[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[Senate]
[Pages 3753-3755]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       AFFORDABLE HEALTH CARE ACT

  Mr. DURBIN. Madam President, there has been a lot of discussion about 
the affordable health care act passed by Congress. In fact, just next 
week, across the street, the Supreme Court will take up this bill and 
decide whether it is constitutional. It is an important decision. It is 
one that will affect millions of Americans, and scarcely anyone 
understands the impact of this law and what it means to their daily 
lives.
  The first aspect I wish to speak about is the most controversial 
aspect of it, the so-called individual mandate. What is it? From my 
point of view, it is a basic method of saying to everyone in America: 
You have a personal responsibility. You cannot say you are just not 
going to buy any health insurance; that you don't think you are ever 
going to need it and are not going to worry about it.
  The problem is, of course, those people who make that statement get 
sick. Some of them get involved in accidents. Some go to a doctor and 
are diagnosed with terrible illnesses and diseases that require 
treatment and surgery, and that costs a lot of money. The uninsured 
people show up at hospitals. They are not pushed away; they are invited 
in. They receive the treatment. Then they can't pay for it.
  It turns out that 63 percent of the medical care given to uninsured 
people in America isn't paid for--not by them. It turns out the rest of 
us pay for it. Everyone else in America who has health insurance has to 
pick up the cost for those who did not accept their personal 
responsibility to buy health insurance.
  So, so what? What difference does that make? It makes a difference. 
It adds $1,000 a year to our health insurance program. In other words, 
you and me and everyone with health insurance is subsidizing those 
people who say: Don't mandate anything on me. Don't tell me I have a 
personal responsibility. But when I get sick, you can pay for it.That 
is what the individual mandate comes down to.
  I listen to those who say, well, this is just too darn much 
government to say that people who can afford it need to have health 
insurance. Keep in mind, this health care bill says if people cannot 
afford it--if they are too poor or their income is limited--there is a 
helping hand, not only in the Tax Code but even through Medicaid to 
make sure they have affordable health care insurance which will never 
cost them more than 8 percent of their income. A lot of American 
families would jump at health insurance that would only cost 8 percent 
of their income. But the law says people have to be willing to pay up 
to 8 percent of their income to have health insurance. The reason, of 
course, is if they don't pay, everyone else pays. If they get sick, 
they cost us $116 billion a year in uncompensated health care coverage 
paid for those who do not accept their personal responsibility to buy 
health insurance.
  Ruth Marcus has an article in this morning's Washington Post, and I 
ask unanimous consent that it be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

               [From the Washington Post, Mar. 20, 2012]

          116 Billion Reasons To Be for the Individual Mandate

                            (By Ruth Marcus)

       The most compelling sentences in the Obama administration's 
     brief defending the constitutionality of the health-care law 
     come early on. ``As a class,'' the brief advises on Page 7, 
     ``the uninsured consumed $116 billion of health-care services 
     in 2008.''
       On the next page, the brief drives the point home: ``In 
     2008, people without insurance did not pay for 63 percent of 
     their health-care costs.''

[[Page 3754]]

       Those figures amount to a powerful refutation of the 
     argument that the individual mandate--the requirement that 
     individuals obtain insurance or pay a penalty--exceeds the 
     government's authority to regulate interstate commerce. To 
     me, $116 billion seems like a whole lot of commerce.
       But let's leave the Supreme Court justices to hack their 
     way through the underbrush of the Commerce Clause. Because 
     those numbers are not only relevant to Commerce Clause 
     jurisprudence, they illuminate the fundamental irrationality 
     of public opposition to the individual mandate.
       The mandate is by far the most unpopular feature of a law 
     on which Americans are otherwise evenly divided. A Kaiser 
     Family Foundation poll this month found that two-thirds of 
     those surveyed disliked the mandate. Even among Democrats, a 
     majority (53 percent) opposed the requirement; independents 
     (66 percent) and Republicans (77 percent) were even more 
     hostile.
       Yet this is a provision that the overwhelming majority--
     those with insurance--should support, for the simple reason 
     that these people currently end up footing the bill for much 
     of that $116 billion.
       As the government's brief notes, ``Congress found that this 
     cost-shifting increases the average premium for insured 
     families by more than $1,000 per year.''
       In other words, those worried about having to pay ever-
     higher premiums should be clamoring for the individual 
     mandate, not agitating for repeal.
       Indeed, for all the bristling over the mandate, it will be 
     irrelevant to the 80 percent of non-elderly Americans who 
     already have insurance, either through their employers, 
     government programs, or purchased on their own.
       The biggest real-world risk to these people would be if the 
     court were to overturn the mandate yet allow the rest of the 
     health-care law to remain in place, driving premiums ever 
     upward.
       Amazingly, Republicans have managed to transform the 
     mandate from an exemplar of personal responsibility into the 
     biggest public policy bogeyman of all time.
       The irony of the fight over the mandate is that President 
     Obama was against it before he was for it. During the 2008 
     campaign, one of the signature differences between Obama and 
     Hillary Clinton was that Clinton's health plan included an 
     individual mandate whereas Obama's mandate covered only 
     children.
       Once elected, Obama quickly recognized the inescapable 
     truth: An individual mandate was essential to make the plan 
     work. Without that larger pool of premium-payers, there is no 
     feasible way to require insurance companies to cover all 
     applicants and charge the same amount, regardless of their 
     heath status.
       In part, hostility to the mandate reflects a broader 
     uneasiness with the perceived encroachment of big government.
       In the Kaiser poll, 30 percent of those who opposed the 
     mandate cited government overreach as the biggest reason. Not 
     surprisingly, twice as many Republicans (40 percent) cited 
     that reason as did Democrats (18 percent).
       But opposition to the mandate also stems from the public's 
     failure to understand--or, alternatively, the 
     administration's failure to communicate--basic facts.
       For example, Kaiser found that when people were told that 
     most Americans ``would automatically satisfy the requirement 
     because they already have coverage through their employers,'' 
     favorability toward the mandate nearly doubled, to 61 
     percent.
       Favorable attitudes rose to nearly half when people were 
     told that without the mandate, insurance companies would 
     still be allowed to deny coverage to those who are sick; that 
     without the mandate people would wait until they were sick to 
     purchase insurance, driving up premium costs; or that those 
     unable to afford coverage are exempt.
       ``People don't understand how the mandate works at all and 
     they don't understand why it's there,'' Kaiser's polling 
     director, Mollyann Brodie, told me.
       Brodie suspects that it's too late to change minds. ``This 
     law as a whole has really become a symbolic issue to people 
     and they really aren't open to information,'' she said.
       Maybe, but the administration must keep trying--not only to 
     sell the law's goodies but to explain how the mandate makes 
     them possible. Otherwise, they could end up winning the minds 
     of the justices, yet losing the hearts of the people whose 
     votes they need to keep the law in place.

  Mr. DURBIN. Madam President, this article spells it out. This issue 
of an individual mandate is an issue of personal responsibility. If you 
believe someone should be able to walk away from their responsibility 
to have health coverage they can afford and that their medical bills 
should be your family's responsibility, then cheer on all these folks 
who are saying we are going to repeal ObamaCare. That is what it boils 
down to. Do you want to pay their bills? I don't think we should have 
to. I think everyone in this country should accept that responsibility.
  There are some other aspects of the affordable health care act which 
we don't hear talked about from those who are calling for its repeal. 
Let me tell my colleagues one. Do you have a child graduating from 
college, looking for a job? I have been in that circumstance. My wife 
and I raised three children. Some of them found a job, but it took a 
little while. While they were looking for a job, did you ever say to 
your son or daughter fresh out of college: How about health insurance. 
They probably said to you: Sorry, Mom; sorry, Dad. I can't do that now. 
When I get a job, I will get back to it. But I feel just fine. I feel 
just fine.
  It doesn't work that way, and any responsible parent knows it. So we 
changed the law, and here is what we said: If you have family health 
insurance, it can cover your son or daughter up to the age of 26. That 
expanded the reach of health insurance coverage. It covered these young 
college graduates and young people looking for work so they had that 
protection even when they were unemployed.
  So did it make any difference? Thanks to this provision, 2.5 million 
young people have gained coverage nationwide, and 102,000-plus in my 
State of Illinois. That means for 2.5 million parents, some peace of 
mind, knowing their kids are covered by the family plan. That was part 
of this bill which many Republican Presidential candidates are saying 
they want to repeal. Really? Do you want to explain that to 2.5 million 
families who have the peace of mind that their son or daughter is 
covered with health insurance up to the age of 26?
  How about the seniors paying for their Medicare prescription drug 
bills. There was this doughnut hole, which means if seniors have 
prescription drugs covered by Medicare and they are expensive, they 
will reach a point during the course of a year when they have to go 
into their savings to pay for about $2,000 worth of prescription drugs 
before the government comes back and starts helping them again. We 
started closing that doughnut hole, closing that gap, giving $250 of 
that $2,000 they have to pay back to people in a rebate initially, and 
then providing a discount on drugs for seniors. That is part of 
affordable care. That is part of what the Republicans scream is 
ObamaCare.
  Is it a good idea? Well, just ask 152,000 Medicare recipients in 
Illinois who have received this rebate to help pay for their 
prescription drugs. Ask 144,000 seniors in Illinois who have received a 
50-percent discount on drug costs, and then ask the millions across 
America who have benefited. We are giving people on fixed incomes and 
limited savings a helping hand so they can have the prescription drugs 
they need to be healthy and strong and safe and independent. Is that 
what you want to be when you are a senior? Most of us do, and this bill 
helps.
  Third, this bill basically covers preventive services. We all know 
the story: Get in and see a doctor for a colonoscopy or a mammogram. 
Early detection and treatment is money saved and lives saved. We 
extended preventive care under Medicare. For 1.3 million Medicare 
recipients in Illinois--just in my State, 1.3 million; more in the 
Presiding Officer's State--they have preventive care now that they 
didn't have before. It means they are likely to stay healthy longer and 
cost less to our health care system. This is another aspect they want 
to repeal, those who are running against the affordable care act, 
running against the health care bill President Obama has pushed for.
  There is also a provision which says insurance companies have to 
spend 80 percent of the premiums they collect--80 percent--on actual 
medical care. They can take 20 percent for profits and administrative 
costs and the like but 80 percent on actual medical care. The State of 
Minnesota already had that on the books, and it worked. So we said 
let's do it nationwide so if premiums go up, it is to reimburse health 
care--not to take out in profits, not to take it out in bonuses, not to 
spend on an advertising budget for an insurance company. That is a big 
change. The insurance companies hate it like the devil hates holy 
water, and the Republican Presidential candidates want to

[[Page 3755]]

repeal it. I think it is a sensible change to ensure coverage and one 
that we ought to protect, not prohibit.
  There are other provisions in this law as well, but one that affects 
me personally and has affected, I am sure, thousands of Americans is 
the question of preexisting conditions. Do you have one? A lot of 
people do. A lot of people don't even know they have one. Sometimes 
insurance companies dream them up. They would deny coverage for health 
insurance if somebody had--get ready--acne, a preexisting condition so 
no coverage. If there is a history of suicide in a family, they would 
deny them health care coverage, preexisting condition.
  Let me just say to every parent listening: Thank the Lord if your 
child doesn't have asthma, diabetes, or something more serious because 
until the affordable care act was passed, that was enough to disqualify 
your child and maybe your family from health insurance coverage. Oh, 
they can't wait to repeal that. They say: Let's repeal ObamaCare. Let's 
get rid of that preexisting condition provision, and let those 
insurance companies deny coverage.
  America, is that what you want? Is that what you are looking for? Is 
that too much government to say to insurance companies: You can't deny 
children under the age of 18 health insurance coverage if they are 
victims of diabetes, if they have had a bout with cancer, if they have 
asthma? Oh, some of these folks are for the Wild West: Get government 
out of my life.
  I will tell my colleagues this: We know sensible regulation of 
insurance coverage gives people peace of mind and gives families a 
chance to know their child with a challenge or a problem is still going 
to get the very best medical care.
  There is something called lifetime limits, which is another change. 
You go to the doctor, and the doctor says: Well, sorry to tell you, but 
you have been diagnosed with a form of cancer. We can treat it. It is 
going to take aggressive chemo, radiation, maybe even surgery. It is 
going to take some time, and it is going to cost some money, but at the 
end of the day we are going to save your life, and you are going to 
live. You are going to live to see your daughter's wedding, and you are 
going to live to see your grandchildren.
  Then you get into it. You say: I am determined, my family is with me. 
I am going to pray for it and get the right outcome.
  Guess what happens. It turns out the cost blows the lid off your 
health insurance coverage. You had a lifetime limit on how much they 
would pay, which you never thought you would use until that diagnosis 
came down. So now we have basically said we are removing lifetime 
limits on health care. That is part of ObamaCare. That is part of the 
affordable care act.
  So I say to my Republican friends and those running for President: 
You want to go to the American Cancer Society and enter into a debate 
with them about whether lifetime limits are the right thing to do? They 
are going to explain to you thousands and thousands of American 
examples of why people with lifetime limits end up in a tragic 
situation where they need more coverage, they need more care. Their 
lives can be saved, but their health care coverage is cut off. That was 
the old days. That was before the affordable care act.
  So those who want to repeal it stand up and get cheering crowds. In 
those cheering crowds are cancer patients. They ought to stop and think 
before they start cheering and know what they are cheering for.
  The affordable care act is a sensible, reasonable step in a direction 
toward containing health care costs and making health care insurance 
coverage fairer for Americans all across our Nation.
  Is it a perfect law? Of course not. As I have said many times, the 
only perfect law I am aware of was carried down a mountain on clay 
tablets by Senator Moses. Ever since, we have done our best. We can 
always do better, and I am open to change, I am open to improvement. 
But for those who want to walk away from the affordable care act, 
listen to what they are walking away from.
  They are imposing a $1,000 premium on families to pay for the 
uninsured who will not accept their personal responsibility to buy 
health insurance. They are walking away from helping seniors pay for 
their Medicare prescription drugs. They are turning their back on 
families with young children fresh out of college looking for jobs, 
with no health insurance coverage. They are inviting the insurance 
companies to once again turn down your child and your family because of 
a preexisting condition. They are saying, once again: Let's get into 
the world of lifetime limits on insurance no matter how much health 
care costs.
  That is their idea of a future--not mine, not my family's. I have 
lived through part of this. Many others have as well. So when you hear 
their cheering crowds about repealing the affordable care act, hoping 
the Supreme Court finds some aspect unconstitutional, step back and ask 
those cheering crowds about their own health insurance.
  The last thing I want to say is this. It is interesting that Senators 
are debating this. You ought to see our health insurance. You ought to 
see what we have as Members of Congress. We have the Federal Employees 
Health Benefits Program. Guess what. It is a government-administered 
program. Oh, my goodness. You mean Republican Senators are part of a 
government-administered health care program? Yes. And you mean to tell 
me they have to deal with an insurance exchange? Yes. That is what the 
Federal Employees Health Benefits Program is.
  Eight million Federal employees and their families choose once a 
year--in my case from nine different plans that cover Illinois. We like 
our coverage in my family. Federal employees like their coverage. 
Senators like their coverage. But when it comes to extending this same 
benefit to every other American, oh, what a horror story; that is too 
much government. Really? If you are a person of principle and believe a 
government-administered health care plan is too much government, step 
up here in the well and tell people: I am giving up my Federal health 
insurance. I have not heard a single Republican Senator say that--not 
one. So let's find out. When we come down to the question about health 
care insurance for all Americans, I think they deserve at least the 
kind of coverage that Members of Congress have.
  Madam President, I yield the floor.

                          ____________________