[Congressional Record Volume 155, Number 142 (Monday, October 5, 2009)]
[Senate]
[Pages S10081-S10085]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. KYL. Mr. President, all eyes are on the Senate now with respect 
to the health care debate, because the Finance Committee has 
essentially completed work on the legislation and sometime this week is 
expected to vote on it, thus making it possible for that bill to come 
to the Senate floor. The question is, what do people think about the 
bill we debated and amended in the committee over a period of 2 weeks? 
Going back over my notes about all of the amendments we proposed and 
the discussion we had, a couple of things stuck out. First, Republicans 
have always said we believed it was important to address some of the 
problems that exist in our current system, problems with insurance and 
also health care delivery, primarily to bring costs down for all 
Americans and, in particular, for small businesses that provide 
insurance to employees, that there were some people who simply couldn't 
afford to buy insurance and we needed to find a way to help them as 
well.
  Republicans offered scores of amendments. Virtually all of them were 
rejected. One or two were accepted. We had a lot of good ideas. I am 
sorry the Democratic majority turned down our ideas. We will offer some 
of those alternatives when the bill comes to the floor and perhaps hope 
for a better reception. It isn't as if Republicans didn't have good 
ideas on how to address the problems. Our ideas were rejected. Instead, 
we end up with a bill, and I thought: What is the best way to describe 
the bill? I decided maybe I could identify 10 problems with it as a way 
of illustrating what is of concern. These may not be the most important 
10 problems. There are certainly a lot of other issues, but here are 10 
reasons I came up with this morning for the American people to think 
about and for Senators to think about that would be problems and 
reasons for us to oppose the bill.
  The first has to do with senior citizens who are on Medicare, because 
the bill cuts $500 billion from Medicare. In July, President Obama 
spoke at the AARP tele-townhall event and said:

       I think there is a misperception that's been out there that 
     somehow there is any discussion on Capitol Hill about 
     reducing Medicare benefits. Nobody is talking about reducing 
     Medicare benefits.

  The problem is, this is not a misconception. We are not only talking 
about reducing Medicare benefits. That is exactly what the Finance 
Committee bill does. The Baucus bill will reduce Medicare benefits for 
millions of seniors to pay for a new health care bureaucracy.
  This isn't just my word. Here is the nonpartisan Congressional Budget 
Office estimating that the Baucus bill would cut Medicare by nearly 
$500 billion in the following ways: $210.9 billion in cuts to 
hospitals, nursing homes, home health care, and hospice; $123.5 billion 
in cuts to private Medicare plans known as Medicare Advantage. Here is 
what the CBO says about that. They estimate that the extra benefits 
offered by Medicare Advantage plans, such as preventative screenings, 
vision and dental care, will drop from $125 per month to only $42 per 
month under the Baucus bill, a direct reduction in benefits for 
seniors.
  Misconception about reducing benefits? No. Real dollars, $123.5 
billion in cuts to Medicare Advantage plans which will, according to 
CBO, cut benefits for seniors.
  There is $22.6 billion in savings supposedly from a Medicare 
commission which Chairman Baucus has noted are executive branch cuts. 
These will be direct cuts to Medicare. And there is $4.6 billion in 
cuts to imaging services, wheelchairs, and physician-owned hospitals. 
Some of these cuts will directly reduce benefits such as those benefits 
offered by Medicare Advantage plans I mentioned. Others will do so 
indirectly as, for example, when doctors are paid less or home health 
care is cut. The bottom line is, it is disingenuous to say that 
Congress can cut this much spending, $500 billion from Medicare, and 
not have any detrimental effect on seniors' care. Medicare savings 
should be used to preserve and strengthen Medicare, not shifted to pay 
for new entitlement programs.
  Reason No. 2, rationing of care. I think at the end of the day, this 
is probably the most worrisome thing to me. And it is worrisome to a 
lot of senior and nonsenior citizens who can see their care being 
rationed under this legislation. The Baucus bill would create a new 
nonprofit corporation known as the Patient Centered Outcomes Research 
Institute to conduct what is known as comparative effectiveness 
research. Billions have been spent in the private sector to identify 
the best kind of treatment and care available, especially for cutting-
edge technologies and treatments for patients' care. For the first 
time, this bill takes government money to conduct the research, and the 
net result of it will be to ration care.
  The bill, for example, asserts that the Secretary of HHS can use this 
comparative effectiveness research when making coverage determinations. 
Coverage determinations are what Medicare is going to cover, what they 
will pay for; in other words, what kind of treatment one gets to have.
  I am quoting now from the bill:

       The secretary would be required to use an iterative and 
     transparent process when using research from the institute in 
     making coverage determinations.

  That is what they intend to do.
  You will hear people say: Oh, no, that is not our intention. Well, 
these are the words of the bill. As a matter of fact, there is over $1 
billion that was passed in the stimulus bill that is going to be used 
by a new Federal agency called the Federal Coordinating Council, to use 
comparative effectiveness research as the basis for rationed care. So 
you have this nonprofit entity as well as a Federal entity, both of 
which will use this research for coverage determinations.
  As I said, a lot of folks, particularly on the other side, say: Well, 
we don't support the rationing of care. We are against it too. Yet 
every single Republican amendment that was offered to make sure this 
research could not be used to ration care was defeated on party-line 
votes in the Finance Committee. The Republicans supported the 
amendments to ensure no rationing. The Democrats opposed all these 
amendments.
  There is another way the bill is very arbitrary and will result in 
the rationing of care. It arbitrarily singles out 10 percent of the 
Nation's physicians every single year and cuts their reimbursements 
under Medicare by 5 percent. What they are doing is saying those 
doctors who spend more than other doctors--the doctors in the top 10 
percent of spending--are going to have their reimbursements cut at the 
end of the year because, presumably, that spending was unnecessary. 
Well, how do we know that? Why isn't it the top 5 percent? Why isn't it 
the top 20 percent? It is a purely arbitrary number.
  As I was discussing this on Saturday morning with a prominent 
physician, he said: The problem is the physicians who will get their 
reimbursements cut are the real experts to whom all the other 
physicians refer their toughest patients. I have seen that happen. I go 
to the doctor, and my physician says: I am not sure about this. I want 
you to go see a specialist in this area, and he sends me to somebody 
else. That doctor may prescribe something that costs a little more 
money, but he knows that is what I need. Well, he is going to get 
whacked by 5 percent. Obviously, this will result in a race to the 
bottom, where doctors will be encouraged to underspend one another 
rather than ensure the appropriate care is delivered to their patients.
  Even the Budget Committee chairman, who sits on the Finance 
Committee, Senator Conrad, said the provision ``leaves me cold.'' Well, 
it leaves me cold too. But every Democrat on the Finance Committee 
voted against my amendment to eliminate this provision.
  There was a recent editorial in the Washington Times that illustrates 
the problem with this. I quote now:

       . . . if a doctor authorizes expensive care, no matter how 
     successfully, the government will punish him by scrimping on 
     what already is a low reimbursement rate for treating 
     Medicare patients. The incentive, therefore, is for the 
     doctor always to provide less

[[Page S10082]]

     care for his patients for fear of having his payments docked.

  That is wrong. The editorial concludes this way:

       And because no doctor will know who falls in the top 10 
     percent until year's end, or what total average costs will 
     break the 10 percent threshold, the pressure will be intense 
     to withhold care, and withhold care again, and then withhold 
     it some more. Or at least to prescribe cheaper care, no 
     matter how much less effective, in order to avoid the 
     penalties.

  Withholding care, denial of care, delay of care--it is rationing. So 
the rationing of care is both direct through the use of the comparative 
effectiveness research or, in this case, indirect, forcing the doctors, 
in effect, to do the dirty work for Washington by withholding care.
  Here is a third reason: waste, fraud, and abuse. The bill purports to 
attack waste, fraud, and abuse. But let me tell you about a little 
provision in the bill, and you tell me whether you think this is 
subject to abuse. Early Friday morning; that is to say, after midnight 
Thursday night, the chairman rolled into the bill an amendment that 
would ``streamline'' enrollment in Medicaid, the Children's Health 
Insurance Program, and the new premium tax credits program under the 
bill.
  Specifically, this amendment would provide a single application form 
for all three subsidy programs. The form can be filed online, in 
person, by mail or telephone. You heard me right: by telephone. How 
will a State Medicaid agency know if the person is truly eligible for 
the program, if the person is a U.S. citizen or is even the person he 
or she purports to be? Poll after poll shows the American people 
believe fraud, waste, and abuse should be addressed prior to creating 
new government programs. The Baucus bill exacerbates the fraud, waste, 
and abuse inherent in Federal public health programs.
  A fourth reason: rising health insurance premiums. You all heard that 
under this legislation, health care is going to cost less. Wrong. 
Health care is going to cost more. Rather than reducing the cost of 
premiums, they are going to go up under the bill. Do not take my word 
for it. Here is the Congressional Budget Office, again, nonpartisan:

       Premiums in the new insurance exchanges would tend to be 
     higher than the average premiums in the current-law 
     individual market.

  That is according to the Congressional Budget Office. Premiums will 
be higher than the average of premiums under current law.
  The bill provides that every insurance company has to offer at least 
two particular kinds of insurance and they cannot offer any more than 
four. The lowest actuarial value they can offer is 65 percent. What 
does that mean? Individuals will have to buy richer health insurance 
plans with higher premiums than they would under the current market 
regardless of their financial or medical circumstances.
  The average actuarial value of an individual insurance plan today, 
according to the Congressional Budget Office, ranges ``from 40 percent 
to 80 percent, with an average value that is between 55 and 60 
percent.'' The bill, remember, mandates that the very lowest is 65 
percent, which means it is going to be more than, higher than the value 
that currently exists for most and for the average. In my State, the 
average actuarial value for an individual plan is 61 percent. The 
average value for a high-deductible health plan is 48 percent.
  The bottom line is, the Baucus bill not only mandates that you buy 
insurance, but you have to buy insurance that is going to have a higher 
premium than the insurance you pay for today. Part of the reason 
insurance will cost more is because the Baucus bill would require all 
insurers to cover a minimum set of standardized benefits in addition to 
the current State-mandated benefits.
  The Council for Affordable Health Insurance estimates that current 
mandated benefits increase the cost of basic health coverage from a 
little less than 20 percent to perhaps 50 percent. So get ready 
America, you are going to see your premiums go up under this 
legislation, not down.
  Here is a fifth reason to oppose the bill. Under this legislation, 
there are penalties on your employer, which will be passed on to you in 
the form of lower wages. Under the Baucus bill, employers with over 50 
employees, that do not offer health insurance to their workers would be 
required to pay a penalty for each employee who receives a tax credit 
to purchase coverage through the insurance exchange.
  Where does the money come from to pay the penalty? Well, the CBO has 
warned Congress about so-called free rider proposals. Here is what they 
say:

       Supporters of such surcharges often refer to them as ``free 
     rider'' penalties.

  That is what is in the bill.

       Although the surcharges would be imposed on the firms, 
     workers in those firms would ultimately bear the burden of 
     those fees, just as they would with pay-or-play requirements.

  Continuing to quote:

       Employer surcharges tend to be more targeted. . . . Many of 
     those workers are more likely to have earnings at or near the 
     minimum wage, and the size of such surcharges--if based on 
     actual costs imposed on government programs--could be larger 
     per affected worker than the assessments being considered in 
     many play-or-pay requirements.

  What that is saying is, when you put a fee on the employer, that fee 
is passed on to the employees in the form of lower wages or, in some 
cases, even fewer workers and that it is most likely to more 
dramatically affect those who have earnings at or near the minimum wage 
than those at higher wage scales. So you are hurting the very lowest 
paid workers.
  Senator Enzi offered an amendment in the committee that would have 
required the Secretary of Labor to certify that the bill would not 
result in lower wages or in an increase in the unemployment rate before 
the bill could go into effect. You would think that would be a good 
guarantee that the bill would not have the adverse consequences I 
indicated.
  Well, an interesting thing happened in the committee. The amendment 
first passed 21 to 0. Everyone thought it was a good idea to guarantee 
that the bill would not reduce people's wages or result in laid-off 
workers. Yet early in the hours on Friday--in other words, after 
midnight Thursday night--the Democrats in the committee changed Senator 
Enzi's amendment into a mere report to Congress. So after first voting 
in favor of the amendment to ensure that workers' wages would not be 
reduced, they then came back late and undid what they had passed 
earlier. Why would they do that, when the first amendment passed 21 to 
0? Because, of course, it is an impossible certification under the 
bill. The bill will reduce wages--CBO said so--and the Democrats in the 
committee realized, therefore, they could not stick with that 
certification and have the bill be effective. So wages will be lost and 
some jobs will be lost.
  Well, here is a sixth reason to oppose the bill: If you like your 
current insurance, you will not be able to keep it. You have heard the 
President promise this over and over: If you like your current 
coverage, you will be able to keep it. No, you will not--not under this 
bill. This has been proven now time and time again. I think it is one 
of the reasons the President is so sensitive about this. In fact, in 
his speech to the Congress, he changed his terminology a little bit. He 
said: If you like your insurance, we will not do anything to require 
you to change it. He had to change his terminology because, of course, 
what he was saying before is absolutely false.
  By saying the government will not require you to change your plan, 
that is technically true. But it is lawyers' words. The problem is, the 
insurance you have now you will not have anymore because it will not 
exist anymore. No one will require you to change it. It simply will not 
be available to you. Why not? Well, there are several different 
reasons.
  For seniors, the Baucus bill cuts billions of dollars from the 
Medicare Advantage Program. That will force those plans to cut benefits 
under their plans or to drop coverage altogether.
  For those who are privately insured, Senator Hatch offered an 
amendment that would have required the Secretary of HHS to certify the 
bill would not cause more than 1 million Americans to lose their 
current coverage. The amendment failed on a party-line vote. Let me 
repeat that. The Hatch amendment said: Well, we have to at least 
certify that no more than 1 million people will lose their coverage 
under this bill. That cannot be certified because that is not what is 
going to happen. A lot more than 1 million people

[[Page S10083]]

are going to lose their coverage. So his amendment lost on a party-line 
vote.
  It is true the Baucus bill does not require insurers to drop coverage 
for people who like their current health insurance plans, but the 
practical effect of the bill will be to cause Americans to lose the 
coverage they currently enjoy.
  For the seniors, by the way, under the Medicare Advantage plan, I 
quoted the numbers earlier. Let me quote them again. CBO estimates the 
extra benefits offered by the Medicare Advantage plan--such as 
preventive screenings, vision, and dental care--will drop from $135 per 
month to only $42 per month under the Baucus bill. So you are going to 
lose over $90 worth of care, benefits, that you currently have. No, you 
are not going to be able to keep the insurance you have today, even if 
you like it.
  Here is a seventh reason: This may seem like a small thing to most 
people, but the precedent is enormously dangerous in our country. We 
have all seen what happens when the government takes over part of the 
economy: insurance companies or the bank bailouts or the automobile 
companies. When the government takes these things over, they begin to 
make the decisions; for example, setting the pay of the people who work 
in those companies. It started out just capping the high executives' 
pay.
  Under this bill, however, insurance companies' pay for all employees 
would be subject to the Federal regulation. If you pay somebody a 
certain amount of money, you will not be able to deduct it as a part of 
the ordinary and business expense that you do today. So it is a way of 
indirectly capping pay. It would limit the tax deduction for health 
insurance executives and other highly paid workers at $500,000. By the 
way, it would not limit the deduction of pharmaceutical companies or 
hospital industry executives and so on. But it is another example of 
what happens when Washington takes over another segment of the economy.
  Robert Reich, by the way, who is the former Secretary of Labor under 
the Clinton administration, wrote an op-ed in the Wall Street Journal 
in which he pointed out that sometimes these relatively high--and 
$500,000 is, to me, a lot of money--but there are people who are paid a 
lot more than that in these high-paid industries because of what they 
are able to do for their particular company, and he warns about the 
effect of legislation such as this that would effectively cap pay of 
employees.
  Here is another thing--the eighth reason--taxing you through your 
health insurance plan. This is another one of the sneaky ways in which 
the bill actually gets at you, but they put the tax first on the 
insurance company. I told you the Congressional Budget Office said the 
wage earners would actually pay the penalty imposed on businesses. 
Well, here is an example of where the Baucus bill imposes a 40-percent 
excise tax on any health insurance plan that is above $8,000 for a 
single person and $21,000 for family plans. Who ends up paying the 
increased tax on the insurance company? Of course, you do. They pass it 
on to you through higher premiums.
  According to the nonpartisan Joint Tax Committee, which provided the 
Finance Committee with a distributional analysis of this provision, the 
bulk of this $200 billion tax increase falls on those President Obama 
promised to protect. Do you remember: ``Nobody under $200,000 is going 
to pay any new taxes under my bill''? Well, here is what happens in the 
first year this tax is in place. It raises taxes on 13.8 million tax 
units; that is, either an individual or a family who files an income 
tax return; that is, it raises taxes by $13 billion on 13.8 million tax 
units. Of those 13.8 million tax units--individual filers or families--
only 1.2 million will have incomes above $200,000. So about 12.6 
million of these tax filers who are under $200,000 in income will pay 
this tax. Not going to tax anybody under $200,000? Wrong. This means 91 
percent of the affected taxpayers will be hit by the premium increase 
as a result of this tax.

  By the way, the average tax increase for those earning under $200,000 
is $900. This is every year, by the way. Within 6 years, the number of 
tax units hit by this tax would nearly triple to almost 40 million 
individual or family filers, and the tax would collect over $52 billion 
in that year.
  Here is a ninth reason for opposing the bill: taxing the chronically 
ill. This is an amendment I offered because this is just wrong. As my 
colleagues know, under the tax law today, if you are so unfortunate as 
to be hit by a huge medical bill in any given year, and it exceeds 7.5 
percent of your gross adjusted income on your income tax form, then you 
get to take a deduction for any amount above 7.5 percent of your 
income. The reason for that is because we don't want anyone in this 
country to have to suffer unnecessarily or out of proportion simply 
because of an accident, in effect. This is literally the lightning 
strikes situation. Most people would not have medical bills exceeding 
7.5 percent of their adjusted gross income, but the few who do have 
been stricken enormously hard. They don't deserve it. In fact, the 
Internal Revenue Service actually treats this as an involuntary 
expense.
  Under the IRS Code, there are few things that happen to you by pure 
luck of the draw, as it were. Most of the IRS Code applies to you based 
on decisions you made: You invested and lost money or you invested and 
made money and you get taxed on it as a result of the decision you 
made. You bought a house and you have a mortgage deduction, you know 
how much that is, you are taxed on a decision you made.
  This, you had nothing to do with it; you just got sick. So your 
expenses are enormous compared to your income. We have always said in 
that case: We don't want that to hurt you; we are going to make sure 
you don't pay more than a certain amount in your taxes. Anything above 
7.5 percent you get to deduct.
  Under the Baucus bill, that 7.5 percent goes up to 10 percent, so now 
you are going to have to eat 10 percent of this catastrophic cost 
before you can even get to the point where you can have a tax 
deduction. Yet, as I quote the Congressional Research Service, ``the 
deduction can ease the financial burden imposed by costly medical 
expenses.'' For the most part, the Federal Tax Code regards these 
expenses as involuntary expenses that reduce a Federal taxpayer's 
ability to pay taxes by absorbing a substantial part of income.
  The Joint Tax Committee has estimated that increasing the threshold 
to 10 percent would increase taxes by $15 billion over 10 years. Who 
are these unfortunate taxpayers? Are they rich people? No. Twenty-one 
percent of them who claim this deduction earn under $40,000, or less 
than 200 percent of poverty. So almost one-fourth of the people who 
take advantage of this are literally--they are at 200 percent of 
poverty. They are making $40,000 a year. Those are exactly the kinds of 
people you want to be able to take advantage of a tax provision like 
this. They get killed when they have an expense that big, and 5.8 
million taxpayers or 87 percent who claim this deduction earn under 
$100,000, and that is not wealthy by any means. Mom and dad are 
working. Together they earn, let's say, $90,000. Well, 87 percent of 
the people who claim this deduction are in that category. Those are 
people we should be helping by not having them pay quite as much in 
taxes, but under the bill we make it harder for them. We raise the 
threshold from 7.5 to 10 percent.
  I wanted to actually reduce it to 5 percent to help people with their 
health care costs. Isn't the whole point of this bill to reduce 
people's health care expenditures? Isn't that the whole idea? No. We 
are not going to reduce them; we are not even going to leave them the 
same. We are going to raise them.
  That brings up the tenth and final reason: taxing middle-class 
families. Under current law, employees can make tax-free contributions 
for medically necessary goods and services to pay out-of-pocket 
expenses. We would assume that to be the case. Although there is no 
legal limitation, employers generally establish a $5,000 limit that 
they provide to their workers.
  Senator Baucus is proposing to limit the contributions to $2,500 a 
year, and the Joint Tax Committee estimates that this limit would raise 
$15 billion over 10 years.
  Now, why are we doing this? Is it good tax policy? No. We are doing 
it because we have to raise revenue. You see, the Democrats, who 
proposed this amendment, said at the very outset:

[[Page S10084]]

We are going to make sure it is ``revenue neutral.'' What does revenue 
neutral mean? When you are proposing to spend $800 billion, $900 
billion, $1 trillion in order to make it revenue neutral, you have to 
come up with $800 billion, $900 billion, or $1 trillion in new taxes or 
revenue or savings in order to offset the cost of that. So they have to 
raise money by a variety of taxes--I have mentioned a couple of them--
or by penalties in ways that help them to get to this $800 million, 
$900 million, or $1 trillion.
  Well, here is another one of the taxes. We limit the contribution 
limit to $2,500 a year. That way the Federal Government will bring in 
$15 billion more in revenue.
  Who takes advantage of this? Well, the 35 million people who use 
these flexible spending accounts spend 43 percent on hospital 
admissions and physician visits, 26 percent to purchase prescription 
and over-the-counter drugs to manage chronic diseases, 21 percent for 
dental, and 10 percent for vision. These are medical expenses that help 
make people healthier or prevent them from getting sicker. Isn't that 
what we want to be promoting, rather than hurting?
  Americans with chronic conditions spend nearly $4,400 a year in out-
of-pocket medical expenses for ailments such as diabetes and autism. 
Why shouldn't we be helping them by allowing their employers to put 
money into these flexible spending accounts for them to offset against 
their medical expenses?
  Well, maybe this is just for the rich. No. There again, wrong. The 
median income for a policyholder utilizing a flexible spending account 
is $55,000--hardly the rich. So, once again, we tax middle-class 
families in order to raise money to pay for the expense of this 
legislation.
  These are just 10 reasons. I could keep going. There are dozens and 
dozens of reasons to oppose this legislation, but just start with these 
10:
  No. 1, $500 billion in Medicare cuts that is going to result in less 
care for America's seniors--benefit cuts.
  No. 2, rationing of care, both directly and indirectly, through this 
comparative effectiveness research and through other means that force 
the physicians, in effect, to provide less care if they want to be 
paid. More fraud, waste, and abuse. We thought we were going to 
actually save money from waste, fraud, and abuse. No. We are going to 
do things such as let people register by telephone when we are not 
going to be able to verify their eligibility for subsidies under this 
program.
  Rising health insurance premiums: The Congressional Budget Office 
says the increase in the insurance costs will be passed on to the 
premium holders, so our insurance premiums go up, not down.
  Taxes on employers which, again, according to the people who know 
best--nonpartisan--reduce employees' wages.
  If you like your current coverage, you would not be able to keep it. 
That is a reason to oppose this legislation. If you like your current 
coverage, you ought to be able to get to keep it.
  No. 7, unwarranted government intrusion. I just cited the example of 
the capping of pay, but there are so many other situations in which 
this tangled web of government regulations will virtually create 
government-run health care in this country, with or without a 
government-run insurance plan or the so-called public option.
  No. 8, taxing you through your health insurance program. Here, again, 
they impose a tax on the insurance company because insurance companies 
are bad. Well, insurance companies are bad until you want them to pay 
for your health care. Then they are OK, I guess. In any event, the 
insurance company has to pass it on to you, so your premiums go up. 
That is what the experts say will happen.
  Taxing the chronically ill: Why should we not allow people to deduct 
from their income taxes the expenses of these catastrophic events in 
their life that all of us--none of us want these things to happen to 
us, and we should at least be able to deduct part of these expenses in 
our income taxes.
  Finally, taxing middle-class families through the inability to take 
advantage of what their employers would otherwise provide by way of 
flexible spending accounts so they could actually have money to spend 
on chronic diseases such as diabetes--just one that I mentioned.
  The whole exercise is we are going to make health care costs go down, 
we are going to reduce premiums, and we are going to recognize that 
people have too hard a time coping with these issues in today's 
society. We only make it worse if we adopt the Baucus bill because it 
will raise insurance premiums, it will lower wages, it will increase 
taxes, and it will reduce the care people get. How is that for a deal? 
Only something offered in Washington, DC, could be that bad a deal.
  That is what is coming down the pike. In a couple of weeks, that bill 
is going to be--actually, it would not even be that bill; it will be a 
worse bill. I have described what many say is the best it is going to 
get, the bill that came out of the Finance Committee. It is only going 
to get worse from here because this bill is going to be combined--not 
by Republicans but by Democrats--behind closed doors with the bill that 
came out of the HELP Committee which, if anything could be worse, is. 
So somewhere in between this bill and that bill, that is what we are 
going to have on the Senate floor. It is a bad deal for the American 
people.
  One final point. I see my friend, the Senator from Tennessee, Mr. 
Alexander, coming to the floor. He has been saying something over and 
over and over again that bears repeating. I will tell Senator 
Alexander, I was in church yesterday, and I don't know how many people 
told me exactly this: Read the bill and find out how much it costs. If 
we do that, and if we tell our constituents how much it costs and what 
is in the bill, I predict a lot of my colleagues are going to say: 
Thanks but no thanks; my constituents really don't want this bill.
  So in addition to all of the other things I have said, maybe I should 
have started with the proposition: Read the bill and find out how much 
it costs. I suspect my friend from Tennessee might just mention that.
  Thank you, Mr. President.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee is 
recognized.
  Mr. ALEXANDER. Mr. President, I wish to thank the Senator from 
Arizona for his thoughtful comments and for his late nights on the 
Finance Committee on the health care bill. He is exactly correct. I 
don't know where in the United States you could go and somebody 
wouldn't say: You should read the bill, No. 1; and you should know what 
it costs, No. 2, before you start voting on it. That is one of the 
handful of things in American life I don't think requires any 
explanation. But if it requires any, the people in Arizona are going to 
be asking Senator Kyl, just as they do me in Tennessee: What is this 
shifting of Medicaid costs to the States, and how much is it going to 
cost us? Our Governor in Tennessee says it will put the State budget in 
the tank and damage our colleges and universities. We ought to read the 
bill and know what it costs.
  What about these Medicare cuts? We will wait to read the bill and see 
how much they are, but what we hear is they are a half trillion 
dollars, and not just in cuts on Medicare, but it is cutting Medicare 
for seniors and spending it on a new program. As the Senator from 
Kansas said the other day, it is like writing a check on an overdrawn 
bank account and buying a big new car with it, and then new taxes.
  So I remember when in the HELP Committee we all were working on a 
bill, and it went right through with the Democratic majority, but when 
the American people began to read it, there began to be some problems. 
So I am very hopeful that we will do in the Senate as 99.8 percent of 
the American people expect us to do: Read the bill; know what it costs. 
When we see the Medicaid mandates that require new State taxes and the 
Medicare cuts for seniors that will be spent on other programs and new 
taxes, then that might change the picture.
  Mr. President how much time do we have left on our side?
  The ACTING PRESIDENT pro tempore. The time is not equally divided. 
Senators are permitted to speak for up to 10 minutes. The time is not 
equally divided, so we are just in a period of morning business until 4 
o'clock.
  Mr. ALEXANDER. Thank you very much.

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