Pat Roberts

Mr. ROBERTS

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. ROBERTS. Parliamentary inquiry, Mr. President.

Mr. ROBERTS. I will try it again. I thought it was worked out. I ask unanimous consent for the second time that the order for the quorum call be rescinded so I may be--

Mr. ROBERTS

Mr. ROBERTS. Madam President, I understand I am recognized for 15 minutes; is that correct?

Mr. ROBERTS. Madam President, I understand the distinguished Senator from Michigan wishes to attend the very important Democratic conference on a brand new health care bill. I understand that, and I shall try to expedite my remarks, only with the suggestion to the Presiding Officer that when you are late in the Senate, you are early, and they are not going to say anything important without you. I wish to yield at this time to the distinguished Senator from Georgia, who I understand has a statement to make.

Mr. ROBERTS. Madam President, President Obama has repeatedly made two pledgees to the American people--and we have heard it and heard it before, and we will probably hear it again--about health care reform. The first is, if you like the health care you have, you can keep it. We know the bill before us breaks this pledge because all but two in the majority voted to preserve the nearly $500 billion in cuts to Medicare, which includes $120 billion in cuts to Medicare Advantage. The nonpartisan Congressional Budget Office, or CBO, has confirmed that these cuts to Medicare Advantage mean that ``approximately half'' of the Medicare Advantage benefits will be cut for the nearly 11 million seniors who are enrolled in this program. This vote confirms whether Americans will be able to preserve and keep the health care benefits they have and like. That answer, unfortunately, is no. So now let's look at the President's second pledge: that he will not raise taxes on families earning under $250,000 or individuals earning under $200,000. A number of my colleagues have pointed to comments made last year in Dover, NH, by then-Candidate Obama, who said: I can make a firm pledge-- And we have heard this before-- . . . no family making less than $250,000 will see their taxes increase--not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes. I think he said ``by one dime'' at the end of that. Yet time and again in this bill, that pledge is also broken. This bill calls for nearly $500 billion in new taxes, penalties, and fees that hit virtually every American, including middle-class families making less than $250,000 and individuals earning less than $200,000. Even though the majority has tried to disguise these taxes as various ``fees'' and presents them as being paid for by targeted health care industries, the reality is that this bill taxes the average American coming and going. It taxes you if you have health insurance. It taxes you if you do not have health insurance. It taxes you if you use medical devices, such as a hearing aid or a pacemaker. It taxes you if you save on your own to pay for your health care expenses. And it effectively increases taxes for individuals and families with catastrophic medical expenses. Americans should understand that the higher taxes called for in this bill will come straight out of their pockets, with the middle class bearing much of this tax burden. Let me give you a few examples of the new taxes proposed and who will pay for them. The bill imposes a 40-percent excise tax on health insurance providers that offer high-cost health insurance plans. This provision is the largest tax hike in the bill and raises almost $150 billion and will be paid for primarily by individuals--not the health insurance provider, but by individuals--through increased income and payroll taxes. By the time this bill is fully implemented, 84 percent of this tax on ``high-cost plans'' will be paid by Americans who earn less than $200,000--taxpayers the President promised would not pay additional taxes. Second, the bill imposes new taxes on health insurance providers and medical device manufacturers. Both the nonpartisan Congressional Budget Office and Joint Committee on Taxation have said these taxes will be passed on to consumers in the form of higher insurance premiums. The new $60 billion tax on health insurance providers alone could raise premiums by as much as 2 percent according to some analyses, and that increase could come as early as next year. Not only that, the $19.3 billion in new taxes on medical devices could increase costs for up to 80,000 medical products, such as heart stents, blood pressure monitors, eyeglasses, pacemakers, hearing aids, and advanced diagnostic equipment. Such a tax would stifle and will stifle innovation and reduce the ability for manufacturers to develop new lifesaving devices and technologies. So make no mistake, the cost of this tax will be passed on to and paid for by anyone who uses a medical device, including those middle- class taxpayers the President has pledged will not experience any tax increase. If you need a pacemaker or a stent, you will pay more for it because of these new taxes. If you need a diagnostic procedure, you will pay more for it because of this new tax. Furthermore, under this bill, the floor for deducting medical expenses from income tax is raised from 7.5 percent to 10 percent of adjusted gross income. Those who will take this deduction are most often seniors and those with serious or catastrophic medical issues. For a family of four, earning $57,000 in 2013, limiting the deduction means they would lose a tax deduction of $1,425. A family of four earning $92,000 would lose a tax deduction of $2,300. It goes without saying, I think, that losing a portion of your tax deduction means you pay more in taxes. These are real dollars to hard- working Americans. This provision alone raises $15 billion in new taxes on Americans who deduct medical expenses. Finally, this bill raises taxes for the more than 35 million Americans who participate in flexible spending accounts, or FSAs. For the first time, this benefit to middle-income workers is taxed to pay for new government spending and an expansion of entitlement programs. FSAs are a key benefit for many families for whom health insurance does not cover or does not cover sufficiently some of their highest cost health care expenses such as dental, vision, as well as prescription drug costs. They are also important for individuals who manage chronic diseases such as diabetes, heart disease, or cancer. Flexible savings accounts allow the participants to set aside money out of their own pocket to pay for these necessary expenses. However, under this bill, the government caps how much can be set aside in an FSA account at $2,500, effectively raising the tax burden on certain FSA participants and increasing their health care costs. The typical worker who contributes more that $2,500 to their FSA has a serious medical condition. This means that under this bill, workers with serious illnesses and earning an average of $55,000 will be paying more in taxes. I have highlighted a few of the many tax hikes in this bill and the fact that the middle-class taxpayers will bear the brunt of these higher taxes, but if there are any doubts remaining about what this bill means for Americans' pocketbooks, let's consider this. An analysis by the nonpartisan Joint Committee on Taxation looked at four tax provisions in the bill and how, when taken together, they will affect Americans. They looked at the tax credit for health insurance, the additional Medicare payroll tax, and several I have already mentioned, including the high-cost plan tax and the medical expense deduction limit. Their analysis shows that when this bill is in full effect, on average individuals making over $50,000 and families making over $75,000 would see their taxes go up under this bill. Even after taking into account the premium tax credit, the subsidy that the government will provide to help people offset the cost of health insurance, when this bill is fully in effect, more than 42 million individuals and families or 25 percent--one-quarter of all tax returns under $200,000--will see on average their taxes go up as a result of this bill. In addition, based on the same information, the Joint Committee on Taxation identified two groups of taxpayers. The first are those individuals and families who are not eligible to receive the premium tax credit to purchase health care, and second are those individuals and families whose taxes will increase first before they then see some type of tax reduction as a result of their premium tax credit. Taking these two groups together, the number is even more disturbing: 73 million individuals and families or 43 percent of all tax returns under $200,000 will on average see their taxes increase under this bill, says the Joint Committee on Taxation. To put it another way, under this bill, for every one individual or family that benefits from the tax credit to purchase insurance, this bill raises taxes on three middle-income individuals and families. These tax increases are on top of those I discussed earlier, such as the new taxes on FSAs, so the estimates I have already mentioned understate the tax impact, again, on middle-income taxpayers. The JCT the Joint Committee on Taxation--has confirmed that these additional taxes, such as the FSA tax, will likely further raise the taxes of middle-income Americans. All Americans, and middle-class taxpayers especially, need to take notice of what these higher taxes will mean for them and their families. They need to know these taxes will be used in part to pay for a vast expansion of the role of government in health care and more government intrusion into families health care choices. Paying for health care on the backs of the middle-class and working Americans is the wrong solution for health care, violates the President's pledge to these taxpayers, and is terribly counterproductive in regard to the No. 1 issue facing this country, and that is jobs and the economy. I urge my colleagues--I plead with my colleagues--to support the Crapo motion to prevent the enormous tax hike this bill inflicts on middle-class Americans. Mr. President, I appreciate your indulgence. I know you are ready to go to your conference. I yield the floor. The PRESIDING OFFICER (Mr. Nelson of Florida.) The majority leader is recognized.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I rise today in support of the motion of my good friend from Nebraska, my colleague from Nebraska, Senator Johanns to--the official words say: to commit the bill back to the Senate Finance Committee with instructions to strike the cuts to the Medicare home health care benefit. What the distinguished Senator is trying to do is bring some common sense to the cuts to a very vital source of health care, not only to rural areas but all over this country, and that is home health care. The bill we are considering, the bill sometimes called the ``behind closed doors'' bill, would cut home health care by $42 billion. The Senator from Nebraska says that is a head-scratcher, and it certainly is. It is more than a head scratcher; it is a Lizzie Borden amputation in regard to a vital program. Home health care is critical for our seniors. Obviously, that is the truth. As the cochair of the Senate Rural Health Care Caucus, I certainly understand that. So does the Senator from Nebraska. He was saying yesterday how many times he visits his rural hospitals, rural clinics, rural hospices, and you do that a lot if you are from Nebraska or Iowa or Texas or Kansas. At any rate, in my home State of Kansas and other rural areas, many seniors live alone or out in the country miles away from a local hospital or a doctor's office. Even if they have a very good doctor, they can't get there because of their health condition. So home health care allows those seniors the freedom and the independence to stay in their home in the comfort of knowing somebody is there assisting their health care needs. More importantly, home health care is the cost- effective care, as the Senator from Nebraska has pointed out, that keeps the senior out of a nursing home or hospital and--guess what-- saves the government money. Over the long term, if you cut home health care, you are going to increase the cost in regard to nursing homes, no question about it. In my State I have had the pleasure of being able to see firsthand, as has the Senator from Nebraska, the great work our Kansas Home Health Care Association members do every day. Last year I was invited into the home of a lovely couple in Concordia, KS, America, not too far from Nebraska, and despite having multiple health issues, Duane and Phyllis were able to stay in their home with their little dog Josie, all thanks to the services provided by a home health care aide and a home nurse. What is going to happen to seniors such as Duane and Phyllis if we slash $42 billion from home health care payments? Forty-two billion dollars is one of the largest Medicare cuts in the whole bill next to Medicare Advantage and the hospitals. The Senator from Nebraska had that chart showing serious cuts to all of our providers. Don't forget that this cut comes on the heels of several years of additional cuts to home health care--around $35 billion all told--that already have a large percentage of Kansas home health care agencies operating at very slim or negative Medicare margins. I know the same is true in Iowa, and the same is true in Texas, in Montana, in Nebraska, and all over the country. I keep hearing my colleagues, however, on the other side of the aisle insisting that their $\1/2\ trillion cut to all Medicare--here is the quote--``won't affect the benefits guaranteed to seniors.'' Please stop that. Please stop that. That is the most disingenuous smokescreen in this whole debate. It may be true that this bill does not explicitly cut benefits. My friends across the aisle, however, cannot deny that their cuts in reimbursements to providers will affect those benefits, because when you cut the reimbursements to providers, guess who pays the price. The patients--Duane and Phyllis and their little dog Josie. I tell you what. You come to their house and you make that argument that if you close down or make cuts to home health care, Duane is not going to like it, Phyllis is not going to like it, and Josie will bite you on your leg. As I said, many of my Kansas home health care agencies are already operating at negative margins. Their projected share of these cuts, as provided by the distinguished Senator from Nebraska, is almost $240 million. To the Senator from Montana, the distinguished chairman of the Finance Committee, my dear friend, that is $60 million in Montana; and Nevada, where the distinguished majority leader lives, the chart that has been provided to me by the Senator, $263 million. We have Senator Cornyn sitting right behind me here. Senator Cornyn, you are in the $6.8 billion category for Texas. I might ask the Senator, What is going to happen if you get cut $6.8 billion in regard to home health care service?

Mr. ROBERTS. I thank the Senator. The Senator from Nebraska has already pointed out what happens in Nebraska, and I know what will happen in Kansas. Nearly two-thirds of Kansas home health care agencies will have negative margins within only 5 years, probably 2 or 3, if these cuts are allowed to occur. How are these agencies supposed to stay in business with these kinds of cuts? The home health care benefit will be worthless to a Kansas Medicare patient whose home health care agencies will go out of business. So, yes, in fact, this bill will effectively cut benefits. Again, get rid of the smokescreen. This doesn't apply just to the home health care benefit. The same can be said for the effect of the cuts, as demonstrated by the Senator from Nebraska, for reimbursements to hospitals. This bill is going to cost the Kansas Hospital Association $1.5 billion. They have some outside experts who came in. I asked them: What is going to be the effect of the cuts? They already have cuts. They only get reimbursed 70 percent now, and $1.5 billion on top of that. We ought to have a chart--and I am sure we will have a chart--that would show Iowa or Nebraska or any State here, Texas especially, because of the number of folks there. So hospitals, hospices, skilled nursing facilities, and all of the rest. I want every senior to know that while maybe it is technically accurate, again, for my friends across the aisle to claim this bill doesn't cut Medicare benefits, there is no way--no way--you can slash $\1/2\ trillion from payments to providers without affecting their ability to keep their door open, especially in rural and small town America. Seniors should know they will be left with a worthless benefit. To paraphrase my friend Senator Alexander from Tennessee, it would be like having a bus ticket without a bus. Thank you, Senator Johanns. Thank you for the work you are doing. Thank you for this motion. I hope we are successful. I hope people will wake up and understand the severity of what these cuts will do. I urge every Member of this Senate to support Senator Johanns when we come to a vote on this issue. Thank you, Mr. President. I yield the floor.

Mr. ROBERTS. We could go back and back, sir--I do not care--and then forth and forth.

Mr. ROBERTS. There is no ``forth.''

Mr. ROBERTS. There is no ``forth,'' Mr. Chairman.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I thank the distinguished Senator from Montana and my chairman of the Finance Committee. Let me say first to the Senators from Washington State that I think all Senators appreciate both Senators bringing to the attention of the Senate the heartfelt feelings in regard to the tragedy that happened in their State. I share their dismay with regard to what has happened. I know the thoughts and prayers of all Senators are with them. I appreciate the remarks they have brought to the body at this time. I would now like to discuss briefly the motion to commit in regard to Medicare and the tremendous cuts that are proposed in the bill--a bill I define not as the Finance Committee bill, not as the HELP Committee bill, but the bill that was done behind closed doors, which I think was most unfortunate. This bill slashes--and I think that is the appropriate word--nearly $\1/2\ trillion from Medicare. Then it is used to establish a huge new government entitlement program. Earlier this year during the Finance Committee markup of the health care reform legislation, I offered a nearly identical amendment to the McCain motion to commit we are now considering, which is a motion simply to send the legislation back to the Finance Committee with instructions to strike the cuts to Medicare in this bill. Unfortunately, my amendment during that time failed in committee on a party-line vote. Let me see if I understand this correctly. Medicare is going broke. It has around $38 trillion in projected future unfunded liabilities. It is a huge, crushing entitlement program that threatens to bankrupt this country. But instead of owning up to this enormous threat and doing something about it for our financial future, instead of considering a Medicare reform bill to address this menace to future generations of Americans, instead of guaranteeing that the government-run plan we currently have remains solvent, instead we are actually cutting some $465 billion from Medicare in order to start a brandnew, huge, crushing entitlement program that makes no sense. If Medicare needs to be reformed--and I certainly believe it does-- then we should be considering a Medicare reform bill right now. We certainly should not be cutting Medicare for the purpose of financing a huge new entitlement program. My friends on the other side of the aisle have the temerity--that is a pretty strong word, but I think it applies--to assert these huge cuts will actually make Medicare more solvent. Nothing could be further from the truth. I have news for them. Cutting reimbursements to doctors, cutting reimbursements to hospitals and other providers--all providers--and it has been mentioned by my distinguished colleague from Nebraska--home health care providers, hospices is not reform. These cuts will hurt Medicare beneficiaries, our seniors who have worked their entire lives with the promise that this program would support them through their older age. Medicare already pays doctors and hospitals well below cost--70 percent approximately for hospitals, 80 percent for doctors approximately. The only saving grace is that these providers have the ability to shift their losses on to private payers to keep their doors open or their practices going. But there is a limit to their ability to cost shift. There is only so much the private sector is willing to absorb. American families already pay--now get this--an extra $90 billion in a hidden tax to make up the Medicare and Medicaid underpayments that we in past years have provided each year. More cuts to reimbursements coupled with the massive increase to Medicaid this bill assumes will push these limits, meaning that fewer doctors will open their doors to new Medicare patients. They are doing that right now. We are rationing right now as to access to doctors who accept Medicare patients, and health care access and quality for our seniors will be compromised. Take the $105.5 billion cut to hospitals as an example. I know the National Hospital Organization has signed off on these cuts. I don't know why, but they have signed off on these cuts. I also know for a fact they will harm Kansas hospitals. I asked my Kansas Hospital Association--I did, at my request--to run the numbers on how this bill will affect their bottom lines. Their findings are frightening. According to the Kansas Hospital Association's outside experts, this bill will result in nearly $1.5 billion in losses to Kansas hospitals over the next 10 years. It may be true that some urban hospitals that currently have large percentages of uninsured patients may have some of their cuts offset by the potential reduction this bill will make to the uninsured population. But that is no consolation to a hospital in McPherson, KS, for example, that may be too large to qualify for the higher reimbursements allotted for what we call critical access hospitals, and has, unfortunately, the misfortune of serving a smaller than average uninsured base. Those hospitals will see huge cuts without seeing any of the gains. This bill's $100 billion cut will only hurt these hospitals and their ability to serve Medicare and even non- Medicare patients. Remember the cost sharing. Medicare's own actuaries at CMS, the Center for Medical Services-- sort of an oxymoron--have agreed that the Democrats' cuts to hospitals and other providers could be dangerous and could cause them to end their participation in Medicare. So why are we doing this? Another huge cut to Medicare in this bill is that $120 billion cut to the Medicare Advantage Program. My distinguished colleague from Nebraska has already talked about that, the effects of Medicare Advantage to Nebraska. Let me talk about Kansas. Close to 11 million, or one-quarter, of Medicare beneficiaries are enrolled in Medicare Advantage; 40,000 of those beneficiaries are in Kansas. I want to read an excerpt from one letter I received from a very satisfied Medicare Advantage customer in Shawnee, KS. Ms. Lila J. Collette is enrolled in Humana Gold Plus, a Medicare Advantage plan. She writes: Please use everything in your power to let me and the many, many other people in Kansas who have chosen Humana Gold Plus to keep this wonderful plan. Ms. Collette is not alone. Satisfaction rates among seniors enrolled in Medicare Advantage plans are very high. I know they are very unpopular to the other side and there are a lot of allegations made, but these people made that decision on their own, so why are we essentially gutting this program that provides quality and choice to our seniors? I could go on about the cuts to hospice, home health care providers, nursing homes, but I think you get the point. I disagree with the failure to prioritize the solvency of Medicare over the establishment, again, of new government programs. And I certainly will never agree to financing these government expansions by bleeding the Medicare Program dry. That is why, as I have said, I offered amendments in the Finance Committee markup that would have struck these Medicare cuts. Again, unfortunately, they were defeated on a party-line vote. As the President is fond of saying, ``Let me be clear.'' This bill is funded on the backs of our seniors and those who provide Medicare to our seniors. This bill slashes Medicare by $\1/2\ trillion. This bill threatens access to care for seniors and health care for all Americans. I hope my colleagues will join me in opposing these cuts by voting for the McCain motion to commit. This is the key vote. Don't kid yourselves, this is the key vote. You are either for protecting Medicare or not. I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that I be permitted to engage in a colloquy with my Republican colleagues.

Mr. ROBERTS. Mr. President, this is the health care bill. There are a lot of things in this bill that I object to. The $2.5 trillion cost, the 24 million people still left uninsured, the unconscionable $\1/2\ trillion cuts to Medicare and our senior citizens, with another $\1/2\ trillion in job-killing tax increases, in my view, the stunning assaults on liberty, and the Orwellian policies making health insurance even more expensive--any one of these things would make me vote no on this bill. But one issue has me troubled the most; that is, the issue of rationing. We have several of my colleagues here who will speak to this subject, and we will engage in a colloquy. I don't think this issue has sunk in with the American people and, for that matter, the media. I want everyone to understand something. This bill aims to control the government's spending by rationing your access to health care. Let me repeat that. This bill aims to control the government's spending by rationing your access to health care. There are at least four government entities--we decided to call them ``the rationers''--that will stand between you and your doctor, and these four entities are represented by the four walls on this chart behind me blocking the doctor-patient relationship. You can see a pair of senior citizens and with frowns on their faces and then we have the rationers. We have an institute, a board, a center, and a task force, some of which are in place now and some are not. But every Senator should know about them and every health care recipient or especially senior citizen should know about them. Senator Reid's bill establishes the Patient-Centered Outcomes Research Institute--that is the first wall--to conduct something called comparative effectiveness research, or CER, which is research that compares two or more of the same treatment options for the same condition to see which one works best. That sounds like a good idea. But, unfortunately, when CER is conducted by a government under pressure to meet a budget, it can be manipulated in some very sinister and counterproductive ways, as has been demonstrated by the United Kingdom's CER Institute. They call theirs the National Institute for Health and Clinical Excellence. The acronym is NICE, but NICE is not very nice in Great Britain. NICE is notorious for delaying or outright denying access to health care treatments based on CER that takes into account the cost of the treatment and the government's appraisal of the worth of the patient's life or comfort. Some of the more shocking CER decisions handed down by NICE over the years include: restricting access to drugs to save seniors' vision from macular degeneration until the patient is blind in one eye, inconceivable; denying access to breakthrough treatments for aggressive brain tumors; and refusing to allow Alzheimer's therapy until the patient deteriorates. The Patient-Centered Outcomes Research Institute will be the American version of NICE using CER to save the government money by rationing your health care. Over the past few months, I have offered several amendments, along with Senators Kyl, Coburn, and Enzi, to protect American patients from NICE-style rationing, to prohibit this bill from valuing cost containment over the care of patients. Unfortunately, they have all been voted down on party-line votes in the HELP Committee, the Finance Committee, and previously on the floor. Let's move to the independent Medicare advisory board. That is the second wall between patients and their doctor. The Obama-Reid bill establishes a new independent Medicare advisory board, an unelected body of 15 experts who will decide Medicare payment policy behind closed doors with minimal congressional input--something that is happening all too often around here. Although the bill says this anonymous board shall not include any recommendation to ration health care, what else would you call denying coverage for Medicare patients based on cost? That is what this board will do--deny payment for knee replacements or heart surgery or breakthrough drugs, all to achieve an arbitrary government spending target. I don't know what you call that, but I call it rationing. Also notice that this board will necessarily ration access to health care based on age and disability. Its payment policies will only affect the elderly and disabled who receive Medicare. What will be a patient's recourse if Medicare refuses to pay for an innovative new therapy that could save or prolong their life? These are the reasons why the Wall Street Journal has dubbed this board the rationing commission. Let us move now to the CMS innovation center. We come to the third wall between the doctor and patients. The Centers for Medicare and Medicaid Services, or CMS--and every provider knows what that is-- administers the Medicare Program upon which 43 million Americans rely. That is almost 15 percent of the population. CMS already rations care. This has already been referred to by Senator Thune and others in their comments on the floor. It is not authorized to but it does so indirectly through payment policies that curtail the use of virtual colonoscopies, certain wound-healing devices, and asthma drugs. In fact, courts recently had to intervene to prevent CMS from rationing a relatively expensive asthma drug in Medicare because rationing is currently against the law. However, the Reid bill establishes a new CMS innovation center which will, for the first time, grant CMS broad authority to decide which treatments to ration. Let's go now to the U.S. Preventive Services Task Force. That is the last one right here. The U.S. Preventive Services Task Force is yet another panel of appointed experts--a lot of those in this bill--who make recommendations on what preventive services patients should receive. Currently, the task force recommendations are optional, but the Reid bill bequeaths this unelected and unaccountable body with new powers to determine insurance benefit requirements in Medicare, Medicaid, and even in the private market. The task force has already revealed the types of recommendations it will be making. Just last week it decided to reverse its longstanding recommendation that women get regular, routine mammograms to detect breast cancer starting at age 40. One has to wonder if the task force's abrupt about face has anything to do with the fact that the Federal Government's financial responsibility for these screenings and for the health care needs they could potentially reveal will be greatly expanded if this health care reform bill passes. In the words of one prominent Harvard professor: Tens of thousands of lives are being saved by this screening, and these idiots want to do away with it. It's crazy. It's unethical, really. The outcry from oncologists, the American Cancer Society, the American College of Radiology and breast cancer survivors and families across the country has forced our Health and Human Services Secretary, Kathleen Sebelius, to backpedal away from the task force recommendation, saying they do not affect government policy. As a matter of fact, Secretary Sebelius said: Let you and your doctor make the decision. But this bill relies on the task force's recommendation, some 14 times throughout the legislation, to set benefits and determine copayments and make grant awards. So contrary to the Secretary's assertion, if this bill passes, the recommendation of the task force will become government policy. Not only that, it will be forced onto private insurers as well. Some may ask, after my comments: Why so cynical? Why not trust these tools that they will only be used for good, to advance medical science and patient care. I hope that is the case. To those folks I answer by showing this chart over here by Dr. Ezekial Emmanuel and his ``complete lives system.'' As many of you know, Dr. Emmanuel is the brother of White House Chief of Staff Rahm Emmanuel. He is a bioethicist, one of those special advisers to the President. Perhaps he could actually be the rationing czar. Dr. Emmanuel has published very disturbing ideas on how to ration care, which could be summed up by this ``Brave New World'' humpback whale graph we have here, along with aging groups of the population. Dr. Emmanuel's Complete Lives System--something that sounds a little bit like a cure-all elixir sold out of Del Rio, TX--basically works off the premise that the older you are, the more you have lived and, therefore, the less you deserve in terms of health care. I would like to point out that the average age of a Senator is 62-- just something for all of you to think about, as you look at this chart depicting the Complete Lives System. As shown on this chart, if you are 10 years old, you are doing pretty good right here. Twenty years old, that is when you think you are bulletproof and you do not want insurance, but you have a lock under this plan. Thirty years old, you are in pretty good shape. Forty, here comes the roller coaster. Fifty, you are in trouble. Sixty, you might as well forget it. Seventy, well, you are off the chart. President Obama has clearly listened to Dr. Emmanuel's counsel. Remember his observation in an interview this summer that, as patients get closer to the end of their life: ``Maybe you're better off not having the surgery, but taking the shots and the painkiller'' instead. Well, as someone who falls toward the end of Dr. Emmanuel's bell curve here--as shown over here on this chart--this type of thinking is unbelievable: Telling someone they cannot have a knee replacement because they are too old? How old is too old, according to Dr. Emmanuel? The Wall Street Journal reported on the age rationing that occurs in Canada. In that country, apparently 57 is too old for hip surgery. Perhaps they can drive south and find care right here in the United States. But I am not sure where they will go if this bill passes. The White House may complain that I am taking Dr. Emmanuel's musings out of context. My response to that is this: This is the context right here. This is how the government will contain costs. All these policies must be viewed through the prism of these ideas: This institute, this board, this center, this task force follows that blueprint. This is the goal: to save the government money by rationing care, by basing that rationing on some pseudoscientific graph such as this. At least in the United Kingdom they are honest about it. These are the tools of rationing. These tools will restrict your ability, and your family's ability, to get a knee replacement or a breakthrough cancer drug or treatment for Alzheimer's or a mammogram. They will destroy the American health care system--the best health care system in the world. And they are the main reason why I will vote no on this bill. I yield to Senator Snowe.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that my staff member, Mr. Brett King, be granted the privileges of the floor.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I come to the floor today to join my good friend from Iowa, Senator Grassley, who is our ranking member on the Senate Finance Committee, to raise concerns about a too-little- discussed aspect of the health care bill the Senate will soon debate. While much of the health reform debate to date has focused on the health care side of the bill and the $500 billion in higher taxes, fees, and fines that will be required to pay for it, very little attention has been paid to how these taxes and fines will be implemented and administered and, most importantly, enforced. I think that is a very critical discussion. We need to have that discussion, and it is one the American people fully need to understand as this debate gets underway. This is important stuff. Senator Grassley has already sounded the alarm about how the Senate Finance Committee bill expands the size and reach of the Internal Revenue Service, the IRS, further into the lives of every American. But listen up: All the health care bills we have seen so far call for reforms to be carried out to a great extent by the Internal Revenue Service--that is right, the IRS, the Nation's tax collector. This isn't CMS, the Department of Health and Human Services; this is the IRS. So the Nation's tax collector will be in charge of implementing, administering, and enforcing a significant portion of this bill. Under the various bills, the IRS is given unprecedented authority to obtain information about your family's health care decisions. The IRS is authorized to collect new information--information that is unrelated to an individual or a family's tax liability--in order to carry out health care reform. This information will be used to implement, administer, and enforce several controversial provisions. For example, the IRS--again, not the Department of Health and Human Services--is the government agency that will determine whether everyone has insurance and will assess a tax penalty on anyone without insurance. The IRS will have to collect additional information from individuals and families in order to make this determination. We don't know how this information will be collected or how it may be used. The IRS would assess taxes on employers who do not provide affordable coverage for their employees. Since affordability would be determined on an individual's total income, an employer would have to collect income information from all of his or her employees. This will require employers to provide additional information about their employees to the IRS--information I am sure that an employer would just as soon not ask about. We don't know how an employer would use this information or how it would be protected. In addition, the IRS will have to work with the new health care exchanges to verify whether an individual is eligible for a subsidy and will have to share information about taxpayers with those exchanges. However, we still don't know if the exchange will be a State agency or a private entity, so we don't know how the IRS will collect and safeguard taxpayer information. Yet even as the health care bill creates new responsibilities for the IRS, consider that the IRS is having a lot of trouble doing its No. 1 job--tax administration--efficiently and effectively. Two reports were issued recently that I think raise questions about the IRS's ability to carry out its new responsibilities in this bill, let alone its original responsibilities. Last week, the Government Accountability Office, or GAO, released its annual audit of the IRS's financial statements for 2008 and 2009. In the report, the GAO found that while the IRS has made progress in addressing internal control deficiencies, the report also states that deficiencies remain with regard to the IRS's internal control over unpaid tax assessments and over information security. The report states that ``the serious challenges IRS faces as a result of these remaining deficiencies adversely affect the IRS's ability to . . . obtain current, complete, and accurate information it needs to make well- informed decisions.'' Then, on Monday, the Treasury Inspector General for Tax Administration found that because of the way the Making Work Pay credit--the credit created in this year's stimulus bill to provide workers with a one-time tax credit of up to $400--has been implemented and administered by the IRS, more than 15 million taxpayers may actually end up having to pay back some of their credit to the IRS. Similar administrative problems with the home buyer tax credit have led to waste and abuse of taxpayer dollars. The IG's audit of the IRS's administration of the credit found that the IRS may have allowed thousands of taxpayers to claim millions of dollars in credits to which they were not entitled to despite recommendations made a year ago by the IG that the IRS take steps to verify eligibility for the credit. In its audit, the inspector general found that more than 19,000 taxpayers claimed $139.4 million in credits for homes they had not yet purchased but would allegedly purchase. In addition, over 70,000 taxpayers claimed more than $479 million in credits despite indications that they were not first-time home buyers. The IG also identified 582 taxpayers under 18 years of age who claimed almost $4 million worth of credits. By the way, the youngest taxpayers receiving the credit were 4 years old. Mr. President, the problems the IRS has encountered in administering these credits and the issues raised by the GAO about the security of taxpayer information--I will repeat that: the security of taxpayer information, your taxes--raise serious questions about whether the IRS is up to the task of implementing and enforcing the far-reaching tax proposals that are called for in the health care bill. Wait, there is more. We know the IRS will need additional funding and employees--employees with expertise and training--if they are to implement, administer, and enforce the dozen or so new tax provisions called for in the health care bill. How much will that cost? That is a good question. Nobody knows. These costs are not included in estimates provided by either the Congressional Budget Office or the Joint Committee on Taxation. The bill as passed by the Senate Finance Committee--I don't know what is in the bill that will be considered, just announced by my friends across the aisle. They are doing that behind closed doors. But the bill as passed by the Finance Committee doesn't include any funding for the IRS for any administrative or personnel costs associated with this bill. We will see if the leader's bill that will be announced sometime tomorrow, which is being talked about in the hallways, contains such estimates. Estimates of a more narrow bill by an independent group found that the IRS administration alone would cost several billion dollars--never mind the costs for the Department of Health and Human Services or CMS or other new Federal offices that will be created. We can only assume the cost to administer and enforce the taxes, fees, and fines in this bill will be significantly higher. Americans need to understand what health care reform means for their health care, but they also need to know what the IRS's significant and intrusive new role would be in implementing and enforcing such health care reform. All the proposals we have seen so far expand the reach of the IRS even further into the lives of ordinary Americans, allowing them to collect more information than ever before about you and your health care choices in order to tax you based on those choices. Do Americans want the IRS to collect even more information about them and their families than it already does? I don't think so. Do they want the IRS having access to information about their health care decisions? Again, I doubt it. Furthermore, would the IRS be able to do the job? Will they get it right? Recent reports by the IRS's own IG and the GAO cast doubt on the agency's ability to effectively administer the wide-reaching provisions in the health care bill. Americans should be very concerned about putting the IRS in charge of administering more than $500 billion in new taxes, fees, and fines in this bill and expanding its reach further into Americans' lives. Americans should be concerned about this path that the Senate leadership and the White House is taking us down, placing this very complex health care bill in the hands of the IRS, especially when they have not provided the resources the IRS will need to get the job done-- not to the funding. Madam President, the bottom line is that Americans need to know, need to understand, and need to question whether they want the Internal Revenue Service more involved in their daily lives and their health care decisions. Under the proposals we have seen, that is the case. Sit up, America, and take notice. I think if we took a poll or had yet another townhall meeting, most Americans would say no to any further IRS involvement in their lives and no to IRS intrusion into their health care. I yield the floor. I see the distinguished ranking member of the committee, a distinguished Senator who has been an expert on the IRS and basically bringing reform almost on an individual basis to that agency. I yield to Senator Grassley.

Mr. ROBERTS. Madam President, it is my understanding that I am going to be recognized for approximately 15 minutes, and I seek unanimous consent that Senator Grassley follow me for 15 minutes, so we would take approximately 30 minutes of the Senate's time at this point. I think I should probably ask unanimous consent to proceed as in morning business.

Mr. ROBERTS

Mr. ROBERTS. Will the distinguished Senator yield?

Mr. ROBERTS. I tell the Senator Semper Fi, and on behalf of the minority, I yield back all our time. Cloture Motion

Mr. ROBERTS. I would be delighted to respond to my good friend from Maryland. I am in a position to yield back all the minority's time. We have no more speakers.

Mr. ROBERTS. Today, the U.S. Marine Corps is celebrating its birthday. As I speak, the Commandant of the Marine Corps, the Drum and Bugle Corps and various and assorted marines are over in the Russell Building. I am to cut the cake, and I am getting into deeper and deeper trouble if we delay the ceremonies to the degree they could be delayed. If somebody wants to talk, obviously, you have 7 minutes, but I appreciate any consideration you might be able to give us.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, suddenly I find myself a member of the powerful Appropriations Committee, but it comes under a dark cloud indeed. The distinguished chairman, who does such a great job in behalf of our veterans and military construction, has pointed out the terrible tragedy that has happened at Fort Hood. So I am here standing in, if you will, for Senator Hutchison, who does such a good job, in partnership with my colleague and my friend and my neighbor, whom I respect a great deal. So I appreciate the opportunity to speak on the bill before us. As Senator Hutchison departs as early as she possibly can to get to Texas to assist in the challenge of this great tragedy, we wish her well, and our prayers are with her and all the people at Fort Hood and all the people in Texas. As the distinguished chairman has stated, a lot of time and energy have gone into putting this legislation together. Senator Hutchison wanted to thank Chairman Johnson and his staff for working hard to address the needs of our servicemembers and veterans. I am going to repeat just a couple of things that are in the full statement of the distinguished Senator from Texas. As Chairman Johnson has pointed out, the Military Construction, Veterans Affairs, and Related Agencies appropriations bill includes for fiscal year 2010 $76.7 billion in discretionary spending, $23.2 billion for military construction, $53.2 billion for our veterans, $55.8 billion in mandatory spending for veterans' benefits, and $1.4 billion for military construction projects to assist our troops in Afghanistan in their fight against terrorism. A lot of the figures Senator Hutchison has here have been mentioned by the distinguished chairman, so I won't go into those, but Senator Hutchison wanted to indicate and wanted to highlight that she was very pleased that the bill provides full funding for the base realignment and closure actions. The funds are essential to bringing our troops home, predominantly from Europe and Korea, and basing them in the United States. By fully funding BRAC, we can help the Department of Defense to stay on schedule to achieve this goal by September of 2011. Senator Hutchison would also like to highlight that the legislation contains the necessary funds for the Defense Department program especially designed to help our servicemembers who were forced to relocate in this harsh economic housing environment--I might add that we see this at Fort Leavenworth and Fort Riley as well in Kansas--the Homeowners Assistance Fund. Chairman Johnson has been absolutely instrumental in making this program a success. The legislation contains about $1.4 billion in emergency funding for the war in Afghanistan. Senator Hutchison, myself--almost every Senator knows that the policies of this conflict have been passionately debated on the Senate floor in recent days, but I am sure we can all agree that independent of our views on the war or the strategy of that national security threat, we must provide the infrastructure needs of our sailors, soldiers, airmen, and marines, who, by the way, celebrated their birthday today. This bill does just that. In addition, I would point out that the distinguished ranking member wanted to express her strong commitment to making sure that our NATO allies--our NATO allies--fund their fair share of these joint projects. The chairman has already gone over the figures for the Department of Veterans Affairs, although Senator Hutchison did want to point out that it includes funding to enhance outreach and services for mental health care, combat homelessness, further meet the needs of women veterans, and expand our health care to rural areas--something the chairman knows all about, something which I like to think I know something about, and something that I know Senator Hutchison knows about a great deal. Finally, we have included $48.2 billion in advanced appropriations for veterans' medical care for fiscal year 2011. This funding will allow the VA to better plan the budget for our veterans' health care. Congress has shown its resolve time and again to care for our Nation's veterans and provide the infrastructure for our men and women in uniform. We all owe them a debt of gratitude and will do our part to take care of them. So I ask my colleagues to support this bill. We have no objection on this side. Again, I wish to thank the distinguished chairman for all of his work and leadership. I yield the floor. (At the request of Mr. Roberts, the following statement was ordered to be printed in the Record.)

Mr. ROBERTS. Will the chairman yield?

Mr. ROBERTS. The chairman has accurately described the contents of the amendment. We have no objection and ask that it be agreed to.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I understand I am allowed 10 minutes of this morning business period; is that correct?