[Congressional Record (Bound Edition), Volume 160 (2014), Part 7]
[Senate]
[Pages 9441-9443]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. BLUNT. Mr. President, I wish to talk a little bit about health 
care this morning.
  The majority leader has suggested in past weeks that all of these 
contacts and concerns I get from Missourians are just made up--although 
he didn't target Missourians and say only Missourians were making up 
these stories; he just said everybody was making up these stories. But 
that is clearly not true.
  The law regarding health care--the law that is applied every day with 
great consistency--continues to be the law of unintended consequences, 
the law that so often is impacted by what we think we are doing in the 
Congress, only to find that the consequences of those actions go well 
beyond the discussion the Congress was having. Certainly if we had that 
debate again today, the debate we had in 2009 and early 2010, the 
Congress would be better prepared for that debate, the country would be 
better prepared for that

[[Page 9442]]

debate, and people would understand what is at stake. What I see every 
day are things that people didn't anticipate would happen.
  Here is a letter we got from Jack in Kansas City, MO. He said:

       I'm a retired hospital CEO and glad to be retired because 
     of Obamacare.

  He points out in an absolutely correct way that in most communities 
in Missouri, particularly our small and midsized communities, the 
hospital is a real source of pride and place of healing, a major 
employer.
  Of course, the potential end result of what is happening now with the 
changes we made and how hospitals are treated, particularly hospitals 
in rural areas, hospitals in underserved inner-city areas, is that the 
programs that were in place are basically going away. And why did they 
go away? Because the President assumed and the Members of Congress, I 
am sure, who voted for this piece of legislation assumed, that 
everybody would be covered, that everybody would have insurance, so we 
didn't need to have special programs that dealt with people who didn't 
have insurance and hospitals that dealt with people who didn't have 
insurance, and we didn't need special programs for underserved areas. 
Clearly, that is not the case.
  If we look back at the debate, many people were saying: This will not 
work out the way the well-intended proponents of this law think it will 
work out, and we are going to continue to have people without 
insurance.
  In fact, the Congressional Budget Office reiterated again just 
recently that at the end of 10 years, how many people won't have 
insurance? Thirty million. Thirty million people didn't have insurance 
when we started, and to disrupt the entire health care tableau of the 
country to add possibly 10 million, I think we are going to have people 
who lose insurance at work who previously had insurance through their 
work. I think that will be one of the major unintended consequences as 
we approach the end of this year and go into next year.
  I am talking to too many employers in Missouri who are saying there 
is a place for people to go now. They can go to the exchange. We 
struggled with this for a long time. Even though we are not covered by 
the law, even though we don't have 50 employees, we are no longer going 
to provide the insurance at work--that many of these employers have 
provided for decades and others have provided over all the time they 
have been in business, even if it is less than decades.
  Norman from Warrensburg, MO, is concerned about what would happen 
with Medicare and Medicare Advantage. He says: I was struck with 
Guillain-Barre in 2005 which has left me disabled as well as other 
resulting health issues. We expend more than $3,000 out of pocket 
annually just for my prescriptions alone and that was under a Medicare 
Advantage plan. This plus the Medicare premiums and the physician care 
takes almost all of our Social Security benefits. We live in a small 
community.
  He describes Warrensburg as a small community of around 18,000, and 
it would probably be one of those communities to lose the Medicare 
Advantage type of insurance, which is the gap that he thinks allows his 
family to have the health care they have and would like to continue to 
have.
  Paula from O'Fallon, MO, says she believes a lot of people's spouses 
are going to leave their jobs because they are going to look at who has 
the better insurance and try to benefit from that better insurance. 
According to her, her husband's company is paying a large fine because 
their insurance is better than ObamaCare. I imagine more realistically 
what that letter might have said is that their insurance isn't exactly 
what the Department of Health and Human Services believes is the right 
kind of insurance, when the government makes these decisions instead of 
the people or the people closest to them, their employers.
  One of the benefits of the employer-provided system was that people 
didn't have to worry about this. In fact, almost everybody looked at 
their insurance and they talked with their employer and they decided 
they would get more information when they needed it, and when they 
needed it usually the information they got was pretty good information 
for them to have.
  Now we have people trying to figure out, if they have choices, a 
complexity of choices and alternatives that they never had to deal with 
before. Frankly, they are not going to like that, and I think one of 
the other unintended consequences of this law is that people are going 
to begin to say: I know a government-run program wouldn't be as good as 
the health care I used to have, but I just don't want to be responsible 
for it anymore. What we probably are doing is building a groundswell of 
people who no longer want to be forced into the decisions they never 
had to make, because 85 percent of everybody who had insurance had 
insurance at work, and 90 percent of them thought the insurance they 
had at work met their needs. I think we would be lucky if very far into 
the Affordable Care Act, 90 percent of the people who have insurance 
think the insurance they have moving forward meets their needs.
  Angelyn from Dexter, MO, said her aunt and uncle are searching for a 
new doctor after their doctor moved out of State. They are having 
trouble finding a physician in the Dexter area that will take new 
Medicare patients--another unintended consequence.
  The people who voted for this bill cut Medicare itself. I wasn't for 
it, but it is the law. One of the reasons I said I wasn't for it is we 
are cutting a program we already knew is challenged--Medicare--by $500 
billion to form a new program. There is no city council, there is no 
county government, there is nowhere else in America where people would 
go to a meeting and say, OK, we have a program that is in real trouble, 
so what we are going to do is cut that program to start a new program--
and particularly a program such as Medicare that people have been led 
to believe they can rely on. When we cut Medicare by $500 billion over 
10 years something happens.
  What Angelyn's aunt and uncle are seeing is one of the things that 
happens is people try to find a doctor who will take Medicare only and 
find doctor after doctor who says: We are going to continue to serve 
the Medicare patients we have as long as they are around to serve, but 
we are not serving new Medicare patients.
  Joanna in Kansas City said her son goes to college where he is 
required to have health insurance. His health insurance he gets through 
the school has increased 40 percent this year.
  Wayne in Moberly said his premiums and prescription drug costs have 
increased and he is concerned it is because of all the new requirements 
that have to be met. He said: ``The future does not look good from 
where I stand as a small business owner and a farmer.''
  Donna in Napoleon, MO, said her insurance had gone from $93 twice a 
month to $156 twice a month. The interesting point in her letter is she 
said her insurance would go up even more if she gets a chance to work 
more. There is a lot to be said for assisting people to get health 
insurance who cannot otherwise afford to get health insurance, but one 
of the things I never heard debated in any extensive way is what 
happens when people are at the edge of moving to a new level of work 
which then gives them a lower level of benefit.
  Donna is saying that if she gets to work more hours, she will have 
less assistance buying her health insurance and her health insurance 
goes up. The government should not be in the business of looking for 
ways to encourage people not to work, as in the part-time work we see 
all over the country now.
  One of the great workplace impacts of the health care law was that 
the government for the first time ever said to most employers--
employers of more than 50 people--you have to provide health insurance 
to anybody who works 30 hours a week. So what did employers for the 
first time hear the government saying? If someone works less than 30 
hours a week, they don't have to have to provide health insurance. So 
employer after employer made the decision that for new employees we are 
going to hire three people at 27 or 28

[[Page 9443]]

hours a week rather than two people at 40 hours. We are going to meet 
our workforce needs in a new way. Consequently, those individuals don't 
have coverage. Many individuals at that level of hourly work who used 
to have coverage no longer have coverage. An awful lot of companies 
used to provide coverage at half time--at 20 hours--but if the 
government says they don't have to provide it until 30 hours, it turns 
out a lot of people don't work more than 30 hours because they don't 
have an opportunity or maybe they work almost 60 hours, but they have 
to work 60 hours at two different jobs, as did a lady I mentioned just 
last week who contacted our office.
  David in Kansas City said he is retired from the railroad industry, 
and on April 1 his former company canceled plans for retirees 65 and 
older. David had access to a retiree plan from the railroad industry. 
He doesn't have that anymore.
  A lot of companies have done that, not just the railroad industry. 
IBM announced they would no longer provide health care coverage for 
their retirees. As soon as the retirees are 65 and older they are 
placed on Medicare, but what kind of supplement do they have? They used 
to have a supplement that was part of a big IBM plan and now they don't 
have that anymore. UPS announced the dependents and spouses who are in 
part of the UPS family wouldn't have insurance anymore. The unintended 
consequences keep on coming, and we need to continually look at what we 
need to do to see that people have access to great health care.
  We are talking now--as we should be--about veterans health care and 
how veterans could have access to great health care. This is the moment 
right now where we can look at this issue in a new way. The veterans 
service organizations are looking at this issue. Alternatives are good. 
Veterans should have the best health care, in the best location for 
them, in the best way the taxpayers can provide it.
  The Veterans' Administration should be the best at some things. They 
should be better than anybody else at dealing with IED accidents, eye 
injuries, the loss of limbs, and other issues that are unique to 
veterans in unfortunate numbers because of the kind of conflicts in 
which we have been involved. Nobody should be better at that than the 
VA.
  The VA may be the absolute best place to go for a particular injury, 
such as post-traumatic stress. Our veterans have problems because of 
the conflicts they have been in, but they also have problems because 
the National Institutes of Health says one out of four adult Americans 
has a diagnosable mental health problem. In a hearing a couple months 
ago, I asked the Secretary--the Surgeon General of the Army and the 
other forces about this: Do you think that is reflected in the 
military, and the answer was yes. She said: We recruit from the general 
population. We don't have any reason to believe our population serving 
in the military doesn't reflect similarly with regard to mental health 
issues. Some of those mental health issues, such as post-traumatic 
stress, the VA should be better than anybody else at, but a lot of 
mental health issues in the VA, there is no reason they should be any 
better than any of the other facilities. Veterans may have to drive to 
another State to get to a veterans facility or have to drive 120 miles 
or 150 miles in the VA's van transportation. If that is what someone 
wants to do as a veteran, I think we ought to be sure veterans can do 
that, but if veterans want to get better care closer to home, more 
choices, we should do that.
  Let the Veterans' Administration compete to be the best at what they 
can provide. There is no particular reason to believe the Veterans' 
Administration is going to be better than everybody in the country at 
normal internal medicine. There is no reason to believe the Veterans' 
Administration is going to be the best at dealing with cancer or heart 
issues or other issues. If there is a veterans hospital that somehow 
has figured out how to do that, fine, but don't make veterans drive 120 
miles by a dozen facilities that can do just as well or better because 
we have decided to put people in a system that is totally defined by 
the government.
  One of the things we are learning is people can make better choices 
in so many areas than when the government makes those choices for them. 
So as we think about our veterans, as we think about what we can do to 
be sure they get the best care, that they are honored, their service is 
honored in a way they were led to believe it would be honored, this is 
a great time to have this discussion.
  So whether it is health care for everybody else or health care for 
veterans, the Congress of the United States--and the country--has 
probably never been in a better position to talk about these issues. We 
see the unintended consequences of taking steps in the wrong direction. 
Now is a great time for our veterans and health care generally to see 
what we could do to take steps in the right direction.
  I note the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  The ACTING PRESIDENT pro tempore. The Senator from New York.
  Mr. SCHUMER. Mr. 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.

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