[Congressional Record (Bound Edition), Volume 158 (2012), Part 4]
[Senate]
[Pages 4581-4584]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           HEALTH CARE REFORM

  Ms. COLLINS. Mr. President, during the past week, the Supreme Court 
heard arguments on the constitutionality of President Obama's health 
care law. This week also marks the 2-year anniversary of the 
President's signing that law.
  There is no question that our health care system required and still 
requires significant reform. In passing this law, however, Congress 
failed to follow the Hippocratic oath of ``first, do no harm.'' The new 
law increases health care costs, hurts our seniors and health care 
providers, and imposes billions of dollars in new taxes, fees, and 
penalties. This, in turn, will lead to fewer choices and higher 
insurance costs for many middle-income American families and most small 
businesses--the opposite of what real health care reform should do.
  I find it particularly disturbing that President Obama's health care 
law does not do enough to rein in the cost of health care and to 
provide consumers with more affordable choices. In fact, Medicare's 
Chief Actuary estimates the law will increase health care spending 
across the economy by more than $300 billion. The nonpartisan 
Congressional Budget Office says the law will actually increase 
premiums for the average family plan by $2,100. Moreover, a recent 
report issued by the CBO found that the new law will cost $1.76 
trillion between now and the year 2022. That is twice as much as the 
bill's original 10-year pricetag of $940 million.
  The new law will also mean fewer choices for many middle-income 
Americans and small businesses. All individual and small group policies 
sold in our country will soon have to fit into one of four categories. 
One size does not fit all.
  In Maine, almost 90 percent of those purchasing coverage in the 
individual market have a policy that is different from the standards in 
the new law.
  I am also very concerned about the impact of the law on Maine's small 
businesses, which are our State's job creation engine. The new law 
discourages small companies from hiring new employees and from paying 
them more. It could also lead to onerous financial penalties even for 
those small businesses that are struggling to provide health insurance 
for their employees.
  According to a Gallup survey taken earlier this year, 48 percent of 
small businesses are not hiring because of the potential cost of health 
insurance under the new law. The Director of the Congressional Budget 
Office has testified that the new health care law will mean 800,000 
fewer American jobs over the next decade.
  Even when the law tries to help small businesses, it misses the mark. 
For example, I have long been a proponent of tax credits to help small 
businesses afford health insurance for their employees. The new credits 
for small businesses in the health care law, however, are so poorly 
structured and phased out in such a way that businesses will actually 
be penalized when they hire new workers or pay their employees more. 
Moreover, they are temporary. The tax credits are temporary and can 
only be claimed for 2 years in an insurance exchange.
  I am also very concerned that the new law is paid for, in part, 
through more than a $500 billion cut in Medicare--a program which is 
already facing serious long-term financing problems. It simply does not 
make sense to rely on deep cuts in Medicare to finance a new 
entitlement program at a time when the number of seniors in this 
country is on the rise. We need to fix and save Medicare, not add to 
its financial strains.
  Moreover, according to the administration's own Chief Actuary, those 
deep Medicare cuts could push one in five hospitals, nursing homes, and 
home health providers into the red. I am particularly concerned about 
the impact on rural States like Maine. Many of those providers could 
simply stop taking Medicare patients. That would jeopardize access to 
care for millions of our seniors.
  It did not have to be that way. The bitter rhetoric and the partisan 
gridlock over the past few years have obscured the very important fact 
that there are many health care reforms that have overwhelming support 
in both parties.
  For example, we should have been able to agree on generous tax 
credits for self-employed individuals and small businesses to help them 
afford health insurance. That would have reduced the number of 
uninsured Americans. We should have been able to agree on insurance 
market reforms that would prevent insurance companies from denying 
coverage to children who have preexisting conditions, that would permit 
children to remain on their parents' insurance policies until age 26, 
that would require standardized claim forms to reduce administrative 
costs, and that would allow consumers to purchase insurance across 
State lines. Those are just some examples of health care reforms that 
would enjoy and do enjoy widespread bipartisan support.
  We also should be able to agree on delivery system reforms that 
reward value over volume and quality instead of quantity. We should be 
able to agree on reforms that increase transparency throughout the 
health care system so consumers can compare prices and quality more 
easily.
  I know the Presiding Officer's State, and Dartmouth College in 
particular, has done a great deal of work in this area, as have many 
health care providers and many hospitals in the State of Maine. They 
are experimenting with new delivery models that will help them better 
control chronic disease treatments, which, in turn, will not only 
improve the quality of health care but also help to lower costs.
  We should be able to agree on ways to address the serious health care 
workforce shortages that plague rural and small-town America. Simply 
having an insurance card will do you little or no good if there is no 
one available to provide the health care.
  In short, I believe we made--Congress made--a real error in passing 
ObamaCare. We should repeal the law so we can start over, to work 
together in a bipartisan way to draft a health care bill that achieves 
the consensus goals of providing more choice, containing health care 
costs, improving quality and access, and making health care coverage 
more affordable for all Americans.
  I yield the floor and suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. SESSIONS. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Shaheen). Without objection, it is so 
ordered.
  Mr. SESSIONS. Madam President, I ask unanimous consent to speak as in 
morning business for up to 15 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SESSIONS. Madam President, I am here today to share a new and 
stunning revelation unearthed by my staff on the Senate Budget 
Committee. One of my responsibilities as the ranking member is to look 
at the long-term cost of legislation, so we wanted to ascertain the 
long-term cost of the President's health care bill--I mean the kind of 
long-term cost analysis that has been going on for a number of years 
with regard to Medicare, Social Security, and Medicaid, over a 75-year 
period. I was floored by what we discovered.

[[Page 4582]]

  First, let's put in a little context. President Obama told the 
American people repeatedly that his health care bill would cost $900 
billion over 10 years and that it would not add one dime to the public 
debt. But we have shown that the cost score for the first 10 years of 
implementation, when the bill is fully implemented, is actually $2.6 
trillion--almost three times as much.
  In addition, the offsets used to reduce the law's official cost were 
enormous and phony, as I have discussed before and will detail at 
another time. These are unacceptable offsets. You have heard the story 
of Mr. Mistoffelees, the Napoleon of Crime. I say that this bill is the 
Napoleon of criminal offsets. The more we learn about the bill, the 
more we discover it is even more unaffordable than was suspected.
  Over a period of about 3 months, our staff worked diligently to 
estimate the new unfunded liability that would be imposed by the 
passage of this legislation. This is not the total cost of the bill but 
the unfunded mandatory coverage obligations incurred by the U.S. 
Government on behalf of the people of the United States over a period 
of time.
  An unfunded obligation is basically the amount of money we will have 
to spend on a mandatory expense that the bill does not have a funding 
source to meet--money we don't have but money we are committed to 
spend. It is this kind of long-term unfunded obligation that will place 
this Nation's financial situation at such great risk. It is the thing 
that has called witness after witness before the Budget Committee, on 
which I am ranking member, who tell us we are on an unsustainable path. 
That means money we will either have to print, borrow, or tax to meet 
the obligations we would incur as a people as a result of the passage 
of this bill.
  For instance, it is widely agreed that Social Security has an 
unfunded liability of $7 trillion over 75 years. That is an enormous 
sum. It is double the entire amount of the U.S. budget today. My staff 
used the models that are used by the Centers for Medicare and Medicaid 
Services. They talked with the individual experts about these numbers 
and worked diligently to come up with a figure using appropriate 
methods. That figure, using the administration's own optimistic 
assumptions and claims about the cost of the law, is an incredible $17 
trillion that would be added to the unfunded liabilities of the United 
States over the next 75 years. That is more than twice the unfunded 
liability of Social Security.
  I wish to emphasize that this $17 trillion figure is not an estimate 
based on what we think the bill will really cost if all the 
administration's claims and promises were to be proven false--and 
certainly there have been matters proven false already. We used the 
administration's own figures. So the unfunded liability is almost 
certainly not going to be less than $17 trillion, but if any more of 
the administration's claims unravel--as so many already have--the cost 
of the program's unpaid-for obligation will rise radically higher than 
$17 trillion. For instance, former CBO Director Douglas Holtz-Eakin, an 
expert in these matters, says that millions more individuals may lose 
their current employer coverage and be placed into the government-
supported exchanges than currently projected--than what the 
administration has projected. But we didn't follow Mr. Holtz-Eakin's 
arguments or concerns; we took the administration's assumptions.
  Let me briefly explain some of what now comprises this additional $17 
trillion in unfunded obligations.
  Madam President, $12 trillion is for the health care law's premium 
subsidy program. You see, the law created new regulations that drive up 
the price of insurance for millions of Americans. The writers of the 
law knew it would inflate the cost of insurance premiums, so to cover 
that cost, they had to include new government subsidies so people could 
pay for their more expensive insurance.
  On Medicaid, this new health care law has added another $5 trillion 
to its unfunded liabilities. This is on top of the substantial unfunded 
obligations the Federal and State governments have already had to take 
on in order to support Medicaid. They have protested vigorously to us, 
warning of these additional deep expenditure requirements that are 
falling on the States.
  These figures don't even account for the dozens of new bureaucracies 
that will be created to implement the President's health care law or 
the expansion of the bureaucracies. Those costs are not included in the 
$17 trillion or the cost estimates the administration used for the 
bill. For instance, the IRS has requested 4,000 new IRS agents and $300 
million in additional funds for their part in implementing the new law.
  At a time when we should be trying--we have to--to shore up programs 
that are threatened by default--Medicare, Social Security, Medicaid--
this health care law adds an entirely new obligation--one we cannot pay 
for--and puts the entire financing of the U.S. Government in jeopardy. 
We don't have the money. We don't have another $17 trillion in unfunded 
liabilities that we can add to our account. We have to reduce the ones 
we have. This has been obvious for several decades. People have talked 
about it repeatedly.
  Instead of doing something about those programs that are headed to 
bankruptcy, we add--under this President's determined insistence and a 
straight party-line vote--one of the largest unfunded mandates in 
history on top of what we already have. How can we possibly justify 
this? It cannot be justified.
  This bill has to be removed from the books because we don't have the 
money. There are a lot of other reasons, butthat is one of them. It is 
inescapable. It would be absolutely irresponsible for this Congress to 
maintain a law that would run up this kind of debt--2\1/2\ times the 
unfunded obligations of Social Security--and we are worried about our 
children being able to have their Social Security checks on time.
  This is not a little bitty matter, it is important. So I will be 
sending a letter to the GAO, the Government Accountability Office. They 
do these kinds of scorings over 75 years. We will ask them to construct 
their independent estimate of the unfunded health care law obligations. 
I believe they will be similar to the ones my staff has produced. I 
hope they are better, but I am afraid they are not. And even if they 
come close to what we have calculated, it is pretty clear that the 
money that will be coming in could be far less and the obligations 
could be far more than what are being projected, as Mr. Holtz-Eakin and 
others have said. It is an urgent matter.
  I plan to come to the floor in the coming days to continue to explain 
the true fiscal cost facts about this legislation. There are many other 
serious problems with it. It is unpopular, unaffordable, 
unconstitutional, and it has to be repealed.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Madam President, I appreciate the opportunity to speak. I 
ask unanimous consent to speak as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARPER. Madam President, I feel compelled to say a word on the 
heels of our colleague from Alabama, whom I salute as he heads off into 
the setting Sun. I wish him well and to have a good break.
  When I was in the Navy during the Vietnam war, when we weren't flying 
a lot of missions off the coast of Cambodia and Vietnam, we flew into a 
lot of other countries, including Japan. I have always had an interest 
in Japan in terms of the way they provide health care. One thing that 
intrigues me about that is that they spend half as much money for 
health care as we do. They spend 8 percent of gross domestic product. 
We spend 16 percent of gross domestic product. They get better 
outcomes--everything from longer life expectancy to lower rates of 
infant mortality--and they cover everybody. They cover everybody. It is 
not socialized medicine. They have a private health care delivery 
system and private health insurance companies as

[[Page 4583]]

well as we do, but they get a better result for about half the money we 
do, and we have to compete with them.
  It is not a fair competition. We have our businesses that are 
competing directly with the Japanese and, frankly, with other countries 
as well. But when they are spending half as much money for health care, 
and we are trying to compete our businesses against theirs, it is not a 
fair fight. It is like having one arm tied behind our back.
  For years, Presidents, Members of Congress--Democrat and Republican--
have talked about this challenge--the fact we spend so much more money 
for health care than the rest of the world, and we don't get better 
results and, in a lot of cases, we get worse results and we don't cover 
everybody. We have a lot of people uncovered. That is not smart.
  For years, for decades, nobody took it on. They tried during the 
Clinton administration but gave up during that course. They didn't have 
the kind of bipartisan support that is needed. Frankly, we didn't have 
the bipartisan support I would like to have had on health care reform 
when we took it up during the earlier part of this current 
administration.
  A lot of people have focused on the individual mandate as being 
constitutional or unconstitutional. I am not a lawyer. I don't pretend 
to be an expert on that stuff. I studied a little economics when I was 
a Navy ROTC midshipman at Ohio State. When I got out of the Navy and 
moved to Delaware to get an MBA under the GI bill, I studied some more 
economics and all, but I don't pretend to be a lawyer. But I do know 
this: Health insurance companies have said to all of us--Democrats, 
Republicans, Presidents, now and in the past--look, if you expect us to 
provide health insurance for folks with preexisting conditions, you 
have to make sure the pool of people we have to cover includes not just 
people who have preexisting conditions--not just people who are sick or 
have illnesses or conditions that are expensive to treat--you have to 
make sure we have a pool of people to insure that includes some healthy 
people.
  The way some countries deal with this is they mandate for everybody 
to have coverage. We didn't want to do that. We didn't want to mandate 
that everybody have coverage, but we wanted to incentivize people, 
including healthier people--including healthier young people the ages 
of my sons who are in their early twenties--to make sure at least some 
of those young men and women end up in that pool, so healthy people end 
up in that pool.
  So part of the request from the health insurance industry, in return 
for doing away with preexisting conditions and basically screening out 
sick people, saying they are not going to provide coverage for them, 
was to make sure a lot of healthier people ended up being in that 
health insurance pool.
  The way we decided to do it in the health care bill, in the law 
rather than just mandate people get coverage, was to incentivize them. 
If they choose not to, that is their business. If they happen to be 
poor, we will help them pay down their cost for health care. But if 
they are not poor, and they have the financial means, we would like for 
them to get coverage. We are not going to mandate it, but the first 
year we have the means to be able to have coverage and they choose not 
to, there will be a fine or a penalty of some kind--maybe a couple 
hundred bucks, and that will increase not to $1,000 or $2,000, but it 
will go up several hundred dollars in order to encourage people to get 
the coverage.
  At the end of the day, some people will say: I am paying $600--
whatever it ends up being. Maybe instead of paying this fee I should 
just go ahead and get some health insurance coverage. The idea is to 
provide some plans that are reasonably affordable so folks can take 
advantage of them.
  So that is the issue of the mandate. The Supreme Court will decide 
whether under the commerce clause of the Constitution that just as we 
compel people to pay into Social Security, it can be a similar kind of 
compunction to say we would like people to get covered for health care, 
but in this case not to mandate it, as we do with Social Security. So 
we will see how it works out in the Supreme Court.
  They heard arguments this week, and I am sure the arguments will 
continue on the air waves, at townhall meetings, and on television for 
months to come and maybe beyond that. Who knows. But the heart and soul 
of the health care reform legislation has less to do with mandates for 
me than it does with how to get better health care outcomes for less 
money. For me, that is it--better health care outcomes for less money.
  We don't have to look at Japan and other countries to figure that 
out. All we have to do is look at places such as Minnesota's Mayo 
Clinic, in Ohio the Cleveland Clinic, Pennsylvania's health care 
delivery system, which is called Geisinger, Utah's Intermountain 
Healthcare, and California's Kaiser Permanente. What do they have in 
common? They get better health care outcomes for tens of millions of 
people for less money than most other health care delivery systems in 
this country. Better results for less money.
  How do they do it? Well, they have figured out what works, and they 
do more of that. They figured out what doesn't work to get better 
health care outcomes for less money, and they do less of that. They 
have moved away from what we call a fee-for-service approach to health 
care.
  People get sick, they go see a doctor, they go see a nurse. They have 
visits and get shots or they get lab tests done or get x-rays or MRIs. 
We treat people when they get sick. For years, that is the way we have 
done health care in this country, including Medicare and Medicaid. Much 
smarter ideas have come out of Cleveland's clinic, and they have a huge 
health care clinic in northern Ohio, the Mayo Clinic, Geisinger in 
Pennsylvania, Intermountain in Utah, and Kaiser Permanente mostly in 
California.
  Here is what they do. They do not just incentivize health care 
providers--doctors, nurses, and hospitals--to work on people when they 
are sick. Their incentive works entirely different. What they do in 
those places is focus on how to keep people healthy, not just how to 
incentivize the doctors, hospitals, and nurses to keep people healthy, 
but how do we incentivize the patient, the person whose health is at 
stake, how do we incentivize them to take personal responsibility for 
their own health care.
  In my mind that is the heart and soul of the health care reform right 
there. Among the smart things that work are large purchasing pools. We 
have an 8-million-person pool for us that we are part of. Members of 
Congress, our staffs, all Federal employees, Federal retirees, and our 
dependents are part of a huge purchasing pool called the Federal 
Employees Health Benefits Plan. It is approximately 8 million people. 
We don't have 8 million Federal employees, but we have 8 million people 
when we add in retirees and dependents and so forth. We are part of 
this big health care purchasing pool. We get lower prices.
  It is not free. We pay about 28 percent of the cost of our premiums 
as Federal employees and servants, if you will, to people in our 
respective States, and our employers, the taxpayers, pay the other 72 
percent or so.
  But what we are going to do is provide the opportunity for 
individuals, for families, for businesses--small and midsize 
businesses--all over the country, in less than 24 months, to be able to 
join a similar kind of purchasing pool. We are going to start them, and 
every State--New Hampshire, Delaware, Alabama, and every other State--
will have the opportunity to have their own large purchasing pool to be 
able to take advantage of lower administrative costs.
  The administrative costs for our Federal Employees Health Benefits 
Plan is $3 out of every $100 of the cost of the premium. So $3 out of 
every $100 of premium costs goes for administration. In most plans for 
individuals, for families and small businesses, it is more like 20 or 
30 percent. So 3 percent for our large purchasing pool, and we will 
have those available, in fact, in every State.

[[Page 4584]]

  The other thing we have going for us in the Federal Employees Health 
Benefits Plan is we use private health insurance plans. We are not 
using socialized medicine or stuff like that. The private health 
insurance plans in the country can sign up and say they want to be able 
to offer their plans to the folks who are Federal employees with 
dependents, to Federal retirees, and so we can choose among them. So 
there is a lot of competition between those health insurance companies, 
and we get the benefit from that competition. It drives down cost. 
Competition helps drive down cost and improves the range of 
opportunities.
  The other thing I like about the law is that, for the most part, 
insurance can't be sold across State lines. But we make an exception. I 
will use Delaware as an example. We are boundaried on the west by 
Maryland, to the north by Pennsylvania, and to the east by New Jersey. 
When we establish our own health insurance pool in 2014, we will have 
about 900,000 people. So we will have a huge health insurance pool, but 
we are sure not going to have 8 million people.
  But what we will have under the law is the opportunity to create an 
interstate compact between Maryland or Delaware or Delaware and 
Pennsylvania or Delaware and New Jersey or maybe all of the above and 
have a multistate purchasing pool or exchange. The great thing about 
this approach is we, No. 1, will have a bigger pool, which will drive 
down administrative costs and increase the competition.
  The health care that would be available in Delaware plans could be 
offered in Maryland, could be offered in Pennsylvania or offered in New 
Jersey. So we would have a larger purchasing pool, more competition, 
and a better deal for the consumer. I think that is another part of the 
heart and soul.
  So two things, and I will close on this and then turn to what I came 
to the floor to talk about. But I was inspired by my friend from 
Alabama. In terms of the key reforms in the health care legislation, 
No. 1, move away from fee-for-service--just paying for treating people 
when they are sick. Migrate away from that. We still need to treat 
people when they are sick, but migrate to a system like we have at 
Mayo, Cleveland Clinic, Geisinger, Intermountain Health, and Kaiser 
Permanente where they focus on how we keep people well. Focus on 
prevention and wellness and focus on treating people in a coordinated 
fashion as a team, not as individual providers. Very smart.
  The other key element is this idea of creating these large purchasing 
pools and trying to incentivize people to be part of the health care 
delivery system by taking better care of themselves. So those are the 
two keys.

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