[Congressional Record Volume 158, Number 48 (Thursday, March 22, 2012)]
[Senate]
[Pages S1988-S1991]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. FRANKEN. Madam President, I would like to join many of my 
colleagues who are each talking a little bit about the affordable care 
act, which celebrates its second anniversary of being signed into law 
by the President tomorrow. Even though the law will not be fully 
implemented until 2014, millions of Americans and Minnesotans are 
already enjoying the benefits from important provisions in the law.
  For example, no child in Minnesota, no child in New Hampshire, and no 
child in America can now be denied health insurance coverage because he 
or she has a preexisting condition. Parents across Minnesota and around 
the country can sleep a little bit easier knowing that if their child 
gets sick, they will still be able to get the health care coverage they 
need. That is a big deal.
  Speaking of parents, young adults can now stay on their parents' 
health insurance until they are 26. Thanks to the affordable care act, 
32,189 young adults in Minnesota are now insured on their parents' 
policy. Because of this law health insurance companies can no longer 
impose lifetime limits on health care benefits.
  Just a few weeks ago, I heard from a Minnesotan in his thirties who 
has hemophilia. He had already hit his lifetime cap three times, but 
because of the health care reform law he still has insurance. No 
American can ever again have their health insurance taken away from 
them because they have reached some arbitrary lifetime limit, and I am 
proud of that.
  Let's talk about seniors. I go to a lot of senior centers around my 
State. I know the Presiding Officer goes to senior citizen centers 
around New Hampshire. Because of the health care law more than 57,000 
seniors in Minnesota receive a 50-percent discount on their covered 
brand-name prescription drugs when they hit the doughnut hole, at an 
average savings of $590 per senior. By 2020, the law will close the 
doughnut hole entirely. You know who likes that--seniors. You know what 
else seniors like--the fact that in 2011, 424,000 Minnesotans with 
Medicare received preventive services without copays, such as 
colonoscopies and mammograms and free annual wellness visits with their 
doctors. I could go on and on with what we have already gained, but I 
wish to talk a little bit about a provision I wrote with the catchy 
name ``medical loss ratio,'' which is sometimes called the 80/20 rule 
because of my medical loss ratio provision which I based on a Minnesota 
law.
  Health insurance companies must spend 80 to 85 percent of their 
premiums on actual health care. This is 85 percent for large group 
policies, 80 percent for small group and individual policies on actual 
health care, not on administrative costs, marketing, advertisements, 
CEO salaries, profits but on actual health care. We have already heard 
the medical loss ratio provision is working. The plan is already 
lowering premiums in order for companies to comply with the law. For 
example, Aetna in Connecticut lowered their premiums on an average of 
10 percent because of this provision in the law.
  Another key provision in the law is the value index. The value index 
rewards doctors for the quality of the care they deliver, not the 
quantity--for the value of the care, not the volume.
  My home State, Minnesota, is a leader--if not the leader--in 
delivering high-value care at a relatively low cost. Traditionally, in 
Minnesota, our health care providers have been well underreimbursed for 
it. For example, Texas gets reimbursed 50 percent more per Medicare 
patient than Minnesota does. This isn't about pitting Minnesota against 
Texas or Florida, it is about rewarding those low-valued States to 
become more like Minnesota.
  Imagine if we brought down Medicare expenditures by 30 percent around 
the country while increasing its effectiveness. It will bring enormous 
benefits not just to Minnesota but across the country because it will 
bring down the cost of health care delivery nationwide, and that is 
what we need to be addressing, the cost of health care delivery, 
because we all know bringing down the health care costs is key to 
getting our long-term deficits in order. In fact, there is probably 
nothing more important that we can do. That is where the value index is 
so important.

  I have gone over a number of the benefits from health care reform 
that have already kicked in, but I obviously didn't mention them all. 
According to the Wall Street Journal, health care reform has already 
added jobs to our economy. I barely touched on the great stuff that 
kicks in, in 2014, such as the exchanges which will allow individuals 
and small businesses to pool with others to get more affordable health 
insurance that is the right fit for them. Of course, while presently no 
child can be denied health insurance for preexisting conditions, 
starting in 2014 no American will be denied health insurance or 
penalized for having a preexisting condition.
  The Congressional Budget Office, a nonpartisan agency of Congress, 
has crunched the numbers and reported that the affordable care act will 
insure 31 million additional Americans and bring down our national 
deficit by billions of dollars in its first 10 years and by 
approximately $1 trillion in its second 10 years.
  I ask the American people not to fall victim to disinformation. There 
are no death panels. The affordable care act cuts the deficit. Under 
this law, businesses under 50 employees don't have to provide insurance 
for their employees and will not suffer penalties if they don't. They 
will not have to pay fines and they will not be dragged into prison. 
There is so much junk out there that is just plain false, and it is 
doing everyone in this country a giant disservice.
  My colleagues and I disagree on many things. Can we all at least 
agree to talk about this law in a factual manner? The benefits of this 
law are tremendous and Americans across the country are already 
experiencing it. I urge all my colleagues to acknowledge these benefits 
and to support the continued implementation of the Patient Protection 
and Affordable Care Act.
  (The remarks of Mr. Franken pertaining to the introduction of S. 2225 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. FRANKEN. I thank the Chair and I yield the floor.
  The PRESIDING OFFICER. The Senator from Nebraska.
  Mr. JOHANNS. I ask unanimous consent to speak for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. JOHANNS. Madam President, the anniversary of any new law should 
be a time to celebrate accomplishments and new landmarks. But the 
almost constant flow of bad news, unfavorable reports, and broken 
promises makes the second anniversary of the health care law anything 
but a celebration. Rather, it is something that even the White House 
seems embarrassed to mention.
  The truth is the policy behind the bill was flawed. The truth is that 
the law is fundamentally flawed. It raises taxes and health care costs 
for working Americans. It puts bureaucrats between patients and their 
doctors. It tangles our Nation's job creators in regulations and 
redtape, and it defies

[[Page S1989]]

our country's most sacred document--the Constitution of the United 
States.
  Next week, the U.S. Supreme Court begins hearings to determine 
whether the health care law violates the Constitution. It is one of the 
most important cases reviewed in recent history. The Court has set 
aside a remarkable 6 hours for oral arguments--more time than has been 
devoted to a case in over four decades. Its ruling will have a far-
reaching impact on our health care system, but it doesn't stop there. 
It will have a far-reaching impact on our economy, and fundamentally on 
the expanse of congressional authority over the individual citizen.
  I hope the Supreme Court will resolve the countless problems in this 
law for good by striking it down in its entirety.
  The facts tell us that with the passage of time, things have not 
gotten better with this law; they have, in fact, gotten worse. Take 
last week's report from the nonpartisan Congressional Budget Office as 
one example. We learned something about the cost of this bill. Before 
the bill was passed, many of us were saying this bill was filled with 
budget gimmicks to make it look cheaper to the American people than it 
was. Well, we learned that the cost of the law's coverage provisions 
alone is projected to balloon to $1.7 trillion.
  The problem is that CBO only does 10-year projections, so the major 
provisions of this law were delayed until 2014. Why? Well, the reason 
for that is it was done to mask the true costs of this bill when it was 
fully implemented. When we eliminate gimmicks such as this and consider 
the law's first 10 years of full implementation, I fully expect the 
total cost of this legislation will not be the $900 billion promised by 
President Obama, it will be $2.6 trillion. This law certainly doesn't 
bend the cost curve down.
  CBO concludes that families buying insurance on their own will pay an 
astounding $2,100 more a year for that insurance. Yet then-Candidate 
Obama promised that Americans would see their premiums decrease by 
$2,500 by the end of his first term.
  The recent CBO report also noted that the Federal Government will 
spend $168 billion more on Medicaid compared to last year's estimate.
  The truth keeps coming out. That means more people will be trapped in 
a broken program where waiting lines will, in fact, be longer, 
emergency room visits will be more frequent, because that is the only 
place they can find care, health care outcomes will get worse, and 40 
percent of physicians today won't even see patients in this program.
  This law does not deliver better quality health care either. Imposing 
Medicaid on more people is like giving someone a ticket to ride a bus 
that has broken down hundreds of miles away but claiming they have a 
ticket so, in fact, they have the opportunity for transportation. Not 
only that, the law puts all the pressure and burden on our States to 
implement the Medicaid Program's largest expansion since 1965, placing 
$118 billion in unfunded mandates on States, when our States are 
struggling to figure out how they balance their budgets today. As a 
former Governor who has balanced budgets, I believe this expansion 
dumped on our States to manage is a critical and fatal flaw of this 
legislation.
  CBO also recently projected that up to 20 million more working 
Americans could lose their employer-sponsored health care coverage 
because of this health care law. That is an incredible shift, 
especially when we consider that our President promised no fewer than 
47 different times: ``If you like your plan, you can keep it.''

  In addition to a potential 20 million employees losing their current 
coverage, 7 million seniors are likely to lose their Medicare Advantage 
plans. According to the Congressional Budget Office Director, more than 
3,200 Nebraskans enrolled in Medicare Advantage will, in fact, have 
their benefits cut in half. Families in 17 States, including Nebraska, 
no longer have access to child-only health insurance because of 
mandates in the law.
  Wait a second. I just said in 17 States they no longer have access to 
a child-only health insurance policy because of this law's effect. That 
is incredible.
  Our Nebraska insurance commissioner called this collapse of the 
child-only market ``an example of the unintended consequences of this 
imperfect law.''
  Here we see the President's promise, again, flipped on its head: This 
law forces you to say goodbye to the coverage you like for children.
  Over the past 2 years, I have traveled across the great State of 
Nebraska hosting townhalls, roundtables, and meetings, and I am finding 
that the more folks know about this law, the more they detest it. 
Religious schools and hospitals and charities are troubled because the 
law will force them to violate their deeply held beliefs. Seniors are 
concerned that the law will limit access to care because it siphons 
$500 billion from Medicare and uses it as a piggy bank to spend on 
other government programs.
  The administration's own Medicare Actuary has projected ``the prices 
paid by Medicare for health services are very likely to fall 
increasingly short of the costs of providing these services.'' The CMS 
Actuary continued that these Medicare cuts could result in ``severe 
problems with beneficiary access to care.''
  Let me translate that. That means this law will make it more 
difficult for senior citizens to get health care because the Federal 
Government is not paying its way. Others wonder what the 159 new boards 
established by this law will mean for access to health care, and hard-
working Nebraskans question how the law's $\1/2\ trillion in taxes will 
affect their families. Approximately 428,000 Nebraskan households 
making less than $200,000 will pay higher taxes--approximately 428,000. 
That is based on estimates by the Joint Committee on Taxation.
  Small businesses across Nebraska have shared with me that they are 
holding off on hiring because of the mandates in this legislation. At a 
roundtable last week, business men and women expressed their concerns 
about the law's tax on health insurance companies in the fully insured 
market, and with good reason. The health insurance tax alone could 
impose $87 billion in costs on businesses and their employees over the 
law's first 10 years alone.
  An analysis by the National Federation of Independent Business 
indicates this law will force the private sector--will force the 
private sector--to cut between 124,000 and 249,000 jobs between now and 
2021. That is not just a statistic, those are families who will lose a 
job because of this health care bill.
  It is remarkable that in the midst of our economic situation, the 
President's signature legislation actually reduces jobs. These are some 
of the many reasons Nebraskans are demanding louder than ever that this 
law be repealed.
  Now, some of the law's supporters have taken up the mantra: Well, 
don't repeal it, repair it. That is a nice slogan. This law, though, is 
so fatally flawed no bandaid is ever going to fix it.
  I experienced firsthand how difficult it is to change this law when I 
worked to repeal the 1099 reporting requirement, which nearly everybody 
agreed was idiotic. It would have increased paperwork burdens on our 
Nation's job creators by up to 2,000 percent.
  The administration even agreed this pay-for in their law needed to 
go, and, in the end, 87 Senators supported full repeal of the 
provision. But it took 9 months and 7 votes before my efforts to repeal 
a provision that everybody agreed was idiotic was finally successful. 
So anyone who tells you we can tinker with the law to fix it might as 
well offer you ocean-front property in the State of Nebraska.
  The 2,700-page law is one of the largest pieces of legislation ever 
passed in this Nation's history. Its provisions are interconnected, 
ill-fated, and far-reaching, and they will affect every single American 
economically, socially, and physically. We cannot sit idly by and allow 
for the negative consequences to continue unraveling, and they will.
  As I said, I hope the Supreme Court strikes down this entire law. But 
if it does not, we will continue our fight to repeal it, as Nebraskans 
demand that I do. We must protect the rights of Americans to choose 
their doctors, to select their insurance, to trust their care, and to 
protect their conscience rights. We must ensure employers see reforms 
that reduce regulations and redtape and instead increase efficiencies 
and address the underlying costs. We must give States the flexibility 
to run their Medicaid Program in

[[Page S1990]]

the best way that serves the needs of those vulnerable populations in 
that State.
  This law is misguided. It stifles job growth and does not improve 
health care for millions of Americans, and it should be wiped off the 
books. Americans are demanding it, Nebraskans are demanding it, and 
they deserve that.
  Mr. LEAHY. Mr. President, 2 years ago this week, President Obama 
signed into law the affordable care act. This landmark act will extend 
health insurance coverage to 30 million uninsured Americans in the next 
few years. Reform based on good-quality and affordable health 
insurance, talked about for decades, is finally becoming a reality. 
Over 15 months, Congress debated and then passed the most sweeping and 
comprehensive reforms to improve the everyday lives of every American 
since Congress passed Medicare in 1965. It was an arduous process, but 
in the end this achievement proved that change is possible and that the 
voices of so many Americans who over the years have called on their 
leaders to act have finally been heard.
  Americans are already beginning to see some of the benefits of 
insurance reform. Seniors on Medicare who have high-cost prescriptions 
are starting to receive help when trapped within a coverage gap known 
as the ``doughnut hole.'' The affordable care act completely closes the 
coverage gap by 2020, and the new law makes it easier for seniors to 
afford prescription drugs in the meantime. In 2010, more than 7000 
Vermonters received a $250 rebate to help cover the cost of their 
prescription drugs when they hit the doughnut hole. Last year, nearly 
6800 Vermonters with Medicare received a 50-percent discount on their 
covered brand-name prescriptions, resulting in an average savings of 
$714 per person. Since the affordable care act was signed into law, 
more than 4000 young adults in Vermont have gained health insurance 
coverage under these reforms, which allow young adults to stay on their 
parents' plans until their 26th birthdays. The improvements we are 
seeing in Vermont go on and on: 81,649 Vermonters on Medicare and more 
than 100,000 Vermonters with private insurance gained access to and 
received preventative screening coverage with no deductible or copay. 
These are just a few of the dozens of consumer protections included in 
the law that are benefiting Vermonters and all Americans every day.
  Now that the law is in effect, many of the essential 
antidiscrimination and consumer protections of the affordable care act 
are being implemented, allowing consumers to take control of their own 
health care decisions. Known as the Patients' Bill of Rights, these 
rules protect consumers against the worst health insurance industry 
abuses that have prevented millions of people from receiving the health 
care they need. Going forward, insurance plans can no longer deny 
children coverage because of a preexisting health condition; insurance 
plans are barred from dropping beneficiaries from coverage simply 
because of an illness; dozens of preventive care services must be 
covered at no cost and with no copay; and Americans will have access to 
an easier appeals process for private medical claims that are denied.
  Yet another major reform now protects hard-working Americans from one 
of the most egregious insurance industry practices: setting lifetime or 
annual limits on health insurance coverage. Before this change in the 
law, wherever I traveled in Vermont, I was often stopped in the grocery 
store, at church, on the street, or at the gas station by Vermonters 
who shared their personal, wrenching stories about how they could no 
longer get medical treatment because they had met their annual or 
lifetime maximum. Many of these Vermonters were perfectly healthy 
before being diagnosed with cancer or diseases that can cost well 
beyond their means for treatment. Instead of being able to focus on 
getting healthy, patients instead had to worry about whether their next 
doctor's visit will push them above the insurance company's arbitrary 
limit.
  Beginning in 2014, insurance companies will no longer be allowed to 
deny coverage to individuals with preexisting health conditions or to 
charge higher premiums based on health status or gender. We learned in 
a report issued by the National Women's Law Center this week that until 
these reforms are implemented, insurance companies are continuing to 
charge women higher premiums than men. In States where this practice is 
not prohibited, women can pay substantially more than men solely 
because of their gender. Those who wish to turn back the clock and 
repeal the affordable care act threaten to return the American people 
to a broken health insurance system where women can be charged more 
than men, children can be denied insurance coverage because they were 
born with a health condition, and individuals risk losing their health 
insurance solely for getting sick.
  In addition to these improvements to our health insurance system, 
over time the affordable care act will insure 93 percent of our 
population and make a substantial investment in our economic vitality 
in the years ahead. I was proud to work with Senator Grassley and 
others to include strong antifraud provisions in the law that have 
already helped prevent and detect fraudulent activities that in the 
past have cost American taxpayers millions of dollars each year. 
Despite the specious arguments from opponents of reform, this bill is 
the largest deficit reduction measure upon which many in Congress will 
ever cast a vote. The Congressional Budget Office estimated that 
comprehensive reform will reduce the Federal deficit by $143 billion 
through 2019, and by more than $1 trillion in the decades to come.
  Regrettably, opponents of the affordable care act have sought to 
continue their political battle by challenging the landmark legislation 
in the courts, right from the moment President Obama signed it into 
law. These opponents seek to achieve in the courts what they could not 
in Congress. They want judges to override legislative decisions 
properly assigned by the Constitution to Congress, the elected 
representatives of the American people.
  In my view, the partisan legal challenges to the affordable care act 
depend on legal theories so extreme they would not only undo the 
progress we have made in the affordable care act for kids, families, 
and senior citizens, they would turn back the clock even farther to the 
hardships of the Great Depression. They seek to strike down principles 
that have been settled for nearly three quarters of a century and have 
helped us build and secure the social safety net through Social 
Security, Medicare and Medicaid. These challenges to Congress's 
constitutional authority to enact the affordable care act have been 
rejected by three courts. Judges appointed by Republican Presidents and 
Democratic Presidents have rejected these challenges, and they were 
right to do so. Now the case is before the Supreme Court, which will 
hear arguments next week.
  I have joined congressional leaders in filing an amicus brief 
defending the affordable care act. I did so not only because I have 
fought for decades to secure affordable health care for all Americans 
but because I am convinced that Congress acted well within the limits 
of Article I of the Constitution in doing so. Before passing the 
affordable care act, Congress expressly considered and rejected 
arguments that the law, including the requirement that individuals have 
health insurance, is not constitutional. I believe we must defend the 
enumerated powers given to Congress by the Constitution so that our 
ability to help protect hard-working American workers, families, and 
consumers is not wrongly curtailed by the courts.
  What is telling about the partisan nature of these challenges is that 
many of those who now claim that the requirement that Americans have 
health insurance or face a tax penalty is unconstitutional are the very 
ones who proposed it. Republican Senators like Senator Hatch, the 
former chairman of the Judiciary Committee, and Senator Grassley, the 
ranking member of the Judiciary Committee, proposed a health insurance 
requirement as an alternative when they opposed President Clinton's 
plan to provide access for all Americans to health care. They were for 
the individual mandate until President Obama was for it, and now they 
are against it. Their views may have changed, but the Constitution has 
not. What they fail to mention are the consequences of removing this 
provision. If individuals are not required to have health insurance, 
then they will wait

[[Page S1991]]

until they are sick to get coverage, driving up the costs for everyone 
else in the meantime. This will mean that many of the consumer 
protections in the law, such as the ban on preexisting health 
conditions, would disappear, once again leaving millions uninsured. For 
sake of the health and security of our Nation, the Supreme Court should 
not cast aside this landmark law and Congress's time-honored ability to 
act on behalf of the American people.
  The affordable care act is a tremendous achievement that will improve 
the lives of Americans for generations to come. For decades, we have 
heard heartbreaking stories about the enormous challenges Americans 
face because they are uninsured or underinsured. With each year that we 
move forward to implement the features of the affordable care act, 
these stories are becoming fewer and fewer and are being replaced by 
stories of the success of these reforms, one family at a time, all 
across Vermont and all across America.
  There is still much more to accomplish, and there are still millions 
of Americans who are struggling to buy or keep adequate health 
insurance coverage for their families or themselves. As these reforms 
are implemented over the next few years, I will continue to work with 
Vermonters and the Department of Health and Human Services to help 
Americans have the access to the quality, affordable health insurance 
that each and every American needs and deserves.
  I yield the floor.

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