[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
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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
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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
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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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