Thursday, June 18, 2009

U.S. Senator Johnny Isakson (R-GA)
Floor Statement on Health Care Reform
Remarks as Delivered on the Senate Floor

Madam President, for just a minute, I want to talk about health care. I am a member of the Health, Education, Labor and Pensions Committee. We began yesterday the opening statements on the bill that is pervasive in its coverage around the country as to the future of health care in America.

I rise as one not to be a critic but to lay out the challenge this legislation portends for all of us and maybe to raise some points that thoughtfully will be considered before we make a serious mistake on the funding side, the expense side, and the borrowing side.

A few weeks ago, in Georgia, at a Rotary speech, I referred to ``a trillion-dollars in debt.'' A gentleman stood up in the Q and A section of that time, and he said: Senator Isakson, I only got a high school education. Can you explain to me what a trillion is?

I do not know how many of you have thought about that, but if you had to do it right now, could you explain what it is? I could not. So I decided to go home that night and figure out some easy way to demonstrate how much a trillion is. I thought maybe it would be good to determine how many seconds it takes for a trillion seconds to go by. So I did the math on the calculator. I thought I made a mistake and did it again. I had it checked.

It takes 317,097 years, 11 months, and 2 days for a trillion seconds to go by. That is almost incomprehensible, but it does give you some idea of the issues we have to be concerned about in terms of spending and cost and savings.

The CBO has scored the parts of the health bill that have actually been drafted--which is about two-thirds of it--at a potential cost of $1 trillion over 10 years. Obviously, we are going to have to pay for that. There have been some discussions in the last few days of suggested pay-fors. But I want to discuss for a minute how we have to be very careful not to use words such as ``a pay-for'' that in fact only move obligations around.

For example, President Obama, for whom I have great respect, said to the medical association on Monday that one of the pay-fors, by having public coverage for everybody, would mean there would be no indigent patients; therefore, everybody would be getting paid for their services and that would save us $11 billion a year in DSH payments, which is the disproportionate share of treatments which charity hospitals in New York and Atlanta get through Medicaid because they take a disproportionate number of indigent patients.

There is only one flaw in that analysis. Yes, we might not appropriate $11 billion a year for disproportionate share anymore, but we are not doing it because we are raising Medicaid coverage to 150 percent of poverty and providing health insurance through a public plan. So the cost remains the same. It just moves from a cost to pay charity hospitals for disproportionate share to a cost of providing the coverage through Medicaid or through the private plan.

The unintended consequence of removing disproportionate share would be taking the economic model through which charity hospitals are financed and turning it upside down. Because in my city of Atlanta, for example, where Grady Hospital exists--and Grady has gone through a reformation; we have created a foundation, and we have done everything we can to save the hospital--it gets a tremendous part of the DSH payment from Medicaid for disproportionate share because it takes a disproportionate number of the indigent patients because private for-profit hospitals will not. But if private for-profit hospitals have indigent patients who now have coverage, and they are closer to the patient than Grady is, the patient will then go to the private hospital, so the DSH payment goes down or evaporates for the public hospital, and so does the funding mechanism upon which their public bonds and their public debt were financed. So we have to be careful about the unintended consequences.

Secondly, on Medicaid, I am a product of the Georgia State legislature, and I know the distinguished Acting President pro tempore today is a product of the New York Assembly. We all dealt with Medicaid. Medicaid is a program where the Federal Government pays about two-thirds of it. The States pay about a third of it. And the States run it.

When we got into this business of expanding Medicaid under this legislation to 150 percent of poverty--which is a 50-percent increase in eligibility--I thought back to my days in the legislature about how much money that was that my State then was going to have to come up with under the one-third match.

In Georgia, in 1968--the first year we had Medicaid--the State's share of Medicaid for the year was $7,791,000. In 2008, the State's share was $2,468,376,258, which would go up by $1 billion if we raised the eligibility to 150 percent.

I know the President has said that for 4 years the Federal Government will take over the entire obligation of that increase to 150 percent. But that is only putting off the inevitable for the States, which will be a percent of their budget they cannot afford.

Medicaid, in Georgia, in 40 years has gone from 1 percent of our budget to 12 percent of our budget. With this proposal, it would go to 18 percent.

We must remember, in the economic stimulus bill, a significant amount of that money was Medicaid money to go to the States to fund what is already an existing shortfall.

So I come to the floor to say this: I am for every goal of the preamble of the health care bill that has been introduced in the HELP Committee. I want to make policies more affordable, coverage more pervasive, access easier, and I want to lower costs. But as Acting Chairman Dodd said yesterday in the committee, history will not look favorably on you if you do not do something because it is hard. He is right. But neither will history look favorably upon you if you do something easy when it is hard. This is hard work, and we cannot take the easy way out to pile debt on the people of the United States of America.

Hopefully we will thoughtfully consider these ramifications I have discussed and others and move forward with a health proposal we can pay for and that accomplishes its goals rather than an easy answer that puts us in a desperate situation as a country and ultimately takes us to an economic demise in this country.