[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 27976-27978]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, I would like to say a word about health 
care. The Democratic leader, Senator Reid, today announced that he has 
completed work on a health care bill. We have been waiting for that. It 
has been written behind closed doors in Senator Reid's office for the 
last several weeks, so we have not known exactly what might be in it.
  We have had two pieces of legislation from the Senate, one written by 
the HELP Committee, upon which I serve, another one from the Finance 
Committee. Now a bill has come from the House of Representatives. It 
has actually been passed there. Now the Democratic majority leader will 
be bringing forward his version of the bill. The bill seems to grow 
each time we have a new one--a little faster than the Federal debt 
grows even. This one seems to be another 2,000-page, trillion-dollar 
bill.
  But the point I want to make tonight is that the American people's 
response to this work will be what all of ours should be: We want to 
read the bill. We want to know what it costs. And we want to make sure 
we have time to understand exactly how it affects the health of each 
American.
  This is the most personal kind of debate we could have about the 
health of every single American. It affects 17 percent of our economy. 
It is a dramatic proposal, an enormous amount of money, at a time when 
our debt has reached $12 trillion. A great many Americans are concerned 
about Washington, DC, because we do not seem to have a check and a 
balance on the various proposals for Washington takeovers, more debt, 
more spending, more taxes. Tonight I would like to do a simple thing, 
which is not to make a Republican speech but to read a letter, or parts 
of a letter, and insert it in the Record, that was written by eight 
Democratic Senators on October 6 to Senator Reid.
  I think their words say a great deal about this bill and about how we 
should proceed on it. The letter is dated October 6, from eight 
Democratic Senators. It says, in part:

       Dear Leader Reid:
       . . . .Whether or not our constituents agree with the 
     direction of the debate, many are frustrated and lacking 
     accurate information on the emerging [health care] proposals 
     in Congress. Without a doubt--

  Say these eight Democratic Senators----

     reforming health care in America is one of the most 
     monumental and far-reaching undertakings considered by this 
     body in decades. We believe the American public's 
     participation in this process is critical to our overall 
     success of creating a bill that lowers health care costs and 
     offers access to quality and affordable health care for all 
     Americans.

  And then, if I may read a couple more paragraphs from the letter from 
these eight Democratic Senators to the Democratic leader:

       Every step of the process needs to be transparent, and 
     information regarding the bill needs to be readily available 
     to our constituents before the Senate starts to vote--

  ``to vote''----

     on legislation that will affect the lives of every American.

  The eight Democratic Senators continue:

       The legislative text and complete budget scores from the 
     Congressional Budget Office of the health care legislation 
     considered on the Senate floor should be made available on a 
     website the public can access for at least 72 hours prior to 
     the first vote to proceed to the legislation.

  Let me read that again. That is not 40 Republicans--although all 40 
of us agree with it--this is eight Democratic Senators to the 
Democratic leader: ``The legislative text,'' No. 1, the ``complete 
budget scores,'' No. 2, ``from the Congressional Budget Office,'' 
posted on ``a website,'' No. 3, for ``72 hours'' before ``the first 
vote to proceed on the legislation.''
  The distinguished Democratic leader's announcement was only made a 
few minutes ago, but my understanding is we do not yet have a complete 
legislative text. Hopefully, that will come tonight or in the morning.
  Second, I understand the estimates from the Congressional Budget 
Office are preliminary estimates. This letter says: ``complete budget 
scores.'' We know what a ``complete budget score'' is around here. It 
was talked about in the Finance Committee debate. The Director of the 
Congressional Budget Office said a complete estimate of the health care 
bill would take about 2 weeks to do. So the question is, Do they have 
it? And then: ``72 hours'' before ``the first vote to proceed.''
  So I think the eight Democratic Senators, along with all 40 
Republican Senators, have a bipartisan agreement here on how we should 
start this debate. We want to be able to read it, we want to know what 
it costs, and we want to see how it affects every American. That means, 
No. 1, a complete text. No holes, no ``We will get back to you later'' 
a complete text. No. 2, a complete estimate. Those are these words 
here: A complete estimate of the cost and how it affects every 
American. And third, for 72 hours on the Web site so not only we in the 
Senate but our constituents, the people who expect us to weigh in on 
this, have a chance to read it before we have our first vote, which I 
don't think is scheduled.
  There is other language here, but I ask unanimous consent that this 
letter from the eight Democratic Senators of October 6 to the Honorable 
Harry Reid be included in the Record following my remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. ALEXANDER. Mr. President, the last thing I would say is this: I 
think it is pretty obvious why we want to read the bill and know what 
it costs and understand how it affects the health care of every 
American, which it will, but in case anyone is wondering why we want to 
read the bill, it is because the bills we have already seen increase 
insurance premiums, raise taxes, and cut Medicare. That is what we have 
seen from the two Senate bills and the House bill. We on the Republican 
side think this ought to be about reducing costs, reducing premiums, 
but the Democrats' proposals increase premiums, increase taxes, and cut 
Medicare. Not only does it cut Medicare in the bills we have seen so 
far by $400 billion or $500 billion; it doesn't spend it

[[Page 27977]]

on grandma, it spends it on somebody else, even though the Medicare 
Program, the trustees tell us, will begin to go broke by 2015.
  There are some other problems with the bills we have seen before, so 
we would want to be able to ask these same questions about the new bill 
we haven't yet seen but we are about to see.
  On Medicare, how big are the cuts? Then we hear in this new bill 
there are Medicare taxes, new Medicare payroll taxes. On which 
employees or which employers? And if their taxes are raised, are they 
spent to make Medicare solvent or are they spent on a new program? It 
is inconceivable to me that we could be even thinking about having 
savings in Medicare and spending it on something else when Medicare is 
about to go broke.
  Then there are some other questions. The Democratic leader said it 
doesn't add to the debt. I hope he is right, but we have questions to 
ask about that. Does his proposal include a full dealing with the issue 
of physician reimbursement? What we mean by that is when we create 
these big government programs, then some agency in Washington tells how 
much we can pay doctors for different services and how much we pay 
hospitals. Right now, in the government programs we have--Medicare, for 
example--doctors are only paid about 80 percent of what they are paid 
for serving the roughly 200 million of us who have private plans. And 
for those who are in Medicaid--low income; that is the largest 
government program--it is about 60 percent. Doctors are paid about 60 
percent of what they were paid if they saw private physicians. Then, as 
a result, 50 percent of doctors won't see new people in that Medicaid 
Program, which is why so many people think: I am not so sure a new 
government-run program of insurance is such a good idea, because I 
might end up in it and it might be like Medicaid and 50 percent of the 
doctors won't see new Medicaid patients.
  Why might you end up in a government program if you are not there 
now? Well, in the other bills we have seen--and this would be a 
question we have about Senator Reid's bill--the combination of sections 
means that a great many employers are going to look at the bill and the 
requirements that are placed on them and they are going to write a 
letter to their employees and say: Congratulations, there is a new 
government plan. I have sent a check to the government, and instead of 
having employer insurance, you are in the government plan. Well, you 
may not have been thinking that was the kind of health reform you 
wanted.
  There is the matter of the States. I will admit that as a former 
Governor I may be more worried about this than some people, but I see a 
former mayor in the Presiding Officer's chair today. I won't speak for 
him, but I know I used to sit back there in Nashville and nothing would 
make me madder than some Member of Congress coming up with a big idea, 
pass it into law, issue a press release, take credit for it, and send 
me the bill when I was Governor. So all of the other bills we have seen 
say, It is a great idea to expand Medicaid. We are going to dump about 
14 million more Americans in this program for low-income Americans and 
we are going to send the bill for part of it to the State.
  Well, our Democratic Governor thinks that is a bad idea, because our 
State, which is fiscally well managed--Tennessee--and virtually every 
other State is having the worst time they have had since the Great 
Depression in managing their resources. Here they have the Medicaid 
Program going up at 8 percent a year, and they are cutting higher 
education and other programs. That is what is going on in the States. 
So we will have to ask the question: How much does this new bill 
transfer costs to the States?
  There are a great many questions we will need to ask, and they are 
appropriate questions. The Republican leader pointed out that when we 
did the farm bill, we talked for 4 weeks. We debated, we had 
amendments, we came to a conclusion, and we had a bipartisan result. 
When we did No Child Left Behind, it was 7 weeks. I remember on the 
Energy bill of 2005, which put us on a new direction, Senator Bingaman 
and Senator Domenici and others worked very hard on it, but on the 
floor it took 8 or 9 weeks. We need to have a full discussion of 
whatever bill finally comes to the floor, and this may be the bill. It 
is at least 2,000 pages. It is at least $1 trillion. Maybe it is a good 
bill. But the American people will have a lot of questions about 
whether their premiums are going up instead of down, their taxes are 
going up instead of down; how much are the Medicare cuts--why are they 
being spent on somebody else instead of the people in Medicare? What 
about these Medicare payroll taxes? What about new State taxes? Will I 
lose my insurance? These are big questions and they deserve to be 
answered.
  A good way to start is to take the advice of the eight Democratic 
Senators who wrote the Democratic leader and said: Before we have our 
first vote, Mr. Leader, No. 1, we want to see the complete text which 
we don't yet have; we want to see a complete estimate by the 
Congressional Budget Office; and we want it to be on the Internet for 
at least 72 hours--the words were very strong--because we have a duty 
to the American people that they know how this affects them, because it 
is a very personal matter.
  I thank the President.

                               Exhibit 1


                                                  U.S. Senate,

                                  Washington, DC, October 6, 2009.
     Hon. Larry Reid,
     Senate Majority Leader, U.S. Capitol, Washington, DC.
       Dear Leader Reid: As you know, Americans across our country 
     have been actively engaged in the debate on health care 
     reform. Whether or not our constituents agree with the 
     direction of the debate, many are frustrated and lacking 
     accurate information on the emerging proposals in Congress. 
     Without a doubt, reforming health care in America is one of 
     the most monumental and far-reaching undertakings considered 
     by this body in decades. We believe the American public's 
     participation in this process is critical to our overall 
     success of creating a bill that lowers health care costs and 
     offers access to quality and affordable health care for all 
     Americans.
       Every step of the process needs to be transparent, and 
     information regarding the bill needs to be readily available 
     to our constituents before the Senate starts to vote on 
     legislation that will affect the lives of every American. The 
     legislative text and complete budget scores from the 
     Congressional Budget Office (CBO) of the health care 
     legislation considered on the Senate floor should be made 
     available on a website the public can access for at least 72 
     hours prior to the first vote to proceed to the legislation. 
     Likewise, the legislative text and complete CBO scores of the 
     health care legislation as amended should be made available 
     to the public for 72 hours prior to the vote on final passage 
     of the bill in the Senate. Further, the legislative text of 
     all amendments filed and offered for debate on the Senate 
     floor should be posted on a public website prior to beginning 
     debate on the amendment on the Senate floor. Lastly, upon a 
     final agreement between the House of Representatives and the 
     Senate, a formal conference report detailing the agreement 
     and complete CBO scores of the agreement should be made 
     available to the public for 72 hours prior to the vote on 
     final passage of the conference report in the Senate.
       By publically posting the legislation and its CBO scores 72 
     hours before it is brought to a vote in the Senate and by 
     publishing the text of amendments before they are debated, 
     our constituents will have the opportunity to evaluate these 
     policies and communicate their concerns or their message of 
     support to their Members of Congress. As their 
     democratically-elected representatives in Washington, DC, it 
     is our duty to listen to their concerns and to provide them 
     with the chance to respond to proposals that will impact 
     their lives. At a time when trust in Congress and the U.S. 
     government is unprecedentedly low, we can begin to rebuild 
     the American people's faith in their federal government 
     through transparency and by actively inviting Americans to 
     participate in the legislative process.
       We respectfully request that you agree to these principles 
     before moving forward with floor debate of this legislation. 
     We appreciate your serious consideration and look forward to 
     working with you on health care reform legislation in the 
     weeks ahead.
           Sincerely,
     Blanche L. Lincoln.
     Mary L. Landrieu.
     Claire McCaskill.
     Mark L. Pryor.
     Evan Bayh.
     Joseph I. Lieberman.
     Ben Nelson.
     Jim Webb.


[[Page 27978]]


  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. Mr. President, I ask unanimous consent to speak as in 
morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SESSIONS. Mr. President, I wish to thank Senator Alexander for 
his remarks because I think I have heard it said that this new health 
care bill, don't worry about it, it is going to be revenue neutral. But 
if you create a bill that is revenue neutral by taking hundreds of 
billions of dollars out of Medicare, which we already know is heading 
into default in the next 5 or 6 years, and you do it by raising taxes, 
both of which are to fund a new program that we don't have the money 
for, then that is not, in my mind, what the average person would say in 
commonsense thought is revenue neutral.
  I think that is what we are talking about. We need to be able to see 
the details of it. I appreciate Senator Alexander for that fine summary 
of where we are. I hope our Members will take it to heart.

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