[Congressional Record Volume 158, Number 50 (Tuesday, March 27, 2012)]
[Senate]
[Pages S2042-S2045]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
Mr. ROCKEFELLER. Mr. President, this week there is plenty of drama
unfolding at the Supreme Court, the stately building across the street
from where we now stand. The Justices are deliberating inside the
building. There is a lot of shouting and clamoring outside. That is to
be expected. But I am here today to encourage all of us to pause for a
minute and to step back from the hype and think about what the broader
health care reform means to so many Americans, not just the citizens
the Presiding Officer and I represent but Americans across this
country.
I do think, because I believe strongly that the rhetoric surrounding
the issues has become so polarizing, many people routinely overlook the
profound ways the law has already made life better to so many
Americans. Let's remember why we started down this path of health
reform at all.
Let me say for the record this is a path that has been well trodden
over the years by both Democrats and Republicans--in fact, over the
last century--but we had never managed to enact meaningful reform in
our system. Yes, we added on some extraordinary things such as
Medicare, Social Security, and Medicaid, but reform of the system we
had not done. So we rejoiced in what happened in the mid-1960s, but
that doesn't help us in terms of the overall disposition of the system.
When we renewed this debate about how to fairly make sure everyone in
the country could get the health care they needed, we actually, at the
time as we started, had 46 million uninsured Americans. To be uninsured
is not pleasant; it is a fearful condition. Employers had been dropping
coverage for a decade due to skyrocketing health care costs. People
were losing their jobs and with them their coverage. Even those who had
coverage were being saddled with horrendous bills, and they were thrust
into bankruptcy even though many of them thought they had coverage that
was protecting them financially. They did not, but they thought they
did.
Some of those with preexisting conditions could not get back into the
system at any cost whatsoever. Preexisting conditions are something
people have--tens and tens of millions of Americans have those.
Americans thought our system was broken and unfair, and they thought
it was time to finally achieve our shared goal of access to care and a
more affordable system. That was sensible.
[[Page S2043]]
Let's start by looking at part of the law that protects those with
preexisting conditions. As I just mentioned, there are about 133
million Americans, individual Americans, who live every day with
chronic illnesses--or they fail to live--because of chronic illnesses.
What happens to them when insurance companies refuse to cover their
illnesses even while the insurance companies are collecting premiums
from them? That is called rescission. It is a dirty trick the insurance
companies have been doing to us in America for years. This law stops
that.
Before health reform, millions of Americans, including children,
could be denied the health care they needed due to a preexisting
condition. They might have had asthma. I had asthma until I was 12
years old. I wasn't worried about insurance, I gather, or maybe I
didn't get sick, but anyway I couldn't have gotten insurance in those
days because I had a preexisting condition.
If a woman has a C-section, she has a preexisting condition. If
someone has acne, that person can have a preexisting condition. If
people have almost anything, they can have a preexisting condition if
the insurance company says they do, so they just cut them off. It is
called rescission. They cut them off even though they are paying
premiums. That is unfair.
I want to talk about what this has meant to real people every day. It
means people have lived in fear of losing their employer-sponsored
coverage or even leaving a job to start their own business for fear
that they could not get coverage. It meant if somebody did get
coverage, the insurance company could just carve out their condition.
In other words, they could just get rid of them, dump them.
What is the practical implication of this insurance company abuse?
Consider this: People could get coverage if they had cancer, but the
cancer would not be covered. Not good. And the preexisting condition
doesn't have to be as complex as cancer. Insurance companies could deny
coverage for something as simple as allergies.
Before health reform, insurance companies could even deny coverage to
a woman if she was a victim of domestic violence and had to be treated.
That is unimaginably cruel, but it was a fact.
That is no more. Under the health reform law preexisting conditions
will no longer be a barrier to quality affordable health care. That is
over. They cannot do it. It is against the law--the law which so many
are trying to repeal.
Is there anyone here who would like to go back to the old days, those
good old days when individuals, including millions of children, were
punished for things they couldn't possibly control? They were subject
to devastating medical costs without the benefit of insurance--or their
families were. I don't think people would want to go back there, but,
of course, that is what will happen if we abandon all of this.
Let's talk now about another piece of this great effort that also is
often overlooked, and it is the coverage of young adults under the age
of 26. I know that is a particular matter the Presiding Officer likes
about this bill.
In the past, many young adults in my State and everywhere have gone
without health insurance as they made their way into the world after
graduation. That is a ticklish time. Most of these young adults are not
slackers, as they have sometimes been called. Many simply start out in
low-wage or part-time jobs that typically do not offer health coverage.
Because they were over the age of 18, and therefore technically adults,
they were not able to maintain coverage under their parents' health
insurance plan.
This meant many young adults would forfeit basic things such as
checkups or put off seeing a doctor when they had health problems in
the hope it would go away. But that is no way to live, particularly not
when 15 percent of young Americans suffer from a chronic health
condition such as depression or diabetes--yes, that young--and not when
a staggering 76 percent of uninsured adults report not getting needed
care because of cost.
Before health reform young adults represented one-third of our
Nation's uninsured population. People always think of young people as
healthy. Not so. They take risks. They end up in the emergency room
often. Think about how many young adults and their families are so much
in a better position. Why is that? That is because the law now allows
young adults, with no coverage of their own, to pay premiums and to
stay on their parents' health insurance policy up to their 26th
birthday. This applies even if they no longer live at home, if they are
no longer a student or they are no longer dependents on their parents'
tax returns. In other words, they have coverage up to the age of 26.
As a result, over 2.5 million young adults gained coverage they did
not have before--that is a fact today--including more than 16,000 young
adults in West Virginia. Those families have the peace of mind that
their families will be financially protected should an injury or an
illness occur.
It is important to know that young people suffer a lot of mental
health conditions, maybe a little bit more than the rest of the
population. We don't think about that because they are young and
therefore always ebullient. No, they are young and often troubled,
trying to figure out what life holds for them. These conditions cause
them problems, they need insurance, and they can get it.
So right off the bat, parents such as Sam Hickman from West Virginia
are able to get young adult coverage. Isn't our country a better
place--it would seem to me--when people have the security of knowing
they are covered in case of illness or injury. To me, it just makes
sense; maybe more important, to the people it brings peace of mind.
It is not all. The law provides access to free preventive health
services and easier primary care, as well as increased financial
assistance for students through new scholarships and loan repayment
programs to build a stronger health care workforce. That is a major
part of this bill.
In West Virginia, as the Presiding Officer knows, and all across the
country, particularly in rural areas, we have a shortage of various
kinds of necessary physicians and health care providers. In fact, one
of my favorite parts of this law is the significant new financial
incentives it creates to encourage young adults to go into primary
care--dentistry, pediatrics, nursing, and mental health--to precisely
address those shortages. It is in the bill.
Doesn't it make sense, given the shortage of skilled health care
professionals in this country, to make it easier for young people to
get into those well-paying stable jobs?
Health care job growth continues to be a major stabilizing factor in
our economy. Creating additional jobs in our local communities is
something many in this body have fought for in all kinds of ways--tax
credits and plans and all kinds of things--but in the meantime, health
reform tackles that problem too, just inexorably. Health care jobs
continue to grow year after year, most of them private, obviously.
Just look at the numbers from the month of February of this year. The
health care sector once again led the Nation's job growth last month,
adding about 49,000 jobs, which was about the same as the month before.
Health care is the economic engine--in fact, it kind of undergirds our
economy. It is silent, it is relentless, and it will not stop because
health care is something people cannot walk away from--the receiving of
or the providing for.
Another important group helped by health care reform is our Nation's
seniors, starting with lowering the cost of their Medicare prescription
drug coverage. That is very important in West Virginia, as the
Presiding Officer knows. Thanks to the new health care law almost
40,000 people with Medicare in West Virginia received a $250 rebate--
they have already got it--to help cover the cost of their prescription
drugs when they hit that famous doughnut hole in 2010. I will not
bother to explain that.
In 2011, more than 36,000 West Virginians with Medicare received a
50-percent discount on their covered brand-name prescription drugs when
they hit the doughnut hole. That is called very good news. Then we go
on to close the doughnut hole entirely.
This discount I am talking of resulted in an average savings of $653
per person and a total savings of over $23.5 million in our State of
West Virginia. By 2020, the law will close the doughnut hole
completely, and I think that is rather sensational news for seniors.
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Closing the doughnut hole is not all this law does for seniors. Under
the new law, seniors can receive recommended preventive services. We
talk about that all the time, and we always think it is not in a
bill. Preventive services such as flu shots, diabetes screening, as
well as new annual wellness visits--all things seniors should do but
often decline to do because of lack of access or thinking they have to
pay for it and they don't have the money. So now they can get all of
these screenings for diabetes and flu shots and all kinds of other
things for free. So far, more than 32.5 million seniors nationwide have
already received one or more free preventive services, including the
new, as I indicated, annual wellness visit, which is a very good idea
for any person.
In 2011 more than 230,000 people with Medicare in West Virginia
received free preventive services such as mammograms, colonoscopies, or
a free annual wellness visit with a doctor, and 54 million Americans
with private health insurance gained preventive service coverage with
no cost sharing, including 300,000 people in the State of West
Virginia.
The new law also provides new grants and incentives to improve health
care coordination and quality, as well as a new office, the Federal
Coordinated Health Care Office. We have to have that. I kind of wish we
didn't have to, but we do because it is a new science. This is trying
to get away from the health care system as usual, so we do have that
one little addition, sort of managing care for seniors and managing
care for individuals with disabilities and, importantly, eligible for
both Medicare and Medicaid. Those, obviously, are known as our dual-
eligibles: those who are poor enough to be on Medicaid and old enough
to be on Medicare, so they can't afford life, so to speak. They need
help and they need health care, and under this bill they get that.
There are about 8, 9, 10, 11 million of them in this country.
Many doctors, many hospitals, and many other providers are taking
advantage of the new options to help them work better as teams to
provide the highest quality care possible. That is called coordinated
care. It is new, it is important, and it is going to be really helpful.
That is good news because many chronic illnesses can be prevented or
managed better through this coordinated care. It means doctors actually
talk to each other.
The way it is now, when a patient gets an x ray taken by a dentist or
by somebody else, the patient has to carry the x ray with them--if they
can manage to get their hands on it--to go see another doctor, as
opposed to a system, such as telemedicine, which has the technology to
shoot the information over the Internet so the next doctor already has
it, so he or some of his people are thinking about what they are going
to do next. It is so important to talk to each other, but we don't.
Doctors and hospitals often operate as if in a vacuum, sort of taking
it on a case-by-case basis. That is bad for patients.
The health care law also helps stop fraud with tougher screening
procedures and stronger penalties and new technology. New technology
can catch all kinds of things. Thanks in part to these efforts, we
recovered $4.1 billion in taxpayer dollars in 2011. That was last year.
The second year's recovery hit this recordbreaking level also. West
Virginia tax dollars should not go to pay for criminals who are
defrauding the system, and the administration is cracking down on this.
Believe it or not, it is.
And I am not done. In just over 18 months, a new competitive health
insurance marketplace called an exchange--which has everybody nervous
for no reason at all; it is great news--will be up and running in West
Virginia and all across the country where individuals and small
businesses can shop for coverage in the private health insurance
market. This is not government; it is all private. An estimated 180,000
West Virginians will be eligible for $687 million in premium tax
credits to help cover the cost of private health insurance in the year
2014 when the exchanges start.
Families all over the country will finally have more power when it
comes to buying health insurance that works for them--having more power
is a big deal if you are trying to shop for health insurance--thanks to
a clear, transparent summary of benefits. Yes, you actually get to see
the choices from which you can pick. You have a list of all the
services they are going to provide. It is required by law. They can't
cheat. They can't just say: Oh, we will take care of you. Sign up with
us. We are a big insurance company.
So they get the transparent summary of benefits and coverage that
will let them compare benefits on an apples-to-apples basis, which will
come standard with every single private insurance plan, which will be
what makes up the exchanges. They will go through that, and they will
pick out what best suits them.
In fact, it is quite telling that this little-known provision I have
just talked about is the single most popular one in the entire law. I
didn't know that. Eighty-four percent of Americans think that is really
good. They like the idea of being able to choose what they are going to
get in health care coverage. The insurance companies, of course, hate
it and have been fighting with everything they have, but we have been
beating it back, Mr. President, as you would expect me to do.
What that tells me is that people are frustrated and fed up with the
confusing information they have been getting from their health
insurance companies, and they are tired of guessing games about what is
actually covered. They have a right to know, and now they can. So I
look forward to September of this year when every insurance company
finally has to come clean about what benefits are actually covered and
the products they are selling. It will be there in black and white.
They can read it, and families will obviously have much more purchasing
power in their hands.
What is wrong with that?
While opponents have gotten used to talking about how the law costs
too much, in fact, it has great provisions that will not only improve
the quality of care but also save hundreds of billions of dollars--yes,
that is true--for example, the average $2,500 discount thousands of
West Virginia small businesses received last December as a result of
the medical loss ratio rule. That was what followed the public option.
Everybody so loved the public option. They thought it was wonderful.
The only problem is that it could not get votes from the Finance
Committee, so it could not come down here and we could not do anything
about it, so we invented the medical loss ratio. It is totally
understandable, right? The question is, How does it work? Does it help
people? And it does because it says that health insurance companies are
required to spend at least 80 percent of small businesses' and 85
percent of large businesses' health insurance premium dollars on actual
medical care--not on administration, not on marble pillars, not on CEO
salaries and all of that. They have 20 percent or 15 percent to do all
of that. But if they fail to do that, they have to rebate to the
consumer, to the patient who has been paying the premiums, the fact
that they have not been abiding by this 80 percent or 85 percent law,
and that is probably going to be several billions of dollars--at the
very least, hundreds and hundreds of millions, and that is kind of like
billions--and it starts this year. I am delighted.
Now, the Independent Payment Advisory Board, or IPAB, is another
example. IPAB is not well understood and therefore not well received.
What is not understood is generally not well received. That doesn't
mean it is not good. IPAB will be made up of smart doctors, nurses, and
other health care experts who will figure out ways to improve the
quality of Medicare services and make sure the Medicare trust fund
stays strong. And IPAB is legally forbidden in this law--which the
folks across the street are now considering--from recommending cuts to
Medicare benefits or in any way increasing cost sharing on the part of
Medicare recipients. That is in the law--cannot cut benefits, no cost
sharing.
Yet the House just last week rallied behind an effort to repeal IPAB.
They didn't know what it was or they had really bad dreams about what
it was, so they repealed it and felt better. The House vote is a good
example of what happens when special interest wins and seniors lose.
The Independent Payment Advisory Board was created to protect
Medicare for seniors by improving the quality of
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Medicare services and by extending the life of Medicare for years to
come. Instead of making Medicare better, House Republicans want to
decimate the program and force seniors to pay much more and give
private health insurance companies and other special interests the
authority to raid the Medicare trust fund, which they will do in order
to pad their bottom line, which they would love to do. This would take
us exactly in the wrong direction. Every single senior in America
should be outraged.
You can even get simple things like better information about private
health insurance by just going to the Web site healthcare.gov. The
information is out there to help people shop for better coverage today.
There is so much more that has already happened and more to come,
such as the nearly $70 million in grants West Virginia has already
received for things like community health centers. We put aside $10
billion in the bill for maybe up to 1,000 new rural health care clinics
across America. As the Presiding Officer knows, in places such as
Lincoln County in West Virginia, people don't want to go to hospitals,
but they will go to clinics happily because they are on the first
floor, tend to be in buildings that used to be stores or whatever, and
they get good medical care right there.
In closing, why would we want to throw this law out the window
knowing just these facts? Think about it. The reforms here are the most
significant reforms in health care in several generations. It is an
effort that 50 years from now history will record the same way we do
Social Security or Medicare Programs--as an essential part of the
implicit promise to care for its citizens, to allow people to age with
dignity, and to find ways to make our society a better place.
So as we mark the 2-year anniversary of the health care reform law
becoming the law of the land--and the folks across the street will
decide if that stands up or not, but I think they will--I, for one, am
proud of my role in its passage and grateful that Congress came
together on such a historic issue.
I thank the Presiding Officer.
I yield the floor and note the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. KYL. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Tester). Without objection, it is so
ordered.
Mr. KYL. I ask unanimous consent to speak in morning business for up
to 10 minutes.
The PRESIDING OFFICER. Without objection, it is so ordered.
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