[Congressional Record (Bound Edition), Volume 155 (2009), Part 17]
[Senate]
[Pages 23548-23555]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. ALEXANDER. Mr. President, a lot of what we say in Washington, DC, 
doesn't make its way through to the people out across the country who 
hire us. It is called, in different words, Washington-speak or 
gobbledygook by some people. Sometimes we have a hard time 
understanding ourselves. But one thing has gotten through to the 
American people: the idea that we should, No. 1, read the bills that 
come before us and, No. 2, we should know what they cost before we vote 
on them.
  I think the reason for that is because, over the last several months, 
we have suddenly seen a whole series of Washington takeovers and 1,000-
page bills and the people in this country are getting worried about a 
runaway Federal Government, thinking we may be overreaching here. We 
had a 1,200-page bill in the House of Representatives on energy and 
global warming. It was available for 15 hours before the vote. We had a 
stimulus bill--that was $800 billion, not counting interest--that was 
1,100 pages and was available online for 13 hours. We had a $700 
billion bailout, called the financial sector rescue package, which was 
available for 29 hours. The other day in the Finance Committee, 
Republicans said let's put the bill online for 72 hours. That was voted 
down by the Democratic members of the committee.
  What we Republicans would like to say is this: We want health care 
reform. We have our ideas and suggestions that we have made. We think 
we should focus on reducing costs, that we should go step by step in 
that direction, starting, for example, with allowing all small 
businesses to pool together so they can offer health insurance to their 
employees at a reasonable cost. The estimates are that millions more 
Americans would be able to get health insurance from small businesses.
  We have other suggestions for reducing costs. But the first thing we 
would say is, as this bill comes to the Finance Committee--and I see 
the Senator from Delaware and the Senator from Texas, who are both 
members of that Finance Committee--we want to be able to read the bill 
and know what it costs. Over the next 3 weeks, we hope, on the 
Republican side, to help the American people understand what this 
health care bill means for them. You hear lots of competing claims 
about it--it does this or that, and we are scaring you or they are 
scaring you. Let's take it one by one.
  If we have time to read the bill, and we know what it costs--the 
President said this bill cannot have a deficit. If we don't know what 
it costs, how can we do what the President wants us to do? I hope we 
take a sufficient amount of time. The bill is in concept form now, and 
then the majority leader will take it into his office and merge the

[[Page 23549]]

Finance Committee bill with the bill that we on the HELP Committee 
worked on in July, and out of that will come another bill. We will need 
the CBO to look that bill over, which I am sure will be well over 1,000 
pages. It will take a couple weeks to see what it costs. Then we can 
work on it.
  Why is it so important that we actually have the text of the bill and 
know what it costs? Because the bill has $\1/2\ trillion in Medicare 
cuts in it. On the other side, they say: Don't say that; you are 
scaring people. Well, it either has it or not. We say it has it. The 
President said there will be Medicare savings. The truth is, it is 
worse than that. What it appears to be is we are going to cut Grandma's 
Medicare and spend it on somebody else. There may be savings in 
Grandma's Medicare, but, if anything, we ought to spend any savings on 
making Medicare solvent because the trustees of Medicare have told us 
it will go broke in 2015 to 2017. So the people have a right to know 
will there be cuts to hospitals, hospices, home health, to Medicare 
Advantage. One-fourth of seniors on Medicare have Medicare Advantage, 
and it is going to be cut.
  We need ample time to say: What do those cuts in Medicare mean to 
you? Will the bill raise your taxes? We say it will; some say it will 
not. But from our reading of the bill, it looks like there will be at 
least a $1,500 tax per family, if you don't buy certain government-
approved insurance. There is the employer mandate requiring you to 
provide insurance. That is a tax. There are $838 billion of new taxes 
on insurance companies, medical device companies, which will be passed 
on to consumers. That is a tax.
  The Presiding Officer was a Governor, as I was. He was chairman of 
the National Governors, and many Governors are very upset because we 
are expanding Medicaid in their States and sending a large part of the 
bill to them. So that could be more State taxes.
  Now we hear from the Governors. There was an article in the 
Washington Post yesterday, and I ask unanimous consent that it be 
printed in the Record following my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. ALEXANDER. The article says: ``States Resist Medicaid Growth. 
Governors Fear For Their Budgets.''
  The Tennessee Governor--a Democrat--said:

       I can't think of a worse time for this bill to be coming. 
     I'd love to see it happen. But nobody's going to put their 
     state into bankruptcy or their education system in the tank 
     for it.

  The Governor of South Dakota said:

       That's a heck of an increase, and I don't know how I'm 
     going to pay for it.

  The Governor from Ohio said:

       I have indicated that I think the States, with our 
     financial challenges right now, are not in a position to 
     accept additional Medicaid responsibilities. Governor 
     Schwarzenegger of California said it will add up to $8 
     billion to California, and California is nearly going broke 
     anyway. Senator Feinstein said she cannot support a bill that 
     puts that kind of additional tax on States.

  Basically, it is the old trick of we in Washington saying here is a 
great idea, we will pass it, and send part of the bill to the States. 
What will the States have to do? They will have to cut the money that 
goes to the University of Texas or Delaware or Tennessee. They have to 
raise taxes, or they cannot cut benefits because cutting benefits is 
against the law.
  So how much will these Medicaid mandates cause taxes to be raised in 
your State?
  There are other questions we would like to ask. Will this bill raise 
your insurance premiums? The whole point of this exercise, we think--
and a lot of the American people think--is we want to reduce costs--
costs to you when you buy your health insurance and costs to your 
government. Your Federal Government is going broke if we don't do 
something about rising health care costs, just as you might.
  You would think this bill would reduce your costs--to you for 
premiums and to you for your government. But that is not what the CBO 
says. It says that, in some cases, premiums for exchanged plans would 
include the effect of these new taxes and the premiums would increase. 
Then there will be more government-approved insurance plans, which may 
turn out to be more expensive for you to buy. In other words, you would 
not be able to buy the plan you now have. You will have to buy a new 
government-approved plan that will cost more.
  There will be higher premiums for young Americans under this bill. 
Almost everybody thinks that. So we need to have a full discussion over 
the next 2, 3 or 4 weeks. Is this going to raise your health care 
premiums? If so, why are we doing that? Then, is it going to raise the 
Federal debt? Well, everybody is saying no, no, no, this will be 
deficit neutral. The President says: Don't send me a bill without it. 
Except this bill, as we understand it, doesn't include what we 
elegantly call the doc fix. Every year, we have to approve, or 
overturn, provisions in the law for that.
  The PRESIDING OFFICER. The Senator has used 9 minutes.
  Mr. ALEXANDER. I thank the Chair. Those are provisions that set the 
payment rates for physicians. We always do that. We know we are going 
to do it. We do it every year. Yet this bill assumes we are not going 
to do that. If we do include the doc fix, that adds $285 billion to the 
debt.
  We are going to be asking these questions. Please give us the text so 
we can read the bill. We are going to ask the CBO: Exactly what does it 
cost? Then we will be coming to the floor and going to town meetings at 
home and we are talking to the American people about how this affects 
them. Does it cut your Medicare? If so, how? Does it raise your taxes? 
If so, how? Will it bankrupt your State or hurt education in your 
State? If so, how? Does it increase or reduce your health care premiums 
or add to the Federal debt of your government?
  These are the questions we need answers to, and we are looking 
forward to the debate; and then we are looking forward to passing 
health care reform that, step by step, begins to reduce the cost of 
health care to you and your government.
  I yield the floor.

                               Exhibit 1

                [From the Washington Post, Oct. 5, 2009]

                     States Resist Medicaid Growth

                          (By Shailagh Murray)

       The nation's governors are emerging as a formidable 
     lobbying force as health-care reform moves through Congress 
     and states overburdened by the recession brace for the 
     daunting prospect of providing coverage to millions of low-
     income residents.
       The legislation the Senate Finance Committee is expected to 
     approve this week calls for the biggest expansion of Medicaid 
     since its creation in 1965. Under the Senate bill and a 
     similar House proposal, a patchwork state-federal insurance 
     program targeted mainly at children, pregnant women and 
     disabled people would effectively become a Medicare for the 
     poor, a health-care safety net for all people with an annual 
     income below $14,404.
       Whether Medicaid can absorb a huge influx of beneficiaries 
     is a matter of grave concern to many governors, who have cut 
     low-income health benefits--along with school funding, prison 
     construction, state jobs and just about everything else--to 
     cope with the most severe economic downturn in decades.
       ``I can't think of a worse time for this bill to be 
     coming,'' said Tennessee Gov. Phil Bredesen (D), a member of 
     the National Governors Association's health-care task force. 
     ``I'd love to see it happen. But nobody's going to put their 
     state into bankruptcy or their education system in the tank 
     for it.''
       These fears are resonating with members of Congress and 
     have already yielded some important legislative changes, 
     including alterations to the Senate Finance bill, which 
     includes billions of dollars in additional funding, added 
     after governors raised a fury about the original, lower sum. 
     But House and Senate negotiators are reluctant to make 
     further concessions, and in recent days, House Democrats have 
     debated whether to trim Medicaid funding in their bill to 
     make room for other priorities.
       Yet lawmakers are wary about imposing a huge new burden on 
     an imperfect program that serves one of the most challenging 
     segments of the population, through a fragmented network of 
     state-run systems.
       Among the 11 million people the nonpartisan Congressional 
     Budget Office estimates will sign up for Medicaid under the 
     new rules, many are single adults and parents who have gone 
     for years without health coverage. Many of these individuals 
     also live in communities that lack the services to treat 
     them.
       ``States are already at a breaking point, and so they 
     should be thankful that this bill

[[Page 23550]]

     is only going to cost them an additional $30 billion,'' Sen. 
     Charles E. Grassley (Iowa), the ranking Republican on the 
     Finance Committee, told colleagues during the panel's two-
     week-long debate on reform. But Grassley added: ``We are 
     deluding ourselves, though, if we think that we are going to 
     do anything in this bill to make Medicaid a better program 
     for the people it serves.''
       The response from Democratic governors to the new burdens 
     that may be imposed on them has ranged from enthusiastic to 
     restrained. On Thursday, the Democratic Governors Association 
     delivered a letter to House and Senate leaders signed by 22 
     of its members. It was silent on Medicaid but lauded the 
     broader reform effort as essential. ``We recognize that 
     health reform is a shared responsibility and everyone, 
     including state governments, needs to partner to reform our 
     broken health care system,'' the letter noted.
       Yet congressional Democrats are sufficiently alarmed about 
     the potential impact that they already are seeking special 
     protections for their states. Even Senate Majority Leader 
     Harry M. Reid cut a deal with Senate Finance Committee 
     Chairman Max Baucus (Mont.) to ensure that the federal 
     government would pay the full cost of expanding Medicaid in 
     Reid's state, Nevada.
       Reid, who faces a potentially difficult 2010 reelection 
     bid, responded to a Republican outcry over his stealth move 
     by pointing to Nevada's crippling foreclosure crisis. ``I 
     make no apologies, none, for helping people in my state and 
     our nation who are hurting the most,'' Reid said on the 
     Senate floor.
       Among the most vocal opponents of Medicaid expansion are 
     Republican governors from Southern and rural Western states 
     that offer minimal coverage under current law and are less 
     equipped to handle an influx of new beneficiaries, compared 
     with more urban states with better-established social-
     services infrastructures. The list includes Mississippi, 
     governed by Haley Barbour, chairman of the Republican 
     Governors Association. Barbour denounced the proposed 
     Medicaid expansion at a news conference last month as a 
     ``huge unfunded mandate'' likely to result in state tax 
     increases.
       The wake-up call for the nonpartisan National Governors 
     Association came early in the summer, when Baucus and 
     Grassley announced that they were considering only a 
     temporary increase in federal funding to pay for new Medicaid 
     enrollees. NGA leaders mobilized through their health-care 
     task force, and after a round of conference calls with 
     committee negotiators and bilateral talks between individual 
     governors and senators, the temporary increase was made 
     permanent.
       Governors still worry that the boost is not enough to fully 
     close the funding gap. Recession victims already are flocking 
     to Medicaid, and enrollment is expected to rise through 
     fiscal 2010, according to the Kaiser Family Foundation's 
     Commission on Medicaid and the Uninsured. The pace of 
     increase is expected to ease after fiscal 2010, leaving 
     states with a short window before an anticipated onslaught in 
     2014, when the proposed Medicaid expansion would take effect.
       South Dakota Gov. Mike Rounds (R) saw Medicaid enrollment 
     in his state climb to 104,000 residents this year, costing 
     the state $265 million out of a budget of $1.2 billion. But 
     he expects a $50 million increase next year, and, even taking 
     into account federal aid from the economic stimulus bill, 
     South Dakota faces a $100 million shortfall. ``That's a heck 
     of an increase, and I don't know how I'm going to pay for 
     it,'' Rounds said.
       Bredesen said Tennessee could face $1 billion in extra 
     Medicaid costs for the first five years of the expansion. ``I 
     have no idea how we're going to afford it,'' he said.
       Nor can governors say for certain how many people will show 
     up to claim the new benefits. Because low-income people are 
     harder to track--they tend to move more frequently, and they 
     often don't file tax returns--state officials don't know 
     precisely how many will be eligible. Rounds estimates an 
     enrollment increase of about 75,000 people but concedes that 
     the number could be much higher.
       Another mystery is how many people who qualify for Medicaid 
     under current rules--a sizable portion of the uninsured 
     population--will decide to finally sign up. This is the 
     ``woodwork effect'' that unnerves state officials around the 
     country because it could lead to much higher costs.
       ``That's part of the problem we're having, is getting hard 
     numbers,'' Rounds said. ``We just don't know.''
       In South Dakota and many other states, communities lack 
     doctors and other healthcare providers who are willing to 
     treat Medicaid patients, either because the providers aren't 
     available or because Medicaid payment rates are so low. The 
     House reform bill would increase Medicaid payment rates to 
     the same level as Medicare rates, at a 10-year cost of $80 
     billion. In some states, Medicaid rates are as low as 40 
     percent of Medicare rates. But the finance panel rejected a 
     Grassley amendment that would have increased provider rates 
     in the Senate bill.
       Despite Medicaid's drawbacks, including rigid rules and a 
     complex bureaucracy, many health-care experts still view it 
     as the most practical way to insure the poorest Americans. 
     Low-income adults account for about half of the uninsured 
     population, and in states that provide minimum Medicaid 
     coverage, few parents and no childless adults are covered 
     unless they meet other eligibility criteria.
       ``If you're trying to expand coverage, at least Medicaid is 
     already up and operational in every state,'' said Diane 
     Rowland, executive director of the Kaiser Commission on 
     Medicaid and the Uninsured. ``You're not creating something 
     new with start-up glitches. For any of its flaws, it has been 
     operating, it is paying bills, it is contracting with managed 
     care, it has an eligibility system already in place.''
       As the reform debate unfolds on the House and Senate 
     floors, health-care negotiators are prepared for a flood of 
     pleadings like the one Reid made that could add up to many 
     billions, forcing reductions to other portions of the bill. 
     California Gov. Arnold Schwarzenegger (R), for one, estimated 
     that the Medicaid expansion could cost his state $8 billion a 
     year. Sen. Dianne Feinstein (D-Calif.) underscored those 
     concerns with her own pledge: ``I could not support a bill 
     that pushes additional costs on California state government 
     or its counties.''

  The PRESIDING OFFICER. The Senator from Texas is recognized.
  Mr. CORNYN. Mr. President, I join my colleague from Tennessee in 
discussing health care, which, as the Presiding Officer knows, has been 
the subject for several weeks now in the Finance Committee and across 
the entire country for the last few months.
  Currently, we are waiting for the CBO to come back to the Finance 
Committee and tell us what the preliminary cost estimate is of the 
Finance Committee bill, as voted with amendments that were passed in 
the Finance Committee. Soon, if we can believe the reports, the 
majority leader will bring to the floor a so-called merged bill from 
the two Senate committees--the HELP Committee and the Finance 
Committee--and then we will be asked to offer amendments and vote on 
that bill.
  While we are waiting for the process to unfold, I think it is very 
important to carefully ask the questions that the American people--
including my constituents in Texas--are asking me, questions I believe 
Senators should ask themselves as we debate health care reform on the 
Senate floor.
  The first question I would like to propose is: Will we have a 
transparent debate? The American people want transparency. I cannot 
tell you how many of them have contacted me from my State and elsewhere 
and have said: We want to read the bill language. Amazingly enough, 
many have cited back to me pages--references either from the House 
bills or the HELP Committee bill or otherwise--and said: What does this 
mean? I have concerns about that.
  The second question is: Will Congress actually listen to the concerns 
of our constituents once they learn more about what is in these bills? 
In other words, ultimately, the question is: Will we know what is in 
the bill before we are required to vote on it? Will we know how much it 
is going to cost before we vote on it, both in committee and on the 
floor of the Senate?
  If you will remember, way back in August of 2008--that seems like a 
long time ago, but it is almost yesterday--President Obama pledged that 
our debates on health care reform would be transparent. I applauded him 
for that at that time. He said negotiations should take place on C-
SPAN, so anybody and everybody who cared about it could see it. I 
remember, on January 20 of this year, sitting up there near the dais 
when our President spoke, and he said things I agreed with, such as: 
``We need greater transparency in government.'' He said: ``Transparency 
promotes accountability and it promotes public confidence in what we do 
here.''
  Well, the converse is also true; secrecy breeds suspicion and 
ultimately promotes cynicism about what we do here. That is why this is 
such an important issue. Unfortunately, those Americans who have been 
counting on a transparent process in Washington have been disappointed 
so far. We have seen special deals negotiated by the White House with 
lobbyists which have not been disclosed to the American people, some 
which we have learned about and some which we may not yet know about. 
One is the deal with the pharmaceutical industry--holding their 
exposure to $80 billion under this legislation. That deal was 
reinforced

[[Page 23551]]

last week by a vote in the Finance Committee.
  I wasn't a party to that deal. I am sure the Presiding Officer was 
not. I wonder how many other deals have been cut between the White 
House and various interest groups that we don't know about. We also 
learned about a deal cut with some hospitals--some but not all. A CBO 
score on an amendment last week had to be redone because it was $11 
billion off because the CBO, the nonpartisan office charged with 
telling us how much this bill will cost, didn't know about this hold 
harmless agreement with the hospital association.
  We need to know of these deals because they will not necessarily be 
reflected in the bill language, and only the White House, presumably, 
and the special interest groups that cut these deals know about them. 
But I think it is important the American people know about them so they 
can evaluate whether we are appropriately doing our job.
  I have heard it time and time again, particularly since the passage 
of the stimulus bill that we got roughly at 11 o'clock on a Thursday 
night and were required to vote on in less than 24 hours--my 
constituents are saying: Is it asking too much to have you read the 
bill before you vote on it? I voted no on that bill for a lot of 
reasons, but I didn't have the time, nor I suspect did many Members of 
Congress have the time, to read it before we were required to vote on 
it.
  We don't set the voting schedule; the majority leader does. I think 
that is another reason they want us to slow down. Let's find out what 
is in the bill. Let's let the American people read what is in the bill. 
Tell us what it is going to cost, and let's have a good, old-fashioned 
debate about what is in the best interests of the American people.
  The third special deal that was disclosed had to do with Medicaid. 
You remember the majority leader from Nevada said: The unfunded mandate 
for Medicaid expansion is too much for my State to absorb. Lo and 
behold, a new deal was cut with new language that would give four 
States a better deal than they would have had in the original proposal 
by the chairman of the Finance Committee, Senator Baucus. One of those 
four States, lo and behold, happens to be the State represented by our 
distinguished majority leader. I think these examples reveal why 
transparency is so important.
  As the distinguished Senator from Tennessee pointed out, we are going 
to have this mysterious merger of the Finance Committee proposals with 
the Health, Education, Labor, and Pensions Committee bill behind closed 
doors, presumably--I heard reports it is occurring now, maybe even as 
we speak, in the conference room of the majority leader without any of 
us being present. I think it is a perilous, indeed, a dangerous way for 
us to do business.
  As the distinguished Presiding Officer knows, the first amendment 
offered by our side of the aisle last week in the Finance Committee was 
offered by the Senator from Kentucky, Mr. Bunning. His amendment would 
have required a 72-hour waiting period before we would vote on the 
Finance Committee bill. During those 72 hours, we would, hopefully, 
have had actual legislative text not just conceptual language available 
to us and available to the American people so they could read it. We 
would also insist, under his amendment, on a score; that is, a cost of 
the Congressional Budget Office telling us how much Medicare was going 
to be cut, how much taxes would be raised, and how the bill would be 
paid for. That seemed like an eminently reasonable amendment to me. 
But, unfortunately, a majority did not carry the day in the committee, 
and it failed.
  I hope we have another chance to come back to that issue, perhaps 
even as one of the first amendments as we take up this bill on the 
floor because I think it is incredibly important to public confidence, 
to accountability, to try to do something about the cynicism that has 
crept into the public's perception of what we are doing. That is 
reflected in 16 percent of respondents in a recent Rasmussen poll 
saying they rate Congress as either good or excellent--16 percent. We 
need to do better than that. We need to restore confidence in what we 
are doing, and I think transparency will help; otherwise, what are we 
left with? We are left with people wondering whether there is some 
reason we don't want the public to read the bill. Maybe there is a 
reason that they don't think the public should read the language 
because maybe they don't intend to read the language before they vote 
on it.
  Some have said the language is just simply too complicated; that an 
average person cannot understand it if they read it, and that even some 
Senators would not be able to understand it if they read it before they 
voted on it.
  I ask us all to take a deep breath and one step back and think about 
the consequences. If some staffer is the one writing the language, and 
Members of Congress, members of committees, Members of the Senate do 
not read it and it perhaps is not written in understandable language so 
we know what the impact will be, how does that promote public 
confidence? It is something that ought to give us pause, and we ought 
to reconsider as we reflect on what the message sends.
  Mr. President, I ask unanimous consent for 2 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CORNYN. Mr. President, I ask, in conclusion, for my colleagues to 
think about what we are doing. One-sixth of the economy is going to be 
affected by our decision on these health care proposals. What we do in 
these bills will literally affect the life of every man, woman, and 
child in the United States of America--all 300 million of us. I don't 
think it is too much to ask that we slow this down, that we get the 
text, the actual bill language, that we know how much it is going to 
cost, and we post it online so the American people can read it and give 
us their reaction.
  We are called representatives for a reason. We represent 
constituents. I am proud to represent 24 million Texans. I guarantee, 
they want to know what is in this bill and how it is going to impact 
them and their families. It is very important that we answer this 
question in the affirmative.
  That question again is: Will this be a transparent debate? That is 
the first question I have but not the last that I will be appearing 
back on the Senate floor in the coming days to ask. These are the kinds 
of questions that deserve a candid answer. I hope, in the interest of 
bipartisan good faith, we will somehow find a way to come together and 
help make this a more transparent process.
  Mr. President, I ask unanimous consent that the quorum call be 
reflected equally, taken from both times on each side.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CORNYN. I yield the floor, and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. THUNE. Mr. President, I ask unanimous consent the order for the 
quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senator from North Dakota is recognized.
  Mr. THUNE. Mr. President, a number of my colleagues have been down on 
the Senate floor today talking about probably the biggest issue the 
Congress will deal with this year, and arguably for many years, either 
in the past or in the future, and that is the issue of health care 
reform. We know that issue is now staring us squarely in the face. The 
various committees that have jurisdiction over that issue in the 
Congress have acted: three in the House, now two in the Senate. It is 
expected the Senate Finance Committee will produce a bill sometime 
later this week.
  It is a critical debate for the Senate, for the American people, 
because it does represent literally one-sixth of the American economy. 
One-sixth of our entire GDP today consists of spending on health care--
government heath care, privately delivered health care, but health care 
nonetheless.

[[Page 23552]]

  The question before the Senate in the next week or two when this 
eventually reaches the floor is, what are we going to do to try to 
address the fundamental problem I think most people perceive with our 
health care system today, which is it costs too much? Arguably there 
are lots of Americans who do not have access to health insurance. All 
of us want to see that issue addressed and that those Americans who 
currently do not have health insurance have a way of being able to 
access that health care coverage.
  Many today use emergency services. It is not that people are going 
without health care, but they do not have coverage. We need the people 
in this country to have the assurance and the confidence they are going 
to have some sort of insurance that will protect them against those 
types of life-threatening illnesses, just the day-to-day illnesses that 
afflict people across this country. Yet I think the big issue for most 
Americans is the issue of cost.
  As I said before, when you look at double-digit increases for small 
businesses, for families, that really does affect all Americans in one 
form or another. It is a very personal issue. Health care is personal 
to people for obvious reasons, but it is an issue that affects their 
pocketbooks in a real, tangible way, and that is why I think there is 
so much attention and concern focused on the direction in which 
Congress intends to proceed.
  One of the issues that bears heavily upon that debate is the whole 
fiscal situation in which we find ourselves. If we were having this 
debate at another time, perhaps the circumstances being somewhat 
different, you might come to different conclusions. But one thing we 
all have to keep in mind as we look at how do we address this issue of 
health care in this country is doing it in a way that is fiscally 
responsible. The reason for that is we see deficits, huge deficits as 
far as the eye can see. For the fiscal year we just concluded on 
September 30, $1.6 trillion annual deficit; next year it is expected to 
be $1.5 trillion--trillions and trillions of new spending each and 
every year.
  This last fiscal year I mentioned, the deficit being $1.6 trillion, 
that literally represents 43 cents out of every dollar the Federal 
Government spent. Forty-three cents out of every single dollar the 
Federal Government spent this last year was borrowed. It is all debt.
  The PRESIDING OFFICER. The time on the Republican side has expired.
  Mr. THUNE. I ask unanimous consent to proceed until such time as the 
other side comes and claims their time.
  The PRESIDING OFFICER. Without objection, it is so ordered. The 
Senator is recognized.
  Mr. THUNE. The point I want to make simply is this: To put that into 
perspective for an average American family, if you are an average 
American family and your annual income is $62,000--from all your hard 
work and labor over the course of the year you generate $62,000 for 
your household--that would be the equivalent of spending $108,000. What 
the Federal Government is doing by borrowing 43 cents out of every 
dollar it spends is the equivalent to a family, a household in this 
country making $62,000, of spending $108,000. What family in America 
can do that? What small business in America can do that, can continue 
to borrow like that? They cannot. It is fundamental; you cannot do 
that.
  The Federal Government does it. We continue to borrow from the 
Chinese, and we say we will pay the bills at a later date. But one 
thing most Americans understand is, No. 1, you can't spend money you 
don't have; and, No. 2, when you borrow money, it does have to be paid 
back. What we are looking at right now is deficits and debt mounting to 
the point that 10 years from today the amount that every household will 
owe in this country is $188,000.
  How would you like to be a young couple just getting married, you 
just exchanged your marriage vows, and knowing when you start out your 
life as a family you are going to get a wedding gift from the Federal 
Government to the tune of a $188,000 IOU? That is in effect what we are 
doing to the next generation of Americans.
  That is the backdrop against which this whole health care debate gets 
underway. We have deficits and debt that is piling up to the tune of 
$188,000 per household at the end of the year 2019. So we ought to be 
looking at how we, No. 1, solve the health care crisis in a fiscally 
responsible way that does not spend trillions of more dollars and raise 
taxes and borrow more and more money.
  Those are all issues I think need to be very carefully considered by 
all Members of the Senate as we make these important votes.
  The other point I will make is this: There are, in the proposals that 
have been put forward--in all of them--tax increases to pay for this. 
The most recent version, the Finance Committee bill, is a $1.7 trillion 
cost over a 10-year period. That is the least expensive, I might add, 
of all the bills that have been produced so far. There are five bills 
that have been produced by the Congress. The Finance Committee bill, to 
their credit, is at least the least costly of those, $1.7 trillion over 
10 years. That is still $1.7 trillion in new spending.
  Bear in mind that we already have a Medicare system which is destined 
for bankruptcy in the year 2017. We have all kinds of other long-term 
liabilities and Social Security and Medicaid and entitlement programs 
that pile up. We are going to have to do something about those at some 
point. Yet here we are talking about adding an almost $2 trillion new 
entitlement on top of that crumbling foundation. I think most Americans 
would take issue with elected leaders who would do that, would take a 
program that literally is on the verge of bankruptcy and try to add 
another $2 trillion program on top of it.
  There is the overall cost of it to the taxpayers, but it is also how 
it is paid for. Obviously, it has to be paid for somehow or we deal 
with this issue of borrowing, which I mentioned earlier, so what is 
being proposed is a series of tax increases and a series of 
reductions--cuts in Medicare programs.
  The Medicare cuts are going to be bad enough. Medicare Advantage 
takes a big whack, which is going to affect a lot of seniors around the 
country. The providers take a whack; hospitals, home health agencies, 
hospices, all those things will take a big whack. But you also have 
about $400 billion of tax increases embedded into the latest version of 
the proposal--much higher than that in some of the other bills moving 
through the House--but nevertheless the American public is going to be 
handed the bill for this which will inevitably lead to higher taxes. So 
much so that the Joint Committee on Taxation, the Congressional Budget 
Office have estimated that 71 percent of the penalty will hit people 
earning less than $250,000 a year. That conflicts and contradicts 
directly the commitment the President made of not raising taxes on 
people making less than $250,000 a year.
  They have also gone so far as to say the taxes that would be imposed, 
and there are a series of taxes as I said--insurance companies will be 
hit with taxes--the Congressional Budget Office said those taxes will 
be passed on, dollar for dollar, to people across this country. So the 
insurance companies, yes, they may remit the taxes, but they are going 
to pass on the cost. So you are going to see not only higher taxes on 
the insurance companies that get passed on in the form of higher 
premiums to individuals in this country--in other words, you are going 
to have higher insurance costs--but you also have taxes put in here 
that hit people who do not have health insurance. Those taxes get up to 
be about $1,500 per year for people who do not have insurance. So 
people would be penalized, and that would apply, again, across all 
spectrums of earners, wage earners in this country.
  But the CBO, as I said earlier, estimated 71 percent of that penalty 
is going to fall on people who earn less than $250,000 a year. If you 
project on further--this, again, is the Congressional Budget Office and 
the Joint Committee on Taxation--they have said by the year 2019 89 
percent of the taxes will be paid by taxpayers earning less than 
$200,000 a year. So that huge tax burden, that $400 billion initially

[[Page 23553]]

that will grow when the bill is fully implemented, will fall 
disproportionately on people making less than $250,000 a year; 89 
percent of those taxes paid by taxpayers earning less than $250,000 a 
year.
  So the enormous amounts of taxation that are contemplated in this 
bill--in addition to the Medicare cuts that are proposed to pay for and 
finance these changes in health care--are being passed off as health 
care reform.
  My view on this is, No. 1, we, the American people, need to know 
these facts. I think what that would suggest is there ought to be an 
ample amount of time when we finally do have a bill. I know the Finance 
Committee is marking up their version of it. They expect to report it 
out later this week. But what we are going to see reported out is 
concepts, generalities. We do not have a bill with legislative language 
to react to yet. That is going to be put together with the bill 
produced by the Health, Education, Labor and Pensions Committee 
earlier. Those will be merged. At some point, that will be reduced to 
legislative language. When it is, we expect it will be in excess of 
1,000 pages.
  We now are talking conservatively about having a bill on the Senate 
floor, not next week but the week after, which will be fully longer 
than 1,000 pages, none of which any Member of the Senate has yet seen. 
The American people, the people who are going to be most impacted, will 
not have had an opportunity to be engaged in this debate or have their 
voices heard. So we need to make sure, at a minimum, we slow this 
process down so we take it step by step so we are not rushing to do 
something very quickly and hurriedly that would be a big mistake for 
the American people.
  I suggest at a minimum we ought to have a very transparent, open 
process. When we have a bill, if it is in excess of 1,000 pages, that 
we have plenty of time not only for Members of the Senate to review it 
and read it and understand it but also for the American people to have 
that same opportunity.
  There were amendments offered in the Senate Finance Committee that 
would allow a 72-hour period. That seems to be reasonable. That is 3 
days, 3 days to look at something in excess of 1,000 pages. Yet that 
was voted down. My Republican colleagues on the committee offered that 
amendment, and it was voted down by the Democratic majority on the 
committee. But 72 hours at a minimum--I can't imagine that you could 
contemplate and fully grasp and understand that amount, that volume of 
information, and that kind of a bill in 72 hours, to start with. But at 
a minimum that should have been passed. That amendment was defeated at 
the Senate Finance Committee as were a number of other amendments that 
were offered by my colleagues on the Republican side.
  Having said that, first off I think we ought to have an ample amount 
of time to review this bill. Second, I argue in terms of the process 
itself that rather than throwing overboard, throwing away what is a 
very--it is flawed. We have a flawed health care system in this 
country. It is not perfect. OK? It has its problems. We all acknowledge 
that. We can fix those problems. But we should not throw everything 
good about it overboard. This will create all kinds of new government 
involvement and intervention in the decisions pertaining to health 
care. Now government is going to dictate what kinds of insurance plans 
or what should be in an insurance plan that, in order to be in 
compliance with this bill, you would have to be able to put forward. So 
people are going to have less and less choice, less and less freedom. 
Government is going to have more and more say, more control, more 
decisionmaking.
  I think most people across this country find that to be very 
threatening. I think they are genuinely, honestly concerned about 
having the government have more and more influence on one-sixth of the 
economy on an issue that is as personal to them as their health care.
  At a minimum, they ought to have an opportunity to review the bill. 
Second, we ought to take this thing and do it step by step and not 
throw it all overboard, not take what is good about the American health 
care system and throw it in the ditch simply because it has some flaws 
that need to be fixed. Those issues can be addressed.
  We need to cover those who don't have coverage. We need to try to 
address the issue of cost. But these bills do not do that. We have not 
seen a bill yet, of the five that are being worked on in Congress, 
that, No. 1, reduces health care costs.
  They all bend the cost curve up. You ask the Congressional Budget 
Office, and in every circumstance they will tell you: This does not 
reduce or drive down health care costs; it actually increases health 
care costs for most Americans.
  Secondly, we have not had a bill yet that is actually what I would 
not characterize as a budget buster. All of these bills are several 
trillion dollars, as I said earlier, on top of programs that are 
destined for bankruptcy in the very near future.
  Let's start slow. Let's take this step by step. Let's do this in a 
way that allows the American people to be engaged in this debate. It 
does affect them and their livelihoods in a very personal way. It does 
affect their pocketbooks. It will raise their taxes. And it will also--
again, not my words; the Congressional Budget Office's--``lead to 
higher health care costs, not lower health care costs,'' which, at the 
end of day, was that not the whole purpose of this exercise in the 
first place?
  So we are going to do everything we can on our side to open this and 
allow the American people to see it, to give ample time for them to be 
engaged and, secondly, to make sure that when health care reform is 
done by Congress, it is done in a way that is consistent with what I 
think most Americans believe should be done; that is, reducing and 
driving down health care costs, not increasing premiums as these bills 
do, not spending trillions of dollars of their tax dollars in piling on 
additional entitlement programs on programs that are already going out 
of business here in the next few years. But we should do it in a way 
that is fiscally responsible. I think that is the least the American 
people expect of us. I think we ought to deliver on that. We ought to 
deliver on health care reform but reform that truly accomplishes those 
important goals.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Udall of Colorado.) The Senator from 
Oklahoma.
  Mr. INHOFE. Mr. President, I ask unanimous consent that I be 
recognized to speak as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. It is my understanding that we have someone coming down 
wanting to speak, but there are a couple of things I wanted to mention.
  First of all, when the Senator from South Dakota talks about health 
care reform, there are some things we can do for health care reform 
that we have promoted for quite some time. Certainly, medical 
malpractice is very significant. It is a huge cost. Defensive costs are 
a very large part of our health care costs. HSAs came into being a few 
years ago, and we have pilot programs where they--let's keep in mind, 
health care is the only product or service in America that I know of 
where there is no encouragement to shop around. Well, if you have HSAs, 
this is encouragement because if you spend less, you can enjoy the 
benefits of that; that is, put that into other programs. So I think 
there are some things we can do.
  The second thing I would say about the subject that was covered very 
well by the Senator from South Dakota is that we don't know for sure 
what is going to be in the bill that comes out, but we do know this: 
Speaker Pelosi, over on the House side, has said that any bill that 
comes out of conference is going to have a government option. So they 
can masquerade it, they can talk about co-ops, they can talk about all 
of these things; we are going to eventually get something that comes 
out of conference and it is going to have a government option. That is, 
some people would say, socialized medicine. You can't compete with the 
government and have a system that has delivered the benefits our system 
has.

[[Page 23554]]




                             Cap and Trade

  Secondly, the Senator from South Dakota could just as well be talking 
about another piece of legislation that is up right now; that is, the 
cap-and-trade bill. It is another one that has the same thing where you 
do not know the blanks.
  Last Wednesday, there was a news conference by the Senator from 
Massachusetts, Mr. Kerry, and the Senator from California, Mrs. Boxer, 
and they gave this program--they talked about this new kind of cap and 
trade, but they did not give any specifics. Nothing that was in there 
was specific in terms of where is the cap, how does the trading take 
place, how does the rationing take place.
  The bottom line is this, though: Anything that has to do with any 
kind of cap and trade is going to be at least--at least--a $300 billion 
annual tax increase. That was true back as long ago as the late 1990s 
when the Kyoto bill was up. We had the Kyoto bill; they did a study on 
this thing; it was done by the Wharton School of Economics. They said 
that the cost of this, if we were to comply with the restrictions of 
that treaty, would be somewhere between $300 and $330 billion a year. 
To put that into perspective, because sometimes it is confusing when 
you are talking about billion dollars and trillions of dollars, I 
remember the largest tax increase that was a general tax increase was 
back in 1993 in the Clinton-Gore White House, and it was $32 billion. 
So this would be 10 times that amount.
  So we have had several bills in the Senate since that time, and I 
would only say this: This is a different debate. It is going to come up 
and we are going to have a chance to talk about it. But the bottom line 
is that the Administrator of the EPA, Lisa Jackson, a very fine person, 
a person who was appointed by President Obama, made the statement that 
if we were to pass the Waxman-Markey bill, something like that, sign it 
into law, it wouldn't have the effect of reducing CO2 at 
all. The reason is very obvious: We would only be doing that here in 
the United States.


                    Amendment No. 2566 to H.R. 3326

  Lastly, I did want to make one comment about a couple of votes that 
are going to come up, or at least one vote that is coming up at 3:45 
today. My junior Senator from Oklahoma, Mr. Coburn, has an amendment. 
It is an excellent amendment. It is one I will support, although I have 
to say that I was tempted not to because I would only like to start the 
ball rolling, that if this body is willing to redefine what an earmark 
is, we could be unanimous on this side. An earmark should be an 
appropriation without authorization. This has been a 200-year fight 
between authorizers and appropriators, and if we will get to the point 
where we will accept the fact that if something has gone through the 
scrutiny of an authorization--the highway bill is a good example of 
this. We have 30 criteria in that authorization bill. We come up with 
criteria to determine how much should be spent in different categories. 
And on the floor, there are always things coming up that did not go 
through the authorization process, and therefore I would call those 
earmarks.
  So I would only say this: In the amendment Senator Coburn has, it is 
going to address some 55 that are called earmarks, of which 6 were 
authorized. I would like to be able to take those six out. I don't know 
whether we can do that. It would be very difficult to do prior to the 
vote.
  But nonetheless, for future reference, if we are going to talk about 
earmarks, I think we need to define what an earmark is. It is an 
appropriation that has not been authorized. That is the thing we need 
to get after, and that will be one of my new wars I am starting.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Vermont is recognized.


                    Amendment No. 2601 to H.R. 3326

  Mr. SANDERS. Mr. President, I want to use this opportunity to say a 
few words about an amendment that will be voted on later this 
afternoon, and it is the Sanders-Dorgan Yellow Ribbon outreach 
amendment, No. 2601.
  Every Member of the Senate knows that we have seen many thousands of 
soldiers coming home from Iraq and Afghanistan and they have come home 
with post-traumatic stress disorder in very large numbers. They have 
come home with traumatic brain injury, TBI, also at frightening 
numbers. The government, in a number of ways, has developed many 
programs to try to provide help and medical care for these brave 
soldiers and for their families.
  In Vermont, a couple of years ago, we helped establish what I think 
is an excellent program that many other States around the country are 
beginning to look at, and the basic premise of the program we have 
established in Vermont is that while it is enormously important to make 
sure those who come home from Iraq and Afghanistan get the best 
services possible, we establish those health care services, those 
services don't mean anything unless the soldiers are able to take 
advantage of the services.
  Given the nature of PTSD and TBI, that is sometimes, especially for 
the members of the Reserve and National Guard, very difficult. So you 
will have instances, especially in rural America, where people will 
come home from Iraq, they are going to be in emotional trouble, and 
there are going to be strains and stresses on their families, with 
their kids. They may be suffering from PTSD, but one of the symptoms of 
PTSD is you do not stand up and say: You know what, I have troubles and 
I need help. That is not what you do.
  What we established in Vermont was an outreach program which was 
largely filled with the veterans from Iraq who would go out to the 
communities and drop in and sit down with soldiers and their wives face 
to face and just get a sense of how they are doing and through that 
personal visitation suggest to them that if there is a problem, they 
might want to take advantage of the services the VA is providing, which 
in my State are quite good, and to make them aware that it is not 
unusual, that they are not the only people who are dealing with PTSD or 
TBI. In truth, this outreach program has been quite successful.
  Some years ago, the Congress established a Yellow Ribbon Program 
which is doing a good job, and the goal of that program is to educate 
people who come home from Iraq and Afghanistan about the services 
available to them. But we have not yet funded the kind of strong 
outreach effort that I believe we need where we are literally sending 
people out to National Guard families, especially maybe in rural areas, 
and making them understand that their problems are not unique, that 
there are services available to help them.
  So outreach is the word here. We do it in Vermont in a very informal 
way, just person to person.
  This amendment is $20 million, and the offset comes from the $126 
billion in funds in title IX of the bill. It does not cut any one 
particular account. This $20 million represents a fraction of 1 percent 
of the entire title.
  So the issue here is that we have a serious problem with PTSD and 
TBI. I think it is terribly important that we do everything we can on a 
personal level to reach out to the families to get them the services 
they need. But, once again, you can have the greatest service in the 
world--I know we are trying. The Department of Defense is trying its 
best--but those services don't mean anything if veterans don't access 
them. So the goal is to get people into the services.
  I would very much appreciate support for the Sanders-Dorgan amendment 
which will be coming up in a while.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.


                    Amendment No. 2583 to H.R. 3326

  Mr. TESTER. Mr. President, later today the Senate will vote on the 
McCain amendment No. 2583. This amendment would terminate funding for 
research and development of the Army's full-scale hypersonic test 
facility known as the MARIAH hypersonic wind tunnel.
  The MARIAH Hypersonic Wind Tunnel Program is under development in 
Butte, MT. It is the Nation's only program to develop the wind tunnel 
technology required to test and evaluate

[[Page 23555]]

new hypersonic missiles, space access vehicles, and other advanced 
propulsion technology, technology the Air Force says we will need.
  MARIAH will be the first true air hypersonic wind tunnel program. The 
program has met its technical milestones and has not encountered 
significant setbacks. In fact, the Army Aviation Missile Command has 
given this project high marks. Here is what the Army has said:

       This research has shown great potential to be used in a 
     missile test facility and is the only technology shown to 
     have any possibility of meeting the requirement for a Missile 
     Scale Hypersonic Wind Tunnel.

  The Army has asked the MARIAH Program to provide testing capabilities 
at speeds of up to Mach 12. This is the next generation of hypersonic 
flight, something that has never been done before. To get to that 
capability, cutting-edge research and technologies are required.
  The program already has provided very real and discernible benefits 
to both the scientific community as well as our armed services. There 
is no other facility in the world capable of meeting the performance 
requirements at Mach 8 and above.
  According to a 2000 Air Force Science Advisory Board report, this 
type of testing will be needed for space access vehicles, global reach 
aircraft, and missiles that require air-breathing propulsion to reach 
speeds above Mach 8.
  The MARIAH project has worked with Princeton University and Lawrence 
Livermore and Sandia National Laboratories to develop technologies and 
computer modeling that exists nowhere else in the world.
  The team has achieved world records by reaching test pressures of 
over 200,000 psi.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. TESTER. I ask unanimous consent for additional time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  It also has developed one of the most powerful electron beams in the 
world.
  Working with Sandia National Labs, MARIAH has developed a 1-megawatt 
electron beam to boost the energy supply needed to generate the 
enormous pressures required in a wind tunnel of this caliber.
  It is the most powerful electron beam in the world, and its benefits 
can be applied well beyond this project to include shipboard missile 
defense, large- scale sterilization of food, mail and other items that 
could have a biohazard or bioweapon contaminant.
  In conjunction with Princeton University, MARIAH has successfully 
developed three-dimensional computational fluid dynamic computer models 
capable of simulating the previously unexplored physics necessary for 
the Mach 8 and above conditions.
  This is groundbreaking research that must be done before any missile, 
rocket or aircraft can be tested at hypsersonic speeds.
  Why does this matter? Why do we care about hypersonic capabilities?
  The answer is foreign competition and foreign capabilities.
  We know that Russia, China, and others are aggressively developing a 
new type of missile that is believed to be too fast for U.S. missile 
defense systems that are either planned or in use.
  In particular, the India-Russia joint venture BrahMos is now engaged 
in laboratory testing of supersonic cruise and antiship missiles 
capable of speeds in excess of Mach 5.
  According to the Air Force Research Labs' report of April 2009 
entitled ``Ballistic and Cruise Missile Threats'':
  Russian officials claim a new class of hypersonic vehicle is being 
developed to allow Russian strategic missiles to penetrate missile 
defense systems.
  That report is referring to comments made by the commander of the 
Russian rocket forces who said last December that ``By 2015 to 2020 the 
Russian strategic rocket forces will have new complete missile systems 
. . . capable of carrying out any tasks, including in conditions where 
an enemy uses anti- missile defense measures.'' This is a direct 
reference to hypersonic capabilities.
  And yet some have said our military does not need this technology.
  But when it comes to figuring out how to defeat this potential 
threat, I believe we should look into the future, not look back at 
reports that are 5 or 10 years old.
  This project is about seeing a potential threat to our national 
defense looming on the horizon and finding a way to defeat it. It is 
vital to our national security.
  I urge my colleagues to reject the McCain amendment.
  I yield the floor.

                          ____________________