[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[Senate]
[Pages 22916-22921]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. I wonder, before the Republican leader leaves, if I 
could ask him a quick question? I ask unanimous consent that Senators 
Barrasso, McCain, and Bennett, and the Republican leader, be permitted 
to engage in a colloquy during our 30 minutes and that I be notified 
when we have about 4 minutes left.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. ALEXANDER. I ask the Senator from Kentucky, the Republican 
leader, is it not true that the Finance Committee Democrats voted down 
a Republican proposal to put the health care reform bill on the 
Internet for 72 hours so Americans could read it?
  Mr. McCONNELL. I would say to my friend from Tennessee that is 
absolutely correct.
  Mr. ALEXANDER. I believe the Republican leader said the bill might be 
2,000 pages long?
  Mr. McCONNELL. Certainly, well above 1,000 and probably 2,000.
  Mr. ALEXANDER. If I am not mistaken, there are several versions of 
the bill in the House of Representatives that will come over here. Then 
there is a version that we did in the Health Committee here that will 
have to be integrated with that bill; is that not correct?
  Mr. McCONNELL. It is my understanding it is the intention of the 
majority leader and the administration to merge the bill that came out 
of the Health Committee on which the Senator from Tennessee serves and 
the bill that is in the Finance Committee now.
  Mr. ALEXANDER. It is my understanding in the Finance Committee they 
are not even writing a bill yet; they are just working on concepts?
  Mr. McCONNELL. Apparently, the Finance Committee will actually go to 
a final vote on a concept paper, not an actual bill--which I think will 
inevitably produce a dilemma for the Congressional Budget Office in 
trying to assess the cost of a concept bill. Then, apparently, they 
will turn that into a bill, and then the Congressional Budget Office 
will have to score, once again, the final bill, and the number there 
may be different from the number of the concept paper.
  Mr. ALEXANDER. How long do you suppose it would take, once the two 
bills are put together, for the Congressional Budget Office to tell us 
how much it costs?
  Mr. McCONNELL. I would think for an accurate score we would have to 
ask them. What a challenge that will be. But I assume it will take a 
while.
  Mr. ALEXANDER. Well, I thank the Republican leader. In our discussion 
today, I see the Senator from Wyoming is here, it is almost 
embarrassing to say that--I mean, to people outside Washington, and 
maybe even to people inside Washington, the idea that we would not take 
72 hours to read a 2,000-page bill that spends $1 trillion or $1.5 
trillion that affects virtually every American and that may have a lot 
of unresolved questions in it.
  It is hard to imagine people would not think that was common sense, 
that

[[Page 22917]]

we ought to read it before we vote on it.
  Mr. McCONNELL. I think we can add, the American people, I think 
correctly, could only assume there is some effort to try to hide the 
true impact of this rush effort to reorganize one-sixth of our economy, 
a $1 trillion bill, well over 1,000 pages that nobody has taken the 
time to read. It is not even produced in final bill language.
  The American people begin to get the drift that this is a process 
that is going to, I think, enrage them. It enrages them already. I 
think the rage about it is only going to escalate in the coming weeks.
  Mr. ALEXANDER. I thank the Republican leader for his time. I would 
think every civics class in America, if the teacher would give a test, 
would say: Should an elected representative read a bill before he or 
she voted on it? Yes.
  Should he or she know how much it costs? Yes.
  Even the President has said we cannot have a deficit. Well, how are 
we going to know if it creates a deficit if we do not read the bill and 
if the nonpartisan Congressional Budget Office has not told us how much 
it costs?
  I thank the Republican leader. The Republican leader mentioned there 
may be some questions we would want to know. There are some.
  Governors across the country may want to know how much it is going to 
cost them and their budgets because, the other day, the chairman of the 
National Governors Association and the Republican Governors Association 
held a joint press conference and they said this: If you are going to 
expand Medicaid in our States, if the Federal Government is going to do 
it, the Federal Government ought to pay for it.
  Medicaid is the largest government-operated health care program we 
have in the country. About 55 or 60 million Americans are there. The 
Federal Government pays about 60 percent of it and the State 
governments pay about 40 percent.
  I noticed two articles in the newspaper. I ask unanimous consent to 
have these articles printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the New York Times, Sept. 29, 2009]

                  Majority Leader Protects Home State

                            (By Robert Pear)

       Washington.--The Senate majority leader, Harry Reid of 
     Nevada, has secured a special deal protecting his state 
     against the costs of expanding Medicaid under one of the 
     major health care bills moving through Congress.
       Mr. Reid, a Democrat, complained about the impact on Nevada 
     when the chairman of the Senate Finance Committee, Max 
     Baucus, Democrat of Montana, unveiled his bill on Sept. 16.
       Now Mr. Baucus has modified the bill to spare Nevada and 
     three other states, and Mr. Reid, who faces a potentially 
     difficult race for re-election next year, is taking credit 
     for getting a ``major increase'' in federal money for his 
     state.
       The Senate bill, like a companion measure in the House, 
     would expand Medicaid to cover childless adults, parents and 
     other people with incomes less than 133 percent of the 
     poverty level, or $29,327 for a family of four. The federal 
     government would pay most of the new costs--anywhere from 77 
     percent to 95 percent, with a higher share in poorer states, 
     in the first five years.
       Under Mr. Baucus's original proposal, the federal 
     government would have paid 87 percent of the new costs in 
     Nevada. Under the modified version, the federal government 
     would pay 100 percent of the new costs for the first five 
     years. Severe financial problems have prompted Nevada and 
     other states to cut spending and furlough workers, and some 
     states have even considered releasing prison inmates to save 
     money.
       There is no guarantee that the provision will be retained 
     as the legislation moves through Congress. Many other 
     lawmakers are trying to influence its particulars to favor 
     their states, but few have the power of the majority leader 
     to get their way.
       Mr. Baucus revised his bill to give extra help to certain 
     ``high-need states.'' The states were not named in the bill. 
     But only four states meet the criteria: Michigan, Nevada, 
     Oregon and Rhode Island.
       The changes came at the expense of other states, including 
     California, Florida and Illinois, which would see significant 
     increases in state Medicaid spending under the new formula.
       The Finance Committee resumes work on the legislation 
     Tuesday, with some of the biggest fights still to come.
       Many states worry that the expansion of Medicaid could 
     saddle them with long-term financial obligations.
       Representative Nathan Deal of Georgia, the senior 
     Republican on the House Energy and Commerce Subcommittee on 
     Health, said Mr. Reid ``appeared to be playing politics to 
     favor Nevada over other states.''
       ``Senator Reid should know that this legislation is not 
     only bad for Nevada, but it is bad for the rest of the United 
     States,'' Mr. Deal said.
       James P. Manley, a spokesman for Mr. Reid, brushed aside 
     the criticism.
       ``Senator Reid makes no apologies for fighting for federal 
     money for his constituents,'' Mr. Manley said. ``Under 
     Republican governors, Nevada has consistently underfunded 
     programs such as Medicaid.''
       Mr. Baucus said other provisions of the bill would help all 
     states--for example, by reducing what they spend on 
     prescription drugs for Medicaid recipients and on the 
     Children's Health Insurance Program.
       About 220,000 people are on Medicaid in Nevada, and Charles 
     Duarte, the state Medicaid director, said Monday that 
     enrollment could double under the legislation being 
     considered by Congress.
       Many parents and childless adults would qualify for 
     Medicaid for the first time, Mr. Duarte said. And many people 
     who are eligible but not enrolled would sign up for Medicaid 
     because, under the legislation, they could be required to pay 
     financial penalties if they did not have insurance.
       The Finance Committee has rejected several Republican 
     amendments that would have blocked the expansion of Medicaid 
     if it was found to impose additional costs on states.
       ``We have got to protect the states from the impact of one 
     more federal mandate at a time when states are in dire 
     circumstances financially,'' said Senator Michael D. Crapo, 
     Republican of Idaho.
       But Senator Kent Conrad, Democrat of North Dakota, said 
     states must share the cost of covering the uninsured.
       ``We are going to have a real hard time dealing with this 
     problem,'' Mr. Conrad said, ``if it is all supposed to be on 
     the federal government, which has record deficits and record 
     debt, and if the states just expect the federal government to 
     write a check for 100 percent of everything.''
       All the major health care bills moving through Congress 
     would expand Medicaid, adding perhaps 11 million people to 
     the rolls, the Congressional Budget Office says.
       The Democratic staff of the Finance Committee estimates 
     that, under existing law, state spending on Medicaid will 
     total $1.7 trillion from 2013 to 2019. That figure could 
     increase by $33 billion under Mr. Baucus's bill. But when the 
     new costs are combined with savings elsewhere in the bill, 
     Democrats say, state spending would increase by only $22 
     billion, or 1.3 percent, over the levels now projected.
       A few states, like Arkansas, Colorado, Maryland and 
     Virginia, could see increases of 4 percent or more, according 
     to the data.
       Maine and Vermont have led the way in expanding Medicaid. 
     But Senator Olympia J. Snowe, Republican of Maine, said that 
     after talking with the governors of those states, she had 
     concerns about the burdens that would be placed on states 
     under the bill.
                                  ____


             [From the Wall Street Journal, Sept. 29, 2009]

               States' Quarterly Tax Revenue Plunges 17%

                          (By Conor Dougherty)

       State tax revenue in the second quarter plunged 17% from a 
     year earlier as rising unemployment and falling consumption 
     dragged down sales- and income-tax collections, according to 
     Census figures released Tuesday.
       It was the sharpest decline since at least the 1960s. The 
     biggest drop was in state income taxes, which were down 28% 
     in the second quarter from a year earlier. Corporate income 
     taxes, which tend be volatile, increased 3%.
       The numbers aren't adjusted for inflation or tax-rate 
     changes.
       The steep declines show how the recession continues to 
     cripple state finances, despite support from the stimulus 
     package and signs of a nascent recovery in economic activity. 
     Falling revenue, combined with growing demand for social 
     programs like food stamps or Medicaid, forced states to slash 
     spending and scramble to raise revenue through measures from 
     new taxes to slot machines and pricier fishing licenses.
       ``This brings really bad news for almost every single state 
     and leaves them with an unprecedented budget crisis,'' said 
     Lucy Dadayan, a senior policy analyst with the Nelson A. 
     Rockefeller Institute of Government at the State University 
     of New York.
       States--which, unlike the federal government, are generally 
     required to balance their budgets--have already responded to 
     revenue declines with employee furloughs and higher taxes and 
     fees. But with tax collections continuing to decline, many 
     have been forced to reopen budgets midsession to push through 
     even more drastic cuts to staffing and services. In Michigan, 
     stalled budget negotiations between the governor and the 
     legislature could force the state to shut down if a deal 
     isn't reached by Wednesday at midnight local time.

[[Page 22918]]

       With lower-than-expected revenue, the governor of 
     Massachusetts cut that state's budget four times over the 
     fiscal year that ended in June, including drawing down 
     reserves from a rainy-day fund and eliminating unfilled jobs. 
     With revenue still weaker than expected, the state may be 
     forced to reopen the budget as early as next month, said a 
     spokesman for the Executive Office for Administration and 
     Finance.
       Without a budget, Michigan state employees wouldn't report 
     to work, and the governor would likely have to take emergency 
     steps to keep essential services such as hospitals and 
     prisons operating. ``We remain optimistic that we will have a 
     budget in place because everyone wants to avoid a shutdown,'' 
     says Liz Boyd, a representative for Gov. Jennifer Granholm.
       Some of the sharpest tax declines were in states that have 
     been among the hardest-hit by the recession, in particular 
     those with high concentrations of jobs in the battered 
     housing sector. In Arizona, overall tax revenue fell 27% in 
     the second quarter from a year ago. Tax revenue fell 12% in 
     Florida and 14% in California.
       States across the country saw drastic declines in personal 
     income taxes, the largest source of state funding, 
     representing about one-third of states' overall revenue. The 
     largest decline was in New Mexico, where income taxes fell 
     59%. In 11 states--including California, New York and 
     Wisconsin--personal income taxes fell more than 30%.

  Mr. ALEXANDER. One is from the Wall Street Journal: State quarterly 
tax revenues plunge 17 percent. Talking about how budgets in 
California, Florida, other States are going down.
  Then there is another article, September 29--actually these both 
appeared yesterday--in the New York Times entitled ``Majority Leader 
Protects Home State.''
  Well, the majority leader, Senator Reid, has done exactly what all 
the Governors hope would be done. He has said: If the Federal 
Government is going to expand Medicaid in my State, the Federal 
Government is going to pay for it.
  But, I would say to the Senator from Wyoming, I wonder how citizens 
in Wyoming and California and Florida and other States will feel if 
they pay more in taxes so Nevadans can pay less in taxes? Is that not 
the kind of question Senators from virtually every State might want to 
be sure about by reading the bill and knowing what it costs before it 
comes to the floor?
  Mr. BARRASSO. It seems to me the people of Wyoming have those very 
concerns, as does the Governor of Wyoming.
  I served in the Wyoming State Senate for 5 years, and we know that 
one of the largest budgets is Medicaid, the aid we give to people in 
need of health care. But it is almost the same as what we are paying 
for K-12 education. In Wyoming, we sure do not want to pay for what is 
happening in the majority leader's home State.
  I was home yesterday. Yesterday morning, getting on the plane to come 
back from Wyoming--I go home every weekend. I was at the Wyoming 
football game, where we won, we beat the University of Nevada Las 
Vegas, the leader's home State. That was another great day for Wyoming 
football.
  But when you go to a game like that in Wyoming, a lot of people come 
up to you and ask you questions. One of the questions that came up this 
past weekend was: Have you read the bill? What is in it? What is it 
going to cost? People of Wyoming say: Am I going to be able to read it? 
How do I read the bill? Is it going to be on the Internet? Will I be 
able to see it?
  To try to explain: There is no bill. There is this concept paper. I 
have it here. It is called the chairman's mark. It is the concept paper 
of 220 pages. You look at this, this is not even in legislative 
language yet. So you are going to be asked to vote on legislation, not 
just a concept paper.
  Mr. ALEXANDER. I think the Senator from Wyoming is making an awfully 
good point. He is a distinguished orthopedic surgeon, a doctor, one of 
two physicians in the Senate. Both of them happen to be on the 
Republican side of the aisle at this time, Senator Coburn, and I know, 
Dr. Barrasso, since we are talking about Medicaid, which is a program 
that every State has that serves low-income people, that States pay 
typically roughly 40 percent for, one of the questions somebody might 
have who reads the bill is: How many more low-income people are going 
to be added to that bill?
  Because it is my understanding that Medicaid reimburses physicians at 
such a low rate, that about 40 percent of physicians will not see 
Medicaid patients. So by dumping more low-income Americans into 
Medicaid, we are dumping them into a program where they have 40 percent 
of a chance of not seeing the doctor or getting the services they want 
to have. Have you had any experience with that?
  Mr. BARRASSO. Absolutely. In my practice for 25 years in Casper, WY, 
I took care of a lot of people on Medicaid. I took care of anybody who 
needed to see me.
  But you are right. Across the board, there are many people on 
Medicaid who do not--are not able to see a doctor. The number you 
quoted is exactly the one I have.
  I have an article that I ask unanimous consent to have printed in the 
Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

             [From the Wall Street Journal, Sept. 27, 2009]

                           Max's Mad Mandate

       The more we inspect Max Baucus's health-care bill, the 
     worse it looks. Today's howler: One reason it allegedly 
     ``pays for itself'' over 10 years is because it would break 
     all 50 state budgets by permanently expanding Medicaid, the 
     joint state-federal program for the poor.
       Democrats want to use Medicaid to cover everyone up to at 
     least 133% of the federal poverty level, or about $30,000 for 
     a family of four. Starting in 2014, Mr. Baucus plans to spend 
     $287 billion through 2019--or about one-third of ObamaCare's 
     total spending--to add some 11 million new people to the 
     Medicaid rolls.
       About 59 million people are on Medicaid today--which means 
     that a decade from now about a quarter of the total 
     population would be on a program originally sold as help for 
     low-income women, children and the disabled. State budgets 
     would explode--by $37 billion, according to the Congressional 
     Budget Office--because they would no longer be allowed to set 
     eligibility in line with their own decisions about taxes and 
     spending. This is the mother--and father and crazy uncle--of 
     unfunded mandates.
       This burden would arrive on the heels of an unprecedented 
     state fiscal crisis. As of this month, some 48 states had 
     shortfalls in their 2010 budgets totaling $168 billion--or 
     24% of total state budgets. The left-wing Center for Budget 
     and Policy Priorities expects total state deficits in 2011 to 
     rise to $180 billion. And this is counting the $87 billion 
     Medicaid bailout in this year's stimulus bill.
       While falling revenues are in part to blame, Medicaid is a 
     main culprit, even before caseloads began to surge as 
     joblessness rose. The National Association of State Budget 
     Officers notes that Medicaid spending is on average the 
     second largest component in state budgets at 20.7%--exceeded 
     only slightly by K-12 education (20.9%) and blowing out state 
     universities (10.3%), transportation (8.1%) and prisons 
     (3.4%).
       In some states it is far higher--39% in Ohio, 27% in 
     Massachusetts, 25% in Michigan, Rhode Island and 
     Pennsylvania. Forcing states to spend more will crowd out 
     other priorities or result in a wave of tax increases, or 
     both, even as Congress also makes major tax hikes inevitable 
     at the national level.
       The National Governors Association is furious about Mr. 
     Baucus's Medicaid expansion, and rightly so, given that 
     governors and their legislatures will get stuck with the bill 
     while losing the leeway to manage or reform their budget-
     busters. NGA President Jim Douglas of Vermont recently said 
     at the National Press Club that the Baucus plan poses a 
     ``tremendous financial liability'' and doesn't ``respect that 
     no one size fits all at the state level.'' He added: ``Unlike 
     the federal government, states can't print money.''
       Mr. Baucus hopes to use his printing press to bribe the 
     governors, at least for a time. Currently, the federal 
     government pays about 57 cents out of every dollar the states 
     spend on Medicaid, though the ``matching rate'' ranges as 
     high as 76% in some states. That would rise to 95%--but only 
     for five years. After that, who knows? It all depends on 
     which budget Congress ends up ruining. Either the states will 
     be slammed, or Washington will extend these extra payments 
     into perpetuity--despite the fact that CBO expects purely 
     federal spending on Medicaid to consume 5% of GDP by 2035 
     under current law.
       As for the poor uninsured, they'll be shunted off into what 
     Democratic backbencher Ron Wyden calls a ``caste system.'' 
     While some people will be eligible for subsidized private 
     health insurance, everyone in the lowest income bracket will 
     be forced into Medicaid, the country's worst insurance 
     program by a long shot. States try to control spending by 
     restricting access to prescription drugs and specialists. 
     About 40% of U.S. physicians won't accept Medicaid at all.
       Why? One reason is that Medicaid's price controls are even 
     tighter than Medicare's,

[[Page 22919]]

     which in turn are substantially below private payers. In 2009 
     or 2010, 29 states will have either reduced or frozen their 
     reimbursement rates to providers. Democrats love Medicaid 
     because is it much cheaper than subsidizing private 
     insurance, but that is true only because of this antimarket 
     brute force. Of course, such coercion will be extended to the 
     rest of the health market under ObamaCare.
       The states aren't entirely victims here. Both Republican 
     and Democratic state houses regularly game the Medicaid 
     funding formula--which itself is designed to reward higher 
     spending--to steal more money from national taxpayers. Then 
     when tax collections fall during downturns, budget gaskets 
     blow all over the place. This dynamic helps explain the 
     spectacular budget catastrophes in New York and California. 
     We'd prefer a policy of block grants, which would extricate 
     Washington from state accounting and encourage Governors to 
     spend more responsibly.
       That's not going to happen any time soon, but the least Mr. 
     Baucus can do is not make things worse. Instead, his Medicaid 
     expansion is a disaster on every level--like the rest of 
     ObamaCare.

  Mr. BARRASSO. This as also from the Wall Street Journal from 
September 27, called: ``Max's Mad Mandate.'' The first paragraph says: 
One reason this Finance Committee bill allegedly pays for itself is 
because it will break all 50 State budgets by permanently expanding 
Medicaid.
  It says: They are going to expand Medicaid. The Senator was a 
Governor. The Senator had to deal with this in Tennessee: Using 
Medicare to cover everyone up to at least 133 percent of the Federal 
poverty level, that will add some 11 million new people to the Medicaid 
rolls, which is not going to help, if currently, as the article goes 
on, about 40 percent of U.S. physicians will not accept Medicaid at 
all.
  Mr. ALEXANDER. I have thought for some time that any Senator who 
votes to expand Medicaid in the States without paying for it at the 
Federal level ought to be sentenced to go home and serve as Governor 
for 8 years and try to pay for it and raise the taxes and deal with the 
people who cannot do that.
  But that is the kind of question I think a Governor would want: Read 
the bill and know what it costs. For example, I believe there is a 
question about the Finance Committee, in its concept papers, may say: 
Well, we will pay for it for 5 years--or we will pay 77 to 95 percent 
of it.
  The Governors are saying--now these are Democratic Governors as well 
as Republicans--they are all saying to us: Do not do that to us. Our 
revenues are down 17 percent, 18 percent, 20, 35 percent in some of our 
States. If you are going to pass it, pay for it. That is a question 
governors should have a chance to ask and get an answer for. That is 
why we need to read the bill.
  Mr. BARRASSO. That is why the National Governors Association is 
furious with this huge expansion of Medicaid. It quotes the Governor of 
Vermont, who says: Unlike the Federal Government, States cannot print 
money. Many of us, such as Wyoming, live within our budgets. We live 
within our means. We balance the budget every year. For Washington, in 
its effort to take over health care in the country, to force the States 
to pay for it, in what is, to me, a trickery or a financial gimmick, to 
say they can make the books balance, is not a favor to the American 
people.
  That is why people at home ask me every weekend: Can I read the bill? 
Have you read the bill? Can I read the bill? What is it going to cost? 
It ultimately gets down to people are very worried about a government 
takeover, very worried that at a time we are spending all this money as 
a nation, against my wishes, another trillion dollars for kind of an 
experiment that is going to fund a lot of it through Medicare. We have 
not even gotten into the discussion of Medicaid.
  Mr. ALEXANDER. Let's talk about Medicare because many people, unless 
they follow health care every day, confuse Medicaid, which is the 
program for low-income Americans that States help administer--there are 
about 55 or 60 million Americans in that program--and Medicare, which 
is the program that about 40 million seniors have.
  We have had a lot of talk about Medicare. The President says: There 
are no Medicare cuts. Then, on the other hand, he said: We are going to 
take up to $\1/2\ trillion out of Medicare and spend it on a new 
program.
  We are saying: You are going to cut one-quarter of the Medicare 
beneficiaries' Medicare Advantage payments. The other side is saying: 
No, that is not what we are doing. We are saying: How can you cut 
Medicare and spend it on another program when Medicare is going broke?
  Well, I would think the American people would want to know the answer 
to those questions, and we should know the answer before we vote. Is 
that not another reason we should read the bill to find out who is 
telling the truth about Medicare?
  Mr. BARRASSO. It is the reason that, No. 1, we should read the bill. 
It is the reason we should make sure the people all across the country 
have a chance to read the bill. The people of Wyoming want to read the 
bill. It is the reason we need some time for those people from all our 
home districts to get back to us.
  As I say, all around Wyoming, the wisdom does not come from 
Washington, the wisdom comes from America, from your State and my State 
and the other States. I want those people to be able to read the bill, 
come up with better ideas or suggestions, and a lot of times folks at 
home will see what I call unintended consequences, something that is in 
the bill that you say: Well, I had not thought about that.
  We have the hospitals across Wyoming, those people want to read it. 
The doctors, the nurses, the physicians assistants, and the patients, 
the people who are mostly going to be affected by this, they want to 
know what is in the bill, which is why I say that is the reason to put 
it on the Internet. People can read it ahead of time and then let them 
have time to comment back to us.
  Mr. ALEXANDER. I see the Senator from Utah has come. Let me ask one 
more question to Dr. Barrasso. Because we are told--and here is another 
reason to put the bill on the Internet for 72 hours and to wait a 
couple weeks or whatever it takes for the Congressional Budget Office 
to tell us how much it costs, because the President has said: There 
cannot be one dime added to the deficit, which we agree with.
  In fact, we think the whole goal of this ought to be to reduce the 
cost of health care to you and then to your government but not one dime 
to the deficit.
  But one of the assumptions of the bill coming through the Finance 
Committee has to do with what we elegantly call in the Senate the ``doc 
fix,'' the fact that basically the government sets what doctors will be 
paid when they see a Medicare patient. What we do every year is change 
what is in the formula because it cuts the physicians.
  So is not the assumption that we are going to continue to cut what we 
pay physicians, and if we come along and change that in the second 
year, will not we then be adding to the deficit?
  Mr. BARRASSO. Well, you will be adding to the deficit. That is why 
seniors all across this country have great concerns about what is being 
proposed.
  I am saying: Who is opposed to this? The No. 1 group is seniors, by 2 
to 1. Seniors are opposed to what is happening because they know this 
is going to be paid for out of their own Medicare.
  Just 10 or 15 minutes ago, we heard the majority leader on the floor 
of this Senate say--and I wrote it down. He said, talking about his 
plan, he said: If you like what you have, you can keep it. That is what 
he said.
  But you and I both know there are 11 million Americans, seniors in 
this country, on Medicare Advantage, which is a program set to help 
people in cities and people in rural communities. They have both in 
Tennessee. We sure have the rural communities in Wyoming.
  It says they cannot keep that if they like it--or 11 million, it is 
double the number on it in the last couple years because it is so 
popular, because it actually does what Medicare itself does not do, 
works with prevention, works with coordinated care. That is what our 
seniors want. That is why seniors across the country are so opposed to 
this.

[[Page 22920]]


  Mr. ALEXANDER. I see the Senators from Utah and Arizona have come to 
the floor. We were talking, Senator Barrasso and I, about how well the 
majority leader has done in helping to do what all of us would like to 
do in his home State.
  He has noticed, I guess he has heard from his Governor, that the 
Finance Committee is saying we are going to expand Medicaid in the 
State, but the States are going to help pay for it. The majority leader 
has put something in the bill so Nevada does not have to pay for it.
  I notice--to Senator McCain--according to the New York Times, in 
Arizona overall tax revenues fell 27 percent in the second quarter of 
this year from a year ago.
  I wonder how Arizonans are going to feel about paying for Nevada's 
Medicaid.
  Mr. McCAIN. I find it entertaining when our constituents ask: Have 
you read the bill? Of course we haven't been able to because there is 
no bill. If I could just quote what happened here. This says:

       The Chairman's Mark will provide additional assistance that 
     would be made available to high-needs states which are 
     defined as states that (1) have total Medicaid enrollment 
     that is below the national average for Medicaid enrollment as 
     a percentage of state population as of the date of enactment 
     . . .

  It goes on and on for a few more sentences. What does it mean? It 
means they got a special deal for four States, one of them being the 
State of Nevada. Who pays? Who pays? The other States. So we have a 
complaint by the distinguished majority leader that his State of Nevada 
would have to pay an amount that they don't appreciate, so we shifted 
it so that three other States--I am sure my friend from Tennessee knows 
which ones. I believe one of them is Oregon. I am not sure what the 
other three are.
  Mr. ALEXANDER. Michigan, Rhode Island, and Oregon are the three 
others.
  Mr. McCAIN. So our constituents who don't happen to live in those 
fortunate four are now going to pay additional funds because we put in 
the chairman's mark. Everybody wonders why people are so mad. They 
wonder why is it that there are these tea parties, why is it that there 
are people marching on Washington, what are they mad about? I hear the 
pundits and those who very seldom go outside the beltway or outside 
Manhattan say they are a bunch of crazies. It is this kind of thing. It 
is this kind of thing. We are going to do a legislative appropriations 
bill here that has $500,000 in it so that Senators can send out 
postcards to announce townhall meetings. Has anybody had any trouble 
getting people to townhall meetings? We need to spend $500,000 
additional to notify people?
  Getting back to the point of the Senator from Tennessee, this is what 
is wrong. This is what is wrong with the way we do business. We cut 
special favors for special States, not based on need or requirements 
but on the influence of the individual Senator or Member of Congress. 
That is what they are mad about.
  May I mention one other thing to my friend from Tennessee. Yesterday, 
there was a big vote in the Finance Committee that dominated the 
headlines. The so-called public option was voted down by a significant 
margin. And we hear rumors that finally the administration will come up 
with a proposal. Doesn't that mean the goal will be basically to get 
any bill through both the House and Senate and then go into conference 
behind closed doors and rewrite the bill? That is my greatest fear.
  Mr. ALEXANDER. That is my fear. The danger is that they will put the 
bills together from these various committees and ram it through, and 
then we won't be able to ask the questions: Is my State going to pay 
more taxes for Medicaid? Is my Medicare benefit going to be cut, or is 
the national debt going to increase? These are important questions we 
have a right to know the answers to before we begin the vote on the 
bill.
  I ask the Senator from Utah, what does he see coming down the pike?
  Mr. BENNETT. Mr. President, I have said repeatedly that I would vote 
against my own bill, even if it were to pass the Senate unanimously, 
unless there were an ironclad guarantee--iron is not strong enough; 
carved in marble guarantee--from the President that he would veto a 
conference report that came back that did not have the kinds of 
protections I think my bill has.
  I agree completely with the Senator from Arizona. The big fear is 
that we craft something in the Senate that is reasonable and then 
submit it to a conference and it comes back in a conference report that 
is not amendable and gets passed by a majority vote here and we are 
stuck with it.
  As important as it is that we try to get the Senate bill right, we 
must recognize that there are two Houses of Congress. At the moment, 
the other body is not showing the degree of analysis we are trying to 
get going here in the Senate. The House bill is completely 
unacceptable.
  If I could pick up on the comment about the consequences of what is 
being done with respect to Medicaid, I will add the experience from the 
State of Utah to the experience that has been referred to for other 
States.
  In Utah, an expansion of Medicaid, as outlined in the Finance 
Committee bill, would mean anywhere from an additional $150 million to 
$248 million to Utah taxpayers. I realize that in a State such as 
California that is multiple billions of dollars in debt, an extra $150 
million to an extra quarter of a billion is not a lot of money. But in 
Utah, it is a significant amount. We need to pay attention to the fact 
that every State is facing those kinds of significant increases.
  I call the attention of the Senate to an analysis that is in today's 
Congressional Quarterly, dated September 30, talking about the bill as 
it is moving through the Finance Committee. I quote:

       Under current law, taxpayers can deduct expenses that 
     exceed 7.5 percent of their adjusted gross income. Under the 
     Baucus original proposal, that floor would have been raised 
     to 10 percent, starting in 2013.

  Then further:

       According to data from the Joint Committee on Taxation, 45 
     percent of the taxpayers affected and 53 percent of the 
     revenue from the change would come from people 65 and over.

  So for those who are asking--and we read about them in the paper all 
the time--why are the elderly upset, they have Medicare? The elderly 
are smarter than that, and they recognize that 53 percent of the 
increase that would come as a result of these proposed changes would 
come from them.
  Mr. ALEXANDER. Would the Senator not agree that therefore older 
Americans who depend on Medicare might especially want to read the 
bill?
  Mr. BENNETT. They certainly are going to want us to read the bill and 
be honest with them as to what is in it. They are going to want us to 
go into the managers' package, into the small details that usually are 
considered technical and get passed over, and be very specific in 
saying to our constituents: We know what is in the bill, and we are 
being very upfront with you in telling you what is in the bill.
  One of the things we need to be upfront about is the amount of 
increase this will cost seniors and the amount of impact it will have 
on States. States will then have to turn around and raise their taxes, 
and seniors will pay twice, with the increase at the Federal level and 
the increase at the State level.
  Mr. ALEXANDER. The Senator from Wyoming was home last weekend. I 
wonder if he is hearing especially from senior Americans who worry 
about the effect of this bill on Medicare.
  Mr. BARRASSO. I heard that in Wyoming this past weekend. People who 
depend upon Medicare are rightly suspicious, very suspicious about this 
program. As they try to learn more about it, what they learn is that it 
is going to cut Medicare. They are learning it is going to increase 
taxes. They are learning it will limit what they have in terms of 
choices for their health care.
  For all Americans, if you ask: What do you think, is this going to 
cost more or less, they think it is going to cost more. When I ask 
people at townhall meetings: Do you think you will have better or worse 
care, the show of hands is that they will have worse care.

[[Page 22921]]

Americans don't want to pay more and get less. People want value for 
their money.
  People who depend on Medicare are rightly more suspicious than other 
folks because of the impact this is going to have on them. They 
understand $500 billion is going to be cut from their health care.
  Mr. ALEXANDER. We have 4 minutes left. I believe I will wrap up and 
leave the last minute to the Senator from Utah. Our point is a pretty 
simple one. We believe, we Republicans, that after this bill is put 
together, we ought to have ample time to read it, that it ought to be 
on the Internet for 72 hours, and that we ought to hear from the 
nonpartisan Congressional Budget Office how much it costs. Why would we 
do that? Because we have differences of opinion over whether it hurts 
people on Medicare, over whether States will have to raise taxes in 
order to pay for Medicaid, over whether the assumptions made will 
actually add to the debt, over how large taxes are on small businesses. 
We have differences of opinion. The only way we can intelligently 
debate those is if we can read the bill and know what it costs.
  On the Republican side, we believe we should focus on reducing costs 
and go step by step to re-earn the trust of the American people by 
fixing health care in that way, starting with such ideas as permitting 
small businesses to pool their resources in order to offer insurance to 
a larger number of people. Another way to reduce cost would be to find 
ways to eliminate junk lawsuits against doctors.
  The Senator from Utah may have other thoughts about the importance of 
reading the bill.
  Mr. BENNETT. Mr. President, I will make this comment with respect to 
the remarks of the Senator from Tennessee with reference to the CBO. We 
need hard numbers, but we do have a preliminary understanding already.
  The Director of the CBO, Mr. Elmendorf, was asked if it is true that 
the fees established in the bill would ultimately be passed on down to 
the health care consumer, and his response:

       Our judgment is that the piece of legislation would raise 
     insurance premiums.

  If we go more deeply into the CBO analysis, we find that not only 
would premiums in the individual market be higher than under the 
proposed reform, but taxes on insurers and drugs and devices would be 
passed on to consumers in the form of higher premiums. Finally, CBO 
also says that the premiums would be extremely high even after the 
proposed reforms because taxpayers would be subsidizing expensive 
plans. We clearly need the kind of careful analysis that clothes these 
comments with actual numbers. Without those, how can we vote with any 
kind of clarity on the proposal before us.
  Mr. ALEXANDER. I thank the Senator from Utah and yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Illinois is 
recognized.

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