Floor Speech: Sen. Murkowski speaks on her concerns about the Democrat health care proposal currently being debated in the U.S. Senate.

"I thank my colleagues and I thank particularly the senior Senator from Maine for her long, arduous work as part of a small group of Senators who did try, honestly and with great integrity, to advance this process so we would have a bipartisan product to deal with. I appreciate her efforts. I heard a little bit of her frustration as she spoke on the floor this evening. I thank her for her leadership.

"I concur with my fellow Senator from Oklahoma that we all agree reforms are needed in the health care world. We all agree that the status quo is not acceptable. But where we differ is certainly what leads us to the discussion this evening, and tomorrow, and up to the vote tomorrow evening at 8 o'clock.

"Typically, this time of year, going into Thanksgiving and then the holidays that follow in December, we consider this the season of giving, where we give thanks and do a lot of giving back. Unfortunately, what we are looking at this particular November, with this particular bill, kind of makes it a season of taking--taking away your ability to choose the health insurance you want, taking away nearly $ 1/2 trillion by cutting from Medicare--a program that is already strapped, a program that provides so much for our seniors and the disabled. But we recognize that program is seriously underfunded and looking to literally go off a cliff by 2017--by taking more of your salary and increasing the Medicare payroll tax for government intrusion into your health care decisions.

"This health care bill is a massive overreach by the Federal Government that will result in our government having more involvement in your family's health care decisions and greater government intervention, cutting into 16 percent of our economy.

"Before we get into the policy debate on the health care bill, I asked one of the interns in my office to go down to the Dirksen post office. We had gotten an inquiry from a constituent from Alaska wanting to know if we could send a copy of the bill. The bill, as you can see on some of the Members' desks, is large. When it was weighed at the post office in the Dirksen building, it weighed in at 20 pounds 5.5 ounces. That is probably close to the size of the turkey my family and I will purchase for Thanksgiving. It is going to take about $45 to mail that by priority mail to Alaska. So we suggested that perhaps the Internet is a better option.

"In this 2,000-plus page bill, you will find the government requiring that you comply with an individual mandate where the Federal Government is going to tell you you have to buy health insurance, regardless of whether the premiums are affordable. This goes back to the concerns of the Senator from Maine. So much of this is about the affordability. If we require individuals to purchase health care insurance but we have not done anything, or enough, to make it more affordable for them, all we are doing is setting them up for additional penalties. Failure to comply will result in a $750 penalty per person to a family.


"We also know in this bill our government is going to be telling employers they have to comply with employer mandates, which place onerous penalties on a large number of our small businesses. These are businesses that have 50 or more employees. I think it is important to recognize that the SBA, Small Business Administration, defines a small business as one with 500 or fewer employees. But for the purposes of the employer mandate, we are going to say that if you have over 50 employees, you will be required to provide for that insurance.

"Let's use an example here. Say you have a small business, you employ 51 employees, and one of those employees receives a Federal subsidy for health insurance. Under this Democratic health care reform bill, the employer will be fined $750 for each of its 51 employees--not just the one employee who receives a subsidy but for all of them. So if you are a small business owner in Alaska, in Anchorage, or Fairbanks, or Juneau, who runs a restaurant or a small hotel, that employer needs to know he could be subject to a total of over $38,000 in penalties if only one of his employees seeks a government subsidy. This penalty provision alone in the bill is estimated to raise $28 billion to pay for the Democratic health program.

"The bill before us today also subjects Americans to health insurance that the Federal Government is going to define that this is what you have to have. What the drafters of this 2,000-plus page bill declare is it is an insurance plan with a 60-percent actuarial value. In other words, all of the discussion about ''if you like the health care plan that you have, you can keep it''--yes, in fact, you can, but only if it meets the definitions we are setting forth within this, and the requirement is that it is 60 percent of actuarial value.

"In Alaska, we have over 88 percent of the health benefits that are provided to individuals and small businesses by the largest insurance company operating there, Premera Alaska Blue Cross/Blue Shield. We are told that 88 percent will not meet this 60-percent threshold requirement. So what does that mean? You have had your insurance plan through Premera and your employer provided it. But if it doesn't meet this threshold requirement, what then happens is that those small business employees will not be in compliance with the provisions of the bill, so you are going to see penalties assessed. Many of my constituents will see those penalties assessed. They may lose the insurance they have, which they like, but the penalty will be a massive increase in health care insurance premiums.

"When we talk about the promises of health care reform and what we are going to make available to you, I think most people believe that with health care reform would come a reduction in premiums, or at least not incredible increases in premiums.

"In this bill, we raid the strapped Medicare Program to pay for expanding the role of government in health care reform. We raid future payments to the Medicare patients through increased payroll taxes. I think it is important to recognize that this is an unprecedented and dangerous step that plays a shell game with Americans. We are going to increase your taxes through the Medicare payroll tax, but then we are going to divert that money to pay not for keeping Medicare solvent--I mentioned earlier the insolvency cliff out there--and we are going to divert that money not to keep Medicare solvent, not to increase funds to Medicare, not to increase patient access to doctors and nurses, which so many of my constituents are suffering from but, instead, we institute a new Medicare payroll tax that is used to pay for expanding the size of the Federal Government and creating yet another federally run health plan. We recognize that the insolvency of Medicare is real. The Medicare trustees report from 2009 said that Medicare is going to be insolvent by the year 2017. But the drafters of the bill don't write a reform bill to fix Medicare insolvency. Rather, they are using this as an opportunity to tax Medicare funds to pay for the creation of another Medicare-like system. This is truly the height of hypocrisy. It is working against what is right and what should be done for Medicare.

"The inclusion of a 5-percent Medicare payroll tax is bad enough, but when one realizes that the tax is not indexed to inflation, one can only cringe at the financial pain that is ahead for America's middle class.

"There may be many people out there saying, oh, you are increasing taxes on the rich and individuals earning $200,000 or more, and couples earning $250,000 or more, but you need to put this in context and recognize how far from the truth this can be.

"Back in 1969, Congress enacted the alternative minimum tax, the AMT, to ensure that fewer than 200 individuals paid their fair share of taxes. Unfortunately, the AMT was not indexed to inflation, and today we have nearly 30 million taxpayers who face the long hand of the AMT tax, with many of them falling squarely in the middle of the middle class.

"Congress has consistently taken action to protect the middle class from the AMT. We do this, as we know around here, on a year-by-year basis, and each year it is costing more than the previous year with the number of people who face the tax growing each year. The recent 1-year patch cost $70 billion. A 10-year fix is expected to cost $447 billion. Sadly, history has a habit of repeating itself, and Congress has demonstrated a consistent inability to learn from its mistakes.

"My prediction is if the Medicare payroll tax increase becomes law, Congress will, once again, need to spend large sums of money to protect the middle class from this onerous new tax.

"Let's delve into the Medicare and Medicaid restrictions on doctors and nurses under these government health programs. In my State of Alaska, in our most populated city, Anchorage, we have very few general care doctors who are willing to accept Medicare patients. We had a study done not too long ago, and the number given in that study is there are 13 providers, 13 doctors who are taking on new Medicare-eligible individuals. In Alaska, if you are about to hit the magic age of 65, going on Medicare, you have Medicare as your primary insurance whether you like it or not.  

"What you learn when you are on Medicare is you have very few doctors willing to see you. Eighty-three percent of the primary care doctors in Alaska's largest city will not see Medicare patients. These individuals, who before they were 65 enjoyed unfettered access to care when on private health insurance, whether they had it through the municipality, Anchorage, or they worked for a private employer, they are now realizing the harsh realities of Medicare and that they are going to face some severe restrictions in access to a primary care doctor.

"We are seeing it on a very accentuated basis in Alaska, but we are seeing it in many parts of rural America. It is almost unthinkable to me. A number of constituents have come up to me and have said: Look, just get us out of the Medicare system. Let us go out to the private market and purchase health insurance like we were able to do before we were on Medicare because, regardless of the contributions I make, regardless of how much I have paid into the Medicare system, it doesn't mean anything to me if I don't have access to care.

"They are saying: I know I have worked all these years to pay in, but I want my old insurance back. It is because what we have done is restricted their access to services, and it is something they have never dealt with before.

"This problem is not just in my State. According to GAO, we have States such as Colorado, Oregon, and New Mexico that are facing these major restrictions in access to primary care doctors. Senator Daschle, when he was doing his health care tour last year, when he was in Dublin, IN, and talking to doctors about how best to reform our health care system, the doctors in Dublin told the Senator that the Medicare reimbursement rates are not keeping pace with the costs of a medical practice. So if we know that private insurance pays significantly more than government insurance, then access under a government plan will undoubtedly be reduced. We have seen this both in the Medicare and the Medicaid Programs.

"Under the Medicaid expansion program in this health care bill, we know that Medicaid is now going to include individuals up to 133 percent of poverty. Under the Democrats' health bill, the Federal Government pays all the costs covering newly eligible enrollees through 2016. This is good for the States. It will allow Alaska, for example, to expand the roll of the Medicaid Program and include more Alaskans on the State's Medicaid Program. CBO said after 2016, the share of the Federal spending is going to vary somewhat from year to year but ultimately would average about 90 percent.

"If you are responsible for your State's budget and your State can no longer afford the Medicaid Program in the year 2017, when the Federal Government drops that coverage to somewhere around 90 percent, if your State is a balanced budget State such as Alaska and your State revenues are going down because of what is happening with tourism or a bad fishing season or the price of oil, what then do the States do to continue the Medicaid Program?

"It seems to me there are a couple options. They can either drop the expanded Medicaid population or they could reduce reimbursements rates and place the Medicaid enrollees who once had decent care in Alaska in the same predicament as my Medicare constituents are currently in.

"There is a reason why Democratic and Republican Governors have said this Medicaid expansion is the mother of all unfunded mandates.

"While all these provisions I mentioned are certainly enough for me to decide not to support this health care bill, the most troubling aspect we are seeing played out in the news right now is the impact of government rationing, which will allow the government to deny access to health care services.

"This is something Republicans have been speaking about all summer with regard to various health care bills. We have all seen throughout the news a great deal of concern over the announcement from the U.S. Preventive Services Task Force that it no longer recommends routine mammogram screening for women between the ages of 40 and 49. This task force's recommendation is just a look behind the curtain of what we can expect if the government runs your health care.

"Under this bill, we are going to provide one person, the appointed position of the U.S. Secretary of Health and Human Services. We are going to give her the ability to make a wide variety of determinations, both on the health exchanges as well as in the government-run plan.

"I am very concerned about what we are finding from this task force and what it means for both men and women who suffer from this deadly disease. I can tell you, without a doubt, what this has caused is great confusion. The task force came out with their recommendations and then, shortly thereafter, Secretary Sebelius came out saying women in their forties should continue to get mammograms. The task force is saying women should not even conduct self-breast exams. We have constituents who don't know what they should or what they should not be doing. This is why we need a hearing to better understand how this task force came to their conclusions.

"But the bigger picture is, what we need to appreciate is this ordeal we have been dealing with this week is a glimpse into the chaos of what we could see with a federally run health plan and a massive expansion of the Federal Government's role in your health care.

"I wish to mention, because there have been multiple accounts in the media about, no, we are not intending that this task force recommendation is going to change in any way what coverage might be available to women. I know that some of my colleagues on the other side of the aisle have recognized, in fact, that these recommendations do hold great weight with the policymakers and the insurance companies.

"One of my colleagues from Maryland has said she plans to offer an amendment that would address or limit the cost of breast cancer tests for women 40 and older. She said otherwise insurance companies may use this new recommendation as yet another reason to deny women coverage for mammograms.

"In fact, in the bill, there are at least 14 references to the U.S. Preventive Services Task Force. In section 4105 is a provision that would authorize the Secretary to modify benefits under Medicare if consistent with task force recommendations and deny payment for prevention services the task force recommends against.

"This could be a situation we should be very concerned about how, with recommendations such as we are seeing come out of the task force, they inadvertently or perhaps advertently will impact a woman's access to care.

"I know I have probably gone over my time, and the Senator from Oklahoma is waiting. I will close my comments by saying we do need health care reform. I echo the remarks of the Senator from Maine. We need to do it the right way. Setting an arbitrary timeline, saying we have to get it done by this holiday or that holiday or moving down the calendar--we have to take the time to do it right.

"We have to bring down the premium costs so everyone can have access to affordable health care. Imposing mandates on individuals or on employers, if we haven't done anything to provide for greater affordability, we haven't helped the situation.

"Unfortunately, this bill does not help us with the affordability piece. I am focused, as many of my colleagues are, on an alternative, a step-by-step approach to reduce our health care costs to allow businesses to buy across State lines, allow co-ops to be formed so that fishermen in my State or other coastal States or employees of a small business can pool together to purchase affordable comprehensive coverage.

"Just as important is certainly the need to preserve the rights of patients to see the doctors of their choice. We must make sure we are protecting Medicare coverage for seniors. We have to eliminate the discrimination based on preexisting conditions, ensure that expansion of government health programs will not result in restrictions in access to care because of reduced reimbursements to doctors and hospitals.

"While this bill does attempt to address several of these issues--for instance, the one about eliminating discrimination based on preexisting conditions--it delays the implementations of some of the more worthwhile provisions until the year 2014.

"We have bipartisan support on many of these pieces individually. So why would we not try to work on those areas where we do have agreement, where we do have consensus rather than waiting until 2014?

"I held a townhall meeting in Chugiak, AK, last week. It was a pretty tough night. We had winds that were howling off the mountains, snow all over the place, and real slick and icy roads. Over 200 people decided to brave the weather to come and speak out on the issue of health care reform and what is happening in Washington, DC.

"I will tell you, the one thing those constituents stood and repeated over and over was: Don't pass health care reform that is going to raise our taxes, that is going to increase our premiums, and that will cut Medicare.

"We need to listen to these folks. We need to listen to the American people. We have an opportunity to do it right. There is a lot of good work that goes on by a lot of good people in this body and outside this Chamber. But we are at a point now where because of deadlines--artificial deadlines--we are forced to a process tomorrow evening where we are going to have a vote on a cloture motion on the motion to proceed. As my colleague from Oklahoma pointed out, it is a bit of a shell. We think we are going to this health care bill that is 2,000-some-odd pages, but, in fact, the vehicle we will be using on the motion to proceed is not what this is. I am not going to suggest it is bait and switch, but it could be bait and switch.

"I do believe our opportunity to share our concerns about what is contained in this legislation is now. We need to take the time to explain to our constituents the concerns we have, the problems we have, the unintended consequences we believe are part and parcel of this legislation.

"I thank the Presiding Officer for the time this evening and thank all my colleagues for their coordinated efforts to help provide a little bit of insight to the American people on what we are dealing with in the proposed legislation from the Democratic leader.

"I yield the floor."

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