Floor Statements

Madam President, I ask unanimous consent that Republican Senators be permitted to engage in a colloquy during our time.

Madam President, my grandfather was a Santa Fe railway engineer. He lived in Newton, KS. So far as I can tell, he was one of the most important men in the world. I was 5, 6, 7 years old when I would go out there. He drove one of these great big steam locomotives. If there were as many yellow flags and red flags along the track when he was driving that Santa Fe locomotive as there are with the health care locomotive that is going through the Senate today, I think my grandfather would have been guilty of gross negligence if he did not slow it down and see what those red flags and yellow flags meant.

There is a lot of talk about making history with this bill, but there are a lot of different ways to make history. One of the things I hope we will be very careful to do in the Senate is not to make a historic mistake with this health care legislation.

Now we have even one more red flag to consider. It came out last night from Chief Actuary Richard Foster of the Centers for Medicare and Medicaid Services. The Centers for Medicare and Medicaid Services is not a Republican organization nor a Democratic organization. It is in the Obama administration. But it is the agency in charge of the Federal Government's spending for health care, which, according to Mr. Samuelson, who wrote a column in Newsweek recently, was 10 percent in the year 1980 and 25 percent today of our government's total expenditures.

If we go back to the reason we started all this debate on health care, let's remember that the reason we started the debate was first to see if we can bring down the costs of health care because the red flags and the yellow flags are everywhere for small businesses, for individuals, for our government. We cannot continue to afford the increasing cost of health care in America. So our first goal here is to bring down the costs.

Yet, Mr. Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services, in a lengthy report delivered last night on the health care bill--most of which we have seen but some of which we do not know about yet; it is still being written in the back room--says that it will increase costs. Instead of reducing costs, it will increase costs. It points out the obvious, which is that the taxes in the bill will raise the premiums for the 180 million of us pay who have employer-based insurance, and for those who have individual insurance. It talks about the millions of Americans who will be losing their employer insurance by the

combination of provisions in this bill, many of whom will end up in Medicaid, where 50 percent of doctors will not see a new patient. But maybe the most important finding is the most obvious finding, the one which we have been suggesting to our colleagues day-in and day-out. It is one we ought to pay attention to and one which almost every American can easily understand. And it is this--it has to do with Medicare, the government program on which 40 million seniors depend. This bill would cut $1 trillion--let's start this way. Medicare, the program we depend on, its trustees say it is going broke in 5 years. It is already spending more than it brings in, and it will be insolvent between 2015 and 2017. Those are the Medicare trustees telling us this.

What does this bill do to that?

If I may finish my point.

What does this bill do? It would cut $1 trillion from Medicare. I ask the Senator from Arizona, if the program is going broke and you cut $1 trillion out--and then it has been suggested over the last few days that we add several million more people into Medicare--what do you suppose the result would be?

The Senator from Arizona is exactly right. I believe I have my figures right. I think Mr. Samuelson said in his column the other day that in 1980 the Federal Government was spending 10 percent of all our dollars on health care and today it is 25 percent. And this is the agency in charge of most of that massive Federal expenditure every year.

I thank the Senator from Arizona for being so specific about this and making it clear that this is not a Republican Senator talking, this is a Republican Senator reading the report of the Federal Government's Chief Actuary for the Medicare and Medicaid Program. Senator Barrasso, a physician for 25 years in Wyoming, brought to our attention some of these things earlier this week when he pointed out what this also says.

Isn't the point that if we keep cutting Medicare, there are not going to be any hospitals and any doctors around to take care of patients who need care?

Madam President, I ask unanimous consent to have printed in the Record the summary of the report of the Centers for Medicare & Medicaid Services.

I ask the Senator from Georgia, while this is a complex document, in many ways, isn't it a matter of common sense that if you take a program that is going broke and you take $1 trillion out of it and you add millions of people to it, isn't the end result going to be there is not going to be anyone left to take care of the patients who need help? Isn't that the logical result, just as this report says?

I see the Senator from Nebraska is here, and we had a conversation earlier about the attitude of people in Nebraska. It is very helpful to have independent evaluators who tell us that if you cut $1 trillion out of a program that is going bankrupt and then add more people to it, doctors and hospitals are going to go broke. We have heard that before from the Mayo Clinic, and I think Senator Johanns has been hearing that in the State of Nebraska.

If I could ask the Senator from Nebraska this question. Did a rural hospital in Nebraska or Wyoming or some State not--did I notice in a letter from the Mayo Clinic this week, they said cuts such as this or an expansion of Medicare under these circumstances would cause them to--well, to drop Medicare, period; they lost $840 million this year, and they are beginning to say to some citizens from Nebraska, Montana, other areas: We can't take you if you are a Medicare patient or if you are a Medicaid patient.

I would ask the Senators from Wyoming and Georgia, who are here, to go back to the beginning. When we began this debate, the President, in his summit at the beginning of the year, very correctly-- and I applauded him for that--all of us said we have to reduce health care costs--costs to us, costs to small businesses, and costs to our government. But doesn't this report of the chief actuary of the government say the Reid bill will actually increase health care costs?

So if I am understanding it, we are going to cut $1 trillion, when fully implemented, out of Medicare; we are going to add $1 trillion in taxes, when fully implemented; we are going to run up the debt, we believe on this side; we are going to increase premiums and costs are still going up?

We have about 6 minutes remaining in our time. I wonder if the Senator from Georgia, having heard the comments, has any additional recommendations on the chief actuary's report.

Madam President, how much time remains?

Madam President, if I could conclude our time, with the permission of the Senator from Georgia and Wyoming, instead of racing down this train track with yellow flags and red flags flying everywhere, people often ask us: What would you do? What we would do is what we think most Americans would do when faced with a big problem, not try to solve it all at once but to say, What is our goal? Our goal is reducing cost. What are the first four or five steps we can take to reduce costs? Can we an agree on those? We think we can. Let's start taking them. For example, small business health plans to allow small businesses to offer insurance to their employees at a lower rate. That legislation is prepared and before the Senate.

Reducing junk lawsuits against doctors. That reduces costs.

Allow competition across State lines for insurance policies. That reduces costs.

Going step by step to re-earn the trust of the American people to reduce health care costs is the way to go, instead of making what this new report from the Center for Medicare and Medicaid Services helps to show again would be a historic mistake.

I yield the floor.

Certainly.

I wonder if I might ask the Senator from Idaho and the Senator from Kansas, both the Senators are on the Finance Committee, I believe, and have been working on this health care bill for a long time. It is typical of a big, complex bill such as this that it is difficult to pass, and you get a sense every now and then of whether it is likely to pass or unlikely to pass. This week has been a particularly difficult week for the bill. I have noticed the majority leader trying to create a sense of inevitability about the bill.

But, increasingly, it seems to me, with it becoming clear that with so much of it being paid for by new taxes, and then last night the chief actuary of the Centers for Medicare and Medicaid Services saying the cost is going up, premiums are going up; with the Mayo Clinic saying it is beginning to not take Medicare patients, and the idea of putting millions more Americans into a program already going broke which you are taking $1 trillion out of is a bad idea; I wonder if in all--and all this talk about history being made and the inevitability of this bill, that the Senator from Idaho might not think, looking back over this whole debate, that maybe there are a lot of different ways to make it--that maybe a growing number of Senators might be thinking--not saying yet--might be thinking that this bill would be an historic mistake and that all the king's horses and all the king's men are not going to be able to push this up over the top.

If I can make a short comment, I thank the Senator from Idaho for his leadership on taxes. But Senator McConnell's comment about those two events on December 9--the poll from CNN and the report from the Centers for Medicare and Medicaid Services chief actuary--made me think about the immigration bill 2 years ago, in 2007. There were a lot of our best Senators working to pass comprehensive immigration bill, including Senators McCain, Kennedy, Kyl, Martinez, Members on both sides of the aisle, who worked very hard to do it. There seemed to be a sense of inevitability that that bill might pass. The President was even behind it.

But then it began to have so many problems, and the red flags began to pop up just like they are popping up with this comprehensive health care bill. There came a time, perhaps much like December 10, when the sense of inevitability was replaced by a sense that we were making a historic mistake, and a bill that got on the floor with 64 votes only had 46 to get off.

I have a feeling this bill, the more we learn about it, the wiser thing to do is to let it fall of its own weight. Then we can start over, step by step, to reearn the trust of the American people by reducing health care costs. We can do that. That is the sense I have.

I appreciate the Republican leader's observation about those important events on the 9th.

I think it is important to reflect on the season we have here. A couple of nights ago, the Senator from Arizona gave an impressive speech in front of the Capitol for the lighting of the Christmas tree. This is the Christmas season coming up, 2 weeks from tomorrow, a very important season. The majority leader said it is very important for us to stay through Christmas if necessary to debate this bill. We said: All right, that is what we will do. We will stay to New Year's Day. We will stay to Valentine's Day because this is indeed a historic bill and we don't want to make a historic mistake because it affects our children, our grandchildren, 17 percent of the economy, all 300 million Americans.

None of us have ever seen our constituents more involved in an issue than in this issue. So we are here ready to go to work.

I am wondering, as I listen to the Senator from Arizona, not only do we not know what this bill is that we are supposed to enact by 2 weeks from today, our friends on the other side don't know what it is. They cannot tell each other what it is.

They came out of--they had sort of a rally yesterday. One of the Senators described it as sort of a ``go team, go'' rally, but they did not know what they were going to. All we have heard they are going to-- and I imagine the Senator from Oklahoma, who is a physician, who has delivered many babies, seen many patients, still continues to do it, would have some comment on this--all we have heard is they may try to expand Medicare.

We heard yesterday from the executive director of the Mayo Clinic Health Policy Center, I ask unanimous consent to have his letter printed in the Record.

I will just read one sentence from it:

Expanding the current Medicaid system to persons 55 to 64

years old would ultimately hurt patients by accelerating the

financial ruin of hospitals and doctors across this country.

I am very puzzled why ideas like this are being cooked up behind closed doors 2 weeks before Christmas, and we do not know what they are, they don't know what they are, and the suggestion is we not vote today and we go home this weekend.

Mr. President, if the Republican leader will think back

when he first came to the Senate as a young aide in 1969, the year before I was a young aide in the Senate,

I can remember President Johnson, a Democrat, and Everett Dirksen, the Republican leader, dealing with the open housing legislation in 1968, a very controversial bill. How did they deal with it? The Democratic President had the bill literally written in the office of the Republican leader, with staff members and Senators trooping in and out. The country looked to Washington and said: Well, the Republican leader and the Democratic President both think it is important. They are trying to work it out. In the end, they voted for cloture. In the end, they got the bill.

I thank the Senator from Idaho. The point you are making is, if you are going to add $\1/2\ trillion--this bill as proposed is paid for by about half through Medicare cuts and about half through tax increases, and it is paid for some by sending huge new bills to State governments. But I guess the point the Senator is making basically is that we are going to add $\1/2\ trillion in taxes over 10 years or much more than that when the bill is fully implemented. Who is going to end up paying those taxes? It is not going to be insurance companies. It is not going to be medical device

companies. It is going to be the people who--it is going to be us. Isn't that true? Don't you expect that most of the companies upon which the new taxes are imposed will pass those taxes along to the American people?

I wonder if I may take a minute to talk about another form of taxes, which would be State taxes. Now, people might be thinking: Well, you are talking about a Federal health care bill. How do you get State taxes in there? Well, let me try to explain that just a little bit.

I remember as Governor of Tennessee some years ago, nothing used to make me madder than Washington politicians who would come up with a big idea, take credit for it, hold a press conference and announce it; call it, for example, historic, and then send the bill to me, the Governor, to pay it. Then usually those same politicians would come back to Tennessee and they would make a big speech about local control at the Jefferson Day dinner or the Jackson Day dinner. In fact, sometimes Republicans were just as bad as Democrats in doing it.

I also remember that in 1994 there was a political revolution in the country. This body switched dramatically to the Republican side, and one of the main arguments was no more unfunded mandates. In other words, don't be coming up with big ideas in Washington and sending the bill to the Governor or to the State legislature or to the mayor or to the county commission and expect them to raise property taxes or cut services or raise college tuitions to make it up.

So what I wish to say today is this: This legislation already includes a huge new bill for the State governments. As it is now written, Medicaid for low-income Americans is expanded, and there is a big bill to the States. Our Governor, who is a Democrat, by the way, has been very effective in pointing this out; that Senator Reid's bill will add $700 million over 5 years to our State. There is no way our State can pay this bill without a tax increase of significant size or seriously damaging higher education or seeing college tuition begin to go through the roof, just as we saw it do in California the other day when it went up 32 percent. Why did it go up? Because the State has had to spend so much of its money on health care bills, many of which are required by the Federal regulations of Medicaid.

There is a rumor going around that there was a big deal cut last night that would pave the way for passage of this bill that says that instead of a new government-run program, we will simply expand two of the government-run programs we already have--Medicare for seniors and Medicaid for low-income Americans.

I would ask these questions: First, with Medicare, how in the world can we take $1 trillion out of Medicare when the program is fully implemented and give 34 million or 35 million more Americans a chance to opt in it at a time when the trustees of Medicare have said it is going broke in 5 years. Insofar as Medicaid goes, if it is true that the idea is to expand Medicaid to 150 percent of the poverty level-- and, of course, we are not invited to any of the meetings; they were all written in the back room so we don't know the details--but if it is true we are going to expand Medicaid even more, our Governor has said in our State that doubles the cost of this legislation to our State.

So down the road, in a few years, what we are going to see in Tennessee is a new State income tax, seriously damaging higher education, and I think it is--

On your time, yes.

My understanding of the proposal by the Finance Committee bill and by the Reid bill is that the Federal Government expands Medicaid and pays for 100 percent of it for a few years, but after that, the State has a significant portion of the bill. Am I not correct in that?

I am not going to divide the time.

Mr. President, I will retain the floor, and then the Senator can make his statement later.

The fact is, after 3, the Federal Government sends a big bill to the States. The fact is, the Governor of Tennessee, who is a Democrat and who has worked with other Governors and is actually leading the National Governors Association's effort to see the impact of this kind of legislation, says it will cost our State $700 billion over 5 years and $1.4 billion if we expand Medicaid up to 150 percent of federal poverty level. The State pays part of that bill. That means a big State tax increase. It means big higher education increases.

As a former Governor, I guarantee that if this happens, a few years from now when the federal government shifts costs onto the states, there will be a revolt in the States and people will be asking who did this. I would seriously say that any Senator who votes to expand Medicaid and sends a significant part of the bill to the States ought to be sentenced to go home and be Governor and try to govern the State under those conditions.

I think this kind of legislation, and especially the rumor I have heard regarding a dramatic increase in the expansion of Medicaid, will be a damaging blow to the American public's higher education from which it will never recover, tuition will go to a level where only the rich can afford to go to school, and the idea of public higher education will be left aside, all because Washington politicians ran up the bill, took the credit, made an announcement, and sent a huge bill to State governments that are struggling with their worst fiscal condition since the Great Depression.

I thank the Senator. It is true that in the legislation the estimate is that the Federal Government would pay 100 percent of the increased expansion of Medicaid for 3 years and that it will cover about 90 percent of the cost after that, which sounds like a lot. But we throw so much money around up here, we have completely lost any appreciation of what that amount of money costs at the State level. In our State, our Governor has said that the 133-percent increase is about $700 million over 5 years, and that is a big, new tax or a big increase in college tuition.

If I may, I ask unanimous consent to have printed in the Record an article from the Wall Street Journal of December 4 from the dean and CEO of Johns Hopkins Medicine.

The dean, who writes a very sympathetic column which I will not read but a sentence or two of, is describing the current health care bill. He says:

Even if only half those individuals seek Medicaid coverage,

such a large expansion would likely have an excruciating

impact on the State's budget. And Maryland is not alone.

According to a Kaiser Foundation survey conducted earlier

this year, three-quarters of the States have expressed

concern that expanding Medicaid could add to their fiscal

woes. Already, as Kaiser notes, 33 States cut or froze

payment rates to those who deliver health care to Medicaid

patients. . . .

The proposal--and the Reid bill is maybe exacerbated by this deal we have been hearing about--is to shift millions more low-income Americans into a program called Medicaid, when only 50 percent of doctors will see new patients in that program, and then send a huge bill to the States, which will damage higher education.

I remember, after I was Governor, I heard on the radio that the State of Tennessee had done a wonderful thing. It would double the number of children covered by Medicaid at the same amount of cost. It went through my mind that it would never happen. That program became the TennCare Program, which has nearly bankrupted our State.

Mr. President, how much time remains?

Mr. President, day in and day out Republicans have come to the floor and said: Instead of a comprehensive, 2,000-page approach to try to fix this massive health care system all at once in a way that raises taxes and premiums and makes Medicare cuts, why don't we, instead, identify the goal of reducing the cost of health care to individuals and to the government and take commonsense steps toward that goal.

We have suggested small business health care plans which have been offered, scored by the CBO to save money and expand coverage. We have offered proposals to limit the number of junk lawsuits against doctors. There may be an argument about how much that saves, but there is no argument that would not drive down the costs. We have suggested allowing purchasing of health insurance across State lines to increase competition, and creating health insurance exchanges. There are efforts in wellness and prevention that we have made specific proposals concerning. In terms of corralling waste, fraud and abuse in Medicare and then spending the savings on Medicare, instead of a new program, that is the Republican agenda.

Pick a goal: reducing health care costs and move step by step toward that goal in a way that reearns the trust of the American people, instead of a comprehensive, 2,000-page bill filled with taxes, mandates, surprises, and a Washington takeover of health care.

There is a real choice. We regret the fact that we seem to be continuing to move on this track without the track we are offering. We want to defeat what is proposed, not in the debate. Change the debate toward reducing costs step by step.

I yield the floor.

Well, I thank the Senator from Arizona for his motion, and I thank the Senator from Florida for his amendment, because Medicare Advantage is very important to Tennesseans. We have 243,000 Tennesseans who have opted for Medicare Advantage. About one-fourth of all Americans who are on Medicare have chosen Medicare Advantage because it provides the option for increased dental care, for vision care, for hearing coverage, for reduced hospital deductibles, and many benefits. It is helpful to low-income and minority Americans, and it is especially helpful to people in rural areas.

What the Republicans have been arguing all week is that, contrary to what our friends on the other side are saying, this bill cuts those Medicare Advantage benefits. The Director of the Congressional Budget Office says that fully half--fully half--of the benefits in Medicare Advantage for these 11 million Americans will be cut. Our Democratic friends say: No, that is not true. That is not true. We are going to cut $1 trillion out of Medicare over a fully implemented 10-year period of this bill, but nobody will be affected by it.

Well, the Senator from Florida apparently doesn't believe that. He says: We have 900,000 Floridians who don't want their Medicare Advantage cut. And he is saying, in effect, we don't trust this Democratic bill to protect these seniors in Medicare Advantage.

So I ask the Senator from Texas: If the people of Florida and the Senator from Florida don't trust the Democratic bill to protect Medicare Advantage, why should 240,000 Tennesseans trust the Democratic bill to protect Medicare Advantage?

If I may respond to the Senator from Texas, I think he is exactly right. There is a lot of very appealing talk that we hear from the advocates of the so-called health reform bill. But when we get right down to it, and when we examine it closely, we find a big increase in government-run programs. What does that mean for low-income Americans, and what does it mean for seniors who depend on our biggest government-run programs, Medicare and Medicaid? It means they risk not having access to the doctor they want. The Senator from Wyoming mentioned the Mayo Clinic, widely cited by the President and by many on the other side as an example of controlling costs, is beginning to say: We can't take patients from the government-run programs in some cases because we are not reimbursed properly.

What is going to happen behind all this happy talk we are hearing about health care is, we are going to find more and more low-income patients dumped into a program called Medicaid. Under this program half the doctors will not see a new Medicaid patient. It is akin to giving someone a bus ticket on a bus line that runs half the time. Medicare is going to increasingly find itself in the same shape as Medicaid. The Mayo Clinic has already said they can't afford to serve patients from the government-run programs. The Senator from Texas is exactly right. We don't have to persuade the 11 million Americans who have chosen Medicare Advantage that it is a good program. They like it. In rural areas, between 2003 and 2007, more than 600,000 people signed up for it. In a way, the Senator from Florida may have a sweetheart deal, but in a way he has done us a favor. We have been trying to say all week the Democrats are cutting Medicare. They are saying: Trust us, we are not cutting Medicare. The Senator from Florida is saying: Floridians don't trust you. You are cutting their Medicare Advantage. I want to have an amendment to protect them. Senator McCain is saying: Let's protect all seniors' Medicare Advantage.

The answer to the Senator from Arizona is no. I do not know of one. I know of one Senator at least who does not believe it. He is the Senator from Florida. It is interesting that all week we have been going back and forth. We have been saying to the Democrats: You are cutting Medicare benefits. They have been saying: No, we are not.

We have been saying: Yes, you are.

No, we are not.

I am sure the people at home must say: Well, who is right about this? Well, the Senator from Florida, who sits on the other side of the aisle, has said: I am not willing to go back to Florida and say to the people of Florida that your benefits are going to be cut if you are on Medicare Advantage, so I want an amendment to protect you. The Senator from Texas wants and amendment to protect 11 million seniors and so does the Senator from Oklahoma and so does the Senator from Louisiana and so does the Senator from Wyoming, and the Senator from Tennessee.

So the Senator from Arizona is saying, we believe you are cutting Medicare Advantage benefits for 11 million Americans. The Senator from Florida does not trust your bill. We do not either. We want an amendment that protects 11 million seniors.

If I may say to the Senator from Arizona one other thing, we have talked a lot about our good friend, the Senator from Florida, and how he has been so perceptive on noticing that his Floridians with Medicare Advantage may lose their Medicare benefits.

I say to the Senator from Arizona, I believe there are other Medicare benefits that are likely to be cut in this bill. Aren't there cuts to hospice? Aren't there cuts to hospitals? Aren't there cuts to home health care, which we talked about yesterday? So if Floridians do not trust the Democratic bill to protect their Medicare benefits from Medicare Advantage, why should they trust the Democratic bill to protect any of their Medicare benefits?

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.

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. President, during the next 55 minutes, we will have several Republican Senators come to the floor. I ask unanimous consent that during that time, Senator McCain be allowed to be the manager of a colloquy among the Republican Senators.

Mr. President, before Senator McCain begins, if I may, I wish to take a moment to establish where we are today and what happened yesterday as a lead-in to what he is about to discuss.

Yesterday, Senator McCain offered an amendment on the floor of the Senate that would do two things: It would send this 2,074-page Democratic health care bill back to the Finance Committee and say to them, No. 1, take out the cuts in Medicare, and No. 2, any savings in Medicare must go to make Medicare more solvent. That is what the McCain amendment would have accomplished. That was defeated. Fifty-eight Democrats said yes to the cuts in Medicare. They said yes to using the money that comes from these cuts to create a new entitlement program. Forty Republicans and two Democrats said, no, we don't want cuts to Medicare and we do not want a new entitlement program.

So yesterday we made it clear that the central core of this bill includes nearly $\1/2\ trillion in cuts to Medicare. There is no question about that. Everyone concedes that. The President said that when he addressed us. The Congressional Budget Office says that. The question is whether it is a good idea or a bad idea, and yesterday, by 58 votes, the Democrats said yes to these cuts in Medicare.

Today, we want to talk about one aspect of those cuts which is Medicare Advantage. We are going to talk about these cuts in a careful, accurate way so the 11 million seniors who have Medicare Advantage understand exactly what the risk is to their Medicare Advantage policies.

We can see that a portion of the overall Medicare cuts that the Democrats approved yesterday is a $120 billion cut over the next 10 years to the Medicare Advantage program. Now, what is Medicare Advantage? Medicare Advantage is an option seniors have. If you choose this option, Medicare pays a fixed amount every year for your care, to companies that might come to you and offer a Medicare Advantage plan which you can choose instead of the original Medicare plan.

Many seniors choose these plans--11 million seniors. Nearly one out of four seniors in America who are part of Medicare chooses the Medicare Advantage plan. In my home State of Tennessee, the number is about 230,000 Tennesseans.

Why do they choose it? Well, it includes some benefits they may not have in the original Medicare plan. These benefits include dental care, vision care, hearing coverage, reduced hospital deductibles, lower co- payments, lower premiums, coordinated

chronic care management, and physical fitness programs.

The distinguished Senator from Oregon was on the floor and he mentioned grandma. I have mentioned grandma a few times--no disrespect to grandpa; he is in the same boat. He said grandma didn't need to worry about her Medicare Advantage plan because none of the benefits would be cut. That is not what the Director of the CBO, who is often cited by the chairman of the Finance Committee, has said. He said that half of the benefits currently provided to seniors under Medicare Advantage would disappear under the Finance Committee plan, which is much like the plan we are considering. The benefits that would disappear would include those I mentioned.

Today, with Senator McCain leading the discussion, we wish to talk about the Medicare Advantage plan, and why cuts to Medicare Advantage play a central part of this $2.5 trillion bill. Cuts to Medicare pay for about half of that $2.5 trillion cost, and the ones we are talking about today are the Medicare Advantage plans. I understand there will be an amendment by Senator Hatch, who has joined us, and I am sure he will talk about his own amendment. He was present on the Finance Committee when Medicare Advantage was created. I understand there will be an amendment to send this back to the Finance Committee saying don't cut Medicare Advantage.

I can do that. The Senator is correct. If the Senator from Pennsylvania, Senator Casey, said that, he is merely repeating what the Director of the CBO stated, when he said that fully half of the benefits of Medicare Advantage will be lost.

To answer the Senator's question, Medicare Advantage is an option that 11 million of the 40 million seniors who are on Medicare have chosen. The reason they choose it is because it is a plan offered by private companies, often to people in rural areas, often to minorities----

Yes, lower income Americans also choose these. They often choose it because the plans generally offer these benefits: dental care, vision care, hearing coverage, reduced hospital deductibles, lower co-payments, lower premiums, coordinated chronic care management, and physical fitness programs.

Mr. President, I see the Senator from Texas, the Senator from Idaho, and the Senator from Wyoming have all come to the floor, in addition to the sponsor of the motion, Senator Hatch. I am sure they are prepared to reflect on who is hurt by these cuts.

The only thing I would emphasize is what the Senator from Arizona has said is that disproportionately low-income Americans in Texas, Idaho, Tennessee, Wyoming, and Utah are hurt. Only one-third of eligible White seniors who do not have Medicaid or employer-based insurance are enrolled in Medicare Advantage. But the number increases to 40 percent for African Americans and 53 percent for Hispanics.

My understanding is the answer is no. That it is the reason 11 million Americans choose Medicare Advantage because these benefits are not available under the original Medicare plan.

I might say we are operating under a colloquy managed by Senator McCain. So Republican Senators are free to engage in discussion.

I wonder if I might ask the Senator from Idaho to go back over a point he made a moment ago because he went over it quickly and it is such an important point and one reflected by the chart behind him about what he just said. Repeatedly we are told that seniors won't lose benefits if you cut nearly $\1/2\ trillion in Medicare. So if you could take

a moment--I believe you were in the Finance Committee markup where the bill was being written that was offered by the distinguished Finance Committee chairman, and I believe you were talking to the head of the Congressional Budget Office, who is often cited by our friends on the other side as the nonpartisan authority for exactly what the bill does, and you asked him whether the benefits of Medicare Advantage recipients would be cut. Would you describe that in a little more detail so people understand exactly the scenario?

I would direct my comment to the Senator from New

Hampshire, too. The President of the United States said something a few weeks ago that I thought was profound and that I agreed with, he said this debate is not just about health care; it is about the role of the Federal Government in the everyday lives of the American people. I believe he is exactly right about that, which is why so many Americans are turning against this bill.

Would the Senator from New Hampshire agree the President was correct, that this debate is about, in my words now, Washington takeovers, more taxes, more spending, and more debt? It is not just about health care. The enormous interest across the country in these votes comes from a much larger picture than this health care bill.

Mr. President, if I may say to the Senator from Arizona, I greatly appreciate his making this amendment, because there is so much said here on the Senate floor that must be hard for many people to follow. But one thing I believe everybody agrees on is there are going to be $465 billion in cuts to Medicare over the next 10 years, period. Everybody agrees with that. The President of the United States has said we are going to pay for this new health care bill with one-half from Medicare cuts and one-half from taxes. Everyone agrees with that.

What Senator McCain's amendment is saying is two things--and Senator McCain, let me see if I characterize properly your amendment, because it is a very simple amendment, as I read it. It is saying, send it back to the Finance Committee and say, bring the health care bill back without the Medicare cuts, without these cuts to hospitals, cuts to hospices, cuts to nursing homes, cuts to Medicare Advantage, and cuts to home health agencies.

Second, if we are going to take money from grandma's Medicare, let's spend it on grandma. Let's take the savings we find in Medicare and absolutely make sure we spend it on Medicare, which the trustees have said is likely to go broke between 2015 and 2017.

Did I correctly characterize the Senator's amendment?

And does the Senator recall a few years ago when the Republicans suggested saving $10 billion over 5 years in Medicare, the majority leader said that was immoral, and that other Democratic Senators thought it was awful? If $10 billion in savings to try to make Medicare stronger is immoral, what is spending nearly $\1/2\ trillion on a new program called?

Well, if I may say--and then I think maybe others could respond--if you are going to spend $2.5 trillion a year, you have to get the money from somewhere. What the Democratic health care bill does is get it three places. One is from seniors, one is from taxes, and one is from the grandchildren of seniors; that is, debt. It comes from those three places.

What we heard earlier this week was the Congressional Budget Office saying the total effect of that $2.5 trillion is that for most Americans, premiums would continue to go up as they already are, and that for people who go into the individual market they will go up even more--they will go up even more--except there will be some subsidies for a little over half of those people, and where is the subsidy money coming from? It is coming from Medicare. So that is the answer to the question.

Mr. President, I would ask the Senator from Oklahoma, who is a physician himself, if one of the

effects of cuts in Medicare is to make it more difficult for people who are on Medicare to see a doctor. It is like giving somebody a bus ticket and not having a bus.

I have been reading in the newspapers, for example, in the Washington Post last month, that the Mayo Clinic, which is often held up as an outstanding example of a clinic that keeps costs under control, has announced it no longer will accept Medicaid patients from Nebraska and Montana, and some Mayo clinic facilities in Arizona and in Florida are beginning to say no more Medicare patients.

Is this what the Senator from Oklahoma thinks could be happening at other hospitals and centers, even very good ones such as the Mayo Clinic where they allegedly keep costs at a reasonable level?

How much time is left?

How many Medicare Advantage members are there, for example, in Arizona? Is it a small program or a large program?

I may say to the Senator from Arizona, I have heard our friends on the other side say Republicans are scaring seniors about Medicare cuts. Mr. President, it is not Republican Senators who are scaring seniors about Medicare cuts; it is the Democratic health care bill that is scaring seniors, because there are $\1/2\ trillion of Medicare cuts that will pay for half of this program, and they are outlined on this chart, as the Senators have discussed.

Mr. President, I am here.

Mr. President, I agree with the Senator. That is why we have 22 minutes on the Republican side to clear up some misconceptions.

The Democratic health care bill does cost $2.5 trillion over 10 years when it is fully implemented. If I may say so, it is arrogant to think the American people couldn't figure out the difference between the first 10 years, when the bill wasn't implemented in 4 of those years, and they would like to know that it costs $2.5 trillion.

If it is on your time.

The Senator is right. It is paid for by cutting grandma's Medicare. It is paid for by cutting grandma's Medicare by $465 billion over a 10-year period of time, and about $500 billion in taxes----

No. I admit it costs $2.5 trillion, and the attempt to pay for it is through Medicare cuts, tax increases, and increases to the deficit by not including the physician reimbursement in the health care bill.

I will concede to the Senator from Montana that the attempt of the Democrats to pay for this $2.5 trillion bill consists of Medicare cuts, tax increases, and additions to the deficit by not including the physician reimbursement, which is an essential part of any 10-year health care plan. There may be other problems, but those are the three things I know about.

I would say no to that, Mr. President, because the Director of the Congressional Budget Office made it clear there would be specific cuts in benefits for those who have Medicare Advantage, which is about one out of four seniors.

Mr. President, it is clear there are $465 billion in cuts in Medicare. The Chair and the Senator from Montana and the Senator from Connecticut have all agreed that is a big part of how the bill is supposedly paid for. It is specific enough to say that $135 billion comes from hospitals; $120 billion from Medicare Advantage, which 11 million seniors have; nearly $15 billion from nursing homes; $40 billion from home health agencies; $8 billion from hospices.

The Director of the CBO testified that provisions like that would result in specific cuts to benefits for Medicare Advantage. He said that fully half of the benefits currently provided to seniors under Medicare Advantage would disappear. The changes would reduce the extra benefits, such as dental, vision, and hearing coverage, that currently are made available to beneficiaries.

I wholeheartedly disagree with that. The Medicare trustees have said that between 2015 and 2017 Medicare will be approaching insolvency. They have asked that we take urgent action. The urgent action recommended by the Democratic majority is that we take $465 billion out of the Medicare Program over 10 years and spend it on a new entitlement.

It is hard for me to understand how that can make Medicare more solvent, when you take money out of grandma's Medicare and spend it on someone else.

Yes.

I say to the Senator from Arizona that he is exactly right. Another way to describe it, the Senator from Kansas said it was like writing a big check on an overdrawn bank account and buying a big new car. Maybe another way, if I may respond to the Senator from Arizona--I ask unanimous consent that Republican Senators, on our time, be allowed to engage in a colloquy.

I would like to finish responding to Senator McCain, if I might.

I hope the Parliamentarian is keeping track of the Republican time. I am enjoying the questioning, and I thank the Senator for his question. One of the things--in fact, a great compliment has been paid to the Senator from Arizona. It is rare that a Senator can have something he said actually begin to break through the fog.

Dana Milbank, a columnist for the Washington Post, wrote a column about it being all about grandma and wondering why we never mention grandpa. Maybe Mr. Milbank hasn't seen the movie ``My Big Fat Greek Wedding,'' where the man said, ``I'm the head of the house,'' and the woman said, ``I'm the neck, because I can turn the head any way I want.''

We are talking about grandma because she can help persuade grandpa. If we take $465 billion out of Medicare over 10 years, grandma and grandpa and those who are younger and looking forward to Medicare will be affected.

If I may say to the Senator from Arizona--and I see the Senator from Oklahoma and the Senator from Nebraska--it wasn't long ago, in response to the question--in fact, in 2005, when we sought to restrain the growth of Medicare by $10 billion over 5 years, and this is what they said--remember, they are ``restraining'' the growth of Medicare by $465 billion and spending it on a new program, and Republicans were, at that time, trying to save $10 billion over 5 years.

``An immoral document,'' said Senator Reid and Senator Dodd. The Senator from Connecticut said that funding for Medicare would be cut. Senator Rockefeller: ``A moral disaster of monumental proportion.'' Senator Boxer, in the same way, compared it to Katrina. Senator Kerry said we are ``passing the costs on to seniors.'' Senator Levin said people are ``going to be hurt by this bill.'' ``Irresponsible and cruel,'' said Senator Kohl. Senator Reed and Senator Hillary Clinton also made similar comments.

That was for $10 billion of restraining the growth of Medicare to spend it on the existing program. Yet this proposal by the Democrats would take $465 billion and spend it on a new program.

Mr. President, I am happy to see a debate actually break out on the Senate floor on this issue.

As long as it is on Democratic time.

I mean whatever time the Senator uses should be on Democratic time.

Mr. President, we have enjoyed our discussion with the distinguished chairman of the Finance Committee and thank him for his questions.

Senator Coburn, who is a physician--the Senator from Montana talked about doctors being overpaid. He talked about----

Didn't I hear the words ``providers overpaid''?

I must have misunderstood. Normally when we talk about providers, we talk about hospitals and physicians.

We have a physician on the Senate floor, the Senator from Oklahoma. I wonder if he, having heard this debate, might want to comment. I might say, isn't it true that the McCain motion, which we have on the floor, would send this back to the Finance Committee and say: If there are savings, let's spend it on Medicare to actually strengthen it?

I congratulate the Senator from Arizona on his analysis of the Medicare cuts. I heard the Democratic leader talk about figures and how we have some figures and the Democrats have other figures. I agree with him. I think someone watching this must think we are on two different planets sometimes, so let me focus in on the figures.

I believe I heard my colleague say to pay for this health care bill over 10 years there would be $465 billion in the Medicare cuts. Where does that figure come from?

I think the Senator from Arizona is right. The President of the United States, in his address to us about health care, and the New York Times, the Wall Street Journal--everyone who has reported on the Congressional Budget Office figures said the same thing. We are going to pay for this bill, which is $2.5 trillion over 10 years when fully implemented, by $465 billion cuts in Medicare.

What Senator McCain in his amendment that we are in support of is saying is, don't cut grandma's Medicare to pay for someone else's insurance. He goes on to say, if you are going to find some savings in waste, fraud, and abuse in grandma's Medicare, spend it on grandma. The reason for that is that the Medicare trustees have said to us that there is $38 trillion in unfunded liabilities for the Medicare Program and that the program will start going bankrupt between 2015 and 2017. According to the Medicare trustees, they say, ``We need timely and effective action to address Medicare's financial challenges,'' and the proposal, if I may say to the Senator from Arizona, who is on the Finance Committee and deeply involved in what we need to do about our Nation's finances, I don't think the Medicare trustees were thinking that the timely and effective action we could take to keep Medicare from going broke was to take $465 billion out of it and spend it on some new program.

I see the Senator from Idaho here. I wish to hear his observations. If there is any issue in this entire health care debate that symbolizes why we on the Republican side want to change the debate to a step-by-step approach to reducing the cost of premiums, it would be the Medicare issue. As the Senator from Arizona said, what we need to do about Medicare is make it solvent as quickly as we can, as effectively as we can. The Senator from Kansas said the other day that the proposal to take $465 billion from grandma's Medicare and spend on it some new program is like writing a check on an overdrawn account in a bank to buy a big, new car. There is a lot of truth to that.

The President said earlier this year something I agree with. He said this health care debate is not just about health care. It is about the role of the Federal Government in the everyday life of Americans. He is exactly right about that. This health care debate, which we are beginning this week, is not just about health care. It is about the stimulus package, about the takeover of General Motors. It is about the trillion dollar debt. It is about the Washington takeovers. It is about too much spending, too much taxes, too much debt. The Medicare provisions in this bill are a perfect symbol of that. That is why Senator McCain is right. What he is saying is, don't cut grandma's Medicare and spend it on some new program. If you can find some savings in the waste, fraud, and abuse of grandma's Medicare, spend on it grandma. Make sure those of us who are older and those of us who are younger and looking forward to Medicare can count on its solvency.

Later this week we will talk more about premiums going up. There was a lot of discussion yesterday because, according to the Wall Street Journal, some health premiums would rise. For people who get their insurance from large employers, this bill won't make much difference. And for small employers, if you get your insurance from a small employer, it won't make much difference. If you are going to the individual market to buy insurance yourself, your premiums will go up, except we are going to get some money from somewhere to help pay part of your premiums, at least for about half of Americans who are in the individual market. Where are we going to get that money? From grandma. We are going to get it from Medicare. So that is what is wrong with this bill. And what is right about the McCain amendment is, it says simply, don't cut Medicare. If we find savings, which we hope we can in Medicare, we should spend it on making Medicare solvent.

I wonder if the Senator from Idaho is hearing from seniors in his State about the proposed $465 billion cuts to Medicare and how they feel about taking that money and spending it to create a new program?

In discussing the Medicare cuts, another provision of the bill which we will be talking about this month and next month as we go through the health care debate is what about the problem of paying doctors and hospitals who see Medicare patients. They get paid about 83 percent of the rate they would be paid if they were seeing a private care patient. Every year Congress has to make an adjustment in something we did a few years ago which automatically cuts the amount of money that we pay doctors who are seeing Medicare patients.

That is a big problem for Medicare patients. Because if the doctors can't be paid, they won't see the patients, and Medicare patients may find themselves increasingly in the condition that Medicaid patients do, low-income Americans who are covered through the State program-- that is our largest government-run program--where they are paid about 60 percent of what doctors who see private patients are paid and about half of Medicaid doctors won't see new patients.

I ask the Senator, does he see anywhere in this bill a provision for the $\1/4\ trillion that will be needed to pay doctors 10 years from now what they are making today? If it is not in the bill, where is that $\1/4\ trillion going to come from? Is it going to come from Medicare cuts, or will it come from adding to the deficit?

Mr. President, how much time remains on the Republican side?

Would the Chair let me know when 4 minutes remain.

The Senator from Idaho will conclude our remarks at that time.

The Senator from Idaho has made an important point, anticipating our Democratic friends will have the next 30 minutes and some other things they may be saying the rest of the day. There was a lot of talk yesterday about the CBO report about the effect of this $2.5 trillion proposal on premiums. Rather than take my word for it, let's go to the news section of the Wall Street Journal of today which has the headline: ``Some Health Premiums to Rise.'' That means going up. That means the cost of your insurance is going up for some Americans.

So my question is, why would we spend $2.5 trillion over 10 years, cut Medicare, raise taxes, and run up the debt to raise some health premiums? I thought the whole exercise was to lower the cost of health care premiums.

The article says:

The analysis released Monday by the nonpartisan

Congressional Budget Office and the Joint Committee on

Taxation--

We are supposed to pay some attention to these outfits as nonpartisan--

painted a more complicated and uncertain picture. It said

people who pay for their own insurance would see a higher

bill, albeit for more generous benefits--

That is the government-approved insurance you are going to be forced to buy.

unless they are lower earners who qualify for a new

government tax credit.

Where is the money going to come from for those subsidies? It is going to come from grandma. It is going to come from Medicare. It is going to come from taxes. And it is going to come from increasing the debt.

Those are facts.

Employees of small firms--

Says the Wall Street Journal--

would effectively see their insurance premiums unchanged--

So for small firms, we are going to spend $2.5 trillion over 10 years, cut Medicare, cut taxes, and run up premiums for millions of Americans, so your insurance will continue to go up at about the rate it already was. Why should we be doing that?

while workers at large firms would see something between

unchanged and slightly lower premiums under the bill--

Compared to what would already happen--

according to the analysis.

We need to change the debate. We need to start over. Instead of this comprehensive 2,000-page bill that is full of taxes, mandates and, as a general effect, raises premiums and taxes and cuts Medicare, we should set a clear goal, reducing costs, and begin to go step by step toward that goal--reducing junk lawsuits against doctors, allowing health care to be purchased across State lines to increase competition, allowing small businesses to combine in health plans so they can offer more insurance to employees at a lower cost.

These three bills I mentioned have been offered and rejected so far by the Democratic majority. We should have more flexibility in health savings accounts, efforts at waste, fraud, and abuse, which are, in effect, Medicaid--the largest government program--and Medicare--the second largest--and more aggressive steps to encourage wellness and prevention.

One approach, the comprehensive 2,000-page bill, Washington-takeover approach, Americans are very leery of. In my respectful opinion, this bill is historic in its arrogance for thinking we could take a system that affects almost all 300 million Americans, 16 percent of the economy, and change it all at once.

Instead, why don't we go step by step to re-earn the trust of the American people? Republicans will be making those proposals on the floor this month and next month and as long as it takes to try to see that we get real health care reform. Cutting grandma's Medicare by $\1/ 2\ trillion and spending it on a new program at a time when Medicare is going broke is not real health care reform.

Mr. President, for those who are watching, Republican Senators are reading through the bill, reading the bill in its entirety. It is kind of like reading the entire New Testament in Greek. It is better to have somebody help interpret it. We have been talking about page 396, title II, subtitle A, section 2001, which expands Medicaid. We have heard eloquent statements about how moving 15 million low-income Americans into a program called Medicaid, which is a medical ghetto, is not health care reform. We have also heard Senator after Senator say what right do we have to expand Medicaid and tell the States that you are going to pay for it. What kind of arrogance do we have to say that to States that are in their worst fiscal condition since the Depression?

The Reid bill requires states to expand Medicaid eligibility to cover all persons under 133 percent of poverty, which means those earning about $14,000 per year for an individual and about $29,000 per year for a family. Individuals who are not otherwise covered by an employer- sponsored insurance would not be eligible for tax credits. In effect, every American below 133 percent of poverty would be locked into Medicaid which is like confining them to a medical ghetto. With this bill we are on path to expand the largest ``public option'' we already have, Medicaid, and it could bankrupt the States, because they will be paying for it. As the former Governor of Tennessee, I do not see how Tennessee can pay for their part of the Medicaid expansion included in Senator Reid's health care bill without a new income tax, or seriously damaging higher education by raising tuition like California just did, or both.

I am opposed to this expansion of Medicaid, which, according to the CBO, would cost States an additional $25 billion, and add 15 million people to the Medicaid Program. This would be the largest single expansion of Medicaid in the program's history. Why? Because nearly half of the reduction of the uninsured in the Reid health care bill is due to people moving into the government-run program that is Medicaid.

Expanding Medicaid to cover uninsured individuals is a terrible vehicle for health care reform, because dumping this many more people into that program will increase problems for beneficiaries getting access to care and for maintaining quality. Plus the program is already riddled with fraud and abuse; this would just invite more of that. Most Governors are struggling with Medicaid in its current form, and they agree that expansion is a bad idea. This includes Democratic Governors.

Tennessee's Medicaid Program is called TennCare. The Tennessean from Thursday printed an article that reports how ``People covered by TennCare may face new limits on their coverage and reductions in their benefits next year, under a plan unveiled Wednesday to help slice state spending.'' The article continues, ``The limits are meant to help TennCare, the State's Medicaid program for the poor, pregnant women and children, meet Govenor Phil Bredesen's goal of reducing spending by most State agencies by as much as 9 percent as the State deals with a shortfall in tax receipts that could reach as much as $1.5 billion over the next two fiscal years.''

If the Reid health care bill is passed, TennCare might introduce a $10,000 annual cap on hospital coverage for the 1.2 million enrollees. Additionally, they might also eliminate coverage for occupational, speech and physical therapy, and limit enrollees to no more than 15 outpatient procedures and 15 lab procedures in a year. This past Sunday, the Tennessean ran another story titled, ``Bredesen faces painful choices as TN begins budget triage'' which states ``there is no quarrel with the general position that Tennessee State Government faces a grim situation'' and the Governor anticipates that roughly $750 million in cuts will be needed for the next fiscal year. To make matters worse ``state tax collections are already $101.3 million less than assumed when this year's budget was enacted.''

Another article from the Tennessean reported that the State ``might release as many as 4,000 non-violent felons, possibly even including people convicted of drug dealing or robbery, under a plan outlined Monday by the Department of Corrections to deal with the state's budget crisis,'' and Tennessee is not alone in its budget crisis. Even though many States are going through budget crises much like Tennessee, Senator Reid has proposed to as even more costs onto these States. Earlier this month, the National Governors Association released a fiscal survey of the States and an accompanying release, ``The State Fiscal Situation: The Lost Decade.''

That report said:

The recent economic downturn started in December 2007 and

likely ended in August or September 2009, making it one of

the deepest and longest since the Great Depression.

It went on to say:

Medicaid spending, which is about 22 percent of state

budgets, averaged 7.9 percent growth in FY 2009, its highest

rate since the end of the last downturn six years ago.

Medicaid enrollment is also spiking, with projected growth of

6.6 percent in FY 2010 compared with 5.4 percent in 2009.

We don't yet have an estimate from Tennessee of how much Senator Reid's bill will cost the state, but we expect it to be in the ballpark of what the Senate Finance bill would have cost, which according to Governor Bredesen would have cost an additional $735 million over 5 years. Tennessee can't afford to get a $735 million bill from Washington. Not only is it wrong to ask states to pay for expanding this program, but I think it is wrong to dump low-income Americans into a government-run program that is failing.

Medicaid is a program that, if given the choice, none of us would join. A 2002 Medicare Payment Advisory Committee survey found that ``approximately 40 percent of physicians restricted access for Medicaid patients,'' meaning they won't take new Medicaid patients, because reimbursement rates are so low. Only about half of U.S. physicians accept new Medicaid patients, and yet this is how the majority leader proposes we cover the uninsured.

Why is there such an access problem for people on Medicaid? It is because Medicaid reimbursement rates to doctors and hospitals are so low. Medicare pays 80 percent of what the private insurers pay and Medicaid pays about 72 percent of what Medicare pays. Which means if you are a doctor or a clinic, or a hospital, you get paid about 60 percent for serving a Medicaid patient versus one of us who has his or her private health care. You can see why this spells trouble, and the Senate bill does nothing to fix this problem. In fact, by dumping 15 million more people into the program it will only make things worse. Who would want to be one of those 15 million people?

In addition to access problems, the quality of care for Medicaid patients is significantly lower than those with private insurance, and even those with no insurance. According to a survey by the National Hospital Ambulatory Medical Care, Medicaid patients visit the emergency room at nearly twice the rate of uninsured patients, and a 2007 study published in the Journal of the American Medical Association found that patients enrolled in Medicaid were less likely to achieve good blood pressure control, receive breast cancer screening, or have timely prenatal care than similar patients enrolled in private plans. Another study of cancer patient outcomes found that even after adjusting for patients who became eligible as a result of their cancer diagnosis, Medicaid patients have significantly lower survival rates than non- Medicaid patients.

The final example I will give today of why dumping 15 million more people into Medicaid is such a bad idea comes from the Government Accountability Office, GAO. The GAO has determined that the program is plagued by fraud and abuse. In 2009, the GAO labeled Medicaid as a ``high-risk'' program, finding $32.7 billion in improper payments in 2007 alone. That is 10 percent of the program's total spending.

As a former Governor, I am particularly concerned about the impact and expansion of Medicaid would have on the State budgets and the resulting squeeze on higher education spending. When a governor looks at his budget and sees the things he has to pay for like elementary and secondary education, prisons, roads, and Medicaid. Then a Governor looks at the things they want to spend money on like higher education and a Governor, knowing they have to balance their budgets every year, can't spend money he or she doesn't have, so something has to give, and it's usually higher education. As I noted earlier, the New York Times reported Friday that the University of California Board of Regents will raise undergraduate fees 32 percent by next fall to make up for steep cuts in state funding. The article goes on to report that ``The University of California now receives only half as much support from the state, per student, as it did in 1990. Even with the higher student fees, the system needs a $913 million increase in state financing next year to avoid further [budget] cuts.''

From 2000 to 2006, spending by State governments on Medicaid has risen 62.6 percent, because of that higher Medicaid spending; higher education has only seen an increase of 17.1 percent over the same time period. As a result, tuition at a public 4 year university has risen an average of 63.4 percent. So Congress passes a generous Medicaid benefit, and the governors have to pay the bills. Then the governor has to say to our college students: your turn, pay up. Expanding Medicaid is exactly the opposite of real health care reform.

Senator Corker, you were the chief financial officer of the State of Tennessee. You were the mayor of Chattanooga. How would you like it if someone in Washington passes a program and sends you the bill?

I think we are out of time.

The Governor of Tennessee, who is a Democratic Governor, has estimated that the cost to our State of this bill, of moving 15 million Americans into this medical ghetto, is about $800 million over 5 years. In my view, finding that much money would seriously damage higher education, raise tuition in Tennessee like California's, which just went up, or require us to enact a new State income tax, or all of those things at once.

I yield the floor.

Mr. President, I see the Republican leadership in the Chamber. It seems as if every other word we hear coming from the other side is that this vote tonight is historic. I agree, it is historic. But I think my view of why it is historic is a little different from their view.

I wonder if my colleagues would not agree with me that this bill is historic in its arrogance? It is historic in its arrogance to think that we in Congress are wise enough to take this entire complex health care system, that serves 300 million Americans and is 16 percent of our economy, and think we can write a 2,074-page bill and be wise enough to change it all at once. It is historic in its arrogance by dumping 15 million low-income Americans into a medical ghetto called Medicaid, which none of us or any of our families would ever want to be a part of for our health care. It is historic in its arrogance by sending the States, that are going broke, a big chunk of the bill for what we have just done. It is historic in its arrogance because it tells Americans that the bill costs $849 billion and then thinks we are not smart enough to read the print and figure out that the real cost is $2.5 trillion when it actually is implemented. It is historic in its arrogance by telling us that paying for reimbursement for physicians is not an important part of a health care bill. It is historic in its arrogance because it cuts and taxes grandma's Medicare, which according to the trustees will be broke by 2015 to 2017, and then spends it on somebody else other than grandma. The bill is arrogant because its telling us it will reduce premiums for most Americans, when, in fact, it increases premiums for most Americans.

So People say: Where is the Republican health care bill? My answer to that is, don't expect Senator McConnell to come rolling in here with a wheelbarrow with a 2,074-page budget-busting, debt-ridden, arrogant piece of legislation because that is not what we believe in.

What we need to do as a Congress is re-earn the trust of the American people by setting a clear goal of reducing health care costs, showing some humility, and starting to move step by step in that direction. I hope during this hour that we have a chance to talk about the specific steps to reduce health care costs that we Republicans have offered day after day to no avail.

The Senator from Arizona is exactly right.

There is no Senator in the Chamber who has a better record of working across party lines on bipartisan steps in the right direction than the Senator from Arizona. But going to Mr. Samuelson's comment--I was talking to a businessman this morning.

I said: If you had a problem in your company, would the first thing you would do is to tear the whole company down and start over again? Or if the football team had lost two or three games, would you blow up the stadium and run everybody off? No, that is not the way you do it.

The person I was talking to said: What I would do, I would identify the problem, I would test the solution, I would phase it in, and I would make sure we can afford it.

The American people know that. I think they are sitting up there looking at us saying: What are these guys doing? Two-hundred-fifty million of us have health care policies, 85 percent. We would like for the rest of America to have that opportunity too. But we know we can't afford that until we get the costs down.

Why don't we do as the Senator from Arizona suggested, let's move step by step in the right direction to re-earn the trust of the American people by reducing costs?

He said: Why haven't we done that? One of those steps is to allow small businesses to pool their resources and purchase a health plan, which the Congressional Budget Office has said would allow nearly 1 million more employees of small businesses to be covered. Their rates would be lower than they are paying today. It would save $1.4 million of Medicaid. This is what the Congressional Budget Office said. So it would reduce costs, increase insurance coverage, and lower premiums. The reason we are not considering it is because when we brought it up, the Democrats said no. They filibustered it. They didn't come across the aisle and say that is a pretty good idea; let's put that together with two or three of ours, and we will reduce costs.

I say to Senator Bennett of Utah, you have founded a company. You have run a company. If you were having a problem with the cost of a product or some other fundamental problem, is the first thing you would do, is to think you were wise enough to tear the whole thing down and start over again? Or if you called in a consultant and he recommended that to you, what would you say to him?

It sounds right to me. It is another part of the arrogance of this bill, which is to say we are not smart enough to figure it out. The majority is saying the 10-year cost of the bill is $849 billion, but it doesn't start counting until the fifth year, and Senator Reid thinks the American people are not smart enough to figure that out. That is part of the arrogance of the bill.

That is $2.5 trillion, right?

Mr. President, I would say to the Senator from Arizona, that is a part of the problem. But I think of it a little different way. There has been a lot of talk this week about medical care availability for women in America. In Tennessee, in 45 of our 95 counties, there are no OB/GYN doctors. So pregnant women in Tennessee in those counties have to drive 50, 60, 70 or 80 miles for prenatal health care. They might have to check into a hotel for a few days in a big city in order to have their baby.

That is exactly right. In fact, a number of us have offered to the Senate, as a part of the way we would go about reducing health care costs, basically adopting the same kind of provisions they did in Texas which still leaves anyone who is hurt, a complete right to recover from that injury, but makes a major change in the availability of doctors to that patient. And in the case of Tennessee, we were talking about OB/GYN doctors to women who are about to have babies. The Senator from Arizona said that would save at least $54 billion over 10 years. No one doubts that reform of medical malpractice, junk lawsuits against doctors, would reduce costs. The point we are trying to make here is, instead of that historically arrogant 2,074-page bill that presumes we know enough to change every aspect of health care in America, why don't we re-earn the trust of the American people, who have lost a lot of confidence in those of us in Washington, and start taking steps in the right direction to reduce cost? We could do it by adopting our legislation to reduce unwarranted medical malpractice suits. That would be one step.

Mr. President, I would like to thank the Senators from Arizona, Utah, and Idaho. Reading that big bill is very hard to do. So for those who are watching, what we have been trying to do--as Senator McCain and Senator Kyl just did--is take specific provisions and discuss them and interpret them.

We have done that with the higher premiums. We have done that with the higher taxes that the bill will require. We have done that with the Medicare cuts. Earlier today we had an hour discussion, led by Senator Corker, that discussed how the bill would send the costs for Medicaid expansion to States.

We have talked now about what we would do if this bill were to fail, which we hope it does. We think this bill is historic in its arrogance--arrogance that we could turn over this whole system, that we think the American people cannot figure out that the bill costs $2.5 trillion, instead of the $849 billion, as advertised.

What we propose is, we move step by step in the direction of cutting health care costs for individuals and for our government. We have proposed legislation that would reduce junk lawsuits, combat waste, fraud, and abuse, allow small businesses to pool resources to purchase insurance, allow Americans to purchase health insurance across State lines, expand health savings accounts, and promote wellness and prevention.

That is OK as long as it is taken from the Democratic time.

Mr. President, the Republican side should now have 60 minutes; correct?

That will extend until about 2:05.

Mr. President, the debate has begun. The debate is about reducing health care costs--the cost of premiums every American has or the cost to the government that every American has to be responsible for. The bill we have been presented goes in the opposite direction. It raises taxes. It means higher premiums. It cuts Medicare. It transfers major new costs to States which, in turn, will damage higher education and/or increase taxes or both.

Our purpose on the Republican side is to take this next hour, as we intend to take several hours, all the hours allocated to us today and tomorrow, and help the American people have a chance to read the bill section by section, to understand what it costs and to understand how it affects them.

In this next hour, the Senators from Georgia, Mr. Chambliss and Mr. Isakson, and the Senator from Kansas Mr. Brownback, will be focusing on tax increases. We will be referring specifically to page 348, title I, subtitle (f), part 2 of this 2,074-page bill, which has to do with the tax on employers. We believe a great many employers will look at this big bill, look at the tax on them, if they don't pay insurance, look at the new government program and say: It is going to be a lot easier for me to pay the fine and write a letter to the employees and say: Congratulations, I have written a check to the government. You are on the government plan.

Then we will go to page 2,040 of the bill, which is the new Medicare payroll tax. That is a tax on hiring. You heard that right, a tax on hiring in the middle of a 10-percent unemployment situation. How is that going to create any jobs? We don't think it will.

Then Senator Chambliss, especially, and Senator Isakson, because of his background as a small businessperson, will talk about what Republicans want to accomplish. If you are waiting for the Republican leader to roll in a wheelbarrow with a 2,074-page Republican version of health care reform, you will never see it. We don't believe in that. What we do believe in is identifying a goal--reducing the cost of your premium, reducing the cost to the government, and then going step by step toward that goal; for example, by reducing junk lawsuits, by allowing small businesses to pool their resources to purchase insurance, which we have offered but the Democrats will not allow to come forward, and by allowing people to purchase health insurance across State lines. Senator Chambliss and others of us will talk about this during the next hour.

That is the Republican plan, to do what most Americans want done, to reduce the cost of premiums, and to not increase premiums and taxes, or cut Medicare.

There is one hidden tax I wish to talk about because it is in the bill, and it is in the news. Most Americans may have seen that the University of California yesterday raised tuition 32 percent. There are, in our country, around 18 million students who are in higher education. What I wish to say to them is, if this bill passes, their tuition is going up. California's tuition is going up again. It is going up in Tennessee. It is going up in North Dakota, in Nebraska, in Georgia, everywhere there is a public college, university, or community college there are going to be new taxes or higher tuition or both.

In California right now, they are pointing fingers at each other about the 32-percent tuition increase. But they should be pointing the finger at us, Washington, DC, Congress, because it is we who have allowed the Medicaid Program, the largest government-run program we have in the country, to go year after year with increases of 7 or 8 percent. We require every State, if it opts in, to have a government- approved Medicaid Program. In our State, it is called TennCare. That Medicaid Program is helping bankrupt the States.

Here is a State of Tennessee headline: ``State looks at $1 billion in cuts.'' Part of that is from the recession. But part of that is because of the increased cost of Medicaid. What does this bill do? It sends to the States another $25 billion in increased Medicaid costs. What will that mean? Higher tuition rates, higher taxes, or both. The University of California has the reputation as the best public university in the world. It will not be that very long if the Congress of the United States doesn't rein in Medicaid and reduce its cost so Californians can afford to have both a health program and a fine university system. The Governor of Tennessee has said the same thing. He has been outspoken about this. He has talked about exactly the dollars it will cost us. In the House bill, it is $1.4 billion over 5 years. In my view, I don't see how the State of Tennessee can pay that without a big State tax increase or without damaging higher education or both.

Someone might look at this and say: What does health care have to do with a 32-percent tuition increase in California? It has everything to do with it. Instead of reining in Medicaid, we are expanding Medicaid. By doing that, we are making it impossible for virtually every State to properly support higher education. The only choice they have, other than taxes, is raising tuition for 18 or 20 million students across the country. Californians, if this bill passes, your tuition is going up one more time.

I call on the Senator from Georgia, Mr. Isakson. He spent a number of years as the leader of the Republicans in the Senate. He dealt with the Medicaid question. He dealt with the question of taxes. As a small businessman for most of his life, he understands well the impact of new taxes on hiring and mandates on businesses.

I wonder if the Senator would yield for a question?

If the employee were eligible for the Medicaid Program in Georgia and lost employer insurance and went into the Medicaid Program, isn't it true that the employee who went into the new government plan under this bill is likely to pay a higher premium and have a harder time finding a doctor?

Mr. President, I thank the Senator from Georgia. I am going to throw the question right back to Senator Isakson in just a minute.

I appreciate Senator Chambliss taking time to point out what Republicans are for because it seems as if no matter how many times a day we say it, our Democratic friends do not hear it.

Let me put it this way: Let's say Senator Isakson, who has been a small businessman, buys a new small business. He takes it over, and he sees that generally it is working pretty well but

it has some problems with it. I wonder if the first thing he would do is come in and say, I tell you what, let's just turn it all upside down and change it all, or would he say, let's identify the problem, and let's take a few steps in the direction of fixing that problem.

What Republicans are saying is, we have a big health care system that in general works pretty well. Mr. President, 250 million of us have health insurance plans; 47 million do not. Senator Chambliss has just pointed out who those people are. Thirteen million or 14 million are already eligible for plans and for one reason or another do not sign up. A few million are illegally here. Some others are young and think they are invulnerable and do not sign up. But we are saying the problem is the cost, people cannot afford to buy their own insurance, the government cannot afford its health care costs, and people are going broke over this. So we want to reduce the cost.

Senator Chambliss identified this step-by-step approach. He mentioned reducing junk lawsuits against doctors. We have proposals for that. Combating waste, fraud, and abuse--we have introduced legislation for that. Senator Isakson talked about allowing small businesses to pool their resources. Additional ways to reduce cost is allowing people to purchase insurance across State lines, so you can shop for more insurance and reduce your cost through competition, and amending the health savings account laws so you can withdraw your money in a tax- free way to pay for your insurance premium, and encouraging wellness and prevention. We could take those six steps, reduce costs, and then take six more.

I wonder, Senator Isakson, with your experience in business, if you think it makes any sense for us to just come in here and say: OK, we are really smart here in the U.S. Congress. This is a big country, with 300 million people. We are just going to turn the whole health care system upside down, write a 2,074-page bill, change the premiums, raise the taxes--do all these things--or would you go step by step in the right direction and try to re-earn the confidence of the American people who have lost a lot of confidence in Washington, DC?

I say to Senator Chambliss, one of the most difficult issues I think for many Americans who are watching what we are doing is the plan to cut Medicare. The new bill goes a step further. The way I read it--and I indicated the sections in the bill a moment ago--we are not only cutting Medicare, we are going to tax Medicare. Then we are not even going to spend the money on Medicare. In other words, we are going to cut grandma's Medicare, tax grandma's Medicare, then spend grandma's money on somebody else, and grandma's Medicare is going broke in 3 or 4 years, according to the Medicare trustees.

It must be a little confusing to the American people. I mean, one day Senator Reid comes out and, a big hurrah, we are going to reduce the deficit and we are only going to spend $800 billion, and then the next day Republicans come out and say, No, when the program gets going, it is $2.5 trillion over 10 years. I wonder if I could say to the Senator from Georgia, while we have heard you talk about these projections, the senior Republican on the Joint Economic Committee has come to the floor, the Senator from Kansas.

How do you explain this to people in Kansas, Senator Brownback, who must be very confused by this back and forth?

I wonder if I could ask the Senator from Kansas, haven't we heard this story somewhere before? As I remember, back in the late 1960s there was a so-called millionaires' tax. We were going after 155 very rich people in America who weren't paying any taxes and now we call it the alternative minimum tax, and if we don't fix it every year more and more people will end up paying this tax. I think last year there were 28 million Americans who would have had to pay the tax.

I wonder if I might ask Senator Isakson from Georgia, we talked a little bit about his experience as a small businessman. Senator Brownback has talked about taxes and how they are going to go up. According to the Republican Budget Committee analysis, the new taxes in this bill that we have on our desks would be about $850 billion over a 10-year period of time. Senator Isakson has been a small businessperson. Some of those taxes would be on you. Who is going to pay the taxes?

As we were discussing earlier, it could be paid out of the pockets of the 18 million or 20 million students who go to, for instance, the University of Kansas and Kansas State. We began this discussion by pointing out that California raised tuition yesterday 32 percent for its students. They are pointing fingers at each other, but they should be pointing at us for not reining in Medicaid because over time that is the biggest reason.

I have a question I will ask any of the Senators who want to comment. Someone asked me yesterday: Where is all this opposition to these health care bills coming from? We have seen the Gallup poll and the Pew poll. These are not Republican Polls. They are well-respected polls in this country that are showing that independent voters, by 2 to 1, say they don't want this bill.

I have been in and out of politics for many years. I have never had as many people stop me on the street or in the airport or wherever, and say, ``Please don't do this.'' Somebody asked me yesterday: Why is there that much opposition?

My answer was--and this is what I would appreciate comments on--this is not just about health care. This is, as President Obama said one time, a proxy for a national debate about the role of government in Washington and in everyday American life. This is about the stimulus package, about the Washington takeover of car companies. This is about the growing debt; this is about the takeover of student loans; this is about every Washington takeover, and every increase in debt. That is what this debate is about. I think that is why we are seeing such intensive opposition. I wonder if you have any reflection?

I am afraid our time is almost up.

I thank Senators Brownback, Chambliss, and Isakson. I think all four of us want the American people to know above all that we have repeatedly said that instead of 2,000-page bills that raise taxes, raise premiums, cut Medicare, and transfer costs to States, we would rather identify the goal of reducing costs and go step by step toward that goal. We have introduced specific legislation to take those steps, which could be bipartisan, such as allowing small businesses to pool their resources to purchase insurance, that Senator Isakson talked about, and reducing junk lawsuits, as Senator Chambliss talked about, and allowing competition across State lines. We have our step-by-step plan.

We believe the American people have lost confidence in Washington and that they would prefer that we go step by step in the right direction to reduce costs and re-earn their trust rather than pass a 2,074-page bill that will bankrupt the country.

I yield the floor.

Mr. President, I wonder if you could let me know when I have consumed 9 minutes.

Thank you, Mr. President.

Mr. President, I was listening to my friends on the Democratic side. I wish they could have been in the Senate 4 or 5 years ago. Actually that would have reduced our numbers, so as much as I like them, I would not have wished that. If they had been here, they might have been some help in arguing to the Democrats who blocked Miguel Estrada from even having an up-or-down vote, who blocked Judge Pryor of Alabama from having an up-or-down vote. The Democrats at that time seemed to argue a completely different point of view.

What we want on the Republican side is very simple.

You see this bill I am leaning against? This is the new bill. This is the Harry Reid--the distinguished majority leader's health bill. We want to make sure the American people have a chance to read it and they have a chance to know exactly what it costs and they have a chance to know exactly how it affects them. That is not

an unreasonable request, we don't think. That is the way the Senate works. That is our job.

When it came to the Defense authorization bill, we spent a couple of weeks doing that. When it came to No Child Left Behind, the Education bill, we spent 7 weeks going through it, and neither of those bills was 2,074 pages long. The Homeland Security bill took 7 weeks. The Energy bill in 2002 took 8 weeks. A farm bill last year took 4 weeks. So we have a little reading to do, a little work to do. We have done some preliminary reading, but what we want to make sure of is that the American people read the bill, know what it costs, and know how it affects them because health care is a very personal matter.

I have done some reading since the bill came out last night. I was also a little bit amused to hear our friends complaining about how we are slowing things down. Well, this bill has been hidden in the majority leader's office for 6 weeks. He wouldn't let any of us read it. I don't know who he has been in there with writing it, but I guess it takes a long time to write a 2,074-page bill. But he didn't bring it out until last night, and now we have it printed out. Now he wants to vote on Saturday.

Well, that is all right with us if he wants to vote on Saturday or Sunday or Monday or Thanksgiving Day. We are going to be here because these are the most important set of votes we are ever likely to take in this body, at least during the time I am here.

Let me give a preliminary report to the American people in terms of the Thanksgiving spirit about this bill. It came out with a lot of fanfare. It has been hidden in the majority leader's office for 6 weeks, but here is my early verdict in terms of the Thanksgiving season. This is the same turkey you saw in August, and it is not going to taste any better in November. It is not much different than what worried you in August. In fact, it has gotten a little bit worse.

If I may, let me give just a few thoughts about the bill. Why would I say it is the same turkey you saw in August, and you didn't like it in August? Well, it is still going to have higher premiums for you to pay. It is still going to have higher taxes for you to pay. There are still going to be big Medicare cuts for seniors to absorb in their program. And while it is a little too early to tell, there is very likely to be more Federal debt. It is still a big bill--more than 2,000 pages--and if you wait until it is fully implemented, it is still somewhere between $2 trillion and $3 trillion over a 10-year period of time.

The Republican Budget Committee staff has looked it over carefully since last night and says it is about $2.5 trillion in spending over 10 years. It still starts taxing you and cutting your benefits immediately if you are on Medicare, but the benefits that come to you for the most part don't start until 2014.

Let me be a little specific about it. It still leaves 24 million Americans uninsured, although it reduces the number of uninsured Americans by 31 million according to the Congressional Budget Office. It still doesn't take care of the physicians reimbursement. One of the most difficult issues we have is what we should do about the amount of money we allow doctors to make when they see patients who are in the government programs. In the Medicare Program, doctors only make about 83 percent of what they would be paid if they were seeing the 177 million of us who have private insurance. We regulate that. Doctors who see Medicaid patients, about 60 million patients in the low-income government program, only get paid about 63 percent, which is set by the state, of what they would get paid if they saw somebody who has a private policy. In fact, 50 percent of doctors will not see new patients in the biggest government program we have--Medicaid. So as you can imagine, a lot of doctors can't see the people in the government program.

This new bill takes care of the doctors reimbursement for only 1 year. It leaves out about $250 billion over the 10-year period of time, so add that in when you are figuring out whether this adds to the debt.

Does it have higher premiums? Yes, it does. The Congressional Budget Office says the new government plan in this bill would have premiums that are higher than private plans. Your common sense would also tell you that, because if we have $800 billion in new taxes somebody is going to have to pay those taxes. If they are on medical devices or insurance policies, do you think the insurance company is just going to pay those taxes? No, they are not. They are going to pass those on to you in the form of premiums. So higher taxes mean higher premiums.

There is also $28 billion in new taxes from employers who have to pay a fine when they don't provide employer-based insurance. Under this bill, the chances are very good--in fact, the Congressional Budget Office says maybe 5 million Americans will lose their insurance. How could they lose their insurance under a bill such as this? The reason would be that the employer will read this big, complicated thing and say: I don't want anything to do with that. I will pay the fine. I will write a check to the government. Then I will write a letter to all of my employees and say: Congratulations, there is a new government plan, and you are in it.

That is going to happen to millions of Americans who have private insurance today through their employers. The employer is going to simply say it is cheaper for them to pay the fine. It is easier for them to pay the fine than deal with this 2,074-page bill.

According to the Congressional Budget Office, 5 million Americans-- and others think many millions more--will lose their employer-based insurance, and they will end up in the government plan. I just said in the government plan, the largest one we have, Medicaid for low-income Americans, 50 percent of doctors will not see those patients--new patients--because of the low reimbursement rates. The bill still relies on the States to pay for some of Medicaid. That is not new either. That concerns me greatly as a former Governor. Our current Democratic Governor said the bills he had seen so far would add over $1 billion to State taxes or spending over the next 5 years which, in my way of thinking, would require a new State income tax that would seriously damage higher education or both.

In other words, we are saying give us a pat on the back. Thank you very much for expanding Medicaid, and I am going to send some of the bill to the States and let the States either raise college tuition or raise taxes or cut spending or put in new taxes to pay for it.

There is also a new Medicare tax. The money that is raised from that, the Medicare payroll tax, is not spent on grandma, not spent on Medicare; it is spent on a new program. So we are going to cut Medicare and tax Medicare and not spend it on Medicare, which is going broke in 2015, according to its trustees. We have a new government program. Those are new. But, basically, it is still the same turkey you didn't like in August, and it is not going to taste any better at Thanksgiving dinner on Thursday.

We need to start over. We need to go in the right direction. We need to cut costs. Republicans have offered a number of ways to do that: small business health plans, reducing junk lawsuits against doctors, competition across State lines. All of these steps would cut costs. We don't need a 2,074-page bill. We need to take it step by step in the right direction to cut health care costs, and when we take those five or six steps, we can take five or six more.

I thank the President and yield the floor.

Mr. President, I would like to acknowledge the service of Senator Byrd, the senior Member of the Senate who, today, will become the longest serving Member of the U.S. Congress ever in our Nation's history.

When I first came to this body as a young aide to Senator Howard Baker 42 years ago, Senator Byrd had already been here as a Senator for 10 years. He had been in the Congress 6 more years than that.

I remember when he, Senator Baker, was elected majority leader and Senator Byrd was the Democratic leader, Baker went to Byrd and said: Bob, I have a proposal for you. I will never learn the rules as well as you know them, so I won't surprise you if you won't surprise me.

Senator Byrd said to Senator Baker: Howard, let me think about it.

So he thought about it overnight, came back, and that was their deal the next day, and that is the way they worked for 4 years in managing this Senate. Senator Byrd and Senator Baker both read David McCullough's book. Senator Byrd told me it changed their minds about the Panama Canal in 1980 in a decisive decision that was controversial in the Senate. I worked with him and the late Senator Kennedy, whom the Presiding Officer succeeded, on American history, and we have legislation pending which I hope we will pass when we reauthorize the Elementary and Secondary Education Act consolidating all the Federal Government's activities to encourage our children to learn U.S. history so they will know what it means to be an American.

Senator Byrd now more than ever is a part of that history. He is an indispensable Member of this body. He teaches us as well as serves with us and we honor him for his service.

I yield the floor.

Mr. President, will you please let me know when 8 minutes has elapsed?

I, too, see the Secretary of Interior on the floor, who formerly was a Member of this body. We miss him. We are glad he is here. We are glad he is taking care of the treasured landscapes of America.