[Congressional Record Volume 159, Number 180 (Wednesday, December 18, 2013)]
[Senate]
[Pages S8978-S8981]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. McCAIN:
  S. 1851. A bill to provide for incentives to encourage health 
insurance coverage, and for other purposes; to the Committee on 
Finance.
  Mr. McCAIN. Mr. President, I am introducing the Empowering Patients 
First Act, companion legislation to H.R. 2300, introduced in the House 
of Representatives by Congressman Tom Price. I thank Congressman Price 
for all the hard work he did on this legislation. I am very grateful 
for that.
  I believe this legislation would give patients, families, and doctors 
the power to make medical decisions, and not Washington.
  Specifically, this legislation would enable everyone to purchase 
health insurance through deductions, credits, or advanceable credits; 
equalize tax treatment of employer-sponsored plans and plans purchased 
by individuals by letting individuals buy health insurance

[[Page S8979]]

with pre-tax dollars; let small business owners band together across 
State lines through association health plans, known as AHPs, and take 
advantage of the increased purchasing power which larger businesses are 
able to take advantage of through increased bargaining power, volume 
discounts, and administrative efficiencies. It would let consumers buy 
insurance across State lines, and let individuals own their insurance 
like a 401(k) plan so they can take it with them across State lines if 
they change jobs.
  I don't think there is any doubt in the majority of Americans' 
minds--and poll after poll indicates--that ObamaCare is a failure. The 
American people do not believe in it. And it isn't just the problems 
with the rollout of the Web site--it is all of the aspects of it which 
have become so complex and so difficult.
  Basically, it is as some of us who fought it day after day here on 
the floor said: an experiment in social engineering, where young people 
who are healthy are going to pay for the health care of those who are 
older and sicker--a redistribution of wealth that then-Senator Obama 
favored and stated when he was running for President.
  That is not the way to address health care needs in America. It has 
not bent the health care curve down. It has not allowed people, if they 
want to keep their insurance, to be able to keep it. I noticed that was 
voted as the biggest lie of the year by one of the periodicals here. 
And it is a failure.
  We on the other side of this issue are also required to come up with 
alternatives, because we vowed to repeal and replace ObamaCare, not 
just repeal it. I believe that what Congressman Price has introduced, 
and what I am introducing today as a companion bill, is a step in that 
direction.

  It is time that we on this side of the aisle came up with our agenda 
for health care in America because we know that the inflation 
associated with health care costs is unsustainable, that there are 
millions of Americans who do not have health care, and there is a 
particular problem for those with preexisting conditions.
  We need to repeal this horrendous mistake--which, by the way, was 
done on strictly party line votes, the first entitlement program ever 
enacted that was done without a single bipartisan vote on it. As many 
of us predicted back in 2009 when this legislation was passed, it was 
doomed to failure. Time after time, amendment after amendment, as we 
attempted to repeal it for 25 days, I believe it was, of floor 
consideration back in 2009, it was voted down on a party line basis.
  They sowed the wind and are now reaping the whirlwind. We need to 
repeal the Affordable Care Act, and we need to replace it because 
health care in America is still not satisfactory, nor have we fulfilled 
the needs and the obligations we have to all of our citizens.
  The problems with the Affordable Care Act are well known: A failed 
Web site rollout that has hindered enrollment and the purchase of 
mandated coverage. As of December 17, only an estimated 440,835 people 
have enrolled for a health plan. That is 6.2 percent of the enrollment 
goal of 7 million by March 31, 2014.
  There is a destructive tax on medical devices that will discourage 
innovation and encourage these businesses to move offshore. We have 
already seen medical device manufacturers leaving the United States of 
America as they said they would if they were taxed to the point where 
they could not be competitive with medical devices that were 
manufactured in foreign countries.
  There is disappointment for Americans who are happy with their 
current coverage and want to keep their coverage. It is estimated that 
10 million Americans will have their health plans terminated due to 
ObamaCare.
  According to a December 17 Washington Post-ABC poll, only 19 percent 
of Americans believe ObamaCare is improving the country's health care 
system. Only 8 percent believe ObamaCare is improving their insurance 
coverage. Only 5 percent of Americans believe their health care costs 
are decreasing as a result of ObamaCare, and 47 percent of Americans 
believe the President's health care law is increasing the cost of their 
health care.
  It is clear that ObamaCare is not working for the American people, 
and they have little faith in the administration's efforts to fix our 
broken health care system.
  This legislation I am introducing today makes the purchase of health 
care financially feasible for all Americans--from deductions to 
advanceable, refundable credits so that everyone has an economic 
incentive to purchase coverage they want for themselves and their 
families, not what the government forces them to buy. In addition, it 
allows greater choices in portability, so that every health policy is 
owned by the patient, regardless of who pays. This means the coverage 
would go with the person if they change or lose their job. It gives 
employers more flexibility in the benefits offered and provides many 
more coverage options for people with preexisting conditions so that no 
one is priced out of the market, regardless of health status.
  It addresses increasing costs by clamping down on abusive lawsuits, 
ends the practice of defensive medicine, gains significant savings from 
health care efficiencies--sifting out waste, fraud, and abuse--and 
bringing our Nation's budget under control.
  Finally, it establishes doctor-led quality measures, ensuring that 
patients receive quality care defined by people who know medicine, not 
by government. It encourages healthier lifestyles by giving employers 
and health policies more flexibility to offer discounts for healthy 
habits through wellness and prevention programs.
  If enacted, this legislation would save trillions of dollars. Douglas 
Holtz-Eakin, who is the former director of the Congressional Budget 
Office and one of the most credible people in this town, estimates this 
legislation would save American tax payers $2.37 trillion in its first 
decade alone. According to the analysis of Mr. Holtz-Eakin, compared to 
current law this legislation would produce smaller premium increases on 
average, yielding lower premiums than current law--nearly 19 percent 
for single policies and up to 15 percent for family policies; increase 
patient access to physicians; produce a 10-percent increase in medical 
productivity; and increase the number of insured individuals by 29 
percent.
  Americans are looking for an alternative to ObamaCare. This 
legislation is a step in the right direction and will provide Americans 
an alternative that empowers patients, families, and doctors to make 
the medical decisions, not those in Washington, DC.
  I find of interest in the Wall Street Journal an opinion piece 
entitled ``ObamaCare's Troubles Are Only Beginning,'' by Michael 
Boskin, a very well respected economist. It says:

       Be prepared for eligibility, payment and information 
     protection debacles--and longer waits for care.

  He says:

       The shocks--economic and political--will get much worse 
     next year and beyond. Here's why: The ``sticker shock'' that 
     many buyers of new, ACA-compliant health plans have 
     experienced--with premiums 30% higher, or more, than their 
     previous coverage--has only begun. The costs borne by 
     individuals will be even more obvious next year as more 
     people start having to pay higher deductibles and copays.
       If, as many predict, too few healthy young people sign up 
     for insurance that is overpriced in order to subsidize older, 
     sicker people, the insurance market will unravel in a ``death 
     spiral'' of ever-higher premiums and fewer signups. The 
     government, through taxpayer-funded ``risk corridors,'' is on 
     the hook for billions of dollars of potential insurance-
     company losses. This will be about as politically popular as 
     bank bailouts.
       The ``I can't keep my doctor'' shock will also hit more and 
     more people in coming months. To keep prices to consumers as 
     low as possible--given cost pressures generated by the 
     government's rules, controls and coverage mandates--insurance 
     companies in many cases are offering plans that have very 
     restrictive networks, with lower-cost providers that exclude 
     some of the best physicians and hospitals.

  Finally, there is an article entitled ``Second wave of health care 
plan cancellations looms.'' It goes on to say:

       An analysis by the American Enterprise Institute, a 
     conservative think tank, shows the administration anticipates 
     half to two-thirds of small businesses would have policies 
     canceled or be compelled to send workers into the ObamaCare 
     exchanges. They predict up to 100 million small and large 
     business policies could be canceled next year.

  I ask unanimous consent these articles be printed in the Record.
  It is time for us to begin to consider alternatives and recognize 
that this legislation needs to be repaired and replaced.
  I yield the floor.

[[Page S8980]]

                            [Dec. 15, 2013]

                ObamaCare's Troubles Are Only Beginning


    Be prepared for eligibility, payment and information protection 
                  debacles--and longer waits for care.

                         (By Michael J. Boskin)

       The White House is claiming that the Healthcare.gov website 
     is mostly fixed, that the millions of Americans whose health 
     plans were canceled thanks to government rules may be able to 
     keep them for another year, and that in any event these 
     people will get better plans through ObamaCare exchanges. 
     Whatever the truth of these assertions, those who expect 
     better days ahead for the Affordable Care Act are in for a 
     rude awakening. The shocks--economic and political--will get 
     much worse next year and beyond. Here's why:
        The ``sticker shock'' that many buyers of new, ACA-
     compliant health plans have experienced--with premiums 30% 
     higher, or more, than their previous coverage--has only 
     begun. The costs borne by individuals will be even more 
     obvious next year as more people start having to pay higher 
     deductibles and copays.
       If, as many predict, too few healthy young people sign up 
     for insurance that is overpriced in order to subsidize older, 
     sicker people, the insurance market will unravel in a ``death 
     spiral'' of ever-higher premiums and fewer signups. The 
     government, through taxpayer-funded ``risk corridors,'' is on 
     the hook for billions of dollars of potential insurance-
     company losses. This will be about as politically popular as 
     bank bailouts.
       The ``I can't keep my doctor'' shock will also hit more and 
     more people in coming months. To keep prices to consumers as 
     low as possible--given cost pressures generated by the 
     government's rules, controls and coverage mandates--insurance 
     companies in many cases are offering plans that have very 
     restrictive networks, with lower-cost providers that exclude 
     some of the best physicians and hospitals.
       Next year, millions must choose among unfamiliar physicians 
     and hospitals, or paying more for preferred providers who are 
     not part of their insurance network. Some health outcomes 
     will deteriorate from a less familiar doctor-patient 
     relationship.
       More IT failures are likely. People looking for health 
     plans on ObamaCare exchanges may be able to fill out their 
     applications with more ease. But the far more complex back-
     office side of the webssite--where the information in their 
     application is checked against government databases to 
     determine the premium subsidies and prices they will be 
     charged, and where the applications are forwarded to 
     insurance companies--is still under construction. Be prepared 
     for eligibility, coverage gap, billing, claims, insurer 
     payment and patient information-protection debacles.
       The next shock will come when the scores of millions 
     outside the individual market--people who are covered by 
     employers, in union plans, or on Medicare and Medicaid--
     experience the downsides of ObamaCare. There will be longer 
     waits for hospital visits, doctors' appointments and 
     specialist treatment, as more people crowd fewer providers.
       Those with means can respond to the government-driven 
     waiting lines by making side payments to providers or seeking 
     care through doctors who do not participate in insurance 
     plans. But this will be difficult for most people.
       Next, the Congressional Budget Office's estimated 25% 
     expansion of Medicaid under ObamaCare will exert pressure on 
     state Medicaid spending (although the pressure will be 
     delayed for a few years by federal subsidies). This pressure 
     on state budgets means less money on education and 
     transportation, and higher state taxes.
       The ``Cadillac tax'' on health plans to help pay for 
     ObamaCare starts four years from this Jan. 1. It will fall 
     heavily on unions whose plans are expensive due to generous 
     health benefits.
       In the nearer term, a political iceberg looms next year. 
     Insurance companies usually submit proposed pricing to 
     regulators in the summer, and the open enrollment period 
     begins in the fall for plans starting Jan. 1. Businesses of 
     all sizes that currently provide health care will have to 
     offer ObamaCare's expensive, mandated benefits, or drop their 
     plans and--except the smallest firms--pay a fine. Tens of 
     millions of Americans with employer-provided health plans 
     risk paying more for less, and losing their policies and 
     doctors to more restrictive networks. The administration is 
     desperately trying to delay employer-plan problems beyond the 
     2014 election to avoid this shock.
       Meanwhile, ObamaCare will lead to more part-time workers in 
     some industries, as hours are cut back to conform to 
     arbitrary definitions in the law of what constitutes full-
     time employment. Many small businesses will be cautious about 
     hiring more than 50 full-time employees, which would subject 
     them to the law's employer insurance mandate.
       On the supply side, medicine will become a far less 
     attractive career for talented young people. More doctors 
     will restrict practice or retire early rather than accept 
     lower incomes and work conditions they did not anticipate. 
     Already, many practices are closed to Medicaid recipients, 
     some also to Medicare. The pace of innovation in drugs, 
     medical devices and delivery is expected to slow 
     significantly, as higher taxes and even rationing set in.
       The repeated assertions by the law's supporters that nobody 
     but the rich would be worse off was based on a beyond-
     implausible claim that one could expand by millions the 
     number of people with health insurance, lower health-care 
     costs without rationing, and improve quality. The reality is 
     that any squeezing of insurance-company profits, or reduction 
     in uncompensated emergency-room care amounts to a tiny 
     fraction of the trillions of dollars extracted from those 
     people overpaying for insurance, or redistributed from 
     taxpayers.
       The Affordable Care Act's disastrous debut sent the 
     president's approval ratings into a tailspin and 
     congressional Democrats in competitive districts fleeing for 
     cover. If the law's continuing unpopularity enables 
     Republicans to regain the Senate in 2014, the president will 
     be forced to veto repeated attempts to repeal the law or to 
     negotiate major changes.
       The risk of a complete repeal if a Republican takes the 
     White House in 2016 will put enormous pressure on Democratic 
     candidates--and on Republicans--to articulate a compelling 
     alternative to the cost and coverage problems that beset 
     health care. A good start would be sliding-scale subsidies to 
     help people buy a low-cost catastrophic plan, purchasable 
     across state lines, equalized tax treatment of those buying 
     insurance on their own with those on employer plans, and 
     expanded high-risk pools.
                                  ____


                     [From FoxNews, Nov. 20, 2013]

             Second Wave of Health Plan Cancellations Looms

       A new and independent analysis of ObamaCare warns of a 
     ticking time bomb, predicting a second wave of 50 million to 
     100 million insurance policy cancellations next fall--right 
     before the mid-term elections.
       The next round of cancellations and premium hikes is 
     expected to hit employees, particularly of small businesses. 
     While the administration has tried to downplay the 
     cancellation notices hitting policyholders on the individual 
     market by noting they represent a relatively small fraction 
     of the population, the swath of people who will be affected 
     by the shakeup in employer-sponsored coverage will be much 
     broader.
       An analysis by the American Enterprise Institute, a 
     conservative think tank, shows the administration anticipates 
     half to two-thirds of small businesses would have policies 
     canceled or be compelled to send workers onto the ObamaCare 
     exchanges. They predict up to 100 million small and large 
     business policies could be canceled next year.
       ``The impact I'm mostly worried about is on small young, 
     entrepreneurial firms that will suddenly face much higher 
     health insurance premiums if they want to offer health 
     insurance to their employees,'' said AEI resident scholar 
     Stan Veuger. ``I think for a lot of other businesses . . . 
     they can just send their employees to the exchanges or offer 
     them a fixed subsidy every month to buy health insurance 
     themselves.''
       Under the health care law, businesses with fewer than 50 
     workers do not have to provide health coverage. But if they 
     do, the policies will still have to meet the benefit 
     standards set by ObamaCare.
       As reported by AEI's Scott Gottlieb, some businesses got 
     around this by renewing their policies before the end of 
     2013. But the relief is temporary, and they are expected to 
     have to offer in-compliance plans for 2015. According to 
     Gottlieb, that means beginning in October 2014 the 
     cancellation notices will start to go out.
       Then, businesses will have to either find a new plan--which 
     could be considerably more expensive--or send workers onto 
     the ObamaCare exchanges.
       For workers, their experience could mirror that of the 5 
     million or so on the individual market who already received 
     cancellation notices because their plans did not meet new 
     standards under the Affordable Care Act.
       President Obama announced last week that insurance 
     companies could offer out-of-compliance plans for another 
     year. But that only means the cancellation notices will 
     resume late next year.
       Obama met Wednesday with state insurance commissioners 
     about the change. In a statement afterward, National 
     Association of Insurance Commissioners President Jim Donelon 
     voiced concern with the change but said: ``We will work with 
     the insurance companies in our states to implement changes 
     that make sense while following our mandate of consumer 
     protection.''
       The business community has already been hit with another 
     side effect from ObamaCare. Because the law will require 
     businesses with more than 50 full-time workers to offer 
     health coverage, there are reports that companies are 
     shifting employees to part-time status to avoid hitting the 
     threshold.
       Though the administration describes these accounts as 
     anecdotal--and has already delayed the employer mandate by a 
     year--studies suggest otherwise.
       The International Franchise Association and the U.S. 
     Chamber of Commerce have studied the impact and say the 
     president's health care law has resulted in higher costs and 
     fewer full-time positions.
       A survey showed 31 percent of franchise businesses, and 12 
     percent of non-franchise businesses, have already reduced 
     worker hours. It also showed 27 percent of franchise 
     businesses, and 12 percent of non-franchise businesses, have 
     replaced full-time workers with part-time employees.

[[Page S8981]]



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