are we going to say to families who don't have many extra dollars it's in our national interest to raise our costs? are we going to keep out of our country people with products and ideas, causing them to keep our products and ideas out of their country? are we that afraid of competing in the world? we tennesseans have been much better off since federal express started flying in china and nissan started building cars in tennessee. the federal express employs 30,000 people in the tennessee -- in the memphis, tennessee, area. nissan announced this week it's going to build electric cars not in japan, but in smyrna, tennessee. that's because we trade with the world. this creeping protectionism we see is a threat to the middle-class budget of every american. senator johanns has made an important step toward keeping

that. let me talk about another threat to the middle-class families' budget, and that is health insurance. how do we pay for health care? and i don't have to explain to anyone who might be listening or reading these remarks that health care for most americans is a cost that is difficult to afford. it's difficult for most small businesses. we have many large businesses who are having a difficult time competing in the world marketplace because of health care costs. some, we think of the auto industry in detroit, has claimed that the legacy costs of health care have put them out of business, unable to compete even with car companies that locate in the united states and make cars here, employing american workers. so we on the republican side, like our friends on the democratic side, want health care reform this year. and president obama is going to town meetings and saying what he is for.

he's saying let's do it this year. he is saying let's make sure we cover the 47 million americans who are uninsured. he is saying let us make sure we can afford it. we don't want more debt, the president is saying. we certainly agree with that. he's already proposed over the next ten years more new debt than it costs to wage all of world war ii. that's according to "the washington post." so we agree with him. we don't want a new health care bill with more new debt. we don't want a health care bill that puts more new taxes on states as they pay for state-operated health care programs like medicaid. and we want to make sure that americans who want, who like their insurance are able to keep the insurance they have. about 138 million americans have employer-sponsored health insurance, which they like, and they like the quality of the health care they get. so we don't want to just think

about the 47 million who are uninsured. we want to think about all 300 million americans, and we republicans agree with the president. we want health care reform this year. we want a health care plan that you can afford. we want a health care plan your government can afford so your children don't get a big debt piled on top of them. and we want to make sure that the uninsured are covered as well. we want to make sure on this side that washington doesn't come in between you and your doctor. in other words, you and your doctor make the health care choices, not some washington bureaucrat who might cause to you wait in line or deny treatment that you and your doctor think is needed. so how does the senate bill that we're working on stack up with the president's ideas that we should cover everybody, be

able to pay for it, and allow people to keep their insurance? well, i'm very disappointed to report, madam president, that according to the congressional budget office, which is a nonpartisan agency in the congress, and the congress of course is majority democrat by a large margin, has given us some very disturbing information about the bill we're working on in the health committee, a place i'm about to go in a few minutes to continue considering parts of the bill, since we only have a little bit of the bill that's come before us. here's what we know about cost. the congressional budget office has said that in the first ten years of the kennedy bill which has been presented to us, it will add $1 trillion to the debt, the national debt. $1 trillion. senator gregg of new hampshire, who is the ranking republican on the budget committee, has pointed out once the health care program envisioned in the kennedy bill is up and going,

then over a ten-year period, say year 5 through 14, that it would be $2.3 trillion added to the debt, a debt that already, madam president, is more new debt in the next ten years, according to "the washington post," than we spent in all of world war ii in today's dollars. people in tennessee and across this country are saying, whoa, wait a minute, this is getting out of control. we need some limits. we know you've got a printing press there in washington, d.c., but our children and our grandchildren and even we are going to pay the consequences if we don't have some limits on the amount of debt. so i would think the president would say to the senators who are working on this, wait a minute, senators. i said this needs to be something that pays for itself. we can't add $2.3 trillion. that's not all, madam president. we don't even half half -- even

have half the kennedy bill. sph*ft most important parts are yet to come. some of the most expensive parts are yet to come. and the assumptions we're left to work with -- because we hear them discussed -- is that there will be a big expansion of the medicaid program that states help to operate and help to pay for, usually about 40% of the costs, and an expansion of the reimbursement rates that go to doctors and hospitals who participate in the medicaid program. what would that cost? well, in the state of tennessee, if we increase medicaid to 150% eligibility, to 150% of poverty level, which sounds pretty good, that adds about $600 million to the state cost of medicaid in tennessee. and if we increase the medicaid reimbursement rates, that adds another $600 million to the state costs of medicaid. and when the stimulus funding goes away after two years, which

was sent to the states to help pay for medicaid costs, that's another $600 million. we throw so many dollars around up here that it's hard to say what's important. just to give you one idea of what would happen if a senator went home to be tkpwofrp and had to manage a medicaid -- went home to be governor and were faced with a $1.2 billion, $1.5 billion, $1.8 billion new state cost about 2015, where would he get that money, or she? the 10% income tax state would raise about $1.2 billion. the cost we're talking about adding to states are astronomical. most states who are having a difficult time even balancing their budgets this year, some nearly bankrupt -- think of california -- and add to that huge new medicaid costs as well

as a federal addition to the debt of $2 trillion or $3 trillion is an unimaginable prospect and totally inconsistent with what president obama has said, who said very sternly to congress two or three weeks ago, we need to pay as we go if we're going to spend a dollar, we need to save a dollar. or we need to tax a dollar. so we'd have to raise or save $2 trillion or $3 trillion to pay for the kennedy bill as we know it or -- and if you live in a state that would have increased medicaid costs, we could have, depending on what these provisions say, huge new state taxes to pay for them. so, that bill gets an "f" on the first aspect of the president's request, costs and debt. the second is that we cover the 47 million uninsured. unfortunately, even though we add perhaps $2 trillion to $3

trillion to the federal debt and a lot of new state taxes, the bill that we're considering in the senate health committee will only reduce the number of -- will only cover 16 million more people who are not now insured. in other words, we've reduced the uninsured to -- the number of reduced from 47 million to 30 trillion. i think that's a flunking grade as well for a bill. then what about allowing you to keep your insurance if you like it? well, the congressional budget office also had something to say about that. it said that if the kennedy bill as it is presented were enacted, 15 million people would go from private insurance that they now have to an existing or a new government-run health care plan. you might do that because you choose to or you might do that because your employer says i think i'll quit offering the

insurance you now have. so this doesn't seem to fit what the president is suggesting we do. so with all respect, mr. president -- madam president, i know that there's been a lot of hard work done on this bill. but we need to stop and start over, even to get close to the president's own objectives. let's take the 46 million or 47 million uninsured americans. we need to be realistic about what we're dealing with here. 11 million of those are noncitizens. about half of those are illegally here. so we deal with those in one way or another. about two-thirds -- about a third of them, about 15 million or 20 million, have incomes of over $75,000 a year. in other words, they can afford health insurance but just don't have it. and many of the others who are uninsured are young and believe they're invincible and would

only buy health insurance on their way to the hospital. so the question is: do we raise costs for everybody else in a failed attempt to try to pass a one-size-fits-all for all these 46 million uninsured americans or do we come up with different ways of trying to entice them or require them to have an insurance policy, at least a catastrophic insurance policy so we all aren't paying $1,000 more insurance so you cannot have insurance and go to the emergency room when you have a problem? so that's who the insurance really are. and then let's think about the approach that the kennedy bill and other bills are making to the so call government-run programs. now there's some competing polls in the newspapers depending on how you ask the question. "the new york times" the other day had a huge headline. everybody likes a government-run health care program. but "the wall street journal"

and other polls who presented questions different ways said that by a 2-1 margin, most people preferred a private insurance policy that they chose themselves, which is what, 120 million, 140 million americans have chosen today. so why do we need a government program? think about that. the president says, well, we need to keep the insurance companies honest. that's a little like saying we need a government drugstore to keep the drug stores honest or we need a government car company. actually we've about got one with g.m., to keep the other auto companies honest. or a government anything to keep the rest of the -- that's not the way this country is supposed to work. we h have a big free-market system. we're entrepreneurs in this country. we want a limited federal government. we really ought to get out of the car business and out of the banking business and out of the insurance business and stop these washington take overs. yet, the most imposing feature of the health care proposals

proposed by our democratic friends is a big new government-run program to -- quote -- "keep everybody honest." i don't see that we need such a program under the proposals republicans have offered. i think we agree that whatever plan we have should require that everybody have a chance to be a part of it, that a preexisting condition that you might have doesn't disqualify you and that your rate needs to be reasonable. i think -- thank you, madam chair. so we agree on that. and we think competition is what helps keep prices low. now the president says you need a government-run program for competition, but that's like putting an elephant -- the government -- in a room with a lot of mice and say, all right, fellows compete. after awhile there wouldn't be any mice left and your only choice would be big government because they'd lower prices and subsidize it to make sure they succeeded. after awhile that might be your only choice. what's wrong with that?

most medicaid patients can tell you what's wrong with that. 48% of doctors won't see medicaid patients. why? mostly because the reimbursement rates are so low. the government program is cheaper, but it doesn't allow you to get any health care. it's like giving you a bus ticket, but there's no bus to catch. and so what we choose to do in our plans is to expand the medicaid program at an enormous cost to state taxpayers and -- a big increase to the federal debt. we'll be dumping low-income americans into government programs that exist, and new programs we create for which they might not be able to gain admission -- or to which they might not gain admission. so we have better ideas, we think. they're in the wyden-bennett bill which is bipartisan. they're in the burr-coburn bill. they're in the legislation introduced by senator gregg of tphafplt they're in the legislation that senators hatch

and cornyn are working on. we would like to give dollars to low-income americans so they can choose to buy an insurance policy and have the same kind of coverage that most of the rest of us can buy. we would rather give them choices in the private market which by far is what most americans have and choose today. we can do that at -- without adding debt to the -- to the national debt, the wyden-bennett bill is scored at no extra debt. and we can do that in a way that reduces the uninsured more than the kennedy bill does. so, madam president, with respect, i suggest we start over. we do it in a bipartisan way. that we take some suggestions, actually from the republican side, which hasn't been done at all. that's another thing the president said, he said he wanted a bipartisan bill, we've had a completely partisan bill. we don't like that. we came here to be a part of solving a big problem.

we have our ideas on the table. they're not considered. everyone's being polite to us, but it's we've got the votes, we won the election, and we have the bill. we will have added two or three trillion to the debt, stuff low-income people in government programs and we'll still have $30 million people uninsured. i thank you, madam president, and i yield the floor. a senator: madam president? the presiding officer: the senator from colorado. a senator: madam president, i rise today to speak about the urgent need for health care reform. and i want to thank both the finance and "help" committees for the enormous amount of effort they're putting into this monumental task. mr. bennet: when it comes to health care, colorado 0ians will -- coloradans will point you in the right direction. they want us to leave alone the

parts of the system that aren't broken. they agree that all americans should have access to affordable and secure health care coverage. but, madam president, they're skeptical that washington can get this done without breaking the bank. they want us to find way to pay for these reforms now and not just pass on the cost to the next generation in the form of increased debt. that's a tall order, but the right one, and simple common sense. we will be tempted throughout the process to settle for half fixes at easier political victories that help a few people but don't deliver real reform for all families. we have to work hard across partylines. showing resolve means not giving into the usual political posturing that characterized the debate on health care for 30 years and gotten us nowhere. failing to act responsibly now will result in yet another lost decade of soaring health care costs for families an small businesses.

working families with good health insurance are now spending over $3,700 of their own annual income just on premiums. drug co-pace and other out-of-pocket costs. the amount a family has to pay before health insurance coverage kicks in has gone up by over 30% in the last two years alone. even the amount that all of us pay to kofort uninsured as a part of our health care premium, a hidden tax on every family in the country that has health insurance, has increased to over $1,000 a year. this hidden tax will only continue to increase for all families if we keep walking down this path. our top priority must be to stop this ever increasing spiral of health care costs that creates such a struggle for families an small businesses. but we do not have the luxury of spending recklessly to accomplish these goals. i agree with the president, reforming the health care system is the most pressing fiscal challenge our nation faces right

now. that's right, fiscal challenge. fail to reduce costs and health reform won't work, fail to pass meaningful reform, we will face a worsening fiscal mess. americans spend $2 trillion on health care each year, yet premiums continue to skyrocket and our coverage is not keeping up with what we're paying for it. coloradans know that this is a bad deal and it's getting worse every day that we don't act. we don't have to look very hard for enormous cost savings. the potential savings in medicaid and medicare are in front of us. we must look at inefficiencies and address these first. medicare's payment incentives spur doctors and nurses to recommend procedures instead of spending more quality time with patients. we can empower medical professionals to do the best job possible by fixing this incentive structure and it starts with medicare. if we want a culture -- if we want a culture change in health care, we must start with our largest health care spending

program, medicare. if nothing changes in the next eight years the cost of health insurance for families covered by their employer will rise b by $1 -- 124%. the average annual percent to cover a family will increase from $1,000 to $25,000. as you can see increases in the growth of health care costs have rapidly outpaced increases in family income. the median income has risen b by $11,300 in the last decade and projected to increase in the next decade. income growth will stay relatively stable. let's look at growth of health care costs in the same time. in the last decade health care insurance to cover a family rose by $5,400. and now the cost of health insurance for a family will increase by $14,000 in this next decade. this rapid increasing growth is clearly unsustainable. what you can see from this

chart, madam chair is that median income in real dollars, the increase, remains essentially flat over these decades. 1996 to 2006, the growth wa was $11,300. 2006, to 2016, $20,600. look at the growth of median health care premium costs costs, $5,400 over this period, $14,000 over this period. it is clearly unsustainable. we've come out after decade when median family income in the united states in real dollars actually declined by $300. over the cost of this same time, health care costs went up by 80% and the cost of higher education went up by 60%. these are not nice to have, these are essential things if our middle class is to remain intact and we're to preserve the american dream for the next

generation of americans. our revenue as consumers have been far outstripped by costs of things that are essential to all of us. it is one of the reasons we find ourselves in the fiscal mess we're in. in order to finance that gap, we piled on credit card debt. we had home mortgage loans we couldn't afford, all to try to finance this gap. it's unsustainable. it's a house of cards and we're dealing with the consequence now already some coloradans are seeing cutbacks on the benefits of their coverages and some businesses are no longer able to afford coverage for their workers. faced with the unchecked increases, health coverage is a luxury some families an small businesses can afford. many people are cutting back on other essentials, visiting the doctor less frequently even when they know they need care. we must meet this economic challenge head on. the first goal is fixing health care, but we can't forget the second goal. it's just as important.

fiscal responsibility. a more efficient health care system can save taxpayers money in the long run. a study from the white house council of economic advisers shows that smart reform will slow the rapid rise in health care cost by 1.5% or more. slowing health care cost by 1.5% will have a significant impact on our federal budget. if we were to look at how much we'll save by reforming our health care, economists have shown us our federal deficit will degrees. by 2040, we will have saved enough money to reduce our federal budget deficit by 6% from health care costs savings alone. just this 1.5% would increase the income of the average family by $2,060 in the next decade, growing our economy and improving our ability to get a handle on the deficit. colorado families will us use $2,600 to make purchases, put away for college tuition an retirement and obtain new employment skills to improve

their earning potential. part of fiscal responsibility is empowering middle-class families and the current health care system is holding them back. if nothing changes, employers will see about a 10% increase in their health care cost next year. businesses are straining to pay salaries already, remain competitive because health care costs are so high. every day they're make tough decisions about what kind of benefits they can afford offer and whether they can even offer health coverage at all. coloradan gene butler is the clerk and treasurer for a small town. the town has about 400 people and employs six people in its government. two of those town employees, the town police officer and the head of maintenance who overcease roads, water and sewer, gets health benefits providedded with their employment. the town pace the full premium for the two employees, though they do have to pay some out-of-pocket costs.

the costs of maintaining this plan has become an increased burden on this small town. the coverage has been in place for about 10 years and it has increased in cost almost every single year. gene said that the town budget for a significant increase every year with the hope that it is budgeted enough. in 2008 the increase was 25%. the year before it was 15%, 40% in two years. no other town expense requires such a big year-to-year increase. most are budgeted to increase with the inflation rate. their current plan with the h.m.o. cost town $804 a month and the employees $750 in out-of-pocket expenses, but that plan is no longer available. gene said that similar plans from other providers would increase the cost premium anywhere from 33% to 235%. even with the smallest cost increase the total annual cost to the town will be close

to $12,000. she told me that her official name is jean, but i can call her jeanne. she said -- quote -- "my town board has to decide whether to accept the higher rates, reduce the coverage, require the employer to pay a larger share of the premium or try something else. it's not an easy decision." she may have summed up the problem she face more than fin anyone, she'd said that should call it sick care, not health care. because jeanne cannot find another plan, hard decisions are being made about employees. we cannot continue down this path when we know that health care costs are overwhelming businesses and working families. ann brown and her husband gordon run new vista image, a large printing company in golden. the business has nine employees and has health care benefits covering 60% of each employee's

premium. but not that of their dependents. ann said that she is happy with the availablity in colorado. she and her husband built in the cost of health care when they began their business because she knew it would help attract the best employees. ann said that she understands how important a healthy workforce is and supports wellness programs so that employees can prevent major medical conditions. whenever she brings someone in, she knows the first question asked c will be: do you have a health care plan? the business has been forced to offer less and less coverage to keep the premiums within its budget. health care is one of the biggest ticket items they worry about. she said that the percent increase over the previous year has been in the double digits. as a result they've had to offer less coverage with higher deductibles and more out-of-pocket cost. the plan's deductible has gone from $1,500 to $3,000.

ann said that they will likely have to take a $5,000 deductible. she knows how much it can be for employees to absorb. a few years ago when an employee was facing a serious health condition, the business covered the deductible so the employee wouldn't be saddled with medical bills. i would do it again, ann said, although she knows that higher deductibles mean a less generous plan to offer to her employees and less after competitive edge for the businessover all. teresa from colorado, for years she saved up money to buy a home, then learned she had breast cancer. after 14 months of treatment, the money ran out and teresa had to take a loan out to finish paying for the rest of her treatment. for teresa her health insurance coverage only took her so far. while being cancer free for four years, she constantly worries that her cancer will come back and with it the huge financial strain that it would bring.

all these wants it is health care she can count on. these are people who have done everything right. played by the the rules, looked out for their fellow employees an fellow citizens. our health care system is failing them. people shouldn't have to wait until they get sick to learn their health insurance won't kofort cost of their treatment. -- cover the cost of their treatment. families shouldn't have to watch their loved ones go through sicknessicknesssickness and deae anxiety of medical bills that are becoming increasingly unaffordable. we know that health care reform would not be easy. as the president said, if it were easy, we would have done it a long time ago. for these coloradans, their families, and their businesses, the system must change. for the nation's long-term prosperity, the system must change. we cannot burden future generations with responsibility for the reform we need today. if we make the hard choices, we will create a better health care