[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Senate]
[Pages 21006-21008]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Mr. BROWN. Mr. President, I have come to the floor, much as I have 
every day for the last 3 weeks or so, to share letters from 
constituents in Ohio--from Findlay and Mansfield and Ravenna and 
Gallipolis and Bucyrus and Cleveland. These are letters from people who 
have often suffered because our health care system doesn't work for 
them.
  We understand the health care system works for many; that many people 
are pleased with their health insurance. We understand--and the Chair 
certainly does, as a member of the Health, Education, Labor, and 
Pensions Committee--that we have made sure people who have insurance 
they are satisfied with can keep that insurance. As you know, we have 
built consumer protections around those health care plans that people 
now benefit from to make sure preexisting conditions are not banned 
from coverage; to stop discrimination based on gender or age; to make 
sure insurance companies cannot throw somebody off their rolls because 
they have an annual cap on the insurance. But as we throw these words 
around on this debate, words like ``exchange'' and ``market 
exclusivity'' and ``gateway'' and ``direct negotiations'' and all these 
terms, it is important to always bring it back to people whom we know, 
people who have written letters--from Eugene, OR, or from Toledo, OH--
people who have written letters to us about the health insurance 
system. I would like to share a few of these letters today as I have 
for the last 2 or 3 weeks.
  Heather from Lorain County, the county where I live, west of 
Cleveland, writes:

       I am a resident of Elyria, OH, a Registered Nurse of 14 
     years, living with relapsing-remitting multiple sclerosis. I 
     live at both ends of the stethoscope. I am a frontline 
     witness to the disintegration of our health ``care'' system 
     both as a caregiver and as a patient. Health care is a NON-
     partisan issue, but it's been all about dollars and cents, 
     not common sense.

  She is right about that. We simply have let too many people fall 
through the cracks. We have not relied enough on nurses like Heather, 
people who deliver the care directly. We have allowed our health care 
system in that sense to get away from us.
  Mary from Jefferson County, eastern Ohio, along the Ohio River--
Steubenville is the community that is the county seat in their county.

       I am writing this on behalf of my brother, an insulin 
     dependent diabetic who is a retired factory employee in 
     Kettering, OH. He has recently been notified that he will be 
     losing most of his pension and all of his health care.

[[Page 21007]]

       I have contacted almost all health care insurance companies 
     trying to a get single coverage policy. Due to his diabetes, 
     he is excluded from any coverage and completely uninsurable. 
     His insulin alone is approximately $8,000 a year. The reason 
     is not that diabetes is a pre-existing condition but is a 
     chronic condition.
       My brother worked in the factory for over 30 years, paid 
     into the program, paid his taxes. It is a true sin that these 
     older Americans are being treated this way in our system.

  Mary writes about diabetes, which is an increasing problem in this 
country. It is an increasing health problem that afflicts so many, not 
just older people like Mary's brother but younger people too, 
especially people diagnosed with diabetes at very young ages. Our 
legislation deals with that. It deals with that particularly for 
children, on preventive care and wellness programs dealing with 
childhood obesity--all of those issues.
  It deals with people like Mary's brother in Kettering who suffer 
because of, in too many cases, a cap on coverage. If you are spending 
too much, according to the insurance company, one year, they do not pay 
any more. The rest of it comes out of pocket. Sometimes they dump you 
and you lose your insurance. That kind of discrimination by the 
insurance companies will be prohibited under our health care bill even 
if you have insurance you are happy with. We want you to stay in the 
plan if you are happy with your insurance, but we are going to build 
these consumer protections around it so things don't happen to you like 
happened to Mary's brother.
  This comes from Scott in Hamilton County--that includes Cincinnati on 
the Ohio River in southwest Ohio.

       I recently changed employers. My previous employer was not 
     required to offer COBRA. I was not aware of this and was 
     quite shocked. My new employer had a waiting period of 90 
     days before I could enroll in the employer-sponsored plan. 
     Between the time I left my old job and before I could enroll 
     in a new plan, my wife found out she was pregnant. But when 
     attempting to find new coverage, we kept being turned down 
     due to the pregnancy being deemed a pre-existing condition. 
     There should have been a better option. Please do what you 
     can to support health care reform.

  If I didn't live in this country and I didn't know that these things 
happen, I would just think they made up that story. This guy has 
insurance. He switches jobs. Between leaving his job and his next job, 
he is uninsured. His wife gets pregnant, and they can't get insurance 
because she has a preexisting condition. How stupid does that sound?
  What is wrong with out health insurance system? It has a lot of good 
things, but what is wrong with the system that allows him to fall 
through the cracks so at best she will have a pregnancy with no 
difficulties, generally good pregnancy, but still that costs thousands 
of dollars. Imagine if she has a particularly difficult pregnancy with 
all kinds of expensive care for her and for their newborn baby. Imagine 
the tens of thousands of dollars. They will go into debt because, as 
Scott from Hamilton County says, health insurance was not available 
because of this preexisting condition--his wife got pregnant.
  Dinah from Cuyahoga County, up near Cleveland, writes:

       I've been a small business owner in graphics design for 17 
     years. We always provide our employees with the best fully-
     paid health care we could afford. Throughout the whole time, 
     the cost of health care was our largest expense after 
     salaries. Business has declined----

  As it has throughout our Nation in many places----

     and we have been forced to lay off employees from our once 
     high of eight to just two of us. Now we are on the edge of 
     having to close down unless business increases soon.
       We have learned that we are in a catch-22 situation. If I 
     lay off my last employee to stay in business, we no longer 
     have two persons to qualify for a group and thus the group 
     insurance will be canceled by our insurer. Getting an 
     individual policy with reasonable coverage at age 62 is no 
     easy trick. And we have no idea if my one employee, single 
     and 40, will qualify either. We have no idea whether we will 
     be accepted or will have some kind of preexisting condition 
     we're not aware of. With two and a half years to go before 
     Medicare, I'm pretty close to my worst fears being realized.
       Fight on for the public option. Please don't give up and 
     settle for something that just puts a band aid on this huge 
     problem. So many people so desperately need your help.

  That is what we never can forget in this body when we talk about 
market exclusivity and talk about the gateway and exchange and all 
these terms--direct negotiations. We can never forget people like Dinah 
from Cuyahoga County, saying, ``So many people so desperately need your 
help.'' They need our help in this body. We have to pass this bill by 
the end of the year. She says, ``Fight on for the public option.'' She 
understands that insurance companies so often play games with people 
such as Dinah and Scott and Heather and some of the other people I will 
read letters from today.
  Mr. President, that is why you, on the HELP Committee, and why I, on 
the HELP committee, and Senator Dodd and others, why we fought for the 
public option. That is an option. What it will do is inject competition 
into the health care system, competition with insurance companies so 
that insurance companies--even though we are going to change the rules 
for insurance companies, we also know they always try to game the 
system. They want to insure you because you are healthy. They are not 
so sure they want to insure you because you might be expensive. We 
cannot let them do that anymore. That is why we are changing the rules. 
That is why we also need the public option, so the public option can 
compete and keep these insurance companies honest. Dinah gets that. Not 
all of our colleagues in this body get that. That is why it is so 
important to make sure this health care system improves so it works for 
everybody.
  Ruth from Greene County, the Xenia area in the State, sort of 
southwest Ohio, writes:

       Last year, my granddaughter Lilly was diagnosed with cystic 
     fibrosis, a fatal genetic disorder. She requires many 
     specialized enzymes and foods and three daily breathing 
     treatments to keep her lungs from deteriorating. She also 
     needs specialized care from a cystic fibrosis center and will 
     likely be hospitalized for lung infections at some point.
       Without insurance this treatment would not be possible, and 
     with insurance companies' ability to deny coverage for 
     preexisting conditions, what is her long-term ability to get 
     health coverage? Currently, her parents are changing jobs. 
     How will they get affordable health insurance for their 
     daughter is a big question.

  It appears from the letter from Ruth that her granddaughter Lilly has 
insurance right now and is getting good treatment and good medical 
care, as most Americans are at this point.
  But it seems there are two things she is talking about. One is her 
parents have had, for whatever reason, to change jobs--Lilly's parents. 
What is going to happen with their insurance when their new employer 
and their new employer's insurance company understands they have a 
daughter with cystic fibrosis? And then she asks a question that is 
just as crucial: What happens to Lilly when she gets older? What 
happens to somebody who has a chronic health condition such as cystic 
fibrosis or anything else? When they get to be adults, what happens to 
them? What happens to their ability to get health care coverage?
  That is why the public option is so important, why our bill is so 
important. The public option will compete with private insurance 
carriers to make sure they stay honest, that they do not dump people 
like Lilly, so they do not play this preexisting condition game, so 
they don't game the community rating system, so they don't discriminate 
against people because of gender or geography or age or anything else.
  The last two letters I would like to read are actually both from 
physicians.
  Michael, from Montgomery County, the Dayton area, writes:

       As a physician I see what happens to people every day when 
     they cannot get health insurance. I see the abuses they 
     suffer at the hands of the greedy insurance companies. I also 
     see constant erosion in payments to doctors, hospitals, and 
     all health care providers. The only thing that is increasing 
     is the redtape. The redtape doesn't provide care. It takes 
     caregivers away from patients.

  Michael is a medical doctor in Montgomery County in southwest Ohio. 
Michael understands, because he has been victimized by it, he has been 
harassed

[[Page 21008]]

by it, he has been annoyed at best by it, that he deals and his office 
deals with all kinds of insurance company redtape.
  Mr. President, I have heard you actually talk about it in committee. 
You know Medicare has less than 5 percent administrative costs. The 
paperwork for Medicare is much less than the paperwork Michael's office 
has to do, dealing with hundreds and hundreds of different insurance 
companies. Medicare keeps its administrative costs under 5 percent. 
Insurance companies' administrative costs are 15, 20, sometimes even 30 
percent. That is the redtape he is talking about.
  Medicare is not perfect. Medicare has redtape. It needs to be 
streamlined every way we can do that so it is simpler and cleaner, the 
way we need to build the public option to be.
  But we also know private insurance has huge administrative costs, 
huge salaries for their executives. People have come down to the floor 
and read what the salaries are of United Health and some of the other 
insurance companies--Aetna, CIGNA--the top executive salaries, often 
into the tens of millions of dollars each. We know they have those 
kinds of administrative costs. We know they have the profits they make. 
Fine, they should make profits, but sometimes they are excessive.
  We also know they have costs for huge numbers of people in these 
private insurance companies who are there to deny care. When did you 
ever hear Medicare turn somebody down for a preexisting condition? I 
don't think it has ever happened. When did you ever hear Medicare say: 
Sorry, you are spending more than your cap; that is the end; we are not 
going to take care of you. The fact is, the preexisting condition, the 
denial of coverage because of your gender or your age or your 
geography, doesn't happen with Medicare. It does happen with private 
insurance.
  Michael understands that when he writes. He talked about the greedy 
insurance companies. Not all of them are but some are, and some of the 
executives are way overpaid. We know that.
  Most important, we need to cut through the redtape. That is why the 
public plan, competing with the private insurance plans, will make the 
private plans better, and, frankly, the energy and the dynamism of the 
private plans probably will make the public option better too. That is 
the whole point of competition.
  The last letter I will read comes from Ellen from Cuyahoga County, 
the Cleveland area.

       I am a physician and a partner in a small business that 
     offers health care benefits to its employees. For them, but 
     most as a wife of a cancer survivor, I feel there is no more 
     important issue than health care. We must provide affordable 
     health care to all Americans.

  We hear it from doctors, we hear it from a nurse, we hear it from 
patients, we hear it from family members, family members who care 
deeply about their family and what it has done to them.
  We are about to leave here for the next month. When we come back in 
September, there is a deadline on negotiations in the Finance 
Committee. If the six--three Democratic and three Republican Senators--
do not come to agreement, it is time to move forward with the Health, 
Education, Labor, and Pensions bill we wrote. Our bill, as you recall, 
is a bipartisan bill. Our bill that we passed out of the HELP Committee 
went through 11 days of markup, 11 days of considering amendments, 
debating, discussing, arguing--whatever we do when we get together. 
Never in my 17 years in the House of Representatives and the Senate 
have I seen a bill have that much attention, have that many amendments, 
spend that long working on it. This bill has been vetted. We know the 
ins and outs of it.
  We accepted 161 Republican amendments. Some of them were minor, some 
of them were major amendments. The Republicans did not win on some of 
the big issues, but the big issues were decided, in many ways, by the 
election. The big issues are things such as, should there be a 
Medicare-like plan or should we continue the privatization of Medicare, 
which is what Republicans want to do. There are very big differences 
there.
  But the fact is, this bill is a bipartisan bill. It came out of 
committee with a strong vote. We know it will cover almost every 
American. We know it will bend the cost curve down so we will begin to 
save money. We know it will ban all kinds of insurance company gaming 
of the system, provide consumer protections for people who now have 
health insurance that they are generally satisfied with, and make sure 
those people do not lose their insurance because of preexisting 
conditions or discrimination.
  We have work to do after being back in Ohio and the Chair back in 
Oregon for the next month. It is important we get back to work, after 
listening to our constituents and getting more input on these bills. It 
is important that we go back to work in September and pass health care 
legislation.
  I yield the floor, and I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SESSIONS. 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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