[Pages S9944-S9949]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

HEALTH CARE REFORM

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. McCONNELL. 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

[[Page S9945]]

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 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.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the New York Times, Sept. 29, 2009]

Majority Leader Protects Home State

(By Robert Pear)

Washington.--The Senate majority leader, Harry Reid of
Nevada, has secured a special deal protecting his state
against the costs of expanding Medicaid under one of the
major health care bills moving through Congress.
Mr. Reid, a Democrat, complained about the impact on Nevada
when the chairman of the Senate Finance Committee, Max
Baucus, Democrat of Montana, unveiled his bill on Sept. 16.
Now Mr. Baucus has modified the bill to spare Nevada and
three other states, and Mr. Reid, who faces a potentially
difficult race for re-election next year, is taking credit
for getting a ``major increase'' in federal money for his
state.
The Senate bill, like a companion measure in the House,
would expand Medicaid to cover childless adults, parents and
other people with incomes less than 133 percent of the
poverty level, or $29,327 for a family of four. The federal
government would pay most of the new costs--anywhere from 77
percent to 95 percent, with a higher share in poorer states,
in the first five years.
Under Mr. Baucus's original proposal, the federal
government would have paid 87 percent of the new costs in
Nevada. Under the modified version, the federal government
would pay 100 percent of the new costs for the first five
years. Severe financial problems have prompted Nevada and
other states to cut spending and furlough workers, and some
states have even considered releasing prison inmates to save
money.
There is no guarantee that the provision will be retained
as the legislation moves through Congress. Many other
lawmakers are trying to influence its particulars to favor
their states, but few have the power of the majority leader
to get their way.
Mr. Baucus revised his bill to give extra help to certain
``high-need states.'' The states were not named in the bill.
But only four states meet the criteria: Michigan, Nevada,
Oregon and Rhode Island.
The changes came at the expense of other states, including
California, Florida and Illinois, which would see significant
increases in state Medicaid spending under the new formula.
The Finance Committee resumes work on the legislation
Tuesday, with some of the biggest fights still to come.
Many states worry that the expansion of Medicaid could
saddle them with long-term financial obligations.
Representative Nathan Deal of Georgia, the senior
Republican on the House Energy and Commerce Subcommittee on
Health, said Mr. Reid ``appeared to be playing politics to
favor Nevada over other states.''
``Senator Reid should know that this legislation is not
only bad for Nevada, but it is bad for the rest of the United
States,'' Mr. Deal said.
James P. Manley, a spokesman for Mr. Reid, brushed aside
the criticism.
``Senator Reid makes no apologies for fighting for federal
money for his constituents,'' Mr. Manley said. ``Under
Republican governors, Nevada has consistently underfunded
programs such as Medicaid.''
Mr. Baucus said other provisions of the bill would help all
states--for example, by reducing what they spend on
prescription drugs for Medicaid recipients and on the
Children's Health Insurance Program.
About 220,000 people are on Medicaid in Nevada, and Charles
Duarte, the state Medicaid director, said Monday that
enrollment could double under the legislation being
considered by Congress.
Many parents and childless adults would qualify for
Medicaid for the first time, Mr. Duarte said. And many people
who are eligible but not enrolled would sign up for Medicaid
because, under the legislation, they could be required to pay
financial penalties if they did not have insurance.
The Finance Committee has rejected several Republican
amendments that would have blocked the expansion of Medicaid
if it was found to impose additional costs on states.
``We have got to protect the states from the impact of one
more federal mandate at a time when states are in dire
circumstances financially,'' said Senator Michael D. Crapo,
Republican of Idaho.
But Senator Kent Conrad, Democrat of North Dakota, said
states must share the cost of covering the uninsured.
``We are going to have a real hard time dealing with this
problem,'' Mr. Conrad said, ``if it is all supposed to be on
the federal government, which has record deficits and record
debt, and if the states just expect the federal government to
write a check for 100 percent of everything.''
All the major health care bills moving through Congress
would expand Medicaid, adding perhaps 11 million people to
the rolls, the Congressional Budget Office says.
The Democratic staff of the Finance Committee estimates
that, under existing law, state spending on Medicaid will
total $1.7 trillion from 2013 to 2019. That figure could
increase by $33 billion under Mr. Baucus's bill. But when the
new costs are combined with savings elsewhere in the bill,
Democrats say, state spending would increase by only $22
billion, or 1.3 percent, over the levels now projected.
A few states, like Arkansas, Colorado, Maryland and
Virginia, could see increases of 4 percent or more, according
to the data.
Maine and Vermont have led the way in expanding Medicaid.
But Senator Olympia J. Snowe, Republican of Maine, said that
after talking with the governors of those states, she had
concerns about the burdens that would be placed on states
under the bill.
____

[From the Wall Street Journal, Sept. 29, 2009]

States' Quarterly Tax Revenue Plunges 17%

(By Conor Dougherty)

State tax revenue in the second quarter plunged 17% from a
year earlier as rising unemployment and falling consumption

[[Page S9946]]

dragged down sales- and income-tax collections, according to
Census figures released Tuesday.
It was the sharpest decline since at least the 1960s. The
biggest drop was in state income taxes, which were down 28%
in the second quarter from a year earlier. Corporate income
taxes, which tend be volatile, increased 3%.
The numbers aren't adjusted for inflation or tax-rate
changes.
The steep declines show how the recession continues to
cripple state finances, despite support from the stimulus
package and signs of a nascent recovery in economic activity.
Falling revenue, combined with growing demand for social
programs like food stamps or Medicaid, forced states to slash
spending and scramble to raise revenue through measures from
new taxes to slot machines and pricier fishing licenses.
``This brings really bad news for almost every single state
and leaves them with an unprecedented budget crisis,'' said
Lucy Dadayan, a senior policy analyst with the Nelson A.
Rockefeller Institute of Government at the State University
of New York.
States--which, unlike the federal government, are generally
required to balance their budgets--have already responded to
revenue declines with employee furloughs and higher taxes and
fees. But with tax collections continuing to decline, many
have been forced to reopen budgets midsession to push through
even more drastic cuts to staffing and services. In Michigan,
stalled budget negotiations between the governor and the
legislature could force the state to shut down if a deal
isn't reached by Wednesday at midnight local time.
With lower-than-expected revenue, the governor of
Massachusetts cut that state's budget four times over the
fiscal year that ended in June, including drawing down
reserves from a rainy-day fund and eliminating unfilled jobs.
With revenue still weaker than expected, the state may be
forced to reopen the budget as early as next month, said a
spokesman for the Executive Office for Administration and
Finance.
Without a budget, Michigan state employees wouldn't report
to work, and the governor would likely have to take emergency
steps to keep essential services such as hospitals and
prisons operating. ``We remain optimistic that we will have a
budget in place because everyone wants to avoid a shutdown,''
says Liz Boyd, a representative for Gov. Jennifer Granholm.
Some of the sharpest tax declines were in states that have
been among the hardest-hit by the recession, in particular
those with high concentrations of jobs in the battered
housing sector. In Arizona, overall tax revenue fell 27% in
the second quarter from a year ago. Tax revenue fell 12% in
Florida and 14% in California.
States across the country saw drastic declines in personal
income taxes, the largest source of state funding,
representing about one-third of states' overall revenue. The
largest decline was in New Mexico, where income taxes fell
59%. In 11 states--including California, New York and
Wisconsin--personal income taxes fell more than 30%.

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. One of the questions that came up this
past weekend was: 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.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the Wall Street Journal, Sept. 27, 2009]

Max's Mad Mandate

The more we inspect Max Baucus's health-care bill, the
worse it looks. Today's howler: One reason it allegedly
``pays for itself'' over 10 years is because it would break
all 50 state budgets by permanently expanding Medicaid, the
joint state-federal program for the poor.
Democrats want to use Medicaid to cover everyone up to at
least 133% of the federal poverty level, or about $30,000 for
a family of four. Starting in 2014, Mr. Baucus plans to spend
$287 billion through 2019--or about one-third of ObamaCare's
total spending--to add some 11 million new people to the
Medicaid rolls.
About 59 million people are on Medicaid today--which means
that a decade from now about a quarter of the total
population would be on a program originally sold as help for
low-income women, children and the disabled. State budgets
would explode--by $37 billion, according to the Congressional
Budget Office--because they would no longer be allowed to set
eligibility in line with their own decisions about taxes and
spending. This is the mother--and father and crazy uncle--of
unfunded mandates.
This burden would arrive on the heels of an unprecedented
state fiscal crisis. As of this month, some 48 states had
shortfalls in their 2010 budgets totaling $168 billion--or
24% of total state budgets. The left-wing Center for Budget
and Policy Priorities expects total state deficits in 2011 to
rise to $180 billion. And this is counting the $87 billion
Medicaid bailout in this year's stimulus bill.
While falling revenues are in part to blame, Medicaid is a
main culprit, even before caseloads began to surge as
joblessness rose. The National Association of State Budget
Officers notes that Medicaid spending is on average the
second largest component in state budgets at 20.7%--exceeded
only slightly by K-12 education (20.9%) and blowing out state
universities (10.3%), transportation (8.1%) and prisons
(3.4%).
In some states it is far higher--39% in Ohio, 27% in
Massachusetts, 25% in Michigan, Rhode Island and
Pennsylvania. Forcing states to spend more will crowd out
other priorities or result in a wave of tax increases, or
both, even as Congress also makes major tax hikes inevitable
at the national level.
The National Governors Association is furious about Mr.
Baucus's Medicaid expansion, and rightly so, given that
governors and their legislatures will get stuck with the bill
while losing the leeway to manage or reform their budget-
busters. NGA President Jim Douglas of Vermont recently said
at the National Press Club that the Baucus plan poses a
``tremendous financial liability'' and doesn't ``respect that
no one size fits all at

[[Page S9947]]

the state level.'' He added: ``Unlike the federal government,
states can't print money.''
Mr. Baucus hopes to use his printing press to bribe the
governors, at least for a time. Currently, the federal
government pays about 57 cents out of every dollar the states
spend on Medicaid, though the ``matching rate'' ranges as
high as 76% in some states. That would rise to 95%--but only
for five years. After that, who knows? It all depends on
which budget Congress ends up ruining. Either the states will
be slammed, or Washington will extend these extra payments
into perpetuity--despite the fact that CBO expects purely
federal spending on Medicaid to consume 5% of GDP by 2035
under current law.
As for the poor uninsured, they'll be shunted off into what
Democratic backbencher Ron Wyden calls a ``caste system.''
While some people will be eligible for subsidized private
health insurance, everyone in the lowest income bracket will
be forced into Medicaid, the country's worst insurance
program by a long shot. States try to control spending by
restricting access to prescription drugs and specialists.
About 40% of U.S. physicians won't accept Medicaid at all.
Why? One reason is that Medicaid's price controls are even
tighter than Medicare's, which in turn are substantially
below private payers. In 2009 or 2010, 29 states will have
either reduced or frozen their reimbursement rates to
providers. Democrats love Medicaid because is it much cheaper
than subsidizing private insurance, but that is true only
because of this antimarket brute force. Of course, such
coercion will be extended to the rest of the health market
under ObamaCare.
The states aren't entirely victims here. Both Republican
and Democratic state houses regularly game the Medicaid
funding formula--which itself is designed to reward higher
spending--to steal more money from national taxpayers. Then
when tax collections fall during downturns, budget gaskets
blow all over the place. This dynamic helps explain the
spectacular budget catastrophes in New York and California.
We'd prefer a policy of block grants, which would extricate
Washington from state accounting and encourage Governors to
spend more responsibly.
That's not going to happen any time soon, but the least Mr.
Baucus can do is not make things worse. Instead, his Medicaid
expansion is a disaster on every level--like the rest of
ObamaCare.

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. The Senator was a
Governor. The Senator 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, 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.

[[Page S9948]]

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. They 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.

[[Page S9949]]

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.
The ACTING PRESIDENT pro tempore. The Senator from Illinois is
recognized.

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