Health Care Reform

Floor Speech

HEALTH CARE REFORM -- (Senate - September 23, 2009)

Mr. ALEXANDER. Mr. President, I commend my friends on the Democratic side for their interest in health care reform and their coming here to express their views. I can say to them very clearly there is 100 percent agreement on the Republican side that we do not want the status quo, and there is 100 percent agreement on the Republican side that there would be one thing worse than the status quo and that would be higher premium costs, more debt for the government, and higher taxes.

I am afraid that is what my friends are arguing for because they are continuing to say they want to insure at least 30 million more people, they want to improve the benefits for people already on insurance, and they want to reduce costs. That does not add up. So I think it is time we get down to some reality in this discussion about: How can we best achieve health care reform in this country?

We, on the Republican side, want health care reform, but we do not want more debt, more taxes, and higher premium costs for people who cannot afford their insurance policies now. Yet the proposals we have seen on that side of the aisle do that.

Our focus should be about one thing. Health care reform should be about one thing: reducing costs, reducing costs to individuals and small businesses who are paying for health care, and reducing the cost to our government, which is the responsibility of every single one of us taxpayers in this country.

We have had several proposals from the Democratic side that increase the debt and increase the cost, and the President himself, in effect, rejected them in his address to Congress the other day because he said there cannot be one dime of deficit, not one dime. So the bill that came out of the HELP Committee in the Senate--it is out of here. The bill that is coming out of the House of Representatives that has been through several committees--it cannot be considered under the President's own standard that it cannot increase the deficit one dime.

I am glad he is saying that. I am glad he is saying that because he is already proposing we increase our national debt by $9 trillion over the next 10 years--doubling our national debt, tripling it over 10 years, spending more over the next 10 years, three times as much as we spent in World War II--amounts that have most people in this country alarmed about the debt of this government. So this should be a straightforward discussion about costs, reducing the cost of health care to you, if you are buying health care, and reducing the cost of health care to your government, which you are responsible for.

So the President has done us a favor. He said do not worry about the Senate bill that came out of the HELP Committee because--in effect, he said this--it adds to the deficit, so it has to go. For the bills coming out of the House of Representatives, the Congressional Budget Office has told us it adds to the deficit in the first 10 years, and it adds to the deficit even more in the next 10 years, so it has to go.

So now we have a new bill, and it is already a 250-page--I misspoke. It is not a bill yet. It is 250 pages of concepts. It is important for the American people to understand this. I think one of the things we have all heard, as much as anything, when we have gone home is: Did you read the bill? That is a pretty good question. It is a pretty big job because we have gotten in the habit around here of coming up with 1,000-page bills that Senators and Congressmen do not read. So the American people are saying to us: At least read the bill. They are saying to us, second: At least know what it costs. So that is a bare minimum of what we should insist on as we are going forward.

The bill introduced by the distinguished Senator who is the chairman of the Finance Committee is 250 pages of concepts. So everyone understands where we are in the process, the Finance Committee is meeting. They will be meeting all week. My guess is they will be meeting next week. They are trying to agree on what those concepts will finally be. The chairman has recommended what he thinks they ought to be, and now the committee is going to say what they think they should be.

Then, as I understand it, the Democratic leader is going to try to fit this bill that came out of the HELP Committee--that the President, in effect, has rejected because he says no deficit--well, it has a deficit--and he is going to try to put that bill that raises costs with the Baucus bill and turn it into one bill. The bill that came out of the HELP Committee is already nearly 1,000 pages. I do not know yet what will be coming out of the Finance Committee.

So in a week or two, we are going to be having another big bill we will have to read. Then the Congressional Budget Office, which is our official nonpartisan outfit that tells us what things cost--appointed by the majority
but still nonpartisan--told Senator Baucus yesterday it would take about 2 weeks for them to tell us how much it will cost.

So the way I am adding up the weeks, I am saying a week or two for the Finance Committee to come up with a bill--maybe a week to write the bill--and the Congressional Budget Office says after the bill is written, it takes 2 weeks to know the formal cost.

Then we ought to have several weeks to debate the bill. That is what we did with the Energy bill for 4 or 5 weeks and, of course, we should do just that. So we need the time to do it, and we need to be able to say to people when we go home: I read the bill and I know exactly what it costs and here is what I think about it.

What about the Baucus concepts--not the Baucus bill; they don't have the bill yet--but the concepts. The Congressional Budget Office released an analysis of the impact of the Baucus budget plan on insurance. It shows that the premiums for those in the individual market under the Baucus bill don't go down, they go up. This is supposed to be about reducing the cost of premiums that Americans have for their health care, and under the Baucus bill so far, on its first day of consideration by the full Finance Committee, the premiums go up and taxes on insurers, drugs, and devices would be passed on to consumers in the form of higher premiums. This is not fearmongers saying that; this is not Republicans saying that; it is not the doctors saying that; it is the Congressional Budget Office appointed by the majority, the Democratic majority. Premiums go up under the Baucus bill. That means Americans will pay more, not less, for their health insurance under the bill as it is today.

Here is what the Congressional Budget Office said:

Under current law, premiums on employment-based plans would not include the effect of the annual fees imposed under the proposal on manufacturers and importers of brand-name drugs and medical devices, on health insurance providers, and on clinical laboratories.

These are new taxes.

Premiums for exchange plans----

These would be plans in the exchange that you might choose if you were an individual--

Premiums for exchange plans would include the effect of those fees, which would increase premiums by roughly 1 percent.

That is the Congressional Budget Office about the Baucus concepts.

CBO, the Congressional Budget Office, went on to say:

At the same time, premiums in the new insurance exchanges----

These are the marketplaces where under this plan you would go to buy your insurance----would tend to be higher than the average premiums in the current-law individual market.

So the premiums under the new bill and the new exchange would be higher than you are paying today. CBO says:

Again, with other factors held equal, because the new policies would have to cover preexisting medical conditions and could not deny coverage to people with high expected costs for health care.

CBO goes on to say:

People with low expected costs for health care, however, would generally pay higher premiums.

So if you make a promise to improve the benefits, somebody else is going to pay for them. That is mathematics. That is the way the world works. Fortunately, we have the Congressional Budget Office to say under this plan premiums would go up. It continues:

For families, premiums plus cost-sharing payments would range from about $2,900 for those with incomes of $30,000, to nearly $20,000 annually for premiums for those with incomes above $96,000.

So costs go up to individuals under the Baucus concepts. Additionally, we should consider the cost to our government. Most Americans are very much aware--I think that is why they have been turning out in record numbers in town meetings--that the government is not some remote, abstract thing; we own it, and we own the debt too. According to the Budget Committee staff, the real 10-year cost of the Baucus concept when fully implemented will be $1.67 trillion because the main spending provisions won't go into effect until 2013.

In other words, when we talk about 10-year costs around here, the next 10 years aren't an accurate picture because the bill isn't fully implemented until you get on down the road 3 or 4 years to 2013. So if you take a full 10 years--a full implementation of the bill--the Budget Committee says it is about $1.67 trillion in new costs. However, there are new taxes and fees to pay for that: $838 billion over 10 full years of implementation, and those new taxes and fees go into effect immediately.

The long-term deficit reductions predicted in the bill depend on Congress--that is us--approving cuts year after year to Medicare providers. Medicare providers are doctors, hospitals, hospices, and home health agencies. In other words, to make this bill balance the budget and not add to the deficit, we are going to have to have cuts year after year to Medicare, cuts to doctors, cuts to hospitals, cuts to hospices, and cuts to home health agencies.

I thought I heard the President say in his speech the other night there will be no cuts to Medicare. He did say that. It turns out not to be true in the Baucus proposal. It could be true if Congress were willing to support cuts year after year to Medicare, hospitals, doctors, home health agencies, and hospices, but we have never done that. In fact, a few years ago we Republicans tried to restrict the growth of Medicare by $10 billion a year--I think it was from 43 percent to 41 percent over 5 years--and we had to bring the Vice President back from overseas to cast the deciding vote because everybody on the Democratic side wouldn't even vote for $10 billion in reduced savings to Medicare. Yet what we are proposing here assumes that suddenly we have all changed and we are going to allow cuts year after year to people who provide services to Medicare.

CBO found that its projections ``assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case,'' it wisely said.

CBO goes on: ``For example, the sustainable growth rate''--we call that the ``doc fix'' around here when we come in once a year and automatically--doctors' payments under Medicare, which is already only 80 percent--doctors earn only about 80 percent under Medicare compared to what they earn when they see private patients--so we automatically cut their pay by 20 percent and we always come in and raise it back up to about what it was the year before.

So CBO is telling us that the sustainable growth rate--the ``doc fix'' ``governing Medicare to physicians--has frequently been modified.'' That is an understatement. It has been modified almost every year ``to avoid reductions in those payments'' and that ``the long-term budgetary impact could be quite different if those provisions were ultimately changed or not fully implemented.''

So unless we have massive cuts in Medicare, we are not going to be able to balance the budget with this bill.

We don't know how much this bill will cost State governments. The distinguished Senator from Nebraska is on the floor. He was a Governor. I was a Governor. We have all struggled with Medicaid. I think our view is that dumping another 15 million low-income Americans into Medicaid is not health care reform. Doctors and providers are only reimbursed about 61 or 62 percent of their costs for providing services to Medicaid patients, so 40 percent of doctors won't see Medicaid patients. Dumping a low-income American into the Medicaid program is like giving them a bus ticket to a bus line that only runs 60 percent of the time. It is not health care reform. Even so, this will cost State governments, and all the Governors--Democrats and Republicans--are opposed to the concept in this bill that transfers some of the cost of increased Medicaid to the States. Their view is--and I think they are right on this--if the Federal Government wants to expand Medicaid, the Federal Government should pay for it. I haven't been able to even get an estimate of how much this will cost Tennessee. We are trying to figure that out. Senator Cornyn said his estimate is about $2 billion a year for Texas.

Additionally, the proposal cuts nearly $500 billion from Medicare to fund this new government program even though Medicare will start going bankrupt in 2017. Yesterday I heard the president of the Mayo Clinic on National Public Radio say that any public option that looked like Medicare would bankrupt the country overnight, since trustees have said that Medicare is likely to go broke in 2015 to 2017.

I am afraid we need to start over. I admire Senator Baucus's effort, but we don't do comprehensive very well here. A 1,000-page bill is not likely to solve the problem. It is time to bring an end to the era of these 1,000-page bills that are so complicated no one can understand them or have time to read them. Instead, I believe we should move step by step to lower health care costs and re-earn the trust of the American people.

I see the Senator from Nebraska and I will soon defer to him, or to the Senator from South Dakota, whichever one is next. But in conclusion, these are the things we can start doing today to move step by step in the right direction to lower costs: allow small businesses to pool to reduce health care costs; reform medical malpractice laws; allow individual Americans the ability to purchase health insurance across State lines; ensure that Americans who currently qualify for existing programs such as Medicaid and SCHIP who are not enrolled to be signed up; create health insurance exchanges so you can find coverage; and incentivize health reform technology. We can agree on those things. We can take those steps and we can reduce the costs of health care to each American family and to our government.

I thank the President and I yield the floor.

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