[Congressional Record Volume 159, Number 165 (Tuesday, November 19, 2013)]
[House]
[Pages H7247-H7250]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
The SPEAKER pro tempore (Mr. DeSantis). Under the Speaker's announced
policy of January 3, 2013, the Chair recognizes the gentleman from
Nebraska (Mr. Fortenberry) for 30 minutes.
Mr. FORTENBERRY. Mr. Speaker, thank you for the time.
I don't have to tell you all that there is a debate raging in our
country about the future of health care. I want to share, first of all,
a story that I received by email from Yvonne who lives in the town of
Firth, Nebraska, right near me. She says this:
We are a farming family of five in southeast Nebraska and
recently received notification from Blue Cross/Blue Shield of
Nebraska--an insurance company--that our insurance premiums
are increasing from $578 per month to $1,092 per month. That
is $514 more, resulting from the misnamed ``Affordable Care
Act.''
Yvonne goes on and says:
Even if I play with the numbers and drop our family income
to be eligible for subsidies, my family has never needed
government assistance in the past to pay for health
insurance. Why should we need it now, other than Washington's
interference? Would you please tell me how I am supposed to
find an extra $500 in my monthly budget to afford this new
improved policy.
Mark, who lives in Lincoln, says he is 49. He said he had his
insurance canceled, and he had a very good policy. And this is what he
had to say:
I had a $5,000 deductible policy; and after that,
everything was covered. My policy was not a junk insurance
policy. And it was canceled.
{time} 1845
Mr. Speaker, many Americans are awakening to sticker shock and are
feeling, frankly, very betrayed by the earlier comments that if you
like your health care plan, you can keep it. Clearly, there is a
significant problem here. And what has happened?
Well, Mr. Speaker, we need the right type of health care reform--
health care that is actually going to reduce costs and improve outcomes
while also protecting vulnerable persons. But what we have gotten
instead through the new law is a shift of cost to more unsustainable
spending by government, a shift of cost from one American to
[[Page H7248]]
another; and we also have a serious erosion of health care liberties.
This is another email that I received from Joan. She talked about her
son. She has maintained her son's policy--a young man--in case of a
catastrophic event so it would not be a burden to the hospital.
She said:
He does not make enough money to file taxes, but his
premium goes from $85 to $220. So my son will no longer have
insurance of any kind. My son's new policy is required by law
to include things he can never, ever use--maternity for a
male and pediatric services for an adult. Please at least
allow the insurance carriers to call this what it is--an
insurance subsidy from my son to others.
This young man is 30 years old. I don't know the circumstances of the
family as to why they are providing a policy for their 30-year-old son,
but clearly the family is trying to do the right thing and help one
another; but they are being forced by escalating costs to reconsider
the very idea of carrying health insurance themselves and doing the
right thing.
Mr. Speaker, when I was a much younger man in my twenties, I had an
individual insurance policy that I bought. I thought it was the right
thing to do. I didn't want to impose the risk of my own health care
needs--in case something went wrong--on the rest of society. And I
bought this policy. It was a pretty big burden to carry for someone in
their twenties. It was fairly expensive. So I decided to raise the
deductible to $1,000 to basically help better manage the costs.
Well, one day I had a very severe headache, and it just didn't seem
to go away; and as this went on, I decided it was necessary for me to
seek medical attention.
So thinking about it, I decided to simply bypass the family doctor,
assuming that they would probably refer me to the ear, nose, and throat
specialist. And so I made an appointment with the ENT doctor, probably
saving myself about $50 by simply going to the specialist.
When I got there, she examined me and they took an x-ray. Afterward,
the doctor said, I really can't tell from the x-ray what the problem
is. I'm going to need to do a CAT scan. I interrupted her at that
moment and injected in the conversation and said, Doctor, I understand
if you might be worried about liability and there might be this test
that is normal protocol for you to run. She interrupted me and said,
Why are you saying this to me? I said, Because I need to know if you
really need this test. I'm actually paying for it.
Again, I had the $1,000 deductible.
She said, Oh, let's think about this. I'm only looking at your
sinuses. So that means that we could probably ask one of the two
entities in town with a CT scan machine if they will widen the cross-
section and let's see if they'll give you a discount for doing that.
So she asked her assistant to help. They called both places in town,
found out the price, found out if they would lower the price based upon
a wider cross-section for this test, and one of them did. And I don't
remember the exact amount, but I think it was $75.
Mr. Speaker, I saved $75 by simply asking a simple question. The
doctor got the test that she needed and the community resource was more
properly allocated, all because I had the incentive to watch the cost.
This is one of the problems here that we have in the whole health
care debate. Because, again, the Affordable Care Act, sometimes called
ObamaCare--and there are a lot of people who want to move away from
that expression ``ObamaCare,'' and I respect that, because it has
always seemed to me to be a bit disrespectful toward the President, so
let's call it the Affordable Care Act. The Affordable Care Act shifts
costs to more government spending and actually is moving costs from one
individual to another.
Now, how did we get here?
Well, you remember in the Bush administration the number that was
being talked about was that there were 50 million Americans who were
uninsured. It has been a while now since I looked at that statistic.
From memory, as I recall, that was actually an aggregate statistic that
reflected the number of people within a year who had some trouble
accessing affordable, quality health insurance. It was not necessarily
a snapshot in time.
So the number might have been bigger than what was suggested, but it
laid the ground work for where we are now. Of course, President Obama
and the administration used that number as well; but when you parse the
number down and look at Americans who were having problems accessing
affordable, quality health insurance, whether because of preexisting
condition or some other issue, that number may have come down to
perhaps 10 million to 15 million persons.
Now that is a real problem. That is a lot of people who need help.
And the right response is to engage in policy debate that will actually
help them access affordable, quality health insurance; but we have done
so by turning the entire health care system inside out. And it is
creating havoc, sticker shock; and many Americans are feeling betrayed,
particularly those who are buying their insurance in the open market,
the individual market.
Soon, many more will be receiving the price shock who have employer-
based insurance because of a couple of factors. And what are those
factors?
First of all, in the new law what has happened is there is a
shrinkage of the age ratio. It used to be six categories, as I recall--
now it is three--by which you can price the product. That means younger
people are actually subsidizing older people. You can have a debate
about the merits of that, but that is one of the cost drivers.
Secondly, there are all types of new mandated benefits. You heard it
in the emails that I received. First of all, a very young man is having
his insurance rates skyrocket simply because he is a young male. In
Nebraska, we have one of the highest rate increases for single males.
It is second only to Arkansas. It is 220-plus percent, as I recall.
Why is that? We were somewhat a less regulated State, if you will.
But what that created were market conditions whereby a young person who
was relatively healthy could get an affordable, quality health
insurance policy that protected them from catastrophic incidents. If
they were in an accident or an unfortunate disease happened to strike
them, they were covered; but now it is pushing those policies to a
level where people are questioning as to whether or not they can afford
it. A policy designed to help people is hindering those who have been
doing the right thing from purchasing insurance.
The mandated benefits issue: as the older gentleman writing me
pointed out, I don't need maternity services. Again, those were
incorporated into the law. An inability to customize an insurance
policy based upon one's particular needs after us deciding what is a
reasonable set of basic coverages that are necessary, which used to
occur State by State.
The third is no denials. Now, this one is a little bit more sensitive
because, again, we do have Americans who are being held by this law and
who had previously been either denied because of preexisting conditions
or, for one reason or another, were having problems accessing
affordable, quality health insurance.
So as we move forward into a debate as to how we are going to reform
the system and perhaps get this right, it is necessary that we carry
forward either this way or another way. It used to be the government's
subsidy of high-risk pools in which we allowed people to have access to
more affordable insurance. Either that way or the way whereby we all
absorb the cost across insurance policies and that we take care of
people who rightfully need access.
And so there are a few embedded policies in this Affordable Care Act
that do make some sense. The first one was allowing young people to
stay on their parents' policies a little bit longer--until the age of
26. I supported that before the Affordable Care Act made sense. It
replenishes your insurance pool, helps enculturate the concept of
buying insurance at a young age, and hopefully that carries forward
into creating a more robust, dynamic marketplace.
Second is, again, dealing appropriately with people who have
preexisting conditions. There are a lot of ways to do that--either,
again, by subsidizing the market directly, since it was somewhat
broken, or absorbing the cost across all insurance products.
The third issue was removing insurance caps for those who actually
[[Page H7249]]
bumped up to their total maximum benefit.
I know of cases where families were struggling with a severe disease
condition that would meet their insurance cap. The response was they
simply had to leave their job and go find another job and get employer-
based insurance to basically start the clock over. That doesn't save
the system any money. It just burdens the family.
So those are three aspects of the current health care bill that makes
some sense, but we did not have to do so by turning the entire system
inside out and harming disproportionately large numbers of Americans
who have been doing the right thing: protecting themselves and not
relying on society for the imputed costs of their own health care risk;
who were trying in a marketplace to find the right product for
themselves, but now who have lost access to basic products like good
catastrophic coverage, which will lower costs for younger people. That
is a very strong disincentive for young people to actually enter the
insurance market, and that needs to be corrected.
I think it is also part of our responsibility, for those of us who
have said ``no'' to the Affordable Care Act and who have said there are
better ways to reform the health care system to start laying out some
specifics.
Well, one of the specifics should be that we all ought to try to
agree that the health savings account idea is a way in which we form a
hybrid model that actually benefits the marketplace, benefits
individuals, and retains the robustness of what private market
competition can give you.
Let's take, for instance, the case of the surgical procedure called
LASIK. Now, I am not aware of insurance policies that regularly carry
that procedure whereby the eye is operated on to correct vision. Large
numbers of Americans have been helped by this extraordinary
technological invention. And it appears to me from a cursory look at
that market that prices have fallen, outcomes have improved, and the
doctors who do this surgery seem to do pretty well with basically no
insurance involved.
So let's look at the health savings account model as a hybrid model
whereby we retain the government subsidy in a certain sense by allowing
people to set aside an account on a tax-free basis and they accumulate
monies that go toward their first dollar of health care costs, taking
better control over those first dollars that are expended.
Now, Mr. Speaker, I recently had a medical issue. I had a sore spot
on my ear. I didn't think much about it, but after about 3 weeks of it
being there, I thought at my age maybe it is good to get that checked.
So I went to the dermatologist, and he looked at it and he said,
Jeff, I think this is 50-50 it may be a cancerous-type condition. I
said, All right. He said, I'm going to put you on a medicine that we
can go ahead and get started now while we wait for the biopsy to come
back.
So I went to the pharmacist to get the medicine. My co-pay was $5. I
am very grateful for that. It was very easy for me, and I am thankful I
had the insurance to be able to do this. It was $5.
I asked the pharmacist, How much does this medicine cost? He said, I
don't know. Let me check. He came back and said, It's $500. I said,
Well, this is Friday. I'm not sure on Monday if I'm going to need this
medicine or not. It's 50-50. Maybe we just ought to wait, And I chose
to wait.
So on Monday the doctor called back and said it was benign--not
cancerous--nothing to worry about, and I didn't have to take the
medicine.
Well, I had no incentive not to take the medicine. The doctor didn't
necessarily think through the question with me. He didn't have to
because my co-pay was $5. Again, I am grateful for that. But the point
being that $495 of waste would have occurred in the system had I not
simply asked a question, and I didn't have an incentive to ask a
question. I was simply trying to make sure that we weren't imprudently
using that much medicine when it may go to waste; and I am glad I
turned it down.
Again, that is the point. If you have your own health savings
account, which is coupled with a catastrophic policy, two things are
occurring at once: first of all, you are controlling your first dollar
costs. You have a normal conversation with your doctor about ordinary
health care. Is this the pathway we need to go? What are our
alternatives? Who can provide those in town--maybe at a cheaper rate,
with the same quality?
For that, we need price transparency in medicine. It is an important
part of market reform that needs to occur. But if something really goes
wrong and you are on the hospital gurney getting rolled into an
operating room, you shouldn't have to pull off your mask and say, Can
somebody give me the price of the anesthesia around here? That is not
the point. That is different. That is a catastrophic condition. With
catastrophic insurance, you should be protected from having to worry
about those market dynamics.
So I think this is a good hybrid model whereby, again, the government
incents you to put a little bit of money aside in a tax-free account
which, by the way, can accumulate over time. Most people don't get sick
in their life, and a lot of this money could grow to a substantial
amount over time and actually be a supplement in retirement or a
supplement to Medicare. We have got long-term cost problems in the
Medicare program.
{time} 1900
So, again, it is thinking dynamically, creatively as to how we
restructure health care and give improved opportunities for a robust
marketplace for health insurance that doesn't just consolidate the
marketplace into fewer and fewer companies. It has been suggested that
what is happening now is this is becoming like a utility system whereby
there are going to be a few insurance carriers that work with
hospitals, and that is it. The government will have a role in setting
certain rates, and that is it. So you lose the dynamic of the
competitive model for the insurance market. We should protect people's
access. We should allow people to have access to affordable, quality
insurance and not simply be denied for preexisting conditions. There
are a lot of ways to do that. If we do that, we can keep the market
dynamic basis for controlling health care costs.
We do this in all other areas of our lives, and it is normal to us.
There is no reason that we have to put on blinders when we are dealing
with ordinary health care costs and simply submit to the system
whatever they tell us to do. There is no reason for that. What we could
see--again, if we inject this sort of competitive marketplace for
ordinary costs--is competition in the marketplace for ordinary
processes and procedures in medicine, for drugs. Then you could see,
like in the LASIK surgery example, prices falling, innovation
occurring, and a health care system making reasonable returns for its
efforts. Right now, we have a health care system that is very, very
frightened. Doctors are very frightened of the next steps in terms of
the evolving dynamic of the Affordable Care Act. You have many doctors
who are saying they are not going to be able to afford to take on any
more Medicare patients. You already have this problem in Medicaid. So
you want a robust, dynamic market in which people are innovating, in
which costs are falling, and in which health care outcomes are
improving.
Health Savings Accounts give people the opportunity to control that
first-dollar cost, but if they are really sick or have an accident,
they are protected and don't have to worry about those costs. That
makes a lot of sense to me, Mr. Speaker. In the Affordable Care Act,
unfortunately, though, what we have is a dampening of the marketplace
for the Health Savings Account idea. It ought to be exactly the
opposite. Now, there is a reasonable argument that some have made that
this is not appropriate for people who are older, who have increasing
health care costs, and who don't have the time to set enough money
aside to meet their normal, ordinary expenses--fair enough--but it is
an important model that we should be eagerly embracing for the young
generation so that they can have affordable, quality catastrophic
insurance, so that they have incentive to move into the market, and so
that the market responds to their questions as to:
Why does this cost this much? Who is providing the best service? Does
this really make sense?
With our simply trying with the diminished marketplace and with a
lack
[[Page H7250]]
of incentive to actually watch those first-dollar costs that the Health
Savings Account gives us, then there are not really those incentives
to, again, force transparency and to ask simple questions as to how you
best manage the resources that you have in partnership with the medical
community, like I did when I was trying to reduce my own costs for that
CAT scan. The doctor very willingly accommodated my request, and that
community resource was better allocated.
To me, that is a commonsense solution that we all ought to be
embracing. Instead, what we have now is a huge shift of cost to more
unsustainable government spending and to many Americans being
disproportionately hurt because of skyrocketing premiums or because
they are losing the health care that they were promised they could
keep. Now, that is simply not fair. There is a better way to fix this
system.
In the last few weeks, because of the problematic rollout of the
marketplace Web site--the ``exchange'' as it is called--it has brought
more and more attention to this issue. It is my hope, Mr. Speaker, that
we just don't get into finger-pointing and ``we told you so,'' for
those of us who are against this, but that we actually sit down and try
to construct something that is much more reasonable and fruitful for
the entire system.
Mr. Speaker, the formal definition of a ``law'' is: an ordinance of
reason given by those in authority for the common good. You have a real
question here as to the reasonableness of this law, because it is so
unfairly and disproportionately hurting a lot of people, and whether
that meets the definition of its being for the common good.
As I suggested, there are aspects of the current law that we can
retain--keeping young people on insurance longer, removing the caps on
insurance, and protecting people who have preexisting conditions. Those
should be retained, I feel; but as we move forward with a robust
debate, we ought to keep in mind: let's do everything--let's do all we
can--to give America a better path forward, the path that they deserve,
so that any health care reform meets the true definition of a truly
just law in that it promotes the common good, which means society's
well-being.
What does that common good look like?
It is a vibrant marketplace for affordable, quality insurance.
Persons who have had a condition shouldn't be denied. There should be a
dynamic by which the person controls his first-dollar cost because he
owns those dollars, and he is protected, if something really goes
wrong, through catastrophic policies.
That shift to the health care paradigm could lend itself to the right
type of reform for the next generation for Medicare, for instance. If
you have had a huge savings account accumulate over time because you
are not one of the unfortunate--you are one of the majority of people
who, fortunately, does not get stricken by something serious over your
lifetime--then you will be able to potentially use that money for your
own well-being and retirement or as a further supplement to the
Medicare program.
This is what is called ``thinking outside the box.'' Let's think
dynamically as to how these programs can mutually reinforce one
another--the current health care reform and our important health safety
nets in retirement. That is what we ought to be thinking about.
So, Mr. Speaker, I just submit these comments this evening because I
think it is important to try to unpack what has gone wrong and why and
to frame the debate in a manner that is actually constructive so that
America gets the type of health care reform that we deserve--a robust
health care system that leads the world, that improves health care
outcomes while reducing costs, and that also protects vulnerable
persons.
Mr. Speaker, I yield back the balance of my time.
____________________