[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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