[Congressional Record Volume 155, Number 167 (Monday, November 9, 2009)]
[Senate]
[Pages S11264-S11265]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. JOHANNS. Mr. President, I rise today to speak about health care 
and the debate that is heading our way, especially now following the 
action of the House this last weekend. We all read the articles, we 
hear the debate, we hear the talk about trying to find a compromise 
when it comes to the government-run health insurance program. Some 
oppose it with passion. Some say they will not support reform without 
it. There is a whole variety of opinions.
  One idea that seems to be picking up steam in this effort to find a 
compromise is the idea of a trigger, whatever that means. Proponents 
call it a safeguard. They say it will trip only if insurance premiums 
go up.
  Here is the problem with that. Inherent in the underlying legislation 
is the sure-fire trip that could set off the trigger. You see, we 
already know that current proposals in this health care reform 
initiative itself will cause premiums to rise. The government mandates 
and taxes and all of the other things that are going to be burdened 
upon health insurance policies are going to cause the premiums to rise. 
We are saddling policies with huge new fees and taxes and mandates.
  The Finance bill piles $67 billion in new fees on the very policies 
that the vast majority of Americans have. Can anyone claim with a 
straight face that premiums will not go up under these circumstances, 
caused by governmental action? The nonpartisan Congressional Budget 
Office--if you have any wonder about this--confirms it. Its analysis of 
the Finance Committee bill says the fees imposed would, and I am 
quoting from the CBO, ``be passed on to purchasers and would ultimately 
raise insurance premiums by a corresponding amount.''
  This idea of a trigger that trips only if premiums rise is an 
illusory safeguard. It is because the trigger is rigged to shoot.
  Further evidence is the fact that the trigger fires if health 
insurance is deemed, and again I am quoting, ``unaffordable.'' Guess 
who gets to decide that. The government will decide that. It will 
decide what affordability is. So bureaucrats pull the trigger by simply 
labeling premiums ``unaffordable'' after all of these fees and higher 
taxes on these policies kick in. This illusory safeguard is meant to 
appease those of us concerned about making Washington the great czar of 
health care, but it doesn't work.
  I believe the American people see through this. I urge those who 
support a trigger to be straightforward about what their stance is. If 
they are for government-run health insurance, say let's go there.
  Incidentally, I will passionately debate that position. I don't 
believe it is in the best interests of our Nation, but I will not 
criticize them for holding that opinion. After all, that is what the 
Senate floor is for, to debate opinions. On the other hand, I take 
issue with disguising a government takeover of health insurance and 
calling it a trigger. I take issue with laying additional taxes on 
health insurance policies and then calling a press conference to 
complain that premiums went up. The implication that the trigger will 
never fire, quite honestly, gets to be folly.
  I gave a speech a week or so ago on the floor and I talked about the 
opt-in and the opt-out. There is no real option if States will have to 
face the unfunded mandate's tax and fees. I pointed that out in that 
speech. The only thing States can opt out of, or choose not to opt in 
to, I believe, when we see the actual language, will be the benefits. 
All of the other burdens will fall upon the taxpayers of that State. It 
is an illusory option. It is a false promise, just like the trigger.
  Just like the trigger. Some suggest the trigger is just like the 
trigger in the part D, the Medicare prescription drug benefit. I have 
heard that argument too. But, boy, is there a world of difference 
between what happened there and what is being proposed here.
  You see, Part D was designed to ensure competition in an entirely new 
marketplace. It was measurable. It was not discretionary. It asked this 
question: Would private insurance companies enter into this 
marketplace? Well, they did. The trigger being discussed now is very 
different. It is set up to shoot. It is based upon the word 
``affordability,'' and the government holds the power of deciding that 
issue. Then the government holds the power to tax policies, and, of 
course, as the CBO pointed out, that is going to translate into higher 
premiums.
  You see, what I see happening here is that the government is setting 
itself up to be both the pitcher and the umpire--the pitcher, who 
throws the ball, and the umpire, who gets to call the strike. I do not 
think the game is working fairly.
  The goal of a trigger is to ensure competition. So let's drop the 
illusions, and let's enable real competition. Let's allow insurance 
companies to compete across State lines. The so-called trigger is just 
camouflaging the true intent: to establish a government-run system.
  I can't help but wonder, is the intention to confuse opt-in, opt-out, 
triggers, co-ops, exchanges? But it all boils down to the same thing: 
you are going to end up with a government-run health insurance industry 
and a government-run health care system. Whether it is opt-in, opt out, 
trigger, co-ops, it really is no real option. There is no free 
marketplace. Instead, it is government making your health care 
decisions, forcing you, dictating to you not only to carry insurance 
but dictating the kind of policy you will have and requiring that your 
plan be approved in Washington, causing many to be displaced from their 
private insurance.

[[Page S11265]]

  Now is not the time to raise taxes, add mandates, and put jobs in 
jeopardy. This massive, all-at-once approach is a very risky experiment 
with 16 percent of our economy. It is a huge gamble. It is a dangerous 
risk being taken with our health care.
  Common sense tells us that change is needed in this arena, but how 
about a step at a time to see if that change works, and then we can 
move forward to the next step. We can take positive steps. But opt-
outs, out-ins, co-ops, exchanges, triggers--they are illusions and not 
solutions.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. ALEXANDER. Mr. President, how much time remains?
  The ACTING PRESIDENT pro tempore. There is 5\1/2\ minutes remaining 
in morning business.
  Mr. ALEXANDER. I ask the Presiding Officer to inform me when I have 
30 seconds remaining.
  Mr. President, the House of Representatives passed, by just five 
votes, a health care reform bill over the weekend. Some said it was 
historic. It is, indeed, historic. It is a combination of higher 
premiums, higher taxes, Medicare cuts, and more Federal Government 
debt.
  Millions of Americans, if it were to pass, will be forced into 
government plans when their employers stop offering health care 
insurance.
  As a former Governor of Tennessee, I simply do not see how Tennessee 
can pay for its part of the Medicaid expansion without imposing a new 
State income tax and damaging higher education or both.
  Health care reform is supposed to be about reducing costs, not 
increasing costs. Instead of raising taxes, raising premiums, Medicare 
cuts, more debt, and transferring new costs to States, we should be 
taking steps toward reducing health care costs.
  On the Republican side, we proposed a number of those, starting with 
small business health plans which would allow small businesses to pool 
together their resources and offer insurance to their employees. That 
would be a good place to start. The Congressional Budget Office has 
said that the small business health care plan which Senator Enzi has 
proposed and is waiting for us to pass would reduce the cost of 
Medicaid, would increase the number of insured by 750,000 at least, and 
would lower the cost of insurance for 3 out of 4 small business 
employees.
  So instead of this 2,000-page bill that raises premiums, raises 
costs, cuts Medicare, and increases the debt, why don't we start step 
by step to reduce costs?
  I was privileged to attend the White House fiscal responsibility 
summit in February. The President invited me, and I was glad to go. He 
talked then about what is obvious about our country's fiscal situation 
and said that putting America on a sustainable fiscal course ``will 
require addressing health care.''
  Then, at the President's White House health reform summit in March, 
the President himself introduced the ``b'' word, the ``bankruptcy'' 
word, which I am beginning to hear more and more about as these bills 
come toward us. The President said:

       If we don't address costs, I don't care how heartfelt our 
     efforts are, we will not get this done. If people think we 
     can simply take everybody who is not insured and load them up 
     in a system where costs are out of control, it's not going to 
     happen.

  This is President Obama talking in March:

       We will run out of money. The Federal Government will be 
     bankrupt; state governments will be bankrupt.

  Well, that is the ``b'' word. That is our President talking. I think 
we should listen to those words and the repeated warnings from careful 
advisers that the cost of these health care proposals is going to get 
us in a state of fiscal ruin.
  Here in Washington, we hear more about the Federal deficit, not so 
much about the condition of our States. At one time, maybe half the 
Senators were former Governors, as the Presiding Officer is and I was. 
Today, I think it is 12. But those of us who can remember those days 
remember what it was like trying to control Medicaid costs.
  Governor Bredesen, a Democrat of Tennessee, told us over the weekend, 
our State--he told all of us that the House-passed bill will add $1.4 
billion to the State budget over 5 years. If that is the case--and I 
know it is hard to put billions, trillions, jillions together up here 
and make them make sense, but let me try to make sense of what that 
could mean for our State, which is a conservative, well-run State. I 
don't see how the State of Tennessee could pay for its State share of 
the expanded Medicaid Program without instituting a new income tax or 
without seriously damaging higher education or both. And that is just 
one part of the new cost.
  So what we are saying to the American people is, let's read this 
bill, let's know what it costs, and let's see how it affects you.
  We will be seeing a Senate bill coming out from behind the closed 
doors of the majority leader within a few days. We look forward to 
debating it. We look forward to moving ahead with health care reform. 
But to us, raising premiums, costs, and taxes and cutting Medicare is 
not health care reform. Reducing costs with small business health 
plans, competition across State lines, reducing junk lawsuits against 
doctors--that is the direction we ought to go if we want to avoid 
seeing that ``b'' word show up on the front pages of our newspapers 
more and more.
  I yield the floor.

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