[Congressional Record Volume 155, Number 168 (Tuesday, November 10, 2009)]
[Senate]
[Pages S11310-S11313]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. We are in the middle of the health care debate. We 
have different points of view. I am sure people are confused by what 
they hear. I think that would be inevitable with a 2,000-page bill, 
which is the House-passed bill. That is all we have today while the 
Democratic majority leader writes his version of whatever we are 
expecting to act on, behind closed doors.
  Earlier this week I talked to a woman in my home town. She expressed 
what I suppose many people believe. She said: I am very confused by 
what I hear, but I do not like what I hear. My husband lost his job. He 
was one of the lucky ones; he got a new job. But it only pays 60 
percent of what he was earning doing the same work, and he does not 
have any benefits.
  So, she said: I went back to work. I am a small business woman. We 
needed the benefits, so I went back to work.
  But she said: These proposals I am hearing about do not seem to be 
working out the way they are supposed to. They are putting more costs 
on us when we buy our insurance and when, as a small business person, I 
have to buy insurance.
  She said: I do not like what I hear.
  I think she is expressing a real concern--it is a complicated bill. 
There is a lot of concern on both sides. We heard the other side 
talking about myths and reality. I see the Senator from South Dakota. 
It looks as though he has the 2,000-page bill with him. It is good that 
he is young and strong and can carry such things. His eyes are good, 
and he can read it. It will take a while to do that, which is why, when 
this bill gets to the Senate floor, we want to make sure we read the 
bill, we

[[Page S11311]]

know what it costs, and we help the American people understand how it 
affects them.
  I would ask the Chair if he would please let me know when I have 60 
seconds remaining on my 10 minutes.
  The ACTING PRESIDENT pro tempore. The Chair will advise the Senator.
  Mr. ALEXANDER. What I would like to suggest this morning is that we 
ought to focus on a forgotten word, and the word is ``cost.'' This is 
supposed to be about reducing the cost of health care not increasing 
the cost of health care; reducing the cost of our premiums, which 250 
million of us have. We have health care plans upon which we or somebody 
else pays premiums for us. We would like for those to go down or at 
least stabilize. That is what this reform is supposed to be about--and 
reducing the cost of health care to our government because all of us, 
including our President, have seen that we are going to go broke if we 
do not do that.
  Here is the President speaking at the White House health summit on 
March 5 in words I thoroughly agree with:

       If people think we simply can take everybody who is not 
     insured and load them up in a system where costs are out of 
     control, it is not going to happen. We will run out of money. 
     The Federal Government will be bankrupt. State governments 
     will be bankrupt.

  That is President Obama using the B-word. Yet the bill we have coming 
toward us is indeed historic. But it is historic in its combination of 
higher premiums not lower premiums, of higher taxes, of Medicare cuts, 
and of more Federal debt.
  Millions of Americans will be forced into government plans, perhaps 
including a new one, when their employers look at the option and say: 
We are out of here. They will write their employees: Congratulations. 
We are going to write a check to the government. That is better for us 
as a company, our bottom line, and you are in the government health 
care plan.
  That is going to come as a shock to millions of Americans. We do not 
hear as much about it here. But one way the House of Representatives 
plans to pay for this expensive bill, that's going to cost between $2 
trillion and $3 trillion, according to various estimates when it is 
fully implemented over 10 years, is to shift some of the cost to the 
States.
  The numbers we throw around here after a while do not have any 
reality to them, but if you are a Governor--and our Governor, a 
Democratic Governor, has said that the House-passed bill--now that is 
not the Senate bill because the Senate bill is still behind closed 
doors; we have not seen it--but the House-passed bill will add about 
$1.3 billion cost to the State of Tennessee over the next 5 years for 
its share of the Medicaid costs, including reimbursement of physicians.
  I have been the Governor of Tennessee. I know how much money that is, 
and I cannot see how the State of Tennessee can afford to pay for its 
share of these proposed Medicaid costs unless it institutes a new State 
income tax or seriously damages higher education or both.
  So we should take a different approach. Instead of a 2,000-page bill 
with higher premiums--people say: Well, that is a myth. Well, it is not 
a myth. I mean, if you add $900 billion in taxes over 10 years to 
insurance companies and medical devices, who do you think is going to 
pay it? The people who pay for insurance premiums are going to pay it. 
If you tax the oil companies, who do you think is going to pay the tax? 
The people who buy gasoline. Taxes are not paid out of thin air; 
companies pass them on. So premiums are going to go up.
  They are also going to go up because of government requirements for 
an ``approved government policy.'' Senator Collins of Maine said 87 
percent of people in Maine would be paying more for the premiums they 
have today if they had to buy them new under the House-passed plan. So 
why do we not take a different direction? Instead of these 2,000-page 
bills, that cost $2 or $3 trillion, and are full of surprises and 
confusion, why do we not just set a goal of reducing costs? Why do we 
not go step by step in reducing those costs? I bet we could agree on a 
lot of things. Going step by step in the right direction is one good 
way of getting where we want to go. It also provides bipartisan support 
which would provide bipartisan support of the country, which the 
President and the majority will need to sustain the program. We want 
the President to succeed because we want our country to succeed. He is 
our President. But this bill will not help him succeed. It will not 
help our country succeed.
  Just to conclude with one example of what a step would be is the 
small business health care plan, which we worked on for a long time. 
Senator Enzi from Wyoming has been the principal sponsor. It would 
allow small businesses to combine and offer insurance to a larger 
number of employees.
  According to the Congressional Budget Office, such a plan, as I just 
described, would add nearly 1 million, 750,000 people would become 
insured. Three out of four people who are employees of small business 
would have lower rates, and we would reduce the cost of Medicaid by 
$1.4 billion.
  That is just a step, but it is a step in the right direction. So I 
would hope we can focus on costs, reducing costs. Republicans have a 
series of steps we would like to take in that direction. We reject 
these 2,000-page bills that raise taxes and premiums and Medicare cuts. 
We hope we can come to some agreement before we conclude the debate.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from South Dakota is 
recognized.
  Mr. THUNE. Mr. President, I want to commend the Senator from 
Tennessee. I totally support his approach. I think handling health care 
reform in a way that reflects a more thoughtful step-by-step approach 
is the correct way to proceed.
  The leadership, the Democratic leadership in the House of 
Representatives, wanted to pass a health care reform bill in the worst 
possible way. They succeeded on Saturday, passing it in the worse 
possible way. It is a 2,000-page bill which was debated for about 4 
hours and passed on a party-line vote. It was a partisan bill, very 
limited amount of debate, very few number of amendments that were 
offered. I think the Republicans were able to offer one substitute 
during that entire debate.
  They passed out a 2,000-page bill that expands the Federal Government 
by $3 trillion over 10 years when it is fully implemented. So you have 
a 2,000-page bill coming out of the House of Representatives, a $3 
trillion expansion of the Federal Government, and I think what the 
American people are probably asking in observing this process is, What 
does it all mean for me?
  Well, let me tell you what it means. If you are a taxpayer in this 
country, if you are someone who currently does not have insurance in 
this country, you are going to pay higher taxes. If you are somebody 
who has insurance, you are going to pay higher taxes. If you are a 
medical device manufacturer, you are going to pay higher takes. If you 
are a small business, you are going to pay higher taxes. If you are 
someone who has a flexible spending account, you are going to pay 
higher taxes. If you are someone who has a health savings account, 
you are going to pay higher taxes. If you are someone who itemizes on 
your tax return and deducts your medical expenses, you are going to pay 
higher taxes.

  So pretty much that kind of covers the gamut. Everybody in this 
country is going to be hit with higher taxes to pay for this 
monstrosity, this 2,000-page bill, which, according to the CBO, raises 
taxes in the first 10 years by three-quarters of $1 trillion.
  What is interesting about that, when I mention that people who do not 
have insurance are going to pay higher taxes, there is, in this bill, 
what is called an ``individual mandate.'' Those who would pay the 
higher tax under the individual mandate--it would raise taxes by about 
$33 billion--are people who currently do not have health insurance 
coverage. What is interesting about that is that the CBO has looked at 
who would be impacted by the individual mandate and found that almost 
half of that tax burden would fall on taxpayers who are making between 
$22,800 a year and $68,400 a year. So about half of the individual 
mandate, about half of that $33 billion tax increase, would fall on 
individuals who, in their incomes, fall into the middle of that 
category, $22,800 a year to $68,400 a year. That is according to the 
Congressional Budget Office.
  Now, it raises taxes by $135 billion on businesses through what is 
called a

[[Page S11312]]

``pay-or-play mandate.'' In other words, if you do not offer health 
insurance, you do not offer insurance that meets the government 
requirement, then you pay a payroll tax starting at 2 percent, up to 8 
percent of payroll. That raises $135 billion in this bill in additional 
taxes and taxes that are going to hit small businesses.
  There are also taxes on what they call ``high-income earners.'' That 
raises about $460 billion in the bill. It is designed to hit people who 
make between $500,000 and up to $1 million a year, which is sort of the 
traditional ``tax the rich and pay for this thing.''
  The dirty little secret in all of that is that tax hits a lot of 
small businesses. In fact, about one-third of that tax is going to fall 
on small businesses that file or are organized as subchapter S 
corporations or LLCs and therefore file on the individual tax return.
  So we are going to be faced with a situation where next year a small 
business--when the tax cuts that were enacted in 2001 and 2003, the top 
marginal income tax rate--goes from 35 percent to up to 39.6 percent. 
You will add in this health care, this 2,000-page bill, a 5.4-percent 
surtax on those high-income earners. So if you can believe this, the 
top marginal income tax, Federal income tax rate in this country, will 
go up to 45 percent--45 percent.
  That is the highest rate we have seen in 25 years. As I said, it 
would be one thing if it were just hitting high-income individuals who 
were making more than $\1/2\ million a year, but it does not. It hits 
small businesses, small businesses that are organized as partnerships, 
subchapter S corporations, LLCs, and, therefore, file an individual tax 
return.
  So they have $460 billion of tax increases there, $135 billion in the 
pay-or-play mandate, $33 billion in tax increases through the 
individual mandate--all totaled, $752 billion in new taxes in this 
2,000-page bill that are going to be passed on and paid for by the 
American public.
  The Joint Tax Committee said of the Senate bill--by the way, this is 
the Senate version of the bill. This is only 1,500 pages. We do not 
know--as the Senator from Tennessee pointed out--what the final Senate 
bill is going to look like.
  All we know is that this is the version that was reported out of the 
Finance Committee, 1,500 pages also filled with higher taxes on 
individuals and small businesses.
  The argument was made that we will make the people who are wealthy, 
the affluent, pay for this. What the Joint Tax Committee found was that 
87 percent of the tax burden in the Senate Finance Committee bill would 
be paid by wage earners making less than $200,000 a year and a little 
over 50 percent would be paid by those making under $100,000 a year. If 
one fits into those categories, there are 46 million Americans who will 
be hit with higher taxes under the 1,500-page Senate Finance Committee 
bill as opposed to the 2,000-page House bill that passed on Saturday.
  I remind my colleagues that when we talk about a massive $3 trillion 
expansion of the Federal Government, it has to be paid for somehow. Of 
course in this case, it is paid for in the form of higher taxes and by 
way of Medicare cuts that will hit very hard on seniors, $170 billion 
in cuts to Medicare Advantage, cuts to providers such as hospitals, 
home health agencies, hospices. Everybody gets to have their 
reimbursements cut in order to finance this $3 trillion monstrosity of 
an expansion of the Federal Government.
  Having said that, it would be one thing if, in fact, the goal was 
accomplished, which is to reduce health care costs. Ironically, after a 
$3 trillion expansion of the Federal Government and three-quarter 
trillion dollars in additional taxes in the first 10 years, we don't 
see any impact on insurance premiums. In fact, they will not go down; 
they will actually go up.
  I want to read what the Congressional Budget Office said about that:

       On balance, during the decade following the 10-year budget 
     window, the bill would increase both federal outlays for 
     health care and the federal budgetary commitment to health 
     care, relative to the amounts under current law.

  That is consistent with everything we have heard so far from the 
Congressional Budget Office about the impact this bill would have on 
overall health care costs and on the premiums average Americans would 
end up having to pay.
  With respect to State governments, because something has been said in 
this bill about the expansion of Medicaid, in fact, there is a massive 
expansion of the Medicaid Program, to the point that a decade from now 
one-quarter of the entire population would be on Medicaid. This was a 
program that at one time was designed to assist poor, disabled people 
who really need assistance with health care. A decade from now, with 
this expansion of Medicaid, we would see one-quarter of the population 
on Medicaid.
  The other component of that, the element I think should be so 
disturbing to States--as we all know, Medicaid is a State-Federal 
shared responsibility. I see the Senator from Nebraska, Mr. Johanns, a 
former Governor, who knows full well about the cost of Medicaid to 
State budgets. What this bill would do is increase the amount of cost 
passed on to States by $34 billion. States are going to have to look at 
how they are going to finance this thing, probably in the form of 
additional and higher taxes.
  We have a $3 trillion expansion of the Federal Government, cuts to 
Medicare that will affect not only seniors but also most providers, and 
massive increases in taxes which will hit squarely small businesses and 
individuals, in particular individuals who make less than $100,000 a 
year. We need to do what the Senator from Tennessee suggested; that is, 
start over and do this step by step rather than a massive expansion of 
the government that raises taxes and increase health care costs.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Gillibrand). The Senator from Nebraska.
  Mr. JOHANNS. Madam President, if I may start out today and use a 
portion of my time to ask if the Senator from South Dakota would answer 
a question or two about Medicaid, the first question I have for the 
Senator from South Dakota is, when it comes to Medicaid, why would we 
be putting a mandate on States at a time when every State in the 
country is going through a difficult budget cycle? In fact, Nebraska 
literally, as I speak, is in special session to cut the budget by over 
$300 million. Why would we do that with this health care bill?
  Mr. THUNE. Madam President, that is exactly the point. Why would we 
pass on $34 billion in additional cost to States when, as my colleague 
suggested, in States such as Nebraska and South Dakota, it is on the 
front page every day about decisions made at the State level, about 
cuts that will have to occur, looking at revenue increases, with the 
economy in the difficult situation it is in? I can't imagine 
complicating that by passing on an additional $34 billion in cost that 
every Governor and every State legislature will have to deal with.
  Mr. JOHANNS. Madam President, I begin my comments and thank the 
Senator from South Dakota for answering that question. Having been a 
Governor and, for that matter, a mayor, this is a very difficult time 
back home. When I refer to ``back home,'' I refer to Nebraska, but 
every Senator could say the same. State budgets are struggling.
  Today, I rise because I believe there is another important point to 
be stressed as Senators on both sides of the abortion issue decide how 
they want to approach their vote relative to this legislation.
  We saw a clear pro-life approach when the House passed what is now 
being referred to as the Stupak amendment. That amendment is 
straightforward. It says no Federal tax dollars will pay for abortions, 
whether that is directly or through subsidies or any other means. Put 
another way: If you accept a subsidy from the Federal Government, you 
cannot use that to fund an abortion. It is clear and straightforward. 
This carries on the longstanding tradition of separating tax dollars 
from abortions.
  Now the focus is on the Senate. The House passed their legislation on 
Saturday. I have heard very little about the importance of what some 
have characterized as little more than a procedural vote. In reality, 
it is an important vote that might well become the deciding factor in 
the debate over Federal funding of abortion. Let me explain. It all 
depends on whether the

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ban on Federal funding of abortions is weakened in the Senate bill 
compared to the House.
  As I speak today, the Senate bill is being written behind closed 
doors by the majority leader and others. If their final product 
includes anything less than the House-passed ban, the critical vote for 
pro-life Senators will be their vote on cloture on the motion to 
proceed. Why? Because if the motion to proceed is successful, it will 
end, in my opinion, any chance to match the House bill's ban on using 
Federal funds to fund abortion. It is the way the Senate works, 
according to its rules. Sixty votes would be needed to change the bill 
once a motion to proceed passes. Let me repeat: 60 votes would be 
needed to change the bill once a motion to proceed passes. We all know, 
regrettably, that there are not 60 Senators who would support the House 
provision that bans Federal funding for abortions; therefore, we would 
lack the votes to close the door on Federal funding of abortions if 
this bill proceeds to the floor with a weakened approach.
  The ban on Federal funding of abortions must be a part of the Senate 
bill before debate is allowed to proceed. Don't be fooled by the claims 
that the motion to proceed to the bill is a first step in improving the 
bill; it will be the final say for the pro-life community.
  I applaud my colleagues on both sides of the aisle who have declared 
they will accept nothing less than a complete separation between 
Federal funds and abortion services. I wish to express unequivocally, I 
stand firmly with them. If we are presented with a weakened ban on 
Federal funding of abortion compared to the House version, we must vote 
against cloture on the motion to proceed to the bill. In my judgment, 
this point should be nonnegotiable.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. JOHNSON. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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