Floor Statements

Mr. President, it is always a privilege to hear the assistant Democratic leader, who is one of the most skillful orators in the Senate. In this case, he needs to be because he is put in the awkward position of having to defend, as I heard him, 1,000-page bills and Medicare cuts, which is an awkward place for the assistant Democratic leader to be.

As far as the Republican plan, he has heard our plan many times. We want to reduce costs. Instead of 1,000-page bills and changing the whole system and adding to the debt and cutting Medicare and raising premiums for millions of Americans, we would like to say our goal is to reduce costs--costs to you when you buy your health insurance and the cost of your government. We would like to go step by step in the right direction, which we say is reducing costs and re-earning the trust of the American people, and then we can take some more steps. We have offered a number of proposals to do that, none of which have been seriously considered.

For example, small businesses should be able to pool their resources the way big businesses can. If they could, they could afford to offer insurance--it has been estimated by the Congressional Budget Office--to millions more Americans. We should make a serious effort to eliminate junk lawsuits against doctors, which everyone agrees adds costs to the insurance premiums we buy and to the cost of health care.

We could allow Americans to purchase insurance across State lines. We could create health insurance exchanges so if you are buying an individual policy, you could buy that more easily. We can go across party lines to encourage the use of more technology. Almost all Republicans and I imagine some Democrats would like to change the incentives behind health spending, so we take the money we are using to subsidize health insurance now and spread it more equitably among all the people and allow them to buy more of their own insurance.

Those are five or six steps we could take in the direction of cutting costs. Instead, what we are presented with is, yes, another 1,000-page bill. We have some questions about the bill because it appears--we know it will cut your Medicare, and I want to go back to that in a moment-- half the bill will be paid for by Medicare cuts. Forty million seniors depend on Medicare. Are we going to cut grandma's Medicare? We are not even going to spend it on grandma. We are going to spend it on a new program, at a time when the trustees of the Medicare Program have told us Medicare is going to go broke between 2015 and 2017. We are going to raise your taxes.

That is what the bill coming toward us would be. We are going to make it hard for your States to support colleges and education or raise your State taxes because we are sending the bill to them for a large Medicaid expansion. For millions of Americans, we are going to increase your premiums. We are going to make it more expensive for you to buy the same kind of policy you already have because the government is going to tell you exactly what kind of policy you should have. We are going to increase your Federal debt because the plan, as we hear about it, does not have any provision for paying doctors serving Medicare more over the next 10 years--which we always do--so that is another $285 billion on your debt, just if we pay doctors 10 years from now what we pay them today for the government-run programs. We are going to spend another $1 trillion. And, yes, it is a 1,000-page bill.

So we what we are saying is, we have had before this Senate for a long time a number of proposals we could use to reduce your cost when you buy health insurance and reduce the cost of your Federal Government, which is going broke because of health care expenses, but they are not being seriously considered. So we are saying, at least if you are going to come up with these 1,000-page bills to change our entire system, we want to read it and we want to know what it costs. Even the President has said we cannot add one dime to the deficit. How can we know we are not adding one dime to the deficit if we cannot read the bill and we do not know what it costs?

Senator Bunning of Kentucky brought up that in the Finance Committee the other day, and the Democrats voted it down. They said you cannot even put the bill up for 72 hours--this 1,000-page bill--so we can find out if it cuts your Medicare, if it raises your taxes, if it bankrupts your State, if it increases your premium, if it increases the Federal debt. We cannot even find that out. They said: No, not even 72 hours.

Well, some Democratic Senators have taken a look at that and said-- the Democrats who voted that down; and every vote against the 72-hour provision was a Democratic vote--they said: We do not agree with that. Eight Democrats have written Senator Reid, and they said: The legislative text and the complete Congressional Budget Office scores of the health care legislation, as amended, should be made available to the public for 72 hours prior to the vote on the final passage of the bill in the Senate. Further, the legislative text of all amendments filed and offered for debate should be posted on a public Web site prior to beginning debate on the amendment on the Senate floor. The conference report ought to be as well.

I think what that means, in plain English, is that once the Finance Committee bill--which is not a bill now; it is just concepts--goes into Majority Leader Reid's office, and he puts it together with the HELP Committee bill, which will be turned into legislative text, we would like for that to be on the Internet for 72 hours so we in the Senate and our staffs and the American people can read it.

Second, we want to make sure the Congressional Budget Office has a chance to read the entire bill so some staff member does not change it in the middle of the night, as they apparently did with the HELP Committee bill, and we can know exactly how much each of the provisions cost, and then we can start voting, then we can offer our amendments. As the Republican leader was saying today, some of our amendments are going to have to do with Medicare, the program that 40 million seniors depend on.

Let's be clear about this. Some things are facts. Half the bill is going to be paid for by Medicare cuts. Half the bill is going to be paid for by Medicare cuts. You can call them anything you want to, but they are Medicare cuts.

The second thing about it is, it may be grandma's Medicare we are cutting, but we are going to spend it on somebody other than grandma. We are going to take that money out of the Medicare Program, which is a $38 trillion unfunded liability and which the trustees say is going to go broke in 2017 and which 40 million Americans depend on, and we are going to take those savings and we are not going to spend it to make Medicare stronger; we are going to spend grandma's Medicare benefits on somebody else. We are going to cut her benefits and spend it on you. Does that make sense? We don't think so. We don't think so. We don't think we should be paying for this new $1 trillion bill by writing a check, as the Senator from Kansas has said, on an overdrawn bank account and buying a new car, which is what that turns out to be.

The Republican leader talked about what the cuts are to Medicare Advantage: $140 million. One-fourth of seniors on Medicare have Medicare Advantage accounts. Cuts include $150 billion for hospitals that care for seniors; $40 billion, home health agencies; $8 billion, hospices--all from Medicare to be spent on something else.

The President said people who are currently signed up for Medicare Advantage are going to have Medicare at the same level of benefits. Well, we want to read the bill and know what it costs because that is not what the Congressional Budget Office Director said. He testified that seniors under Medicare Advantage would have benefits that disappear under the bill that is coming out of the Finance Committee. He said those changes would reduce extra benefits such as dental, vision, and hearing coverage that currently are made available to beneficiaries.

We want to read the bill. We want to know what it costs. We want to know why we are cutting Medicare by $\1/2\ trillion--that is the first question--and the second question is, Why are we spending that money on something else when it ought to be spent on making Medicare stronger? The bill has $\1/2\ trillion in savings from Medicare. At least they could take that money and use it toward the money we pay to physicians. I mentioned it a little earlier, but every year physicians say: The government-run program of Medicare only pays us 80 percent of what private insurance plans pay us, and you are about to cut that. So we almost always, on a bipartisan basis, put it back up. That is not in the bill. We don't even include that. We don't take that into account. So that is going to add to the debt.

Then there are other questions we have in addition to the Medicare cuts. What about the elegantly called ``doc fix'' that will add to the debt? It is the Medicaid Program. To some people, that may get a little confusing. Medicare is for seniors. Medicaid is the program that usually has a different name in most States. It is a program that started years ago, and the Federal Government pays 40, 45 percent of it and the States pay the rest. It has been going straight to the Moon. According to the New York Times, costs are rising in Medicaid this year at record rates--7.9 percent.

I know as a former Governor, here is what really happens. You sit there making up your budgets, and you do the part for prisons and you do the part for kindergarten through the 12th grade and the part for highways and the part for State parks, and then the rest of the money is usually split between higher education and Medicaid. Guess what is happening. Medicaid goes up and higher education doesn't get the money. Then what happens? College tuition goes up because colleges such as the University of Tennessee and Texas and New Mexico and Colorado are underfunded today primarily because of increasing Medicaid costs.

What this bill does is dump a lot more low-income Americans into that Medicaid Program and send a lot of the bill to the States. The Governor of Tennessee, a Democrat, said in the morning paper that it is going to cost us $735 million at least--maybe over $1 billion--over the next 5 years. Tennessee can't afford that. Tennessee is a conservative, well- managed State. Governor Schwarzenegger has said that in California it could be up to $8 billion. California is already nearly bankrupt. The Democratic Governor of Michigan has said he doesn't see how they can pay for this. The Governors of every State have said to us: Mr. Senator, Mr. Congressman, if you want to expand Medicaid, if you want to expand Medicaid, pay for it; pay for it in Washington, don't send it to us.

So we are looking forward to reading this bill. We are looking forward to knowing what it costs. We have our proposals. I will be glad to spend some time on the floor with the assistant Democratic leader and talk with him about the Republican proposals to take us step by step toward reducing health care costs, first for you and your premiums and next for your government, and why we are skeptical of this 1,000- page bill. But we at least want to know what it costs. We at least want to know why it is cutting Medicare by half-trillion-dollar, and if it is being cut, why is grandma's Medicare cut being spent on some new program. We would like to know how much does it raise your taxes. We would like to be able to tell you what it is going to do to your State's education system and to your State taxes. We would like to be able to tell millions of Americans: Will this really raise your premiums instead of lowering them and will it really increase your Federal debt?

So we are grateful eight Democratic Senators have joined us in saying to the majority leader: Let's make sure this bill is finally a bill that will give us all the language before us, that it is on the Internet for 72 hours, and that we know exactly what the provisions cost--all of that before we have our first vote.

I thank the President, and I yield the floor.

Mr. President, would the Chair let me know when 9 minutes has expired?

Mr. President, a lot of what we say in Washington, DC, doesn't make its way through to the people out across the country who hire us. It is called, in different words, Washington-speak or gobbledygook by some people. Sometimes we have a hard time understanding ourselves. But one thing has gotten through to the American people: the idea that we should, No. 1, read the bills that come before us and, No. 2, we should know what they cost before we vote on them.

I think the reason for that is because, over the last several months, we have suddenly seen a whole series of Washington takeovers and 1,000- page bills and the people in this country are getting worried about a runaway Federal Government, thinking we may be overreaching here. We had a 1,200-page bill in the House of Representatives on energy and global warming. It was available for 15 hours before the vote. We had a stimulus bill--that was $800 billion, not counting interest--that was 1,100 pages and was available online for 13 hours. We had a $700 billion bailout, called the financial sector rescue package, which was available for 29 hours. The other day in the Finance Committee, Republicans said let's put the bill online for 72 hours. That was voted down by the Democratic members of the committee.

What we Republicans would like to say is this: We want health care reform. We have our ideas and suggestions that we have made. We think we should focus on reducing costs, that we should go step by step in that direction, starting, for example, with allowing all small businesses to pool together so they can offer health insurance to their employees at a reasonable cost. The estimates are that millions more Americans would be able to get health insurance from small businesses.

We have other suggestions for reducing costs. But the first thing we would say is, as this bill comes to the Finance Committee--and I see the Senator from Delaware and the Senator from Texas, who are both members of that Finance Committee--we want to be able to read the bill and know what it costs. Over the next 3 weeks, we hope, on the Republican side, to help the American people understand what this health care bill means for them. You hear lots of competing claims about it--it does this or that, and we are scaring you or they are scaring you. Let's take it one by one.

If we have time to read the bill, and we know what it costs--the President said this bill cannot have a deficit. If we don't know what it costs, how can we do what the President wants us to do? I hope we take a sufficient amount of time. The bill is in concept form now, and then the majority leader will take it into his office and merge the Finance Committee bill with the bill that we on the HELP Committee worked on in July, and out of that will come another bill. We will need the CBO to look that bill over, which I am sure will be well over 1,000 pages. It will take a couple weeks to see what it costs. Then we can work on it.

Why is it so important that we actually have the text of the bill and know what it costs? Because the bill has $\1/2\ trillion in Medicare cuts in it. On the other side, they say: Don't say that; you are scaring people. Well, it either has it or not. We say it has it. The President said there will be Medicare savings. The truth is, it is worse than that. What it appears to be is we are going to cut Grandma's Medicare and spend it on somebody else. There may be savings in Grandma's Medicare, but, if anything, we ought to spend any savings on making Medicare solvent because the trustees of Medicare have told us it will go broke in 2015 to 2017. So the people have a right to know will there be cuts to hospitals, hospices, home health, to Medicare Advantage. One-fourth of seniors on Medicare have Medicare Advantage, and it is going to be cut.

We need ample time to say: What do those cuts in Medicare mean to you? Will the bill raise your taxes? We say it will; some say it will not. But from our reading of the bill, it looks like there will be at least a $1,500 tax per family, if you don't buy certain government- approved insurance. There is the employer mandate requiring you to provide insurance. That is a tax. There are $838 billion of new taxes on insurance companies, medical device companies, which will be passed on to consumers. That is a tax.

The Presiding Officer was a Governor, as I was. He was chairman of the National Governors, and many Governors are very upset because we are expanding Medicaid in their States and sending a large part of the bill to them. So that could be more State taxes.

Now we hear from the Governors. There was an article in the Washington Post yesterday, and I ask unanimous consent that it be printed in the Record following my remarks.

The article says: ``States Resist Medicaid Growth. Governors Fear For Their Budgets.''

The Tennessee Governor--a Democrat--said:

I can't think of a worse time for this bill to be coming.

I'd love to see it happen. But nobody's going to put their

state into bankruptcy or their education system in the tank

for it.

The Governor of South Dakota said:

That's a heck of an increase, and I don't know how I'm

going to pay for it.

The Governor from Ohio said:

I have indicated that I think the States, with our

financial challenges right now, are not in a position to

accept additional Medicaid responsibilities. Governor

Schwarzenegger of California said it will add up to $8

billion to California, and California is nearly going broke

anyway. Senator Feinstein said she cannot support a bill that

puts that kind of additional tax on States.

Basically, it is the old trick of we in Washington saying here is a great idea, we will pass it, and send part of the bill to the States. What will the States have to do? They will have to cut the money that goes to the University of Texas or Delaware or Tennessee. They have to raise taxes, or they cannot cut benefits because cutting benefits is against the law.

So how much will these Medicaid mandates cause taxes to be raised in your State?

There are other questions we would like to ask. Will this bill raise your insurance premiums? The whole point of this exercise, we think-- and a lot of the American people think--is we want to reduce costs-- costs to you when you buy your health insurance and costs to your government. Your Federal Government is going broke if we don't do something about rising health care costs, just as you might.

You would think this bill would reduce your costs--to you for premiums and to you for your government. But that is not what the CBO says. It says that, in some cases, premiums for exchanged plans would include the effect of these new taxes and the premiums would increase. Then there will be more government-approved insurance plans, which may turn out to be more expensive for you to buy. In other words, you would not be able to buy the plan you now have. You will have to buy a new government-approved plan that will cost more.

There will be higher premiums for young Americans under this bill. Almost everybody thinks that. So we

need to have a full discussion over the next 2, 3 or 4 weeks. Is this going to raise your health care premiums? If so, why are we doing that? Then, is it going to raise the Federal debt? Well, everybody is saying no, no, no, this will be deficit neutral. The President says: Don't send me a bill without it. Except this bill, as we understand it, doesn't include what we elegantly call the doc fix. Every year, we have to approve, or overturn, provisions in the law for that.

I thank the Chair. Those are provisions that set the payment rates for physicians. We always do that. We know we are going to do it. We do it every year. Yet this bill assumes we are not going to do that. If we do include the doc fix, that adds $285 billion to the debt.

We are going to be asking these questions. Please give us the text so we can read the bill. We are going to ask the CBO: Exactly what does it cost? Then we will be coming to the floor and going to town meetings at home and we are talking to the American people about how this affects them. Does it cut your Medicare? If so, how? Does it raise your taxes? If so, how? Will it bankrupt your State or hurt education in your State? If so, how? Does it increase or reduce your health care premiums or add to the Federal debt of your government?

These are the questions we need answers to, and we are looking forward to the debate; and then we are looking forward to passing health care reform that, step by step, begins to reduce the cost of health care to you and your government.

I yield the floor.

Exhibit 1

[From the Washington Post, Oct. 5, 2009]

States Resist Medicaid Growth

(By Shailagh Murray)

The nation's governors are emerging as a formidable

lobbying force as health-care reform moves through Congress

and states overburdened by the recession brace for the

daunting prospect of providing coverage to millions of low-

income residents.

The legislation the Senate Finance Committee is expected to

approve this week calls for the biggest expansion of Medicaid

since its creation in 1965. Under the Senate bill and a

similar House proposal, a patchwork state-federal insurance

program targeted mainly at children, pregnant women and

disabled people would effectively become a Medicare for the

poor, a health-care safety net for all people with an annual

income below $14,404.

Whether Medicaid can absorb a huge influx of beneficiaries

is a matter of grave concern to many governors, who have cut

low-income health benefits--along with school funding, prison

construction, state jobs and just about everything else--to

cope with the most severe economic downturn in decades.

``I can't think of a worse time for this bill to be

coming,'' said Tennessee Gov. Phil Bredesen (D), a member of

the National Governors Association's health-care task force.

``I'd love to see it happen. But nobody's going to put their

state into bankruptcy or their education system in the tank

for it.''

These fears are resonating with members of Congress and

have already yielded some important legislative changes,

including alterations to the Senate Finance bill, which

includes billions of dollars in additional funding, added

after governors raised a fury about the original, lower sum.

But House and Senate negotiators are reluctant to make

further concessions, and in recent days, House Democrats have

debated whether to trim Medicaid funding in their bill to

make room for other priorities.

Yet lawmakers are wary about imposing a huge new burden on

an imperfect program that serves one of the most challenging

segments of the population, through a fragmented network of

state-run systems.

Among the 11 million people the nonpartisan Congressional

Budget Office estimates will sign up for Medicaid under the

new rules, many are single adults and parents who have gone

for years without health coverage. Many of these individuals

also live in communities that lack the services to treat

them.

``States are already at a breaking point, and so they

should be thankful that this bill is only going to cost them

an additional $30 billion,'' Sen. Charles E. Grassley (Iowa),

the ranking Republican on the Finance Committee, told

colleagues during the panel's two-week-long debate on reform.

But Grassley added: ``We are deluding ourselves, though, if

we think that we are going to do anything in this bill to

make Medicaid a better program for the people it serves.''

The response from Democratic governors to the new burdens

that may be imposed on them has ranged from enthusiastic to

restrained. On Thursday, the Democratic Governors Association

delivered a letter to House and Senate leaders signed by 22

of its members. It was silent on Medicaid but lauded the

broader reform effort as essential. ``We recognize that

health reform is a shared responsibility and everyone,

including state governments, needs to partner to reform our

broken health care system,'' the letter noted.

Yet congressional Democrats are sufficiently alarmed about

the potential impact that they already are seeking special

protections for their states. Even Senate Majority Leader

Harry M. Reid cut a deal with Senate Finance Committee

Chairman Max Baucus (Mont.) to ensure that the federal

government would pay the full cost of expanding Medicaid in

Reid's state, Nevada.

Reid, who faces a potentially difficult 2010 reelection

bid, responded to a Republican outcry over his stealth move

by pointing to Nevada's crippling foreclosure crisis. ``I

make no apologies, none, for helping people in my state and

our nation who are hurting the most,'' Reid said on the

Senate floor.

Among the most vocal opponents of Medicaid expansion are

Republican governors from Southern and rural Western states

that offer minimal coverage under current law and are less

equipped to handle an influx of new beneficiaries, compared

with more urban states with better-established social-

services infrastructures. The list includes Mississippi,

governed by Haley Barbour, chairman of the Republican

Governors Association. Barbour denounced the proposed

Medicaid expansion at a news conference last month as a

``huge unfunded mandate'' likely to result in state tax

increases.

The wake-up call for the nonpartisan National Governors

Association came early in the summer, when Baucus and

Grassley announced that they were considering only a

temporary increase in federal funding to pay for new Medicaid

enrollees. NGA leaders mobilized through their health-care

task force, and after a round of conference calls with

committee negotiators and bilateral talks between individual

governors and senators, the temporary increase was made

permanent.

Governors still worry that the boost is not enough to fully

close the funding gap. Recession victims already are flocking

to Medicaid, and enrollment is expected to rise through

fiscal 2010, according to the Kaiser Family Foundation's

Commission on Medicaid and the Uninsured. The pace of

increase is expected to ease after fiscal 2010, leaving

states with a short window before an anticipated onslaught in

2014, when the proposed Medicaid expansion would take effect.

South Dakota Gov. Mike Rounds (R) saw Medicaid enrollment

in his state climb to 104,000 residents this year, costing

the state $265 million out of a budget of $1.2 billion. But

he expects a $50 million increase next year, and, even taking

into account federal aid from the economic stimulus bill,

South Dakota faces a $100 million shortfall. ``That's a heck

of an increase, and I don't know how I'm going to pay for

it,'' Rounds said.

Bredesen said Tennessee could face $1 billion in extra

Medicaid costs for the first five years of the expansion. ``I

have no idea how we're going to afford it,'' he said.

Nor can governors say for certain how many people will show

up to claim the new benefits. Because low-income people are

harder to track--they tend to move more frequently, and they

often don't file tax returns--state officials don't know

precisely how many will be eligible. Rounds estimates an

enrollment increase of about 75,000 people but concedes that

the number could be much higher.

Another mystery is how many people who qualify for Medicaid

under current rules--a sizable portion of the uninsured

population--will decide to finally sign up. This is the

``woodwork effect'' that unnerves state officials around the

country because it could lead to much higher costs.

``That's part of the problem we're having, is getting hard

numbers,'' Rounds said. ``We just don't know.''

In South Dakota and many other states, communities lack

doctors and other healthcare providers who are willing to

treat Medicaid patients, either because the providers aren't

available or because Medicaid payment rates are so low. The

House reform bill would increase Medicaid payment rates to

the same level as Medicare rates, at a 10-year cost of $80

billion. In some states, Medicaid rates are as low as 40

percent of Medicare rates. But the finance panel rejected a

Grassley amendment that would have increased provider rates

in the Senate bill.

Despite Medicaid's drawbacks, including rigid rules and a

complex bureaucracy, many health-care experts still view it

as the most practical way to insure the poorest Americans.

Low-income adults account for about half of the uninsured

population, and in states that provide minimum Medicaid

coverage, few parents and no childless adults are covered

unless they meet other eligibility criteria.

``If you're trying to expand coverage, at least Medicaid is

already up and operational in every state,'' said Diane

Rowland, executive director of the Kaiser Commission on

Medicaid and the Uninsured. ``You're not creating something

new with start-up glitches. For any of its flaws, it has been

operating, it is paying bills, it is contracting with managed

care, it has an eligibility system already in place.''

As the reform debate unfolds on the House and Senate

floors, health-care negotiators are prepared for a flood of

pleadings like the one Reid made that could add up to many

billions, forcing reductions to other portions of the bill.

California Gov. Arnold Schwarzenegger (R), for one, estimated

that

the Medicaid expansion could cost his state $8 billion a

year. Sen. Dianne Feinstein (D-Calif.) underscored those

concerns with her own pledge: ``I could not support a bill

that pushes additional costs on California state government

or its counties.''

Mr. President, I wish to thank the Senator from Arizona for his thoughtful comments and for his late nights on the Finance Committee on the health care bill. He is exactly correct. I don't know where in the United States you could go and somebody wouldn't say: You should read the bill, No. 1; and you should know what it costs, No. 2, before you start voting on it. That is one of the handful of things in American life I don't think requires any explanation. But if it requires any, the people in Arizona are going to be asking Senator Kyl, just as they do me in Tennessee: What is this shifting of Medicaid costs to the States, and how much is it going to cost us? Our Governor in Tennessee says it will put the State budget in the tank and damage our colleges and universities. We ought to read the bill and know what it costs.

What about these Medicare cuts? We will wait to read the bill and see how much they are, but what we hear is they are a half trillion dollars, and not just in cuts on Medicare, but it is cutting Medicare for seniors and spending it on a new program. As the Senator from Kansas said the other day, it is like writing a check on an overdrawn bank account and buying a big new car with it, and then new taxes.

So I remember when in the HELP Committee we all were working on a bill, and it went right through with the Democratic majority, but when the American people began to read it, there began to be some problems. So I am very hopeful that we will do in the Senate as 99.8 percent of the American people expect us to do: Read the bill; know what it costs. When we see the Medicaid mandates that require new State taxes and the Medicare cuts for seniors that will be spent on other programs and new taxes, then that might change the picture.

Mr. President how much time do we have left on our side?

Thank you very much.

Mr. President, I would like to change the subject. I wish to talk a little bit on the perils of energy sprawl. Right behind the health bill may come an energy or climate change bill. There has been a lot of discussion about that. I would like to talk about it in a new and different way.

I just went over to an organization called Resources for the Future that is run by former Congressman Phil Sharp, a group that has done a lot of good work in the conservation area, most recently in coordinating the Outdoors Resource Review Group's recommendations that included permanent funding for the Land and Water Conservation Fund.

There were about 200 conservationists there. I wish to talk to my colleagues a little bit about the message I shared with them. I began with them in this way: As many Americans did last week, I spent a number of hours watching Ken Burns' film on our national parks. I am also reading Douglas Brinkley's book about Theodore Roosevelt, called ``The Wilderness Warrior: Theodore Roosevelt and the Crusade for America.'' I had a few minutes to visit Douglas Brinkley, who was in Washington, DC. Doing this reminded me that the men and women we honor most in the conservation movement, and who founded many of our most important organizations, were not always so honored when they spoke up. Many who spent the last century protecting our landscapes, our air and our water and our habitats were regarded as trivial, eccentric or even went unnoticed.

John Muir, founder of the Sierra Club, was an obscure hermit when he began to preach nature like an apostle. To some, President Teddy Roosevelt must have seemed a little daffy when he declared he would protect pelicans and warned a country, enamored with Manifest Destiny, that we should keep nature unmarred. President Lyndon Johnson used to make jokes about Lady Bird Johnson running around the White House with Laurance Rockefeller protecting flowers, as he would say. Today, we honor those men and women for having had the wisdom and courage to recognize that preserving our natural heritage is essential to the American character. Italy may have its art, India may have its Taj Mahal, but we have the Great American Outdoors.

That is why a recent paper by the Nature Conservancy, a scientific paper, titled ``Energy Sprawl or Energy Efficiency: Climate Policy Impacts on Natural Habitat for the United States of America,'' will one day, I believe, occupy a place among the pioneering actions we honor in the conservation movement. The paper warns, in the next 20 years, new energy production, especially biofuels and wind power, will consume a landmass larger than the State of Nebraska. This so-called ``energy sprawl,'' as the authors termed it, will be the result of government cap and trade and renewable mandate proposals designed to deal with climate change. The paper should serve as a ``Paul Revere ride'' for the coming renewable energy sprawl. There are negative consequences from producing energy from the Sun, the wind, and the Earth, just as there are positive effects. Unless we are as wise in our response to this as the authors were in their analysis, our Nation runs the risk of damaging the environment in the name of saving the environment.

The first insight of the Nature Conservancy paper is in describing the sheer size of the sprawl. The second insight is in carefully estimating the widely varying amounts of land consumed by different kinds of energy production. Finally, the paper suggests four ways to reduce carbon emissions, while minimizing the side effects of energy sprawl on the landscape and wildlife habitat. The first recommendation is energy conservation. Second is generating electricity on already- developed sites, such as when solar panels are put on rooftops or when a chemical company uses byproducts from its production processes to make heat and power. The third recommendation is to make carbon regulation flexible enough to allow for coal plants that recapture carbon or nuclear power plants that produce no carbon or for international offsets. Fourth, the paper suggests careful site selection.

This makes me think of my own experience as Governor of Tennessee 25 years ago. The Presiding Officer was a very successful Governor of our neighboring Commonwealth of Virginia. Twenty-five years ago, our State banned new billboards and junkyards on a highway over which 2 million visitors travel each year to the Great Smoky Mountain National Park. Then, that decision attracted very little attention. Today, that decision helps to preserve one of the most attractive gateways to any national park. It is hard to imagine what that road would be like today if we hadn't made that decision 25 years ago. We know that if the billboards had gone up then, they would be impossible to take down today. It would be the same with wind turbines in the foothills of the Smokies or along the Blue Ridge Parkway, with wind turbines, solar thermal plants, and other new forms of energy production--once they go up, it would be hard to take them down.

My purpose today, with Resources for the Future and with the conservation groups, was to challenge those organizations who have traditionally protected our landscapes, air and water and wildlife habitat to do the same for the threat of energy sprawl. I asked for them to suggest to us in the Senate, Members of the House, and others in government what are the most appropriate sites for low-carbon or carbon-free energy production. Second, I asked the conservationists to do something that gives many of them a stomachache whenever it is mentioned--to rethink nuclear power. Because, as the Nature Conservancy's paper details--while not endorsing nuclear--in several ways nuclear power produces the largest amounts of carbon-free electricity with the least impact.

I learned a long time ago it helps an audience to know where its speaker is coming from so I reminded them that I grew up hiking and camping in the great Smoky Mountains National Park, and I still live 2 miles from the park boundary today. I reminded them that, as a Senator, I have fought and still fight for strict emission standards for sulfur, nitrogen, and mercury, because too many of us still breathe polluted air. I have introduced legislation to cap carbon from coal plants because I believe human production of carbon contributes to global warming. I have helped to create 10,000 acres of conservation easements adjacent to the Smokies because it preserves the views and the wildlife needs the space. I drive one of the first hybrid plug-in electric cars because I believe electrifying our cars and trucks is the quickest way to clean the air, keep fuel prices down, reduce foreign oil use, and help deal with climate change. I object to 50-story wind turbines along the Appalachian Trail for the same reason I am the cosponsor of legislation to end the coal mining practice called mountaintop removal, not because I am opposed to coal plants or wind power in appropriate places but because I want to save our mountaintops.

Let me offer a few examples to give a clearer picture of what this coming energy sprawl may look like. As the Nature Conservancy paper notes, most new renewable electricity production will come from wind power, which provides about 1.5 percent of our country's electricity today. Hydroelectric dams produce about 7 percent, and some of them are being dismantled. Solar and all other forms of renewable electricity produce about another 1 percent. President Bush first suggested that wind power could grow from 1.5 percent today to 20 percent by 2030, and President Obama has set out enthusiastically to get this done. In fact, the combination of Presidential rhetoric, taxpayer subsidies and mandates have very nearly turned our national electricity policy into a national windmill policy.

To produce 20 percent of America's electricity from wind turbines would require erecting 186,000 1.5 megawatt wind turbines, covering an area the size of West Virginia. According to the American Wind Energy Association, 1 megawatt of wind requires 60 acres of land; in other words, that is a 1.5-megawatt wind turbine every 90 acres. These are not your grandmother's windmills. They are 50 stories high. If you are a sports fan, they are three times as tall as the skyboxes at the University of Tennessee football stadium. The turbines themselves are the length of a football field. They are noisy, and you can see their flashing lights for up to 20 miles. In the Eastern United States,

such as in Tennessee and Virginia, where the wind blows less, turbines work best along scenic ridge tops and coastlines.

The National Academy of Sciences says that up to 19,000 miles of new high-voltage transmission lines would be needed to carry electricity from 186,000 wind turbines in remote areas to and through population centers.

So many wind turbines can create real threats to wildlife. The Governor of Wyoming has expressed concern about protecting the sage grouse's diminishing population in his State as a result of possible habitat destruction from wind farms. The American Bird Conservancy estimates that each wind turbine in this country may kill as many as seven or eight birds each year. Multiply that by 186,000, and you can predict the annual death of close to 1.4 million birds each year. Then there are the solar thermal plants, which use big mirrors to heat a fluid and which could spread over many square miles. Secretary of the Interior Ken Salazar recently announced plans to cover 1,000 square miles of federally owned land in Nevada, Arizona, California, Colorado, New Mexico, and Utah with such solar collectors to generate electricity. Dianne Feinstein, the senior Senator from California, who has spent most of her career trying to make the Mojave Desert a national monument, strongly objected to a solar thermal plant in the desert on Federal land just outside the Mojave National Preserve that would have covered an area 3 miles by 3 miles. Plans for the plant were recently canceled.

The only wind farm in the Southeastern United States is on the 3,300- foot-tall Buffalo Mountain in eastern Tennessee, not far from my hometown. The wind there blows less than 20 percent of the time, making the project a commercial failure. Because of the unavailability of wind power, renewable energy advocates suggest that we southeasterners use biomass, a sort of controlled bonfire that burns wood products to make electricity. Biomass has promise, to a point. Paper mills can burn wood byproducts to make energy. Clearing forests of dead wood and then burning it not only produces energy but can help to avoid forest fires. According to the Conservancy's paper, biofuels and biomass burning of energy crops for electricity take the most space per unit of energy produced. For example, the Southern Company is building a new 100- megawatt biomass plant in Georgia. Southern estimates it will keep 180 trucks a day busy hauling about 1 million tons of wood a year to the plants. One hundred megawatts, the size of that plant, is less than one-tenth the production of a nuclear plant, which will fit on 1 square mile. To produce the same amount of energy as one nuclear plant would require continuously foresting an area one-third larger than the 550,000-acre great Smoky Mountain National Park. You can make your own estimate of the number of trucks it would take to haul that much wood.

That is the second important insight of the Nature Conservancy report: a careful estimate of the widely different amounts of land each energy-producing technique requires. The gold standard for land usage is nuclear power. You can get a million megawatt hours of electricity a year--that is the standard unit the authors chose--per square mile, using nuclear power. The second most compact form of energy is geothermal energy. To generate the same amount of power, coal requires 4 square miles, taking into account all the land required for mining, extraction, and waste disposal. Solar thermal takes 6. Natural gas takes 7. Petroleum takes 17. Photovoltaic cells that turn sunlight into electricity requires 14 square miles for the same unit of power. Wind is even more, taking 28 square miles to produce the same unit of electricity. That doesn't include lands consumed by the up to 19,000 miles of new transmission lines.

These differences in land use are pronounced, even though the Nature Conservancy paper's analysis is conservative. The authors include upstream inputs and waste disposal as part of their estimate of an energy producer's footprint. They add uranium mining and Yucca Mountain's 220 square miles to the area our 104 nuclear reactors actually occupy. If one were to consider only each energy plant's footprint, to produce 20 percent of U.S. electricity would take 100 nuclear reactors on 100 square miles; or, to visualize it a different way, 186,000 wind turbines on 25,000 square miles.

Visualize the difference this way. Thru hikers regularly travel the 2,178 miles from Springer Mountain, GA, up through Tennessee and Virginia to Mount Katahdin, ME. A row of 50-story wind turbines along the 2,178-mile Appalachian Trail would produce the same amount of electricity produced by four nuclear reactors on 4 square miles.

Because of all these wide differences, policymakers have the opportunity to choose carefully among the various forms of producing carbon-free electricity, as well as to think about where such energy production should go and should not go.

There are four ways that The Nature Conservancy suggests we approach these decisions:

First, focus on energy conservation. That is hard to argue with, and that is their preferred alternative to energy sprawl. It is hard to see how anyone could disagree. To cite one example, my home State of Tennessee leads the Nation in residential per-person electricity use. If Tennesseans simply used electricity at the national average, the amount of electricity we would save each year would equal two nuclear plants. Oak Ridge National Laboratory scientists have said that fuel efficiency standards have been the single most important step our country has taken to reduce carbon emissions.

The second recommendation for energy sprawl is, in scientific terms, end-use generation of electricity which already occurs on already- developed sites. The example is cogeneration that occurs at a paper factory, for example, that uses waste product to produce electricity and heat to run its facility. A more familiar and promising example is solar power on rooftops. In other words, since rooftops already exist, covering them with hundreds of square miles of solar panels would create no additional sprawl. There are still obstacles to the widespread use of solar panels. In the Southeast, solar still costs four to five times what the Tennessee Valley Authority pays on average for other electricity. There is the obstacle of aesthetics. But companies are now producing solar film embedded with attractive roofing materials, although that costs more. And there is still the problem that solar power is only available when the Sun shines. Like wind, it cannot be stored in large quantities. But unlike wind, which often blows at night when we have plenty of spare electricity, the Sun shines when most people are at their peak power use. As former Energy Secretary James Schlesinger wrote recently in the Washington Post, because of their intermittence, wind and solar systems have to be backed up by other forms of electricity generation, which adds to their cost and land usage.

The third recommendation is to make carbon regulation flexible, allowing for carbon recapture at coal plants, for nuclear power, and for international offsets. So far, the sponsors of climate and energy bills in the Congress have not heeded this advice, I am sorry to say. In fact, both the Waxman-Markey bill in the House and the Bingaman Energy bill in the Senate contain very narrowly defined renewable electricity mandates. Instead of allowing States to choose their methods of producing the required amount of carbon-free electricity, the legislation tilts heavily toward requiring wind power. For example, the legislation allows existing and new wind turbines within the renewable mandate, but only new hydroelectric power. It does not count nuclear power, which is carbon free, or municipal solid waste or landfill gas as renewable.

In the same way, 75 percent of the so-called renewable electricity subsidies enacted since 1978 have gone to wind developers. A study by the Energy Information Administration shows that wind gets a subsidy of 31 times that of all other renewables combined. These policies have created a heavy bias toward the form of renewable electricity--wind power--that could consume our treasured mountaintops and be very destructive to wildlife. A national policy that encourages wind power in the Southeast, such as Tennessee or Virginia, where the wind barely blows, makes about as much sense as mandating new hydroelectric dams in the Western desert where there is no water.

It is my opinion that if we are truly seeking to reduce our carbon output, the policy that would create the least energy sprawl would be a carbon-free electricity standard allowing for the maximum flexibility for those renewable electricity techniques that consume less land and require fewer transmission lines.

Finally, to deal with energy sprawl, The Nature Conservancy suggests paying attention to site selection. This is where the conservationists can be a big help to the Senators. Those who have spent their time protecting treasured landscapes and protecting wildlife could help us ask the right questions and know the right answers. For example, should energy projects be placed in national parks or national forests? If so, which forests and which energy projects? Should there be generous taxpayer subsidies for renewable electricity projects within 20 miles of the Grand Tetons or along the Appalachian Trail? What about the large amounts of water needed for solar thermal plants or for nuclear plants? Should turbines be concentrated in shallow waters 20 miles or more offshore where they cannot be seen from the coast? And should transmission lines run under water? Couldn't wind turbines be located in the center of Lake Michigan where the wind blows more strongly instead of along its shoreline where people can see them? Should there be renewable energy zones, such as the solar zones Secretary Salazar is planning where most new projects could be placed and where the most appropriate locations for those zones and those transmission lines could be picked?

In a recent op-ed in the New York Times, the Massachusetts secretary of energy and environmental affairs asked this question: Wouldn't it make a lot more sense to place wind turbines offshore in the Atlantic and run transmission lines underwater than to build new transmissions lines to carry wind power from the Great Plains to Boston? Should the subsidies for cellulosic ethanol be larger than those for corn ethanol? Or should there be no subsidies at all? And should there be a special effort to encourage conservation easements on private lands that protect treasured viewscapes and habitats?

These are the questions that the American people and the conservation groups that have traditionally protected our landscapes and our habitats could help us answer properly.

According to the Wall Street Journal, on August 13, ExxonMobil pleaded guilty in Federal court to killing 85 birds that had come into contact with crude oil or other pollutants in uncovered tanks of wastewater facilities on its properties. The birds were protected by the Migratory Bird Treaty Act which dates back to 1918. The company paid $600,000 in fines and fees for killing those 85 birds.

Should the migratory bird law be enforced against developers of other energy projects--for example, renewable electricity and transmission lines? One wind farm near Oakland, CA, estimates that its turbines kill 80 golden eagles a year. The American Bird Conservancy estimates the 25,000 wind turbines in the United States kill somewhere between 75,000 and 275,000 birds a year. ``Somebody is getting a get-out-of-jail card free,'' Michael Fry of the Bird Conservancy told the Journal. And what would be the fine for the almost 1.4 million birds that 186,000 turbines might kill? For those who think birds may not be as important as some other subjects, read Douglas Brinkley's book about Teddy Roosevelt. Almost all of his wilderness activities started with his interest in birds. According to Mr. Brinkley, the largest spectator sport in America, even ahead of NASCAR, is bird watching.

These statistics raise the question of whether there ought to be some kind of parity among all energy companies in the application of laws and policies. For example, oil and gas companies receive taxpayer subsidies, but they bid to lease and drill on Federal land and waters and then they pay a royalty for the privilege. Should taxpayer- subsidized developers of renewable electricity projects also be required to pay a royalty for the privilege of producing electricity on Federal lands and waters? And if so, could this be a source of permanent funding for the Land and Water Conservation Fund or other conservation projects on the theory that if the law allows an environmental burden, it ought to require an environmental benefit?

Based on estimates from the Joint Committee on Taxation and the Congressional Budget Office, taxpayers will pay wind developers a total of $29 billion in Federal subsidies over the next 10 years to increase wind power production from 1.5 to 4 percent of our total electricity.

There are an estimated 500,000 abandoned mines in our Nation--47,000 in California alone. To date, Congress has allocated a total of about $4 billion for their cleanup, and the end of the cleanup is nowhere in sight. Would it not be wise before the energy sprawl occurs to require bonds on Federal lands for the removal of energy equipment that is abandoned or not used anymore? Wind turbines wear out in 20 or 25 years. Solar thermal farms can cover hundreds of acres. Policy subsidies and prices can change.

In Germany, for example, a prominent maker of solar equipment suggested cutting the government subsidy for solar equipment because it is permanently raising the prices of German-made products, and Germans are buying cheaper panels made in China. In other words, the Germans are subsidizing Chinese manufacturing.

So if the large U.S. subsidies for wind power were to disappear, as was promised when they were created, and this led to the abandoning of some renewable projects, it might be a good idea if someone were required to take away any abandoned equipment.

Which brought me to my last point: asking conservationists, especially in this country, to rethink nuclear power.

In our country, fears about proliferation and waste and disposal have stymied the ``atoms for peace'' dream for large amounts of low-cost, clean, reliable energy from nuclear power. Twelve States even have moratoria against building new nuclear plants. Still, the 104 U.S. reactors built between 1970 and 1990 produce 19 percent of America's electricity and, as I have said, 70 percent of our carbon-free electricity.

I believe that what Americans should fear most about nuclear power is this: The rest of the world will use it to create low-cost, carbon-free electricity while we who invented it will not. That would send our jobs overseas looking for cheap energy, and it would deprive us of the technology most likely to produce large amounts of carbon-free electricity to deal with climate change and to do it in a way least likely to harm the landscape and wildlife habitat.

Look at what the rest of the world is doing. Of the top five greenhouse gas emitters, who together produce 55 percent of all the carbon in the world, only the United States has no new nuclear plants under construction. China, the world's largest carbon emitter, recently upped its goal for new nuclear reactors to 132. Russia, the No. 3 emitter, plans two new reactors every year until 2030. Of the next two emitters, India has six reactors under construction and 10 more planned. Japan already has 55 reactors and gets 35 percent of its electricity from nuclear. It has two under construction and plans for 10 more by 2018.

According to the International Atomic Energy Agency, there are 53 reactors worldwide under construction in 11 countries, mostly in Asia and not one in the United States. South Korea gets nearly 40 percent of its electricity from nuclear and plans another eight reactors by 2015. Taiwan gets 18 percent of its power from nuclear and is building two new reactors.

In the West, France--we never like to give France credit for outdoing us in anything--but France gets 80 percent of its electricity from nuclear and, as a result, has among the lowest electricity rates and carbon emissions in Western Europe, behind Sweden and Switzerland, both of which are half nuclear. Great Britain has hired the French electric company EDF to help build reactors. Italy has announced it will go back to nuclear.

Where does that leave the United States? We still know how to run reactors better than anyone else, we just don't build them anymore. Our fleet of plants is up and running 90 percent of the time. No one does that well except us. We have 17 applications for new reactors pending before the Nuclear Regulatory Commission, but we have not

started construction on any new nuclear plant in 30 years in the United States.

The 104 we currently have in operation will begin to grow too old to operate in 20 years. That is why I believe the United States should build 100 new nuclear plants in 20 years. All 40 Republican Senators support that goal, and a number of Democratic Senators also are strong supporters of nuclear power.

Building 100 plants in 20 years would bring our nuclear-produced electricity to more than 40 percent of our total generation and it would all be carbon free. Add another 10 percent for hydroelectric dams--that is carbon free; 7 or 8 percent for wind and solar, now about 2.5 percent--that is carbon free; 25 percent for natural gas--that is low carbon; and you begin to get a very clean and low-cost electricity policy.

According to the National Academy of Sciences, construction costs for 100 nuclear plants are about the same as they would be for 186,000 wind turbines. New reactors could be located mostly on sites with existing reactors. There would be little need for new transmission lines. Taxpayer subsidies for nuclear would be one-tenth what taxpayers would pay wind developers over 10 years. And for so-called green jobs, building 100 nuclear plants would provide 4 times as many construction jobs as building 186,000 wind turbines. And, of course, nuclear is a base load source of power operating 90 percent of the time--the kind of reliable power a country like the United States, which uses 25 percent of the energy in the world, must have. Wind and solar are useful supplements, but they are only available, on average, about one-third of the time, and they can't be stored in large amounts.

What about the lingering fears of nuclear? Well, the Obama administration Energy Secretary, Dr. Steven Chu, the Nobel Prize- winning physicist, says nuclear plants are safe and he wouldn't mind living near one. That view is echoed by thousands of U.S. Navy personnel who have lived literally on top of nuclear reactors in submarines and Navy ships for more than 50 years without incident. The Nuclear Regulatory Commission agrees, and its painstaking supervision and application process is intended to do everything humanly possible to keep our commercial fleet of reactors safe.

On the issue of waste, Dr. Chu says there is a two-step solution. Step 1 is, store the spent nuclear fuel on site for 40 to 60 years. The Nuclear Regulatory Commission agrees this can be done safely, maybe for 100 years. Step 2 is research and development, to find the best way to recycle fuel so that its mass is reduced by 97 percent, pure plutonium is never created, and the waste is only radioactive for 300 years instead of 1 million years. That kind of recycling would take care of both the waste and the third fear of nuclear power--the threat that other countries might somehow use plutonium to build a bomb.

One could argue that because the United States failed to lead in developing the safe use of nuclear technology for the last 30 years, we may have made it easier for North Korea and Pakistan to steal or buy nuclear secrets from rogue countries.

I concluded with this prediction: Taking into account these energy sprawl concerns, I believe the best way to reach the necessary carbon reduction goals for climate change, with the least damage to our environment and to our economy, will prove to be, No. 1, building 100 new nuclear plants in 20 years; No. 2, electrifying half the cars and trucks in 20 years--we probably have enough unused electricity to plug these vehicles in at night without building one new power plant--and No. 3, putting solar panels on rooftops. To make this happen, the government should launch mini-Manhattan Projects, like the one we had in World War II, for recycling used nuclear fuel, for better batteries, for electric vehicles, to make solar panels cost competitive, and, in addition, to recapture carbon from coal plants. This plan I have just described should produce the largest amount of electricity with the smallest amount of carbon at the lowest possible cost, thereby avoiding the pain and suffering that comes when high-cost energy pushes jobs overseas and makes it hard for low-income Americans to afford their heating and cooling bills.

My fellow Tennessean Al Gore won a Nobel Prize for arguing that global warming is the inconvenient problem. For those who believe he is right--and if you are also concerned about energy sprawl--then I would suggest nuclear power is the inconvenient solution.

Mr. President, I yield the floor. I suggest the absence of a quorum.

Mr. President, earlier this year, we lost a great Tennessean and champion of the great American outdoors. James D. Range was a lifelong outdoorsman who loved America's wild spaces. He grew up in Johnson City, TN, hunting and fishing in the backwoods of the Appalachian Mountains. It was in his those early years that Jim-- who was also an Eagle Scout--became passionate about preserving our outdoors for future generations.

He became a passionate advocate for the country's fish and wildlife and their habitat and a true champion of natural resource conservation.

Jim was a trusted advisor and counsel to Senate majority leader Howard Baker and the Senate Environment and Public Works Committee, where he served with integrity and distinction. As a Senate staffer, Jim was instrumental in the crafting and passage of a string of landmark laws, including the Clean Water Act.

After Jim left the Senate, he continued to pursue his love for the outdoors by cofounding and serving as chairman of the Theodore Roosevelt Conservation Partnership, an organization that is dedicated to the stewardship of America's natural landscape, helping to expand fish and wildlife habitat and increasing public access to quality hunting and fishing.

Jim didn't stop there. He furthered his commitment to the cause of conservation through service on the boards of directors for Trout Unlimited, Ducks Unlimited, the Wetlands America Trust, the Recreational Boating and Fishing Foundation, the American Sportfishing Association, the American Bird Conservancy, the Pacific Forest Trust, the Yellowstone Park Foundation, the Bonefish and Tarpon Trust, the National Fish and Wildlife Foundation, the Interstate Commission on the Potomac River Basin, the Sportfishing and Boating Partnership Council, and the Valles Caldera Trust.

Jim was so instrumental in the conservation movement in this country that he was awarded the U.S. Department of the Interior's Great Blue Heron Award, was named Conservationist of the Year in 2003 by Outdoor Life magazine and received the Norville Prosser Lifetime Achievement Award from the American Sportfishing Association.

Both our natural and political environments are better because of Jim Range. Tennesseans, and all Americans, owe Jim a great debt of gratitude. His leadership serves as a great example to all of us.

Madam President, I ask unanimous consent that the Senator from Georgia and I be permitted to engage in a colloquy.

Madam President, I ask if the Acting President pro tempore will let me know when we have 5 minutes remaining on the Republican side.

Madam President, the Senator from Georgia and I wish to talk a little bit today about the health care plans coming through. Fundamentally, our position is that we do not want to see another Washington takeover. We are deeply concerned about the cuts in Medicare that will affect seniors, about the taxes--both the increase in Federal taxes and State taxes, which we will talk more about--about the trillion dollars in new spending, and about the threats to the health care choices the legislation coming through would pose.

Instead of such a large enterprise as what I have just described, we would propose that we take practical, small steps to reducing costs such as allowing small businesses to pool their resources, reducing junk lawsuits against doctors, allowing consumers to purchase across State lines, and creating health insurance exchanges. There are other steps that could be taken; in other words, instead of scaring the country half to death with new taxes and Washington takeovers and threatening their health care choices, let's don't throw the whole system out. Let's take practical steps to reduce costs and to improve services.

Today we wish to specifically talk more about two government-run programs that already exist. One is Medicaid, which is the program for low-income Americans that today serves about 59 million Americans. About 60 percent is paid for by the Federal Government and about 40 percent by the States. The second is Medicare, which seniors know very well because about 40 million American seniors are dependent upon Medicare. We are concerned because the proposals coming through the Senate Finance Committee would shift costs of Medicaid to the States, causing State budgets to be put in ruin, according to the Governors of those States, and either taxes go up or services are cut. We are concerned because the President and others have said we are going to pay for this big new program by savings in Medicare, not to be put in Medicare for seniors, but for the new program.

A lot of people say it is hard to find opportunities for bipartisanship when we talk about health care, but I think

I have found one. I am on the Senate floor today to say I would like to be a cosponsor of the Reid amendment, the proposal by the majority leader of the Senate--the respected Harry Reid from Nevada. The New York Times reported yesterday that the majority leader had heard from his Governor and from other people in his State, and he was deeply concerned about the legislation that is coming through because it would increase costs in Nevada.

In fact, I have a copy of the letter from the Governor of Nevada to majority leader Harry Reid, and it says: As you know, like the U.S. Constitution, most State constitutions require a balanced budget, including Nevada. Nevada will spend $907 million for programs on Medicaid. This is about 14 percent of our budget. We can't afford more taxes. Revenues are down.

So the majority leader did exactly what I think a Senator would do. He introduced an amendment, or proposed an amendment, to the Senate Finance Committee and said: Take care of Nevada. If the Federal Government is going to expand coverage for Medicaid, then the Federal Government ought to pay for it.

That is exactly what I believe. That is exactly the opinion of all of the Governors. The National Governors Association, of which I used to be chairman, has said to us: If you are going to expand Medicaid, if that is your big idea in Washington, then pay for it.

Nothing irritates Governors and legislators more than Washington politicians who come up with big ideas, announce them, take credit for them, and then send the bill to the Governor and the legislature. I was a Governor. The Senator from Georgia was in the Georgia Legislature for 17 years. He was the leader of the Republicans in the senate for 8 years. He knows a good deal about State budgets and about the Medicaid Program and how it is an integral part and a very difficult problem for State governments.

I am wondering if the Senator from Georgia thinks there might be opportunity for more bipartisan support for Senator Reid's amendment to have the Federal Government pay for 100 percent of Medicaid costs if Medicaid is expanded.

Mr. President, going back to the Senator's point, the thing I think about, those of us who have been a Governor or in the legislature--in fact, I have said to some of my colleagues many times that if we expand Medicaid for low-income Americans--which States have to pay a third or more of--without paying for it, that we Senators ought to be sentenced to go home and serve as Governor for 8 years to see what it is like. I mean that because I can remember as Governor for 8 years balancing budgets, first I would come up with the money for kindergarten through the 12th grade--that was a pretty set amount--then for the highways, and then for the prisons, and I would get down toward the end and there would be a certain amount of money left to either go into higher education or it would go for increasing Medicaid costs. Almost always that was the choice. If I put it into Medicaid, I had to take it out of education, and that would keep the University of Tennessee or Georgia or the community colleges from getting better.

Guess what happens when the State can't put the money in. The tuition rates go up.

There is an article in the New York Times today which I ask unanimous consent to have printed in the Record.

Mr. President, the headline is ``Rate of Enrollment in Medicaid Rose Rapidly, Report Says.''

The recession is driving up enrollment in Medicaid at

higher than expected rates, threatening gargantuan State

budget gaps--

This is the New York Times; this is not the Republican Party saying this--

even as Congress and the White House seek to expand the

government health insurance program for the poor and

disabled.

It goes on to say:

As unemployment surged, enrollment in State Medicaid

programs grew by an average of 5.4 percent in the previous

fiscal year, the highest rate in 6 years . . . in eight

States, the growth exceeded 10 percent.

Three-fourths of the agency directors of Medicaid said they

already fear their appropriations will not be enough and that

lawmakers will have to find more money or, more likely, cut

benefits or provider payments.

One such State is Nevada.

The home State of the majority leader.

We're seeing the trajectories of our enrollment growth as

well as our revenues all going in the wrong direction--

Said their head of financing. State budgets were buffered from even worse pain by the stimulus package, but the New York Medicaid director said her State would face a $5 billion annual gap and would have to consider deep cuts in home and personal care, and that is before we make any changes or add any costs.

When the Federal Government talks about adding State Medicaid costs:

Three-fourths of the Medicaid directors--

The New York Times said--

said they thought the changes might deepen their budget

holes.

What do you suppose in Georgia--already struggling in the way you have just described--would happen if--and this is why we said we insist on reading the bill before we vote on it and knowing how much it costs before we vote on it. We want to know exactly what the provisions are because I hear that States will be required to pay 5 to 22 percent in the first 5 years of the Medicaid expansion, and then after 5 years they might have to go up to 35 percent or so.

What do you suppose will happen to Georgia if these kinds of costs are added to the State budget?

No, it is not fair or right. The Governors have said, Democratic and Republican Governors--and the Senator raised a second point about this Medicaid expansion: that dumping millions more low-

income Americans into Medicaid is not health care reform because Medicaid, as the Senator just pointed out, so poorly reimburses the doctors and the hospitals that about 40 percent of doctors will not see Medicaid patients.

So when we say to someone: Congratulations, we have just fixed the health care system; we have dumped you into Medicaid, you are giving somebody a bus ticket to a bus system that operates 60 percent of the time. So the first thing we are doing with the proposal as it is coming toward us is we are--and I am not exaggerating--we are potentially bankrupting States.

Speaking of States, let me just share one letter with Senator Isakson from the Governor of California.

This is a State that has really struggled with its budgets. They have a number of problems.

Here is what the ``Terminator'' has to say. He wrote to Senator Reid and to Senator McConnell on the Republican side and Speaker Pelosi. It is a long letter. This is the basic idea. Arnold Schwarzenegger says:

I will be clear on this particular proposal: if Congress

thinks the Medicaid expansion is too expensive for the

federal government, it is absolutely unaffordable for states.

Governor Schwarzenegger goes on to say:

Proposals in the Senate envision passing on more than $8

billion in new costs to California annually--crowding out

other priorities or constitutionally required state spending

and presenting a false choice for all of us. I cannot and

will not support federal health care reform proposals that

impose billions of dollars in new costs on California each

year.

I ask unanimous consent that this letter be printed in the Record.

Madam President, I say to the Senator from Georgia that we are not being clever when we say we would like to be cosponsors of the Harry Reid amendment. The problems of the States are so well documented today. They don't just exist in Nevada or the two or three other States he picked out yesterday; they exist in California, which is now not part of the Reid amendment. I guess that Senators Feinstein and Boxer would be happy to cosponsor the Reid amendment if it included California. I certainly would be if it included Tennessee. I know the Senator from New York and others would be also.

Our States cannot afford to have the Federal Government say: We are going to expand your health care, Mr. and Mrs. Low-Income American. It is not a very good health care program. And then we are going to send 40 percent of the bill to States that are already bankrupt, making it more difficult for them to provide good care.

The Senator is being very sensible. I think most Americans would agree with us that our goal is to reduce the costs of health care--reduce the costs of your health care insurance when you buy it and reduce the costs to your government that is running up a big debt every year.

The Senator from Georgia mentioned two specific ways we can take steps in the right direction without getting into this business of taking over so much in Washington, with trillions of dollars of debt, passing on big taxes to States, and cutting Medicare and threatening seniors in a whole variety of other ways. One was to allow small businesses to pool their insurance so they could offer more to their employees. That could affect millions of Americans. Another was to sign up more people who are already eligible. Another is to do something about junk lawsuits against doctors that are driving up costs. Another is to create more insurance exchanges in the States. We have proposed these.

People say: Where is the Republican plan? If they are looking for some comprehensive, trillion-dollar, thousand-page bill, they are not going to see it. If they are looking for four or five practical steps to move in the right direction, we talk about that every day, and we are not afraid to warn against the big, thousand-page bill plans. We compliment the Senator from Nevada for recognizing that it would ruin his State if we passed this bill, and we hope we have the opportunity to cosponsor that amendment so it applies to every State.

That is exactly right.

As we think about Senator Reid's amendment and also the step-by-step proposals, one way to describe his amendment is to say to Nevada--and Oregon, Rhode Island, and Michigan--that we are going to pay 100 percent of your Medicaid costs. That is a step in the right direction. I think that is the way I should characterize that. That is not a criticism of the majority leader. That is saying: Mr. Majority Leader, you are going in the right direction, but you didn't include Tennessee, and Tennessee is not expected to recover to the 2008 levels until 2014. State employees won't receive raises for 6 years, the reserves will be depleted, and there will be no new construction projects.

Our Governor, a Democrat, said this proposal is the mother of all unfunded mandates. So I think Tennessee Senators would like to be included in the Reid amendment. I imagine the Texas Senators would too. The Texas Medicaid office says the proposal would cost their State $20 billion over 10 years if we here expand Medicaid there and make them pay for a third or 40 percent of that. The South Carolina Governor says it would cost their State $1.1 billion over 10 years. I imagine those Senators would like to be a part of this. The Alaska Governor says it would cost $140 million in State general funds. I imagine the Alaska Senators would like to cosponsor the amendment. Governor Schwarzenegger--I suppose his Senators would like to be part of this as well. The Nebraska Governor says this could mean higher taxes in Nebraska, cutting State aid to Nebraska school districts as well as State appropriations to universities. This proposal is not in Nebraska's best interest. The South Dakota Governor said so as well.

This is serious business for the States. It is easy, when you come to Washington, to forget about the States. In the States, if you are a Governor or if you are a legislator, as the Senator from Georgia and I have been, you have to put all your responsibilities out there ahead of you. The first one is education. You take the available money and spend it as best you can and you balance your budget. Then

you look up to Washington, and here comes some Congressman or Senator saying: I have a great idea; let's expand health care all over your State and you will pay for it. That is called an unfunded Federal mandate. It is the wrong thing to do. The Senator from Nevada noticed it in his State.

All States would like to be part of that amendment.

That often confuses people. Medicaid is the program we have been talking about, of which States administer and pay a third or 40 percent. That has about 59 million people in it. The proposal is to move it to where one out of four Americans would be on Medicaid. There is also Medicare, which has about 40 million people, all seniors.

That is the way it is with most Americans. It has become a personal issue, and I think that is why so many people are going to townhall meetings.

Yes, and that is not just a casual statement. Those are the Medicare trustees, whose job it is to look over the Medicare money, who are saying it is going broke by 2015 to 2017.

I hear our friends on the other side say: Republicans are trying to scare you about Medicare cuts. We are not trying to scare anybody about Medicare cuts. We just listen, and the President said in his speech to us that the savings for this program--nearly $\1/2\ trillion in savings to pay for the new program is coming from savings in Medicare. That is Medicare cuts. We know the specific proposals are $130 billion in cuts to Medicare Advantage, which one out of four Medicare seniors has; $120 billion in Medicare cuts to hospitals; $40 billion to home health agencies; $8 billion to hospices.

Our point, if I am correct about this--and if I am not, please correct me--of course there could be savings in Medicare, in the growth of it, but if we have savings in Medicare, we ought to put the money into Medicare; we ought not to take it from grandma and spend it on somebody else. That is the problem. The other day, the Senator from Kansas said it is like writing a check on an overdrawn bank account to buy a big, new car. Whatever money we ought to have ought to go in the overdrawn bank account, which is Medicare.

Madam President, how much time do we have remaining?

Two minutes fifty-four seconds. If the Senator from Georgia will permit me, I ask unanimous consent to put in the Record the following----

I thought you said 2 minutes 54 seconds. We will continue. I remember former Senator Warner once said when he first came to the Senate, he was sitting there wondering what to do. One of the older Senators came over and said to him: Son, you will have no trouble getting used to this. All you have to do is stand up and start talking and eventually you will think of something to say.

I think we have something of considerable importance to say. What we are saying is we need health care reform and the focus should be on reducing costs and we ought to go step by step toward those costs. That is our proposal, instead of these big, comprehensive, trillion-dollar, 1,000-page bills with all these unintended consequences.

We are talking about one of those unintended consequences, which is a very severe consequence for the States. The idea that Senators and Congressmen would decide to expand a program that is going to cover one out of four Americans, called Medicaid, and just send the bill to the States which, according to today's Wall Street Journal: ``plunging state revenues noted that the second quarter was the worst performance for state taxes since at least the 1960s.'' This is not just Nevada and Michigan and Oregon and Rhode Island, which are the four States that were in the majority leader's amendment. This is virtually all the States.

If the Senator from Georgia will indulge me for a moment, I have several letters from Governors to Senators that I ask unanimous consent to have printed in the Record at the end of our remarks.

Madam President, here is a letter to Mr. Bill Nelson, a Senator from Florida, from Gov. Charlie Crist, talking about enrollment in Florida's Medicaid Program increasing and how the State of Florida cannot afford to spend more.

I have a letter from Governor Otter of Idaho to Senator Crapo: ``It has been estimated that combined federal-state Medicaid costs in Idaho could increase by $501 million.''

I have a letter from Governor Daniel of Indiana to Senator Lugar which says: ``We have estimated that the price for Indiana could reach upwards of $724 million annually.''

We talk about big numbers in Washington so much that maybe this doesn't sound like much. But I did an estimate of what it would cost, I say to Senator Isakson, in Tennessee if we expanded Medicaid in the way it is proposed here and we increase the reimbursement rate so patients in Medicaid will actually have somebody to go see, a doctor or a hospital to go see. I said it equaled about a new 10-percent State income tax. Some group in Tennessee said: The Senator is wrong, it is only

about a 3-percent new State income tax. Well, either one, we don't want elected representatives in Washington deciding for us whether we want a new 10-percent or 3-percent State income tax.

There are just a few more I wish to include. I have a letter to Senator Reed from the Governor of Rhode Island. Of course, Rhode Island was included in the majority leader's amendment. They should feel pretty good. They are going to get 100 percent of their Medicaid paid.

The Governor of Arizona has written to Senator McCain and Senator Kyl to point out that ``Arizona is facing one of the worst financial deficits in the nation. . . .'' If Arizona is facing one of the worst financial deficits in the Nation, why is it left out of the majority leader's amendment? It seems to me the citizens of Arizona deserve just as much attention. I imagine their Senators would like to cosponsor it as well.

I have a letter from the Governor of Louisiana talking about an unprecedented fiscal situation and the Governor of Mississippi saying:

In Mississippi, the issue of Medicaid expansion hits close

to home, since our state's share of the Medicaid is currently

$707 million. . . .

``According to the National Association of State Budget Officers, Governor Barbour said, Medicaid expenses . . . were $336 billion'' for State and local government and a third of that is State money, and we are just going to up it. We don't raise that money, we just send them an edict from Washington and say: We have decided that a good thing to do is to increase the number of low-income Americans in your Medicaid Program and you pay for it, you take it out of this road, you take it out of this teacher's salary, you raise the tuition at the University of Tennessee or Georgia and you cut their State funds. That is up to you, but we are going to pass the program.

Here is a letter to the Senator from Nebraska saying this new unfunded Federal Medicaid mandate could result in higher taxes in Nebraska or in cutting State aid to Nebraska school districts. I imagine the Senators from Nebraska, both of whom were Governors, would be happy to be cosponsors of the Reid amendment.

Here is the letter to Senator Graham from the Governor of South Carolina. Another from the Governor of Alabama; a letter from the Governor of Alaska and the Governor of Guam.

I say to Senator Isakson, we have been fairly specific on one point. I heard on the television this morning someone said this is so confusing to the American people; they don't understand it. I think they can understand an unfunded Federal mandate. I think they can understand the Governor has to raise taxes unless Congress pays 100 percent of it. I think they can understand it when the majority leader picks out four States and says we will pay 100 percent of ours and the rest want to be part of that as well.

Madam President, I thank the Senator from Georgia for his experience in State government and for his comments today. We want the majority leader to know our comments yesterday were not to be critical of him, just to say we think he is on the right track. He said to four States: If we expand your Medicaid, we are going to pay for it. We would like to include all States.

I yield the floor.

Exhibit 1

State of Arizona,

Phoenix, AZ, July 16, 2009.

Senator John McCain,

U.S. Senate,

Washington DC.

Senator Jon Kyl,

U.S. Senate,

Washington, DC.

Dear Senator McCain and Senator Kyl: Thank you for the

opportunity to provide information about Arizona's Medicaid

program, the Arizona Health Care Cost Containment System

(AHCCCS).

As you know, Arizona is facing one of the worst financial

deficits in the nation and projections show that the State is

expected to make a slow recovery. In the meantime,

unemployment has continued to increase and counter-cyclical

programs like AHCCCS have continued to experience record-

breaking enrollment. In the last four months alone, AHCCCS

has grown by more than 100,000 new enrollees, and July 2009

enrollment is almost 17 percent above the same month in 2008.

Total enrollment, including our Title XXI KidsCare program,

in July reached 1,275,109 members, which is almost 19 percent

of the state's total population.

I am proud that AHCCCS program has served as a model for

other state Medicaid programs across the country in terms of

cost containment. This is due, in large part, to the fact

that AHCCCS is a capitated managed care model and 65 percent

of its long-term care members receive home and community

based services rather than institutional care. According to

the Kaiser Family Foundation, AHCCCS has the lowest per

member per year (PMPY) cost among Medicaid programs in the

country. The average PMPY costs are: 1) $5,645.52 for acute

care; 2) $45,960.72 for long-term care, which is a blended

average of our elderly and physically disabled and

developmentally disabled programs. The weighted average PMPY

cost across all Title XIX groups is $7,182.60.

I am concerned that the Medicaid expansion proposals being

discussed at the federal level do not consider the fiscal

difficulties states are facing and are likely to continue to

face over the next few years. At the same time as Congress is

considering prohibiting states from changing their Medicaid

eligibility standards, there have been discussions about

establishing a federal floor for Medicaid provider rates,

which even further limits state flexibility in setting

funding levels. State flexibility has been key to Arizona's

success in developing and efficiently managing a Medicaid

program that provides high quality care at a low cost.

Even with our strong cost containment measures, I remain

concerned about Arizona's ability to sustain the existing

AHCCCS model, let alone a mandatory expansion to 150 percent,

regardless of whether the federal government provides full

financing of the expansion for the first five years. Medicaid

is already an increasing share of state budgets--Arizona's

General Fund spending on AHCCCS has increased by 230% over

the past ten years, and has risen from 8 percent of General

Fund spending in FY 1999 to an estimated 16 percent in FY

2009. Maintaining this level of spending increases will be

difficult, especially given that Medicaid enrollment and

costs continue to rise. Moreover, Arizona's revenues are not

expected to turn around for several years and, even when they

do rebound, we would require significant revenue growth in

order to sustain rising expenditures for the existing

Medicaid program.

Attached, please find data responsive to your requests.

There is a summary sheet that provides an overview of the

information requested, along with several other sheets that

provide additional detail. As you know, there are many

unanswered questions regarding the proposals. This analysis

includes the assumptions that were used to develop the

figures, which will obviously change as the proposals are

refined.

Please do not hesitate to contact my office if you have

questions or should require additional information. I share

your concern regarding Arizona's ability to expand its

Medicaid program and what the long-term fiscal implications

will be for Arizona, and I hope you find this information

useful as you consider the various proposals that are before

you.

Sincerely,

Janice K. Brewer,

Governor.

I wonder, before the Republican leader leaves, if I could ask him a quick question? I ask unanimous consent that Senators Barrasso, McCain, and Bennett, and the Republican leader, be permitted to engage in a colloquy during our 30 minutes and that I be notified when we have about 4 minutes left.

I ask the Senator from Kentucky, the Republican leader, is it not true that the Finance Committee Democrats voted down a Republican proposal to put the health care reform bill on the Internet for 72 hours so Americans could read it?

I believe the Republican leader said the bill might be 2,000 pages long?

If I am not mistaken, there are several versions of the bill in the House of Representatives that will come over here. Then there is a version that we did in the Health Committee here that will have to be integrated with that bill; is that not correct?

It is my understanding in the Finance Committee they are not even writing a bill yet; they are just working on concepts?

How long do you suppose it would take, once the two bills are put together, for the Congressional Budget Office to tell us how much it costs?

Well, I thank the Republican leader. In our discussion today, I see the Senator from Wyoming is here, it is almost embarrassing to say that--I mean, to people outside Washington, and maybe even to people inside Washington, the idea that we would not take 72 hours to read a 2,000-page bill that spends $1 trillion or $1.5 trillion that affects virtually every American and that may have a lot of unresolved questions in it.

It is hard to imagine people would not think that was common sense, that we ought to read it before we vote on it.

I thank the Republican leader for his time. I would think every civics class in America, if the teacher would give a test, would say: Should an elected representative read a bill before he or she voted on it? Yes.

Should he or she know how much it costs? Yes.

Even the President has said we cannot have a deficit. Well, how are we going to know if it creates a deficit if we do not read the bill and if the nonpartisan Congressional Budget Office has not told us how much it costs?

I thank the Republican leader. The Republican leader mentioned there may be some questions we would want to know. There are some.

Governors across the country may want to know how much it is going to cost them and their budgets because, the other day, the chairman of the National Governors Association and the Republican Governors Association held a joint press conference and they said this: If you are going to expand Medicaid in our States, if the Federal Government is going to do it, the Federal Government ought to pay for it.

Medicaid is the largest government-operated health care program we have in the country. About 55 or 60 million Americans are there. The Federal Government pays about 60 percent of it and the State governments pay about 40 percent.

I noticed two articles in the newspaper. I ask unanimous consent to have these articles printed in the Record.

One is from the Wall Street Journal: State quarterly tax revenues plunge 17 percent. Talking about how budgets in California, Florida, other States are going down.

Then there is another article, September 29--actually these both appeared yesterday--in the New York Times entitled ``Majority Leader Protects Home State.''

Well, the majority leader, Senator Reid, has done exactly what all the Governors hope would be done. He has said: If the Federal Government is going to expand Medicaid in my State, the Federal Government is going to pay for it.

But, I would say to the Senator from Wyoming, I wonder how citizens in Wyoming and California and Florida and other States will feel if they pay more in taxes so Nevadans can pay less in taxes? Is that not the kind of question Senators from virtually every State might want to be sure about by reading the bill and knowing what it costs before it comes to the floor?

I think the Senator from Wyoming is making an awfully good point. He is a distinguished orthopedic surgeon, a doctor, one of two physicians in the Senate. Both of them happen to be on the Republican side of the aisle at this time, Senator Coburn, and I know, Dr. Barrasso, since we are talking about Medicaid, which is a program that every State has that serves low-income people, that States pay typically roughly 40 percent for, one of the questions somebody might have who reads the bill is: How many more low-income people are going to be added to that bill?

Because it is my understanding that Medicaid reimburses physicians at such a low rate, that about 40 percent of physicians will not see Medicaid patients. So by dumping more low-income Americans into Medicaid, we are dumping them into a program where they have 40 percent of a chance of not seeing the doctor or getting the services they want to have. Have you had any experience with that?

I have thought for some time that any Senator who votes to expand Medicaid in the States without paying for it at the Federal level ought to be sentenced to go home and serve as Governor for 8 years and try to pay for it and raise the taxes and deal with the people who cannot do that.

But that is the kind of question I think a Governor would want: Read the bill and know what it costs. For example, I believe there is a question about the Finance Committee, in its concept papers, may say: Well, we will pay for it for 5 years--or we will pay 77 to 95 percent of it.

The Governors are saying--now these are Democratic Governors as well as Republicans--they are all saying to us: Do not do that to us. Our revenues are down 17 percent, 18 percent, 20, 35 percent in some of our States. If you are going to pass it, pay for it. That is a question governors should have a chance to ask and get an answer for. That is why we need to read the bill.

Let's talk about Medicare because many people, unless they follow health care every day, confuse Medicaid, which is the program for low-income Americans that States help administer--there are about 55 or 60 million Americans in that program--and Medicare, which is the program that about 40 million seniors have.

We have had a lot of talk about Medicare. The President says: There are no Medicare cuts. Then, on the other hand, he said: We are going to take up to $\1/2\ trillion out of Medicare and spend it on a new program.

We are saying: You are going to cut one-quarter of the Medicare beneficiaries' Medicare Advantage payments. The other side is saying: No, that is not what we are doing. We are saying: How can you cut Medicare and spend it on another program when Medicare is going broke?

Well, I would think the American people would want to know the answer to those questions, and we should know the answer before we vote. Is that not another reason we should read the bill to find out who is telling the truth about Medicare?

I see the Senator from Utah has come. Let me ask one more question to Dr. Barrasso. Because we are told--and here is another reason to put the bill on the Internet for 72 hours and to wait a couple weeks or whatever it takes for the Congressional Budget Office to tell us how much it costs, because the President has said: There cannot be one dime added to the deficit, which we agree with.

In fact, we think the whole goal of this ought to be to reduce the cost of health care to you and then to your government but not one dime to the deficit.

But one of the assumptions of the bill coming through the Finance Committee has to do with what we elegantly call in the Senate the ``doc fix,'' the fact that basically the government sets what doctors will be paid when they see a Medicare patient. What we do every year is change what is in the formula because it cuts the physicians.

So is not the assumption that we are going to continue to cut what we pay physicians, and if we come along and change that in the second year, will not we then be adding to the deficit?

I see the Senators from Utah and Arizona have come to the floor. We were talking, Senator Barrasso and I, about how well the majority leader has done in helping to do what all of us would like to do in his home State.

He has noticed, I guess he has heard from his Governor, that the Finance Committee is saying we are going to expand Medicaid in the State, but the States are going to help pay for it. The majority leader has put something in the bill so Nevada does not have to pay for it.

I notice--to Senator McCain--according to the New York Times, in Arizona overall tax revenues fell 27 percent in the second quarter of this year from a year ago.

I wonder how Arizonans are going to feel about paying for Nevada's Medicaid.

Michigan, Rhode Island, and Oregon are the three others.

That is my fear. The danger is that they will put the bills together from these various committees and ram it through, and then we won't be able to ask the questions: Is my State going to pay more taxes for Medicaid? Is my Medicare benefit going to be cut, or is the national debt going to increase? These are important questions we have a right to know the answers to before we begin the vote on the bill.

I ask the Senator from Utah, what does he see coming down the pike?

Would the Senator not agree that therefore older Americans who depend on Medicare might especially want to read the bill?

The Senator from Wyoming was home last weekend. I wonder if he is hearing especially from senior Americans who worry about the effect of this bill on Medicare.

We have 4 minutes left. I believe I will wrap up and leave the last minute to the Senator from Utah. Our point is a pretty simple one. We believe, we Republicans, that after this bill is put together, we ought to have ample time to read it, that it ought to be on the Internet for 72 hours, and that we ought to hear from the nonpartisan Congressional Budget Office how much it costs. Why would we do that? Because we have differences of opinion over whether it hurts people on Medicare, over whether States will have to raise taxes in order to pay for Medicaid, over whether the assumptions made will actually add to the debt, over how large taxes are on small businesses. We have differences of opinion. The only way we can intelligently debate those is if we can read the bill and know what it costs.

On the Republican side, we believe we should focus on reducing costs and go step by step to re-earn the trust of the American people by fixing health care in that way, starting with such ideas as permitting small businesses to pool their resources in order to offer insurance to a larger number of people. Another way to reduce cost would be to find ways to eliminate junk lawsuits against doctors.

The Senator from Utah may have other thoughts about the importance of reading the bill.

I thank the Senator from Utah and yield the floor.

Will the Democratic leader yield?

He asked me what our plan is. I would be glad to tell him.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

How much time remains on the Republican side?

Madam President, I ask unanimous consent that we be permitted to engage in a colloquy for up to 20 minutes.

Madam President, all of us were home in August. It was a pretty good thing we were, because the people of the United States had a lot to say to us about the health care bill. I think President Obama was very correct when he said the health care reform bill is a proxy for the role of Federal Government in our everyday lives.

I think that is what we are debating here. On the one side, we have an effort by the majority and the President to do this massive, comprehensive health care reform with thousand-page bills and White House czars and trillions in spending and debt. That is on the one side. On the other side we have Republicans saying we want health care reform, but let's focus on reducing costs to each American who has a health care policy--that is 250 million of us--that is why people are showing up at town meetings; it is not some abstract thing--and reducing costs to our government, because we know that $9 trillion more in debt is coming.

Yes, I will.

The Senator is right. He and I and the Senator from Georgia are on the HELP Committee. We worked and we spent many hours in June and July marking up that version of the health care bill. We finished our work about July 15. That bill was 839 pages. It wasn't even presented to us until early in September, and we still don't know what it costs. I wonder if the Senator from Georgia heard much about reading the bill and how much it costs.

Maybe the Senator from Georgia and the Senator from Arizona know more about this than I do, and they are debating concepts but they are getting down to specifics. I saw in a morning newspaper that Nevada was somehow miraculously taken care of in the provisions for Medicaid expenses. We have had Governors, both Democrats and Republicans, here saying if you are going to expand on Medicaid in our State, pay for it. What happened in Nevada?

That is a very good point. The Senator from Georgia was in small business for many years before he came to the senate.

May I interrupt for a moment? I often hear it said that you Republicans are not for health care too much. The difference is we have a little more humility than to try to take on the whole health care system at once and fix the whole world. We are ready to go step by step, and that is one of the most important steps--to allow small businesses to pool their resources and offer health care to their employees. I think the estimate is it would add maybe a million new people who could be insured that way.

As I listen to the Senator, I wonder if the Senator from Georgia is having the same impact. Every single step he said Republicans are for, whether it is getting rid of runaway junk lawsuits, going across State lines to buy insurance, whether it is allowing small businesses to pool resources, or incentivizing prevention and wellness, they are all focused on reducing costs.

I ask the Senator from Georgia, I thought this was supposed to be about reducing costs for health care premiums and costs to our government; but it seems to me we are talking about more billions and more debt and more spending and taxes.

Going back to the point of the Senator from Arizona, I hear our friends on the other side say you have used scare tactics, saying there will be Medicare cuts. I ask the Senator, did I not hear the President say he was going to take a half trillion dollars out of Medicare for seniors? There are about 45 million seniors on Medicare and who depend on Medicare, and they will spend it on new programs. Is that not what I heard him say?

May I ask the Senator, if there are savings in Medicare, shouldn't it be spent on Medicare?

The Senators from Arizona and Georgia have raised a number of questions that need to be answered. How much is the expansion of Medicaid going to cost States in State taxes? How much of the Medicare costs are going to cost people on Medicare? Are individual premiums actually going up instead of down, which is what the Congressional Budget Office said. Why is there not something for getting rid of junk lawsuits in the bill? Why don't we have a small business health insurance pool?

The point we made when we first started is if we are taking on 17 or 18 percent of the whole economy in another one of these 1,000-page-plus bills, why then do the Democratic Senators vote down the amendment to say that

the bill needs to be online for 72 hours so we and the American people can read it? Shouldn't we read the bill we are voting on, and shouldn't we know how much it costs before we start voting on it?

If there is one point we would want to make, it is this. It is such an ambitious program. The stakes are so high. This is no abstract debate. The reason people are turning up at town meetings is because this is about their health care insurance and also whether your government is going to go broke in the next few years, dumping a lot of burdens on our children and grandchildren.

What we are saying is we need to read the bill and know how much it costs before we start voting on it. We need to read the bill. It needs to be online 72 hours. That is a modest request, it seems to me. That is a short period of time. Then we need to know how much it costs. Does it raise our premiums or lower them? Does it cut your Medicare, or does it not cut your Medicare? Does it increase the national debt, or does it not increase the national debt? We need to know the answers to those questions. It would be the height of irresponsibility for us to begin debating a bill that affects 17 percent of the economy at a time when our debt is going up so rapidly without having, one, read the bill and, two, knowing exactly what the nonpartisan Congressional Budget Office tells us every provision costs.

I thank the Senator from Arizona and the Senator from Georgia. They said what we believe. We need to stop, start over, and get it right. Above all, we--it seems such a basic thing to say it is almost embarrassing to say it on the Senate floor--we need to make sure we read the bill before we vote on it, and we need to make sure we know what it costs before we vote on it. Those two things are minimum requirements.

From the Republican side, we want to reduce health care costs, and rather than try a comprehensive health care reform of the whole system, we would like to work step by step in the direction of reducing costs in order to re-earn the trust of the American people. Senator McCain and Senator Isakson have outlined a series of steps ranging from eliminating junk lawsuits against doctors to allowing small businesses to pool their resources, all of which would help reduce costs. I thank the Senators.

I yield the floor. I suggest the absence of a quorum.

Mr. President, I see the majority leader is still on the floor, and I wish to thank him and the Republican leader for organizing last night's reception honoring Henry Clay, a great Senator, whose portrait will be hanging in the stairway outside of here. There was a time in history when Henry Clay, Daniel Webster, and John Calhoun were better known than the Presidents of the United States. That was in the 1850s, before the Civil War. It was good to take a moment all together, Democrats and Republicans, and think about that history and to honor the man who was known as the great compromiser, who during a time when our Nation was completely split over the Civil War, on three different occasions, found a way to try to bring it together. Of course, he died before the great war.

Mr. President, I ask unanimous consent that during the Republican morning business time I be permitted to enter into a colloquy with my colleagues Senator McCain, Senator Coburn, Senator Brownback, Senator Thune, and Senator Murkowski, who will be here shortly.

Mr. President, health care reform is the agenda for the Nation and it ought to be. We, on the Republican side, want health care reform, but we want the right kind of health care reform. Our focus is on costs. Our focus is on the cost to each American as he or she buys their health care policy; our focus is on the cost of the Government of the United States, for which each American has a responsibility to pay. What we have to do is to reduce costs to make it easier for Americans to afford their health care and to afford their government.

Every single one of us knows that unless we reduce the increasing costs of health care we will not be able to pay our bills in Washington, DC. We are in the midst of appropriations bills, and there is well-meaning debate here about whether we should spend more money for national parks and for safe drinking water and other urgent needs we have. That is the bill we are talking about today--clean air. Well, we should spend money on those urgent needs. Americans want us to do that. But we can't have those dollars, as the Senator from Alabama pointed out yesterday, if we continue to increase the debt--trillions in debt--and run up the interest rate bill.

We are headed toward a situation where, by the end of this decade, we will be spending $800 billion a year on debt--more than we spend on national defense, eight times as much as we spend from Washington on education this year. So those dollars could either be in the pockets of the American people for them to spend for themselves or we could be spending those dollars to clean the air, to relieve traffic congestion or to provide Pell grants and student loans so Americans can go back to school. Those are the things government ought to be spending money on, not on increasing debt.

So health care reform is, first, about cost--the cost to Americans for their own health care policies and the cost of their debt. The President noted this the other night and said in his remarks to us and to the American people that the health care bill couldn't add one dime to the deficit. That is reassuring because the President's proposals are already adding $9 trillion to the deficit over the next 10 years. He is doubling or tripling the national debt, which means he is adding more to the debt by a factor of two and then three than all the other Presidents put together. So surely we don't want to add more to it with a health care reform bill.

But when the President said that, he completely wiped out all the Democratic health care bills that have been proposed so far from the House and from the Senate. The Congressional Budget Office has said the Senate HELP Committee and the bills in the House all add to the debt in the first 10 years and in the years after that. So they should be off the table, according to the President's own standards.

Now we are looking at the Finance Committee in the Senate to see what they can do. Mr. Baucus, the Senator from Montana, has worked very hard in a good-faith, bipartisan way to try to develop a bipartisan bill--a comprehensive bill. But as we read the bill, there are a great many things to be worried about. For example, if you don't buy a health care plan, the IRS will tax you.

The President and George Stephanopoulos, on a Sunday show--and Senator Graham said the President seemed to be on every Sunday show except the Food Channel--were talking about the definition of tax. So that is the first thing. The second is the Medicare cuts.

I see the Senator from Arizona has come, and I would say to the Senator, through the Chair, we have received permission from the Chair to engage in a colloquy between myself and other Republican Senators who might come. I have already pointed out that the President himself has disqualified all the plans our committee worked on, the HELP Committee and from the House, because they all add to the debt. Now we see the Baucus plan coming forward, and I wonder if the Senator from Arizona has had an opportunity to look at--of course, that is not a bill yet. We all understand that. It is just concepts, and we will want to make sure we have time to read the bill and to know what it costs. But I wonder if the Senator from Arizona has had an opportunity yet to form an opinion about whether the Baucus bill does what we had hoped, which is reduce the cost to the American people of what their insurance costs and reduce the cost to the American people of their government in Washington.

One of my friends said to me after I was Governor: Rooster today, feather duster tomorrow. And I am afraid I am in the feather duster category.

The Senator has made a terrific point. I want to go to the Senator from Oklahoma, who has just arrived, to

talk about this, one of the physicians in the Senate. But on the first point, we need to read the bill, and there is no bill. Yesterday, Republicans tried to get the Finance Committee to say once there is a bill that at least for 72 hours it would be on the Internet. Then we need to know what it costs because even the President said----

They could let us know what they think of it, and then we need to know what it costs.

As to Medicaid, every Governor in America is worried about this. The Democratic Governors and Republican Governors have said to us: If you want to expand the Medicaid Program, which the States pay 40 percent of, you pay for it because we can't raise State taxes or raise tuitions or cut the highway program to do that.

The Senator from Oklahoma heard Senator McCain's question. The Senator from Oklahoma and Senator Barrasso the Senator from Oklahoma has delivered thousands of babies, and the Senator from Wyoming is an orthopedic surgeon. They have been touring the country, listening to a lot of doctors and physicians and medical personnel. I wonder if you have a reaction, Senator Coburn, to the questions of Senator McCain?

I would say to the Senator from Arizona, that is exactly right. The Congressional Budget Office did an analysis of the impact of Senator Baucus's plan on insurance premiums. It showed the premiums for those in the individual market would go up. So, to the point of the Senator from Oklahoma, one of the effects of the one remaining bill that is being considered here, at a time when we are trying to reduce the cost to Americans of their policies and their government, is that premiums would go up.

Mr. President, I ask Senator Coburn, isn't it true that, under the Baucus plan, about half of it would be paid for by Medicare cuts, which would then be spent on a new program?

The Senators from South Dakota and Kansas have joined us.

Senator McCain is leading a colloquy on the Baucus bill and health care.

I wonder, I ask Senator Thune, if you see the Baucus bill as a bill-- it is not a bill yet--that is likely to reduce costs?

Senator Thune, I see the Senator from Kansas is here. I wonder if Senator Brownback from Kansas or you from South Dakota have been hearing from your constituents about the possibility of shifting costs from Washington to the States when, because we in Washington say it is a great idea to expand Medicaid, then we shift some of the cost of that to the State, the State taxes go up or State services go down. I wonder if you have heard anything from the people of Kansas about that, Senator Brownback?

I believe the National Governors Association chairman, of Vermont, said that all Democratic Governors as well as all Republican Governors said: Don't shift it to us. If you want to expand Medicaid from Washington, pay for it from Washington.

Medicaid is the largest government program we have today, bigger than Medicare; it has low-income Americans in every State. I believe the Baucus proposal plans to add about 11 million more low-income Americans to this plan that 40 percent of doctors will not see patients for?

We have 5 minutes left. We will go to Senator Thune and let Senator Brownback wrap up our time.

But ``Medicare cuts,'' those are scary words to most Americans. And some people say: Well, you Republicans are trying to scare the seniors of America when you say the words ``Medicare cuts.''

But is it not a fact that the Baucus plan would cut Medicare by about $500 billion and use it for a different program instead of shoring up the Medicare Program?

We have about a minute and a half left in our time. I wonder if Senator Brownback would conclude.

I thank Senators Thune and Brownback.

Obviously, we believe that instead of a 1,000-page bill, we should do what Senator Brownback said. We should go step by step to re-earn the trust of the American people. For example, permitting small business plans to pool their resources to offer more insurance to a million people; buying insurance across State lines; stopping runaway junk lawsuits against doctors; signing up those people already eligible for Medicaid and SCHIP; and encouraging technology.

All of those are steps we can agree on and reduce costs, without running trillions of dollars of new debt, more taxes, and Medicare cuts. I thank the Senators from South Dakota and Kansas for participating in our colloquy.

I yield the floor.

Mr. President, I concur with the remarks of the distinguished chairman of the subcommittee. I believe these are good amendments. We are able to clear them with the relevant members and their staffs. I support their adoption.

Beyond that, I would like to say to the chairman, I appreciate her willingness to accommodate the amendments and the positions of a large number of Republican Senators who have important issues that we will have a chance to vote on, and for including us in the process. I thank her for that, and we look forward to the rest of the day and concluding work on the bill.

If I may, I know the Senator from Missouri is waiting to speak because he has an important meeting to go to. But if I could take 2 minutes, I think the Senator from Louisiana is making a point that concerns not just him but a number of us in the Senate on both sides of the aisle. Maybe the best way to suggest that is this way.

No. 1, the focus should be on the 18 new czars appointed by this President who were not confirmed, never have existed before, and the number of them.

No. 2, it was not the Republican side of the aisle that raised these concerns first. Perhaps this would best express the concern that many of us have. It was offered by Senator Byrd, senior Member of the Senate, the constitutional conscience of the Senate, who in a letter on February 23 said--this was a letter to President Obama--

The rapid easy accumulation of power by White House staff

can threaten the constitutional system of checks and

balances. At the worst, White House staff have taken

direction and control of problematic areas that are the

statutory responsibility of Senate-confirmed officials.

That would be exactly the point in terms of an environment or energy czar and energy or environment Secretary.

As Presidential assistants and advisers,

Senator Byrd goes on to say--

these White House staffers are not accountable for their

actions to Congress, to cabinet officials, and to virtually

anyone but the President. They rarely testify before

Congressional committees--

Et cetera.

Then, Senator Collins, on behalf of six Senators, wrote the President a very respectful letter focusing on the 18 new czars who had been appointed by the President simply asking what their authorities and duties are, how they are appointed, whether they are willing to testify, whether they would consult with us. Senator Feingold, the Democratic chairman on the constitution subcommittee, has expressed his concern and indicated he might hold hearings.

I think Senator Vitter is selecting a single example of this unusual number of new czars and raising the question of the constitutional checks and balances that is the same issue that Senator Byrd and Senator Feingold and many of the rest of us raised.

Mr. President, in just a few minutes, the Senator from Maine will have the floor. Senator Feinstein has asked those Senators who have amendments which are part of the unanimous consent agreement to come on over and call them up. I think Senator Coburn is probably coming following Senator Collins from Maine.

I listened carefully to Senator Whitehouse and to the distinguished chairman of the Environment and Public Works Committee. I wish to make an observation, if I may, which will take only 3 or 4 minutes, not to prolong the debate.

First, what Senator Thune and Senator Murkowski were saying is that the question of climate change is so important that we in the Congress ought to deal with it, not the Environmental Protection Agency. That is the point of the amendment.

Second, I am one Senator who believes we need to deal with climate change and who believes humans are contributing to it, and we need to stop stuffing so much carbon into the atmosphere. But while my friends on the other side often speak in great rhetorical flourishes about the inconvenient problem of climate change that my friend and fellow Tennessean Al Gore talks about, they are conspicuously silent about the inconvenient solution, which is nuclear power.

Even the President of the United States went to New York this week and made an entire speech talking about our commitment to climate change and lecturing the developing countries of the world about climate change when they are ahead of us on nuclear power and the President, in his entire remarks, didn't mention it once. I simply think that ought to be noted in the midst of this debate.

The largest contributors to carbon in the air are China, the United States, Russia, India, and Japan. There are 44 nuclear reactors under construction this minute, almost all of them in Asia. China has 4 reactors under construction and has announced plans for 130 more reactors. Why? Because nuclear power is carbon free. The United States hasn't built a new nuclear plant in 30 years. Russia intends to build 2 reactors a year in order to replace the 30 percent of electricity they get from natural gas so they can sell that gas to Europe at a big profit.

Japan is building two nuclear reactors a year. They derive 36 percent of their electricity from nuclear. South Korea gets nearly 40 percent of its electricity from nuclear, and they are planning 8 more reactors by 2015. India is developing thorium reactors instead of uranium. France is 80 percent nuclear and is selling electricity to Germany, which is the only major European country still renouncing nuclear power. And here we sit worried about climate change, having 104 reactors that we built before 30 years ago, which produce 20 percent of our electricity, but 70 percent of our carbon-free electricity, and the President goes to New York and doesn't say one word about nuclear power. He wants to build 186 50-story wind turbines, which will operate about a third at a time, and not at all in our part of the country, instead of taking the greatest technological advance of the last century, which we already use to produce 70 percent of our carbon-free electricity, and say let's do more of that.

I am hopeful that as this debate proceeds, the President will say let's double our nuclear production and build

100 new nuclear plants in the next 20 years. We should be able to agree on 100 new nuclear plants and electrifying our cars and trucks. If we do those two things alone, we would meet the Kyoto Protocol by 2030. But we don't hear a word about it.

Let's bring up the inconvenient problem of climate change and let's deal with it here. But let's bring up the inconvenient solution of nuclear power. As far as science goes, the chief scientist in the Obama administration, a Nobel Prize winner, Dr. Chu, says nuclear power is safe and nuclear waste--used nuclear fuel--can be safely dealt with for the next 40 to 60 years by having it stored onsite, while we have a mini Manhattan Project over the next 20 years to find the best way to recycle used nuclear fuel that doesn't produce plutonium.

This is a good debate. I am glad Senators have come to the floor to talk about this, and this is an appropriate amendment on which to have the discussion. The point of the Republican amendments were, let's do it in Congress, not the agency. If we are going to talk about the inconvenient problem, climate change--and I agree it is a problem and we need to deal with it--let's talk about the inconvenient solution, nuclear power, which today provides 70 percent of our carbon-free electricity, which is what we are debating.

Mr. President, will the Senator yield for a question?

Mr. President, I would ask the distinguished assistant Democratic leader if he is aware that the manufacturing czar in President Bush's time was appointed by the President and confirmed by the Senate and testified before the Senate? And I wonder if he is also aware that the AIDS czar was appointed by the President and confirmed by the Senate and testified before the Senate?

Senator Collins has been careful--I believe he is aware; I wonder if he is aware--that she is not talking about any czars whom we confirm and the President appoints and who testify, and she is only talking about the 18 new czars under the Obama administration, just as Senator Byrd did in February.

I wonder if the Senator is aware of those things?

Mr. President, I thank the assistant Democratic leader for his comments, and I want to especially thank the Senator from Maine.

The Senator from Illinois suggested that the waters had gotten muddied because some of us didn't count very well in terms of the number of czars who might exist in the Obama administration. That is why we are so fortunate to have the Senator from Maine, who is always careful, always thoughtful, and always experienced. What she has done is gone back to Senator Byrd's first letter in February, in which he expressed his concern about the constitutional issues here, and then she has counted 18 new czars in the Obama administration. Her letter of September 14 to the President is limited, thoughtful and respectful, and she simply asks that the President identify the specific authorities and responsibilities of those positions, the process by which the administration examines these people, and whether they are willing to testify before us. She is the ranking member of the committee Senator Lieberman chairs and will have an opportunity during the hearings to explore this.

Some of us are concerned that the administration is too dedicated to too many Washington takeovers, and the unusual number of new czars is the most visible symbol of the large number of Washington takeovers. I think we are fortunate that we have as thoughtful a Senator as the Senator from Maine and an independent Senator from Connecticut, Joe Lieberman, who will look into it. I am sure Senator Byrd will want to weigh in. Senator Feingold may want to have a hearing. So we will have an opportunity to have a thoughtful resolution.

I thank the Senator from Maine for her amendment and her leadership on this issue, and I look forward to hearing more from her on it.

Madam Chairman, if I could say to the Senator from California, the Senator from New Mexico has been waiting and the Senator from Louisiana has been waiting.

Madam President, I wish to thank the Senator from Oklahoma, the Senator from California, the Senator from North Dakota, and the Senator from New Mexico for their work on this amendment. The Senator from Oklahoma stated it exactly right, and that is our intention. I wish to thank the Senators involved.

Madam President, the Senator from Oklahoma has asked to be present when we do that, so I wonder if it might not be possible to take up other amendments at this time.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

I move to lay that motion upon the table.

The motion to lay upon the table was agreed to.

Amendment No. 2531

In 60 seconds I would like to thank Chairman Feinstein for being so accommodating working with Republican Members. I would like to thank my colleagues for moving this bill along. Senators Cochran, Inouye, Reid, and McConnell have been terrific. The staff members, Peter and Rachael and Scott; on our side, Leif and Rachelle and Rebecca. We thank you for your hard work.

I ask unanimous consent that each side be granted 4 additional minutes in morning business.

Mr. President, how much time is available for the Republican side?

Thank you very much, Mr. President.