Pat Roberts

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to again pay tribute to one of the Senate's finest: our colleague, the late Craig Thomas from Wyoming. Two years ago this week, the Senate lost a steady hand and a man who did much for his State of Wyoming. Craig was dependable in the finest sense of the word. He defined the word ``dependable.'' He was the epitome of a workhorse, not a show horse. On a personal note, for many Senators, why, Craig was not only a colleague but a dear friend. I will cherish that always. Craig was also a fellow marine. In this case, Semper Fidelis--always faithful--is most appropriate. If anyone faced trouble in their life, the one person you would want by your side would be Craig Thomas. This is why I am proud and honored again to join with my colleagues Kent Conrad and Tom Harkin, and with the new Senator from Wyoming, John Barrasso, and the distinguished Senator from Utah, Orrin Hatch, to introduce the Senate Rural Health Caucus bill in honor of Senator Thomas. The bill we are introducing is the Craig Thomas Rural Hospital and Provider Equity Act, with emphasis on the ``equity.'' The people of Wyoming and all of Craig's colleagues knew he fought for rural America and always put the needs of his State above all else. On the health care front, why, Craig was truly a champion for strengthening our rural health care delivery system and providing relief to our hospitals and other providers in our rural areas. He served for 10 years as the cochair of the Senate Rural Health Caucus. He actually took over the reins as cochair after my fellow Kansan, Bob Dole, retired from the Senate. And as I know personally, it is hard to follow in the footsteps of Senator Dole--for that matter, Senator Thomas. However, Craig did this with great ease and great pride. His steady leadership put the caucus on the map, and he made great strides in showing all of our colleagues the true needs of rural health care. We will truly miss him during the current health care debate. I and the members of the caucus miss him and his leadership greatly. One of the biggest accomplishments for Craig in the Rural Health Caucus was passage of the Medicare Modernization Act in 2003, which provided a big boost to our rural hospitals and providers. There was recognition and support from our colleagues from all of our geographical areas, large and small, for including these badly needed rural health provisions. These provisions included in the Medicare bill provided much needed relief to rural health providers, enhanced beneficiary access to quality health care services, and improved provider payments in our rural areas. So many times those payments simply do not even come close to the costs of the provider and the service they provide to our rural citizens. However, you would never know that it was Craig Thomas behind the scenes working to get these rural health provisions included in the Medicare bill. Craig was more concerned with getting the work done rather than taking the credit. So instead of taking individual credit for his hard work and his dedication on the Medicare bill, he applauded the entire Rural Health Caucus and patted everybody else on the back. It is this kind of leadership that set Craig Thomas apart from his colleagues. However, Craig knew that while passage of the Medicare bill was a giant step for rural health, we still had much work to do to ensure our rural system can continue to survive. Sometimes when they ask me about health care reform--``they'' meaning most of the people interested in health care reform: the media, others, the health care providers--I simply say one of the things we want to do is to make sure we preserve what we have. This is why we were proud and honored to carry on his legacy by introducing the Craig Thomas Rural Hospital and Provider Equity Act in the 110th Congress, and again in this Congress. We can enhance Craig's legacy certainly in this way. I wish to especially recognize a member of Craig's former staff who has always worked extremely hard to advance rural health care causes and who has remained a champion for Wyoming as a member of Senator John Barrasso's staff: Erin Dempsey. I know my staff has worked very closely with Erin over the years, and I have a great amount of respect for her hard work. We always have an expression: We are only as good as our staff here--or at least some of us do actually admit to that. Erin, thank you for being such a hero alongside Craig, and now Senator Barrasso. We are proud of you for everything you have done on behalf of rural health care. This Congress, with health care reform at the front and center, Senators Barrasso, Conrad, Harkin, Hatch, and I will do our very best to lead in Craig's absence and to ensure that rural health does not get left behind. I have made a personal commitment to make sure we get this bill done and ultimately provide the much needed relief to our rural communities. The Craig Thomas Rural Hospital and Provider Equity Act recognizes that rural health care providers have very different needs than their urban counterparts and that health care is not one size fits all. The Craig Thomas Rural Hospital and Provider Equity Act--and the acronym of that, by the way--everything has to be an acronym in Washington--is R-HoPE--so the R-HoPE Act of 2009 makes changes to Medicare regulations for rural hospitals and providers. It recognizes the difficulty in achieving the same economies of scale as large urban facilities. This legislation equalizes Medicare's disproportionate share of hospital payments to bring the rural hospitals in line with our urban hospitals. This bill also provides additional assistance for small rural hospitals that have a very low volume of patients. Often these hospitals have trouble making ends meet under the Medicare payment system. The Craig Thomas Rural Hospital and Provider Equity Act, R-HoPE Act, also provides a Capital Infrastructure Loan Program to make loans available to help rural facilities improve crumbling buildings and infrastructure. In addition, rural providers can apply to receive planning grants to help assess capital and infrastructure needs. The bill extends to January 1, 2011, two incentive programs aimed at improving the quality of care by attracting health care providers to health professional shortage areas. The first is the Medicare Incentive Payment Program, which provides a 10-percent bonus payment to physicians who will practice in shortage areas. The second is the Physician Fee Schedule Work Geographic Adjustment--that is a mouthful-- but it simply means it will bring rural doctors' Medicare fee schedules for wages more in line with urban doctors. The bill also recognizes that other providers do play a great role in the rural health care delivery system. Our bill increases the payment cap for rural health clinics to keep them in line with community health centers. It provides a 5-percent add-on payment for rural home health services. And it provides a 5-percent add-on payment for ground ambulance services in our rural areas. One of the provisions in the bill--and this is the one that Craig Thomas certainly championed--is a provision to allow marriage and family therapists and licensed professional counselors to bill Medicare for their services and be paid the rate of social workers. Currently, the Medicare program only permits psychiatrists, psychologists, social workers, and clinical nurse specialists to bill Medicare for mental health services that are provided to our seniors. However, most rural counties--most rural counties--simply do not have a psychiatrist or a psychologist. Marriage and family therapists, however, and licensed professional counselors are much more likely to practice in a rural setting and are often the only mental health professionals available. Finally, this bill uses technology to improve home health services and quality of care by creating a pilot program providing incentives for home health agencies to purchase and utilize home monitoring and also communication technologies and facilitates telehealth services across State lines. Today I am proud and honored to introduce this bill on behalf of our former Senator and colleague, Craig Thomas. We miss him greatly as a personal friend, a confidante and colleague. Our thoughts and prayers are with his wife Susan, his sons Peter, Patrick, and Greg, and his daughter Lexie. Mr. President, it is time to pass this bill. Mr. President, 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. Mr. President, today, those of us who have strongly insisted that no terrorist currently in Guantanamo Bay should or will be transferred to the United States, I think, have won a big victory. I am going to be very frank about it. Faced with an embarrassing defeat, and listening to the American people, the Democratic leadership has accepted an amendment offered by Senator Jim Inhofe of Oklahoma, myself, and many others that prohibits the use of Federal funds to transfer or locate any Gitmo terrorist to the United States. This is an important, commonsense victory for the security of our country and more especially for Fort Leavenworth, KS. Following President Obama's decision to close Gitmo at the end of this year, there has been much speculation about moving terrorists to Leavenworth, especially in the press, and even on the Senate floor. I responded with remarks several weeks ago: ``Not on my watch.'' The problem is that while we have prohibited the use of funds to transfer terrorists to the United States, the Obama administration still has proposed no plan to meet their own January deadline. That does remain a challenge, and it means that while we won a victory today--no funds--it seems to me we must remain vigilant to make sure future plans do not include locations in the United States, including Leavenworth. There are simply too many security risks and the possibility of negative impacts on our Kansas citizens and the Intellectual Center of the Army at Fort Leavenworth to even consider moving terrorists to Kansas. I hope President Obama and his team designated to come up with a plan can come to the realization that closing Gitmo actually poses new problems in terms of security and logistics and legal issues. Now that we are all on the same page, let's find a better answer and one that does not endanger Leavenworth, KS, or any other community in the United States. I also wish to associate myself with the remarks of the distinguished Senator from Nebraska, Mike Johanns, who I think summarized the whole situation very well. I wish to thank Senator Inhofe for persevering. I wish to thank my dear friend and colleague, the distinguished Senator from Hawaii, Mr. Inouye, for his leadership in this regard. But during this debate, and for some time, it seems to me we have seen a change in how those who are incarcerated at Gitmo are now being defined and described in the media, in the administration and, as a consequence, by some Americans. I understand there is a poor perception of Guantanamo Bay. I think that is a fact we all realize. We heard another Senator from the other side of the aisle describe that in detail--as a matter of fact, ascribed all the problems to the Bush administration. But I do not think that is relevant. To say there are no terrorists there, to say there are not even enemy combatants there, is doing a disservice to us all by trivializing the crimes committed by the men at Guantanamo Bay. I ask you, when did we start making terror politically correct? This same question was asked by Daniel Pearl's father, Judea Pearl, in an article that ran in the Wall Street Journal this past February. It is called: ``Daniel Pearl and the Normalization of Evil.'' I think every Senator and every American should read it, more especially in regard to this debate on where we locate these terrorists. As you may know, and we should all remember, Daniel Pearl was the American journalist who was captured and beheaded--beheaded--on a video by the ``nonterrorist, nonenemy combatant'' Khalid Shaikh Mohammed in 2002--beheaded by Khalid Shaikh Mohammed, who is actually sitting at Guantanamo Bay right now. Listen to what Judea Pearl, a respected professor at UCLA, has to say about that act of terror on his son: Those around the world who mourned for Danny in 2002 genuinely hoped that Danny's murder would be a turning point in the history of man's inhumanity to man, and that the targeting of innocents to transmit political messages would quickly become, like slavery and human sacrifice, an embarrassing relic of a bygone era. But somehow, barbarism, often cloaked in the language of resistance, has gained acceptance in the most elite circles of our society. The words ``war on terror'' cannot be uttered today without fear of offense. Civilized society, so it seems, is so numbed by violence that it has lost its gift to be disgusted by evil. Well, this Senator remains disgusted by evil. I am disgusted by those who target innocent civilians as they spew their hatred. I refuse to adopt what Danny's father calls ``the mentality of surrender.'' And that is weaved throughout this debate in regard to what happens to these terrorists. It is not too late. We can all refuse to surrender to the idea that terrorism is somehow a tactic, to refuse to believe it is an acceptable tool of resistance. There is still time for Americans to remember that there are men at Guantanamo who cannot be released and most certainly should not be on American soil. Mr. President, I yield back.

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

Mr. ROBERTS

Mr. ROBERTS. Mr. President, I rise today to offer a special tribute to Kent Wells, a Kansan and longtime friend, who has turned his own battle with multiple myeloma into a fight for continued research to benefit the Multiple Myeloma Research Foundation, MMRF. Multiple myeloma is an incurable cancer of the plasma cell. It is the second most common blood cancer. There are approximately 50,000 people in the United States living with multiple myeloma and an estimated 15,000 new cases of the disease are diagnosed each year. The Multiple Myeloma Research Foundation, which was established in 1998 as a nonprofit organization, has a unique mission to urgently and aggressively invest in research that will result in the development of effective treatments and, ultimately, a cure. Today, MMRF has raised over $100 million to support the world's most cutting-edge myeloma research. The foundation is widely recognized as the driving force behind progress made against the disease and one of the Nation's most groundbreaking cancer research organizations. When Kent received his diagnosis in 2007, he began working with the foundation, personally benefiting from the research and the clinical drugs that have been established. But he understands all too well that much more must be done, and Kent has chosen to fight for his own health and for the health of others by further supporting the work of MMFR. This week, on Kent's behalf, dozens of his friends and colleagues are sponsoring an event that will raise money for the Multiple Myeloma Research Foundation so that it can continue the efforts to develop the necessary research to conquer this disease. It should come as no surprise to Kent that his friends and colleagues from all walks of life have come together to share this fight with him and his wife Debbie and their sons, Trevor and Bryan. I first met Kent in 1975. Kent was a young man from Garden City, KS, interning in Washington for my predecessor, Congressman Keith Sebelius. I was the Congressman's chief of staff at that time. I would like to take a little credit for giving Kent his start in public service, hiring him for that internship. ``Potomac Fever'' must have bit Kent because after he finished law school at George Washington University, he became a legislative assistant for Senator Nancy Kassebaum. And our friendship continued. Yes, I admit to omitting one small part of his biography here. Kent did receive his undergraduate degree from the University of Kansas in Lawrence. He is a proud Jayhawk, something that he never lets this Wildcat forget. Truth be told, I think that Kent would have chosen Jayhawk basketball over Washington internships, but he didn't make the team. Kent, I never told you that we would have welcomed you with open arms to the K-State team. Instead, Kent had to settle for pickup games in Washington when he came to work for Senator Kassebaum. One of the genuinely nice things about working in Washington is that staff for the Kansas delegation get to know one another and actually become family--not on every occasion or in every instance--but often in sharing a common experience. I could get into quite a laundry list of mutual experiences I have enjoyed with Kent, his brother Kim, and the Wells family, great supporters and friends. Not to embarrass Kent, but with his smile and personality he could brighten up any room regardless of the occasion. Kent Wells is just one of those people you like to be around, and that genuine personality plus a lot of talent has served him, and those he has worked for, well. That is, of course, with the exception of the pickup basketball games I mentioned before. It was at a local gym that the Dole, Kassebaum, Roberts staffers and other hangers-on would play Saturday mornings. My role, given my athletic career had sunset years previous, was to pass the ball to the players like Kent and set blind-side picks. Kent is a slasher but really prefers an outside set shot. Somehow, we ended up on opposing teams. My team would be composed of big Bill Taggart, who simply walked around the gym for exercise and would occasionally kick the out of bounds ball back; Rich, ``The Mule'' Armitage--enough said; a couple of pickup players who simply ran with the ball as fast as they could. Kent and Randy Miller, another staffer and good basketball player, had their own handpicked team that, for the most part, scored at will with absolutely no respect for an elder Member of Congress except to call fouls. The trash talk would go something like: ``All he does is foul people, stay at one end of the court and try that old flat hook shot.'' ``I know, but we have to have five people, just stay out of his way or if we get him, tell him to pass you the ball.'' You would think one would expect a little more respect, especially since I would bring my young son David to shoot baskets on another court. But not these guys. The Jayhawk crimson and blue was running in their veins and they pretty much ran me off the court. But I did set some hellish blind side picks, hit 1 out of every 10 flat hook shots, and had great times that are wonderful memories. Kent's career goes well beyond Capitol Hill. Today he is a successful telecommunications executive, but one of his joys is that he has passed the love of KU basketball to Trevor and Bryan, both of whom proudly sport KU attire on campus at USC and Wisconsin. Now we have come full circle with the Wells family. Thanks to his Dad's passion for public service, Bryan Wells begins an internship with my office this summer. He is clearly a chip off the old block. I stand today with all of the Wells family and friends in support of Kent's efforts to promote increased awareness and research for the Multiple Myeloma Foundation. He and others facing this disease are not alone.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I ask unanimous consent to speak as in morning business--in fact, I think we are in morning business. I ask unanimous consent to be recognized for 20 minutes.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I wish to thank our Republican leader for so succinctly summing up the issue we face in regards to the terrorists--and, yes, they are terrorists--who are at Guantanamo Bay and for what I think is the almost unbelievable suggestion that we move these folks to a homeland, USA, and my remarks will continue in that regard. I thank the leader for raising the subject. I rise today to speak about Guantanamo Bay, but I wish to point out that I am speaking about a Guantanamo Bay that some of my colleagues and some citizens of our great country might not recognize. Obviously, the Guantanamo Bay I am speaking of houses ``terrorists.'' I have been there, and there are terrorists at Gitmo. I have seen them. As a matter of fact, I have seen interrogation procedures with the terrorists. They are not ``enemy combatants'' fighting an ``overseas contingency operation,'' but terrorists whom we must wage a war on terror against because they continually plan to launch attacks against us. Senator McConnell spoke of the 10 percent who have been released and who have shown back up on the battlefield. There is a wonderful picture--well, it isn't a wonderful picture; it is a very telling picture--of one of these terrorists who was incarcerated at Gitmo and whom we released. He was treated and fitted with a prosthesis--with health care better than many of my small communities get. There is a picture of him back on the battlefield waving his prosthesis in one hand and with an AK-47 in the other. If that doesn't tell the story, I don't know what would. The reason I explain this is because we have seen a change in how those who are incarcerated at Gitmo are now being defined and described both in the media and in the administration, and as a consequence, by some Americans. I understand there is a poor perception of Guantanamo Bay, but to say there are no terrorists there, to say that there are not even enemy combatants there is doing a disservice to us all by trivializing the crimes committed by those who are incarcerated there. I ask my colleagues: When did we start making terror politically correct? And why? I understand this administration has great feelings about these issues, and many Americans have great feelings about these issues. Many Americans disagree very strongly with the past administration. I know this administration wants to draw a line of demarcation and say: This is not our policy, whether it is the war in Iraq, whether it is our operations in Afghanistan, whether it is our foreign policy, our national security policy, or whether it is intelligence. These are all very legitimate topics for debate and discussion, but in the process of this debate and this discourse, we should not ignore reality. This same question as to why we would do this was asked by Daniel Pearl's father, Judea Pearl, in an article that ran in the Wall Street Journal this past February. I have the article here. It is called ``Daniel Pearl and the Normalization of Evil.'' Every Senator and every American should read this article and should take it to heart. As I think most people know--and we should all remember--Daniel Pearl was the American journalist captured and beheaded--beheaded on video-- by the ``nonterrorist, nonenemy combatant'' Khalid Sheikh Mohammed in 2002. He was beheaded by Khalid Sheikh Mohammed, who is actually sitting at Guantanamo Bay right now. Listen to what Professor Judea Pearl, who is a respected professor at UCLA, has to say about that act of terror when he and Danny's mother looked at a picture of their son, Daniel: Those around the world who mourned for Danny-- His son-- in 2002 genuinely hoped that Danny's murder would be a turning point in the history of man's inhumanity to man, and that the targeting of innocents to transmit any political message would quickly become, like slavery and human sacrifice, an embarrassing relic of a bygone era. But somehow,-- And I continue to quote Professor Pearl-- barbarism, often cloaked in the language of resistance, has gained acceptance in the most elite circles of our society. The words ``war on terror'' cannot be uttered today without fear of offense. Civilized society, so it seems, is so numbed by violence that it has lost its gift to be disgusted by evil. Well, I remain disgusted by evil, and more than that, I am fatigued by those who seemingly ignore it. I am disgusted by those who target innocent civilians as they spew their hatred, and I refuse to adopt what Danny's father called ``the mentality of surrender.'' I think it is not too late. It is not too late for a wake-up call. We can all refuse to surrender to the idea that terrorism is somehow a tactic. To refuse to believe it is an acceptable tool of resistance. There is still time for Americans to remember that there are men at Guantanamo Bay who cannot be released and most certainly should not be on American soil. In fact, Americans must remember there are men at Gitmo who planned the September 11 attacks, the USS Cole attack prior to that--this was before we even connected the dots--and the attacks on American Embassies in Africa, causing great loss of human life. There are men at Gitmo who have perpetuated horrible crimes against humanity and would like to do so again because they don't like who we are or the way we live. Terrorist detainees should be held, as they are now, at Gitmo, in compliance with international law. That should be respected, of course. Ask the Red Cross or our new Attorney General, Eric Holder. Guantanamo, despite what some might think, is a first-rate facility that safely keeps these men out of civilized societies, affords them human treatment, and gives them religious respect. Again, I know. I was there. Certainly, Khalid Sheikh Mohammed did not afford Daniel Pearl those courtesies. No, Khalid Sheikh Mohammed and others like him were--and still are--on a jihad against every man, woman, and child in our country. Yet we should bring these terrorists to American soil? Not only is that just plain wrong, it is logistically a situation that will not work. We can't do it without a tremendous infusion of funds and a lot of other problems. In Dodge City, KS, at the coffee clatch that I attend, they call that flatout dumb. In fact, for those who would like to bring these nonterrorists, nonenemy combatants to hometown, USA, let me paint a picture. Fort Leavenworth, KS, has been mentioned many times as a possible location for the 100 or so terrorists whom Defense Secretary Gates says can't be released but can't be tried. Leavenworth: where we educate all future Army officers, where we host foreign military officers every year to build relationships and foster military cooperation. Leavenworth: the intellectual center of the Army. Do my colleagues think Army officers want to study at Fort Leavenworth if terrorists are there? Do they think they want to send their kids to school on the base minutes away from the most dangerous men in the world? Do they think foreign countries, especially friendly Muslim nations, will want to send their best and brightest officers to a place that houses men who we all agree are not appropriate for a civilized society? I don't think so. Not a chance. Even worse, I can't believe we are asking the people of Leavenworth to hang out with the ``welcome terrorists'' banner or put out the welcome mat to terrorists or to share their community not only with terrorists but with every protestor who will inevitably show up or with every terrorist who will view a facility on the mainland as a target, as they do. And before someone says Fort Leavenworth is secure, let me tell you it is secure all right; but for military prisoners who are compliant and for civilian prisoners who are not on a jihad against America. Guantanamo Bay is a fortress, a humane, Red Cross-approved fortress, but a fortress nonetheless. Moving such a facility to hometown, USA, will require security beyond reality. I can't even begin to imagine what it would look like at Leavenworth, but I do know it is unrealistic to think a place such as Leavenworth, which has a railroad running through it and a river running next to it and highways all around it, would not be secure. No, it is not secure enough. In fact, the only place that is would have to be a fortress in the middle of nowhere--or Guantanamo Bay. Let's also not forget the cost to taxpayers if such a thing would actually happen. We would not be able to mix these prisoners with the general prison population there, let alone the public. We would have to build a hospital and medical facilities, exercise and eating facilities, places for religious worship, and the list goes on and on and on. We have that at Gitmo. If anyone thinks that is crazy, I recommend they travel to Gitmo and take a look. They already have all of those facilities there. In fact, the medical facilities I saw are better than most in most of our small rural communities in this country. Why we keep coming back to this ridiculous argument, why we keep trivializing the crimes committed by those at Gitmo, and why we keep offering up our American communities as a reasonable alternative is beyond me. But I will say this: not in our backyard, not in Kansas, not on this Senator's watch, not on my watch. I don't know how many times I have to say or shout this on the Senate floor before this misbegotten idea is put to rest. But trust me--trust me--I will continue to do it until we come to our senses or until one of my colleagues who wants to close Gitmo offers a site in their State as a reasonable alternative. One Senator has a lot of tools in his toolbox for keeping the Senate tied up in knots. If someone gets the bright idea of moving these prisoners to Kansas, we can all cancel our summer travel plans because we are going to be spending a lot of time here doing nothing. Come to think of it, that might be a better alternative as to where we are headed. Thank you, Madam President. I yield the floor. Madam President, it has come to my attention that I don't think we have a quorum, so I suggest the absence of a quorum.

Mr. ROBERTS

Mr. ROBERTS. I thank the distinguished Senator and nattily dressed chairman of the Budget Committee. Mr. President, on rollcall vote 136, I voted ``nay.'' It was my intention to vote ``yea.'' Therefore, I ask unanimous consent that I be permitted to change my vote, since it will not affect the outcome.

Mr. ROBERTS

Mr. ROBERTS. Madam President, I rise today as a cosponsor and in support of the amendment offered by my friend from Arizona, Senator Kyl. I thank the Senator for introducing the amendment on behalf of health care providers not only in Arizona and Kansas but all across the country, and, as a result, the patients they serve. I think we all know we have marching orders, if I can describe it that way, from the administration and from others to complete health care reform this year. But the President has been a little vague about what he envisions, stating that he will leave the details to the Congress, and the devil is, indeed, in those details. Senator Kyl has certainly pointed out one of the details that has to be fixed. Let me be clear. I am not opposed to health care reform. I don't know who would be opposed to health care reform. But we must beware of what lurks under the banner of reform. I do support, as do many others, a system of affordable, accessible health care for all Americans. But I do not support a system that replaces the judgment of your doctor with that of a government agency, as described so ably by Senator Kyl. For this reason I share the concern of the Senator regarding the implementation of something called comparative effectiveness research. I wish more of my colleagues were in the Chamber to listen to this-- listen to the description of what could happen in regards to something called comparative effectiveness research. The acronym for that, by the way, is CER. This gets in the woods of health care reform. Comparative effectiveness research, or CER, is simply research that compares the effectiveness of two or more health care services or treatments. CER is not necessarily a bad thing. In fact, it has the potential to provide benefits to medical science and also, obviously, to patients. However, with CER policy--again, the devil is in the details. When discussing the details of comparative effectiveness research, we need to focus on another term, ``least costly alternative.'' This is where comparative effectiveness research has the potential to have a huge and negative impact on patient and doctor choice. If comparative effectiveness research is used to deem two health care services or treatments to be interchangeable, then CMS, within the Department of Health and Human Services, will be able to invoke the least costly alternative to only reimburse the health care provider based on the cost of the cheapest treatment. One need not look any further than the Congressional Budget Office's Budget Options, Volume I, Health Care, written under the direction of OMB Director Orszag, to see that the use of least costly alternative authority to restrict doctors' decisions and ration health care is clearly on the table. Here is a good example. One of the CBO health care budget options discussed the savings that could be realized if CMS applied Medicare's least costly alternative policy to include something called viscosupplements. You use viscosupplements to treat a degenerative joint disease of the knees called osteoarthritis. A lot of Senators have knee problems--not only weak knees but sometimes knees that need a little help. So even though CBO recognizes that there may be justifiable reasons your doctor would choose to provide one viscosupplement over another to help your knees, this option would allow the Government to use least costly alternative authority to interfere with and restrict your doctors's decision. This is very dangerous territory. Rather than having to depend on the rigorous clinical trials conducted by the Food and Drug Administration, the CMS could use the much lower bar of comparative effectiveness research to declare that the two treatments are interchangeable and thus can be subject to the least costly alternative policy. This type of Government interference in the doctor-patient decisionmaking process ignores the very large and important differences that exist among people, among patients--I think that should be obvious--in favor of a one-size-fits-all health care solution that could and would lead to rationing of health care. Let this be a warning to all patients, all doctors, all hospitals, all nurses, all ambulance providers, all pharmacists, all home health care providers--all of the people who provide health care throughout America, rural and urban. You are on notice that this policy combination--comparative effectiveness research and least costly alternative--may be the Holy Grail of cost containment at the expense of patient care. That is what Senator Kyl's amendment gets at. My colleague's amendment prohibits the use of comparative effectiveness research to deny coverage of health care treatments under a Federal health program. It requires that comparative effectiveness research take into account the individuals and their treatment responses and their preferences, and it does protect doctor and patient sovereignty over health care decisions. For these reasons I urge my colleagues to vote yes on the Kyl amendment. I yield the floor.

Mr. ROBERTS

Mr. ROBERTS. Madam President, in the midst of this debate on the $410 billion omnibus spending package, the Finance Committee heard from Treasury Secretary Geithner as part of the committee's annual review of the President's budget. This is a very ambitious budget, particularly, coming on the heels of this omnibus package. It seems as if we have one huge bill after another--TARP, omnibus, stimulus, and now budget. For the first time we are looking at a budget that tops $3.6 trillion. At a time when many families are struggling, this budget asks them, to support Federal spending on new and very questionable programs and higher taxes to support those programs. We ought to be concentrating instead on the scope of the economic recovery package, not on these other programs--which I will go into in just a moment. I also want to help set the record straight with regard to the Federal deficit. If we are ever going to achieve any progress, and with some bipartisan support, then we ought to quit looking in the rear-view mirror and citing some statistics that do not add up. Facts are stubborn. Since the new administration took office, we have heard a persistent drumbeat from the majority about the legacy of debt that they say they have inherited from the previous administration. The President did inherit a significant debt, but to say it was solely a result of Republican policies and those of the previous administration is simply not telling the full story to the American people Or, as the late great Paul Harvey would say: ``Now the rest of the story.'' I borrowed this chart from Senator Grassley, the ranking member and previous chairman of the Finance Committee. It shows the deficit as a percentage of GDP over the past 8 years. It begins with the economy that the previous administration inherited. The deficit levels for those earlier years of the decade reflect the downturn in the economy, the burst of the tech and the impact of the 9/11 terrorist attacks on the economy. However, the deficit levels came down when we had bipartisan support for tax relief--not tax cuts, tax relief--that was passed in 2001, 2003. Look at what happened. The deficit shrank noticeably between 2004 and 2007, from $413 billion in 2004 to $163 billion in 2007. Nobody ever talks about that. If you really wanted to get somewhat partisan, you could point to the fact that we were not in power then in 2007. That is when the majority took over. But I am not into that. It doesn't make much difference. It seems to me we should quit looking in the rear-view mirror and look on down the road with what we do for economic recovery. In other words, under the policy of the previous administration, the deficit shrank by more than half during this period from 2004 to 2007. Those are the facts. It was not until 2 years ago, when Democrats came to power in Congress, that the deficits began to increase again. The spending spree over the past 2 years was led by the majority who wrote and pushed through a $700 billion financial bailout bill that has contributed significantly to the deficit the country now faces. This bill, I will be very fair about it--this bill was bipartisan. It had the support of both Democrats and Republicans in the Congress, and a Republican President. As a Member of the Senate at that time President Obama supported the bill. When we talk about the deficit that the country is facing, let's keep this in mind. Again, we cannot keep looking in the rear-view mirror with facts that are misleading if we wish to achieve bipartisan progress in addressing the deficit. The American people are very fearful, if not fed up, with the current rampant and unceasing spending that is going on in Washington--$700 billion to bail out financial firms that are too big to fail--with more requests for assistance expected; a $250 billion placeholder is provided in the President's budget; a questionable stimulus bill that will cost $787 billion--more than $1 trillion, when you add in interest; and there is a $410 billion omnibus bill and a $3.6 billion budget proposal. They simply want to know, and I think every Senator here wants to know as well, where does it end? When will we have spent enough and how on Earth are we going to pay for it? Is it going to work? Those are the questions. At least a partial downpayment for this spending is included in the budget. The President has returned to the tried and true majority playbook to pay for more spending by simply raising taxes. I take issue with the statement that the tax increases in the President's budget will be borne primarily by those families who earn over $250,000--the ``not one dime'' argument. This budget raises taxes on small businesses, the Nation's job creators. It passes on the cost of a cap-and-trade--or as I see it a cap-and-tax--system, not only to businesses but to consumers in the form of higher prices for energy. To my way of thinking, nobody has explained to this Senator how that is going to work or if we have the technology to make it work. It may be desirable, but I have yet to see how it is going to work or the technology. The budget raises taxes on domestic energy producers. It raises taxes on investments. American consumers and families will pay higher taxes under this cap-and-trade proposal. The counter argument is that they are targeting what they have determined are the wealthy to pay for their spending priorities. I always said I wonder when it would be time for those in Congress who believe this is the way to do things to determine who is rich or who is not. That is called class warfare in my view, but that is another speech and another story. In other words, most Americans do not need to worry about these tax increases because it will not affect them, it will only affect their neighbor. I have yet to see a tax imposed on one set of taxpayers where the cost was not ultimately passed on to someone else. We are all in this economy together, and a tax increase on one neighbor is likely to be felt by the guy next-door. The President's budget includes several of what I call anthill issues. These were the issues I discussed with Secretary Geithner. The reason I call them anthill issues is you do not want to be giving a speech, or standing on an anthill--and I have had that experience, with a fellow Senator in Kansas, where she was standing on an anthill. I suggested she move. She said she was happy where she was. And I said: I don't think you will be in about 2 or 3 minutes. That was the case and she moved. I have read with interest over the past few days the comments from several of my Democrat colleagues who have expressed the same concerns I have about these so-called anthill issues, those that bite, and that is a good sign. One anthill issue proposal would increase revenue by reducing the amount of mortgage interest that homeowners who pay taxes in the top brackets can deduct. At a time when the Federal Government is taking unprecedented steps to shore up the housing market and make home ownership possible for qualified homeowners, it seems counterintuitive. That is a Senate word, ``counterintuitive.'' ``It seems like we shouldn't be doing this.'' Those are the real words. It seems counterintuitive, to say the least, to reduce an inherent incentive in the Tax Code to own a home. Does it make sense to tell these families who have lived in their home for 10 to 20 years that they can no longer deduct their mortgage interest? And what does reducing the mortgage interest deduction mean for the value of their home? We have already heard concerns that limiting the deduction would further depress home prices. What message does it send to families who may be looking to purchase a home right now, which I thought was the goal. I do not know how the administration can, on one hand, provide billions of dollars to aid housing, including a $75 billion plan that Secretary Geithner announced a few weeks ago, to help those who have bought homes they can no longer afford and aid homeowners who are underwater in their mortgages but, on the other hand, reduce the tax incentive for those earning over a certain amount and who own or are looking to buy. The second anthill proposal targets contributions to charitable organizations. I don't know who thought this up. In this economic climate, many charitable organizations are being asked to do more with less while donors tighten their belts, while at the same time more people are turning to charities for assistance. Yet this budget not only raises income taxes on those in the top two tax brackets, reducing their discretionary income from which they can make charitable contributions, it also reduces the value of the deduction for charitable contributions for these taxpayers. Clearly, these changes will not bring a halt to charitable giving. I know that. But won't it reduce contributions to charities when more Americans are relying more on charitable assistance? Won't the cost of a decline in charitable giving be borne by those most in need of assistance? Secretary Geithner, in testimony, says an estimated $4 billion loss is ``modest.'' I do not agree with that. I suggest that a $4 billion loss to charitable organizations around the country is not modest. Why would the administration create any disincentive that will reduce donations to charity? Finally, the third anthill issue targets certain small businesses for tax increases. This is a point I want to underscore. In Kansas, we have over 60,000 small businesses which make up 97 percent of the State employers. They are the leading job creators. The budget reinstates the 36 percent and 39.6 percent--might as well make it 40 and 41 when you count the deductions that will not be included--in income tax rates for individuals earning over $200,000 and for families earning over $250,000, reinstates the personal exemption phaseout, and limits the benefits of itemized deductions for these taxpayers. These increases will result in higher taxes on many small businesses. I know supporters of the wealth redistribution in the budget say it does not raise taxes on that many small business owners. But the National Federation of Independent Business data shows differently. The data shows that 50 percent of the small business owners who employ 20 to 249 workers would fall into the top two brackets. And over half of the Nation's private sector workers are employed by small businesses with 20 to 500 employees. Small businesses in Kansas feel they are stressed to the limit and they worry that to pay the additional taxes proposed in this budget-- and this is the real world, this is the reality, this is the law of unintended effects that we always fall into--means they are going to have to lay off workers, reduce wages or benefits, or pass these costs on to their customers. None of those are good options. Let me say that tomorrow we are set to pass this $410 billion omnibus spending bill. I am going to oppose this bill. I do not like doing so, but I am going to oppose this bill. There are a lot of things wrong with this bill. And it is clear, it seems to me, that we must--we must--get a grip on Federal spending because in a few weeks we will take up the budget proposal for next year. If there is a silver lining in the President's $3.6 trillion budget, it is that the tax increases would not take effect until 2011, reflecting the administration's acknowledgment that raising taxes when the economy is in crisis is not a good idea. Thus, it appears that the administration expects that the economy will be recovering by 2011. I hope so. And that certainly would be good news. I hope the administration will use caution when determining if the economy is sufficiently recovered to withstand nearly $1 trillion in new taxes in 2011. I hope they will consider stepping off the anthills I have mentioned: limiting deductions for charitable giving, mortgage interest, and tax increases on small businesses. I hope they will not insist on pursuing their spending agenda at the expense of economic recovery. To forestall recovery in order to pursue their tax and spending agenda is simply not right. As the eminent columnist Charles Krauthammer wrote in the Washington Post last week with regard to the President's proposed budget: The day of reckoning has arrived. President Obama has come to redeem us with his far-seeing program of universal, heavily nationalized health care; a cap and trade tax on energy; and a major federalization of education with universal access to college as the goal. Wow, that is an ambitious agenda. However, pursuing this through higher taxes and bigger Government is not a legacy I think the administration will want to pass on to future Presidents or to future generations. That is the rest of the story. I yield the floor.

Mr. ROBERTS. I thank the Presiding Officer and ask that I be recognized for 15 minutes, and I ask unanimous consent that Senator Vitter be recognized to speak following me, after my 15 minutes.

Mr. ROBERTS

Mr. ROBERTS. I thank the Chair. If you take away their freedom overnight, you have a violent revolution on your hands. But steal it from them gradually under the guise of security or stimulus or recovery, and you can paralyze an entire generation. I think we failed on that front. We are not stimulating the economy. We are creating a nanny state based upon a new form of American socialism. The lure of that is especially dangerous, as many people I would have never suspected will be coming to Washington, coming to the honey pot, not doing things for themselves at home but coming to Washington expecting some kind of a stimulus or money or grant. That is not right. It tears at the fabric of what America is all about. I yield the floor.

Mr. ROBERTS. Mr. President, our economy needs a stimulus; there is no question about it. Senator Cardin certainly illustrated that in his remarks. Americans are worried, very worried about job security and how they will support their families and stay in their homes if they lose their jobs. The Senator mentioned businesses in Maryland. I know businesses in Kansas are the same way. All over the country, our Nation's businesses are struggling. Not a day seems to pass without another major U.S. employer announcing stunning layoffs. However, this conference report--this didn't get here until 12 last night. You talk about transparency. I defy any Senator to say he has been through every page of this in terms of transparency. This conference report is a missed opportunity. We had an opportunity to provide pro-growth policies that put money directly into the pockets of families and businesses. When they have more money in their pocket, they can spend it as they see fit rather than handing the money over to the Government to redistribute elsewhere. Instead the conference report further reduces the tax relief that will go to workers from $500 to $400 per individual, from $1,000 to $800 per couple. Estimates are that this tax relief will add about $13 more per week in the worker's paycheck this year. Next year it will add only about $8 a week. How will $8 a week stimulate the economy? It won't even buy a family of four dinner at McDonald's off the dollar menu. They will probably have to split the hamburger. We also had an opportunity to fix housing first--that is the Gordian knot of what faces us in terms of an economic stimulus--to address the core problem in our economy. Unfortunately, our colleagues across the aisle rejected meaningful housing relief during Senate debate. Now the conference report dramatically cuts the tax relief to encourage qualified home buyers to purchase a home, one of the very few things in the stimulus that would have done us some good. Most Americans are clearly opposed to the spending in this bill. A bill negotiated in a back-room deal without the transparency we were promised by the new administration. A bill that increases spending at the expense of putting money directly in the pockets of families and businesses. This bill remains a honey pot for too many special interests. It reinforces a growing and dangerous mindset that the Government--not private enterprise, personal responsibility and hard work--is the creator of wealth and prosperity. It reinforces for individuals, businesses, and State and local governments that the Federal Government is the source for funding for--the honey pot--for whatever they need. I have here the ``Berenstein Bears,'' a little book I read to first, second, and third graders. It should have been required reading prior to the stimulus. ``The Trouble With Money, With the Berenstein Bears.'' Open the book and it reads: When little bears spend every nickel and penny, the trouble with money is they never have any. And then after learning their lesson, the cub asked Momma bear: What about the money we earned? You earned it and it is yours, said Momma. No more, not with this conference report. It borrows money for programs that, in many cases, should be funded by local or State investments and that won't create jobs now, such as $300 million for new cars for Federal employees. The problem with $300 million for new cars is that somebody is going to drive them. Rather than focusing on practical and comprehensive approaches to fixing housing first, this bill diverts Federal funds to controversial and politically skewed groups that will do nothing to address interest rates, availability of credit, or declining home values that are at the root of the housing and mortgage crisis. Two infrastructure provisions have miraculously grown during this conference. First, the Senate bill provided the highest level of funding for Amtrak at $850 million. The House had $800 million. The conference report includes $1.3 billion for the rail company. Does this mean Amtrak will stop in Dodge City, KS at some time other than 4 a.m. which they do today? Second, the high speed rail earmark that is not an earmark, that received $2 billion in the Senate bill and zero in the House, has somehow grown by 400 percent overnight. I know some of my colleagues will come up and say this is not an earmark to the tune of $8 billion in taxpayer money. But press reports have already questioned this definition since it appears the rail link between Los Angeles and Las Vegas will be the major beneficiary. I guess they hit the jackpot. I want to be clear as well that the health care provisions in this bill are not stimulative. Instead they represent major policy changes that should have gone through the regular order. The most egregious example of this stealth maneuvering is $1.1 billion for the establishment of a new Federal board to conduct comparative effectiveness research. The majority is aiming, bluntly put, for research that justifies restricting access for Medicare patients to medical treatments that the Government deems to be not cost effective. That is an extremely dangerous path to be on. One need look no further than Canada and the United Kingdom for examples of comparative effectiveness research being used to deny access for treatments for breast cancer, Alzheimer's disease, rheumatoid arthritis, and much more. I also want to highlight the inequitable increases to Federal Medicaid funding for States. I have heard arguments from my friends from States that reap large windfalls under the regular Medicaid formula as well as under the special bonus formula in this bill. But you cannot tell me with a straight face that the State of New York deserves $12.2 billion more than the State of Kansas. Under this bill, the State of Kansas is estimated to receive an additional $450 million, while the State of New York will receive an additional $12.65 billion. That is nearly 28 times more than what my State will receive. When CBO estimates that total enrollment-driven State Medicaid increases are only expected to be $10.8 billion, well anything more than that is an earmark in my book. So I want everyone to understand the State of New York is getting an earmark that is 28 times what the State of Kansas is getting, 23 times what the State of Iowa is getting, and 41 times what the State of Nebraska is getting. That is not fair. Americans do not want us to place greater debt on future generations by supporting a bill that doesn't provide the right incentives to stimulate the economy and create private sector jobs. The American public does not want the Government determining what is and what is not a beneficial health care treatment. This is not our finest hour as a Congress. We had a real opportunity to stimulate our economy, create jobs, and put money back in families' wallets through common sense tax relief. There is an old story that says you can't kill a frog by dropping him in boiling water. He reacts so quickly to the sudden heat that he jumps out before he is hurt. But if you put him in cold water and warm it up gradually, he never decides to jump until it is too late. He is cooked. Men are just as foolish.

Mr. ROBERTS. Mr. President, if the Chair could let me know when I have about a minute remaining, I would appreciate it.

Mr. ROBERTS

Mr. ROBERTS. I would associate myself with the remarks of Senator Enzi, and would underscore that it is very important to require full openness, transparency and accountability in how research priorities are set and how studies are conducted and communicated. Without this openness, patients have no assurance that their voice will be heard in the process, and no ability to understand how results are being used in decisions that directly affect their health. I look forward to working with my colleagues to ensure that strong provisions for openness, transparency, and accountability are put in place.

Mr. ROBERTS

Mr. ROBERTS. Mr. President, will the Senator yield for a question?

Mr. ROBERTS. These suggestions would improve this bill. Can we improve it, I ask the Senator from Oklahoma, to provide the right incentives to stimulate the economy and create private sector jobs?

Mr. ROBERTS. We have and will have amendments to provide permanent tax relief for middle-income taxpayers. Is anything in there having to do with that?

Mr. ROBERTS. Basically, we have considered amendments to address the problems in the housing market, to fix housing first. Does anything on that list have anything to do with fixing the housing market?

Mr. ROBERTS. Let us beware of the Ides of March and the siren songs of the stimulus, I say to the Senator from Oklahoma. I thank him for doing an outstanding job to warn the majority of the sand trap they are getting into with these projects. Would the Senator not agree?

Mr. ROBERTS. We had seven questions, and I am going to have one, and then I will cease and desist.

Mr. ROBERTS. Yes, I do. We have had before us--and more to come, I think--well-thought-out alternatives to meet the commonsense test. As I said before, we have had amendments to strip out billions in spending in the bill that will not stimulate the economy. It is my understanding that the Senator's amendment deals with smaller programs and, as I have indicated, the public reaction to these programs and these relative to the stimulus package are unbelievable, is that not true?

Mr. ROBERTS. Mr. President, let me ask my distinguished friend and colleague from Oklahoma this. We all know we have to address the problems we face in our economy. It is becoming a crisis. The majority leader said that, the minority leader said that, and everybody who has offered an amendment has said that. But it seems to me we have fundamental differences with the President of the United States, who called some of our concerns picayunish in an op-ed in the Washington Post, and with our colleagues across the aisle, as to what constitutes an effective stimulus. The Senator from Oklahoma is introducing an amendment that I wish more Members could listen to--and they should because it would be in their best interest. The Senator from Oklahoma is offering an amendment that introduces an overdue criteria not only regarding whether the mayors' wishlist, and the programs he is going to enunciate, fit the role of a stimulus, but public outrage? These are the kinds of things that become fodder on late night talk shows, and we could do that--we could sort of do a late night talk show. We could go back and forth and he would mention a project and I would say: Do you mean there is money going for that? But I will skip all that and congratulate the Senator regarding his amendment. Can the economy be best revitalized through a massive and unprecedented increase in Government spending? Or is it better to pursue progrowth policies that put money more directly into the pockets of families and businesses? There is no question, I can answer that. Putting money back in the pockets of American families and businesses stimulates the economy. When they have additional money in their pockets, they can use that money as they see fit--to save, to purchase a home or a car, to make an investment or hire workers. So I think what the Senator from Oklahoma is trying to do--I know what he is trying to do and what I am trying to do in asking him to yield, which is to urge my colleagues to take a hard look, please, at the spending in this bill. We have already asked you to do that. There have been many amendments to do that. Ask yourselves: Is this stimulative? Do the programs in this bill truly promote economic stimulus? Do they create jobs? Do they put meaningful dollars directly in the pockets of families and businesses to encourage the economic growth of our country, or does the bill simply spread the money around to many Federal programs, or Members' requests, in the hope that such spending will solve our economic problems? If we cannot honestly demonstrate the stimulative effect of the programs in the bill, then it is clear to me that taxpayer dollars would be best spent elsewhere or, better yet, returned to the taxpayers. With all due respect to President Obama, in the article he wrote for the Washington Post, the op-ed, these matters are not picayunish--they are not. The economic stimulus mantra from last year--targeted, temporary, and timely--which should also apply to this year's effort, seems no longer to be the drumbeat of the majority. I don't know if the Senator is aware, but one estimate is that this bill would cost $2,700 for every man, woman, and child in the United States. While this bill is touted as creating or conserving jobs, some of the costs of the proposed job creation in the bill are truly astounding, not picayunish. A program at the State Department would create 388 jobs at a cost of $524 million. There are others that create jobs that would cost $480,000 per job and $333,000 per job. I know the Senator from Oklahoma is interested in that because that is the very kind of thing he likes to bring up to make us adhere to our job responsibilities. I know Oklahomans are outraged, and I know Kansans are outraged at this reckless spending, when the vast majority of them live within their means, pay their bills, and make their mortgage payments on time. Where is their benefit under this bill? Where is their $333,000 or $480,000 job? Many constituents who have contacted me have said, ``Just send me a check.'' They are very concerned that their tax dollars are not being used wisely here and that this bill won't get the job done. That is what the Senator from Oklahoma is trying to accomplish. The bill is not targeted. The appropriation portion of the bill spends taxpayer dollars on everything from smoking cessation programs, all-terrain vehicle trails, and $600 million to buy new cars for new Government employees. Again, these matters are not picayunish. As the spending in this bill grows, it has become a honey pot for every conceivable special interest group in this unprecedented environment of national crisis. I am concerned that we are well on our way to federalizing State and local governments, as many elected officials are setting up what I call ``bucket commissions.'' Our Governor in Kansas is doing that, and others are as well. I know we have problems in Kansas, and I know they have problems in Ohio, and I know they have problems in Oklahoma. But they are coming to Washington to fill these buckets. People have actually lobbied for and want the projects the Senator from Oklahoma is talking about. If you want a new county jail, don't pass a bond issue; ask for it in the stimulus. If you want a Frisbee park--I am not making that up--don't ask local taxpayers to foot the bill; ask for it in the stimulus. With this Federal honey pot and the lure that is now out there to come to Washington and make funding requests--and some requests do have merit; I won't quarrel with that. But this is not the right time or place for them. Another danger here is that Federal money too often becomes Federal control--Federal intervention further into the daily lives of Americans. You hear a lot about that back home. To all of those who hear the siren song lure of coming to Washington and obtaining free stimulus money, with apologies to Homer: Circe warned all those lured by the siren songs and to too many who ignored the warning and ended up on rocky shoals: Once he hears to his heart's content, sails on a wiser man. Like as Vlisses wandering men, In red seas [or in the case of this stimulus, red ink] as they pass along. Did stoppe their ears with wax as then, Against the suttle Mermayds [or shall we say Senator's stimulus song.] So shall their crafty filled talk, Here after find no listing ear. Like Circe, I byde them go back and walk, And spend their words some other where. Again, with apologies to Homer, with this siren stimulus song that we sing, those attracted by the lure will bring themselves and all taxpayers to rocky shoals. We are currently in the throes of February cold, with only Valentine's Day as a respite. This bill will have its first effect amidst the winds of March. Those projects that my distinguished friend from Oklahoma is trying to bring to the attention of the Senate will come true in the winds of March. My colleagues and taxpayers all, beware of the Ides of March. Under this massive spending bill, the taxpayer will become Caesar and the Government will become Brutus. ``Et tu, Senator Brutus''--a role no Senator should wish to play. While some funding requests may be worthy of Federal dollars, such decisions should be made as part of the annual appropriations debate, rather than circumventing that important process by adding funding to a bill that is intended to provide short-term stimulus to the economy. This bill is not timely, I say to my friend from Oklahoma. CBO estimates that only 15 percent of this stimulus package will be spent in 2009, and only another 37 percent spent in 2010. The remaining part will be spent in 2011 and beyond. That means that less than half of the money will be spent by the end of next year. This is not the immediate relief families and businesses desperately need now to help get the economy back on track. Rather than looking at more Federal spending and programs to fix our economy, we have tried to redirect this spending to tax relief. We need to return to families more of their hard-earned dollars and allow businesses to keep more of the money they earn, so they can reinvest and grow their businesses. This is particularly true of small business. Unfortunately, only $21 billion, or 3 percent of this bill, goes to small business. I know the Senator from Oklahoma certainly cares about small businesses. They are the Nation's job creators. How can we call this an economic stimulus bill, when only a fraction of this bill is going to help small businesses?

Mr. ROBERTS

Mr. ROBERTS. So the SCHIP legislation ensures one new child for the cost of two. That doesn't seem like a very good deal. But here is what I want to get to. Is this correct, in the view of the Senator from Arizona. You are an insurance company--BlueCross BlueShield in Kansas, for that matter, Arizona, or John Deere from Iowa--I know they provide this kind of insurance for low-income families. What happens to them when SCHIP expands and crowds them out? And another thing, I'm assuming that providers get less in terms of reimbursement from SCHIP than they do from private insurance. So if I am a provider--and this story has been told in Medicaid, it has been told in Medicare, and now it is going to be told in SCHIP--and I get paid less, some providers are going to say: Adios. I am sorry, I am not going to see you. Basically, we had that with Medicare Part D and pharmacists, where they were only reimbursed up to 70 percent, and some of them say: I am not going to do this anymore. Now we are doing it with SCHIP because we are crowding out the private insurance companies. If you are a private insurance company, if you are John Deere of Iowa, and all of a sudden somebody comes along and takes away this number of youngsters from the coverage, how are you going to exist?

Mr. ROBERTS. I thank the Senator.