Jon Kyl

Mr. KYL

Mr. KYL. Mr. President, I believe my colleague, Senator Thune from South Dakota, will be here in a few minutes. Until he arrives, I thought this might be of interest. I promised my constituents I would tell my colleagues what they told me to tell them. I think it would be of interest to share some of these remarks. I went to a meeting on Saturday morning that I thought was going to be a rather staid affair with folks who were primarily senior citizens, but not all of them were. It turned out to be a little bit reminiscent of some of those townhall meetings we saw on television during August because the subject most people wanted to talk about was health care. They weren't happy with what they were hearing the Senate was about to do. Among other things, they wanted to get it clear with me right off that I would pass on their concerns about this to my colleagues. I promised that I would. So let me summarize what some of them had to say and what I think the clear consensus of the group was. First of all, they have a hard time understanding how Senators would pass a bill before we read it or even know how much it costs. I assured them that the procedure we would follow in the Senate was that we would have at least 72 hours after the bill had been finally written and after the Congressional Budget Office had scored the bill--that is to say, told us how much it would cost in all of its component parts and the ways it would be paid for. The reason I can feel fairly certain that will happen is because a number of colleagues on both sides of the aisle have either written to the majority leader or made it clear to him that they will not support a motion to proceed to a bill until we have had an opportunity to, in effect, read it and see how much it costs. That process could take some time, I told my friends. The Congressional Budget Office Director told the members of the Finance Committee, on which I sit, that it can take 2 to 3 weeks after the bill is written to come up with all of these calculations. You will hear many people say we need to move this process on, even before we have the numbers. But I think that given the fact that most of us are committed to ensuring we have the numbers and can digest them and share them with our constituents before we debate and amend the bill, I assume the process will unfold in the Senate in such a way that we do know what it costs, and that means after the final CBO report is provided to us. The next thing they wanted me to convey was that they were very worried about--in fact, maybe that would be a euphemism. They were more than concerned about the degree of government involvement in health care once this process is over. They fail to understand why we had to have what amounts to a government takeover of insurance in this country and dictating everything from what kind of insurance policy you have to have, to how doctors and hospitals are paid, in order to solve the two key problems that exist: No. 1, there are some Americans who need help buying insurance; second, that the costs of health care premiums continue to go up every year, and it is especially hard for small businesses to provide coverage for employees. They asked me: Why do we have to change the entire system, with the government essentially taking it over? I happen to believe we don't. I provided the two basic alternatives to them. One is a step-by-step approach that targets specific problems we have and matches up specific solutions to the problems, on the one hand, which is the approach I favor; on the other hand, essentially changing the insurance we all have today, creating a new insurance exchange, and all insurance would have to go through there. Even if you like your policy, it will change, and you are not going to be able to keep it. Estimates are that, as a result of all of this, in an effort to cover 18 or 20 million more people with insurance, it is going to cost us close to a trillion dollars. It will raise taxes, it will raise insurance premiums, and it will require deep cuts in Medicare. They didn't like that. I guess that brings up the third thing. With regard to Medicare, they were pretty perceptive in asking me the following basic question. One person said: One of two things is going to happen. Either it will be business as usual where we say we will make cuts in Medicare, but the Senate and the House never have the courage to do that, in which case this bill is going to cost a lot of money that is not offset by concomitant savings, or the savings are going to be made, and when they are made, it is going to deeply cut our benefits under Medicare. That person was right. One of those two things is true, and neither one is a good result. I remember a few years ago when we tried to reduce the growth in Medicare by about $10 billion. Republicans and President Bush were excoriated; we were going to ruin Medicare, and our colleagues on the Democratic side took great glee in the public reaction to that proposal to decrease the growth in Medicare by $10 billion. Now we are talking about cutting Medicare by--I said $500 billion. The Finance Committee money is actually $450 billion. So let's be accurate. If that is the way this bill comes out, $450 billion, $120 billion of that is reduction of benefits under Medicare Advantage. So when people say: You would not have your benefits cut, that first $120 billion is a direct cut in benefits, and in my State a lot of seniors have Medicare Advantage policies. The other way in which Medicare is cut--there are basically two things. One is reducing the amount of money we pay doctors and hospitals, and that cannot help but reduce the care we get. The final mechanism is a Medicare Commission is being established to provide--I think it is every year; maybe every 2 years, but let's say every year-- an amount of money that will have to be cut and will automatically be cut from Medicare unless the Congress finds a different way to do it, but Congress would still have to cut the same amount. So we either do it the way we want to do it or we do it the way the commission recommends it. In any event, their recommendation automatically goes into effect if Congress does not act. I have a couple thoughts about that point. We have never been able to effect these cuts in the past because seniors know that it cuts deeply into their care, and they have told us and we have reacted by saying: OK, we will not do it. We could react that way again, in which case all of the savings, or at least a great deal of the savings, that were supposed to result and offset the costs of the bill would not be there. So now the bill is no longer deficit neutral. Now it is not balanced. Now it does add to the deficit and to the debt. If we do allow those cuts to go into effect, seniors are clobbered by deep reductions in the care they receive all the way from nursing homes to physicians to hospitals to hospice, medical devices--you name it. As I said, neither of these results is a good result. There were several people who wanted me to convey their thoughts in that regard. I happen to agree with them, so I could do that. I met, after visiting with this group, with a group of spinal surgeons from all over the country and, in fact, from outside this country. I saw the agenda of their meeting. I was the last speaker. For a layman, such as you and I, Mr. President, it was daunting to read through that agenda--all of the latest techniques in using new laser and stints and all kinds of things that I did not understand, but it was the very latest technology and techniques for treating spinal diseases and conditions. What they told me was--I was the last person to make a presentation-- all of these great things we are doing for our patients we are not going to be able to do under this legislation, first of all, because it will be presumed to cost too much; second, because it will take the FDA and the other government agencies way too long to authorize its use for treating Medicare patients, for example; and, third, because the comparative effectiveness research which has in the past been used by these doctors to help them appreciate the best way, clinically, to treat someone is now going to be used to decide what Medicare can afford to pay. A lot of the more leading-edge techniques and technologies are not going to be approved for that purpose. Their point was that people in China and Europe are going to be treated with the latest techniques more than Americans will because the American system of health care is going to deny people such as these experts the ability to do what they do. One way this is being accomplished is by taking money away from specialists and giving it to general practitioners. There is a rationale for paying general practitioners--family doctors--more money. They are not making enough, and they are the first place most of us enter the medical world. If we have something that does not feel right, we go to our doctor. It is usually a family doctor. Frequently, he can help us, but frequently he says: I think there is something about what you have here that tells me I have to send you to a specialist. We go to the specialist then and he orders some specialized tests and he examines them and he may end up having to provide some kind of very specialized treatment and care that is probably going to cost more money. While the family doctor needs to be paid more, we don't solve that problem by taking money away from the specialists. If we have to add money to the system to ensure that we have enough doctors who can provide quality care, then there is no free lunch and we have to pay for what we get. We should not make it a zero-sum game and take it from Dr. B in order to pay Dr. A. That was another strong message of these specialists. I also happened to meet on Friday afternoon with a group of physicians in Phoenix from all different practices--from specialists to generalists, hospital physicians to others. To a person, they had this question for me. The way they asked it was, Why isn't anybody talking about medical malpractice reform? I said: I am talking about medical malpractice reform. They said: You are not getting through. I said: The problem is there are a bunch of folks on the other side of the aisle who don't want medical malpractice reform, and you know why. And, yes, they understood the answer why. I remind friends who might not have remembered, Howard Dean, a former Governor of Vermont and a former Democratic candidate for President and a former Democratic Party chairman was very candid in a townhall meeting in Northern Virginia on August 17 with Representative Moran where he told the group assembled there that the reason medical malpractice reform was not in the legislation is because they did not want to take on the trial lawyers. That is true, but it does not make it right. Maybe somebody should take on the trial lawyers because there are a lot of estimates of how much money could be saved through meaningful medical malpractice reform. This jackpot justice system of ours that pays trial lawyers and requires physicians to pay as much as $200,000 a year in liability insurance premiums--all of which, of course, have to be passed on to the cost of our care, and perhaps even worse than that, practice what is called defensive medicine--raises the cost of our health care. Defensive medicine is having all kinds of tests performed and maybe putting someone in the hospital an extra day or two all in order to protect from a liability claim that their doctor did not do everything he could to take care of this poor patient and, as a result, the patient got sicker and something bad happened. There are a lot of estimates. First, one estimate is from a study that says 10 cents on every dollar spent on health care is paid in insurance premiums by physicians. Obviously, some of that will still have to be paid with medical malpractice reform, but it could be reduced as has been the experience in the State of Arizona and the State of Texas, which is the reason Senator Cornyn from Texas and I have introduced legislation that will provide modest reforms to the tort system by putting some modest caps on noneconomic damages awards and providing that expert witnesses who testify have to be really expert witnesses in the area of the alleged malpractice. These two things have saved enormous amounts of money. In Arizona, we don't even have caps on damages, but the Requirement that expert witnesses really be expert has ended up saving millions of dollars and reducing the malpractice premiums for physicians in the State of Arizona. This is a reform we could accomplish on a bipartisan basis that not only would not cost anything, it would actually reap financial benefits. The Congressional Budget Office says just the savings to the U.S. Government--because we provide care under Medicaid, Medicare, and to our veterans--would save $54 billion. There are a lot of estimates that are higher than that. There is one estimate that is over $100 billion a year. The Director of CBO acknowledged to people of the Finance Committee when we asked that $54 billion savings would actually be approximately doubled if we take into account the private sector as well. In other words, not only the Federal Government would save that much money, which pays about half of all health care dollars in the United States, the private sector, which pays the other half, could save a like amount of money. These constituents wanted to know why doesn't anybody ever talk about it. I had to tell them we are talking about it. It is just that nobody is listening. That kind of brings up the last point I want to pass on. After meeting with these three different groups in Phoenix and talking with people elsewhere I went over the weekend, it is pretty clear to me people are becoming very frustrated with their government, and this is not good. They don't think their government is listening to them. We are elected to be their representatives, to bring their ideas to Washington. Since they can't all study up on the issues as thoroughly as we are supposed to do, they trust us to not just to do what they want, not what they say, but to use our best judgment. But they do want us to listen to what they are saying and translate that into action. What I hear them saying and what public opinion polls verify is they are very worried about the breadth and the depth of this proposed health care reform. They say it costs too much money; it is going to get us in debt; it will raise taxes which are going to be passed through to them; it is going to raise insurance premiums; and it is going to involve a massive government intrusion into what is primarily a private matter between them and their physician, with their insurance company added into the mix. They see this along the same lines as the government takeover of banks and insurance companies and car companies and everything else, and they don't like it. One of the reasons they don't like it is because they see their own health care being delayed or denied as a result. They appreciate the fact that if the government gets so involved that it can begin to tell insurance companies what they can pay for and tell doctors what they can do for patients, that the next thing that will happen is their care will be delayed and denied and ultimately rationed. I read a chapter in a book by our former colleague, former majority leader of the Senate, Dr. Bill Frist, a renowned heart surgeon. I talked with former Senator Frist about it last week. He actually served for about a year in England under their health system. He makes the point in his book that there are some good things about their health system. He said the bad thing is that if someone has a serious condition, unless they are at the top of the list, they run the risk of never having their serious condition dealt with. He gave an example of a list of 100 patients who needed heart surgery. He said they would do two a day and gradually work down the list. He said what he found was that after a few weeks, peoples' names were being taken off the list. They didn't need the surgery anymore because they had died. He said that would never happen in America. He said if we have 100 people who need heart surgery in America, we would figure out a way to get that heart surgery for them right away, and we wouldn't do two a day until we ran out of time and they ran out of life. He said that is really the difference in a system in which we are controlled by the amount of money the government chooses to put into the system every day versus the kind of system we have that takes care of people and worries about the cost later. That is why it is possible for us to say that even people without insurance get cared for. No one in this country should die because they don't have insurance because we will take care of them. Obviously, having insurance makes the delivery of care easier, more timely, and much more cost-effective, which is why at the end of the day we want to see that everybody is insured. The bottom line is that we do not need to throw out the baby with the bathwater, get rid of the system we have that currently takes care of most people very well in order to insure that last group of folks who don't have insurance. We can provide a voucher or subsidy to them and get them coverage. The other thing we have to do is help to bring down the costs. Republicans have offered numerous solutions on how to do that without having the government take over the system. I mentioned one: Medical malpractice reform. It does not cost a dime, it will save billions of dollars, and it is good policy besides. So why don't we do it? Because there is a vested special interest that does not want it done. It will take money out of their pockets. That is wrong. My question to all of my colleagues is, When are we going to stand up to the special interests? Everybody likes to whack at the insurance companies. How about taking a good hard look at the trial lawyers? And, by the way, while we are talking about insurance companies, Republicans offered several ideas on how to add more competition for the insurance companies so in those situations where they have it good, if we provide for certain reforms that we have offered, such as association health plans, small business plans, more flexible HSAs, interstate sales of insurance, all these things would provide more competition for the insurance companies and force them to lower their rates. This would make health care more affordable because it would help small businesses in providing health care for their employees. All these things came up during these meetings. As I said, I promised my constituents I would be sure to pass their ideas on to my colleagues, and I make these comments in that spirit, hoping that we will listen to our constituents not just in Arizona but in South Dakota and everywhere else around the country. And as a result of listening to a bunch of pretty commonsense folks, perhaps we will make wiser decisions here than we otherwise would have. I see my colleague from South Dakota is here. He had some very erudite comments to make on one of the television shows on Sunday, and I am happy to yield the floor for Senator Thune.

Mr. KYL

Mr. KYL. Mr. President, in the coming weeks, the Senate will consider S. 908, the Iran Refined Petroleum Sanctions Act. Passing this bill should not be difficult 76 Members of this body are registered as cosponsors--but it is vital that we do. I support strong sanctions to build pressure on Iran to end its illegal nuclear weapons program, which, in light of the recent disclosure of the Qom uranium enrichment facility, may be far more advanced than we realize. However, China and Russia continue to thwart meaningful action in the United Nations Security Council. As Bob Robb, a columnist for the Arizona Republic notes, both nations have commercial ties to the Iranian regime and are unlikely to abandon their interests and assist the United States in building pressure on the Iran. Mr. Robb also emphasizes that U.S. efforts to halt Iran's nuclear program have taken on a new urgency after the President cancelled the deployments of the ground-based interceptors to Poland and the Czech Republic. Had the President managed to get support from Russia for more sanctions on Iran in exchange for sacrificing missile defense, things might look different. However, as shown by Secretary Clinton's recent visit to Moscow, Russia's position has not changed, and the U.S. has nothing to show for breaking its strategic commitments with two important allies. Time is not on the administration's side. Every day the Iranians stockpile more uranium and get closer to having long-range missiles capable of delivering the world's most dangerous weapons against our allies, our deployed forces, and our homeland. The time to act is now. Mr. President, I ask unanimous consent that the op-ed by Mr. Robb be printed in the Record.

Mr. KYL

Mr. KYL. Madam President, I wish to take 10 minutes this morning to respond to some comments made by my friend from Illinois, my counterpart, the Democratic whip, comments made in response to Minority Leader McConnell's remarks earlier this week. Yesterday, Senator Durbin made a couple of points. One I specifically want to focus on has to do with the national debt. Senator McConnell had talked about the fact that spending by the Democrats, especially with regard to proposals for new health care legislation, was going to increase the national debt. The Senator from Illinois came back and said he agreed the debt is too high, but he said we need to understand that the reason it is too high is the Bush administration--that, in effect, President Obama inherited the debt. That is not exactly accurate. Here are the actual facts regarding the debt today. On Tuesday, 2 days ago, the Treasury Department reported that the deficit this past fiscal year totaled $1.4 trillion. That is a figure higher than the previous 4 years combined. The previous 4 years were Bush years. Last year was primarily the Obama administration. The Republican leader said: Since January 20 of this year, the Federal Government has borrowed $1.2 trillion or more than $10,500 for every household in the United States. What is the significance of January 20? That is the day President Obama was sworn in as President. Under the President's budget that every Democrat voted for this year, we will have budget shortfalls or deficits averaging $1 trillion each year for the next 10 years. We can't blame this on the Bush administration if spending was as much as the last 4 years combined and the budget shortfall is going to be $1 trillion for the next 10 years. It was never $1 trillion. It wasn't even half that much ever under President Bush. Let me put this in perspective. The President's budget, supported by every Democrat, will double the national debt in 5 years, increasing it from $5.8 trillion to $11.7 trillion. It would almost triple the debt in 10 years. These are estimates from the Congressional Budget Office. By contrast, look at the last 219 years in the history of the country. From 1789 to 2008, Americans amassed a $5.8 trillion national debt. In other words, in 5 years, this President will have a debt equal to all of the previous Presidents from George Washington all the way through George W. Bush. We cannot claim that is inherited from the past. This President's deficit spending is not sustainable. By the end of the budget period, the debt will have skyrocketed to 82 percent of the gross domestic product, which everyone agrees, including the President's advisers, is not sustainable. Think about the interest payments. Think about your own credit card interest payments for interest payments on debt. These will soon be the single largest item in the Federal budget. What if debt interest payments were the single largest item in your own family budget? More than $800 billion a year in 10 years will be spent on interest alone--$800 billion a year. That eclipses what we spend on national security. It is four times as much as we spend on education, energy, and transportation combined. These are not abstract numbers. This will have an effect on every American. In 2019, under the President's plan, each U.S. household's share of the Federal debt will be more than $130,000. That is more than most of us owe on our mortgages. Notably, since the Democrats have taken over the Congress--we are not talking about ``inherited'' now--the Congress has increased the debt limit four times, and the administration has made a request for a fifth increase that we anticipate occurring this November. So should we be worried about the debt? I believe so. Was it a problem inherited from the Bush administration? No. The real problem is what we have done since January 20, since President Obama came into office, since Democrats have been in control of the Congress and the adoption of a budget which is going to triple our debt in just 10 years. And in 5 years we will have more debt than every single President and Congress in the entire history of the country right up through George W. Bush accumulated--in one budget of this administration. The other thing I would like to speak to is comments the Senator from Illinois made on Tuesday. Again, he was critical of Senator McConnell, who noted that all of these bills passed in the House and in the Senate were passed on essentially partisan votes, and that Republican ideas had been ignored. My colleague said: Well, in the HELP Committee there were 150 amendments adopted that had been offered by Republicans. The vast majority of those were purely technical corrections, misspellings, typos, and things of that sort. I do not think anybody can contend that Republicans have had a fair voice in the creation of the health reform legislation around here. Then there was an attack on the messengers. There have been several reports that demonstrate that insurance premiums are going to go up, not down, in this legislation. The attack was not to contend that the figures were wrong but, rather, to attack the messengers--in two cases--to say: Well, the insurance industry actually paid for some of those reports. Does that make the reports wrong? It might raise a question in our minds as to whether they are appropriate, but how about analyzing them to see whether they are wrong. The majority whip then went on to say that the Congressional Budget Office even disagrees with the Republican leader and predicted that the health care premiums would actually not go up. Specifically, he said: ``They predicted if health care reform went through, health care insurance premiums would go up'' on American families. The Senator from Illinois said: Well, there are those who disagree, people with the Congressional Budget Office and others. . . . Let me quote the Congressional Budget Office. It does not disagree. The Congressional Budget Office specifically supports what Senator McConnell said: Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market. CBO was very clear in conversations we have had with them that specifically with regard to American families premiums will be higher. So the Senator from Kentucky, the Republican leader, was correct and the Democratic whip was incorrect. CBO says premiums will be higher. This report issued yesterday from Oliver Wyman said premiums will increase in the individual market approximately $1,500 for single coverage and $3,300 for family coverage every year. In my State and some other States it is even worse. For Arizona, Idaho, Kentucky, Virginia, and the District of Columbia, we will have the highest premium increases, where premiums could increase by as much as $2,619 for individuals and--think about this--$7,426 for families. Think about that as a premium increase under a bill that is supposed to help us afford our health care, but we get socked with a $7,000 increase in the health care premium for our families. Part of this is because of the minimum benefit requirements the bill provides for. They note this will increase costs about 10 percent in the individual market and 3 percent in the small group market. This is under the Baucus bill. Small employers purchasing new policies in this new market will experience premiums that are up to 19 percent higher in year 5 of the reform. Premiums are going up. Milliman, another independent actuarial firm, found that the average actuarial value of a high deductible plan is 48 percent. In Arizona, incidentally, it is 61 percent. What does this mean? Under the legislation, the lowest insurance plan value is defined by the Federal Government. It has to be 65 percent. That means there will be an increase in health insurance premiums by 35 percent for those with high deductible plans. Individuals enrolled in individual health plans with a lower actuarial value than 65 percent will see their premiums increase by 18 percent. So to the allegation that somehow Republicans are wrong when we criticize the Baucus bill for raising individual and family insurance premiums, the reality is, all the experts agree, including the Congressional Budget Office. Then there was another question that had to do with medical devices. The reality is, because of taxes imposed in the Baucus bill, there are going to be a lot of increased expenses, including expenses that are going to be passed on to individuals. One of those is in the medical device industry. Let me quote a letter that some Democratic colleagues of ours-- Senators Klobuchar, Bayh, and Franken and then Senator Lugar on the Republican side sent to Chairman Baucus. I am quoting from it: [T]he provision would harm economic development and health care innovation nationwide. [W]e are concerned that this tax will stifle technological innovations that can improve patient outcomes and lower health care costs. It is also a fact, as I said, that these expenses are passed through. There are several studies that demonstrate that--as well as the comments of the Congressional Budget Office and the Joint Tax Committee--all of whom say it is virtually a dollar-for-dollar passthrough. So if we raise taxes on the medical device industry by $40 billion, then people are going to be paying $40 billion more in insurance premiums because the cost of those medical devices will be reflected in the cost to the insurer and, therefore, the cost to the people who are paying the premiums. There was a concern expressed by my colleague from Illinois that insurance companies will raise their premiums--the point I have been making--but they will do it in a collusive fashion and maybe we should look at the antitrust laws in that regard. Well, they do not have to collude to raise their premiums. Every one of them has an incentive--as the Congressional Budget Office and these other reports demonstrate--for them to be able to stay in business; they have to be able to raise their premiums to reflect their cost of doing business. They do not have to collude to do that. Then the Democratic whip made what I would say is a rather odd argument: Republicans have been critical of the concept of government- run insurance. The Democratic whip said: Well, we have government-run insurance--Federal employees and Members of Congress--and we think it is a good program. And he said under the program, there are nine different health plans to choose from, and we pick the best one for us, and the employer pays part of it and we pay part of it, and so on. That certainly is all true, except for one thing: It is not government run. As he noted, there are nine private plans. This is no different than any other employer. Most large employers, such as the Federal Government, give their employees a choice of two, three, four, maybe sometimes as many as nine or ten plans if they are a big enough employer. The Federal Government is a huge employer, so we can offer nine different plans. But there is no Federal insurance. This is not federally run. This is the Federal Government as the employer doing the same thing that Honeywell as an employer would do for its employees. It gets three or four insurance companies with different kinds of plans and says to its employees: We will pay for part of the cost. You get to pay for the rest of it. That is not federally run or government-run insurance. So the Democratic whip is simply wrong when he says the plan Members of Congress and Federal employees have is government run. That is simply not true. I mentioned the medical device issue. I would note Senator Kerry is another one of our colleagues who, like me and like others, has expressed concerns about this issue because of the fact that the taxes paid by the medical device industry will, in fact, be passed on to consumers. Finally, the Democratic whip asked where the Republican health care plan is. I do not know how many times we have to repeat this, but let me do it one more time. Time and time again, we have said: Here are things we believe will reduce the cost of health care, will help people get coverage who do not have it now, and will reform the system. What are some of the ideas we have proposed? By the way, each of these were offered as amendments in the HELP Committee and in the Finance Committee and in the House of Representatives, and Democrats voted against every one of them every time. So it is not as if we do not have ideas and alternatives that would solve specific problems, it is that the Democrats do not like the ideas and, therefore, have rejected them. But I will repeat a couple of them one more time. Republicans lead with medical malpractice reform, to try to do something about this jackpot justice system where lawyers end up getting most of the money, and doctors and hospitals have to practice defensive medicine to anticipate litigation and to be able to protect themselves against it. There are estimates: as much as 10 cent out of every health care dollar spent is on premiums that doctors have to pay for their liability insurance. There is over $100 billion a year that can be saved from defensive medicine practices if we are able to have medical malpractice reform. The CBO even scored it--in a very narrow way--at $54 billion just in savings to the Federal Government. As my colleague, Senator Ensign, pointed out in an exchange with the CBO Director in the Finance Committee, one could anticipate that about twice that much savings would occur if we add in all of the savings to the private sector as well. So we could be talking about well over $100 billion in savings. This is a huge amount of money. It does not cost the Federal Government a dime. It makes the system more fair, and it is a savings that can be passed on in the form of lower premiums and lower health care costs. Another idea we have talked about a lot--you have heard it--the sale of insurance across State lines. Let's make the insurance companies have to compete with each other. Sometimes they have little monopolies; there are only two or three companies in a particular State. Well, if we could buy our health insurance like we can buy our casualty insurance, our homes or our car insurance, from any company anywhere in the country, those insurance companies in our States would have to be better competitors. My guess is they would lower our rates and they would give us better benefits. That competition would help us. Again, it does not cost a dime. How about association health plans, letting small businesses and groups band together to create larger risk pools? Risk pools help define the coverage. If we have a big risk pool, chances are we can get cheaper coverage. If we have a small risk pool, it is hard. That is why small businesses find it so hard. So we talk about larger risk pools through association health plans. Madam President, I think I have exceeded my 10 minutes. We could go on and on with Republican ideas that have been proposed but get shot down by the Democrats. So it is not a matter of looking for a Republican proposal. Let me conclude with this: It is true that Republicans will probably not propose a massive trillion-dollar bill as the Democrats have. That is true. We are not going to because we do not do 1,000-page bills in the Congress very well. We do not know the consequences of them. The cost is always enormous. Republicans have a better approach. We believe we should do this step by step: First, regain the trust of the American people that we can do it right, and that we are listening to them about what they want rather than coming up with some grand scheme that a bunch of staffers and consultants in Washington, DC, came up with. Let's listen to the American people, hear what it is they want. They do not want a massive, big spending bill that is going to add to our deficit, that is going to raise their taxes and raise their insurance premiums, and, in the end, not insure very many more Americans. That is not reform. Madam President, I see my colleague from Tennessee is in the Chamber. He has been an eloquent spokesman on this issue, and I am pleased to yield the floor.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Mississippi (Mr. Cochran).

Mr. KYL

Mr. KYL. Mr. President, I was critical of the President's decisions when he canceled the so-called missile shield that would have been located in Poland and in the Czech Republic, among others things, because I was concerned about the message it sends to our allies in the region. After working with them to develop the political and public consensus for this missile shield, the United States essentially pulled the rug out from under these allies and left the consensus in Central and Eastern Europe that the United States, once again, proved to be an unreliable ally. Throughout the Baltic States, Central Europe and other people in the world couldn't fail to notice the same. I am thinking of countries in the Persian Gulf that have relied upon the presence of the United States but have, I think, wondered from time to time whether we are the ally they want to stick with because of the fact that sometimes we have proven to be unreliable. I am concerned about that same issue with respect to Pakistan and Afghanistan. Will our continued public debate over the recommendations that General McChrystal has made to the President result in both allies in the region as well as the leaders of Afghanistan and Pakistan concluding that they better make book with others in the area, including potentially the Taliban? Because after all, those people are going to continue to be in the area; the United States may not. This is where I think the debate about General McChrystal's recommendations about troop levels and other resources in Afghanistan become so very important. I think we need to listen to the advice of the commander in the field, General McChrystal, who produced a very straightforward assessment of the situation in Afghanistan. Obviously, the President is the Commander in Chief, and the decisions are his to make. It is appropriate for him to rely upon others for advice as well as on the commander in the field. But there is a point at which the President's own strategy, which he announced in March, needs to be adequately resourced and we need to move forward. Here is what the President said: The American people must understand that this is a downpayment on our own future. He was talking about the resources that would be needed in Afghanistan. So he selected General McChrystal to implement his strategy. We unanimously confirmed General McChrystal, and then the President asked him to give an assessment of what it was going to take. That assessment was provided in August. It has now been about 50 days since that assessment has been made public--since the President received it. Yet we still don't have a decision. My concern is that this continuing public debate is going to raise doubts around the world about the staying power of the United States; about our willingness to continue commitments we make. Remember, the President himself called this a war of necessity, both during the campaign and after his inauguration. He stressed the fact that we had to do what it took to win in Afghanistan. There are those around the world who are wondering whether we mean to resource this effort to the extent that General McChrystal has said is necessary. What did General McChrystal's assessment say? First, he speaks of what ISAF--that is the international force, including NATO forces--will require. ISAF requires an increase in the total coalition force capability and end strength. In other words, more troops. He warned of the risk of not providing adequate resources, and here is what he said: Failure to provide quality resources risks a longer conflict, greater casualties, higher overall costs, and ultimately, a critical loss of political support. Any of these risks, in turn, are likely to result in mission failure. Is that what we want--mission failure? If we don't quickly make a decision, support the President--if he makes the decision to adequately resource our effort there, then we are not only going to be losing, we are not only going to have mission failure, but we will send a message to everybody around the world that, once again, the United States can't be trusted. Here is what the General said about why it matters: Time matters; we must act now to reverse the negative trends and demonstrate progress. I believe the short-term fight will be decisive. Failure to gain the initiative and reverse insurgent momentum in the near-term--next 12 months-- while Afghan security capacity matures--risks an outcome where defeating the insurgency is no longer possible. Do we want to take the risk that we take so long in getting the additional troops there that success is no longer possible? I hope not. Finally, General McChrystal underscored the reason for his conclusions during a recent speech he gave in London, where he said: I believe that the loss of stability in Afghanistan brings a huge risk that transnational terrorists such as al-Qaida will operate from within Afghanistan again. Now we are having this big public debate. Some prominent Democrats have said we shouldn't resource this the way General McChrystal has announced, and this is why I think we are sending the wrong message. I understand there is some declining support for the war, but this is where Presidential and congressional leadership comes in. I remember, during the debate over the Iraq war, we had a lot of armchair generals and even a lot of pundits who thought they knew better. Well, General Petraeus, it turned out, was right. Thankfully, President Bush at the time followed his recommendations. As a result, the surge in Iraq was successful. General McChrystal and General Petraeus are essentially saying the same thing again. Remember, General McChrystal is an expert in both counterterrorism and counterinsurgency policy. He understands the difference and he understands it takes resources to fight a counterinsurgency campaign because you not only have to defeat an enemy but you have to continue to hold the area you have taken until the indigenous forces--in this case the Afghan police and army--are trained in sufficient numbers to hold the territory. You have to protect the populace. In a counterinsurgency strategy, the key is not killing the enemy, the key is protecting the populace. That is why it takes more troops. Let me read a couple other things the general said: My conclusions were informed through a rigorous multi- disciplinary assessment by a team of accomplished military personnel and civilians, and my personal experience and core beliefs. Central to my analysis is a belief that we must respect the complexities of the operational environment and design our strategic approach accordingly. This is a carefully thought-out strategic assessment with a lot of support. There is a recent article in the Weekly Standard magazine by Fred and Kim Kagan that does an excellent job of explaining why this advice is so wise. It focuses on the nature of the al-Qaida threat that emanates from Afghanistan and the network of support that is established there. Part of this is what has informed General McChrystal's assessment. The article says, and I quote: We should fight [the Taliban and Haqqani groups]-- Another terrorist-led group-- because in practice they are integrally connected with al Qaeda. Allowing the Taliban and the Haqqani networks to expand their areas of control and influence would offer new opportunities to al Qaeda that its leaders appear determined to seize. It would relieve the pressure on al Qaeda, giving its operative more scope to protect themselves while working to project power and influence around the world. In other words, against the United States. The Haqqani group he is referring to is another terrorist-led group. Secretary of State Clinton said it quite succinctly when she stated: If Afghanistan were taken over by the Taliban, I can't tell you how fast al-Qaida would be back in Afghanistan. That is the point. That is why I think we need to get on with our decision. I noted, with interest, a column by E.J. Dionne in the Washington Post entitled ``No Rush to Escalate.'' He quotes in his column historian Robert Dallek, who recently advised President Obama: ``In my judgment,'' he recalls saying, ``war kills off great reform movements.'' Then he goes on to talk about how World War I brought the Progressive Era to a close; that Franklin Roosevelt would have done better if not for World War II; that Vietnam hurt Lyndon Johnson's Great Society. He says: It may just be that some of the President's senior advisers and supporters may be urging him not to devote the necessary resources to Afghanistan because they don't want him to become a war president. That would be most unfortunate. President Obama is the Commander in Chief. He campaigned to become the war President. He said he wanted to end the war in Iraq, which he called a war of choice, and he wanted to win the war in Afghanistan--a war of necessity. He won the election and he, now, as Commander in Chief, has to make these critical decisions. Whether he likes it or not, he is a war President and he will be judged by history not only by his domestic agenda but by how well he leaves the situation in Iraq and Afghanistan. The key with Afghanistan is not to leave the country in the hands of dangerous Taliban or other terrorists who would work with al-Qaida and give them the kind of place they had before from which to train and plan attacks on the rest of the world. Also at stake in this debate is the message we are sending to the rest of the world, to our allies in the Middle East, in the Persian Gulf, to Pakistan. Is it safe to throw in with the United States and to help us in our war against these terrorists or, because the United States may bug out when the going gets tough, do we decide to make book with the other side, as Pakistan had done in the past with various groups including the Taliban? That is part of what is at stake. It is not just Afghanistan but our reputation around the rest of the world as to how we deal with our allies and how we resolve conflicts we get involved in. General McChrystal said it best when he said: We must show resolve. Uncertainty disheartens our allies, emboldens our foes. That is the key message today. I urge the President, in continuing this debate, to bring it to a close as quickly as he can to make the decision. I know Republicans will support a decision that follows the recommendations of General Petraeus and General McChrystal. I ask unanimous consent to have printed in the Record two articles from the Weekly Standard magazine: One, ``How Not to Defeat al-Qaeda, To Win in Afghanistan Requires Troops on the Ground'' and ``Don't Go Wobbly on Afghanistan; President Obama Was Right in March,'' both by Fred and Kimberly Kagan.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Texas (Mrs. Hutchison).

Mr. KYL

Mr. KYL. The following Senators are necessarily absent: the Senator from North Carolina (Mr. Burr), the Senator from Texas (Mrs. Hutchison), and the Senator from Mississippi (Mr. Wicker).

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Ohio (Mr. Voinovich).

Mr. KYL

Mr. KYL. Reserving the right to object.

Mr. KYL. Madam President, it is my understanding that we received this an hour and a half ago. I have no doubt at the appropriate time we will be able to work out some kind of agreement. But our side is going to need some time to look at it. We will need some Republican ideas or amendments as well, and we will need a CBO score. At this time, I will have to, on behalf of Members on our side, pose an objection.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from North Carolina (Mr. Burr).

Mr. KYL

Mr. KYL. Mr. President, I ask for the yeas and nays.

Mr. KYL

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

Mr. KYL

Mr. KYL. Mr. President, all eyes are on the Senate now with respect to the health care debate, because the Finance Committee has essentially completed work on the legislation and sometime this week is expected to vote on it, thus making it possible for that bill to come to the Senate floor. The question is, what do people think about the bill we debated and amended in the committee over a period of 2 weeks? Going back over my notes about all of the amendments we proposed and the discussion we had, a couple of things stuck out. First, Republicans have always said we believed it was important to address some of the problems that exist in our current system, problems with insurance and also health care delivery, primarily to bring costs down for all Americans and, in particular, for small businesses that provide insurance to employees, that there were some people who simply couldn't afford to buy insurance and we needed to find a way to help them as well. Republicans offered scores of amendments. Virtually all of them were rejected. One or two were accepted. We had a lot of good ideas. I am sorry the Democratic majority turned down our ideas. We will offer some of those alternatives when the bill comes to the floor and perhaps hope for a better reception. It isn't as if Republicans didn't have good ideas on how to address the problems. Our ideas were rejected. Instead, we end up with a bill, and I thought: What is the best way to describe the bill? I decided maybe I could identify 10 problems with it as a way of illustrating what is of concern. These may not be the most important 10 problems. There are certainly a lot of other issues, but here are 10 reasons I came up with this morning for the American people to think about and for Senators to think about that would be problems and reasons for us to oppose the bill. The first has to do with senior citizens who are on Medicare, because the bill cuts $500 billion from Medicare. In July, President Obama spoke at the AARP tele-townhall event and said: I think there is a misperception that's been out there that somehow there is any discussion on Capitol Hill about reducing Medicare benefits. Nobody is talking about reducing Medicare benefits. The problem is, this is not a misconception. We are not only talking about reducing Medicare benefits. That is exactly what the Finance Committee bill does. The Baucus bill will reduce Medicare benefits for millions of seniors to pay for a new health care bureaucracy. This isn't just my word. Here is the nonpartisan Congressional Budget Office estimating that the Baucus bill would cut Medicare by nearly $500 billion in the following ways: $210.9 billion in cuts to hospitals, nursing homes, home health care, and hospice; $123.5 billion in cuts to private Medicare plans known as Medicare Advantage. Here is what the CBO says about that. They estimate that the extra benefits offered by Medicare Advantage plans, such as preventative screenings, vision and dental care, will drop from $125 per month to only $42 per month under the Baucus bill, a direct reduction in benefits for seniors. Misconception about reducing benefits? No. Real dollars, $123.5 billion in cuts to Medicare Advantage plans which will, according to CBO, cut benefits for seniors. There is $22.6 billion in savings supposedly from a Medicare commission which Chairman Baucus has noted are executive branch cuts. These will be direct cuts to Medicare. And there is $4.6 billion in cuts to imaging services, wheelchairs, and physician-owned hospitals. Some of these cuts will directly reduce benefits such as those benefits offered by Medicare Advantage plans I mentioned. Others will do so indirectly as, for example, when doctors are paid less or home health care is cut. The bottom line is, it is disingenuous to say that Congress can cut this much spending, $500 billion from Medicare, and not have any detrimental effect on seniors' care. Medicare savings should be used to preserve and strengthen Medicare, not shifted to pay for new entitlement programs. Reason No. 2, rationing of care. I think at the end of the day, this is probably the most worrisome thing to me. And it is worrisome to a lot of senior and nonsenior citizens who can see their care being rationed under this legislation. The Baucus bill would create a new nonprofit corporation known as the Patient Centered Outcomes Research Institute to conduct what is known as comparative effectiveness research. Billions have been spent in the private sector to identify the best kind of treatment and care available, especially for cutting- edge technologies and treatments for patients' care. For the first time, this bill takes government money to conduct the research, and the net result of it will be to ration care. The bill, for example, asserts that the Secretary of HHS can use this comparative effectiveness research when making coverage determinations. Coverage determinations are what Medicare is going to cover, what they will pay for; in other words, what kind of treatment one gets to have. I am quoting now from the bill: The secretary would be required to use an iterative and transparent process when using research from the institute in making coverage determinations. That is what they intend to do. You will hear people say: Oh, no, that is not our intention. Well, these are the words of the bill. As a matter of fact, there is over $1 billion that was passed in the stimulus bill that is going to be used by a new Federal agency called the Federal Coordinating Council, to use comparative effectiveness research as the basis for rationed care. So you have this nonprofit entity as well as a Federal entity, both of which will use this research for coverage determinations. As I said, a lot of folks, particularly on the other side, say: Well, we don't support the rationing of care. We are against it too. Yet every single Republican amendment that was offered to make sure this research could not be used to ration care was defeated on party-line votes in the Finance Committee. The Republicans supported the amendments to ensure no rationing. The Democrats opposed all these amendments. There is another way the bill is very arbitrary and will result in the rationing of care. It arbitrarily singles out 10 percent of the Nation's physicians every single year and cuts their reimbursements under Medicare by 5 percent. What they are doing is saying those doctors who spend more than other doctors--the doctors in the top 10 percent of spending--are going to have their reimbursements cut at the end of the year because, presumably, that spending was unnecessary. Well, how do we know that? Why isn't it the top 5 percent? Why isn't it the top 20 percent? It is a purely arbitrary number. As I was discussing this on Saturday morning with a prominent physician, he said: The problem is the physicians who will get their reimbursements cut are the real experts to whom all the other physicians refer their toughest patients. I have seen that happen. I go to the doctor, and my physician says: I am not sure about this. I want you to go see a specialist in this area, and he sends me to somebody else. That doctor may prescribe something that costs a little more money, but he knows that is what I need. Well, he is going to get whacked by 5 percent. Obviously, this will result in a race to the bottom, where doctors will be encouraged to underspend one another rather than ensure the appropriate care is delivered to their patients. Even the Budget Committee chairman, who sits on the Finance Committee, Senator Conrad, said the provision ``leaves me cold.'' Well, it leaves me cold too. But every Democrat on the Finance Committee voted against my amendment to eliminate this provision. There was a recent editorial in the Washington Times that illustrates the problem with this. I quote now: . . . if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. That is wrong. The editorial concludes this way: And because no doctor will know who falls in the top 10 percent until year's end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties. Withholding care, denial of care, delay of care--it is rationing. So the rationing of care is both direct through the use of the comparative effectiveness research or, in this case, indirect, forcing the doctors, in effect, to do the dirty work for Washington by withholding care. Here is a third reason: waste, fraud, and abuse. The bill purports to attack waste, fraud, and abuse. But let me tell you about a little provision in the bill, and you tell me whether you think this is subject to abuse. Early Friday morning; that is to say, after midnight Thursday night, the chairman rolled into the bill an amendment that would ``streamline'' enrollment in Medicaid, the Children's Health Insurance Program, and the new premium tax credits program under the bill. Specifically, this amendment would provide a single application form for all three subsidy programs. The form can be filed online, in person, by mail or telephone. You heard me right: by telephone. How will a State Medicaid agency know if the person is truly eligible for the program, if the person is a U.S. citizen or is even the person he or she purports to be? Poll after poll shows the American people believe fraud, waste, and abuse should be addressed prior to creating new government programs. The Baucus bill exacerbates the fraud, waste, and abuse inherent in Federal public health programs. A fourth reason: rising health insurance premiums. You all heard that under this legislation, health care is going to cost less. Wrong. Health care is going to cost more. Rather than reducing the cost of premiums, they are going to go up under the bill. Do not take my word for it. Here is the Congressional Budget Office, again, nonpartisan: Premiums in the new insurance exchanges would tend to be higher than the average premiums in the current-law individual market. That is according to the Congressional Budget Office. Premiums will be higher than the average of premiums under current law. The bill provides that every insurance company has to offer at least two particular kinds of insurance and they cannot offer any more than four. The lowest actuarial value they can offer is 65 percent. What does that mean? Individuals will have to buy richer health insurance plans with higher premiums than they would under the current market regardless of their financial or medical circumstances. The average actuarial value of an individual insurance plan today, according to the Congressional Budget Office, ranges ``from 40 percent to 80 percent, with an average value that is between 55 and 60 percent.'' The bill, remember, mandates that the very lowest is 65 percent, which means it is going to be more than, higher than the value that currently exists for most and for the average. In my State, the average actuarial value for an individual plan is 61 percent. The average value for a high-deductible health plan is 48 percent. The bottom line is, the Baucus bill not only mandates that you buy insurance, but you have to buy insurance that is going to have a higher premium than the insurance you pay for today. Part of the reason insurance will cost more is because the Baucus bill would require all insurers to cover a minimum set of standardized benefits in addition to the current State-mandated benefits. The Council for Affordable Health Insurance estimates that current mandated benefits increase the cost of basic health coverage from a little less than 20 percent to perhaps 50 percent. So get ready America, you are going to see your premiums go up under this legislation, not down. Here is a fifth reason to oppose the bill. Under this legislation, there are penalties on your employer, which will be passed on to you in the form of lower wages. Under the Baucus bill, employers with over 50 employees, that do not offer health insurance to their workers would be required to pay a penalty for each employee who receives a tax credit to purchase coverage through the insurance exchange. Where does the money come from to pay the penalty? Well, the CBO has warned Congress about so-called free rider proposals. Here is what they say: Supporters of such surcharges often refer to them as ``free rider'' penalties. That is what is in the bill. Although the surcharges would be imposed on the firms, workers in those firms would ultimately bear the burden of those fees, just as they would with pay-or-play requirements. Continuing to quote: Employer surcharges tend to be more targeted. . . . Many of those workers are more likely to have earnings at or near the minimum wage, and the size of such surcharges--if based on actual costs imposed on government programs--could be larger per affected worker than the assessments being considered in many play-or-pay requirements. What that is saying is, when you put a fee on the employer, that fee is passed on to the employees in the form of lower wages or, in some cases, even fewer workers and that it is most likely to more dramatically affect those who have earnings at or near the minimum wage than those at higher wage scales. So you are hurting the very lowest paid workers. Senator Enzi offered an amendment in the committee that would have required the Secretary of Labor to certify that the bill would not result in lower wages or in an increase in the unemployment rate before the bill could go into effect. You would think that would be a good guarantee that the bill would not have the adverse consequences I indicated. Well, an interesting thing happened in the committee. The amendment first passed 21 to 0. Everyone thought it was a good idea to guarantee that the bill would not reduce people's wages or result in laid-off workers. Yet early in the hours on Friday--in other words, after midnight Thursday night--the Democrats in the committee changed Senator Enzi's amendment into a mere report to Congress. So after first voting in favor of the amendment to ensure that workers' wages would not be reduced, they then came back late and undid what they had passed earlier. Why would they do that, when the first amendment passed 21 to 0? Because, of course, it is an impossible certification under the bill. The bill will reduce wages--CBO said so--and the Democrats in the committee realized, therefore, they could not stick with that certification and have the bill be effective. So wages will be lost and some jobs will be lost. Well, here is a sixth reason to oppose the bill: If you like your current insurance, you will not be able to keep it. You have heard the President promise this over and over: If you like your current coverage, you will be able to keep it. No, you will not--not under this bill. This has been proven now time and time again. I think it is one of the reasons the President is so sensitive about this. In fact, in his speech to the Congress, he changed his terminology a little bit. He said: If you like your insurance, we will not do anything to require you to change it. He had to change his terminology because, of course, what he was saying before is absolutely false. By saying the government will not require you to change your plan, that is technically true. But it is lawyers' words. The problem is, the insurance you have now you will not have anymore because it will not exist anymore. No one will require you to change it. It simply will not be available to you. Why not? Well, there are several different reasons. For seniors, the Baucus bill cuts billions of dollars from the Medicare Advantage Program. That will force those plans to cut benefits under their plans or to drop coverage altogether. For those who are privately insured, Senator Hatch offered an amendment that would have required the Secretary of HHS to certify the bill would not cause more than 1 million Americans to lose their current coverage. The amendment failed on a party-line vote. Let me repeat that. The Hatch amendment said: Well, we have to at least certify that no more than 1 million people will lose their coverage under this bill. That cannot be certified because that is not what is going to happen. A lot more than 1 million people are going to lose their coverage. So his amendment lost on a party-line vote. It is true the Baucus bill does not require insurers to drop coverage for people who like their current health insurance plans, but the practical effect of the bill will be to cause Americans to lose the coverage they currently enjoy. For the seniors, by the way, under the Medicare Advantage plan, I quoted the numbers earlier. Let me quote them again. CBO estimates the extra benefits offered by the Medicare Advantage plan--such as preventive screenings, vision, and dental care--will drop from $135 per month to only $42 per month under the Baucus bill. So you are going to lose over $90 worth of care, benefits, that you currently have. No, you are not going to be able to keep the insurance you have today, even if you like it. Here is a seventh reason: This may seem like a small thing to most people, but the precedent is enormously dangerous in our country. We have all seen what happens when the government takes over part of the economy: insurance companies or the bank bailouts or the automobile companies. When the government takes these things over, they begin to make the decisions; for example, setting the pay of the people who work in those companies. It started out just capping the high executives' pay. Under this bill, however, insurance companies' pay for all employees would be subject to the Federal regulation. If you pay somebody a certain amount of money, you will not be able to deduct it as a part of the ordinary and business expense that you do today. So it is a way of indirectly capping pay. It would limit the tax deduction for health insurance executives and other highly paid workers at $500,000. By the way, it would not limit the deduction of pharmaceutical companies or hospital industry executives and so on. But it is another example of what happens when Washington takes over another segment of the economy. Robert Reich, by the way, who is the former Secretary of Labor under the Clinton administration, wrote an op-ed in the Wall Street Journal in which he pointed out that sometimes these relatively high--and $500,000 is, to me, a lot of money--but there are people who are paid a lot more than that in these high-paid industries because of what they are able to do for their particular company, and he warns about the effect of legislation such as this that would effectively cap pay of employees. Here is another thing--the eighth reason--taxing you through your health insurance plan. This is another one of the sneaky ways in which the bill actually gets at you, but they put the tax first on the insurance company. I told you the Congressional Budget Office said the wage earners would actually pay the penalty imposed on businesses. Well, here is an example of where the Baucus bill imposes a 40-percent excise tax on any health insurance plan that is above $8,000 for a single person and $21,000 for family plans. Who ends up paying the increased tax on the insurance company? Of course, you do. They pass it on to you through higher premiums. According to the nonpartisan Joint Tax Committee, which provided the Finance Committee with a distributional analysis of this provision, the bulk of this $200 billion tax increase falls on those President Obama promised to protect. Do you remember: ``Nobody under $200,000 is going to pay any new taxes under my bill''? Well, here is what happens in the first year this tax is in place. It raises taxes on 13.8 million tax units; that is, either an individual or a family who files an income tax return; that is, it raises taxes by $13 billion on 13.8 million tax units. Of those 13.8 million tax units--individual filers or families-- only 1.2 million will have incomes above $200,000. So about 12.6 million of these tax filers who are under $200,000 in income will pay this tax. Not going to tax anybody under $200,000? Wrong. This means 91 percent of the affected taxpayers will be hit by the premium increase as a result of this tax. By the way, the average tax increase for those earning under $200,000 is $900. This is every year, by the way. Within 6 years, the number of tax units hit by this tax would nearly triple to almost 40 million individual or family filers, and the tax would collect over $52 billion in that year. Here is a ninth reason for opposing the bill: taxing the chronically ill. This is an amendment I offered because this is just wrong. As my colleagues know, under the tax law today, if you are so unfortunate as to be hit by a huge medical bill in any given year, and it exceeds 7.5 percent of your gross adjusted income on your income tax form, then you get to take a deduction for any amount above 7.5 percent of your income. The reason for that is because we don't want anyone in this country to have to suffer unnecessarily or out of proportion simply because of an accident, in effect. This is literally the lightning strikes situation. Most people would not have medical bills exceeding 7.5 percent of their adjusted gross income, but the few who do have been stricken enormously hard. They don't deserve it. In fact, the Internal Revenue Service actually treats this as an involuntary expense. Under the IRS Code, there are few things that happen to you by pure luck of the draw, as it were. Most of the IRS Code applies to you based on decisions you made: You invested and lost money or you invested and made money and you get taxed on it as a result of the decision you made. You bought a house and you have a mortgage deduction, you know how much that is, you are taxed on a decision you made. This, you had nothing to do with it; you just got sick. So your expenses are enormous compared to your income. We have always said in that case: We don't want that to hurt you; we are going to make sure you don't pay more than a certain amount in your taxes. Anything above 7.5 percent you get to deduct. Under the Baucus bill, that 7.5 percent goes up to 10 percent, so now you are going to have to eat 10 percent of this catastrophic cost before you can even get to the point where you can have a tax deduction. Yet, as I quote the Congressional Research Service, ``the deduction can ease the financial burden imposed by costly medical expenses.'' For the most part, the Federal Tax Code regards these expenses as involuntary expenses that reduce a Federal taxpayer's ability to pay taxes by absorbing a substantial part of income. The Joint Tax Committee has estimated that increasing the threshold to 10 percent would increase taxes by $15 billion over 10 years. Who are these unfortunate taxpayers? Are they rich people? No. Twenty-one percent of them who claim this deduction earn under $40,000, or less than 200 percent of poverty. So almost one-fourth of the people who take advantage of this are literally--they are at 200 percent of poverty. They are making $40,000 a year. Those are exactly the kinds of people you want to be able to take advantage of a tax provision like this. They get killed when they have an expense that big, and 5.8 million taxpayers or 87 percent who claim this deduction earn under $100,000, and that is not wealthy by any means. Mom and dad are working. Together they earn, let's say, $90,000. Well, 87 percent of the people who claim this deduction are in that category. Those are people we should be helping by not having them pay quite as much in taxes, but under the bill we make it harder for them. We raise the threshold from 7.5 to 10 percent. I wanted to actually reduce it to 5 percent to help people with their health care costs. Isn't the whole point of this bill to reduce people's health care expenditures? Isn't that the whole idea? No. We are not going to reduce them; we are not even going to leave them the same. We are going to raise them. That brings up the tenth and final reason: taxing middle-class families. Under current law, employees can make tax-free contributions for medically necessary goods and services to pay out-of-pocket expenses. We would assume that to be the case. Although there is no legal limitation, employers generally establish a $5,000 limit that they provide to their workers. Senator Baucus is proposing to limit the contributions to $2,500 a year, and the Joint Tax Committee estimates that this limit would raise $15 billion over 10 years. Now, why are we doing this? Is it good tax policy? No. We are doing it because we have to raise revenue. You see, the Democrats, who proposed this amendment, said at the very outset: We are going to make sure it is ``revenue neutral.'' What does revenue neutral mean? When you are proposing to spend $800 billion, $900 billion, $1 trillion in order to make it revenue neutral, you have to come up with $800 billion, $900 billion, or $1 trillion in new taxes or revenue or savings in order to offset the cost of that. So they have to raise money by a variety of taxes--I have mentioned a couple of them-- or by penalties in ways that help them to get to this $800 million, $900 million, or $1 trillion. Well, here is another one of the taxes. We limit the contribution limit to $2,500 a year. That way the Federal Government will bring in $15 billion more in revenue. Who takes advantage of this? Well, the 35 million people who use these flexible spending accounts spend 43 percent on hospital admissions and physician visits, 26 percent to purchase prescription and over-the-counter drugs to manage chronic diseases, 21 percent for dental, and 10 percent for vision. These are medical expenses that help make people healthier or prevent them from getting sicker. Isn't that what we want to be promoting, rather than hurting? Americans with chronic conditions spend nearly $4,400 a year in out- of-pocket medical expenses for ailments such as diabetes and autism. Why shouldn't we be helping them by allowing their employers to put money into these flexible spending accounts for them to offset against their medical expenses? Well, maybe this is just for the rich. No. There again, wrong. The median income for a policyholder utilizing a flexible spending account is $55,000--hardly the rich. So, once again, we tax middle-class families in order to raise money to pay for the expense of this legislation. These are just 10 reasons. I could keep going. There are dozens and dozens of reasons to oppose this legislation, but just start with these 10: No. 1, $500 billion in Medicare cuts that is going to result in less care for America's seniors--benefit cuts. No. 2, rationing of care, both directly and indirectly, through this comparative effectiveness research and through other means that force the physicians, in effect, to provide less care if they want to be paid. More fraud, waste, and abuse. We thought we were going to actually save money from waste, fraud, and abuse. No. We are going to do things such as let people register by telephone when we are not going to be able to verify their eligibility for subsidies under this program. Rising health insurance premiums: The Congressional Budget Office says the increase in the insurance costs will be passed on to the premium holders, so our insurance premiums go up, not down. Taxes on employers which, again, according to the people who know best--nonpartisan--reduce employees' wages. If you like your current coverage, you would not be able to keep it. That is a reason to oppose this legislation. If you like your current coverage, you ought to be able to get to keep it. No. 7, unwarranted government intrusion. I just cited the example of the capping of pay, but there are so many other situations in which this tangled web of government regulations will virtually create government-run health care in this country, with or without a government-run insurance plan or the so-called public option. No. 8, taxing you through your health insurance program. Here, again, they impose a tax on the insurance company because insurance companies are bad. Well, insurance companies are bad until you want them to pay for your health care. Then they are OK, I guess. In any event, the insurance company has to pass it on to you, so your premiums go up. That is what the experts say will happen. Taxing the chronically ill: Why should we not allow people to deduct from their income taxes the expenses of these catastrophic events in their life that all of us--none of us want these things to happen to us, and we should at least be able to deduct part of these expenses in our income taxes. Finally, taxing middle-class families through the inability to take advantage of what their employers would otherwise provide by way of flexible spending accounts so they could actually have money to spend on chronic diseases such as diabetes--just one that I mentioned. The whole exercise is we are going to make health care costs go down, we are going to reduce premiums, and we are going to recognize that people have too hard a time coping with these issues in today's society. We only make it worse if we adopt the Baucus bill because it will raise insurance premiums, it will lower wages, it will increase taxes, and it will reduce the care people get. How is that for a deal? Only something offered in Washington, DC, could be that bad a deal. That is what is coming down the pike. In a couple of weeks, that bill is going to be--actually, it would not even be that bill; it will be a worse bill. I have described what many say is the best it is going to get, the bill that came out of the Finance Committee. It is only going to get worse from here because this bill is going to be combined--not by Republicans but by Democrats--behind closed doors with the bill that came out of the HELP Committee which, if anything could be worse, is. So somewhere in between this bill and that bill, that is what we are going to have on the Senate floor. It is a bad deal for the American people. One final point. I see my friend, the Senator from Tennessee, Mr. Alexander, coming to the floor. He has been saying something over and over and over again that bears repeating. I will tell Senator Alexander, I was in church yesterday, and I don't know how many people told me exactly this: Read the bill and find out how much it costs. If we do that, and if we tell our constituents how much it costs and what is in the bill, I predict a lot of my colleagues are going to say: Thanks but no thanks; my constituents really don't want this bill. So in addition to all of the other things I have said, maybe I should have started with the proposition: Read the bill and find out how much it costs. I suspect my friend from Tennessee might just mention that. Thank you, Mr. President.

Mr. KYL

Mr. KYL. Mr. President, earlier this month, we paid homage to those who lost their lives in the terrorist attacks on September 11, 2001. Those attacks changed our nation forever, including how we combat the very real and continuing threat of terrorism. One of the most important changes that we made in the wake of September 11 was the enactment of the PATRIOT Act. That legislation, which had strong bipartisan support in the Congress, provided for a number of common sense changes designed to give our national security intelligence community the same tools our police and FBI agents can use against drug dealers and organized crime. Although many of the PATRIOT Act's provisions are now permanent, three critical national security tools--the ``wiretap'' authority contained in Section 206 of the PATRIOT Act; the ``business records'' authority contained in Section 215 of the PATRIOT Act; and the ``lone wolf'' authority contained in Section 6001 of the Intelligence Reform and Terrorism Prevention Act of 2004--will expire on December 31 of this year. The tools in the PATRIOT Act are as necessary today as they were when first enacted. Just this month, the government confirmed that the Foreign Intelligence Surveillance Act of 1978, FISA, which includes PATRIOT Act provisions, was used to build a case against Najibullah Zazi. Although many details remain classified, it appears as if Najibullah Zazi was an al Qaeda associate who was planning to detonate bombs within the U.S. Similarly, it has been reported that the FBI likely used its roving wiretap and business records authorities--two of the PATRIOT Act's expiring provisions--to thwart a terrorist plot uncovered earlier this year in New York, in which four former convicts who converted to radical Islam plotted to use explosives to blow up synagogues and shoot down airplanes with surface- to-air missiles. Those are two high-profile examples from just this year. There are no doubt countless of other instances, not known to the public, where PATRIOT Act authorities have been used by our national security professionals to keep Americans safe. Recognizing the importance of these tools, the Department of Justice has written the Chairman of the Judiciary Committee to urge renewal of the expiring provisions of the PATRIOT Act. In addition, FBI Director Mueller and David Kris, the Assistant Attorney General for the National Security Division, both expressed their strong support for these authorities in testimony before the Judiciary Committee this month. The reality is that the war on terrorism is not going to sunset. Neither should the tools that our investigators and analysts rely upon to prevent attack. That is why Mr. Cornyn and I are introducing today the USA PATRIOT Reauthorization and Additional Weapons Against Terrorism Act of 2009. This legislation permanently renews the three expiring PATRIOT Act provisions and addresses other critical national security needs. I. Renewing the Roving Wiretap Authority The roving wiretap authority allows the Government, in certain circumstances, to focus surveillance efforts on monitoring a particular target rather than a particular telephone number. Gone are the days when you used only one phone at home or in the office. Cell phones are ubiquitous. The point is to intercept the calls of a particular person, not a particular phone. Even so, the Government may have such authority only in limited circumstances. It must provide the FISA Court with ``specific facts'' indicating that the ``actions of the target of the application may have the effect of thwarting the identification'' of third parties necessary to accomplish the ordered surveillance. This tool helps ensure that investigators and analysts may overcome a target's efforts to avoid surveillance, for example, rapidly switching cell phone numbers. As the Department of Justice noted in its September 14, 2009, letter to Chairman Leahy, the roving wiretap authority has ``proven an important intelligence-gathering tool in a small but significant subset of FISA electronic surveillance orders.'' The Department's letter explains that the authority has been used judiciously--on average, only 22 applications for roving wiretaps have been made per year--and that ``the basic justification offered to Congress in 2001 for the roving authority remains valid today. . . . Any effective surveillance mechanism must incorporate the ability to rapidly address an unanticipated change in the target's communications behavior.'' II. Renewing the Business Records Authority The business records authority allows the FISA Court, under appropriate circumstances, to compel the production of needed business records. In its September 14 letter, the Department of Justice expressed its strong support for the business records provision, stating that it ``addresses a gap in intelligence collection authorities and has proven valuable in a number of contexts.'' The Department stated that some of the acquired ``orders were used to support important and highly sensitive intelligence collection operations, of which both Members of the Intelligence Committee and their staffs are aware.'' Although some have questioned the scope and use of this authority, it is important to acknowledge that no one has challenged a business records order in court, even though an explicit right to file such a challenge took effect in 2006. Such authority also exists in at least 300 federal government investigative contexts. III. Renewing the Lone Wolf Authority The ``lone wolf'' provision fills a critical intelligence gap in situations where the government can establish that a non-United States person is engaged in international terrorism but cannot yet identify the foreign power or terrorist group to which he belongs. Although this authority has not yet been used, the Department of Justice made clear in its September 14 letter that there are foreseeable situations in which such an authority ``would be the only avenue to effective surveillance.'' The Department stated that ``it is essential to have the tool available for the rare situation in which it is necessary rather than to delay surveillance of a terrorist in the hopes that the necessary links are established.'' Had we had this authority at the time, we could have examined the computer of Zacarias Moussaoui, perhaps gaining enough information to provide some warning of 9/11. Terrorists do not carry membership cards in organizations, but it does not make them any less dangerous. IV. Addressing Other National Security Needs In addition to reauthorizing these important national security tools, this legislation responds to several other national security needs. For example, it clarifies what kind of information and disclosures trigger the procedures of the Classified Information Procedures Act, CIPA. This clarification is designed to resolve the difficulties created by the Fourth Circuit's approach in United States v. Moussaoui. The legislation also prohibits individuals from providing material support--for example, providing money to support a suicide bomber's family--to international terrorism efforts. It makes it illegal to conspire to violate the current prohibition on receiving military-type training from a foreign terrorist organization. It prohibits the use, transfer, mass transfer, production, and trafficking of false travel documents. Finally, it ensures that convicted terrorists and sex offenders will not be released pending sentencing or appeal. These are good, common sense provisions that all members should be able to support. I look forward to working with my colleagues on both sides to ensure that our national security professionals have the tools they need to continue finding and apprehending terrorists before they attack. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. KYL

Mr. KYL. Mr. President, earlier this month, we paid homage to those who lost their lives in the terrorist attacks on September 11, 2001. Those attacks changed our nation forever, including how we combat the very real and continuing threat of terrorism. One of the most important changes that we made in the wake of September 11 was the enactment of the PATRIOT Act. That legislation, which had strong bipartisan support in the Congress, provided for a number of common sense changes designed to give our national security intelligence community the same tools our police and FBI agents can use against drug dealers and organized crime. Although many of the PATRIOT Act's provisions are now permanent, three critical national security tools--the ``wiretap'' authority contained in Section 206 of the PATRIOT Act; the ``business records'' authority contained in Section 215 of the PATRIOT Act; and the ``lone wolf'' authority contained in Section 6001 of the Intelligence Reform and Terrorism Prevention Act of 2004--will expire on December 31 of this year. The tools in the PATRIOT Act are as necessary today as they were when first enacted. Just this month, the government confirmed that the Foreign Intelligence Surveillance Act of 1978, FISA, which includes PATRIOT Act provisions, was used to build a case against Najibullah Zazi. Although many details remain classified, it appears as if Najibullah Zazi was an al Qaeda associate who was planning to detonate bombs within the U.S. Similarly, it has been reported that the FBI likely used its roving wiretap and business records authorities--two of the PATRIOT Act's expiring provisions--to thwart a terrorist plot uncovered earlier this year in New York, in which four former convicts who converted to radical Islam plotted to use explosives to blow up synagogues and shoot down airplanes with surface- to-air missiles. Those are two high-profile examples from just this year. There are no doubt countless of other instances, not known to the public, where PATRIOT Act authorities have been used by our national security professionals to keep Americans safe. Recognizing the importance of these tools, the Department of Justice has written the Chairman of the Judiciary Committee to urge renewal of the expiring provisions of the PATRIOT Act. In addition, FBI Director Mueller and David Kris, the Assistant Attorney General for the National Security Division, both expressed their strong support for these authorities in testimony before the Judiciary Committee this month. The reality is that the war on terrorism is not going to sunset. Neither should the tools that our investigators and analysts rely upon to prevent attack. That is why Mr. Cornyn and I are introducing today the USA PATRIOT Reauthorization and Additional Weapons Against Terrorism Act of 2009. This legislation permanently renews the three expiring PATRIOT Act provisions and addresses other critical national security needs. I. Renewing the Roving Wiretap Authority The roving wiretap authority allows the Government, in certain circumstances, to focus surveillance efforts on monitoring a particular target rather than a particular telephone number. Gone are the days when you used only one phone at home or in the office. Cell phones are ubiquitous. The point is to intercept the calls of a particular person, not a particular phone. Even so, the Government may have such authority only in limited circumstances. It must provide the FISA Court with ``specific facts'' indicating that the ``actions of the target of the application may have the effect of thwarting the identification'' of third parties necessary to accomplish the ordered surveillance. This tool helps ensure that investigators and analysts may overcome a target's efforts to avoid surveillance, for example, rapidly switching cell phone numbers. As the Department of Justice noted in its September 14, 2009, letter to Chairman Leahy, the roving wiretap authority has ``proven an important intelligence-gathering tool in a small but significant subset of FISA electronic surveillance orders.'' The Department's letter explains that the authority has been used judiciously--on average, only 22 applications for roving wiretaps have been made per year--and that ``the basic justification offered to Congress in 2001 for the roving authority remains valid today. . . . Any effective surveillance mechanism must incorporate the ability to rapidly address an unanticipated change in the target's communications behavior.'' II. Renewing the Business Records Authority The business records authority allows the FISA Court, under appropriate circumstances, to compel the production of needed business records. In its September 14 letter, the Department of Justice expressed its strong support for the business records provision, stating that it ``addresses a gap in intelligence collection authorities and has proven valuable in a number of contexts.'' The Department stated that some of the acquired ``orders were used to support important and highly sensitive intelligence collection operations, of which both Members of the Intelligence Committee and their staffs are aware.'' Although some have questioned the scope and use of this authority, it is important to acknowledge that no one has challenged a business records order in court, even though an explicit right to file such a challenge took effect in 2006. Such authority also exists in at least 300 federal government investigative contexts. III. Renewing the Lone Wolf Authority The ``lone wolf'' provision fills a critical intelligence gap in situations where the government can establish that a non-United States person is engaged in international terrorism but cannot yet identify the foreign power or terrorist group to which he belongs. Although this authority has not yet been used, the Department of Justice made clear in its September 14 letter that there are foreseeable situations in which such an authority ``would be the only avenue to effective surveillance.'' The Department stated that ``it is essential to have the tool available for the rare situation in which it is necessary rather than to delay surveillance of a terrorist in the hopes that the necessary links are established.'' Had we had this authority at the time, we could have examined the computer of Zacarias Moussaoui, perhaps gaining enough information to provide some warning of 9/11. Terrorists do not carry membership cards in organizations, but it does not make them any less dangerous. IV. Addressing Other National Security Needs In addition to reauthorizing these important national security tools, this legislation responds to several other national security needs. For example, it clarifies what kind of information and disclosures trigger the procedures of the Classified Information Procedures Act, CIPA. This clarification is designed to resolve the difficulties created by the Fourth Circuit's approach in United States v. Moussaoui. The legislation also prohibits individuals from providing material support--for example, providing money to support a suicide bomber's family--to international terrorism efforts. It makes it illegal to conspire to violate the current prohibition on receiving military-type training from a foreign terrorist organization. It prohibits the use, transfer, mass transfer, production, and trafficking of false travel documents. Finally, it ensures that convicted terrorists and sex offenders will not be released pending sentencing or appeal. These are good, common sense provisions that all members should be able to support. I look forward to working with my colleagues on both sides to ensure that our national security professionals have the tools they need to continue finding and apprehending terrorists before they attack. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. KYL

Mr. KYL. Mr. President, a September 17, 2009, editorial in the Wall Street Journal, ``Public Option Lite,'' clearly and concisely describes how the Finance Committee chairman's health care plan would result in a near total government takeover of the health care industry. Because it does not include the public option, the chairman's plan has been touted as a more moderate proposal than other bills before Congress. But, as the Journal writes, the absence of the public option ``is a political offering without much policy difference. His plan remains a public option by other means.'' Near total government control would be achieved through the bill's two main mechanisms: an individual mandate for all Americans to purchase government-approved insurance and the regulatory insurance ``exchange.'' The inevitable outcomes of these mechanisms would be ``vast new insurance regulation'' and ``a vast increase in the government's share of U.S. health spending, forcing doctors, hospitals, insurance companies, and other health providers to serve politics, as well as, or even over and above patients.'' Thus, power would be centralized with politicians and bureaucrats, rather than patients and doctors. Along the way, as the editorial points out, the bill would increase the cost of insurance through new taxes and mandates, reduce consumer choice, and ultimately ration health care in an attempt to keep costs under control. The editorial also explains that most of the Medicare cuts used to help pay for this plan ``come from supposedly automatic cuts that a future Congress is unlikely to ever approve, that is, until this entitlement spending swamps the entire federal budget.'' Then, ``The government will have no choice but to raise taxes to European welfare- state levels or impose drastic restrictions on patient care. Or likely, both.'' The article concludes that this plan is ``a recipe to ruin healthcare'' and ``bankrupt the country.'' I ask unanimous consent to have this article printed in the Record and urge my colleagues to consider the facts and arguments contained in this editorial.

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Oklahoma (Mr. Coburn).

Mr. KYL

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

Mr. KYL

Mr. KYL. Mr. President, during the last several months Congress has been engaged in a vigorous debate about how to achieve health care reform. Despite the President's repeated claims to the contrary, we all agree, Republicans and Democrats, that some reforms are necessary. Costs are too high for families and businesses. Too many Americans lack access to affordable options. We need to make health insurance more affordable and more portable. There are two basic approaches before Congress: reforms that impose much more government control over health care or reforms that provide consumers with more affordable options and keep control of health care decisions with families and doctors. I happen to believe that the latter approach is better, that we must empower patients and doctors, not bureaucrats and politicians, to make health care decisions. I think it is clear that after the August recess, a majority of Americans rejected a Washington takeover of health care, along with the mountains of new taxes and debt and bureaucracy it would create. While I appreciate the hard work of the Finance Committee chairman in trying to write a more acceptable bill, the end result is little better than the others, that is, the government's near total control over health insurance, and therefore the delivery of your health care. Along the way, it would also spend nearly $1 trillion and cut Medicare benefits by nearly half a trillion. The Finance Committee chairman's bill is a tangled web of federally documented insurance regulations which would control every aspect of health insurance from covered benefits to permissible premiums. The bill would centralize the power of medical decisions with politicians and bureaucrats, not patients and doctors. It would result in higher health insurance premiums, less consumer choice, and ultimately the rationing of health care. How would the government take over health care under this bill? There are two key provisions that would result in government-run health care for practically all Americans, and empower bureaucrats at the expense of patients. The first is a requirement that every American buy an insurance policy. The second is a regulatory entity called the insurance exchange. First, let's talk about this mandate for everyone to buy an insurance policy. The chairman's plan imposes this individual mandate for all individuals to purchase a government-approved policy. To repeat, not just any insurance, but government-approved and therefore government-defined insurance. Those who do not comply face steep fees--or fines, I should say-- ranging from a $750 to a $3,800 per-year fine. The mandate constitutes direct interference in health care with a host of new regulations that control the insurance plans that would become available to consumers. Michael Cannon, a health policy expert at the Cato Institute, says that the individual mandate would be the ``most sweeping and dangerous measure in any of the bills before Congress.'' He goes on to say: ``Compulsory health insurance is nationalized health insurance, with all that implies for health costs and quality.'' The second control mechanism is an insurance exchange through which all small business and individual market policies must be sold, and eventually large plans would participate as well. The exchange's core function is to impose a new set of Federal rules that literally control everything the companies can and must do. Here are some examples. All companies must offer two government-specified benefit options--they define it as a silver and gold plan--or else the insurer cannot offer any insurance at all. So they have to offer two specifically defined insurance plans. But they can't offer more than four specific types regardless of consumer needs or preferences. It is like telling the car companies they each have to make two kinds of cars and they can't make any more than four kinds of cars. That is exactly what we are talking about, the Federal Government telling the insurance companies: This is the way you have to offer it--you have to offer at least two and you can't offer any more than four. All of the plans must comply with new Federal rating rules. That is how limits on premiums are established. They have to issue coverage to everyone regardless of health status and not cap total coverage regardless of cost. They have to comply with mandatory limits on copays and deductibles. They have to cover a broad range of medical benefits in addition to State-mandated benefits regardless of whether consumers want them. All of this is subject to change from Washington depending on what politicians or bureaucrats believe you need. Remember, it will be illegal for you not to buy this insurance. You will notice that all of these things are required, and it is Washington that is doing the requiring. Under this plan, insurers would no longer retain the flexibility to design insurance products that would satisfy specific consumer preferences. The Federal Government would dictate that all policies must offer the same package of benefits, the same types of plans. Rather than having the freedom to compete, insurers would in essence become prepaid health payment utilities since the Federal Government would, as the Wall Street Journal editorialized last Thursday, essentially be writing all insurance contracts. Since every aspect of insurance coverage would be controlled by Washington and everyone would have to buy the insurance, the government would control how your health care is paid for and therefore how it is delivered. A final point about this insurance exchange. Since it will change the kind of insurance that can be sold, if you lose your current insurance, regardless of whether you bought the policy yourself or you got it through an employer, you will likely not be able to find that similar policy in the future. They will all be different. Insurers will have to comply with the new Federal rules, and that will change the coverage. This is one of the reasons the President was wrong when he repeatedly said: If you like your insurance, you get to keep it. That insurance simply is not going to be around anymore once the companies have to comply with the requirements of the exchange. There will be all new insurance policies written at that point. The proponents of this radical change justify it on the assertion that it will bend the cost curve. In other words, it will reduce costs. But the problem is that massive new regulations will actually increase costs. The Council for Affordable Health Insurance found that mandating universal coverage and regulations in the bill, such as guaranteed issue and modified community rating, will increase the cost of health insurance between 75 and 95 percent. In addition, note that the chairman's plan does not grandfather insurance plans currently offered by small businesses, so they would have to comply with these new Federal rating rules over a 5-year period, so that in short order premiums would rise for many small businesses and their employees as well. Of course, the newly established mandated benefits would also add to the increased cost. Suppose, for example, a healthy individual or family prefers to have a less comprehensive package with a higher deductible. Say a young family of four with two children and two 35-year-old parents wants to buy a CIGNA PPO plan from the individual market with a $2,000 deductible. In my hometown of Phoenix, that plan currently costs $512 a month. If the reforms included in the chairman's plan were implemented, the price of that plan would nearly double to $998 per month. The experts who said the cost of health insurance premiums would rise between 75 and 95 percent are right on the mark with regard to this real-life example I gave with a real-life insurance policy for a family of four in Phoenix. Instead of purchasing health care coverage that is personalized to their needs and budget, this family would be forced to purchase coverage they may not want for routine care that can be paid out of pocket or coverage for diseases and conditions that tend not to afflict their age group. Since insurers would not be allowed to charge according to risk, a low-risk family such as this one would have to pay more to make up for coverage needed by high-risk individuals. Of course, I am not suggesting we turn a blind eye to the needs of Americans, for example, suffering from preexisting health conditions. They struggle to purchase affordable health insurance. We have to address that issue. But that does not require a total Washington takeover of all insurance policies, and it doesn't require raising insurance premiums for millions of other Americans and small businesses. In my view, despite all of these other problems I have discussed, the most damaging impact of this takeover by the Federal Government is the inevitable rationing, the delay and denial of health care to American citizens. Since new Federal mandates and requirements would raise health care costs, politicians will have to search for ways to control spiraling premiums. When traditional cost-containment measures fail, such as reducing provider reimbursements or reducing how much doctors get paid, the government's only option is to control how much health care everyone receives. That means rationing. For a preview of how this plan would lead to rationing, we need only look to the State of Massachusetts where a law was passed in 2006 requiring all residents to obtain health insurance. In fact, the State insurance market now looks like the market that would be created by the chairman's bill, with its guaranteed issue and modified community rating, State-approved plan types and benefit mandates. Massachusetts health care spending is consuming an increasing share of the State's budget. The State passed a $1-per-pack increase in the State's cigarette tax, $89 million in fees and assessments on health care providers and insurers, and cost-sharing increases. It has even ordered insurers to cut provider reimbursements by 3 to 5 percent. But these measures still do not produce enough revenue to cover costs, leaving the State with few options. As a result, a special commission was created by the State legislature which developed a list of options to control costs, such as ``exclud[ing] coverage of services of low priority/value'' and ``limit[ing] coverage to services that produce the highest value when considering both the clinical effectiveness and cost''--in other words, rationing. You ration health care when you say: We will figure in here how much it costs, how much we have available, and therefore how much we can afford to provide. People who have to have that care are therefore going to be the ones who suffer. This is exactly what happens under the chairman's proposal as well. It would establish a panel of health care stakeholders to identify physician services that are overvalued in the Medicare physician fee schedule and create a Medicare commission that would propose automatic Medicare cuts, even if Congress fails to adopt them. Our constituents rely upon us to protect the benefits we have promised them, but what we are going to do in this legislation is establish a commission which would provide for automatic Medicare cuts. If Congress doesn't act affirmatively to somehow stop that from going into effect, it goes into effect. That is abdicating our responsibility to act as their representatives and, worse, putting somebody else in charge of deciding what is best for our Medicare constituents. So when costs grow out of control, the government will adjust the volume of care provided based on how much it is willing to spend; that is to say, to ration your health care. The fact that the Baucus bill does not include the so-called public option, the government-run insurance company, does not mean it does not otherwise totally regulate health care delivery. Together, an individual mandate to buy particular insurance and the regulatory insurance exchange, the two key provisions in the plan, facilitate the government's takeover of health care--some of it government run, all of it government controlled. No longer would families and doctors have the final say. It is almost unthinkable that this could happen in the United States. Republicans have proposed ideas that would improve access and lower the cost of care, including real medical liability reform, allowing people to buy lower cost insurance across State lines, making the tax treatment of health care more fair for those who purchase insurance on their own, and removing barriers to health savings accounts. These are better alternatives than the entire takeover of the system as proposed in the chairman's bill. We all favor health care reform. Republicans favor measures that lower costs and improve access and, importantly, empower patients, not government bureaucrats. I suggest the absence of a quorum.

Mr. KYL

Mr. KYL. Madam President, we can save $11 billion without cutting a dime from this appropriations bill. It turns out there is duplication between spending in the stimulus bill that already passed and this bill. What we do is simply send the bill back to committee to report back forthwith, to rescind the money in the stimulus bill that duplicates the Transportation and HUD financing in this bill, except for any funds that have already been obligated, which, obviously, we would go ahead and spend, and, secondly, any money relating to highway construction. That would be totally protected. Beyond that, any duplication in the stimulus bill would be rescinded. It amounts to about $11 billion. I think that is a great savings we can all support. As I said, it does not take a dime out of this bill. I ask for my colleagues' support. I reserve the remainder of my time.

Mr. KYL. Madam President, I have about 12, 13 seconds. As I said, this motion takes absolutely no money from the appropriations bill before us. What it would do is identify about $11 billion in duplicate funding in the stimulus bill and rescind that. So you would not be voting to cut a dime out of this bill if you support my motion.

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

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Wyoming (Mr. Enzi).

Mr. KYL

Mr. KYL. The following Senator is necessarily absent: the Senator from Wyoming (Mr. Enzi).