the rate of inflation, straining family budgets, and making it difficult for American businesses to remain competitive. Congress should absolutely enact legislation that addresses these issues. But, unfortunately, the pending health care reform proposals in the House and Senate not only ignore the primary issue of cost, they also put in place policies that are going to cause more Americans to lose their jobs and further damage our struggling economy. So now to the main point of my coming to the floor to discuss this issue: Whether it is the $500 billion in tax increases or the growing list of Federal mandates in these pending health care reform bills, the pending bills will take our economy in the wrong direction, contrary to what the President said in that speech several months ago when he said that if you want to fix the economy, you have to do something about health care reform. Maybe if the President had proposed his own bill, maybe he would have proposed something that did it, but what we see evolving in the Congress of the United States is not going to solve that problem. Back in March, again, when the President turned his attention to health care reform, the head of his Council of Economic Advisers, Christina Romer, said--and I have a chart that has the quote: We know that small businesses are the engine of growth in the economy, and we absolutely want to do things to help them. Well, I am not sure how the White House defines the word ``help,'' when it comes to getting small businesses back on track and turning the economy around, but I do know President Obama came up to Capitol Hill this past weekend to pressure House Members to vote for a bill that will have a devastating impact on small business in America. If this is what the administration means when they want to ``help'' small businesses, the old phrase, ``With friends like these, who needs enemies'' comes to mind. The President and Democratic leadership twisted arms and bought support for a bill that the National Federation of Independent Businesses--and that organization tends to be the voice of America's small businesspeople--actively opposed. After the bill passed, the National Federation of Independent Businesses released the following statement about the administration and Congress's efforts to help small business. This is a long quote, so let me read it, but we also have it on a chart here: Small business owners are outraged. Let me start over again. This is from the National Federation of Independent Businesses' comments on what happened in the House of Representatives: Small business owners are outraged. This bill will actually make things worse, not better. With unemployment at a 26-year high, the punitive employer mandates and atrocious new taxes will force small business owners to eliminate jobs and freeze expansion plans at a time when our Nation's economy needs small business to thrive. It doesn't sound like the National Federation of Independent Businesses and the thousands of members they have throughout the United States appreciate the administration's efforts to help. With the marginal tax rate on some small businesses, especially those likely to expand, rising by 33 percent under the House bill, it is no wonder. Here we have a chart that says this. The green, present level of taxation; the red, how the President proposes to increase taxes to 39.6 percent in his budget; and then we have other things that are still in the President's budget that are kind of hidden. I will not go into what PEPs and Peases are, but they are a hidden additional tax rate that brings it up almost another 2 percentage points to 41 percent. Then we have the last big bar that has everything in the previous two, plus the 5.4-percent surtax that is in the House bill. It is these increased taxes on individuals--because a lot of small businesses file individually, they don't file corporate tax returns--that kills small business, the engine that creates 70 percent of the new jobs in America. So we have a situation with these potential tax increases, where any business looking to the capital markets will probably find sources of capital chilled by the 70-percent increase in marginal rates on capital gains that occurs under the House bill. We have this chart over here that shows when you add in the capital gains as well what happens. Because capital gains has a great deal to do with capital formation in America, and higher marginal tax rates tend to discourage that. Some Members might say the National Federation of Independent Businesses' statement was about the House bill, and it was, but bills we have before the Senate aren't much better. The HELP Committee bill has a similar pay-or-play mandate that will cost American jobs, as does the House bill. The Finance Committee bill is filled with tax increases that will directly affect small business owners and their employees, including families who make less than $250,000 a year, which would obviously be a violation of the President's campaign promise that he wasn't going to increase taxes for those earning under $250,000. So here we have another chart: Health care reform raises taxes on families with more than $75,000 in income. That is because $75,000 is below $250,000, so the President violates his campaign promise. Further analysis by the Congressional Budget Office has shown that small businesses could also face significantly higher health insurance premiums as a result of the new insurance market reforms. We have the consulting firm of Oliver Wyman concluding that the insurance reforms could raise premiums by as much as 20 percent. As more American businesses, big and small, face higher premiums and more taxes, workers will end up suffering. The Congressional Budget Office has concluded that pending Senate legislation could force about 3 million people out of their employer- based coverage, and that doesn't even include the potential impact of a new entitlement program, a government-run program we call the public option. All of this doesn't sound like it is helping small businesses or letting people keep what they have, which was another Presidential promise. The bills also make our unemployment situation worse. We are talking about another $1 trillion in spending--$1 trillion we can't afford--that will end up costing Americans jobs. I wish to quote from a recent article jointly published by Health Affairs and the Robert Wood Johnson Foundation. We have that quote right here. I am going to quote a small part of that article: Small, lower-wage firms could be among the most affected-- Meaning most affected by the pay-or-play mandate. Firms might respond by firing or declining to hire workers. Several studies projected the loss of anywhere from 224,000 to 750,000 jobs. That analysis doesn't even take into account the impact of the tax increases and the new Federal mandates. The people who don't lose their jobs, of course, face lower wages because it doesn't matter whether you are an economist to the far right or an economist to the far left, there is agreement that as health insurance costs increase, wages go down. As all the new Federal mandates and the regulatory requirements drive up premiums, businesses will be forced to respond by lowering wages. All of this doesn't sound like a recipe for getting the economy back on track. I wish to review what the pending bills mean for the average worker and our struggling economy: higher unemployment, more than 750,000 jobs lost; increased health insurance premiums, maybe by as much as 70 percent; lower wages, less money in your paycheck; $500 billion in higher taxes for individuals and businesses; more government spending and higher deficits. The administration and the Democratic leadership can make all the promises they want, but facts are the facts. Congress needs to address health care. We need to bring down costs, improve quality, and create a more competitive market for insurance, but we should do it in a way that makes our economy stronger. Unfortunately, the health care reform bills we have seen so far are bad for the economy and particularly bad for an American worker and particularly bad at a time when there is, at least officially, 10.2 percent of people unemployed and, if you take other factors into consideration as I have already spoken about, maybe around 17 percent unemployed. As the New York Times said, maybe the highest rate of unemployment going back to the Great Depression. This is bad. So I can only end by saying, as we look to the debate on health care reform and the analyses of these bills that are done by economists, done by advocates for small business, and the impact it is going to make on the economy, I think we ought to take a second look and not make this situation of the economy worse through a bill that ought to be helping the economy. Everybody agrees we may have the best medical care in the world. We don't have a perfect system, and that system needs to be changed, but in the process of doing it, we have to make sure we do not make a bad situation worse for our economy. Thank you. I yield the floor and suggest the absence of a quorum.

Mr. GRASSLEY

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

Mr. GRASSLEY. I ask unanimous consent to speak in morning business for 5 minutes.

Mr. GRASSLEY. Mr. President, I am here to discuss a very important matter that I had intended to bring up in the Judiciary Committee last week but the agenda did not allow it. It is about the oversight of the Department of Justice and the responses provided by Attorney General Holder to questions from the Judiciary Committee. Two weeks ago, Chairman Leahy--and I thank him for participating--and I sent a letter to the Attorney General asking him to stand by his statements made during his confirmation and answer a number of outstanding requests for information. That list includes questions submitted by members of the Judiciary Committee to an FBI oversight hearing over 1\1/2\ years ago. We all agreed no committee should have to wait that long to get answers to oversight questions. Last Friday, the Judiciary Committee received answers from the Attorney General following his June 17, 2009, testimony. I hoped he would uphold his commitment he made during his confirmation hearing to ``fully and in a timely fashion'' answer Judiciary Committee inquiries. The questions I submitted to Attorney General Holder addressed a number of important issues, including a series of 24 questions related to the Department's involvement with the termination of Inspector General Walpin at the Corporation for National and Community Service. The answers I received were totally inadequate. Instead of answering the 24 questions, the Department responded with a five-paragraph recitation of publicly available facts and information. The Department also said it would respond under separate cover to the document requests. I appreciate the Department's comments that it intends to respond to my requests, but I am very concerned this is more of the same problem Chairman Leahy and I were trying to get at with our letter 2 weeks ago. My questions were more than just requests for documents and asking for a recitation of public facts. They were serious inquiries about the role the acting U.S. attorney played in the termination of that inspector general. I requested specific answers to questions that have arisen in my investigation. For example, I asked about communications between the U.S. attorney and the Office of Professional Responsibility and whether the referral by the U.S. attorney complied with the ethical requirements outlined in the U.S. Attorneys' manual for misconduct by non-Department of Justice attorneys and judges. While this is only one example of the questions I asked, none of the questions were specifically answered. While the Department did say it was going to provide the documents I requested under separate cover, the response seems to indicate that all my questions were answered. They were not answered. I intend to get these answers. This is a prime example of what is wrong with the inadequate responses to all our questions. They avoid the question and filibuster with public facts. I have previously stated that unless the Department of Justice starts answering our questions completely and in a timely manner, I will start holding up nominees. I have done nothing but patiently work in good faith with the chairman and the Department to get answers. Yet despite these threats, it is business as usual. This culture of not answering questions timely, in an evasive manner, and punting document requests to future separate cover letters is unacceptable. We have a constitutional duty to oversee the bureaucracy, and the executive branch is thumbing its nose at the Congress. I know Chairman Leahy agrees oversight is an important part of what the Judiciary Committee does. I hope he will continue to work with all members to get answers from the Attorney General. He has surely helped me. I am tired of wasting time having to raise these concerns publicly, but shaming the Department seems to be the only way they will respond, and even that doesn't work all the time. This administration rode into town on a campaign of accountability and transparency. Attorney General Holder told all of us he respected congressional oversight. Yet in his first set of oversight questions submitted by the committee, he gave us the same nonresponse we have seen from the Department. That is not the accountability or transparency the American taxpayers deserve. This is yet another public warning to the Department. It is time to start responding fully to our requests in a timely manner or face the consequences. I hope the Attorney General and his staff will hear this and provide complete answers to our questions prior to his scheduled appearance in the Judiciary Committee later this month. I see my colleague, Senator Kyl. I think he has interest in this oversight matter as well. I yield the floor.

Mr. GRASSLEY. Mr. President, two things. I thank the Senator from South Dakota for giving us this opportunity to make this point. I hope the Attorney General will respond to our questions. We are just doing our constitutional job of oversight, checks and balances of our system of government. I yield the floor.