[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.

[[Page S2044]]

  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

[[Page S2045]]

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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