[Congressional Record Volume 160, Number 86 (Wednesday, June 4, 2014)]
[Senate]
[Pages S3390-S3391]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTH CARE
Mr. BLUNT. Mr. President, I wish to talk a little bit about health
care this morning.
The majority leader has suggested in past weeks that all of these
contacts and concerns I get from Missourians are just made up--although
he didn't target Missourians and say only Missourians were making up
these stories; he just said everybody was making up these stories. But
that is clearly not true.
The law regarding health care--the law that is applied every day with
great consistency--continues to be the law of unintended consequences,
the law that so often is impacted by what we think we are doing in the
Congress, only to find that the consequences of those actions go well
beyond the discussion the Congress was having. Certainly if we had that
debate again today, the debate we had in 2009 and early 2010, the
Congress would be better prepared for that debate, the country would be
better prepared for that debate, and people would understand what is at
stake. What I see every day are things that people didn't anticipate
would happen.
Here is a letter we got from Jack in Kansas City, MO. He said:
I'm a retired hospital CEO and glad to be retired because
of Obamacare.
He points out in an absolutely correct way that in most communities
in Missouri, particularly our small and midsized communities, the
hospital is a real source of pride and place of healing, a major
employer.
Of course, the potential end result of what is happening now with the
changes we made and how hospitals are treated, particularly hospitals
in rural areas, hospitals in underserved inner-city areas, is that the
programs that were in place are basically going away. And why did they
go away? Because the President assumed and the Members of Congress, I
am sure, who voted for this piece of legislation assumed, that
everybody would be covered, that everybody would have insurance, so we
didn't need to have special programs that dealt with people who didn't
have insurance and hospitals that dealt with people who didn't have
insurance, and we didn't need special programs for underserved areas.
Clearly, that is not the case.
If we look back at the debate, many people were saying: This will not
work out the way the well-intended proponents of this law think it will
work out, and we are going to continue to have people without
insurance.
In fact, the Congressional Budget Office reiterated again just
recently that at the end of 10 years, how many people won't have
insurance? Thirty million. Thirty million people didn't have insurance
when we started, and to disrupt the entire health care tableau of the
country to add possibly 10 million, I think we are going to have people
who lose insurance at work who previously had insurance through their
work. I think that will be one of the major unintended consequences as
we approach the end of this year and go into next year.
I am talking to too many employers in Missouri who are saying there
is a place for people to go now. They can go to the exchange. We
struggled with this for a long time. Even though we are not covered by
the law, even though we don't have 50 employees, we are no longer going
to provide the insurance at work--that many of these employers have
provided for decades and others have provided over all the time they
have been in business, even if it is less than decades.
Norman from Warrensburg, MO, is concerned about what would happen
with Medicare and Medicare Advantage. He says: I was struck with
Guillain-Barre in 2005 which has left me disabled as well as other
resulting health issues. We expend more than $3,000 out of pocket
annually just for my prescriptions alone and that was under a Medicare
Advantage plan. This plus the Medicare premiums and the physician care
takes almost all of our Social Security benefits. We live in a small
community.
He describes Warrensburg as a small community of around 18,000, and
it would probably be one of those communities to lose the Medicare
Advantage type of insurance, which is the gap that he thinks allows his
family to have the health care they have and would like to continue to
have.
Paula from O'Fallon, MO, says she believes a lot of people's spouses
are going to leave their jobs because they are going to look at who has
the better insurance and try to benefit from that better insurance.
According to her, her husband's company is paying a large fine because
their insurance is better than ObamaCare. I imagine more realistically
what that letter might have said is that their insurance isn't exactly
what the Department of Health and Human Services believes is the right
kind of insurance, when the government makes these decisions instead of
the people or the people closest to them, their employers.
One of the benefits of the employer-provided system was that people
didn't have to worry about this. In fact, almost everybody looked at
their insurance and they talked with their employer and they decided
they would get more information when they needed it, and when they
needed it usually the information they got was pretty good information
for them to have.
Now we have people trying to figure out, if they have choices, a
complexity of choices and alternatives that they never had to deal with
before. Frankly, they are not going to like that, and I think one of
the other unintended consequences of this law is that people are going
to begin to say: I know a government-run program wouldn't be as good as
the health care I used to have, but I just don't want to be responsible
for it anymore. What we probably are doing is building a groundswell of
people who no longer want to be forced into the decisions they never
had to make, because 85 percent of everybody who had insurance had
insurance at work, and 90 percent of them thought the insurance they
had at work met their needs. I think we would be lucky if very far into
the Affordable Care Act, 90 percent of the people who have insurance
think the insurance they have moving forward meets their needs.
Angelyn from Dexter, MO, said her aunt and uncle are searching for a
new doctor after their doctor moved out of State. They are having
trouble finding a physician in the Dexter area that will take new
Medicare patients--another unintended consequence.
The people who voted for this bill cut Medicare itself. I wasn't for
it, but it is the law. One of the reasons I said I wasn't for it is we
are cutting a program we already knew is challenged--Medicare--by $500
billion to form a new program. There is no city council, there is no
county government, there is nowhere else in America where people would
go to a meeting and say, OK, we have a program that is in real trouble,
so what we are going to do is cut that program to start a new program--
and particularly a program such as Medicare that people have been led
to believe they can rely on. When we cut Medicare by $500 billion over
10 years something happens.
What Angelyn's aunt and uncle are seeing is one of the things that
happens is people try to find a doctor who will take Medicare only and
find doctor after doctor who says: We are going to continue to serve
the Medicare patients we have as long as they are
[[Page S3391]]
around to serve, but we are not serving new Medicare patients.
Joanna in Kansas City said her son goes to college where he is
required to have health insurance. His health insurance he gets through
the school has increased 40 percent this year.
Wayne in Moberly said his premiums and prescription drug costs have
increased and he is concerned it is because of all the new requirements
that have to be met. He said: ``The future does not look good from
where I stand as a small business owner and a farmer.''
Donna in Napoleon, MO, said her insurance had gone from $93 twice a
month to $156 twice a month. The interesting point in her letter is she
said her insurance would go up even more if she gets a chance to work
more. There is a lot to be said for assisting people to get health
insurance who cannot otherwise afford to get health insurance, but one
of the things I never heard debated in any extensive way is what
happens when people are at the edge of moving to a new level of work
which then gives them a lower level of benefit.
Donna is saying that if she gets to work more hours, she will have
less assistance buying her health insurance and her health insurance
goes up. The government should not be in the business of looking for
ways to encourage people not to work, as in the part-time work we see
all over the country now.
One of the great workplace impacts of the health care law was that
the government for the first time ever said to most employers--
employers of more than 50 people--you have to provide health insurance
to anybody who works 30 hours a week. So what did employers for the
first time hear the government saying? If someone works less than 30
hours a week, they don't have to have to provide health insurance. So
employer after employer made the decision that for new employees we are
going to hire three people at 27 or 28 hours a week rather than two
people at 40 hours. We are going to meet our workforce needs in a new
way. Consequently, those individuals don't have coverage. Many
individuals at that level of hourly work who used to have coverage no
longer have coverage. An awful lot of companies used to provide
coverage at half time--at 20 hours--but if the government says they
don't have to provide it until 30 hours, it turns out a lot of people
don't work more than 30 hours because they don't have an opportunity or
maybe they work almost 60 hours, but they have to work 60 hours at two
different jobs, as did a lady I mentioned just last week who contacted
our office.
David in Kansas City said he is retired from the railroad industry,
and on April 1 his former company canceled plans for retirees 65 and
older. David had access to a retiree plan from the railroad industry.
He doesn't have that anymore.
A lot of companies have done that, not just the railroad industry.
IBM announced they would no longer provide health care coverage for
their retirees. As soon as the retirees are 65 and older they are
placed on Medicare, but what kind of supplement do they have? They used
to have a supplement that was part of a big IBM plan and now they don't
have that anymore. UPS announced the dependents and spouses who are in
part of the UPS family wouldn't have insurance anymore. The unintended
consequences keep on coming, and we need to continually look at what we
need to do to see that people have access to great health care.
We are talking now--as we should be--about veterans health care and
how veterans could have access to great health care. This is the moment
right now where we can look at this issue in a new way. The veterans
service organizations are looking at this issue. Alternatives are good.
Veterans should have the best health care, in the best location for
them, in the best way the taxpayers can provide it.
The Veterans' Administration should be the best at some things. They
should be better than anybody else at dealing with IED accidents, eye
injuries, the loss of limbs, and other issues that are unique to
veterans in unfortunate numbers because of the kind of conflicts in
which we have been involved. Nobody should be better at that than the
VA.
The VA may be the absolute best place to go for a particular injury,
such as post-traumatic stress. Our veterans have problems because of
the conflicts they have been in, but they also have problems because
the National Institutes of Health says one out of four adult Americans
has a diagnosable mental health problem. In a hearing a couple months
ago, I asked the Secretary--the Surgeon General of the Army and the
other forces about this: Do you think that is reflected in the
military, and the answer was yes. She said: We recruit from the general
population. We don't have any reason to believe our population serving
in the military doesn't reflect similarly with regard to mental health
issues. Some of those mental health issues, such as post-traumatic
stress, the VA should be better than anybody else at, but a lot of
mental health issues in the VA, there is no reason they should be any
better than any of the other facilities. Veterans may have to drive to
another State to get to a veterans facility or have to drive 120 miles
or 150 miles in the VA's van transportation. If that is what someone
wants to do as a veteran, I think we ought to be sure veterans can do
that, but if veterans want to get better care closer to home, more
choices, we should do that.
Let the Veterans' Administration compete to be the best at what they
can provide. There is no particular reason to believe the Veterans'
Administration is going to be better than everybody in the country at
normal internal medicine. There is no reason to believe the Veterans'
Administration is going to be the best at dealing with cancer or heart
issues or other issues. If there is a veterans hospital that somehow
has figured out how to do that, fine, but don't make veterans drive 120
miles by a dozen facilities that can do just as well or better because
we have decided to put people in a system that is totally defined by
the government.
One of the things we are learning is people can make better choices
in so many areas than when the government makes those choices for them.
So as we think about our veterans, as we think about what we can do to
be sure they get the best care, that they are honored, their service is
honored in a way they were led to believe it would be honored, this is
a great time to have this discussion.
So whether it is health care for everybody else or health care for
veterans, the Congress of the United States--and the country--has
probably never been in a better position to talk about these issues. We
see the unintended consequences of taking steps in the wrong direction.
Now is a great time for our veterans and health care generally to see
what we could do to take steps in the right direction.
I note the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The bill clerk proceeded to call the roll.
The ACTING PRESIDENT pro tempore. The Senator from New York.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
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