[Congressional Record Volume 156, Number 151 (Thursday, November 18, 2010)]
[Senate]
[Pages S8006-S8008]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
EMPOWERING STATES TO INNOVATE ACT
Mr. BROWN of Massachusetts. Madam President, I rise today and join my
colleague, Senator Wyden, to speak about legislation we have introduced
that will protect not only his State but my State of Massachusetts and
other States by allowing them to waive out of specific requirements of
the Patient Protection and Affordable Care Act.
As my colleagues know, my single priority is and always has been to
ensure that what we do in Washington does not harm my State of
Massachusetts or the rest of the country, and that we are responsible
stewards with every tax dollar that flows from the States into the
Federal Government.
This has been true when it comes to voting against raising taxes on
families and businesses. It has been true when it comes to fighting for
commonsense, progrowth policies that will create jobs in Massachusetts.
It has been true in my efforts to be sure that the Federal health care
reform bill does not diminish or harm the health care innovations that
have occurred in Massachusetts.
It is my belief that Congress needs to be held responsible for its
actions, for the policies it advocates, and the legislation that
ultimately passes through these Halls to become law. When Congress
passes legislation that is harmful--in this case the Federal health
care reform legislation, which I did not support--or there is an
unintended consequence--which I think is the case when it deals with
Massachusetts and the innovations we have had for years, where we have
98 percent of our people already insured--Members need to be bold
enough to stand up and fix it regardless of party affiliation and
regardless of whether it is popular.
I commend the Senator who is about to speak after me for his
leadership on this matter. Senator Wyden has been working very
diligently on addressing the concerns for his State. Today I get a
chance to do the same. Today we get an opportunity to make a correction
to the Federal health care reform bill to be sure we are doing the
right thing, not just for Massachusetts but for other States that seek
to waive out of certain requirements of the Federal health care reform
law.
In many ways, Massachusetts has been on the forefront of implementing
health care reform: expanding access--as I mentioned, 98 percent of our
people are already insured--designing systems to increase market
participation--from the Cadillac plan, all the way to the fully
subsidized Commonwealth Care Program--and increasing transparency for
consumers and providers. We continue to learn, however, lessons every
day in Massachusetts about what works and what does not work, and we
are continuing to work on those very issues to make sure we can do it
better.
This is an important point because it speaks directly to the purpose
of this piece of legislation that I have introduced in a bipartisan
manner with Senator Wyden from Oregon.
As you know, the health care reform efforts of Massachusetts are our
own. We were one of the first States in the country to take this upon
ourselves to address the very serious problem we had in providing funds
to hospitals that were providing care for people who were making a good
wage but who were not paying the bills. As a result, the citizens had
to subsidize the hospitals to the tune of over $1 billion. So we
believed it was imperative for us to get something done.
As difficult as it is to admit this, not every State wants to be like
Massachusetts. I understand that. They may not want to be like Oregon
either. Massachusetts is a great State, with, I believe, the best
hospitals, physicians, doctors, nurses, treatment facilities, research
facilities in the country and around the world. There is a reason why
people come to Massachusetts for the care and coverage they need so
badly.
But I recognize that my colleague from Oregon is interested in
protecting reform efforts in Oregon as well. He does not want to be
like Massachusetts because Oregon is different from Massachusetts.
Oregon's insurance market is different. Its provider network is
different. Its beneficiaries and population are different than in
Massachusetts.
Oregon might want to implement reforms or create a coverage mechanism
that I do not like or that I would not want to work in the State of
Massachusetts, but that is OK. That is what this bill is about. It
allows the individual States to have the right to do what they believe
is imperative and important for their particular State, which is why
the legislation we have introduced--the Empowering States to Innovate
Act--is so important.
Right now, as provided under section 1332--the Waivers for State
Innovation--of the Patient Protection and Affordable Care Act, States
can waive out of provisions of the Federal reform law. That is the good
news. We are allowing States to participate in the process and allowing
them not to have duplicate processes or maybe potentially have lesser
care and coverage if the Federal health care bill is implemented. So it
allows us to continue to provide the care and services we want to
provide to our citizens in Massachusetts. The bad news is, this waiver
authority is not scheduled to take effect until 2017. So what are we
doing until then--a full 3 years after the PPACA is scheduled to be
fully implemented?
For me and my dear friend from Oregon it does not make any sense.
When I see something that does not make any sense in Washington, I do
my best, regardless of party affiliation, to fix it.
The first thing our bill does is to allow States to waive out of
specific parts of the PPACA in 2014 rather than 2017. This makes sense
not only from an operational standpoint, because the PPACA takes effect
in 2014, but also from an economic and fiscal standpoint. Why should
Massachusetts be delayed in obtaining a waiver from the Federal reform
bill when it may already have met or exceeded, in many cases, the
provisions of the act? So holding Massachusetts back by limiting my
State's ability to continue to innovate and remain flexible and
responsive to the health care market costs money, and it costs the
taxpayers money at a point right now where we don't have a whole heck
of a lot of money to go around.
The second piece our bill does is to provide States with certainty
with the waiver process. Not every State will be eligible. Let me
repeat that: Not every State will be eligible for a waiver and not
every waiver will be granted. But our bill provides some certainty for
States that apply for a waiver by requiring the Secretary of Health and
Human Services to begin reviewing applications within 6 months of the
enactment of this bill. I hope this bill is enacted quickly. The
earlier a State knows whether it has received a waiver, the earlier it
can begin implementing its specific plans and proposals. It makes
fiscal sense.
[[Page S8007]]
Taken together, these two changes are not only good for Massachusetts
but potentially for other States. They are good for the other States
that are trying to innovate and advance in the areas of health care
reform, cost containment, and coverage. That is what it should be. It
should be a symbiotic relationship between the Federal Government and
the States. The States should have the right to determine what they
want to do for their citizenry. Do we think maybe some States could do
it better than the Federal Government? I believe when we deal with
health care, Massachusetts is second to none, with all due respect to
the other Senators in this Chamber.
During Wednesday's Finance Committee hearing, Dr. Berwick, who is
from the State of Massachusetts, I might add, said this about State
innovation and flexibility:
The cliche about states as laboratories of democracy is not
just a cliche, it's true. The diversity of approaches that
we're seeing emerge state by state has been there for long
time. I think we should be doing everything we can to
encourage it.
I couldn't agree more. I am a strong supporter of States rights,
especially when it makes sense, and for allowing States to solve
problems without the Federal Government's interference.
Madam President, I ask unanimous consent to have printed in the
Record a letter from the Massachusetts Hospital Association in support
of my efforts today.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Massachusetts Hospital
Association,
Burlington, MA, November 16, 2010.
Hon. Scott Brown,
Russell Senate Office Building,
Washington, DC.
Dear Senator Brown: As you know, the Commonwealth of
Massachusetts has succeeded in expanding healthcare coverage
to more than 400,000 uninsured residents. We can be proud of
the fact that the state has the lowest rate of uninsured in
the country, which has improved the lives of so many
Massachusetts residents and allowed the healthcare system to
operate more efficiently. Our state was able to achieve
expanded coverage of this magnitude through innovative
programs like Commonwealth Care and Commonwealth Choice,
along with other provisions that were part of the
Commonwealth's 2006 healthcare reform law.
For these reasons, the Massachusetts Hospital Association
(MHA) supports the bill that you intend to introduce that
will advance the timeframe for waivers that were included in
the Patient Protection and Affordable Care Act (PPACA). As we
understand Section 1332 of PPACA, states may apply for a
waiver to certain requirements of the federal law so long as
the changes achieve healthcare coverage that is at least as
comprehensive as the federal law would have provided. The
changes are also required not to increase the federal
deficit. The law currently allows states to apply for such a
waiver beginning in January 1, 2017. Your proposed
legislation does not change the terms or process for
approving a waiver that currently exist in the PPACA but does
move up the date by which the waiver process may begin.
While the Commonwealth is still years away from decisions
that will be made in 2014 and beyond, we believe allowing
Massachusetts the opportunity to apply for such waiver
earlier than 2017 may allow the Commonwealth flexibility it
may desire to continue the success it has achieved thus far.
We note that Massachusetts is often referred to as a model
for national healthcare reform and we believe any waiver that
the Commonwealth would apply for, if it so chose, would seek
to achieve a similar goal of affordable, comprehensive health
insurance coverage as required by Section 1332.
Massachusetts hospitals have been and continue to be
supportive of the federal effort to expand coverage to the
uninsured and provide affordable health insurance for all
Americans. At the same time, we have stressed throughout the
national healthcare debate that national reform should
support the Commonwealth's own health reform achievements.
On behalf of Massachusetts member hospitals and the
patients they serve, we look forward to working with you to
preserve Massachusetts healthcare reform as the nation begins
to implement the national healthcare reform law.
Sincerely,
Lynn Nicholas,
President & CEO,
Massachusetts Hospital Association.
Mr. BROWN of Massachusetts. Thank you, Madam President.
We should be encouraging State innovation and not hampering it, and
that is what the Empowering States to Innovate Act does. It helps
ensure that States are not held back from innovating and seeking
solutions that work for their citizens, their taxpayers, and their
communities.
Finally, I wish to associate myself with the comments of the Senator
from Oregon when he makes them about how our bill fits into the Federal
health care reform debate. Enacting this legislation is the right thing
to do because it is good for States such as Massachusetts and Oregon
and Utah that have begun to make changes and reform at the State level
that make sense for their citizens.
The legislation provides flexibility and says one size fits all is
not appropriate and it does not always meet the needs of that
individual State. I know the Federal standard is not in the best
interests of the people of Massachusetts, which is why passing this
bill is the right thing to do.
Let me say I deeply appreciate the Senator from Oregon and his effort
to weed through the quagmire of rules and regulations and come up with
a commonsense solution. I am hopeful others in this Chamber will learn
from our example, that we can work together in a bipartisan manner to
tackle problems and try to solve them without the rhetoric and without
the bomb throwing and just solve problems. Because right now, we need
more people like the Senator from Oregon to do just that.
The ACTING PRESIDENT pro tempore. The Senator's time has expired.
Mr. BROWN of Massachusetts. Thank you, Madam President.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Oregon.
Mr. WYDEN. Madam President, let me commend the Senator from
Massachusetts on a very fine statement, which I think highlights
exactly what we are seeking to do.
The Senator from Massachusetts has been a real pleasure to work with
on this matter. As he says, the whole point of this, as shown by the
recent election, is that people want to find some common ground. They
are not interested anymore in food fights and bickering back and forth
between the political parties. What Senator Brown and I are seeking to
do is to show it is possible on a significant issue--I think we all
understand health care is about as important as it gets--that we can
come together, and the two of us have said we are going to come
together to put the focus on innovation. It is pretty clear that what
works in Springfield, OR, may not be exactly ideal for Springfield, MA.
But what we can do is come up with a way to provide more flexibility
and particularly more choice and more competition for our States and
other States around the country.
So I am very grateful to the Senator from Massachusetts for his
effort. It is early in the lameduck session, and it is my hope this
will be a signal in the Chamber that even on these difficult issues--
issues that were so contentious in the political campaign--it is going
to be possible to come together and find some common ground.
As the Senator suggests, if we can just move away from a Federal
cookie-cutter approach and encourage the kind of creative thinking we
have seen in Oregon and in Massachusetts and other parts of the
country, I think we will be well served and will be in a position to
better contain health care costs. I think we all understand that how to
rein in these medical costs that are gobbling up everything in sight is
first and foremost on the minds of our constituents. Literally, for the
amount of money we are spending today in this country, one can go out
and hire a doctor for every seven families in the United States and pay
the doctor more than $225,000 a year just for taking care of seven
families. I always bring up this as almost a metaphor for health care,
but usually after I am done, the physician who was listening in the
audience comes up and says: Where can I go to get my seven families? It
sounds like a pretty good deal. It just shows that we are spending this
enormous sum of money.
What Senator Brown and I are seeking to do is to encourage additional
innovative approaches in States, approaches that are tailored to the
needs of States' own residents, that will help us, in my view, to
promote choice and competition in the American health care system. The
States are free to do
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whatever they choose. I just offer up my own judgment that right now,
at a time when most Americans still don't get much choice in their
health care coverage, this is an ideal opportunity that both Democrats
and Republicans can support. As States seek to go forward with this
approach, they can make their own choices.
I hope, in particular, States will take a look at what you, Madam
President, the Senator from New York, and I have in our own health care
plan. The Federal Employee Health Benefit Plan provides a lot of
choice, a lot of competition. You can go out and fire your insurance
company if you don't think they are doing a good job. That is the kind
of idea a State could pursue and do so, we hope, more quickly if we act
legislatively to speed up the waiver process. But as Senator Brown has
correctly noted, this is about giving States the freedom to chart their
own course, and I am very hopeful we will be able to get this
legislation passed.
In particular, what I have been concerned about, after talking to
health policymakers over the last few months, is if, in the State of
New York, for example, you go out and set up a process to comply with
the legislation for purposes of 2014 and you see that the waiver, as
now constituted under 1332, starts in 2017, you say: How am I going to
reconcile those two? Am I going to set up one approach for 2014 and
then do another approach in 2017? It is going to put us through a lot
of bureaucratic water torture to try to figure out how to synchronize
those two dates. So it only makes sense to speed it all up and make it
possible for everybody to get started in 2014.
One other point because my intentions have been much discussed. When
I originally started talking about the State waiver, people questioned
whether this was something that was going to be a special opportunity
for Oregon and not for other States. For over a decade, I have been
promoting the idea that all States--all States--be given the freedom to
innovate under health care reform legislation. In fact, to give a sense
of how I got into this, going back and looking at the history of the
Clinton health care plan, in the early 1990s it was pretty evident that
had President Clinton and Republicans thought then about giving States
the kind of freedom Senator Brown and I envision, it might well have
been possible back in the early 1990s to enact health care reform that
would have gotten all Americans quality, affordable coverage. That
opportunity was missed. So I decided by the mid 1990s--if I had the
opportunity, the honor, of representing Oregon in the Congress, I was
going to use every single opportunity to let all States--and I want to
underline all States--have the opportunity to innovate in health care.
So in mid 2005 I started putting together a piece of legislation
called the Healthy Americans Act. It was a bipartisan bill, that had 14
or 15 Senators as cosponsors, depending on when you look back at the
legislative history, that were almost evenly divided between the
political parties. In the Healthy Americans Act, there was a specific
section called ``Empowering States to Innovate.'' There was a provision
in that bill that was first introduced in 2006, and a similar provision
was included as section 1332 in the law the President signed.
So I have long been interested in letting all States have the
opportunity to innovate. One of the reasons I have been interested--and
my good friend, Senator Merkley, is here--is that our State has been
one of the leaders in the whole effort to reform American health care.
From time to time, folks have said I am the Senator from the State of
Waiver rather than the State of Oregon because we have tried so often
to pursue innovative approaches in health care waivers. We were, as
Senator Merkley knows, one of the first States to say Medicaid dollars
that have been authorized for seniors to pay for services in
institutions such as nursing homes should be used instead for home
health care; thereby giving seniors more of what they want, which is to
stay in their homes, at a cheaper price to taxpayers. We began those
efforts, as Senator Merkley knows, with waivers from traditional
Federal law. So we have a long history of doing this, and I have spent
well over a decade trying to establish the principle that all States
ought to have the opportunity to bring their creative juices to this
issue of health care reform.
We have outlined the two key changes in the legislation that is law
today. The first change is to make the waivers effective in 2014 rather
than in 2017 so States only have to change their systems once. The
second thing the Empowering States to Innovate Act does is it requires
the Department of Health and Human Services to begin to review State
waiver applications within 6 months of enactment of the legislation.
This would allow States early notification of whether their State
waivers have been approved and would give them adequate time to roll
out their State-specific plans. I think this, too, will help us create
more competition, more choice, and more affordability in American
health care because it will give the States adequate time to gear up.
That is the philosophy behind the Empowering States to Innovate Act,
whether one likes one particular approach or another. Clearly, there
will be great diversity of approaches tried at the State level.
At a time when we are looking for ways to bring this country together
to deal with the most contentious issues of our time, we ought to be
supporting innovation. We ought to be supporting unleashing creative
kinds of approaches to deal with domestic issues. That is what Senator
Brown and I propose in this legislation. I look forward to working with
colleagues on both sides of the aisle.
I yield the floor.
The ACTING PRESIDENT pro tempore. The junior Senator from Oregon is
recognized.
Mr. MERKLEY. Madam President, I applaud the work my senior Senator
from Oregon, Ron Wyden, has been doing in seeking affordable, effective
health care for all Americans and, in particular, his work to utilize
our State laboratories in developing smart health care strategies that
then, if successful, can become a model for the Nation.
This process of utilizing waivers isn't about a State wanting an
exception so that it can be different; it is about recognizing that
States have powerful opportunities to form policies that work well
under particular circumstances but also may provide insights into our
whole national strategy for affordable, quality health care.
So for the work Senator Wyden and Senator Scott Brown are doing, I
applaud them and support them, and I thank Senator Wyden for his
decades of advocacy for affordable health care.
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