Service Members Home Ownership Tax Act Of 2009--Motion To Proceed

Floor Speech

SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009--MOTION TO PROCEED -- (Senate - November 20, 2009)

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Mr. WICKER. Mr. President, I wonder, before the Senator closes, if he would yield.

Mr. KYL. I am happy to yield to my friend.

Mr. WICKER. Mr. President, I think it is important for us to understand that there are some differences between the bills--the HELP bill, the Finance Committee bill, and the bill that has come out of the House of Representatives--but in each and every case the proposals put forward by the Democrats do have this $ 1/2 trillion cut in Medicare. Indeed, as the Senator pointed out, these involve cuts to hospitals, to Medicare Advantage, Medicare cuts to nursing homes, to home health, and to hospice. There is no question about that. I appreciate the Senator bringing some information to the public and to the Senate about the concerns of his constituents.

In the previous hour, I heard a Senator from the other side of the aisle talk about scare tactics Republicans will be putting forward during the coming weeks of this debate. Of course, you have read letters from your constituents outlining why the people of Arizona are legitimately fearful for the coverage they have enjoyed. I would tell my colleagues that the opposition to these Medicare cuts has come in a bipartisan way. We heard a great deal about that from our friends at the other end of the building when the House of Representatives was talking about this.

The president of the Blue Dog Democrats, Mike Ross, a senior Democrat from Arkansas who has worked to try to make this palatable to people in his constituency, had this to say about these Medicare cuts:

With more than $400 billion in cuts to Medicare, it would force many of our rural hospitals to close, providing less access to care for our seniors.

Less than 12 days ago, Representative Ross from Arkansas said this. His constituency in Mississippi is very much like mine, and I can assure my colleagues that a great number of our hospitals in Mississippi and throughout the country are rural and no doubt they are in Arizona too. So there is a very real concern. The gentleman from Arkansas flatly says it can force many of these hospitals to close.

Representative Larry Kissell from North Carolina said this:

From the day I announced my candidacy for this office, I promised to protect Medicare. I gave my word I wouldn't cut it and I intend to keep that promise.

Representative Kissell from North Carolina concluded that in his judgment, the only way he could keep that promise was to vote no on this legislation.

Representative Michael McMahon of New York said:

Medicare Advantage, which serves approximately 40 percent of my seniors on Medicare, would be cut dramatically.

This is not a Republican scare tactic; this is a flat statement by an elected Democrat from the State of New York in the Northeastern part of our country, one of the larger States. But he said flatly that Medicare Advantage would be cut for 40 percent of his seniors and he voted no on that basis.

Representative Ike Skelton, the chairman of the Armed Services Committee, said:

The proposed reductions to Medicare reimbursement could further squeeze the budgets of rural health care providers.

Chairman Skelton goes on to say:

I also oppose the creation of a new government-run public option and continue to have serious concerns about its potential unintended consequences for Missourians who have private insurance plans they like and, of course, we know that this Reid bill also has the government-run option.

Finally, to quote Representative Rick Boucher, another senior Democrat from Virginia, he said:

I also intend to oppose the bill because of my concern that a government-operated health insurance plan could place at risk the survival of our region's hospitals.

I am concerned, and I am determined to protect the rural health care we have in the State of Mississippi and that we have in these districts that are represented by these comments.

So I wanted to jump in now, before the Senator from Arizona concludes his portion of the initial remarks, and say that the concerns are not only coming from Republicans, they are coming from actuaries, they are coming from people who have analyzed this bill, and they are coming from Democrats who have read the bill, who understand its meaning and who understand that these cuts to Medicare are real and they are hurtful.

I yield back to the Senator.

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Mr. CRAPO. The Senator is right. The way I look at it is that it is the extras. Some say Medicare benefits aren't being cut by these proposals, but that is a real stretch. When you look at Medicare Advantage, it is an outright misrepresentation. The benefits are vision benefits, dental benefits, and the kinds of preventive medicine, such as the mammograms, the PSA tests, and other types of things we have found that help you to dramatically increase your health, if you pursue these kinds of preventive medicine options. They are the ones that will be deprived through these benefits.

Mr. WICKER. Will the Senator yield?

Mr. CRAPO. Yes.

Mr. WICKER. I notice that in Florida that reduction, according to the CBO map, would be 81 percent. That is an unthinkable, drastic change in Medicare Advantage. In my area of the country, over in Arkansas, for example, it has a 40-percent reduction. My State, Mississippi, has a 41-percent reduction. Our neighboring State of Louisiana--these are some examples--has an 81-percent reduction, the same as the proposed reduction this legislation would cause for the State of Florida. I think it is important for our constituents to understand the magnitude of these Medicare Advantage reductions.

Mr. CRAPO. That is absolutely true. Taking a couple of other States, California is 68 percent; Arkansas, 40 percent; New York, 69 percent; New Mexico, 65 percent. The list goes on. The point here is this: The CBO Director made it clear that these will be benefits Medicare Advantage holders will be losing.

I want to move on to some of the other reductions in Medicare. The argument being made by the proponents of this bill is that we can cut $500 billion out of Medicaid and not impact anybody's benefits or the quality of the medical care they are receiving. That is not true. Where are the other cuts, non-Medicare Advantage cuts, coming from? They come from home health agencies, hospice, skilled nursing facilities, hospitals that provide care to seniors, and other Medicare providers in what is called the market basket.

You might say we can just continue to cut the compensation or the allocation of return for procedures and health care provided in these medical providers' services and not have any impact. The reality is far from that. What will happen is this. I will give a couple of specific examples. In general, what happens is, when a home health agency or a skilled nursing facility or a hospital receives these massive reductions of over $100 billion worth of cuts in these areas, they have to adjust somehow. Let me give you some examples. The adjustment is this: In some cases, providers simply stop taking Medicare patients because they can no longer make a profit. In that case, the Medicare population loses access because they have fewer providers from which to choose. In other cases, they reduce services or reduce employees. Again, both the quality and the quantity of health care services to seniors is reduced.

Let me give some examples. A few weeks ago, I spoke to Gary Thietten of Idaho Home Health and Hospice about the impact of Medicare cuts to home health and hospice providers, which is his business. He described to me just how bad the fiscal situation has already become for home health, hospice, and other Medicare providers in Idaho.

Idaho has already lost nearly 30 percent of its home care providers. Let me repeat that. Already, it has lost nearly 30 percent of its home health care providers. They are going out of business because we are squeezing them down so tight. And that included Idaho's largest provider. The providers that are still in business are working under the same Medicare reimbursement levels they received in 2001--8 years ago. If the kinds of cuts contemplated by this legislation go into effect, on top of the current reimbursement issues, the situation will get worse.

Gary said that he compared this situation for home health and hospice providers to the farmers in Idaho. He said that most farmers don't grow just one crop. Similarly, home health agencies do more than just provide home health; they provide hospice and private-duty care along with medical supplies and equipment. All of this will get reduced.

Let me give another example. Robert Vande Merwe of the Idaho Health Care Association talked to me about the impact of these cuts on skilled nursing facilities.

Skilled nursing facilities, such as the hospice facilities, already face a budget challenge under recent CMS rules restricting their compensation for the services they provide. The cuts they have already received, not counting what will come at them in this bill a hundredfold more, have already caused a reduction in reimbursement in Idaho by over $4 million per year to skilled nursing facilities.

He pointed out to me that in the nursing home world, more than 70 percent of the expenses they have are labor, primarily nurses and nursing assistants. He said when payment cuts like these occur, they cannot go to their buildings and take bricks out of it. What they have to do is reduce their employment. That cuts employees. That cuts benefits and services to those who are there.

Let me make this clear. First of all, these cuts are going to reduce jobs and, secondly, they are going to directly tie to the quality and number of staff there to provide care for those in the Medicare system.

Mr. KYL. Mr. President, I ask if my colleague will yield for a quick question.

Mr. CRAPO. Yes.

Mr. KYL. We talked a lot about the rationing of health care that is the inevitable result of these cuts in this bill; that when you reduce the amount of money you compensate hospitals, doctors, nurses, and others, they cannot provide as many services. Some leave the business altogether. As the Senator from Idaho pointed out, some businesses go out of business. So there are fewer entities providing the care. That means it takes longer for patients to obtain the care where it is available, and frequently they do not get as good of care because folks cannot take that much time to take care of them in that sense.

Will my colleague please talk about his concerns about the overall problem of rationing that comes from the reductions in the benefits to providers? By the way, the Senator's chart says ``other Medicare cuts to providers.'' We use that term ``providers'' as a short-cut term. Will my colleague explain what it means to a 70-year-old woman in Idaho who is a provider and how important is that, what happens when you don't pay that provider so that provider is no longer available to take care of her?

Mr. CRAPO. Mr. President, I appreciate that question, who are the providers. If this Medicare beneficiary is in a skilled nursing facility, the provider is the facility itself, which I said we already lost 30 percent of our facilities. It is the nurses and the nurse assistants who are there to assist them and care for them.

The bottom line is, you simply cannot cut hundreds of billions of dollars out of these services and expect to provide the same level of access and quality and available health care.

The same would be true if the care were being provided in a home setting, which a lot of the home care services are compensated by Medicare or in a hospital which is there to provide care in some of the most serious types of circumstances. Whatever it is, whether it is home hospice care, skilled nursing facility, a hospital or what have you, what we see is a reduction in the number of facilities and personnel available, and that is nothing other than rationing.

It is a different kind of rationing than will occur under some other parts of this bill where the government will actually get in the business of saying what kind of health care you can get and at what time in your life you can get it. But it is a kind of rationing that simply forces the availability of health care down so far that the system itself rations it out.

Mr. LeMIEUX. Will the Senator yield?

Mr. CRAPO. Yes.

Mr. LeMIEUX. I wanted to follow up on my colleague's point. With all these cuts to Medicare, $464 billion in this proposal, $192 billion in reductions to most services, $118 billion in cuts to Medicare Advantage, $21 billion cuts to hospitals serving low-income patients, $23 billion from other sources, it seems inevitable that seniors are going to have a lower quality of health care. We were told by the President that if you liked your health care, you were going to be able to keep it. But it seems to me that we need to change that a little bit because under this proposal, you might be able to keep it unless you are a senior and that seniors are going to have a diminished quality of health care under this proposal; is that correct?

Mr. CRAPO. The Senator is absolutely correct. I will comment on that and then conclude and turn the floor over to my colleagues from Mississippi and Florida for their comments. That is exactly right. In fact, one of the most clear and obvious places in which this legislation violates the President's pledge--that if you like what you have you can keep it--is in Medicare Advantage because one out of four Medicare beneficiaries in America will not be able to keep what they have and will see their benefits cut.

There are also other parts of this bill that impact people outside of Medicare in terms of the kind and quality and extent of health care insurance coverage they have and expect that will be impacted. It would impact beyond this. This is about as clear a case there is of violating that promise.

Mr. WICKER. Mr. President, before the Senator leaves that subject matter, I wonder if I could interject. My friend from Idaho also has listed specific cuts under this legislation: hospitals, Medicare Advantage, cuts to nursing homes, cuts to home health, and hospice. But also I think Senators and Americans need to understand that the Reid bill also establishes a permanent board of unelected members appointed by the administration which, in this case, initially at least would be the Obama administration, and they would dictate further savings under Medicare.

This gets to the question of my friend from Arizona about rationing. It would dictate annual Medicare cuts geared toward reducing Medicare spending. These people are not going to be like us--accountable. They will not have to go back to their district every 2 years or their States every 6 years. But they will have the unbelievable power under this legislation to dictate additional cuts that we know not. The Wall Street Journal called this a rationing commission. This ties right in with the concerns that Americans have had over the last 2 or 3 days about these recommendations with regard to mammograms.

I realize I am intruding on the Senator's time, but I have a letter from a physician in Mississippi who is fearful that this sort of rationing board is going to impose the requirement that mammograms not be given until after age 50. He says:

My wife and I have two daughters who had breast cancer in their 40s. One daughter was age 42 and it was picked up on a routine yearly mammogram. The other daughter was age 49 and she found an abnormality by self breast exam and it was confirmed by a mammogram. .....

Now we have a group of unelected people coming forth and saying you are not supposed to get a mammogram, you are not entitled to a mammogram, and we learned that some insurance companies have already decided to follow that dictate. This gentleman, a physician, says my two daughters would be dead from breast cancer if that were imposed.

I am afraid that in addition to these very definite cuts, this permanent board of unelected members would impose the very type of requirement that we are fearful might come forward on mammograms.

Mr. CRAPO. The Senator is correct. I will conclude with this. I think we have all seen folks are almost falling over themselves backing away from the news on the mammograms that came out. But it is a very clear example in a way a study can come out from a government source or otherwise to say we don't need to have this kind of health care in the United States, it is a cost saving. What do you think is the potential for this commission to say: We are charged with saving costs in these programs, and we are going to do that.

I suspect that the mammogram issue is one they would not do it on today because of the reaction to it. Somewhere this commission is going to save tens of billions of dollars, in addition to these kinds of cuts, by reducing services. Color it as you want, you cannot make this kind of reduction of health care services, personnel, and infrastructure without reducing the access to and the quality of care that Americans receive.

I will conclude by saying these issues face every State in America. We are going to see in this arena a dramatic reduction of the quality and content and quantity of health care that our Medicare beneficiaries today see because of these proposals, and they are being done not in order to make the Medicare system more solvent but to finance yet another major Federal entitlement program that will cost hundreds of billions of dollars. As a matter of fact, if you look at the true numbers, the cost will be over $2 trillion in a full 10-year period of time.

There is a lot more we could say, but I know my colleagues from Mississippi and Florida have some remarks they wish to make. I yield to them at this time.

Mr. LeMIEUX. Mr. President, I thank the Senator from Idaho for his great remarks today. I want to follow up on what he started to discuss and continue also with the comments from my colleague from Arizona about Medicare Advantage because it seems to me, being a Senator from Florida where we have the second highest senior population in the country, the highest per capita senior population, we have 3 million people on Medicare, more than 900,000 on Medicare Advantage, that Florida is going to receive the worst impact perhaps of any State in the country because of this proposal.

I am here today to talk about this not just as an American but as a Floridian because I want my fellow Floridians to know, especially seniors, what is in this bill and what it means to them. That is our job. It is our responsibility to read through this document, this 2,074-page bill that we received a day and a half ago and to talk about what it means for the average American and, in my case, the average Floridian.

We find out today this Medicare Advantage Program that 900,000-plus Floridians enjoy is going to have a substantial cut to the benefits. This is not just extras or fringe benefits. These are things people need to stay healthy--eye doctors, hearing aids, programs to make sure folks stay in shape, all sorts of things that contribute to the health and wellness of seniors. Our seniors enjoy this program. The popularity of this program is sky high.

But we are finding out today--and I am looking at this map--that Florida is getting the worst impact of any State in America. Only Louisiana is going to get it as badly as Florida. We get the hurricanes, and now we are going to get the Medicare Advantage cuts--an 81-percent reduction in the benefits to our seniors.

What is that going to mean? It means they are not going to have the health care they enjoy now, which is what the President promised.

Right now this bill says the benefits offered will drop from $135 a month to $42 a month. Florida seniors will lose 81 percent of this additional coverage. I have some constituents who have written to me because they have been hearing about these problems. I want to read one or two of these letters from Floridians who are concerned about losing Medicare Advantage. This one is from Dennis Shelton in Plant City, FL, which is in central Florida. He writes to me:

Senator LeMieux, I am writing this letter to express my deep concern about the proposed cuts in Medicare Advantage funding. I am currently enrolled in an advantage program that is crucial for me to get medical attention. The plan provides doctors, medicines, urgent care and my diabetic supplies. The plan does this significantly better than traditional Medicare at a reduced cost.

By regular visits ..... I have been able to maintain reasonable health. If the cuts reduce services then my health will suffer along with other seniors that are in the Advantage program.

This is distressing and I sincerely hope that you will strongly advise fellow congressmen how important Medicare Advantage programs are to seniors all across the United States.

I am new to this body. I have only had the honor of serving here for a couple of months, so I am still learning the ways of Washington. But my understanding of this health care process and this health care bill is we were going to maintain quality, we were going to try to cut costs for people who have experienced the high cost of insurance, and we were going to try to provide more access.

But what I am finding out from this proposal is that we are going to cut quality for seniors, and we are not going to reduce the costs of health care for the 170 million people who actually have insurance.

It occurs to me that the goals that were set are not being achieved by this plan. Worse still, we are taking a program that seniors rely on and that seniors paid into their whole life through their wages and we are going to cut $ 1/2 trillion out of it, a program that in 7 or 8 years is going to run a deficit and be in tremendous trouble.

The question I have--and maybe my colleague from Mississippi can help me with this since I am new to the Chamber--is why are we going down this
path? This doesn't seem good for seniors. It doesn't seem good for people in any walk of life in America, especially in light of what my colleague from Mississippi pointed out with the mammogram issue that came out and the self breast exam issue that came out this week. Why are we going down this path?

Mr. WICKER. I appreciate the Senator asking that question. The answer is there is no reason for us to go down that path.

Early in our hour, the Republican whip pointed out that there are many proposals the Republicans have that do not require the huge expenditure, the huge expansion of Federal power and actually are relatively simple and relatively inexpensive. For example, we have a proposal:

To reduce junk lawsuits against doctors, by Senator Ensign, the Medical Care Access Protection Act. It is only 28 pages, compared to these huge pieces of legislation in front of us. That would not cost anything. It certainly would not require any reduction in Medicare.

To combat waste, fraud, and abuse, by my friend from Florida, and I congratulate him for that. It is only 21 pages, something Republicans have been begging for and arguing for for years and have been stymied on.

To allow small businesses to pool resources to purchase health insurance for employees. Small business people in restaurants and realty companies, small motels, ought to be able to pool together and have the same purchasing power the huge corporations have. But that would only take 8 pages, it would not involve a cost to the Federal Government, and certainly not involve these draconian cuts of $ 1/2 trillion to Medicare and Medicare Advantage.

Further, we could purchase health insurance across State lines. We certainly agree there is not enough competition in health care purchasing. I would love to see a commercial someday with someone coming in saying, ``I have great news, I just saved a ton of money on my health insurance by switching to XYZ Company.'' We see that in car insurance and life insurance. There is vibrant competition. But if we opened competition across State lines to the 50 States and if I could buy insurance from Idaho, I might find a company that gives me better service, that provides better care or reduced premiums. Or if I could look at a Florida insurance company, the Senator from Florida might look at a Mississippi company. We would use good old American competition that has worked in our market society for years but has not been allowed to work in the area of health insurance.

Then, of course, health savings accounts--a one-page bill by my friend from Arizona and our colleague Senator DeMint. And then wellness and prevention, again only a simple 14 pages.

None of these would require cuts to Medicare. None of these would involve the $2.5 trillion that this spends per decade, once it is fully implemented. So the answer to the question of why we are doing it is, it is not necessary. I guess the reason people might be doing it is that they believe that big government works well. I have a different view on that.

I see, as the Senator pointed out, all of these Federal programs that are not exactly working as efficiently as they were projected to be. My dad is on Medicare. We are going to protect Medicare. Republican and Democrat, we are going to do that. But as the Senator pointed out, it goes broke in the year 2017. We certainly do not need to be taking from Medicare to pay for a new entitlement.

Medicaid, as has been pointed out--many doctors will not take Medicaid payments anymore because it is broke and it doesn't reimburse at a market rate. So we see in my home State of Mississippi, 60 percent of the doctors will not take Medicaid. Yet there are some people in this building, there are some people in this country within the sound of my voice, who believe that somehow a huge $2.5 trillion takeover of one-sixth of our economy can work and will not be like the Census and Fannie and Freddy, like the post office and the highway trust fund, and will not be broke.

It comes down to a difference in philosophy. But certainly we ought to all agree that savings we find in Medicare ought to be used to shore up Medicare, to make sure it is there for people such as my dad and people who are going to rely on that program for years to come.

Mr. LeMIEUX. I thank the Senator for that explanation. That is very helpful to me. What is disconcerting about the path it seems we are on is we are going to have this government-run health care system and if already now people cannot go see their doctor if they are on Medicaid because doctors won't take Medicaid, and if it is growing more and more the case that you cannot see a doctor if you are on Medicare--I have some information here about 29 percent of beneficiaries surveyed saying they are having a problem finding a doctor who will take Medicare.

There is a senior from Sanford, FL, Earl Bean, who was interviewed this week and he said:

I called about 15 doctors and was told repeatedly that they were not accepting Medicare patients. .....

They wouldn't even take his name when he called. So what I am worried about is we are going to enter into a system where 5 years from now, 10 years from now when everybody in the country is basically on a government-run health care program--Medicare, Medicaid, or this new program which unfortunately we all think will push the private insurers out of the business eventually and we all have government health care--is we will be going places, there will be 100 people waiting in the room if we can get a doctor at all, they will be rationing the care, they won't be providing mammograms such as this recommendation that came out this week by the Government task force, for women in their forties to be discouraged from self-breast exams, and we will all have very poor health care unless you are wealthy.

What is already happening now is that those folks who are wealthy--there are doctors now who are not taking Medicaid, they are not taking Medicare, and they are not even taking insurance. So what concerns me--maybe the Senator from Mississippi can comment on that--if we enter on this path, we are going to a world where the majority, the vast majority of Americans are going to have poor quality government-run health care and only the very rich will have access to good doctors and all the best quality of health care. That does not seem to me like an America we want to live in.

Mr. WICKER. I think this constituent of mine, from Brandon, MS, said it very well in a recent e-mail I received. Obviously she is dependent upon home health care.

I support the goal of health care for all. However, that goal should not come at the expense of frail, elderly and disabled homebound Medicare beneficiaries receiving care in their homes and communities.....

She points out what this legislation would do to home health care.

Truly, this bill before us and the one from the House and the one from the two committees takes money from America's seniors to the tune of $ 1/2 trillion, and instead of shoring up the system that needs to be enhanced and protected, it puts that money in the new government entitlement program we have exhibited here. I certainly believe we can do better.

Mr. KYL. Mr. President, I want to interrupt my colleague from Mississippi for a moment and ask him--or I think the Senator from Idaho has some experience with this as well--we have been talking about $ 1/2 trillion in cuts to Medicare. But we have not even talked about the biggest one yet. We have talked about cuts to Medicare Advantage, we have talked about the cuts that will be ordered by this new Medicare Commission. But I guess I would ask my colleague from Idaho, isn't it true that the biggest dollar cuts to Medicare are going to come because we are going to pay the doctors and the hospitals and the nurses a lot less money?

Of course, every one of my constituents who has talked to me about it said wait a minute, if you are going to pay them a lot less money--I am having a hard time finding a doctor who will take Medicare patients. Isn't that going to result in delay of care for me and denial of care, in effect rationing of care? There will not be enough doctors and nurses to take care of me because they are not being paid enough to even keep their doors open.

Mr. CRAPO. The Senator is right. As a matter of fact, if I understand the
legislation correctly, it assumes the current projected cuts for physicians are going to happen. That is how it says it is not going to increase the deficit. You and I both know this Congress will not let that happen.

But even today, 29 percent of Medicare beneficiaries looking for a primary care doctor had a problem finding one because, both with regard to Medicaid and Medicare, because of the problems we have been discussing here, there are fewer and fewer providers who will take patients in those programs.

Mr. LeMIEUX. Mr. President, I was wondering if I could ask my colleague, the leader from Arizona, a question because we are about at the end of our time. My understanding is we are going to have a vote tomorrow at 8 o'clock. Again I am new here. I was hoping the Senator could explain this for me. My understanding is we are going to vote whether to proceed on this bill. It is not going to be this bill, it is going to be some kind of shell bill or something, which hopefully can be cleared up for me. But I am told by folks who work with me that the Congressional Research Service has said when there is a vote to proceed on a bill, that 97 percent of the time that bill passes. So it seems to me if we are voting tomorrow to proceed, that is really a vote on this bill.

Do I understand that correctly?

Mr. KYL. Mr. President, I would say to my colleague from Florida that is exactly right. I was interested in that Congressional Research Service report, a totally nonpartisan report, which essentially makes the point if you vote to proceed to the bill, 97 percent of the time you are voting to approve the bill because they end up passing. Those of our colleagues who say they have problems with this bill, serious problems with the bill, are enablers if they vote to proceed to the debate of this bill. They are enabling those who want to pass a bad bill to do so because that is exactly what will happen.

In order for them to try to fix the bill it would take 60 votes to get an amendment agreed to and that is a very tall order around here.

The second part of the question, yes, this may be a little confusing, but what the majority leader has asked is that we vote on a cloture motion to proceed to a House bill that has to do with bonuses for AIG people. You say, What does that have to do with this? The answer is it has nothing to do with this. The leader ordinarily would have taken the House bill, which is the bottom half of this stack here, would have taken the House-passed health care bill and asked to proceed to that bill. If we then agree to proceed to that health care bill, he would then substitute his own version, which is the second half of the stack here, and then you would have a Senate version that we would begin to amend or act on or at least debate.

I don't think the majority leader wants those on his side of the aisle to have to vote on the House-passed health care bill. It doesn't appear to be very popular out in America. In fact, by about 2 to 1 the American people say they don't want to have anything to do with that bill. So, instead, we are going to a shell bill that has nothing to do with health care and then the leader will simply shift to his substitute health care bill. As my colleague from Florida knows, once you vote to begin the debate on this bill, you have put in motion the process by which it could, and in 97 percent of the cases does, end up getting passed into law.

For those colleagues who say I am not sure I like this bill but you know I will move the process along by at least going to it, the time to stop it and to say let's fix it before is the time right now, not after you get on the bill. It is too late.

Mr. WICKER. Will my colleague yield? This Reid substitute that will be substituted for the shell bill contains taxpayer funding of abortions and it contains a government-run company to compete with the private sector. So Senators who vote to proceed on that bill, in my opinion, are playing with fire and very much risking that type of legislation might come out of the closed room that will be the House-Senate conference.

Mr. KYL. The point is this: Unless they have a way to get 60 votes to get those provisions out they are in effect endorsing them by voting to proceed to the bill because they can't get them out. My colleague is exactly right.

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