[Congressional Record (Bound Edition), Volume 157 (2011), Part 1]
[Senate]
[Pages 1286-1288]
[From the U.S. Government Publishing Office, www.gpo.gov]




                            A SECOND OPINION

  Mr. BARRASSO. Mr. President, I come today to the Senate floor as a 
physician who has practiced medicine in Wyoming for a quarter of a 
century, taking care of the families of Wyoming, and to do what I have 
done throughout the past year--provide a doctor's second opinion on 
this health care law people across the country are now coming to grips 
with as they finally are realizing what is in the bill or, as the 
former Speaker of the House, Nancy Pelosi, once said: First you have to 
pass it before you get to find out what is in it.
  People are finding out what is in it, and people all across the 
country are not happy. We know what the American people want. I know 
what the people of Wyoming want in terms of health care. They want the 
care they need from the doctor they want at a cost they can afford. 
That was the goal many of us had over a year ago when we started this 
discussion and debate on the Senate floor. What ultimately got passed--
and many people believe crammed down the throats of the American 
people--is now a health care law where people are at risk of losing 
what they want and what they have.
  The promises made by the President are such that they have turned to 
be, in many ways, unfulfilled. The President said this would actually 
drive down the cost of care--the health care law--that insurance rates 
would go down $2,500 per family. What people have seen all across the 
country is the cost of their health care insurance rates going up 
instead of down. The President said: If you like the care you have, you 
can keep it. Now we know that a majority of people who get their health 
insurance through their work are not going to be able to keep the 
coverage they have liked.
  So I come to the floor with my colleague, Senator Graham, because we 
have introduced a bill, S. 244, the State Health Care Choice Act, which 
allows States to make a decision to say: Is this something we want in 
our State?
  I will turn to my colleague from South Carolina before getting into 
the specifics. I know the Senator has visited with his Governor about 
the concerns his Governor has, a newly elected Governor who has 
concerns and actually addressed those concerns with the President about 
the health care law and the mandates on the people of South Carolina.
  So I would ask my friend and colleague, are there things we as a body 
ought to be considering to make life easier for the people of his home 
State of South Carolina? And I can talk about things for Wyoming as 
well.
  Mr. GRAHAM. Yes. If I may, Mr. President.
  The PRESIDING OFFICER. The Senator from South Carolina.
  Mr. GRAHAM. No. 1, Senator Barrasso, who is an orthopedic surgeon, 
has been a great addition to the Republican conference and to the 
Senate as a whole. He is a doctor and has practiced medicine longer 
than he has been in politics, I am sure, and he sees this problem from 
the physician's point of view, from the patient's point of view. And 
our Presiding Officer was recently a Governor.
  Here is what my Governor is telling me: that Medicaid is a program 
that needs to be reformed, not expanded the way we are doing it. The 
second largest expense to the State budget in South Carolina is 
Medicaid matching money.
  For those who are home who may be watching, Medicaid is a program for 
low-income Americans. It is a Federal program and a State program, but 
it is a Federal Government mandate that if you reach a certain income 
level, you are eligible for Medicaid services to be administered by the 
States. But, quite frankly, the flexibility the States have is very 
limited, and this bill, the Obama health care bill, expands Medicaid 
eligibility to the point that 29 percent of the people in South 
Carolina would be Medicaid eligible.
  Our State has an $850 million shortfall in our budget. I think 
Wyoming is in pretty good shape, but I think we are probably closer to 
the average State. We have had a dramatic decrease in revenues, and the 
cost of complying with the Medicaid expansion in this bill would be $1 
billion to a State that cannot afford it. I am sure West Virginia is 
very similar.
  So here is my commitment to the body. I would like to give the States 
an opportunity to speak as to whether they want the individual mandate, 
the Medicaid expansion, and employer mandate that I think adds a lot of 
cost to businesses that will decrease job opportunities at a time when 
South Carolina needs every job it can get.
  But one thing we could do by passing this legislation is get this 
debate out of Washington, where everybody has kind of dug in their 
heels, and listen to the people. That is the one thing we have not been 
able to do.
  This bill passed under the cover of darkness on Christmas Eve in a 
process that is not reflective of the hope and change we all would like 
to have. It was the worst of Washington. It is not as if the Republican 
Party has never, behind closed doors, passed bills on a party line. But 
we are all trying to break that formula. And this bill passed on a 
party-line vote on Christmas Eve. To get the 60th vote, quite frankly, 
was unseemly.
  So what I am hearing from my Governor is, please give me some relief 
from a Medicaid Program that is drowning my State.
  So after this opportunity comes to take the debate to the State 
level, I would like to join with Senator Barrasso and the Presiding 
Officer and anyone else in this body who wants to come up with a way to 
fix Medicaid before it bankrupts all the States.
  So this opt-out approach I think would make the debate more 
meaningful. It is not just about what people in Washington think; it is 
about what America wants and what Americans think. The best way to get 
their opinion is to allow them to speak at the State level.
  So if my colleagues on the other side believe this is a great bill, 
then give other people a chance to validate what you think. We may be 
wrong. Senator Barrasso and I may be wrong. We may

[[Page 1287]]

be hearing criticism from this bill that is very limited and unique to 
Wyoming and South Carolina. I don't think so, but we will never know if 
we don't give people the chance to speak.
  That is what this bill does. It allows States, if they choose, to opt 
out of the individual mandate and the employer mandate of Medicaid 
expansion.
  What is my colleague from Wyoming hearing about the effect of this 
bill on the State of Wyoming, and where do you think we should go as a 
nation?
  Mr. BARRASSO. The people of Wyoming overwhelmingly want the 
opportunity to remove themselves from the heavy burden of the Obama-
passed and supported health care law. There are huge expenses. The 
Medicaid mandate is huge.
  Mr. GRAHAM. Mr. President, if I could interrupt and ask the Senator 
from Wyoming about waivers that have been given. Can the Senator tell 
us a little bit about the waivers that have been granted? Aren't we 
basically allowing a State to request a waiver by our bill?
  Mr. BARRASSO. We are doing exactly that. As of last week, the 
Secretary of Health and Human Services has given--just last week--500 
new waivers to allow individuals who get their insurance through work, 
and now a total of 729 waivers affecting 2.2 million people to opt 
out--individuals to opt out--of the specific requirement.
  I think States ought to have the right to make decisions about the 
Medicaid mandate, about the individual mandate that requires everyone 
to buy government-approved health insurance. It is a mandate. Congress 
is telling people they have to buy government-approved health 
insurance. I think it is unconstitutional. The Supreme Court will 
ultimately decide. People will get penalized. There are going to be IRS 
agents checking to make sure people have this government-mandated and 
government-approved health insurance. I think people ought to be able 
to--the State ought to decide if they are going to make every employer 
in the State--the business creators, the entities that hire people, the 
small businesses, the job creators--I think the State ought to have the 
right to make the decision to say, Are we going to make those 
employers--force them--to provide government-approved health insurance.
  It is a big cost for businesses that are trying to hire people. I 
think States ought to be able to opt out of the benefit mandate which 
defines how much insurance somebody has to have. Also, in many cases it 
is overinsurance--more than they need, more than they want, and more 
than they can afford.
  Mr. GRAHAM. Mr. President, I ask the Senator, what percentage of the 
waivers involve union plans?
  Mr. BARRASSO. Well, of the 2.2 million people who have gotten waivers 
by the Secretary of Health and Human Services--and, as I say, you need 
to have friends in high places if you want a waiver, because I know the 
small business owners in my State, and probably in the State of the 
Senator from South Carolina as well, couldn't get to the Secretary of 
Health and Human Services to get these waivers. But 860,000 waivers 
have gone to members of 166 different unions' benefit programs. It is 
interesting, because across the country unions have received 40 percent 
of the waivers, yet union members are only 7 percent of the workforce. 
So it seems a disproportionate number of these waivers have been given 
to members of the unions.
  What I find so intriguing is that these are the same people from the 
same unions that lobbied so hard to get this health care law passed. 
Now that they know what is in it, they don't want it to apply to them. 
That is a concern about which I think the American people will say, 
Well, if all of these different union members can get a waiver, why 
can't I? Why can't States be able to opt out as well?
  In a national poll last Friday, February 4, the majority of Americans 
said States ought to have the right to opt out of the health care law. 
A majority of Americans believe their State ought to have a right to 
opt out. We now know that seven states--Arizona, Georgia, Idaho, 
Louisiana, Missouri, Oklahoma, and Virginia--have already passed laws 
or constitutional amendments making it illegal to force anyone to buy 
health insurance. Their State legislatures--to me, that is how I am 
reading it--say, we are going to opt out whether this law passes or 
not.
  Mr. GRAHAM. Mr. President, along that line, if I could pose a 
question to my colleague: How many States have joined the lawsuit 
saying the individual mandate is unconstitutional, if the Senator knows 
that number? The Senator just indicated how many States have passed 
State laws saying we shouldn't be required to comply with individual 
mandates.
  Mr. BARRASSO. Seven States have already passed laws or constitutional 
amendments making it illegal to force someone to buy health insurance.
  Mr. GRAHAM. How many States have joined the lawsuit?
  Mr. BARRASSO. Twenty-six States have joined the lawsuit, including my 
home State of Wyoming which recently joined. New Governors have been 
elected and sworn into office in January, so five new States have 
joined the lawsuit, saying, This law isn't constitutional. People from 
Congress shouldn't be able to go into your home and make you buy a 
government-approved product if you don't want to buy it. The background 
of the Senator from South Carolina is superior to mine in the legal 
field or the courts, but it sure sounds to me as if rulings from 
Virginia and Florida uphold my firm belief that Congress can't make 
people buy products.
  Mr. GRAHAM. If I may, I think the Senator is going to find this case 
going to the Supreme Court in a year or two--the sooner the better, as 
far as I am concerned. I don't know how the Court will rule, but I can 
understand why attorneys general would be arguing that requiring 
someone to do something to create activity is probably a real stretch 
of the commerce clause. Where does it end? There are two sides to that 
legal coin.
  My point is, I doubt if the attorneys general of these States, who 
are mostly elected--or I am sure all of them are elected--would be 
bringing a lawsuit to challenge the constitutionality if they believed 
their constituents were really for the bill. Does that make sense to my 
colleague, that 26 attorneys general would be suing the Federal 
Government in court if they believed their own citizens felt as though 
this were the right way to go?
  Mr. BARRASSO. I think the attorneys general are making decisions 
based on what they believe is in the best interests of the citizens of 
their State, and they are saying, People of our State have rights, and 
we have a Constitution, and that Constitution should trump the 2,700-
page health care law.
  Mr. GRAHAM. Mr. President, if I could make this point to my 
colleague: No judge is going to ask the average person what they think, 
nor should they. This is a legal question. I don't know how it is going 
to come out. I think it is probably 50-50.
  What we are doing differently, I say to my friend from Wyoming, is we 
are not saying we need to pass it all from Washington or repeal it all 
from Washington. We are saying: Allow people to comment on the product 
that was created on a party-line vote on Christmas Eve, in an unseemly 
fashion, by allowing people at the State level, through their elected 
representative, to have a say. That is different than a court 
challenge. That is different than a Washington debate. Quite frankly, 
if we are going to turn one-fifth of the economy upside down, I think 
it would be very helpful to this country to involve our fellow 
citizens.
  This will be a constitutional academic decision made on the law. What 
we are trying to do, I say to my good friend from Wyoming, is to take 
the debate on health care to the State level so people can speak up 
before we lock the country into a plan that I think is going to ruin 
the viability of the States' budgets by expanding Medicaid to 150 
percent above poverty. Is that not the purpose, to give people the 
chance to speak as they have never had to this point?
  Mr. BARRASSO. What do people want? What do the States want? 
Flexibility, freedom, and choice. I know

[[Page 1288]]

that is what people in Wyoming want. We are rugged individuals who want 
flexibility, freedom, and choice. I think every State ought to have the 
opportunity to make that decision, and that is why this bill is on the 
floor of the Senate.
  Last week I did vote to repeal the entire Obama health care law 
because I think it is bad for patients and providers--the nurses and 
the doctors who take care of those patients--and I think it is bad for 
the taxpayers. I think it will bankrupt the Nation. I think what is now 
happening is it is also bankrupting the States. Governors, having to 
deal with this Medicaid mandate, are realizing that to listen to 
Washington, they are going to have to take money away from education. 
They are going to have to take money away from public services. They 
ought to have a right to make a decision at the State level as to what 
they want to do, what laws ought to apply.
  One size doesn't fit all. I know what works in Wyoming is not 
necessarily what works in South Carolina or West Virginia and certainly 
may not work in California or New York. That is why States ought to 
make a decision about ways to help people in their own State get the 
care they need from the doctors they want at prices they can afford. 
This massive health care law does not accomplish that.
  Mr. GRAHAM. One final question, and I do appreciate the Chair's 
indulgence. The whole idea of the status quo being acceptable is not 
what we are talking about. None of us believes the current health care 
situation is sustainable. Medicare and Medicaid need to be reformed, 
but so do private health care cost increases. There are monopolies out 
there by insurance companies. To be able to buy across State lines 
makes a lot of sense to me.
  Briefly, if my colleague could, what does he see--I want to repeal 
the bill, not just to maintain the status quo, but to replace it with a 
bipartisan product that does improve quality and lowers costs. Is that 
the Senator's position, and how can we do that?
  Mr. BARRASSO. There are things we mutually must do to make it easier 
and cheaper for people to get the health care they need, the doctors 
they want, at the price they can afford. Number 1, as my colleague 
mentioned, make it legal for people to shop around and buy across State 
lines. We can't do that right now in this country. That in itself, as 
studies show, would result in over 10 million Americans who don't have 
insurance today getting insurance.
  Most people get their insurance through work for the simple reason 
that it is a tax deduction to the company they get their insurance 
through, but if they buy insurance personally, individually, they have 
to pay taxes on that money before they pay for the insurance. So I 
think people who end up buying their health insurance individually 
ought to get the same tax benefits as those who get it through work do. 
That would make a big difference in bringing down the specific costs to 
those folks.
  I think we need to have incentives that help people actually stay 
healthy. I ran a program in Wyoming. I was a volunteer at a program 
called the Wyoming Health Fairs, bringing low-cost health screenings to 
people. I did health reports on television called ``Helping You Care 
For Yourself,'' giving people information they could use to stay 
healthy.
  This health care law has money in it aimed at prevention, but it 
basically has money for jungle gyms and street lamps and pathways, but 
actually no incentive to get somebody to get up and exercise and get 
their weight down and their cholesterol under control, their blood 
pressure under control.
  Then I think we have to do something about the lawsuit abuse out 
there, which drives up the cost of care as doctors order tests not 
necessarily to help the patient but to make sure they are not missing 
some very rare condition, and that significantly adds to the cost of 
care, in the billions and billions of dollars every year.
  Mr. GRAHAM. On that note, I would say to the Presiding Officer and to 
my friend from Wyoming, there seems to be a lot of ways to lower costs. 
The status quo is not acceptable. The solution we have chosen in a very 
partisan way I think is going to drive up the budget deficit and 
eventually lead to more people being in government-run health care at a 
time when the government is broke and is, quite frankly, going to take 
the State budget problems and make them unsustainable just by expanding 
Medicaid.
  Our bill is pretty simple. If you think this is a very good idea, let 
it be tested by your Federal citizens through an opt-out provision. If 
you think this is a bill that most people would opt out of if they 
could on our side, give them a chance. The lawsuit is important, but 
this is a decision the Nation needs to make, and the lawsuit is one way 
to approach this. But the best way to come up with health care 
solutions is not going to court but having the Congress and the States 
and the people of America work together in a partnership. That is what 
we have not been able to achieve--a partnership where we listen to the 
States and the people, and from their input we pass laws in a 
bipartisan fashion.
  That is what I hope will happen.
  Mr. BARRASSO. That is why we come to the floor to discuss S. 244. The 
title is State Health Care Choice Act. That is what it truly is--State 
health care, and choice. It is a choice to be made by the States about 
health care because if the American people want anything, it is 
flexibility, freedom, and choice.
  Mr. GRAHAM. I thank my colleague. I have enjoyed the discussion.
  I yield the floor.
  Mr. BARRASSO. I yield the floor.

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