[Congressional Record (Bound Edition), Volume 161 (2015), Part 14]
[Senate]
[Pages 18923-18927]
[From the U.S. Government Publishing Office, www.gpo.gov]




                               OBAMACARE

  Mr. ALEXANDER. Mr. President, let me take my colleagues back 5\1/2\ 
years to February 25, 2010, and the White House health care summit at 
the Blair House--the same place where Senator Arthur Vandenberg sat 
down with George Marshall. They met privately to discuss the postwar 
plans after World War II. The result of that discussion became the 
Marshall Plan. It was the perfect setting--it is the perfect setting 
for a serious, bipartisan discussion for how to improve health care for 
Americans.
  Thirty-six Members of Congress went to the Blair House that day at 
the invitation of President Obama. We were there to discuss the health 
care bill passed by the Democrats, what is now known as Obamacare. We 
stayed there all day. The President stayed there too. It was televised 
continuously. Both then-Minority Leader Boehner and Republican Leader 
McConnell asked me to lead off in speaking for Republicans.
  I said to the President that day that I was there not only to 
represent the view of Republicans but that I was there also as a former 
Governor and that I would like to have a chance to speak for the 
Governors as well because Governors managing States had a big stake in 
all of this.
  I also said that I was at the summit to represent the views of a 
great many of the American people who have tried to say in every way 
they knew how--through town meetings, through surveys, through 
elections in Virginia and New Jersey and Massachusetts--that they 
oppose the health care bill that was passed in the Senate in the middle 
of a snowstorm on Christmas Eve.
  I warned the President then about the unfortunate consequences of 
Obamacare for millions of Americans. I said to the President that this 
would send an unfunded Medicaid mandate to States. I said:

  

       ``It will cut Medicare by about half a trillion dollars and 
     spend most of that on new programs. . . . It means there will 
     be about a half trillion dollars of new taxes in it. It means 
     that for millions of Americans, premiums will go up, because 
     when people pay those new taxes, premiums will go up, and 
     they will also go up because of the government mandates.''

  That is what I said 5\1/2\ years ago. I said directly to the 
President then that instead of this partisan plan passed without the 
support of a single Republican in the Senate, we Republicans were 
prepared to work with him to reform health care. I said 5\1/2\ years 
ago to the President that we need to start over and go step-by-step in 
a different direction toward the goal of reducing health care costs. I 
said then that this means working together in the way that General 
Marshall and Senator Vandenberg did following World War II, and it 
means going step-by-step together to re-earn the trust of the American 
people. Those were my words to the President of the United States at 
the health care summit 5\1/2\ years ago.
  The President and the congressional Democrats listened all day, but 
they didn't take any of my advice and hardly any of the advice of my 
Republican colleagues about what the disastrous outcomes of Obamacare 
would be. So now, 5\1/2\ years after the law was passed and 2 years 
into its implementation, we can say one thing without question: The 
unfortunate reality for the American people is that they are struggling 
with Obamacare and that 5\1/2\ years ago Republicans were right.
  Obamacare was and is an historic mistake. Republicans agreed with the 
President and his party that our health care system was broken. We 
agreed that it needed to be fixed, but we argued that the President was 
moving in the wrong direction. What Obamacare did was to expand a 
broken system that everyone knew was too expensive. Republicans said so 
at the summit in February of 2010, and the facts today show we were 
right.
  Let's take a closer look at what Republicans said then, nearly 6 
years ago, and what unfortunately came true. Let's look also at what 
Democrats predicted back then--or better put, what they promised--and 
which of their predictions and promises came true. Let's go through 
them one by one.
  First, Medicaid. During my opening remarks at the Blair House at the 
summit, I said this: ``Nothing used to make me madder as Governor than 
when Washington politicians would get together, pass a bill, take 
credit for it, and send me the bill to pay.'' That is exactly what 
Obamacare does with the expansion of Medicaid. In addition, it dumps 15 
to 18 million low-income Americans into a Medicaid program that none of 
us would want to be a part of because 50 percent of the doctors won't 
see new patients. So it is like giving someone a ticket to a bus line 
when the bus runs only half the time.
  That is what I said 5\1/2\ years ago. Medicaid had already always 
been one of the Federal Government's biggest unfunded mandates, and 
expanding that mandate on States would only wreak more havoc on State 
budgets that, especially at that time during the height of the 
recession, were already struggling. Our former Tennessee Governor Phil 
Bredesen, a Democrat, said that the proposed Medicaid expansion under 
Obamacare would represent ``the mother of all unfunded mandates.''
  When I was Governor of Tennessee in the 1980s, Medicaid made up only 
about 8 percent of Tennessee's State budget. By last year it was 30.6 
percent. States paying more and more to expand Medicaid means having 
less to spend on other priorities like higher education, roads, and 
schools. In 2012, I said that over the prior 10 years, Tennessee's 
Medicaid costs had gone up 43 percent, forcing the State to decrease 
its funding to colleges and universities by 11 percent. As a result, 
tuition went up 120 percent over those 10 years.

[[Page 18924]]

  According to the Congressional Budget Office, the law will add $14 
million new beneficiaries to struggling State Medicaid programs by 
2025, at an extra cost of $46 billion to States and $847 billion to 
Federal taxpayers by 2025. Why is that so bad? I said at the time--and 
it is still true today--Medicaid's reimbursement rates are so low that 
only about one-half of the doctors will even see Medicaid patients and 
many of those aren't accepting new ones. It is not hard to see why 
expanding a failed program isn't good for Americans who need better 
health care.
  Another thing to consider is that States still haven't had to pay yet 
for covering the new Medicaid enrollees under the expansion. The 
Federal Government promised to pay 100 percent for the first few years, 
but starting in 2017--in just a couple of years--States will have to 
start paying 5 percent and eventually up to 10 percent in 2020. That 
may not seem like much in Washington terms, but it is a lot of money in 
State budgets. States may have to start raising income taxes or gas 
taxes or find some other place to find the money. Regardless of how it 
is paid for, expanding Medicaid puts a huge dent in State budgets. Does 
that mean less money for teachers' salaries? Does that mean tuition is 
going to have to go even higher at community colleges and State 
universities?
  Tennessee hasn't expanded Medicaid, but in its proposal to expand the 
program called Insure Tennessee, Governor Haslam anticipated an 
additional $35.6 million in costs to the State in 2017. In Illinois, 
Medicaid expansion will cost the State $208 million in 2020. In 
Kentucky's expansion, the State will have to pay $74 million in 2017 
and an estimated $363 million in 2021. Governor-elect Bevin hasn't 
started looking for ways to pay for that increase yet because he plans 
to try to repeal it. If you look at the figures you can see why he is 
thinking about it. We were right about Obamacare's enormous impact on 
Medicaid and in turn Medicaid's huge negative effect on State budgets.
  Second, higher premiums. When my turn came at the White House summit, 
this is what I said directly to the President: ``The Congressional 
Budget Office report says that premiums will rise in the individual 
market'' as a result of Obamacare. The President turned to me and said 
I was wrong about that.
  A little bit later in the day, I gave the President a letter from the 
Congressional Budget Office showing that they predicted I would be 
right, that new non-group policies would be about 10 to 13 percent 
higher in 2016 than the average for non-group coverage in that same 
year under the current law. In that same letter, I reminded the 
President, that his own Chief Actuary for the Centers for Medicare & 
Medicaid Services agreed with the Congressional Budget Office.
  You might be thinking that things would have turned out better than 
what I, the Congressional Budget Office, the Joint Committee on 
Taxation, and the Chief Actuary for CMS had predicted, but we all, 
unfortunately, were right. We were all right. Obamacare's premiums were 
and are higher for Americans with individual health care plans. We are 
talking about nearly 16 million Americans who purchase these individual 
plans. They buy these policies for themselves, and the cost of these 
plans is going through the roof.
  On June 1, 2015, the U.S. Department of Health and Human Services 
announced that nearly 700 individual and small-group health plans in 41 
States plus the District of Columbia had requested double-digit premium 
increases for 2016. In Tennessee, the rate hike was 36 percent; in 
Maryland, 26 percent. On average, 2016 premium increases for Oregon's 
biggest insurer on the State health exchange will be over 25 percent; 
for some smaller providers, more than 30 percent; for South Dakotans, 
they will pay 63 percent higher premiums for health insurance through 
the exchange. The list of States experiencing health care spikes goes 
on.
  A recent report of the National Bureau of Economic Research confirmed 
this, going back to the nonpartisan Congressional Budget Office, which 
predicted in 2010 the premiums would go up. They said recently that 
premiums on the Obamacare exchange will increase by 6 percent on 
average every year between 2016 and 2024. Yet 5\1/2\ years ago, the 
President and congressional Democrats told Republicans time and time 
again during the debate that we were wrong, that the law would decrease 
premiums, when in fact our predictions, the administration's own 
estimates, estimates from the National Bureau of Economic Research and 
the nonpartisan Congressional Budget Office, all confirmed premiums for 
individual policies are going through the roof.
  Third, Republicans said 5\1/2\ years ago that Obamacare would 
increase taxes. It did. Obamacare added 21 tax increases to the Tax 
Code. That is $1 trillion over 10 years, according to the Congressional 
Budget Office. A dozen of these target middle-income Americans, in 
clear violation of what the President had promised.
  Then there was our fourth prediction: Obamacare will cost jobs. A few 
years after the law passed, I met with a large group of chief 
executives of restaurant companies in America. The service and 
hospitality industries are the largest employers in our country. 
Usually their employees are low-income, usually minority Americans.
  In the meeting, the chief executive of Ruby Tuesday, Inc., which has 
about 800 restaurants, said to me--and said he didn't mind being 
quoted--that the cost to his company of implementing the new health 
care law was equal to or more than his net profit for that year, and as 
a result, he wasn't planning to build any new restaurants in the United 
States.
  An even larger restaurant company represented at the meeting said 
that because of their analysis of the law, instead of operating their 
store with 90 employees, their goal would be to operate it with 70 
employees. That means fewer employees and fewer jobs because of 
Obamacare.
  More recently, another franchise business which has 550 employees 
told me: We have already begun cutting the hours of our employees to 
get well below the 30-hour threshold, and all of our new job postings 
are for part-time employees.
  This has a bad effect on the employer-employee relations, and, as 
many Tennesseans have told me, 30 hours of work isn't enough to support 
a family. Those lost hours are because of Obamacare.
  These are just a few examples of basic economics. It heaps costs on 
employers. They have less money to expand, so there is less money to 
hire workers. They heap on even higher costs. They cut hours. With 
higher costs, they lay off employees. We have seen all three as a 
result of the employer mandate that says employers with more than 50 
full-time employees need to provide health insurance.
  What is more, Obamacare went a step further and for the first time in 
our history defined ``full time'' as a 30-hour workweek. I asked the 
former Democratic chairman of our HELP Committee: Where did that come 
from? France? Nobody knew where that came from. Full-time work in the 
United States has not been typically considered 30 hours, but it is in 
Obamacare. It is causing large numbers of employees to work only 28 or 
29 hours because their employers can't afford to hire them as full-time 
employees.
  The Congressional Budget Office has projected that Obamacare will 
result in 2 million fewer jobs in 2017 and 2.5 million fewer full-time 
jobs by 2024. At least 450 employers across the Nation, including 100 
school districts, have said Obamacare forced them to cut positions or 
reduce worker hours.
  What we Republicans said would happen years ago was this: that 
Medicaid would destroy State budgets--it did; that premiums and taxes 
would go up--they have; and that jobs would be lost--they have. It has 
all, unfortunately, come true.
  What did President Obama and congressional Democrats promise us about 
this law at about the time of the health care summit 5\1/2\ years ago? 
Were they right or were they wrong? One of the most infamous promises, 
which PolitiFact named--and I will use their words--as the 2013 ``Lie 
of the Year,'' was the President's ``If you like your plan, you can 
keep it.''

[[Page 18925]]

  When Obamacare was fully implemented in 2014, millions of Americans 
learned very quickly that they wouldn't be able to keep the plans they 
liked.
  In October 2013, I received a letter from a woman, Emilie, whom I 
met. She lives in Middle Tennessee, and she has lupus. She was one of 
16,000 Tennesseans who were part of a plan called CoverTN. She wrote me 
about her chronic illness. She said she was deemed uninsurable and that 
the only way to insure her was through CoverTN. She was glad to have 
that coverage, and she was glad to hear about Obamacare. Then she 
learned the truth:

       ``I cannot keep my current plan because it does not meet 
     the standards of coverage. This alone is a travesty. CoverTN 
     has been a lifeline [for me].
       With the discontinuation of CoverTN, I am being forced to 
     purchase a plan . . . that will increase [my costs] by a 
     staggering 410%. My out of pocket expense will increase by 
     more than $6,000.00 a year. Please help me understand how 
     this is `affordable.'''

  This was Emilie in Middle Tennessee.
  We could spend all day telling stories of Americans who liked their 
health care plans but weren't able to keep them under Obamacare.
  In November 2013 that looked as if it might be as many as 5 million 
Americans. The administration then did some last-minute regulatory 
fixes and lowered that number. But still, many Americans lost their 
plans, as Emilie did.
  The President also said:

       ``Medicare is a government program. But don't worry: I'm 
     not going to touch it.''

  The problem was he did touch it; $700 billion worth was taken from 
Medicare to finance Obamacare.
  I said during the debate in 2009 that Obamacare would cut ``grandma's 
Medicare to spend on somebody other than grandma--a new entitlement 
program.'' I said Obamacare would do that at a time when the Medicare 
trustees have told us that Medicare is going broke if we don't fix it. 
That is their job to tell us that. I said then: ``I think what they are 
saying to us is if you are going to cut grandma's Medicare, you ought 
to at least spend it on grandma instead of spending it on somebody 
else.''
  Again, the President went against the promise he repeated over and 
over and raided a program that serves over 55 million older Americans.
  In summary, unfortunately Republicans were right when we said 5\1/2\ 
years ago that Obamacare would force spikes in State Medicaid spending, 
increase premiums and taxes, and hurt jobs. As right as we were, the 
Democrats were wrong. They said that you could keep your plan if you 
liked it, and they were wrong about that. They said Medicare wouldn't 
be affected, and they were wrong about that.
  Finally, we all agreed that health care needed to be fixed. So how 
did we end up with a law that was such an historic mistake? Well, one 
big reason is the debate over Obamacare wasn't really a debate. If it 
had been, we might not find ourselves in a mess today.
  The Senate Democratic leader then had a filibuster-proof majority. He 
didn't think he needed Republican ideas; so they didn't take them. They 
passed a Democratic bill. They voted for it; we voted against it. We 
sat here in a snowstorm on Christmas Eve when they had 60 votes, and 
they unveiled a bill filled to the brim with items from each Democratic 
Members' wish list.
  Along with our warnings about what would happen, we offered a lot of 
thoughtful ideas about how to fix the health care system in a way that 
we thought would lower costs and expand access, while making sure 
patients didn't lose control over their own health care. But Democrats 
also had a majority in the House. They had a Democratic President. They 
didn't need our ideas, and so we got Obamacare.
  So what do we Republicans have to offer Americans?
  Mr. President, how much time do I have remaining?
  The PRESIDING OFFICER (Mr. Lankford). The Senator has 9 minutes 
remaining.
  Mr. ALEXANDER. I thank the Presiding Officer. I will wrap up. I see 
the Senator from Washington on the floor.
  Throughout the Obamacare debate, Senator McConnell, who was the 
minority leader at the time, was criticized for not coming up with a 
comprehensive plan of his own. We told the President and the 
congressional Democrats not to hold their breath waiting for 
``McConnell Care.'' Don't hold your breath waiting for Senator 
McConnell to come down to the Senate floor with a wheelbarrow filled 
with a 2,700-page bill of his own, because that is not how we believe 
the health care system ought to be fixed. We are policy sceptics. We 
doubt that anyone in Washington--Republicans, Democrats, Independents--
have the wisdom to fix such a complex system everywhere in America all 
at once.
  The wisest course would be to try to fix our health care system step 
by step in a way that emphasizes more choices and lower costs. This 
approach to health care reform is not something that Republicans cooked 
up last month. In fact, if you examine the Congressional Record, you 
will find that Republican Senators proposed a step-by-step approach to 
confronting our Nation's health care problems and other challenges 173 
different times on the floor of the Senate during the year 2009. Some 
173 times we talked about our step-by-step different direction for 
health care--almost none of which was included in Obamacare because 
they had the votes and they didn't need our ideas.
  I had hoped the President would listen to us and work with us at 
Blair House, emphasize more freedom, more choices and lower costs. But 
that didn't happen. We suggested allowing individuals to buy a health 
care plan in any State that meets their needs. We suggested reducing 
junk lawsuits against doctors, which only increase costs. We suggested 
expanding health savings accounts and other mechanisms, allowing 
individuals to control how they spend their own health care dollars. We 
suggested returning power to the States to regulate their own markets 
and lower costs. We suggested allowing small businesses to assist 
employees in purchasing the insurance and look at other ways to support 
employers offering health care benefits to their employees. We had 
specific legislative proposals to do these things. We suggested 
lowering barriers at the Food and Drug Administration so that 
innovative drugs and devices could get to the market faster and putting 
the health sector in charge of health information technology. We 
suggested insuring Americans with pre-existing conditions in a way 
through high-risk pools and other insurance incentives. And there are 
many other ideas that we thought then and we think now we could work 
together on in a bipartisan way to lower costs, to increase access, and 
to put patients back in charge of their own health care.
  This week, though, we are talking about repealing Obamacare, but for 
the last 6 years we have also been talking about a completely different 
path of providing health care at a lower cost to more Americans. Those 
steps were outlined in 2009, 2010, and 2011, and they are the same 
steps that we should be taking today.
  I have been saying since 2009 that the historic mistake with 
Obamacare was that we had deliberately expanded a broken health care 
system that already cost too much instead of moving step by step to 
create a system where millions of Americans had choices of plans that 
fit their needs and fit their budgets.
  The way we should accomplish this is the same way we passed Medicare, 
the same way we passed Social Security, the same way the Congress 
passed the Civil Rights Act, and in the same way--I hope and the 
Senator from Washington hopes--we will pass a broad reauthorization of 
the Elementary and Secondary Education Act in the next couple of weeks. 
None of this is done by cramming a bill down the throats of the 
American people with 60 votes during a snowstorm on Christmas Eve.
  I renew our invitation to the President of the United States, and if 
he doesn't accept our invitation, to the next President of the United 
States.
  To our colleagues on the other side of the aisle: Let's forget about 
party; let's

[[Page 18926]]

forget about this side or that side. Let's side with the American 
people whose premiums have gone up, who lost plans they like, whose 
Medicare has been raided, whose State budgets have been destroyed, and 
whose jobs have been lost. Work with Republicans in Congress to fix the 
damage Obamacare has done to health care in America. Work with us to 
replace Obamacare with real reforms at lower costs so more Americans 
can afford to buy insurance.
  Mr. President, I ask unanimous consent to have printed in the Record 
my comments at the health care summit in February of 2010 and the 
letter that I handed to President Obama following our debate at the 
health care summit in 2010.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                     [Thursday, February 25, 2010]

  Alexander Gives Republican Health Care Remarks at White House Summit


 Outlines Republican Steps to Fix Health Care, Challenges Democrats to 
                   Take Reconciliation Off the Table

       Washington.--U.S. Senator Lamar Alexander (R-Tenn.), 
     chairman of the Senate Republican Conference, today delivered 
     the following opening remarks on behalf of Republican members 
     of Congress attending the White House health care summit:
       ``Mr. President, thank you very much for the invitation. 
     Several of us were a part of the summits that you had a year 
     ago, and so I've been asked to try to express what 
     Republicans believe about where we've gotten since then. As a 
     former governor, I also want to try to represent governors' 
     views, because they have a big stake in this; I know you met 
     with some governors just in the last few days. We also 
     believe that our views represent the views of a great number 
     of the American people who have tried to say in every way 
     they know how--through town meetings, through surveys, 
     through elections in Virginia and New Jersey and 
     Massachusetts, that they oppose the health care bill that 
     passed the Senate on Christmas Eve.
       ``And more importantly, we believe we have a better idea. 
     And that's to take many of the examples that you just 
     mentioned about health care costs and make that our goal: 
     reducing health care costs. We need to start over and go step 
     by step toward that goal. And we would like to briefly 
     mention--others will talk more about it as we go along--what 
     those ideas are.
       ``I would like to begin with a story. When I was elected 
     governor, some of the media went up to the Democratic leaders 
     in the legislature and said, `What are you going to do with 
     this new young Republican governor?' And they said, `We're 
     going help him, because if he succeeds, our state succeeds.' 
     And they did that--that's the way we worked for eight years. 
     But often, they had to persuade me to change my direction to 
     get our state where it needed to go. I would like to say the 
     same thing to you. I mean, we want you to succeed. Because if 
     you succeed, our country succeeds. But we would like 
     respectfully to change the direction you're going on health 
     care costs, and that's what I want to mention here the in 
     next few minutes.
       ``I was trying to think if there were any kind of event 
     that this could be compared with. And I was thinking of the 
     Detroit Auto Show, that if you had invited us out to watch 
     you unveil the latest model that you and your engineers had 
     created, and asked us to help sell it to the American people. 
     When we look at it, it's the same model we saw last year. We 
     didn't like it, and neither did they, because we don't think 
     it gets us where we need to go, and we can't afford it. As 
     they also say in Detroit, `We think we have a better idea.'
       ``Your stories are a lot like the stories I heard when I 
     went home for Christmas after we had 25 days of consecutive 
     debate and voted on Christmas Eve on health care. A friend of 
     mine from Tullahoma, Tennessee, said, `I hope you'll kill 
     that health care bill.' Then before the words rattled out of 
     his mouth, he said, `But, we've got to do something about 
     health care costs. My wife has breast cancer. She got it 11 
     years ago and our insurance is $2,000 a month. We couldn't 
     afford it if our employer weren't helping us do that. So 
     we've got to do something.' That's where we are, but to do 
     that, we have to start by taking the current bill and putting 
     it on the shelf and starting from a clean sheet of paper.
       ``Now, you have presented ideas. There's an 11-page memo--I 
     think it's important for the people to understand that 
     there's not a presidential bill; there are good suggestions 
     and ideas on the web. It's a lot like the Senate bill. It has 
     more taxes, more subsidies, more spending. So what that means 
     is, when it's written, it will be 2,700 pages, more or less. 
     It will probably have a lot of surprises in it. It means it 
     will cut Medicare by about half a trillion dollars and spend 
     most of that on new programs, not on Medicare and making it 
     stronger, even though it's going broke in 2015. It means 
     there will be about a half trillion dollars of new taxes in 
     it. It means that for millions of Americans, premiums will go 
     up, because when people pay those new taxes, premiums will go 
     up, and they will also go up because of the government 
     mandates. It means that from a governor's point of view, it's 
     going to be what our Democratic governor calls the `mother of 
     all unfunded mandates.'
       ``Nothing used to make me madder as a governor than when 
     Washington politicians would get together, pass a bill, take 
     credit for it, and send me the bill to pay. That's exactly 
     what this does, with the expansion of Medicaid. In addition, 
     it dumps 15 to 18 million low-income Americans into a 
     Medicaid program that none of us want to be a part of, 
     because 50 percent of doctors won't see new patients. So it's 
     like giving someone a ticket to a bus line where the buses 
     only run half the time.
       ``When fully implemented, the bill would spend about $2.5 
     trillion a year, and it still has sweetheart deals in it--one 
     is out, some are still in. What's fair about taxpayers in 
     Louisiana paying less than taxpayers in Tennessee? What's 
     fair about protecting seniors in Florida and not protecting 
     seniors in California and Illinois and Wyoming?
       ``Our view, with all respect, is that this is a car that 
     can't be recalled and fixed, and that we ought to start over. 
     But we'd like to start over. When I go down to the Senate 
     floor, I've been there a lot on this issue, some of my 
     Democratic friends will say, `Well, Lamar, where's the 
     Republican comprehensive bill?' And I say back, `Well, if it 
     you're waiting for Mitch McConnell to roll in a wheelbarrow 
     with a 2,700-page Republican comprehensive bill, it's not 
     going to happen because we have come to the conclusion 
     Congress doesn't do comprehensive well.' We have watched the 
     comprehensive economy-wide, cap and trade; we have watched 
     the comprehensive immigration bill, we have the best Senators 
     we have got working on that in a bipartisan way; we have 
     watched the comprehensive health care bill. And they fall of 
     their own weight.
       ``Our country is too big, too complicated, too 
     decentralized for Washington to write a few rules about 
     remaking 17 percent of the economy all at once. That sort of 
     thinking works in a classroom, but it doesn't work very well 
     in our big, complicated country. It doesn't work for most of 
     us and if you look around the table--and I'm sure it's true 
     on the Democratic side--we have got shoe store owners and 
     small business people and former county judges and we've got 
     three doctors. We've got people who are used to solving 
     problems, step by step.
       ``That's why we said `step by step' 173 times on the Senate 
     floor in the last six months of last year in support of our 
     step-by-step plan for reducing health care costs. I would 
     like to just mention those in a sentence or two:
       First, you mentioned Mike Enzi's work on the small business 
     health care plan. That's a good start. It came up in the 
     Senate. He will explain why it covers more people, costs 
     less, and helps small businesses offer insurance.
       Two, helping Americans buy insurance across state lines. 
     You've mentioned that yourself. Most of the governors I've 
     talked to think that would be a good way to increase 
     competition.
       Number three, put an end to junk lawsuits against doctors. 
     In our state, half the counties' pregnant women have to drive 
     to the big city to have prenatal health care or to have their 
     baby, because the medical malpractice suits have driven up 
     the insurance policies so high that doctors leave the rural 
     counties.
       Number four, give states incentives to lower costs.
       Number five, expanding health savings accounts.
       Number six, House Republicans have some ideas about how my 
     friend in Tullahoma can continue to afford insurance for his 
     wife who has had breast cancer; because she has a preexisting 
     condition, it makes it more difficult to buy insurance.
       ``So there're six ideas--they're just six steps. Maybe the 
     first six, but combined with six others and six more and six 
     others, they get us in the right direction.
       ``Now, some say we need to rein in the insurance companies; 
     maybe we do. But I think it's important to note if we took 
     all of the profits of the health insurance companies entirely 
     away, every single penny of it, we could pay for two days of 
     health insurance for Americans. And that would leave 363 days 
     with costs that are too high. So that's why we continue to 
     insist that as much as we want to expand access and to do 
     other things in health care, that we shouldn't expand a 
     system that's this expensive, that the best way to increase 
     access is to reduce costs.
       ``Now, in conclusion, I have a suggestion and a request for 
     how to make this a bipartisan and truly productive session. 
     And I hope that those who are here will agree, I've got a 
     pretty good record of working across party lines, and of 
     supporting the president when I believe he's right, even 
     though other members of my party might not on that occasion. 
     And my request is this: before we go further today, that the 
     Democratic Congressional leaders and you, Mr. President, 
     renounce this idea of going back to the Congress and jamming 
     your bill through on a

[[Page 18927]]

     partisan vote through a little-used process we call 
     reconciliation.
       ``You can say that this process has been used before, and 
     that would be right, but it's never been used for anything 
     like this. It's not appropriate to use to rewrite the rules 
     for 17 percent of the economy. Senator Byrd, who is the 
     constitutional historian of the Senate, has said that it 
     would be an outrage to run the health care bill through the 
     Senate like a freight train with this process. The Senate is 
     the only place where the rights to the minority are 
     protected, and sometimes, as Senator Byrd has said, the 
     minority can be right.
       ``I remember reading Alexis de Tocqueville's book Democracy 
     in America, in which he said that the greatest threat to the 
     American democracy would be the `tyranny of the majority.'
       ``When Republicans were trying to change the rules a few 
     years ago, you and I were both there. Senator McCain was very 
     involved in that--getting a majority vote for judges. Then-
     Senator Obama said the following, `What we worry about is 
     essentially having two chambers, the House and the Senate, 
     who are simply majoritarian, absolute power on either side. 
     That's just not what the founders intended.' Which is another 
     way to saying that the founders intended the Senate to be a 
     place where the majority didn't rule on big issues.
       ``Senator Reid in his book, writing about the `Gang of 14,' 
     said that the end of the filibuster requiring 60 votes to 
     pass a bill `would be the end of the United States Senate.' 
     And I think that's why Lyndon Johnson, in the '60s, wrote the 
     civil rights bill in Everett Dirksen's office, the Republican 
     Leader, because he understood that by having a bipartisan 
     bill, not only would pass it, but it would help the country 
     accept it. Senator Pat Moynihan has said before he died that 
     he couldn't remember a big piece of social legislation that 
     passed that wasn't bipartisan.
       ``And after World War II, in this very house and in the 
     room back over here, Democratic President Truman's Secretary 
     of State, General Marshall, would meet once a week with 
     Senator Vandenberg, the Republican Chairman of the Senate 
     Foreign Relations Committee, and write the Marshall Plan. And 
     General Marshall said that sometimes Van was my right hand, 
     and sometimes he was his right hand.
       ``And we know how [Congressmen] John Boehner and George 
     Miller did that on No Child Left Behind. [Senators] Mike Enzi 
     and Ted Kennedy wrote 35 bills together; you mentioned that 
     in your opening remarks. You and I and many other others 
     worked together on the America COMPETES Act. We know how to 
     do that--and we can do that on health care as well.
       ``But to do that, we'll have to renounce jamming it through 
     in a partisan way. And if we don't, then the rest of what we 
     do today will not be relevant. The only thing bipartisan will 
     be the opposition to the bill, and we'll be saying to the 
     American people--who I've tried to say this in every way they 
     know how--town halls and elections and surveys--that they 
     don't want this bill, that they would like for us to start 
     over. So if we can do that--start over--we can write a health 
     care bill. It means putting aside jamming it through. It 
     means working together the way General Marshall and Senator 
     Vandenberg did. It means reducing health care costs and 
     making that our goal for now, not focusing on the other 
     goals. And it means going step by step together to re-earn 
     the trust of the American people. We would like to do that, 
     and we appreciate the opportunity that you have given us 
     today to say what our ideas are, and to move forward. Thank 
     you very much.''
                                  ____



                                                  U.S. Senate,

                                Washington, DC, February 25, 2010.
     Hon. Barack Obama,
     President, The White House,
     Washington, DC.
       Dear Mr. President, During today's discussion on health 
     care, you and I disagreed about whether the health care bill 
     that passed the Senate on a party-line vote on December 24 
     would cause health insurance premiums to rise even faster 
     than if Congress did not act. I believe premiums will rise 
     because of independent analysis of the bill:
       On November 30, the non-partisan Congressional Budget 
     Office (CBO) wrote in a letter to Senator Bayh that ``CBO and 
     JCT estimate that the average premium per person covered 
     (including dependents) for new nongroup policies would be 
     about 10 percent to 13 percent higher in 2016 than the 
     average premium for nongroup coverage in that same year under 
     current law.''
       When you asserted that CBO says premiums will decline by 14 
     to 20 percent under the Senate bill, you are leaving out an 
     important part of CBO's calculations. These reductions are 
     overwhelmed by a 27 to 30 percent increase in premiums due to 
     the mandated coverage requirements in the legislation. CBO 
     added those figures together to arrive at a net increase of 
     10 to 13 percent--as shown in their chart in that same 
     letter.
       In that same letter, CBO wrote, ``The legislation would 
     impose several new fees on firms in the health sector. New 
     fees would be imposed on providers of health insurance and on 
     manufacturers and importers of medical devices. Both of those 
     fees would be largely passed through to consumers in the form 
     of higher premiums for private coverage.''
       On December 10, the chief actuary for the Centers for 
     Medicare and Medicaid Services--who works for your 
     administration--concurred with the CEO. In his analysis, the 
     actuary said, ``We anticipate such fees would generally be 
     passed through to health consumers in the form of higher drug 
     and device prices and higher insurance premiums.'' He also 
     said, ``The additional demand for health services could be 
     difficult to meet initially with existing health provider 
     resources and could lead to price increases, cost-shifting, 
     and/or changes in providers' willingness to treat patients 
     with low-reimbursement health coverage.''
       For these reasons, the Senate-passed bill will, indeed, 
     cause Americans' insurance premiums to rise, which is the 
     opposite of the goal I believe we should pursue.
       Sincerely,
                                                  Lamar Alexander.

  Mr. ALEXANDER. Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.

                          ____________________