[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.
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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
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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.
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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
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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
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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.
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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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