Health Care
Floor Speech
HEALTH CARE -- (Senate - September 24, 2009)
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Mr. ALEXANDER. The Senators from South Dakota and Kansas have joined us.
Senator McCain is leading a colloquy on the Baucus bill and health care.
I wonder, I ask Senator Thune, if you see the Baucus bill as a bill--it is not a bill yet--that is likely to reduce costs?
Mr. THUNE. I think that is the big question about all of these various pieces of legislation we have had in front of us. What do they do to reduce costs? Even the Congressional Budget Office has said repeatedly, in this bill in particular, the Baucus bill, the most recent version of a health care reform proposal here, there is a $1.7 trillion cost over 10 years when fully implemented.
If you actually look at what it does for most people in this country, they are going to see their health care costs not go down but go up. The premiums are actually going to increase. The reason for that is many of the taxes imposed in the bill to help pay for the cost of the $1.7 trillion expansion are going to get passed on. So the people who get hurt by this are hard-working Americans who are expecting, if Congress is actually reforming health care, that would mean health care costs, the costs people pay for premiums for their health care coverage, would actually go down. The Congressional Budget Office, under questions that were raised yesterday by some of our colleagues, responded that dollar for dollar, those additional--those taxes that would be imposed to pay for this would actually be passed on and you would see higher health care costs.
So there has not been anything in this entire debate yet, or any of the bills that have been put before various committees or that eventually we assume will be considered on the floor here in the Senate and in the House of
Representatives, that has actually impacted costs in a way that they go down, that reduces the overall cost for the people in this country.
Furthermore--and I talked about this with the Senator from Tennessee; we had this discussion on the floor yesterday--many Americans, those I heard
from in my State of South Dakota during the month of August in the many conversations I had out there, are very concerned. They are really concerned about two issues: one is control, one is cost. Who is going to control their health care? Is the Federal Government going to do it, the bureaucrat in Washington, DC? In this country, are we ceding one-sixth of our economy, more and more control to the people in Washington, DC? The Baucus bill, inasmuch as it doesn't at this moment contain the government plan, still assumes a high level of government involvement, government intervention. The government would determine which health care plans it would have to approve, which would meet the standards the government set. So you have a high level of government intervention with this plan as you have had with all the other plans.
But perhaps even more important--and this is the issue I think most Americans are really homing in on--is the cost. What is the cost to me as a taxpayer? In this case, $1.7 trillion over a 10-year period when fully implemented. And does it reduce my cost of health care? They are going to look at it two different ways. One is, what am I going to have to owe in the form of higher taxes to finance this; and second, how is it going to impact the cost of health care for me in terms of the premiums I pay? I think it is fair to say--it is not what we are saying, it is what the Congressional Budget Office has determined--that actually the cost of health care for a lot of Americans, under this proposal, the Baucus proposal, is going to go up.
Mr. ALEXANDER. Senator Thune, I see the Senator from Kansas is here. I wonder if Senator Brownback from Kansas or you from South Dakota have been hearing from your constituents about the possibility of shifting costs from Washington to the States when, because we in Washington say it is a great idea to expand Medicaid, then we shift some of the cost of that to the State, the State taxes go up or State services go down. I wonder if you have heard anything from the people of Kansas about that, Senator Brownback?
Mr. BROWNBACK. I certainly have. I appreciate the Senator from Tennessee leading this discussion and also asking that question. As a former Governor, he has dealt with these issues. He knows that when Washington dictates something--or too often Washington will dangle a little bit of money out here and say: We would like the State to do this, and here is a little money to get it started. Then 3 years in the program, 5 years in the program, the money is pulled away at the Federal level and the State is left with trying to fund this.
It is on two levels that I get it at the State level: No. 1, trying to drive so many more people into Medicaid; that is, by raising the amount of coverage of people in Medicaid, it then gets a big price tag with it--at the Federal level initially and at the State level as well--and State budgets are really strapped right now. I was just talking with some State legislators yesterday, and they are looking at a multiple hundreds of millions of dollars hole next year--that alone, without adding additional Medicaid requirements from the Federal Government on top of that. It is clearly a huge problem for them if you are going to add a cost at a time when they don't have the funds.
The Federal Government, much of it, is saying: We are going to pay for it initially, and the proposals under Baucus are to pay for most of it initially, but I don't think there is any question that then, over time, the State is going to have to assume a bigger role of that, and that is going to be up to State responsibility.
Mr. ALEXANDER. I believe the National Governors Association chairman, of Vermont, said that all Democratic Governors as well as all Republican Governors said: Don't shift it to us. If you want to expand Medicaid from Washington, pay for it from Washington.
Mr. BROWNBACK. Pay for it and pay for it completely. But this is also a more pernicious piece of this, and that is we have 40 percent of our physicians in Kansas saying they are not taking more Medicaid patients. That is 40 percent now. Now you are talking about expanding Medicaid, the number of people in Medicaid, when 40 percent of your doctors are saying: We aren't taking them. You are saying: Why won't the doctors take it? It is not that they don't want to have Medicaid patients, but it is the reimbursement ratios they get. Listen to these numbers from MedPAC saying that Medicare provider reimbursement rates are about 80 percent of private insurance. So private insurance, and then 80 percent of that is Medicare, and then Medicaid is 72 percent of Medicare. So you are cutting it back even further, to the point that physicians are saying: I just can't afford to take more.
Mr. ALEXANDER. Medicaid is the largest government program we have today, bigger than Medicare; it has low-income Americans in every State. I believe the Baucus proposal plans to add about 11 million more low-income Americans to this plan that 40 percent of doctors will not see patients for?
Mr. BROWNBACK. They won't see them. Now what you are doing is driving people into a system that is a very low reimbursement system, that physicians are, almost half, saying: We won't take any more.
My concern here is that you are going to drive people in this system where you are not going to be able to get health care; they are not going to be able to get health care at all because of these reimbursement rates, because of the reimbursement rates physicians are having under Medicaid.
So I think that is a deadly piece of this overall proposal. It is the cost to the States, and then it is also that you are driving people into an area where providers are fleeing and heading out of.
Mr. ALEXANDER. We have 5 minutes left. We will go to Senator Thune and let Senator Brownback wrap up our time.
But ``Medicare cuts,'' those are scary words to most Americans. And some people say: Well, you Republicans are trying to scare the seniors of America when you say the words ``Medicare cuts.''
But is it not a fact that the Baucus plan would cut Medicare by about $500 billion and use it for a different program instead of shoring up the Medicare Program?
Mr. THUNE. We know for a fact that the Medicare trustees have said the Medicare Program is destined to be bankrupt in the year 2017. So Medicare is already on an unsustainable path. It needs to be shored up. And what we are talking about doing is getting savings, if you want to call them that, or ``cuts,'' I would say out of Medicare to create a whole new entitlement program here in Washington, instead of fixing and making more sustainable a Medicare Program that, as I said, is destined for bankruptcy by the year 2017.
I think most seniors and most providers around the country are going to be very concerned about the idea of having cuts in the Medicare Program, $500 billion, as the Senator from Tennessee has mentioned, go to paying for this new entitlement program which, as I said earlier, over a 10-year period is going to cost $1.7 trillion.
So I think you are not only going to have, as the Senator mentioned, a lot of providers very concerned about cuts, I think you are going to have an awful lot of seniors who are concerned about how their Medicare benefits are going to be impacted by this proposal. I would add to what the Senator has already talked about, and I know the Senator from Tennessee's Governor has called some of these Medicaid expansions ``the mother of all unfunded mandates.''
I have had numerous conservations with my Governor in my State of South Dakota about this. It would cost our State about $45 million a year, new revenues they would have to raise, to meet the matching requirements under this expansion of Medicaid.
In my State of South Dakota, that is real money. I know that does not sound like a lot out here in Washington. But that really is. My Govenor is very concerned, as are all Governors, about the impacts not just on Federal budgets but on State budgets.
Of course, as the Senator from Tennessee and the Senator from Kansas have pointed out, Medicare--and I might add, I love the quote from the CEO of Mayo, which the Senator from Tennessee has mentioned, ``If the public plan looks like Medicare, I think the country would go broke almost overnight,'' because Medicare is already proposed to go broke by 2015 to 2017.
I think that is the problem we run into when we try and build upon a foundation that is already crumbling. The Medicare Program is destined to go bankrupt. We are talking about adding a whole new entitlement. Instead of trying to figure out how to plow some of these savings back into Medicare and make it sustainable, we are actually adding to and building upon a foundation that is already crumbling.
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