Lamar Alexander

Mr. ALEXANDER

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

Mr. ALEXANDER. Mr. President, I would like to thank the Senators from Arizona, Utah, and Idaho. Reading that big bill is very hard to do. So for those who are watching, what we have been trying to do--as Senator McCain and Senator Kyl just did--is take specific provisions and discuss them and interpret them. We have done that with the higher premiums. We have done that with the higher taxes that the bill will require. We have done that with the Medicare cuts. Earlier today we had an hour discussion, led by Senator Corker, that discussed how the bill would send the costs for Medicaid expansion to States. We have talked now about what we would do if this bill were to fail, which we hope it does. We think this bill is historic in its arrogance--arrogance that we could turn over this whole system, that we think the American people cannot figure out that the bill costs $2.5 trillion, instead of the $849 billion, as advertised. What we propose is, we move step by step in the direction of cutting health care costs for individuals and for our government. We have proposed legislation that would reduce junk lawsuits, combat waste, fraud, and abuse, allow small businesses to pool resources to purchase insurance, allow Americans to purchase health insurance across State lines, expand health savings accounts, and promote wellness and prevention.

Mr. ALEXANDER. Mr. President, for those who are watching, Republican Senators are reading through the bill, reading the bill in its entirety. It is kind of like reading the entire New Testament in Greek. It is better to have somebody help interpret it. We have been talking about page 396, title II, subtitle A, section 2001, which expands Medicaid. We have heard eloquent statements about how moving 15 million low-income Americans into a program called Medicaid, which is a medical ghetto, is not health care reform. We have also heard Senator after Senator say what right do we have to expand Medicaid and tell the States that you are going to pay for it. What kind of arrogance do we have to say that to States that are in their worst fiscal condition since the Depression? The Reid bill requires states to expand Medicaid eligibility to cover all persons under 133 percent of poverty, which means those earning about $14,000 per year for an individual and about $29,000 per year for a family. Individuals who are not otherwise covered by an employer- sponsored insurance would not be eligible for tax credits. In effect, every American below 133 percent of poverty would be locked into Medicaid which is like confining them to a medical ghetto. With this bill we are on path to expand the largest ``public option'' we already have, Medicaid, and it could bankrupt the States, because they will be paying for it. As the former Governor of Tennessee, I do not see how Tennessee can pay for their part of the Medicaid expansion included in Senator Reid's health care bill without a new income tax, or seriously damaging higher education by raising tuition like California just did, or both. I am opposed to this expansion of Medicaid, which, according to the CBO, would cost States an additional $25 billion, and add 15 million people to the Medicaid Program. This would be the largest single expansion of Medicaid in the program's history. Why? Because nearly half of the reduction of the uninsured in the Reid health care bill is due to people moving into the government-run program that is Medicaid. Expanding Medicaid to cover uninsured individuals is a terrible vehicle for health care reform, because dumping this many more people into that program will increase problems for beneficiaries getting access to care and for maintaining quality. Plus the program is already riddled with fraud and abuse; this would just invite more of that. Most Governors are struggling with Medicaid in its current form, and they agree that expansion is a bad idea. This includes Democratic Governors. Tennessee's Medicaid Program is called TennCare. The Tennessean from Thursday printed an article that reports how ``People covered by TennCare may face new limits on their coverage and reductions in their benefits next year, under a plan unveiled Wednesday to help slice state spending.'' The article continues, ``The limits are meant to help TennCare, the State's Medicaid program for the poor, pregnant women and children, meet Govenor Phil Bredesen's goal of reducing spending by most State agencies by as much as 9 percent as the State deals with a shortfall in tax receipts that could reach as much as $1.5 billion over the next two fiscal years.'' If the Reid health care bill is passed, TennCare might introduce a $10,000 annual cap on hospital coverage for the 1.2 million enrollees. Additionally, they might also eliminate coverage for occupational, speech and physical therapy, and limit enrollees to no more than 15 outpatient procedures and 15 lab procedures in a year. This past Sunday, the Tennessean ran another story titled, ``Bredesen faces painful choices as TN begins budget triage'' which states ``there is no quarrel with the general position that Tennessee State Government faces a grim situation'' and the Governor anticipates that roughly $750 million in cuts will be needed for the next fiscal year. To make matters worse ``state tax collections are already $101.3 million less than assumed when this year's budget was enacted.'' Another article from the Tennessean reported that the State ``might release as many as 4,000 non-violent felons, possibly even including people convicted of drug dealing or robbery, under a plan outlined Monday by the Department of Corrections to deal with the state's budget crisis,'' and Tennessee is not alone in its budget crisis. Even though many States are going through budget crises much like Tennessee, Senator Reid has proposed to as even more costs onto these States. Earlier this month, the National Governors Association released a fiscal survey of the States and an accompanying release, ``The State Fiscal Situation: The Lost Decade.'' That report said: The recent economic downturn started in December 2007 and likely ended in August or September 2009, making it one of the deepest and longest since the Great Depression. It went on to say: Medicaid spending, which is about 22 percent of state budgets, averaged 7.9 percent growth in FY 2009, its highest rate since the end of the last downturn six years ago. Medicaid enrollment is also spiking, with projected growth of 6.6 percent in FY 2010 compared with 5.4 percent in 2009. We don't yet have an estimate from Tennessee of how much Senator Reid's bill will cost the state, but we expect it to be in the ballpark of what the Senate Finance bill would have cost, which according to Governor Bredesen would have cost an additional $735 million over 5 years. Tennessee can't afford to get a $735 million bill from Washington. Not only is it wrong to ask states to pay for expanding this program, but I think it is wrong to dump low-income Americans into a government-run program that is failing. Medicaid is a program that, if given the choice, none of us would join. A 2002 Medicare Payment Advisory Committee survey found that ``approximately 40 percent of physicians restricted access for Medicaid patients,'' meaning they won't take new Medicaid patients, because reimbursement rates are so low. Only about half of U.S. physicians accept new Medicaid patients, and yet this is how the majority leader proposes we cover the uninsured. Why is there such an access problem for people on Medicaid? It is because Medicaid reimbursement rates to doctors and hospitals are so low. Medicare pays 80 percent of what the private insurers pay and Medicaid pays about 72 percent of what Medicare pays. Which means if you are a doctor or a clinic, or a hospital, you get paid about 60 percent for serving a Medicaid patient versus one of us who has his or her private health care. You can see why this spells trouble, and the Senate bill does nothing to fix this problem. In fact, by dumping 15 million more people into the program it will only make things worse. Who would want to be one of those 15 million people? In addition to access problems, the quality of care for Medicaid patients is significantly lower than those with private insurance, and even those with no insurance. According to a survey by the National Hospital Ambulatory Medical Care, Medicaid patients visit the emergency room at nearly twice the rate of uninsured patients, and a 2007 study published in the Journal of the American Medical Association found that patients enrolled in Medicaid were less likely to achieve good blood pressure control, receive breast cancer screening, or have timely prenatal care than similar patients enrolled in private plans. Another study of cancer patient outcomes found that even after adjusting for patients who became eligible as a result of their cancer diagnosis, Medicaid patients have significantly lower survival rates than non- Medicaid patients. The final example I will give today of why dumping 15 million more people into Medicaid is such a bad idea comes from the Government Accountability Office, GAO. The GAO has determined that the program is plagued by fraud and abuse. In 2009, the GAO labeled Medicaid as a ``high-risk'' program, finding $32.7 billion in improper payments in 2007 alone. That is 10 percent of the program's total spending. As a former Governor, I am particularly concerned about the impact and expansion of Medicaid would have on the State budgets and the resulting squeeze on higher education spending. When a governor looks at his budget and sees the things he has to pay for like elementary and secondary education, prisons, roads, and Medicaid. Then a Governor looks at the things they want to spend money on like higher education and a Governor, knowing they have to balance their budgets every year, can't spend money he or she doesn't have, so something has to give, and it's usually higher education. As I noted earlier, the New York Times reported Friday that the University of California Board of Regents will raise undergraduate fees 32 percent by next fall to make up for steep cuts in state funding. The article goes on to report that ``The University of California now receives only half as much support from the state, per student, as it did in 1990. Even with the higher student fees, the system needs a $913 million increase in state financing next year to avoid further [budget] cuts.'' From 2000 to 2006, spending by State governments on Medicaid has risen 62.6 percent, because of that higher Medicaid spending; higher education has only seen an increase of 17.1 percent over the same time period. As a result, tuition at a public 4 year university has risen an average of 63.4 percent. So Congress passes a generous Medicaid benefit, and the governors have to pay the bills. Then the governor has to say to our college students: your turn, pay up. Expanding Medicaid is exactly the opposite of real health care reform. Senator Corker, you were the chief financial officer of the State of Tennessee. You were the mayor of Chattanooga. How would you like it if someone in Washington passes a program and sends you the bill?

Mr. ALEXANDER. I think we are out of time.

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

Mr. ALEXANDER. Mr. President, I see the Republican leadership in the Chamber. It seems as if every other word we hear coming from the other side is that this vote tonight is historic. I agree, it is historic. But I think my view of why it is historic is a little different from their view. I wonder if my colleagues would not agree with me that this bill is historic in its arrogance? It is historic in its arrogance to think that we in Congress are wise enough to take this entire complex health care system, that serves 300 million Americans and is 16 percent of our economy, and think we can write a 2,074-page bill and be wise enough to change it all at once. It is historic in its arrogance by dumping 15 million low-income Americans into a medical ghetto called Medicaid, which none of us or any of our families would ever want to be a part of for our health care. It is historic in its arrogance by sending the States, that are going broke, a big chunk of the bill for what we have just done. It is historic in its arrogance because it tells Americans that the bill costs $849 billion and then thinks we are not smart enough to read the print and figure out that the real cost is $2.5 trillion when it actually is implemented. It is historic in its arrogance by telling us that paying for reimbursement for physicians is not an important part of a health care bill. It is historic in its arrogance because it cuts and taxes grandma's Medicare, which according to the trustees will be broke by 2015 to 2017, and then spends it on somebody else other than grandma. The bill is arrogant because its telling us it will reduce premiums for most Americans, when, in fact, it increases premiums for most Americans. So People say: Where is the Republican health care bill? My answer to that is, don't expect Senator McConnell to come rolling in here with a wheelbarrow with a 2,074-page budget-busting, debt-ridden, arrogant piece of legislation because that is not what we believe in. What we need to do as a Congress is re-earn the trust of the American people by setting a clear goal of reducing health care costs, showing some humility, and starting to move step by step in that direction. I hope during this hour that we have a chance to talk about the specific steps to reduce health care costs that we Republicans have offered day after day to no avail.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I thank the Senator from Georgia. I am going to throw the question right back to Senator Isakson in just a minute. I appreciate Senator Chambliss taking time to point out what Republicans are for because it seems as if no matter how many times a day we say it, our Democratic friends do not hear it. Let me put it this way: Let's say Senator Isakson, who has been a small businessman, buys a new small business. He takes it over, and he sees that generally it is working pretty well but it has some problems with it. I wonder if the first thing he would do is come in and say, I tell you what, let's just turn it all upside down and change it all, or would he say, let's identify the problem, and let's take a few steps in the direction of fixing that problem. What Republicans are saying is, we have a big health care system that in general works pretty well. Mr. President, 250 million of us have health insurance plans; 47 million do not. Senator Chambliss has just pointed out who those people are. Thirteen million or 14 million are already eligible for plans and for one reason or another do not sign up. A few million are illegally here. Some others are young and think they are invulnerable and do not sign up. But we are saying the problem is the cost, people cannot afford to buy their own insurance, the government cannot afford its health care costs, and people are going broke over this. So we want to reduce the cost. Senator Chambliss identified this step-by-step approach. He mentioned reducing junk lawsuits against doctors. We have proposals for that. Combating waste, fraud, and abuse--we have introduced legislation for that. Senator Isakson talked about allowing small businesses to pool their resources. Additional ways to reduce cost is allowing people to purchase insurance across State lines, so you can shop for more insurance and reduce your cost through competition, and amending the health savings account laws so you can withdraw your money in a tax- free way to pay for your insurance premium, and encouraging wellness and prevention. We could take those six steps, reduce costs, and then take six more. I wonder, Senator Isakson, with your experience in business, if you think it makes any sense for us to just come in here and say: OK, we are really smart here in the U.S. Congress. This is a big country, with 300 million people. We are just going to turn the whole health care system upside down, write a 2,074-page bill, change the premiums, raise the taxes--do all these things--or would you go step by step in the right direction and try to re-earn the confidence of the American people who have lost a lot of confidence in Washington, DC?

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

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

Mr. ALEXANDER. That will extend until about 2:05.

Mr. ALEXANDER. Mr. President, the debate has begun. The debate is about reducing health care costs--the cost of premiums every American has or the cost to the government that every American has to be responsible for. The bill we have been presented goes in the opposite direction. It raises taxes. It means higher premiums. It cuts Medicare. It transfers major new costs to States which, in turn, will damage higher education and/or increase taxes or both. Our purpose on the Republican side is to take this next hour, as we intend to take several hours, all the hours allocated to us today and tomorrow, and help the American people have a chance to read the bill section by section, to understand what it costs and to understand how it affects them. In this next hour, the Senators from Georgia, Mr. Chambliss and Mr. Isakson, and the Senator from Kansas Mr. Brownback, will be focusing on tax increases. We will be referring specifically to page 348, title I, subtitle (f), part 2 of this 2,074-page bill, which has to do with the tax on employers. We believe a great many employers will look at this big bill, look at the tax on them, if they don't pay insurance, look at the new government program and say: It is going to be a lot easier for me to pay the fine and write a letter to the employees and say: Congratulations, I have written a check to the government. You are on the government plan. Then we will go to page 2,040 of the bill, which is the new Medicare payroll tax. That is a tax on hiring. You heard that right, a tax on hiring in the middle of a 10-percent unemployment situation. How is that going to create any jobs? We don't think it will. Then Senator Chambliss, especially, and Senator Isakson, because of his background as a small businessperson, will talk about what Republicans want to accomplish. If you are waiting for the Republican leader to roll in a wheelbarrow with a 2,074-page Republican version of health care reform, you will never see it. We don't believe in that. What we do believe in is identifying a goal--reducing the cost of your premium, reducing the cost to the government, and then going step by step toward that goal; for example, by reducing junk lawsuits, by allowing small businesses to pool their resources to purchase insurance, which we have offered but the Democrats will not allow to come forward, and by allowing people to purchase health insurance across State lines. Senator Chambliss and others of us will talk about this during the next hour. That is the Republican plan, to do what most Americans want done, to reduce the cost of premiums, and to not increase premiums and taxes, or cut Medicare. There is one hidden tax I wish to talk about because it is in the bill, and it is in the news. Most Americans may have seen that the University of California yesterday raised tuition 32 percent. There are, in our country, around 18 million students who are in higher education. What I wish to say to them is, if this bill passes, their tuition is going up. California's tuition is going up again. It is going up in Tennessee. It is going up in North Dakota, in Nebraska, in Georgia, everywhere there is a public college, university, or community college there are going to be new taxes or higher tuition or both. In California right now, they are pointing fingers at each other about the 32-percent tuition increase. But they should be pointing the finger at us, Washington, DC, Congress, because it is we who have allowed the Medicaid Program, the largest government-run program we have in the country, to go year after year with increases of 7 or 8 percent. We require every State, if it opts in, to have a government- approved Medicaid Program. In our State, it is called TennCare. That Medicaid Program is helping bankrupt the States. Here is a State of Tennessee headline: ``State looks at $1 billion in cuts.'' Part of that is from the recession. But part of that is because of the increased cost of Medicaid. What does this bill do? It sends to the States another $25 billion in increased Medicaid costs. What will that mean? Higher tuition rates, higher taxes, or both. The University of California has the reputation as the best public university in the world. It will not be that very long if the Congress of the United States doesn't rein in Medicaid and reduce its cost so Californians can afford to have both a health program and a fine university system. The Governor of Tennessee has said the same thing. He has been outspoken about this. He has talked about exactly the dollars it will cost us. In the House bill, it is $1.4 billion over 5 years. In my view, I don't see how the State of Tennessee can pay that without a big State tax increase or without damaging higher education or both. Someone might look at this and say: What does health care have to do with a 32-percent tuition increase in California? It has everything to do with it. Instead of reining in Medicaid, we are expanding Medicaid. By doing that, we are making it impossible for virtually every State to properly support higher education. The only choice they have, other than taxes, is raising tuition for 18 or 20 million students across the country. Californians, if this bill passes, your tuition is going up one more time. I call on the Senator from Georgia, Mr. Isakson. He spent a number of years as the leader of the Republicans in the Senate. He dealt with the Medicaid question. He dealt with the question of taxes. As a small businessman for most of his life, he understands well the impact of new taxes on hiring and mandates on businesses.

Mr. ALEXANDER. I wonder if the Senator would yield for a question?

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

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

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

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

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

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

Mr. ALEXANDER. I have a question I will ask any of the Senators who want to comment. Someone asked me yesterday: Where is all this opposition to these health care bills coming from? We have seen the Gallup poll and the Pew poll. These are not Republican Polls. They are well-respected polls in this country that are showing that independent voters, by 2 to 1, say they don't want this bill. I have been in and out of politics for many years. I have never had as many people stop me on the street or in the airport or wherever, and say, ``Please don't do this.'' Somebody asked me yesterday: Why is there that much opposition? My answer was--and this is what I would appreciate comments on--this is not just about health care. This is, as President Obama said one time, a proxy for a national debate about the role of government in Washington and in everyday American life. This is about the stimulus package, about the Washington takeover of car companies. This is about the growing debt; this is about the takeover of student loans; this is about every Washington takeover, and every increase in debt. That is what this debate is about. I think that is why we are seeing such intensive opposition. I wonder if you have any reflection?

Mr. ALEXANDER. I am afraid our time is almost up.

Mr. ALEXANDER. I thank Senators Brownback, Chambliss, and Isakson. I think all four of us want the American people to know above all that we have repeatedly said that instead of 2,000-page bills that raise taxes, raise premiums, cut Medicare, and transfer costs to States, we would rather identify the goal of reducing costs and go step by step toward that goal. We have introduced specific legislation to take those steps, which could be bipartisan, such as allowing small businesses to pool their resources to purchase insurance, that Senator Isakson talked about, and reducing junk lawsuits, as Senator Chambliss talked about, and allowing competition across State lines. We have our step-by-step plan. We believe the American people have lost confidence in Washington and that they would prefer that we go step by step in the right direction to reduce costs and re-earn their trust rather than pass a 2,074-page bill that will bankrupt the country. I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Thank you, Mr. President.

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

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I was listening to my friends on the Democratic side. I wish they could have been in the Senate 4 or 5 years ago. Actually that would have reduced our numbers, so as much as I like them, I would not have wished that. If they had been here, they might have been some help in arguing to the Democrats who blocked Miguel Estrada from even having an up-or-down vote, who blocked Judge Pryor of Alabama from having an up-or-down vote. The Democrats at that time seemed to argue a completely different point of view. What we want on the Republican side is very simple. You see this bill I am leaning against? This is the new bill. This is the Harry Reid--the distinguished majority leader's health bill. We want to make sure the American people have a chance to read it and they have a chance to know exactly what it costs and they have a chance to know exactly how it affects them. That is not an unreasonable request, we don't think. That is the way the Senate works. That is our job. When it came to the Defense authorization bill, we spent a couple of weeks doing that. When it came to No Child Left Behind, the Education bill, we spent 7 weeks going through it, and neither of those bills was 2,074 pages long. The Homeland Security bill took 7 weeks. The Energy bill in 2002 took 8 weeks. A farm bill last year took 4 weeks. So we have a little reading to do, a little work to do. We have done some preliminary reading, but what we want to make sure of is that the American people read the bill, know what it costs, and know how it affects them because health care is a very personal matter. I have done some reading since the bill came out last night. I was also a little bit amused to hear our friends complaining about how we are slowing things down. Well, this bill has been hidden in the majority leader's office for 6 weeks. He wouldn't let any of us read it. I don't know who he has been in there with writing it, but I guess it takes a long time to write a 2,074-page bill. But he didn't bring it out until last night, and now we have it printed out. Now he wants to vote on Saturday. Well, that is all right with us if he wants to vote on Saturday or Sunday or Monday or Thanksgiving Day. We are going to be here because these are the most important set of votes we are ever likely to take in this body, at least during the time I am here. Let me give a preliminary report to the American people in terms of the Thanksgiving spirit about this bill. It came out with a lot of fanfare. It has been hidden in the majority leader's office for 6 weeks, but here is my early verdict in terms of the Thanksgiving season. This is the same turkey you saw in August, and it is not going to taste any better in November. It is not much different than what worried you in August. In fact, it has gotten a little bit worse. If I may, let me give just a few thoughts about the bill. Why would I say it is the same turkey you saw in August, and you didn't like it in August? Well, it is still going to have higher premiums for you to pay. It is still going to have higher taxes for you to pay. There are still going to be big Medicare cuts for seniors to absorb in their program. And while it is a little too early to tell, there is very likely to be more Federal debt. It is still a big bill--more than 2,000 pages--and if you wait until it is fully implemented, it is still somewhere between $2 trillion and $3 trillion over a 10-year period of time. The Republican Budget Committee staff has looked it over carefully since last night and says it is about $2.5 trillion in spending over 10 years. It still starts taxing you and cutting your benefits immediately if you are on Medicare, but the benefits that come to you for the most part don't start until 2014. Let me be a little specific about it. It still leaves 24 million Americans uninsured, although it reduces the number of uninsured Americans by 31 million according to the Congressional Budget Office. It still doesn't take care of the physicians reimbursement. One of the most difficult issues we have is what we should do about the amount of money we allow doctors to make when they see patients who are in the government programs. In the Medicare Program, doctors only make about 83 percent of what they would be paid if they were seeing the 177 million of us who have private insurance. We regulate that. Doctors who see Medicaid patients, about 60 million patients in the low-income government program, only get paid about 63 percent, which is set by the state, of what they would get paid if they saw somebody who has a private policy. In fact, 50 percent of doctors will not see new patients in the biggest government program we have--Medicaid. So as you can imagine, a lot of doctors can't see the people in the government program. This new bill takes care of the doctors reimbursement for only 1 year. It leaves out about $250 billion over the 10-year period of time, so add that in when you are figuring out whether this adds to the debt. Does it have higher premiums? Yes, it does. The Congressional Budget Office says the new government plan in this bill would have premiums that are higher than private plans. Your common sense would also tell you that, because if we have $800 billion in new taxes somebody is going to have to pay those taxes. If they are on medical devices or insurance policies, do you think the insurance company is just going to pay those taxes? No, they are not. They are going to pass those on to you in the form of premiums. So higher taxes mean higher premiums. There is also $28 billion in new taxes from employers who have to pay a fine when they don't provide employer-based insurance. Under this bill, the chances are very good--in fact, the Congressional Budget Office says maybe 5 million Americans will lose their insurance. How could they lose their insurance under a bill such as this? The reason would be that the employer will read this big, complicated thing and say: I don't want anything to do with that. I will pay the fine. I will write a check to the government. Then I will write a letter to all of my employees and say: Congratulations, there is a new government plan, and you are in it. That is going to happen to millions of Americans who have private insurance today through their employers. The employer is going to simply say it is cheaper for them to pay the fine. It is easier for them to pay the fine than deal with this 2,074-page bill. According to the Congressional Budget Office, 5 million Americans-- and others think many millions more--will lose their employer-based insurance, and they will end up in the government plan. I just said in the government plan, the largest one we have, Medicaid for low-income Americans, 50 percent of doctors will not see those patients--new patients--because of the low reimbursement rates. The bill still relies on the States to pay for some of Medicaid. That is not new either. That concerns me greatly as a former Governor. Our current Democratic Governor said the bills he had seen so far would add over $1 billion to State taxes or spending over the next 5 years which, in my way of thinking, would require a new State income tax that would seriously damage higher education or both. In other words, we are saying give us a pat on the back. Thank you very much for expanding Medicaid, and I am going to send some of the bill to the States and let the States either raise college tuition or raise taxes or cut spending or put in new taxes to pay for it. There is also a new Medicare tax. The money that is raised from that, the Medicare payroll tax, is not spent on grandma, not spent on Medicare; it is spent on a new program. So we are going to cut Medicare and tax Medicare and not spend it on Medicare, which is going broke in 2015, according to its trustees. We have a new government program. Those are new. But, basically, it is still the same turkey you didn't like in August, and it is not going to taste any better at Thanksgiving dinner on Thursday. We need to start over. We need to go in the right direction. We need to cut costs. Republicans have offered a number of ways to do that: small business health plans, reducing junk lawsuits against doctors, competition across State lines. All of these steps would cut costs. We don't need a 2,074-page bill. We need to take it step by step in the right direction to cut health care costs, and when we take those five or six steps, we can take five or six more. I thank the President and yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I am glad I had the opportunity to hear the comments of the Senator from Iowa on Senator Byrd. We all have enormous respect for Senator Byrd. I had a chance this morning to say a word about him and to reflect on, among other things, that when I first came here as a young aide 42 years ago to Senator Baker, Senator Byrd had already been here for 10 years as a Senator. So it is quite a span of history, and all of us have many stories, including the instructions he would give us to stand behind our desk when we vote, and not work at the table when we preside. He kept order in the Senate, and we are grateful to him for that.