[Congressional Record (Bound Edition), Volume 155 (2009), Part 16]
[Senate]
[Pages 21698-21700]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, I congratulate the Republican leader, 
the Senator from Kentucky, on his remarks. He made it very clear that 
we on the Republican side of the aisle want health care reform, but our 
definition of that is a little different from that on the other side of 
the aisle. We want health care reform that reduces costs--costs to the 
American people when they buy health insurance and the costs of the 
government of the American people. We do not want more debt and another 
Washington takeover, which we are seeing so much of these days.
  President Obama said in his address to us that he ``will not sign a 
plan that adds one dime to our deficits--either now or in the future. 
Period.'' That is good.
  As David Brooks wrote in the New York Times this past Friday:

       This sound bite [of the President] kills the House health 
     care bill.

  It kills the House health care bill, because it would add $220 
billion to the deficit over the first 10 years of its operation and 
another $1 trillion over the next 10 years after that.
  The President's sound bite about the deficit would effectively knock 
out the bill passed by the Senate HELP Committee as well. According to 
a recent letter from the Congressional Budget Office to the ranking 
member of the Senate HELP Committee, Senator Enzi of Wyoming:

       The 10-year cost of the coverage expansion [of that bill] 
     to the Federal Government, including such a change in 
     Medicaid eligibility, would probably exceed $1 trillion.

  So that is off the table.
  There appears to be growing bipartisan concern about a health care 
bill that might add to the debt. Senator Warner of Virginia said on 
Monday:

       My feeling is, [health care reform] can't just be paid for 
     in a 10-year window. It has to be paid for in the out years 
     as well.

  That is Washington-speak for over the long term. He says:

       This is so much bigger than health care. It goes to the 
     deficit. It goes right to the heart of our competitiveness.

  That is Senator Warner of Virginia. I couldn't agree more. All of the 
health care reform bills produced so far by the Democratic Congress--
either in the Senate or in the House--flunk the first test, which is 
reducing cost--cost to the American people and cost to the American 
government.
  In July, the Congressional Budget Office Director, Douglas Elmendorf, 
said that the House bill and the Senate HELP bill did not propose ``the 
fundamental changes that would be necessary to reduce the trajectory of 
Federal health spending by a significant amount.''
  Additionally, the Congressional Budget Office has indicated that the 
House bill would result in a ``net increase in the Federal budget 
deficit of $239 billion'' over 10 years. This is likely a low-ball 
estimate, because it assumes that Congress will increase taxes by $583 
billion over the next 10 years.
  So if we are going to implement health care reform without increasing 
our debt, how are we going to pay for it? Who is going to pay for it is 
the more precise question. Here are some of the answers that have been 
proposed so far by the Democratic side of the aisle.
  No. 1, grandma's Medicare is going to pay for it. The bills--and the 
President's own plan, which we have yet to see the details of--propose 
``Medicare savings.'' Nice words for Medicare cuts. If there is $500 
billion in savings to be found in Medicare, we should use it to keep 
Medicare solvent, because the trustees of Medicare say that we are now 
spending at such a rapid rate that we will run out of money for 
Medicare by 2017. We should not use Medicare cuts to pay for a new 
government program. We should use any Medicare savings to make Medicare 
stronger.

[[Page 21699]]

  No. 2, the way to pay for these bills we have been seeing in the 
House and the Senate is to shift the costs to the States. This is done 
by expanding Medicaid, which is the largest government-run program we 
have today. Almost 60 million low-income Americans have their health 
care from Medicaid, which the Federal Government pays about 60 percent 
of and the States 40 percent. The plans we have been hearing about have 
the Federal Government expanding Medicaid coverage--this is the State 
plan I was talking about--from 60 million to 80 million or 90 million 
people and, after a few years, asking the States to pick up their 
additional share of the cost of that expansion.
  According to the National Governors Association, expanding Medicaid 
to 133 percent of the Federal poverty level would cost the States an 
additional $31 billion per year. Although details are still lacking--
and we may find out more today about the proposals from the Senate 
Finance Committee--the Democratic Governor of Tennessee, Governor 
Bredesen, said on Friday that he is concerned about the plan being 
proposed by Senator Baucus and that his guess was it might cost our 
State as much as $600 million to $700 million per year.
  In Washington that doesn't sound like a lot of money, but to 
Tennessee that is a lot of money. We had a big fight a few years ago 
over whether to have a new State income tax. We don't now have one, and 
our former Governor didn't succeed on that. People got very upset about 
that. That would only have raised $400 million. But this is an increase 
of $600 million or $700 million that would, after a few years, be 
shifted to the States.
  That is not all. Since States only reimburse doctors and hospitals 
for about 60 percent of their cost of serving the 60 million patients 
on Medicaid, these expansion proposals of Medicaid usually also require 
States to increase reimbursements to doctors and hospitals. Increasing 
reimbursements to doctors and hospitals would basically double the 
increased cost to States. So you can see why earlier in the debate many 
of the Governors--including many of the Democratic Governors of this 
country--objected to this proposal. Governor Bredesen called those 
proposals ``the mother of all unfunded mandates.'' We know where 
unfunded mandates lead in our State, and that is higher State taxes.
  No. 3, in addition to cutting Medicare and increasing State taxes by 
expanding Medicaid, the bills we have seen ask small businesses to help 
pay for the bills through employer mandates and fines. Under the Senate 
HELP Committee bill, for example, firms with more than 25 workers would 
have to pay the new tax, with penalties equal to $750 per year per 
full-time employee and $375 for part-time employees. The Congressional 
Budget Office estimated that this would raise $52 billion over 10 
years. The House bill would impose over $200 billion in fines on 
businesses who cannot afford to finance their workers' health coverage.
  There is another consequence to that. We have often heard the 
President say: Well, if you like your health care plan, you can keep 
it. But, what he doesn't go on to say is that if we create this 
government plan and if we require employers to pay $750 per full-time 
employee and $375 for a part-time employee, many employers are going to 
look at that and decide it is much cheaper to pay the $750 or the $375 
for an employee. So they will just pay the government a fine and let 
the government plan offer health care to their employees. It is 
estimated by most groups that have looked at the plans we have seen 
that the combination of a government plan and an employer tax will 
result in millions of Americans losing their employer-provided health 
insurance.
  Then there is one other way of paying for the bill: to tax people who 
have health care insurance. That is why the Democratic Senator from 
West Virginia, Mr. Rockefeller, is quoted as saying today that the bill 
coming out of the Finance Committee--which we haven't seen yet--has a 
big tax on coal miners, on the middle class. That is according to 
Senator Rockefeller.
  So we are barking up the wrong tree. This debate about health care 
should be about reducing costs. That should be the first goal of what 
we mean when we say the words ``health care reform''--reducing the cost 
to individuals and families and small businesses that are buying health 
care plans and paying for insurance--that is 250 million individuals in 
the country today--reducing the cost to the government in higher health 
care spending.
  That is why Republicans have suggested we should start over. A lot of 
good work has been done. A great many of us understand much better this 
complex subject we are dealing with. There is no embarrassment in 
saying we have gotten to this point; we are headed in the wrong 
direction. The Mayo Clinic, the Democratic Governors, the Congressional 
Budget Office, millions of Americans in town meetings are saying: You 
are heading in the wrong direction. You say: Ok, fine. We hear you. 
Let's start over.
  How should we start over? Instead of passing 1,000-page bills that 
add to the debt and increase costs, we should work step by step to re-
earn the trust of the American people. The era of 1,000-page bills is 
over. Smaller steps in the right direction are still a very good way to 
get where we want to go. There are some steps we can take, some things 
we can do today to move step by step in the right direction and to 
lower costs.
  No. 1, allowing small businesses to pool and reduce health care costs 
by putting their resources together would increase accessibility for 
small business owners, unions, associations and their workers, members 
and families to health care. This legislation has already been 
considered in the Senate and in the House. It is nearly ready to pass. 
Estimates are that passing a small business health insurance plan would 
permit small businesses to offer coverage to one million more 
Americans.
  No. 2, reform medical malpractice laws so runaway junk lawsuits don't 
continue to drive up the cost of health care. The President mentioned 
that the other night in his remarks. I congratulate him for that. But, 
we should do even more than he suggested. We have 95 counties in 
Tennessee, and in 60 of them we don't have an OB/GYN doctor because 
they will not practice there anymore. Their medical malpractice 
insurances premiums are too high--over $100,000. So pregnant women have 
to drive a long way--to Memphis or to Nashville or to other large 
cities--for their prenatal health care or to have their babies. That is 
a way to lower costs--reduce junk lawsuits.
  There is some disagreement about how much that would save, but there 
is no disagreement that junk lawsuits contribute to higher medical 
costs.
  No. 3, allow individual Americans the ability to purchase health 
insurance across State lines. As a former Governor, I jealously protect 
States rights. I like States to have responsibilities. But, I think, in 
terms of health care, we should allow more purchasing of policies 
across State lines, as people do with their car insurance today. That 
is a third way to take a step toward health care reform that actually 
begins to lower costs.
  No. 4, we don't have to pass a new bill in order to insure more 
Americans. About 20 percent of the uninsured Americans--maybe 10 
million or 11 million--are already eligible for existing programs, such 
as Medicaid and the Children's Health Insurance Program. They are not 
enrolled. We should sign them up.
  No. 5, we could create health insurance exchanges. I hear that from 
the Democratic side; I hear it from the Republican side. These are 
marketplaces in each State so individuals and businesses can shop 
around and find a cheaper and a better source of health insurance.
  No. 6, all of us have talked about encouraging health information 
technology, which the Government Accountability Office has said ``can 
improve the efficiency and quality of medical care and result in costs 
savings.''
  I have suggested six areas we could work on together to reduce cost. 
We have forgotten, in this health care debate, what we set out to do. 
The first

[[Page 21700]]

goal of health care reform is to reduce cost--the cost of health care 
to Americans, to American businesses, and the cost to Americans of 
their government, which is spiraling out of control in debt because of 
the cost of health care. We are spending 17 percent of everything we 
produce in this country--and we produce 25 percent of all the wealth in 
the world year in and year out--on health care; twice as much on health 
care as a percentage as most industrialized countries. If we don't 
reduce costs, we will bankrupt the government and make health care 
unaffordable for most Americans.
  The President of the United States was right to say he will not sign 
a bill that increases the deficit. Since that eliminates all the 
legislation the Democratic Congress has produced so far, I hope we will 
now take Republican advice and start over and get it right. A good way 
to begin would be for the President to send us a health care reform 
bill that not only doesn't add to the debt but that begins step by step 
to reduce costs to the American people and to the American Government. 
And by taking those steps, we can re-earn the trust of the American 
people.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. NELSON of Florida. Mr. President, I ask unanimous consent the 
order for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. NELSON of Florida. Mr. President, I ask that the time I use be 
allocated on the Democratic time and that the Republican time be 
reserved.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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