[Congressional Record Volume 156, Number 38 (Tuesday, March 16, 2010)]
[Senate]
[Pages S1576-S1577]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. KYL. Mr. President, I wish to address now the health care 
legislation we passed in the Senate and that is pending over in the 
House of Representatives.
  There is a news report that Democrats are going to use the strangest 
of all procedural tactics to try to pass the Senate health care bill 
over in the House of Representatives, and this is against a backdrop of 
a lot of strange things--the use of the reconciliation process, all the 
backroom deals that result in the various benefits for various Senators 
and Representatives--we have heard so much about.
  It almost seems Democratic leaders view the views of their 
constituents as an obstacle to be overcome, and every time the polls 
show even more opposition to the legislation, they decide to try even 
more clever ways of getting around their constituents' views--wheeling 
and dealing, backdoor legislation--but nothing quite as brazen, I guess 
I would say, as the process we now see developing. This is a process I 
became familiar with as a Member of the Senate--not when I was in the 
House of Representatives because I do not believe it was ever used 
then, although it might have been and I was not aware of it. But it is 
a process by which House of Representatives Members can actually say 
they have passed a piece of legislation without ever voting on it.
  You might say: That does not quite comport with what I learned in 
eighth grade civics class, and you would be right. We all know the only 
way a President can sign a bill is if identical versions of legislation 
pass both the House and the Senate.
  Well, the House does not want to have to vote on the Senate health 
care bill because, as the Speaker of the House said: ``Nobody wants to 
vote for the Senate bill.'' So now what they have done is concoct a way 
you can actually pass the bill without ever voting for it, and it is by 
including the substantive Senate-passed bill into the rule that as a 
procedural matter the House votes on to consider each measure. So as a 
rule to consider the reconciliation bill is brought to the House floor, 
it would contain a provision that would deem the Senate-passed bill 
passed, even though the House Members would never vote on it.
  That is wrong. It is probably unconstitutional. Any House Member who 
believes he or she can go home and say to their constituents: Well, I 
never voted for the Senate-passed bill is, frankly, not going to get 
away with it because, by voting for the rule, they will have voted for 
the Senate-passed bill.
  It seems to me this is the time for principled Members of the House 
of Representatives to stand and say: Enough. I may even somewhat like 
what we are trying to do with this health care legislation, but 
somebody has to stand for principle, and principle means, at a minimum, 
voting for legislation that you send to the President for his 
signature--not standing behind a rule which deems legislation to have 
been passed, even though it was never separately voted on.
  It seems to me, first of all, we should make it crystal clear we will 
make this famous to the American people, if in fact they decide to use 
this process--something that has never been used for a bill such as 
this before. This so-called deeming rule will become part of the 
lexicon of American political discourse, and people will come to know 
it, just like they did the House banking scandal and certain other 
things here in Washington, to represent a time period and a group of 
people who were willing to violate all rules of sensibility, of 
morality, as well as legality in order to try to accomplish ends that 
could not be accomplished in other ways.
  Nobody who votes for this rule and then later claims they did not 
have anything to do with passing this Senate bill is going to be able 
to get away with that. The American people will understand it. Frankly, 
whether they are sympathetic to the underlying health care legislation, 
they are not going to be sympathetic to Members of the House of 
Representatives who decide to do this kind of end run, this sort of 
scheme to deem a bill passed that has never been separately voted on in 
that body.
  I hope the health care legislation we have now debated for a year can 
stand or fall on its merits. The American people have made it clear 
they do not want this legislation. Twenty-five percent do, but seventy-
three percent have said either stop altogether or stop and start over. 
That is what we should be doing. Because of this wave of opposition by 
our constituents, our colleagues in the House should not try to get 
around that by using a procedure that is totally inappropriate to the 
purpose.
  The PRESIDING OFFICER. The Senator has spoken for 10 minutes.
  Mr. KYL. Mr. President, might I make a parliamentary inquiry: Is 
there more time remaining on the Republican side?
  The PRESIDING OFFICER. Fifty-one minutes.
  Mr. KYL. Thank you, Mr. President.
  What I would like to do, until Senator Grassley arrives--I first ask

[[Page S1577]]

unanimous consent to have printed in the Record a letter from Gov. 
Janice K. Brewer of Arizona, dated March 10, 2010, to President Barack 
Obama.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                 Executive Office,


                                             State of Arizona,

                                      Phoenix, AZ, March 10, 2010.
     Hon. Barack Obama,
     President of the United States, The White House, Washington 
         DC.
       Dear Mr. President: We share common ground in that we have 
     both been called to lead during some of the most difficult 
     times our nation has faced. Like you, I hear painful stories 
     on a regular basis from people who are struggling to survive.
       Yet in their time of need, our state government is on the 
     brink of insolvency.
       During this downturn, Arizona has lost the largest 
     percentage of jobs in the United States. The flagging economy 
     has resulted in a loss of state revenues in excess of 30%, 
     placing tremendous pressure on our state budget. Today, 
     Arizona faces one of the largest deficits of any state.
       There is no doubt that this fiscal calamity has been 
     compounded by the enormous spending increases we are facing 
     as a result of our Medicaid program, which has seen 
     population growth of almost 20% in the past 12 months.
       It is for that reason I write to you today.
       You have repeated on several occasions that the debate on 
     health care reform has consumed the past year and you most 
     recently called on Congress to vote the measure ``up or 
     down''. As the Governor of a state that is bleeding red ink, 
     I am imploring our Congressional delegation to vote against 
     your proposal to expand government health care and to help 
     vote it down.
       The reason for my position is simple: we cannot afford it. 
     And based on our state's own experience with government 
     health care expansion, we doubt the rest of America can, 
     either.
       Arizona is one of a few states that have pursued health 
     care policies similar to those that you are proposing for the 
     nation. In 2000, Arizonans voted to provide health care 
     coverage up to 100% of the federal poverty limit for all 
     residents, including childless adults, through the expansion 
     of the state's Medicaid program.
       While the expansion resulted in a modest reduction in the 
     state's uninsured rate, the voters did not earmark adequate 
     funding for the expansion and, as a result, our expenditures 
     have become unsustainable, exploding from $3.0 billion to 
     $9.5 billion during the past decade. Based on our state's own 
     experience with underfunded government health care programs, 
     Arizona can serve as a case in point for what will happen 
     across our nation if your proposal is enacted.
       Even with generous and enhanced federal matches, as well as 
     recognition as one of the country's best Medicaid models, the 
     program today demands nearly one in five state dollars. As a 
     result, we find ourselves even more limited in our ability to 
     invest in other critical state services, such as education 
     and public safety, not to mention job creation and other 
     economic development activities.
       Unfortunately, your proposal to further expand government 
     health care does not fix the problem we face in Arizona. In 
     fact, it makes our situation much worse, exacerbating our 
     state's fiscal woes by billions of dollars. Following are 
     some of Arizona's concerns:
       Makes Arizonans pay twice to fund other states' 
     expansions--Your proposal continues the inequities 
     established in the Senate bill with regard to early expansion 
     states. While there is some mention of additional funding for 
     states that have already expanded coverage, it is clear it 
     will not fully cover the costs we will experience as a result 
     of the mandated expansion. Therefore, Arizona taxpayers will 
     have the misfortune to pay twice: once for our program and 
     then once more for the higher match for other states.
       Makes states responsible for financing national health 
     care--In addition, your proposal, as well as the Senate bill 
     it is based on, effectively terminates the partnership that 
     has existed with the states since the inception of Medicaid. 
     For 28 years, Arizona and the federal government have been 
     partners in administering the Medicaid program. States have 
     been provided with important flexibility to develop and 
     create programs that work for their citizens. However, under 
     your proposal, more power is centralized in Washington, DC, 
     and the states become just another financing mechanism. Not 
     only will states be forced to pay for this massive new 
     entitlement program our ability to control the costs of our 
     existing program will be limited. These policies are simply 
     not sustainable, and will result in a greater burden on state 
     budgets and state taxpayers.
       Creates a massive new entitlement program our country 
     cannot afford--Your proposal creates a vast new entitlement 
     program that our country does not have the resources to 
     support. Our nation faces trillion dollar deficits far into 
     our future. Medicare has an unfunded liability of $38 
     trillion, and physicians are destined to realize a 21 percent 
     decrease in Medicare reimbursement until Congress finally 
     accounts for the $371 billion in additional costs associated 
     with their rates.
       Mr. President, I am concerned that Washington does not 
     recognize the fiscal realities states are facing, and likely 
     will continue to face, for several years to come. Our country 
     is living beyond its means and the federal government is 
     leading the way by its example.
       As Governor, it has been a painful process to move the 
     State towards fiscal sanity. I have even proposed a temporary 
     revenue increase, something I have never done in my 28 years 
     of public service, to help mitigate impacts to education, 
     public safety, and health services for our most extremely 
     vulnerable citizens. Though Arizona's budget deficit is not 
     of my creation, I am firm in my determination and 
     responsibility to resolve it. I believe we have a moral 
     imperative as leaders to not bankrupt and diminish the 
     capacity of future generations.
       I understand that there are tremendous pressures to show 
     some progress on health care given the time and effort that 
     has been spent to date on this important issue. Indeed, 
     improving access to quality health care is a laudable goal. 
     However, the approach being taken by your administration has 
     been proven by states like Arizona to be unsustainable in the 
     long run.
       Mr. President, I humbly request that you heed Arizona's 
     experience and reconsider your proposed policies that will 
     further strain already overburdened state budgets.
       Thank you for your consideration, and for your tireless 
     efforts on behalf of our citizens.
       Yours in service to our great nation.
           Sincerely,
                                                 Janice K. Brewer,
                                                         Governor.

  Mr. KYL. Let me briefly describe the reason for this request.
  Arizona is suffering, as are other States, from the economic 
downturn. We have an unemployment rate now that has more than doubled. 
In fact, it has gone from 3.6 percent in June of 2007 to 9.2 percent 
this month. Our State faces a $1.4 billion shortfall in the current 
fiscal year and a $3.2 billion shortfall for the next fiscal year, 
despite the fact that the Governor and the State legislature have 
imposed significant spending reductions.
  State revenues are down by 34 percent. Notwithstanding this, over 
200,000 Arizonans have enrolled in the State's Medicaid Program, known 
as AHCCCS--which is our Arizona health Care Cost Containment System--
just since the beginning of 2009. That is nearly 20,000 new enrollees 
every month. The last thing, given these kinds of numbers, Washington 
should be doing is making the States' economic or fiscal problems even 
worse. Yet that is exactly what Governor Brewer says the Senate health 
care bill would do because it would require every State to expand its 
Medicaid Program.
  The Federal Government would foot the bill for 3 years. Then the 
States would have to help finance the expansion in 2017 and in 
subsequent years. She estimates the bill would increase the cost in 
Arizona by nearly $4 billion over the next 10 years. Making matters 
worse, the early expansion States--States such as Arizona that have 
already expanded Medicaid to cover the uninsured, as I noted--will 
actually get fewer Federal dollars than the States that have not yet 
expanded their Medicaid Programs, in effect punishing those who have 
tried to do the right things--the exact things Democrats have wanted in 
the health care bill.
  As she observed in her letter:

       Arizona taxpayers will have the misfortune to pay twice: 
     once for [Arizona's] program and then once more for the 
     higher match for other states.

  Additionally, States currently retain important flexibility in 
administering their Medicaid Programs so they are not caught off-guard 
as the economy changes. But as Governor Brewer notes, that flexibility 
would be eliminated under the Senate bill. She says:

       Under your proposal, more power is centralized in 
     Washington, DC, and the states just become another financing 
     mechanism. Not only will states be forced to pay for this 
     massive new entitlement program, but our ability to control 
     the costs of our existing program will be limited. These 
     policies are simply not sustainable, and will result in a 
     greater burden on state budgets and state taxpayers.

  Mr. President, since I put the letter in the Record, I will not 
reflect further on it but note the fact that this is yet one more 
reason for Members to oppose the Senate-passed bill in the House.
  The PRESIDING OFFICER. The Senator from Iowa.

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