[Congressional Record Volume 160, Number 33 (Thursday, February 27, 2014)]
[Senate]
[Pages S1235-S1236]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROBERTS:
  S. 2064. A bill to provide for the repeal of certain provisions of 
the Patient Protection and Affordable Care Act that have the effect of 
rationing health care; to the Committee on Finance.
  Mr. ROBERTS. Mr. President, I come to the floor today to discuss 
ObamaCare provisions that should be keeping my colleagues and all 
Americans up at night. Obviously, my views are very different from my 
colleagues who have just propounded their views on the same subject.
  Unfortunately, since the implementation of ObamaCare began, the 
stories and reports have only confirmed the many warnings that I and 
many of my colleagues made during the debate. Most of the stories 
Kansans tell me now involve many hundreds of dollars in increases in 
monthly premiums or people simply losing their coverage. These are real 
stories from real Kansans, and they are not lies.
  Compounding the problem, this administration has made it a routine 
practice to do what we call a regulations dump on Friday. This is a 
deliberate posting of sometimes thousands of pages of regulations 
during the time when the American public and the press is least likely 
to be paying attention.
  Most recent reports from the Centers for Medicare and Medicaid 
Services--what we call CMS--are that millions of small businesses will 
face increased premium rates under ObamaCare. The President promised to 
make it easier for small businesses to offer coverage and, lo and 
behold, it may even become impossible for them to do so.
  Then there are the cuts our seniors are about to face to their 
Medicare plans. We can't forget that the President pilfered--that is a 
good word, pilfered--$1 trillion from Medicare to pay for ObamaCare. 
These cuts have been delayed, but the most recent regulation on Part D 
and Medicare Advantage will be extremely detrimental to seniors' access 
to the availability of Medicare plans. And because of this, for once--
for once--I wish to speak about a subject where we get ahead of the 
curve, get in front of the next disaster, and repeal specific 
provisions of this law that I think will be most harmful to patients.
  I have talked before about how this law comes between patients and 
doctors, but I think we need to bring more attention to the specter of 
what I call rationing--yes, rationing. In the absence of complete 
repeal, I urge my colleagues that these provisions must be repealed.
  During the health care reform debate, and many times since then, I 
have spoken at length about rationing. Specifically, I want people to 
know about what I refer to as the four rations that are included in 
ObamaCare. Yes, this is a very real threat. And, yes, they will ration 
care.
  Let me start with something called the Centers for Medicare and 
Medicaid Services Innovation Center. That is a pretty big, fancy 
government name. The Center has an enormous budget to match, aimed at 
finding innovative ways to reform payment and the delivery of health 
care. That sounds very good, but what this means is that the 
``innovation center'' can now use taxpayer dollars to invest in ways to 
reduce patient access to care.
  Let me say that again. The government can now use taxpayer dollars to 
invest in ways to reduce patient access to care. It gives the 
government new powers to cut payments to Medicare beneficiaries with 
the goal to reduce program expenditures. The reality is they are going 
to reduce patients' ability to access the care they want and need--all 
hidden under the cloak of innovation. And that isn't innovation at all. 
Even if they did give it a fancy title, folks, it is smoke and mirrors. 
This outfit is already pushing out all of the regulations to implement 
ObamaCare that are now hurting patients--all the regulations we hear 
about from our health care providers.
  Let me move to the second ration. It grants new authorities to the 
U.S. Preventive Services Task Force--that is another nice-sounding 
entity with a long title. This Preventive Services Task Force used to 
be a body that was scientific and academic, that reviewed treatment, 
testing, and prevention information, and made recommendations for 
primary doctors. Nothing is wrong with that. It used to be an academic 
body that made recommendations, not a body pushing through mandates and 
regulations. Many would argue that is still what they do today. 
However, the effect of their recommendations is they are significantly 
more costly and burdensome. Because of ObamaCare, the task force can 
now decide what should and, more importantly, should not be covered by 
health plans. That is not prevention, that is rationing. If the task 
force doesn't recommend it, then it won't be covered by health plans 
and patients bear the cost of the procedure. We are seeing this already 
with things such as prostate exams and mammograms for breast cancer 
which have been so helpful to so many people--saved their lives.
  The third rationer is the Patient Centered Outcomes Research 
Institute. Yes, that is another mouthful. This is the outfit that was 
given millions and millions of dollars to do comparative effectiveness 
research. I am not opposed to research. I don't know anyone in this 
body who is opposed to research, especially when it is used to inform 
the conversation between doctors

[[Page S1236]]

and their patients. But there is a reason this was formerly called 
cost-effective research. There is a very fine line between providing 
information to doctors and patients to determine the best course of 
care and using that information to decide whether the care or treatment 
is worth paying for. I have long been concerned that instead this 
research will be abused to arbitrarily deny patients access to 
potentially lifesaving treatments or services. That simply should not 
happen. The research should only be used for the doctor and the patient 
to make the best health care decision.
  Finally, the fourth rationer--my personal nemesis--the Independent 
Payment Advisory Board--IPAD. This is a board made up of 15 unelected 
bureaucrats who will decide what gets to stay and what gets to go in 
Medicare coverage. They will decide which treatments and services will 
be covered and which will not, with no accountability whatsoever.
  When proposed, supporters of the health care law told me: We are too 
close to our constituents. It is too difficult to make the hard 
decisions.
  Then they said: Let's have somebody else do it.
  That was during the debate with regard to IPAD.
  I couldn't believe it. I believe we are elected to make the hard 
decisions and take care of the hard votes, and I believe that is the 
way Kansans want it, and I think that is the way virtually everybody in 
every other State wants it. This board diminishes our constitutional 
responsibility.
  Even worse is the fine print of the Independent Payment Advisory 
Board, or IPAD. If Kansans or any Americans determine they do not like 
the direction the board is taking and they call my office and, down the 
road, any other office of any other distinguished Senator to ask me to 
do something about it--which is what you get when you go back home on 
any regulation today: what are you going to do about it?--it will take 
60 votes in the Senate to overturn their decision--60.
  On the surface this sounds OK until you realize that the President 
doubtless will never support Congress overturning the recommendation of 
this board made up of his bureaucrats. So he will veto it, and 
overriding a veto, obviously, takes a two-thirds vote. That is 66 votes 
to overturn a decision by the payment board.
  My colleagues have been changing the rules around here because they 
think 60 votes is too high a threshold. What are the chances of 
reaching 66? But wait. There is even more. If the Secretary appoints a 
board unable to make recommendations for cuts to Medicare--tough 
decisions, albeit--then she gets the authority to make the decision of 
what to cut, one person.
  This President has already cut $\1/2\ trillion from Medicare to pay 
for ObamaCare and gave himself the ability to go after even more 
Medicare dollars and have no accountability. This, my friends, is 
frightening; it is ridiculous; it is irresponsible; but it is not new.
  I have been talking about the four rationers for a long time and what 
it means to patients, especially senior patients.
  What upsets me, scares me, as I watch all the other warnings and 
broken promises come true, is what is going to happen to Kansans and 
all the folks back home when the warnings about the four rationers come 
true.
  We need to protect the all-important doctor-patient relationship, 
which the four rationers put at risk. That is why today I come to the 
floor to introduce the Four Rationers Repeal Act of 2014.
  For once, look beyond the current troubles we are experiencing. We 
have to get ahead of the curve. This legislation repeals the 
Independent Payment Advisory Board; it repeals the euphemistically but 
misleadingly named Innovation Center; it repeals the changes made to 
the Preventive Services Task Force; and it makes sure any--any--
comparative effectiveness research, called CER, is used by the doctor 
and patient, not coverage providers or CMS, to determine the best care 
for patients.
  This legislation is relatively simple. It should be supported by all 
of my colleagues to address some of the egregious changes from 
ObamaCare that are about to happen just around the bend. It is time to 
get ahead of the curve this time, prevent it.
  I really believe that in order to protect this all-important doctor-
patient relationship, we need to repeal and, most importantly, replace 
ObamaCare with the real reforms that work for Kansans and all 
Americans.
  However, in the meantime we can also start taking it down, piece by 
piece, which is what my Four Rationers Repeal Act does. I urge my 
colleagues to support this proposal. For once, let's get ahead of the 
curve.
                                 ______