John Thune

Mr. THUNE

Mr. THUNE. If the Senator from Oklahoma would yield for another question, does the CMS Actuary and the Congressional Budget Office conclude, when it is all said and done, that the overall cost of health care goes up, not down? It seems to me, at least, that as to the points the Senator mentioned, if we were sincere about reforming health care in this country, what most small businesses, what most individuals, what most families want to see is health care costs going down. This actually bends the cost curve up, according to the CMS Actuary, with a $234 billion increase in health care costs over 10 years. According to the Congressional Budget Office, it is a $160 billion increase in health care over 10 years. So there is a slight difference in terms of their analyses, but both conclude that health care costs will go up. The amount we spend on health care as a part of our total economy in this country----

Mr. THUNE

Mr. THUNE. The Senator from Texas has touched on a very important issue. The motion she offers, and which I cosponsor, does lay out what is a simple principle of fairness that most Americans understand. When you implement public policy, if you are going to raise taxes, you ought to align the tax increases and the benefits so they start at essentially the same time. What this bill does is it starts collecting taxes, increases taxes on Americans 4 years before the major benefit provisions kick in. On January 1 of 2014, 99 percent of the spending under the bill kicks in. But the tax increases begin less than 3 weeks from today. Sixteen days from now is when the tax increases in the bill start. A tax on prescription drugs, a tax on medical devices, a tax on health plans--all begin 16 days from now. A lot of those taxes will be imposed upon the American economy and passed on to people and small businesses in the form of higher premiums. People are going to get higher premiums 4 years before they are likely to see any benefit. Ninety-nine percent of the spending under the bill doesn't kick in until January 1, 2014, or 1,477 days from now. Most Americans, as they listen to the debate, believe as I do, as a simple principle of fairness, you ought to align the benefits and the taxes. We had a vote yesterday on the Crapo motion that would recommit all the tax increases. Many of us believe raising taxes on small businesses when you have an economy in recession is not a smart thing to do; it is going to cost us a lot of jobs. Small businesses have made that clear. I also think, in addition to the principle of fairness that is at play, when it comes to raising taxes 4 years prior to the benefits kicking in, you also need to have a transparent sort of understanding about what the cost of the bill is going to be. One of the reasons the revenue increases, the tax increases were begun immediately or 16 days from now, but the majority of the spending, 99 percent, doesn't occur until January 1 of 2014 and beyond is to understate the true cost. They wanted to bring the cost of the bill in under $1 trillion. If you can see, starting this year and going through 2019, it ends up at about $1 trillion or $1.2 trillion on this chart. But if you look at the fully implemented period; that is, 2014, when the benefits and spending begin, and take that through the next 10 years, the total spending in the bill is $2.5 trillion over a 10-year period. That is one thing the American people need to know. One of the reasons this is being done, tax increases starting January 1 next year or 16 days from now, most of the benefits not starting until 1,477 days from now, is so they can say this is only a $1 trillion bill or under $1 trillion, the way it has been advertised, when, in fact, it is going to cost $2.5 trillion when fully implemented. We are here 16 days before the Christmas holiday, and there are things Congress needs to do. There are a number of fairly urgent matters that need to be dealt with before the end of the year, some of which have been mentioned this morning. But trying to jam through a new health care program, a $2.5 trillion expansion of the Federal Government in Washington, 70 new government programs, trying to jam it through in the next 9 days or so before Christmas seems to be done more out of a political necessity, the need for a political accomplishment or a political victory, than it does with making good public policy. As the American people are approaching this holiday season, the best thing we can do, the best Christmas gift we could give the people, frankly, is for Congress to adjourn and go home before passing this $2.5 trillion expansion. What does it mean? If you are a small businessperson, the Christmas gift you get this year is a big lump of coal from the Congress in the form of higher taxes. If you are a senior citizen, 1 of the 11 million who are on Medicare Advantage and this bill passes, your Christmas gift this year is benefit cuts. The same thing applies to many of our providers--hospitals, nursing homes, home health agencies, hospices. If you are an average American family who is worried about the high cost of health care, your Christmas gift this year is, if this bill passes, that your health insurance premiums will continue to go up year over year at twice the rate of inflation. You lock in higher premiums for most people across the country, you raise taxes on small businesses, you cut benefits to Medicare beneficiaries and, for future generations, you create a $2.5 trillion new entitlement program they will be paying for, for as far as the eye can see. The CMS Actuary, last week, said, in addition to all the other things they mentioned--the overall cost of health care is going to go up, 20 percent of hospitals will close--that the Medicare cuts that are being proposed cannot be sustained on a permanent basis. If that is true, how will this be financed? Either with more taxes or borrowing, putting it on the debt and handing the bill to future generations. That is what we are left with. Once you lock in a $2.5 trillion expansion of the Federal Government, it is going to be hard to reduce the cost. The spending is not going to go away. The way it will be paid for, if the Medicare cuts are not sustainable, is the tax increases. The increases that are already in here would have to be increased even further or, worse yet, for future generations, if you are a young American, it will be put on your bill. The Senator from Texas and my colleagues who are here this morning all voted yesterday to get rid of the tax increases in the bill. But the motion she offers and that I cosponsor would at least, as a principle of fairness, make sure those tax increases don't begin before the benefits do.

Mr. THUNE. I will say to my colleague from Texas, as to the taxes, the fees, the tax increases, everything in our motion very simply states they ought to be aligned with the beginning of the benefits. The benefits and the exchanges and, frankly, all the major policies--the substance of this bill--begin in 2014; the individual mandate, the State exchanges, the subsidies, as I said, premium tax credits, Medicaid expansion, the employer mandate, 2014; the government plan, 2014. The substance of this bill begins in 2014. Unfortunately, the tax increases begin 4 years earlier, 16 days from now. Sixteen days from now, January 1 of this coming year, is when the taxes start being raised. And, of course, the CBO has said those tax increases are going to be passed on in the form of higher premiums to people across this country. The benefits start 1,477 days from now. So what we simply say in this motion is, let's commit this bill and bring it back out with the tax increases--if there are going to be tax increases; and many of us believe there should not be any, which is why we voted for the Crapo motion yesterday--but if you are going to raise taxes on America's small businesses, families, and individuals, at least align those so the policy, the substance of this bill, which begins 4 years from now, is synchronized so we are not slapping a huge new tax increase on America's small businesses in the middle of a recession and passing on those higher costs, which is what they will do, to people in this country in the form of higher insurance premiums. So I say to the Senator from Texas, this is a very straightforward, simple motion. I hope our colleagues on both sides will support it. It is a matter of principle, of fairness when its comes to making policy that I think the American people have come to expect. We ought to be honest and give the American people a complete understanding of what this bill really costs. Because they have done what they have done--by instituting the tax increases immediately and the spending 4 years from now--it understates the overall cost of this legislation. The American people need to know this is a $2.5 trillion bill when it is fully implemented. The only reason they can bring that in under that number is because they start raising taxes immediately and do not start paying benefits out for another 4 years. So I say to the Senator from Texas, I hope when we get to this vote, it will be a big bipartisan vote in the Senate, and I hope we will make a change in this legislation that implements some semblance of fairness and also gives us a true reflection of what the bill really costs.

Mr. THUNE

Mr. THUNE. So we have a very small number of Americans who will derive a benefit. But you have a whole lot of Americans who will actually be paying the freight. The Senator mentioned earlier--I saw his chart--that 73 million Americans are going to end up with higher taxes as a result. Many of the premium tax credits, if you could give credit to the taxpayers receiving this, which you can't because it goes to the insurance company, but if you could, three-quarters of that will go to people who currently have no income tax liability. It seems as if the advertising on this is very inconsistent with reality and the facts. The fact is, most Americans will see taxes and premiums go up. Very few Americans are going to get some premium tax credit to help subsidize their premium cost, and that will go directly to the insurance company. I understand the Senator from Idaho and the Senator from Nevada are both members of the Finance Committee. They have been involved with this from the beginning. That is my understanding of this, which is hard to fathom how that constitutes a tax cut.

Mr. THUNE. That is precisely why the arguments made by the other side that somehow this is a tax cut sort of defy what I think most Americans have come to expect when they get a tax cut; that is, that they get to keep more of what they earn. What we are talking about is a payment that will be made to an insurance company, a tax credit for premium subsidies that will go to an insurance company. There will be very few Americans, as a percentage of the total population, who will actually derive any sort of benefit. My understanding is, about 10 percent of all Americans will get some benefit from the premium subsidies that will go to the insurance company, not directly to the taxpayer; is that correct?

Mr. THUNE. My understanding is, those premium tax credits actually go to the taxpayer. When you say this is a tax cut for people, does it end up in the pockets of the average taxpayer?

Mr. THUNE. My colleague from Texas is exactly right. Her motion and the motion I am cosponsoring, which we hope to vote on next, will be a follow-on motion to the motion the Senator from Idaho is offering. It seems a basic principle and a matter of fairness to the American people that if you are going to create public policy, that you do it in a way that treats people fairly and does not raise their taxes before a single dollar of the premium tax credits and the exchanges that are designed to create the new insurance product for people would take effect. That is what this bill does. The motion of the Senator from Idaho commits all of the tax increases--and I will support that wholeheartedly, and I hope my colleagues in the Senate will do the same because these tax increases are the absolute worst thing we can do at a time when we have an economy in recession and we are asking small businesses to lead us out of the recession. Seventy percent of jobs in the country are created by small businesses. It is much higher in my State of South Dakota. These tax increases could not be more poorly timed in terms of getting the economy restarted and creating jobs for Americans and getting them back to work. Since most people get their insurance--at least currently-- through their employer, one of the best things you can do to provide insurance is to put people back to work. This bill has the opposite effect. It is a job killer because of all of the tax increases. Every small business organization has said that. That is why it is so important we support the motion of the Senator from Idaho. Senator Hutchison and I will also offer a motion--hopefully, we will get a vote on it later--that at least will delay the tax increases until such time as the benefits begin. It essentially aligns the revenue increases and the benefits so they are synchronized and you do not have this period of 10 years where you are taxing people for 10 but only delivering a benefit for 6. Again, I think that violates a basic principle of fairness most Americans should expect when it comes to their elected leaders making public policy which will have a profound impact on them and their lives. I certainly hope we get a vote on that motion, and I hope our colleagues will support it. To me, it is unconscionable that you would raise taxes by $72 billion, which is what this does, up until the year 2014 before the premium subsidies and the exchanges kick in which would deliver the benefits that are supposed to be delivered under this bill. The Senator from Texas and I look forward to getting a vote on that motion. I hope we can win on the Crapo motion later today. I appreciate my colleagues being here to point out how important it is that we have public policy that is fair and also that we not do things that are counter to job creation at a time when we are asking small businesses to get out there and create jobs and make investments.

Mr. THUNE

Mr. THUNE. If the Senator missed that point, I can get the chart out.

Mr. THUNE. I thank my colleagues from Tennessee, Wyoming, Alabama, Kentucky, and Arizona, all who have been here. In closing, I will quote the Associated Press: In part to reduce costs, the legislation would delay until Jan. 1, 2014, creation of so-called insurance exchanges in which individuals and small businesses could shop for affordable coverage. All done to disguise the bill's real cost of this, which it is being acknowledged now widely by the Democrats as well. This is not a $1 trillion bill; this is a $2.5 trillion bill. It is a job killer. It cuts Medicare, raises taxes, and raises premiums for most of the American people. I yield back our time.

Mr. THUNE. I think we have to wrap up. But I just want to make one point in closing and say to the Senator from Tennessee, the Senator from Wyoming--the leader is here from Kentucky--that the citizens in my State of South Dakota, and I think most citizens, would expect that if we are going to reform health care, we do something about their cost, which clearly that point has been made very clear, repeatedly, here-- that all the studies say that does not happen. The other thing I will mention is, I cannot imagine any of our constituents would say that if you are going to implement public policy, you should raise taxes in 3 weeks and not start the benefits until 4 or 5 years later. It just seems to me the average American out there has to be saying: OK, that is like me going to the bank and taking out a mortgage, but I can't move into the house for another 4 or 5 years, and in the meantime I will be making payments.

Mr. THUNE. The Senator has made a payroll. He knows what this is like, how hard these decisions are when it comes to making decisions about whether you are going to hire somebody and to try and squeeze those costs down so you can buy a new piece of equipment. I think all small businesses are dealing with that. The Senator from Wyoming mentioned the National Federation of Independent Business which, of course, is a very business-oriented organization that represents a lot of small businesses across the country, indicating the employer mandate would cost about 1.6 million jobs so the job issue is so absolutely pertinent to this debate. That is why NFIB and the Chamber of Commerce and every business organization I think I know of in this country, including organizations such as the American Farm Bureau organization, which represents a lot of farmers and ranchers in my State, those are the organizations that speak for these various small businesses. They have all weighed in, and they weighed in heavily, in no uncertain terms, that this sets us back. This does not move us forward. You talked about getting that cost curve down. Every analysis that has been done, including by the referees--the Congressional Budget Office, the Actuary at CMS--all come back with the same conclusion. The Senator from Alabama also probably has a lot of small businesses in his State, members of the National Federation of Independent Business, the Chamber of Commerce, the Association of Wholesale Distributors, the National Association of Manufacturers, lots of these organizations that have weighed in. It seems to me they have looked at this carefully, and they have come to the same conclusion. I would be interested in what the Senator from Alabama might be hearing from the small businesses he represents, with regard to the impact this would have on jobs.

Mr. THUNE. Madam President, the Senator has been the mayor of a good- sized city, a small businessperson, actually probably bigger than a small businessperson. But if you were running a business and you were in an environment such as we are in today, a tough economy, trying to figure out ways to cut back on your costs and figure out a way to sell a little bit more of whatever it is you are making or doing, and somebody comes to you and says: We are going to reform health care and we want to do something that will get health care costs down and yet what they are selling is going to raise your taxes and, according to the referees--the Actuary at the Center for Medicare Services is sort of a referee in all this; they don't have a political objective; they simply want to get the facts out. Of course, that is the role that is played traditionally in Congress by the CBO, both of which now say--the CBO says it is going to increase health care spending by $160 billion over the first 10 years and the CMS Actuary is now saying it will increase health care costs by $234 billion over the first 10 years. You also have now the CMS Actuary saying it could close 20 percent of the hospitals, that 17 million people who get their insurance through their employers are going to lose it, that the Medicare cuts are not sustainable on a permanent basis in this legislation, and that a lot of these tax increases are being passed on in the form of higher premiums which will mainly be borne by people trying to provide insurance. If you are sitting there as a businessperson--and you have been there--and you are looking at that balance sheet and that income statement and somebody is trying to sell you on an idea about health care reform that has the features I mentioned, how do you react to something such as that? I see what small business organizations are saying, but the Senator has been there. Tell me how you view it.

Mr. THUNE. Would the Senator from Ohio yield for a question?

Mr. THUNE. Will the Senator yield for a question?

Mr. THUNE. Will the Senator yield for an additional question?

Mr. THUNE. It doesn't matter which market you get your insurance in, except if you are in the individual market, you will pay much higher insurance premiums than the status quo, which is locking in double the rate of inflation premiums for the foreseeable future. The red line on the chart represents the spending under this bill. This is what the CBO says will happen. You will see the cost curve bent up, not down. You are going to have more money coming out of our economy to pay for health care than you do today. That is what small businesses are reacting to. That is why they are coming out strongly and adamantly opposed to this legislation. It bends the cost curve up, increases the cost of health care, rather than bending it down. We heard the same thing come out of the Actuary of the CMS just last week. Again, the experts are saying--the referees, the people who don't have a political agenda--repeatedly, that this will increase the cost of health care. This will drive health insurance premiums higher. The other point I wish to make, because after I have shown you how health care costs will go up under this legislation, the other amazing thing about it--this is, again, one of those phony accounting techniques or gimmicks that Washington uses, the same old business in Washington, the Washington smoke and mirrors, the ways of disguising what this really costs: In order to bring this thing in at about $1 trillion, which is what the majority wanted to do, they had to use budget gimmicks. The Senator from New Hampshire knows all about this because he has followed this closely as chairman of the Budget Committee for many years. He can attest to the fact that one of the things they will do is start the tax increases immediately. So on January 1 of next year-- which is now 18 short days away--all these businesses across the country are going to see their taxes go up--in 18 days. But the amazing thing about it is, many benefits don't get paid out for another 1,479 days. So they front-load all the tax increases; the tax increases will be passed on immediately. By 2013, every American family will be paying--starting next year--$600 a year. So every American family will feel the brunt of the additional costs for taxes and the premium increases that will follow from those. The remarkable thing about it is, they structured a bill that would punish small businesses and people who will pay these taxes on January 1 of 2010--18 days away. They don't pay out benefits for another 1,479 days. What does that do? In the 10-year window they use to measure what this will cost, it dramatically understates the cost of the legislation. So we are faced with not a $1 trillion bill but a $2.5 trillion bill, when it is fully implemented and when all the budgetary gimmicks and phony accounting is actually taken into consideration. This is a bad deal for small businesses. That is why all the small business organizations have come out opposed to it. You cannot get up, day after day, and defy reality, logic, reason, and facts. That is what those who are trying to push this huge government expansion and huge takeover of health care in this country are trying to have the people believe. They are dead wrong. I believe the American people are tuning in to that, which is why, increasingly, in public opinion polls, they are turning a thumbs down on this by majorities of over 60 percent. I see the Senator from New Hampshire. I appreciate him indulging me for an extra few minutes. I yield the floor.

Mr. THUNE. Would the Senator from Arizona yield? I see a number of our colleagues and the leader. I would simply add that this idea of expanding Medicare, which just emerged last week, was a bad one, and one even I think a lot of the Democratic Senators have come out in opposition to, which is why we are now back to the drawing board. But this relentless effort to try to tweak this bill around the edges, to somehow get that 60th vote, doesn't do anything to change the fundamental features of the bill, which the leader and the Senator from Arizona have been talking about, and that is the tax increases and spending.

Mr. THUNE. I appreciate the Senator from Arizona yielding and the discussion of all our colleagues on the Senate floor this evening, pointing out how flawed this process is and that it is being conducted behind closed doors in contradiction of all the promises and commitments that were made that this would become a transparent and open process. I think the Senator from Arizona has been great at holding the other side accountable when it comes to all these pronouncements about how this was going to be an open, transparent process, and that is just not the case. There is something going on right now that we are not privy to, and I think at some point they are going to throw something, as the Senator from Arizona said, at the wall, hoping that the latest thing will stick. But I do want to make an observation with regard to the discussion held earlier today because a Member from the other side--the Senator from Minnesota--had indicated that he thought this chart was somehow inaccurate or misleading, and I want to point out again, Madam President, that the chart is very accurate. In fact, the taxes in the bill begin 18 days from now, on January 1 of next year. January 1, 2010, is when the taxes in this bill begin. In fact, almost $72 billion of taxes will have been collected before the benefits that start to kick in will be paid out--the premium subsidies that are going to support the exchanges, that are supposedly going to help those who don't have insurance get access to it. That is 1,479 days from now. The Senator from Minnesota got up and said, and I quote: We are entitled to our own opinions; we are not entitled to our own facts. The fact is, benefits kick in on day one. The large majority of benefits kick in on day one, and we shouldn't be standing up here with charts that say the exact opposite. Well, Madam President, it is not me saying this; it is the Congressional Budget Office. The Congressional Budget Office has said that 99 percent of the coverage spending in this bill doesn't kick in until January 1, 2014--1,479 days from now. Now, I ask my colleagues, and most Americans around this country: Do you think it is fair to construct a bill that in order to understate its total cost starts raising taxes in 18 days, but doesn't start delivering 99 percent of the coverage benefits until 1,479 days from now? If the other side wants to have an argument about whether 99 percent of the coverage benefits kick in in the year 2014 or 100 percent, I am happy to have that argument. The point is simply this: Taxes start 18 days from now--tax increases--so that $72 billion in taxes will have been imposed upon the American people, and the benefits 1,479 days from now. So, Madam President, I want to make that point and refute the argument that was made by the Senator from Minnesota that a large majority of benefits kick in on day one. Ninety-nine percent of the benefits don't kick in until later. Incidentally, I have an amendment on which I hope we will get a chance to vote that delays the taxes until such time as the benefits begin. We think it is only fair to the American people that we synchronize the tax increases with the benefits. Many of us don't support the tax increases in the first place, which is why we will be supporting the Crapo amendment to recommit the tax increases back to the committee to get rid of them. But if you are going to have tax increases and start raising revenue immediately, you ought to start paying out the benefits today, or at least delay the tax increases so the benefits and the tax increases are synchronized. That, to me, is a fair way to conduct and do public policy for the American people. The reason it was done this way, let's be honest about it--and the newspapers have made it pretty clear in some of their statements--for instance, the Washington Post states: The measure's effective date was also pushed back to the year 2014. That projection represents the biggest cost savings of any legislation to come before the House or Senate this year. The measure's effective date was also pushed back. They keep pushing the date back to understate the cost. The reason they want to start collecting revenue right away and not start spending until later is because they know if they start the spending early on, they are going to start inflating significantly the cost, and the goal was to try to keep it under $1 trillion. We all know now, and they have acknowledged, the 10-year, fully implemented cost of this isn't $1 trillion, it is $2.5 trillion. The American people deserve to know the facts. That is the fully implemented cost. The only reason they can say in the 10 years it comes in at $1 trillion or thereabouts is because the tax increases started January 1, 2010, and the benefits--99 percent of the benefits--don't start kicking in until January 1, 2014. So I thank the Senator from Arizona for giving me the opportunity to clarify that. It is important we make this debate about the facts. I have tried to do that when I speak, and I am happy to have the opportunity to restate the facts as they exist and as they have been presented to us by the experts--by the Congressional Budget Office and by the CMS Actuary, both of whom have concluded the same thing when it comes to the benefits and the impact this will have on premiums in the country. I think that is probably the most devastating blow to the argument the other side has made in support of this bill--when the CMS Actuary came out last week and said this is actually going to increase the cost of health care in this country by $234 billion over the next 10 years. So, Madam President, I am happy to yield. I see a number of our colleagues on the Senate floor, and the leader is here as well, and I would certainly yield time to the leader.

Mr. THUNE. Madam President, I wish to start by referring briefly to the remarks made earlier by the Senator from Alaska. She indicated earlier on the floor that she is going to be offering a motion of disapproval for a set of regulations that are not final yet but have been announced by the EPA that they are coming forward with, the so-called endangerment finding. I wish to indicate that I intend to support her on that resolution. I cosponsored the amendment she tried offering earlier this year to one of the appropriations bills that would have prevented the EPA from moving forward with the endangerment finding for a year, which would have allowed Congress an opportunity to examine this issue and perhaps approach it with a legislative solution as opposed to having the EPA move forward in a way even they acknowledge they don't have statutory authority to do. I might say that the end result of what is being proposed at EPA--if they are successful--is they will implement a cap-and-trade program, only it will be a cap without the trade. The reason they are moving forward, in my view, is because there isn't the political will in the Congress to pass a punishing cap-and- trade proposal this year. The House of Representatives passed it narrowly this year. There are a number of Members of the House who I think would like to have that vote over again. I know there aren't the votes in the Senate because many Senators on both sides realize the impact it would have on the economy--the number of jobs that would be lost in our economy and how it would punish certain parts of our country with crushing energy costs, at a time when we don't need to pile costs on small businesses and consumers who are trying to come out of a recession. This is a wrongheaded move by the EPA. It is something they should not be acting on independently. This should be resolved by the Congress of the United States. Honestly, if the EPA moves forward, there are a number of industries in South Dakota that will be impacted and a number of businesses in my State. If the litigation is successful--and, inevitably, there will be lots of lawsuits filed--and if the 25,000-ton number is reduced to the 250-ton number that is used as a threshhold in the Clean Air Act, there will be literally millions of entities that will be covered--hospitals, churches, farmers, ranchers, and small businesses. In South Dakota, we have a lot of farmers and ranchers who make their living in small businesses that would be adversely impacted were these regulations to be enacted and then move forward with regulating and putting the caps in place. If the litigation is successful, we know what will be subsequent to that. I say that as a lead-in to talk about impacts on small businesses. There are so many things happening right now in Washington that have an adverse and detrimental impact on the ability of small businesses to create jobs. I have heard the President talk about creating jobs--that is his No. 1 priority--and we need to give incentives to small businesses to create jobs. I have heard my colleagues on the other side talk about how important job creation is. Yet everything coming out of Washington, whether it is in the form of heavyhanded regulation, such as this endangerment finding coming out of EPA, or in the form of a cap-and-trade proposal or whether it is this massive expansion of the Federal Government--the $2.5 trillion expansion to create a new health care entitlement--all these things are raising clouds over the small business sector of our economy, which creates about 70 percent of the jobs. We are essentially telling small businesses that you may end up with these massive new energy taxes or with this employer mandate that will cost you up to $750 per employee if you don't offer the right kind of insurance; you are going to be faced with all these taxes imposed on health insurers and prescription drugs and medical device manufacturers that will be passed on to you. Then we are saying go out and create jobs, in light of all this policy and uncertainty in Washington, all these proposals to tax and spend and borrow more money by the Federal Government. You cannot blame small businesses for acting with a little bit of hesitancy when it comes to making major capital investments and when it comes to hiring new people. Those are the very things we want small businesses to do. We want to encourage that type of behavior. We want to encourage that kind of investment. We want to encourage job creation. Unemployment is at 10 percent. We have lost 3.3 million jobs since the beginning of the year. Who will put people back to work? It will be the small businesses in our economy. In South Dakota, they are about 96 percent of the game, when it comes to employment in South Dakota. Here we are debating a health care reform bill which, in addition to spending $2.5 trillion to create this new health care entitlement, raises taxes on small businesses, cuts Medicare, and at the end day, according to the experts--the CBO and the Chief Actuary at the CMS, which is the so- called referee in all this, who tells us what these things will cost and their impact--they have all said premiums will either stay the same or go up. So the best small business can hope for under this is the status quo. I hear my colleagues on the other side coming down here, day after day, making statements, saying this is going to be good for small businesses, and this will help small businesses deal with the high cost of health care. The problem with all their arguments is one thing: They are completely and utterly divorced from reality. You cannot look at this health care reform proposal and come away from it and say this is a good thing for small businesses, when small businesses are saying this will drive up their cost of doing business, it will raise health care costs, and these taxes you are going to hit us with will make it harder to create jobs. Why do we proceed in the face of this and then deny what all these small businesses are saying, what the experts are saying, and what increasingly the American people are saying, which is that this is a bad idea. So why don't you reconsider this and start over again and do some things that will actually lower health care costs. That is what small businesses are saying. We have people down here saying this is good for small business. What are small businesses saying--and large businesses, for that matter. The NFIB represents small businesses all over the country. They said: This bill will not deliver the widely promised help to the small business community. They say: It will destroy job creation opportunities for employees, create a reality that is worse than the status quo for small businesses. It is the wrong reform at the wrong time, and it will increase health care costs and the cost of doing business. That is the National Federation of Independent Businesses, as I said. How about large businesses? The Chamber of Commerce expressed their disappointment with the Senate health care bill and has weighed in with strong opposition against it. That includes the National Association of Wholesaler Distributors, the Small Business Entrepreneurship Council, the Association of Builders and Contractors, the National Association of Manufacturers, the Independent Electrical Contractors, and the International Franchise Association. The list goes on and on. The Small Business Coalition for Affordable Health Care--50 organizations around the country that are members of the group--including many that have members in South Dakota, not the least of which is the American Farm Bureau Federation. That represents farmers and ranchers who are still businesspeople out there trying to make ends meet. They said this: Our small businesses and self-employed entrepreneurs have been clear about what they need and want: lower costs, more choices, and greater competition for private interests. They say: These reforms fall short of long-term, meaningful relief for small business. Any potential savings from these reforms are more than outweighed by the new tax, new mandates, and expensive, new government programs included in this bill. That is what small businesses across the country are saying. The reason they are saying that is because, as I mentioned, not only are they hit with these taxes every year, there is a tax on health plans that will amount to $60 billion over 10 years, which will be passed on to small businesses. There is a new payroll tax, Medicare tax, which incidentally, for the first time ever, instead of going to Medicare, will be used to create a new entitlement program. That will hit about one-third of small businesses in this country, we are told. As I said earlier, they have the employer mandate, which is going to hit a whole lot of small businesses--another $28 billion that will hit small businesses across this country. So you have all these new taxes heaped upon our small business sector. The small businesses are saying: What do we get out of this? What is this going to do to affect our health care costs? I will show you. This chart represents what the CBO has said health care costs would do if this bill is enacted. The blue line represents the cost of essentially, if you will, doing nothing. In other words, the blue line represents what will happen if Congress does nothing, the year over year increases we are already seeing. It represents the status quo. We have heard people from the other side say we have to do better than the status quo. The President and the Vice President say that and our Democratic colleagues say that. You cannot accept the status quo and then attack Republicans for being in favor of status quo. The blue line represents the status quo. The blue line is what will happen year over year, in terms of increases in health insurance premiums that small businesses and individuals will deal with. It doesn't matter where you get your insurance--the small business group market or the large business employer group market or the individual market. If you get it in the individual market, your rates will be 10 to 13 percent higher. I ask unanimous consent to extend my remarks for another 5 minutes.

Mr. THUNE. Madam President, will the Senator from Minnesota yield for a question?

Mr. THUNE. Did the Senator understand that what I was pointing out on the chart--the point I was making--was that the tax increases start 18 days from now, and the benefits--the spending benefits under the bill, which are the premium tax credits and the exchanges that are designed to provide the benefits delivered under this bill--don't start until 2014. Did the Senator miss that?

Mr. THUNE

Mr. THUNE. Mr. President, I want to address the issue of health care reform, of course, which is the main reason Congress is here this weekend and was here last weekend, and in all likelihood will be here next weekend. But I also think it is important we put these things into an overall context and take a look at the bill we are voting on right now. We are going to have a vote on final passage tomorrow. We had a cloture vote this morning on a spending bill, and the spending bill-- which represents six, I think, appropriations bills that did not get done earlier this year--represents a package of spending that overall increases by 12 percent over last year. That is an interesting number, given the fact that the Consumer Price Index--which is the sort of, if you will, conduit to which a lot of these decisions that are made around here is tied; in other words, the CPI is what we view to be inflation; and sometimes we say we mark up bills at inflation or inflation plus this or inflation plus that--where the CPI was, ending on October 1 of this year, about two-tenths of 1 percent but in the negative column. So you have a CPI that is actually negative, an inflation index that is actually negative for most Americans. This, again, is representative of the totality of our economy and what things cost, and that is a lot of times how appropriations bills are measured. So you have a CPI, Consumer Price Index, that is running in the negative, and yet you have appropriations bills--this one representing, again, as I said earlier, six appropriations bills, individual appropriations bills that did not get done earlier--packaged into one big spending bill that is a 12-percent increase over the previous year. How can we go to the American people and justify year-over-year spending increases that are 12 percent, when they are having to balance their budgets and tighten their belts and live in an economy where some people are losing their jobs? But certainly everybody is trying, struggling to survive out there. That is true for small businesses. That is true for families. That is true for pretty much everybody, it seems, except the Congress. Here in Washington, DC, we seem not to be listening to what is happening in America. We are marking up spending bills at 12 percent over last year's level, at a time when the CPI is actually running in the negative--when you have negative cost-of-living increase. Yet we are marking up appropriations bills that represent a 12-percent increase over last year's spending level? Put that on top of a stimulus bill that passed earlier this year that, with interest, is a $1 trillion spending bill. So you have a $1 trillion spending bill with interest passed earlier this year, much of which went to the very same Federal agencies that are going to benefit from this 12-percent increase over last year in annual appropriations. So you have a $1 trillion stimulus bill, you look at appropriations bills--again, this being representative of most of the bills this year--that year-over- year increase at 12 percent, at a time when most Americans are having to tighten their belts. We hear that. We also hear that TARP is now going to be used as a slush fund, so to speak, to pay for all kinds of other government spending. In other words, they have decided--at least, I think the administration has--to use the TARP fund as sort of a ``pay for'' for lots of things they want to do. Most of us know that the TARP fund was created specifically to stabilize our financial markets, to prevent what we thought at the time was going to be an imminent financial collapse. That purpose has been served. I have a bill that would end TARP at the end of this year on December 31. If it is not allowed to expire at the end of this year, when it is set to expire--if it is not allowed to expire, if it is extended and it goes well into next year--it can be used, as I said, for all these other things that politicians have designs on doing. So my legislation would end it at December 31 of this year, as was intended, and make sure any funds that are paid back in from loans that have been made or assets that have been acquired actually go back to the Treasury to pay down the Federal debt. Because that is what, in fact, TARP was intended to do. Once the job was accomplished, it was not to become a ``grab bag'' and ``found money'' for Congress to use for all these other things. You have the TARP fund now morphing and evolving into this sort of political slush fund to be used for all these other spending priorities. You have the stimulus, this $1 trillion stimulus bill, out there. You have this appropriations bill with a 12-percent year-over- year increase over last year's level. On top of all that, we pile on a $2.5 trillion expansion of the Federal Government in Washington to pay for a new entitlement program with the health care reform bill that has been, is being debated in the Senate in the last week and in the week to come. So at some point you have to say--and I think the American people look at us and say--enough already. I think that is what they are saying. I think the reason we are seeing these public opinion polls that are turning a thumbs-down on this massive expansion of the Federal Government here in Washington to fund health care is because the American public is becoming increasingly uncomfortable with the idea that the Federal Government continues to run the credit card up. The stimulus money was all borrowed money. The TARP money is borrowed money. The appropriations bills, for the most part, this year are--or for a large part, at least--borrowed money. Mr. President, 43 cents out of every dollar the Congress spent in the last year--the fiscal year ending September 30--was borrowed money. We continue to borrow and borrow and pass on the debt to future generations. We cannot continue to do that and expect to have a future that enjoys the same level of prosperity and the same level of economic growth and vitality we have experienced in the past. You cannot continue to pile up these massive amounts of debt. The Federal debt is going to double in 5 years, it is going to triple in 10, if we continue on the current path. Right now, I do not see anything that is going to put any brakes on this. The capacity and the appetite and the willingness and the inclination of Washington, DC, and politicians here to continue to spend and spend seems to be unlimited. At some point, we have to put the brakes on. We have people who have a foot on the pedal. The Democratic majority in the House of Representatives, the Democratic majority here in the Senate, the White House, all have their feet on the accelerator. Somebody has to put on the brake. That is what we are trying to do. That is why I think it is important we end TARP before it gets misused and spent for all these other things and why it is important we rein in these appropriations bills. We are doing everything we can to stop this appropriations bill from being passed at a 12-percent increase over last year's level. And we are doing everything we can, I would say, to stop this massive expansion--$2.5 trillion expansion--of the Federal Government to fund the new health care entitlement, at a time when we have all these other debt problems and deficits, as far as the eye can see. So I wanted to, in shifting gears, paint that as sort of the context against which this whole health care debate is occurring. But I want to shift, if I could, to some of the more recent developments with regard to the debate over health care. I think there are a couple things that, to me, are game changers in terms of the debate. One of those, of course, is the study that came out yesterday from the CMS, or the Centers for Medicare & Medicaid Services, the Actuary who points out the health care reform bill that is currently before the Senate will not drive health care costs down but will, in fact, increase health care costs by $234 billion, and that today, about one-sixth of every dollar we spend is on health care; that 10 years from now, in 2019, that will be almost 21 percent--that is what the CMS Actuary said--that the total amount we spend on health care in this country--which today is about 17 percent--10 years from now will be almost 21 percent. So the amount spent on health care as a percentage of our gross domestic product goes dramatically up, not down. And $234 billion is what the CMS Actuary said health care costs would go up by in the next 10 years. Of course, we had previously the CBO essentially saying the same thing. The Congressional Budget Office--for those who live outside of Washington, DC--is sort of the nonpartisan estimator, if you will, of what a lot of these Federal programs are going to cost. The Congressional Budget Office said that under the bill put forward by the Senate majority here, the Democratic leadership in the Senate, you would actually increase health care spending by $160 billion over the next 10 years, again bending the health care cost curve up, not down. So now you have the experts--the Congressional Budget Office, the Centers for Medicare & Medicaid Services Actuary--all saying health care costs are going to go up, not down, and significantly up. You have the small business organizations out there saying--the National Federation of Independent Business, the Chamber of Commerce, the National Association of Wholesalers and Distributors, and I might add there is another group that has been formed called the Small Business Coalition for Affordable Healthcare, which represents 50 different business organizations--this health care reform bill will increase the cost of doing business in this country and will drive up health care costs. So they have come out in opposition to it, as have all the other business organizations I mentioned, for the same reason. They realize health care reform ought to be about getting their costs down and improving their ability to create jobs. By the way, three- quarters of the jobs created in our economy are created by small business. So what are we going to do to small businesses? Pile on a bunch of new taxes to pay for this expansion, this $2.5 trillion expansion of the Federal Government in the form of this new health care entitlement. All for what? So they can see their health care costs continue to go up. You pile on the new taxes, you cut Medicare to all the providers out there. And I want to draw them into this too because not only have the small businesses said this is going to drive health care costs up-- and they have come out opposed to it--not only has the Congressional Budget Office said that, not only the Centers for Medicare & Medicaid Services Actuary said that, you have academics saying that, but now you also have the providers saying that. Hospitals and physicians groups are coming out and saying this latest proposal by the Democratic majority to expand Medicare will put hospitals out of business. Because hospitals get underreimbursed by Medicare, and so do physicians. So what do they do? They shift costs over to the private payers, which is everybody else in this country, and everybody else sees their premiums go up. It shrinks the number of private payers, expands the number of government payers, and for these hospitals in places such as South Dakota--I see my colleague from Wyoming on the floor--that are very dependent on Medicare, they are going to see less and less reimbursement coming into their facilities, which does not cover their costs, and very soon you will have a lot of hospitals, particularly in rural areas, going out of business. That has been stated. The chairman of the Senate Budget Committee, Senator Conrad from North Dakota, came out and said that basically this latest proposal would bankrupt a lot of hospitals in his State. I think that is true for a lot of States and particularly in rural States such as mine and the Senator from Wyoming. We have small businesses saying: We can't sustain these increases. We think this is a really bad deal. We have the experts, the analysts, the Congressional Budget Office, and the Center for Medicare and Medicaid Services saying this increases costs for health care in this country. And now we have the American people weighing in and saying: We think this is a bad deal. We think it is going to increase our health care costs. The CNN poll that came out 2 days ago said 61 percent of Americans oppose the health care reform bill that is pending right now in the Senate. Other polls show similar results. So we have a very sizable majority of the American people who have now weighed in saying this is a bad deal because it cuts Medicare, it raises taxes, and at the end of the day, it raises premiums. So who is for this? Who thinks this is a good thing? Well, apparently a number of Democrats here in the Senate, but that is an increasingly shrinking universe of people. The American people have said it is a bad deal. The experts say it is a bad deal. Small businesses say it is a bad deal. Providers say it is a bad deal. What is left? Well, I am hoping there are a couple of courageous Democrats who are going to step forward, agree with the American people, and say: We are listening to the American people. We are listening to the experts. We are listening to small businesses that create two-thirds or three- quarters of the jobs in our economy. And we agree we are going to stop this train wreck from happening, sit down, start over, do this right, work with Republicans, and write a bill that actually does constrain costs, that drives the cost curve down and provides access for more Americans. I hope there are a few Democrats out there who will do that because I think on our side we have all concluded, based on what we hear from the American people, what we hear from the experts, what we hear from the business community, what we hear from the provider community, the hospitals and the physicians, that this is a really bad deal. At the end of the day, after all of this new spending, after all the new taxes, after all the Medicare cuts, what are we left with? What everybody says they want out of health care reform is lower costs. Our colleagues on the other side come down here repeatedly and say we have to do something about the cost of health care. People in this country are struggling with health care costs, absolutely. We could not agree more. What they will do with this bill if it passes is make matters worse, not better, by increasing costs for most Americans. I wish to show my colleagues exactly what I mean. If you are a family of four--and this is, again, according to the Congressional Budget Office, which looked at this and analyzed these bills and said: If you are in the small group market or large group market, you are going to see year-over-year increases in health care costs, which is somewhere between 5 and 6 percent, which is what we are seeing today--and by the way, that is twice the rate of inflation historically--but a 5- to 6- percent increase in health care premiums. If you are in the individual marketplace, you are going to see your premiums go up anywhere from 10 to 13 percent beyond that. So if you are in the individual market, it gets much worse. But if you are in the small group or large group market, here is what it says: If you are in a family of four today and you are receiving your insurance through your employer and they are getting their insurance through a large group market, you are paying about $13,000 a year. In 2016, 7 years from now, you are going to be paying over $20,000 a year for health insurance coverage. So your health insurance coverage is going to go up under this bill, not down, according to the Congressional Budget Office. It is going to go up at a rate that is double the rate of inflation. Again, this is for people who get their insurance in the large and small group markets. The yellow line represents the large group market, the red line represents the small group markets, but the result is the same. It is an upward trajectory. It is a spike up in the cost of health insurance for people who get their coverage for health insurance in one of those two markets. Again, as I said before, if you are in the individual marketplace, you could spike this thing like this because their costs are going to be 10 to 13 percent above and beyond what you are seeing here in the large group market. That is according to the Congressional Budget Office. So 90 percent of Americans, according to the Congressional Budget Office, are going to see their health insurance premiums stay the same, and by ``stay the same,'' I mean go up by twice the rate of inflation-- in other words, locking in the status quo--or worse yet, if you are in the individual marketplace, it will be going up 10 to 13 percent. So all of this talk about lowering the cost of health care and not settling for the status quo may sound good, it is great rhetoric, but it is absolutely factually inaccurate. So our colleagues who come down here day after day talking about how this health care reform bill is going to drive down the cost of health care are not listening. They are not listening to the American people. They are not listening to the experts. They are not listening to the small business community. They are not listening to the provider community. I have to say that even the academic community has weighed in on this particular issue as well. I wish to read for my colleagues something that was said recently by the dean of the Harvard Medical School: Speeches and news reports could lead you to believe the proposed congressional legislation would tackle the problems of cost, access, and quality, but that's not true. The overall effort will fail to qualify as reform. I find near unanimity of opinion that whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health care spending rather than restrain it. This will make an eventual solution even more difficult. That from the dean of the Harvard Medical School. So I hope that before this debate concludes--the push is to get it done by the end of the year. I am not sure why. It seems to me, at least, that this is not something we want to hurry. We are talking about reordering or restructuring one-sixth of the American economy. As I said, today it represents 17 percent of our GDP. We spend about $2.5 trillion a year on health care. We ought to get this right. There is an intent on the other side to jam this through sometime next week. Well, I hope we can put the brakes on this. I hope there are a couple of courageous Democrats--at least one but two would be better, maybe even more--who will step forward and say: We are going to listen to the American people. We are going to listen to the providers out there, the hospitals and physicians. We are going to listen to the experts. We are going to listen to the small business community that creates the jobs. And we are not going to blindly follow the leader and take this country over the cliff when it comes to health care delivery and when it comes to our economy. There is one final point I will make about that because I thought this was a remarkable finding by the CMS in their study. They essentially said that the savings that are proposed in Medicare--the new Federal spending that relies on Medicare cuts which are unlikely to be sustainable on a permanent basis--we all, over here, agree with that. The appetite for the Congress, the willingness for the Congress to cut reimbursements to hospitals and to nursing homes and to home health agencies and to hospices, I find very suspect. So at the end of the day, if you cannot sustain those--and let's say, for example, for a minute that you can. Let's say these Medicare cuts take effect. If they take effect, and if the Democrats have their way and they expand Medicare, we are going to put more and more people onto a sinking ship because we have a program that is going to be bankrupt in 2017, we are told by the actuaries. We are going to cut $1 trillion out of it over the next 10 years when it is fully implemented, and we are going to put more people onto it. So if those cuts occur, we are going to have more and more hospitals going out of business because they flat aren't going to be able to make ends meet. That is the other thing, by the way, the CMS Actuary found in their study. But they said they don't believe we can sustain these Medicare cuts on a permanent basis. Meaning what? Meaning that the cost of this program, $2.5 trillion over 10 years, is going to fall on the backs of future generations because it will be borrowed. It will be added to the debt, which is growing at $1 trillion a year, as I said earlier. We are going to have a vote, if you can believe that, here in the very near future to actually raise the debt ceiling by $2 trillion over and above what it is today, which is $12 trillion. This debt situation is probably the most serious crisis and challenge facing this country going forward. It just seems as though there is an endless, limitless appetite for spending and borrowing around here, and at some point the chicken is going to come home to roost and the bills will have to be paid. You can't continue to sustain this level of borrowing. These Medicare cuts are unsus-tainable, which is what the CMS Actuary says. That means a lot of the cost of this new program is going to be financed partly by tax increases, which, as I said, are harmful to small businesses, but secondly by more and more borrowing and more and more debt. More and more future generations, younger Americans, will be faced with a massive inheritance of Federal debt because we weren't willing to make the hard choices to be able to live within our means. So I hope when it is all said and done, there will be some people who will step forward, have the courage not to blindly follow the leader but to say with the American people, with the experts, with the small business community, with the provider community, with even some of the academic community, that this does nothing to constrain or lower health care costs. The emperor has no clothes. If they do that, we can sit down together. We are not here for a minute to suggest we shouldn't have health care reform. All we are here to suggest is that it ought to be done the right way, it ought to be done on a bipartisan basis, and it ought to be done in a way that actually bends the cost curve down rather than raises it and that does not cost us $2.5 trillion of cuts to Medicare, which is going to impact a lot of seniors, increase taxes, which is going to crush small businesses, or debt, which is going to punish future generations. That is what this debate is about. It is a consequential debate for America's future. The stakes are very high. I hope the American people will be engaged in it, and I hope we will be able to find some bipartisan support for defeating this really bad idea and moving to something that actually will make a difference, that will restrain costs, and that will provide health insurance reform that is meaningful reform and that doesn't bankrupt us, doesn't bankrupt hospitals, doesn't bankrupt future generations, doesn't cost us jobs by putting new taxes on small businesses, and actually bends the cost curve down. I yield the floor.

Mr. THUNE

Mr. THUNE. I would say to my friend from Texas, Senator Hutchison, that as we have examined this legislation and have looked at its cost and its benefits and how that is distributed over time, it has become clear that what the other side has tried to do--the Democrats have tried to do--with this bill is understate its true cost by front- loading the tax increases and back-loading the spending. In other words, the tax increases kick in right away, when much of the benefit of the bill does not kick in for several years. So I want to point something out, just to illustrate what the Senator from Texas has said; that is, the tax increases in the bill begin on January 1 of this year. So 21 days from now, Americans, individuals, families, and small businesses are going to see their taxes go up. Unfortunately, they are not going to see any benefit come until 1,482 days later. What that, in effect, does is it understates the total cost of this legislation. They have said: We want to get this under $1 trillion. The President said: I need a bill under $1 trillion. So they have tried to come up with a bill that is about $1 trillion. But what they do not tell you is that by delaying the benefits and front-loading the tax increases, you are actually going to have a 4- or 5-year period where people are having to experience tax increases. That is going to impact the small businesses because you have a Medicare payroll tax increase, which, by the way, for the first time, will not be used for Medicare but will be used to create a whole new entitlement health care program. You have an employer mandate which is going to hit small businesses. You have the tax on medical device manufacturers, on prescription drugs, on health plans. You have all these taxes that kick in right away. So what happens? These taxes get passed on to the consumers in this country in the form of higher premiums, so people are going to see their premiums go up. Small businesses are going to see their taxes go up immediately--well, 21 days from now. But Americans are not going to see any benefit from this for 1,482 days. So what we have is a gimmick that has been used to disguise the total cost of this bill, which we all know when fully implemented is not $1 trillion but $2.5 trillion. So the Senator from Texas and I have a motion, which I believe is supported by the Senator from Wyoming, who is in the Chamber, that would delay the tax increases until such time as the benefits begin so we synchronize or align the tax increases and the fees to begin at the same time the benefits do so we will reflect the true cost of this legislation to the American people and not unfairly begin punishing small businesses by raising their taxes before a single dollar of benefit is going to be distributed to the American people.

Mr. THUNE. We do want to get a vote--a vote on our amendment and on other amendments. Right now, that is being prevented or blocked. We haven't had a vote since Tuesday. We have amendments that are ready to go. The other side said they are open to amendments and they want to get the bill moving forward, but we are being prevented from getting votes on amendments. In the meantime, this backroom deal that is being cut, which we haven't seen--supposedly it has been sent to the CBO to find out what it will cost. We are waiting for that deal to emerge. In the meantime, we are looking at a piece of legislation that costs $2.5 trillion when fully implemented. As the Senator said, it relies on Medicare cuts and tax increases to finance it. Just yesterday, the chief actuary at the Center for Medicare and Medicaid Services basically said the savings that are relied upon, in terms of Medicare cuts, are unlikely to be sustainable on a permanent basis. They raise the question about whether those cuts are actually going to occur and, if they do, whether they will be sustained. If they are not, then you have the question of whether a lot of these providers out there--if the cuts do occur, and they continue to lose more and more every time they see a Medicare patient, then they are going to quit participating in the Medicare Program. You will have fewer providers offering services, making it more difficult for people--especially in places such as Wyoming and South Dakota--to get access to health care. You are assuming all these cuts in Medicare are going to occur, and you are assuming all these tax increases. Even with all that, you have a $2.5 trillion expansion of the Federal Government, which inevitably is going to rely more and more on borrowing. You are going to see more and more of this going on the debt, and we will pass it on to future generations. As CMS pointed out, it is unlikely these Medicare payment cuts are going to be sustainable without driving hospitals and doctors and other health care providers out of business. When they start reacting to this and those Medicare cuts are no longer sustainable, then you have built in all this new spending, and there is no way to pay for it without raising taxes dramatically, which would be, I guess, something the other side--since they have already demonstrated a significant willingness to raise taxes in this bill or borrowing, neither of which is good for the future of the country or our economy. Right now, our economy is trying to come out of a recession. Small businesses, which create the jobs in our economy, are faced with higher taxes under this bill. They have come forward and said--every conceivable business is saying this will drive up the cost of doing business, and it will raise the cost of health care in this country. So you have all these small businesses saying we are not going to be able to create jobs. You have that specter out there. You also have the idea of the Medicare cuts, which are, according to the CMS actuary, unlikely to be sustainable, leading to borrowing and debt, which means we are already running a $1 trillion deficit every year and piling more on the Federal debt and there will be a movement here to raise the debt limit by almost $2 trillion. So we will pass this on to future generations, future young Americans, who are going to bear the cost of this massive expansion of the Federal Government. There isn't anything in this that is good for the American public, which is why they are reacting the way they are, and why you are seeing these 61 percent of Americans coming out in the polls against it. I say to my friend from Wyoming, his thoughts with regard to this issue, these Medicare cuts being sustainable, how it is going to impact the delivery of health care around this country, and what it will do to future generations in terms of the additional debt and borrowing.

Mr. THUNE. That is exactly what our concern is. I would also add this recent study that came out yesterday by the CMS chief actuary sheds a lot of additional light on what is a very bad proposal, a big government proposal that does create 70 new programs here in Washington, DC, but does nothing to affect in a positive way the health care costs that most Americans are dealing with right now. The actuary goes on to say that access to care problems is plausible and even probable under the Reid bill. So the issue we have talked about in States such as Wyoming and South Dakota, where people travel long distances to get access to health care, would be aggravated by this legislation because there would be a need for more and more providers--hospitals, physicians--who currently don't take Medicaid patients. You expand Medicare, which is the latest proposal the Democrats have put forward, and as a consequence of that you get fewer and fewer hospitals, fewer and fewer physicians who are accepting Medicare patients, because Medicare and Medicaid are both underreimbursed, therefore creating a cost shift where the cost is shifted over to private payers whose premiums continue to go up and up. So that is why we see all of these studies coming out saying premiums are going to go up, taxes are going to go up, and Medicare benefits are going to be cut, particularly for seniors who have Medicare Advantage. At the end of the day, this ends up being a $2.5 billion expansion of the government here in Washington, DC. But to the point the Senator from Texas made--and I think--I know we are running out of time. We want to vote. We want to vote on this motion. We don't think you ought to start taxing people in 21 days and not start delivering benefits for almost 1,500 days.