[Congressional Record Volume 155, Number 133 (Monday, September 21, 2009)]
[Senate]
[Pages S9576-S9578]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. KYL. Mr. President, during the last several months Congress has 
been engaged in a vigorous debate about how to achieve health care 
reform. Despite the President's repeated claims to the contrary, we all 
agree, Republicans and Democrats, that some reforms are necessary.
  Costs are too high for families and businesses. Too many Americans 
lack access to affordable options. We need to make health insurance 
more affordable and more portable.
  There are two basic approaches before Congress: reforms that impose 
much more government control over health care or reforms that provide 
consumers with more affordable options and keep control of health care 
decisions with families and doctors.
  I happen to believe that the latter approach is better, that we must 
empower patients and doctors, not bureaucrats and politicians, to make 
health care decisions. I think it is clear that after the August 
recess, a majority of Americans rejected a Washington takeover of 
health care, along with the mountains of new taxes and debt and 
bureaucracy it would create.
  While I appreciate the hard work of the Finance Committee chairman in 
trying to write a more acceptable bill, the end result is little better 
than the others, that is, the government's near total control over 
health insurance, and therefore the delivery of your health care.
  Along the way, it would also spend nearly $1 trillion and cut 
Medicare benefits by nearly half a trillion. The Finance Committee 
chairman's bill is a tangled web of federally documented insurance 
regulations which would control every aspect of health insurance from 
covered benefits to permissible premiums.
  The bill would centralize the power of medical decisions with 
politicians and bureaucrats, not patients and doctors. It would result 
in higher health insurance premiums, less consumer choice, and 
ultimately the rationing of health care.
  How would the government take over health care under this bill? There 
are two key provisions that would result in government-run health care 
for practically all Americans, and empower bureaucrats at the expense 
of patients.
  The first is a requirement that every American buy an insurance 
policy. The second is a regulatory entity called the insurance 
exchange. First, let's talk about this mandate for everyone to buy an 
insurance policy. The chairman's plan imposes this individual mandate 
for all individuals to purchase a government-approved policy. To 
repeat, not just any insurance, but government-approved and therefore 
government-defined insurance.
  Those who do not comply face steep fees--or fines, I should say--
ranging from a $750 to a $3,800 per-year fine. The mandate constitutes 
direct interference in health care with a host of

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new regulations that control the insurance plans that would become 
available to consumers.
  Michael Cannon, a health policy expert at the Cato Institute, says 
that the individual mandate would be the ``most sweeping and dangerous 
measure in any of the bills before Congress.''
  He goes on to say: ``Compulsory health insurance is nationalized 
health insurance, with all that implies for health costs and quality.''
  The second control mechanism is an insurance exchange through which 
all small business and individual market policies must be sold, and 
eventually large plans would participate as well.
  The exchange's core function is to impose a new set of Federal rules 
that literally control everything the companies can and must do. Here 
are some examples. All companies must offer two government-specified 
benefit options--they define it as a silver and gold plan--or else the 
insurer cannot offer any insurance at all. So they have to offer two 
specifically defined insurance plans. But they can't offer more than 
four specific types regardless of consumer needs or preferences. It is 
like telling the car companies they each have to make two kinds of cars 
and they can't make any more than four kinds of cars. That is exactly 
what we are talking about, the Federal Government telling the insurance 
companies: This is the way you have to offer it--you have to offer at 
least two and you can't offer any more than four.
  All of the plans must comply with new Federal rating rules. That is 
how limits on premiums are established. They have to issue coverage to 
everyone regardless of health status and not cap total coverage 
regardless of cost. They have to comply with mandatory limits on copays 
and deductibles. They have to cover a broad range of medical benefits 
in addition to State-mandated benefits regardless of whether consumers 
want them.
  All of this is subject to change from Washington depending on what 
politicians or bureaucrats believe you need. Remember, it will be 
illegal for you not to buy this insurance. You will notice that all of 
these things are required, and it is Washington that is doing the 
requiring.
  Under this plan, insurers would no longer retain the flexibility to 
design insurance products that would satisfy specific consumer 
preferences. The Federal Government would dictate that all policies 
must offer the same package of benefits, the same types of plans.
  Rather than having the freedom to compete, insurers would in essence 
become prepaid health payment utilities since the Federal Government 
would, as the Wall Street Journal editorialized last Thursday, 
essentially be writing all insurance contracts. Since every aspect of 
insurance coverage would be controlled by Washington and everyone would 
have to buy the insurance, the government would control how your health 
care is paid for and therefore how it is delivered.
  A final point about this insurance exchange. Since it will change the 
kind of insurance that can be sold, if you lose your current insurance, 
regardless of whether you bought the policy yourself or you got it 
through an employer, you will likely not be able to find that similar 
policy in the future. They will all be different. Insurers will have to 
comply with the new Federal rules, and that will change the coverage. 
This is one of the reasons the President was wrong when he repeatedly 
said: If you like your insurance, you get to keep it. That insurance 
simply is not going to be around anymore once the companies have to 
comply with the requirements of the exchange. There will be all new 
insurance policies written at that point.
  The proponents of this radical change justify it on the assertion 
that it will bend the cost curve. In other words, it will reduce costs. 
But the problem is that massive new regulations will actually increase 
costs. The Council for Affordable Health Insurance found that mandating 
universal coverage and regulations in the bill, such as guaranteed 
issue and modified community rating, will increase the cost of health 
insurance between 75 and 95 percent.
  In addition, note that the chairman's plan does not grandfather 
insurance plans currently offered by small businesses, so they would 
have to comply with these new Federal rating rules over a 5-year 
period, so that in short order premiums would rise for many small 
businesses and their employees as well. Of course, the newly 
established mandated benefits would also add to the increased cost.
  Suppose, for example, a healthy individual or family prefers to have 
a less comprehensive package with a higher deductible. Say a young 
family of four with two children and two 35-year-old parents wants to 
buy a CIGNA PPO plan from the individual market with a $2,000 
deductible. In my hometown of Phoenix, that plan currently costs $512 a 
month. If the reforms included in the chairman's plan were implemented, 
the price of that plan would nearly double to $998 per month.
  The experts who said the cost of health insurance premiums would rise 
between 75 and 95 percent are right on the mark with regard to this 
real-life example I gave with a real-life insurance policy for a family 
of four in Phoenix. Instead of purchasing health care coverage that is 
personalized to their needs and budget, this family would be forced to 
purchase coverage they may not want for routine care that can be paid 
out of pocket or coverage for diseases and conditions that tend not to 
afflict their age group. Since insurers would not be allowed to charge 
according to risk, a low-risk family such as this one would have to pay 
more to make up for coverage needed by high-risk individuals.
  Of course, I am not suggesting we turn a blind eye to the needs of 
Americans, for example, suffering from preexisting health conditions. 
They struggle to purchase affordable health insurance. We have to 
address that issue. But that does not require a total Washington 
takeover of all insurance policies, and it doesn't require raising 
insurance premiums for millions of other Americans and small 
businesses.
  In my view, despite all of these other problems I have discussed, the 
most damaging impact of this takeover by the Federal Government is the 
inevitable rationing, the delay and denial of health care to American 
citizens. Since new Federal mandates and requirements would raise 
health care costs, politicians will have to search for ways to control 
spiraling premiums. When traditional cost-containment measures fail, 
such as reducing provider reimbursements or reducing how much doctors 
get paid, the government's only option is to control how much health 
care everyone receives. That means rationing.
  For a preview of how this plan would lead to rationing, we need only 
look to the State of Massachusetts where a law was passed in 2006 
requiring all residents to obtain health insurance. In fact, the State 
insurance market now looks like the market that would be created by the 
chairman's bill, with its guaranteed issue and modified community 
rating, State-approved plan types and benefit mandates.
  Massachusetts health care spending is consuming an increasing share 
of the State's budget. The State passed a $1-per-pack increase in the 
State's cigarette tax, $89 million in fees and assessments on health 
care providers and insurers, and cost-sharing increases. It has even 
ordered insurers to cut provider reimbursements by 3 to 5 percent. But 
these measures still do not produce enough revenue to cover costs, 
leaving the State with few options. As a result, a special commission 
was created by the State legislature which developed a list of options 
to control costs, such as ``exclud[ing] coverage of services of low 
priority/value'' and ``limit[ing] coverage to services that produce the 
highest value when considering both the clinical effectiveness and 
cost''--in other words, rationing. You ration health care when you say: 
We will figure in here how much it costs, how much we have available, 
and therefore how much we can afford to provide. People who have to 
have that care are therefore going to be the ones who suffer.
  This is exactly what happens under the chairman's proposal as well. 
It would establish a panel of health care stakeholders to identify 
physician services that are overvalued in the Medicare physician fee 
schedule and create a Medicare commission that would propose automatic 
Medicare cuts, even if Congress fails to adopt them. Our constituents 
rely upon us to protect the benefits we have promised

[[Page S9578]]

them, but what we are going to do in this legislation is establish a 
commission which would provide for automatic Medicare cuts. If Congress 
doesn't act affirmatively to somehow stop that from going into effect, 
it goes into effect. That is abdicating our responsibility to act as 
their representatives and, worse, putting somebody else in charge of 
deciding what is best for our Medicare constituents.
  So when costs grow out of control, the government will adjust the 
volume of care provided based on how much it is willing to spend; that 
is to say, to ration your health care.
  The fact that the Baucus bill does not include the so-called public 
option, the government-run insurance company, does not mean it does not 
otherwise totally regulate health care delivery. Together, an 
individual mandate to buy particular insurance and the regulatory 
insurance exchange, the two key provisions in the plan, facilitate the 
government's takeover of health care--some of it government run, all of 
it government controlled. No longer would families and doctors have the 
final say. It is almost unthinkable that this could happen in the 
United States.
  Republicans have proposed ideas that would improve access and lower 
the cost of care, including real medical liability reform, allowing 
people to buy lower cost insurance across State lines, making the tax 
treatment of health care more fair for those who purchase insurance on 
their own, and removing barriers to health savings accounts.
  These are better alternatives than the entire takeover of the system 
as proposed in the chairman's bill. We all favor health care reform. 
Republicans favor measures that lower costs and improve access and, 
importantly, empower patients, not government bureaucrats.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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