[Congressional Record (Bound Edition), Volume 155 (2009), Part 18]
[Senate]
[Pages 23667-23673]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, it is always a privilege to hear the 
assistant Democratic leader, who is one of the most skillful orators in 
the Senate. In this case, he needs to be because he is put in the 
awkward position of having to defend, as I heard him, 1,000-page bills 
and Medicare cuts, which is an awkward place for the assistant 
Democratic leader to be.
  As far as the Republican plan, he has heard our plan many times. We 
want to reduce costs. Instead of 1,000-page bills and changing the 
whole system and adding to the debt and cutting Medicare and raising 
premiums for millions of Americans, we would like to say our goal is to 
reduce costs--costs to you when you buy your health insurance and the 
cost of your government. We would like to go step by step in the right 
direction, which we say is reducing costs and re-earning the trust of 
the American people, and then we can take some more steps. We have 
offered a number of proposals to do that, none of which have been 
seriously considered.
  For example, small businesses should be able to pool their resources 
the way big businesses can. If they could, they could afford to offer 
insurance--it has been estimated by the Congressional Budget Office--to 
millions more Americans. We should make a serious effort to eliminate 
junk lawsuits against doctors, which everyone agrees adds costs to the 
insurance premiums we buy and to the cost of health care.
  We could allow Americans to purchase insurance across State lines. We 
could create health insurance exchanges so if you are buying an 
individual policy, you could buy that more easily. We can go across 
party lines to encourage the use of more technology. Almost all 
Republicans and I imagine some Democrats would like to change the 
incentives behind health spending, so we take the money we are using to 
subsidize health insurance now and spread it more equitably among all 
the people and allow them to buy more of their own insurance.
  Those are five or six steps we could take in the direction of cutting 
costs. Instead, what we are presented with is, yes, another 1,000-page 
bill. We have some questions about the bill because it appears--we know 
it will cut your Medicare, and I want to go back to that in a moment--
half the bill will be paid for by Medicare cuts. Forty million seniors 
depend on Medicare. Are we going to cut grandma's Medicare? We are not 
even going to spend it on grandma. We are going to spend it on a new 
program, at a time when the trustees of the Medicare Program have told 
us Medicare is going to go broke between 2015 and 2017. We are going to 
raise your taxes.
  That is what the bill coming toward us would be. We are going to make 
it hard for your States to support colleges and education or raise your 
State taxes because we are sending the bill to them for a large 
Medicaid expansion. For millions of Americans, we are going to increase 
your premiums. We are going to make it more expensive for you to buy 
the same kind of policy you already have because the government is 
going to tell you exactly what kind of policy you should have. We are 
going to increase your Federal debt because the plan, as we hear about 
it, does not have any provision for paying doctors serving Medicare 
more over the next 10 years--which we always do--so that is another 
$285 billion on your debt, just if we pay doctors 10 years from now 
what we pay them today for the government-run programs. We are going to 
spend another $1 trillion. And, yes, it is a 1,000-page bill.
  So we what we are saying is, we have had before this Senate for a 
long time a number of proposals we could use to reduce your cost when 
you buy health insurance and reduce the cost of your Federal 
Government, which is going broke because of health care expenses, but 
they are not being seriously considered. So we are saying, at least if 
you are going to come up with these 1,000-page bills to change our 
entire system, we want to read it and we want to know what it costs. 
Even the President has said we cannot add one dime to the deficit. How 
can we know we are not adding one dime to the deficit if we cannot read 
the bill and we do not know what it costs?

[[Page 23668]]

  Senator Bunning of Kentucky brought up that in the Finance Committee 
the other day, and the Democrats voted it down. They said you cannot 
even put the bill up for 72 hours--this 1,000-page bill--so we can find 
out if it cuts your Medicare, if it raises your taxes, if it bankrupts 
your State, if it increases your premium, if it increases the Federal 
debt. We cannot even find that out. They said: No, not even 72 hours.
  Well, some Democratic Senators have taken a look at that and said--
the Democrats who voted that down; and every vote against the 72-hour 
provision was a Democratic vote--they said: We do not agree with that. 
Eight Democrats have written Senator Reid, and they said: The 
legislative text and the complete Congressional Budget Office scores of 
the health care legislation, as amended, should be made available to 
the public for 72 hours prior to the vote on the final passage of the 
bill in the Senate. Further, the legislative text of all amendments 
filed and offered for debate should be posted on a public Web site 
prior to beginning debate on the amendment on the Senate floor. The 
conference report ought to be as well.
  I think what that means, in plain English, is that once the Finance 
Committee bill--which is not a bill now; it is just concepts--goes into 
Majority Leader Reid's office, and he puts it together with the HELP 
Committee bill, which will be turned into legislative text, we would 
like for that to be on the Internet for 72 hours so we in the Senate 
and our staffs and the American people can read it.
  Second, we want to make sure the Congressional Budget Office has a 
chance to read the entire bill so some staff member does not change it 
in the middle of the night, as they apparently did with the HELP 
Committee bill, and we can know exactly how much each of the provisions 
cost, and then we can start voting, then we can offer our amendments. 
As the Republican leader was saying today, some of our amendments are 
going to have to do with Medicare, the program that 40 million seniors 
depend on.
  Let's be clear about this. Some things are facts. Half the bill is 
going to be paid for by Medicare cuts. Half the bill is going to be 
paid for by Medicare cuts. You can call them anything you want to, but 
they are Medicare cuts.
  The second thing about it is, it may be grandma's Medicare we are 
cutting, but we are going to spend it on somebody other than grandma. 
We are going to take that money out of the Medicare Program, which is a 
$38 trillion unfunded liability and which the trustees say is going to 
go broke in 2017 and which 40 million Americans depend on, and we are 
going to take those savings and we are not going to spend it to make 
Medicare stronger; we are going to spend grandma's Medicare benefits on 
somebody else. We are going to cut her benefits and spend it on you. 
Does that make sense? We don't think so. We don't think so. We don't 
think we should be paying for this new $1 trillion bill by writing a 
check, as the Senator from Kansas has said, on an overdrawn bank 
account and buying a new car, which is what that turns out to be.
  The Republican leader talked about what the cuts are to Medicare 
Advantage: $140 million. One-fourth of seniors on Medicare have 
Medicare Advantage accounts. Cuts include $150 billion for hospitals 
that care for seniors; $40 billion, home health agencies; $8 billion, 
hospices--all from Medicare to be spent on something else.
  The President said people who are currently signed up for Medicare 
Advantage are going to have Medicare at the same level of benefits. 
Well, we want to read the bill and know what it costs because that is 
not what the Congressional Budget Office Director said. He testified 
that seniors under Medicare Advantage would have benefits that 
disappear under the bill that is coming out of the Finance Committee. 
He said those changes would reduce extra benefits such as dental, 
vision, and hearing coverage that currently are made available to 
beneficiaries.
  We want to read the bill. We want to know what it costs. We want to 
know why we are cutting Medicare by $\1/2\ trillion--that is the first 
question--and the second question is, Why are we spending that money on 
something else when it ought to be spent on making Medicare stronger? 
The bill has $\1/2\ trillion in savings from Medicare. At least they 
could take that money and use it toward the money we pay to physicians. 
I mentioned it a little earlier, but every year physicians say: The 
government-run program of Medicare only pays us 80 percent of what 
private insurance plans pay us, and you are about to cut that. So we 
almost always, on a bipartisan basis, put it back up. That is not in 
the bill. We don't even include that. We don't take that into account. 
So that is going to add to the debt.
  Then there are other questions we have in addition to the Medicare 
cuts. What about the elegantly called ``doc fix'' that will add to the 
debt? It is the Medicaid Program. To some people, that may get a little 
confusing. Medicare is for seniors. Medicaid is the program that 
usually has a different name in most States. It is a program that 
started years ago, and the Federal Government pays 40, 45 percent of it 
and the States pay the rest. It has been going straight to the Moon. 
According to the New York Times, costs are rising in Medicaid this year 
at record rates--7.9 percent.
  I know as a former Governor, here is what really happens. You sit 
there making up your budgets, and you do the part for prisons and you 
do the part for kindergarten through the 12th grade and the part for 
highways and the part for State parks, and then the rest of the money 
is usually split between higher education and Medicaid. Guess what is 
happening. Medicaid goes up and higher education doesn't get the money. 
Then what happens? College tuition goes up because colleges such as the 
University of Tennessee and Texas and New Mexico and Colorado are 
underfunded today primarily because of increasing Medicaid costs.
  What this bill does is dump a lot more low-income Americans into that 
Medicaid Program and send a lot of the bill to the States. The Governor 
of Tennessee, a Democrat, said in the morning paper that it is going to 
cost us $735 million at least--maybe over $1 billion--over the next 5 
years. Tennessee can't afford that. Tennessee is a conservative, well-
managed State. Governor Schwarzenegger has said that in California it 
could be up to $8 billion. California is already nearly bankrupt. The 
Democratic Governor of Michigan has said he doesn't see how they can 
pay for this. The Governors of every State have said to us: Mr. 
Senator, Mr. Congressman, if you want to expand Medicaid, if you want 
to expand Medicaid, pay for it; pay for it in Washington, don't send it 
to us.
  So we are looking forward to reading this bill. We are looking 
forward to knowing what it costs. We have our proposals. I will be glad 
to spend some time on the floor with the assistant Democratic leader 
and talk with him about the Republican proposals to take us step by 
step toward reducing health care costs, first for you and your premiums 
and next for your government, and why we are skeptical of this 1,000-
page bill. But we at least want to know what it costs. We at least want 
to know why it is cutting Medicare by half-trillion-dollar, and if it 
is being cut, why is grandma's Medicare cut being spent on some new 
program. We would like to know how much does it raise your taxes. We 
would like to be able to tell you what it is going to do to your 
State's education system and to your State taxes. We would like to be 
able to tell millions of Americans: Will this really raise your 
premiums instead of lowering them and will it really increase your 
Federal debt?
  So we are grateful eight Democratic Senators have joined us in saying 
to the majority leader: Let's make sure this bill is finally a bill 
that will give us all the language before us, that it is on the 
Internet for 72 hours, and that we know exactly what the provisions 
cost--all of that before we have our first vote.
  I thank the President, and I yield the floor.

[[Page 23669]]

  The ACTING PRESIDENT pro tempore. The Senator from Texas is 
recognized.
  Mr. CORNYN. Mr. President, I wish to thank my colleague from 
Tennessee for speaking so eloquently and raising the issues that are on 
the minds not just of Senators who are going to have to vote on this 
legislation but our constituents all across America--people who will be 
directly affected by what we do here on health care reform.
  Yesterday, I came to the floor and I asked the question: Will we have 
a transparent debate? This morning, when I got up and checked my e-
mail, I was delighted to see that eight Democratic Senators have 
written to the majority leader, Senator Reid, and said they wanted to 
have bill language posted on the Internet and a score or cost by the 
Congressional Budget Office at least 72 hours before we are required to 
vote on the bill. That is exactly what we had requested in the Finance 
Committee, which we lost strictly on a party-line vote, an amendment 
that would have made that part of the bill. So I consider that 
progress. I am delighted that these eight Democratic Senators have 
asked the majority leader for that. I think that is a minimum we should 
expect in terms of transparency.
  Today, I have a new question, and that is whether seniors will get to 
keep the Medicare benefits they currently have. Will seniors be able to 
keep the Medicare benefits they currently have? The President has made 
this a consistent theme, that if you like what you have, you are going 
to be able to keep it. He said in August that if you like your health 
care plan, you can keep your health care plan. It seems pretty 
straightforward and unambiguous.
  Last month, he was more specific about one part of Medicare. He said:

       People currently signed up for Medicare Advantage are going 
     to have Medicare and the same level of benefits . . . These 
     folks will be able to get Medicare just as good and provide 
     the same benefits.

  Some of these programs get a little confusing, but let me explain 
that Medicare Advantage is a private sector competitor to Medicare fee-
for-service, where you just--it basically provides people with an array 
of coverages, and I think Senator Alexander mentioned vision and dental 
care and prescription drug coverage and the like.
  I believe allowing seniors to keep the benefits they currently have 
under Medicare Advantage--and there are some 11 million of them--is a 
goal Republicans share with the President. So if the President is 
sincere when he says that Medicare--and particularly Medicare 
Advantage--beneficiaries can keep what they have, we would like to help 
him keep that promise. Medicare Advantage is working for about 11 
million seniors to give them a choice with their health benefits, and 
half a million of those are in Texas. Half a million Medicare Advantage 
beneficiaries are in Texas.
  As we have heard, Medicare fee-for-service, which is the government-
run plan, pays doctors about 20 percent less than employer-sponsored 
insurance for reimbursements for services. That is why in my State, 
about 42 percent of doctors will not see a new Medicare patient under a 
fee-for-service arrangement, because the fees are so low that the 
doctors can't provide the service at that price and still stay in 
business. So what happens is that 89 percent of seniors have 
supplemental coverage. My mother, who passed away this last spring, 
bought supplemental coverage to try to make up for the difference where 
Medicare fee-for-service left that gap. Of course, many low-income 
Americans depend on Medicare Advantage as their supplemental coverage.
  Some have claimed that Medicare Advantage provides extra payments, 
and they want to cut Medicare Advantage because they say it will reduce 
insurance company profits and not harm coverage. But under Federal law, 
that is simply not the case. Under Federal law, the fact is that 75 
percent of those payments to Medicare Advantage over and above what 
Medicare fee-for-service pays go directly to better benefits for 
seniors, under current law. That is why we hear they get vision 
coverage, dental coverage, prescription drug coverage; they get better 
benefits because we as a Congress say 75 percent of those so-called 
extra payments go to provide better benefits. Unfortunately, the 
Finance Committee bill will take those benefits away from seniors 
enrolled in Medicare Advantage. In other words, if we were to call up 
this Finance Committee bill today and to pass it, it would violate the 
President's promise, that the 11 million people on Medicare Advantage 
would not see a cut in their benefits.
  There are various numbers floating around. That is why we need what 
Senator Alexander said: the numbers from the Congressional Budget 
Office. But the Finance Committee proposal cuts nearly $113 billion 
from the Medicare Advantage Program. Common sense tells us you can't do 
that without having a negative impact on Medicare Advantage for those 
11 million seniors, 500,000 of them in Texas, as I said.
  The Congressional Budget Office agrees with that sort of intuitive or 
commonsense conclusion. They estimate that the Finance Committee bill 
will cut benefits by more than half to Medicare Advantage seniors. 
During the Finance Committee markup, the Congressional Budget Office 
Director, Dr. Doug Elmendorf, told us that approximately half of the 
Medicare Advantage benefits will be cut for those seniors enrolled in 
Medicare Advantage.
  So just as yesterday when my question was, will this debate be 
transparent, my question for today is, will seniors get to keep the 
Medicare benefits they currently have? I think that should be a focus. 
I know it will be a focus for the 11 million who are on Medicare 
Advantage. But for all seniors who are seeing a proposed cut of $\1/2\ 
trillion in Medicare in order to pay for a new government program while 
Medicare itself is on the brink of bankruptcy and has tens of trillions 
of dollars of unfunded liabilities, this is a question a lot of my 
constituents in Texas and a lot of seniors across the country are 
asking: Will seniors get to keep the Medicare benefits they currently 
have? That is what the President promised. We need to make sure this 
bill keeps that promise.
  In the coming days, I will come back to the floor and ask more 
questions about these extraordinarily complex proposals we have seen, 
including the bills that have come out of the HELP Committee, the 
Finance Committee, and out of the House of Representatives, because I 
think we need to break it down into smaller pieces and ask these 
discrete questions so the American people can judge for themselves 
whether these bills do what the President has promised.
  Mr. President, I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Tennessee is 
recognized.
  Mr. CORKER. Mr. President, do I have 10 minutes allocated?
  The ACTING PRESIDENT pro tempore. There is 9 minutes remaining.
  Mr. CORKER. It sounds as if I have 9 minutes.
  The ACTING PRESIDENT pro tempore. That is correct.
  Mr. CORKER. Thank you, Mr. President.
  I also rise today to speak about the debate before the Congress right 
now, which is health care reform.
  I believe we need health reform in this country and health insurance 
reform in this country. I would love to see us embark on a set of time-
tested, budget-neutral principles. I absolutely believe we ought to 
address the issue of preexisting conditions. I absolutely believe we 
ought to look at exchanges where citizens all across this country have 
access to the same kinds of choices I have as a Senator. I hope we will 
address the issue of cross-state competition where people in States are 
not just stuck with the choices that exist because of the monopolies 
that occur within their State boundaries. So I would love to see some 
cross-state competition.
  I absolutely believe we ought to have Tax Code changes. I think we 
ought to limit the amount of tax-free benefits individuals can receive 
from their employers. I will just throw out a number. If that number 
was established at

[[Page 23670]]

$17,000, for instance, about $450 billion would be generated over a 10-
year period that could be used as a voucher or refundable tax credit to 
enable 15 to 20 million Americans to be able to access private, 
affordable, quality insurance.
  I think we ought to address tort reform. We know there is so much in 
the way of medical procedures that are done, in essence, for defensive 
medicine so that they are not sued or the victims of junk lawsuits.
  I am one of those people who absolutely believes it is time in this 
country that we had certain health reforms and health insurance reform. 
I think now is the time to debate and put into place those sensible, 
time-tested reforms. My guess is, if we sat down in a bipartisan way, 
which I know is not occurring at this moment, we could go 50 yards down 
the field in a way to create access for Americans in our country that 
all of us want to see and, again, do so in a way that doesn't push off 
costs into future generations.
  I have serious problems with what is being discussed in the Finance 
Committee today as far as how we are going to pay for the many reforms 
that go beyond what I just discussed. In many cases, it is very 
unnecessary. Let me go over a couple of those.
  No. 1, I think most people are aware by now that the Senate Finance 
Committee mark is basically causing States to have an unfunded 
liability. The Governor of our State, who is on the other side of the 
aisle, just sent me a letter yesterday and told me he expects the 
revenues in the State of Tennessee to be at 2008 levels in the year 
2013. In other words, there has been a tremendous decrease in revenues 
for State government. Yet per the mark before the Finance Committee 
today, they are pushing off on the citizens of our State a $735 million 
unfunded liability. That doesn't sound like a lot of money in 
Washington, but I can assure you it is a lot of money for the State of 
Tennessee. As you can imagine, as the years go out that number 
increases tremendously.
  It is my belief there are States all across this country that are 
going to be coming to us asking why we are pushing off an issue to the 
State. I think that is incredibly irresponsible. I think we need to 
ensure that does not occur.
  I have to tell you, an issue I have an even greater problem with is 
the fact that we all know we have a $40 trillion unfunded liability as 
it relates to Medicare. Two or three years ago, there was a broad 
consensus, on a bipartisan basis, that we needed to address the 
unfunded liability that threatens our country under the entitlement 
programs--mostly Medicare, which is $40 trillion. This bill takes $400 
billion to $500 billion from Medicare and uses it to create a whole new 
entitlement. Instead of doing those things that would strengthen 
Medicare, which the trustees have said is going to be insolvent in 
2017--instead of doing that, which is the responsible thing for us to 
focus on today, this Finance Committee mark would take money from a 
program that is insolvent and use it to leverage a new entitlement 
program. I think that is the most irresponsible, shortsighted thing 
this Congress can do.
  In addition to that, it doesn't even deal with the issue of the doc 
fix. We all know physicians and providers who serve seniors today, to 
make the same money in 10 years they are making today, would cost $285 
billion. Instead of dealing with that issue, the can is being kicked 
down the road, and we are not dealing with that.
  I think the American people respect--and I respect--the people who 
came before us who are called the ``greatest generation.'' Sometimes 
they are called the ``greatest generation'' because of their sacrifices 
and their military efforts overseas. Sometimes it is because they saved 
and made the tough choices that have helped make this country great. 
But I believe if this Congress acts to take money from Medicare, which 
is insolvent, and doesn't use those cost savings to make Medicare more 
solvent, we will be contributing to the fact--and there is no doubt in 
my mind that the political leadership that exists today in this country 
is undoubtedly the most selfish that this country has ever seen. We are 
witnessing that today. We are a part of that today.
  It is my belief if we continue to throw future generations under the 
bus, which is what we are doing with legislation like is being proposed 
today--we are throwing future generations under the bus to score a 
political victory that we all know is not paid for--the wrath of the 
American people is going to come upon us, and it should.
  Mr. President, I have a letter from our Governor. I ask unanimous 
consent to have this letter printed in the Record. It talks about the 
costs this program will put on the State of Tennessee.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                           State of Tennessee,

                                   Nashville, TN, October 5, 2009.
     Hon. Bob Corker,
     U.S. Senate,
     Washington, DC.
     Hon. Bart Gordon,
     House of Representatives,
     Washington, DC.
       Dear Bob and Bart:  The following information is in 
     response to my telephone conversation with Bob last week, and 
     represents our best snapshot of where we are as of Sunday 
     evening the 4th. I hardly need to tell you that these numbers 
     represent a difficult problem for our state.

                      PROJECTED TENNESSEE NET NEW COSTS OF SENATE FINANCE REFORM 2014-2019
                                                  [$ millions]
----------------------------------------------------------------------------------------------------------------
                                                              Best estimate      Optimistic        Pessimistic
----------------------------------------------------------------------------------------------------------------
New Medicaid Members:
    Newly Eligible Members................................             $175               434               175
    Already Eligible Not Enrolled.........................              911               488             1,361
                                                           -----------------------------------------------------
        Total New Membership..............................            1,086               922             1,537
Cost Savings Offsets:
    Elimination of Optional Groups >133%..................              (78)              (78)              (78)
    Additional Drug Rebates (net).........................             (191)             (191)             (191)
    TN-CoverTN Elimination................................              (91)              (91)              (91)
    TN-Access TN Savings..................................              (31)              (31)              (31)
    TN-CoverRx Savings....................................               (6)               (6)               (6)
                                                           -----------------------------------------------------
                                                                       (397)             (397)             (397)
Additional Costs:
    Mandated Pharmacy Extensions..........................               30                30                30
    Presumptive Eligibility Net Costs.....................               16                16                16
                                                           -----------------------------------------------------
                                                                         46                46                46
                                                           =====================================================
        Total State Costs of Reform.......................              735               571             1,186
----------------------------------------------------------------------------------------------------------------

       We've maintained good lists of assumptions and sources 
     behind each of these numbers, and if you or your staff would 
     like to review them, we'll certainly make them available to 
     you.
       The ``Best Estimate'' column is neutral to possibly 
     slightly optimistic; the line for ``Elimination of `Optional' 
     Groups'' in particular will be difficult, although it has 
     been made clear to us that we are expected to do so. Some of 
     these cuts would be unpleasant (e.g. complete transfer to the 
     Exchange of women with breast or cervical cancer, or 
     institutionalized patients) and will require the specific 
     approval of CMS, which has historically been difficult. I 
     want to acknowledge that the White House, and Nancy Ann 
     DeParle in particular, have been very helpful in facilitating 
     our getting the best information available.

[[Page 23671]]

       I would also point out two areas that are potential 
     problems that are not incorporated in the table:
       1. Broader Pharmacy Benefits ($1.07 billion exposure). The 
     Baucus bill contains a provision that Exchange plans are 
     required to have no lifetime or annual limits on ``any 
     benefits'' and that the pharmacy benefit design be at least 
     as good as Medicare Part D. We have (as do many states) a 
     much more limited pharmacy benefit than this for Medicaid and 
     I can't imagine that there won't be pressure to extend the 
     Exchange mandated benefit to Medicaid as well. It would cost 
     the state about a billion dollars over the period to do this, 
     and of course there are many sub-areas of restrictions and 
     controls such as mandates in the areas of preferred drug 
     lists, prior authorization criteria, quantity limits, or 
     additional drug rebate limitations (all of which are present 
     in Part D) that would drive costs up substantially as well.
       The fear is that new requirements here would not occur as a 
     single action to be teed-up and discussed in the Congress, 
     but quietly and state-by-state in the ongoing process of 
     renewing waivers, approving state plans, and the like. It is 
     right now the stated intention of Senate Finance to leave the 
     Medicaid pharmacy benefit design alone; it would be of 
     enormous relief to us to get that clearly written into the 
     law.
       2.- Provider Payment Rates ($2.1 billion exposure). Our 
     analysis is based on an assumption that we will not be 
     required as either a matter of law or practicality to 
     increase provider rates to maintain an adequate provider 
     network with the influx of new patients (and in the 
     environment of federal cuts to Medicare rates). We currently 
     pay on the average at 85% of Medicare (the national average 
     is 72%), but separately from reform have budgeted to reduce 
     these to the equivalent of 79% of Medicare in the next fiscal 
     year as the stimulus money runs out. The cost of increasing 
     provider payments from 79% to 100% of Medicare it $2.1 
     billion over the 5\1/2\ year period being considered. 
     (Furthermore, in several states where provider payments have 
     been recently reduced in response to budget needs, providers 
     have filed suit in federal court seeking to prevent them, and 
     in at least two states (California and Washington) have been 
     successful. If this were to happen in Tennessee it would 
     represent a further immediate unbudgeted cost of 
     approximately $113 million annually, or an additional $1.2-
     1.4 billion over the ten year period.)
       Bob and Bart, the problem that we're facing is simple: by 
     2013, we expect to have returned to our 2008 levels of 
     revenue and will have already cut programs dramatically--over 
     a billion dollars. At that point, we have to start digging 
     out--we will have not given raises to state employees or 
     teachers for five years, our pension plans will need shoring 
     up, our cash reserves (``rainy day fund'') will have been 
     considerably depleted and in need of restoration, and we will 
     not have made any substantial new investments for years. 
     There will have been major cuts to areas such as Children's 
     Services that we really need to restore. On top of these, 
     there are all the usual obligations that need to be met--
     Medicaid, for example, will continue to grow at rates in 
     excess of the economy and our tax revenues. It's going to 
     take at least a full decade to dig our way out and back to 
     where we were prior to the recession.
       In this environment, for the Congress to also send along a 
     mandatory bill for three quarters of a billion dollars for 
     the health reform they've designed is very difficult. These 
     are hard dollars--we can't borrow them--and make the 
     management of our finances post-recession even more daunting 
     than it already is. We keep a running budgetary estimate for 
     my own use of what we project in the years ahead, and I've 
     attached the current version of it to give you a sense of 
     what we are facing.
       I would point out that the problem is entirely recession-
     related. If our revenues had grown from the 2008 base at the 
     normal average rates we have experienced over the years--good 
     times and bad--we would have well over $2 billion of 
     additional revenue in 2019 (and smaller obligations in the 
     pension area) and would definitely be prepared to accommodate 
     reform.
       I very much want to support the President, and Lord knows 
     that we have plenty of people in Tennessee who need help with 
     health insurance. But this is an extraordinary time for us 
     (and we are better off than many other states) and I will 
     appreciate any way in which you can help us manage through 
     this.
           Warmest regards,
                                                    Phil Bredesen,
                                                         Governor.
       Attachment.

[[Page 23672]]

     
     


[[Page 23673]]

  Mr. CORKER. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Bennet). The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Ms. MIKULSKI. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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