[Congressional Record Volume 158, Number 49 (Monday, March 26, 2012)]
[Senate]
[Pages S2020-S2023]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  Mr. COATS. Mr. President, this past Friday marked the 2-year 
anniversary of when the president's health care law, the affordable 
care act, otherwise known as ObamaCare, was signed in to law. I wasn't 
in the Senate at the time; I was actually in the State of Indiana 
campaigning to be in the Senate as a representative of that State. As 
such, I had spent a considerable amount of time crisscrossing the State 
and talking to Hoosiers about the health care plan. From diners and 
restaurants all across Indiana to small businesses, large businesses, 
medium-size businesses, big industrial giants, small mom-and-pop 
operations, medical providers, and ordinary citizens, we in Indiana 
join the nearly two-thirds--or perhaps even more than two-thirds--of 
the country that oppose this law.
  Hoosiers didn't then, and they don't now, want to have a one-size-
fits-all nationalized health care system. They want a healthier health 
care system. They want reforms to the current problems and excessive 
rising costs of health care. This is the first of many attempts I will 
make to discuss why we need to address this law, which is moving toward 
ever and ever greater implementation and particularly kicks in over the 
next two years. Hoosiers, as I said, did not want the plan then and 
they don't want it now. They don't want to have Federal bureaucrats 
making their health care decisions for them. They want less government 
intervention and higher quality of care, and they don't want a health 
care system that increases costs and premiums while hurting job 
creators with fines and penalties. They want affordable care and good 
job opportunities.
  Two years after passage of that act, I continue to hear these 
messages from the people of Indiana and from others as we discover more 
and more information about what is contained in this massive 2,700-page 
bill that was passed in early 2010. I wish to discuss a few of the 
impacts of the ObamaCare law today. The first is the individual 
mandate, and of course that is one of the issues the Supreme Court is 
hearing right now and will be making a determination on.
  ObamaCare is the biggest example of government intrusion in the 
everyday lives of Americans, whether by forcing individuals to buy 
health insurance, enacting onerous regulations on small businesses, or 
by raising taxes and imposing penalties. The health care law forces 
every American to purchase a health insurance plan or, if they choose 
not to do so, to pay the government a fine. This is unprecedented in 
American history. It is the first time the Federal Government is 
forcing citizens to purchase a product or a service they may or may not 
want or pay a fine for their decision to say no.
  This administration basically is saying to Americans: We know what is 
better for you than you know for yourself. We know what is better for 
you than what your doctor suggests is needed, and if you don't get a 
government-approved health care plan, we are going to assess you a 
fine.
  That is a basic, fundamental principle of constitutional law and the 
Supreme Court will be making that determination. But I suggest that 
this Congress needs to continue to debate this and be prepared to act 
depending on what the Supreme Court decision is, which will come down 
several months from now.
  The second thing I wish to talk about briefly is the higher costs 
that emanate from this particular piece of legislation. In addition to 
mandating that all Americans have health insurance, ObamaCare hits 
individuals and families with increased costs at higher premiums. The 
Nation's nonpartisan budget experts at the Congressional Budget Office 
estimate that when fully implemented, this law will increase insurance 
premiums on a family policy by an average of $2,100 a year. Therefore, 
the affordable care act is hardly affordable and increases the already 
high premiums people have to pay for insurance.
  The President's own Chief Actuary at the Center for Medicare Services 
reported that the law will increase national health care costs by $311 
billion in the first 10 years alone--increase is the key word here. The 
goal of reforming the Nation's health care system initially was to 
reduce the skyrocketing costs for Americans, not increase them. Yet, we 
are now being told by the experts and the President's own people that 
Obamacare will increase costs.
  I also wish to speak about the impact of this law on businesses. I 
talked to dozens if not hundreds of businesses across the State of 
Indiana, both in the campaign year of 2010 and then last year traveling 
as a Senator throughout the State. The President's health care 
prescription results in bad side effects for American businesses by 
hitting job creators with new taxes and new regulations that they 
desperately don't need at this point in our struggle to regain economic 
growth. Take the employer mandate. The law penalizes businesses that do 
not provide employees with government-approved health care plans. 
Beginning in 2014, American businesses with more than 50 employees will 
be fined $2,000 per employee if they do not offer a health insurance 
plan approved by the Federal Government.
  I have talked to a number of business people who have gone through 
painful negotiations with their workers and with their laborers and 
with staff. They have put together a health care plan that is accepted 
by both management and by employees who recognize that if they cannot 
maintain some semblance of control over costs, the jobs might not be 
available in the future because the company cannot afford to keep 
people at work. So in recognition of all of this negotiation that goes 
on and the contractual obligations that both sides work to achieve, 
understanding that if the business is hit with too much tax and too 
many regulations the business may not survive, those plans now come 
under the scrutiny of the Federal Government, and the Federal 
Government will determine whether those plans are sufficient and 
adequate. If it determines they are not, then a fine is levied against 
the business.
  I cannot tell my colleagues how many business people told me: Look, I 
would rather pay the fine than have the government impose all of these 
new regulations on us when we are working carefully with each employee 
to make sure they have their basic insurance needs covered. Yet, if we 
are forced into a set plan of set procedures for every employee, then I 
have two choices, the business people say: I can either refuse to do so 
and pay the penalty of about $2,000 per employee, or I can let people 
go. The bottom line is, if I can't make my bottom line, I cannot keep 
these people employed.
  The arbitrarily fixed basis that small businesses under 50 employees 
will not be subject to this leaves manufacturers and business people 
who are slightly below that level--say at 45 or 40 or 35--a dilemma as 
they are seeking to expand their business. ``As soon as I hire No. 50, 
then my business is no longer exempt. So what do I do? I freeze out 
hiring more people and look to double up people's salaries or put 
people on overtime.'' At a time when we have over 12 million people 
looking for a job and millions of people underworked or working two and 
three part-time jobs to make ends meet, we are imposing this law on 
them. It could not have come at a worse time.
  Then there is a medical device tax and several other taxes that are 
included in this bill that we continue to find as we read the fine 
print.
  Indiana is a State that is home to a lot of medical device 
manufacturers. In

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fact, there are over 300 registered medical device manufacturers that 
employ 20,000 Hoosiers in the State of Indiana and another 28,000 
people who benefit from that employment. There are more than 400,000 
workers employed nationwide by this industry.
  So what did the ObamaCare plan propose? Well, we need some pay-fors. 
To pay for the law, the administration decided to impose a 2.3 percent 
tax on these medical device manufacturers.
  The PRESIDING OFFICER (Mr. Tester). The Senator's time has expired.
  Mr. COATS. Mr. President, I sense I am approaching a deadline in 
time. I am wondering if I could, with the consent of my colleague, ask 
unanimous consent for 5 more minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. COATS. Thank you, Mr. President.
  These medical device manufacturers are employing people at an average 
rate of about 41 percent greater than the average worker rate of pay in 
my State, so these are desired jobs. But, again, employers and 
manufacturers of medical devices are telling me they are being forced 
to go overseas because of the burden of regulation and a tax that has 
nothing to do with the essential program of the health care plan.
  That is not the only tax that is imposed in this law. There are many 
hidden taxes here that we are just learning about. Let me name five: 
the excise tax on charitable hospitals; the drug industry tax, separate 
from medical devices; the health insurance industry tax; the insurer 
excise tax; and a Blue Cross-Blue Shield tax hike.
  The Joint Committee on Taxation found that the health care law 
imposes more than $550 billion in new taxes and penalties, most of 
which will fall on the middle class.
  Third, the impact on the State of Indiana.
  ObamaCare forces States to expand Medicaid rolls so significantly 
that it will be imposed--and this has been talked about earlier today--
upon the States in a way that can cripple their ability to try to find 
some balance in their budgets. In Indiana, where our budget is in far 
better shape than many other States, we still cannot afford the current 
Medicaid Program, let alone the projected new costs that will be 
required under the ObamaCare law.
  An outside group has estimated that $3.1 billion in new costs over 
the next decade will be imposed on Indiana taxpayers if the 1.5 
eligible Hoosiers enroll in Medicaid as a result of this health care 
law. This added expense does not include any payment relief to 
providers and, therefore, shifts costs to patients by driving up 
premiums for all Hoosiers.
  In conclusion, we have to ask the question: What is the remedy for 
this fatal disease called ObamaCare? Well, the remedy may lie with the 
Supreme Court. They are hearing arguments on this today, and will for 
the next 2 days, and we will have a decision on the constitutionality 
of this law by the summer. But the health care debate also, most 
likely, will end up back here in Congress one way or another, and that 
leaves us the responsibility of addressing this.
  From forcing individuals to purchase insurance, to taxing successful 
job creators and burdening State budgets, I believe the health care law 
is so deeply flawed that it must be scratched and replaced with real 
reform, reform that lowers the cost of care, allows the doctor--your 
doctor, not the government--to decide the kind of medical care you 
need, and provides flexibility to States.
  Real health care reform lowers costs, it improves access to quality 
care, empowers individuals, and preserves personal liberties; and that 
is not what we have in the law that currently is on the books. So 
whether through congressional legislation or court action, ObamaCare 
needs to be overturned and replaced with commonsense provisions that 
put patients--not government, not bureaucrats--in charge of health care 
decisions.
  ObamaCare has proven to be the wrong prescription, and it is time for 
a new treatment. Americans want reform that remedies our ailing health 
care system, not one that weakens it and drives it deeper and drives us 
deeper as a Nation into debt.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. BINGAMAN. Mr. President, since this is the 2-year anniversary of 
the passage of the health care reform law, the affordable care act, and 
since the Supreme Court, of course, is meeting across the street 
hearing various arguments attacking the legislation--they heard 
arguments this morning; they are going to hear arguments again tomorrow 
morning; and they are going to hear arguments again Wednesday morning--
I believe it is a crucial time to remind all Americans why this law was 
needed, why it still is needed, and how it will benefit families across 
this country.
  In my view, there is considerable confusion about what the health 
care reform legislation will accomplish. And I am not surprised. The 
opponents of the legislation have worked hard in the last couple of 
years trying to confuse many Americans into thinking the bill contains 
all kinds of nefarious provisions.
  The Kaiser Family Foundation did a poll, however, that demonstrated 
when Americans are asked about the actual provisions that are contained 
in the law, there is strong bipartisan support for those reforms. So I 
wish to take a little time to straighten out what the provisions in the 
law are and how I see them impacting on our health care system.
  Health care reform was needed when it was enacted 2 years ago for two 
important reasons. First, before reform--and even today--one in six 
Americans was uninsured. That number was growing, is still growing. In 
my home State of New Mexico, the situation was even worse. We had more 
than one in five people in my State uninsured. That is the second 
highest rate of any State in the Nation. The large majority of the 
uninsured are working people. They have low incomes. They cannot afford 
to pay the very high cost of health insurance.
  The second important reason we enacted health care reform was that 
the cost of health care was continuing to grow at an unreasonable rate.
  As you can see on this chart I have in the Chamber--this is based on 
data from the Centers for Medicare and Medicaid Services, Office of the 
Actuary--they estimate that national health expenditures per capita 
increased from 5 percent of gross domestic product in 1960 to 18 
percent in 2010. So absent any intervention, this figure was projected 
to exceed 40 percent by 2080.
  The affordable care act significantly improves the situation. It does 
not solve all the problems in our health care system, but it 
substantially improves the situation. Due to the affordable care act, 
over the next 10 years, the rate of uninsured will be reduced by more 
than half. That is according to the Congressional Budget Office 
estimate. Low-income families will be able to afford health insurance, 
so they will not have to worry about going broke because they get sick. 
The rest of America will not see their insurance premiums rise to 
absorb the cost of expensive hospital care when the uninsured have 
nowhere else to turn.
  With full implementation of this law, Americans will get higher 
quality health care while at the same time we begin to rein in the 
growing costs of health care. The law does so while protecting key 
parts of the health care system, such as Medicare. It extends the 
solvency of Medicare from 2017--prior to the enactment of this 
legislation--to 2024. Despite claims to the contrary, these reforms are 
fiscally responsible. They decrease Federal health care spending by 
well over $1 trillion over the next two decades.

  Stated simply, the law protects the aspects of our health care system 
that are working well and fixes many of those aspects that are broken, 
and it does so in a fiscally responsible way. It achieves this through 
provisions that are intended to support three main goals. Let me go 
through those briefly.
  The first of those goals is to expand coverage and ensure health 
insurance is affordable. The second of those goals is to improve the 
quality of health care. The third is to begin reining in the rapidly 
rising costs of health care and create efficiencies in our health care 
system.
  Let me start with this coverage expansion under the affordable care 
act. Under the law people who need health care can get health insurance 
coverage.

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There is financial assistance to those who cannot afford it. According 
to the Congressional Budget Office's most recent projections, 93 
percent of Americans will have affordable health insurance coverage by 
2016 with full implementation of this act. That is 30 million more 
Americans who will be covered who are currently uninsured.
  Some of these provisions have already taken effect and have had a 
significant impact. For example, young adults up to the age of 26 can 
now receive health insurance coverage under their parents' insurance 
regardless of their marital or school or employment situation. Since 
the implementation of this provision, 2.5 million uninsured young 
people across the country have gained health insurance coverage. This 
includes over 21,000 young people in my home State of New Mexico.
  In addition, 20,000 seniors in my State who are in the so-called 
coverage gap for prescription drugs under Medicare are now saving on 
their prescription drugs because that so-called doughnut hole is 
decreasing in size as a result of this legislation. This is already 
benefiting 3.6 million seniors nationwide.
  Children with preexisting conditions are no longer able to be 
discriminated against, and adults with preexisting conditions who 
cannot get insurance have the option for coverage in a high-risk pool. 
With full implementation of the law, those adults will be in the same 
circumstance as children with preexisting conditions in that they will 
not be able to be discriminated against.
  What is more, the major coverage provisions are still to come. They 
begin in 2014. Medicaid will be expanded to cover more low-income 
Americans, those whose incomes go up to 133 percent of the Federal 
poverty level. This is a critical provision since experts tell us the 
expansion of Medicaid coverage is the most cost-effective way to 
provide insurance to low-income uninsured individuals and families.
  Seventeen percent of the nonelderly population nationwide benefit 
from the Medicaid expansion and the tax credits in this legislation. In 
New Mexico, as well as the States of Texas and Louisiana and 
California, which have high rates of uninsured, the estimate is that 36 
percent to 40 percent of residents could benefit.
  Lower and middle-class income families will be eligible for health 
insurance tax credits to help purchase health insurance. While most 
Americans will still get health insurance through their employers, 
those who do not can purchase health insurance through the health 
insurance exchanges. These will be virtual insurance shopping malls in 
each State that will offer an easy-to-understand menu of options with 
which to compare insurance plans. So we will have informed and 
empowered consumers who can choose the plan that is right for them and 
their family. The intent of the health insurance exchange is to level 
the playing field, increase competition among insurers, and thereby 
keep rates competitive.
  Contrary to much of the rhetoric we have heard, States will not 
shoulder the fiscal burden of this coverage expansion. Limiting costs 
to States was a priority when we drafted this health care reform 
legislation. In fact, the Federal Government commits to assume 100 
percent of the cost of the Medicaid expansion for newly eligible 
individuals during the first 3 years, beginning in 2014. Federal 
contributions are going to phase down after that slightly over the 
following years, so that by 2020 the Federal Government will be 
responsible for 90 percent of the cost of those newly covered 
individuals.
  For example, my State of New Mexico is expected to receive $4.5 
billion in 2014, 2015, and 2016, as we expand coverage to more 
enrollees. This will allow access to Medicaid for about 180,000 newly 
eligible New Mexicans.
  Let me refer to this chart that is beside me. This shows the 
Congressional Budget Office's estimate of the expansion impact on State 
spending on Medicaid. As we can see, contrary to a lot of the 
statements that are made on the Senate floor and elsewhere, this 
increase is less than 3 percent. This is additional spending on 
expansion. It is a small fraction, 2.8 percent, of State Medicaid 
spending. This is for the period 2014 through 2022.
  While reform expands Medicaid, it also makes it possible for some 
current Medicaid enrollees to become eligible to participate in the 
health insurance exchanges and brings them into the private market. 
According to the Urban Institute analysis, the net effect of enactment 
of the affordable care act on State budgets, in the worst case 
scenario, will see States realizing net budgetary savings of at least 
$40 billion during the period 2014 to 2019. It is possible those gains 
could be as high as $131 billion.
  With respect to affordability--and I know my colleague who was just 
on the floor was talking about affordability--the impact on New Mexico 
families is a good example. On average, families in my State will see a 
decrease in insurance premiums, perhaps as much as 60 percent. In 
addition, two-thirds of New Mexicans could potentially qualify for 
subsidies or Medicaid, and nearly one-quarter could qualify for near 
full subsidies or Medicaid.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. BINGAMAN. I see a colleague who wishes to speak. Therefore, I 
will ask unanimous consent that the balance of my statement be printed 
in the Record as if read.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. INHOFE. Does the Senator wish to continue?
  Mr. BINGAMAN. Mr. President, my colleague has said I could proceed 
for a few more minutes. Let me just----
  Mr. INHOFE. Mr. President, I ask unanimous consent that at the 
conclusion of the remarks of the Senator from New Mexico, I be 
recognized for up to 25 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BINGAMAN. I thank my colleague from Oklahoma for his courtesy. 
Let me talk a little about the second and the third goals I outlined 
earlier.
  The second goal of the affordable care act is to improve the quality 
of care. There is not a lot of discussion about that, but that is a 
main thrust of this legislation. A strong, well-trained health care 
workforce is essential if we are going to have quality health care in 
this country.
  Many provisions of the bill will strengthen the health care 
workforce. One obvious question is, What is the need we are trying to 
address? Let me point out that 25 percent of the counties in the United 
States are designated as health care professional shortage areas. In my 
State, 32 of the 33 counties are designated as health care professional 
shortage areas. We are absolutely last. New Mexico is absolutely last 
in all States with regard to both access to health care and the 
utilization of preventive medicine.
  The affordable care act contains key provisions to improve access and 
delivery of health care services to these areas. We train a great many 
additional physicians, nurses, pediatric specialists, and other health 
care providers. There is a major push to improve the quality of care by 
focusing on outcomes and effectiveness of medical treatments. All this 
is very positive and should have been done many years ago in this 
country. I am glad we are finally doing it as part of this health care 
reform legislation.
  The third and final goal of the legislation, as I mentioned earlier, 
is to begin to rein in costs and eliminate waste and inefficiency. 
Experts agree there is a tremendous amount of waste and inefficiency in 
our health care system. Anyone who has gone to a hospital can see that. 
Estimates indicate that as much as one-third of medical care does not, 
in fact, improve anyone's health. I think this bears repeating. A full 
one-third of all dollars spent on health care in this country does not 
contribute to the overall health of the population.
  We are trying to deal with that in a variety of ways in this 
legislation, to get more cost-effective treatment and to get more 
efficiency in our health care system.
  The law provides for savings by stopping investments in so-called 
Cadillac insurance plans. Second, there is new transparency and 
accountability for insurers to justify premium increases. Third, the 
law requires that insurers spend at least 80 percent of the premiums 
they collect on actually providing medical care rather than on CEO 
salaries and shareholder profits and administrative costs. Fourth, the

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affordable care act increases competition and price transparency 
through these health insurance exchanges we established. Fifth, the law 
establishes an independent body to recommend policies to Congress to 
help Medicare lower costs while providing better care. I can go into 
quite a discussion of the advisory board we established to try to 
control growth in the cost of Medicare. I think it is a very 
meritorious provision and one about which a great deal of bad 
information has been provided.
  In conclusion, the facts demonstrate clearly to me that these reforms 
will move us forward toward more affordable health care, with greater 
choice for American families. We will see less waste. We will see less 
inefficiency in our health care system. We will see higher quality of 
care. We will start to bring rising health care costs under control.
  These are worthy goals. They are the goals of this health care reform 
legislation. I look forward to seeing them achieved in the coming 
months and years.
  Again, I thank my colleague for his courtesy in allowing me to 
continue longer than was planned.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Oklahoma.

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