[Congressional Record (Bound Edition), Volume 160 (2014), Part 7]
[Senate]
[Pages 9492-9503]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           BURWELL NOMINATION

  Mr. CARPER. Mr. President, while Senator McConnell is still here in 
the Senate Chamber, I wish to follow up on his comments about the loss 
of Christopher Stout.
  My wife and I have a son of our own named Christopher. He is roughly 
10 years younger than Christopher Stout at his death. So as soon as 
Senator McConnell began talking about the loss of his life, it 
resonated with me as a father. It also resonated with me as a former 
commander chief in the National Guard for 8 years and as a Navy

[[Page 9493]]

veteran who served three tours in Southeast Asia in the Vietnam war.
  Sometimes we don't focus enough on what is being accomplished by our 
service men and women such as Christopher Stout and their service to 
our country in Afghanistan and our purpose there. Our role has been to 
go into a place in which 9/11 attacks were conceived and guided, 
killing thousands of Americans. Our purpose is, as we draw down on our 
troops there at the end of this year, to be down to about 9,800 troops, 
roughly half a year from now, and even fewer in the years to come. But 
our goal is threefold; that is, when we leave, we leave behind not only 
a place that is less likely to foment and launch attacks against this 
country or any other country, but also we leave behind a country that 
can feed itself, defend itself, and govern itself.
  The Presiding Officer was adjutant general for the State of Montana, 
and he understands full well, having served in combat and for a long 
period of time, the importance of the role the Christopher Stouts have 
played and the reverence we hold for them and for their service in life 
and beyond.
  I also hasten to add in following up on the minority leader's 
comments, there are some things we had in the military. I served 5 
years Active Duty, 18 years Reserve as a P-3 aircraft naval flight 
officer and later as a mission commander. There are some things we had 
in the military that frankly a lot of people in this country haven't 
had for too many years. Until last year about 40 million people in this 
country did not have health care. They did not have access to health 
care, and we have changed that. We have changed that dramatically.
  Does everybody have access to affordable health care today? No, but 
we no longer have 40 million people anxious to get access to health 
care. That has been cut by roughly one-quarter. We will reduce it again 
this year and again next year, but among the things we had in the 
military is an annual physical. The idea is that you actually get an 
annual physical in your birthday month. My birthday month is January. I 
got my first annual physical, I think, when I was 17 from a Navy 
doctor, and I got them for years and years after that.
  A lot of people in this country, including people on Medicare--they 
could have lived to be 105--and until about 3 years ago with the option 
of the Affordable Care Act they got one annual physical paid for by 
Medicare when they turned 65 and joined Medicare. That was it. It was 
called the Welcome to Medicare physical. If they could have lived 
another 40 years, they would have gotten another one paid for by 
Medicare.
  The reason the military provides annual physicals for its members, 
Active Duty and Reserve, is in order to catch health care problems when 
they are small, when they can be treated, and we do this to save money. 
I served in the military and in and out of military bases all over the 
country, all over the world, and in almost every one of them there was 
not just a doctor, a Navy corpsman and so forth, but there was a place 
to go--if you had a problem and needed medical attention, you could get 
it--a clinic. Today we have thousands and thousands of clinics all over 
this country where people, whether they have 5 cents or $5 or $50 to 
their name, have health care coverage. They can go get primary health 
care. They can get primary health care. We have grown dramatically 
access to primary health care in places all over America, not just 
Delaware but all the other 49 States as well.
  There has been a lot of attention on the VA, some of the very 
disappointing circumstances that are going on in Phoenix and other 
places such as that in terms of waiting lists, and they need to be 
aggressive and they will be, but one of the great innovations the VA 
came up with 15 or more years ago was electronic health care records.
  When I was in the Navy and on Active Duty, and the Presiding Officer 
may remember, we used to carry around with us--roughly this size--a 
brown manila folder, and it included my medical records for years, from 
the time I got my first physical as a 17-year-old Navy midshipman until 
my last one. People on Active Duty don't carry these around anymore. We 
have electronic health records pioneered by the VA and now we have them 
in the Department of Defense. The reason we have them is because it 
enables us to better coordinate delivery of health care to people who 
otherwise may not have it. The Affordable Care Act actually introduces 
for the first time for millions of people electronic health care 
records, not for them to carry around or access necessarily--although, 
in some cases they can--but so the people providing care for them can 
do it in a better coordinated and smarter way and a more cost-effective 
way, providing better results for less money.
  The other thing we had in the military was the medicine. If someone 
needed to take medicine, prescription medicines or that sort of thing, 
they could actually get a medicine that was going to help them, keep 
them well or help them stay well, be productive. We adopted about 7 or 
8 years ago the primary Medicare Part D prescription drug program in 
Medicare which has turned out to be a great success, although they had 
a big problem with it when people would fall into the doughnut hole. A 
lot of folks who got pretty good coverage for maybe the first half of 
the year would lose their coverage and have to pay. They didn't get any 
help from Medicare Part D. We started fixing--filling the doughnut 
hole--with the passage of the Affordable Care Act, and over the next 6 
or 7 years we will complete fixing that doughnut hole and people will 
not fall off the cliff, the Medicare Part D participants, as they have 
been, because of what is in the Affordable Care Act. Do you know who 
pays for that? The pharmaceutical companies pay for that, not the 
taxpayers. The pharmaceutical companies pay for that expansion, making 
Medicare Part D a good program, cost-effective, under budget, and 85 
percent of the people who use it like it. All of those things coincide 
with the benefits we enjoyed in the military, and they are made 
available in part and parcel for more people through the adoption of 
the Affordable Care Act.
  Are there problems with the Affordable Care Act? Sure there are. Are 
there things we need to fix? Sure we should. Will Sylvia Mathews 
Burwell help us fix those? She will provide great leadership. She and 
I, interestingly, have our lives intertwined in a strange way. We found 
out when I first met her. I called Erskine Bowles. I learned over 1 
year ago the President had nominated Sylvia Mathews Burwell to be 
President Obama's OMB Director. I noticed she had worked in the Clinton 
White House with Erskine Bowles when he was Chief of Staff to President 
Clinton the second term.
  So I called Erskine, and I said: Tell me about Sylvia Mathews 
Burwell.
  He said: I will tell you about Sylvia Mathews Burwell. I have known 
people as smart as Sylvia. I have known people who are as good at 
working with other people as Sylvia is. I have known people as good as 
Sylvia at getting things done. I have not known one person who does all 
three of those things as well as she does.
  He told me a story when she was working as Bob Rubin's right-hand 
person, top assistant. Bob Rubin was then the Secretary of the 
Treasury. President Clinton was meeting with Chief of Staff Erskine 
Bowles, Bob Rubin, the Secretary of the Treasury. Bob Rubin had one of 
his top aides with him, Sylvia Burwell. Erskine recounted the story of 
how the President was grilling Treasury Secretary Rubin on a particular 
issue and Secretary Rubin was kind of struggling to respond in an 
appropriate way to the President's inquiries. Sylvia Mathews Burwell, 
the assistant, wrote a note, and when the President was not looking, 
handed it discreetly to advise Bob Rubin, who glanced at the note and 
then reengaged the President on the issue, and the President said: That 
is a brilliant insight. That is really a brilliant insight, Bob.
  Erskine Bowles, not to be deterred, said to the President: Mr. 
President, Sylvia wrote a note and gave it to him. That is how he was 
able to give you that answer.

[[Page 9494]]

  If I had people as smart as Sylvia on my staff, I would look a lot 
smarter too. But she covered herself with glory in those years at the 
White House. She finished up. This is a gal who grew up in Hinton, WV, 
a little coal mining town on the New River where I lived when I was 4 
years old. Her husband Stephen proposed to her at the Blue Stone Dam on 
the New River where my grandfather and father used to take me as a 
little boy to fish.
  She later graduated from Hinton High School, a public high school, a 
little coal mining town. Where did she go to school? She went to 
Harvard. After that where did she go to school? She was a Rhodes 
Scholar. She went to Oxford, and she came out and she went to work for 
a great consulting company, McKinsey & Company, and started working in 
the White House doing all kinds of things during the Clinton 
administration, higher and higher responsibilities, ending up as OMB 
Deputy Director the last part of the year, when we actually had four 
balanced budgets in a row, if you will recall.
  She knows how to manage. She knows how to manage people, she knows 
how to manage financial resources, and she is terrific working with 
people. That is why Senator Tom Coburn, my wingman in terms of 
leadership on the Senate Committee on Homeland Security & Governmental 
Affairs, actually came along with Senator Jay Rockefeller from West 
Virginia, actually came, a Republican and a Democrat, to introduce her 
for her confirmation hearing before the Senate Finance Committee, on 
which I served, to endorse her candidacy. I thank Dr. Coburn for doing 
that. One would expect Senator Rockefeller to do that. He has been a 
longstanding huge fan, but Senator Coburn and I have only gotten to 
know her for the last year and a half and have loved working with her 
and think she has done a terrific job at OMB and that she will do a 
terrific job at the Department of Health and Human Services.
  I wish to say a special thank-you to her parents who are still alive 
and who still live in Hinton, WV, a real thank-you for raising not one 
but two young women, including Sylvia's younger sister Stephanie, for 
instilling the kind of values and the kind of education in them that 
has enabled them both to go on and do extraordinary things with their 
life.
  I say thank you to Stephen, who proposed marriage to then-Sylvia 
Mathews at that Blue Stone Dam on the New River all those years ago. I 
thank him for sharing his wife with our country. These are tough jobs, 
demanding jobs, and in some cases thankless jobs, and he is willing to 
take on some extra responsibility as a dad in helping to raise their 
children, both under the age of 10. I think Helene is about 6 and I 
think the younger daughter is maybe 4 years old. They know their mom is 
changing jobs. They know she still has a job. If we confirm her today, 
it is a huge job.
  Is there work to do? Sure, there is. Is there work to do in 
implementing the Affordable Care Act? Sure, there is. Is there work to 
do in tweaking it and making it better? Sure, there is.
  I will close with this for my Republican friends--and I love them 
all. For my Republican friends who moan and groan about the enormous 
burden the Affordable Care Act is putting on the American people, let 
me say this: I have a friend who if you ask him: How are you doing, 
says: Compared to what?
  If things are so bad now with the Affordable Care Act, let's just 
say: Compared to what?
  Here is where we were 3 or 4 years ago. The country of Japan spends 8 
percent of their GDP on health care. We spent 18 percent, until 
recently, with the Affordable Care Act. They get better results, higher 
rates of longevity, lower rates of infant mortality, arguably better 
results than we did until at least a couple of years ago, and in Japan 
they cover everybody. Until this year we had about 40 million people 
who went to bed at night who did not have health care coverage.
  I regret that anybody who is inconvenienced or disadvantaged all 
because of the adoption of the Affordable Care Act. I regret it for 
every one of those people, but you know what. I regret that all those 
folks in this country, tens of millions of them, didn't have access to 
health care. I regret the fact that all those people on Medicare never 
got a second physical, and if they had gotten one, they would have a 
much better life. I regret that all the folks in the Medicare 
prescription drug program--millions of senior citizens--fell into the 
doughnut hole and stopped taking their medicines and got sick, had to 
be hospitalized, and ended up in nursing homes. It cost a lot of money 
and they died with not a happy life. I feel badly for them.
  My dad used to say to us, rather than moan about our problems, fix 
them--fix them. There are plenty of things we can do to make the 
Affordable Care Act better. I know what they are. But the idea about 
going back to where we were? That dog doesn't hunt. It is not a good 
thing in Delaware and I don't think it is a good thing in Kentucky, 
where Gov. Steven Beshear has led, provided great leadership in his 
State to make sure the hundreds of thousands of people who needed 
health care have it today who didn't have it before.
  We want to make sure the opportunity they have realized in Kentucky 
and those States that don't have that opportunity, that have no 
exchange to sign up in--they have no expansion of the Medicaid 
Program--my hope is they will look to Kentucky as an example and to 
Delaware as an example, to see what we can do for our people.
  Last point. Most of the people who serve here are people of faith--
some are Protestant, some are Catholic, some are Jewish, different 
religions. Most people here are people of faith. Most of our sacred 
Scriptures have a couple things in common. One of the things they have 
in common is the Golden Rule. Chaplain Barry Black, who gives the 
opening prayer most days the Senate is in session, likes to say that 
the Golden Rule is: Treat other people the way you want to be treated, 
love thy neighbor as thyself. He says those are the CliffsNotes of the 
New Testament. As it turns out, the Golden Rule is the CliffsNotes of 
every major religion in the world. I don't care if you are Protestant, 
Catholic, Jewish, Muslim, Hindu, Buddhist, almost all of them have 
something like the Golden Rule in their sacred Scriptures.
  In the New Testament, in the Book of Matthew, Matthew 25, there is 
something we have all heard. Not everybody knows where it came from or 
even that it is in the Bible, but it is. The Scripture talks about, 
when I was hungry, did you feed me? When I was thirsty, did you give me 
to drink? When I was naked, did you clothe me? When I was sick and in 
prison, did you come to see me?
  Matthew 25 doesn't say anything about when I had no health care, and 
when I had to depend on the emergency room for health care when I got 
very sick and ran up a big tab that somebody else had to pay for 
because I was hospitalized for a while--a long while. It doesn't say 
that in Matthew 25, but the intent is the same.
  Where were you? We were here, and we voted to try to do something 
about it, to make sure people did have better access to health care, 
and we can improve on what we have done and we need to do that. We have 
a moral imperative to the least of these in our society to look out for 
them, to help them look out for themselves as well. We also have the 
fiscal imperative given our budget constraints to meet that moral 
imperative in a fiscally responsible way. Sylvia Mathews Burwell 
understands that as well as anybody I know. She has demonstrated that 
in her leadership in OMB. She will demonstrate that if we confirm her 
today to be the Secretary at the Department of Health and Human 
Services.
  I hope my colleagues, Democrats and Republicans, will follow the 
leadership of Senator Tom Coburn, a Republican from Oklahoma, and his 
wingman Tom Carper, a Democrat from Delaware, in supporting this 
nomination.
  With that, I yield back the floor and suggest the absence of a 
quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The bill clerk proceeded to call the roll.

[[Page 9495]]


  Mr. GRASSLEY. 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. GRASSLEY. Mr. President, this afternoon we are going to vote on 
the nomination of Ms. Burwell to be the Secretary of HHS. I am going to 
support that nomination. I am here on the floor to alert people to some 
of the problems she will face and hopefully she can correct.
  For starters, I hope that everybody remembers the government has 
checks and balances. Congress passes laws, the executive branch 
enforces them, and it is our responsibility to make sure that those 
laws are enforced according to the intent of Congress. When they are 
not enforced, we have a responsibility to point that out, and that is 
what I will be doing. I hope she will be able to correct the issues 
that my colleagues and I will be pointing out this morning.
  We also have a situation where Congress passed the Affordable Care 
Act, and in that process the President has done a lot of things that 
some of us think are illegal and in some cases even unconstitutional. 
Hopefully, she, as the new director, will make sure that those 
practices don't continue.
  When Ms. Burwell was nominated, I said that anyone put in charge of 
ObamaCare would be set up to fail. The theme of this law has really 
been ``by any means necessary.'' In other words, it doesn't really 
matter what the law says, do whatever it takes to get this program 
underway: the President can fix it later. He has done that 38 times--
and surely sometimes contrary to what the law says and contrary to the 
oath he took to uphold the laws of this country: The legislative 
process was certainly, by no means, necessary; if you want to change 
it, change it.
  The implementation of this law has operated similarly. The department 
we are considering Ms. Burwell to lead has ignored the plain read of 
the statute whenever it was considered necessary. In other words, don't 
bother to come to Congress to correct something you think is not 
working; just correct it yourself. Deadlines were considered to be 
written in pencil.
  If the statute needed to be creatively reinterpreted to make the 
program work, the Department of HHS did so, and that still continues 
today. Consequently, that is why I am pleading with Ms. Burwell to 
change things.
  The Department is supposed to implement the employer mandate, which 
is a year overdue, and it has been significantly altered from the 
statute. The Department is supposed to implement risk corridors this 
year, although the legal authority to distribute funds is questionable 
and the standards used to make those distributions will likely be kept 
very quiet.
  Speaking of things that will be kept quiet, Congress is going to want 
to know what the premiums will be next year for health insurance. We 
consider the information very important and relevant.
  My State of Iowa is considered to be one of the States most at risk 
for premium spikes. The Department will want to use any means necessary 
to hide the premiums until after the November elections unless, of 
course, the premium numbers are good, and then I am sure the Department 
will shout them from the rooftops, much as they did with enrollment 
numbers.
  We have heard over and over about enrollment numbers, but the 
enrollment numbers don't tell the whole story--not even close. I was 
under the impression that the law was supposed to increase coverage and 
lower costs. So far that is not the case. The independent research firm 
McKinsey found that 74 percent of the people getting coverage through 
ObamaCare plans were previously insured. If those numbers are accurate, 
that means one in four people getting coverage was previously 
uninsured. Certainly that is what I hear from my constituents. They 
have had to change their coverage, and often that coverage has been 
much more expensive.
  Furthermore, the McKinsey research also found that the majority of 
people who shopped for an ObamaCare plan but did not purchase that plan 
cited affordability as the No. 1 reason for not buying that insurance.
  A poll released by the Kaiser Foundation found that roughly 4 in 10 
uninsured Americans named affordability as their primary reason for 
going without health insurance. It is not working as it was intended.
  I hope Ms. Burwell will change the relationship the Department has 
with Congress. I hope she will be willing to break the ``by any means 
necessary'' mindset that we have seen for the last 5 years. I hope she 
doesn't disappear into the bunker over there in that office building 
and that we will never hear from her again.
  Her challenge is very severe. The law appears to be shifting around 
the previously insured more than it is covering the previously 
uninsured. The previously uninsured are citing costs as a primary 
reason for not purchasing insurance.
  I will support the nomination of Ms. Burwell today and hope that down 
the road--several months from now--I am not sorry I did that. I think 
she is a person who has the capability of turning things around, and 
that she will do that. But the law remains far from being worthy of 
support.
  I yield the floor and suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. THUNE. 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.
  Mr. THUNE. Mr. President, the ObamaCare train wreck just keeps 
rolling on. Every day it seems there is another story about another 
ObamaCare failure.
  Mr. President, 80,000 Oregonians must reenroll in health plans after 
the State's ObamaCare exchange site failed. The health care coverage of 
2 million Americans enrolled on the exchanges could be in jeopardy.
  The Congressional Budget Office says there have been so many delays 
and changes to ObamaCare that it can no longer estimate the fiscal 
effects of the law. And that is just the ObamaCare news from yesterday. 
The Democrats' victory lap is a distant memory replaced by the constant 
flow of stories about ObamaCare's many failures. Americans are losing 
their health insurance, Americans are losing their doctors, Americans 
are unable to obtain medications, employers are facing higher costs, 
and employees are facing higher costs. The list goes on.
  The President promised that his health care law was going to be a 
solution for American families. If they liked their health care plans 
and their doctors, they could keep them. If they didn't like their 
health care or if they didn't have health care, they would be able to 
get an affordable plan. Those were the promises that were made.
  Unfortunately, Americans quickly discovered those promises were not 
to be kept. Millions of Americans were forced off their health care 
plans and into the exchanges where they frequently found they were 
paying more and getting less. Too many Americans discovered their new 
health care coverage meant losing doctors and hospitals they liked and 
that their choice of replacement was limited.
  When the President was campaigning for his health care law, he 
claimed families would see their health care premiums drop by $2,500. 
In fact, health care premiums have increased by almost $3,700 under the 
President, and they are still going up.
  Middle-class Americans are hurting. The past 5\1/2\ years of the 
Obama administration have brought higher prices and fewer 
opportunities. Gas prices have almost doubled. Food prices have risen. 
Meanwhile, Americans' household income has declined by more than $3,500 
on the President's watch. So Americans who once confidently expected to 
be able to put their children through college and retire comfortably 
are now struggling to make ends meet. Too many families are living 
paycheck to paycheck, desperately praying they won't be faced with any 
unexpected bills. ObamaCare was supposed to make

[[Page 9496]]

things better for these families. It was supposed to make health care 
more affordable and ease Americans' health concerns. Instead, it is 
making things much worse.
  Today the Senate will vote on Sylvia Burwell's nomination to be 
Secretary of the Department of Health and Human Services. As much as 
Democrats might want it to be true, a change in personnel at the 
Department of Health and Human Services won't make the mess ObamaCare 
has created disappear. Changing HHS Secretaries isn't going to lower 
Americans' health care costs or give them back the doctor or the health 
plan they lost. It is not going to help the small businesses that are 
struggling under ObamaCare's burdensome mandates or restore the $1 
trillion Americans will lose in wages, thanks to the health care law. 
It is not going to bring back the jobs that have been lost as a result 
of ObamaCare.
  Every Senator who voted for this law owes the American people an 
explanation. Every Senator who voted for this law ought to be telling 
American families what he or she is going to do to fix this mess. 
Americans deserve better than ObamaCare, and we could give them better 
than ObamaCare, if Members of the Senate would decide this was the 
wrong approach and decide to go in a different direction. I hope 
eventually they will come to that conclusion.
  I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, I come to the floor today with huge 
concerns about the Obama health care law. I do it as a physician, as a 
doctor, who has taken care of families all around the State of Wyoming 
for a couple of decades; as a past president of our State medical 
society; as someone committed to preventive care, coordinated care; as 
the medical director of the Wyoming health fairs to give people low-
cost screenings for health care around the State Those continue today. 
There is one in the small community of Afton, WY, this very Saturday--2 
days from today. So the effort continues to actually make sure people 
can get prevention, early recognition of problems, and actual care.
  The President's health care law hasn't done that. The President keeps 
focusing on the word ``coverage'' instead of what people wanted, which 
was care. It is interesting today, because in the Wyoming Tribune 
Eagle, front page, today's newspaper, headline: Health-care law plagued 
by inconsistencies. At least 2 million people, the headline says, 
enrolled in insurance have problems with data that could affect their 
coverage. This is an Associated Press article on the front page of the 
Wyoming Tribune Eagle. A huge paperwork headache for the government 
could also be jeopardizing coverage for some of the people who just got 
health insurance under the President's health care law.
  The President went on television 4 days before the kickoff of the 
exchanges and said this is going to be easier to use than amazon.com. 
He said that. It is cheaper than your cell phone bill. And, of course, 
he said people could keep their doctor if they liked their doctor.
  When people see how this rolled out and the problems they have had 
with it, they now have huge concerns about whether they can actually 
trust the Federal Government with anything. They see all of the 
problems coming out of Washington and they are saying, Why should we 
trust the government, the Washington-based government, with anything?
  Let's take a look at some of the States that set up their own 
exchange. Yesterday's Wall Street Journal: State Exchanges Seek Costly 
Fix. Five States that launched health exchanges under the Affordable 
Care Act expect to spend as much as $240 million to fix their sites or 
switch to the Federal marketplace.
  Not one person is going to get care because of that. That is $240 
million to fix the bad sites that have already wasted money. How can 
people in these States of Oregon, Minnesota, Massachusetts, Maryland, 
Nevada--how can they say this is good for them? This health care law--
for people who wanted the care they need from a doctor they choose at 
lower cost find more wasted government money--in Oregon alone, $255 
million, money previously spent. The FBI is investigating them now in 
Oregon because of this. They say they want more money to upgrade the 
system. Minnesota: $141 million. What are we hearing from Minnesota? We 
are hearing school districts say we have to pay a lot more, so we are 
not going to be able to pay for teachers. We are not going to be able 
to pay for bus drivers. We are going to have to take it away from 
students to pay for the mistakes of this administration, this 
government, this law forced down the throats of the American public and 
voted for by many in this Chamber who never read it. They never read 
the bill, because they trusted Nancy Pelosi. She said, First you have 
to pass it before you get to find out what is in it.
  We don't have to turn the clock back very far to go to the June 4 
article posted in Roll Call, the local paper. Headline: Fiscal 
diagnosis--now, as a physician we do a physical diagnosis, but they are 
talking about a fiscal diagnosis: Fiscal Diagnosis Only Gets Tougher 
for Health Care Law. The first paragraph says, For Democratic lawmakers 
who were hesitant to sign onto this sweeping 2010 health care law, one 
of the most powerful selling points was that the Affordable Care Act 
would 
actually reduce the federal budget deficit . . .
  Four years later, headline: Fiscal Diagnosis Only Gets Tougher for 
Health Care Law.
  So we can talk about all of those numbers, but I want to talk about 
people who have actually been hurt by the health care law. There are 
people who have been helped, but there are many who have been hurt. 
People in my State--thousands and thousands--have had letters of 
cancellation. If they have gone onto the Web site and bought insurance, 
they found they paid a lot more for what they had to buy, because a lot 
of times it wasn't actually what they needed for themselves or for 
their family or what was best for them; it included coverage they would 
never use and don't want but still had to pay for, because the 
President seems to think he knows better what that family in Wyoming 
wants or needs than they do. That is not what America was built on--the 
government telling people what they have to buy, what they have to 
choose, what they have to have as their health insurance or their care.
  It is interesting that even National Public Radio has a story about a 
couple, a family--because one of my colleagues from Connecticut comes 
to the floor and says he thinks ObamaCare is working. This couple says 
it doesn't work--does not work. ``Frustrated By The Affordable Care 
Act, One Family Opts Out.'' This is a family in Texas, reported on 
National Public Radio. Rachel's husband wanted to make sure they had 
insurance. Rachel was skeptical, but Nick, her husband, went on line 
and started shopping. He had a lot of trouble getting through the 
glitchy Web site at first, but eventually he found a plan that would 
work just for his wife. He was concerned about his wife. She was 
pregnant. So this past January, as soon as the plan began, Nick printed 
out a list of obstetricians from the plan's Web sites. He said: I 
handed it to Rachel, fully confident, fully feeling like I had 
accomplished something for her, I had come through for my wife.
  Well, they called obstetricians because she was pregnant. Some would 
just say, We don't take Obama. One of the best was: ``The doctor takes 
it here in the actual practice, but whatever hospital you use''--none 
of those hospitals take ObamaCare.
  She said: It was mind numbing, because I was sitting there thinking, 
I am paying close to $400 a month just for me to have insurance that 
doesn't even work. What am I paying for?
  How could this not be working, her husband said. The United States 
Government has set this up. It is this whole big deal, he said. They 
are having commercials everywhere saying we need to use this, and these 
people are just saying, no, no, no, and it just made me so mad.
  So, as the headline says, they opted out.

[[Page 9497]]

  That is what the President has given the American people; not 
affordable care, not available care, not quality care, not access to 
care but a lot of promises not delivered upon. Many people across this 
country have been hurt by this health care law.
  I am going to continue to work on ways to reform health care in 
America in a way that is good for patients as well as the providers who 
take care of them, and responsible for the American taxpayers.
  Thank you, Mr. President. I yield the floor.
  The ACTING PRESIDENT pro tempore. The Senator from Ohio.
  Mr. PORTMAN. Mr. President, my colleague from Wyoming, Dr. Barrasso, 
has been talking about a lot of the issues related to the Affordable 
Care Act, otherwise known as ObamaCare. He has talked about the fact 
that the mandates in this legislation don't work for many Americans. 
The one-size-fits-all approach that was taken doesn't work in my State 
of Ohio and around the country.
  He also spoke about the cost. Unfortunately, it is not the Affordable 
Care Act; it tends to be, for a lot of people, the unaffordable care 
act. Costs have gone up already too high. We are now finding a lot of 
small businesses in my home State of Ohio are simply squeezed to the 
point where they are worried whether they will be able to provide 
health care at all, given the huge increases in cost.
  These are all very serious concerns and reasons that I think we need 
to repeal and replace with policies that work better to provide people 
more choices and provide people lower cost of care so they can get 
health care for themselves and their families.
  I want to talk about a very specific aspect of ObamaCare and its 
implementation that concerns me. I came to the floor a couple of days 
ago to talk about this because I had just learned, actually from some 
press reports, about some potential problems with implementation. 
Unfortunately, since that time it has been confirmed through other 
sources that many of my concerns are legitimate. The concern is very 
simple: That despite assurances by the administration to the contrary, 
they have yet to put in place a mechanism to assure that the people who 
are getting the subsidies under ObamaCare are eligible for them. This 
is a major problem because we are talking about billions and billions 
of dollars. It is a surprise, probably, to a lot of my constituents and 
other folks who might be listening today that the administration hasn't 
even put in place the basic processes, the mechanisms we would expect 
in an automated system, to ensure that when people apply for these 
subsidies--which are substantial; up to 400 percent of poverty, 
remember, and up to 10,000 bucks for a family of 4, for instance--that 
they may or may not be eligible and yet they may be getting these 
payments. Some people may be overstating their income and some people 
may be understating their income, and some folks may get a very 
unfortunate surprise of a big tax bill because of it.
  It is unbelievable that after a few years of implementation, still 
there is not in place some sort of a system to ensure that the right 
people are getting these huge amounts of taxpayer dollars. Improper 
payments of these subsidies may be going, we are told, to over a 
million people who aren't eligible to receive them. Yesterday the 
Associated Press reported that the number is actually closer to 2 
million people who are receiving subsidies, despite apparent 
discrepancies between what they are submitting--the data they are 
giving about their income information--and what the IRS already has. By 
the way, the Health and Human Services folks and CMS confirmed this 
report yesterday when they said: ``The typical family of four generated 
21 separate pieces of information that required verification, and all 
were attested to under penalty of perjury.'' Given that we expect this 
subsidy program to cost about $36 billion this year alone, these 
improper payments would likely result in billions of wasted taxpayer 
dollars.
  So at the very least, I am concerned that folks are going to find 
they have some very unpleasant and unexpected tax bills coming up, and 
the most we are seeing is a lot of taxpayer dollars that aren't going 
to the intended purpose.
  It is not as if we did not anticipate this problem. This is obviously 
something a lot of people thought about and talked about. In fact, we 
knew it would be difficult to verify all these dozens of pieces of 
information we just heard about from CMS. That is why last year 
Congress acted in a bipartisan fashion to require the Department of 
Health and Human Services to certify that it had these controls in 
place to verify the eligibility of subsidy recipients. We enshrined 
that requirement in law as part of what was called the Continuing 
Appropriations Act--better known as the Ryan-Murray budget agreement--
at the end of last year. Part of the Ryan-Murray budget agreement was 
to say that CMS at HHS had to have in place these controls to ensure 
people were getting the funds that were appropriate for them.
  On January 1, as required by law, Secretary Sebelius certified to 
Congress ``that the American Health Benefit Exchanges [the so-called 
marketplaces] verify that applicants for advance payments of the 
premium tax credit and cost-sharing reductions are eligible for such 
payments and reductions, consistent with the requirements of [the 
Affordable Care Act].'' So Secretary Sebelius made certain commitments 
there. She also further told Congress that the exchanges had 
``implemented numerous systems and processes to carry out'' their 
verification responsibilities, including their income verification 
responsibilities. So this is an assurance given to us by the Secretary 
of Health and Human Services. We are now learning through reports in 
the press--which were spurred by confidential sources within HHS, by 
the way--that these verification methods are not in place or, if they 
are, they are very poorly functioning at best. In fact, HHS is planning 
to begin the verification process--here we are 5 months later--for some 
of this information by hand at some point in the future.
  When I learned of these reports--and they have been in the Washington 
Post and they have been in Politico--I hoped they were mistaken. So I 
wrote to the Secretary of Health and Human Services. I also wrote to 
the IRS Commissioner--this was last month--asking if these allegations 
were true and, if they were, what HHS was planning on doing about them.
  If the Post or Politico got the story wrong, I would have expected a 
quick response saying: No, these reports are wrong. The internal 
reports they are referring to are inaccurate.
  But instead I did not get an answer. I gave them until June 1 to give 
me an answer, to give them some time to get back to me. It is now June 
5 and I have received nothing--nothing to address my concerns. In fact, 
I have received no answer at all. I know some of my colleagues have 
raised similar concerns without receiving answers. Like so many issues 
that have arisen with the implementation of ObamaCare, the 
administration's response has been nothing but silence and 
stonewalling--no transparency.
  We do not have time for political games. The American people do not 
have time for it. We have true budget pressures. Folks are already 
paying a lot in terms of income taxes. They do not want to pay more. 
They certainly do not want the income taxes they are paying going to 
folks who are not eligible for this $36 billion worth of benefits going 
out this year.
  Since the administration refuses to voluntarily provide the 
information we need to do our job overseeing the expenditure of these 
funds, I think serious action is necessary. That is why today I am 
making a formal written request to HHS Inspector General Daniel R. 
Levinson to begin an investigation into these reports which call into 
question the accuracy of the Secretary's certification required, again, 
by the Continuing Appropriations Act, the Ryan-Murray legislation at 
the end of the year.
  I know the IG is scheduled to provide a report to Congress next month 
regarding how effective HHS has been in

[[Page 9498]]

preventing subsidy payments on the basis of inaccurate or fraudulent 
information, but in light of the apparent inconsistencies between the 
Secretary's certification and the recent media reports, I think a more 
in-depth and targeted investigation is warranted. The IG's office has 
promised that ``ensuring that taxpayer dollars are spent for their 
intended purposes'' under ObamaCare is its ``top priority.'' That is 
what that said. So these allegations certainly should strike at the 
very heart of that mission.
  If it is true that HHS has failed to implement a modern, effective 
system for verifying the eligibility of folks seeking subsidies, we 
need know about it. They say sunlight is the best disinfectant. Well, I 
think that is the case here. The best way to ensure that these tax 
dollars are not wasted is to simply get the information. Let us know 
what is going on.
  I hope the Obama administration and, after her confirmation--I think 
she will be confirmed--Secretary Burwell will show their commitment to 
responsible government by joining me in calling for this investigation 
and responding quickly and accurately to whatever shortcomings it 
uncovers. But if the administration does not, then it will fall to 
those of us in this Chamber on both sides of the aisle to take action. 
I sincerely hope it will not come to that.
  I plan to support Director Burwell's nomination today because I think 
she is a manager, and I think that is what we need right now at the 
Department of Health and Human Services. I would say this ought to be 
one of her top priorities as the new manager at HHS--to ensure that the 
problems we have seen with the implementation of ObamaCare do not 
continue and specifically that we are not seeing huge amounts of 
taxpayer dollars being misspent, being wasted through inaccurate 
verification of these subsidies.
  With that, I yield the floor for my colleague from Nebraska.
  The PRESIDING OFFICER (Mr. Booker). The Senator from Nebraska.
  Mr. JOHANNS. Mr. President, at the very start of my comments, let me 
make it clear that the nominee we are voting on today will have my 
support. I like her from a personal standpoint. I think she is 
competent. I think she is able to do the job that is before her. But I 
do believe the problem she is going to face is that this law is so 
fatally flawed that she cannot be successful in implementing it.
  The simple fact is that it is deeply flawed, and it was from the 
beginning. The policy simply does not work. We know now that ObamaCare 
drives up costs, it comes between the doctor and the patient, and it 
limits health care choices for individuals and for their families. But 
I urge the new head of HHS--when and assuming she is confirmed--to 
address all those things that are within her control.
  It is critical that the new leader work to restore the transparency 
and accountability that has been lacking at this Department. One of the 
latest has been mentioned in other comments by Senators, but it is 
especially disturbing. It comes from the Washington Post. The article 
from the Post said: ``The government may be paying incorrect subsidies 
to more than 1 million Americans.'' Mr. President, 1 million Americans 
are getting incorrect subsidies. The article goes on to say that the 
computer systems necessary to verify individuals' income were either 
defective or they were not even built. That calls into question 
Secretary Sebelius's commitment to Congress in January that, in fact, 
the systems were ready and they were working.
  Senator Moran and I wrote a letter. We asked for answers from HHS 
about this news report. Well, nothing but crickets, no response 
whatsoever.
  Just yesterday the Associated Press reported that more than 1 in 4--
or at least 2 million--ObamaCare exchange enrollees have data 
discrepancies, casting even more doubt on HHS's competency to 
administer the ObamaCare subsidies.
  Families could be in for a shock next April when the IRS notifies 
them that they must repay money to the Treasury because HHS 
miscalculated their subsidy. This is troubling because Nebraskans are 
definitely feeling the effect of ObamaCare, just like citizens across 
the country. Let me talk about a couple of stories quickly.
  A college instructor from Nebraska wrote to me saying:

       Due to ObamaCare, I will be unable to teach more than two 
     courses per term.
       Overall, I am losing at least 20 percent of my adjunct 
     income, and I will definitely be in a rough situation with 
     zero money coming in this summer.

  Regarding ObamaCare, she explains:

       We have a one-shoe-fits-all situation, and I don't wear 
     that shoe.

  A young college student in Nebraska shared identical or similar 
concerns. She says:

       Through my job, I was previously able to work 32 hours a 
     week, but am now only allowed 28 hours.
       That is a very significant amount of my already small 
     college student budget.

  Americans like these constituents do not want a law that decreases 
their earnings and mandates Washington-prescribed insurance that costs 
more with fewer benefits.
  My colleagues and I stand ready to work toward a better health care 
alternative. We are committed to vigilant oversight of ObamaCare 
because Americans' health care and trillions in taxpayer dollars are at 
stake.
  But it is my hope that Ms. Burwell, if confirmed, will reverse these 
troubling patterns at HHS and provide Congress and the American people 
with the responsiveness, the accountability, and the transparency this 
post requires.
  With that, I yield the floor for my colleague, Senator Sessions.
  The PRESIDING OFFICER. The Senator from Alabama.
  Mr. SESSIONS. I thank my colleague.
  I serve as the ranking member of the Budget Committee and have worked 
with Ms. Burwell in her now just 13 months, I think, of service in the 
tremendously important position of Director of the Office of Management 
and Budget. I do not believe she has the background, the qualities, and 
experience--proven managerial leadership--required at that huge 
Department of Health and Human Services. She has 500 people working in 
the budget office, and that is an important office. At HHS there are 
over 70,000. She once served on a board of a local hospital. She simply 
is not the person whom we need today to bring order out of the disarray 
we have in the health care system of this country and the total 
collapse of integrity and consistency in the implementation of 
ObamaCare.
  There are a couple things I care about, but I really think it time 
for this administration to stop moving around insiders, political 
allies, and put some people in these critical positions capable of 
operating them at the highest possible level.
  Ms. Burwell violated the Medicare trigger, for example. If the 
trustees of Medicare issue a report that it is heading to insolvency, 
it is a critical matter. The administration by law is required within 2 
weeks to submit a plan to fix Medicare. They have been submitting this 
report for years.
  As the President's director, under 31 U.S.C. 1105, Ms. Burwell was 
the person responsible for submitting Medicare legislation to Congress. 
We asked her about that before she was confirmed. During her hearings, 
she said she would ``do everything in her power'' to comply with the 
Federal law. Yet, despite this assurance, she refused to comply with 
the law and never submitted a plan. Don't we need a plan to fix 
Medicare? Don't we need the Chief Executive of America, through the 
budget director, to submit a plan to fix it?
  She also violated the law and denied Congress needed transparency 
with respect to the health care law, the ObamaCare law. The Omnibus 
appropriations bill signed into law in January required HHS to include 
in its fiscal year 2015 budget a detailed accounting of spending to 
implement the health law. But neither the budget director, Ms. Burwell, 
nor the agency she now will head submitted sufficient information to 
comply with that.
  My time is up, but I will say that I am very much taken with Ms. 
Burwell. She is a delightful person. Many of my colleagues think highly 
of her, and

[[Page 9499]]

some, like our West Virginia Senators and others, really think she will 
do a good job. But this is not the right position for her. This 
government is drifting into disarray in a whole host of ways. We need 
the strongest possible, capable leader, with proven health care 
managerial experience for the good of America and for the good of 
President Obama. This is not the right nominee.
  I thank the Chair and yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, first let me comment on Sylvia Burwell, 
the nominee who is before us. She has done an excellent job as the 
Director of OMB. Her credentials are incredible. She is acknowledged by 
both Democrats and Republicans as being an outstanding manager, a 
person who is fully capable to manage HHS, an extremely important 
agency that has over 70,000 workers who work for Health and Human 
Services, has a budget of over $1 trillion, and 11 Federal agencies. 
Sylvia Burwell is the right person to manage that agency and to move it 
forward in carrying out the very important work of our country.
  For Maryland, I take pride because some of the agencies are 
headquartered in my State. The National Institutes of Health--world 
class. The best research in the world is done right here as a result of 
U.S. leadership, and that comes under HHS.
  The FDA, which insures us safe products in food and drugs, is 
headquartered in Maryland. But, again, that is world class--the best in 
the world. It is important that we get the very best person as our 
Secretary, and Sylvia Burwell is that person.
  CMS is headquartered in Baltimore, with Medicare and Medicaid--over 
100 million people. Again, it is the best in the world. So I am very 
pleased that Sylvia Burwell is willing to step forward at this time to 
head that agency. I encourage my colleagues to confirm her nomination. 
We will have that vote a little later today.
  I wanted to take a moment to thank Secretary Sebelius for her service 
to our country. Through very difficult times--and these have not been 
easy political times--she has steered a very steady ship at HHS and did 
this country proud. I thank her very much for her service to our 
country and for helping the hundreds of millions who have benefited 
from the services at HHS.
  But a significant part of the mission at HHS is the implementation of 
the Affordable Care Act of 2010. I have heard my colleagues talk about 
it, so let me point out how much progress we have made. What a 
difference the Affordable Care Act has made. I would urge the people in 
this country to look at the facts. My colleagues make comments that 
just are not true. Look at the facts. The growth of health care costs 
has gone down. The projected expenses are less today than they were in 
2010 when we passed the Affordable Care Act.
  We have bent the cost curve of health care. Yes, the Affordable Care 
Act has helped us do it. One of the reasons is we have more people who 
have health insurance today and who have third-party payment. They go 
to doctors rather than emergency rooms. That brings down the growth 
rate of health care costs. We are keeping people healthier. That was 
the whole concept of the Affordable Care Act.
  Unfortunately, for my friends on the other side of the aisle, their 
answer is: Repeal, repeal, repeal. They have no plan for health care. 
We have seen under the Affordable Care Act that we have implemented 
delivery system reforms that keep people out of hospitals, keep 
readmission rates down, that provide preventive health care, so that we 
keep people healthy. That was the concept of the Affordable Care Act. 
Now that we are implementing it--and it takes time to implement it 
because it is a complicated law when you are dealing with health care.
  It would have been more helpful if we had had support to look at ways 
that we could make it even better. But we have not had that type of 
cooperation in the Congress.
  So more people are insured. The cost rates have been brought down. We 
reduced the debt and deficit of this country. But for the passage of 
the Affordable Care Act, our deficits would be larger today. That is 
not one Member saying that. Look at what those who are charged with 
doing the projections for this country have said. They have said that 
the debt today is smaller as a result of the passage of the Affordable 
Care Act.
  As far as those who pay the costs, the consumers who pay the health 
insurance premiums and pay the doctor bills and hospital bills, they 
have seen relief under the Affordable Care Act. There is guaranteed 
value for their insurance premium. At least 80 to 85 percent of that 
premium dollar must go to direct benefits. As a result, millions of 
Americans in 2012--over 8 million Americans--received rebates from 
their insurance company. They actually got checks back equaling about 
half a billion dollars.
  Consumers are getting better value for their dollars. We know it is 
not easy at times for actuaries to be able to predict the exact costs 
of health care. But now we have protection in the code. If the premium 
they charge you is too much, you will get a rebate for the excess that 
you paid--real protection.
  I must tell you, as I go around the State of Maryland--I know the 
Presiding Officer finds the same thing in the State of New Jersey--
families are happy they can keep their adult children on their 
insurance policies until the age of 26. Millions of Americans have 
taken advantage of that provision in the Affordable Care Act. They are 
very happy about that.
  I cannot tell you how many people I have talked to in Maryland who 
have benefited from the elimination of preexisting conditions or the 
fear of losing their insurance policy because someone has gotten sick. 
Insurance companies can no longer do that. So if you have a child with 
asthma and you are trying to get insurance, before the Affordable Care 
Act they would not have covered the cost of taking care of that child's 
asthma. Today you get full coverage.
  We have eliminated preexisting conditions because that is what 
insurance should do. It should cover your needs. Now it does. Before 
the Affordable Care Act, there were limits, caps--no longer caps. 
People had insurance and still had to file personal bankruptcy. Those 
days are over thanks to the Affordable Care Act. It is being 
implemented in a way that Americans are benefiting from the passage and 
implementation of the Affordable Care Act.
  In regard to our seniors and our disabled population who are covered 
under Medicare, they are very happy the preventive health care benefits 
are now without any copayment. They can take care of their health care 
needs. They can get the care they need.
  As the Presiding Officer knows, when we passed the prescription drug 
plan, we had what is known as the doughnut hole, which is a coverage 
gap. After you incurred a certain amount of cost, then 100 percent was 
your expense. Many seniors had to leave prescription drugs on the 
counter at the drug store because they could not afford to pay for the 
cost of prescription drugs, even though they thought they had coverage.
  Thanks to the passage of the Affordable Care Act, that is being 
eliminated today. We are providing full coverage. Despite the claims on 
the other side of the aisle, take a look at the facts. Medicare is more 
solvent today than it was before the passage of the Affordable Care 
Act. We helped ensure the future of Medicare by the passage of the 
Affordable Care Act. That is the fact. That is the record.
  We are on this path to improve our health care system. It is working. 
We have reduced hospital readmissions. The accountable care 
organization is a provision where we take the creativity of private 
operators where they can work together to figure out how they can help 
people be healthier. In my State of Maryland, there are several that 
are working, that are figuring out ways they can use community 
facilities and health care to keep people healthier and to reduce the 
cost of health care and make it more efficient by delivery system 
reform. It is working. It is working.

[[Page 9500]]

  We strengthened the primary care network. We all talk about that. We 
knew we had to provide more primary care doctors and nurses. We have 
done that under the Affordable Care Act. It takes time. But we are 
already seeing the benefit of that. We have increased dramatically 
community health center budgets. I have visited the community health 
centers in my State. I now see where they have mental health services 
being provided in the community that was not being provided before the 
Affordable Care Act.
  They now have dental services that are being provided in underserved 
areas that were not being provided before the Affordable Care Act. We 
now have prenatal services that are being provided in communities that 
did not have that service before the passage of the Affordable Care 
Act. What is the result? For low birth-weight babies we have reduced 
that number. Infant survival rates are increasing.
  I take pride that in supporting the Affordable Care Act I helped 
bring about those results. We are providing more resources in our 
communities. That is the record of the Affordable Care Act. That is 
what we have been able to do. I am particularly proud of the fact that 
under the essential health benefits, we now provide pediatric dental 
benefits. That is a little personal to us in Maryland, because in 2007 
we lost a youngster, a 12-year-old, Deamonte Driver.
  He lived not more than 10 miles from here. His mom tried to get him 
to a dentist. He had a tooth problem. She could not get him to a 
dentist. Nobody would treat him. He had no insurance. His tooth decay 
became an abscessed tooth. That problem went into his brain. He had two 
emergency surgeries costing a quarter of a million dollars. He should 
have had $80 of dental care. That would have taken care of his needs. 
As a result of that, he lost his life.
  This bill is making a huge difference. My point is this. For small 
businesses, they have greater choice and they have credits available to 
make it easier. We have expanded Medicaid. We have done a lot. We have 
the best health care in the world that is provided right here in the 
United States. We are now on the path of having the best health care 
system in the world. The Affordable Care Act helps us get there. We can 
take a giant step in that direction by approving the nomination of 
Sylvia Burwell as Secretary of Health and Human Services.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.
  Mr. VITTER. Mr. President, on April 29 of this year, Louisiana's 
House Republican delegation wrote a letter to Senator Landrieu, as well 
as myself, urging us to represent a majority of Louisianan's opinions 
and oppose the nomination of Sylvia Burwell to become HHS Secretary 
unless significant changes were made to the path we are on regarding 
the implementation of ObamaCare.
  They asked us to oppose Ms. Burwell's nomination until an agreement 
is reached to provide for the equitable treatment and protection of all 
Americans under ObamaCare, and until the administration, including Ms. 
Burwell, committed not to pick and choose what parts of the law they 
would implement; not to pick and choose what deadlines they would meet, 
what deadlines they would ignore; not to pick and choose mandates they 
would enforce, such as the individual mandate, and what mandates they 
would ignore, such as the employer mandate.
  This is that letter dated April 29. I ask unanimous consent that it 
be printed in the Record. I agreed with that sentiment. I agreed with 
those concerns. So I responded shortly thereafter in a letter dated May 
19 that I would oppose Ms. Burwell's nomination because of those 
concerns, because there is no evidence that Ms. Burwell would put an 
end to any of that, would put an end to the administration's common 
practice of creating special rules for big business, special rules for 
Washington insiders, for not simply following the law, not simply 
implementing the law but picking, choosing, and doing parts of the law, 
such as delaying parts of the law when it was politically convenient.
  The Senate's consideration of Ms. Burwell's nomination to become 
Secretary of HHS invited a conversation to discuss all of that, to 
discuss her responsibilities for the full, impartial, fair, legal 
implementation of ObamaCare. I paid attention very much to that 
discussion. I was hopeful about it. Unfortunately, it was 
disappointing, in my view, in terms of her responses.
  During the nomination process, Ms. Burwell was asked on a number of 
occasions how she would continue to implement and enforce various 
aspects of ObamaCare. Again, these concerns obviously arose because of 
the administration's decisions to make more than 20 unilateral changes 
to the law as written, to timing, to applicability of various 
provisions.
  One of these decisions which was particularly highlighted in my House 
colleagues' letter of April 29 was to give big business relief from the 
employer mandate while there was no relief for individuals. Millions 
will face a steep penalty--face it right now under the individual 
mandates. Not only did Ms. Burwell punt to the Treasury Department, her 
response failed to even acknowledge that the administration has failed 
to execute the law as written because the law is broken.
  The American people have really had enough of the administration 
passing blame through certain Federal agencies or to bureaucrats or to 
Congress or to political parties. They have had enough of the blame 
game. They have had enough of finger pointing. What I find even more 
hypocritical in this regard is that the administration worked with many 
Members of Congress behind closed doors to give Congress and Washington 
insiders special treatment under ObamaCare, to give them a way to avoid 
higher costs and lower quality care, the way Americans are suffering 
from that.
  So I will also oppose Ms. Burwell's nomination until the American 
people get the same relief from ObamaCare as the Washington elite, as 
the Washington exemption from ObamaCare, as the Congressional subsidy. 
To date, at least 4.7 million Americans, including 92,000 Louisianans, 
have had their health insurance plans canceled as a result of the 
mandates of the law.
  Many of these folks were then dealt with a choice of going without 
health insurance or taking the gamble of purchasing an expensive plan 
on the government-run ObamaCare exchange.
  Again, the law, as written, was intended to make every Member of 
Congress and our staff walk in those same shoes, but the 
administration, again, was fast and loose with the law and created a 
special rule contrary to statute. Ms. Burwell was part of that 
administration, creating a special exemption, a special subsidy, a 
special rule not found in the statute.
  So in contrast to that experience of many Louisianans, millions of 
Americans, Members of Congress, and congressional staff can get out of 
that mandate of ObamaCare. Many congressional staff have been exempted 
from having to go to the exchange, which is clearly a requirement under 
the statute. Members of Congress and staff who do go to the exchange 
get a huge taxpayer funded subsidy--nowhere in the statute and nowhere 
available to any other American at the same income levels.
  For all of these reasons, because of this disparate treatment, 
because of ignoring the law, because of amending the law over and over 
by administrative fiat, I have to oppose Ms. Burwell's nomination.
  She gave no indication in any of her testimony or in any discussions 
leading up to this confirmation vote that she would change any of that, 
and it is pretty clear she will not.
  I will oppose the nomination.
  If Ms. Burwell is passed by the Senate as Secretary of the HHS, I 
urge her to take heed of these calls. We have a law before us. We need 
to follow the law--not in some cases but in all cases, not implement 
here but not there, not give some folks special treatment and special 
exemptions not found under the statute but implement the law as 
written.

[[Page 9501]]

  That will be her responsibility as much as anyone in the 
administration. I urge her to be a true leader in the administration, 
to start doing that in an appropriate, legal way.
  I ask unanimous consent to have printed in the Record the April 29, 
2014, and May 19, 2014, letters I referred to previously.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                Congress of the United States,

                                   Washington, DC, April 29, 2014.
     Senator Mary Landrieu,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
     Senator David Vitter,
     U.S. Senate, Hart Senate Office Building, Washington, DC.
       Dear Senator Landrieu and Senator Vitter: We write to 
     respectfully request that you place a hold on the nomination 
     of Ms. Sylvia Burwell for Secretary of the Department of 
     Health and Human Services until an agreement is reached to 
     provide for the equitable treatment and protection of all 
     Americans under the Affordable Care Act (ACA). The 
     President's signature health care law, which contains a 
     laundry list of job-killing mandates and taxes, is wreaking 
     havoc on our economy and creating hardships for hardworking 
     taxpayers who received cancellation letters for their health 
     insurance policies due to unworkable ACA requirements. To 
     date, at least 4.7 million Americans, including at least 
     92,000 Louisianans, have had their health insurance plans 
     cancelled as a result of this law. In addition to losing 
     their health insurance coverage, Americans across the country 
     are seeing their health insurance premiums and deductibles 
     skyrocket while their provider networks become narrower. In 
     Louisiana, some individuals are seeing premium increases 
     greater than 100%.
       Since the passage of the ACA, the Obama Administration, 
     through the Department of Health and Human Services and the 
     Department of the Treasury, has unilaterally delayed or 
     changed the law at least 20 times. For instance, the 
     Administration has delayed the enforcement of the employer 
     mandate for large employers until 2015 and for businesses 
     with between 50 and 99 employees until 2016. In December, the 
     Department of Health and Human Services decided to vastly 
     expand the ``hardship exemption'' to include individuals who 
     ``received a notice saying that your current health insurance 
     plan is being cancelled, and you consider the other plans 
     available unaffordable.'' These actions, among many others, 
     are tacit admissions that the Obama Administration knows this 
     law is both unworkable and unpopular. Unfortunately, the 
     Administration has yet to provide this relief to all 
     Americans.
       Families across Louisiana have faced cancelled health 
     insurance plans, rising health insurance premiums, and the 
     loss of access to doctors and hospitals while watching the 
     Administration pick political favorites through selective 
     exemptions from the ACA. It is wholly unfair for families to 
     still be threatened with penalties from the IRS at the same 
     time as insurance companies and businesses are granted 
     unilateral relief. Please join us in calling for fairness for 
     all under the law by placing a hold on Ms. Burwell's 
     nomination until she agrees to provide equitable treatment 
     for all Americans under the Affordable Care Act.
           Sincerely,
     Steve Scalise,
       Member of Congress.
     Bill Cassidy,
       Member of Congress.
     Vance McAllister,
       Member of Congress.
     Charles Boustany,
       Member of Congress.
     John Fleming,
       Member of Congress.
                                  ____



                                                  U.S. Senate,

                                     Washington, DC, May 19, 2014.
     Congressman Steve Scalise,
      House of Representatives, Rayburn House Office Building, 
         Washington, DC.
     Congressman Charles Boustany,
     House of Representatives, Longworth House Office Building, 
         Washington, DC.
     Congressman Vance McAllister,
     House of Representatives, Cannon House Office Building, 
         Washington, DC.
     Congressman Bill Cassidy,
     House of Representatives, Longworth House Office Building, 
         Washington, DC.
     Congressman John Fleming,
     House of Representatives, Cannon House Office Building, 
         Washington, DC.
       Dear Louisiana Congressional Colleagues: I write in 
     response to your letter asking to hold the nomination of Ms. 
     Silvia Burwell for Secretary of the Department of Health and 
     Human Services until an agreement is reached to provide the 
     American people the same treatment under Obamacare as large 
     businesses. 1 share your opinion that the Administration's 
     decision to give large businesses relief from the employer 
     mandate while millions still face a penalty under the 
     individual mandate is both unfair and drives a deeper wedge 
     between the American people and those with powerful lobbyists 
     and access to power. What I find even more hypocritical is 
     that Congress worked behind closed doors to give themselves 
     special treatment under Obamacare to avoid higher costs and 
     lower quality care. I will oppose Ms. Burwell's nomination 
     until the American people get the same relief from Obamacare 
     as the Washington elite and their corporate allies.
       Like you, I have heard from hardworking Louisianans every 
     day on skyrocketing premiums, higher out of pocket costs as a 
     result of lower quality health plans being offered on the 
     federal exchange, and limited access to their doctors. 
     Members of Congress and their staff would be facing these 
     exact consequences had they not bent the rules last summer to 
     keep their generous employer-based, taxpayer funded subsidy 
     to avoid higher costs and only make available high-quality, 
     gold level health plans to ensure they were able to keep 
     their doctors.
       To date, at least 4.7 million Americans, including at least 
     92,000 Louisianans, have had their health insurance plans 
     canceled as a result of this law. Many of these people were 
     then dealt with the choice of going without health insurance 
     or taking the gamble of purchasing an expensive plan on the 
     government run Obamacare exchange. In contrast, high level 
     Congressional staff who often negotiate directly with the 
     Administration were able to alleviate the inconvenience of 
     procuring their health insurance on the broken federal 
     exchange and keep the plan they liked on the Federal Employee 
     Health Benefits Program (FEHBP).
       I join your efforts in calling for fairness for all under 
     the law, and will oppose Ms. Burwell's nomination and any 
     other bureaucrat that puts the needs of the political elite 
     before the American people.
           Sincerely,
                                                     David Vitter,
                                                     U.S. Senator.

  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. I rise today also to speak about health care issues, the 
Affordable Care Act, and Sylvia Mathews Burwell, the nominee to be 
Secretary of Health and Human Services.
  The Affordable Care Act has completed its first year of open 
enrollment. Despite some significant technical challenges, 8 million 
Americans have used the State or Federal health insurance marketplaces, 
as created by the ACA, to access insurance.
  I want to talk about the status of the ACA today, some challenges--
including some comments made by my colleague from Louisiana--and then 
talk about Sylvia Mathews Burwell.
  Of the 8 million Americans who have used the exchanges to access 
health insurance, over 216,000 of them are Virginians. In addition to 
the 8 million, 3 million more people have been enrolled in Medicaid or 
CHIP as of February--in addition to the marketplaces open--and those 
Medicaid and CHIP expansions were because of the Affordable Care Act 
provisions.
  In addition, an estimated 3.1 million young adults have gained 
coverage by being able to stay on family policies until age 26. The 
combined number, just in this expansion of coverage, is now more than 
14 million Americans.
  Let me put that in context. One year in, 14 million Americans have 
insurance through the ACA. That is more than the total population of 
the following States: West Virginia, Idaho, Hawaii, New Hampshire, 
Montana, Delaware, South Dakota, North Dakota, Vermont, and Wyoming. 
One year in, more people have insurance through the ACA than the 
combined populations--entire populations--of those 10 States.
  The number dwarfs the population of New Jersey, which is about 9 
million today--this 14 million number, which is growing every day. So 
imagine a program, even with all the challenges and the rollout, within 
1 year providing insurance to more people than the combined population 
of these 10 States, significantly more than the Virginia population as 
well.
  Gallup has polled, since 2008, the percentage of Americans who don't 
have health insurance--American adults who don't have health insurance. 
The number was down to 13.4 percent when the poll was last taken in 
April, which is the lowest monthly uninsured rate since Gallup started 
taking this poll.
  Have there been challenges? Sure. Have there been those who have had 
some difficulty? Sure. We have been dealing with them on the phone--as 
the Presiding Officer has too. But the uninsured rate is dropping 
dramatically. Even at 1 year with the problems, people are receiving 
insurance as a result of the ACA.
  Each one of them has a story. Each one of them has a story of what it 
was

[[Page 9502]]

like to live without health insurance and what it is like to live now 
with the security and comfort of health insurance--not only for when 
you get ill but also for when you are going to bed at night worried 
about what will happen to you if you get ill, what will happen to you 
if your spouse is in an auto accident, what will happen to you if your 
children get diagnosed with something that might well be a preexisting 
condition under an earlier day.
  The stories aren't just about the 14 million who have health 
insurance because of the ACA. They are also stories of the nearly 20 
million Americans who have received rebates because they overpaid 
premiums and the insurance companies now have to send them money. It is 
people who cannot be charged discriminatory rates because they are 
women. It is seniors who are able to get preventive care under Medicare 
for free or reduced-price prescription drugs for free. It is all the 
Americans who had preexisting conditions which would have blocked them 
from insurance coverage before the ACA passed.
  Just briefly, I am one of these stories. When I went onto the open 
market to buy health insurance a couple of years ago--and like most 
good families, when you want to do something, you put this really smart 
person on it--my wife. She started to call around about health 
insurance. Two insurance companies said to her: We can write you a 
policy on four of your five family members.
  One wouldn't insure me. I think politics is viewed as a dangerous 
line of work.
  One wouldn't insure one of my children. Well, here is an important 
safety tip. Don't tell my wife or any wife or mother: We will only 
insure part of your family.
  My wife said in each instance: I actually think this is against the 
law now. I think you have to provide insurance for everybody, and not 
just for four of the five. The insurance company rep called the boss 
and then called back and said: We are sorry; you are right. We have to 
write you insurance on every member of the family.
  Everybody has a story and increasingly these stories accumulate. 
Whether it's coverage or a preexisting condition ban or equal treatment 
in rates between men and women, these stories are starting to 
accumulate and are showing us that this ACA can and will be successful.
  Of course, there are measures to improve it that we still need to 
embrace. I am proud to cosponsor today a bill that the lead sponsor, 
Senator Franken, called the Family Coverage Act. It was introduced 
today.
  The ACA requires large employers to offer affordable health care 
coverage to the employees. The IRS definition of affordability suggests 
that means that an employee's share of the premiums of individual 
coverage, rather than family coverage, is less than 9.5 percent of 
family income.
  If the employee has an offer of affordable insurance, the employee in 
the family cannot receive premium tax credits. If it is not affordable, 
you can receive tax credits.
  This measure of affordability, based on what the premium is for the 
individual, versus what the family premium is, leaves a lot of spouses 
and families cut out from the possibility of receiving tax credits 
under the ACA.
  An average plan for an individual costs about $5,600, but according 
to the Kaiser Family Foundation, that average rises to about $15,700 
for families. GAO estimates that the currently used definition of 
affordability would prevent nearly 460,000 uninsured kids from 
accepting tax credits, even though their parents qualify for the tax 
credit under the ACA. This is known as the family glitch. It was sort 
of an unforeseen consequence when the bill was written.
  The Family Coverage Act, which Senator Franken is championing with 
many other cosponsors, would change the definition of affordability 
within the ACA so that family members of the parent who works for a 
company that offers health insurance can qualify for tax credits as 
well.
  I have cosponsored fixes and improvements to the ACA in the Small 
Business Tax Credit Accessibility Act, a small business tax credit 
enhancement, and in the Expanded Consumer Choice Act. Through a plan 
called the ``copper plan,'' it provides all of the coverage but at a 
lower premium, because those choosing the plan will pay more on the 
deductible so they can buy down their premium by more cost sharing.
  There is the Commonsense Reporting Act of 2014, introduced by Senator 
Warner, to ease the compliance burden on employers, and the Protect 
Volunteer Firefighters and Emergency Responders Act. Many of us were 
cosponsors of that bill. There is an act called the EACH Act, which is 
a technical correction to the religious exemption in the ACA.
  I have also written a lot of letters to the administration asking 
them to do things within their administrative purview to make the act 
better.
  This is what we should be doing. We shouldn't be talking about 
repealing the Affordable Care Act and taking 14 million people who have 
insurance through the ACA and telling them: Back out into street with 
you.
  We shouldn't be talking about stonewalling a wonderful public servant 
from coming in and being head of the HHS. We should be engaged in the 
business of reforms and improvements.
  This is what legislators do. When I was Governor of Virginia, my 
legislature would pass about 1,000 bills a year. They would come to my 
desk for my review, editing, amending, signing, and potentially 
vetoing. What I noticed was that of the action of my legislative body, 
800 bills were reforms to existing law. Only about 200 were new laws.
  What legislative bodies do is they go into existing laws, improve 
them, fix them, and make them better, and that is what we should be 
about here.
  Certainly we have learned, through the bad rollouts and some other 
things, that nobody can stand back and say this thing is perfect and no 
reforms are needed. Reforms are always needed.
  But I would also hope my colleagues might have learned something--
those who wanted to repeal the Affordable Care Act. Those who were 
willing to shut down the Government of the United States to advocate a 
repeal of the Affordable Care Act should also be focused now on reforms 
not repeals, because repeals mean those 14 million would lose insurance 
and families like mine would now be subject again to being turned down 
because of preexisting health conditions.
  It strikes me that the reform caucus is growing and the repeal caucus 
is shrinking--as it should. Every day finds more and more people who 
have had this experience and understand that the ACA should not be 
allowed to be repealed. I am thrilled that is occurring.
  One more item about the Affordable Care Act. It has been stated by 
some, including some in this Chamber, that the Affordable Care Act has 
done a horrible thing by allowing Members of Congress and their staffs 
to get a subsidy in their health insurance that the American public 
doesn't get. Then there are those who have stood and made that case on 
the floor of this body, on television, and in this country. They have 
talked about that subsidy as this horrible thing that these 
congressional staffers--such as those who are sitting here at the desk 
or those who work in my office--shouldn't be getting.
  The Presiding Officer knows--and I know--that statement is 
inaccurate. The subsidy that anyone gets in this building is an 
employer contribution to their health insurance premium. It has been a 
long and standard feature of employer-provided health care plans in 
this country that employers contribute to the health insurance of their 
employees.
  In the private sector, over 55 million Americans have employers who 
contribute to the health insurance premium of their employees. Hard-
working men and women who are working in this Senate or working in the 
House or who are working on congressional staffs have every bit as much 
right to have an employer that would contribute part of the premium 
cost for them as do the people who work at newspapers, automobile 
manufacturers, retail stores, and restaurants. All

[[Page 9503]]

over this country, employer provision of a portion of the premium is a 
standard feature of how insurance has been provided for decades.
  For those who say that Members of Congress are getting some special 
treatment, some congressional subsidy, when the reality--and they know 
the reality--is that this subsidy is just the employer-provided share 
of a premium that is standard among all Americans, I find it very 
troubling.
  What would they propose? Would they propose that uniquely, if you 
happen to work for the article I branch--the legislative branch--you 
should be denied an employer contribution to your health insurance, 
just like other Americans get, because you work for the article I 
branch that is specified in the Constitution? I think that is 
essentially their argument.
  I had not intended to get into this topic today, but I think it is 
very clear we should make plain to the American people that public 
servants who do work in this Chamber and in the House Chamber, and for 
Members who were elected in the States and districts in this country--
they are entitled to the same kind of treatment by their employer, 
which is a standard feature of life in most American companies, 
nonprofits, State and local governments, and other institutions.
  I have known Sylvia Mathews Burwell for 25 years. I met her when she 
was working for the Clinton administration as a young hotshot West 
Virginia student, educated at Harvard, a Rhodes scholar like some other 
notable Members of this body.
  I am proud to support her confirmation to be Secretary of Health and 
Human Services. She has had a strong background not only in the public 
sector, most recently as the Director of the Office of Management and 
Budget, but she has also had a superb track record in the private 
sector. When dealing with health care issues, we know that strong 
private sector experience is very important in an issue that is so 
significant.
  I have been very impressed with Sylvia Mathews Burwell's work in the 
Office of Management and Budget. I think she brought a more 
businesslike and regular order approach to the Federal budgeting issues 
that are so important, and I think she will take that approach and 
expertise into the HHS position--not just around matters of the 
Affordable Care Act but around a whole portfolio of issues which are so 
critically important.
  We have got to be about reforms and improvement. Sylvia Mathews 
Burwell is a person who walks in to work every day, wanting things to 
be better today than they were yesterday, and she has the experience to 
do this job. I am proud to stand and support her nomination.
  Mr. President, I yield the floor and I suggest the absence of a 
quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. COONS. 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.

                          ____________________