Speeches & Floor Statements

Floor Remarks of U.S. Senator Lamar Alexander (R-Tenn.) -- Colloquy with Republican Colleagues on Health Care Reform

Posted on September 30, 2009

Mr. ALEXANDER. I wonder, before the Republican leader leaves, if I could ask him a quick question? I ask unanimous consent that Senators Barrasso, McCain, and Bennett, and the Republican leader, be permitted to engage in a colloquy during our 30 minutes and that I be notified when we have about 4 minutes left. The ACTING PRESIDENT pro tempore. Without objection, it is so ordered. Mr. ALEXANDER. I ask the Senator from Kentucky, the Republican leader, is it not true that the Finance Committee Democrats voted down a Republican proposal to put the health care reform bill on the Internet for 72 hours so Americans could read it? Mr. McCAIN. I would say to my friend from Tennessee that is absolutely correct. Mr. ALEXANDER. I believe the Republican leader said the bill might be 2,000 pages long? Mr. McCONNELL. Certainly, well above 1,000 and probably 2,000. Mr. ALEXANDER. If I am not mistaken, there are several versions of the bill in the House of Representatives that will come over here. Then there is a version that we did in the Health Committee here that will have to be integrated with that bill; is that not correct? Mr. McCONNELL. It is my understanding it is the intention of the majority leader and the administration to merge the bill that came out of the Health Committee on which the Senator from Tennessee serves and the bill that is in the Finance Committee now. Mr. ALEXANDER. It is my understanding in the Finance Committee they are not even writing a bill yet; they are just working on concepts? Mr. McCONNELL. Apparently, the Finance Committee will actually go to a final vote on a concept paper, not an actual bill -- which I think will inevitably produce a dilemma for the Congressional Budget Office in trying to assess the cost of a concept bill. Then, apparently, they will turn that into a bill, and then the Congressional Budget Office will have to score, once again, the final bill, and the number there may be different from the number of the concept paper. Mr. ALEXANDER. How long do you suppose it would take, once the two bills are put together, for the Congressional Budget Office to tell us how much it costs? Mr. McCONNELL. I would think for an accurate score we would have to ask them. What a challenge that will be. But I assume it will take a while. Mr. ALEXANDER. Well, I thank the Republican leader. In our discussion today, I see the Senator from Wyoming is here, it is almost embarrassing to say that -- I mean, to people outside Washington, and maybe even to people inside Washington, the idea that we would not take 72 hours to read a 2,000-page bill that spends $1 trillion or $1.5 trillion that affects virtually every American and that may have a lot of unresolved questions in it. It is hard to imagine people would not think that was common sense, that we ought to read it before we vote on it. Mr. McCONNELL. I think we can add, the American people, I think correctly, could only assume there is some effort to try to hide the true impact of this, this rush effort, to reorganize one-sixth of our economy, a $1 trillion bill, well over 1,000 pages that nobody has taken the time to read. It is not even produced in final bill language. The American people begin to get the drift that this is a process that is going to, I think, enrage them. It enrages them already. I think the rage about it is only going to escalate in the coming weeks. Mr. ALEXANDER. I thank the Republican leader for his time. I would think every civics class in America, if the teacher would give a test, would say: Should an elected representative read a bill before he or she voted on it? Yes. Should he or she know how much it costs? Yes. Even the President has said we cannot have a deficit. Well, how are we going to know if it creates a deficit if we do not read the bill and if the nonpartisan Congressional Budget Office has not told us how much it costs? I thank the Republican leader. The Republican leader mentioned there may be some questions we would want to know. There are some. Governors across the country may want to know how much it is going to cost them and their budgets because, the other day, the chairman of the National Governors Association and the Republican Governors Association held a joint press conference and they said this: If you are going to expand Medicaid in our States, if the Federal Government is going to do it, the Federal Government ought to pay for it. Medicaid is the largest government-operated health care program we have in the country. About 55 or 60 million Americans are there. The Federal Government pays about 60 percent of it and the State governments pay about 40 percent. I noticed two articles in the newspaper. I ask unanimous consent to have these articles printed in the Record. Mr. ALEXANDER. One is from the Wall Street Journal: State quarterly tax revenues plunge 17 percent. Talking about how budgets in California, Florida, other States are going down. Then there is another article, September 29 -- actually these both appeared yesterday -- in the New York Times entitled "Majority Leader Protects Home State." Well, the majority leader, Senator Reid, has done exactly what all the Governors hope would be done. He has said: If the Federal Government is going to expand Medicaid in my State, the Federal Government is going to pay for it. But, I would say to the Senator from Wyoming, I wonder how citizens in Wyoming and California and Florida and other States will feel if they pay more in taxes so Nevadans can pay less in taxes? Is that not the kind of question Senators from virtually every State might want to be sure about by reading the bill and knowing what it costs before it comes to the floor? Mr. BARRASSO. It seems to me the people of Wyoming have those very concerns, as does the Governor of Wyoming. I served in the Wyoming State Senate for 5 years, and we know that one of the largest budgets is Medicaid, the aid we give to people in need of health care. But it is almost the same as what we are paying for K-12 education. In Wyoming, we sure do not want to pay for what is happening in the majority leader's home State. I was home yesterday. Yesterday morning, getting on the plane to come back from Wyoming -- I go home every weekend. I was at the Wyoming football game, where we won, we beat the University of Nevada Las Vegas, the leader's home State. That was another great day for Wyoming football. But when you go to a game like that in Wyoming, a lot of people come up to you and ask you questions. The questions that came up this past weekend are -- one is: Have you read the bill? What is in it? What is it going to cost? People of Wyoming say: Am I going to be able to read it? How do I read the bill? Is it going to be on the Internet? Will I be able to see it? To try to explain: There is no bill. There is this concept paper. I have it here. It is called the chairman's mark. It is the concept paper of 220 pages. You look at this, this is not even in legislative language yet. So you are going to be asked to vote on legislation, not just a concept paper. Mr. ALEXANDER. I think the Senator from Wyoming is making an awfully good point. He is a distinguished orthopedic surgeon, a doctor, one of two physicians in the Senate. Both of them happen to be on the Republican side of the aisle at this time, Senator Coburn, and I know, Dr. Barrasso, since we are talking about Medicaid, which is a program that every State has that serves low-income people, that States pay typically roughly 40 percent for, one of the questions somebody might have who reads the bill is: How many more low-income people are going to be added to that bill? Because it is my understanding that Medicaid reimburses physicians at such a low rate, that about 40 percent of physicians will not see Medicaid patients. So by dumping more low-income Americans into Medicaid, we are dumping them into a program where they have 40 percent of a chance of not seeing the doctor or getting the services they want to have. Have you had any experience with that? Mr. BARRASSO. Absolutely. In my practice for 25 years in Casper, WY, I took care of a lot of people on Medicaid. I took care of anybody who needed to see me. But you are right. Across the board, there are many people on Medicaid who do not -- are not able to see a doctor. The number you quoted is exactly the one I have. I have an article that I ask unanimous consent to have printed in the Record. Mr. BARRASSO. This as also from the Wall Street Journal from September 27, called: "Max's Mad Mandate." The first paragraph says: One reason this Finance Committee bill allegedly pays for itself is because it will break all 50 State budgets by permanently expanding Medicaid. It says: They are going to expand Medicaid. You were a Governor. You had to deal with this in Tennessee: Using Medicare to cover everyone up to at least 133 percent of the Federal poverty level, that will add some 11 million new people to the Medicaid rolls, which is not going to help, if currently, as the article goes on, about 40 percent of U.S. physicians will not accept Medicaid at all. Mr. ALEXANDER. I have thought for some time that any Senator who votes to expand Medicaid in the States without paying for it at the Federal level ought to be sentenced to go home and serve as Governor for 8 years and try to pay for it and raise the taxes and deal with the people who cannot do that. But that is the kind of question I think a Governor would want: Read the bill and know what it costs. For example, I believe there is a question about the Finance Committee, in its concept papers, may say: Well, we will pay for it for 5 years -- or we will pay 77 to 95 percent of it. The Governors are saying -- now these are Democratic Governors as well as Republicans -- they are all saying to us: Do not do that to us. Our revenues are down 17 percent, 18 percent, 20, 35 percent in some of our States.. If you are going to pass it, pay for it. That is a question governors should have a chance to ask and get an answer for. That is why we need to read the bill. Mr. BARRASSO. That is why the National Governors Association is furious with this huge expansion of Medicaid. It quotes the Governor of Vermont, who says: Unlike the Federal Government, States cannot print money. Many of us, such as Wyoming, live within our budgets. We live within our means. We balance the budget every year. For Washington to, in its effort to take over health care in the country, to force the States to pay for it, in what is, to me, a trickery or a financial gimmick, to say they can make the books balance, is not a favor to the American people. That is why people at home ask me every weekend: Can I read the bill? Have you read the bill? Can I read the bill? What is it going to cost? It ultimately gets down to people are very worried about a government takeover, very worried that at a time we are spending all this money as a nation, against my wishes, another trillion dollars for kind of an experiment that is going to fund a lot of it through Medicare. We have not even gotten into the discussion of Medicaid. Mr. ALEXANDER. Let's talk about Medicare because many people, unless they follow health care every day, confuse Medicaid, which is the program for low-income Americans that States help administer -- there are about 55 or 60 million Americans in that program -- and Medicare, which is the program that about 40 million seniors have. We have had a lot of talk about Medicare. The President says: There are no Medicare cuts. Then, on the other hand, he said: We are going to take up to $1/2 trillion out of Medicare and spend it on a new program. We are saying: You are going to cut one-quarter of the Medicare beneficiaries' Medicare Advantage payments. The other side is saying: No, that is not what we are doing. We are saying: How can you cut Medicare and spend it on another program when Medicare is going broke? Well, I would think the American people would want to know the answer to those questions, and we should know the answer before we vote. Is that not another reason we should read the bill to find out who is telling the truth about Medicare? Mr. BARRASSO. It is the reason that, No. 1, we should read the bill. It is the reason we should make sure the people all across the country have a chance to read the bill. The people of Wyoming want to read the bill. It is the reason we need some time for those people from all our home districts to get back to us. As I say, all around Wyoming, the wisdom does not come from Washington, the wisdom comes from America, from your State and my State and the other States. I want those people to be able to read the bill, come up with better ideas or suggestions, and a lot of times folks at home will see what I call unintended consequences, something that is in the bill that you say: Well, I had not thought about that. We have the hospitals across Wyoming, those people want to read it. The doctors, the nurses, the physicians assistants, and the patients, the people who are mostly going to be affected by this, they want to know what is in the bill, which is why I say: That is the reason to put it on the Internet. People can read it ahead of time and then let them have time to comment back to us. Mr. ALEXANDER. I see the Senator from Utah has come. Let me ask one more question to Dr. Barrasso. Because we are told -- and here is another reason to put the bill on the Internet for 72 hours and to wait a couple weeks or whatever it takes for the Congressional Budget Office to tell us how much it costs, because the President has said: There cannot be one dime added to the deficit, which we agree with. In fact, we think the whole goal of this ought to be to reduce the cost of health care to you and then to your government but not one dime to the deficit. But one of the assumptions of the bill coming through the Finance Committee has to do with what we elegantly call in the Senate the "doc fix," the fact that basically the government sets what doctors will be paid when they see a Medicare patient. What we do every year is change what is in the formula because it cuts the physicians. So is not the assumption that we are going to continue to cut what we pay physicians, and if we come along and change that in the second year, will not we then be adding to the deficit? Mr. BARRASSO. Well, you will be adding to the deficit. That is why seniors all across this country have great concerns about what is being proposed. I am saying: Who is opposed to this? The No. 1 group is seniors by 2 to 1. Seniors are opposed to what is happening because they know this is going to be paid for out of their own Medicare. Just 10 or 15 minutes ago, we heard the majority leader on the floor of this Senate say -- and I wrote it down. He said, talking about his plan, he said: If you like what you have, you can keep it. That is what he said. But you and I both know there are 11 million Americans, seniors in this country, on Medicare Advantage, which is a program set to help people in cities and people in rural communities. You have both in Tennessee. We sure have the rural communities in Wyoming. It says they cannot keep that if they like it -- or 11 million, it is double the number on it in the last couple years because it is so popular, because it actually does what Medicare itself does not do, works with prevention, works with coordinated care. That is what our seniors want. That is why seniors across the country are so opposed to this. Mr. ALEXANDER. I see the Senators from Utah and Arizona have come to the floor. We were talking, Senator Barrasso and I, about how well the majority leader has done in helping to do what all of us would like to do in his home State. He has noticed, I guess he has heard from his Governor, that the Finance Committee is saying we are going to expand Medicaid in the State, but the States are going to help pay for it. The majority leader has put something in the bill so Nevada does not have to pay for it. I notice -- to Senator McCain -- according to the New York Times, in Arizona overall tax revenues fell 27 percent in the second quarter of this year from a year ago. I wonder how Arizonans are going to feel about paying for Nevada's Medicaid. Mr. McCAIN. I find it entertaining when our constituents ask: Have you read the bill? Of course we haven't been able to because there is no bill. If I could just quote what happened here. This says: The Chairman's Mark will provide additional assistance that would be made available to high-needs states which are defined as states that (1) have total Medicaid enrollment that is below the national average for Medicaid enrollment as a percentage of state population as of the date of enactment.... It goes on and on for a few more sentences. What does it mean? It means they got a special deal for four States, one of them being the State of Nevada. Who pays? Who pays? The other States. So we have a complaint by the distinguished majority leader that his State of Nevada would have to pay an amount that they don't appreciate, so we shifted it so that three other States -- I am sure my friend from Tennessee knows which ones. I believe one of them is Oregon. I am not sure what the other three are. Mr. ALEXANDER. Michigan, Rhode Island, and Oregon are the three others. Mr. McCAIN. So our constituents who don't happen to live in those fortunate four are now going to pay additional funds because we put in the chairman's mark. Everybody wonders why people are so mad. They wonder why is it that there are these tea parties, why is it that there are people marching on Washington, what are they mad about? I hear the pundits and those who very seldom go outside the beltway or outside Manhattan say they are a bunch of crazies. It is this kind of thing. It is this kind of thing. We are going to do a legislative appropriations bill here that has $500,000 in it so that Senators can send out postcards to announce townhall meetings. Has anybody had any trouble getting people to townhall meetings? We need to spend $500,000 additional to notify people? Getting back to the point of the Senator from Tennessee, this is what is wrong. This is what is wrong with the way we do business. We cut special favors for special States, not based on need or requirements but on the influence of the individual Senator or Member of Congress. That is what they are mad about. May I mention one other thing to my friend from Tennessee? Yesterday, there was a big vote in the Finance Committee that dominated the headlines. The so-called public option was voted down by a significant margin. And we hear rumors that finally the administration will come up with a proposal. Doesn't that mean the goal will be basically to get any bill through both the House and Senate and then go into conference behind closed doors and rewrite the bill? That is my greatest fear. Mr. ALEXANDER. That is my fear. The danger is that they will put the bills together from these various committees and ram it through, and then we won't be able to ask the questions: Is my State going to pay more taxes for Medicaid? Is my Medicare benefit going to be cut, or is the national debt going to increase? These are important questions we have a right to know the answers to before we begin the vote on the bill. I ask the Senator from Utah, what does he see coming down the pike? Mr. BENNETT. Mr. President, I have said repeatedly that I would vote against my own bill, even if it were to pass the Senate unanimously, unless there were an ironclad guarantee -- iron is not strong enough; carved in marble guarantee -- from the President that he would veto a conference report that came back that did not have the kinds of protections I think my bill has. I agree completely with the Senator from Arizona. The big fear is that we craft something in the Senate that is reasonable and then submit it to a conference and it comes back in a conference report that is not amendable and gets passed by a majority vote here and we are stuck with it. As important as it is that we try to get the Senate bill right, we must recognize that there are two Houses of Congress. At the moment, the other body is not showing the degree of analysis we are trying to get going here in the Senate. The House bill is completely unacceptable. If I could pick up on the comment about the consequences of what is being done with respect to Medicaid, I will add the experience from the State of Utah to the experience that has been referred to for other States. In Utah, an expansion of Medicaid, as outlined in the Finance Committee bill, would mean anywhere from an additional $150 million to $248 million to Utah taxpayers. I realize that in a State such as California that is multiple billions of dollars in debt, an extra $150 million to an extra quarter of a billion is not a lot of money. But in Utah, it is a significant amount. We need to pay attention to the fact that every State is facing those kinds of significant increases. I call the attention of the Senate to an analysis that is in today's Congressional Quarterly, dated September 30, talking about the bill as it is moving through the Finance Committee. I quote: Under current law, taxpayers can deduct expenses that exceed 7.5 percent of their adjusted gross income. Under the Baucus original proposal, that floor would have been raised to 10 percent, starting in 2013. Then further: According to data from the Joint Committee on Taxation, 45 percent of the taxpayers affected and 53 percent of the revenue from the change would come from people 65 and over. So for those who are asking -- and we read about them in the paper all the time -- why are the elderly upset, they have Medicare? The elderly are smarter than that, and they recognize that 53 percent of the increase that would come as a result of these proposed changes would come from them. Mr. ALEXANDER. Would the Senator not agree that therefore older Americans who depend on Medicare might especially want to read the bill? Mr. BENNETT. They certainly are going to want us to read the bill and be honest with them as to what is in it. They are going to want us to go into the managers' package, into the small details that usually are considered technical and get passed over, and be very specific in saying to our constituents: We know what is in the bill, and we are being very upfront with you in telling you what is in the bill. One of the things we need to be upfront about is the amount of increase this will cost seniors and the amount of impact it will have on States. States will then have to turn around and raise their taxes, and seniors will pay twice, with the increase at the Federal level and the increase at the State level. Mr. ALEXANDER. The Senator from Wyoming was home last weekend. I wonder if he is hearing especially from senior Americans who worry about the effect of this bill on Medicare. Mr. BARRASSO. I heard that in Wyoming this past weekend. People who depend upon Medicare are rightly suspicious, very suspicious about this program. As they try to learn more about it, what they learn is that it is going to cut Medicare. They are learning it is going to increase taxes. They are learning it will limit what they have in terms of choices for their health care. For all Americans, if you ask: What do you think, is this going to cost more or less, they think it is going to cost more. When I ask people at townhall meetings: Do you think you will have better or worse care, the show of hands is that they will have worse care. Americans don't want to pay more and get less. People want value for their money. People who depend on Medicare are rightly more suspicious than other folks because of the impact this is going to have on them. They understand $500 billion is going to be cut from their health care. Mr. ALEXANDER. We have 4 minutes left. I believe I will wrap up and leave the last minute to the Senator from Utah. Our point is a pretty simple one. We believe, we Republicans, that after this bill is put together, we ought to have ample time to read it, that it ought to be on the Internet for 72 hours, and that we ought to hear from the nonpartisan Congressional Budget Office how much it costs. Why would we do that? Because we have differences of opinion over whether it hurts people on Medicare, over whether States will have to raise taxes in order to pay for Medicaid, over whether the assumptions made will actually add to the debt, over how large taxes are on small businesses. We have differences of opinion. The only way we can intelligently debate those is if we can read the bill and know what it costs. On the Republican side, we believe we should focus on reducing costs and go step by step to re-earn the trust of the American people by fixing health care in that way, starting with such ideas as permitting small businesses to pool their resources in order to offer insurance to a larger number of people. Another way to reduce cost would be to find ways to eliminate junk lawsuits against doctors. The Senator from Utah may have other thoughts about the importance of reading the bill. Mr. BENNETT. Mr. President, I will make this comment with respect to the remarks of the Senator from Tennessee with reference to the CBO. We need hard numbers, but we do have a preliminary understanding already. The Director of the CBO, Mr. Elmendorf, was asked if it is true that the fees established in the bill would ultimately be passed on down to the health care consumer, and his response: Our judgment is that the piece of legislation would raise insurance premiums. If we go more deeply into the CBO analysis, we find that not only would premiums in the individual market be higher than under the proposed reform, but taxes on insurers and drugs and devices would be passed on to consumers in the form of higher premiums. Finally, CBO also says that the premiums would be extremely high even after the proposed reforms because taxpayers would be subsidizing expensive plans. We clearly need the kind of careful analysis that clothes these comments with actual numbers. Without those, how can we vote with any kind of clarity on the proposal before us. Mr. ALEXANDER. I thank the Senator from Utah and yield the floor.