Pat Roberts

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent to call up amendment No. 4325.

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

Mr. ROBERTS. Mr. President, much like Senator Cardin's amendment, my amendment also recognizes the need to ensure that the youngest in our population have access to health care. My amendment does this by exempting medical devices primarily to be used by or for pediatric patients. The CBO and the Joint Committee on Taxation both confirmed that these excise taxes will not be borne by the medical device industry. The tax will be passed on to patients in the form of higher prices and higher insurance premiums. My amendment prevents this new tax from raising the cost for pediatric medical devices--those devices that treat the youngest in our population, children who have serious or life-threatening illnesses, such as a heart patient or a cancer patient. I urge my colleagues to support the amendment.

Mr. ROBERTS. Mr. President, it is my understanding that we have reached an understanding that this amendment will be a side-by-side amendment to the amendment offered by Senator Cardin. So at the time it would be considered we would have the vote. Mr. President, included in the $\1/2\ trillion of new taxes in the health care reform law is a tax hike of $20 billion on medical devices. That is right. This new law imposes a $20 billion excise tax, a tax of 2.3 percent, on lifesaving medical devices. The nonpartisan Congressional Budget Office and the Joint Committee on Taxation both confirmed that these excise taxes will not be borne by the medical device industry--will not be borne by the medical device industry. Instead, the tax will be passed on to patients in the form of higher prices and higher insurance premiums. Recognizing that this tax, as initially proposed, was unpopular-- because as written it would have increased taxes on medical devices such as eyeglasses and hearing aids--the bill was modified to exclude these and other items that are generally purchased by the general public at retail for individual use. Yet even with these exemptions, patients still bear the burden of this new tax. Here are just a few examples of the people who will be hit by this new tax and the types of devices that will be taxed. People with disabilities, diabetics, amputees, people with cancer, and those with heart problems are just some of the people who will see their health care costs go up because of this tax. During debate on the health care bill, I offered amendments to simply strike this unfair tax. Unfortunately, the majority did not approve these amendments. My amendment today prevents this new tax from raising the costs for pediatric medical devices--those devices that treat the youngest in our population: children who have serious or life- threatening illnesses such as cancer or a heart problem. The amendment exempts from the excise tax medical devices primarily designed to be used by or for pediatric patients. This tax on medical devices is a tax on innovation as well. It harms research and development that leads to medical advancement. It creates an additional burden for medical device manufacturers to develop new products or to redesign them to meet the specific needs of pediatric patients. As the FDA notes on its Web site: Designing pediatric medical devices can be challenging: [Obviously] children are often smaller and more active than adults, body structures and functions change throughout childhood, and children may be long-term device users. With these challenges and other barriers that exist to the development, approval, and availability of pediatric devices, it seems to me--and I think it should be clear to everyone, all of my colleagues--we should not add another barrier by taxing medical device manufacturers who develop and manufacture pediatric devices. Imposing the excise tax on pediatric medical devices will do nothing but slow innovation for these necessary and lifesaving devices. So when innovative and lifesaving technologies are taxed, when the cost of many tests increases because the devices used in the tests are taxed, when new devices are not developed, and when fewer manufacturers are able to survive in the anticompetitive environment this tax will create, the consumers of health care will suffer for it. I urge my colleagues to support this amendment to exempt pediatric medical devices from the excise tax to ensure that the youngest patients who need the lifesaving treatment these devices can offer do not have to pay more for that treatment. This is a step in the right direction to correcting the serious flaws in the health care law. Mr. President, I yield the floor. Mr. President, I suggest the absence of a quorum.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, recently, Leader McConnell and Dr. John Barrasso, the distinguished Senator from Wyoming, and I engaged in a colloquy regarding President Obama's nominee for the head of CMS, the Centers for Medicare Services, Dr. Donald Berwick. Simply put, Dr. Berwick has a long history of interesting statements--pertinent statements--that support government rationing of health care, an issue I have vigorously fought against throughout the entire health care debate. The White House response to our colloquy, it seems to me, was most unfortunate, if not rather incredible. Here is what the Obama administration had to say: No one is surprised that Republicans plan to use this confirmation process to trot out the same arguments and scare tactics they hoped would block health insurance reform. The fact is, rationing is rampant in the system today, as insurers make arbitrary decisions about who can get the care that they need. Dr. Don Berwick wants to see a system in which those decisions are transparent--and that the people who make them are held accountable. This is a fascinating response. Instead of flatout denials of government rationing, we have excuses. If you read between the lines, you will notice that for the first time ever in this debate, the Obama White House is admitting their health care plan will ration health care. It just doesn't make it transparent. Remember, when Republicans, such as myself and Jon Kyl and Dr. Coburn, the Senator from Oklahoma, tried to warn that health care reform would result in government-rationed care, we were dismissed as crazy reactionaries or even worse. President Obama accused us of trying to scare people, and no less than the American Association of Retired Persons, AARP--that organization that purports to represent Medicare patients and seniors all across our great Nation--said our rationing concerns were a mere ``myth''--that ``none of the health care reforms . . . would stand between individuals and their doctors or prevent any American from choosing the best possible care.'' How interesting that now, after the health care bill has become law, the President is admitting we were right all along. Here is the quote: Don Berwick wants to see a system in which those [rationing] decisions are transparent--and that the people who make them are held accountable. That is a complete and utter about-face. Although cloaked in the typical straw man arguments that have come to characterize this administration, the statement is undeniable. The government is going to ration your health care. To set the record straight, I don't accept rationing, whether it be transparent or otherwise. I am opposed to rationing whether it is done by the government or by an insurance company. I am not defending any of the practices of insurance companies that have unjustly denied claims. I am against rationing whether it is proposed by Republicans or Democrats or think tanks or the special interest sidelines in this city. But the Obama administration's response does nothing to address my concerns that our government will ration health care. Instead, we finally have an admission from the White House that this is what they plan to do. I am not holding my breath for an apology or a correction from the President or the AARP or any of the other organizations that demonized our concerns for the past year. But I do intend to ask some very tough questions of Dr. Berwick, the President's pick to implement and enforce literally thousands of regulations that will soon come pouring out of the Department of Health and Human Services, and that will inevitably include rationing. It is nothing personal, as I have said before. I have met Dr. Berwick. He is a very personable, affable, intelligent man. I don't doubt that he has support from his peers who know him. I am not questioning his honor or his motives or his love for this country. As an aside, I would appreciate it--and I know a lot of other Members of this body would as well--if the White House extended the same courtesy to me and, for that matter, anybody else raising serious policy questions. But we have a fundamental disagreement about the future of our health care delivery system. I happen to think it is important that we have this conversation so the American people can understand what is going on. Please quit attacking my motives and the motives of others. Accentuate the policy, eliminate the politics, and don't mess with those in between raising reasonable questions. That is an old song that rather dates me, but I think it is appropriate. Questions such as this: What did Dr. Berwick mean when he said: I am a romantic about the [British] National Health Service; I love it. All I need to do to rediscover the romance is to look at the health care in my own country. So he is both romantic and supportive of the British National Health Service. With cancer survival rates for women 10 percentage points higher in the United States than in England and over 20 points higher for men, why does he think their government-run system is superior to our system? Please explain this quote: If I could wave a magic wand . . . health care [would be] a common good--single payer . . . health care [would be] a human right--universality is a nonnegotiable starting place . . . justice [would be] a prerequisite to health equity as a primary goal. While that may sound very nice, very idealistic, the reality is, declaring health care to be a human right necessarily places some citizens' rights above others--suppressing the rights of some in favor of another government-favored group. If you are saying health care is a universal right, what you are essentially saying is that some people have a right to someone else's property, whether that be taxable income or doctor services or their health care. I disagree with this argument. Health care has become an entitlement for some in this country, but it cannot be properly described as a right without egregious government coercion and income redistribution and patient care consequences. But maybe that is OK with Dr. Berwick. After all, he did say that ``any health care funding plan that is just, equitable, civilized, and humane must--must--redistribute wealth from the richer among us to the poorest and less fortunate.'' I want to hear more from Dr. Berwick on this point. Furthermore, what did he mean when he said that ``equity'' is a necessary component of ``quality''? Does that mean high-quality care should not be available unless it is available to all? This certainly seems to square with the United Kingdom's practice of delaying access to the latest breakthrough drugs and technologies because of their high costs. What does Dr. Berwick think this attitude will do to investments and innovations in lifesaving treatments? And what about this quote: Limited resources require decisions about who will have access to care and the extent of their coverage. The complexity and cost of health care delivery systems may set up a tension between what is good for the society as a whole and what is best for an individual patient . . . Hence, those working in health care delivery may be faced with situations in which it seems that the best course is to manipulate the flawed system for the benefit of a specific patient . . . rather than to work to improve the delivery of care of all. Is this a suggestion that it is a doctor's duty to concentrate on the good of society or the good of his or her patient? That certainly sounds like a proponent of socialized medicine to me. I use that word very carefully. Finally, this is a question about the following statement by Dr. Berwick: Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been around for centuries. That is an amazing statement. I know Dr. Berwick is familiar with the Liverpool Care Pathway to death that is employed in the British health care system and its reliance on morphine and counseling. He should also be aware of the growing concerns of many British doctors that this so- called pathway to death is being overused for patients who would have otherwise recovered, especially stroke patients. Is this what is being advocated for the American health care system? For Medicare patients? This certainly sounds like the ``death panels'' that became so roundly ridiculed and dismissed by ObamaCare supporters during last year's debate. I know that ``socialized medicine'' and ``death panels'' have become loaded terms. I understand that. But if that is what you are for, you should just say so. Don't be afraid to have this discussion. Dr. Berwick certainly has not been shy about his views in the past. Maybe this is a comment more appropriately directed at the administration than at Dr. Berwick, but do not hide behind straw men and name-calling of those who disagree with you. I have legitimate concerns--many of us have legitimate concerns-- about the direction we are taking in this country with particular regard to health care. The thousands of people in Kansas who have contacted me over the last year have very legitimate concerns, too, and if you do not think I deserve some answers, they certainly do. The American people are sick and tired of being told that they are crazy or racist or that they do not know what they are talking about or being misled or that any question raised is simply partisan politics. Promise after promise has been broken, from the pledge not to raise taxes to the promise that if you like what you have you can keep it, to the falsehood that this new law does not cut Medicare. And remember the one about lowering premiums. The list goes on and on. Now it is beyond a shadow of a doubt that the law will ration health care. I think we are duty-bound to hold this administration and its nominees accountable for these broken promises and for what lies ahead for patient care. That is why I will continue to ask the hard questions that need to be asked of this nominee. I will continue to fight against what I truly believe is government rationing of health care. I did so on the HELP Committee when we considered it, the Finance Committee when we considered it, and during the reconciliation process when we considered it. All, of course, were defeated by party-line votes. And I will continue to maintain that the American health care system, with all of its flaws, is the best health care system in the world. We need to fix the flaws. We do not need rationing. In the case of Dr. Berwick, we need answers. I yield the floor. It appears to me there is not a quorum, so I suggest the absence of a quorum.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that I may be recognized for 15 minutes.

Mr. ROBERTS

Mr. ROBERTS. If the distinguished Republican leader will yield, I will be happy to respond. First, I thank the distinguished leader and the doc from Wyoming, who is always bringing forward new and important information about the health care bill and some of the problems that we are experiencing with it, for allowing me to join in this colloquy. We are talking about President Obama's nominee to be administrator of the Centers for Medicare and Medicaid Service--CMS is the acronym. Rest assured, every health care provider in America knows about CMS, and the nominee is Dr. Donald Berwick. I just met with Dr. Berwick and had an opportunity to hear some of his thoughts on the direction he thinks American health care, and particularly Medicare and Medicaid, should take. He is a very affable, friendly doctor from Connecticut. He has a wide background in terms of health care. I have also been reading up on Dr. Berwick, who has a prolific record of statements and speeches and books that further lay out his ideas for the future of health care. I recommend everyone within the health care industry and every health care consumer get hold of these speeches and these statements and, if possible books and read them. Here is what I have learned. Dr. Berwick, I would tell the distinguished Republican leader, is a huge fan, a major champion, and a contributor to the British national health care system called NHS. As a matter of fact, I have a quote of Dr. Berwick regarding the NHS. I am romantic about the National Health Service; I love it. The NHS is not just a national treasure; it is a global treasure. Well, I understand that people become very passionate about their jobs, but romantic seems to me a little unique, but we will let that go. Now, why is this important? Because the NHS rations health care. The NHS denies and delays patient access to therapies in regard to breast cancer, Alzheimer's, multiple sclerosis, kidney cancer, macular degeneration--this happens to be my favorite example: patients required to go blind in one eye first before they get treatment for the other eye--and brain tumors. A patient group coalition called the group that rations health care in Great Britain unfair and unacceptable. The quote by Dr. Berwick is: The decision is not whether or not we will ration health care--the decision is whether we will ration with our eyes open. Consequently, I think the good Senator from Wyoming has something to say about that in regard to rationing health care and the British system.

Mr. ROBERTS. If the leader will yield, it is one thing to use the British health care system and be romantic about it, to quote Dr. Berwick, as an example for rationing, for practicing health care cost containment. It is another thing to do it by age, which is happening. But it is rationing by region, which the leader has pointed out and Dr. Barrasso has pointed out, that should strike fear in the hearts of any person living in any rural area in the country. His tenet for modernizing the American health system is reducing what he calls ``the oversupply of inventory.'' That is how he defines it. Dr. Berwick's oversupply of inventory is, in truth, the rural patients' lifeline. I know Dr. Barrasso understands that. As the leader has said, in Kentucky--well, in Kansas, demanding a patient in Kansas drive 200 or 300 miles to Wichita or Kansas City or Denver so their infant can get proper care is ridiculous. I can foresee a time when the rural health care system will consist of a bandaid and a bed pan. Dr. Berwick is the perfect nominee for a President whose aim has always been to save money by rationing health care. I would like to add, at this particular time, in addition to the rationing the good doctor talked about, the national health system in Great Britain utilizes an end-of-life pathway to death; an end-of-life pathway to death--that is a shocking description--that many British doctors say leads to premature death in patients who could have otherwise recovered. To say that is noteworthy is unjust. It is egregious. Dr. Berwick's ideas on end-of-life care seem to mirror this death pathway. The quote is: ``Most people who have serious pain do not need advanced methods; they just need the morphine and the counseling that have been around for centuries.'' This is a rather stunning statement, it seems to me. But it is very similar to President Obama's remarks about the elderly approaching the end of their life. The President has said that as you get older, ``maybe you're better off not having the surgery, but taking the shots and the pain killer.'' The only thing missing in that is the walker. Consequently, he has also remarked that ``the chronically ill and those towards the end of their life are accounting for 80 percent of the total health care bill out here.'' We know that. ``[T]here is going to have to be a very difficult democratic conversation that takes place.'' That is the end of the quote by the President. It sounds like this ``difficult democratic conversation'' has already happened in the United Kingdom and that their pathway-to-death solution mirrors Dr. Berwick's and President Obama's ideas exactly. But age rationing, as has been indicated, is not the only way to do it, as the leader has pointed out. We have regional discrimination as well.

Mr. ROBERTS. I say to the leader, this isn't anything new. Dr. Barrasso has been predicting this for some time. Those of us on the Finance Committee and the Health committee, we got a double dose. During the health care debate, we tried to warn of the ``four rationers'' that were embedded in the bill. That is what we called them. I made several statements on them. We have: the Patient-Centered Outcomes Research Institute, the Independent Payment Advisory Board, the CMS Innovation Center, and the U.S. Preventive Services Task Force. Dr. Berwick was actually the vice chair of the U.S. Preventive Services Task Force until 1996. You may remember this, as Dr. Barrasso pointed out, this was the body that recently ignited a firestorm by recommending that women wait until age 50 before they receive a mammogram. That certainly angered many doctors in America, and whoever said that beat a hasty retreat. We also warned that ObamaCare, I say to the leader and my friend from Wyoming, will result in higher costs, not lower, a prediction not only by the CBO but by the bravest man in America, CMS expert, Richard Foster, who--it is amazing to me that he is still on the job, thank goodness. He recently backed all that up, in terms of higher premiums, higher cost, rationing, access to doctors by the elderly, and has renewed his warning time and time again. Now our predictions are coming true and President Obama's CMS nominee, Dr. Berwick, will be the man who cuts health care costs by putting the rationing plans into practice. We will call it cost containment, but it will be rationing. I hope my colleagues will join me in carefully reviewing the statements and the speeches and the books and everything else that good Dr. Berwick has stated in the last 30 years on rationing. I think if we do that, most of us will agree he is the wrong man, wrong time, wrong job. I thank the leader and the good doctor for allowing me to join in this colloquy.

Mr. ROBERTS

Mr. ROBERTS. I am very privileged to represent the State of Kansas.

Mr. ROBERTS. Nebraska is fine, but they----

Mr. ROBERTS. I mean, their football teams are a completely different----

Mr. ROBERTS. So it is Kansas.

Mr. ROBERTS. I appreciate it.

Mr. ROBERTS. Mr. President, I understand I have 10 minutes in which to make my remarks. Is that correct?

Mr. ROBERTS. I appreciate that. Over the past 2 years, Americans have seen an unprecedented government reach into the private sector, some of which may be necessary. They are angry about it, as they should be. For many, the overreach of government began with the bank bailout or TARP. The $700 billion TARP that I opposed was passed in the fall of 2008 when every day we awoke to see a new financial crisis headlining the front page. TARP was initially intended to purchase troubled assets and get them off the books of the troubled banks. Yet, over time, the program evolved into a fund--some would call it a slush fund--to include bailouts for the auto industry and the housing market. The term ``bailout'' will never be the same again. I think the American people are right to demand that they are never again put on the hook to bail out a failed company. They are right to demand that those who got us into the financial mess not be allowed to do so again. Unfortunately, the financial regulatory reform bill that the Senate is set to take up and debate does not achieve these goals. I know both sides are now involved in discussions, and the next 48 hours are going to be absolutely crucial to determine if, in fact, we can get a bipartisan bill. But with any business, if it is mismanaged, if its leaders make poor decisions, the business should be allowed to fail. Success and failure have, until recently, been the cornerstone of what has made our economy one of the strongest in the world. The bailouts of financial and auto companies have turned that philosophy on its head. I think it is a dangerous road to go down. We need to set a new course. It is what the American people want. This bill does not end bailouts. Instead, it allows some of the largest financial institutions to contribute to a bailout fund, to be used if a company were again to fail. Well, this does nothing to deter companies from taking risks that could lead to failure and the need for a future bailout. In fact, it sends a signal that the government will bail out institutions, just as it bailed out Fannie Mae and Freddie Mac, the two troubled mortgage giants that have received $125.9 billion, might as well make it $126 billion, in direct government funding and now have an unlimited U.S. credit line. Yet there is no mention, no mention, of Fannie Mae or Freddie Mac in this bill. Failure to deal with Fannie Mae and Freddie Mac keeps taxpayers on the hook for more bailouts of these entities. The bill also allows the FDIC and the Federal Reserve to come to the aid of failing financial firms, which means that financial markets will be fully aware of the government's authority and inclination to prop up large failed financial institutions. The very existence of this authority undercuts the claim that the government will actually ever wind up with such firms. Those firms, along with their creditors and shareholders, will take more risks and, yes, put the financial system into even greater danger. There has also been much attention paid to the creation of something called a Bureau of Consumer Financial Protection, BCFP. I would hate to try to pronounce that acronym. This sounds like a good idea at first. We all want, everyone in this Senate wants, to ensure strong consumer financial protection. That is not the issue. Yet, rather than working with regulators to strengthen existing consumer protection rules and crack down on unfair deceptive and abusive practices, this provision adds another layer of bureaucracy and financial regulation that will ultimately be harmful for consumers, and I mean all consumers, by raising their costs for financial products, and eliminating the types of financial products and services that are available to choose from. Not only that, this bill increases the regulatory burden for banks, including our community banks, that are already subject to 1,700 pages of regulations in the consumer area alone. Under this bill, our community banks would have to comply with an additional 27 new or expanded regulations, including new burdens on small business loans. No telling how many pages these new regulations will add or how much they will increase the cost of lending to small business. Finally, this bill harms the very innovation and entrepreneurship that has made our country so successful and created one of the strongest economies in the world. It does this by limiting the ability of small startup companies to raise seed capital. Currently, angel investors--that is quite a name--but angel investors, those higher income individuals who wish to invest in a promising startup company, to take the risk, must have a net worth of at least $1 million or income of $250,000. This bill increases those requirements to $2.3 million and $450,000, respectively. Estimates are that this provision, along with a provision in the bill that would subject startups and investors to 50 different sets of State regulations, would disqualify about 77 percent of current investors. In 2007, these individuals invested $26 billion in more than 57,000 ventures across the country. We are talking about companies such as Amazon, Google, Facebook. All benefitted from angel investors. Yet this bill makes it harder for promising young companies to get the capital they need to get started to grow and become successful. At a time when the unemployment rate is 9.7 percent, I think the last thing Congress should do is to make it more difficult for small businesses to start up and be successful. Small businesses are, as the President has acknowledged, the leading job creators in the country. Everyone--everyone--all of us agree we need better regulation of our financial system. However, the financial regulatory reform bill that came out of the Banking Committee does not achieve that goal. I dearly hope the chairman of the committee and the ranking member can reach some accommodation to produce a better product. It does not address the problems, as written, that led to the financial turmoil but, instead, imposes additional regulatory burdens on our community banks and financial institutions that did not contribute to that turmoil. It does not discourage risk taking by large financial institutions. It does nothing--nothing--to address Fannie Mae or Freddie Mac, which had a central role in the collapse of the housing markets that helped trigger the financial crisis. It does not ensure that taxpayers never again have to bail out a failed company. However, it does increase the Federal bureaucracy and make it more difficult and costly for consumers to obtain credit for their families and small businesses. This approach will not benefit consumers or community banks or our economy. We need to work to improve this bill. It is vital for our economy we get it right when addressing financial regulatory reform because the consequences will be seen for years--for years--to come. I yield the floor.

Mr. ROBERTS. Madam President, will the chairman yield for a second?

Mr. ROBERTS

Mr. ROBERTS. Madam President, each of us privileged to serve in this Chamber knows that the Senate and each of our offices could not operate successfully without the assistance of talented and dedicated staff. One former Senator who certainly knew this was my fellow Kansan, Bob Dole. During his nearly 35 years in the House and Senate--and most especially during his decade as Senate Republican Leader--Bob was ably assisted by some of Capitol Hill's best and brightest. One of those individuals was Jim Whittinghill, who many of my colleagues will remember from his years as Bob's deputy chief of staff. Jim passed away on Thursday. I have been in contact with Senator Dole since learning of Jim's passing, and he asked me to enter the following statement in the Congressional Record: Jim Whittinghill--or ``Whit'' as his friends called him-- and he had many--worked with me during my time as Senate Republican leader from 1986 until 1994 in a series of positions, including Deputy Chief of Staff. Whit was a top flight staffer who provided me with counsel on a wide variety of issues, including 2nd amendment rights and energy. He was a proud Republican, but he was respected on both sides of the aisle. Democrat Senators and staffers knew that Whit's word was his bond, and he was very influential and helpful in reaching bi-partisan agreements. After his years on Capitol Hill, Whit went on to have a very successful career in the private sector. He will be greatly missed by all those who worked with him. On a personal note, let me add that I was in the House of Representatives when Whit was working for Bob, and I agree with all that Bob said about him. I know I join with many others in this Chamber who knew Whit in extending our condolences to his family and friends.

Mr. ROBERTS

Mr. ROBERTS. Thank you, Mr. President. This motion commits the bill back to the Finance Committee with instructions to repeal ``the four rationers'' of health care reform. These four horsemen of the rationing apocalypse are the Patient Center Outcomes Research Institute, already conducting research that will be used to deny coverage and ration care; the CMS Innovation Center, which will grant new powers to CMS--that should be a pleasant thought by any beleaguered hospital administrator--the U.S. Preventive Services Task Force, which is given new powers--that is the outfit that said women should not have mammograms until age 50--wonderful--and the Independent Payment Advisory Board, vested with extraordinary power to set Medicare payment rates and make policy decisions. These rationers comprise the infrastructure for the ``Brave New World'' of big government intrusion into health care decisions of all Americans, and they must be repealed. Start over. Put patient care first. Get them back in the corral. Support the amendment.

Mr. ROBERTS. Mr. President, this amendment protects the rural health care delivery system by exempting critical access hospitals from dangerous payment cuts by the Independent Payment Advisory Board. This board is an unelected and unaccountable body, nefarious to be sure, with unprecedented power to set payment rates and make other Medicare policy changes. While most hospitals are exempt from the board's cuts by virtue of the special deals they cut with the administration--for shame--critical access hospitals, which are among the most vulnerable in the country, are not exempt. I do not know why critical access hospitals were let out of this exemption--perhaps a drafting error; I do not know--but I can think of no other more deserving providers than critical access hospitals throughout our rural areas--in Montana and in Kansas--to be spared from the Independent Payment Advisory Board's cuts. Save the rural health care delivery system.

Mr. ROBERTS. Surely, you are not going to raise a point of order?

Mr. ROBERTS. I ask consent to call up Roberts-Inhofe-Brown amendment No. 3579, and I ask unanimous consent Senator Crapo be added as cosponsor.

Mr. ROBERTS. I ask unanimous consent the reading of the amendment be dispensed with.

Mr. ROBERTS. Mr. President, I take it the chairman has raised the point of order, so we are at regular order.

Mr. ROBERTS. I thank the Senator. Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974 and section 4(g)(3) of the statutory Pay-As-You-Go-Act of 2010, I move to waive all applicable sections of those acts and applicable budget resolutions for purposes of my amendment in saving rural hospitals, and I ask for the yeas and nays.