Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Here is a letter from Vanderbilt University to Congressman Cooper from the Chancellor which says: Our overarching concern with [this proposal] is that the legislation forces institutions, including Vanderbilt, to switch to direct lending. Here is a distinguished university, one of the top research universities in the world. They have chosen--they believe it is best for their students and for their campus to use the private banks and non-profits. We know better, of course, than Vanderbilt University, what is best for the campus and best for the students. We say no, July 1, only the government. In their letter they continue: Vanderbilt opposes the elimination of the FFEL program. We encourage Congress to carefully study the many alternate proposals. . . . In addition to our concerns about the elimination of choice, competition, and the high level of services, products and debt management we believe would come with this switch, we are very concerned that the proposed timeframe for this mandated conversion is unreasonable. So Vanderbilt opposes that. So does the Baptist College of Health Sciences, so does Maryville College, so does the Middle Tennessee School of Anesthesia, so does Dyersburg State Community College. I ask to have these remarks printed in the Record and an article I wrote in the Washington Post that was published on Sunday, March 7, about the student loan takeover. Exhibit 1 Vanderbilt University, September 10, 2009. Hon. Jim Cooper, Longworth House Office Building, Washington, DC. Dear Congressman Cooper: The House of Representatives will soon consider H.R. 3221, the Student Aid and Fiscal Responsibility Act which would fundamentally restructure the federal student aid system and funnel the projected savings into a variety of higher education and K-12 programs as well as deficit reduction. While Vanderbilt supports efforts to restructure and expand federal student aid programs, we have serious reservations about this legislation. As you know, one proposed change has to do with the Direct Loan (DL) program, in which the government acts as the lender, and the Federal Family Education Loan (FFEL) program, in which lending institutions provide loans to students. Vanderbilt has a long and successful history of participation in the FFEL program which has provided our students with superior loan products, service, and choice in their federal loans for many years. Earlier this year, the administration proposed eliminating the FFEL program, requiring all institutions to participate in DL and using the projected $87 billion in savings over 10 years from this switch to fund a mandatory Pell Grant and expand the Perkins Loan program. [Other estimates have put the ten-year savings figure at closer to $47 billion.] H.R. 3221 seeks to implement those proposals. Unfortunately, the legislation has attracted a host of other education-related provisions which, while perhaps meritorious in their own right, we believe should not be attached to federal student aid legislation. We applaud and strongly support a number of provisions of

Mr. ALEXANDER. Mr. President, I ask unanimous consent to temporarily set aside the pending motion so that I may offer a motion to commit, which is at the desk.

Mr. ALEXANDER. If I may consult with Senator Gregg, then respond. If you will make the request later, I would be grateful.

Mr. ALEXANDER. Mr. President, could you let me know when 8 minutes has been consumed?

Mr. ALEXANDER. Mr. President, this has been a debate filled with passion and good intentions and a lot of hard work. Our political parties have come to vastly different conclusions. The President and the majority have said, this is an historic occasion. I agree. But I believe, as do most of us, that it is an historic mistake, and it is important to say why we think that. This is the fundamental mistake, that with the law that was passed yesterday and what the majority has proposed to do in this second bill, to expand a health ObamaCare delivery system that we all know is more expensive than we can afford, instead of stepping back and instead seeking to reduce the cost of that health ObamaCare delivery system so that more Americans can afford to buy health insurance. That is the mistake. I wish to try to say in 3 or 4 minutes what this bill means to Tennesseans. I was listening to the Senator from Montana and the Republican Senators talk about debt. We believe, I believe, that this bill, these two bills, will increase each Tennessean's share of the national debt. The Senator from Montana says: Well, but the Congressional Budget Office says it does not. Well, that would be like going to the Congressional Budget Office and saying: I have got a horse farm here. Tell me how much it costs to operate over the next 10 years. The CBO would say: Would you like me to tell you how to do it with the horses or without the horses? If you tell me how to do it without the horses, it is not going to cost as much. Or, if I have a gas station, would you like me to tell you how to operate that with the gas in it or without the gasoline? That is what we are saying here. They have gone to the Congressional Budget Office and said: Tell us how much this health bill costs. They have said to them: With the doctors or without the doctors? They say: Oh, no, keep the doctors out. Because, according to the President's own budget, that is $371 billion over 10 years. If you put that in, then the whole bill adds to the deficit, so they leave it out. So that is why we say, and I would say, that the first thing this bill does is add to the debt, each Tennessean's share of the debt. The second thing is, it adds $8,470 in new spending for every Tennessean. Thirdly there are 243,000 Tennesseans enrolled in Medicare Advantage, which is about one out of four persons in Medicare who will have their benefits reduced by half, according to the Congressional Budget Office Director in testimony before Congress, whose veracity we have been hearing extolled on all sides. The next thing it does is about 1.4 million Tennesseans making less than $200,000 will pay higher taxes, based on estimates by the Joint Committee on Taxation. Some 300,000 Tennesseans in the individual health insurance market will see premium rate increases of 30 to 45 percent based upon a Blue Cross/Blue Shield study of Tennessee and other analysis. Next, Tennessee's small businesses employing 50 or more people and construction companies employing 5 or more people--that is 5,000 construction companies in Tennessee--will pay higher health ObamaCare costs because of new government mandates. Then here is the other one. This is the one that was just added over the weekend: 200,000 Tennessee students including--I checked--11,000 at the University of Tennessee-Knoxville where I was this week, will be overcharged by $1,700 to $1,800 over the next 10 years on their student loans in order to help pay for the health ObamaCare bill and other programs. Let me say that again. Over the weekend, without any debate in the Senate, they have stuck in this bill--they are going to overcharge 19 million students in America, 200,000 in Tennessee, $1,700 or $1,800 more than it costs the government to borrow the money, because the government is taking over the student loan program. They borrow the money at 2.8 percent, they loan it out at 6.8 percent, they take the difference, they spend it, $8.7 billion of it to help pay for the health ObamaCare program. So that is 200,000 Tennessee students. These are not Wall Street financiers. This is a mom with a child and a job going to school to get a better job. That is 200,000 Tennessee students. And $1.1 billion in costs will be forced on the Tennessee government. That is according to our State Democratic Governor, who said that is the cost of the Medicaid expansion and what happens to the State after the physicians reimbursement expires in 2 years for Medicaid. This will force States, Tennessee for sure, and many other States, to raise taxes, cut services, or increase college tuition. According to an Oliver Wyman study, 30 percent of young people will pay up to 35 percent more in premiums as premiums go up in the individual market. Then finally, of course, the bill does add in Tennessee about 200,000 people to our TennCare or Medicare rolls. But that is not health ObamaCare reform because nationally only about half of doctors will see new Medicaid patients. So we are saying to people, we are giving you health ObamaCare, but it is like saying, we are giving you a bus ticket to a bus line where the bus only runs half the time. When you put these low-income Americans into this program in such large numbers, what that additionally does is create more opportunities for physicians, for hospitals, and for drugstores to say, we cannot serve Medicaid patients any more. That is why we feel this is the wrong course and an historic mistake. What we would do instead is replace this bill with a different bill that focuses on costs. We have said it over and over again. We said it at the health ObamaCare summit. We would start with allowing people to buy health care across State lines; with allowing small businesses to combine their resources to offer insurance to more people at lower costs; with reducing the number of lawsuits against doctors for malpractice. We would step up efforts against waste, fraud, and abuse, expand health savings accounts. All of these were proposals made before the Senate, basically ignored. But the fundamental mistake and the reason we have such a difference of opinion between that side of the aisle and this side of the aisle is that that side of the aisle, which has the majority, is expanding a health ObamaCare delivery system that we all know is too expensive, and we think instead what we should be doing is focusing on reducing health ObamaCare costs so that more Americans can afford to purchase health ObamaCare insurance. I yield back my time to the Senator from New Hampshire.

Mr. ALEXANDER. Mr. President, I wonder if the Senator from Montana would permit me to consider that request and then respond to him within a few minutes.

Mr. ALEXANDER. A ``no'' means savings to students.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I was talking with the Senator from New Mexico and the Senator from Wyoming about Stewart Udall, whom the majority leader also talked about a little earlier. He is the father of Senator Tom Udall and the uncle of Mark, and a great, distinguished American. He lived 90 long, good years, and did so much in our country to focus on conservation and the outdoors. So we remember and celebrate his life and send from our family, and I am sure from the entire Senate, our best wishes to our colleagues Tom and Mark and to their families.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I have been in and out of public life a long time, and I have never had anything affect me in a personal way like the health care debate. I got up this morning in West Millers Cove in Blount County and drove to the Knoxville airport, and almost every single person with whom I talked on the way into the airplane had something to say to me about the health care debate. When I get on the plane, here comes another fellow right down the aisle, hands me a note, and says: Thanks for all your hard work. None of them are for the health care bill passed last night. They are all deeply concerned and deeply worried about it, and they see it as I see it. They see it as a historic mistake. Unlike the Social Security bill, the Medicare bill, the Medicaid bill, the civil rights bills of 1957 and 1964 and 1968 and later, all those bills passed with significant bipartisan support. But the bill last night was a completely partisan act. The only thing bipartisan about it is the opposition to it. I think it is important that we continue to say why that is true. The fundamental mistake is that the bill basically expands a health care delivery system that we all know is too expensive at a time of enormous concern about the national debt. In the middle of a great recession, we are expanding a health care delivery system that we know is too expensive; instead of focusing our attention and working together to set as a goal of reducing the cost of the health care delivery system so more Americans can afford to buy insurance. That is the basic difference of opinion. The Democrats believe we should expand the system we have now. Of course, they make some changes, but basically it is an expansion of a system that is too expensive, and they make it more expensive. We believe what we should do, instead, is to reduce the cost of the American health care delivery system, and by doing so make it possible for more Americans to be able to afford health insurance. Here is what the bill does now, as we see it. It imposes even larger taxes on job creators in the middle of a recession. It will mean Medicare cuts and premium increases for millions of Americans. The Medicare cuts, it is said, are alright because there is some fraud and abuse in Medicare. We agree with that. But what we are saying is that Medicare, according to its trustees, is going broke by 2010, and every penny of savings in Medicare ought to go to Medicare to help make it stronger. This bill spends almost all the money on a new entitlement, and the bill last night cuts Medicare even more deeply. Some say: Well, it only hurts providers and hospitals. Well, those hospitals are the ones that may announce, as some are announcing, that we are not going to accept Medicare patients anymore because we are already being reimbursed so little. But it also cuts Medicare beneficiaries' benefits. The Congressional Budget Office says that fully half of those who have Medicare Advantage--and that is one out four Medicare beneficiaries in the country--will see their benefits cut. That is what this bill does. As far as premium increases go, the President and I had a little friendly discussion about that at the health care summit. I said: For millions of Americans, individual premiums would go up. He said: No, they won't. I said: With respect, Mr. President, the Congressional Budget Office says yes, they will, by 10 to 13 percent, on the average. He said: Oh, no, oh, no, they will be getting a better policy. But that is like saying: If the government requires you to buy a better car and it is more expensive, it may be better but it is still more expensive. For a variety of reasons individual premiums are going to go up, and one is the government requirement that you buy a better policy. Senator Collins, who was the insurance commissioner in Maine, has surveyed her State, and her conclusion is that 87 percent of the individual policies there will be more expensive under this bill. It is true that maybe half of those persons would get subsidies--paid for by taxpayers--but that still leaves maybe 40 percent of the individual policies in Maine where individual premiums will go up. They will go up because we are dumping more people into Medicaid--the State program for low-income Americans--and we don't reimburse physicians and hospitals adequately for those patients. Today, one-half of doctors won't see new Medicaid patients. So what do hospitals and the doctors do when they do see a Medicaid patient? They transfer part of the cost of seeing that patient--that Medicaid patient--on to someone who has private insurance. So that forces premiums to go up. When you have a provision in the bill, as this bill does, which says that my policy can't go up much when compared with my son's policy, well, that might keep my policy from going up so much, but my son is going to be paying a lot more. So younger Americans are going to be very surprised as the cost of their policies goes up. Then the provision in the bill with the requirement to buy policies was weakened, and because it is weak, a lot of young people especially may not join the policy. When they do not, that will leave sicker and older people within the system, and that will help drive premium costs up as well. So for all those reasons, for millions of Americans, it is accurate to say that premiums will go up. I was at the University of Tennessee this morning--a tremendous university. Dr. Chu, the President's Energy Secretary, is visiting there today and tomorrow. I wish I could be with him to talk about the work they are doing, between the Oak Ridge National Laboratory and the university and its science program. Senator Bingaman has visited there before. But one of the undercurrent stories in America today is the condition of America's public higher education. State funding for public higher education has been flat for the last 10 years. Why is that? Because Medicaid costs continue to rise. Governors can't control those budgets or control those costs, and the reason they can't is because we write the program up here and then send them about a third to 40 percent of the bill. They cannot afford it, so what do they do? They cut the amount of money that goes to the University of Virginia or the University of Tennessee or the University of New Mexico or the University of Wyoming and then what happens? Either quality goes down, fewer students are served, fewer faculty are attracted or tuition goes up, which is why the students are protesting in California about the 34-percent increase in tuition at the University of California. They probably didn't even imagine the reason for that is the Federal Government is causing Medicaid costs to continue to rise and Governors, therefore, make cuts and tuition goes up. This bill will make that worse. Then, on top of that, you have the last-minute takeover of the Federal student loan program. Suddenly, 19 million students--well, 15 million of those 19 million will go to the Federal Government to get their loan, beginning in July, instead of to 2,000 lenders across the country. The Government is saying we are going to save money. That may be true. But guess what the Government is going to do with its money. They are not going to say: Because the Government can borrow the money at 2.8 percent it is going to cost us less to operate the program, therefore, we are going to give students the savings. They are going to spend the savings. So they are going to borrow it at 2.8 percent and loan it to the students at 6.8 percent. That is overcharging America's students to help pay for the health care program. These students are not Wall Street financiers. They are working people, some of them pretty grown up, in their thirties and forties, going back to Walter State Community College. They often have a job. They are not going to be very happy when they find out they are paying higher interest. The estimate that we have made in our office is it might be $1,500-$1,700 dollars over 10 years in more interest. That is the amount the Governor is going to be overcharging them to pay for other government programs, including health care. The action that is being taken may be historic. But we believe that it is a historic mistake and that throughout the rest of this year the debate will not end about health care; but it will change. It will be larger than just health care. As the President himself said last year, the health care debate is a proxy for a larger debate about the role of government in America's life. We believe that is a debate our country should have, and we believe the country will soundly reject a policy of more taxes, more spending, more debt, and more Washington takeover. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, will the Senator from Arizona take a question?

Mr. ALEXANDER. I thank the Senator, and I will sit down and listen to his explanation on the other issue. But I heard the Senator mention the news this morning, that the new bill--which we have not seen, and which, suddenly, of course, as is usually the case, we have to rush and pass over the weekend before we read it--is going to save the government money. I do not think very many Americans believe that. But my question is this: I wonder if the Senator knows whether this comprehensive health care bill--which is going to ``save'' the government money; not run up the deficit--includes the amount of money it costs the government to pay doctors to serve Medicare patients. If it does not include that amount--which I believe I heard the Representative from Wisconsin say was $371 billion in the President's budget over 10 years--would that not be like asking the Congressional Budget Office to tell you the cost of a horse farm without the horses? Can the Senator from Arizona imagine a comprehensive health care program that does not include the cost of paying doctors to serve Medicare patients? If it does not, does that not clearly mean that just that one provision will guarantee that the bill will increase the Federal deficit?

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I appreciate the Senator from Arizona bringing this up, and I think it is important for the American people to be reminded that the Senator from Arizona has a certain amount of credibility on this matter because about 4 years ago--when we were in the majority and we became frustrated because Democrats were blocking President Bush's judicial appointments--it was the Republicans who said--I didn't, but some Republicans said--well, let's just jam it through. We won the election, let's get it with 51 votes. Let's change the rules. But Senator McCain and a group of others said: Wait just a minute. He said then what he has said just today. He said the U.S. Founders set up the Senate to be a protector of minority rights. As Senator Byrd, the senior Democratic Senator, has said: Sometimes the minority is right. And it was Alexis de Tocqueville who said, when he wrote his observations about our country in the 1830s, that potentially the greatest threat to American democracy is the tyranny of the majority. This is supposed to be a place where decisions are made based upon consensus, not just a majority. As Senator Byrd has said: Running the health care bill through the Senate like a freight train is an outrage. It would be an outrage. I would ask the Senator from Arizona whether he believes it is not just the higher premiums and the higher taxes and the extra costs to States; that, in the end, the reason this health care bill is so deeply unpopular is because of the process because, first, there were 25 days of secret meetings, and now they are jamming it through by a partisan vote. Something this big, this important ought to be decided by consensus in the Senate.

Mr. ALEXANDER. Well, when they jump, they may be. But Senator Reid and his Democratic colleagues, I would say to my friend from Arizona, are not going to have any incentive to catch these House Members who vote for the bill because the President will have already signed it into law, and he will be well on his way to Indonesia, as the Senator from Arizona has just said. We have 41 Republican Senators who have signed a letter saying that you are not going to make new deals and send them over here and change them by reconciliation.

Mr. ALEXANDER. I wonder if the Senator from Arizona would agree with me that what is happening is the President is inviting the House Democrats to join hands and jump off a cliff and hope Senator Reid catches them.

Mr. ALEXANDER. Madam President, the Senator from Arizona and I and Senator Barrasso, who will be here in a few minutes, had the privilege of being invited by the President to a lengthy health care summit a couple of weeks ago at the Blair House, a historic location right across from the White House. Over the 7\1/2\-hour discussion, there were some obvious differences of opinion. In fact, my friend, the majority leader, said: Lamar, you are not entitled to your own facts. I think he is right about that. We want to use the real facts. But the American people, once again, seem to have understood the real facts. In the Wall Street Journal yesterday, March 10, there was an article by Scott Rasmussen and Doug Schoen. Mr. Rasmussen is an independent pollster, and Mr. Schoen was President Clinton's pollster. Here is one of the things they said. We were saying, with respect to the President: Mr. President, your plan will increase the deficit. This is a time when many people in America believe the deficit is growing at an alarming rate and will bring the country to its knees in a few years if we do not do something about it. The President and his Democratic colleagues said: No, the Congressional Budget Office says we do not increase the deficit. The American people do not believe that, according to Mr. Rasmussen and Mr. Schoen. They say: . . . 66 percent of voters believe passage of the President's plan will lead to higher deficits. They are right about that. Why do I say that? Because not included in the comprehensive health care plan that the President has yet to send up--we do not have a bill yet. We have an 11-page memo which is suggested recommendations in a 2,700-page Senate bill. We do not have a bill. But the plan does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients over the next 10 years. According to the President's own budget--and Paul Ryan, the Congressman from Wisconsin, brought this up at the summit--that costs $371 billion over 10 years. Let me say that once more. What we are being asked to believe is, here is a comprehensive health care plan that does not add to the debt, but it does not include what it costs to prevent the planned 22 percent pay cuts for doctors that serve Medicare patients. That is akin to asking you to come to a horse race without a horse. Does anybody believe a comprehensive health care plan is complete and comprehensive if it does not include what you actually are going to pay doctors to see Medicare patients? Of course not. You have to include that in there. That adds $371 billion to the President's proposal, and that, by itself, makes it clear the proposal adds to the deficit. The Senator from Arizona is here, and I say this to the Senator. Also in the article in the Wall Street Journal it said: Fifty-nine percent of the voters say that the biggest problem with the health care system is the cost. . . . That is what we have been saying over and over again. Let's don't expand a program that costs too much. Let's fix the program by reducing costs. According to the survey--remember this is an independent pollster and a Democratic pollster: Fifty-nine percent of voters say that the biggest problem with the health care system is the cost: They want reform that will bring down the cost of care. For these voters, the notion that you need to spend an additional trillion dollars doesn't make sense. If the program is supposed to save money, why does it cost anything at all? Asked the pollsters. I ask the Senator from Arizona that question. If this program is supposed to save money, reduce costs, why does it cost anything at all?

Mr. ALEXANDER. Madam President, I congratulate the Senator from Arizona for his consistency, for 5 years ago saying to members of his own party that the Senate is a place where minority rights are protected. As Senator Byrd has said, sometimes the minority is right. It slows things down, yes; but it forces us to get it right. I ask unanimous consent to have printed in the Record the editorial from the Wall Street Journal to which I referred a little earlier.

Mr. ALEXANDER. Madam President, I ask unanimous consent that the Senator from Wyoming be allowed to lead the colloquy in our remaining time.

Mr. ALEXANDER

Mr. ALEXANDER. Madam President, I ask unanimous consent that the Republican Senators be able to engage in a colloquy.

Mr. ALEXANDER

Mr. ALEXANDER. I thank the President. Here is a third reason, in addition to government mandates and taxes, that will cause premiums to rise. We call it cost-shift. Premiums will increase because the bill dumps 15 million to 18 million more Americans into the government program called Medicaid. This is the analysis of the Chief Actuary on January 8, 2010. I ask unanimous consent that the relevant portions be printed in the Record.

Mr. ALEXANDER. The one-size-fits-all provision in the Democratic bill says all individual and small group policies must have an actuarial value of 60 percent. Senator Susan Collins of Maine, who was the insurance commissioner of Maine, made a speech on the Senate floor on December 18, and pointed out that 87 percent of the individual policies that are purchased in Maine today would cost more under the Reid bill. I commend to my colleagues the Senator's testimony of December 18, 2010. Senator Collins used the example that the most popular individual market policy sold in Maine costs a 40-year-old about $185 a month. Under the Senate bill that 40-year-old would have to pay at least $420 a month, more than twice as much for the policy that meets the new minimum standard, or face a $750 penalty. It is true Maine citizens, as is true for all Americans--about half of them--would receive subsidies to help them buy that policy, but the average premium for the other half of the 87 percent is going to go up under the Democratic bill. We believe Americans ought to have more choices than that. That is a fundamental difference of opinion. Should Washington decide you need to buy a richer policy, or should you decide that for yourself based upon the other needs of your family? The Congressional Budget Office does state, as I have mentioned, that there are a number of enrollees--about half--who would have the subsidies, and that is in the letter I have already introduced into the Record. But someone is paying for those subsidies: the taxpayers are paying for them, which brings up the second reason I said on Thursday that premiums for millions of Americans in the individual market will go up. The commonsense idea is that if you tax an insurance company or a medical device company or a manufacturer of drugs, they will pass the taxes on to whom? To us, who are buying insurance policies or medical devices or drugs. So we end up paying. In fact, one part of the President's proposal deliberately does that. It is a 40-percent excise tax on insurance companies for what we call Cadillac plans, the high- cost private insurance plans. A letter from the Joint Committee on Taxation, dated February 24, says the 40-percent excise tax will raise $32.7 billion, all of which will be passed along to consumers in the form of higher insurance premiums. That may be a good thing. In fact, I think it is because it helps to discourage the purchase of more expensive policies. But it does raise premiums in the individual market. The Joint Committee on Taxation Memorandum on High Cost Plans, dated September 29, says: The excise tax would be mainly passed along through increases in premiums. Because the new tax is indexed to regular inflation plus 1 percent instead of medical inflation, which goes up very much higher and quicker, the new tax, like the alternative minimum tax, will pretty soon start to hit Chevy and Buick insurance policies and not just Cadillac policies. But there are other taxes in the President's proposal. There are up to $\1/2\ trillion in new taxes, which will be passed on to consumers: $20 billion in excise taxes on lifesaving medical devices, $33 billion on drugs, and $60 billion on health insurance companies. In the previously mentioned CBO letter and a JCT letter to Senator Grassley in October of last year, both said these taxes will be passed on to patients, increasing health insurance premiums. The Chief Actuary of the Center for Medicare and Medicaid Services, who is a part of the Obama administration said: We anticipate such fees would be generally passed through to health consumers in the form of higher drug and device prices and higher insurance premiums. That was on December 10 of last year, about the Senate bill. The Lewin Group, on October 30, said: Employer spending would increase steadily under the [Democratic] act, reflecting the cost of paying the various excise taxes under the act. Total employer health spending would increase by 2.1 percent by 2019. I ask unanimous consent to have printed in the Record the executive summary of the Lewin Group letter.

Mr. ALEXANDER. Now, the President said: Wait a minute. The premiums in the individual market will go down 14 to 20 percent. That is also in the same letter. Of course, he is right about that. They go down because of administrative efficiencies and new enrollment, but he left out that there are other factors involved so that the government mandates will drive them up 27 to 30 percent or, in the end, the average, as the CBO said, premium per person covered in an individual policy would be up 10 to 13 percent. The bill has subsidies in it for some Americans. The same letter says about half of Americans who buy in the individual market will get a subsidy. Well, we are paying for that subsidy, but let's concede that point. Still, that leaves half of the people in the individual market for whom premiums will go up on an average of 10 to 13 percent. Why is that? One reason is because the Senate bill says people will have to buy a richer policy than they have today. That means it has a higher actuarial value. They call it in the bill ``minimum creditable coverage.'' It means this is the amount of insurance I think you should have before you buy a policy. That might be a good decision. It undoubtedly would be good to have the insurance. It just costs 27 to 30 percent more than today's average. The National Federation of Independent Businesses wrote a December 12 letter in opposition to the Senate bill saying the benefit mandates will put small business owners ``at risk of having to drop coverage due to cost increases that outpace their health budgets.'' I ask unanimous consent to have printed in the Record the letter from NFIB to Senator McConnell and Senator Reid, dated December 8.

Mr. ALEXANDER. The National Federation of Independent Business letter says the same. There are other reasons the premiums will go up. Mr. President, seeing no one else here, I wonder if I might ask unanimous consent for 5 additional minutes.

Mr. ALEXANDER. Mr. President, it was my privilege last Thursday, along with some other Members of the Senate, to attend a health care summit at the invitation of President Obama. It went on a long time. We learned one thing we already knew, that our President is smart and knows a lot about health care. So he stayed the whole time. But it gave those of us on the Republican side a chance we do not have the opportunity to have as often, which is, to be on center stage and let the American people know, A, who we are, and, B, what our ideas are. So it was a terrific way for us to show, for example, that our goal is to reduce health care costs, that we wish to move step by step toward that goal. We identified a number of areas, such as being able to buy health insurance across State lines, allowing small business health plans to pool together, reducing junk lawsuits--all of which will tend to bring down the cost of premiums, which is what most Americans want. During the discussion, early on, actually, the President and I had a little disagreement about whether his plan, which is based upon the Senate bill, which passed on Christmas Eve, would raise premiums. What I had said in my opening remarks on behalf of Republicans was that millions of Americans, under the Democratic plan, would pay higher insurance premiums in the individual market because of government mandates and taxes. The President says that is wrong. I cited a Congressional Budget Office report to show I was right. And rather than dispute the President of the United States in public--I thought I had enough time to make my case--I said I would send him a letter, which I did that same day. So I ask unanimous consent, Mr. President, to have printed in the Record the letter I gave to President Obama on Thursday.

Mr. ALEXANDER. The point is, Medicaid only pays doctors and hospitals about 60 percent of the cost of serving the 60 million patients who are now there. The Democratic bill would add 15 million to 18 million more patients. So what do the doctors and hospitals do? They see these patients, but then they shift the costs to the patients they see who have private insurance. The President himself said that adds about $1,000 to every policy today, this cost-shifting. I have included that comment from the Chief Actuary. The PriceWaterhouseCoopers report on the Senate Finance Committee bill in October of 2009 indicated that the net effect of the bills before Congress will make the Medicare and Medicaid cost-shift even more severe, raising the cost of private insurance premiums for large employers by $255 a year between 2015 and 2019. I ask unanimous consent to have printed in the Record the relevant portions of the PriceWaterhouseCoopers report.

Mr. ALEXANDER. But today what I wish to do in the next few minutes is explain why I believe I am correct, that under the President's health insurance plan, which is based upon the Senate plan, for millions of Americans in the individual market, premiums would go up because of one-size-fits-all government mandates, because of taxes that are passed on to consumers; but for other reasons as well--by shifting costs. When you dump 15 million people or 18 million people into a program called Medicaid, what happens is, we do not pay the doctors and the hospitals well enough to take care of those folks. So those providers shift the costs to people who are paying with private insurance, and premiums go up. Costs for young people in the individual market will go up under this plan because if you put in a rule that says my insurance at my age cannot go up more than a certain amount compared with my son's insurance, then his insurance goes up, and because a scheme like the Democratic plan depends upon requiring everybody to buy insurance. There is a weak provision for that, and I suspect many young people will rather pay the $750 fine rather than buy a $2,500 insurance policy, which they think they cannot afford. The President made the point in his usual very persuasive way that, wait a minute, actually you would be getting better insurance. But that is comparing apples and oranges. As George Will said on ABC's ``This Week'' yesterday--he asked this question: If the government required you to buy a better, more expensive car, even if it was better than the car you have, it would still be more expensive, would it not? That is the case with the President's health care plan. In fact, premiums will go up for millions of Americans in the individual market, up more than they otherwise would over the next several years--and we all know how rapidly they are rising--and the whole exercise we have been going through over the last year is to bring premiums down, not help drive premiums up. What I said to the President, with respect, was that the Congressional Budget Office, on November 30, said this about the Senate bill: The Congressional Budget Office and the Joint Committee on Taxation estimate that the average premium per person covered for new nongroup-- That means individual policies-- would be about 10 to 13 percent higher in 2016 than the average premium for nongroup-- That is individual coverage-- in the same year under current law. In other words, if you buy an individual policy--that means not a policy with your employer--by 2016 it will be at an average of 10 to 13 percent higher than it otherwise would. I ask unanimous consent to have printed in the Record the relevant parts of the Congressional Budget Office letter of November 30 to Senator Evan Bayh on this point.