as the u.s. senate continues work on health care legislation this week, quinney ike university is releasing its

latest health care poll. >> the senate is about to meet for the 19th day to debate health care legislation. in about 20 minutes of senators will have votes on the bill. if the motion is passed, the bill continues towards a final passage vote expected thursday evening. republicans but yesterday. republican leaders say they

didn't reach a decision on that and we'll discuss it again during today's party lunches. the senate will recess for those party lunches between 12:30 and 2:30 p.m. eastern time. democrats and republicans will continue with the general debate on the health care bill for the rest of the day. alternating between democrats and republicans each hour. live senate coverage now on c-span2.

senate will come to order. the chaplain, dr. barry black, will lead the senate in prayer. the chaplain: let us pray. eternal spirit, whom we seek in vain without, unless first we find you within, may the hush of your presence fall upon our spirits, quiet our minds, and

allay the irritations that threaten our peace. breathe through the heat of our desires, your coolness and obama. lord, strengthen the members of this body. take their spirits from strain and stress, and let their ordered lives confess the beauty of your peace. fill them so full of your goodness that they will know how to discern your best for their decisions. make them faithful leaders by your standard of righteousness.

we pray in your holy name. amen. the presiding officer: please join me in reciting the pledge of allegiance. i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all. the presiding officer: the clerk will read a communication to the senate. the clerk: washington, d.c, december 22, 2009, to the senate: under the provisions of rule 1, paragraph 3, of the standing rules of the senate, i hereby appoint the honorable edward e. kaufman, a senator from the state of delaware to perform the

duties of the chair, signed robert c. byrd, president pro tempore. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: following leader remarks, the senate will resume consideration of the health care legislation. the time until 7:18 this morning is equally divided and controlled between the two leaders or their designees. the senate will then proceed to a series of three roll call votes that will be stacked in relation to the reid motion to table the reid amendment number 3273278, the harkin amendment ad motion to invoke cloture on the substitute 2876, after cloture is invoked the majority leader will be recognized and the time will be equally divided and controlled between the two leaders or their designees. at 9:30 and until 5:30 p.m. today, time will be controlled at alternating one-hour blocks of time with the republicans controlling the first hour. the senate will recess from

12:30 until 2:30 p.m. for the weekly conferences. mr. president, tensions have been high because of the -- this legislation which has been on the floor for a considerable period of time. i would hope that everyone would understand that the -- this part of the session is winding down and that i would hope that everyone would go out of their way to be thoughtful and contract to those on -- considerate to those on both sides of the aisle. this is not the time for any personal attacks or any -- any misacrimonious. it is time to leave here in a peaceful nature. we have the christmas holiday coming. we know how important that is to families. we hope that everyone would help us to get out of here and back to our families as quickly as we can. i would designate the time that i have remaining -- that the

democrats have remaining to senator disenator durbin. the presiding officer: under the previous time, the leadership time is reserve. under the previous time the senate will resume consideration of h.r. 3590, which the clerk will report. the clerk: h.r. 3509, an act to amend the internal revenue code to modify the first-time home buyers credit in the case of the arm forces anker is other federal employees and for other purposes. the presiding officer: under the previous order the time until the expiration of cloture on amendment 3276, will be equally divided and controlled between the two leaders or their designees. a senator: mr. president? the presiding officer: the senator from texas. mrs. hutchison: mr. president, i will be taking the leader time on our side. how much time is there? the presiding officer: six minutes. mrs. hutchison: mr. president, today we are taking another step toward passing a bill that has not seen light of day for very

long. it is a bill that is going to change health care policies in this country -- policy in this country forever if it is finally coming to enactment. it will take effect in 2014. and the reason that we are talking about this bill and trying to let people know what is in it is because we hope that there is still a chance that this bill will not become law. this bill was drafted behind closed doors without republican input. the votes are 60-40. 60 democrats and 40 republicans make up the united states senate and that's what providing cloture on this bill. this is a bill that increases taxes by over half a trillion dollars over a 10-year period. that's over $500 billion. and half a trillion dollars in

cuts in medicare. now, mr. president, this is a time when we should not be increasing taxes. small businesses are burdened already. this adds to their burden. families are trying to make ends meet. they're trying to make their mortgage so they will not be thrown out of their homes much they are trying to pay their bills. they trying to find jobs in the highest level of unemployment in our country since the depression. and we are going to heap taxes and burdens on them, starting as early as next year. in two weeks. this is not a time to raise taxes. we don't need a tax burden increase. we don't need medicare cuts and we do need health care reform that would lower the cost of health care. this is going to do the opposite. we are going to increase taxes,

lower the service for medicare in our country. mr. president, i remember reading some of the history and the antidotes about the vote on the constitutional amendment to allow women right to vote. there was one congressman who was wavering. and he said what finally made up his mind, and he was the congressman that made the difference, was his mother wrote him a letter and said, please vote for the women today. vote for the women today. what is going to be said about this bill that changes health care policy for every american? what is going to be written

about how the votes were brought together to have a bill that would tax our american people half a trillion dollars and take medicare as the pay for for this program is that there will be special protection for seniors in florida and new york to prevent them from suffering the cuts to medicare advantage. but no other state. insurance companies in only two states, nebraska and michigan, are exempt from the taxes that will take effect on insurance companies raising the premiums for every insured person in this country. changes to the language restricting physician ownership of medical facilities appear to only benefit a single benefit in nebraska. additional payments to louisiana, massachusetts, vermont to expand medicaid will cost taxpayers in every other

state in america over a billion dollars. this is part of the deal that was brokered to make sure that 60 votes would pass this bill. mr. president, the people of nebraska will never pay a dime for medicaid increases whereas my state of texas will carry a new burden of over $9 billion. and every other state in america will eventually take the burden of the medicare-medicaid iincreases. not ever. even the governor of nebraska has said, he does not think that is fair. so, mr. president, i think we can do better. we can do better in this country than having the history of the overhaul of our health care system that is going to affect the quality of life and the tax burden on every american, i

think we should have a better history, mr. president. so i'm asking my colleagues to think about this vote. we could change one vote, one person who says, i don't want the united states senate to do something this way. i want the united states senate to rise to the level that we know has been the tradition of this senate for all of the years of our republic. and that is that we would have an open, transparent process. that we would have bipartisan input. that a republican amendment, one might have passed. that what we offer is what we promise the american people, lower costs -- the presiding officer: the senator's time has expired. mrs. hutchison: and a way for people to have more affordable access. mr. president, we still have a chance. that's why we're here today.

and i hope that we can turn away from this process and share the light of day with our colleagues and with america. thank you, mr. president. and i yield the floor. mr. durbin: mr. president? the presiding officer: the deputy majority leader. mr. durbin: a famous washington figure once wrote a book entitled "slouching toward gamora." if you were to describe what's happening in the united states senate procedurally, we would call it lurching toward cloture. the cloture rules in the senate require 30 hours between votes. and as a kos commonsense -- as a consequence, we find ourselves in the early morning hours and the early, early morning hours before the christmas holiday and it calls for the senate to convene at extraordinary times as we did this morning. but it's for good purpose. this is to bring a close a debate that has been going on for more than three weeks.

we notice more and more republican senators coming to to the floor with ideas and amendments. and the obvious question we have to ask is: where have you been? for the first 21 debate on this bill, the republicans offered four -- four substitute amendments. they offered six motions to take the bill off the floor and send it back to committee and quit the deliberations, but now only four substantive amendments. now they say they are brimming with ideas for this bill. they had a chance. they had more than a chance. they were invited into this process early on. i say to the senator from texas, she knows that three of her colleagues met over 61 times with their democratic counterparts trying to come up with a bipartisan approach and they couldn't. we also know that in the health, education and labor committee, that the republicans came and engaged in more than 50 days of deliberations in that committee. offered and had accepted more than 150 republican amendments

to this bill. we were not excluding republicans from the process. they excluded themselves. when it came time for a final vote in the health, education, labor and pension committee, not a single republican senator would vote for it. senator coburn of oklahoma offered and had accepted 38 amendments to this bill and wouldn't vote for it. other senators were the same. they had their chance and they department use their chance. in fact, the record shows now that after almost a year of deliberations, we have one republican congressman from new orleans, louisiana, who voted for the house health care reform proposal, and one republican senator, senator snowe of maine, who voted for the senate finance committee proposal. mrs. hutchison: mr. president? mr. durbin: to say that the republicans have been actively engaged in this process is a misstatement. here is why we have to go forward, even if we have to meet at 7:00 in the morning or even if we have to meet this christmas week. when this bill is passed, we know from the congressional budget office several things

will occur. first, 30 million americans who currently don't have health insurance will have the peace of mind of knowing that they have health insurance. secondly, we know that 94% of the american people will finally be insured, the highest percentage in the history of the united states. we know that the rates for health insurance premiums will start to come down, as they must, so that businesses and individuals can afford it, and we know that finally consumers across america will be able to stand up and fight back when health insurance companies turn them down in their moments of need. we say in this bill, in this new amendment that we are going to say to health insurance companies you cannot deny coverage to anyone under the age of 18, any child in america for a pre-existing condition. that is going to bring peace of mind to millions of american families who understand that without this, they couldn't get the health insurance they absolutely need for their children. let me address very quickly this notion that this is somehow a mystery amendment. this amendment has now been before the american public for

at least 20 hours. i'm sorry. make that 70 hours on the internet, and the bill itself has been before the american public now for more than three weeks on the internet. you can find it not only on the democratic senate website, you can find it on the republican website. they have put our bill on the website because they don't have a comprehensive health care reform bill. so they put ours up for people to read. there has been ample opportunity for people to read and dissect and be critical and raise questions. that's the way it should be. and before our final vote on this measure, america will have had its chance to read this and understand the import of this effort, and this effort is substantial. this is something we have built up to for decades. to finally put the senate on record as to whether we are endorsing the current health care system in america that is unaffordable, discriminates against people, and leaves so many people behind, a system that currently rations care and

says to 50 million americans you have no coverage, and to millions of others you have coverage that won't be there when you need it. we have got to bring that to an end. as senator harkin said the other day in closing the debate, this is a real debate over whether or not health care is going to be a right or a privilege in america. if you believe it is a privilege for those who are wealthy and well off, then of course you'll vote against this effort. if you believe it's a right that should be extended to more americans, i hope you will join us in supporting it. i yield the floor. mr. reid: mr. president, is all time expired? the presiding officer: 40 seconds remain. mr. reid: i yield back that time. mr. president? the presiding officer: time is yielded back. mr. reid: i move to table amendment number 3278, and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

the presiding officer: does any senator still wish to vote or change their vote? if not, on this motion, the ayes are 60, the nays are 39, and the motion to table is agreed to.

the majority leader. mr. reid: it's my understanding the second-degree amendment has been withdrawn, is that right? the presiding officer: under the previous order, amendment numbered 3277 is withdrawn. mr. reid: i ask for the yeas and nays on amendment numbered 3276. the presiding officer: is there a sufficient second? the yeas and nays were previously ordered. the clerk will call the roll. vote:

the presiding officer: if not, on this vote the ayes are 60, the nays are 39, and the amendment is agreed to. the clerk will report the motion to invoke cloture. the clerk: cloture motion. we the undersigned senators in accordance with the provisions of rule 22 of the standing rules

of the senate hereby move to bring to a close the debate on the reid substitute amendment 2786 to h.r. 3590, the patient protection and affordable care act, signed by 17 senators. the presiding officer: by unanimous consent, the mandatory quorum is waived. the question is is it the sense of the senate that debate on amendment numbered 2786 as amended, offered by the senator from nevada, mr. reid, to h.r. 3590, the service members homeownership tax act of 2009, shall be brought to a close. the yeas and nays are mandatory under the rule. the clerk will call the roll. vote:

the presiding officer: are there any senators wishing to vote or to change their vote? if not, on this vote the ayes are 60, the nays are 39, three-fifths of the duly senators having voted in the affirmative, the motion is agreed to. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i would ask the clerk to call amendment 2878. the presiding officer: the clerk will report. the clerk: the senator from nevada, mr. reid, for mr. cardin proposes amendment 2878. mr. reid: i ask that further rearing of the amendment be waived. the presiding officer: without objection, so ordered. mr. reid: i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be a sufficient second. the yeas and nays are ordered. mr. reid: i ask the clerk to report amendment 3292. the clerk: the senator from nevada mr. reid proposes amendment 3292 to amendment 2878.

mr. reid: mr. president, it's my understanding that senator mcconnell and i have agreed that -- i should i understand, we've agreed that the time until 9:30 will be equally divided and controlled between the two leaders. and at 9:30 we'll go into -- as we have worked in recent days, into having blocks of time until our caucus at -- until 12:30. the presiding officer: under the previous time the time until 9:30 is equally controlled between the leaders or designees, and the time until 5:30 will be alternated in one hour block of sometimes with the majority controlling the first -- mr. reid: mr. president? i would ask everyone to acknowledge that we have our regular weekly caucus at 12:30. we'll come back at 2:30 and

going back with blocks of time until 5:30 this evening. the presiding officer: without objection. mr. reid: mr. president, i said when the senate opened today and i'll say again because of the long hours we've spent here for weeks now, there's a lot of tension in the senate. and feelings are high. and that's fine. everybody has very strong concerns about everything we have done and have to do. but i would hope that everyone would go back to their gentlemenly ways and i would hope that -- i was trying to figure out how to say this. gentlemanly ways. we used to say in the house gentlewomen, so i guess the same here. so anyway, i hope everyone has -- i've said to a number of people rodney king, let's just all try to get along.

that's the way we need to do it. this is a very difficult time the next day or so, and let's try to work through this. we have, -- for those of the christian faith, we have the most important holiday, and that is christmas. and i would hope everyone would keep in mind that that's a time when we reflect on peace and the good things in life. i would hope that everyone would kind of set aside all their personal animosity if, in fact, they have any the next little bit and focus on that holiday. mr. mcconnell: mr. president? the presiding officer: the minority leader. mr. mcconnell: let me just add to my good friend, the majority leader, he and i have an excellent relationship. we speak a number of times in the course of every day and have no animosity whatsoever, and we are working on an agreement that

will give certainty to the way to end this session, and hopefully the two of us together can be recommending something that makes sense for both sides in the not-too-distant future. the presiding officer: who yields time? the presiding officer: the senator from montana. mr. baucus: mr. president, what's the regular order?

the presiding officer: the time until 9:30 is equally divided between the leaders and their designees. mr. baucus: thank you. mr. president, the senate is not in order. the presiding officer: the senate will come to order. members please take your conversations off the floor. the chair recognizes the senator from montana. mr. baucus: mr. president, it has been more than a month since the majority leader moved to proceed to the health care forum bill before us today. at long last, the senate is now in the final throes of passing this historic legislation. from the beginning, this senator has sought out what abraham lincoln called the better angels of our nature, and that's why we have proceeded the way we did, and that's the way that this senator has always sought to legislate. a year and a half ago, i convened a bipartisan retreat at the library of congress. half a year ago, i convened

three bipartisan roundtables with health care experts. half a year ago, the finance committee conducted three bipartisan walkthroughs of the major concept behind the bill before us today. mr. president, the senate is not in order. the presiding officer: members, please take your conversations from the floor. the senator from montana. mr. baucus: we went the extra mile. i reached out to my good friend, the ranking republican member of the finance committee. i reached out to the ranking republican member of the "help" committee. we sought to craft a bill that would appeal to the broad middle. woe -- we sought to craft a bill that could win the support of republicans and democrats alike. we met a group of six of us, three democrats and three republicans, we met for more than 30 times, we met for months, and i might add encouraged by the president to do so.

our group met with the president several times. the president encouraged us to keep pursuing our negotiations, hoping to get bipartisan agreements. we did not reach a former agreement. the leadership on the other side of the aisle went to great lengths to stop us from doing so. but even though we did not reach a former agreement, we came very close to doing so. the principles that we discussed are very much the principles upon which the finance committee built this bill. the principles that we discussed are very much the principles reflected in the bill before us today. i might say actually our work began much earlier than i have already indicated. we met all the preceding year, about ten hearings in the finance committee working toward health care reform. we also finished with a white paper in nova year ago, november, 2008, and i dare say with some trepidation that basically that is the foundation, that white paper is

the foundation from which almost all ideas of health care reform have emanated. i might say also to be totally fair the ideas of that paper have been floating around for some time and the principles came from massachusetts health care reform. most of the health care experts, the policy experts and the health care economists who have been working on health care reform have published their ideas, and we sought out the best and compiled them and put the best together in that white paper that was published in november of last year. from the debate that the senate has conducted this past month, you would not know it. that is, the principles we put together. during this debate, some on the other side of the aisle have mischaracterized the bill before us. some on the other side of the aisle set about a systematic campaign to demonize this bill. through bare assertion alone, with the thinnest connection to

fact, they have sought to vilify our work. if one listened to their assertions alone, one would not recognize the bill before us. and so let me quite simply state the facts. some on the other side of the aisle assert that this bill is a government takeover of health care. the fact is that the nonpartisan congressional budget office says that this bill would reduce the government's fiscal role of health care. just three days ago, c.b.o. wrote, and i quote -- "c.b.o. expects the proposal would generate a reduction in the federal budgetary commitment to health care during the decade following the ten-year budget window." some on the other side of the aisle assert that this bill would add to our nation's burden of debt. the fact is that the nonpartisan congressional budget office says that this bill would reduce the deficit by $132 billion the first ten years and by by $650 billion and and $1.3 trillion in the second

ten years. reduction. in the second ten years of between $650 billion and and $1.3 trillion reduction of the deficit in the second ten years of this bill. and the fact is that this is the most serious deficit reduction effort in more than a decade. some on the other side of the aisle assert that this bill would harm medicare. the fact is that medicare's independent actuaries says that this bill would extend the life of medicare by nine years. the fact is that this is the most responsible effort to shore up medicare in more than a decade. some on the other side of the aisle assert that this bill does not do enough to insure the insured. -- to insure the uninsured. the fact is the nonpartisan congressional budget office says that this bill would extend access to health care to 31 million americans who otherwise would have to go without. the fact is that c.b.o. says,

and i quote -- "the chair of legal nonelderly residents with insurance coverage would rise from about 83% currently to about 94%." end quote. nothing that senators on the other side of the aisle have proposed would come close. the congressional budget office estimated that the republican substitute offered in the house of representatives would have extended coverage to just three million people. the fact is that c.b.o. says of that plan, and i quote -- "the share of legal nonelderly residents with insurance coverage in 2019 would be about 83%, roughly in line with the current share." that's their description of the republican substitute in the house of representatives. contrast that with the increase in the persons insured in the bill before us from 83% to about 94%. i could cite the facts about the republican substitute in the senate. the fact is that there is no republican substitute.

some on the other side of the aisle assert that they simply prefer more modest reform of welcome. the fact is that the republicans controlled the senate from 1995-2001, and from 2003-2006, and the fact is that before they took control in 1994, 36 million americans, 15.8% of nonelderly americans were without health insurance coverage. in the last year of their control in 2006, nearly 47 million americans, that is, 17.8% of nonelderly americans, were without health insurance coverage. the legacy of republican control was 10 million more americans uninsured. some on the other side of the aisle say that we are moving too fast. the fact is it was 1912 when former president theodore roosevelt first made national health insurance part of the progressive party's campaign platform. the fact is that people of goodwill have been working on this for nearly a century.

and the fact is health care reform for america is now within reach. the fact is the most serious effort to control health care costs is now within reach. the fact is life-saving health care coverage for 31 million americans is now within our reach. let us at long last grasp that result. let us this time not let this good thing slip through our hands and let us at long last enact health care reform for all. mr. president, i suggest the absence of a quorum and ask the time be charged equally against each side. the presiding officer: without objection. the clerk will call the roll. quorum call:

mrs. hutchison: mr. president? the presiding officer: the senator from texas. mrs. hutchison: mr. president, i'd like to ask now is -- the presiding officer: the senate is in a quorum call. mrs. hutchison: i ask unanimous consent the quorum call be lifted. the presiding officer: without objection. mrs. hutchison: are we now in a period where we go back and forth without limits? the presiding officer: we are. mrs. hutchison: thank you, mr. president. mr. president, i ask that i be notified after five minutes, after which senator vitter, i think, is going to speak. the presiding officer: the chair will so notify. mrs. hutchison: mr. president, we have talked a lot about what is in this bill, the massive tax increases, the massive cuts in medicare, but there is another issue that i think looking down the road we are going to need to pursue because we have talked about how ground breaking this bill is. in fact, the majority calls it

historic. it is historic. we believe it is historic in the bad precedents it is setting, both in process and also in substance. so i think that some of these precedents are going to be tested under the constitution of the united states, and i just wanted to start talking about a couple of those. number one, in the effort to get the class vote, clearly there were deals made. there were deals that affect individual states and even one that affects two insurance companies that will have a different treatment from all the other insurance companies in america. it is said that there will be two nebraska insurance companies that will not have to pay the tax increases of the insurance companies that will be levied on all of the other health insurance companies in our

country. so i think that there is an issue that must be raised under the constitution, the equal protection clause of our constitution to take a set of companies in an industry, competitors, and of course we value the free market system and the free enterprise system in our country, and pluck out two competitors and say you will be treated differently because we need your vote to -- we needed your vote to pass this bill. i think it should be tested under the constitution of the united states, and it is my hope that some insurance company that has standing to bring this suit will be able to test this precedent because i think it is a very bad precedent and it is certainly bad policy to start passing laws that distinguish

some parts of an industry versus other parts of an industry that -- that would be treated in a different way. so i hope that we will do that. number two, i believe there is a tenth amendment issue. many states, including my state of texas, has health insurance plans for their state employees. states with large number of state employees find that self-insurance is a better way to go than private insurance programs. so in this bill every insurance company that plans to increase its premiums must get approval from the department of health and human services first. now, my state of texas, with its self-insurance plan, that has to

go to the secretary of health and human services to ask permission to increase the premiums on their state self-insured insurance plan, that is a violation of the tenth amendment as i see it. i am very concerned that a state that has state employees that voluntarily sign on to be state employees, that accept a state-insured self-insured plan would then be able to be told by the federal government that you can't imcrease your premiums to cover the cost -- increase your premiums to cover the cost and keep the sound system that you have in place. now, other states have self-insurance plans. so, i believe they would be very affected by this. and i believe there will be a standing for a state with this

type of plan to be able to challenge this part of this bill and, hopefully, bring it down if it is a violation of the tenth amendment. but know, then, i want to talk about another area that i think is a stretch in this bill. and that is apparently the individual mandate is being justified by the commerce clause of our constitution. now, the commerce clause basically says that no state may impede interstate commerce. you may say out in america i don't see the connection. i'm going to be mandated to buy health insurance or be fined if i don't because states can't impede interstate commerce. well, i would agree with people

out there that that seems like a disconnect. because apparently using the commerce clause the majority leader is saying that the federal government has right to manage insurance and that a requirement of an individual mandate is part of the federal capability to manage insurance in this country and you can't impede that right by the federal government because you can't impede interstate commerce. now, you know, i think this whole individual mandate issue is going to be a center for discussion, debate, and opposition to the bill that is clearly moving down a track that we are trying to stop, but that train is moving.

i think we're going to have to talk about the individual mandate. people are saying to me: how can the federal government i have to buy insurance? and i think that they have a point. i mean, you have to buy automobile insurance because if you have a wreck, you have to be responsible. so you get the right, licensed by the state to drive your car, and in exchange for that, a state may require that you have collision insurance on your automobile. and many states do. but when you say you have to buy an insurance policy, that, i think, crosses a line where a person has a right to say i'm not going to buy insurance. now, if you say, well, as long as you are not as burden to the

federal government or to the state government or to any other taxpayer, that should have that right. but that's not the way this bill is written. the bill is a federal mandate that every person in america has to have health insurance or be find if they -- fined if they don't. so at least if we were going to write such a provision to keep the right of an individual not to have a mandate under the commerce clause of the constitution, at least you ought to say that a person would have to sign something that says, i will give a promissory note if i do not choose to buy insurance. but that's not the way this bill is written. so, mr. president, i think this, along with the state mandate on

medicaid, which, again, is -- i think it's an equal protection issue, and maybe that's a stretch. but that one state will not have to ever pay the state share of the increase in medicaid that is in this bill. but the other 49 states in america will is certainly a violation of our responsibility to treat all states equally or to have formulas that have some ability to say there is a standard that has been set should prevail. but not in this bill. in this bill my state of texas will have almost a $10 million increase in its state share of medicaid because of the expansion in this bill. but there are states that are accepted from the increases and one state that is accepted forever because of a deal made

to get that 60th vote to pass this bill. i think people are looking at this issue in america today and saying: what has gotten into the people in congress that are voting for this bill? the presiding officer: the chair apologizes. i did not notify you at five minutes. your five minutes have passed. mrs. hutchison: mr. president, thank you for the notification. i think there are issues that will be raised going forward in the future and there is still time for one senator in the 60 to change the vote and, therefore, mr. president, i hope that one will hear from his or her constituents enough that that person will say it's time to slow this bill down. it is time to slow this bill down. i'll going to change my vote so that people can see all the effects that we haven't talked about yet and let's do this

right. we can lower the cost of health care. we can provide more access to more people to have health care coverage, which should be the goal, of this legislation, this massive reform of a health care system that is working, that has provided the best quality of health care in the world, we have a chance to keep it. -- to keep it by slowing this bill down and that's why we're fighting. that's why we're still here talking two days before christmas, three days before christmas. we want to stop this bill and do it right. doing it right is more important than doing it fast. and i think the american people believe that too. thank you, mr. president. and i yield the floor. a senator: mr. president? the presiding officer: the senator from louisiana. mr. vitter: thank you, mr. president. how much time remains on the minority side before 9:30, mr.

president? the presiding officer: 24 minutes remain on the minority side. mr. vitter: thank you, mr. president. mr. president, since this latest version of comprehensive health care reform was unveiled a few days ago, a 2,733-page bill, i've budget looking at it very -- i've been looking at it very carefulfully, elf with the louisiana perspective -- especially with the louisiana perspective and i want to share that perspective with my colleagues today. of course, mr. president, we have heard the senate health care reform bill referred to as the louisiana purchase because of the $300 million provision in it related to our medicaid match rate. quite frankly, mr. president, i don't like that nickname for two reasons. first of all, the fact that we in louisiana have to pay a

higher medicaid under present law because of the hurricanes is a real inequity which i support fixing. it's a shame that the merits of that fix, which are very real, have been completely lost in this debate because of the way this louisiana fix has been used and abused, quite frankly, in trying to pass this mega bill. but, secondly, mr. president, i like the phrase because it suggests that louisiana, in general, would fare very well under the bill overall. and, really, nothing could be further from the truth. this bill, overall, sells louisiana short. it sells louisiana out. in fact, rather than the louisiana purchase, i think the bill could be very accurately called the louisiana sellout. now, what are those costs and those serious problems for

louisiana i'm talking about? let's start with medicaid, the program for the poor. let's start with tha that $300 million fix. it's certainly true that that fix is there, the $300 million benefit to the state under our medicaid program. but, mr. president, that's not all of the picture. that's not even all of the medicaid picture. because besides that fix in the bill, overall, there's a dramatic expansion of medicaid. a huge expansion. and louisiana state government and louisiana taxpayers have to help pay for that expansion. and that extra cost to the state government -- to state taxpayer is way more than th the $300 million benefit. by very conservative estimates by the louisiana department of

health an hospitals, tt -- and hospitals, it's at leas least $1.3 billion over 10 years of full implementation. so, sure, $300 million benefit, but at least minimu minimum $1.3 billion cost -- extra cost to the state. now, three things are important about these figures. one is obvious. $300 million is a whole lot less than $1.3 billion. but, secondly, this $1.3 billion over 10 years of full implementation is a very conservative estimate. a very conservative estimate from the louisiana department of health and hospitals. and, number three, while this money is one time, this goes on forever. this is the first decade cost, but it goes on forever from there and every 10 years this grows and is repeated. so what does that mean?

that means in the first 10 years of full implementation, the next impact on the state is at leas least $1 billion and it goes on from there. now, i'm very concerned about a lot of other groups in louisiana, not just state government and the state budget. and i'm particularly concerned about louisiana seniors. of course, louisiana seniors like seniors everywhere depend on medicare. they've paid into it their whole lives. this bill is a simple fact, it's confirmed by the congressional budget office, it's nonpartisan, this bill cuts medicar medicare $466 billion. medicare now is already facing insolvency by 2017. so instead of fixing that in a real way, the bill steals almost half a trillion dollars from medicare and uses it not within medicare, but to help pay for a

brand-new entitlement. a senator: will the senator yield for a question? mr. vitter: i won't at this time. i'll be happy to yield after my presentation. that means cuts in homes, hospice, nursing homes and medicare advantage. there are over 151,000 louisiana seniors on medicare advantage that are -- they are going to be particularly hard hit. they like that choice now. they will not have that choice as it exists now under this bill. how about louisiana taxpayers? i'm also very, very concerned about louisiana taxpayers. again, according to the nonis nt son congressional budget office the bill contains $518 billion of tax increases nationwide. over a half trillion dollars of tax increases.

after that often repeated promise that no one who earns less than $200,000 will be affected. well, think again. the point committee on taxation, nonpartisan, has said 42.1 million americans earning below $200,000 will get a tax increase over the next several years. 42.1 million. that means hundreds of thousands of louisiana taxpayers will be hit, will get a tax increase. i'm talking about folks who earn well below $200,000. we'll also pay more in the form of higher insurance premiums, because, again, the nonpartisan congressional budget office has said this bill increases overall health care costs, it doesn't decrease those costs. what about louisiana's small businesses? surely, surely this bill

protects them in the midst of this serious recession. well, not exactly. the biggest impact on businesses is a brand-new mandate in the bill. most businesses have to either provide a government-defined health insurance benefit or they have to pay a new tax to the government. the nfib, national federation of small business, says that's going to cost the nation 1.6 million jobs. translated to louisiana, that's tens of thousands of additional lost jobs in louisiana on top of our current high unemployment. again, we're in the middle of a serious recession. this will cost us jobs on top of that. there is also another big problem here which is an incentive for businesses to drop coverage. i mentioned that brand-new mandate. either you provide a

government-defined health benefit or you pay a new tax to the federal government. the other problem with that is for a lot of business, it's going to be cheaper to drop coverage and pay the new tax, and so many employees who have coverage now that they are reasonably satisfied with are going to lose it. and that's a big, big concern as well. and just for good measure, the bill forces pro-life taxpayers to in many very meaningful ways subsidize abortion. now, louisiana is one of the most proudly pro-life states in the nation, so that is particularly offensive. everyone who cares about life, who has followed this issue, whether it's the catholic bishops, national right to life, other organizations has said clearly the language in this

bill doesn't protect against taxpayer-funded abortion. the language in this bill does not honor the hyde amendment which has been federal law since 1977. the language in this bill crosses an important line, does not offer the conscience protections we have depended on for years, and so this sets radical new precedent in terms of taxpayer and federal government support of abortion, and that's a really big louisiana concern as well. so what do we have, mr. president? we have a 2,733-page bill, megahealth care reform, with all of these very serious problems for louisiana and important louisiana groups and important louisiana citizens, seniors, small business, taxpayers, the state budget which is already facing serious, serious cuts and

challenges. if we really want to put louisiana first, considering all these costs, we have to say no to this bill. if we really want to put america first, considering all these unsustainable costs, we have to say no to this bill. but we can and we should say yes to the right kind of health care reform. this isn't a debate about yes or no, health care reform or not. this is a debate about what the right kind of health care reform is. and to me, we need to start over with that right kind of reform, and to me that would mean something like starting by passing five bills. each one doesn't need to be longer than 25 pages. each one focused like a laser beam on a real problem that affects real louisianans, real americans, offering a real,

concrete, focused solution. my five bills would be this -- cover pre-existing conditions. that's a real problem in louisiana. that's a real problem in america. let's have a focused bill that does that. secondly, allow buying insurance across state lines. that would dramatically expand competition in the marketplace. that would lower premiums. that would give all folks wanting health insurance dramatically increased costs than tha something real about prescription drug prices.d cut a special deal with the pharmaceutical industry as the white house has. let's pass reimportation and pass real generics reform. fourth, let's pass tort reform and take all of that unnecessary cost out of the system. that doesn't provide better health care for anyone, it doesn't do anything positive for

anyone except wealthy trial lawyers. let's pass tort reform. and fifth, let's allow small business to pool across state lines, to form larger pools of insurance across state lines and gain from that extra buying power. why shouldn't a restaurant in baton rouge that may only have seven or eight people to cover in health insurance, why shouldn't they be able to pull through the national restaurant association, create a pool of millions nationwide and enjoy the same buying power that apple computers or toyota has and get the same benefit in the insurance marketplace through that increased buying power and increased competition? so, mr. president, i urge all of my colleagues to put their state first and vote no, to put our nation first and vote no, and to start anew with the right sort

of focused reform as i have outlined. thank you, mr. president. i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i have just a couple of points to make in few of the last statement just to correct some misimpressions given by the last statement. the last speaker said the medicare cuts -- implying this is going to hurt medicare. the fact is -- and i wish the speaker would -- previous speaker would say on the floor so i could ask him questions, but he is fleeing the floor because he knows i am going to mention facts in total refutation to the assertions he is making. he makes these statements, they are misrepresentations, and he leaves the floor. let me just talk about some of the things he said which are incorrect. one, he basically says that medicare is going to be hurt.

there are huge, big cuts to medicare. the fact is that we're helping the medicare trust fund with this legislation. the fact is that the chief actuary at h.h.s. has said this legislation before us will increase the solvency of the medicare trust fund another nine years. that's a fact. second, he is trying to say there are a lot of big tax cuts here -- excuse me, tax increases here. that's a mis -- he is trying to direct the public away from what the fact is. the fact is the joint committee on tack says there are are $436 billion of tax cuts in this legislation, reductions in taxes. $431 billion of tax cuts in the form of tax credits for people who purchase insurance at an exchange. it's a tax cut. $436 billion of tax cuts in exchange, and i might say $40 billion of that is small business tax cuts. they are not increases.

they are tax cuts for small business, and the tax cuts for individuals is $436 billion. frankly, i wish all of our data for me, i don't have it right now, to refute other points he made. he talked about premiums going up. the joint committee -- the congressional budget office basically says 93% of americans will find their premiums will come down because of this legislation. and for a certain class of individuals, those in the -- in the individual market, in the small group market will get very significant reductions of premiums on account of this bill. it just really irritates me, frankly, when senators come out on the floor and make all these misstatements and they are not based at all on fact. mr. president, you know what we need to do around here? we need to get more and more institutions that objectively analyze policy so we know what the facts are.

it's pretty hard to argue the facts. the c.b.o. does a pretty good job, joint committee on tax does a pretty good job. somehow if this country could turn to an organization or a series of organizations to find the facts, just the facts, i think it would help a little bit. again, it is hard to argue the facts, because if you have good facts, you generally can work on good policy. back to premiums. the c.b.o. says that 93% of premiums will go down. and actually for about 5/6 of those insured, those who work for larger companies, called the large group market, premiums will go down not a lot but a little. according to c.b.o., up to 3% reduction of premiums. they look at the year 2016 as a benchmark year. c.b.o. says for those, about 70% of americans who work for large companies, premiums will actually go down 3%. what about 13% of americans whose insurance -- who work for

small groups, that is, small companies? basically, the c.b.o. joint committee on tax says that those could go up one percentage point and also down two percentage points. it's about even. it's difficult to tell. but those who get credits in the small group market will find their premiums down by 8% to 11%. that is, those individuals who qualify in exchange to get credits, work for small companies, will find their premiums go down 8% to 11%. what about the nongroup market, the individuals? well, basically, if you compare apples to apples, that is, insurance to date with what the insurance will be back in -- in future years, a lot higher quality insurance -- strike that. compare today's insurance premiums with what it might be in the future, the real premiums will go down 14%-20%, but because of better benefits, premiums could go up 10%-13%.

7% of americans, i mentioned earlier 93% of americans find their premiums go down, 7% they go up, but for those 7%, they are going to have a lot better coverage, they are going to have a lot better insurance in 2016. all the insurance market reforms will have kicked in. denial of pre-existing condition and market status and health status and so on and so forth. and get this -- the nongroup market, 17% of americans buy insurance in the nongroup market, 10% of that 17% because of tax credits will find their premiums go down by guess how much? 56%-59%. what's more, 17% of americans buy insurance individually. of those 17%, 10% of those will find their premiums will be reduced 56%-59%. that's according to the joint committee on tax. only one small group in the joint committee on tax will find

an increase in 2016. that is, 7% of americans in 2016, but that will be compensated with a lot better insurance, high-quality insurance. no more rescissions, no more denial based on a pre-existing condition. the ratings reforms will have kicked in. annual limits, lifetime limits will have been repealed. there will be a heck of a lot better insurance, so maybe the premiums will go up a little bit. they will get a heck of a lot better buy for what they are getting. like buying a new car instead of a used car. so in a real sense, every american is going to find his or her premiums go down, 7% will find their premiums will go up a little bit but they are getting a heck of a lot better insurance for the premiums that they will be paying. so i just -- he's wrong, the previous speaker is wrong when he says this is going to increase premiums. the joint committee on tax says it will not. i didn't hear him quote joint

committee on tax saying premiums are going to be going up, but the joint committee on tax if you look at the actual analysis finds that the premiums will actually go down. mr. president, seeing nobody wishes to speak, i'd like to address the question of the constitutionality of the individual mandate. let me just read into the record an analysis by mark hall, prepared by the o'neill institute. basically, he says that health insurance mandates have been a component of the many recent health care reform proposals because of a federal requirement that individuals transferring money to a private party is unprecedented, a number of legal issues must be examined. this paper analyzes whether congress can legislate a health insurance mandate and the potential legal challenges that might arise, given such a mandate. the analysis of legal challenges to health insurance mandates applies to federal individual mandates but can