Lamar Alexander

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, after a lot of serious debate and discussion, we apparently are about to come to the point where we have our first vote on health care reform. What is it the Democrats--those on the other side--propose we do? Add one-quarter of a trillion dollars to the national debt. I thought this debate was supposed to be about reducing costs--reducing costs to the government and reducing costs to individuals across this country who cannot afford to pay for health care insurance. And then, as we find ways to reduce the costs of what we are doing, we can begin to expand health care coverage to the Americans who do not have insurance. But it is as big a problem--or bigger--today that those who do have health care insurance--and that is about 250 million of us out of 300 million--that many Americans cannot afford their health care. So our focus is, I thought, on cost. How do we reduce costs to the government and costs to the American people? What we see is that the very first vote on health care reform will be on a proposal to increase the debt by $247 billion over 10 years in order to pay for Medicare doctors reimbursements. This is not the insurance companies talking. This is not the Republicans talking. This is not one news commentator talking. This is the proposal by the Democratic side, that the first vote will be to increase the debt by a quarter of a trillion dollars. I wish to talk for a few minutes about this bill as we see it. Here we are supposed to be having legislation to reduce the costs to the government, and we apparently are going to, as the first step in the wrong direction, add a quarter of a trillion dollars to the government. The second thing we are trying to do is to reduce your costs--the costs that each of us pays for our health care insurance. The outlines of the bill we see coming through the Congress would actually increase premiums. I would ask the American people and ask my colleagues: If our goal is to reduce costs--and we are adding to the debt and increasing premiums instead of reducing premiums and reducing the debt--why are we doing this? Let me start first with adding a quarter of a trillion dollars to the debt. Here is what the proposal would be. You will remember a few days ago there was a great deal of congratulations when the Finance Committee finished a lot of hard work, and they said: This is a deficit-neutral bill. It doesn't add anything to the debt. That is what the Congressional Budget Office said based on a series of assumptions. That is something to be proud of because the President himself has said he won't sign a piece of legislation that adds one dime to the debt, and then he added to that, ``and I mean it,'' like a parent who wanted to make sure he was being heard by unruly Members of Congress. I am glad he said that. I heard him say it earlier in the year when he had a summit on the condition of the Federal budget. Democrats and Republicans--we all went down to the White House. People came in and said: If we don't do something about the increasing debt in our country, our children and grandchildren aren't going to have a country. That was not overstating it. Everyone at the President's summit agreed that the principal cause of runaway debt in America is health care. It is Medicare and Medicaid. Just these past few days--here is the weekend newspaper in Tennessee. This is the Nashville Tennessean on Saturday: ``Deficit leaps to $1.4 trillion.'' I think most Americans--I know at least most Tennesseans-- are deeply concerned about this. But lest you think a Republican Senator is exaggerating the problem, let me just read a few paragraphs from the Associated Press story: Deficit leaps to $1.4 trillion. Economists warn of crisis if U.S. fails to act. This is an Associated Press story. What is $1.42 trillion? It's the federal budget deficit for 2009, more than three times the most red ink ever amassed in a single year. It's more than the total national debt for the first 200 years of the Republic, more than the entire economy of India, almost as much as Canada's, and more than $4,700 for every man, woman and child in the United States. Yet the first proposal, the first vote on health care is going to be to add to that debt. The Associated Press article continues: As a percentage of U.S. economic output, it is the biggest deficit since World War II. And, some economists warn, unless the government makes hard decisions to cut spending or raise taxes, it could be the seeds of another economic crisis. Yet the first vote on the health care reform bill will be to add a quarter of a trillion dollars over the next 10 years to the national debt. Quote: ``The rudderless U.S. fiscal policy is the biggest long- term risk to the U.S. economy,'' said Kenneth Rogoff, a Harvard professor and former chief economist for the International Monetary Fund. Quote: ``As we accumulate more and more debt, we leave ourselves very vulnerable.'' Yet the first vote that is proposed on the health care reform bill is to add a quarter of a trillion dollars to the national debt. This seems unbelievable. I ask unanimous consent to have printed in the Record following my remarks the article by the Associated Press from the National Tennessean of last Saturday.

Mr. ALEXANDER. Mr. President, the issue at hand is something with which we are all very familiar. It is called the doctors reimbursement problem. When the 40 million seniors on Medicare go to see a doctor, the doctor is paid at a rate set by the government. That rate is only about 80 percent of what the doctor would be paid if the doctor was seeing a person with private health care insurance. There is a complicated formula in the law that says those doctor payments will go down over the next several years--by as much as 25 percent over the next 2 years. The Congressional Budget Office has estimated that over the next 10 years, just to pay physicians the same they are being paid today, which I don't think very many physicians would be happy with, will cost $247 billion more than is accounted for in the Baucus bill that came out of the Finance Committee. So they just assumed it wouldn't be paid to physicians and the doctors would be, in effect, paying for the health care bill. Well, suddenly some people on the other side of the aisle said: Oh, we can't do that, so we will just separate it from the health care debate. Actually, I think they have done us all a favor because they have made it the first vote on the health care reform bill. So we will have a chance to vote up or down on whether we want to add a quarter of a trillion dollars to the national debt. My experience in life is that most people remember their first impression, and if their first impression of voting on the health care reform bill is that the Congress starts off by just brazenly adding a quarter of a trillion dollars to the national debt at a time when the deficit has just leaped to $1.4 trillion in 1 year, then I think the American people will have a pretty good idea of what we are about here. I think the President doesn't--I can't imagine him wanting this, based upon his saying, ``I will not sign health care reform that adds even one dime to our deficit.'' And this is part of health care reform, make no mistake about that. This is part of the bill. It is part of the problem. We are looking at health care over the next 10 years. That is the way our budget cycles work. Everyone is scoring it or estimating its costs based upon what it costs over the next 10 years. To pay doctors 10 years from now what they are being paid today--which I doubt many doctors would be very happy with--will cost $247 billion. So instead of saying, let's find ways to cut other programs or raise taxes, we say, let's add a quarter of a trillion dollars to the debt. Adding a quarter of a trillion dollars to the national debt as the first step in the health care reform debate is the first step in the wrong direction. Of course we need to fix the problem of doctors reimbursement. It needs to be a part of what we do this year in health care reform. But just as with other parts of health care reform, we don't add to the debt to do that. At least that is what the President has said. At least that is what Republicans have said. And at least that is what the American people are saying at a time when the debt goes up and up and up. The next problem is that not only is the cost to the government going up and our first vote on health care reform about to be to add to the debt, the outlines of the bill we are seeing increases premiums. Over the weekend, the President said: Well, it is those mean old insurance companies trying to mislead you. You don't have to be an insurance company to understand that the premiums are likely to go up. In the first place, the Finance Committee reduced the penalty you pay if you don't buy insurance to a level that will cause a lot of people not to buy insurance--at least that is the estimate of many--and if younger people especially don't buy insurance, the pool of people who do buy insurance gets smaller and the people in that pool find their premiums going up. No. 2, the bill says--the outlines of the bill; of course we don't really have a bill. We will have a bill within the next several weeks, I imagine, or maybe several days. The bill says it is going to make it more expensive for my sons--one who is 30 and one is 40--to buy insurance and closer to what it costs for me. Right now across the country, I might pay eight times as much for my insurance as younger people do, but under this law it is going to say: We don't like that big gap between younger people and older people, so it might have to be two to one or three to one. Basically, it raises the cost of insurance for young people as a way of reducing it for older people. That means the premiums of younger people will go up, and it also means they may elect to get out of the system, make the pool smaller, and as a result of that, all premiums would go up. No. 3, there is a provision in the law that says you must buy in many cases a government-approved health care insurance. Many people choose a high-deductible insurance where you only buy insurance for the big problems you know you can't afford and you pay less for your monthly premiums that way. A government-approved insurance policy might make it not as easy for you to do that. One estimate in Tennessee is that the cost for one of these high deductible plans would go from $50 a month to $400 a month--a big increase for those who buy high-deductible insurance policies. That is the third way your premium might go up. Then the fourth way and final way, in addition to this concept we see coming from the Finance Committee that your premiums might go up, is there are $955 billion in new taxes. They say that is if we are taking a 10-year period after the program is fully implemented. They say: Well, those are taxes on other people. But they are taxes on your insurance company, taxes on the person you buy a medical device from, taxes on other people in the health care industry. What do you suppose companies do in any area that get additional taxes? For the most part, they pass those taxes on to you. So there have been a number of independent observers who have said that because the individual mandate has been weakened, because young people are going to have to pay more for their insurance as compared to older people, because the government-approved policy is not going to allow so many high-deductible policies that many Americans like, and because nearly $1 trillion in taxes is eventually going to be over 10 years passed on to people who buy insurance, for all of those reasons, premiums are likely to go up. So we are about to begin the debate on this floor on health care reform. It is one we need. What Republicans believe--and I see my friend from Delaware who I gather wishes to speak, and I will wind up so he can. But here is what we should do. We need health care reform, but health care reform is first and foremost about reducing costs, first to the government and next to individuals. To re-earn the trust of the American people on this score, we should start step by step with specific proposals that reduce costs; for example, allowing small businesses to pool their resources and offer insurance to their employees. Our own committees have estimated that this could add millions of people to the insured rolls. Second, reduce junk lawsuits that drive up costs. We disagree about how much it drives up the cost of insurance, but we don't disagree that it does. Third, allow people to buy insurance across State lines. That would create more competition. Fourth, create more health insurance exchanges so people can shop and find more different kinds of policies. Fifth, most all of us agree we need to encourage more health information technology and make health care simpler in that way. Perhaps we could even agree to change the tax incentives so that they don't all go to one group of people and are not going to lower and middle-income people. There are four or five or six or seven ideas we could go step by step with to reduce costs. If we did that, we would be moving in the right direction. It is the wrong direction to start the health care debate with a vote that adds a quarter of a trillion dollars to the national debt at a time when we just added $1.4 trillion to the national debt in the past year. Of course we need to fix the doctors reimbursement, but it needs to be paid for by--it can't be added to the debt. Whatever steps we take ought not just reduce the cost to the government; they need to reduce the costs to Americans, all of us who have health care insurance. Let's find ways to go step by step to reduce costs to the government and to reduce costs to premium holders and not start off by adding a quarter of a trillion dollars to the national debt. Exhibit 1 [From the Tennessean] Deficit Leaps to $1.4 Trillion (By Martin Crutsinger) Washington.--What is $1.42 trillion? It's the federal budget deficit for 2009, more than three times the most red ink ever amassed in a single year. It's more than the total national debt for the first 200 years of the republic, more than the entire economy of India, almost as much as Canada's, and more than $4,700 for every man, woman and child in the United States. As a percentage of U.S. economic output, it's the biggest deficit since World War II. And, some economists warn, unless the government makes hard decisions to cut spending or raise taxes, it could be the seeds of another economic crisis. Treasury figures released Friday showed that the government spent $46.6 billion more in September than it took in, a month that normally records a surplus. That boosted the shortfall for the full fiscal year ending Sept. 30 to $1.42 trillion. The previous year's deficit was $459 billion. ``The rudderless U.S. fiscal policy is the biggest long- term risk to the U.S. economy,'' says Kenneth Rogoff, a Harvard professor and former chief economist for the International Monetary Fund. ``As we accumulate more and more debt, we leave ourselves very vulnerable.'' Forecasts of more red ink mean the federal government is heading toward spending 15 percent of its money by 2019 just to pay interest on the debt, up from 5 percent this fiscal year. President Barack Obama has pledged to reduce the deficit once the Great Recession ends and the unemployment rate starts falling, but economists worry that the government lacks the will to make the hard political choices to get control of the imbalances. Friday's report showed that the government paid $190 billion in interest over the last 12 months on Treasury securities sold to finance the federal debt. Experts say this tab could quadruple in a decade as the size of the government's total debt rises to $17.1 trillion by 2019. Without significant budget cuts, that would crowd out government spending in such areas as transportation, law enforcement and education. Already, interest on the debt is the third-largest category of government spending, after the government's popular entitlement programs, including Social Security and Medicare, and the military. As the biggest borrower in the world, the government has been the prime beneficiary of today's record low interest rates. The new budget report showed that interest payments fell by $62 billion this year even as the debt was soaring. Yields on three-month Treasury bills, sold every week by the Treasury to raise fresh cash to pay for maturing government debt, are now at 0.065 percent while six-month bills have fallen to 0.150 percent, the lowest ever in a half-century of selling these bills on a weekly basis. The risk is that any significant increase in the rates at Treasury auctions could send the government's interest expenses soaring. That could happen several ways--higher inflation could push the Federal Reserve to increase the short-term interest rates it controls, or the dollar could slump in value, or a combination of both. Spending likely to increase The Congressional Budget Office projects that the nation's debt held by investors both at home and abroad will increase by $9.1 trillion over the next decade, pushing the total to $17.1 trillion under Obama's spending plans. The biggest factor behind this increase is the anticipated surge in government spending when the baby boomers retire and start receiving Social Security and Medicare benefits. Also contributing will be Obama's plans to extend the Bush tax cuts for everyone except the wealthy. The $1.42 trillion deficit for 2009--which was less than the $1.75 trillion that Obama had projected in February-- includes the cost of the government's financial sector bailout and the economic stimulus program passed in February. Individual and corporate income taxes dwindled as a result of the recession. Coupled with the impact of the Bush tax cuts earlier in the decade, tax revenues fell 16.6 percent, the biggest decline since 1932. Immense as it was, many economists say the 2009 deficit was necessary to fight the financial crisis. But analysts worry about the long-term trajectory. The administration estimates that government debt will reach 76.5 percent of gross domestic product--the value of all goods and services produced in the United States--in 2019. It stood at 41 percent of GDP last year. The record was 113 percent of GDP in 1945. Much of that debt is in foreign hands. China holds the most--more than $800 billion. In all, investors--domestic and foreign--hold close to $8 trillion in what is called publicly held debt. There is an additional $4.4 trillion in government debt that is not held by investors but owed by the government to itself in the Social Security and other trust funds. Inflation is a threat The CBO's 10-year deficit projections already have raised alarms among big investors such as the Chinese. If those investors started dumping their holdings, or even buying fewer U.S. Treasurys, the dollar's value could drop. The government would have to start paying higher interest rates to try to attract investors and bolster the dollar. A lower dollar would cause prices of imported goods to rise. Inflation would surge. And higher interest rates would force consumers and companies to pay more to borrow to buy a house or a car or expand their business. Most economists say we have time before any crisis hits. In part, that's because the recession has erased worries about inflation for now. In its effort to stimulate the economy, the Fed cut a key interest rate to a record low last December and is expected to keep it there possibly through all of next year. Demand for loans by businesses and consumers is so weak that low rates are not seen as a recipe for inflation. Robert Reischauer, a former head of CBO, said that in an optimum scenario, Congress will tackle the deficits next year. A package of tax increases and spending cuts could be phased in starting in 2013 and gradually grow over the next decade.

Mr. ALEXANDER. I thank the President, and I yield the floor.

Mr. ALEXANDER

Mr. ALEXANDER. Again, it has been said there is not much bipartisanship in this debate. That is not true. There has been a partisan rejection of a bipartisan bill. Fourteen of us signed up on the bill which Senator Wyden, a Democrat, and Senator Bennett, a Republican, offered. There is another option the various committees had. It didn't increase the debt a penny. It gave people more choices. It didn't have a new government program. It had a lot of good principles in it, but that was rejected. That didn't get the time of day, no more than the Republican step-by-step proposals, but there are other bipartisan efforts other than Wyden-Bennett. There is the Reid amendment offered by the majority leader. He became concerned about how the Baucus bill was going to transfer to the State of Nevada big, new Medicaid costs that might result in new taxes. Every single Governor in the country is concerned about that, Democratic or Republican. So the majority leader fixed the problem for Nevada and three other States. We will call that the Reid amendment and when this bill comes to the floor we are going to introduce a Reid amendment and we are all going to support it because we want it for Texas, we want it for South Dakota, we want it for New York, we want it for California. If the Federal Government is going to expand Medicaid, the Federal Government needs to pay for the Medicaid expansion and not send it to the States. So that will be a bipartisan step. Then there is another bipartisan step, and that was from eight Democratic Senators who wrote in and said: We want to be able to read the bill and know what it costs before we start voting on it. All 40 of us agree with that on the Republican side and we believe that is the right thing to do: Put it on the Internet for 72 hours. Senator Bunning has offered an amendment for that. That now has bipartisan support. That means, when this bill is finally written--it is not a bill yet-- when it comes out of the back rooms, it will at least be on the Internet for 72 hours. Then we will need to have a complete fiscal estimate. That ought to take a couple or 3 weeks. Then we need to come to the floor and debate it because we need to know: Are your premiums going up or down? Are taxes going up or down? What about these Medicare cuts: $500 billion in Medicare cuts not spent to restore Medicare but for a new government program, I think. My point is, there are a number of questions that need to be answered. Let me conclude in this way: We have a bipartisan approach. We want to read the bill and know what it costs. Enough of us do that, so I think we will do that, and we will have at least as good a debate as we did on the farm bill. That took a month. The Energy bill took 2 or 3 months. This is one-sixth of the economy, and we will need several weeks to talk. What will we be talking about? We will be talking about--at least I will be talking about--whether this bill is reform; whether it will reduce costs, and whether it will raise your premiums or lower your premiums. If it weakens the individual mandate; if it says young people can't buy inexpensive policies anymore; if it says millions of us have to buy government-approved, richer policies instead of policies with high deductibles; and if it imposes $955 billion of taxes that will be passed on, raising our premiums; if it raises our premiums instead of lowering our premiums, then why are we doing this? That is not health care reform. That is not reducing costs. We should instead take the Republican approach and go step by step to reduce costs starting with small business health care plans, reducing junk lawsuits, allowing insurance to be sold across State lines, creating health insurance exchanges, implementing health information technology, and changing tax incentives. I yield the floor.

Mr. ALEXANDER. Madam President, I congratulate the Senator from Arizona for identifying so well, among other things, how Republicans would like to approach the health care reform costs. We want to reduce costs for individuals who are buying insurance, and we want to reduce the cost of our government. Rather than a comprehensive 1,000-page, trillion-dollar bill filled with surprises, we prefer to go step by step in the right direction; that is, reducing costs. The Senator from Arizona has mentioned ways to do that. Whether it is allowing small businesses to pool their resources, which could add millions of people to the rolls of the insured in the country, whether it is reducing junk lawsuits against doctors, whether it is allowing for the buying of insurance across State lines or health insurance exchanges or using health information technology, we can take steps in the right direction to regain the trust of the American people and move toward reducing costs. The Senator also did a very clear job of pointing out how the Baucus bill may actually increase costs. There has been a lot of squirming around on the other side because it has been suggested that instead of premiums going down--which is the whole point of this exercise, reducing costs--they might go up. I would like to talk about that a little bit today. Premiums, your premiums--and let's talk about who the ``you'' is. We have about 170 million Americans who have employer-based insurance, and we have a total of about 250 million Americans--that is most of us--who have some kind of insurance premium that either we pay or is paid for us. I think our goal is to make it easier to afford those premiums; in other words, to reduce costs. But the Baucus bill, in at least four ways, increases costs, and raises premiums. One way is it reduces the penalty for individuals and families who are required to buy insurance so they might not buy insurance, and if the young and healthy go out of the insurance pool, premiums of everybody who is in the insurance pool go up. No. 2, the Baucus bill will say--and so do the other bills the Democrats have presented--that my children, who pay lower premiums than I do, will have higher premiums because under the law there can't be as much difference between what an older person pays and what a younger person pays. So for most young Americans who buy insurance--and in this case they will be required to buy insurance or pay a penalty, so their premiums go up. There is a third reason premiums go up. Premiums will go up because, when you buy insurance, you don't just get to buy any kind of insurance; you buy a government-approved, basic policy. It sounds like a little more Washington takeover to me. When you go out to buy your government-approved, basic policy, what you will find under this bill is that for millions of Americans, it will cost you more. Your premiums will go up. There are a great many Americans who make the sensible decision of buying a high deductible policy. They say: I will pay most of my health care costs up to a point, but I will buy the insurance for the catastrophe in my life that I could never afford. Well, those policies will not be as available. Then, finally, there are going to be $955 billion in new taxes. The bill is very careful about not placing them directly on you; it puts them on everybody you buy things from. It puts them on people from whom you buy your medical devices; it puts them on people from whom you buy your health insurance. We all know what will happen when we put taxes on people from whom we buy things. If we put taxes on oil companies, what happens? They pass it on to us at the gas pump. If you put taxes on all these health care services, what happens? Our insurance premiums go up. So one does not have to be an actuary to figure this out. If the individual mandate penalty is weaker, premiums go up. If young people can't buy cheaper policies--cheaper than mine if there is a rule--their premiums go up. If we all have to buy government-approved policies, or most of us do, that are richer than what many of us want to buy today, our premiums go up. If we have $955 billion in new taxes when the bill is fully implemented, most of which are passed along to us, our premiums go up. So I would ask this question: What is this exercise all about? I thought it was about reducing costs. I thought it was about lowering the cost of our insurance premiums. But it looks as though it will increase the cost of our insurance premiums and, if that is true, we ought to reject this bill for that one reason alone. Of course, we haven't even seen the bill. It is not written yet. It has to be combined by the majority leader in a dark office somewhere and then we will see it. But that is what we should be looking for. It is often said that--that is another reason why the Republican idea of a step-by-step approach to reduce costs makes a lot more sense than these big, comprehensive, 1,000-page, $1 trillion bills. We want to reduce the cost of insurance, but we don't want to pass a bill that raises premiums to do that. It has been said there is not much bipartisanship. Madam President, I hope you will please let me know when I have consumed 9 minutes.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, the Senator from Oklahoma, a practicing physician who has delivered hundreds or thousands of babies----

Mr. ALEXANDER. I thank the Chair, and I yield the floor.

Mr. ALEXANDER. I thank the Chair very much. I will conclude my remarks. What we are proposing to do is cut Medicare--take money from grandma--and instead of spending it on grandma by making Medicare more solvent, we are going to take that money, while the program is about to go insolvent, and create a new program. So these are the kinds of questions the American people have a right to ask and have answered. That is why we want to read the bill. Because we see, as we look at this bill, higher premiums, higher taxes, Medicare cuts for more government, and we don't believe that is health care reform. Mr. President, I ask unanimous consent to have printed in the Record the entire article from which I quoted.

Mr. ALEXANDER. I thank the Chair. Here is what Mr. Holtz-Eakin said: One inconvenient truth is the fact that Congress will not allow doctors to suffer a 24 percent cut in their Medicare reimbursements. Doctors today are paid about 80 percent of what private insurers will pay if they see Medicare patients and, under the law, that gets cut every year and every year we come in and fix that. Continuing to read from his article: Senate Democrats chose to ignore this reality and rely on the promise of a cut to make their bill add up. Taking note of this fact pushes the cost of the bill well over $1 trillion and destroys any pretense of budget balance. In other words, Mr. Holtz-Eakin is saying he doesn't believe we in Congress are going to cut doctors' pay when they serve Medicare patients by roughly $250 billion over the next 10 years. That is about the amount of money it would take just to pay doctors 10 years from now what they are being paid today, and most wouldn't be happy with that. So either the doctors are going to pay for this bill--$250 billion of it--or you are, because it is going to add to your debt, or your children or your grandchildren are. It is one way or the other. It is either doctors pay or your kids pay because it is not deficit neutral. He says: It is beyond fantastic to promise that future Congresses, for 10 straight years, will allow planned cuts in reimbursements to hospitals, other providers, and Medicare Advantage--thereby reducing the benefits of 25 percent of seniors in Medicare. His point is these are not only cuts in Medicare--$\1/2\ trillion worth of cuts--the cuts are being used to start a new government program. And here, as both Senator Harkin and Senator Coburn reminded us, Medicare in 5 or 6 years is going bankrupt--belly up.

Mr. ALEXANDER. Thousands of babies is one of the most eloquent spokesmen for what needs to be done in health care in the Senate. I am delighted he took time to come to the Senate floor today. It helps to have someone here who has such a passion for patients and who can talk to the American people on this complicated subject in terms of what this health care plan means for us. That is why so many of us on the Republican side agree with what eight Democratic Senators wrote to the majority leader the other day. They said: We would like to read the bill and know what it costs before we start voting on it. That seems so sensible that maybe the American people would laugh out loud if that would be a request, but it is. It is important to us and them and many more of the Senators--I believe virtually all of the American people--that we honor that request. What that means is that the legislative text being put together by Majority Leader Reid somewhere--the merging of the Finance bill and the HELP bill--that full text, and as the Democratic Senator said, the complete budget scores should be made available for 72 hours on the Internet before we begin to vote. The Director of the Budget Office has said it might take 2 weeks, 3 weeks, to have complete budget scores so we can know what the bill costs. But if it takes 2 weeks, if it takes 3 weeks, if it takes 4 weeks, we need to know. The President has said we cannot add a dime to the deficit. How are we going to know if we are adding a dime to the deficit if we do not read the bill and do not know what it costs? We cannot guess what is in the bill. We cannot guess at what it costs when we are talking about huge numbers--hundreds of billions, trillions of dollars. We have our work cut out for us. We can stay here and do this. We are prepared to do this. We Republicans agree with the Democratic Senators that we need to read the bill and know what it costs. We need to see the complete legislative text and the complete budget numbers. Why is that so important? Among other reasons, what we are hearing is that what the bill coming out of the Finance Committee does is, among other things, three big things. Instead of reducing costs, it has higher premiums, it has higher taxes, and it has Medicare cuts. That is not health care reform if it has higher premiums, higher taxes, and Medicare cuts for more government. What is the goal of this exercise? The first goal is reducing costs for each person who buys insurance. How many of us go home and hear that every weekend? I cannot afford my insurance; do something about it. Reducing costs. What else do we hear? People are saying: I cannot afford my government. You guys are running up the debt trillions of dollars, hundreds of billions of dollars. What we need to do is to reduce the cost of health care for individuals across America and for the government of individuals. But this bill raises premiums, raises taxes, and cuts Medicare to create more government. How does it drive up premiums? The Congressional Budget Office has said the obvious, which is that when we impose taxes on medical devices and on the insurance companies, what do they do with it? It is $900 billion-plus worth of taxes. They pass it on to us. So our premiums go up. Or there are new ``government approved'' policies that we will need to buy. If you are one of those Americans who likes to buy a catastrophic policy--that is, pay a lower premium so that you pay your own medical expenses unless something really terrible happens to you or your family--that is a pretty wise choice for many Americans. You may not be able to do that quite so easily under this bill because you will have to buy a government-approved plan or pay a fine. And then younger Americans may be surprised by the amount of money they have to pay. So it is very likely that for millions of Americans this bill will raise their premiums instead of reducing their cost, and 250 million Americans either pay premiums or have premiums paid for them. Then raising taxes. Here we are in the middle of a recession, 10 percent unemployment, and we are talking about nearly $1 trillion of tax increases that will be passed on to us in one way or the other. There is a $1,500 penalty per family if you don't buy insurance. There is an employer mandate. So if you are a small business, you will have to either provide insurance or pay that penalty. Then the governors of both parties--Democrats and Republicans--are in a near cardiac arrest over the prospect of the Medicaid expansion. I mean 14 million new people--low-income Americans--dumped into State Medicaid Programs. I say ``dumped'' because doctors and hospitals are reimbursed so poorly that only 40 percent of doctors will see Medicaid patients. So we are going to say: Congratulations, Mr. and Ms. Low- Income American, into the Medicaid you go in your State. Not only is it not health care reform for those individuals, but the governors can't manage it, the legislators can't manage it, and the taxpayers can't manage it. I have read, on the floor, comments from most Democratic Governors and most Republican Governors. They are in a situation where their States' budgets are in the worst shape since the 1960s. Medicaid is going up at 6 and 7 percent. They are taking money from higher education and K-12 grades and spending it on Medicaid, and now we are about to dump not only more low-income Americans into Medicaid, but we are going to send a part of the bill to the State governments which can't afford it. So that is State taxes, and it cuts your Medicare. The question I would like to raise is, what about those Medicare cuts and are doctors themselves going to be paying for this bill? There is an article today, or October 13, the former head of the Congressional Budget Office, Douglas Holtz-Eakin. These Congressional Budget Office heads are known to be pretty straight. This one was appointed by the Republican Congress; Mr. Elmendorf, whom we all respect, was appointed by a Democratic Congress, but they are all nonpartisan. Mr. Holtz-Eakin says: . . . the plan proposed by the Democrats and the Obama administration would not only fail to reduce the cost burden on middle-class families, it would make that burden significantly worse. The bill creates a new health entitlement program that the Congressional Budget Office estimates will grow over the longer term at a rate of 8 percent annually. To avoid the fate of the House bill . . . the Senate did three things: It promised that future Congresses would make tough choices to slow entitlement spending, and it dropped the hammer on the middle class. Mr. President, could you let me know when I have consumed 10 minutes?

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I ask unanimous consent to have printed in the Record remarks I made this weekend on the Saturn car company, which has lived and apparently passed away in the State of Tennessee but has contributed a lot to our State over the last 20 years.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, would the Chair please advise when I have consumed 9 minutes.

Mr. ALEXANDER

Mr. ALEXANDER. Mr. President, I congratulate the Republican leader for his comments. If it weren't so serious, he and I and the Senator from Texas would probably all be amused to hear the Democratic leader come here day after day and say the Republicans don't have a health care plan and then attack our plan. That is typical of the kind of talk we are getting about health care reform from the Democratic side. We are getting double-talk. It reminds me, a few years after I was Governor of Tennessee--it must have been the early 1990s--I was driving along in Nashville as a private citizen. I had the radio on. It might have been an Arkansas radio station, but I think it was a Nashville station. The announcer said: Big news. The Tennessee legislature has passed a new law creating a Medicaid program called TennCare. Here is what it will do. It will cover twice as many people for the same amount of money. Everybody was happy about that. Nobody had to raise taxes. Nobody had to pay any more money. Twice as many people get health care. I remember what went through my mind: I bet that doesn't happen. That sounds too good to be true. The same idea went through my mind when I picked up a paper this morning and read: The Senate Finance Committee has finished its work. We are going to give 29 million more Americans health care. It is going to cost hundreds of billions of dollars more, and it is going to reduce the Federal deficit all at once. What went through my mind was: That sounds too good to be true. It sounds like the TennCare story. Let's remind ourselves what the Republican leader said a minute ago. The focus is reducing cost. We all know there are people who don't have health care and who need it. We would like to extend it to them. But we can't afford to do that until we reduce the cost of the health care we have. It is going to bankrupt us as individuals if we don't reduce the cost of our health care premiums. It is going to bankrupt our government if we don't stop the growth of health care. Our first goal is reducing cost, which is why the Republican plan for health care is to take several commonsense steps in the right direction--reducing cost--that will get us where we want to go. We have said those on the floor time after time after time. They include allowing small businesses to pool their resources so they can offer insurance to more of their employees. They include taking steps to stop junk lawsuits against doctors, which are driving up malpractice premiums and causing problems for patients. For example, many women who are pregnant in rural West Tennessee counties have to drive all the way to Memphis to see a doctor because doctors would not practice there anymore because of the high cost of medical malpractice premiums, which is driving up the cost of health care. We could create exchanges in each State so people could shop for individual insurance. We could allow people to buy their insurance across State lines. We all believe that if we did a better job of encouraging technology, we could reduce cost and reduce paperwork. All doctors and nurses and medical assistants know that. Those are five steps we could take together to reduce cost, and we could begin to add to our rolls the 11 or 12 million people who are already eligible for programs we have today. That would make a big difference. Instead, what our friends on the other side want to do is transform the system at a cost of closer to $1.6 to $1.8 trillion, when fully implemented. The question will be, Will it reduce our costs? That is why we want to read the bill. We want to know what it costs. This is not a bill. This is some pages of concepts. This is not a formal, complete estimate of its cost. That only comes when we have a bill. We have had 8 Democratic Senators who have written to the majority leader and said what all 40 Republicans have said. The legislative text and the complete budget scores from the Congressional Budget Office that are going to be considered should be available on a Web site for 72 hours prior to the first vote. Democrats voted that down in the Finance Committee. They voted down the idea of allowing 72 hours to read a 1,000-page bill and to find out what it costs. Apparently, some Democrats are coming to their senses and saying: No, we would like to have the bill. We would like to read it. We would like to have a formal, complete score--their words--of what it costs, and then we will start voting. This is not a bill. These are concepts. Then the majority leader is going to put this all together into another bill or create a bill. Then it will take a couple weeks to find out what that costs. We have some questions to ask in the meantime. First, we would like the Democrats to join us in step-by-step solutions to reduce cost. Next, we want to know whether it is going to reduce the cost to government and whether it will reduce the cost to each of us who is buying health insurance. As I look at the outlines, I think it might not. For example, as the Republican leader said, we know it is going to cost about twice as much as the $800 billion advertised because it doesn't start taking effect for a few years. The taxes start right away, but the benefits don't start for a few years. That is the first thing. The second thing is, it is going to put 14 million more people into the Medicaid Program--not Medicare, this is the Medicaid Program. This is the program States operate that is paid for two-thirds by the Federal Government and a third by the States, about which all the Governors have said: If Washington is going to expand the Medicaid Program, Washington ought to pay for it. I suspect when we start asking questions, we will find Medicaid Program costs are underestimated. All the Governors think so. We had one of the most painful letters I have ever read from the Democratic Governor of Tennessee. Senator Corker put it in the Record. He talked about how Tennessee's condition was similar to the condition of most States. He said: For example, by 2013, we expect to return to our 2008 levels of revenue. We will already have cut programs dramatically. We will have to start digging out. We haven't given raises to State employees or teachers for 5 years. Our pension plans will need shoring up. Our rainy day fund will have been depleted. We would not have made any substantial investments in years. There will be major cuts to areas such as children's services. We are going to expand a program that is already causing the State of Tennessee and most other States to go toward bankruptcy. That is the way we are going to achieve reform. That is half the reform. Most Governors who have had anything to do with the Medicaid Program say that dumping low-income Americans into the Medicaid Program, where 40 percent of the doctors would not see them, is not health care reform. Medicaid costs are underestimated. Also, I don't think the Congressional Budget Office estimate of these concepts we saw includes what we inelegantly call the doc fix. Every year the system we have reduces payments to doctors who work on Medicare patients. So we come back and raise the amount of money. If we only pay doctors 10 years from today what we are paying them today to serve Medicare patients, it will cost $285 billion, and that is not in this bill. When we ask our questions and read the bill and find out what it costs, we will find it doesn't reduce the deficit. Even if it did, it is going to cost $1.6 or $1.8 trillion. Who is going to pay for it? Half of it is going to come from cuts in Medicare, which serves seniors. Instead of putting any savings in Medicare to strengthen that program, which is going bankrupt in 2015-2017, we are going to spend it on a new program. Eight hundred billion will come in new taxes. Our insurance premiums are likely to go up instead of down because we will all be buying new government-approved programs. If Speaker Pelosi is successful in adding the government-run option into the bill before it finally gets through, millions of Americans will be losing their insurance because employers will be paying a fine, instead of the insurance, because their employees can go to the government program. We are going to be paying for it. If you are a Medicare beneficiary, if you pay taxes, if you are a State taxpayer, if you buy insurance, you are going to be paying for this program. So it is important for the next 3 to 4 weeks that as we debate this, we ask these questions. Mr. President, I see the Senator from Texas on the floor, and I wonder, as I conclude my remarks, whether he has thought a little bit about whether it is going to be possible to ensure 29 million more people, spend hundreds of billions of dollars, and still reduce the deficit and reduce costs to the American people who are trying to afford their insurance premiums today.

Mr. ALEXANDER

Mr. ALEXANDER. 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. ALEXANDER

Mr. ALEXANDER. 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.

Mr. ALEXANDER. 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. ALEXANDER. 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.

Mr. ALEXANDER

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

Mr. ALEXANDER

Mr. ALEXANDER. 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?

Mr. ALEXANDER. Thank you very much.

Mr. ALEXANDER

Mr. ALEXANDER. 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. ALEXANDER

Mr. ALEXANDER. 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?

Mr. ALEXANDER. 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. ALEXANDER. 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.

Mr. ALEXANDER

Mr. ALEXANDER. 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.