[Congressional Record (Bound Edition), Volume 158 (2012), Part 3]
[Senate]
[Pages 3979-3980]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AFFORDABLE CARE ACT

  Mr. HARKIN. Again, Mr. President, tomorrow we celebrate the second 
anniversary of the signing of the affordable care act into law. Our 
Democratic leader, Senator Reid, in his opening remarks today, outlined 
the tremendous progress we have made. I listened to the comments made 
by our distinguished Republican leader, and all I heard was: Repeal 
ObamaCare, repeal ObamaCare.
  But I never heard what they want to replace it with. They just want 
to go back to the old system where the insurance companies ran 
everything before, where people were thrown off their policies because 
they had an illness, where because of preexisting conditions people 
could not get health care coverage, where we had this big doughnut hole 
which we are now closing for the elderly?
  The one aspect I want to focus on this morning in my brief time is an 
extraordinary element of the affordable care act that is not being 
talked about a lot but which members of the committee I now am 
privileged to chair, the HELP Committee, worked so hard to include in 
the affordable care act; that is, the array of provisions that promote 
wellness, disease prevention, and public health.
  Taken together, these provisions have begun to jump-start America's 
transformation into a genuine wellness society. They are transforming 
our current sick care system into a true health care system. I have 
said this many times: We do not have a health care system in America. 
We have a sick care system. If people get sick, they get care--one way 
or the other. But there is very little out there to help people keep 
healthy and to maintain wellness and to keep them from going to the 
hospital in the first place. Now, that would be a true health care 
system, and that is what we have begun to establish with the affordable 
care act, by preventing chronic diseases, enabling people to stay 
healthy, and stay out of hospitals in the first place.
  Right now in the United States about 75 percent of all our health 
care spending--75 percent of the Nation's health care spending--is on 
chronic diseases. Only 4 percent is spent for prevention. So during the 
last year we have data for--2005--the United States spent about $2 
trillion on health care. Of every $1 spent, 75 cents went toward 
treating patients with chronic diseases, many of which are preventable. 
Only 4 cents went toward prevention. That ought to tell us something 
right there. That is the old system, and that is the system the 
Republicans want us to go back to: Spending more and more to treat 
people after they get sick rather than trying to put something forward 
to keep people healthy.
  Well, in the affordable care act we have tremendous opportunities to 
again move us to more prevention and wellness. We have made 
historically new investments in this area of

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wellness, prevention, and public health. Here is one example of that, 
as shown on this chart.
  Before our health care reform bill, our law, was passed, just take 
the issue of colorectal cancer screening; we know, if people get it 
early and detect it early, their chances of survival are tremendous. If 
people detect it too late, then they are going to be in the hospital, 
and they are going to have cancer, they are not going to live. But we 
know, by people getting a colorectal cancer screening early, we can 
prevent a lot of unnecessary deaths and illnesses and treatments later 
on.
  Cholesterol screening: We know if people get good cholesterol 
screening, they can get on either a drug or a good diet, an exercise 
program, reducing the prevalence of heart disease.
  Tobacco cessation: Need we keep repeating around here how much it 
costs our society from the plague of tobacco use?
  Well, here is where we were before health care reform, as shown on 
this chart. About 68 percent were covered for colorectal cancer 
screenings, about 57 percent were covered for cholesterol screenings, 
and only 4 percent were covered for tobacco cessation.
  After health care reform, now there is 100 percent--100 percent--
coverage for colorectal screenings with no copays and deductibles, I 
might add; 100 percent coverage for cholesterol screenings, and 100 
percent coverage for tobacco cessation.
  That is prevention, that is wellness, keeping people healthy in the 
first place. What do the Republicans want? They want to go back to what 
it was. We have made too much progress in prevention and wellness to go 
back to the old ways of just treating people after they get sick.
  Now, again, we have been able to promote a lot of activities around 
the country to promote health and wellness. For example, in Illinois, 
the State made improvements to its sidewalks and marked crossings to 
increase student physical activity levels. You might say: Well, big 
deal.
  Well, it is a big deal. Because of these improvements, the number of 
students who are walking to school has doubled--doubled--and it is 
expected to save the school system about $67,000 a year just on bus 
costs. So kids are healthier and we save money.
  In Alabama, Mobile County is using funds from this prevention fund to 
support tobacco quit lines to help residents live tobacco free--again, 
under the Tobacco Cessation Program.
  Officials enacted a comprehensive smoke-free policy expected to 
protect 13,000 of their residents--this is in Mobile County, AL--from 
being exposed to secondhand smoke. All across America, more and more is 
being invested in prevention. We know that, for example, a 5-percent 
reduction in the obesity rate--just a 5-percent reduction in the 
obesity rate--will yield more than $600 billion in savings on health 
care costs over 20 years.
  Again, our prevention fund is out there getting people the necessary 
support and information they need to reduce obesity. So with the 
misguided efforts to repeal the health care reform law, again, most 
Americans know what is at stake. They are going to lose a lot of these 
prevention activities that enable us to take charge of our own health 
care to make sure we get our colonoscopies on time, our mammogram 
screenings.
  Every woman in America now over age 40 gets a free mammogram 
screening--no copays, no deductibles. The Republicans want to take that 
away from the women of this country. Colonoscopies, as I said, without 
copays or deductibles, Republicans want to take that away. Annual 
physicals. We know a lot of people do not get annual physicals because 
it costs money. It costs them. Now they can get an annual physical 
free--no copays, no deductibles. Republicans want to take that away.
  Again, I think we have to ask the question--every time I hear the 
Republicans talking about doing away with ObamaCare or the affordable 
care act, we have to ask: Are we going to cut short this transformation 
into a wellness society in preventing diseases, keeping people healthy 
in the first place? I think the answer is clear. Americans are not 
going to allow all these hard-earned protections and benefits in the 
affordable care act to be taken away. We are not going to be dragged 
backward. We are going to continue our march forward to make ourselves 
more healthy. We are not going back to the old system, where only a 
little over half the people in this country got cholesterol screening, 
68 percent got colorectal cancer screening.
  We want people to get early screening, early support services for 
preventive care so they stay healthy. Not only is it going to help our 
family budgets, it is going to help our Federal budget if we have 
people healthier and not going to the hospital in the first place. This 
is one of the big aspects of the affordable care act that is not talked 
about a lot. But to me it is one of the most important aspects of 
moving us, again, to a society where we are not just relying on people 
going to the hospital and paying for high hospital bills and things 
such as that in the future.
  I am going to yield the floor. I just wanted to make those comments 
about one aspect of the affordable care act. Of course, we do know 
there are many other benefits in the affordable care act people do not 
want to lose. Right now, we ban lifetime limits, which helps more than 
100 million people. They want to take that away. Republicans want to 
take that away. We cover vital preventive services, which I just went 
over; young people remaining on their parents' coverage up to age 26--
more than 2.5 million helped so far. Republicans want to take that 
away. They want to end all that. I do not think the American people 
want to end it. I think the American people want to move forward with 
health care reform because we have made too much progress--too much 
progress in making sure health insurance is affordable, available.
  I guess I have just one more thing to say, if my friend from Rhode 
Island will let me.
  Everyone in this Senate body belongs to the Federal Employees Health 
Benefits Program. Do you know what. We have coverage for preexisting 
conditions. We have no lifetime bans in our policies. Yet that is what 
we did. Remember the debate? We wanted to say to the American people: 
Whatever we have, we want you to have too. We put that in the 
affordable care act.
  The Republicans say: We are going to take that away from the American 
people but keep it for ourselves. I do not think so. I do not think so. 
I do not think the American people want to say: You Senators and you 
Congressmen can keep all that, but you can take it away from all of us. 
We are not going to do it. We are not going to go backward.
  I yield the floor for my distinguished friend from Rhode Island who 
played such a pivotal role in getting the affordable care act through 
on our committee and has been one of the more eloquent spokespersons on 
this health care bill in the last couple years.
  The PRESIDING OFFICER (Mr. Warner). The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, I ask unanimous consent to speak for 
15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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