[Congressional Record (Bound Edition), Volume 155 (2009), Part 12]
[Senate]
[Pages 16197-16200]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            MORNING BUSINESS

  The ACTING PRESIDENT pro tempore. Under the previous order, there 
will now be a period of morning business for 1 hour, with time equally 
divided and controlled between the two leaders or their designees, with 
Republicans controlling the first half and the majority in control of 
the second half, with Senators permitted to speak for up to 10 minutes 
each.
  The Senator from Nebraska is recognized.
  Mr. JOHANNS. I thank the Chair.
  (The remarks of Mr. Johanns pertaining to the submission of S. Res. 
206 are located in today's Record under ``Submission of Concurrent and 
Senate Resolutions.'')
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee is 
recognized.
  Mr. ALEXANDER. Madam President, how much time is remaining on 
Republican time?
  The ACTING PRESIDENT pro tempore. There is 18 minutes remaining.
  Mr. ALEXANDER. Thank you, Madam President. Will you please let me 
know when 4 minutes remain?
  The ACTING PRESIDENT pro tempore. The Chair will do so.
  Mr. ALEXANDER. Madam President, let me talk about a threat to the 
middle-class family's budget, and that is health insurance. How do we 
pay for health care? I do not have to explain to anyone who might be 
listening or reading these remarks that health care, for most 
Americans, is a cost that is difficult to afford.
  It is difficult for most small businesses. We have many large 
businesses who are having a difficult time competing in the world 
marketplace because of health care costs. We think of the auto industry 
in Detroit which has claimed that the legacy costs of health care have 
put them out of business, unable to compete, even with car companies 
that locate in the United States and make cars here employing American 
workers.
  So we on the Republican side, like our friends on the Democratic 
side, want health care reform this year. President Obama is going to 
town meetings and saying what he is for. He is saying: Let's do it this 
year. He is saying: Let's make sure we cover the 47 million Americans 
who are uninsured. He is saying: Let's make sure we can afford it.
  ``We do not want more debt,'' the President is saying. We certainly 
agree with that. He already has proposed, over the next 10 years, more 
new debt than it cost to wage all of World War II according to the 
Washington Post. So we agree with him, we do not want any health care 
bill that creates more new debt. We do not want a health care bill that 
puts more new taxes on States as they pay for State-operated health 
care programs such as Medicaid.
  We want to make sure that Americans who like their insurance are able 
to keep the insurance they have. About 177 million Americans have 
employer-sponsored health insurance which they like. They like the 
quality of the health care they get. We do not want to think about the 
47 million who are uninsured, we want to think about all 300 million 
Americans.
  We Republicans agree with the President. We want health care reform 
this year. We want a health care plan that you can afford. We want a 
health care plan your Government can afford, so your children do not 
get a big debt piled on top of them, and we want to make sure all of 
the uninsured are covered as well.
  We want to make sure, on this side, that Washington does not come in 
between you and your doctor. In other words, you and your doctor make 
the health care choices, not some Washington bureaucrat who might cause 
you to wait in line or deny treatment that you and your doctor think is 
needed.
  So how does the Senate bill that we are working on stack up with the 
President's ideas that we should cover everybody, be able to pay for 
it, and allow people to keep their insurance? Well, I am very 
disappointed to report that, according to the Congressional Budget 
Office, which is the nonpartisan agency in the Congress--and the 
Congress, of course, is majority Democratic, by a large margin--has 
given us some very disturbing information about the bill we are working 
on in the HELP Committee, a place that I am about to go in a few 
minutes to continue considering parts of the bill, since we only have a 
little bit of the bill that we are being asked to consider.
  Here is what we know about cost: The Congressional Budget Office has 
said that in the first 10 years of the partial Kennedy bill which has 
been presented to us, it would add over $1 trillion to the debt, the 
national debt, $1 trillion.
  Senator Gregg of New Hampshire, who is the ranking Republican on the 
Budget Committee, has pointed out that once the health care program 
envisioned in the Kennedy bill is up and going, that over a 10-year 
period, say years 5 through 14, it would be $2.3 trillion added to the 
debt, a debt that already has more new debt in the next 10 years, 
according to the Washington Post, than we spent in all of World War II 
in today's dollars.
  People in Tennessee and across this country are saying: Whoa. Wait a 
minute. This is getting out of control. We need some limits. We know 
you have got a printing press there in Washington, DC, but our children 
and grandchildren and even we are going to pay the consequences if we 
do not have some limits on the amount of debt.
  I would think the President would say to the Senators who are working 
on this: Wait a minute, Senators, I said this needs to be something 
that pays for itself. We cannot add $2.3 trillion.
  That is not all. We do not even have all the Kennedy bill. Some of 
the most important parts are yet to come. Some of the most expensive 
parts are yet to come. The assumptions that we are left to work with--
because we hear them discussed--is that there will be a big expansion 
of the Medicaid Program that States help to operate and help to pay 
for, usually about 40 percent of the cost, and an increase in the 
reimbursement rates that go to doctors and hospitals who participate in 
the Medicaid Program.
  What would that cost? Well, in the State of Tennessee, if we increase 
Medicaid eligibility to 150 percent of the poverty level, which sounds 
pretty good, that adds about $600 million to the State cost of Medicaid 
in Tennessee.
  If we increase the Medicaid reimbursement rates, that adds another 
$600 million to the State costs of Medicaid. When the stimulus funding 
goes away after 2 years, which was sent to the States to help pay for 
Medicaid costs, that is another $600 million.
  Now we throw so many dollars around up here that it is hard to say 
what is important. But to give you one idea of what would happen if a 
Senator went home to be Governor and had to manage a Medicaid Program 
that expanded that much and were faced with a $1.2, $1.5, $1.8 billion 
new State cost about 2015, where would he or she get that money? A 10-
percent income tax in our State would raise about $1.2 or $1.3 billion. 
So the costs we are talking about adding to States are astronomical. 
Most States are having a difficult time even balancing their budgets 
this year, some nearly bankrupt--think of California--and add to that 
huge new Medicaid costs, as well as a Federal addition to the debt of 
$2 or $3 trillion. It

[[Page 16198]]

is an unimaginable prospect and totally inconsistent with what 
President Obama has said, who said very sternly to Congress 2 or 3 
weeks ago: We need pay as we go. If we are going to spend a dollar, we 
need to save a dollar or we need to tax a dollar. So we would have to 
raise or save $2 or $3 trillion to pay for the Kennedy bill, as we know 
it, and if you live in a State that has increased Medicaid costs, you 
could have, depending upon what these provisions say, huge new State 
taxes to pay for it.
  That bill gets an ``F'' on the first aspect of the President's 
request, cost, and debt.
  The second is that we cover the 47 million uninsured. Unfortunately, 
even though we add perhaps $2 to $3 trillion to the Federal debt, and a 
lot of new State taxes, the bill we are considering in the Senate HELP 
Committee will only cover 16 million more people who are not now 
insured.
  In other words, we would reduce the uninsured from 47 to 30 million. 
We would have 30 million people left even though we added $2 or $3 
trillion to the Federal debt and a lot of new State taxes. I think that 
is a flunking grade as well for this bill.
  Then what about allowing you to keep your insurance if you like it? 
Well, the Congressional Budget Office also had something to say about 
that. It said: If the Kennedy bill, as it is presently, were enacted, 
about 15 million people would go from private insurance that they now 
have to an existing or a new government-run health care plan.
  You might do that because you choose to, or you might do that because 
your employer says: I think I will quit offering the insurance you now 
have.
  So this does not seem to fit what the President is suggesting we do. 
With all respect, I know that there has been a lot of hard work done on 
this bill, but we need to stop and start over even to get close to the 
President's own objectives.
  Let's take the 46 or 47 million uninsured Americans. We need to be 
realistic about what we are dealing with here. Some 11 million of those 
are non-citizens, and about half of those are illegally here. So we 
deal with those in one way or another. About one-third of the 
uninsured, about 15 or 20 million, have incomes of over $75,000 a year. 
In other words, they could afford health insurance but do not have it. 
About 13 million are young and believe they are invincible and would 
only buy health insurance on their way to the hospital.
  So the question is, do we raise costs for everybody else in a failed 
attempt to try to pass a ``one size fits all'' for all of those 46 
million uninsured Americans, or do we come up with different ways of 
trying to entice them or require them to have an insurance policy, at 
least a catastrophic insurance policy, so we all are not paying $1,000 
more in insurance so you cannot have insurance and go to the emergency 
room when you have a problem?
  That is who the uninsured are.
  Then let us think about the approach the Kennedy bill and other bills 
are making to the so-called government-run programs. There are some 
competing polls in newspapers, depending on how you ask the question. 
The New York Times, the other day, had a huge headline: Everybody likes 
the government-run health care program. But the Wall Street Journal and 
other polls that have presented questions in different ways said that 
by a 2-to-1 margin most people preferred a private insurance policy 
that they choose themselves, which is what 120 or 140 million Americans 
have chosen today.
  Why do we need a government program? Let's think about that. The 
President said: Well, we need to keep the insurance companies honest. 
That is a little bit like saying: We need a government drugstore to 
keep the drugstores honest, or we need a government car company--
actually we have almost got one with GM--to keep the other auto 
companies honest, or a government anything. That is not the way this 
country is supposed to work. We have a big free market system. We are 
entrepreneurs in this country. We want limited Federal Government.
  We ought to get out of the car and banking business and out of the 
insurance business and stop these Washington takeovers. Yet the most 
imposing feature of the health care proposals proposed by our 
Democratic friends is a big, new government-run program to keep 
everybody honest.
  I do not see that we need such a program under the proposals that 
Republicans have offered. I think we agree that whatever plan we have 
should require that everybody have a chance to be a part of it, that a 
preexisting condition you might have does not disqualify you, and that 
your rates need to be reasonable.
  The ACTING PRESIDENT pro tempore. The Senator has 4 minutes 
remaining.
  Mr. ALEXANDER. I thank the Chair.
  We agree on that. We think competition is what helps keep prices low. 
The President says you need a government-run program for competition. 
But that is like putting an elephant, the government, in a room with a 
lot of mice and saying: All right, fellows, compete. After a while, 
there would not be any mice left. Your only choice would be big 
government, because it has the power to lower prices and subsidize 
itself to make sure it succeeds.
  What is wrong with that? Most Medicaid patients can tell you what is 
wrong with that. Some 40 percent of doctors restrict access to Medicaid 
patients. Why? Mostly because the reimbursement rates are so low. The 
government program is cheaper, but it does not allow you to get any 
health care. It is like giving you a bus ticket, but there is no bus to 
catch.
  So if what we chose to do in our plans is to expand the Medicaid 
Program, at enormous cost to State taxpayers, and have big increases in 
the Federal debt, we will be dumping low-income Americans into 
government programs that exist, and new government programs we create 
to which they might not gain admission.
  So we think we have better ideas. They are in the Wyden-Bennett bill, 
which is bipartisan. They are in the Burr-Coburn bill. They are in the 
legislation introduced by Senator Gregg of New Hampshire. They are in 
the legislation Senator Hatch and Senator Cornyn are working on.
  We would like to give dollars to low-income Americans so they can 
choose to buy an insurance policy and have the same kind of coverage 
that most of the rest of us can buy. We would rather give them choices 
in the private market, which is what, by far, most Americans have and 
choose today. We can do that without adding debt to the national debt. 
The Wyden-Bennett bill is scored at no extra debt. And we can do that 
in a way that reduces the number of uninsured more than the Kennedy 
bill does.
  So, Madam President, with respect, I suggest we start over, we do it 
in a bipartisan way, that we take some suggestions actually from the 
Republican side, which has not been done at all. That is another thing 
the President said. He said he wanted a bipartisan bill. We have had a 
completely partisan bill in the Senate. We do not like that. We came 
here to be a part of solving this big problem. We have our ideas on the 
table. They are not being considered. Everyone is being polite to us, 
but it is: We have the votes. We won the election. We will write the 
bill.
  I am afraid America will not be better off, and the President's goals 
will not be met because we will have added $2 or $3 trillion to the 
Federal debt, have a big new tax for states and locally, stuff low-
income people into government programs, and we will still have 30 
million people uninsured.
  Madam President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Colorado.
  Mr. BENNET. Madam President, I rise to speak about the urgent need 
for health care reform. I wish to thank both the Finance and HELP 
Committees for the enormous amount of effort they are both putting into 
this monumental task.
  When it comes to health care, if you talk with Coloradans, they will 
point you in the right direction. They want us to end double-digit 
premium increases on the middle class and small businesses. They want 
us to leave alone the parts of the system that are not

[[Page 16199]]

broken. They agree that all Americans should have access to affordable 
and secure health care coverage.
  But they are skeptical that Washington can get this done without 
breaking the bank. They want us to find a way to pay for these reforms 
now and not just pass on the cost to the next generation in the form of 
increased deficits and debt.
  That is a tall order, but it is the right one and simple common 
sense. We will be tempted throughout this process to settle for half-
fixes and easier political victories that help a few people but do not 
deliver real reform for all families. We have to work hard across party 
lines and avoid these temptations.
  Showing resolve means not giving in to the usual political posturing 
that has characterized the debate on health care for 30 years and has 
gotten us nowhere. Failing to act responsibly now will result in yet 
another lost decade of soaring health care costs for families and small 
businesses.
  Working families with good health insurance are now spending over 
$3,700 of their own annual income just on premiums, drug copays, and 
other out-of-pocket costs. The amount a family has to pay before health 
insurance coverage kicks in has gone up by over 30 percent in the last 
2 years alone.
  Even the amount all of us pay to cover the uninsured as a part of our 
health care premium--a hidden tax on every family in the country who 
has health insurance--has increased to over $1,000 a year. This hidden 
tax will only continue to increase for all families if we keep walking 
down this path.
  Our top priority must be to stop this ever-increasing spiral of 
health care costs that create such a struggle for families and small 
businesses. But we do not have the luxury of spending recklessly to 
accomplish these goals.
  I agree with the President that reforming the health care system is 
the most pressing fiscal challenge our Nation faces right now. That is 
right, fiscal challenge.
  Fail to reduce costs and health reform will not work. Fail to pass 
meaningful reform and we will face a worsening fiscal mess. Americans 
spend over $2 trillion on health care each year. Yet premiums continue 
to skyrocket, and our coverage is not keeping up with what we are 
paying for it.
  Coloradans know this is a bad deal, and it is getting worse every day 
we do not act.
  We do not have to look very hard for enormous cost savings. The 
potential savings in Medicare and Medicaid are right in front of us. We 
must look at inefficiencies and perverse incentives in the system and 
address those first. Medicare's payment incentives spur doctors and 
nurses to recommend procedures instead of spending more quality time 
with patients.
  We can empower medical professionals to do the best job possible by 
fixing this incentive structure. It starts with Medicare. If we want a 
culture change in health care, we must start with our largest health 
care spending program, Medicare.
  If nothing changes in the next 8 years, the cost of health insurance 
for families covered by their employer will rise by 124 percent. The 
average annual cost to cover a family will increase from $11,000 to 
$25,000.
  As you can see, increases in the growth of health care costs have 
rapidly outpaced increases in family income. Median income has risen by 
$11,300 in the last decade, and it is projected to increase by $10,600 
in the next decade. Income growth will stay relatively stable.
  Let's look at the growth of health care costs in this same time. In 
the last decade, health care insurance to cover a family rose by 
$5,400, and now the cost of health insurance for a family will increase 
by $14,000 in this next decade. This rapid increase in growth is 
clearly unsustainable.
  What you can see from this chart is that median income, in real 
dollars--the increase--remains essentially flat over these decades. 
From 1996 to 2006, the growth was $11,300. From 2006 to 2016, we see 
$10,600. But look at the growth in median health care premium costs at 
the same time: $5,400 over the first period; $14,000 over the second 
period. It is clearly unsustainable.
  We have just come out of a decade when median family income in the 
United States, in real dollars, actually declined by $300, and over the 
course of this same time, health care costs went up by 80 percent and 
the cost of higher education went up by 60 percent. These are not 
``nice to haves.'' These are essential things if our middle class is to 
remain intact and we are to preserve the American dream for the next 
generation of Americans.
  Our revenues as consumers have been far outstripped by the costs of 
that which is essential to all of us, and it is one of the reasons we 
find ourselves in the fiscal mess we are in. Because in order to 
finance that gap, we piled on credit card debt, we had home mortgage 
loans we could not afford--all to try to finance this gap. It is 
unsustainable. It has been a house of cards, and we are dealing with 
the consequences now.
  Already, some Coloradans are seeing cutbacks on the benefits in their 
coverage, and some businesses are no longer able to afford coverage for 
their workers. Faced with these unchecked increases, health coverage 
becomes a luxury few families and small businesses can afford. Many 
people are cutting back on other essentials, visiting the doctor less 
frequently, even when they know they need care.
  We must meet this economic challenge head on. The first goal is 
fixing health care. But we cannot forget the second goal. It is just as 
important: fiscal responsibility. A more efficient health care system 
can save taxpayers money in the long run.
  A study from the White House Council of Economic Advisers shows that 
smart reform will slow the rapid rise in health care costs by a percent 
and a half or more. Slowing health care costs by just a percent and a 
half will have a significant impact on our Federal budget.
  If we were to look at how much we will save by reforming our health 
care, economists have shown us our Federal deficit will decrease. By 
2040, we would have saved enough money to reduce our Federal budget 
deficit by 6 percent from health care cost savings alone.
  Just this point and a half would increase the income of the average 
family in this country by $2,600 in the next decade, growing our 
economy and improving our ability to get a handle on the deficit. 
Colorado families will use $2,600 to make purchases, put away for 
college tuition and retirement, and obtain new employment skills to 
improve their earning potential. Part of fiscal responsibility is 
empowering middle-class families. The current health care system is 
holding them back.
  If nothing changes, employers will see about a 10-percent increase in 
their health care costs next year. Businesses are straining to pay 
salaries already and remain competitive because health care costs are 
so high. Every day, they are making tough decisions about what kind of 
benefits they can afford to offer and whether they can even offer 
health coverage at all.
  Coloradan Jean Butler is the clerk and treasurer for the small town 
of Blanca in Costilla County. The town has about 400 people and employs 
6 people in its government. Two of those town employees, the town 
police officer and the head of maintenance--who oversees roads, water, 
and sewer--get health benefits provided with their employment.
  The town pays the full premium for the two employees, though they do 
have to pay some out-of-pocket costs. The cost of maintaining a plan 
that covers just these two employees has become an increased burden on 
the small town. The coverage has been in place for about 10 years and 
has increased in cost almost every single year.
  Jeannie said the town budgets for a significant increase every year, 
with the hope it has budgeted enough. In 2008, the increase was 25 
percent; the year before, it was 15 percent--40 percent in 2 years. No 
other town expense requires such a big year-to-year increase. Most 
others are budgeted to increase with the inflation rate.
  The current plan with San Luis Valley HMO costs the town $804 a month 
and the employees $750 in out-of-pocket expenses. But that plan is no 
longer

[[Page 16200]]

available. Jean said that similar plans from other providers would 
increase the cost premium anywhere from 33 percent to 235 percent. Even 
with the smallest cost increase, the total annual cost to the town will 
be close to $12,000.
  Jeannie said--Jeannie told me her official name is Jean but that I 
could call her Jeannie; and she said everybody else does--Jeannie said:

       My [town] board now has to decide whether to accept the 
     higher rates, reduce the coverage, require the employee to 
     pay a much larger share of the premium, or try something 
     else. It is not an easy decision.

  Jeannie may have summed up the problem we face as well as anyone. She 
pointed out that:

       They should call it sick care not health care because the 
     insurance companies do not pay to keep anyone healthy.

  Because Jeannie cannot find another plan, hard decisions are being 
made about employees. We cannot continue down this path when we know 
health care costs are overwhelming businesses and working families.
  Ann Brown and her husband Gordon run New Vista Image, a large-format 
digital design and printing company in Golden. The business has nine 
employees and provides health care benefits, covering 60 percent of 
each employee's premium but not that of their dependents.
  Ann said she is happy with the choices available in Colorado for 
different types of plans, and she believes in the employer-provided 
benefits model. She and her husband built in the cost of health care 
when they began their business because she knew it would help attract 
the best employees.
  Ann said she understands how important a healthy workforce is and 
supports wellness programs, so employees can prevent major medical 
conditions. Whenever she brings someone in, she knows the first 
question asked will be: Do you have a health care plan?
  Nevertheless, the business has been forced to offer less and less 
coverage in order to keep premiums within its budget. Health care is 
one of the biggest ticket items they worry about. Ann said that in 
recent years, the percent cost increase over the previous year has been 
in the double digits. As a result, they have had to offer less 
coverage, with higher deductibles and more out-of-pocket costs.
  The plan's deductible has gone from $1,500 to $3,000, and Ann said it 
is likely the next step they will have to take is a $5,000 deductible. 
She knows how hard those out-of-pocket costs can be for employees to 
absorb. A few years ago, when an employee was facing a serious health 
condition, the business covered the deductible so the employee would 
not be saddled with the medical bills.
  ``I would do it again,'' Ann said, although she knows higher 
deductibles mean a less generous plan to offer to her employees and 
less of a competitive edge for the business overall.
  Teresa Trujillo of Pueblo, CO, has employer-based coverage. For 7 
years, Teresa saved up money to buy a home, and then learned she had 
breast cancer. After 14 months of treatment, the money ran out and 
Teresa had to take a loan out to finish paying for the rest of her 
treatment.
  For Teresa, her health insurance coverage only took her so far. While 
she has been cancer-free for 4 years, she constantly worries that her 
cancer will come back, and with it, the huge financial strain it would 
bring. All she wants is health care she can count on.
  These are people who have done everything right, played by the rules, 
looked out for their fellow employees and fellow citizens. Our health 
care system is failing them. People should not have to wait until they 
get sick to learn their health insurance will not cover the cost of 
their treatments. Families should not have to watch their loved ones go 
through sickness and also deal with the anxiety of paying for medical 
bills that are increasingly becoming completely unaffordable.
  We know health care reform will not be easy. As the President has 
said, if it were easy, we would have done it a long time ago. But for 
these Coloradans--for their families and for their businesses--the 
system must change. For our Nation's long-term prosperity, the system 
must change. We cannot burden future generations with responsibility 
for the reform we need today. If we make the hard choices, we will 
create a better health care system, a better economy, and a better 
future for our children and our grandchildren.
  I thank my colleagues for listening this morning.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. SPECTER. Madam 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.

                          ____________________