[Congressional Record Volume 158, Number 47 (Wednesday, March 21, 2012)]
[House]
[Pages H1490-H1493]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 THE AFFORDABLE CARE ACT: KEEPING SENIORS HEALTHY AND REDUCING HEALTH 
                               CARE COSTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 5, 2011, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 38 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I don't plan to use the entire time, but I 
come to the floor this evening basically to talk about the Affordable 
Care Act. Some call it the health care reform.
  This Friday will be the second anniversary of the President's signing 
of the Affordable Care Act, or health care reform, and I'd like to talk 
a little bit about how it's helping so many people with patient 
protections and added benefits, whether you're talking about seniors or 
young people or women or just the general public.
  The main thing that is heralded, if you will, by the Affordable Care 
Act is the opportunity over the next few years to expand health 
insurance to so many Americans who do not have health insurance now. We 
estimate there are variously between 40, maybe 45 million Americans 
that simply have no health insurance; and what that means is they 
either don't go to a doctor or they don't get any kind of health care 
unless they get very sick and end up going to the emergency room. The 
consequences of that is that they take no preventative care. They end 
up in the emergency room. Oftentimes, they can't afford to pay the cost 
of the emergency room, and that cost simply gets passed on to the 
hospital or, ultimately, to everyone else who is paying for health 
insurance.
  So basically, what the Affordable Care Act does over the next few 
years is try to expand insurance coverage to something like 98, 99 
percent of all Americans, taking up those 45 million people and, for 
the most part, making sure that they have health insurance. It does 
that in two basic ways:
  First of all, it expands Medicaid, which is the health insurance 
program for people below a certain income. About 15 million Americans 
who have no health insurance now would be eligible for Medicaid under 
the Affordable Care Act over the next few years when it kicks in.
  In addition to that, for the rest of the Americans who have no health 
insurance, most of them are people that either don't get it on their 
job, they're not eligible, or they're not offered health insurance by 
their employer, or they may be individuals who are employed on their 
own or at home or not employed in some capacity. They have a very hard 
time buying a health insurance policy on what we call the individual 
market. So what the Affordable Care Act does, it sets up exchanges in 
every State, or throughout the country, where you can get a very good 
package for a reasonable price, a very low-cost price, and, at the same 
time, it provides a subsidy through tax credits to many Americans, 
depending upon their income.
  We estimate for a family of four making up to $70,000 or $80,000 a 
year would be eligible for some sort of subsidy or tax credit that 
would make their health insurance policy more affordable. So 
essentially, what we do is, between expansion of Medicaid and the 
subsidies, if you will, and the low-cost insurances offered now on 
these exchanges around the country, most people would end up with 
health insurance.
  Now, what I wanted to talk about today are some of the benefits, if 
you will, that have already kicked in for various groups of people, 
particularly seniors. I wanted to start with seniors because many 
seniors, as you know, because they're on a fixed income, have a hard 
time making ends meet. Oftentimes, they can't afford their rent, they 
can't afford food, and for them to take extra money out of pocket to 
pay for health care costs is oftentimes very difficult, and they have 
to make choices between heat or food as opposed to health care.
  One of the things that I really want to stress today, because I 
listened in the last few nights, because of the anniversary of the 
Affordable Care Act coming up on Friday, I've heard some of my 
colleagues on the Republican side of the aisle actually suggest that 
somehow the Affordable Care Act was going to negatively impact 
Medicare. Nothing could be further from the truth. In fact, the 
Affordable Care Act expands benefits for seniors under Medicare in many 
significant ways.
  But it's particularly interesting that I hear that from the other 
side of the aisle, from the Republican side of the aisle this week 
because, on Tuesday, the Republicans unveiled their budget for the next 
fiscal year.

                              {time}  2050

  Once again as they did last year in last year's budget, the 
Republican budget this year essentially gets rid of Medicare, or what I 
would say ends traditional Medicare. So it's kind of strange to hear 
the Republicans talk about Medicare and the Affordable Care Act since 
the Affordable Care Act actually expands benefits for seniors under 
Medicare, whereas they unveiled their budget this week that actually 
abolishes, for all practical purposes, Medicare as we know it.
  What the Republican budget does, once again, is say to seniors, Well, 
we're going to give you a voucher. We're going to give you a certain 
amount of money through a voucher, if you will, and you can take that 
and go out and buy private insurance instead of getting the guaranteed 
benefit under Medicare that seniors now have.
  The problem with a voucher is that it's a fixed amount of money, and 
it's not all clear that seniors can buy health insurance with a 
voucher. But even if they could, because it's a fixed amount of money 
and it doesn't increase significantly over the years, what you'll find 
with that voucher is that more and more seniors would have to pay out 
of pocket either to purchase the insurance because the voucher is not 
enough or because they probably can't get a decent package equivalent 
to the Medicare guarantee, and therefore would have to pay out of 
pocket for certain costs that are not covered by the health care plan 
that they purchased with the voucher.
  So it's sort of ironic to hear the Republicans talk about the 
Affordable Care Act and suggest that the Affordable Care Act should be 
repealed because of its impact on Medicare when in fact they're doing 
their best under the budget to basically end Medicare as we know it.
  Let me talk a little bit about some of the benefits.
  I want to talk about how the Affordable Care Act helps seniors, and 
then a little bit about how it helps women, and then a little bit about 
how it helps young people.
  Of course, it helps everybody by simply expanding health care 
coverage for those who don't have health insurance.
  But the benefits, in particular, I want to talk about and start with 
seniors.
  I mentioned before that no group has been hit harder by soaring 
health care costs than seniors. With the economy struggling over the 
last several years, seniors have suffered even more as they've watched 
many of their pensions and investments dwindle, making

[[Page H1491]]

the cost of addressing their health care needs even more challenging.
  Now, as a result of the Affordable Care Act, some of the financial 
burdens plaguing seniors trying to manage their health care needs have 
been alleviated.
  For example, all Medicare beneficiaries now have access to 
preventative care and services without any copay, coinsurance, or 
deductible. Many times you will find that seniors won't even access 
health care because of the copay, which is about 20 percent in most 
cases.
  So now services like annual wellness visits, cholesterol and other 
cardiovascular screenings, mammograms, cervical cancer screenings, 
prostate cancer screenings are completely free of charge to seniors. No 
copay. The fact of the matter is that the Affordable Care Act expands 
benefits for seniors, makes it so seniors pay less.
  More than 32.5 million seniors nationwide have received one or more 
free preventative services, and 2.3 million seniors have already 
received a free annual wellness visit to their doctor, which again is a 
critical step in preventing a more serious illness because if the 
senior citizen goes for the annual checkup or has some of these 
preventative services free of charge, then that avoids them having to 
get sicker, ending up in a nursing home or ending up in a hospital.
  The most important thing, though, in terms of expansion of benefits 
under the Affordable Care Act for seniors is the closing of the 
Medicare part D doughnut hole.
  Seniors before the Affordable Care Act would run out of their part D 
benefits on the average by September of the year. In other words, if 
they spent more than $2,500 approximately on drugs, they wouldn't get 
any help under Medicare part D until they got to a higher catastrophic 
level of $5,000. So that was the doughnut hole, that gap when they 
weren't getting any money to help pay for their prescription drugs.
  What the Affordable Care Act does is it closes the Medicare part D 
doughnut hole and provides a 50 percent discount on brand name drugs. 
3.6 million seniors have already received the discount, saving a total 
of $2.1 billion, with each senior saving an average of $604.
  Now, by 2020 that doughnut hole is closed completely. Now it's a 50 
percent discount, but gradually that will close by 2020 when all their 
drugs are covered and the doughnut hole ceases to exist.
  I also want to stress that the Affordable Care Act has cracked down 
on fraud in Medicare. In fiscal year 2011, a joint anti-Medicare fraud 
task force of the Health and Human Services Department, Department of 
Justice, recovered more than $4.1 billion in fraudulent Medicare 
payments on behalf of taxpayers.
  A lot of times, my senior citizens will say to me well, there's a lot 
of fraud in Medicare. There is. But the Affordable Care Act has 
significantly cracked down on a lot of that fraud, $4.1 billion in 
fiscal year 2011.
  Now, I mention this again by way of contrast. Here we are in the 
Affordable Care Act expanding benefits, making it so seniors don't have 
to pay more, and what are the Republicans doing with their budget? They 
have a budget that basically says we'll give you a voucher. You go out 
and buy your health insurance. If you can't afford it, you have to pay 
the difference. The basic guarantee of Medicare and a good benefit 
package simply won't be there, and seniors will just end up paying more 
out of pocket.
  Now, I wanted to talk a little bit about how the Affordable Care Act 
levels the field for women's health care because we know that 
traditionally in health care there has been a huge gender gap.
  A report issued this week from the National Women's Law Center shows 
that more than 90 percent of the best selling health plans still charge 
women more than men for the same coverage just because women use more 
health services. The health care law, the Affordable Care Act, will 
prohibit this discriminatory practice, which we call gender rating, 
beginning in 2014. So that when the Affordable Care Act fully kicks in, 
this gender gap will simply disappear.

  Now, you might say to yourself, well, how is that possible? It's 
mainly because insurers have considered millions of women as having 
what we call preexisting conditions. In other words, they were denied 
coverage or they were charged more for having had breast cancers, 
Cesarean-section childbirth, having even been pregnant. Some policies 
would charge women more because they were pregnant or consider that a 
preexisting condition. Or for being victims of domestic abuse, for 
example.
  So denying women insurance on these grounds is unconscionable, and 
thanks to the Affordable Care Act, beginning in 2014, women will no 
longer be denied coverage by any insurers based on these preexisting 
conditions, and they can't be charged more because of the preexisting 
conditions.
  Now, we've seen again by contrast, what have the Republicans been 
doing? They say repeal the Affordable Care Act, which would let these 
preexisting conditions and this gender gap continue. But beyond that, 
over the last year or so, we've seen the Republicans essentially 
declare war on women, and I just want to give you an example.
  One of the ones that has received the most attention lately are these 
attempts by the Republicans to block access to contraception. I don't 
know how far they're going to go in terms of denying women coverage, 
but that's one of the things that we've seen in the headlines for the 
last few months or so.
  Let me give you some other examples under the Affordable Care Act. 
Insurance companies are now prohibited from requiring women to obtain a 
pre-authorization or referral for access to OB GYN care. Health care 
reform also requires insurance plans to cover important preventative 
services, including critical immunizations, numerous health screenings, 
and counseling services, with no cash cost-sharing by women.
  Women in new private plans under the Affordable Care Act, they 
provide free coverage of important lifesaving preventative services.
  But the other thing that would often happen is that many health 
insurance plans have what they call lifetime dollar limits on health 
benefits so that if a woman--this would be true for anyone if they have 
that lifetime dollar limit in it--but oftentimes it was applied to 
women in particular; that if you spent a certain amount of money on 
your health care over your lifetime, that was it. You didn't get any 
more coverage under your plan. So that is also prohibited under the 
Affordable Care Act.
  Now, I just mentioned those few things that apply to women because 
there really continues to exist a gender gap but that will be closed 
and eliminated under the Affordable Care Act when it completely kicks 
in.
  Now, the last group I wanted to mention just because I always felt 
that many times in Congress we don't pay a lot of attention to kids, 
and I felt that it's very important for us to recognize the fact that 
policies and the practices and the laws don't necessarily help 
children, and children are very vulnerable. It's like, the seniors are 
vulnerable, the children are vulnerable.
  One of the things that's significant about the Affordable Care Act, 
it really makes a difference for children in terms of keeping them 
healthy and also keeping them insured.

                              {time}  2100

  And a lot of times Americans have to make choices with regard to 
their kids about whether they can afford health care services because 
of the prohibitive cost of insuring children.
  Under the old system, before the Affordable Care Act, sick children 
were often denied health coverage if their parents were forced to 
change insurance because they either switched or lost their jobs. 
Insurance companies declined or dropped coverage for children when 
young adults got sick or had an accident. That's no longer the case. 
Under the Affordable Care Act, basically there is a prohibition on 
insurers denying coverage of children under age 19 for having a 
preexisting children.
  Up to 17 million children with preexisting conditions are now 
protected from that type of discrimination. Currently, there are 7.3 
million American children without any health insurance. Beginning in 
2014, the law will provide access to quality coverage. That's 
accomplished again by expanding Medicaid coverage and also by providing 
affordable insurance on these exchanges with a tax credit or some kind 
of help

[[Page H1492]]

from the Federal Government to pay for the insurance.
  The other thing I wanted to point out, though--and this is really 
significant because, again, it has kicked in and I've had many of my 
constituents come up to me and mention it--is that the Affordable Care 
Act requires health plans to allow parents to keep children under age 
26 without job-based coverage on their family's coverage and give 
millions of parents and young adults the peace of mind that they can 
start their lives and careers without being crippled by health care 
expenses.
  What happens is that because of the economy and the difficulties 
we've had with the economy over the last few years, a lot of kids or 
young adults, when they graduate high school, when they graduate 
college, are not able to find a job, or while they are in college they 
can't afford health insurance on their own because they have to go out 
and buy it on the individual market. What the Affordable Care Act says 
is you can be kept on your parents' policy and the insurance company 
has to provide that option up to the age of 26. That's very 
significant. Millions of young people that did not have coverage are 
now covered by that under their parents' policy.
  I just wanted to take a couple more minutes. I wanted to give some 
examples of the numbers of people in my district, the Sixth 
Congressional District in New Jersey, that have been impacted in a 
positive way by the Affordable Care Act.
  These statistics come from my committee that I serve on, the 
Committee on Energy and Commerce. And just to give you some idea, in my 
district, in the Sixth District of New Jersey:
  6,800 young adults in the district now have health insurance that 
didn't have it before;
  9,100 seniors in the district received prescription drug discounts 
worth $6.9 million, an average discount of $760 per senior. This is for 
their prescription drug coverage;
  There were 63,000 seniors in the Sixth District in New Jersey that 
received Medicare preventive services without paying any copays, 
coinsurance, or deductibles;
  31,000 children and 130,000 adults now have health insurance that 
covers preventive services without paying any copays, coinsurance, or 
deductibles;
  There are 620 small businesses in the Sixth District that received 
tax credits to help maintain or expand health insurance coverage for 
their employees;
  There have been $1.8 million in public health grants that have been 
given to community health centers, hospitals, doctors, and other health 
care providers to improve the community's health. Community health 
centers have really expanded in the district because of the Affordable 
Care Act; and
  There are 8,000 to 35,000 children with preexisting health conditions 
who can no longer be denied coverage by health insurers.
  I can give you more statistics, but I just want to point out that 
these benefits under the Affordable Care Act are impacting constituents 
in every district in the country, not just mine. Not only the thousands 
of people in my district, but all over the country, millions of people.
  I just wanted to talk a little bit about the cost issue, because I 
always hear the Republicans say, Oh, your costs are going to go up 
because of the Affordable Care Act. In fact, costs for health insurance 
now without the Affordable Care Act have gone up, but the Affordable 
Care Act actually is reducing costs for health insurance. Whatever cost 
increases that are being exhibited now are because the Affordable Care 
Act hasn't gone into effect completely. It kicks in gradually over the 
next few years.
  I also hear some of my Republican colleagues say, Oh, your health 
insurance went up. That's because it hasn't kicked in yet. Once it 
kicks in, there are a lot of positive impacts on costs that will make a 
difference.
  Let me just talk about some of the statistics in terms of costs that 
I think are significant.
  Since enactment of the health care law, the reform, the ACA, premiums 
are generally lower or stable. Average premiums for Medicare Advantage 
enrollees are 7 percent lower in 2012 than they were in 2011. Since the 
health care law was enacted, these premiums have fallen by 16 percent. 
Average premiums for Medicare part D, the prescription drug program, in 
2012, have seen no increase from the 2011 level. The Medicare part B 
deductible has fallen by $22 to $144 in 2012, the first time in 
Medicare history that the deductible has actually fallen. For most 
Medicare part B enrollees, the standard part B premium in 2012 is quite 
stable. It's 3.6 percent higher than the premium they paid in 2011, 
matching the 3.6 percent COLA increase seniors are receiving in their 
Social Security checks.
  The growth in private plan premiums has also slowed. In September 
2011, Mercer, an independent benefits consulting firm, released a 
survey of employers showing that health insurance premium increases 
will average 5.4 percent in 2012, the smallest increase measured since 
1997. Despite Republican claims, the health care law has played 
essentially no role in recent private plan premium increases. In fact, 
the premium increases have taken effect only because the ACA has not 
fully kicked in at this point.
  There are two provisions that I wanted to mention that deal with cost 
and that address cost in the Affordable Care Act that I think are 
significant and that put downward pressure on premiums.
  One is the rate review, and that is, under the health care law, there 
is a new transparency and accountability for insurers, with insurers 
being required to publicly justify on the Internet any premium 
increases they are seeking that are over 10 percent. And the Department 
of Health and Human Services has rate review authority to publicly deem 
these increases to be unreasonable, and they've done that in a number 
of States. The health care law also provides $250 million in health 
care insurance rate review grants to the States to make them enforce 
and keep premiums down.
  Finally, under the health care law, insurers must spend at least 80 
percent of premiums on medical care and quality improvement rather than 
CEO pay, profits, and administrative costs. If insurers don't meet 
these standards, they have to pay rebates to their consumers starting 
this summer. These are significant ways of cutting back on costs.
  What do we see from the other side of the aisle? Again, repeal the 
Affordable Care Act. If the Affordable Care Act were repealed, all the 
things that I talked about would disappear. Costs would climb. More and 
more people would have no insurance. All the benefits for seniors--the 
fact that you can have your children on the policy until 26, the gender 
gap for women, all these things, all the benefits would disappear and 
only the bad impacts from insurance companies being able to do whatever 
they want would remain.
  The Republicans talk about repealing the Affordable Care Act. They 
don't say what they would substitute for it. What we do know--and I'm 
going to close with this, Mr. Speaker--this week we heard from the 
Republicans in terms of what they want to do with their budget. Again, 
what does their budget do? It essentially privatizes Medicare. It makes 
it into a voucher program, causing seniors to spend more money out of 
pocket for the type of guaranteed benefits they receive now under 
Medicare. It even goes and impacts Medicaid.
  A lot of people are not aware of the fact that Medicaid, which most 
people see as a program for poor people, actually pays most of the 
costs for nursing home care in this country. What happens is that if 
you have to go to a nursing home, you have to spend all your assets 
essentially--with few exceptions--on paying for that nursing home care; 
and then after you have no assets left, the Medicaid kicks in and pays 
for your nursing home care.
  What do the Republicans do in their budget? They basically slash 
Medicaid. They block-grant it to the States. They slash it from 20 
percent to 30 percent based on different accounts. That's a 20 percent 
to 30 percent slash, and that money goes back to the States because the 
States have to match Medicaid. They also abolish the expansion of 
Medicaid, that I mentioned before, under the Affordable Care Act 
because they assume under the budget that the Affordable Care Act is 
going to be repealed.
  So not only is there a negative impact on Medicare because it becomes 
a voucher and essentially traditional Medicare disappears and seniors 
pay

[[Page H1493]]

more out of pocket, but with regard to Medicaid, which pays for nursing 
home care, the States are going to get so much less money that the 
quality of nursing home care will seriously diminish.

                              {time}  2110

  I remember back in the seventies when you would go to many nursing 
homes, and they were terrible places. Because we upgraded them and we 
provided money to the States to pay for Medicaid, which they matched, 
the quality of nursing homes improved significantly. Well, what 
happened--and I'm not just telling this. The nursing home industry has 
said this--with these types of cuts that are being proposed in the 
Republican budget, a lot of nursing homes will close, and their quality 
of care will diminish. They won't have as many nurses on staff. They 
won't be able to do a lot of the things they do now to make people's 
lives in nursing homes more comfortable.
  And the budget assumes the repeal of the Affordable Care Act, which 
means that the expansion of Medicaid, the subsidy to pay for health 
insurance, all the things that I have talked about before would simply 
disappear.
  So I know I make a stark contrast between what the Republicans are 
proposing and what we're doing with the Affordable Care Act and trying, 
on the Democratic side, to shore up and expand Medicare benefits. But 
the fact of the matter is that it is a stark contrast, a very stark 
contrast in terms of a world view of what we are going to do in terms 
of health insurance coverage and what we're going to do to protect 
seniors in Medicare. And I think it's very important for my colleagues 
to understand these differences as we proceed over the next few weeks.
  So I am very proud of the fact that on Friday, we will be celebrating 
the second anniversary of President Obama signing the Affordable Care 
Act. And I am also proud of the fact that, as a Democrat, we are going 
to oppose the Republican budget. When the Republican budget was 
proposed last year, it passed the House, but it didn't pass the Senate; 
and we heard nothing more about it.
  And that's exactly what we plan on doing this year because we can't 
allow Medicare to be destroyed. We can't allow the Medicare guarantee 
to disappear. We can't allow Medicare to basically wither on the vine, 
as former Speaker Gingrich said, as it's vouchered and as it's 
privatized, as the Republicans suggest in their budget.
  With that, Mr. Speaker, I yield back the balance of my time.

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