[Congressional Record Volume 157, Number 41 (Thursday, March 17, 2011)]
[Senate]
[Pages S1772-S1774]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
Mr. ALEXANDER. Mr. President, this is St. Patrick's Day, as Reverend
Austin mentioned, and we celebrate that. We are coming up on another
important anniversary, and that is the anniversary of the enactment of
the health care law, which the majority regards as a historic
achievement and most Republicans regard as a historic mistake.
I want to talk a little bit about that law, but there is another
anniversary I remember very well that came a few days before enactment
of the health care law--the so-called health care summit that was held
at the Blair House. It was a remarkable event.
The President of the United States, who is highly intelligent and
well-versed on health care, invited a bunch of us down to discuss
health care. He stayed and we stayed for 6 or 7 hours. During that
discussion, it was a pretty free exchange. I especially remember one of
them. I had been asked by Senator McConnell and Representative Boehner
to represent Republicans in presenting our side, and the President's
invitation gave us a platform we usually don't have. He has a better
platform than we do most of the time.
We made our argument that we would prefer an approach on health care
that instead of expanding the health care delivery system, which we all
know costs too much, we should go step by step to reduce the cost of
health care so more people can afford to buy insurance. That was the
basic discussion we had. We got down to some facts. I had said that,
according to the CBO, the President's plan would raise individual
premiums and make insurance cost more for individuals who buy insurance
by 10 to 13 percent. The President said, after I finished:
So, Lamar, when you mentioned earlier that you said
premiums go up--that's just not the case, according to the
Congressional Budget Office.
I said:
Mr. President, if you're going to contradict me, I ought to
have a chance to respond. The Congressional Budget Office
report says that premiums will rise in the individual market
as a result of the Senate bill.
The President said:
No, no, no, no--let me--and this is an example of where
we've got to get our facts straight.
I said:
That's my point.
And it went on from there. I had to make a decision at that moment
whether I should continue to have a public disagreement with the
President. I thought I was right, and he thought he was right, so I
decided it would be more appropriate for me not to do that in public,
to let other Senators and Congressmen have their say. I exchanged a
letter with the President that day, and I came to the floor of the
Senate later that week to make my argument on why I believed premiums
would go up.
Mr. President, I ask unanimous consent to have printed in the Record
the transcript of my exchange with the President and that of Senator
Kyl and a couple of Members of Congress and the letter I sent to the
President that day which made my point rather than publicly argue with
him. My remarks I made on the floor of the Senate later that day are in
the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The White House
Discussion on Cost Containment at Bipartisan Meeting on Health Care
Reform
(Blair House, Feb. 25, 2010)
(Roughly 11 a.m.)
THE PRESIDENT: For folks who even with those lower costs
still can't afford coverage, we'd provide some subsidies. But
here's what I want to emphasize is that even without the
subsidies it's estimated by the Congressional Budget Office
that the plan we put forward would lower the costs in the
individual market for the average person who's just trying to
buy health insurance and they don't--they're not lucky enough
to work for a big company, would lower their costs by between
14 and 20 percent.
So, Lamar, when you mentioned earlier that you said
premiums go up--that's just not the case, according to the
Congressional Budget Office.
SENATOR ALEXANDER: Mr. President, if you're going to
contradict me, I ought to have a chance to--the Congressional
Budget Office report says that premiums will rise in the
individual market as a result of the Senate bill.
THE PRESIDENT: No, no, no, no--let me--and this is an
example of where we've got to get our facts straight.
SENATOR ALEXANDER: That's my point.
THE PRESIDENT: Well, exactly. So let me respond to what you
just said, Lamar, because it's not factually accurate. Here's
what the Congressional Budget Office says. The costs for
families for the same type of coverage as they're currently
receiving would go down 14 to 20 percent. What the
Congressional Budget Office says is, is that because now
they've got a better deal because policies are cheaper, they
may choose to buy better coverage than they have right now
and that might be 10 to 13 percent more expensive than the
bad insurance that they had previously. But they didn't say
that the actual premiums would be going up. What they said
was they'd be going down by 14 to 20 percent. And I promise
you, I've gone through this carefully with the Congressional
Budget Office. And I'll be happy to present this to the press
and whoever is listening, because this is an important issue.
SENATOR ALEXANDER: Well, may I--may I--
THE PRESIDENT: Let me just finish, Lamar. Now, the--what
we've done is we've tried to take every single cost
containment idea that's out there. Every proposal that health
care economists say will reduce health care costs, we've
tried to adopt in the various proposals. There are some
additional ideas that Republicans have presented that we
think are interesting and we also tried to include. So, let
me give you an example.
You mentioned the idea of buying across state lines,
insurance. That's something that I've put in my proposal
that's actually in the Senate proposal. I think that it shows
some promise. You mentioned that as--that Mike Enzi has
previously said, that he's interested in small businesses
being able to pool in the equivalent of some sort of
exchange. So that's where there's some overlap.
But I just think it's very important to understand that
what we've done is to try to take every single cost
containment idea that's out there and try to adopt it in this
bill. What I'd like to do is to see if we can proceed and
have a very concrete conversation about what are the ideas
that you guys have that you don't think are in our bill to
contain costs. And what I want to do is to see if maybe we
can adopt some of those or refine what we've already done in
order to further reduce costs.
SENATOR ALEXANDER: Mr. President, I've had my time--
THE PRESIDENT: And what I'd like to do also is to make sure
that you maybe suggest some of the ideas that are currently
in the bill that you think are good, because, Lamar, in your
opening introduction, what I saw was sort of a--the usual
critique of why you thought it was bad. But as I said, we've
adopted a lot of the ideas that we've heard from your side of
the aisle. So I hope maybe you could say, well, those are the
ones that we think are good ideas; here are the things that
we think are bad ideas, as opposed to just painting in broad
brush. Go ahead.
SENATOR ALEXANDER: Mr. President, let me--let me show some
respect for my colleagues here. They're all here eager to
speak, all sure they could do a better job than I could on
any of these points. And what I would like to do is get back
directly to you with why I believe--with respect--you're
wrong about the bill. Your bill would increase premiums, I
believe; you say it wouldn't. So rather than argue with you
in public about it, I'd like to put my facts down, give them
to you. Maybe other colleagues will say that. As far as Mike
Enzi's proposal, he is ready to talk about it; others are.
THE PRESIDENT: Good.
SENATOR ALEXANDER: So I appreciate the opportunity that
Mitch and John gave me to talk. You've made some interesting
points, and why not let other members of Congress have a
chance to talk.
THE PRESIDENT: I think it's a great idea. I'd like to get
this issue settled about whether premiums are reduced before
we leave today, because I'm pretty certain I'm not wrong. And
you give us the information--and we're going to be here all
afternoon. I promise you we'll get this settled before the
day is out. All right.
[[Page S1773]]
Mitch, who would you like to talk about cost?
(REMARKS FROM CONGRESSMAN CAMP--LATER IN THE MEETING)
CONGRESSMAN CAMP: I'm almost done. I do want to say on this
issue on premiums, CBO, in their letter, on page four, does
say that the estimated average premium per person for non-
group policies would increase by 10 to 13 percent.
THE PRESIDENT: This is the discussion that I just had to--
about Lamar. And--
CONGRESSMAN CAMP: Yes, they do say that. And they do say
that the value of the benefit is higher, and that is why it
goes up.
THE PRESIDENT: Right.
CONGRESSMAN CAMP: But the reason the value of the benefit
is higher is because of the mandates contained in the
legislation. And this is one of our big concerns with a lot
of the issues that have been raised. Yes, we have
similarities. But when all of this is structured around a
government-centered exchange that sets the standard for these
policies, states can't get out of these requirements unless
they seek a waiver from the Secretary. That kind of approach
raises costs. And so both of your comments were correct that
costs do go up and it's because they have a richer benefit,
but the reason it's richer is because of the mandates
contained in these very large bills.
(REMARKS FROM SENATOR KYL LATER IN THE MEETING)
SENATOR KYL: Now, let me give you a couple of examples.
Dave Camp, I think, pointed out the answer to the dispute
that you and Lamar Alexander had a moment ago, and he was
exactly right. Let me quote from the Congressional Budget
Office letter--this is from Doug Elmendorf to Evan Bayh,
November 30th, 2009: ``CBO and Joint Tax Committee estimate
that the average premium per person covered, including
dependents for new non-group policies, would be about 10
percent to 13 percent higher in 2016 than the average premium
for non-group coverage in the same year under current law.''
Oliver Wyman, a very respected third-party group says it's
even more--about 54 percent; in my state of Arizona, 72
percent increase. Why is it so? For a variety of reasons, but
one of which both you and Dave Camp agreed on. It is a richer
benefit. How did it get that way? Because the federal
government would mandate it under your legislation in the
insurance exchanges. And as a result, there would be a higher
cost. How does this happen?
THE PRESIDENT: Okay, Jon. I'm going to go to you, Jim, but
I--since as has tended to happen here, we end up talking
about criticisms of the existing bill as opposed to where we
might find agreement, I feel obliged just to go through a
couple of the points that you raised.
Just to go back to the original argument that Lamar and I
had and we've now chased around for quite some time. Look, if
I'm a self-employed person who right now can't get coverage
or can only buy the equivalent of Acme insurance that I had
for my car--so I have some sort of high-deductible plan. It's
basically not health insurance; it's house insurance. I'm
going to--I'm buying that to protect me from some
catastrophic situation; otherwise, I'm just paying out of
pocket. I don't go to the doctor. I don't get preventive
care. There are a whole bunch of things I just do without.
But if I get hit by a truck, maybe I don't go bankrupt. All
right, so that's what I'm purchasing right now.
What the Congressional Budget Office is saying is, is that
if I now have the opportunity to actually buy a decent
package inside the exchange that costs me about 10 to 13
percent more but is actually real insurance, then there are
going to be a bunch of people who take advantage of that. So,
yes, I'm paying 10 to 13 percent more, because instead of
buying an apple, I'm getting an orange. They're two different
things.
Now, you can still--you still have an option of--no, no,
let me finish. The way that this bill is structured uses a
high-cost pool, a catastrophic pool, for people who can't
afford to buy that better insurance, but overall for a basic
package--which, by the way, is a lot less generous than we
give ourselves in Congress. So I'm amused when people say,
let people have this not-so-good plan, let them have a high-
deductible. But there would be a riot in Congress if we
suddenly said, let's have Congress have a high-deductible
plan, because we all think it's pretty important to provide
coverage for our families. And the federal health insurance
program has a minimum benefit that all of us take advantage
of. And I haven't seen any Republicans--or Democrats--in
Congress suddenly say, ``You know what, we should have more
choices and not have to have this minimum benefit.''
So what we're basically saying is we're going to do the
same thing for these other folks that we do for ourselves--on
the taxpayers' dime, by the way.
Now, there is a legitimate philosophical difference around
that, but I think it's just very important for us to remember
that saying there's a baseline of coverage that people should
be able to get if they're participating in this big pool is
not some radical idea. And it's an idea that a lot of
states--we were talking earlier about what states do--a lot
of states already do it.
____
U.S. Senate,
Washington, DC, February 25, 2010.
Hon. Barack Obama,
President, The White House,
Washington, DC.
Dear Mr. President: During today's discussion on health
care, you and I disagreed about whether the health care bill
that passed the Senate on a party-line vote on December 24
would cause health insurance premiums to rise even faster
than if Congress did not act. I believe premiums will rise
because of independent analysis of the bill:
On November 30, the non-partisan Congressional Budget
Office (CBO) wrote in a letter to Senator Bayh that ``CBO and
JCT estimate that the average premium per person covered
(including dependents) for new nongroup policies would be
about 10 percent to 13 percent higher in 2016 than the
average premium for nongroup coverage in that same year under
current law.''
When you asserted that CBO says premiums will decline by 14
to 20 percent under the Senate bill, you are leaving out an
important part of CBO's calculations. These reductions are
overwhelmed by a 27 to 30 percent increase in premiums due to
the mandated coverage requirements in the legislation. CBO
added those figures together to arrive at a net increase of
10 to 13 percent--as shown in their chart in that same
letter.
In that same letter, CBO wrote, ``The legislation would
impose several new fees on firms in the health sector. New
fees would be imposed on providers of health insurance and on
manufacturers and importers of medical devices. Both of those
fees would be largely passed through to consumers in the form
of higher premiums for private coverage.''
On December 10, the chief actuary for the Centers for
Medicare and Medicaid Services--who works for your
administration--concurred with the CBO. In his analysis, the
actuary said, ``We anticipate such fees would generally be
passed through to health consumers in the form of higher drug
and device prices and higher insurance premiums.'' He also
said, ``The additional demand for health services could be
difficult to meet initially with existing health provider
resources and could lead to price increases, cost-shifting,
and/or changes in providers' willingness to treat patients
with low-reimbursement health coverage.''
For these reasons, the Senate-passed bill will, indeed,
cause Americans' insurance premium to rise, which is the
opposite of the goal I believe we should pursue.
Sincerely,
Lamar Alexander.
Mr. ALEXANDER. We talk a lot about the law of unintended consequences
in dealing with legislation. In this case I believe the health care law
is a situation where we had a lot of predictable consequences.
Republicans were saying, for example, premiums are going to rise. In
fact, they have. We were saying specifically that individual premiums
will rise. It was predictable they would because, in the first place,
the health care law requires that individuals buy a better policy than
what they buy today. So if they are going to buy a Cadillac instead of
a Chevy, it will cost more and they will get more benefits.
Second, there are some taxes in the health care law, such as with
medical devices, that are passed on to the consumer and premiums will
go up.
Third, a lot of people who moved into Medicaid are going into a
system of government health care where the doctors aren't properly
reimbursed. Many of the doctors shift the costs over to the people who
buy insurance. That is called cost shifting.
For all those reasons, we have seen stories regularly in California,
Nevada, Wisconsin, and Connecticut that individual premiums, over the
last year, have gone up at least partially due to mandates included in
the new law.
Let's look at some of the other issues we talked about during that
time. We said the bill would raise taxes. In fact, it does--$813
billion. As I mentioned, the tax on medical devices is passed right
along to people who buy insurance, and their costs go up.
We said it would cut Medicare, and it has. Eleven million Medicare
Advantage recipients--about one-fourth of everyone who has Medicare--
are seeing or will see their benefits reduced.
We said there would be thousands of pages of new regulations that
would hamper small businesses and individuals as they go about their
daily lives. We are beginning to see them come. The most notorious is
that form 1099 which causes 40 million businesses to file a report
every time they buy something that costs more than $600. We hear a lot
of talk about repealing that. We have tried to repeal it for some time,
but it is still the law.
Something that particularly bothered me about the debate were the
unfunded mandates on State governments. We hear about college tuition
going up in California 30, 40 percent. People would be surprised to
think that the reason may be that the Federal Government is imposing
more
[[Page S1774]]
health care costs on California, and the money that ought to go for the
University of California or the University of Tennessee isn't there.
Where does the university get the money to keep its excellence? It
raises tuition.
Our former Democratic Governor, who just retired, said the health
care law imposes on Tennessee more than $1.1 billion in new costs
between 2014 and 2019. That is an unfunded mandate from Washington that
will cost the people of Tennessee.
Fewer jobs will be created as a result of this law. Someone might
say: How can you say that? I will give an example. I met with a group
of leaders of the restaurant industry in America. They are CEOs of all
the big restaurant companies. They are the second largest employer in
America. They hire a lot of low-income people. One of them said they
had been operating their stores with 90 employees on the average, and
as a result of the health care law, their goal was to operate with 70
employees. That is fewer jobs. And there were many other examples of
that around the room.
Even the student loan takeover has created a problem because students
are actually paying more in interest on their student loans to help pay
for the new health care law, which I think a lot of students would not
appreciate.
The health care law that was passed a year ago, which some believe is
a historic achievement, we believe is a historic mistake. We believe it
would have been better and will be better to, instead of expanding a
health care system that costs too much, go step by step to reduce its
costs so more people can afford insurance. We will continue to advocate
that position. We voted to repeal the health care law. We lost that
vote. But we are continuing to work.
The ACTING PRESIDENT pro tempore. The Senator's 8 minutes has
expired.
Mr. ALEXANDER. With Senator Johanns' leadership and others, we will
work to repeal the 1099 provision. Senator Hatch and others are working
to give Governors more flexibility in the Medicaid Program. And we will
continue to advocate solutions such as allowing people to buy insurance
across State lines.
Next Wednesday is an important anniversary. Some believe it is a
historic achievement. We believe it is a historic mistake and that
there is a better solution to health care costs.
I thank the leader for his courtesy in giving me a chance to go
ahead.
I yield the floor.
____________________