[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[Senate]
[Pages 28289-28293]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. ALEXANDER. Mr. President, I was listening to my friends on the 
Democratic side. I wish they could have been in the Senate 4 or 5 years 
ago. Actually that would have reduced our numbers, so as much as I like 
them, I would not have wished that. If they had been here, they might 
have been some help in arguing to the Democrats who blocked Miguel 
Estrada from even having an up-or-down vote, who blocked Judge Pryor of 
Alabama from having an up-or-down vote. The Democrats at that time 
seemed to argue a completely different point of view.
  What we want on the Republican side is very simple.
  You see this bill I am leaning against? This is the new bill. This is 
the Harry Reid--the distinguished majority leader's health bill. We 
want to make sure the American people have a chance to read it and they 
have a chance to know exactly what it costs and they have a chance to 
know exactly how it affects them. That is not an unreasonable request, 
we don't think. That is the way the Senate works. That is our job.
  When it came to the Defense authorization bill, we spent a couple of 
weeks doing that. When it came to No Child Left Behind, the Education 
bill, we spent 7 weeks going through it, and neither of those bills was 
2,074 pages long. The Homeland Security bill took 7 weeks. The Energy 
bill in 2002 took 8 weeks. A farm bill last year took 4 weeks. So we 
have a little reading to do, a little work to do. We have done some 
preliminary reading, but what we want to make sure of is that the 
American people read the bill, know what it costs, and know how it 
affects them because health care is a very personal matter.

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  I have done some reading since the bill came out last night. I was 
also a little bit amused to hear our friends complaining about how we 
are slowing things down. Well, this bill has been hidden in the 
majority leader's office for 6 weeks. He wouldn't let any of us read 
it. I don't know who he has been in there with writing it, but I guess 
it takes a long time to write a 2,074-page bill. But he didn't bring it 
out until last night, and now we have it printed out. Now he wants to 
vote on Saturday.
  Well, that is all right with us if he wants to vote on Saturday or 
Sunday or Monday or Thanksgiving Day. We are going to be here because 
these are the most important set of votes we are ever likely to take in 
this body, at least during the time I am here.
  Let me give a preliminary report to the American people in terms of 
the Thanksgiving spirit about this bill. It came out with a lot of 
fanfare. It has been hidden in the majority leader's office for 6 
weeks, but here is my early verdict in terms of the Thanksgiving 
season. This is the same turkey you saw in August, and it is not going 
to taste any better in November. It is not much different than what 
worried you in August. In fact, it has gotten a little bit worse.
  If I may, let me give just a few thoughts about the bill. Why would I 
say it is the same turkey you saw in August, and you didn't like it in 
August? Well, it is still going to have higher premiums for you to pay. 
It is still going to have higher taxes for you to pay. There are still 
going to be big Medicare cuts for seniors to absorb in their program. 
And while it is a little too early to tell, there is very likely to be 
more Federal debt. It is still a big bill--more than 2,000 pages--and 
if you wait until it is fully implemented, it is still somewhere 
between $2 trillion and $3 trillion over a 10-year period of time.
  The Republican Budget Committee staff has looked it over carefully 
since last night and says it is about $2.5 trillion in spending over 10 
years. It still starts taxing you and cutting your benefits immediately 
if you are on Medicare, but the benefits that come to you for the most 
part don't start until 2014.
  Let me be a little specific about it. It still leaves 24 million 
Americans uninsured, although it reduces the number of uninsured 
Americans by 31 million according to the Congressional Budget Office. 
It still doesn't take care of the physicians reimbursement. One of the 
most difficult issues we have is what we should do about the amount of 
money we allow doctors to make when they see patients who are in the 
government programs. In the Medicare Program, doctors only make about 
83 percent of what they would be paid if they were seeing the 177 
million of us who have private insurance. We regulate that. Doctors who 
see Medicaid patients, about 60 million patients in the low-income 
government program, only get paid about 63 percent, which is set by the 
state, of what they would get paid if they saw somebody who has a 
private policy. In fact, 50 percent of doctors will not see new 
patients in the biggest government program we have--Medicaid. So as you 
can imagine, a lot of doctors can't see the people in the government 
program.
  This new bill takes care of the doctors reimbursement for only 1 
year. It leaves out about $250 billion over the 10-year period of time, 
so add that in when you are figuring out whether this adds to the debt.
  Does it have higher premiums? Yes, it does. The Congressional Budget 
Office says the new government plan in this bill would have premiums 
that are higher than private plans. Your common sense would also tell 
you that, because if we have $800 billion in new taxes somebody is 
going to have to pay those taxes. If they are on medical devices or 
insurance policies, do you think the insurance company is just going to 
pay those taxes? No, they are not. They are going to pass those on to 
you in the form of premiums. So higher taxes mean higher premiums.
  There is also $28 billion in new taxes from employers who have to pay 
a fine when they don't provide employer-based insurance. Under this 
bill, the chances are very good--in fact, the Congressional Budget 
Office says maybe 5 million Americans will lose their insurance. How 
could they lose their insurance under a bill such as this? The reason 
would be that the employer will read this big, complicated thing and 
say: I don't want anything to do with that. I will pay the fine. I will 
write a check to the government. Then I will write a letter to all of 
my employees and say: Congratulations, there is a new government plan, 
and you are in it.
  That is going to happen to millions of Americans who have private 
insurance today through their employers. The employer is going to 
simply say it is cheaper for them to pay the fine. It is easier for 
them to pay the fine than deal with this 2,074-page bill.
  According to the Congressional Budget Office, 5 million Americans--
and others think many millions more--will lose their employer-based 
insurance, and they will end up in the government plan. I just said in 
the government plan, the largest one we have, Medicaid for low-income 
Americans, 50 percent of doctors will not see those patients--new 
patients--because of the low reimbursement rates. The bill still relies 
on the States to pay for some of Medicaid. That is not new either. That 
concerns me greatly as a former Governor. Our current Democratic 
Governor said the bills he had seen so far would add over $1 billion to 
State taxes or spending over the next 5 years which, in my way of 
thinking, would require a new State income tax that would seriously 
damage higher education or both.
  In other words, we are saying give us a pat on the back. Thank you 
very much for expanding Medicaid, and I am going to send some of the 
bill to the States and let the States either raise college tuition or 
raise taxes or cut spending or put in new taxes to pay for it.
  There is also a new Medicare tax. The money that is raised from that, 
the Medicare payroll tax, is not spent on grandma, not spent on 
Medicare; it is spent on a new program. So we are going to cut Medicare 
and tax Medicare and not spend it on Medicare, which is going broke in 
2015, according to its trustees. We have a new government program. 
Those are new. But, basically, it is still the same turkey you didn't 
like in August, and it is not going to taste any better at Thanksgiving 
dinner on Thursday.
  We need to start over. We need to go in the right direction. We need 
to cut costs. Republicans have offered a number of ways to do that: 
small business health plans, reducing junk lawsuits against doctors, 
competition across State lines. All of these steps would cut costs. We 
don't need a 2,074-page bill. We need to take it step by step in the 
right direction to cut health care costs, and when we take those five 
or six steps, we can take five or six more.
  I thank the President and yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Nebraska is 
recognized.
  Mr. JOHANNS. Mr. President, I wish to compliment the Senator on his 
very excellent presentation on a bill we just got in the middle of the 
night last night. I am a little bit tempted to ask the Senator if I 
could have a copy of that bill on my desk, but the less we have to 
handle it, the less we risk bodily injury, so that is all right. Just 
keep it right there at your desk.
  I wish to zero in on one issue today. It is a very important issue to 
Nebraskans. It is a very important issue to Americans. That is the 
issue of abortion. An overwhelming majority of Americans suggest--take 
the position, I should say--that we should not use Federal funds for 
abortions. Just yesterday, I was looking at an article and it said six 
in ten Americans favor a ban on using Federal funds for abortions. I 
have found over and over again that Nebraskans feel the same way.
  A constituent in Gretna, NE, said to me, and I am quoting:

       Please know that I do support some health care reform; 
     however, I cannot in good conscience support any legislation 
     that contains any abortion mandates.

  Someone from Bellevue, NE, said, and I am quoting again:

       I am writing to urge you to ensure that language is 
     included in any health care reform proposal or bill to 
     explicitly exclude

[[Page 28291]]

     abortion . . . The use of my tax dollars forces me to support 
     a procedure that is against my conscience.

  So as we move forward, we need to focus on what people are saying to 
us. That is why in this bill we need the exact language in the House 
bill.
  The Stupak amendment is the essence of a continuation of current law. 
Don't be fooled by those who suggest this is something new and 
different. The Hyde law prohibits Federal funding of abortion through 
Federal programs such as Medicaid. It prohibits Federal funding for 
private health insurance policies that cover abortion. An example is 
the current Federal Employees Health Benefits Program. The 250 
participating health plans do not cover elective abortions. Federal 
employees pay a share of the cost. The Federal Government pays the 
balance--or the taxpayers. Federal employees cannot opt for elective 
abortion coverage because taxpayer dollars are subsidizing the cost of 
the employee plans.
  As many have said during this debate, if it is good enough for 
Federal employees, well, it should be good enough for the citizens.
  The Stupak-Ellsworth-Pitts amendment says: New government subsidies 
could not be used to purchase an insurance plan that covers abortion. 
The proposed government insurance plan also could not cover abortion. 
However, the stark and alarming differences that exist in the Senate 
bill are immediately obvious.
  The Senate bill says: People who receive a new government subsidy 
could--could--enroll in an insurance plan that covers abortion. It 
requires--requires--at least one plan on the insurance exchange to 
offer abortion services.
  Supporters say: Don't worry. Public funds would be segregated, so 
they wouldn't be used for abortion. But this provides no solace 
whatsoever. It is impossible to segregate funds. How will the 
government ensure citizens who receive a subsidy to buy a health 
insurance plan do not use those Federal dollars to pay for health 
insurance premiums?
  Put another way, citizens get charged a premium that includes 
abortion coverage. The taxpayers pay a percent of the premium. Who can 
determine what dollar went here or what dollar went there? Well, as 
many have pointed out already, it is a shell game--nothing more, 
nothing less.
  The Senate bill makes a sharp detour from current law. The very clear 
line established by the Hyde amendment is obliterated. The Federal 
Employees Health Benefits Plan does not allow this shell game and 
neither should this new regime.
  National Right to Life is not fooled by this game. They call this 
provision ``completely unacceptable.'' It was remarkable how quickly 
they read this language and saw through it. National Right to Life goes 
on to say that it ``closely mirrors the original House language that 
was rejected by 64 Democrats.'' I am going to quote:

       It tries to conceal that unpopular reality with layers of 
     contrived definitions and hollow bookkeeping requirements.

  I stand here today to say to National Right to Life, thank you for 
standing up for life. I hope more will do the same. You are absolutely 
correct in saying that it would ``require coverage of any and all 
abortions throughout the public option program. This would be Federal 
Government funding of abortion, no matter how hard they try to disguise 
it.'' They weren't fooled.
  My best view of this is that other pro-life leaders will courageously 
stand up today and tell Americans they should not be fooled either. We 
have to draw a line. This isn't a partisan issue.
  Last week, a Democratic colleague said:

       What is clear is that for this bill to be successful, there 
     can be no taxpayer funding for abortion.

  Yet the Stupak-Ellsworth-Pitts protections are stripped from this 
bill. Since it is not in the underlying bill, I want to be very candid, 
I don't see it in the final bill. I don't believe there are enough pro-
life Senators to break a filibuster to make this a part of the final 
bill. That is why this motion to proceed we will be voting on in hours 
has become the key vote on abortion. It is the key pro-life vote.
  Some say cloture on a motion to proceed is just a procedural effort. 
It begins debate, and then you can do amendments and potentially even 
vote the bill down. The facts suggest otherwise. Listen to this, from 
the Congressional Research Service: Between the 106th and 110th 
Congress, there were 41 cases in which the U.S. Senate approved a 
motion to proceed and eventually then voted on final passage; 40 of 
those 41 bills received final approval. In other words, all but one 
passed into law. Well, that tells us all we need to know. This motion 
to proceed on this life issue is critical.
  Some of my colleagues would argue that if we don't like the bill, we 
must not block the opportunity to amend it; therefore, they would say 
we should vote for the motion to proceed. I don't think any pro-life 
Senator could take that position, and here is why: If we proceed to the 
bill, any changes will require 60 votes. I sincerely wish there were 60 
pro-life votes in the Senate, but by my count I don't get there; 
therefore, we won't be able to change this. If there is a Senator 
willing to suggest otherwise, I respectfully invite him or her to come 
to the floor and share the list of 60 Senators who are willing to vote 
for a provision that ensures the Stupak amendment will be there. I 
don't think that is going to happen.
  So it comes down to this: If you don't believe tax dollars should 
fund abortion, vote against the motion to proceed. It is our last 
chance to protect life in this debate.
  Congressman Stupak and about 40 of his Democratic colleagues stood 
strong on their pro-life convictions, and they literally changed the 
outcome in the House. They stared the Speaker in the eye and said, 
about this procedural vote: Look, if it is not pro-life, we are not 
there. And the Speaker had no choice but to put the Stupak amendment up 
for a vote. Over 40 courageous Congressmen stuck to their convictions, 
and they made a difference.
  Today in the Senate, we don't need 40 Democrats to stand up for what 
is right; we need just 1. If just one pro-life Democrat would say: I 
will not vote to move this bill until it is fixed, until it is truly 
pro-life, that would happen.
  Those who say they are pro-life but refuse to take that stand, I 
worry they are not standing up for life.
  I have a record of voting pro-life. I know how I am going to vote on 
this, because it is the right thing to do. I ask for a pro-life Senator 
to come down here and stand up on this bill. Pro-life Americans are 
waiting, and they are not fooled.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Bennet). The Senator from Wyoming is 
recognized.
  Mr. BARRASSO. Mr. President, here you have it, what we have been 
waiting for for weeks and weeks, what has been put together behind 
closed doors. People all across the country have seen the doors behind 
which people, in secret, have been writing this bill. It is 2,074 
pages. Some people call it remarkable; I call it a monstrosity.
  The leader of the majority, Senator Reid, has said that of all the 
bills we have seen, it will be the best. Mr. President, it is the best 
of the worst. It just looks like more of the same. All of the things I 
have been talking about--it still does those sorts of things. It still 
raises taxes on Americans, higher payroll taxes--and this is the 
Associated Press talking, not just me. Companies will pay a fee. That 
is from the Associated Press as well. It adds an array of tax 
increases, a rise in payroll taxes. That is from the Washington Post. 
It relies primarily on a new tax. That comes from the Washington Post 
as well. Then the New York Times says: New taxes and new fees. It is 
more of the same. It is the best of the worst.
  What about Medicare cuts? Oh, they are in here, too, you better 
believe it. It is relying on cuts in future Medicare spending to cover 
costs. That is from the Associated Press. It is financed through 
billions of dollars in Medicare cuts. That is from the Washington Post. 
There will be reductions in Medicare. It is all in here--taking away 
the

[[Page 28292]]

 health care of the seniors of this country, who have relied on 
Medicare and have been promised Medicare, to start a brandnew program 
which is in these 2,074 pages. It is just wrong.
  Then look at the budget gimmicks. The costs of this legislation--and 
the CBO came up with some number, but it is not what the real cost is. 
This thing is going to cost $2.5 trillion over a 10-year period. They 
try to get the number down. How do they do it? They start collecting 
taxes on day one, but until they actually implement the program--the 
things that are supposed to help Americans, they have delayed those 
things through 2014. Here we are in 2009, and the people who are 
watching at home and saying: This is going to help me next week, forget 
it, wait another 5 years. That is the way they maneuver and manipulate 
the numbers.
  Here we have it--a bill that still raises taxes, still cuts Medicare, 
uses lots of budget gimmicks, and will cost the American people 
trillions and trillions of dollars.
  Mr. President, obviously health care is one of the most important 
issues Congress is going to take up this year and maybe in our careers 
in the Senate. This may be the most important issue and bill we are 
ever asked to vote upon.
  I travel home to Wyoming every weekend. I talk to people. I was there 
for 5 days over Veterans Day.
  I say to them: What do you need? What do you think? What are your 
thoughts on this?
  They say: Deliver to Washington a clear and simple message: Fix what 
is wrong with the health care system. Whatever you do, don't make 
things worse for me.
  I have town meetings and ask people: Do you think it is going to cost 
more or less if this is passed? And I have had telephone townhall 
meetings with folks around Wyoming, and there is a way you can poll and 
ask people their ideas. People believe it is going to cost them more. I 
ask: Is your care going to be better or worse? People believe it is 
going to be worse, that they are going to pay more and get less.
  That is not the kind of value the people of Wyoming or anywhere in 
America want. It is not the kind of work they expect out of Congress. 
They want us to fix what is wrong with the health care system. As 
Senator Alexander said earlier, we need a step-by-step approach in the 
right direction, dealing with the things we can do to improve the 
system. Whatever you do, they say, don't make matters worse for me. 
That is what people care about. That is what they care about in the 
telephone townhall meetings and the meetings we have in person.
  They say: What does this mean for me and my family? What will it mean 
to our health care? What happens if I get sick? That is what people 
care about. None of them want to read this bill, and probably none of 
them will read the bill. It is on the Internet, after weeks behind 
closed doors. I hope the people in Wyoming and around America read it 
so that they know about the travesties in the bill and the impact it 
will have on them personally. It is the wrong prescription for America. 
And it is not just me saying that.
  Yesterday, there was an article in the Wall Street Journal, and the 
dean of Harvard Medical School--it is in Boston, which is where they 
have this whole Massachusetts health care plan. He said that it is not 
working in Massachusetts and that this is not going to work for 
America. He gave the health care bill we are looking at in this 
Congress a failing grade. It doesn't do a good job in dealing with 
costs, access, or quality. It misses the boat on all of them.
  The people who believe this is going to be helpful collectively are 
delusional, absolutely wrong. They have no idea how this will be for 
the health of our Nation. Yet this is what we are looking at. As 
Senator Reid says, what we have seen, of all the bills he has seen, it 
is the best. It may be, but it is the best of the worst. It looks like 
more of the same.
  Some people in Wyoming in townhall meetings say: Don't take away my 
freedom to choose the plan I want. Well, this bill sort of does that. 
If they have something they like, this has a lot of numbers and 
mandatory sets in there--the sorts of things that will take away 
freedoms of the people to choose specifically what they want because of 
all of the mandates this has to cover, and it has to cover this, that, 
and the next thing. A lot of people don't want that.
  People also say: Don't cut my Medicare. I hear that all around 
Wyoming and around the country. There are 11 million people on Medicare 
Advantage. That Medicare Advantage Program is actually the only 
Medicare Program that does a good job of working on preventive care and 
coordinating care, and that is going to be slashed under this program. 
So we are going to take away prevention and the things that have to do 
with coordinated care. Just take a look at this monstrosity of over 
2,000 pages.
  People say: Don't cut my Medicare or raise my taxes. We are looking 
at 10.2 percent unemployment right now. This is not the time to raise 
taxes. It is just not the time. We need to focus on getting jobs moving 
in the economy and helping people hire new people. With that 10.2 
percent unemployment, the last thing you want to do is raise taxes, but 
that is what this bill will do. That is not just me saying that; it is 
also the AP, the Washington Post, and the New York Times. All along the 
way, it is higher payroll taxes, companies paying fees, raising payroll 
taxes, primarily new taxes and fees--one after another--to pay for 
something the American people do not want.
  The people say: Don't make me pay more for my family's health care. 
But that is what is going to happen across the board. Premiums are 
going to increase, the premiums for people who have insurance--the 
premiums people pay who have insurance. For the 85 percent of Americans 
who have insurance, those costs will go up. This plan was designed, 
theoretically, when it was announced a year ago, to get costs down, to 
get premium costs down. This raises the premiums for the American 
people.
  We are living in a time and in an economy when people say they can't 
afford this sort of a bill. The American people don't want it.
  I travel around the State and visit with people. I visited with a 
young lady from Cody, WY, who has health insurance through her job, and 
she likes it. She takes care of her family. She found out that because 
of increasing premiums--which will get worse if this bill passes--the 
raises people think they are going to get will not be coming to them. 
In some places, they have had their pay cut a little bit so they can 
continue with the health care they have. They like the care, but they 
don't like the cost of their care. Again, this doesn't get the costs 
down for American families. Premiums will go up.
  This is what we have been seeing all across the country. Whether it 
is independent people, whether it is people who work for government, 
whether it is people who sell insurance or those who buy insurance or 
people who need insurance, across the board, people say these atrocious 
health care proposals will make matters worse for the families, for the 
men and women of this country. They are going to be paid for not just 
by them but also by the young people, as the debt continues to 
accumulate in our Nation and goes on to impact the young people of this 
Nation.
  The people of Wyoming want practical, commonsense health care 
reform--the kinds of reforms that will drive down the cost of medical 
care, that will improve access to providers, that will create more 
choices. They don't want things that will increase the costs or things 
that will limit access or things that will take away their choices.
  Obviously, the majority leader and the Democrats in Congress have a 
very different plan in mind. Their legislation is going to force upon 
Americans higher health insurance costs through higher premiums, higher 
taxes, Medicare cuts, and more government control over health care 
decisions. That is not reform.
  There are only two physicians in the Senate. The two of us bring a 
unique

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perspective to the health care debate. I practice medicine, taking care 
of families from all across the great State of Wyoming. I have 
dedicated my life's work to helping patients live longer, live 
healthier, and stay well. I can say, without reservation, in this 
Nation, we do offer some of the finest medical care in the world. I am 
not blind to the fact that our health care system has failings. I have 
seen them firsthand. We can fix a broken system in a way that actually 
works to get costs down, to get more people covered, to give people 
more choices, not in this plan, not in this atrocious plan which raises 
taxes, cuts Medicare, and takes away choices from the American people.

                          ____________________