[Congressional Record (Bound Edition), Volume 157 (2011), Part 3]
[Senate]
[Pages 3996-3998]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      HEALTH CARE AND JOB CREATION

  Mr. BLUNT. Madam President, next Wednesday marks the first 
anniversary of the day President Obama signed the bill into law that, 
in my opinion and in the opinion of most Americans, is the greatest 
involvement in our Nation's health care system in history.
  What we see, as that law is discussed, as it is challenged in court, 
is a bill that was signed into law that was full of problems when it 
was signed into law. It was a bill full of constitutional questions, 
and, in fact, while some courts have said it may be constitutional, 
others have said it is not.
  It was a bill where the courts say the Federal Government cannot make 
you buy a commercially available product, then the same people who were 
saying a year ago that this requirement is not a tax are saying: Maybe 
it is a tax. Maybe the Constitution allows us to define that particular 
purpose as a tax on the American people.

[[Page 3997]]

  But a year ago, they were saying: This is not a tax at all. This is 
definitely not a tax. There is no way this could ever be interpreted as 
a tax.
  But when courts say you cannot do this the way this bill does it, 
suddenly they try to reinvent what the law was designed to do.
  One of the reasons this bill has so many of these problems is there 
was a rush to get a bill into law, a bill with more government control 
of health care into law, a bill that could not have passed the Senate 
the day the President signed it into law. A bill that was full of 
concerns, a bill that the Senate voted on never believing that it 
actually would become law but would create a vehicle to become law, 
became the only option the House leaders thought was available to them, 
and they passed it. They passed it without the kind of process that 
would have produced a law that could stand a constitutional challenge, 
produced a law to which Americans would be more responsive.
  While I believe the law was misguided in its concept, more 
importantly, it was put together in what I think will be seen as the 
worst possible way--a rush to judgment, to get a law on the books. Now 
the people who voted for the law are saying things like: There may be a 
better way than an individual requirement that everybody buy a 
specified, defined insurance policy. Not all the people are saying that 
but some are. They are saying: Maybe we ought to look for that better 
way. The time to look for that better way was before the bill was 
signed into law, not after it was signed into law. Even the White House 
is saying: Certainly let's work together to change this. This is headed 
in fundamentally so much the wrong direction, changing it would not be 
the best option.
  Already in the Senate we have voted not to vote on a repeal of this 
law that would allow us to replace it with better things. Unless those 
votes change, that will not happen this year. But the view that 
Americans have of this law is not likely to change either. I certainly 
do not believe government has the authority in the Constitution to 
penalize people for not buying a commercially available product.
  Sometimes people say that the States require that under their 
constitution, to buy auto insurance if you drive a car. No. 1, that is 
a State decision, and No. 2, they do not require you to drive a car. 
You don't have to have that particular product if you do not make that 
decision. This gives you no options but to pay a penalty or to do what 
the government says you have to do.
  During the debate surrounding this bill and immediately following the 
enactment of the bill, the American people began to tell us that this 
was not the approach they wanted. In Missouri, where I am from, the 
first place that had an issue on the ballot where voters could speak 
about whether they wanted to be part of this new concept of more 
government control of health care, 71 percent of them said they did not 
want to be part of it. That was in a primary election. Hundreds of 
thousands of people voted and 71 percent of them said: We do not want 
to go in this direction.
  Missouri is a State that generally is pretty reflective of the 
country in our elections, in our economy, in how our population comes 
together. Madam President, 71 percent of them said: Let's not do this; 
let's do something besides this. They had a sense that this was a 
misguided plan that put government between them and their doctors, that 
had as one of its major tenets that the government would describe a 
certain regimen of care that would have to be followed for doctors and 
hospitals to be reimbursed. Missourians by and large believe this 
significantly changes--some would say implodes--our current health care 
system.
  To make it worse, this law cuts Medicare by $500 billion, not to save 
Medicare or improve Medicare, but it cuts Medicare by $500 billion so 
we could start another health care program. This makes so little sense 
as we look at Medicare--one of our major challenges as the demographics 
of the population change. Medicare is one of the areas where we know 
that in a handful of years, Medicare will face a generation of great 
challenge. We look for savings in Medicare not to save Medicare but to 
start a new program. That would be totally unacceptable anywhere except 
Washington, DC. It makes as little sense to people as the idea that we 
could come up with a new $1 trillion program over a handful of years 
and say that is going to save money. Nobody believes that.
  When you look at the greater concept of what this law will do, if it 
is ever implemented, to change the relationship of people and their 
government, I can't think of anything, besides the government taking 
over the economy, that actually has greater potential to change that 
relationship than the government having more control of your health 
care. What more controlling element could the government look to than 
your health care and your family's health care to make sure that you 
never got on the wrong side of that government? It does change that 
relationship.
  It also creates real uncertainty in what should be the No. 1 goal in 
America today: private sector job creation. If a year ago the President 
would have signed bills into law that encouraged private sector job 
creation or created more certainty about our health care costs, about 
our utility bills, about our taxes, about regulation, rather than 
signing this bill into law, I believe we would be much further down the 
road toward seeing private sector jobs, jobs that create taxpayers that 
help government provide the services only government can provide. We 
would be much further down that road.
  The very clear message I and others heard all over the country in the 
last year was, we do not want to create these jobs with all of these 
issues out there not yet really decided and if they are decided, likely 
to be decided in a way that makes that job-creating decision less of a 
good situation than it would have been otherwise.
  Cap and trade, in the middle of the country, in Missouri, the sixth 
most dependent State on coal for its utilities--the estimate was that 
it would double the utility bills in a dozen years. What is the job-
creation message there?
  We are exactly where we were 2 years ago on the tax question because 
just a few months ago the President signed a bill that extended current 
tax policies but only for 2 years. So we are no further down the road 
on that question than we were 2 years ago today.
  The President calls for regulations that make sense. I join him in 
that. But we see none of that coming from the regulating authorities 
right now. The clear message people had was, they would like the 
government to create more certainty in the areas the government 
controls so they can decide whether they want to take the certain risk 
you always have when you create a job.
  I was in northwest Missouri not too long after this bill was signed 
into law 1 year ago and very well remember a conversation I had with 
someone whose business was going well. In fact, he said: I have 47 
employees. You will remember the bill creates a threshold of 50, that 
you have different kinds of obligations and regulations once you get to 
50--over 50 employees--than you had before that. He said: I have 47 
employees. I need to hire six more people right now. But I have looked 
at this health care law, my accountants have looked at this health care 
law, and we are not going to get 1 employee closer to 50 than we are 
right now.
  So there are six jobs that did not get created. His view of what to 
do about his current situation was, I am going to pay overtime until I 
can figure out what I am doing that is not making much money or, in 
fact, maybe even losing a little money, and I am going to quit doing 
that. I am going to be sure we get back to where we are truly a 47-
employee business again, instead of what should be a 53-employee 
business.
  Many employers I talked to said: We are not going to hire full-time 
employees. We think we can get our job done with more part-time 
employees who do not force us into the environment under this law, 
where the government

[[Page 3998]]

comes in and says: You have to pay a penalty or you have to offer an 
unknown insurance policy that will be created by some group created by 
the Congress that says what everybody's insurance policy has to look 
like.
  ``One size fits all'' almost never fits anybody, and it will not fit 
anybody in this insurance plan that this bill anticipates and mandates. 
What you need is more competition, more choice, real, sustainable 
understanding that the marketplace works. On the job creation front, 
private sector job creation will not occur until we do the things we 
need to do that create more certainty in the job-creating marketplace: 
letting families keep more of what they earn, economic incentives for 
small business, government that does not constantly talk about how it 
can raise all the costs that you have as the underlying costs of the 
business you create.
  While I would be voting--if we would have a chance to repeal this 
bill--I would also be working hard to replace it with better solutions. 
Maybe the only good thing about this health care bill is, it requires 
us to either go down a road most Americans now think is the wrong 
direction or to truly tackle these big questions involving health care, 
things such as small business health care plans--at one time they were 
called association health care plans--where you could find some bigger 
group to affiliate with if you are an individual or a business and get 
your insurance that way rather than trying to get it as an individual.
  Medical liability reform is a concept I have sponsored legislation on 
and others have, over and over again, to see it pass the House of 
Representatives and not get voted on seven times in the Senate. The 
medical liability bill last year, the estimate was it would save $56 
billion for health care under current government programs and at least 
that much more in health care costs for Americans who pay for their own 
health care or have their own private insurance. That is over $100 
billion in savings at a time when we need to be looking for every $100 
billion in savings we can find. Unfortunately, in our current 
situation, it takes several of those $100 billion in savings--16 of 
them, in fact--to just get the budget back in balance. We cannot afford 
to not do things that would save $100 billion.
  Risk pools. Nobody wants people not to be able to get insurance 
because of preexisting conditions. But they are not moving in the 
direction this bill would allow them to move. In fact, the people who 
have signed up for the concept the bill put out there of how to open 
risk pools, I think, is about 6 percent of the anticipated number. When 
the target is 6 percent of what you thought the law would encourage 
people to do, obviously there is something wrong with the way that is 
put together. It is only 94 percent short of the estimate of people who 
would rally to risk pools that allowed for access if you have a 
preexisting condition. There are better ways to expand these risk pools 
that are better than telling people: No, you will get insurance the 
same way everybody else gets it, for the same thing they pay for it, 
anytime you need it, which is what the bill says. You will have to pay 
a penalty, in the interim, that is much less than it would have cost 
you to have insurance. People will figure that out and pretty quickly.
  On what may have been that same visit with the employer in Rockport, 
MO, I was talking to a hospital in that area right after this bill 
passed. They said: I guess, if this bill goes into law, we will put the 
insurance application forms in the ambulance. That way you can get your 
insurance on the way to the hospital. Because, after all, under the 
bill, you would pay 100 percent of what everybody else was paying. So 
why would you want to pay 100 percent until the day you knew you needed 
it? This is a badly thought-out concept. Expanding risk pools in other 
ways and helping fund and encourage those risk pools would have been 
the better way to do that.
  Being sure families still make family decisions about health care 
instead of being told: No, there is only one option your health care 
plan that is defined by the government will pay for; encouraging 
coverage available in other States, buying this product across State 
lines. There is no reason not to have a health care marketplace. It 
does not just have to be buying the product in the half dozen States 
that touch Missouri, the six or seven States that touch Missouri. There 
is no reason it cannot be bought in a marketplace that is the national 
marketplace. Competition produces better choices, and it also produces 
more choices so you can look at the health care plan that is right for 
your family or you as an individual, rather than the health care plan 
some newly created board and agency said had to be the health care plan 
for everyone to meet the new Federal Government standards.
  Tax equity. If you buy a health care plan on your own, you should do 
that with pretax dollars, just like the biggest corporations in America 
buy health care for their employees with pretax dollars.
  More transparency of how health care works. I would like to know, if 
I am on the way to get a health care procedure, I would like to know, 
before I leave to do that, what do people charge and what are their 
results. Most trips for health care are not to the emergency room, they 
are planned trips for health care. Once you are in the car, if it means 
driving another 20 minutes or 1 hour and 20 minutes to get to the place 
that does a better job for less money, I think most Americans would do 
that.
  We know this. These factors are generally known. I remember a study 
just 1 year or so ago that was checking to see the survival rates for 
inhospital heart attacks based on the response time. That information 
is all available. At this point, it is available anonymously. But if it 
is available anonymously, it would also be available specifically.
  More transparency in the system. How do you go to the place to get 
the best results or, if the results are the same, how do you go to the 
place that gets the best results for the better cost? When employers 
are telling us they are not hiring because of the uncertainty created 
by this law, when courts are ruling the law is unconstitutional or even 
when courts disagree on this topic--when some courts think it is 
unconstitutional and some think it is--when voters are overwhelmingly 
rejecting it every opportunity they have had at the polling place to 
vote on it, something is wrong with the direction we are headed.
  Americans deserve a plan where the people are still in the driver's 
seat, where the people are bigger than the government, where the people 
are making decisions for themselves and their families about lots of 
things but particularly about health care.
  I am working and will keep working to repeal this bill and replace it 
with policies that make more sense, policies that move us toward more 
competition, more transparency, and better health care. The anniversary 
of this signing next week would be better spent if we were all here 
next week trying to come up with policies that make health care sense, 
that make economic sense, that meet the constitutional standard, and 
still keep people in charge of these important life-sustaining, health-
sustaining decisions.
  I yield the floor and 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. HOEVEN. Madam 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.
  Mr. HOEVEN. Madam President, I ask unanimous consent to speak as in 
morning business for 10 minutes.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

                          ____________________