John Thune

Mr. THUNE

Mr. THUNE. Mr. President, earlier this week the Senate Finance Committee, by a vote of 14 to 9, reported out its version of health care reform. That makes now five committees that have acted on this issue, five committees of jurisdiction--three in the House of Representatives and two in the Senate--all of which have now at least put out their products. But I say that loosely because what emerged from the Senate Finance Committee was not, in fact, legislative language; it was a concept paper. It is yet to be reduced to legislative language. That will take some time, I suspect, because many of the concepts that were included in the concept paper are pretty complex. So what is happening now on the issue of health care reform, at least in the Senate, is in the leader's office. The chairman of the Health, Education, Labor, and Pensions Committee is meeting with the chairman of the Finance Committee, and I suspect a number of the members of the White House to hammer out what will eventually be the bill I suspect will come to the floor of the Senate. I say that only because the process has been very much flawed from the beginning. It is not one that is inclusive in terms of allowing ideas from our side of the aisle to be incorporated. It has not been a bipartisan process, to say the least. My guess is that at the end of the day, what comes out of the leader's office will be a very different bill than anything we have seen so far. But I think there are certain characteristics in that bill that have been in all of the bills. I think we know a few basic things about all of the bills so far that are consistent, those things that have not changed. The first one is it will lead to higher premiums. The second one is it will lead to higher taxes. The third one is it will include cuts in Medicare. So those three basic characteristics are the same with regard to all of the bills, the three that have emerged from the committees in the House of Representatives and now the two that have emerged from Senate committees and are currently being married up in the leader's office. I predict when that bill comes to the floor of the Senate, the American people will have the same thing to look forward to that they have now with all of these various bills: higher premiums, higher taxes, and cuts in Medicare. Why is that significant? It is significant for this reason: Health care reform, at least as stated in terms of its purpose, is to lower costs. For the past decade and beyond we have been talking about health care costs in this country and how we have to do something to rein in the escalating costs people deal with every single year for health care and double-digit increases in health care costs for many of those years. So the whole purpose of health care reform, at least my understanding of it, and I think as stated by the President and others, is that we need to rein in and get control of health care costs in this country. That is why it is ironic that of the five bills so far that have emerged from House and Senate committees, none bend the cost curve down. All increase premiums for people in this country, increase the costs for health care coverage. In the Senate Finance Committee bill--the most recent version, which, as I said earlier, was reported out this week by a 14-to-9 vote--there wasn't a direct assessment or estimate of what that increase in premiums would be. There were simply generalized comments by the Congressional Budget Office that, yes, these increased taxes in the bill would be passed on generally dollar for dollar. In other words, the taxes that are imposed--a 40-percent excise tax on some of these insurance companies--would be passed on in the form of higher costs or premiums to health care consumers in this country without being more specific or quantifying in any more precise way what those increased costs would be. Nevertheless, they said basically the same thing we have seen in all of these various bills, and that is that health care costs--coverage, premiums--are going to go up. We are going to have higher premiums. In the last week or so we have now seen two studies where independent analysts have looked at this and concluded the same thing. In fact, the PricewaterhouseCoopers study from a few days ago went so far as to say if you are an individual buying in the individual marketplace, you are going to see your health care premiums go up about $2,600 if this bill becomes law. That would be in the year 2019 at the end of a 10-year window, which is what the people who analyze these things look at. So it is about a $2,600-per-person increase in premium if you are buying on the individual market. If you are a small employer who is employing 50 or fewer employees or an individual who is employed at one of those small businesses, you would see premiums increase $2,100 if you are an individual. If you are a family, you would see premiums increase $5,400 under the bill that was produced and emerged from the Senate Finance Committee. So whether you are an individual buying on the individual marketplace or whether you are getting your insurance through your employer, you will see higher premiums, higher health care costs according to this analysis. If you are a family, it is the same thing. It is just a varying difference in the amounts, but it is anywhere from $2,100 up to $5,400 of increased premium costs, according to the PricewaterhouseCoopers study. This week there was a study released by Oliver Wyman which came to the conclusion that if you buy your insurance on the individual marketplace, you will see a $1,500 increase for single coverage and $3,300 for family coverage annually. That is exclusive of inflation. That doesn't include the normal inflationary costs that we deal with year in and year out for health care in this country. This study concluded the same thing the PricewaterhouseCoopers study did; that is, whether you buy on the individual marketplace, whether you get it through your employer, if you are an individual or you are a family, you will see higher premium costs. As I said, in this particular study, it is $1,500 for single coverage, $3,300 for family coverage annually. They also broke it down State by State, which is important because I think everybody wants to know how this is going to impact our constituents, including my constituents in South Dakota. In this particular case, if you are someone buying on the individual market and you are an individual buying a single policy, you will see your health care premiums go up 47 percent. If you are someone who has a family buying on the individual marketplace, buying a family policy, you are going to see your premiums go up 50 percent. If you are in the small group market, if you have the good fortune of being in a larger group, you will see, if you are an individual, your premiums go up 14 percent. If you are a family in a small group market, you will see your premiums go up 15 percent, exclusive of inflation. So those are two recent studies where independent analysts have looked at the bill produced by the Senate Finance Committee and concluded there would be significant increases in premiums and in what people would pay for health care in this country. So it begs the question: How is this reforming health care? The stated purpose of health care reform is to lower costs, to drive down costs for individuals and families. As you can see from these studies, that certainly isn't the case. Of course, the Congressional Budget Office, as I said earlier, indicated in response to questioning about the Senate Finance Committee that although they hadn't drilled down and figured out exactly what those premium increases would be, that inevitably you would have higher premium costs simply because the taxes imposed under the legislation would be passed on to health care consumers, and everybody who is buying health care out there would see their premiums increase, generally speaking, dollar for dollar. That was the conclusion of the Congressional Budget Office. So higher premiums, that is the first thing we know about all of the health care reform plans so far that have been put forward. The second thing we know as well, with certainty, is that they all include higher taxes. The House versions of this legislation used payroll taxes. They have an employer mandate--what we refer to as a pay-or-play mandate. There are additional, I guess you would say, ``add-on'' taxes for people who are in higher income categories, so they finance it with different forms of taxes. The tax increases proposed by the Senate Finance Committee--as I said earlier, there is an individual mandate, so if you don't have insurance, you will pay penalties. That will be a certain tax or fee on individuals in this country which will hit a lot of lower income individuals. But the insurance companies which would be hit with these tax increases, of course, would then pass those on to health care consumers. So, again, we see increases in taxes. What the Congressional Budget Office did with respect to the issue of taxes is, it did go so far as to say where that tax burden would lie. Under the Congressional Budget Office estimate, 89 percent of the higher taxes in this bill produced by the Senate Finance Committee would fall on those wage earners, those taxpayers in this country earning less than $200,000 a year. They went so far as to say that, I think it was 71 percent of those--and that was in the year 2019--71 percent of that tax burden would fall on those earning under $200,000 a year when the bill initially kicks in. So we are going to see significantly higher taxes on people making under $200,000 a year, according to the Congressional Budget Office. The Joint Committee on Taxation has also analyzed this issue, and they came to some conclusions earlier this week as well, one of which was that, similarly, we would see almost 90 percent of the tax burden under this bill falling on those households with incomes under $200,000 a year. They went so far as to say that more than half of the tax burden would fall on those households with incomes under $100,000 a year. So almost 90 percent of the tax burden falls on wage earners, taxpayers with incomes under $200,000 a year, and over half of the tax burden falls on those wage earners, those taxpayers with incomes under $100,000 a year. That is according to the Joint Committee on Taxation. So what does that mean? Well, that means the President's promise that health care reform would not impose taxes on those earning less than $250,000 is just a bunch of hot air. It just doesn't add up. We have the Joint Committee on Taxation and the Congressional Budget Office all saying that the disproportionate share of these taxes--the tax burden-- about 90 percent is going to fall on $250,000 and under and over half, over 50 percent of the tax burden, falling on income earners, wage earners, taxpayers in this country with under $100,000 in income. So the whole idea that somehow working families are going to be spared from the higher taxes under this bill just doesn't hold water. So what we are going to see in this bill is not only higher premiums that are going to affect people across this country who are expecting, because they have heard that health care reform is supposed to lower their health care costs--they are going to see higher premiums. Premiums are going to go up. They are also going to see their taxes go up, and go up significantly because if you look at the Joint Committee on Taxation--and this is a letter that was written in response to questions that were raised by members of the Senate Finance Committee, and it says: Subsidy phase-outs raise marginal tax rates because for every additional dollar you earn, you are eligible for a smaller subsidy, imposing potentially high effective tax rates on that additional dollar and reducing your incentive to earn that additional dollar. According to the Joint Committee on Taxation, families earning 150 percent of the Federal poverty line--and that is $32,200 of income in this country; that is, 150 percent of the Federal poverty line--will face an effective marginal tax rate of 59 percent, meaning that for every additional dollar these taxpayers earn, they are losing 59 cents of it in foregone subsidies in taxes: Effective marginal tax rate, 59 percent on a wage earner who is making--that is 150 percent of the Federal poverty level or $32,200. So there are lots of higher taxes in this legislation and lots of higher premiums. Of course, the final point I will mention, and the other point we know is consistent in all the bills, is significant cuts in Medicare. Under the Senate Finance Committee, there is almost a half trillion dollars' worth of cuts in Medicare in the form of Medicare Advantage, which is about $133 billion that will be cut out of seniors who are receiving benefits under Medicare Advantage: hospitals, home health agencies, hospices, pharmaceuticals--everybody gets a haircut under this proposal, all of which I would argue is unlikely to happen. Here is why. Anytime Congress has enacted changes in Medicare that were designed to achieve savings, they inevitably go back and reverse course. We have lots of history to support that assumption. But, nevertheless, let's assume for a minute these taxes did occur. A $500 billion, or $\1/2\ trillion, cut in Medicare that impacts seniors and health care providers in this country will be one of the results of the reform legislation that is being proposed by the Democrats in the Senate. The Finance Committee's version of that is the most recent. So that is $\1/2\ trillion in Medicare cuts, $\1/2\ trillion in tax increases, and $1.8 trillion in new spending when it is fully implemented. There was sort of a smoke-and-mirrors approach used to shield the true cost of this by having the revenues kick in immediately. The tax increases kick in right away, but the actual costs under the plan don't kick up for about 4\1/2\ years. You have all these tax increases hitting people right away, and so the 10-year cost of this is understated significantly. CBO said $829 billion over the first 10 years. I think the important number to look at is what is the cost of this when fully implemented over a 10-year period. It is $1.8 trillion. That is $1.8 trillion in new spending, which is financed with higher taxes, cuts in Medicare, and, ironically, no savings to health care consumers because every analysis done says it is going to lead to higher premiums. I argue as well, in addition to higher premiums, there will be higher taxes and Medicare cuts. You are also going to see a significant reduction in the quality of service in this country, as you have more and more government expansion in Washington, DC, more and more government involvement in the decisions that are made. The government will now put mandates on what types of policies meet their threshold, their standard. I think, inevitably, in every model around the world where you have that level of government intervention, it leads to a rationing of care, denials of care, and delays with respect to care. I argue that the whole idea of this being characterized or labeled as reform is completely mislabeled. There is nothing that is reform about this. It raises premiums, raises taxes, and cuts Medicare. I think you are going to see, in addition to that, diminishment in the services that are available to people in this country through many of these programs. What is the alternative? We believe that rather than throwing the entire health care system overboard in this country, we ought to be looking at what we can do on a step-by-step basis to improve it. Republicans have offered a number of alternatives. We can allow buying insurance across State lines. We believe interstate competition in buying insurance would put downward pressure on prices in this country. That is a good solution. We can have small business health plans, allowing small businesses to join groups. Group purchasing power will bring downward pressure on insurance prices. By the way, that is something a number of us voted for many times here in the Congress. It has always been defeated. Also, we can deal with the issue of medical malpractice reform, which, according to CBO, has significant savings-- $54 billion. That applies to the government side of health care. If you extend that to private health care--I think there are estimates that defensive medicine in this country costs $100 billion to $200 billion annually. So if you could address that issue that deals with litigation costs and defensive medicine, you would see savings grow over the estimates of the CBO. Having said that, those are several things, just off the top right there, that we think are step-by-step improvements in our health care system in this country. That doesn't throw overboard everything that is good about American health care. It doesn't move us toward a government plan or a single-payer system like they have in Europe, Canada, or someplace like that. It preserves the competition we have in the marketplace today and a market-based delivery system for health care in this country. We will continue to talk about those ideas, as well as many others, including providing tax credits that will give access to health care for those who don't have it. There is a way to do that that is very simple. By the way, the Baucus bill, the Finance Committee bill, still leaves 29 million people in this country without health insurance. In spite of $1.8 trillion in spending, new taxes, higher premiums, and everything that goes with that, you are still not getting many of the people who don't have health insurance covered. We think the bill that will be brought before the Senate--we don't know what it is at this point because it is being written behind closed doors--is the wrong approach, and the correct approach is a step-by- step process that addresses the shortcomings, the flaws, and attempts to fix those in a way that doesn't bust the bank or the budget, that doesn't raise taxes on consumers and raise premiums for health care consumers, and that doesn't cut Medicare for seniors across this country and for many of the providers that are out there. Mr. President, I hope that as the American people listen to this debate, they will engage on this issue; that the bill--whatever comes out of the discussions going on in the leader's office, I hope there is an ample amount of time for the American people to analyze it and for Members of the Senate to digest it. This is literally one-sixth of the American economy. We are talking about reorganizing one-sixth of our entire economy. We should do it with great deliberation and great diligence and with a great amount of care and, I argue, not by throwing the current system overboard and wrecking it but by taking a step-by- step approach that improves the system we have today and provides access to those who don't have health insurance and does something to bend the cost curve down and drive health care costs down rather than raising them, like all the bills that have been produced by the Democratic majority in the Congress. I yield the floor.

Mr. THUNE

Mr. THUNE. I think it is incredible because it is now validated by the Congressional Budget Office that if you were to incorporate that, you would drive down the cost of health care in this country by literally billions and billions of dollars. Yet there is no mention or reference to medical malpractice reform in this bill.

Mr. THUNE. I am happy to yield to my colleague from Arizona.

Mr. THUNE. Madam President, I wish to highlight a few sentences from that article regarding the bill that was reported out of the Finance Committee earlier this week. In that article he says this: The bill would impose nearly $400 billion in new taxes and fees. Nearly 90 percent of that burden will be shouldered by those making $200,000 or less. It might not appear that way at first because the dollars are collected via a 40-percent tax on sales by insurers of ``Cadillac'' policies, fees on health insurers, drug companies, and device manufacturers. But the economics are clear. These costs will be passed on to consumers by either directly raising insurance premiums or by fueling higher health care costs that inevitably lead to higher premiums.

Mr. THUNE. Madam President, my understanding is that the Congressional Budget Office does not only contemplate the cost of litigation, it does not take into consideration the cost of the practice of defensive medicine, which, as the Senator from Arizona noted, is an enormous additional cost, and many independent estimates suggest $100 billion to $200 billion annually. The CBO study only took into consideration government health care, so it didn't include the private health care delivery in this country. But many physicians, as the Senator noted, practice defensive medicine because they are worried about being sued. All these duplicative tests and additional practices that are undertaken by doctors in this country to avoid the lawsuit potential or the risk they incur when they practice medicine adds significantly--as I said, as independent estimates suggest, to the tune of $100 billion to $200 billion annually.

Mr. THUNE. Absolutely. I think that in a moment of honesty Howard Dean recently said that the reason medical malpractice reform is not included in this legislation is because they didn't want to take on the trial lawyers. It seems to me that you cannot have a meaningful discussion about lowering health care costs in this country absent the inclusion of this issue--an important issue--of the practice of defensive medicine, which is tied directly to medical malpractice lawsuits in this country, and the desperate need we have for reform in that area.

Mr. THUNE. Madam President, I wish to pick up where my colleague from Tennessee left off and talk a little bit about this issue that is before us and before the country right now, the issue of health care reform. I would submit to my colleagues in the Senate that the purpose of reform, as has been stated now for many years as reform has been talked about, is that we have to do something to get health care costs under control. We have to rein in these increasing, double-digit, every year inflationary increases people are seeing in their health care costs. So the purpose of health care reform, as stated, is to lower the costs of health care for people in this country, as well as to extend coverage, provide access to coverage for those who don't normally have it, which, as has been noted in the past, is about 15 percent of the population. About 85 percent of the people in this country do have health care, and their concern is: What are we going to do to drive down the costs of health care? What are we going to do to make my health insurance cost less and my health care coverage cost less? In that vain, I wish to point out an article from yesterday in the Wall Street Journal, which I would recommend to my colleagues and which was written by former CBO Director Douglas Holtz-Eakin. Madam President, I ask unanimous consent to have that article printed in the Record.

Mr. THUNE. Well, that is clearly the case. If you look at the 10-year cost of this, because the revenues--the tax increases--are front- loaded, and we get to see basically 10 years of tax increases and only about 5\1/2\ years of actual implementation of the program, what you have to do to get a full picture of what the cost of this program will be is take the fully implemented cost. When you take the fully implemented cost, I would say to my colleague from Arizona, you are looking not at the $829 billion that was reported by the CBO; because of this distortion and this creation of a revenue source before the actual costs kick in, you are looking at a $1.8 trillion new entitlement program fully implemented over a 10-year period.

Mr. THUNE. I believe the answer to that question, I might state through the Chair, is 2013, 2014.

Mr. THUNE. The taxes, I would say to my colleague, again through the Chair, kick in immediately. You get the revenues starting to come in right away. So the revenues are front-loaded, the costs of the program are back-loaded, so it understates and distorts what this new proposal will cost.

Mr. THUNE

Mr. THUNE. Mr. President, this week the latest version of the health care reform plan was scored by the CBO. The expectation is that sometime in the next few days, the Finance Committee will report out a bill which at some point will be merged with the bill that was produced by the HELP Committee. I rise to make some observations about the process generally, because we are talking about literally one-sixth of the American economy. This is not something that is inconsequential, and certainly it is something that is personal to most Americans. Health care is something they value deeply. Any type of reform ought to focus on patient-centered health care--not insurance centered, not politician centered, not Washington, DC centered, but patient-centered health care. As we get into this debate, we ought to have an opportunity not only for Members of the Senate to carefully examine what is in this legislation but also for the American people. The American people deserve and have a right to know what is going to be in any final bill. My first point is that we have tried. An amendment was offered in the Finance Committee by the Senator from Kentucky, Mr. Bunning, that would require for any bill that ultimately, once it is reduced to legislative language and has an estimate from the CBO about what it might cost, there be 72 hours for people to evaluate it, Senators as well as the general public. That amendment was defeated in the committee deliberations. Seventy-two hours is the bare minimum that ought to be required and necessary for people here in the Senate to look at what will be inevitably north of 1,000 pages of legislative language. The reason I say ``will be'' is because we don't know yet. We haven't seen legislative language to date. All we have is a concept paper. The Finance Committee will be voting out a concept paper. That concept paper has been scored by the Congressional Budget Office but it is just that. It is a concept paper. We have yet to see anything that resembles legislative language that ultimately is what we in the Senate will be asked to vote on. The simple expectation is that there ought to be an adequate amount of time, whatever that amount is, but at a minimum 72 hours was all that was requested by the Senator from Kentucky in his amendment before the Finance Committee. That was defeated by the Democratic majority. He subsequently offered that today, a resolution as an amendment to the currently pending legislation, the CJS appropriations bill. It was objected to. There was a point of order raised against it. It is pretty clear that our colleagues on the majority side do not want to consider having any sort of a requirement imposed that would allow people an adequate amount of time to review this incredibly consequential and impactful piece of legislation coming before the Senate. I make that observation to start with because it is relevant. This process needs to be open and transparent. The American people have a right to know exactly what is in this legislation. Even Senators and Senators on the Finance Committee right now don't know because they haven't seen bill language. What they are going to be voting on is a concept paper. And what the estimate that has been provided by the CBO is in response to is a concept paper, not legislative language. I argue to my colleagues that we need to have at least a certain amount of time. I would argue more than that--it ought to be 2 weeks, when we are talking about something this voluminous and this consequential for Americans or the American economy. I regret that our colleagues on the Democratic side of the aisle are objecting to what is even a minimum amount of time to review this legislation, and that would be a 72-hour time limit. I don't believe for a minute that the Finance Committee bill, even if and when it is reduced to legislative language, is the thing we will be voting on. There has been a lot of reaction to it and a lot written in the last couple of days about how this would be scored by the CBO. And there is a story out today that it actually would reduce the deficit, which I will get into in a moment. But before addressing that, this bill, when it does become a bill, will have to be married with another bill passed earlier by the HELP Committee. Those two will be merged. Where will they be merged? They will not be merged on the floor of the Senate. They will be merged behind closed doors in the majority leader's office by a handful of people who will be determining what is in the legislation. Then at some point they will have to come out and we will get an opportunity to look at it. I don't think the work the Finance Committee is putting in right now is anywhere close to what the end result will be. I argue that we will see a very different product produced by the majority leader when they go behind closed doors and a handful of people write the health care bill that will come before the Senate. Those are a couple of observations I wished to make with respect to the process and how flawed I believe it is with regard to the issue of being open and transparent and making sure there is accountability to the people. The second observation I wish to make has to do as well with the fact that most Americans believe there is a right way and a wrong way to do this. The right way ought to be making sure we are prioritizing our spending and being careful with taxpayer dollars. The wrong way is for Washington to go about this in the traditional way; which is, to raise taxes still higher, put the country further into debt, and more money into programs we do not believe--at least a lot of us do not believe--will work in the long run. Again, I will point out in a minute why we think this is the case, why these programs will not work in the long run. The right way to do this is for us to protect and expand that doctor- patient relationship and to do it in a way that is fiscally responsible and to do it in a way that gets at the real crux of the issue; that is, how do we reduce the cost of health care in this country. As to the current bill, which I mentioned earlier, there have been some news stories in the last day or so about how this bill reduces the deficit, with $829 billion in spending and about $81 billion in surplus to reduce the deficit. What I think is important for people to focus on is, because there is a delayed implementation of these provisions in this bill that do not start kicking in until 2014 or thereabouts, the numbers that are being used by the other side and being reported upon by the media reflect a 10-year period starting now and going forward. But when the bill is fully implemented, when all the provisions are finally in place and we get the 10-year window from that point forward--or from that point through the 10-year window--that is when we get a real assessment of what the costs are. If we do that, the cost of this legislation is not the $829 billion that has been put out publicly and has been sort of picked up by the media in the last day or two, but it is nearly double that amount. It is $1.8 trillion. So it is a massive amount of new spending, a massive expansion of the Federal Government at the Federal level, and a massive amount of spending that somehow is going to have to be paid for either in the form of additional revenues, cuts in Medicare--which is what is being proposed--which I do not think, frankly, is ever going to happen. We tried back in 2005 when we were reforming Medicare to shave $10 billion out of that. We could not get the votes for it in the Senate. We had to bring the Vice President back from Pakistan to cast the deciding vote. So the notion that somehow we are going to be voting to cut $500 billion from Medicare is a pipe dream. You would have to be smoking something to believe that is actually going to happen. That is one of the ways that $1.8 trillion of new spending is paid for. The other way it is paid for is with higher taxes. The problem with that is the taxes do not just fall on the ``rich'' or ``wealthy.'' They do not just fall on the insurance companies, which is where some of the taxes and fees in the Finance Committee bill are directed. They fall on the American people. In fact, I think it is important to point out the Congressional Budget Office, when asked about this, said 90 percent of the tax burden in 2019--90 percent of the tax burden in the health care bill--would fall on wage earners making less than $200,000 a year. That directly violates and contradicts the commitment and the promise the President made that he would not impose taxes on people making less than $250,000 a year. So we have these massive tax increases which, according to CBO, are going to fall disproportionately on people making less than $200,000 a year, and we have these cuts in Medicare which, in my view, are not going to happen or, if they do, could be very devastating to seniors, as well as to a lot of the health care providers across this country. But here is what is most amazing about all that: almost $2 trillion in new spending over a 10-year period--$500 billion, $600 billion of tax increases; $500 billion in Medicare cuts to pay for this--and who is to say if the Medicare cuts do not happen a lot of this will not end up being borrowed, which piles up huge debt on future generations of Americans. But after all that, and after all the bills, including the Finance Committee bill, it assumes a tremendous level of government intervention and involvement in the health care economy of this country. The government is going to be in the middle of making decisions that traditionally have been made by doctors and patients. But after all that, we would assume, at the end of the day, the underlying purpose and goal of this--which is to reduce health care costs--would have been achieved. The truth is, it does not reduce costs. The bottom line is, after everything else is said and done, and we look at all the spending and all the taxing and all the new government expansion and all the new government interference and involvement and intervention in the health care economy and the fundamental doctor-patient relationship, we have not done anything to lower costs for the Americans who are struggling with the high cost of health care. In fact, the Congressional Budget Office, during the Finance Committee markup last week, when asked whether the insurance company taxes would be passed on--and how would that impact the people who are actually having to pay the insurance premiums out there--they said those new taxes will be passed on dollar for dollar. We have seen all kinds of varying estimates about the amount of the increase, but there has not been a bill yet, of the five that have been produced by any of the committees in the Congress, that bends the cost curve down. They all raise and increase costs. I think that is the Achilles heel, ultimately--that the American people, who are struggling with the high cost of health care, are looking for solutions and for reforms that will actually put downward pressure on prices, and all that is being talked about is spending a couple trillion dollars of their tax dollars, raising taxes and cutting Medicare in order to raise their overall cost of insurance. Only in Washington, DC, could something that stunning actually make it in the light of day. So at the end of the day, it ought to be about reducing costs for Americans. It ought to be about trying to provide access for those who do not have access to health insurance. By the way, the most recent version of the Baucus bill--the Finance Committee bill--still leaves 25 million Americans uncovered. So we are not covering a lot of people we are proposing to cover. We are increasing costs of health care for people who currently have insurance, and we are creating a couple trillion dollars of new spending when this bill is fully implemented over 10 years that, again, is going to, in some way, have to be financed with taxes, Medicare cuts, or, worse yet, perhaps borrowing, which will come on the backs of future generations. The amount of debt we are going to have at the end of 2019, according to CBO, is enough so that every household in this country will owe $188,000. Imagine if you are a young couple today just exchanging your vows, you are starting your family, you are getting ready to move on with your life, and you get handed a big fat wedding gift from the Federal Government to the tune of a $188,000 IOU. That is not fair to future generations. We ought to learn to live within our means. We talk about reforming health care. We ought to put reforms in place that actually reduce the cost of health care for working-class families in this country, that do not raise their taxes, that do not borrow from their children and grandchildren. Those are the types of things we would like to see as part of this debate. We have already put forward a number of proposals that would do just that: allowing people to buy insurance across State lines--interstate competition would put downward pressure on prices and insurance rates across this country--allowing people to join larger groups, small business health plans--something we voted on repeatedly in the Congress which has been consistently defeated in votes--dealing with the issue of defensive medicine, which it is estimated costs the health care economy about $100 billion annually; doing something about medical malpractice and all those physicians who order those additional tests simply because they are worried about being sued. We have had proposals put forward that would change the tax treatment of employer-provided health care plans so that those who do not have insurance would have a tax credit that would be available to them so they could go out and buy health insurance in the private marketplace. We are laying out a lot of solutions we believe actually get at the fundamental issue before the American people, and that is the high cost of health care and also trying to provide coverage for those who do not have it. None of these proposals, in my view--and I think the Congressional Budget Office, in their analysis, bears it out. These are all proposals that bend the cost curve up, that increase and raise insurance costs for this country. The only reason they could go out like they did yesterday and say, well, this actually reduces the deficit, is because of the massive tax increases and the massive cuts in Medicare that it assumes will take place. Again, I want to mention one more time, in closing, notwithstanding the numbers that were released yesterday by the Congressional Budget Office--and the way they were reported by the media--the number people need to focus on is the cost of this program when it is fully implemented. Because it is delayed, because many of the provisions in the bill, in its entirety, for the most part, are going to be delayed--the implementation--until 2014, we have to get the full picture of the cost, what it is going to cost in the 10 years once it is fully implemented because a lot of the revenues are front loaded, the costs are back-end loaded. That is why this sort of wires and mirrors--the approach that is being used--understates the overall cost. They can go forward and say, well, we are reducing the deficit over 10 years because of all the tax increases, which kick in right away, but some of the costs in the program do not come into play until later on. So the American people need to be engaged in this debate. They need to have their voices heard. Frankly, they have a right to know exactly what is in this legislation. That is why it should not be rushed. It should be done in a way that allows people to actually review this bill. It ought to be done in the light of day. Secondly, it ought to be done in a way that actually is fiscally responsible to future generations so we do not pile this huge burden of debt on them. But even more importantly than that, it ought to accomplish the stated objective, which is to reduce the overall health care costs for Americans. These proposals do not do that. There are ideas out there and solutions out there that do, some of which I just talked about. If we would be willing to sit down and come to a consensus about those things that actually do drive health care costs down, we could pass health care reform through the Senate this year, through the House of Representatives, put it on the President's desk, and do something that actually meaningfully reduces costs for Americans and what they pay for health care. Mr. President, I yield the floor.

Mr. THUNE. I ask unanimous consent that the order for the quorum call be rescinded.

Mr. THUNE

Mr. THUNE. I ask unanimous consent to proceed until such time as the other side comes and claims their time.

Mr. THUNE. Mr. President, a number of my colleagues have been down on the Senate floor today talking about probably the biggest issue the Congress will deal with this year, and arguably for many years, either in the past or in the future, and that is the issue of health care reform. We know that issue is now staring us squarely in the face. The various committees that have jurisdiction over that issue in the Congress have acted: three in the House, now two in the Senate. It is expected the Senate Finance Committee will produce a bill sometime later this week. It is a critical debate for the Senate, for the American people, because it does represent literally one-sixth of the American economy. One-sixth of our entire GDP today consists of spending on health care-- government heath care, privately delivered health care, but health care nonetheless. The question before the Senate in the next week or two when this eventually reaches the floor is, what are we going to do to try to address the fundamental problem I think most people perceive with our health care system today, which is it costs too much? Arguably there are lots of Americans who do not have access to health insurance. All of us want to see that issue addressed and that those Americans who currently do not have health insurance have a way of being able to access that health care coverage. Many today use emergency services. It is not that people are going without health care, but they do not have coverage. We need the people in this country to have the assurance and the confidence they are going to have some sort of insurance that will protect them against those types of life-threatening illnesses, just the day-to-day illnesses that afflict people across this country. Yet I think the big issue for most Americans is the issue of cost. As I said before, when you look at double-digit increases for small businesses, for families, that really does affect all Americans in one form or another. It is a very personal issue. Health care is personal to people for obvious reasons, but it is an issue that affects their pocketbooks in a real, tangible way, and that is why I think there is so much attention and concern focused on the direction in which Congress intends to proceed. One of the issues that bears heavily upon that debate is the whole fiscal situation in which we find ourselves. If we were having this debate at another time, perhaps the circumstances being somewhat different, you might come to different conclusions. But one thing we all have to keep in mind as we look at how do we address this issue of health care in this country is doing it in a way that is fiscally responsible. The reason for that is we see deficits, huge deficits as far as the eye can see. For the fiscal year we just concluded on September 30, $1.6 trillion annual deficit; next year it is expected to be $1.5 trillion--trillions and trillions of new spending each and every year. This last fiscal year I mentioned, the deficit being $1.6 trillion, that literally represents 43 cents out of every dollar the Federal Government spent. Forty-three cents out of every single dollar the Federal Government spent this last year was borrowed. It is all debt.

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

Mr. THUNE. The point I want to make simply is this: To put that into perspective for an average American family, if you are an average American family and your annual income is $62,000--from all your hard work and labor over the course of the year you generate $62,000 for your household--that would be the equivalent of spending $108,000. What the Federal Government is doing by borrowing 43 cents out of every dollar it spends is the equivalent to a family, a household in this country making $62,000, of spending $108,000. What family in America can do that? What small business in America can do that, can continue to borrow like that? They cannot. It is fundamental; you cannot do that. The Federal Government does it. We continue to borrow from the Chinese, and we say we will pay the bills at a later date. But one thing most Americans understand is, No. 1, you can't spend money you don't have; and, No. 2, when you borrow money, it does have to be paid back. What we are looking at right now is deficits and debt mounting to the point that 10 years from today the amount that every household will owe in this country is $188,000. How would you like to be a young couple just getting married, you just exchanged your marriage vows, and knowing when you start out your life as a family you are going to get a wedding gift from the Federal Government to the tune of a $188,000 IOU? That is in effect what we are doing to the next generation of Americans. That is the backdrop against which this whole health care debate gets underway. We have deficits and debt that is piling up to the tune of $188,000 per household at the end of the year 2019. So we ought to be looking at how we, No. 1, solve the health care crisis in a fiscally responsible way that does not spend trillions of more dollars and raise taxes and borrow more and more money. Those are all issues I think need to be very carefully considered by all Members of the Senate as we make these important votes. The other point I will make is this: There are, in the proposals that have been put forward--in all of them--tax increases to pay for this. The most recent version, the Finance Committee bill, is a $1.7 trillion cost over a 10-year period. That is the least expensive, I might add, of all the bills that have been produced so far. There are five bills that have been produced by the Congress. The Finance Committee bill, to their credit, is at least the least costly of those, $1.7 trillion over 10 years. That is still $1.7 trillion in new spending. Bear in mind that we already have a Medicare system which is destined for bankruptcy in the year 2017. We have all kinds of other long-term liabilities and Social Security and Medicaid and entitlement programs that pile up. We are going to have to do something about those at some point. Yet here we are talking about adding an almost $2 trillion new entitlement on top of that crumbling foundation. I think most Americans would take issue with elected leaders who would do that, would take a program that literally is on the verge of bankruptcy and try to add another $2 trillion program on top of it. There is the overall cost of it to the taxpayers, but it is also how it is paid for. Obviously, it has to be paid for somehow or we deal with this issue of borrowing, which I mentioned earlier, so what is being proposed is a series of tax increases and a series of reductions--cuts in Medicare programs. The Medicare cuts are going to be bad enough. Medicare Advantage takes a big whack, which is going to affect a lot of seniors around the country. The providers take a whack; hospitals, home health agencies, hospices, all those things will take a big whack. But you also have about $400 billion of tax increases embedded into the latest version of the proposal--much higher than that in some of the other bills moving through the House--but nevertheless the American public is going to be handed the bill for this which will inevitably lead to higher taxes. So much so that the Joint Committee on Taxation, the Congressional Budget Office have estimated that 71 percent of the penalty will hit people earning less than $250,000 a year. That conflicts and contradicts directly the commitment the President made of not raising taxes on people making less than $250,000 a year. They have also gone so far as to say the taxes that would be imposed, and there are a series of taxes as I said--insurance companies will be hit with taxes--the Congressional Budget Office said those taxes will be passed on, dollar for dollar, to people across this country. So the insurance companies, yes, they may remit the taxes, but they are going to pass on the cost. So you are going to see not only higher taxes on the insurance companies that get passed on in the form of higher premiums to individuals in this country--in other words, you are going to have higher insurance costs--but you also have taxes put in here that hit people who do not have health insurance. Those taxes get up to be about $1,500 per year for people who do not have insurance. So people would be penalized, and that would apply, again, across all spectrums of earners, wage earners in this country. But the CBO, as I said earlier, estimated 71 percent of that penalty is going to fall on people who earn less than $250,000 a year. If you project on further--this, again, is the Congressional Budget Office and the Joint Committee on Taxation--they have said by the year 2019 89 percent of the taxes will be paid by taxpayers earning less than $200,000 a year. So that huge tax burden, that $400 billion initially that will grow when the bill is fully implemented, will fall disproportionately on people making less than $250,000 a year; 89 percent of those taxes paid by taxpayers earning less than $250,000 a year. So the enormous amounts of taxation that are contemplated in this bill--in addition to the Medicare cuts that are proposed to pay for and finance these changes in health care--are being passed off as health care reform. My view on this is, No. 1, we, the American people, need to know these facts. I think what that would suggest is there ought to be an ample amount of time when we finally do have a bill. I know the Finance Committee is marking up their version of it. They expect to report it out later this week. But what we are going to see reported out is concepts, generalities. We do not have a bill with legislative language to react to yet. That is going to be put together with the bill produced by the Health, Education, Labor and Pensions Committee earlier. Those will be merged. At some point, that will be reduced to legislative language. When it is, we expect it will be in excess of 1,000 pages. We now are talking conservatively about having a bill on the Senate floor, not next week but the week after, which will be fully longer than 1,000 pages, none of which any Member of the Senate has yet seen. The American people, the people who are going to be most impacted, will not have had an opportunity to be engaged in this debate or have their voices heard. So we need to make sure, at a minimum, we slow this process down so we take it step by step so we are not rushing to do something very quickly and hurriedly that would be a big mistake for the American people. I suggest at a minimum we ought to have a very transparent, open process. When we have a bill, if it is in excess of 1,000 pages, that we have plenty of time not only for Members of the Senate to review it and read it and understand it but also for the American people to have that same opportunity. There were amendments offered in the Senate Finance Committee that would allow a 72-hour period. That seems to be reasonable. That is 3 days, 3 days to look at something in excess of 1,000 pages. Yet that was voted down. My Republican colleagues on the committee offered that amendment, and it was voted down by the Democratic majority on the committee. But 72 hours at a minimum--I can't imagine that you could contemplate and fully grasp and understand that amount, that volume of information, and that kind of a bill in 72 hours, to start with. But at a minimum that should have been passed. That amendment was defeated at the Senate Finance Committee as were a number of other amendments that were offered by my colleagues on the Republican side. Having said that, first off I think we ought to have an ample amount of time to review this bill. Second, I argue in terms of the process itself that rather than throwing overboard, throwing away what is a very--it is flawed. We have a flawed health care system in this country. It is not perfect. OK? It has its problems. We all acknowledge that. We can fix those problems. But we should not throw everything good about it overboard. This will create all kinds of new government involvement and intervention in the decisions pertaining to health care. Now government is going to dictate what kinds of insurance plans or what should be in an insurance plan that, in order to be in compliance with this bill, you would have to be able to put forward. So people are going to have less and less choice, less and less freedom. Government is going to have more and more say, more control, more decisionmaking. I think most people across this country find that to be very threatening. I think they are genuinely, honestly concerned about having the government have more and more influence on one-sixth of the economy on an issue that is as personal to them as their health care. At a minimum, they ought to have an opportunity to review the bill. Second, we ought to take this thing and do it step by step and not throw it all overboard, not take what is good about the American health care system and throw it in the ditch simply because it has some flaws that need to be fixed. Those issues can be addressed. We need to cover those who don't have coverage. We need to try to address the issue of cost. But these bills do not do that. We have not seen a bill yet, of the five that are being worked on in Congress, that, No. 1, reduces health care costs. They all bend the cost curve up. You ask the Congressional Budget Office, and in every circumstance they will tell you: This does not reduce or drive down health care costs; it actually increases health care costs for most Americans. Secondly, we have not had a bill yet that is actually what I would not characterize as a budget buster. All of these bills are several trillion dollars, as I said earlier, on top of programs that are destined for bankruptcy in the very near future. Let's start slow. Let's take this step by step. Let's do this in a way that allows the American people to be engaged in this debate. It does affect them and their livelihoods in a very personal way. It does affect their pocketbooks. It will raise their taxes. And it will also-- again, not my words; the Congressional Budget Office's--``lead to higher health care costs, not lower health care costs,'' which, at the end of day, was that not the whole purpose of this exercise in the first place? So we are going to do everything we can on our side to open this and allow the American people to see it, to give ample time for them to be engaged and, secondly, to make sure that when health care reform is done by Congress, it is done in a way that is consistent with what I think most Americans believe should be done; that is, reducing and driving down health care costs, not increasing premiums as these bills do, not spending trillions of dollars of their tax dollars in piling on additional entitlement programs on programs that are already going out of business here in the next few years. But we should do it in a way that is fiscally responsible. I think that is the least the American people expect of us. I think we ought to deliver on that. We ought to deliver on health care reform but reform that truly accomplishes those important goals. I yield the floor. The PRESIDING OFFICER (Mr. Udall of Colorado.) The Senator from Oklahoma.

Mr. THUNE

Mr. THUNE. Let me briefly speak to the amendment because it simply addresses this subject in a slightly different way. It is clear the majority does not want to have a vote on either the Murkowski amendment or my amendment because they get at the fundamental issue which is whether we are going to have a debate in Congress about regulating CO2 emissions or whether we will allow an administrative agency, the EPA, to do that for us. I understand my amendment, which has now been objected to, will not have a vote. We know where the votes are on this. But like the Murkowski amendment, what my amendment is designed to do is to shed daylight on harmful regulations that are taking shape behind the closed doors of the EPA. My amendment is designed to give our constituents a greater say in climate change regulations. The amendment is also designed to force the EPA to consider the dramatic impact these new Clean Air Act regulations on carbon dioxide will have on electricity and gasoline prices. If these regulations move forward, I am concerned that many families, especially those who rely on coal-generated electricity, will see skyrocketing electricity bills. I am also concerned for families and truckdrivers who could see gasoline and diesel prices go up. EPA regulation of CO2 would amount to a tax on millions of working-class families. During debate on the climate change bill, proponents of cap and trade claimed that lower income families will be made whole by giving local distribution companies free allowances to meet the new carbon regulations. Aside from whether this mechanism would actually limit the impact on working families, it is clear such a safeguard is simply not possible under the Clean Air Act. Carbon regulations under the Clean Air Act would effectively be a huge new tax on electricity and gasoline prices paid by families and small businesses. Additionally, new taxes under the Clean Air Act would apply to oil and ethanol refineries. In South Dakota, we produce approximately a billion gallons annually of ethanol. If the EPA moves forward with carbon caps under the Clean Air Act, 12 ethanol plants in South Dakota will be subject to this new tax. Additionally, we have a large soybean processing facility hoping to soon produce biodiesel that would also be covered. Not only will these costs be passed on to consumers in the form of higher prices at the pump, but the new regulations will be a major setback to renewable fuel production. In the end, the energy security benefits of domestic renewable fuel production will be negatively impacted by these new regulations. My amendment 2540 asks EPA to consider the costs and the adverse impacts these regulations will have on the economy before moving forward with an endangerment finding. It is clear that neither the Murkowski amendment nor mine will be voted on. This issue is not going away. The EPA is moving forward. The House has acted on this issue. The Senate doesn't want to take the hard votes on this so they have punted it to the EPA. The EPA is now moving forward by regulation to do what Congress doesn't have the courage or the will to do, and that is to have a debate about the relative costs and, perhaps, benefits of climate change legislation. It is wrong for us to allow the bureaucracy at the EPA to move forward with these regulations that could be so harmful to our economy, so harmful to jobs, so disastrous when it comes to the energy prices paid by families and small businesses. This issue will be back. Senator Murkowski will bring it back. I will bring it back. Others of my colleagues who care about the impact of this particular regulation on small businesses and families will be back to debate the issue even though the Democratic majority will not allow us to get a vote today. I yield the floor.

Mr. THUNE. Mr. President, I wish to speak in support of an amendment that was offered earlier today, actually it was filed, I think it was attempted to be called up by Senator Murkowski. The Democratic majority objected to getting a vote on that amendment, which, I think, suggests they do not want to have a vote on that amendment. Frankly, I can see why. From what I hear about the whole debate on climate change and cap- and-trade legislation that has passed in the House, it will not be voted on in the Senate this year. The reason it will not be voted on is because there are a lot of people in this Chamber who, I think, do not want to have that vote because they know it is a bad vote for them to make. Fear not, EPA has come to the rescue of people who want to see a lot of this stuff accomplished but do not want to have to make a tough political vote on it. So what we are now faced with is the Environmental Protection Agency deciding they are going to regulate carbon emissions under the Clean Air Act and moving forward with the regulations to do that. The Murkowski amendment would essentially prevent funds from being used to do that. It weighs in favor of having Congress deal with this very complex, very weighty, very consequential, and very costly issue to the American people. This legislation, as we all know, would increase energy prices, cost us jobs, be unfair to entire regions of the country, mine included, enlarge an already bloated bureaucracy in Washington, DC, and put our Nation at a certain economic disadvantage. I have been skeptical of that controversial legislation that has passed the House, the cap-and-trade bill over there, for some time, for the reasons I have mentioned. Additionally, I think it is fair to say there would be very little environmental benefit derived from that legislation, were it enacted, without binding, enforceable commitments by China, by India, and other developing countries that are now significant sources of carbon emissions. I find it disappointing that in the middle of this important debate the administration wants to use the back door--issuing regulations to cap carbon dioxide under the Clean Air Act because they cannot get a Waxman-Markey type climate bill through the front door. Instead, the relevant committees of this body and the Senate as a whole should be able to consider whether now is the right time for a new massive energy tax disguised as an EPA regulation. During the previous administration, the EPA had published an Advanced Notice of Proposed Rulemaking that showed just how impractical it would be to regulate carbon dioxide and other greenhouse gases under the Clean Air Act. These onerous regulations covered homes, schools, churches, hospitals, small businesses and potentially even small farms with livestock. Under the Clean Air Act, the primary mechanism for regulating carbon emissions would be a fee placed on each ton of covered pollutant emitted above a certain threshold. This fee, if applied to carbon emissions, is nothing more than a tax on energy that would have severe consequences as our economy struggles to recover from a long recession. While the Bush administration regulations never made it past an initial draft, the Obama EPA is moving quickly to finalize an endangerment finding and regulate carbon dioxide emissions. In April 2009, the EPA issued a draft endangerment finding that linked emissions from motor vehicles to an endangerment of human health. The comment period has closed on this draft endangerment finding, and when the EPA issues a final ruling it will trigger an array of regulations under the Clean Air Act. These command and control regulations will have far reaching consequences for our economy at a time when we can least afford it. According to media reports, EPA will eventually propose regulations for not just mobile sources, but stationary sources that emit over 25,000 tons of carbon dioxide. The first round of regulations on stationary sources would cover approximately 13,000 facilities in the United States. These include powerplants, large manufacturing facilities, refineries, fertilizer manufacturers, and a long list of other facilities that are critical to the health of our economy. In South Dakota, these regulations would place a tax on powerplants, ethanol refineries, and even our largest public university. And we need to remember that these companies will pass these new costs on to you and me. Now is an especially bad time to saddle the American people with what is in effect a gigantic new energy tax that would cause electricity, gasoline, and home heating costs to skyrocket. Additionally, pending the outcome of the final endangerment finding, the EPA might be legally bound to regulate all sources that emit over 250 tons of carbon dioxide. If this statutory threshold of the Clean Air Act is enforced, over 1 million carbon-emitting entities would be faced with a new tax, including commercial buildings, churches, homes, schools, restaurants, and manufacturing facilities both big and small. Regulation of carbon dioxide is far too important for EPA and the administration to craft expensive, cumbersome, top-down regulations under the Clean Air Act. Republicans in the Senate know this, Democrats in the Senate know this, the EPA knows this and the White House knows this. Last year, Congressman John Dingell said that EPA greenhouse gas regulations would lead to ``a glorious mess.'' He continued by stating that ``As a matter of national policy, it seems . . . insane that we would be talking about leaving this kind of judgment, which everybody tells us has to be addressed with great immediacy, to a long and complex process of regulatory action.'' Congressman Dingell said it best when he concluded that carbon regulation under EPA had ``the potential for shutting down or slowing down virtually all industry and all economic activity and growth.'' According to an OMB memo associated with EPA's endangerment finding, ``Making the decision to regulate CO2 under the [Clean Air Act] for the first time is likely to have serious economic consequences for regulated entities throughout the U.S. economy, including small businesses and small communities.'' Representative Collin Peterson, chairman of the House Agriculture Committee, noted in a recent op-ed that EPA regulations of greenhouse gas emissions would result ``in one of the largest and most bureaucratic nightmares that the U.S. economy and Americans have ever seen.'' Senator Murkowski and I have filed an amendment to the fiscal year 2010 Interior and Environment appropriations bill that would prohibit the EPA from moving forward with regulations on carbon dioxide emitted from stationary sources for 1 year. This amendment is not intended to impact the recent announcement from EPA and the Department of Transportation regarding new tailpipe emission requirements for new cars and light trucks. Additionally, this amendment is not intended to impact the regulation of other greenhouse gasses, such as hydrofloural carbons, which are also included in the proposed endangerment finding. This amendment would simply delay the expensive, top-down regulation of carbon emissions from thousands if not 1 million stationary sources in the United States. For those Senators who wish to regulate carbon emissions through a cap-and-trade system, I encourage you to support this amendment as well . You should be supporting this amendment. This amendment is not about whether carbon dioxide emissions should be regulated or whether the Federal Government should take any action to reduce carbon emissions. Rather, this amendment is about the process of regulating carbon dioxide emissions. Should regulations as far reaching and expensive as taxing carbon dioxide be determined by EPA bureaucrats behind closed doors? Or should carbon regulations be openly debated on the floor of the U.S. Senate? The Murkowski amendment gives the Senate a clear choice. Constituents, through their elected representatives, should have a voice in that debate. If carbon dioxide regulations moved through the EPA unchanged, the American people would be deprived of their opportunity to be heard on this very important subject. Meanwhile the cost of gasoline, food, and manufactured goods will skyrocket. I urge colleagues on both sides to acknowledge the extremely dangerous consequences of allowing the administration to unilaterally regulate carbon dioxide under the Clean Air Act. I understand the Murkowski amendment will not be allowed to be voted on. I believe the regulations that amendment addresses should be delayed until Congress has the opportunity to debate the consequences. I will continue to work with Senator Murkowski and other colleagues, families, and small business, to make them aware of what the EPA intends to do by regulation. In addition to speaking on the Murkowski amendment, as I have filed an amendment which is similar, I ask unanimous consent to call up my amendment and ask that it be made pending.

Mr. THUNE

Mr. THUNE. I think that is the big question about all of these various pieces of legislation we have had in front of us. What do they do to reduce costs? Even the Congressional Budget Office has said repeatedly, in this bill in particular, the Baucus bill, the most recent version of a health care reform proposal here, there is a $1.7 trillion cost over 10 years when fully implemented. If you actually look at what it does for most people in this country, they are going to see their health care costs not go down but go up. The premiums are actually going to increase. The reason for that is many of the taxes imposed in the bill to help pay for the cost of the $1.7 trillion expansion are going to get passed on. So the people who get hurt by this are hard-working Americans who are expecting, if Congress is actually reforming health care, that would mean health care costs, the costs people pay for premiums for their health care coverage, would actually go down. The Congressional Budget Office, under questions that were raised yesterday by some of our colleagues, responded that dollar for dollar, those additional--those taxes that would be imposed to pay for this would actually be passed on and you would see higher health care costs. So there has not been anything in this entire debate yet, or any of the bills that have been put before various committees or that eventually we assume will be considered on the floor here in the Senate and in the House of Representatives, that has actually impacted costs in a way that they go down, that reduces the overall cost for the people in this country. Furthermore--and I talked about this with the Senator from Tennessee; we had this discussion on the floor yesterday--many Americans, those I heard from in my State of South Dakota during the month of August in the many conversations I had out there, are very concerned. They are really concerned about two issues: one is control, one is cost. Who is going to control their health care? Is the Federal Government going to do it, the bureaucrat in Washington, DC? In this country, are we ceding one- sixth of our economy, more and more control to the people in Washington, DC? The Baucus bill, inasmuch as it doesn't at this moment contain the government plan, still assumes a high level of government involvement, government intervention. The government would determine which health care plans it would have to approve, which would meet the standards the government set. So you have a high level of government intervention with this plan as you have had with all the other plans. But perhaps even more important--and this is the issue I think most Americans are really homing in on--is the cost. What is the cost to me as a taxpayer? In this case, $1.7 trillion over a 10-year period when fully implemented. And does it reduce my cost of health care? They are going to look at it two different ways. One is, what am I going to have to owe in the form of higher taxes to finance this; and second, how is it going to impact the cost of health care for me in terms of the premiums I pay? I think it is fair to say--it is not what we are saying, it is what the Congressional Budget Office has determined--that actually the cost of health care for a lot of Americans, under this proposal, the Baucus proposal, is going to go up.

Mr. THUNE. We know for a fact that the Medicare trustees have said the Medicare Program is destined to be bankrupt in the year 2017. So Medicare is already on an unsustainable path. It needs to be shored up. And what we are talking about doing is getting savings, if you want to call them that, or ``cuts,'' I would say out of Medicare to create a whole new entitlement program here in Washington, instead of fixing and making more sustainable a Medicare Program that, as I said, is destined for bankruptcy by the year 2017. I think most seniors and most providers around the country are going to be very concerned about the idea of having cuts in the Medicare Program, $500 billion, as the Senator from Tennessee has mentioned, go to paying for this new entitlement program which, as I said earlier, over a 10-year period is going to cost $1.7 trillion. So I think you are not only going to have, as the Senator mentioned, a lot of providers very concerned about cuts, I think you are going to have an awful lot of seniors who are concerned about how their Medicare benefits are going to be impacted by this proposal. I would add to what the Senator has already talked about, and I know the Senator from Tennessee's Governor has called some of these Medicaid expansions ``the mother of all unfunded mandates.'' I have had numerous conservations with my Governor in my State of South Dakota about this. It would cost our State about $45 million a year, new revenues they would have to raise, to meet the matching requirements under this expansion of Medicaid. In my State of South Dakota, that is real money. I know that does not sound like a lot out here in Washington. But that really is. My Govenor is very concerned, as are all Governors, about the impacts not just on Federal budgets but on State budgets. Of course, as the Senator from Tennessee and the Senator from Kansas have pointed out, Medicare--and I might add, I love the quote from the CEO of Mayo, which the Senator from Tennessee has mentioned, ``If the public plan looks like Medicare, I think the country would go broke almost overnight,'' because Medicare is already proposed to go broke by 2015 to 2017. I think that is the problem we run into when we try and build upon a foundation that is already crumbling. The Medicare Program is destined to go bankrupt. We are talking about adding a whole new entitlement. Instead of trying to figure out how to plow some of these savings back into Medicare and make it sustainable, we are actually adding to and building upon a foundation that is already crumbling.

Mr. THUNE

Mr. THUNE. Mr. President, I wish to thank the Senator from Tennessee for very effectively making the arguments that many Americans want to hear voiced in this debate about health care and a whole range of other issues. The Senator from Tennessee has pointed out as a former Governor--and we have another former Governor, the Senator from Nebraska, here today as well--the impact that many of these proposals would have on State budgets. The former Governor of Tennessee has described it as ``the mother of all unfunded mandates.'' I think that is a view that is shared by many other Governors across this country, about the impact some of these expansions would have, not just on Federal budgets but on State budgets. I have had numerous discussions with the Governor of South Dakota about this and he last suggested that the minimum amount, the conservative amount of additional funding that would be required each year to meet some of these expansions of Medicaid that are called for in these various health care reform bills would be about $45 million a year. Around here that doesn't sound like a lot of money, but in the State of South Dakota that is real money. That is a real impact and it would require higher taxes or significant cuts in their budget in my State of South Dakota. So that is one aspect of this argument. I might say that like some of my colleagues who over the month of August were out in their individual States listening to their constituents, I was doing the same thing. I conducted a series of townhall meetings in my State and I heard from people all across my State in every geographic region. Of course, as is typical in the Midwest, people were very respectful and it was a very civil discussion. But one could not miss the intensity people felt on not only the health care issue, because that happened to be the main subject of debate, but a range of other issues. I think it comes down to two fundamental issues. I think at least in my State of South Dakota this seems to be the case--as it was in some of the other meetings around the country in other States--that people were concerned about two issues. One was the issue of control and the other was the issue of cost. With the issue of control, it is a question of who has the power when it comes to the debate about health care and when it comes to the debate about higher energy costs. Is all this sort of consolidation and expansion of the Federal Government here in Washington, DC going to mean people in this country have less control when it comes to their own health care? Is the government going to be stepping in and intervening more and making a lot of these decisions and dictating out of some bureaucracy in Washington, DC what happens in the world of health care, which for most people is very personal to them? That is why I think there was such a visceral reaction across the country to some of these proposals. I think the other issue is cost. People have a sense that things are sort of spinning out of control. I think there are a couple of sort of basic principles that are fairly pervasive in the mindset of most people where I come from in the upper Midwest and that is, No. 1, you can't spend money you don't have; and No. 2, when you borrow money, you do have to pay it back. They see this incredible borrowing spree and this incredible spending spree here in Washington, DC and they are wondering, How is this all going to end? What does it mean not only for me and for my family but for future generations? Are we borrowing at levels that are not sustainable into the future? I think that has really gripped people across this country as they have looked at not only the health care debate but also the question of all of these government takeovers of financial services and insurance companies and auto manufacturers, and the list sort of goes on and on. The most recent example of that would be student loans where, again, we see the Federal Government trying to pull the reins in and move all of the guaranteed loan programs that currently operate in this country through the financial services industry and commercial banks into the Federal Government. The Federal Government would be the entity that makes all of these loans directly. Well, that ends up adding several hundred billion dollars to the Federal debt which we are already talking about raising here in the middle of next month. In the middle of October the debt limit is going to have to be raised. So we have all of that student loan exposure now, liability coming on to folks from the Federal Government. We have TARP which is said to expire at the end of this year, on December 31, unless Secretary Geithner certifies to Congress that he is going to extend it. I wrote a letter--and last week 39 of my colleagues signed it--asking the Secretary of the Treasury when TARP expires on December 31 not to extend it because, there again, there are unobligated balances in TARP funding that could be used that would reduce the overall amount of the debt, the overall amount of the deficit. And the truth be known, I don't think any American wants to see the TARP funds becoming a slush fund to fund other types of endeavors the Federal Government might undertake. They want to see this program that was temporary and was designed to prevent imminent financial collapse and provide stability to the financial services industry expire. Now that that purpose has been served, we should not continue to have hundreds of billions of dollars of taxpayer dollars out there that could be recycled or put into some other industry the government decides to select. I hope the Secretary will heed the suggestion made by myself and 39 colleagues in our letter and let the TARP program expire. I say that because this paints a broader picture, a narrative, that I believe is of great concern to the American people, which is the reason we saw so much intensity at many townhall meetings over the break. The health care debate is occurring right now in real time. We have had four of the five committees record bills that have jurisdiction over health care in the Congress--three in the House and one in the Senate. The Senate Finance Committee is marking up their bill this week. We expect that will be completed and that this could be put on the floor sometime in the next few weeks. That seems to be a very fast schedule considering the consequence of what we are doing. We are talking about one-sixth of the American economy, about reorganizing one-sixth of the American economy. Mr. President, $2.5 trillion annually is spent on health care in this country. I think we better make sure we do it right. All we have seen so far in the Finance Committee is a 220-page summary, which we assume, when translated into legislative language, is going to be more than 1,000 pages. That is something many of us will want to have time to digest, and we would like our constituents to look at it to see whether it makes sense to them. I think probably the biggest reaction I saw during the August break in the discussions I had with constituents in South Dakota was a negative reaction in opposition to the notion of a government plan, that the government would create this public plan option--essentially a government plan. A lot of people who derive health care coverage in the private marketplace today would by default be pushed into that government plan, and you would have the government involved at a much higher level in driving a lot of the health care decisions in this country. There was a real reaction to that. The point I made earlier as to what I think people were reacting to is the issue of control, power. Who has the power? Is the Federal Government trying to buy this expansion, create more power in Washington, and take away some of the power and decisionmaking that should occur between patients and their doctors? That was the one issue. The Finance Committee plan, to their credit, has done away with that--at least for the time being. They decided to proceed in a different direction. That being said, the issue remains that people were responding to during August; that is, the issue of cost. According to the Congressional Budget Office, the overall cost of this, for the immediate 10 years, is a little under $1 trillion. When fully implemented, the cost of the plan is still $1.7 trillion, which has to be paid for somehow. They said they are not going to add to the deficit. The proposal is to reduce Medicare by $500 billion. The balance will be raised in the form of tax increases, revenue raisers. People are looking at this and saying: OK, a $1.7 trillion expansion; what do we get in exchange for that? People will be covered who are not currently covered, but a lot of people who don't have insurance still won't be covered under the proposal the Finance Committee is currently considering. But it is still going to cost $1.7 trillion. If you are a taxpayer saying: OK, what is this going to cost and how may it impact my insurance premiums if I already have health insurance coverage, I think the answer was given by CBO Director Doug Elmendorf in response to a question. Senator Cornyn posed the question, and it had to do with: Will this lead to higher premiums? If you read from the letter, it says: Senator, our judgment is that that piece of the legislation would raise insurance premiums by roughly the amount of the money collected. Whatever is collected in the higher taxes that are going to be put on somebody else--that is always the assumption--is going to be put, in this case, on the insurance companies. But does anybody believe for a minute that will not be passed on to the American consumer? It is going to be. So what does this legislation actually do to drive costs down? My whole argument in this health care reform debate has been that anything we do ought to bend the cost curve down, not raise it. Almost every proposal we have seen increases or raises the cost curve. This is another example, according to the CBO, of a plan that, in the end, is going to raise insurance premiums for most Americans. The other thing I think is important to note here--and the same response was given by the chief of staff of the Joint Tax Committee. He answered the question the same way: We analyzed this largely falling on the consumer, and that would happen in a couple of different ways. This is going to be eventually little paid by the consumer. It is a tax increase. The other point is that the assumption is that the portion that is not raised through revenue increases, tax increases, will be paid for in the form of Medicare reductions. Do we really believe $500 billion in Medicare reductions will be achieved by the Congress? And we know how difficult it is around here to talk about reducing Medicare. My view is, if we are talking about making Medicare more sustainable, we ought to look at how we can reform it and find savings. But this is going to take a new entitlement program and put it on top of a program that we are told will be bankrupt by 2017. I still think we can do health care reform here that does bend the cost curve down, lowers costs for most Americans, and provides access to more Americans as well. We have not seen a proposal yet that doesn't include a significant increase in the amount of Federal Government control, of power in Washington, DC, an expansion of the Federal Government. We have not seen a proposal that actually does anything to get costs under control for most consumers. For most consumers, that is the issue; it is a cost issue. Furthermore, we are looking at proposals, from a taxpayer's standpoint, that will increase spending and borrowing and it will pass more and more of that debt on to future generations. So we need to proceed slowly and get this right. We need to focus on ideas that actually reduce costs, such as allowing people to buy insurance across State lines or to join small business health plans, which is something we have tried to get through for a long period of time, unsuccessfully, or dealing with medical malpractice reform, so people can get insurance in the private marketplace. This level of government expansion, this level of spending and borrowing is unacceptable to the American people. That is why they are reacting so negatively. It comes down to control and who has the power. Is it the Federal Government or the American people? It comes down to costs. What are we doing to future generations with the amount of spending and borrowing we are doing? I hope we will take it slower and get it right and focus on initiatives and ideas that will get costs under control and that before Congress adopts health care reform, that will be the focus, not expansion of government in Washington, DC, at trillions of dollars in additional costs to the American taxpayer and no savings to the ratepayer out there trying to get their insurance premiums under control. I yield the floor.

Mr. THUNE

Mr. THUNE. Madam President, last summer President Bush signed into law a $50 billion foreign aid--HIV/AIDS--bill. Included as part of the PEPFAR bill was a $2 billion authorization that I, and a bipartisan group of Senators, worked to include that focused on the critical public safety, health care, and water needs in Indian country. All of the Senators who worked to include this provision in the final package, including now Vice President Biden and Secretary of State Clinton, recognized that there are great needs internationally, but that we have equal or maybe even greater needs here at home on our Nation's reservations. The final PEPFAR bill created a $2 billion 5-year authorization, beginning in fiscal year 2009, for the emergency fund for Indian safety and health. Over the 5-year authorization, $750 million could be spent on public safety, $250 million on health care, and $1 billion for water settlements. The need for increased funding in these three areas cannot be underestimated. Nationwide, 1 percent of the U.S. population does not have safe and adequate water for drinking and sanitation needs. On our Nation's reservations this number climbs to an average of 11 percent and in the worst parts of Indian country to 35 percent. The Indian Health Service estimates that in order to provide all Native Americans with safe drinking water and sewage systems in their home they would need over $2.3 billion. The heath care statistics are just as startling. Nationally, Native Americans are three times as likely to die from diabetes compared to the rest of the population. In South Dakota, 13 percent of Native Americans suffer from diabetes. This is more than twice the rate of the general population, where only 6 percent suffer from diabetes. On the Oglala Sioux Reservation in my home State of South Dakota, the average life expectancy for males is 56 years old. In Iraq it is 58, in Haiti it is 59, and in Ghana it is 60--all higher than right here in America. In South Dakota, from 2000 to 2005, Native American infants were more than twice as likely to die as non-Native infants. Tragically, there are also great needs in the area of public safety and justice. One out of every three Native American women will be raped in their lifetime. According to a recent Department of Interior report, tribal jails are so grossly insufficient when it comes to cell space, only half of the offenders who should be incarcerated are being put in jail. That same report found that constructing or rehabilitating only those detention centers that are most in need will cost $8.4 billion. The South Dakota attorney general released a study last year on tribal criminal justice statistics and found homicide rates on South Dakota reservations are almost 10 times higher than those found in the rest of South Dakota. Also, forcible rapes on South Dakota's reservations are seven times higher than those found in the rest of South Dakota. There is no better example of these public safety issues as Standing Rock Sioux Tribe, which is located on the North and South Dakota border. In early 2008, the Standing Rock Sioux Reservation had six police officers to patrol a reservation the size of Connecticut. This meant that during any given shift there was only one officer on duty. One day, the only dispatcher on the reservation was out sick. This left only one police officer to act both as a first responder and also as the dispatcher. This directly impacted the officer's ability to patrol and respond to emergencies, and prevented him from appearing in tribal court to testify at a criminal trial. Later in the year, I was able to work with my Senate colleagues and the Bureau of Indian Affairs to bring additional police officers to the Standing Rock Sioux Reservation through Operation Dakota Peacekeeper. This effort increased the number of officers working on the reservation from 12 to 37. This operation, which was a success, was only possible because the Bureau of Indian Affairs was able to dramatically increase the number of law enforcement officials on the reservation during the surge. And this dramatic increase in officers was only possible because the Bureau had been given additional public safety and justice funds in 2008. Since its enactment last year, I have been working with my colleagues to ensure that the emergency fund for Indian safety and health is funded as quickly as possible. Earlier this spring, 13 of us sent a letter to the chairman and vice chairman of the Appropriations Committee asking that the committee increase the allocations in three different bills, including the Interior appropriations bill that we are debating today. As a result of that letter, the allocations in both the Energy and Water Development and Interior appropriations bills were increased by $50 million each, for a total of $100 million. While this funding increase is a positive sign, neither subcommittee directed this additional funding into the emergency fund as requested. Instead, the Energy and Water Development Subcommittee divided the additional funding up between a variety of water settlement projects, and the Interior Subcommittee provided $25 million for public safety construction and $25 million for ``public safety and justice programs as authorized by the PEPFAR Emergency Fund.'' While I am pleased to see that there has been a $100 million increase in funding for Native American public safety and water projects, I think more could be done if we deposited funds directly into the emergency fund, which would be allocated to the areas of greatest need. The emergency fund, unlike general appropriations, is needed because the fund allows the relevant Federal agencies to spend the additional resources in those places where there are actual emergencies. It would allow agencies, like the Bureau of Indian Affairs, to begin additional operations, like Operation Dakota Peacekeeper, and bring immediate solutions to parts of our nation that are most in need. That is why I filed my amendment, amendment No. 2503, today. I have filed an amendment that would simply transfer the $50 million increase in public safety and public safety construction funding into the emergency fund. While I do not intend to seek a vote on this amendment today, I am committed to continuing to work in a bipartisan manner for the much needed funding for the emergency fund. Toward that end, I am encouraged by the discussions I have had with several of my colleagues who are willing to continue this effort.

Mr. THUNE

Mr. THUNE. Mr. President, I join my colleagues in congratulating my friend from Florida for his service to our country. He has served in so many different ways as has already been noted. But he is truly an example of the American success story, someone who came here, established himself, and has risen to the very highest, I guess you would call it, echelons of this country in terms of public service and his contributions to the private economy in this country. So it is with great regret that we say goodbye to him as a Senator but continue to maintain the strong friendships we have built and developed during his service here. They say that someone is measured not by the days in their life but by the life in their days. While Senator Martinez has maybe not served here as long as some other Senators--he and I came into this Senate together back in 2005--he may not be measured by his days of life in the Senate, but he is certainly measured by the life of his days in the Senate because he has added vitally to the debate here. He is an incredibly thoughtful Senator, someone from whom I have to say I have learned a lot--not just in our personal friendship but professionally-- because he brings so many insights and such a thoughtful way in the way he looks at issues--domestic issues, foreign policy issues. I have learned a lot about Cuba. I have learned a lot about Latin America. I have learned a lot about the Hispanic community in this country. And those are insights and contributions that he has made that no one else could make. It is very rare, indeed, to have someone of his experience and life experience and his quality to serve in the Senate and be able to rub shoulders and learn every single day from those experiences. I congratulate Senator Martinez and his family. As he said, like myself and many others of us, Mel married over his head. He has a wonderful wife and family. And I hope that now, when he is not a Member of the Senate, we will get to see a little bit more of him in the State of South Dakota, because his son John married a South Dakota girl. I have been trying to hunt pheasants. He has made trips up there, but it is always a little bit later in the season when that time of the year comes around, and the climate tends to change in South Dakota. But I hope that now that he has a little bit more time to enjoy those types of things, we will get that chance. I want to express my great appreciation to the Senator from Florida for an extraordinary run here in the Senate. He truly is the kind of person where what you see is what you get. That is rare in politics today--genuine, thoughtful, sincere, kind, generous, the kind of person who serves whom I want to see more of in public life. It has been a pleasure and an honor to have had the opportunity to serve with him in the Senate and to call him a colleague. But it is even a greater privilege and honor and opportunity to have been able to call him my friend. So, Mel, best wishes. Whatever you do, you are going to do well. We are proud of you. And thank you for your great contributions to our country. God bless you.

Mr. THUNE

Mr. THUNE. Mr. President, today I thank an American veteran for his valiant service to our country in the Advanced European Theater of Operation during World War II. Edwin C. Petranek was born September 9, 1916, in White River, SD. After graduating from the University of South Dakota in 1942, he was commissioned second lieutenant with the ROTC program and assigned to the 34th Infantry Division. Ed then went on to serve in Africa, Italy, and France until 1945 as a member of the 1st Battalion, Company A and B, 143rd Infantry, 36th Division as platoon leader. Ed was eventually made first lieutenant, and his division took part in breaking the German defenses around Rome and in the invasion of southern France. He was wounded four times in the line of duty and returned to combat again and again. Ed left the European theater only after shattering his hip and being fitted with a full body cast. Ed recovered and received a medical discharge in 1946 but stayed in the Army Reserves for 10 additional years, during which he returned to South Dakota and completed a master's degree. Upon receiving an honorable discharge in 1956, Ed continued to serve in a civilian capacity as an educator and coach. Here his commitment to excellence remained evident as he earned induction into the South Dakota Athletic Director Hall of Fame. Both at home and abroad, the perseverance exhibited by South Dakota's own Ed Petranek remains an example to us all. This man has been awarded the Silver Star, a Purple Heart with three oak leaf clusters, a Bronze Star with cluster for meritorious service, and many other honors. Ed was also presented the French Legion of Honor. Today we have the chance to thank him for his dedication and to reflect on the true meaning of service.

Mr. THUNE

Mr. THUNE. Mr. President, today I recognize Sarah Josephine Even, an intern in my Washington, DC, office, for all of the hard work she has done for me, my staff, and the State of South Dakota over the past several weeks. Sarah is a graduate of T.F. Riggs High School in Pierre, SD. Currently she is attending South Dakota State University, where she is majoring in journalism and mass communication. She is a hard worker who has been dedicated to getting the most out of her internship experience. I would like to extend my sincere thanks and appreciation to Sarah for all of the fine work she has done and wish her continued success in the years to come.