[Congressional Record Volume 158, Number 47 (Wednesday, March 21, 2012)]
[Senate]
[Pages S1873-S1875]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
AFFORDABLE HEALTH CARE ACT
Mr. DURBIN. Madam President, there has been a lot of discussion about
the affordable health care act passed by Congress. In fact, just next
week, across the street, the Supreme Court will take up this bill and
decide whether it is constitutional. It is an important decision. It is
one that will affect millions of Americans, and scarcely anyone
understands the impact of this law and what it means to their daily
lives.
The first aspect I wish to speak about is the most controversial
aspect of it, the so-called individual mandate. What is it? From my
point of view, it is a basic method of saying to everyone in America:
You have a personal responsibility. You cannot say you are just not
going to buy any health insurance; that you don't think you are ever
going to need it and are not going to worry about it.
The problem is, of course, those people who make that statement get
sick. Some of them get involved in accidents. Some go to a doctor and
are diagnosed with terrible illnesses and diseases that require
treatment and surgery, and that costs a lot of money. The uninsured
people show up at hospitals. They are not pushed away; they are invited
in. They receive the treatment. Then they can't pay for it.
It turns out that 63 percent of the medical care given to uninsured
people in America isn't paid for--not by them. It turns out the rest of
us pay for it. Everyone else in America who has health insurance has to
pick up the cost for those who did not accept their personal
responsibility to buy health insurance.
So, so what? What difference does that make? It makes a difference.
It adds $1,000 a year to our health insurance program. In other words,
you and me and everyone with health insurance is subsidizing those
people who say: Don't mandate anything on me. Don't tell me I have a
personal responsibility. But when I get sick, you can pay
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for it.That is what the individual mandate comes down to.
I listen to those who say, well, this is just too darn much
government to say that people who can afford it need to have health
insurance. Keep in mind, this health care bill says if people cannot
afford it--if they are too poor or their income is limited--there is a
helping hand, not only in the Tax Code but even through Medicaid to
make sure they have affordable health care insurance which will never
cost them more than 8 percent of their income. A lot of American
families would jump at health insurance that would only cost 8 percent
of their income. But the law says people have to be willing to pay up
to 8 percent of their income to have health insurance. The reason, of
course, is if they don't pay, everyone else pays. If they get sick,
they cost us $116 billion a year in uncompensated health care coverage
paid for those who do not accept their personal responsibility to buy
health insurance.
Ruth Marcus has an article in this morning's Washington Post, and I
ask unanimous consent that it be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Washington Post, Mar. 20, 2012]
116 Billion Reasons To Be for the Individual Mandate
(By Ruth Marcus)
The most compelling sentences in the Obama administration's
brief defending the constitutionality of the health-care law
come early on. ``As a class,'' the brief advises on Page 7,
``the uninsured consumed $116 billion of health-care services
in 2008.''
On the next page, the brief drives the point home: ``In
2008, people without insurance did not pay for 63 percent of
their health-care costs.''
Those figures amount to a powerful refutation of the
argument that the individual mandate--the requirement that
individuals obtain insurance or pay a penalty--exceeds the
government's authority to regulate interstate commerce. To
me, $116 billion seems like a whole lot of commerce.
But let's leave the Supreme Court justices to hack their
way through the underbrush of the Commerce Clause. Because
those numbers are not only relevant to Commerce Clause
jurisprudence, they illuminate the fundamental irrationality
of public opposition to the individual mandate.
The mandate is by far the most unpopular feature of a law
on which Americans are otherwise evenly divided. A Kaiser
Family Foundation poll this month found that two-thirds of
those surveyed disliked the mandate. Even among Democrats, a
majority (53 percent) opposed the requirement; independents
(66 percent) and Republicans (77 percent) were even more
hostile.
Yet this is a provision that the overwhelming majority--
those with insurance--should support, for the simple reason
that these people currently end up footing the bill for much
of that $116 billion.
As the government's brief notes, ``Congress found that this
cost-shifting increases the average premium for insured
families by more than $1,000 per year.''
In other words, those worried about having to pay ever-
higher premiums should be clamoring for the individual
mandate, not agitating for repeal.
Indeed, for all the bristling over the mandate, it will be
irrelevant to the 80 percent of non-elderly Americans who
already have insurance, either through their employers,
government programs, or purchased on their own.
The biggest real-world risk to these people would be if the
court were to overturn the mandate yet allow the rest of the
health-care law to remain in place, driving premiums ever
upward.
Amazingly, Republicans have managed to transform the
mandate from an exemplar of personal responsibility into the
biggest public policy bogeyman of all time.
The irony of the fight over the mandate is that President
Obama was against it before he was for it. During the 2008
campaign, one of the signature differences between Obama and
Hillary Clinton was that Clinton's health plan included an
individual mandate whereas Obama's mandate covered only
children.
Once elected, Obama quickly recognized the inescapable
truth: An individual mandate was essential to make the plan
work. Without that larger pool of premium-payers, there is no
feasible way to require insurance companies to cover all
applicants and charge the same amount, regardless of their
heath status.
In part, hostility to the mandate reflects a broader
uneasiness with the perceived encroachment of big government.
In the Kaiser poll, 30 percent of those who opposed the
mandate cited government overreach as the biggest reason. Not
surprisingly, twice as many Republicans (40 percent) cited
that reason as did Democrats (18 percent).
But opposition to the mandate also stems from the public's
failure to understand--or, alternatively, the
administration's failure to communicate--basic facts.
For example, Kaiser found that when people were told that
most Americans ``would automatically satisfy the requirement
because they already have coverage through their employers,''
favorability toward the mandate nearly doubled, to 61
percent.
Favorable attitudes rose to nearly half when people were
told that without the mandate, insurance companies would
still be allowed to deny coverage to those who are sick; that
without the mandate people would wait until they were sick to
purchase insurance, driving up premium costs; or that those
unable to afford coverage are exempt.
``People don't understand how the mandate works at all and
they don't understand why it's there,'' Kaiser's polling
director, Mollyann Brodie, told me.
Brodie suspects that it's too late to change minds. ``This
law as a whole has really become a symbolic issue to people
and they really aren't open to information,'' she said.
Maybe, but the administration must keep trying--not only to
sell the law's goodies but to explain how the mandate makes
them possible. Otherwise, they could end up winning the minds
of the justices, yet losing the hearts of the people whose
votes they need to keep the law in place.
Mr. DURBIN. Madam President, this article spells it out. This issue
of an individual mandate is an issue of personal responsibility. If you
believe someone should be able to walk away from their responsibility
to have health coverage they can afford and that their medical bills
should be your family's responsibility, then cheer on all these folks
who are saying we are going to repeal ObamaCare. That is what it boils
down to. Do you want to pay their bills? I don't think we should have
to. I think everyone in this country should accept that responsibility.
There are some other aspects of the affordable health care act which
we don't hear talked about from those who are calling for its repeal.
Let me tell my colleagues one. Do you have a child graduating from
college, looking for a job? I have been in that circumstance. My wife
and I raised three children. Some of them found a job, but it took a
little while. While they were looking for a job, did you ever say to
your son or daughter fresh out of college: How about health insurance.
They probably said to you: Sorry, Mom; sorry, Dad. I can't do that now.
When I get a job, I will get back to it. But I feel just fine. I feel
just fine.
It doesn't work that way, and any responsible parent knows it. So we
changed the law, and here is what we said: If you have family health
insurance, it can cover your son or daughter up to the age of 26. That
expanded the reach of health insurance coverage. It covered these young
college graduates and young people looking for work so they had that
protection even when they were unemployed.
So did it make any difference? Thanks to this provision, 2.5 million
young people have gained coverage nationwide, and 102,000-plus in my
State of Illinois. That means for 2.5 million parents, some peace of
mind, knowing their kids are covered by the family plan. That was part
of this bill which many Republican Presidential candidates are saying
they want to repeal. Really? Do you want to explain that to 2.5 million
families who have the peace of mind that their son or daughter is
covered with health insurance up to the age of 26?
How about the seniors paying for their Medicare prescription drug
bills. There was this doughnut hole, which means if seniors have
prescription drugs covered by Medicare and they are expensive, they
will reach a point during the course of a year when they have to go
into their savings to pay for about $2,000 worth of prescription drugs
before the government comes back and starts helping them again. We
started closing that doughnut hole, closing that gap, giving $250 of
that $2,000 they have to pay back to people in a rebate initially, and
then providing a discount on drugs for seniors. That is part of
affordable care. That is part of what the Republicans scream is
ObamaCare.
Is it a good idea? Well, just ask 152,000 Medicare recipients in
Illinois who have received this rebate to help pay for their
prescription drugs. Ask 144,000 seniors in Illinois who have received a
50-percent discount on drug costs, and then ask the millions across
America who have benefited. We are giving people on fixed incomes and
limited savings a helping hand so they can have the prescription drugs
they need to be healthy and strong and safe and independent. Is that
what you want to be when you are a senior? Most of us do, and this bill
helps.
[[Page S1875]]
Third, this bill basically covers preventive services. We all know
the story: Get in and see a doctor for a colonoscopy or a mammogram.
Early detection and treatment is money saved and lives saved. We
extended preventive care under Medicare. For 1.3 million Medicare
recipients in Illinois--just in my State, 1.3 million; more in the
Presiding Officer's State--they have preventive care now that they
didn't have before. It means they are likely to stay healthy longer and
cost less to our health care system. This is another aspect they want
to repeal, those who are running against the affordable care act,
running against the health care bill President Obama has pushed for.
There is also a provision which says insurance companies have to
spend 80 percent of the premiums they collect--80 percent--on actual
medical care. They can take 20 percent for profits and administrative
costs and the like but 80 percent on actual medical care. The State of
Minnesota already had that on the books, and it worked. So we said
let's do it nationwide so if premiums go up, it is to reimburse health
care--not to take out in profits, not to take it out in bonuses, not to
spend on an advertising budget for an insurance company. That is a big
change. The insurance companies hate it like the devil hates holy
water, and the Republican Presidential candidates want to repeal it. I
think it is a sensible change to ensure coverage and one that we ought
to protect, not prohibit.
There are other provisions in this law as well, but one that affects
me personally and has affected, I am sure, thousands of Americans is
the question of preexisting conditions. Do you have one? A lot of
people do. A lot of people don't even know they have one. Sometimes
insurance companies dream them up. They would deny coverage for health
insurance if somebody had--get ready--acne, a preexisting condition so
no coverage. If there is a history of suicide in a family, they would
deny them health care coverage, preexisting condition.
Let me just say to every parent listening: Thank the Lord if your
child doesn't have asthma, diabetes, or something more serious because
until the affordable care act was passed, that was enough to disqualify
your child and maybe your family from health insurance coverage. Oh,
they can't wait to repeal that. They say: Let's repeal ObamaCare. Let's
get rid of that preexisting condition provision, and let those
insurance companies deny coverage.
America, is that what you want? Is that what you are looking for? Is
that too much government to say to insurance companies: You can't deny
children under the age of 18 health insurance coverage if they are
victims of diabetes, if they have had a bout with cancer, if they have
asthma? Oh, some of these folks are for the Wild West: Get government
out of my life.
I will tell my colleagues this: We know sensible regulation of
insurance coverage gives people peace of mind and gives families a
chance to know their child with a challenge or a problem is still going
to get the very best medical care.
There is something called lifetime limits, which is another change.
You go to the doctor, and the doctor says: Well, sorry to tell you, but
you have been diagnosed with a form of cancer. We can treat it. It is
going to take aggressive chemo, radiation, maybe even surgery. It is
going to take some time, and it is going to cost some money, but at the
end of the day we are going to save your life, and you are going to
live. You are going to live to see your daughter's wedding, and you are
going to live to see your grandchildren.
Then you get into it. You say: I am determined, my family is with me.
I am going to pray for it and get the right outcome.
Guess what happens. It turns out the cost blows the lid off your
health insurance coverage. You had a lifetime limit on how much they
would pay, which you never thought you would use until that diagnosis
came down. So now we have basically said we are removing lifetime
limits on health care. That is part of ObamaCare. That is part of the
affordable care act.
So I say to my Republican friends and those running for President:
You want to go to the American Cancer Society and enter into a debate
with them about whether lifetime limits are the right thing to do? They
are going to explain to you thousands and thousands of American
examples of why people with lifetime limits end up in a tragic
situation where they need more coverage, they need more care. Their
lives can be saved, but their health care coverage is cut off. That was
the old days. That was before the affordable care act.
So those who want to repeal it stand up and get cheering crowds. In
those cheering crowds are cancer patients. They ought to stop and think
before they start cheering and know what they are cheering for.
The affordable care act is a sensible, reasonable step in a direction
toward containing health care costs and making health care insurance
coverage fairer for Americans all across our Nation.
Is it a perfect law? Of course not. As I have said many times, the
only perfect law I am aware of was carried down a mountain on clay
tablets by Senator Moses. Ever since, we have done our best. We can
always do better, and I am open to change, I am open to improvement.
But for those who want to walk away from the affordable care act,
listen to what they are walking away from.
They are imposing a $1,000 premium on families to pay for the
uninsured who will not accept their personal responsibility to buy
health insurance. They are walking away from helping seniors pay for
their Medicare prescription drugs. They are turning their back on
families with young children fresh out of college looking for jobs,
with no health insurance coverage. They are inviting the insurance
companies to once again turn down your child and your family because of
a preexisting condition. They are saying, once again: Let's get into
the world of lifetime limits on insurance no matter how much health
care costs.
That is their idea of a future--not mine, not my family's. I have
lived through part of this. Many others have as well. So when you hear
their cheering crowds about repealing the affordable care act, hoping
the Supreme Court finds some aspect unconstitutional, step back and ask
those cheering crowds about their own health insurance.
The last thing I want to say is this. It is interesting that Senators
are debating this. You ought to see our health insurance. You ought to
see what we have as Members of Congress. We have the Federal Employees
Health Benefits Program. Guess what. It is a government-administered
program. Oh, my goodness. You mean Republican Senators are part of a
government-administered health care program? Yes. And you mean to tell
me they have to deal with an insurance exchange? Yes. That is what the
Federal Employees Health Benefits Program is.
Eight million Federal employees and their families choose once a
year--in my case from nine different plans that cover Illinois. We like
our coverage in my family. Federal employees like their coverage.
Senators like their coverage. But when it comes to extending this same
benefit to every other American, oh, what a horror story; that is too
much government. Really? If you are a person of principle and believe a
government-administered health care plan is too much government, step
up here in the well and tell people: I am giving up my Federal health
insurance. I have not heard a single Republican Senator say that--not
one. So let's find out. When we come down to the question about health
care insurance for all Americans, I think they deserve at least the
kind of coverage that Members of Congress have.
Madam President, I yield the floor.
____________________