[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 20377-20379]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. CASEY. Mr. President, I rise today to address a topic we have 
been debating for many weeks and months but especially the last couple 
of weeks, and that is health care. We have spent a good deal of time in 
Washington talking about the details of various provisions, the 
different ideas that have been introduced in bills and through the work 
of the committee.
  I happen to be a member of the Health, Education, Labor, and Pensions 
Committee, known by the acronym ``HELP.'' In our committee, we spent 
about 60 hours in hearings and 25 hours or so in discussions with our 
Democratic and Republican colleagues, working through some ideas. We 
accepted about 160 Republican amendments before our bill came out of 
committee. As you might know, the vote in committee was 13 Democrats 
voted for it, 10 Republicans voted against it. But despite that divide 
in the vote, there

[[Page 20378]]

was a good exchange on important issues.
  Mr. President, you know as well as I do some of the issues with which 
we are wrestling. We want to try to provide the President a bill that, 
first of all, in a general sense, provides stability--stability with 
regard to cost, lowering the cost and also controlling cost, and 
stability with regard to choices. I believe what we are going to send 
to the President this fall will allow people to keep the health care 
they want to keep if they like what they have and are happy with it. 
But if you don't have any health care or you have a plan that costs too 
much or is of poor quality, you can choose another option. I hope the 
options will be both private plans and a public option, but that is a 
point of contention we will be talking a lot about as well.
  Finally, we want to make sure there is quality, at long last that we 
reach a point where we are introducing quality measures into our health 
care system. Theories and proposals and strategies have been talked 
about too much and not enacted or put into the law. There are a lot of 
good examples by private companies across the country that have 
wellness policies, that invest in keeping people healthy so they do not 
have to spend money from our health care system treating a disease--
getting out ahead of a problem, so to speak. And there is prevention, 
with all kinds of ways to save lives, to improve quality, and to save 
money as well.
  I wanted to walk through some provisions in some detail, not to take 
too much time because I know we are at the end of our week.
  First is the fundamental urgency of where we are now. I believe we 
cannot wait. We have talked this issue to death for the last 15 years 
especially, since the early 1990s. But even if you look at it beyond 
that, for about 60 years or so since President Truman introduced this 
idea of doing something substantial on health care, we have talked 
about it. The time for action is now. In my judgment, this is no longer 
just a nice thing to do. It is a necessity for our economy. We cannot 
even begin to imagine a strong economy over the next decade or longer 
without health care reform. More American families are unable to get 
the coverage they need. So where we are now, the status quo, is not 
just unacceptable, it is economically unsustainable as we debate this 
issue today.
  Let me go to the second chart with that same concept about it being 
unsustainable, the status quo, staying on the road we are on. Premiums 
have doubled over the last 9 years, three times faster than wages. If 
we do nothing in the next 30 years, a third of our economy will be 
spent on health care. That is unsustainable. Health care spending will 
increase from $2.5 trillion to $7 trillion in the period between now 
and 2025.
  This might be the most stunning set of numbers of all. Every week, 
44,230 people lose their health insurance. We cannot say that enough. 
We cannot repeat that number enough. How can we build an economy, how 
can we be a successful, vibrant, growing economy when every single week 
44,230 people lose their health insurance? We could chart this just 
from the time our committee voted the bill out of committee a couple 
weeks ago in the HELP Committee. Every week since then, more than 
44,000 are losing their health insurance.
  This is a Pennsylvania number, roughly a 3-year number. From January 
2008 to December 2010, the projection is that 178,520 people will lose 
their coverage. For our State, the Commonwealth of Pennsylvania, that 
is unsustainable. We cannot grow an economy with those numbers.
  Without reform--this is a State of Pennsylvania number--family 
coverage would cost $26,679 in 2016, consuming 51.7 percent of 
projected Pennsylvania family median income. I don't know of any family 
in America, even a very wealthy family, who can pay half their income 
to health care, certainly not a middle-income family. But that is the 
road we are on. That is going to happen if we stay where we are and 
stay with the status quo. And that is 7 years away, that is not 25 or 
30 or 50 years. In 7 years, staying on the road we are on means the 
average family in Pennsylvania is going to have to pay more than half 
their income to health care. To say that is unsustainable is something 
that is an assertion of an understatement by a mile.
  Here are some of the themes I talked about before--stable costs, 
secure choices, and quality care. These are some of the themes we have 
to keep mentioning.
  On the lower cost issue, preventing illness and disease, as I said 
before, does have a cost implication. It is not all the savings, but we 
know from research and experience that we will have savings.
  Uncompensated care. This is a factor we can consider today. People 
think: I have health care. There are uninsured people out there, maybe 
50 million people uninsured. Someone who has health care might think: I 
wish they could get coverage, but I am afraid if they get coverage, I 
am going to be paying more. That is a lot of the debate. But what we 
fail to realize sometimes in the debate is people are paying right now 
for the uninsured. Having uninsured Americans is not free. We all pay 
for that, and by one estimate, $1,000 per year for every American who 
has health insurance.
  One of the things we are trying to do in this legislation is to cover 
97 percent, or one bill might have it at 95 percent, but above 90 
percent of Americans is the goal for coverage.
  I go to the next chart on reducing waste, fraud, and abuse. One 
estimate is we could save $60 billion per year. Some say that is an 
estimate and that is just what one group said. Let's say it is wrong. 
Let's say it is not quite $60 billion. What if it is off by a little? 
What if it is $40 billion? That is still a lot of savings. What if it 
is $30 billion? What if they are way off? That is a lot of savings 
every year. But we are not doing that today, preventing that kind of 
fraud, waste, and abuse.
  Capping out-of-pocket limits. Even when they have the benefit of 
health care delivery, the out-of-pocket costs keep going up and up. So 
many small businesses worry about this when they are forced, if they 
want to employ people, to pay more and more, and forcing people to pay 
more out of their own pockets.
  Small businesses and individuals join purchasing pools for lower 
rates. The reason that is important is because all the desks in this 
Chamber--every one of us has health care, really good health care, if 
you are a Federal employee. Thank goodness. I am blessed by that health 
care. My wife and my four daughters and I all benefit from that, just 
like every Member of the Senate and every Member of the House and 
everyone who works in the Federal Government. That is good. Guess what. 
The reason we have health care and choice of lots of options and plans 
is because we pool all those people, millions of Americans who happen 
to be connected in some way to the Federal Government pool. They are in 
one pool, and that keeps costs down. Why is that good enough for 
Senators and Congressmen, why is that available to them but small 
businesses don't have the same plan or the same option available to 
them? I think every small business in America should have the benefit--
the cost-reduction benefit, at a minimum--that comes from pooling their 
resources and their individuals. That is part of the reform we are 
talking about. It is not a concept, it is in the bill. And that is 
important to emphasize.
  Finally, if you like what you have, you can keep it. I said that 
earlier. We should keep saying that because it is important.
  Ensuring coverage even when families move, lose a job, or have an 
illness--why in America, if we can figure out so many complicated 
things, can't we guarantee when someone loses their job they will not 
lose their health care? It does not make sense that we have accepted 
that, tolerated that inequity for so long.
  ``Gateway'' is a word about which we have been hearing a lot. What 
does that mean? It is really a marketplace. It allows people to go to a 
Web site and find out what they want in their health care plan, not 
having to read hundreds

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of pages of fine print that the best lawyers in America sometimes do 
not understand.
  A marketplace is a gateway that allows families and businesses to 
compare rates, benefits, plans, both private and, we hope--we hope--a 
public option. Why can you go online and learn about a car or some 
other major purchase in your life and you can't do the same thing for 
health care? It is ridiculous, in a word. That is what this would 
allow--giving people the ability to do just that, just as they do for 
every other major purchase in their life.
  Secure choices is important. Individuals will have their choice of 
doctors and individualized care. Government and insurance will not 
interfere in the doctor-patient treatment decisions. I know there is a 
lot of talk about government getting in the middle. It is just not 
true, and people know it is not true. We have to make sure people 
understand that is a fundamental building block of what we are talking 
about. We want people to be empowered, we want them to have more 
choices, and we want them to have the choice of both the public option 
and private plans as well.
  I am almost done, Mr. President. My colleague from Arizona is here, 
and I want to make sure he has his time on Friday to speak.
  This is bill language. Sometimes we talk about concepts, and the 
American people never get to the point of seeing in front of them 
language from a bill that is actually understandable and is focused on 
the real problem.
  One of the biggest problems people in our State and a lot of States 
run up against is a preexisting condition prevents them from getting 
treatment. It is unbelievable that we have tolerated that for so long 
as well. Why can't we say we are going to pass a law that at long last 
says a preexisting condition will not prevent you, your son, daughter, 
spouse, or loved one from getting the care they deserve? We should not 
have to do it. Insurance companies have forced us to legislate, to make 
this the law.
  Here is the language. It is not complicated. It is not mysterious. It 
is not lawyer language:

       A group health plan and a health insurance issuer offering 
     group or individual health insurance coverage may not impose 
     any preexisting condition exclusion . . .

  Let me read that again:

     . . . may not impose any preexisting condition exclusion with 
     respect to such plan or coverage.

  That is in the bill. It is not a fuzzy concept, it is very specific.
  One of the reasons I and so many others are saying we cannot stay on 
the path we are on, we cannot accept again and again the status quo, is 
because of that--because the status quo means ``may not impose any 
preexisting condition exclusion'' does not become part of the law and 
we have to continue to deal with the horrific and inexcusable nightmare 
of a preexisting condition preventing someone in America, someone who 
might be very sick in America, from getting treatment, from getting the 
benefit of health care they ought to have a right to expect.
  So when we pass this bill, we have to make sure people understand 
that is in the bill, and that is very specific and it is very pointed 
and focused on a real problem for families.
  Finally, children. One of the goals here, obviously, is to make sure 
that no child, especially poor children and those with special needs, 
is worse off as a result of this bill. Children are different from 
adults. They can't be treated the same way. They need strategies and 
treatments that adults don't have. They have different health care 
needs. It is critical that children, especially those who are 
disadvantaged, who happen to be poor, who have special needs, get the 
highest quality care, which they deserve. That is why I have a 
resolution as part of that which I have introduced.
  Finally, with regard to children--no child worse off. Because we want 
them to grow into healthy and productive adults, they need to get the 
highest quality care throughout their childhood. We want them to get 
from this picture in a crib to that picture getting a diploma. So we 
want them to have the kind of quality health care that will allow us to 
prevent disease and illness in a child early enough which will allow 
them to lead a productive life and get ready to contribute to our great 
economy and to our great country.
  There is a lot to do. There is still more work to do, but we need to 
continue to talk about what is in these bills and to have a vigorous 
debate. We are a long way from getting this done, but I believe we are 
on the right track. I believe it is not only important, but unless we 
do this, I think we are heading down a path that is unsustainable for 
our economy, for our country, and especially for our families.
  Mr. President, I yield the floor, and I suggest the absence of a 
quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. McCAIN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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