Congressional Record, Volume 156 Issue 34 (Wednesday, March 10, 2010)

[Congressional Record Volume 156, Number 34 (Wednesday, March 10, 2010)]
[Senate]
[Pages S1324-S1327]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE

Mr. JOHANNS. Mr. President, I rise to speak to the Senate health care
bill and to talk a little bit about some of the issues related to that
bill, in terms of financing and scoring and, to be very candid, about
some of the accounting gimmicks that try to hold this bill together. I
will be joined by Senator Wicker and Senator Barrasso in this colloquy.
Let me get started.
If you start to study the bill, and for many of us who have served in
other capacities--myself as Governor and as a mayor--the first thing
you want to do is ask yourself: Does it work? Is the financing of this
bill such that it makes sense? Is it an honest portrayal of the income
you expect and the expenses you expect? Certainly, that is where I
start and, I suggest, many of my colleagues start.
The one thing about this health care bill that struck me immediately
and struck others is, first of all, there are 10 years of tax
increases. They total over $\1/2\ trillion--a massive amount of tax
increases.
The second thing you see is, there are 10 years of Medicare cuts,
again about $\1/2\ trillion total. You do those things and some other
things and it pays for 6 years of spending because even though some of
the issues relative to this health care bill kick in initially, the
vast majority of it does not kick in for 3 or 4 years.
When you put that all back together, you begin to realize what you
have is a health care bill that costs about $2.5 trillion over a 10-
year score.
Then you start working through a whole bunch of other issues. You
have a Senate bill that takes $52 billion in higher Social Security
taxes and revenues and counts them as offsets. That would be money
normally reserved for the Social Security trust fund. You look at the
CLASS Act. One Member of this body--a Member who is very respected for
what he has done relative to budgeting--called this a Ponzi scheme.
The CLASS Act was initially opposed by our friends on the other side
or by leading Democrats. But it is back alive. It is included in the
Senate bill. It is another Federal entitlement that is going to create
an insolvency problem very quickly. It takes money from premiums that
are supposed to go for benefits and uses them as offsets and pay-fors.
CMS experts have looked at this, and they reached a conclusion that
is reliable. They said the CLASS Act faces ``a significant risk of
failure,'' and then said, and may lead to ``an insurance death
spiral.''
Our friends on the other side claim the bill will simultaneously
extend the solvency of Medicare and then magically decrease the
deficit. But the reality of that, again, comes from CMS actuaries who
say: Well, wait a second here, that is double-counting. You can't use
the same dollar twice. You can't count it twice. CMS concludes that the
Medicare cuts in the legislation cannot be simultaneously used to
finance other Federal outlays, such as coverage expansions under this
bill or to extend the trust fund.

So when you cut all the way through this and see what is happening
here, it doesn't hold together. This is a financial plan that is built
upon sand, and you can almost guarantee it is going to collapse.
So let me, if I might, ask my colleague, Senator Wicker, what he
thinks of all of this. Can he offer some thoughts as to where this bill
is headed and the financial mechanisms of this bill?
Mr. WICKER. I appreciate my colleague from Nebraska getting into the
weeds because it is important that we know the details of the numbers
here. I think there is also a sort of big-picture aspect to this. There
are a lot of Americans out there who may not have read the details the
Senator from Nebraska just outlined, but they instinctively know you
can't do all this to one-sixth of our economy and save money for the
Federal Government at the same time. They instinctively know this is
going to turn out, as big entitlement programs always do, to be more
expensive than has been estimated and it is going to cost the American
taxpayer and future generations in terms of the national debt.
I would like to pivot and talk about what this is going to do to
State governments because that is an additional aspect over and above
the gigantic numbers the Senator from Nebraska mentioned.
Really, almost half of the additional coverage in this Senate bill,
which the House is being asked to adopt lock, stock, and barrel without
even changing so much as a semicolon, half of the coverage is going to
be under Medicaid. We all know Medicaid requires a huge Federal
investment, but Medicaid also always requires a State match. Under the
provisions of this bill, if it is enacted, States will be told that the
magnificent Federal Government has increased coverage, and now, Mr.
State Legislator, Mr. State Governor, you figure out a way to pay your
part of it.
I know this much: In my State of Mississippi, our legislators and our
Governor have had to stay up late 2 years in a row figuring out a way
to pay for the Medicaid match they are already being asked to pay, much
less this new mandate of additional persons who would be covered under
this Senate language. There is no way the State of Mississippi can
stand this new Medicaid coverage without an increase in our taxes at
the State level. I don't think we can cut teachers enough, although
teachers might have to be cut to pay this Federal mandate. I don't
think we can cut local law enforcement enough, although that might have
to be cut too. It is just a huge, unfunded burden on the States. Quite
frankly, even if all of the promises that are being made on the Senate
side come true--that we will clean this up in reconciliation, which I
frankly doubt can possibly happen--the States are going to be faced
with this huge unfunded mandate.
You don't have to take our word for it on this side of the aisle.
Democratic Governor after Democratic Governor has had press
conferences, they have sent letters, they have sent messages, they have
made themselves available to the press. Governor Bredesen of the State
of Tennessee said this bill is the ``mother of all unfunded mandates''
and has urged, even at this late date, that we not go down this road.
So I appreciate my friend from Nebraska pointing out what this is
going to do to the Federal budget, and I would simply commend the
bipartisan State officials who have been talking to anyone within the
sound of their voices saying that State governments cannot afford this
mandate at the State level, and it will inevitably result in an
increase in taxes at the State level--something we certainly don't need
at this time of economic hardship.

[[Page S1325]]

Perhaps Senator Brownback has some thoughts he would like to add, and
I know others may be joining us, too, Mr. President.
Mr. BROWNBACK. I appreciate my colleagues allowing me to join in this
colloquy because it is incredibly important and I believe the American
public believes it is incredibly important because, if for no other
reason, they are looking at it and saying: We don't want this bill. We
don't think this bill is the right way to go. We don't think this
procedure is the right way. So they oppose it on process and they
oppose it on product. And you don't have to believe me. Listen to these
poll numbers: 68 percent say the President and the congressional
Democrats should keep trying to work with Republicans to craft
legislation.
By the way, that big, all-day-long meeting at Blair House to talk
about this, where we put forward a series of ideas, virtually all of
them were rejected--a bipartisan incremental compromise, which is much
more the way the American public wants to go.
A Rasmussen poll says that 57 percent of the voters say the health
care reform plans we are discussing in Congress will hurt the U.S.
economy. Only 25 percent think it will actually help. And 66 percent
believe the health care plan proposed by President Obama and
congressional Democrats is likely to increase the Federal deficit. Do
you know the reason they think that? Because it will. This is going to
increase the Federal deficit.
On top of all that, there is a big intangible here. If this bill
passes, the rest of the world is watching to see if the United States
passes this big increase--an entitlement program--when we are running
$1.5 trillion in deficit and have a $12 trillion debt that is 90
percent of the size of our total economy. They are watching and they
are saying: If the United States does this now, they are not serious
about getting their budget under control. They are going to start
pulling dollars out of the U.S. economy and putting them in other
places. It will make it harder for us to raise capital, it will
increase interest rates, and it is going to hurt the U.S. economy. And
that is a near-term thing that is going to happen because people are
watching this.
I might note the ``Saturday Night Live'' routine where China's
President, Hu Jintao, is lecturing President Obama about how he is
going to get the budget under control by passing a big new entitlement
program. I don't usually cite ``Saturday Night Live,'' but in this case
it lands a little too close to home. And people are saying: Yes, this
doesn't make any sense to me either. This is going to hurt.
The front page of the Wall Street Journal has an article about what
Ireland is having to do to get its budget under control, Greece is a
mess, and our deficit and debt is skyrocketing.
If we pass this, this is going to hurt us in the near term as far as
the cost of raising the capital we need in this economy. It will hurt
States that are really struggling as well. It is a bad idea at a bad
time.
I am glad my colleagues let me join them, and I note that the doctor
is in--the Senator from Wyoming--to help us dissect this bill as well.
Mr. BARRASSO. Well, Mr. President, that is exactly what I am hearing
at home from Wyoming's voters and from my patients. I was in Wyoming
this past weekend. I have had the privilege of practicing medicine
there for 25 years, taking care of families in Wyoming. When I talk to
people, their concerns are the national concerns the Senator from
Kansas has just mentioned--the debt and what our Nation is facing long
term. But they are also very focused on their own personal care. If you
have a town meeting or just talk to people at the coffee shop, the
people of America believe that if this bill passes, the quality of
their own personal health care will go down; that their opportunity to
go to the doctor they have enjoyed a relationship with for years, where
they know them and they know their family, may be gone.
We are also seeing that health care providers all across the
country--even the Mayo Clinic--are saying this bill is a huge lost
opportunity. It was supposed to be designed to help get the cost of
care down, and it is not doing that. It is going to raise the cost of
care. It was designed to improve the quality of care, but it is going
to cost people the quality of their own health care. That is why
Americans don't like this bill. They do not like anything about it.
The Mayo Clinic was used early on by the President in this debate as
the model for how we should have health care in this country. The Mayo
Clinic has said ``no thank you'' to patients on Medicare in Arizona,
``no thank you'' to patients on Medicaid. Yet the President plans to
push this program through. He says he is going to provide coverage for
more Americans, and he is going to do it by putting 15 million more
people on Medicaid--a program that many doctors won't see because the
reimbursement is so low. If all a provider saw were Medicare patients,
they couldn't afford to keep their doors open--not at the hospital or
the clinic. And we are hearing that from hospitals and doctors across
the country. That is why the Mayo Clinic said: No thank you, Mr.
President. We can't take those patients, whether it is Medicare or
Medicaid.
This bill will cut Medicare--the program our seniors depend upon--by
$500 billion for patients who depend on Medicare. It cuts Medicare
Advantage, and that program is an advantage, and the reason people
signed up for it is because it provides preventive care and coordinated
care. But it is not just that; there will be $135 billion in cuts to
hospitals in all our States and communities, $42 billion to home health
agencies. These are the folks who help provide a lifeline for people
who are at home, and it saves money by keeping them out of the
hospital. There are cuts to nursing homes, to hospice providers--
providing services to people in the final days of their lives. That is
why the American people are offended that this bill is being crammed
through.
I see we have the former Governor of Nebraska here on the floor, who
has experienced these issues with Medicaid, with Medicare, and with
nursing homes. So I would ask my friend and colleague whether this the
same thing he is hearing at home in Nebraska.
Mr. JOHANNS. This is exactly what I am hearing at home in Nebraska,
Mr. President.
As a former Governor, as the Senator from Wyoming points out, you
deal with these programs every day. You are trying to figure out how to
fashion a State budget that deals with Medicaid. I said a few weeks ago
that I don't know whom the folks who wrote this bill were talking to
because if you look at the expansion of health care to people in this
bill, really what they are doing is expanding Medicaid by about 15 to
18 million individuals.
The Senator from Wyoming hit the nail on the head. You already have
serious access problems with Medicaid. What do I mean by that? As the
doctor, Senator Barrasso, said, doctors cannot practice on the Medicaid
reimbursement. They would literally go broke. Our little hospitals in
all of our States, our critical access hospitals, would say: We cannot
keep our doors open on Medicaid reimbursement. They can't do it on
Medicaid or Medicare reimbursement. So what is the solution? Well, the
solution certainly isn't adding 15 to 18 million more people who will
walk into a hospital or a doctor's office and who will hear: Sorry, we
don't take Medicaid patients because we can't afford to do that.
The other thing I want to mention, if I might--and then I am going to
ask Senator Wicker to comment on some of these questions also--because
this is a very important point, is that all of a sudden we are starting
to hear a lot of discussion from the White House on down about how we
have to get a handle on cost. And I think they have communicated that
well because, quite honestly, the American people get it. They
understand that if you don't have an impact on cost, you are not going
to get anywhere with health care reform.
My colleagues will remember that we sent a letter to the CMS
Actuary--this is an actuary employed by the Federal Government--and we
said: Take a look at this bill and tell us what you think in these
respects, and one of the respects was health care costs. Let me quote
from that report:

Overall health expenditures under this bill would increase
by an estimated total of $222 billion.

Compared to what? Compared to doing nothing. If we did nothing, we

[[Page S1326]]

would have a better impact on health care costs than this bill is going
to have.
After spending $2.5 trillion, after cutting $\1/2\ trillion out of
Medicare, after raising taxes over $\1/2\ trillion, the CMS Actuary
says to us: After you have done all those things, the overall health
expenditures under this bill would increase by an estimated total of
$222 billion versus doing nothing.
I ask Senator Wicker, is that the kind of health care reform he is
hearing the people back home want?
Mr. WICKER. The people back home want health care reform, but they
certainly want the kind that is going to lower health care costs and
lower health care premiums. The Senator mentioned CMS. It may be that
some people within the sound of our voices do not realize this is a
part of the administration. This is not some outside business group
that has an ax to grind. The actuaries at the Centers for Medicare and
Medicaid Services are called on to tell us the numbers as they see
them. They had no choice but to answer the question accurately and the
question is not one that lends itself to getting public support for
this plan. I think that is why the poll numbers Senator Brownback
mentioned are there. There is only about 25 percent of the American
public that believes at this point we should pass this huge Senate bill
lock, stock, and barrel and send it to the President for his signature.
Senator Barrasso mentioned the $\1/2\ trillion cut in Medicare. We
spent a little time in December debating whether actually there was a
cut in Medicare. Some of our friends on the other side of the aisle
suggested this--the programs that were cut should not be considered
part of the Medicare Program.
Obviously, there is one Democratic Senator who thought so much of
these cuts in Medicare that he got an exemption for his State. That is
what the minority leader has been calling the ``Gator aid.'' Florida,
under the Senate bill--the bill the House is being asked to pass in its
entirety without changes--the Senate bill says we are not going to cut
Medicare Advantage for the State of Florida.
Why the people of the State of Florida are more deserving of Medicare
Advantage and Medicare benefits than the people of Wyoming or
Mississippi or Kansas or Nebraska, I do not know. But somehow the
majority, 60 Members of this Senate, in their wisdom, believed Medicare
was a good program and Medicare Advantage was a very good program for
the people of Florida.
By the same token, I guess the Democratic Senator from Nebraska has
now repudiated what was known as the ``Cornhusker kickback,'' which was
basically saying Nebraska would not have to pay for their share of this
huge Medicaid mandate; all the other States would. Somehow that State
was singled out. Apparently, the people of Nebraska rose in horror at
being singled out for some sort of favor the other people in America
were not getting, so that is being proposed to be changed.
I ask Senator Johanns, if the House votes on this next week, they
will not have a chance, will they, to take that out? The only choice
the House is going to have is to vote for the ``Cornhusker kickback,''
the ``Gator aid,'' the ``Louisiana purchase,'' these special deals for
labor unions, and all that will be sent to the President to be signed
into law and will be part of the statute.
That is the way I understand the Democratic procedure. I ask Senator
Johanns, am I correct?
Mr. JOHANNS. I believe the Senator is correct. Let me offer a
thought, if I might. I think others--maybe I will turn to Senator
Brownback next. If this were a great bill, if this were the kind of
legislation you wanted to take home and go out there and champion and
maybe, if you are up for election, campaign on, then you would not have
to go through all these gyrations and gimmicks and somersaults and
cartwheels to try to get this darn thing passed. But that is exactly
what is happening.
I cannot wait to get up in the morning and run down and turn on the
computer and see what the latest is, because they are, over there at
the House, but they finally figured out that the only way to get this
terrible policy enacted is to pass the Senate bill with all its warts
and moles and ugliness and special deals and whatever. They have to
pass it without pulling a dotted ``i'' out or a crossed ``t.'' They may
be able to say back home: Folks, I didn't support that. What I wanted
was the reconciliation package that would fix all these things. All I
can say is reconciliation was never designed for this. This is not what
reconciliation was designed for. Reconciliation was designed to bring
down the budget deficit. What is happening over in the Senate are more
somersaults, more gyrations, more cartwheels to figure out how to
shoehorn this terrible piece of policy into a rule for which it was
never designed.
Now you are going to end up this day, I guess, where we all show up
and literally you have rulings on what you can do with reconciliation
and what you cannot do. So no House Member can go home and say I voted
for this awful piece of legislation, but we are going to be saved by
reconciliation. Do you know what. Maybe you will, maybe you won't. The
reason why that question cannot be answered today is because
reconciliation was never designed to take control of one-sixth of the
economy; it was never designed to do what folks are trying to do.
Let me wrap up with this, and then I would like to hear Senator
Brownback's thoughts. Enough of the somersaults, enough of the
cartwheels, enough of trying to figure out how many angels fit on a pin
and what size razorblade is going to divide the hair. This is
craziness. This is terrible policy. Please stop now. The country is
begging us to stop and start over with a thoughtful process.
If there were a great bill, we would not be going through this. There
would be bipartisan support such as there has been on many tough issues
through the decades of our history. But, you see, this is not a good
bill. This is a terrible bill. The bottom line is, they are going to
try to fix it with a process that was never designed for this purpose.
I would like to hear the thoughts of Senator Brownback.
Mr. BROWNBACK. We were on the floor in December, the longest
continuous session in the history of the Senate, 25 continuous days,
and we were talking about this and my colleague from Nebraska and I
were joined by our colleague from Utah, Senator Hatch, who has been
around a long time and part of a lot of health care reform legislation.
His point is, if you follow the normal order and work it through a
committee and bipartisan process, almost every health care bill he has
been a part of--and there have been a number of substantial ones--gets
75 votes in this body. People want to support health care reform on a
good bill. They will support it. It will be bipartisan. We are all for
health care. But now you have a bill that is going to be completely
partisan, on one side, not supported by the American public, and then
you are having to jimmy rig a process to try to figure out how we set
this up to do it.
Even Kent Conrad, the chairman of the Budget Committee, who is a
Democrat, says:

Reconciliation cannot be used to pass comprehensive health
care reform. It won't work. It won't work because it was
never designed for that kind of significant legislation.

My experience is, if you try to do something that is not designed to
do this, you are going to get a flawed product and flawed process that
people are going to be mad about. It will hurt this body. I think it
will be very harmful to this country to do this and it should not be
done.
After all the time we spent in December, 25 continuous days in
session, I think the American people spoke when they had a
Massachusetts election and elected Scott Brown. It was clearly about
health care reform.
I know my colleague from Wyoming has been all over speaking about
this on television, getting a lot of feedback from people. He probably
is getting the same sort of feedback that I have, about don't do this.
It wasn't designed to be done, this sort of health care reform, in a
reconciliation process.

Mr. BARRASSO. I heard that just this morning. We had a number of
county commissioners from Wyoming here in Washington. They were at a
speech yesterday given by Speaker of the House Nancy Pelosi, and she
told these county commissioners, this group from all around the
country, we

[[Page S1327]]

need to first pass the bill so then later the American people will know
what is in it. She said this to them and they laughed. They laughed at
the Speaker of the House at this meeting yesterday because these are
county commissioners. They know they are not going to vote on something
the people in the community don't know about. The people in the
community come, they want to know what is going to be discussed and
then voted on.
The people of America do not know what is in this bill. They know
this bill is going to raise taxes by $500 billion. They know this bill
is going to cut Medicare for our seniors who depend upon Medicare by
another $500 billion. They know they are going to be paying for this
thing for 10 years, but there are only 6 years of services. It is
amazing how much the people of America know about the gimmicks of this
bill that, in fact, those who are pushing the bill wish they didn't
know.
That is why three out of four Americans say stop. A quarter of them
say stop, a quarter of them say stop and start over, and only a quarter
of them support what is happening here.
Mr. WICKER. If I can interject, I think that was a very telling
remark from the Speaker of the House yesterday, and if someone didn't
catch that, she said we need to pass the bill so we can then find out
what is in it. The comments are out there on the Internet for the
American people to see. I would like to quote Senator Lamar Alexander
about this entire process. He said:

What the President is doing is asking House Democrats to
hold hands, jump off a cliff, and hope Harry Reid catches
them.

I don't know that Harry Reid will be able to catch them. I will say
this. If there are budget points of order that need to be waived in
this scheme the majority leader has about cleaning up this statute in
conference, I am not going to be a part of 60 votes to waive that point
of order. It will all be on Mr. Reid and his teammates over there to
get this done because I will not be a part of waiving points of order,
helping them get to a supermajority to clean up something, even if it
needs to be done.
This process needs to be stopped, and I would say the next 10 to 14
days are going to tell the tale. The American people do not want this
bill, and it is up to the House of Representatives and to us, saying
what we can on the Senate side, to see if we are going to listen to the
people and stop this bill, go back to the drawing board and try
something that works.
Mr. BROWNBACK. I join my colleague from Mississippi. I would note
that is the case, and why is it the Speaker is saying we have to pass
the bill to see what is in it? They are going to hold it back until
they break enough arms to get a majority vote and then pop it out and
then there will be an hour's debate on one-sixth of the economy being
changed. We saw that same procedure when Majority Leader Reid was
crafting this bill behind closed doors and nobody knew what was in the
bill and then popped it out when you have the deal, when you made
enough deals, broken enough arms, then we can pass this. That is no way
to have a process like this. That is no way to effect this big a piece
of the economy that touches every American's life in the process.
I urge the Speaker not to do something like this. Listen to the
American public and follow normal order. They could send this back to
committee, to the Finance and the HELP Committees, work a bipartisan
agreement on this, say we have to hit this number or that, let's do an
incremental approach and come out with a bill that would have 75 votes.
That is doable.
We put forward a whole bunch of ideas at the Blair House. Here are
different things we would support. Put out a long day of discussion.
That is the normal order that produces good legislation that will stand
the test of time. This will not stand the test of time, and it is going
to bankrupt the country.
Mr. JOHANNS. If my colleagues will permit, let me offer a few closing
thoughts. I so appreciate the opportunity to be on the floor with them.
It was not that long ago that our President of the United States
actually was a Member of this body. He was a Member of the Senate. It
just seems, from time to time, we are asked to comment on the 60-vote
rule. He was asked to comment on that. Here is what he said. ``Removing
the 60-vote threshold would change the character of the Senate
forever.''
He went on to say having majoritarian absolute power on either side
was ``not what the Founders intended.''
The thing about reconciliation is this: It limits debate, it is a
very abbreviated process, and it just comes in and says you are only
going to get 20 hours of debate. Very limited. The second thing is it
only takes a majority vote.
From time to time this issue pops up. But you do not have to study
the history of this great Nation very long to understand what our
Founders were doing. The House is a majority body. Now, States such as
Kansas and Nebraska do not fare very well in that. We do not have a lot
of Members. We are never going to have as many Members as California,
New York, or New Jersey. So literally on every vote you could find
yourself losing.
Our Founders understood that. They came up with an idea for a very
unique body, a body that would be an equalizer. Every State got two.
Every State got two Members. But the important thing about this body
was this: that as issues were passed on the House side by majority
vote, over on this side it was anticipated that something more would be
required to cause the Members to come together and try to work through
the Nation's difficult problems.
Initially there was no way to stop debate. Then about 1915 it was
decided that a two-thirds vote would stop debate. Then, in the mid-
1970s that was changed to 60 votes. That 60 votes is an important
limitation on the power of the Federal Government to impose its will
upon the people.
I will wrap up my comments today by saying this: The will of the
people here is very clear. They do not want this bill. They see this as
a massive government takeover of their lives. They have spoken very
clearly and eloquently in our townhall meetings, in elections that have
occurred, and they have said: We want you to go back and work through
your differences and come up with a bipartisan approach.
Yet if reconciliation is used, you will not only change the character
of this body, you will change how our government operates. If you can
pass this bill through a reconciliation process, you can do anything,
and you end up with literally a system that is vastly different than
was ever intended and a system, in my judgment, that is not good for
the future of our great Nation.
With that, let me wrap up and say again to my colleagues, I
appreciate the opportunity to be on the Senate floor with you today.
I yield the floor, and I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Burris.) The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. ENSIGN. I ask unanimous consent that the order for the quorum
call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

____________________