Speeches & Floor Statements
Colloquy Remarks of U.S. Senator Lamar Alexander (R-Tenn.) and Republican Colleagues -- Health Care Reform
Posted on December 7, 2009
Mr. ALEXANDER. Madam President, on our Republican time, the Senator from Wyoming, Mr. Barrasso, will lead a colloquy and ask for permission to do that concerning Senator Gregg's amendment, which we will be talking about this afternoon, making clear to the American people this Democratic health care bill is being paid for by treating Medicare as a piggy bank. But before we do that, I want to say, briefly, something in response to the majority leader's comments. He, the majority leader, said the Republican leader had said the Democratic health care bill is arrogant. It is historic in its arrogance. It is arrogant to think we are wise enough -- we 100 Senators are wise enough -- in a 2,000-page bill to completely turn upside down and change a comprehensive health care system that affects nearly 300 million Americans and 16 or 17 percent of our economy all at once. It is arrogant for us to imagine the American people are not wise enough to see through the proposals in this bill, which are to transfer millions more Americans into a Medicaid Program for low-income people that none of us would want our families or members a part of. It is arrogant for us, then, to send a significant bill for much of that to State governments. We make the decision, we send them the bill, and do that in a way that in my State, at least, will cause devastating cuts in higher education or huge tax increases. It is arrogant to say to the American people it is an $800 billion bill, which, as the Senator from New Hampshire has pointed out, when it is fully implemented it is a $2.5 trillion bill -- half paid for by Medicare cuts. It is arrogant to say we have balanced our budget when in fact -- when in fact -- we leave outside the budget what it costs to pay doctors to work in the government-run program we have today. So this legislation is historic. It is historic in its arrogance, and the American people will see through it and will expect us to, instead, identify a clear goal. That is the Republican proposal, which is, to reduce costs and go step by step in a direction toward those goals -- whether we are allowing small businesses to put together their plans so they can serve more people at a lower cost, whether it is creating competition by allowing people to buy insurance across State lines, whether it is reducing junk lawsuits against doctors. We have made all these proposals. We are ready not to roll a wheelbarrow of our own in here with a comprehensive proposal. But day after day, we have said, instead of increasing costs, raising taxes, allowing premiums to go up, shifting costs to States, and dumping low-income Americans into Medicaid, let's reduce costs. We have a plan to do that. Amendment No. 2942 I wish to recognize the Senator from Wyoming so we can have a discussion about Senator Gregg's amendment. The PRESIDING OFFICER (Mr. BINGAMAN). The Senator from Wyoming. Mr. BARRASSO. Mr. President, I ask unanimous consent to engage in a colloquy with my colleagues to discuss the issues at hand. The PRESIDING OFFICER. Without objection, it is so ordered. Mr. BARRASSO. I thank the Presiding Officer. Mr. President, I have been looking at the bill, which, to me, is going to hurt the health care system of our country. I am a physician. I have taken care of families in Wyoming for 25 years, and I think if we want to get costs under control, if we want to help families all across America who are struggling with their health care needs, we need to focus on an amendment that is before us today, brought forward by the Senator from New Hampshire. I ask my friend and colleague from New Hampshire, is it not true that the numbers we are looking at are underreported? It is going to be much more expensive and the cuts are going to come from our seniors, those who are vulnerable, those who depend on Medicare for their health care, and we need to make sure and promise the American people we will be protecting those folks who depend on Medicare for their health care? Mr. GREGG. Mr. President, the Senator from Wyoming, first as a doctor, and second as a Senator, raises a very important point; that is, this is the largest expansion in government in the history of the government. Let's begin right there. This is a $2.5 trillion expansion in the size of the government when fully implemented. It is a massive growth in the size of government. Most of that growth comes from the expansion of government in two areas: the expansion and creation of a brandnew entitlement and the expansion of Medicaid, as was alluded to by the Senator from Tennessee. How is that paid for? How is this huge explosion in the size of government paid for? Well, a large part of that is paid for by reducing the amount of money in Medicare that is paid in Medicare, paid to Medicare providers, and available to Medicare recipients -- $460 billion in the first 10 years, $1 trillion in the first 10 years when the program is fully implemented -- that would start in about 5 years -- and then $3 trillion, by our estimates, which are linear -- I suspect it will be more -- over the first 20 years of this bill, a $3 trillion reduction in Medicare benefits. We heard arguments from the other side of the aisle: Oh, that is not going to affect benefits. Well, that is not believable. We know that. You cannot reduce Medicare provider payments and you cannot cut Medicare Advantage -- with the total cuts of both, combined, by $460 billion in the first 5 years, $1 trillion in the first 10 years of full implementation, and $3 trillion over 20 years -- and not affect benefits. This is money that is going to have the most significant impact we have ever had occur on our seniors in their Medicare system. This is a fundamental change in the way Medicare services are paid for and the insurance that is available to seniors under Medicare, specifically, Medicare Advantage. We know for a fact that of the 11 million people on Medicare Advantage, approximately a fourth of them will lose it -- simply lose their Medicare Advantage. We also know hospital groups, provider groups, and doctors are all going to see significant reductions in their reimbursement rates, which means, of course, they are going to change the way in which they treat seniors. Seniors are going to find it harder to find a doctor. They are going to find it harder to get a procedure they need because the reimbursement rate for those procedures is going to have been cut so significantly under this bill. Home health care will be dramatically impacted. The Senator from Wyoming had a very interesting letter from his home health care groups in Wyoming which related to what percentage of home health care agencies would actually close. It was a very high percentage under this proposal. There is no question but that Medicare is in dire straights. It is headed toward insolvency. It goes into a negative cashflow in 2 years, and it has $35 trillion of obligations, which we have no idea how we are going to pay for. So Medicare reform is important. I have supported it. I proposed it. In fact, I proposed it a number of times and have always been voted against by colleagues on the other side of the aisle. But any reform to Medicare of this size -- $464 billion in the first 10 years, $1 trillion in the first 10 years of implementation, $3 trillion over 20 years -- anything that is going to cut Medicare by those numbers, those savings, if they are going to occur, those reductions, should go to benefit making Medicare more solvent. But what happens under this bill? That is not what they are used for. Those dollars which come right out of the pockets of seniors and the people who provide seniors care -- and the ability of seniors to purchase insurance under Medicare Advantage -- those dollars go from the senior over to creating these new major programs, these new entitlements. In fact, I was looking at the bill. It appears to me some of those dollars go to get votes around here. Isn't that incredible? They are going to take money away from seniors and use it for the purposes of getting votes to pass this bill by sending money back to States of Members who are maybe a little wavery on whether they want to vote for this bill. That is where some of the money goes to. But most of the money goes to creating these new entitlements for people who may be deserving -- probably are deserving -- but who are not seniors and who probably have not paid into the insurance fund that seniors have paid into for all their life and, thus, it is totally inappropriate to do that. I have an amendment. It is very simple. It is an amendment that has real teeth, and it is actually an amendment that follows up on a number of statements from the other side of the aisle and some sense of Senates which were voted 100 to nothing around here, which says, simply: No Medicare money can be used to fund other parts of this bill. To the extent Medicare savings occur under this bill as a result of cuts to home health care, cuts to Medicare Advantage, cuts to provider groups, those dollars will not be taken and used to fund new entitlements for people who are not on Medicare, not seniors. They will not be taken to fund the purchase of votes around here to pass this bill. This is a real amendment. A lot of stuff happening around here is sense of the Senates, where people stand up and say: Oh, I am for that. Exactly, what I said -- let's do a sense of the Senate to that effect. But sense of the Senates have no impact at all. They are political cover. This is not political cover. This amendment, as structured, will actually accomplish the goal of not allowing Medicare dollars -- cuts in Medicare that are $464 billion over the first 10 years, $1 trillion over the fully implemented period, and $3 trillion over the 20-year period -- it will not allow any of those dollars to be used to fund new programs in this bill which do not benefit seniors. That is all it says. It seems to me, if you are going to stand up for responsible action in the area of Medicare, if you are going to live by the sense of the Senates that have been voted for here, if you are going to stand behind your word, as the sense of the Senates have called for -- that Medicare money be used for Medicare, and that Medicare money not be used to fund extraneous things that are extraneous to Medicare; Medicare cuts savings -- then you have to vote for this amendment. Mr. THUNE. Will the Senator yield for a question? Mr. GREGG. I would be happy to yield. Mr. THUNE. It strikes me that the Senator's amendment is very straightforward, very simple, and very clear; that is, any savings that come out of the Medicare Program cannot be used to fund a new entitlement program. Mr. GREGG. That is not related to seniors. Mr. THUNE. Correct. And it seems to me, at least, that your amendment gets at what some on the other side have argued, with their amendments, they are trying to accomplish. Could the Senator from New Hampshire describe how the effect, the legal effect, of his amendment differs from, say, for example, the votes we have had, where it was a 100-to-0 vote the other day on a Bennet amendment, what the impact the amendment of the Senator from New Hampshire would be relative to some of the previous votes we have had, which it appears to me, at least, were completely meaningless, sort of cover votes, to try and give people on the other side the opportunity to say: We voted to protect Medicare, when, in fact, they did not? How does the amendment of the Senator from New Hampshire -- how would you distinguish your amendment from those that have been voted on previously? Mr. GREGG. My amendment has force of law behind it. Those amendments have no force of law behind them. They have no effect at all. As the Senator said: a political statement, an editorial comment, a piece of paper written. This amendment, if passed, will have the force of law behind it. It will very simply be structured in a way that the money cannot be taken out of Medicare if it is going to be used for the purposes of funding the new programs in this bill, whether they are the entitlement programs for people who are not seniors -- this expansion of entitlements -- or whether they are for the purposes of getting votes to pass the bill. Mr. THUNE. So if a Senator on either side of the aisle, a Republican on this side or a Democrat, was serious about protecting Medicare, ensuring that Medicare's solvency is protected in this debate and that these funds are not going to be reallocated to create some new entitlement program or spend money on some new -- clearly, $2 1/2 trillion expansion of government, which we know is going to require enormous amounts of revenue which seems to me has to come from somewhere -- what the Senator's amendment would do is simply force, I think, the other side to put up or shut up with regard to this argument they have, which is that they are, in fact, supporting Medicare; the Senator's amendment would essentially say, very clearly, in a very straightforward way, that funds that come in out of savings from Medicare have to be retained in the Medicare account. Mr. GREGG. That is correct. This is the first and only vote Members on this floor are going to have, to make it clear that Medicare dollars will not be used for something other than Medicare. Mr. CHAMBLISS. Would the Senator yield for an additional question? The language in the Bennet amendment that passed 100 to nothing the other day said, basically, that Medicare savings should benefit the Medicare Program and Medicare beneficiaries. That sounds pretty straightforward, pretty simple. But let me ask the Senator -- Mr. GREGG. Well, if I might interject, anybody who voted for that amendment would want to vote for mine. Mr. CHAMBLISS. That is exactly the question I am getting to. Is there anything in the Bennet amendment that removes the expenditure of almost $500 billion from Medicare in the base Reid bill that would require the restoration of those cuts to benefit Medicare versus using it as a fund to pay for the underlying Reid bill? Mr. GREGG. Well, the Senator has made an excellent point. Essentially, the Bennet amendment has no teeth. It has no substance. It has no substantive effect. It is just a statement of purpose. If the statement of purpose is as recited by the Senator from Georgia, then you would need to vote for this amendment, my amendment, if you voted for the Bennet amendment, because my amendment has the teeth that backs up the language of the Bennet amendment. Mr. CHAMBLISS. If I understand what you are saying in your amendment, you are requiring the Office of Management and Budget as well as CMS to certify to Congress, basically, that the savings that are referred to in the Bennet bill as well as in your bill are, in fact, being used to fund Medicare benefits versus being used to fund other benefits outside Medicare until such time as Medicare is fully funded. Mr. GREGG. That is, essentially, what it says. It says that CMS and OMB must certify that no funds are being used to fund the additional activity in this bill that does not relate to Medicare with Medicare funds. It does not say that Medicare savings -- it agrees to the Medicare savings, but those Medicare savings would basically be used for the purposes of reducing the outyear fiscal imbalance of Medicare. So it doesn't contest the Medicare savings as proposed in this bill, although those amendments have -- we have already voted on a number of those. We voted on home health care, and we voted on Medicare Advantage, but to the extent those savings go in, those cuts in Medicare benefits go in, the revenues from those cuts cannot be used and spent to expand the size of government in someplace else which has nothing to do with senior citizens. Mr. BARRASSO. If I could follow up with a question for my colleague from New Hampshire, because as I read the Sunday New York Times, it said the Bennet amendment was completely meaningless; the Bennet amendment was meaningless. It also goes on to say, Senator McCain is trying to keep that $500 billion in Medicare, but the Democrats are trying to take that money out of Medicare and, as the article says, the editorial says: to finance coverage for uninsured Americans but not people on Medicare. So it does seem the New York Times, at least in this segment, got it right: that the Bennet amendment that our colleague from Georgia referred to is meaningless, that the cuts are going to come out of people who depend upon Medicare for their health care to pay for a whole new government program and not to focus on Medicare. Well, don't we owe it to these seniors who have paid into the program and who have been promised the program to save that program first? Mr. GREGG. Well, the Senator from Wyoming is absolutely right. I think the New York Times got it right. It is a convergence of two unique forces of nature that the Republican minority in the Senate and the New York Times should be on the exact, same page on this issue and both be right. Mr. ALEXANDER. I wonder if the Senator from New Hampshire would characterize this discussion this way: As I am hearing it, in order to protect Medicare, a Senator wouldn't want to say: I voted for the Bennet amendment and then I voted against the Gregg amendment, when it counted. Mr. GREGG. It would be virtually impossible to make that argument with a straight face, I think. Mr. BARRASSO. I have a question for my Senate colleague from South Dakota who is here. We heard the majority leader, Senator Reid, come to the floor a few minutes ago and talk about how this bill was going to get premiums under control, keep the cost -- for people who have insurance, keep their premiums under control. I saw a chart from the Senator from South Dakota yesterday that said for 90 percent of Americans, those who have insurance now, that if we did nothing and did not pass this bill, that the premiums would be lower than if we do pass this bill; that passing this bill actually will raise premiums, in spite of the fact the President of the United States promised, while campaigning, that he would lower the cost of premiums for American families by $2,500. I would ask my colleague from South Dakota, isn't it true that if this bill passes, Americans wanting -- feeling they have been promised that premiums would be reduced, are they not doomed to disappointment? Mr. THUNE. The Senator from Wyoming is correct. This is where the real rub in this bill comes into play because what we were told and the promises that were made -- of course, many promises were made throughout the course of the campaign, many of which will never be realized with this legislation. There was also a promise made that taxes wouldn't go up for people making less than $250,000 a year -- not payroll taxes, not income taxes, not any kind of taxes. In fact, we now know that 38 percent of the people who make under $200,000 a year are going to see their taxes go up under this legislation. So promises made during a campaign season tend not to necessarily be adhered to when it comes time to legislate and actually follow through, and I think that is clearly the case here. With regard to the question of the Senator from Wyoming, the whole purpose of health care reform, at least as I understand it -- and I think, for the most part, as the people of South Dakota whom I represent understand it -- is to lower cost. Because everybody complains -- the thing you hear the most when you go home -- and the Senator from Georgia is here. If you go to Georgia, Wyoming, South Dakota, I think the sentiment you hear most frequently from people in our States is: Do something about the cost of health care. We have these year-over-year, double-digit increases or increases that are twice the rate of inflation, and we are dealing with this. Small businesses are dealing with it. More and more people -- families are struggling with the high cost of health care. Nobody argues that. We all, basically, accept the premise that health care costs have been going up and health care reform ought to be focused directly on trying to get those costs under control. The irony in all this is, after cutting $1/2 trillion from Medicare in the first 10 years, and if you go into the fully implemented time period it is about $1 trillion, and $1/2 trillion in tax increases, what happens with premiums? Well, according to the Congressional Budget Office, 90 percent of Americans would be the same or worse off. In other words, 90 percent of Americans would see no improvement in their health insurance premiums. In fact, if you buy in a small group market, if you buy in a large group market, your premiums go up by about 6 percent a year, year over year. In fact, a family of four -- let's put it in a perspective that an American family can understand. If you are a family of four -- this is according to the Congressional Budget Office -- who is paying $13,900 for insurance this year and you are getting your insurance in a large group market because you work for a large employer, in 2016, your insurance cost is going to be over $20,000 a year. In other words, your insurance is going to go up about -- a little under $14,000 to over $20,000 a year in that time period. So what American in their right mind is going to say that is reform? I think most Americans are going to say: What are you doing? You are spending $2.5 trillion, you are raising my taxes, and cutting my parents' or my grandparents' Medicare benefits, for what? So my premiums can stay the same or go up? If you buy your insurance in the individual marketplace, your insurance premiums, according, again, to the Congressional Budget Office, are going to go up anywhere from 10 to 13 percent a year. So you get Medicare cuts, you get tax increases, and for 90 percent of Americans, you stay the same or are worse off. In other words, your insurance premiums are now going to be impacted, you have achieved the status quo or, worse yet, your insurance premiums are going to go up 10 to 13 percent if you are buying in the individual market. That is according to the Congressional Budget Office. So I would say to my friend from Wyoming, the point he made is exactly right. In doing all this, the exercise ought to be about reducing costs. Clearly, that is not the case with this legislation. Mr. CHAMBLISS. Let me address a question to our friend from Wyoming who is a medical doctor, in addition to being an outstanding Senator. What we are being asked to believe from the folks on the other side and what the American people are struggling with and having a hard time believing is, they are saying that even though they are cutting Medicare by a total of $450 billion-plus over a 10-year period, that actually the solvency of Medicare is going to be extended. They expect the American people to believe that somehow. The fact is, we know from the information we received this spring from the bipartisan Medicare Commission, unless something is done, Medicare is going to become insolvent in the year 2017, pure and simple. What we are doing is not taking the savings they are proposing -- and we don't agree with them, but irrespective of that -- irrespective of the savings they are saying are going to be achieved, instead of applying that back, we are going to use that to grow the size of government, tie some reimbursement payments to physicians to the Medicare Program, and now we are looking at about a 23-percent reduction in payments to physicians as reimbursement under Medicare if we don't take some action next year. When you put all this together, the American people are saying: You have to be kidding me. How in the world are you going to extend the life of Medicare by cutting it by almost $500 billion? Mr. BARRASSO. As my colleague from Georgia knows, there is no way you can save Medicare when you cut that kind of money out of it. How, when they cut physicians payments by 23 percent, are we going to have physicians going to any of our small communities in South Dakota, in Georgia, in Wyoming, where we have many people who depend on Medicare for their health care? I worry about access to care. Our colleague, Senator Isakson, yesterday talked about home health care and how, for pennies on the dollar, you can help people. It provides a lifeline for people who are homebound. It keeps them out of the hospital, out of the nursing homes. Instead, this Senate, the Democratically led Senate, yesterday voted to cut $42 billion out of home health care, which people in our small communities and in the rural areas of our State depend upon. So there is no way this program can stay solvent. It is hard for me to fathom and, clearly, hard for the people of Wyoming to fathom, how with all this budget trickery, it is going to work for people who need to go to see a doctor or to have a home health care provider in many of our rural communities. We all have townhall meetings, and when I go to townhall meetings, people say: Don't cut my Medicare, don't raise my taxes, and don't make things worse for me than they are now. Mr. THUNE. If the Senator will yield, the Senator, of course, is one of only two physicians in the Senate and has great experience and great depth on this issue and knows what it is like to serve and provide health care services to people in rural areas, such Wyoming and South Dakota and some areas of Georgia. I think it is interesting, too -- and the Senator from Georgia was here, as was I; I don't think the Senator from Wyoming was here at the time. But in 2005, we had a debate about Medicare, and the Senator from New Hampshire proposed cutting $10 billion in Medicare, taking $10 billion over a 5-year period or about $2 billion a year, and paid for it by income testing the Part D benefit that people got. In other words, the premiums that are paid, those who are in the higher income categories would have to pay a higher premium for their Part B drug benefit than would those in lower income categories. You would have thought that the apocalyptic pronouncements and predictions around here about what that was going to do for Medicare: $2 billion a year, or $10 billion over 5, $2 billion a year, and you heard the other side describe it as immoral, it was cruel, it was a disaster of monumental proportions. That was some of the terminology that was used around here at the time. That was for $10 billion over 5 years, and that basically was to say to people who have higher incomes, the Warren Buffetts of the world ought to pay a little bit more for their prescription drug benefit under Medicare than those in lower income categories, and people on the other side went nuts about that. Now here we are talking about cutting $465 billion over a 10-year period, $1 trillion over 10 years, when it is fully implemented, and it seems to me, I would say to my colleagues, the other side is going to have a lot of explaining to do to the American people about why $10 billion in reductions was immoral, cruel, and a disaster of monumental proportions, but cutting $1/2 trillion out of home health care and nursing homes and hospitals and everything else to pay for an entirely new entitlement program, a $2.5 trillion expansion, somehow makes sense.