[Congressional Record Volume 158, Number 45 (Monday, March 19, 2012)]
[Senate]
[Pages S1768-S1773]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
Mr. JOHNSON of Wisconsin. Mr. President, I wasn't here when they
passed the Patient Protection and Affordable Care Act. This week will
mark the second anniversary of what I call a very Orwellian name for
that piece of legislation because I personally do not believe it is
going to protect patients, nor do I believe it is going to improve the
affordability of our health care system.
The reason I ran for the Senate was primarily because of this law. I
certainly recognized how it was going to result in a lower quality of
health care, how it was going to lead to rationing, and how it was
going to severely limit the amount of medical innovation we enjoy in
this country. In particular, I was offended by the political process
demonizing doctors and health care providers, demonizing the health
care system in order to pass this health care law.
The reason that offended me is a very personal story. It has to do
with my daughter who was born with a very serious congenital heart
defect, her aorta and pulmonary artery were reversed. So her first day
of life, the doctors--who President Obama said would take out a set of
tonsils for a few extra dollars--saved her life within the very first
few hours of life. Then, 8 months later, when her heart was only the
size of a small plum, another incredibly dedicated and incredibly
skilled team of medical professionals totally reconstructed the upper
chamber of her heart. Her heart operates backwards now, but she is 28
years old and now she is a nurse herself in a neonatal intensive care
unit and she is taking care of those babies.
So when they passed the Patient Protection and Affordable Care Act, I
knew the health care system that saved my daughter was at risk. I also
knew this health care law was in no way, shape or form going to reduce
our Federal deficit. It is just not possible. How can we expect to add
25 million people to government-run health care and reduce the deficit
at the same time?
The reason they were able to put forward that fiction is they
proposed a piece of legislation that would have revenue, fees, taxes,
and penalties for 10 years, while at the same time only providing
benefits for the last 6 years of that time period. Basically, what they
did was to say we will raise revenue for 10 years of about $1.1
trillion, and we will have 6 years' worth of cost, a little under $1
trillion. That was the fiction.
Half of that revenue generated is going to be in taxes, fees, and
penalties. Personally, by increasing taxes and increasing fees on
things such as medical insurance, on medical devices, and on
pharmaceuticals, I don't see how that bends the cost curve down. It
would not bend the cost curve down. It is the same logic this President
has used when he is talking about high gasoline prices. He says by
increasing taxes on oil companies we will reduce the price of gas. It
is just not possible. Increasing fees on providers, reducing
reimbursement rates to providers is not going to bend the cost curve
down. It is basically not going to happen.
The other half of the pay-fors--the other half of that $1.1
trillion--was proposed reductions basically in payments to Medicare
providers. Congress, I would say wisely, has not enacted the
sustainable growth rate cuts to providers because they realize, if they
do that, access for seniors to medical care will be reduced. I don't
see how, if we reduce Medicare by $529 billion, that same access also
would not be reduced. From my standpoint, I think it is highly unlikely
Congress will actually enact that $529 billion worth of reductions to
Medicare. When they do not do that, the $143 billion reduction in our
deficit, that fiction, will totally go away.
Another reason for that fiction being exposed is because,
fortunately, Congress realized the CLASS Act portion of ObamaCare
simply wasn't going to save the money they said it was going to save.
It simply wasn't sustainable. Budget Committee Chairman Kent Conrad
actually called the CLASS Act a Ponzi scheme. So this administration
has decided not to move forward with its implementation. In doing so,
that is removing $70 billion of revenue from that budgetary fiction.
I know Senator Kyl has been following this very carefully, in terms
of
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what is going to happen to our Federal budget, and I am wondering if
Senator Kyl would want to comment on how he sees the real effect of the
health care law on the Federal budget and why that is not going to save
us $143 billion in the first year and probably result in far greater
costs to the Federal Government if this thing is actually implemented.
Mr. KYL. Mr. President, I would say my colleague from Wisconsin is
absolutely right. Let me first of all say, millions of citizens around
this country have gotten engaged for the same reason as my colleague
did; as a normal citizen, running his business, he saw what was
happening here and he decided to get involved. Not everyone can run for
the Senate successfully and come back to Washington to bring that
message from America right here to the Senate Chamber, but he has done
it, and I commend him for his leadership.
Yes, he is absolutely right. It turns out that his predictions and
those of us who were on the Senate floor when this bill passed into law
saying it was going to cost a lot more than our Democratic friends
said; that it was going to cost a lot more than the Congressional
Budget Office estimated, well, now the numbers are in and here they
are.
The nonpartisan Congressional Budget Office last week just released
its updated figures, and it shows that the real cost of the ObamaCare
subsidy spending is going to almost double. When ObamaCare was passed,
they estimated the cost would be $938 billion. That is on the Medicaid
part as well as the taxpayer-funded health insurance subsidies. As my
colleague said, that is a 10-year cost. Of course, part of the game is
that they are collecting money over 10 years but only paying benefits
over 6 and that can make it look pretty good, as my colleague said. But
it turns out, when CBO had to reexamine, now with 2 years' experience,
what they found is, looking at the entire 10-year budget window, the
true size of this cost was masked. Now that we have a clearer picture,
voila, CBO says the projected amount is $1.7 trillion over 10 years. In
other words, ObamaCare is going to cost more than $700 billion more
than CBO estimated at the time the law was passed.
How can they miscalculate by almost double, from $938 billion to now
$1.7 trillion? It is not CBO's fault. CBO is a bunch of accountants.
They take what we give them and do their figuring. As the Senator from
Wisconsin said, what the Senate Democrats and the President gave them
was just part of the picture. They said: We are going to give you 10
years' worth of revenues, but we are only going to give you 6 years'
worth of expenses. See how that works out. I wish we could all do our
private budgets at home that way.
Here is another way to look at it. We have all heard of a mortgage
with a bubble payment at the end. That is, in effect, what this was.
They basically said: Look, we know CBO has to estimate 10-year budgets,
so we have a great idea on how to make this cost less. We will put some
of the big expenditures in years 11 and 12. Voila, 10 years of
expenditures, not too bad. But now that 2 years have passed and we are
now looking at a 10-year budget that goes out 10 more years from now--
12 years from when ObamaCare was first calculated--it turns out when we
add in years No. 11 and 12, it adds hugely to the cost--$700 billion
worth.
We all said this at the time. It was a trick. It was smoke and
mirrors. They were pulling a fast one on the American people. We said
that. But we heard: Oh no. You can trust CBO. Sure, we could trust CBO
as far as they could calculate it. But if one had said, how about years
11 and 12, they would have had to say: That is another story, but we
weren't asked about that.
I say to my friend from Wisconsin, he is exactly right. Now the
chickens have come home to roost. Now we know what the real cost of
this is going to be and, oh, by the way, if we want to go out over the
entire period once the law is fully implemented--remember, ObamaCare
has not been fully implemented yet. So what happens when we calculate
its full cost when truly implemented? The Budget Committee, on which
Senator Sessions sits, says total spending under ObamaCare will reach
$2.6 trillion. So these are the real costs we have to pay attention to,
not just the estimates that were made at the time they were trying to
get the law passed.
I might either ask the Senator from Wisconsin or our ranking member
on the Budget Committee, what about this? If we use real numbers and
real costs, are the American taxpayers going to be on the hook for
something akin to $2.6 trillion, according to the Budget Committee?
That is a lot of money.
Mr. JOHNSON of Wisconsin. I wish to point out, the numbers Senator
Kyl is talking about are CBO projections, just using a different
timeframe. That isn't even taking into account what I have been talking
about is an even more significant risk to the deficit, and that is one
particular CBO estimate that says, on net, only 1 million Americans
will lose their employer-sponsored care.
There are 154 million Americans who get their employer-sponsored care
from employer-sponsored plans. To assume that only 1 million people
will lose that coverage and get forced into the exchanges is absurd,
particularly when we have a study by a very reputable firm, McKinsey &
Company, surveying 1,300 employers, which said 30 to 50 percent of
employers plan on dropping coverage and having their employees go into
the exchanges. It is pretty easy to understand why that might happen.
Right now, the health care law is 2,700 pages; there have been another
12,000 pages of rules and regulations. So employers looking at the
health care law are looking at, Do I try and comply with, do I try and
understand 15,000 pages of regulations and then pay $20,000 for a
family plan--which is the new CBO estimate for a family plan in the
year 2016. Do I do that or pay the $2,000 penalty?
With ObamaCare, they are not exposing their employees to a financial
risk. They are making them eligible for huge subsidies, $10,000, if
they have a household income of $64,000.
So I will throw it over to Senator Sessions on the Budget Committee.
My concern is we are not even beginning to contemplate what the effects
of that might be. What does the Senator think of that?
Mr. SESSIONS. I couldn't agree more about the concerns the Senator
raised.
Senator Johnson was a successful businessman. He provided health
insurance for his employees. He had to purchase it. I will just ask him
one quick question. Based on his experience--a year and a half ago he
was doing this business. What are the incentives for a business that is
already in existence, providing health care, why might they not
continue to provide it? Why might a new company, a startup company, a
small business that hopes to grow and have hundreds of employees--why
might they never start with employer-based health care?
Mr. JOHNSON of Wisconsin. Again, it is becoming so complex. It is
becoming so expensive. Again, the big difference ObamaCare throws into
the equation is, in the past, responsible employers--and most employers
truly care about the people who work with them--wouldn't have dreamed
of exposing their employees to financial risk that would be obvious if
they didn't provide health care insurance. But with ObamaCare, that is
not what is happening. Now these exchanges will be available as well as
huge subsidies.
I am not aware of too many large Federal subsidies that go unused,
and that is my concern. So the equation is totally different now. It is
going to be totally different under ObamaCare.
My question for CBO--I know they just conducted a study and did some
sensitivity analysis, but they didn't go anywhere near far enough, from
my standpoint. I think the largest number of employees they took a look
at might have been 20 million individuals. But when we have 154 million
Americans getting employer-sponsored care and the McKinsey study saying
half of those, more than 75 million--I think we need to take a very
serious look at what effect on our budget that would have.
Mr. SESSIONS. I think all of us need to be listening to this because
it is something that was not sufficiently considered during the debate;
that is, that dramatically more employers may quit providing insurance,
new companies that get started will not provide it, people will be on
the exchanges, and it will cost far more than was expected. That is an
entirely new issue.
Assuming the low numbers the Congressional Budget Office said will go
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into the exchanges, just taking the numbers they assumed, let me point
out what Senator Kyl said. President Obama, in an exact quote to the
joint session of Congress when he was promoting this legislation, not
some off-the-cuff figure, said this:
Now, add it all up. And the plan I'm proposing will cost
around $900 billion over 10 years--
This was a deliberate attempt, as has been suggested, to manipulate
the figures because the taxes started right away, but the spending was
4 years delayed essentially, so we only have 6 years of spending under
the plan. It also excluded many other provisions.
For example, the bureaucratic implementation costs were not counted.
The amount of effort, even the IRS will have to hire people who have to
be involved, and this was not counted. New spending to close the
Medicare doughnut hole. We didn't have the money in 2002 or 2003 to
fund that provision. We have never been in worse shape. We are
borrowing 40 cents of every $1 we spend, far worse than we were. Next
year will be the fifth consecutive $1 trillion deficit. We don't have
the money. So now we are spending more on that program that we don't
have, the new or early retiree program.
So once we add all the different provisions in the health care law,
total gross spending over the original 10 years, when only 6 years is
being paid for--over 10 years is actually 1.4 trillion. Those are the
numbers we have. So this was a misrepresentation. This is from 2010
through 2019, 1.4 trillion. But when we add all the costs over the
first full 10 years of this health care bill, it will be $2.6 trillion.
The point is, the bill is not good health policy. The American people
oppose it overwhelmingly. Absolutely, we do not have the money. We have
never had a more systemic death threat to America, and it is so painful
to see this happen.
I thank Senator Johnson for his energy, for the commitment he has
brought to this issue. He has seen it on the other side, the real-world
side, and he is helping to motivate us all to explain to the American
people the dangers of the bill.
Mr. JOHNSON of Wisconsin. I wish to ask Senator Sessions a question.
We have talked about this in the past. I know a lot of people talked
about the Medicare cuts being double counted, and I never quite
understood exactly what that was. Can the Senator maybe explain a
little bit to the American people what that means.
Mr. SESSIONS. Yes.
As a part of the funding for the ObamaCare legislation, there was an
increase in Medicare taxes and a cut in Medicare benefits totaling $400
billion. That money was used to fund the new health care bill by the
U.S. Treasury, an entirely new program. But it is Medicare's money. It
is not the Treasury's money. Medicare has trustees. Medicare loaned the
money to the U.S. Treasury. It was borrowed money that was used to fund
this bill, not money that came in new and free of charge. Since
Medicare is going into default and going to claim its debt in a few
years, the Federal Government is simply going to have to either raise
taxes, cut spending somewhere else or, more likely, convert the
borrowing from Medicare, borrow money on the open market from China and
other places, and then pay Medicare back.
It is, as the CBO Director told me in a letter, December 23, the
night before we voted: You are double counting the money.
No wonder this country is going broke. This isn't extra money. Half
the original estimate of the bill, $900 billion, was funded by borrowed
money from Medicare. This is how this country is surging in its debt
and why we are in danger of the entire economy entering into collapse.
Mr. JOHNSON of Wisconsin. Does the Senator believe those Medicare
savings will actually be realized? Does the Senator believe Congress
will actually enact those savings?
Mr. SESSIONS. That is a good point, because in the past we have
attempted and claimed we were going to make savings in Medicare and
they never occurred.
What I am saying is if these savings were to occur and if the new
taxes on Medicare go into effect, as they are, that money is what is
being used to fund an entirely new health care program. There is real
doubt it will ever achieve those savings in Medicare, because if we
keep cutting doctors and we keep cutting hospitals, they can't keep
doing work. They will start refusing Medicare and Medicaid work. We are
in that position already on some of the cuts that we rescind every year
because we know the health care system would collapse if those cuts
were to go into effect.
Mr. JOHNSON of Wisconsin. That is one of my concerns. Let's say we
actually do enact those cuts to Medicare and we don't reimburse
providers and doctors in some cases to even cover their costs.
I know this is hard to get to, but I have read where only 60 percent
of providers are willing to see and treat Medicaid patients. Now what
we are going to be doing is adding 25 million new individuals onto
Medicaid rolls, where only 67 percent of providers are seeing those.
I would ask Senator Boozman, because he is not only a new Senator but
also a doctor and he ran a business, would he comment on that as well.
I think he has some comments in terms of how this health care law will
be affecting employment and jobs.
Mr. BOOZMAN. I appreciate the Senator's leadership in this area. I
also appreciate the fact that he jumped out and ran for the office and
was elected, because we desperately need people such as Senator
Johnson, people who were successful businessmen who understand the
unintended consequences of much of what we do. I, similar to the
Senator, also have a firsthand understanding of this issue from an
employer's perspective and maybe a little bit unique perspective.
Before I came to Congress, I practiced optometry and helped run an
eye care clinic with my nine other partners for 24 years. So when
President Obama's health care bill came before us when I was in the
House, I fully understood, from both the medical provider and from the
business aspect, that from both accounts, it was the wrong approach to
the problem of rising health care costs and, with the Doctors Caucus in
the House, worked very hard to highlight the problems and to also
highlight the alternative options working through the free market
approach.
There is no doubt about it, we are facing a serious crisis. Health
care costs are crippling Americans. Many Americans lack access to
quality health care. It is stifling our Nation's overall economic
development. There are real difficulties with physicians and hospitals
that they face when it comes to accessibility and affordability of
health care services. But despite all that, there is a right way and a
wrong way to address the problem. The President's health care law is
simply the wrong approach and the wrong answer.
Coming with a pricetag of $1.75 trillion, the law causes many more
problems than it solves. It is not lowering health care costs, as we
are seeing. In fact, it is driving them up. It is not deficit neutral.
It is a budget buster.
Because of Medicare cuts, because of the way it is set up, it is
going to lead to rationing and decreased quality of care. It will not
help the economy. In fact, it is further stalling the recovery.
On that note, specifically, the President's health care law makes it
difficult for small business owners to hire more employees. At a time
when our economic recovery continues to lag, the concerns over new
mandates, confusing rules, and additional taxes in the law have small
business owners rightfully concerned. Again, I can appreciate this in
the sense of not only being an eye care provider, a health care
provider, but somebody who had 85 employees.
Far from getting jobs, as the President promised, it is estimated the
law will actually result in 800,000 fewer jobs over the next decade. It
is almost as if the law was written with no input from America's small
business owners and the health care providers that will run it.
In the 24 years I was at our clinic in northwest Arkansas, we grew
our staff from 5 employees to 85. My colleague from Wisconsin can
attest to the fact that guiding one's business to the point where one
can add personnel is not an easy task. It takes strategic planning and
management, but it also takes an economic environment that allows small
businesses to expand, invest, and
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hire. Instead of doing that, the health care law furthers the climate
of uncertainty that our job creators already face.
Small business owners are certainly hurting in this economy. They are
worrying about tax hikes that Washington keeps threatening to force
upon them. They see an enormous flood of regulations coming their way.
Gas prices keep skyrocketing. Profits are way down as a result of the
sluggish economy. There is so much uncertainty, what mandates will
evolve from this health care law and ultimately what these costs will
be for small business owners only adds to that unease.
When interviewed, business owners said that the major concern that
keeps them from hiring--and I have been out and about as much as
anybody in the last 2 years, and this is exactly what I am hearing--is
the uncertainty caused by the cost that they believe they will incur by
the new health care law. We need to repeal and replace it with health
care reform based on a free market system.
Mr. JOHNSON of Wisconsin. I thank Senator Boozman. I think it is
extremely important for us, in the next coming weeks and months, to
paint a very accurate picture for the American people about what our
health care system is going to look like, what our Federal budget is
going to look like, the effect on American jobs and our economy, and
the effect on our freedoms that we are going to witness if this health
care law is fully implemented. I think it is critical we provide the
American people that type of information.
Of course I know Senator Roberts has some thoughts in terms of how
this health care law will affect jobs and our economy. He has been very
good at describing some of the nonsense regulations that are being
undertaken by this administration. I want Senator Roberts to share his
thoughts about what he thinks--paint us a picture of what is America
going to look like under this health care law.
Mr. ROBERTS. No. 1, I want to give the Senator a lot of credit for
leading this colloquy in regard to where we are 2 years from the
passage. It is hard to say what it is. Now it is ACA, the Affordable
Care Act; it used to be PPACA, the acronym, which I thought was very
appropriate. Of course if you politicize it, it is called ObamaCare. I
don't mean to do that in this debate. But I do thank the Senator for
focusing on jobs and costs.
I thank Senator Kyl for a CBO truth. He ought to start a new program
like the old show ``Truth Or Consequences.'' Senator Kyl pointed out
the consequences. He pointed out the consequences, when you ask the CBO
for a score when you are going to try to pass the bill, they will give
you exactly what you want, but the truth is down the road it costs an
awful lot more.
There is one person you left out in terms of the CBO telling the
truth and that is Richard Foster, who is the Actuary down at the
Department of Health and Human Services. That man ought to get a Purple
Heart, a Medal of Honor--not a Medal of Honor, just give him a Purple
Heart and maybe a Bronze Star for action in the war zone and then maybe
a Medal of Freedom later.
Senator Sessions, who is our resident bulldog on the budget, hit it
on the second counting. I thank him for that. That is a half trillion
dollars. The other half of that is that it is a half trillion that goes
to all these exchanges and the rules and regulations in setting up the
Affordable Health Care Act. Basically, it denies Medicare reimbursement
to all sorts of folks--doctors, nurses, hospices, pharmacists,
ambulance drivers, hospital administrators--on and on. We had a health
care summit in Topeka, KS, and 34 regulations popped out of the
woodwork. We could have had 164 but we sent the 34 in to the Secretary
of HHS. Then he went out to Hays, KS. That is really out there in the
rural health care system. We had seven different regulations. I hope
later when we have a colloquy on regulations we can certainly insert
those into the Record.
Senator Boozman, who is a physician, gave a standpoint of what
happens in regard to rationing.
Let met get Senator Boozman's attention for a minute. Do you know who
enforces this thing, at the end of the year if you do not sign up, if
you do not put on your tax return, which I assume it will be, in terms
of what kind of coverage you have? It is the IRS. The IRS is going to
be the enforcement entity in regard to whether you have a provider. If
you do not, you get fined.
Stop and think a minute about what is going on, and all the waivers
that have been going on in terms of who is enforcing this. Your
friendly Internal Revenue Service--what--reinforcer? I have a lot of
feeling about this.
I took the floor today to discuss something called promises made and
promises not kept. I tell the distinguished Senator from Wisconsin, of
all the words that come back to bite you, this one has. That is the
famous statement prior to passage of the health care reform law by the
President: ``If you like your health care plan, you can keep it.'' I
will give him credit, he may have believed it then. But as we pointed
out with Senator Kyl, Senator Sessions, Senator Boozman, Senator
Johnson--that is not the case. I didn't believe it then and I said so.
Neither did Senator Sessions. Neither did Senator Kyl. Those two are
here now, taking a good look at it. They don't believe it either.
Why? It is pretty simple. Employers and health care providers told me
that when the majority of the provisions of the health care reform law
would take effect, it would be more affordable for an employer to
simply stop offering their employee coverage and pay a penalty rather
than face the predictable increase in premiums and to continue to offer
any coverage.
Now these predictions have turned into facts. A new study just
released by McKinsey & Co., a consulting company, predicts large
numbers of workers will be shifted into the health exchanges in 2014.
That is a shift that folks should be worried about--exactly what you
are talking about, Senator Johnson. Literally thousands of regulations
and waivers are pouring out of the Department of Health and Human
Services; in fact, to date, 12,307 pages of additional regulations to
restrict personal freedom and micromanage the private market.
To make matters worse, there is the predictable worry that the
exchanges would be better described as much like Medicaid HMOs. That is
the kind of service we can expect to get and that threatens access,
choice of doctors, and not to mention the rationing regime that will be
the marching order of the day. I will have a lot to say about that in
the colloquy in the next several days.
At the time the President made his promise, the CBO estimated that,
as Senator Kyl pointed out, only about 7 percent of employees covered
by employer-sponsored insurance would make the switch, or be forced to
switch, to taxpayer-subsidized exchanges. Now I tell the Senator, study
after study is releasing facts and figures that find the health care
reform law will cause many or even most employers to quit offering
their current health insurance.
In a survey by benefits consultants at Lockton, when asked about the
cost of notifying employees of changes required by or resulting from
health care reform law, they said each notification will cost $1 to $3
per employee. Talk about cost. This would raise costs by tens of
thousands of dollars or more for some firms and nearly one in five
firms is considering terminating coverage outright, thanks to the law.
With each study the numbers go up. The McKinsey survey found that 45
to 50 percent of employers say they ``will definitely or probably''
pursue alternatives to their existing health care plans. Even more
alarming, some 30 percent of employers will simply stop offering any
coverage. Those are the facts. There are more to come.
I am going on too long here, I understand that. I simply say again I
thank my colleagues. Contrary to this administration's seeming belief,
there is no such thing as free health care. Somebody does pay. In this
case the American taxpayers will be forced to foot the bill for workers
whose employer-sponsored coverage has been dropped due to health care
reform.
There is another quote I wish to mention. It should be the subject of
another colloquy. There is absolutely no rationing in this bill, it is
just scare talk. Want to bet? There is nothing that hurts the truth
more than stretching it. With PPACA or ACA or
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ObamaCare, jobs and costs will be stressed beyond the limit.
I truly thank the Senator for sponsoring this colloquy.
Mr. JOHNSON of Wisconsin. I appreciate the comments of the Senator.
He mentioned rationing. What is the Independent Advisory Board for? Do
you have a clue? To me that would somewhat lead, potentially, to
rationing. I would be suspicious of that. Senator Kyl stood up here. He
may have some additional comments.
Mr. KYL. Yes. I would say when my colleague from Kansas talked about
the free care, it reminded me of the old saw: You think insurance is
expensive now, just wait until it is free. That is the point. Somebody
has to pay for it at the end of the day, and we just happen to have
some new statistics how this is working out now that CBO has had a
chance to examine how ObamaCare plays out. Here is their newest
estimate. We are talking about real costs to real families.
CBO now estimates that ObamaCare will increase premiums by 10 to 13
percent. To make that number real, that is a $2,100 annual increase in
the cost for the average family of purchasing their own insurance
coverage. Six separate private actuarial analyses have all indicated
ObamaCare will increase premiums with projected increases ranging as
high as 60 percent.
Why is that so? It is like a balloon; you push in on one side, it
pops out the other. Health care is still going to cost. Doctors still
have to treat people, hospitals still have to take care, pay the people
who work in the hospitals and so on. It is not free, as our colleague
from Kansas is pointing out. Somebody has to pay for it. If the
government cannot afford it, then what the insurance companies have to
do is charge the extra expense to the people in the private insurance
market.
When the President complains about why insurance costs are going so
high, he only has himself to blame. If the government is not going to
reimburse the providers adequately, they have to get the money from the
private sector. That is why the $2,100 annual increase in the cost of
insurance for the average family, because of the cost shifting that is
going on. It is a result of the way the government designs the
insurance that is provided for in ObamaCare. It hits the young people
especially hard because they are the ones who have to buy insurance
they do not need, according to America's Health Insurance Plans.
Premiums increase 48 percent for people between 18 and 29 years old.
That is in only 42 of the 50 States, premium increases of 48 percent.
Then of course they also tax health insurance, which we end up paying
for because that cost is passed on to us in the form of higher
insurance premiums. That is a $60 billion tax on health insurance added
on top of the new taxes on innovation, on new pharmaceutical products,
on new medical devices. The taxes that are included in ObamaCare on
those are all passed on to consumers in the form of higher prices.
The bottom line is we are paying for all this one way or the other,
either through new taxes, through what we pay to the government, or
through what we pay in our private insurance, because the physicians
and hospitals have to make up the money one way or the other.
The bottom line is that ObamaCare, which was supposed to have reduced
costs, ends up increasing them. By the way, it was supposed to expand
the numbers of people who are covered but now we find that, according
to Milliman, which is a private association estimating the cost here,
actuaries there have estimated the cost shift from government programs,
Medicare and Medicaid, totals $88.8 billion a year, adding $1,788 to a
family's insurance policy. That is on top of what I spoke of before.
This cost shift obviously will greatly increase with ObamaCare's
Medicaid and Medicare cuts, which are further on down the road here.
That will cause premiums to skyrocket even more.
The bottom line is that we were right when we said it: The law is
going to drive up insurance premiums for families, it is going to drive
up taxes, it is going to reduce innovation. At the end of the day, it
doesn't cover more people. All in all, a great success, I would say.
Mr. JOHNSON of Wisconsin. I remember back in Oshkosh, WI, President
Obama famously promised: If you pass this health care law, the average
costs per family would decline by $2,500 per year. That is one of those
broken promises that Senator Roberts was mentioning earlier.
Mr. ROBERTS. The Senator asked me about IPAB. It is not an iPad or an
iPhone or whatever. I am sure Apple has nothing to do with it.
Well, the administration, in response to a lot of concern about
rationing, wrote an op-ed and sent it to many different publications
and said, ``[T]he claims that the board will ration care are simply
false.'' At the time, I repeated my concerns over and over again.
Senator Kyl will remember those days in the Finance Committee. I think
everybody left when I started my rant. And the health care reform law's
potential to ration care--I made speech after speech--is not only IPAB;
there is the CMS Innovation Center, the new authority granted to the
U.S. Preventive Services Task Force, the Patient-Centered Outcomes
Research Institute, and finally IPAB, and that is not a toothpaste.
At the time, the American public was told over and over that these
provisions of the health care reform law would not result in the
rationing of care, loss of access, or reduced quality. But once again
the Medicare Actuary, Richard Foster--bravest man in the government--
and many others have noted that the kinds of payment reductions
contemplated by IPAB will amount to a de facto rationing by reducing
access to care. The Actuary has stated that the payment reductions in
the law could ``jeopardize access to care for beneficiaries''--senior
beneficiaries. He also predicted that the IPAB reductions in particular
would be difficult to achieve in practice because of the access-related
harm to seniors that would result. That is IPAB for you.
Mr. JOHNSON of Wisconsin. Earlier Senator Roberts mentioned the U.S.
Preventive Services Task Force. Wasn't that the agency that proposed
denying women mammograms until they reached the age of 50?
Mr. ROBERTS. That is correct. For every proposal like that, thank
goodness there has been a reaction by the public and the medical
profession and everybody else to say: Wait a minute, this doesn't make
any sense. Again, it is an agenda-oriented board or commission or
whatever that comes under the banner of rationing.
I have a wonderful chart I will show to you in the next colloquy in
regard to the four rations--and one was just mentioned--and then ask me
about IPAB. They are a little benign. I am going to have to change the
caricatures. They are like the four horsemen of the apocalypse in
regard to the health care system of the United States. As you look at
each one of them and what they are doing, they are rationing care. They
are rationing care.
Mr. JOHNSON of Wisconsin. If this is implemented, we are just
beginning to see the tip of the iceberg of the assault on our freedom
that this is going to represent.
Mr. BOOZMAN. I think this rationing is such an important situation.
We are already seeing rationing right now. As an optometrist more than
being a Senator, I get calls all the time from people who have moved
into town and they can't find a health care provider for their aunt or
uncle who is in the Medicare age group. Physicians are definitely
cutting back because of the payment plan.
Seniors are smart enough to figure out that you can't add 30 percent
more patients under this plan, and along with that, there is no
increase in physician fees, no increase in the infrastructure required
to take care of them. Something has to give, and that is going to be
two things: quality of care and rationing.
The same thing is true of Medicaid. In Arkansas, we are going to have
to increase our Medicaid rolls by 250,000 people. Our State only has 3
million people to begin with. Again, something has to give. How do you
pay for that? The reality is that will cost us in the neighborhood of
$400 million. Where will that come from? It will come from providers.
It will come from decreased funding for education, roads, and things
like that. Again, you can't do this without rationing and
consolidation.
[[Page S1773]]
Mr. JOHNSON of Wisconsin. I think the bottom line of this health care
law is that it is basically going to increase demand while at the same
time reducing supply, and that is not a good thing. It is certainly not
the way you bend the cost curve down.
I understand Senator Sessions has a few more comments.
Mr. SESSIONS. Senator Kyl and the Senator from Kansas, as he has
indicated, were engaged in this cost curve-bending plan. The essence of
the President's proposal--it went to the core of other proposals
financially--was that by a Federal Government expansion of our
authority, we would bend the cost curve and make health care cheaper
for all Americans. That was a fundamental principle that was sold to
businesspeople, and some businesspeople thought it was a great idea,
but it has not happened. Already the premiums in private health care in
America have gone up $2,000, almost $200 a month, and we are going to
see it continue to go up. It does not bend the cost curve down. In
fact, we are seeing the opposite occur.
We have to know that our per-person government debt--Senator Johnson
is on the Budget Committee, and he knows this--is worse than any other
Western world nation. Per capita, we have more debt than Greece, Spain,
Italy, and Ireland, with $44,000 per person that every man, woman, and
child owes. And if the President submitted a budget and if it were to
be enacted--and certainly it will not be--that would go to $75,000 per
person in 10 years.
This health care bill is dramatically adding to that. Every expert we
have had at the Budget Committee has told us that we are on an
unsustainable spending and debt path that will lead to financial
collapse. Erskine Bowles and Alan Simpson, who chaired President
Obama's debt commission, both issued a written statement that America
has never faced a more predictable financial crisis. What they told us
was that spending and running up debt as we are today guarantees a
financial collapse that could impact every person in America and deeply
impact our ability to have health care in this country.
So I think we have to recognize that the Republican-controlled House
of Representatives will unveil a budget plan tomorrow. The Senate is
not going to bring up a budget. The Democratic leader said it is
foolish to have a budget, so we will go for the third consecutive year
without even attempting to pass a budget. It is supposed to be out of
the committee by April 1. It is supposed to be passed by April 15. The
House is going to do it. They are going to step up to the plate, and
they are going to lay out a plan like they did last year, a plan that
will change the debt course of America, a plan that would put us on a
sustainable path so that we don't have to fear financial collapse.
They are going to look at this legislation, and it cannot be imposed.
We do not have the money. It is going to make health care worse, as we
have heard, but more than that, we simply--even if it were a good idea,
a nice thing to have, we do not have the money. We are borrowing 40
cents of every dollar we spend, and they misrepresented the cost. It is
far higher than anyone has expected, and it is going to continue.
For example, our people have looked at the CBO score--on the Budget
Committee--and they have analyzed it fairly, and I am prepared to
defend these numbers. Based on CBO's scores, from 2014--the first year
the law is really in effect--until 2023, it will cost $2.66 trillion.
It is far more than was projected. How much money is that? Over the
same 10-year period, we would spend $626 billion on Federal highways.
We had been fighting over highways, and we finally passed a highway
bill. The Federal money for the whole highway system would be $626
billion, while we are adding a new program that is improperly funded
for $2,600 billion. Over the next 10 years, we expect to spend $1,000
billion for education, and this health care cost is going to be $2,600
billion. We have disasters. We spend a lot of money on disasters. It is
expected that we will spend $111 billion on disasters, whereas we will
spend $2.6 trillion on the health care bill.
This is the kind of thing that has the American people asking us: Are
you crazy? How can you borrow 40 cents of every dollar you spend, as we
are doing today. How can you do that to America? What is the matter
with you people?
They say people back home are not smart, they are just angry. Well,
aren't they right to be angry? We are adding a program that is
financially unsound, that is going to make health care worse, and we
don't have the money. This money needs to be used to save Medicare and
Social Security--programs that are already in great jeopardy. If we
have money, we have to use it to save them, not start a new program of
massive proportions that, over 60, 75 years, is going to cost far more
than anyone imagines.
I thank Senator Johnson for raising this, and I am concerned about
the costs. I know Senator Boozman and others have talked about the
rationing. There are a lot of reasons why we simply can't go forward
with this health care bill. It must be eliminated as we know it. We can
make reforms, but this legislation cannot go into effect.
Mr. JOHNSON of Wisconsin. I certainly appreciate Senator Sessions'
comments and those of Senator Roberts, Senator Kyl, and Senator
Boozman.
There are two points I would like to make. It is important to
understand that all these numbers we are talking about are estimates.
The Federal Government is not particularly good at making those
estimates because if you think back to 1965 when they first passed
Medicare, they projected out about 25 years and said that in 1990 it
will cost $12 billion. In fact, it ended up costing $110 billion--nine
times the original cost estimate.
The other point you were making is, Does it make sense for the
Federal Government to take over one-sixth of our economy? When I went
back to Wisconsin, I asked that question of thousands of individuals.
Do you really believe the Federal Government can take over one-sixth of
our economy--the health care sector--and do it effectively and
efficiently? I asked that to thousands of people. I have had two brave
souls raise their hands. The fact is, the American people do not
believe the American Government is capable of doing that.
In closing, I would like to remind everybody what Speaker Pelosi very
famously said: We have to pass this bill so we can find out what is in
it.
I know Senator Sessions and Senator Boozman are dedicated to making
sure we don't have to fully implement the health care law before we did
figure out what it truly costs us because it could bankrupt this
Nation.
I yield the floor.
The PRESIDING OFFICER (Mr. Coons). The Senator from Connecticut.
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