[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[Senate]
[Pages 4051-4054]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. JOHANNS. Mr. President, I rise today to once again speak about a 
topic I have spoken to many times over the last 2 years; that is, the 
health care law.
  Today I would like to focus on a number of aspects of the health care 
law, but to start I would point out that this law actually enacted the 
largest expansion of Medicaid since its inception in 1965. The law 
dramatically increases government spending, it ties the hands of 
States, it is going to bankrupt State budgets, and it traps nearly 26 
million more Americans in a broken system.
  Last week's Medicaid Actuary report indicates that 25.9 million more 
Americans will be dumped on Medicaid under the new law. The week 
before, the nonpartisan Congressional Budget Office pointed out that 
Federal spending on Medicaid will increase by $168 billion. That is 
just compared to last year's projection. That means this expansion 
alone is projected to cost the Federal taxpayers $795 billion through 
2021.
  That is at a time when not only our Federal budget is struggling, but 
in addition to that our State budgets are in trouble. Added up, the 
Federal Government will spend $4.6 trillion on Medicaid over the next 
10 years, a staggering number--$4.6 trillion.
  Medicaid spending is projected to increase 35 percent once the law is 
fully implemented. So with our national debt now approaching $16 
trillion and compounding exponentially, as we borrow 42 cents of every 
$1 we spend every day, instead of reining in costs, the health care law 
is doubling down with spending.
  But the Medicaid expansion did not stop with wrecking Federal 
budgets. It hammers State budgets as well. This program already 
consumes 24 percent of State budgets. The law's Medicaid expansion will 
force $118 billion in additional unfunded mandates on our States 
through 2023. The National Governors Association has weighed in on this 
issue. They said: ``Spending on Medicaid is expected to consume an 
increasing share of State budgets and grow much more rapidly than State 
revenue growth, resulting in slow or no growth in education, 
transportation, or public safety.''
  The Nebraska impact tells the story. The Governor commissioned a 
study in Nebraska to see what the impact would be on the health care 
law on the State budget. Nebraska will spend an additional $526 million 
to $766 million over the next 10 years on its Medicaid Program. The 
expansion could add up to 145,000 Nebraskans to the Medicaid Program 
over the next decade.
  Currently, one in nine Nebraskans is enrolled in Medicaid. The new 
provisions of the law will expand eligibility to one in five 
Nebraskans, 20 percent. Governor Heineman addressed this issue. He 
said: This unfunded and unparalleled expansion of Medicaid is an unfair 
and unsustainable mandate on Nebraska and other States. The Federal 
health care law is an extraordinarily large and excessive unfunded 
mandate for States. It is potentially devastating to our State budget.
  Today, with me on the floor, I am joined by two former Governors. All 
three of us have had to deal with balancing budgets, and we had no 
choice but to make sure that at the end of our legislative sessions, 
our budgets were, in fact, balanced.
  Senator Alexander was vocal in speaking out against this policy 
during the health care debate. He has a rather unique perspective 
because not only is he a former Governor, he is a former U.S. Secretary 
of Education. I would like the Senator to take a few minutes and 
explain how this law is going to effect the health care system, our 
educational system, our States, and for that matter our country.
  Mr. ALEXANDER. I thank the Senator. He has a unique perspective 
himself as a former Cabinet member, Governor, and now Senator. But all 
three of us here today, including the former Governor of North Dakota, 
have wrestled with this business of the rising costs of Medicaid, paid 
for partly by the States, according to rules set in Washington, and how 
do we deal with public education, especially higher education.
  I remember during the debate two years ago, I suggested to our 
colleagues on the other side of the aisle who were supporting the 
health care law, which I thought was an historic mistake because it 
expanded a health care delivery system we already knew was too

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expensive, instead of taking steps to reduce it. I suggested to them 
that they go home and run for Governor. They ought to be sentenced to 
go home and run for Governor if they vote for it and see whether they 
can implement it over an 8-year-period of time.
  Here is what the Senator from Nebraska is suggesting. Let me try to 
be very specific on the effect of the health care law on higher 
education in the States. This is not all President Obama's fault. Some 
30 years ago, when I was a young Governor, I was still struggling with 
saying: We get down to the end of the budget process and we have money 
either to put in higher education or into Medicaid, and the rules from 
Washington say it has to go to Medicaid.
  I remember going to see President Reagan and saying: Why do we not 
just swap it, Mr. President? You take all of Medicaid. Let the States 
take elementary and secondary education. I wish we had done that. But 
we did not do it. Gradually, the increasing Washington-directed costs 
have distorted State budgets until, as the Senator from Nebraska said, 
24 percent of the State budgets go to the Medicaid program.
  Now we are in a process where because of the health care law, we are 
going to add 25.9 million more Americans onto Medicaid, according to 
the Medicaid Chief Actuary. Employers are going to decide: I would 
rather pay my $2,000 penalty and allow my employees to go into the 
exchange or, if they are lower income, into Medicaid. Then the costs to 
States are going to go up.
  The Senator from Nebraska talked about what the current Governor of 
Nebraska said. Our former Governor, Governor Bredesen, a Democratic 
Governor, estimated that between 2014 and 2019 it would be $1.1 billion 
in new costs for the State of Tennessee from the Medicaid expansion.
  What most people do not realize is the effect this has on higher 
education and student tuition. I hear a lot of talk about let's see if 
we can lower student tuition. One way we can lower it is not take money 
from student loans and spend it to pay for the health care bill. Most 
people are not aware we spent $8.7 billion of so-called profits the 
government makes when it borrows money at 2.8 percent and loans it to 
students at 6.8 percent. The government took some of that money and 
spent it to pay for the health care bill.
  If it did not do that, it could lower the interest rates on student 
loans, according to the Congressional Budget Office, to 5.3 percent and 
save $2,200 per student over 10 years on the basis. So the health care 
law is costing students who borrow money more on their loans.
  In addition, and I will close with this example, it is raising 
college tuition. You say: How could the health care law cause tuition 
to go up in California or Tennessee? If in Tennessee, as last year, the 
increase for Medicaid went up 15.8 percent. That is how much more State 
tax dollars it had to go up. Spending for the University of Tennessee 
and community colleges went down 15 percent. Then the result of that 
was tuition went up in our State by about 8 percent. That was true all 
across our country.
  So the effect--and I will come back to this later if we have more 
time--is that the health care law mandates that the States spend more 
money on Medicaid, and, as a result, the State cuts the money it is 
spending for the University of Tennessee or Nebraska or North Dakota. 
In order to keep the quality of education up, tuition goes up. So 
students are paying more for tuition and they are paying more for 
interest rates on their student loans directly because of the health 
care law.
  President Obama should not be blamed for the last 30 years of rising 
costs of Medicaid. But he should be held responsible and this health 
care law should be held responsible for making it worse.
  Mr. JOHANNS. Senator Alexander has raised some excellent points there 
because Governors only have so much revenue they can deal with; they 
cannot invent it, if you know what I am saying. So Governors have to 
figure out what the needs of the State are. If the Federal Government 
is taking that decision away from Governors by forcing them into 
expanding their Medicaid, there is going to be less money available for 
programs such as K 12 education, higher education.
  Let me, if I might, turn to our colleague Senator Hoeven. He was a 
Governor for 10 years in the State of North Dakota. Will the Senator 
please explain the impact Medicaid expansion would have on budget 
decisions as a Governor and the impact the health care bill is going to 
have on the Senator's State.
  Mr. HOEVEN. I thank Senator Johanns. It is good to be with him. Also, 
to Senator Lamar Alexander from the great State of Tennessee, it is 
great to be with him as well. We share, I guess, the common experience 
of serving as Governors and certainly bring that perspective to our 
work in the Senate.
  As Senator Alexander just said, there is no question ObamaCare is 
making the health care challenge in the United States worse, is making 
it worse. We have to find a way to empower our people. In our roles as 
Governors, before serving in the Senate, that is what we tried to do. 
When it came to Medicaid, when it came to health care, it was how do we 
empower our people, whether it is health care or anything else, in a 
way that not only makes their lives better but that makes sure we are 
fulfilling our responsibility as good stewards of the State's treasury 
on behalf of the citizens of our respective States.
  Last week was the second anniversary of the Obama health care 
legislation--the second anniversary. The fact is, since that law was 
passed--and just 1 minute ago, Senator Alexander expressed some of the 
things he talked about when that debate was had in the Congress. But 
since that law was passed, over the past 2 years, Americans have become 
more unhappy with the legislation. The Obama health care legislation 
has actually become more unpopular over the last few years as time has 
gone by because, quite simply, Americans do not want government-run 
health care. Americans do not want government-run health care. That is 
what ObamaCare is.
  Americans want to be free to choose their own health care provider, 
their own doctors, their own hospitals. They also want to be able to be 
free to choose their own health care insurance. Frankly, they are going 
to do a lot better job than having the Federal Government do it for 
them. That is just a fact. Of course, that is very much at issue now 
with the Supreme Court deliberations, the judicial review they are 
undertaking now on the constitutionality of the individual mandates in 
the Obama health care legislation.
  Of course, the question is, Is that individual mandate 
constitutional? If it is, if they find that individual mandate is 
constitutional, then is there any limit to the government's ability to 
intrude into the lives of our citizens? This is a huge question. If so, 
what happened to the concept of limited government, which was so 
carefully developed by our Founding Fathers in our Constitution?
  It seems to me that concept of limited government is gone. That is an 
incredible problem for all of us that extends far beyond health care. 
As former Governors, we understand the need to limit government, 
whether it is the local level--and the Senator was a mayor. Senator 
Johanns was a mayor in Lincoln, NE, before he was the Governor of 
Nebraska, now a Senator from Nebraska, and he understands that one of 
the fundamental responsibilities of a mayor, of a Governor, of a 
Senator is to make sure we honor the Constitution and we limit the 
power of government, at the local, the State, and the Federal level, to 
intrude into the lives of our citizens. That is exactly what our 
Founding Fathers were striving to do in the Constitution, the whole 
concept of checks and balances.
  We have a legislative branch and a judicial branch and an executive 
branch because that creates checks and balances on the respective 
powers of each branch. Why? To protect our citizens, to limit the reach 
of government. We have a bicameral Congress, the House and the Senate, 
to make it harder to pass laws, not easier--to make it

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harder to pass laws. Again, it is to protect the people of this 
country.
  We have the 10th amendment that reserves powers to the State not 
expressly provided to the Federal Government; again, to limit the power 
of government and protect the people of this great country. Of course, 
that is what we have in our Bill of Rights. That is what it is all 
about.
  So we have ObamaCare; it raises taxes by $\1/2\ trillion. It raises 
taxes $500 billion. It cuts Medicare $\1/2\ trillion, $500 billion. 
Yet, at the same time, it places huge costs, a huge burden on the 
States. The CBO now estimates that over the next 10 years it will cost 
the States $118 billion. That is $118 billion in costs to the States 
who are trying to balance their budgets. They are already facing 
challenges in doing that, and we will put that kind of huge cost on 
them.
  At the same time, think of what it does to our small businesses. 
Again, as a Governor, I know how it was in my State. I think it was 
true when the Senator from Nebraska was Governor and when Senator 
Alexander was Governor of Tennessee. We understood that job creation 
was job one. We had to make sure businesses were able to work 
effectively, to compete, and to employ people. That is the engine that 
drives our economy, the small businesses.
  When we look at ObamaCare, we look at what it does to the States--the 
$118 billion over 10 years--and look at the costs it creates for small 
businesses and look at the confusion it creates in trying to comply 
with all of this. What do small businesses do? The Senator from 
Nebraska talked a minute ago about, OK, what does the small business 
do?
  Well, either, A, they try to comply, and that drives up their costs 
or, B, they cancel their insurance and default to the government-run 
insurance. But it not only creates a problem for them in determining 
whether they are going to continue health care for their employees--and 
our citizens have shown they want the employer to continue doing that, 
and it goes to whether they hire more people.
  Here we are with 8.3 percent unemployment, 13 million people looking 
for work, and we are going to make it harder for small businesses to 
put them to work because they don't know if they can comply with 
ObamaCare, let alone withstand the cost. That affects every single 
American.
  We need to change the approach. That is what we are talking about 
today. We are talking about an approach where we can empower people to 
choose their own health insurance and provider, an approach that 
encourages competition, which will help bring costs down, giving our 
consumers more choice. We are here to talk about how we work with 
States and small businesses to reduce costs, reduce fraud, waste, and 
abuse.
  The President of AARP, Barry Rand, estimates that $100 billion is 
lost annually in waste, fraud, and abuse under Medicaid. Think what our 
States could do on behalf of their citizens in all 50 States if we in 
the Congress, working with an administration that will work with us, 
would empower the States to go after that waste, fraud, and abuse by 
giving their citizens more say over their health care and by 
encouraging competition among insurance companies to provide more 
choice, access, and to go after that waste, fraud, and abuse.
  There are so many things we can do, but it is not through a big, 
monolithic, government-run insurance program that puts costs on the 
States and costs on its citizens. That is what we need to change. We 
need to change it now.
  Again, I thank Senator Alexander for being here and for his work to 
empower our people when it comes to health care. Also, I particularly 
thank Senator Johanns for calling us together to discuss this very 
important issue on behalf of the people of America.
  Mr. JOHANNS. Mr. President, I thank Senator Hoeven for his comments. 
He mentioned that job one for every Governor is job creation. Before I 
turn to Senator Alexander, let me congratulate Senator Hoeven. Whatever 
he did in that capacity worked. He has the lowest unemployment rate of 
any State. I am proud to say Nebraska is No. 2 in that regard.
  I will guarantee one thing you learn: You don't create jobs by 
putting a big wet blanket of more regulations on the job creators. I 
worry that all these rules and regulations are going to have a very 
damaging impact on job creation.
  I would like Senator Alexander to talk about that, what he sees as 
the impact of this health care bill on job creation in our States.
  Mr. ALEXANDER. I thank the Senator. I listened with interest to the 
former Governor of North Dakota and the former Governor of Nebraska. 
Let me give a specific example. In response to the question, after the 
passage of the health care law, I met with a number of representatives 
from chain restaurants. Chain restaurants are the kind at which we go 
out to dinner for a modest cost. They are among the largest employers 
in America. They employ largely low-income and young people--people who 
are the waiters and waitresses we see when we go into Ruby Tuesday or 
O'Charley's or one of these other places, and usually it is someone 
with a part-time job or somebody who is working his or her way up.
  Many of those companies offer some health insurance to their 
employees. At one of the companies, Ruby Tuesday, headquartered in 
Tennessee, the chief executive officer told me the cost of the health 
care law to his company would equal the profit of the company that 
year. This is a company with several billion dollars in revenue.
  One of the companies that is even more successful than Ruby Tuesday 
in terms of profit, and is larger, told me their goal was to have 90 
employees per store. But after the health care law, they said they 
would have 70 employees per store in order to comply with the cost of 
the health care law. This not only raises the cost of business, but it 
reduces employment in the United States.
  Unfortunately, I am afraid what we may find is these restaurant 
companies, after 2014--we are about 1 year away from a ticking time 
bomb for State budgets and businesses and also for people with employer 
health insurance. I am afraid these companies will look at the penalty 
and say they would rather pay $2,000 per employee and let them find 
their way into one of these State exchanges or into the Medicaid 
Program.
  Millions of Americans, because of the health care law, are going to 
lose their employer-sponsored insurance, and millions of Americans will 
not have as many jobs because of the costs imposed on businesses such 
as these restaurants.
  Mr. JOHANNS. The Senator raises a good point. I am mindful of our 
time limit. I am going to take a minute or two to wrap up. I do think 
Senator Alexander and Senator Hoeven both raised very good points.
  I look at the health care law and I often think, whoever wrote this 
law, who were they talking to? They certainly were not talking to our 
small- and medium-sized businesses across this country. Why? Because 
just as Senator Alexander points out, there is going to be a point 
where that business owner, large or small, and in each and every spot 
in between, will look at the penalty of $2,000 per employee and say it 
is vastly cheaper for them to drop coverage and pay the penalty. In 
fact, we figured out what that savings would be for a large retailer in 
the United States. It was over $1 billion a year.
  Does anybody believe for a moment that they are not going to do what 
is right by their shareholders and pay that penalty and save $1 billion 
a year by dropping health care coverage? Once that dam breaks, the dam 
breaks.
  Then do you remember that promise so often made--47 times? The 
President said, ``If you like your plan, you are going to be able to 
keep it.'' Well, people are not going to be able to keep it. They will 
lose their plans.
  They certainly were not talking to Governors when they wrote this 
bill. Any Governor would tell us that Medicaid is a broken system. It 
is literally bankrupting State budgets under current circumstances. 
Then when we add

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26 million more people to Medicaid, we begin to realize they are going 
to have a serious access problem.
  Forty percent of doctors do not take Medicaid patients. Where are 
they going to find their health care? As many of us pointed out, it is 
like saying to someone: Here is your bus ticket, travel anywhere you 
want--oh, by the way, there are not enough buses to haul all the people 
we have given tickets to.
  That is what we are going to be facing--a growing access problem. 
Then, with the cuts to Medicare, they sure could not have been talking 
to Medicare providers because when they start cutting reimbursement 
rates, which is exactly what they are doing with $\1/2\ trillion cut 
out of Medicare, they are going to have access problems there too.
  All of a sudden senior citizens cannot find a doctor. Don't believe 
my statement on that. Read the reports from Richard Foster, the Chief 
Actuary at CMS, who studied this and said these are the consequences of 
this legislation.
  At the end of the day it is pretty clear to all of us that this is a 
failed policy that was quickly put together, rammed through to roll 
over the minority and get this done. We ended up with a very failed 
piece of legislation.
  The American people do not like this legislation any better than the 
day it was passed. In fact, they like it less. The more they learn 
about this legislation, the less they like it.
  I will wrap up with one thought. We all know the Supreme Court is 
hearing arguments on this case these days. It is my hope the Supreme 
Court will intervene and decide that this law is in fact 
unconstitutional, and then we can build a health care law the way it 
should be done--a step at a time, consulting with medical providers and 
Governors all across this country to build a policy that makes sense 
for the health care system and our citizens. That is what should have 
been done in the first place. That is what we need to do.
  With that, I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BOOZMAN. I ask unanimous consent that the order for the quorum 
call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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