Pat Roberts

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to share my concerns about the tax increases called for in the health care reform bill that is now being finalized behind closed doors. I want to make sure the American people truly understand what these tax increases will mean for them and their families. This bill calls for an incredible and shocking $500 billion in taxes, in massive new taxes, taxes that will fall on average Americans who already know their tax burden is too high. We hear a lot about the efforts behind the closed doors to merge three different bills and all the costs and all the efforts to get more voters onboard. But we do not really hear much about the tax increases. They really should make the taxpayer sit up and take notice. The behind-the-doors crowd has tried to disguise some of the new taxes in this bill by presenting them as being paid for by targeted health care industries. However, the reality is that average Americans who purchase health insurance and use medical services, from prescription drugs to hearing aids, are the ones who will foot the bill for this tax-and-spending spree. The higher taxes called for in this bill come straight out of Americans' pocketbooks. American taxpayers, Americans, have the right to know, they have the right to be informed, they have the right to understand, and they have the right to be heard--not only on the spending, not only on the health care reform bill, but in regard to the taxes they will pay. Let me give just a few examples of the new taxes called for and who will actually pay 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. It raises $201 billion. Of this amount, an analysis by the Joint Committee on Taxation, or the JCT, finds that more than 80 percent or $164 billion of the tax will come from increased income and payroll taxes on higher wages. When the bill is implemented, however, the excise tax is likely to hit 40 percent of American families, so the reality is that these families, not the insurance providers, will be on the hook for the $164 billion. The bill raises taxes on those who pay for their health care out of pocket by raising the floor for deducting catastrophic medical expenses from 7.5 percent to 10 percent of adjusted gross income. Those who take this deduction are most often seniors and those with serious medical issues. Eighty-seven percent of taxpayers who claim this deduction have income under $100,000. While an amendment to exempt taxpayers 65 or older from the higher threshold was approved in committee, thank goodness, don't be fooled: the exemption is only in effect in the first 3 years. As a result, in the following years roughly 50 percent of the taxpayers affected by this proposal will be over the age of 65. This makes no sense. The bill raises taxes on the more than 35 million Americans who participate in flexible spending accounts. The median income of a flexible spending account participant is $55,000. This program is a very important benefit for many families for whom health insurance does not cover, or does not sufficiently cover, some of the highest cost health care expenses, such as dental, vision, and also prescription drug costs. It is also important for individuals who manage chronic diseases such as diabetes, heart disease, or cancer. FSAs allows participants to set aside money out of their own pockets to pay for these necessary expenses. However, under this bill the government caps how much can be set aside in a flexible spending account, a person's own account, effectively raising the tax burden on certain FSA participants and increasing their health care costs--typical of a disguised tax in this bill. Another tax attack: It also eliminates the ability of individuals to use money from their accounts, the FSA accounts, to purchase over-the- counter medications. Here we are, trying to put downward pressure on health care costs. Rather than maintaining current law that gives consumers the option to purchase over-the-counter medications through a flexible spending account that they have chosen to put money into, the bill instead directs them to more costly alternatives and increased use of the health care system and limits the consumers' ability to fully use their own accounts. Another example of the stealth taxes called for in this bill is the individual mandate penalty. Although the President has said this penalty is not a tax, the Finance Committee bill adds this provision under a section called the ``Excise Tax on Individuals Without Essential Health Benefits Coverage.'' The government expects to collect $4 billion from this tax. In 2013, almost half of those Americans who will be paying the penalty tax will have incomes between $22,800 and $68,400 for a family of four. This penalty essentially means the IRS will now tax you if you do not buy a health care plan approved by the government. Let me repeat that. This penalty essentially means the IRS will now tax you if you don't buy a health care plan approved by the government. Not only that, this bill also expands 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 these choices. This provision highlights one of the most disturbing aspects of this bill: the increased role the IRS will play in the lives and health care choices of every American. Under this bill, the IRS will gain unprecedented new powers. But here is the clincher. There is no money in this bill to pay for the expansion of the IRS that will have to occur for the IRS to administer and enforce these new tax provisions--emphasis on ``enforce.'' How much will that cost? How many billions will be needed to pay for this growth in government? How many more employees will the IRS have to hire? We don't know. But make no mistake, every American should understand that the IRS will be playing a bigger role in their life and their health care decisions. Question, for all those who braved the townhall meetings. Everyone who wants more IRS involvement in their lives, raise your hands. I don't think in these townhall meetings you will hear many hands clapping. Under this bill, not only will Americans see massive new taxes, they will also see an unprecedented expansion of the Internal Revenue Service and a further reach by government into their lives. This is the wrong solution to health care reform. Americans are looking for real reform that preserves their health care choices. But reform that comes with a $500 billion tax increase and is supervised, if not more, by the Internal Revenue Service is simply not the answer. Mr. President, I yield the remainder of my time. Mr. President, I suggest the absence of a quorum.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to offer legislation with Senator Harkin to fulfill a promise that we made over 30 years ago. We made a commitment to pay 40 percent of the excess cost of educating a special needs child. However, we have not fulfilled that promise. Our legislation annually increases funding for Part B of the Individuals with Disabilities Education Act over a 6-year period. With these increases, we will be able to fully fund Part B in 2015. I encourage my colleagues to add their support to this needed legislation. If the Federal Government would provide its promised share of special education funding, our schools could then use any state and local funds for other educational needs, such as art and music.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to offer legislation with Senator Harkin to fulfill a promise that we made over 30 years ago. We made a commitment to pay 40 percent of the excess cost of educating a special needs child. However, we have not fulfilled that promise. Our legislation annually increases funding for Part B of the Individuals with Disabilities Education Act over a 6-year period. With these increases, we will be able to fully fund Part B in 2015. I encourage my colleagues to add their support to this needed legislation. If the Federal Government would provide its promised share of special education funding, our schools could then use any state and local funds for other educational needs, such as art and music.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to express my opposition, my considered opposition, to Judge Sonia Sotomayor's nomination to the U.S. Supreme Court. As Senators, I think we all know we have an obligation to ensure that our courts are filled with qualified and impartial judges. While Judge Sotomayor has an impressive resume--that is a given--I am concerned that her personal judgments and views will impact her judicial decisions. In addition, I find some of her rulings very troubling. During the Senate's debate on the nomination of Chief Justice John Roberts, then-Senator Obama stated: that while adherence to legal precedent and rules of statutory or constitutional construction will dispose of 95 percent of the cases that come before the Court, so that both a Scalia or Ginsburg will arrive at the same place most of the time on those 95 percent of the cases, what matters on the Supreme Court is those 5 percent of cases that are truly difficult. In those cases, adherence to precedent and the rules will only get you through the 25th mile of the marathon. That last mile can only be determined on the basis of one's deepest values, one's core concerns, one's broader perspectives on how the world works, and the depth and breadth of one's empathy. Thus the entrance of the ``empathy'' issue to this debate. I respectfully disagree with now-President Obama. Judges must decide all cases in adherence to legal precedent and rules of statutory or constitutional construction. It does not mean if they do that they do not have empathy. I agree--and I think everybody would agree--everybody on the Supreme Court has empathy. But the role of a judge is not to rule based on his or her own personal judgments but to adhere to the laws as they are written. While Judge Sotomayor stated during her confirmation hearing that ``it is not the heart that compels conclusions in cases, it is the law,'' I still have concerns regarding her ability to remain impartial. She has made some statements in Law Review articles and speeches that are of serious concern. I am not convinced that Judge Sotomayor will set aside her personal judgments and views. While on the Second Circuit Court of Appeals, Judge Sotomayor joined a four-paragraph ruling on property rights. In Didden v. Village of Port Chester, the appellants claimed that a developer demanded $800,000 in order to avoid condemnation of the property by the city. When the appellants refused to pay the $800,000, they received a petition to initiate condemnation. Although the Second Circuit Court of Appeals dismissed the case, it was noted that relief could not be granted based on the U.S. Supreme Court's decision in Kelo v. City of New London. That four-paragraph ruling didn't even provide an in-depth analysis as to how the Kelo ruling applied to the facts at hand. In fact, the Kelo decision acknowledges that ``a city no doubt would be forbidden from taking land for the purpose of conferring a private benefit on a particular party.'' The four-paragraph ruling in Didden is very troubling. In Kansas, land is gold; farmland is platinum. We have a healthy respect for property rights in Middle America. It also bothers me that a court could make a broad statement without analyzing and applying the facts to case law. Turning to firearm rights, Judge Sotomayor joined an opinion ruling that the second amendment is not a fundamental right and, therefore, does not apply to State and local governments. It is likely that at some point the second amendment's application to States could be argued before the Supreme Court. That could come very quickly. I would certainly hope that should this matter be argued before the Supreme Court, Judge Sotomayor would recuse herself. During her hearing, she did not indicate whether she would recuse herself in any decision. That was not, however, the case during the nomination hearings of Judges Alito and Roberts. I do not discount the fact that Judge Sotomayor is a very accomplished judge and has an extensive judicial record. However, some of her statements, writings, and rulings concern me. They indicate her personal judgments and views may impact her judicial decisions. We have a constitutional obligation to ensure that our judges are impartial and faithful to the law. During Chief Justice John Roberts' confirmation hearing, he noted: Judges and justices are servants of the law, not the other way around. Judges are like umpires. Umpires don't make the rules. They apply them. The role of an umpire and judge is critical. They make sure everybody plays by the rules [not by empathy], but it is a limited role. Nobody ever went to a ball game to see the umpire. I am not convinced that Judge Sotomayor will be an umpire and consistently adhere to the rule of law as opposed to empathy. For these reasons and others cited by some of my colleagues, I oppose her nomination. I yield the floor.

Mr. ROBERTS. Mr. President, I ask unanimous consent that the Republican time for the next hour be allocated as follows: myself for 10 minutes, Senator Barrasso for 10 minutes, Senator Crapo for 15 minutes, Senator Wicker for 10 minutes, and Senator Collins for 15 minutes.

Mr. ROBERTS

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

Mr. ROBERTS. Mr. President, I find myself in a rather unique position here. If you look in the bio sections of all of the outfits that keep herd on us, they will record me as a journalist. That is an unemployed newspaper man, by the way. But I have a great family tradition in journalism, three generations, four generations, actually, of the Roberts family and the State's second oldest newspaper in Kansas. I still carry around my reporter's notebook, have great respect for those of the fourth estate. We shine the light of truth with our own individual flashlight. I do not think I have ever done this in 28 years of public service, but I am irritated. I am more than irritated. I rise today to clear up some recent flagrant mischaracterizations about Medicare payments, especially since the Medicare payments are now being used as a target as a pay-for for the health care reform, the alleged health care reform that Senator Enzi was talking about, specifically the statements made on the front page of today's Washington Post, the fountain of all knowledge here in Washington, in an article entitled ``Obama Eyes the Purse Strings for Medicare.'' I would describe this article--I read it. I read it again. I was a relatively happy person, watching the weather--I do not watch the news much--had my cup of coffee, was going to turn to the sports pages. Then I happened to glance at this, read it, and ruined my whole morning. I came in, I was mean with the staff and everything else. So I thought I better get it off my chest. This article is patronizing. It is condescending. The bad part about it is it is egregious in nature and effect at a crucial time in the health care debate, and that is most unfortunate. The author of this article describes what she sees as ``one of the most effective and lucrative forms of constituent service,'' i.e. setting reimbursement rates for local hospitals, doctors, home health care centers, and other health care providers. Oh, I wish I had that power, as opposed to CMS, which is the subagency, the acronym agency for the Department of Health and Human Services, that does set reimbursement rates for all health care providers in the United States. The author continues, accusing ``longtime Members of Congress'' of such atrocities as ``championing New York City's teaching hospitals'' and making sure ``rural health services are amply funded.'' In this author's mind, these hospitals and other providers are ``flush.'' Flush with Medicare cash as a result. I must admit in my 28 years in Congress, I have absolutely been one of those dastardly Members intent on making darn sure that the rural health care delivery system can remain alive and serve our people, even if it has to be kept on life support, which is the true characterization of what we face. I wonder, since it never appears anywhere in the person's article, in her article, if the author of this piece is aware that the average Medicare reimbursement rate for doctors is about 80 percent of what the commercial market pays or that Medicare only pays about 70 percent of the market rates for hospitals. That is why we have hospital after hospital after hospital for decades in Kansas passing bond issues just to keep their doors open. These are not flush places. These are not posh places in regard to hospitals. Then I go back to the fact that doctors get paid 80 percent. That is why doctors, many of them, are refusing to take--in regard to Medicare--patients. And that is that terrible word that people say is too scary, that is called rationing, that when we set a reimbursement rate, we, meaning the CMS--no, not individual Members of Congress, as the article infers--but these agencies cannot reimburse doctors enough so they can make a living, or other health care providers, that they cease providing Medicare to seniors. What does the senior do then? Well, they are in a very difficult situation. How do you think these providers survive? The answer is that they shift that loss onto the private market to the tune of nearly $90 billion a year. Let me repeat that. Everybody who goes to the hospital, everybody who goes to a doctor and has private insurance, you are paying $90 billion a year in a hidden tax in regard to the people who basically are not covered by Medicare and by Medicaid, if, in fact, you would do what the President has suggested, and maybe take some money--``eyes the purse strings for Medicare,'' Medicare being a target, Medicare being the service for seniors. Wake up, seniors. Wake up, AARP. Wake up, everyone else in the health care field. We are targeting Medicare. My word, if any Senator had come down here except during these last 6 months and said: Let's cut Medicare by 10 percent, they would have been excoriated by this newspaper for hurting senior citizens. Well, in my State of Kansas and in other rural States across the country, we do not have a private market to shift those losses to. Our rural areas do not have the population base to support such a cost shift as $90 billion as happens in the rest of the country. In addition, the folks in these towns are much more likely to depend on Medicare or Medicaid or to simply be uninsured. In short, without some sort of special payment from Medicare, these hospitals would not survive. You tell me, Washington Post, what you would say to the residents of Smith Center here, top center in Kansas. What would you say to the residents of Smith Center if their hospital closed? Smith Center is a great town, close to the geographic center of the lower 48 States, has a population of a little less than 2,000 people. They have a great football team, high school football program, Smith Center Redmen, the pride of north central Kansas, one of the greatest small town football teams in America. The town is served by the Smith County Memorial Hospital, a critical access hospital with 25 beds. For those of you who are unfamiliar with the terminology, a critical access hospital is a rural hospital with 25 beds or less which is at least 35 miles away from another hospital and which provides 24-hour emergency services. Critical access hospitals get special treatment under Medicare. They get paid 101 percent of their costs for inpatient, outpatient, and swing-bed services. I probably should not mention that or this reporter might run out to Smith Center and say: My goodness, you are getting 101 percent. Sure. She should go out and take a look, and talk to the hospital administrator and the people in that hospital. In other words, they do not get the usual 70 percent of the market rate reimbursement for Medicare, for a very good reason, because of the distances they would have to travel. Without the critical access hospital program, the closest hospital for the residents of Smith Center would be all the way in Hays, KS, America, right down here 90 miles away. You tell me what a person's chances of survival are after a car accident or a tractor accident if they have to be driven 90 miles away for emergency care. Smith County Memorial is just one of 83 critical access hospitals in Kansas. They are absolutely essential to the very lives of the people in rural America. Indeed, they are essential to the very existence of rural America at all. I have the privilege of being the cochairman of the Rural Health Care Caucus, along with Tom Harkin of Iowa. We are fighting tooth and nail, holding on by our fingernails to exist, to provide care to the people who live in these small communities. I am happy to admit it, I am happy to admit to this reporter--I hope she comes in for a cup of coffee. I would be happy to give her a cup of coffee, no cream or sugar; there might be a little vinegar in it. But at any rate, please come in for a cup of coffee and visit about this. I am happy to admit it. I will bend over backward to preserve the payment rates that allow these hospitals to stay open and to continue to serve the people in Smith Center, KS, and elsewhere all throughout rural America. I believe this position is completely justified. I sleep just fine at night knowing that I have used my so-called influence through legislation, through the rural health care coalition, through the Finance Committee, through the HELP Committee, to ensure that Medicare pays these hospitals just enough to average a 1-percent Medicare margin, 1 percent, when these hospitals are still fighting for their lives. I would like to personally invite the author of this article or any other member of the Washington Post editorial board, God love them, to visit some of the rural hospitals in Kansas with me. The reporter's name--I hope I get it right; I apologize if I do not. I really sort of apologize. I am picking on her--is Shailagh Murray. Shailagh, why don't you come to Kansas with me and let us go out to Smith Center. Here is the hospital. This is this posh resort that you apparently think we finance with Medicare. It is true, you know, you go through the doors, there are two-inch thick carpets, you go in, there is--let's see, I think there is Mozart's piano concert 21, piano concert No. 21, and they call you by your first name, and you get immediate treatment. Then there are massage facilities and a spa in the back. And that is a lot of what we have in our Dodge City feedlots. That is not the case. Talk to the CEOs, the doctors, the nurses, and the patients. Walk around this small hospital and see the equipment and the facilities. Flush with the Medicare cash? Come on. And flush with Medicare cash that is somehow influenced by individual Members of Congress? I wish. I have been fussing and fighting and feuding and pleading and cajoling with CMS to try at least to get these payments to doctors and hospitals up to the level that they can continue to exist. Flush with Medicare cash? I think not. Look at this hospital. Do you see anything that would lead to a description of this sort? I am not too sure anybody is going to give up their vacation. They have the finest people in the world. That is our best commodity in rural areas. I am not picking on Smith Center. They are doing a fantastic job with the resources they have. But it just makes me very angry that a Washington, DC, paper and reporter would demonize a program that keeps rural America's heart beating. It is a patronizing and dead-wrong description, and it offends me and the people I am privileged to represent in rural Kansas. I want to tell Shailagh, Ms. Murray, I am never going to stop fighting for these hospitals no matter how many deals the American Hospital Association cuts with the White House, no matter how many ugly articles are written here in DC. I am rather amazed at the deal the American Hospital Association allegedly cut--$155 billion in cuts to Medicare for senior citizens. Wake up; it is your Medicare. There is going to be more rationing when doctors say: I am sorry, I just can't afford to continue. That is the target now on the Finance Committee--Medicare. I never thought I would see the day that would happen. But I will not stop fighting for these hospitals. Here we have the American Hospital Association, the Kansas Hospital Association, the Missouri Hospital Association, other hospital associations are not happy with the national association when you crawl in bed and get fleas with the administration. What is the old saying? If you go to bed with the Federal Government, you wake up in the morning and you got something more than a good night's sleep. And that is exactly what has happened with the American Hospital Association. They come through my door and say: Help, help, please get these reimbursement rates up. Every year, we have done that with Medicare and the Medicare Programs. We are being cut by 11 percent, and the cost of inflation in regard to where we try to practice has gone up 7 percent, and whatever other number they said every year. They blame Republicans. Once in a while, they blame Democrats and say: Why on Earth did you cut Medicare? And now we are using Medicare as a target for health care reform for this bill that is impossible for most people to even comprehend? It is amazing. The American Hospital Association bought into it with $155 billion in cuts. They come through my door every year when they want to keep the reimbursement rates level. Don't come through my door for at least a month until I calm down. That is my duty to the people of my State. I feel comfortable with that. I have been a little tough here on a reporter I have never met, obviously. She is spending a lot of her time in the people's house talking with mucky-mucks on the various committees. Those are people with the seniority. I used to be one of those. I used to be somebody. But I urge her to talk to Members who represent rural areas and the rural health care delivery system and understand that this is not a question of this hospital having flush payments. They are hanging by their fingernails just to keep open. It is not true that Members of Congress, even the distinguished Presiding Officer and anybody else who might happen to be listening to my remarks, the great Senator Thune standing to my rear who also represents rural areas and has even a sparser area than I do--it is just not true. This article comes right at the apex of the debate of the health care reform debate. It is just not right. Let me again say to Shailagh: Why don't you come out to Kansas with me. We will visit with Tom Bell, president of the Kansas Hospital Association. We can go out to Smith Center and visit the hospital or as many hospitals as you want. We will see who is flush in regard to Medicare payments. That is certainly not the case with them. I think I have made my point. I must say, as a former journalist, former newspaperman, I used to check my facts. I would ask that they do the same. I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, as I indicated, I rise today to talk about health care reform and the hard truths that have so far been not hidden but I do not think have been very much aware to many Americans. I was inspired to come to the Senate floor today because we are holding hearings in the HELP Committee--and we are holding hearings in the Finance Committee--and a series of events in the Health, Education, Labor, and Pensions Committee made me recall the observations of a well-respected public opinion analyst, pollster Daniel Yankelovich, founder of the New York Times/Yankelovich Poll. The HELP Committee has been struggling--well, we have been working hard; ``struggling'' probably is not the right word; and many thanks to the chairman, Chris Dodd, our ranking member, Mike Enzi, and the members of the HELP Committee--but we have been going through a multiweek markup that I think has been characterized by some very wishful thinking on the part of the majority members of that committee; namely, the hope or the wish that they can somehow not reveal the very real costs and tradeoffs raised by their health care reform bill. I think the American people ought to become more and more aware of this. The bill the HELP Committee is marking up establishes all sorts of new government programs, all sorts of new government mandates and controls--all justified by the need to ``rein in health care costs'' and ``increase health insurance coverage.'' I know those are two very good and noble pursuits, which I support wholeheartedly. As a matter of fact, I think Republicans now have about six bills to do the same thing. They do not get much attention, but we have six bills. But there is a big problem with this bill. It does neither of these things, in my opinion. It neither reduces costs, nor does it significantly increase coverage. In fact, it significantly increases costs for very little gain--``costs,'' c-o-s-t-s. Remember that word. But my colleagues on the HELP Committee continue to wish and to hope they can obscure this reality through a barrage, really, of speeches and rhetoric and what I call misleading figures. It has been this behavior that has caused me to recall Mr. Yankelovich's observations on something called the evolution of opinion. I am going to use that as the basis of my remarks--the evolution of opinion. The article was in Fortune magazine, and it jogged my memory in this regard. But, in any event, I think it serves as an important illustration of the health care reform process so far. Mr. Yankelovich observed that the evolution of a person's opinion could be traced through a continuum of seven stages. That is a fancy way of saying there are steps you go through when you are trying to think something through. First, we have had daunting awareness: the realization that our health care system was not working for every American and needed to be addressed. I think everybody understands that. The second stage, greater urgency: the economy began to go south and people who used to rely on their employer for health insurance began losing their jobs. Then there is the third stage: reaching for solutions. Our committee has held hearings and began to meet with stakeholders. The administration met with stakeholders. The stakeholders, I think, probably met in good faith. And it has only been recently they have discovered they may have signed on to something that is very illusory, to say the least. Fourth, the stage where many on the HELP Committee and elsewhere have arrived at today: the wishful thinking stage, the well-intentioned, romantic, simplistic, perhaps naive moment where all one sees are the benefits, without considering the consequences--the law of unintended effects. For example: the totally misleading claim by the majority that the new data from the Congressional Budget Office revealed a much lower score for this bill, $597 billion--a lot of money--while still expanding health insurance coverage to 97 percent of Americans. This claim is the very definition of ``wishful thinking.'' But facts are stubborn things. The actual CBO numbers say this bill leaves 34 million people still uninsured. That is not 97 percent coverage. In order to gain anywhere near 97 percent coverage, we would have to significantly expand Medicaid--a very expensive proposition which, according to CBO, adds about $500 billion or more to the cost of this bill. More wishful thinking: The $597 billion cost was further artificially lowered through several budget maneuvers, such as a multiyear phase-in and a long-term care insurance program that will increase costs significantly outside the 10-year budget window CBO is required to use. Here we are passing a long-term insurance bill that goes beyond 10 years that CBO cannot even score. After taking these realities into account, a more accurate 10-year score of this bill is closer to $2 trillion. I said that right: not $1 trillion--$2 trillion. This is when we should arrive at the fifth stage of opinion making: weighing the choices. Since the true cost of this bill is approximately $2 trillion, we must own up to the American public about the tradeoffs. We must finally understand that the tradeoffs threaten a health care system that polls tell us has a 77-percent satisfaction rate. This is not to say we should not undertake any reforms, but we need to honestly discuss the costs and benefits of reform proposals. And the majority's proposal is high on cost and low on benefits. The No. 1 tradeoff that Americans need to know is, higher taxes. Remember when the President promised: If you make under $250,000, you will not see your taxes increased, that you would actually see a tax cut. Well, like so many other pledges, those promises had an expiration date, and that date is rapidly approaching. The bill raises $36 billion in the first 10 years in new taxes on individuals who do not purchase health insurance. That is a penalty. It raises another $52 billion in new taxes on employers who do not offer their employees health insurance. As an aside, guess who suffers when the employer's taxes get raised? It certainly is not the employer. It is the employee who gets laid off or does not get a raise. It is the applicant who does not get hired. Even President Obama's own Budget Director admits this fact. At least one economic survey estimates that an employer mandate to provide health insurance, such as the one in the Kennedy-Dodd bill, would put 33 percent of uninsured workers at risk for being laid off--33 percent of uninsured workers. The study went on to say that ``workers who would lose their jobs are disproportionately likely to be high school dropouts, minority, and female.'' It is a job killer for the very people whom the bill ostensibly seeks to help. These new taxes do not come close to paying for this bill, and the ideas that have been coming out of the Finance Committee, on which I am also privileged to serve, the House of Representatives--the so-called people's body--and the administration prove that these new taxes will be just the first of many. One option: a new and higher income tax on taxpayers with earnings in the top income tax brackets--there is some press on that as of now-- including small businesses--essentially a small business surtax--to pay for government-run health care. Keep in mind that this surtax is in addition to the higher income taxes the President is already calling for in his budget. The President's budget proposal calls for raising the top two individual tax rates in 2011. Many small businesses file their tax returns as individual returns, and the National Federation of Independent Businesses, NFIB, estimates that 50 percent of the small business owners who employ 20 to 249 workers fall into the top two brackets. When these higher income taxes are combined with the proposed surtax to pay for the government-run health care, it means that a small business could see its tax bills go up by as much as 11 percent--11 percent--when this health care reform bill finally takes effect--an income tax rate increase of about 33 percent over what they pay today. But it does not stop there. Under the proposal the House is expected to unveil, possibly today, they leave the door open for even more tax increases on small businesses. That proposal is expected to allow, in 2013, for the small business surtax to be raised by several additional percentage points if health care costs are higher than expected, which is likely. These higher income taxes would be a devastating hit on our Nation's small businesses--the same small businesses that create roughly 70 percent of the jobs in this country and are the backbone of our economy. We should not be raising taxes on these job creators if we want our economy to rebound and grow and expand. Small businesses in Kansas tell me they feel they are already stretched to the limit, and they worry that to pay the additional taxes called for in the President's budget, not to mention an additional small business surtax to pay for a government-run health care program, they will have to cut back elsewhere--``cut back,'' meaning layoffs; cutbacks, meaning really it is the worst thing you could do for the economic catalyst of our country, the small business community. Make no mistake, these will be difficult choices. They will have to reduce the wages and benefits of current employees. They will have to pass their costs on to their customers. They will have to lay off workers or not hire new employees. None of these are good options for workers, small businesses, or our economy. But higher taxes are just one of the ways the majority wants to pay for this massive expansion of government. The other method? The other method will be cuts to Medicare. You heard me right: Medicare, cuts to Medicare, cuts to the reimbursements to providers to our senior citizens, cuts we have been trying to prevent, where we have added money in almost every session we have been in. There would be $150 billion from the hospitals. The hospitals have agreed to this with their national organizations but funny thing: The hospitals from Kansas came back to me and said: Not on your life. For a person who has worked hard to prevent cuts in that market basket of provider reimbursements to keep our rural health care delivery system whole, it comes to me as a great surprise that their national organizations would sit down and say: OK, we are going to give up $150 billion, only to learn a couple days or weeks later that some in the House say: That is not enough. So they didn't have a deal--and another few hundred billion from the physicians. I haven't heard any agreement on that from the physicians. Tens of billions from home health care agencies and radiology and home oxygen and PhRMA. Let's don't forget PhRMA, who agreed to a certain amount of cuts--I think it was $80 billion--but now they have learned that figure isn't firm. So whoever else gets strong-armed or weak-kneed into making a deal with this administration, you better be careful. Again, when doctors and hospitals and pharmacists and home health agencies get their reimbursements slashed by Medicare or Medicaid, who pays the price? It is not the provider, at least not at first. It is the people with private insurance who pay a hidden tax to make up the difference--some $88.8 billion per year, according to a recent Milliman study. Once the provider runs out of private payers to shift this cost deficiency onto, who pays? It is the patients who lose access to a doctor or a hospital or a pharmacist or a home health agency. In addition to cutting Medicare payments, this bill will dump, by some estimates, well over a million new people onto a government-run health care plan which will never pay providers enough to cover their costs, despite any rhetoric otherwise. As this number grows and the private market shrinks, the decrease in the number of doctors and hospitals and other providers will be inevitable. We see that already. We already have rationing. We already have shortages. We already have doctors and providers who say: I am sorry, I am not reimbursed to the extent I can stay in business and offer you Medicare. So rationing is not a scare word, it is something that is happening now. It will simply not be possible for them to keep their doors open on the margins that the government will pay them. And that is when rationing of health care will become a way of life in this country. Oh, I can see it now. It will either be by age or by test or by the comparative effectiveness research golden ring that CMS--that is another acronym--an outfit that works for the Department of Health and Human Services. These are the bean counters who look in this way at health care and don't look at the real effects, and I see what can happen. These are the tradeoffs the American people need to know about in this bill. Yep, $2 trillion in new spending, higher taxes, job-killing employer mandates, and rationed health care. And for what? To overhaul a system with which 77 percent of Americans are satisfied. I offered several amendments in the HELP markup just this morning, attempting to force the committee to face stage 5--remember my Fortune magazine and my stages of evolution of thought--to truly weigh the choices, that is the next stage. My amendments would have prevented Federal health subsidies from being funded through higher taxes on employers, higher taxes on individuals and families or through cuts to Medicare. All three were defeated in a party-line vote. I wasn't alone in trying to get the committee to weigh the choices in this bill. Senator Alexander spoke very credibly as a former State governor about the fiscal catastrophe that expanding Medicaid eligibility will cause for the States. Again, he was defeated by a party-line vote. How can we ignore the very real consequences of raising taxes on individuals and employers in a recession--some say the worst recession since in the 1930s? How can we deny that further cutting Medicare will increase costs for everyone else and possibly eliminate access to health care for our seniors? How can we turn a blind eye to all the States that are already facing a financial meltdown and force them to take on billions of dollars of new Medicaid obligations? Some are still stuck in stage 4, still hanging on to their wishful thinking. Well, I am ready to move on to stage 6, and probably everybody else is as well here on the floor. It is called taking a stand. I hope we can all take a stand to preserve the system that works well for the vast majority of Americans and to consider a more cost-conscious, realistic, and patient-friendly approach to greater health care reform. By far the most important stage for us is--yes, the final stage-- stage 7: making a responsible judgment. The policies in this bill are very expensive, and the American people need to know that someway, somehow they will have to pay for them. So we must thoroughly examine the cost and the tradeoffs in health care reform. We cannot simply engage in wishful thinking. The American people expect us to make responsible judgments. There is simply too much at stake. I understand the leadership of this body is in a dash, a rush to finish the hearings in the HELP Committee to produce a bill, as well as to force the Finance Committee to come up with a markup of a bill to pay for all this. I don't know how you pay for $2 trillion while the Finance Committee is talking about $350 billion and those are very controversial. I have a suggestion. I think we ought to put a big banner right up here where the President is not, right over there. I don't think the President would mind very much, and it could just say, ``Do No Harm.'' Then maybe we could put something underneath that and say: ``Slow Down'' or maybe in the language of my State ``Whoa.'' And then put that in the back of the HELP Committee, put in the back of the Finance Committee, and let's do the job right.

Mr. ROBERTS. I am delighted to yield.

Mr. ROBERTS. If my distinguished colleague--well, I will take back my time and yield back for any comments he may want to make. The person on the other end of the phone call, was he for the health care bill or was he against it?

Mr. ROBERTS. Whether for or against, I hope the Senator from Mississippi would have explained that we both have some real concerns, and we hope we can get real health care reform.

Mr. ROBERTS. Mr. President, I ask unanimous consent to proceed as in morning business to speak about the health care deliberations we are undertaking. I know we are under the Defense authorization bill. My remarks should not take that long.

Mr. ROBERTS. I also thank the Senator. Let me just give one quick example of what I am talking about with regard to Medicare. The President of the Kansas Pharmacists Association is from a very small town out West. We conduct a lot of listening tours, and we go into the pharmacy. The pharmacists, we ought to give them a GS-15 salary because they are the people who deal with Medicare Part D. That is the prescription drug program we give to seniors; it is very popular. Let's say a lady named Mildred came in to see her pharmacist there and Mildred talked to Tom, the pharmacist, and said: What is this doughnut hole? And Tom says: Well, that is where you have to pay a bigger copayment. And she says: Well, can't I get a new kind of program or something else that will help me out here? He said: Yes, there are 47 new programs you can choose from. Mildred, the one that you want is right here. She says: Good. Then I am not going to get hurt with the cost of the prescriptions I need. He says: But I can't offer it to you? Why? Because I only get reimbursed 71 percent. That is about the national average. How on Earth can we expect every pharmacist all around the country to administer--and they are the ones doing the administering; it isn't the Area Agency on Aging or the 1- 800-Medicare. So he had to tell her that the program in Medicare Part D that would cover the doughnut hole, he didn't get reimbursed enough and couldn't offer it. Well, he helped her out. All pharmacists try to do that. That is where we are. Or if Mildred goes to the doctor and the doctor says: I am sorry, I can't take any more Medicare patients--that is happening. It is real. This bill exacerbates that--exacerbates it. That is why I am so upset and why I came to the floor today. I will go back to the HELP Committee in good faith to work with my colleagues and we will try to make it bipartisan. I know on Thursday we are supposed to have a markup in the Finance Committee--marching orders from the leadership around here, right in the middle of a Defense authorization bill. We don't need marching orders. We need to slow down. We need to slow down and get this right. Thank you, Mr. President. I yield back the remainder of my time.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, and to all present in terms of staff, this is Friday, and here we are at 1:25. I apologize to the doorkeepers, I apologize to the elevator operators, I don't want to keep you here for a long time, so I will quit apologizing, but there have been some things happening with regard to health care. The distinguished Senator from Rhode Island indicated the need to move forward on health care. Everybody agrees to that. The pace of it, what is going on, is a real concern, so I do have some remarks to make. I will try to make this as quickly and succinctly as possible so everybody can go about their business. I see smiles from the pages, in regards if I can just hurry up and get through my comments. Yesterday, in the HELP Committee's markup of the Kennedy-Dodd health care reform bill, we had a very good discussion about the proper use and the objectives of something called government-conducted comparative effectiveness research. I know that is getting into the weeds in regard to health care language and health care acronyms. It is called CER; remember that term, ``CER.'' It is going to be around for a long time because it has become quite controversial in regard to our health care discussion and what eventually passes. CER is research that compares the relative outcomes of two medical treatments for the same condition to determine which one is better. That is a good thing. It is a good thing to disseminate and to inform doctors and everybody in the health care delivery system--nurses, health care providers, pharmacists, et cetera--it is a good thing. But the first problem with CER is that not every patient is the same. What is better for one patient may not be better, or could actually be worse, for another. For this reason doctors and patients must be able to deviate from the results of something called CER, or a master plan or a master evaluation that could come out of Washington from an outfit called CMS, under the Department of Health and Human Services. The situation is patients must be able to deviate from the results and make treatment decisions on a case-by-case individualized basis. That is what we all want in terms of our treatment with our doctors. The other major problem, I submit, is that CER has been used by other governments, such as the United Kingdom, to base treatment decisions not just on relative effectiveness but on relative cost. There is the rub. If CER is going to inform doctors and everybody in the medical community that this kind of treatment or this kind of best practice is the arena in which you should operate or pasture you should operate in, that is OK. But if it is used to control costs as opposed to care, then we have a problem. By giving priority to the relative costs of the treatments being compared, the government can deny access to health care based on what I would call pseudoscience, under the guise of CER. That brings me back to yesterday's discussion on CER on the health care markup. The Kennedy-Dodd bill includes a section that establishes a new Center for Health Outcomes Research and Evaluation. This outfit is to conduct and support comparative effectiveness research. Section 219(h)(1)--if that isn't getting into the weeds, I don't know what is--includes the following language relating to the practical effect of CER, or comparative effectiveness research. That would, again, be conducted by the center. Center reports and recommendations shall not be construed as mandates for payment, coverage and treatment. That language was in there to get at this problem for those of us who worry that CER will be used by CMS--that is another acronym. That is the outfit that runs Medicaid and Medicare, in terms of services. These are the people who count the beans, these are the people who want to turn the red beans into black beans. These are the people into cost containment. These are the people who many times drive board members in small hospitals crazy. At any rate, to take away the worry, that language was put in there: Senate reports and recommendations shall not be construed as mandates for payments, coverage and treatment. They thought that was enough to protect us in regard to CER dictating medical care and stepping in between you and your doctor. Let's go back to those words ``shall not be construed as mandates.'' What does that mean? ``Mandate'' means to force, compel, bind. This language says the CER shall not be interpreted as forcing CMS, Veterans' Administration or the Department of Defense to restrict payments to doctors based on its results. Senator Mikulski and I and Dr. Coburn as well had a very lively discussion about the intent of this language. Senator Mikulski said the intent of the language was to keep the right to make treatment decisions with the doctor and the patient, not with the government. I certainly agree with that. Senator Mikulski has worked long and hard on this bill, and I respect her for that. She is a good colleague and a good friend. I agree with this intent. But as I pointed out to the Senator, the language in the Kennedy-Dodd bill does not accomplish our common intent of saying the government is not mandated or forced to use the results of this comparative effectiveness research to make payment decisions. Whether you are paid or not in regard to Medicare or, for that matter, Medicaid is not the same thing as prohibiting or preventing CMS from doing so. In order to vigorously protect the rights of patients and doctors to make treatment decisions against the danger that the government will interfere in that process, I believe the bill must prohibit the government from using the results of CER in making payment, coverage, or treatment decisions. Sorry, you cannot have that, you have got to have this treatment, because it is a best medicine practice, regardless of the fact that maybe you and your doctor have had that treatment before and the doctor thinks that treatment is the best treatment for you. I offered new language, and the new language would have placed a clear, bright-line firewall between the conduct of CER--which, by the way, I think is essential to advancing medical science; it is a good thing--and the use of its results to restrict your doctor from using his or her best judgment when treating you. My language, which I further modified at the suggestion of Senator Mikulski, read: ``Center reports and recommendations are prohibited from being used by any government entity for payment, coverage, or treatment decisions.'' Senator Mikulski agreed to consider my suggestion over last night, along with Senator Dodd. I appreciate that. But today when the HELP Committee reconvened in our markup, Senator Mikulski and the majority refused to accept my language and offered counterlanguage that would basically put us back to square one and, in my view, would do nothing to protect patients and doctors from CMS or any other government agency interfering in their treatment decisions. When I asked why my language was unacceptable, which I thought was acceptable for everybody when we left yesterday, I was told that the decision to say my language was not acceptable was based on concerns by ``Washington policy experts.'' I said: Who is that? Which Washington policy expert said my language was not acceptable? When pressed on which policy experts, we learned that the directive came straight down from the White House. Why would the White House be so concerned about prohibiting the Federal Government from using CER to restrict payments to doctors or to direct doctors to follow specific treatment orders? Why would the White House do this on this in-the- weeds proposal, which is not an in-the-weeds proposal at all, it is about what the government is going to do or tell doctors and patients what they can expect. It is clear from statements made by this administration that they see CER as the golden ring for cost containment. The President said when asked, how on Earth are you going to pay for the health care bill, We are going to cut Medicare payments. How are you going to do that? Well, if you have a CER golden ring that comes down from CMS or the National Institutes of Health for cost containment, you can see: This research says that you should follow these practices, not those practices and those practices, or, these practices would certainly cost less. I do not think that is a good thing. From OMB Director Peter Orszag, to the NIH Director, going on to the National Economic Council Director, Larry Summers, and indications from our new Secretary of Health and Human Services, Kathleen Sebelius, a good friend, former Governor of Kansas, all have pointed to the huge potential of CER to be used to contain costs, not to recommend procedures best for patients and the doctors as determined by the patient and the doctor, but by CER to control costs. That is why the White House does not want to prohibit CMS or any government agency from using the results of CER to deny you and your doctor the right to choose the treatment that is best for you. After all of that was said and done, and a lot was said and not much done, I got quite a lecture this morning in regard to my use of the word ``rationing'' to describe what this could lead to. This lecture was referred to as a scare tactic. They indicated that I was using the word ``rationing'' out there as a scare tactic to scare people to say we do not want health care reform. I find that rather condescending. I find that demeaning. And it is certainly not accurate. You tell me, when Medicare refuses to pay your doctor if he or she decides you need a particular course of treatment that deviates from the government standard, what would you call it? I would call it rationing. That is the danger. It is not a scare tactic. Health care rationing is happening right now in this country. We may not have explicit rationing such as in the United Kingdom where the government refuses to give elderly people drugs to treat their macular degeneration until they have already gone blind in one eye--not making that up--or refuses kidney cancer drugs for terminal patients because it is not worth the money to extend their life by 6 months. That is rationing. But we do have de facto rationing, because Medicare and Medicaid refuse to pay doctors anything close to what their costs are. By the way, it's the same thing for pharmacists, the same thing for home health care, and for all of the providers who provide our health care treatment. This means those doctors cannot afford to take Medicare and Medicaid patients--they make the decision then--and it means that those individuals do not have access to care. That is rationing I am talking about. I am talking about a doctor who makes a decision: I am only getting paid about 70 cents in terms of the dollar in regard to my cost in regard to Medicare patients. I have to hire extra people to keep up with paperwork and regulations. Those people do not exist in the rural health care system. We have to try to find them. So it is a lot easier if I drop the Medicare Program. That comes as a sudden jolt and a sudden decision that is not fair in regard to the patients who were being treated by that doctor in terms of Medicare. That is what we call rationing right now in regard to the United States of America. We know the administration wants to use CER to contain costs. We know CMS has a history of denying full payment based on cost. I am not going to take the time on the Senate floor right now to go into all of the problems that CMS has posed for the health care delivery system. Again, these are folks who have a difficult task. They are trying to change the red beans into black beans so that health care does not cost so much. But in terms of their decisions here in Washington in regard to what care is going to be paid for and what is not, they are an absolute nightmare to every hospital administrator, every hospital board member in the 350 or so hospitals I have in Kansas, and the 83 critical access hospitals I have in Kansas. We do not have a very good relationship with CMS. What we have is a meaningful dialog, most of the time, when yet another regulation comes down the pike to contain cost, most of which the doctors have never heard of, not to mention everybody else in the health care delivery system. I can go into quite a rant, as you can expect from my comments in regard to CMS and what they do and what they do not do. Why is the majority, why are the Democrats, resisting any language to protect patients and their doctors, you and your doctor, and your right to make the right treatment decision for you? Why are they trying to muzzle my warnings that this could lead to the rationing of health care? It boils down to the fact that they do not want the American people to know what their true plans could actually be. That is why they are shoving this massive health care reform bill through Congress at warp speed, having markups before we even have complete language or cost estimates. We heard from the distinguished Senator from Rhode Island about the need for health care reform, and the fact that he was complaining about over 100 amendments in the HELP Committee. My goodness. Almost every major bill I have been associated with, you have literally hundreds of amendments. Many fall by the wayside, many are withdrawn. We have dealt with 17, 18 of them as of today. Senator Mikulski and Senator Dodd did a very good job in that respect, along with our ranking member, Senator Enzi from Wyoming. But it would be helpful, if we are going to move forward with the health care reform, if we had the bill. We do not have the bill in the HELP Committee. We have one section of the bill, and then we have a Congressional Budget Office score on one-sixth of the bill that is $1 trillion. And, boy, did that shock everybody. Say $1 trillion for one- sixth of the bill. What is the whole bill going to cost? That estimate is somewhere in the neighborhood of $4 trillion. How on Earth are you going to pay, in the Finance Committee, the pay-for committee, $4 trillion for health care reform, and take it out of the health care delivery system? I do not think you can do it. But we do not know, because we have not seen the legislation. We are being asked to go on a deadline schedule to produce amendments on things such as CER that worry people in regard to possible rationing by a date certain or a time certain, and we have not even seen the bill we are amending. I have never been through a situation like that. Not to mention the specific cost estimates by CBO. This is not right. That is why Chairman Baucus in the Finance Committee had at least the good sense to postpone the markup of his bill until we could work this out. That is why slowing down does not necessarily mean that everybody is opposed to health care reform. It means we ought to get it right. We at least ought to have a bill to read, to know what we are dealing with. I think it is because they know that if Americans knew what they were doing, they would never stand for it. I think we need to get this out to the public, and the public will hopefully fully understand it. I am not going to allow this. Personally, I am going to continue to shout it from the rooftops and beware of what lurks under the banner of ``reform'' to tell every doctor, every hospital administrator, every hospital board member, anybody who has anything to do with the health care delivery system, watch out in regard to CER. It could be the golden ring of cost containment, and it could put you out of business. It could put you out of business. We have examples of CMS doing exactly that. So do not wake up one day and realize that the government has taken over your health care the same way they have taken over the banks and the auto industry. Do not let them ration your health care. Rationing is not what we need. It can be terribly counterproductive, and I hope we can do a better job in the future. I yield the floor and I suggest the absence of a quorum.

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

Mr. ROBERTS. I ask unanimous consent I may proceed as if in morning business for approximately 15 minutes.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I ask unanimous consent that I may proceed for approximately 16 minutes as in morning business.

Mr. ROBERTS. I thank the distinguished Acting President pro tempore. Health Care Reform Mr. President, last week, I came to the Senate floor to talk about the flawed process of our current attempts to reform the health care system in this country and the urgent need to fix those flaws. Those efforts included a letter--my letter--which every Republican member of the Finance Committee and the HELP Committee--Health, Education, Labor, and Pensions Committee--signed requesting some very reasonable steps to be taken by Chairman Baucus, Chairman Kennedy, and Senator Dodd, who is standing in for our friend and colleague, Senator Kennedy. We asked the chairmen to release the details of their plans to reform health care. We asked them to do so in a timely manner to allow us time to read and understand the policies and to get reactions from our constituents, i.e., the people who will benefit or will not benefit, not to mention the providers of health care. We asked them to give us the estimates of how much their plans would cost and how it would impact everyday Americans. Finally, we asked them to identify how they intended to pay for these plans. It was my sincere hope that by receiving this information we could better participate in the quest to ensure that every American--every American--has meaningful access to health care, not to mention patient choice. Well, unfortunately, the health care reform process has been so corrupted by artificial timelines and a ``hurry up'' and a ``riding hell for leather'' mentality that it threatens to destroy a health care system that has served most Americans very well. The American health care system represents one-sixth of our economy, which has been repeated many times on this Senate floor, offers health insurance coverage to 250 million Americans, and employs over 16 million people. It leads the world in medical innovations that save lives inside as well as far outside our borders. So this actually is an international health care bill. President Obama has recognized that most people are happy with their health care. Obviously, they would like some changes, some reforms. But he has repeatedly assured them: If you like what you have, you can keep it. Well, because changes to this system have the potential to impact every single American citizen and citizens of other nations, it seems to me we must ensure we protect the best of its features when we consider changes to shore up its deficiencies. Careful consideration is required. That is why we ask for more details. That is why we ask for more time. To date, our requests for more information have not been met, and I think I am starting to understand why. Yesterday afternoon, the Congressional Budget Office, the CBO, released its first preliminary analysis of the bill we are scheduled to begin marking up in the HELP Committee tomorrow. Let me repeat this: Yesterday afternoon--less than 24 hours--if you are a HELP Committee staffer, you are looking at your watch, and you are wondering how come you do not have more time--the Congressional Budget Office released its first preliminary analysis of the bill that we are scheduled to begin marking up tomorrow. I said in my previous speech, maybe we need a ``process czar,'' a ``fair play czar'' around here. We have 25 czars in the Obama administration. Maybe we need a czar around here to at least be fair, give us more time, give us more consideration, let us know what we are going to be voting on. Before I talk about the results of the CBO's analysis of the Kennedy- Dodd legislation, I need to point out this analysis is incomplete. It is incomplete because, despite our persistent requests for more information from our Democratic colleagues and friends, one day before the markup of possibly the most important health care bill ever to cross the Senate floor, they have not released the complete legislation. In fact, even when the HELP Committee begins our markup tomorrow, we will not have a complete picture of what we are marking up. The most contentious components of the bill will not be released until sometime on Thursday morning--leaving us around 30 hours to digest these significant policies, vet them with our people back home, take the specifics back home to the health care providers and every constituent who certainly is interested and wants to know the details, and then file amendments to see if we can do better, see if we can actually correct some things we think are headed in the wrong direction. I said it is hard to digest all of this in 30 hours. This is not digestion, this is not indigestion--this is heartburn. It may develop into a malady much more serious than that. Most egregious perhaps is the fact that we will most likely be considering these major reforms without any idea of how much they will cost or how they will affect the current system. But, as I said, I am starting to wonder whether that is not part of the plan, which leads me back to yesterday's CBO release analyzing the cost and effect of just one of the six titles to the Kennedy-Dodd health care reform bill--and an incomplete title at that. According to CBO, the incomplete sections of title I will cost $1 trillion--$1 trillion. That is just for one incomplete title of this bill. What will we get for this staggering investment, for a title with a purpose ostensibly to expand health care coverage to the estimated 47 million Americans currently lacking insurance? According to CBO, we will only cover 16 million more Americans. Let me say that again. According to CBO, we will only cover 16 million more Americans. That does not seem like a very good return for a bill that seeks to cover three times that many people. Instead of extending health insurance to 47 million uninsured, we are leaving tens of millions still uncovered. And the CBO says that figure is around 37 million people. So you can see we have some flaws in this approach on this bill. In addition, CBO says that 15 million people would lose their employer-sponsored insurance and another 8 million--again, this is the CBO analysis--would lose coverage from their current source. Whom are we going to trust around here? At least when we asked the CBO to give some specifics, they are providing some specifics; that is, 15 million people would lose their employer-sponsored insurance and another 8 million would lose coverage from their current source. That is 23 million people. That is a lot of folks. As I said, President Obama has consistently promised: If you like the health insurance plan you have, you can keep it. Not those 23 million. Under the Kennedy-Dodd bill, 23 million Americans who may like what they have cannot, in fact, keep it--again, according to the CBO, nonpartisan. I cannot even imagine how much more this bill will cost taxpayers when CBO figures in the rest of the initiatives my friends across the aisle wish to add. I am positive, under the complete plan by my colleagues, millions more Americans will not be able to keep the insurance they like. That is because in addition to the plans that have already been released, they want to establish a new government-run, taxpayer- financed insurance plan that is estimated to replace private insurance for over 100 million Americans. They want an expansion of Medicaid for everyone up to 150 percent of the Federal poverty level. They want to enact dozens upon dozens of new programs. For example, title III of this bill includes--listen to this--a $10 billion per-year-cost in mandatory spending--mandatory spending; this is on the appropriators' side--for something called a Prevention and Public Health trust fund for the Appropriations Subcommittee on Health, with very little, if any, direction on what the money would be used for. This is unprecedented and amounts, in my view, to a slush fund, regardless of any description. Another section provides an unknown amount of money--``such sums as may be necessary''--to fund something called a community makeover-- excuse me--a community transformation grant to build grocery stores, sidewalks, and jungle gyms. Sidewalks, jungle gyms, grocery stores? This is a health care bill, not a rural development bill. I am shocked by the numbers that have come out so far, and they are just the beginning. Well, come to think of it, maybe it is related to health care. Maybe if you build a better sidewalk, people could walk on that sidewalk, pass the jungle gym, exercise on the jungle gym, go to the grocery store, have mandates to buy nothing but fruits and vegetables, come back past the jungle gym, exercise some more, and since the sidewalk is fixed, they could go home, and we would help cure the obesity factor we face today. Maybe that is the tie. Maybe that is the tie. I am shocked, as I said, by the numbers. One independent group--now listen again to this; you have to listen to this--the group called HSI Network in Minnesota has estimated that the cost of the Kennedy-Dodd bill in its entirety could be $4 trillion--$4 trillion. The Lewin Group has estimated that up to 119 million Americans could lose their private insurance coverage under a government-run plan. I am willing to bet the American public will be as shocked as I am once they understand what has been lurking, lurking, lurking under the banner of reform. The refusal to release information such as this until the very last possible minute, under an unjustifiably accelerated timeline, leaving no time for Senators, let alone the American public, to examine the merits of this plan, makes me think the ``health care emperor has no clothes.'' Let me repeat what the CBO has said. Sixteen million Americans newly insured--a good thing--but 37 million Americans still not insured. Twenty-three million Americans lose what they have for $1 trillion. This is the wrong direction. This is the wrong direction. We ought to say: ``Whoa.'' Put a sign up in both committee rooms that says: ``Whoa,'' and put a sign underneath it that says: ``Do no harm.'' To add to this concern I have and the frustration I have in regard to health care reform, CongressDaily reported Tuesday, June 16--that is today--that CBO scored a recent version of the Senate Finance Committee--this is Finance, this is not Health. This is not the one I am talking about; this is the Finance Committee, and I have the privilege of serving on both--that their overall proposal is at $1.5 trillion over 10 years, not $1 trillion, according to several sources. This is a typical news story. The committee's timeline to release and mark up the legislation could slip on the news. Senate Finance Chairman Max Baucus cautioned today the CBO numbers, which he did not confirm, were on a bill that is about 2 weeks old and the bill has evolved since then. The chairman indicated it is unlikely he will release a draft of his committee's bill Wednesday, as he previously estimated--that is tomorrow. The high score could add more credence to an insurance co-op proposal offered by Senate Budget Chairman Kent Conrad as an alternative. So we don't know. Is it $1.5 trillion or is it $1 trillion? We don't know. And if an offhand comment, which may or may not be private, but I don't think anymore anything should be private in regard to health care reform--the chairman indicated, I think, it was a comment in response to Senator Snowe, who said, How do we vote for this bill in committee if we don't know how much it costs and how it is going to merge with the Health Committee's bill. Basically the answer coming back, as everybody knows is, This bill isn't going to be written here, this bill isn't going to be written in committee; it is going to be written in conference. It is called ``trust me.'' I don't see how we can have much trust when ``the emperor has no clothes.'' I yield the floor.

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

Mr. ROBERTS

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

Mr. ROBERTS. Madam President, I understand we are in morning business, and I ask unanimous consent that I be recognized for about 12 minutes.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I rise today to discuss an issue that is one of these ``believe it or not'' issues of waste and abuse concerning billions of tax dollars and stimulus funding. I have some good news and then I have some bad news to report. First the good news. In the last 24 hours, we have been able to reverse a policy that would have used stimulus money to pave the same road twice within a matter of months. I said yesterday that did not pass the Kansas commonsense test or, for that matter, any State's commonsense test, and would be a huge abuse of taxpayer dollars. We have reversed this plan, this silly plan, in a bipartisan way. I wish to personally thank Vice President Biden, the man charged with overseeing all of the stimulus spending, for taking action to correct this abuse after I contacted him. I really thank the Vice President because the White House moved and the Vice President moved in an expeditious fashion, and I, quite frankly, didn't expect they could move that fast, but they got the job done. The Vice President will be in Kansas today, and I asked him to review this rather ridiculous example of wasteful spending occurring in Cherokee County, KS, just a short 2-hour drive south on U.S. Highway 96 from where the Vice President will be. You see, a section of old Highway 96 would have been resurfaced with stimulus funds. Then portions of an EPA Superfund site would have been cleaned up with stimulus funds, and the heavy equipment used for the cleanup would have damaged the newly resurfaced highway, so they would have to go back in and do the highway again. Once this cleanup was complete, additional stimulus funds would have gone to repair the road damage caused by the heavy trucks. Taxpayers would have paid almost $1 million to fix this road twice. Fortunately, in working with the Vice President, we now have media reports that the Superfund cleanup will occur prior to any roadwork. That is the good news. Again, I credit the Vice President and his staff and his team. Now for the bad news. While this spending issue has been fixed, there is a much larger spending issue affecting dozens of Kansas families in Cherokee County, KS, and that is still a major problem. I am going to urge the Vice President to again provide leadership. He is the self- proclaimed new sheriff in town. I am an honorary sheriff of Dodge City, KS, my hometown. So from one sheriff to another, I would simply say to the Vice President: Sheriff, I will ride shotgun or you can ride shotgun. We have the problem only half solved. You see, in April, EPA Region 7 issued a press release saying Cherokee County would receive up to $25 million from the stimulus. According to the press release: By starting or speeding up cleanup at Superfund sites, the [stimulus] funding is also increasing the speed with which these sites are returned to productive use. When a Superfund site is redeveloped, it can offer significant economic benefits to local communities, including future job creation. Unfortunately, for fewer than 100 residents living in the city of Treece, the stimulus funding for this project is literally going down a sinking hole. The city of Treece, KS, sits on the Kansas-Oklahoma border. This small, rural community was once a world leader in lead and zinc mining, mining that lasted for nearly 100 years. As the mining companies shut down in the 1970s, the groundwater began to rise and the pillars that supported the soil above the mine shafts began to collapse and you had a giant sinkhole. Shortly thereafter--in 1983, to be exact--the EPA placed over 500 square miles in southeast Kansas, northeast Oklahoma, and southwest Missouri on the National Priorities List of the Superfund list, including the city of Treece. In total, Cherokee County, KS, where Treece is located, has 115 square miles in the Superfund Program. Last summer, during a listening tour of this part of Kansas, I saw firsthand how 100 men and women and children are living in absolute blight. They live day by day not knowing when--and I mean when, not if--their homes will collapse into the earth below into a giant sinkhole. They remain there despite the loss of businesses and infrastructure because their homes have no market value and they cannot sell them to fund a new home or even rent one. As parts of Cherokee County have been on the Superfund list for the last 26 years, the EPA has removed and replaced contaminated topsoil. According to their stimulus press release, the EPA will continue to remove lead-contaminated residential soil at more than 380 acres in Baxter Springs and Treece. That probably sounds like an admirable thing to do, but as the ground below it caves in, the exposed soil that has not been cleaned up will rise, so essentially this is a never-ending process. You are cleaning up topsoil on a single home, and after the sinkhole sinks, obviously the topsoil is going to be contaminated with the contaminated soil underneath the new topsoil. If you get all that, I think you got the problem. This is a never-ending process. I have worked very long and hard with other members of the Kansas delegation to determine how best to address this situation. The only satisfactory answer anyone has been able to give me is to relocate the town to protect the residents from a complete cave-in. The Federal Government needs to buy out the land from the remaining homes and business owners and then prohibit any future construction on the property affected by the contamination. This is exactly what we did with Pitcher, OK, on the other side of the State line, just a few years ago. Most estimates indicate we could relocate the entire town with $3 million in Federal funding and $500,000 in State funding--funding the State of Kansas has already set aside. During the previous Congress, I introduced legislation to address the Federal portion of this funding. Fast forward to today, with an economy experiencing a lot of turbulence and a so-called stimulus bill that everyone in this body heard was an absolute necessity and not only a job maintainer but a job creator. So I asked the EPA to use $3 million of already allocated stimulus funding to relocate the community--$3 million. I was told no. Instead of solving this problem and relocating the families of Treece to a safe facility, the EPA, with the assistance of the stimulus package, continues to spend even more money, $25 million--eight times the amount needed to relocate the community, the 100 people who live in blight and fear that their homes will sink into a sinkhole--to put new soil--this is what they are currently going to do--onto contaminated soil, which is then going to collapse and recontaminate all the soil. This doesn't make sense. I have had an ongoing dialog with EPA, and they have told me: The wastes are causing great environmental harm to southeast Kansas-- We, of course, knew that-- as evidenced by the documented impacts to birds, fish, mussels, macro-invertebrates, and horses. There is also evidence of harm to humans as it is related to elevated blood lead levels. The letter went on to say: EPA Region 7 believes the situation at the adjacent Region 6 Tar Creek Superfund site in Oklahoma materially differs from the Cherokee County Superfund site, and that is what drives different decisions for the Tar Creek Site. I am going to refer to a couple of charts here. This is a picture of Treece, KS, located right here. You can see all of these white objects here. Basically, that is the chat material that has come out of many mines over 100 years. Here is Treece, KS, and here is Pitcher, OK. Here is a giant chat pile in between. I have been there. You see many little ponds and winding roads, and I advise you not to go fishing in any of those ponds. You might catch a three-eyed fish. At any rate, it is all contaminated, all a sinkhole, whether it is from Treece, KS, in Region 7 with the EPA or whether it is Pitcher, OK, in Region 6 in Dallas. I don't know what the difference is. If this is contaminated, and it is, and this is contaminated and looks the same, and it is, what the heck is the difference? Let me show another angle so you can appreciate what I am talking about. This is what the people of Treece see every day as the Sun rises and sets. This is a giant chat mountain--all of this contaminated soil. This side of the chat mountain is Treece, the other side is Oklahoma-- the same situation, same problem, same contaminated soil, same sinkhole, and the same thing on the other side, except EPA 7 in Kansas City can't get it through their heads that this is identical to the same problem over here. Instead of spending $25 million to clean up and put topsoil on contaminated soil that will sink, why can't we spend $3 million to save the community of Treece and relocate these people? Basically, EPA Region 7 does not have a factual basis, according to them, ``that would allow the use of regular or [stimulus] funds for a residential buy-out at the Treece subsite.'' Why? We were going to spend money for a road to be built twice. We are spending $25 million to put topsoil on a sinkhole. Why can't we put $3 million to relocate this town? Here is my question. EPA acknowledged there is evidence of harm to humans. They listed a whole series of other animals and wildlife, and so on and so forth, that they are worried about. I understand that. But why not provide assistance to relocate fewer than 100 people from harm's way? Furthermore, EPA told me that ``a 10-year timeframe is estimated for complete waste remediation.'' Due to the continual mine collapses, I wonder if the environmental cleanup will ever be completed. I think it is in the best interests of all taxpayers to quit throwing money down sinkholes and provide an opportunity for 100 folks who have no other options to move, as their homes are worth nothing. We do not need to spend, again, $25 million on a problem that will not be solved--topsoil on top of the sinkhole. We need to take care of these people and spend $3 million to let them get on with their lives. While American taxpayers are spending untold millions to prevent mortgage collapses, I can see no better use for the stimulus plan than to get the residents of Treece into safe homes. I said once before, I am an honorary sheriff of Dodge City. I have a badge. You can go to Dodge City and you can meet the marshal, you can see Miss Kitty. You can go down to the Long Branch. We are used to taking care of problems ourselves. Kansas has appropriated $500,000 to do this. All we are asking for is $3 million, not the $25 million that I don't think is going to ever really result in any long-term cleanup. You have to be there to realize just how bad this is, the pools of water and all. People will tell you: Senator, we are going to take you around this way. Don't walk this way. So I would just ask Sheriff Joe, who is the self-declared sheriff on stimulus money, help me out here. Ride sidesaddle or you can drive the stage. Help me get $3 million. You have already stopped the ridiculous situation of building the road twice after we had destroyed it with stimulus money. That is the good news. But the rest of the story is that the citizens of Treece need to be relocated. We can do this for $3 million. This remains an awful way to treat any community. I think it is not a wise use of taxpayer money. It does not pass the Kansas commonsense smell test. I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. I ask unanimous consent that I may proceed for about 12 or 13 minutes as in morning business.

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

Mr. ROBERTS. Mr. President, I rise today to talk about health care reform. What else in regard to the interests of the American people and what we are doing here? As the Republican leader, Senator McConnell, has pointed out in several floor speeches over the past week or so, the desire for health care reform on both sides of the aisle is one that unites this Chamber across both political and geographic boundaries. Our system of health care produces some of the best care in the world and it is the driver of a substantial share of the medical innovations that have wiped out diseases, improved our comfort, and extended our time on this Earth. However, this system is not truly accessible to everybody, and that is the problem. That is what this entire debate boils down to: your ability to have access to a doctor, to go see the doctor of your choice when you need to see that doctor. Solving this problem of access is exceedingly complicated, partly because it evidences itself in so many diverse ways all across the country, so many geographical areas. For example, in our rural areas in Kansas, we are struggling with attracting and retaining doctors and keeping the doors open to our hospitals, to our pharmacies, and clinics. We talk about recruiting athletes. My goodness, the business of recruiting doctors and health care professionals is equally as competitive. In our urban areas such as Kansas City and Wichita, our providers face very different challenges which are just as daunting and which threaten a patient's ability to access health care. On top of that, although some 250 million Americans have health insurance, somewhere in the neighborhood of 27 to 47 million, depending on who you are counting and who is talking, do not. That makes accessing health care expensive and very challenging for them. In addition, the government-run Medicare Program, which is on the verge of bankruptcy, by the way, does not pay doctors and pharmacists and ambulance drivers and nurse clinicians--pardon me, clinical lab folks and home health care providers and almost every health care provider that you can name--they do not pay them enough to cover their cost. Unless these providers have a non-Medicare population to recoup their losses, they cannot stay in business and their patients lose out--a de facto rationing of health care. As a member of both the Finance and HELP Committees, and the cochair of the Senate Rural Health Care Caucus, I am able to participate and have been participating, along with staff, in this complex and very difficult effort. We must reform our health care system into one that guarantees meaningful access for all Americans, and guarantees that patient-doctor relationship. However, this effort to date has been a tale of rhetoric versus that of reality, the promise of cooperation contrasted with the unfortunate but real fact of partisanship, something I do not like to say. Let me explain. President Obama, who ran as a ``postpartisan'' candidate, has made many overtures to Republicans indicating a desire for this process to be bipartisan. He just met with some members of our leadership and obviously the leadership on the other side of the aisle as of today. Others in the Senate have declared their goal to be a bill that attracts upward of 70 votes. Is that possible? I would hope so. It could be. That would be a tremendous victory for the Senate of the United States and the American people. But the reality is something very different. Today in the HELP Committee, the Health, Education, Labor and Pensions Committee, we have just begun the process of walking through a 615-page bill that we are scheduled to mark up next Tuesday. This bill does not have one single Republican contribution, as far as I can tell. Moreover, it is incomplete, with many details missing. For example, the small detail of how much it will cost. There is no cost estimate to this bill of 615 pages, just going through it as of today, going to try to mark it up next Tuesday. Come on. That is not the way we should be doing business. The Finance Committee has conducted a parallel and I think, quite frankly, a better process so far, and I wish to thank Chairman Baucus and Ranking Member Grassley and their staffs for their efforts. But we still have not seen a detailed proposal or cost estimate, and we are being pushed to mark something up in the next few weeks as well. I want everyone to understand why process is important. Health care reform is important, to be sure. Getting things done obviously is important. But so is process. It is not because I do not want health care reform, nor is any Member in this body in a position to say they do not want health care reform. I want every single Kansan, every single American, to be able to see the doctor of their choice when they want to, especially when they have to. I speak today because this health care reform bill will likely involve one of the biggest, most important votes that I or any one of my colleagues will cast during the time we are privileged to serve in the Senate of the United States. This health care reform bill will affect the lives of every single American. It will reform a system that drives one-sixth of our economy, over 16 million American jobs. It will have consequences for medical science and innovation that improve the lives of not only those of us in this great country but all across the world. When people are really sick, they come to the United States. This bill will spend upwards of $2 trillion--$2 trillion--our children and grandchildren will have to some day repay. If we are going to do this, we cannot afford to get it wrong. For this reason, I initiated a letter about a week ago on behalf of all of my Republican colleagues on the Senate Finance Committee and on the HELP Committee. I asked the chairmen of those respective committees, the distinguished chairman, Senator Dodd, who is now serving in Senator Kennedy's absence, to give this process the time and the careful consideration it deserves. That was the message of the letter: Give us the time and the very careful consideration this vital issue deserves. It seems to me our requests have been extremely reasonable. First, please provide us with your detailed plan with enough time for us to read it, to understand it, and get feedback from our constituents back home, the people the bill will affect. We have done this in the Finance Committee. Goodness knows, I do not know how many panels we have had, how many walk-throughs, how many slide presentations. Boy, that is tough in the afternoon to turn the lights off as Senators and try to pay attention to fact after fact after fact and suggestion after suggestion after suggestion and policy objective after policy objective on each day as we go through the legislative swamp, to try to get this from here. Our requests, again, I think--I want to say it again. First, you should provide us with your detailed plan with enough time for us to read it, understand it, get feedback from our constituents back home, the people the bill will affect. The reason I said that twice is that every day we had one of these slide shows, every day we had a PowerPoint, every day we got more information, our office would send it back to the providers of health care in Kansas, much in the same fashion as members of the committee would send to it their people, and say: Hey, is this going to work? These are the people who actually do provide the health care. I know the arguments that say: Well, now, wait a minute. We need to cut out fraud, waste, and abuse, and we need to be much more cost conscious. We need better practices in regard to better medical practices. We need a lot of things to either suggest or to incentivize or to maintain what the health care providers do. But in the end result, if that person is sick, they are going to have to see a doctor, and they are going to have to see a nurse or some health care provider. So in the end result, we better at least be doing something that the providers say, yes, this makes common sense or you are going to see either one of two things: You are going to see a political revolt when they say, no, we are not going to go down that road or else you are going to see a continuation of rationing where providers say: No, I am not going to take part anymore in the Medicare Program, because I am not getting reimbursed up to cost. You can have the best government program in the world, you can have the best government card in the world. But if you cannot find a doctor who provides service or a home health care provider who will provide service, or any provider who will provide that service well, where are you? Second, I would like to see provided the cost estimates from the Congressional Budget Office and the Joint Tax Committee. Let us know how much all of this is going to cost. That is extremely important. We are hearing anything from $1 to $2 trillion. Then, lastly, how will it be paid for? I know we are into an era now where basically we have the printing presses rolling, and we have an Economic Recovery Act and we have many facets of that, we have the stimulus, the omnibus, we had the President's budget and we had TARP, and we had four different other acronyms under TARP, and we did not worry too much about the pay-fors and who was going to pay for it. We let the printing presses roll, because nobody wanted to see economic Armageddon. Could we have done it better? I think so. But that is yesterday's decision. So we should identify how this will be paid for or are we not going to pay for it. Are we simply going to go ahead--there has been some discussion about some aspects of it that you would not pay for. There are other aspects that we need to go into, because they involve probable tax increases, and now is not the time to be increasing taxes, especially on the small business community, despite the need for health care reform. I think asking for these details is absolutely fair. I think it is necessary under the circumstances. In fact, I would be ignoring my responsibilities to my constituents in Kansas if I did not demand these conditions be met. Every single Republican member of the Finance Committee and HELP Committee signed the letter. Every single one expressed a desire to work with our colleagues to achieve bipartisan health care reform. That brings me back to today's HELP Committee walk-through of 615 pages of an incomplete draft, the rushed HELP and Finance markup schedule, Tuesday, and then in about a week or two, the arbitrary floor debate deadlines that we hear from leadership. I hope our letter will slow this hurried dash to an imaginary finish line. Slow it down. Slow it down. I know it is extremely important that we pass good health care reform legislation. It is also extremely important to prevent bad legislation from passing and get America saddled with it for about 20 or 25 years. I wish at the end of every committee room, if in fact the bill gets to committee, the committee of jurisdiction, that we can hold appropriate hearings, we would have a sign that says, ``Do no harm.'' And then right below it perhaps we could put ``whoa,'' until everybody can slow down and read it in regard to process, and cost, and specifics of the bill, and trying to work together to get a good product. There is no reason why the Senate should rush through a bill that has this much at stake. So time out. Time out. Time. Slow down. Give us the details. That is all we are asking for. The people of this great Nation deserve nothing less. Let's get health care reform and let's get it right. I yield the floor. I suggest the absence of a quorum.