[Congressional Record Volume 157, Number 114 (Wednesday, July 27, 2011)]
[Senate]
[Pages S4920-S4922]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
A SECOND OPINION
Mr. BARRASSO. Madam President, I come to the floor today having
listened to my colleagues and looking at the most recent job data,
which shows the effects of our struggling economy. Unemployment is
going up, wages are going down, and there are concerns all around the
country with jobs, the economy, the debt, and spending.
I have to say, I certainly believe, as somebody who has practiced
medicine for 25 years in Wyoming and taken care of families all around
the Cowboy State and been very involved in the debate over the health
care law, that the President's health care law makes matters worse,
absolutely makes matters worse.
The President's health care law makes matters worse by forcing
employers to either offer government-approved health insurance or pay
higher expenses. Each day it becomes obvious to me the new health care
law is designed to ultimately end employer-provided coverage altogether
and to encourage Americans to join government-run exchanges. That is
why, as a doctor, I come to the floor week after week with a doctor's
second opinion about the health care law. Under this law businesses are
permitted to drop out of paying for employer-provided coverage as long
as they pay a fine. The fine is about $2,000 per employee. This number
is far smaller than what it would actually cost the business to provide
family health benefits to each of their employees.
So what happens with small businesses in this country? Well, they are
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going to face an ever-clearer incentive to drop coverage for the people
they employ. They are not required to pay this fine for the first 50
workers who lose coverage. So the question is, Where are these people
supposed to go? Where do they go for their insurance? How does it work?
The President promised them if they like what they have, they can
keep it. Yet the incentives built into the health care law seem to be
encouraging employers to drop their employees. So where do they go?
Well, the new health care law sets up what are called health care
exchanges for these people to enter. Whether they want to or not they
will be forced to go that way. These exchanges are shorthand for
insurance markets where as much as 80 percent of the cost of the
family's insurance could be actually borne by taxpayers. Under these
circumstances, the natural response is for businesses to drop coverage
for their employees altogether and then simply offer them some less
expensive cash benefits.
Meanwhile, what happens to the employees who are going to lose the
coverage they may like and then try to replace it because that is what
is going to happen? They will have to replace it with a plan Washington
mandates. That is of concern to a lot of Americans, and this may be
very bad news for the patient and is really bad news for taxpayers.
Experts predict the annual cost to provide government insurance
subsidies could cost up to nine times more than what the White House
originally claimed. If that isn't proof enough the health care law is
the wrong prescription to help America's job creators continue offering
coverage to their workers, let's take a look at some of the things that
have just come out in the last week.
This week, on Monday, July 25, the National Federation of Independent
Business--a group that represents small businesses all around the
country--released an astonishing new report. The NFIB surveyed 750
small businesses. These are small businesses of less than 50 employees.
The survey asked these small businesses if they planned to drop health
insurance coverage should their employees become eligible for this
government subsidy to buy health insurance in the so-called exchange.
More than one-quarter of the small businesses who offer coverage
today--over one-quarter of the small businesses that offer coverage
today--said they were very likely to drop coverage. I repeat: Very
likely to drop coverage. Another 31 percent said they are somewhat
likely to drop coverage; that they needed to look into it to find the
specifics.
When we take a look and add the ones who are very likely and somewhat
likely to drop coverage, we are looking at over half the small
businesses in this country dropping insurance coverage and effectively
dumping their employees into the government-run exchange.
The small business group in the survey and the response from these
small businesses prompted the Wall Street Journal to print an editorial
highlighting this data. It is entitled ``The Flight to the Exchanges.''
When I read this, I said: Gee, I couldn't have said it better myself.
The President's health care law wraps businesses in reams of
bureaucratic redtape and uncertainty. Adding insult to injury, on
Monday, July 11, of this year, the Department of Health and Human
Services released yet another proposed regulation mandated by the
health care law. The Obama administration issued its proposed insurance
exchange regulation. What the rules do is give the States the specific
framework they must use to set up a program or an exchange with this
Washington-approved and mandated insurance. Here we go again, another
example of where this administration takes roughly 30 pages from the
health care law and turns it into 340 pages of bureaucratic Washington
rules and regulations.
Of course, the Secretary of Health and Human Services is trying to
sell this new rule as offering competition and uses the word
``flexibility.'' But nothing could be further from the truth. How
flexible can a 347-page Washington rule be when it is a rule that
contains the word ``must'' 580 times and includes the word ``require''
811 times? How flexible can that Washington rule actually be?
Well, after examining all the rule's ``musts'' and ``requires,'' one
thing is very clear: This administration is paying lipservice to State
flexibility while their policy is promoting a Washington-mandated,
Washington-dictated, Washington-enforced approach. This regulation
details a very complex and confusing process that States are going to
have to follow. The States have to follow these confusing rules in an
effort to prove to the Department of Health and Human Services they
meet its Washington mandates to set up and run the insurance exchanges,
and they have very little time to do it. So this administration creates
onerous new mandates and then fails to give States ample time to meet
their overwhelming set of requirements.
Let's put this into context for the States. Comments of the
administration's proposed rules are due this September 28. Typically,
it can take the Department of Health and Human Services 6 months to
review those comments about the rules and issue a final rule. That
means we would likely see a final rule in March of 2012. Remember,
there are significant details missing from these exchange regulations.
This regulation is only part of the details States need to review
before they can decide whether to run a health insurance exchange on
their own or let the Federal Government do it.
The administration has yet to release rules explaining the health
care law's essential health benefits package, the individual
eligibility to participate in the exchanges, quality standards for the
exchanges, and quality standards for the participating insurance plans.
Those details may not come out until October or November of this year.
This means States still do not know what the minimum set--the minimum
set--of health services individuals, small businesses, and insurers
will have to offer in the exchange. Pending missing details and further
rules expected to come from the administration this fall, final rules--
final rules--may be in place finally in May or June of 2012. States
would then have to be prepared to submit their plan in June of 2012 to
Health and Human Services to be certified.
But what happens if the rules aren't out by then? Many State
legislatures end their sessions by June, making complying with this
tight time line extremely difficult, if not impossible. It seems to me
this administration will have had 2 years to post their final
regulations while the States may have only 2 months to comply.
What happens if a State isn't ready? They say have no fear;
Washington is here to help. That is what they say. If the Department of
Health and Human Services says a State's insurance exchange is not in
compliance, then Washington will swoop in and set up its own program.
This is often called the Federal fallback or the federally facilitated
exchange, big fancy words for Washington bureaucrats telling States
what they have to do.
The irony of all this is the administration's rules offer very few
details explaining what this Federal fallback exchange will look like,
so the States don't even know what happens if the Federal fallback
comes into play.
Is the Department of Health and Human Services creating a stealth,
back-door Federal exchange? If a State doesn't have adequate time to
meet all the operational program requirements and the burdensome review
process, it sounds to me like the Obama administration will then take
control of the States.
Why should a State such as Utah, for example, that has created an
especially designed insurance marketplace be forced to comply with
onerous and costly requirements of this rule? If they are not willing
to comply, will they face the consequences that Washington will make
the final decision? States should be encouraged to create innovative
solutions that meet the unique needs of their constituents, not forced
to follow a one-size-fits-all laundry list of Washington mandates.
This is why I returned to the floor today, as a physician who has
practiced medicine for a long time, with a doctor's second opinion, to
tell you I believe this health care law is one that is bad for
patients, it is bad for providers--the nurses and the doctors who take
care of those patients--and it is bad for taxpayers. It is why I
believe it
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is important we repeal and replace this health care law.
Madam President, I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Maryland.
Ms. MIKULSKI. Madam President, how much time am I allowed?
The ACTING PRESIDENT pro tempore. Ten minutes.
Ms. MIKULSKI. I thank the Chair.
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