Mr. President, I ask unanimous consent the order for the quorum call be rescinded. Mr. President, I ask unanimous consent to speak as in morning business. Mr. President, I rise today to talk about health reform. I would like to start by…
Mr. President, I ask unanimous consent the order for the quorum call be rescinded.
Mr. President, I ask unanimous consent to speak as in morning business.
Mr. President, I rise today to talk about health reform. I would like to start by telling you the story of a little boy named Isaac. From the day his parents brought him home as a newborn to Isanti, MN, he was sick all the time. He had everything from the flu to bronchitis to ear infections. But unlike most little boys, Isaac never seemed to get better. His parents, as any parents would, did everything they could to help him. They brought him to every medical specialist they could think of but no one could figure out what was wrong.
Finally, Isaac was diagnosed with a rare disease called common variable immunodeficiency. This means every 2 weeks a nurse has to visit his home to give him the medicine that lets his body fight off germs. Without this medicine, Isaac's body cannot fight off even a common cold. The home visits and IV medications Isaac needs are expensive. But Isaac's parents had health insurance, so Isaac was able to have a normal childhood.
Today, Isaac is a 19-year-old college student in Minnesota with dreams of becoming an English teacher. Here is a picture of him. He is the one on the right. That is Isaac.
Because of the toll his illness takes, his family decided that Isaac should go to school part-time. Unfortunately, before the health reform law was passed, young adults over 18 years of age generally had to be in school full time to stay on their parents' health insurance. If Isaac had not been able to stay on his parents' health plan, he would have been in a tremendous bind. His disease is the definition of a preexisting condition, and it would have been nearly impossible for him to find affordable individual coverage. But because of the health reform law that we passed last year, Isaac can now stay on his parents' health insurance, regardless of his school status, through his 26th birthday. He and his family were able to make the choices that made sense for their family without having to worry about Isaac's health insurance. In fact, in a few years, when he turns 26, a key provision of health reform will have kicked in and insurers will no longer be able to discriminate against him or any American because of a preexisting condition.
Isaac's parents may not be doctors, but they are experts when it comes to the needs of their family. They know the truth about what the health reform law has already done for their family. Just like Isaac's family, Minnesotans may not know every word of the health reform law, but they are experts on what they need for their own families.
Let me tell you about another Minnesota family who learned about the benefits of the new law. Maya, whom you can see right here, is one of 3 million Americans with epilepsy. She had her first seizure when she was just 3 years old. Modern medicine has not yet been able to find a way to stop her seizures, but by taking five medications per day she can control them.
Recently, Maya's father was laid off and the family lost his health insurance. Maya's family suddenly had to confront the possibility that they would no longer be able to give Maya the medication she needs to fight her daily seizures. Without insurance, Maya's medications cost more than $1,500 a month, which would quickly bankrupt her family. Losing a job is stressful enough, but before the health reform law Maya's parents would have
had to worry about buying health insurance on the individual market. Because of Maya's preexisting condition that would have been almost impossible.
Fortunately, the health reform law has banned insurance companies from discriminating against children with preexisting conditions. So her family was able to get on to another insurance plan without being denied.
The diagnosis of a chronic illness can happen to anyone at any time. Often, like Maya, it doesn't happen because of a lifestyle choice or genetic predisposition. It just happens. Maya was 3 years old when she was diagnosed. Paying for essential medications and health care services that can help control chronic conditions like Maya's can easily put a hard-working family into bankruptcy.
Medical costs are the cause, wholly or in part, of 62 percent of all bankruptcies in this country. That will change dramatically because of this law. Americans will no longer be discriminated against because of preexisting conditions, and insurance companies can no longer impose lifetime limits on the dollar amount of care they will provide. This is an enormous, almost incalculable, benefit to Americans and their peace of mind.
The truth is, Congress listened to people across this country, people such as Isaac and Maya and their families. By allowing kids to stay on their parents' insurance longer, we listened by ending insurance companies' discrimination against women and people with preexisting conditions, and we listened when the American people said lifetime caps on insurance benefits were forcing millions of chronically ill Americans into bankruptcy.
The people of Minnesota believe, as I do, that a family who works hard should not be financially ruined if their kid gets sick. When I was campaigning I heard this again and again from families across Minnesota--and I was listening. The people asked this Congress to find a way to make health care affordable for everyone, and we did.
Now the insurance companies and their political allies want you to believe the only way to keep your premiums low is to cap the amount of benefits you can receive in your lifetime. But this is just not true. In the health reform law, we worked hard to slow the growth of health care costs without abandoning the over one-third of American adults who struggle with chronic disease.
The truth is, last year we passed a bill that will save the lives of countless Americans and will save billions of taxpayer dollars. That is right. According to the Congressional Budget Office, the referee that everyone here in Congress agrees to abide by whether we like their decisions or not--according to CBO the law saves us money, lots of money; in fact, hundreds of billions of dollars.
Now, let me say a word about CBO to my colleagues. You cannot use CBO's numbers when you like them and then totally dismiss them when you do not. CBO is directed to provide unbiased and independent analysis and estimates. Their analysts use the best research available for their scores and projections. In fact, they established an independent review panel of expert health care economists to advise them in their analysis of the health reform bill. Not only are the experts' names published on CBO's Web site, but their analysis of the law is public as well. CBO is nothing if not transparent and independent.
Of late, we have heard Members of this body frankly mischaracterize the process by which CBO does its job. They have said that CBO must rely solely on information and data fed to them by the majority-- ``garbage in, garbage out.'' ``Garbage in, garbage out'' is how they describe it here on the floor. This could not be further from the truth. Frankly, I find some of my colleagues' new refrain about CBO disturbing and not a little disingenuous.
One of the things we tried to do in health reform was to take steps that would lower the costs of health care in this country. Take for example our efforts to reduce administrative costs by streamlining the way health care providers bill for their services. This is something I pushed for because we recently did it in Minnesota, and it saved $56 million in the first year alone. Nationwide, that should translate to around $25 to $30 billion over 10 years. Actually, the health reform law went well beyond what Minnesota did. So it is not surprising that outside experts such as those at the Commonwealth Fund, Rand, and others estimate much greater savings from administrative simplification, in the range of $162 to $187 billion over 10 years. So when CBO made their analysis and estimated savings of less than $20 billion in the same period, I admit I was a little miffed. But I did not attack CBO. I accepted their results. And we are all duty bound to do the same, even when CBO projects that the law as a whole will save over $100 billion in the first 10 years and over $1 trillion in the following decade.
We accomplished the savings with a number of commonsense solutions, such as stopping insurance companies from padding their bank accounts with profits from sky-high premiums. As part of health reform, we require insurance companies to spend at least 80 to 85 percent of the money they receive in premiums on actual health care, actual health care services--85 percent for large group plans, 80 percent for small group or individual plans. This is a provision I championed. The other 15 or 20 percent can be spent on administrative costs or marketing, on CEO bonuses, and on profits. This provision kicked in this year, and it will hold insurance companies accountable for costs and help contain health care costs in this country.
We also changed the way health care is paid for in this country by starting to reward quality of care, not quantity--value not volume in Medicare. I was proud to fight alongside Senator Cantwell and Senator Klobuchar for the inclusion of the value-based payment modifier in the Medicare reimbursement formulas.
Perhaps the most commonsense thing we did to control costs was making sure everyone has access to preventive care. In Minnesota alone, the law will give millions of people access to free preventive care. Women will be able to get mammograms without any out-of-pocket costs. Starting this year, seniors now have access to free preventive checkups each year without cost. This is completely contrary to claims I have heard on this floor.
A large part of the cuts in Medicare spending--not cuts in benefits, a large part of the cuts in Medicare spending--is cuts to wasteful subsidies for insurance companies.
One of my colleagues has taken to the floor and said this law will ``cut the funding, so people on Medicare Advantage who like it, who like the preventive medicine activities of it, are going to lose those opportunities.'' He goes on to say about the seniors in his State that ``once they lose this, they are going to lose preventive services.'' This is simply not the case. Thanks to this law, everyone on Medicare will enjoy preventive services, so their doctors will catch problems early. Seniors know that an ounce of prevention is worth a pound of cure. That is why preventive services under this law will be covered for everyone without copays, contrary to what my friend on the other side says.
This is what has bothered me about this debate--the constant stream of misinformation.
This same colleague said this on the floor about the law: ``It doesn't solve America's doctor shortage. It does not even address it.'' It does not even address it. Now, no one is claiming this bill solves the doctor shortages we have in this country, but does not even address it? There is a whole title in the law that lays out a number of programs--over 96 pages--that make significant investments in the health care workforce, especially in primary care physicians. Most notably, it created a public health workforce loan repayment program that helps recruit and place more doctors, nurses, and other health care providers in medically underserved areas. That is important for States such as Minnesota. And this was an integral and vital part of health reform. Anyone who states that this law did nothing to address the shortfall of health care providers just has not read the law.
We have seen misrepresentations from opponents right from the beginning with the so-called death panels, and it continues to this day: Medicare recipients are going to be denied preventive care; the law doesn't even address the doctor shortage; CBO is just
fed garbage by the majority and is not allowed to look at anything else.
In November, one of my colleagues cited an oft-discredited assertion originally made by some Republicans on the House Ways and Means Committee. According to one analysis, my colleague said here on the floor, the Internal Revenue Service will need to hire 16,000 new IRS employees to enforce the individual mandate. Well, that is just not true. Some new IRS employees will be needed but nowhere near that number, and overwhelmingly they will be there to administer the tax breaks to small businesses for insuring their employees.
What my colleagues said on the floor is simply not true. No matter how many times it is repeated, it will not become true.
There was a colloquy from June of last year between two of my colleagues. The first Senator said that doctors are leaving Medicare. And that is true. Some are.
He said: The president of the State of New York Medical Society is not taking new Medicare patients.
Then the second Senator said: As well as the Mayo Clinic.
The first Senator answered by responding: Mayo Clinic said, we cannot afford to keep our doors open if we are taking Medicare patients.
Then he moved on.
So is it true that the Mayo Clinic really is not taking new Medicare patients? Well, I called up Mayo, which happens to be in my State, to find out, and they gave me the facts. Do you know what. Of course it is not true. The Mayo Clinic has 3,700 staff physicians and scientists and treats 526,000 patients a year. There is one Mayo Clinic, Arizona Family Practice--one--that isn't accepting Medicare payment for primary care services. Yet this is just part of a time-limited trial for this one clinic with just five physicians on staff. That is it. But this becomes, to quote my colleague: Mayo Clinic said, we cannot afford to keep our doors open if we are taking Medicare patients. Well, the Mayo Clinic is the largest private employer in Minnesota and, believe me, their doors are still open to new Medicare patients.
Medicare reimbursements are low, and Mayo has actually lost hundreds of millions of dollars in the last year alone because of this. Mayo, like the rest of Minnesota, delivers higher value care at a lower cost than clinics and hospitals in other States. That is because Mayo provides coordinated integrated care. Mayo's outstanding doctors are on salaries, so they are not incentivized to order and perform unnecessary and expensive tests and procedures. And Mayo's outcomes are second to none. Yet Mayo is punished for all of this by receiving lower reimbursements for Medicare. That is why I pushed, with other colleagues, for the value index. That is why we need to pass the so- called doc fix that cancels scheduled cuts to reimbursement rates every year.
By the way, the doc fix is something we would have to do whether or not we pass health reform.
Yet, despite all of this, the Mayo Clinic is keeping its doors open to new Medicare patients and should be commended for that. It should not be accused of closing its doors to Medicare patients when it is not. Mayo should not be used as a political football.
Look, I could go on and on with these, but the fact is, if we want to have a debate about the health care law, we really should make an effort to present a case based on what is really in the law and what is really happening on the ground. This is what the American people want from us. Health care is far too important to the lives of our constituents for us to indulge in gross distortion, obvious omission, and absurd extrapolations. The American people do not want that, not for something this important, not for something that affects their lives and the lives of people they love. The American people have given us all tremendous responsibilities.
Minnesotans worry that the floor could drop from under them at any time and that no one will be there to catch them when it does. They worry about their families. They worry about their friends and their community. We owe it to them to be honest with them and with each other, to be responsible, to be real. So let's get real.
As I mentioned in my story about Maya, the little girl with epilepsy, thanks to the new law, she can get health care because insurance companies now cannot discriminate against children with preexisting conditions. In 2014, insurance companies will not be able to discriminate against any American child or adult with a preexisting condition. And in 2014, that is when the mandate kicks in.
Here is what one of my colleagues says about the provision in the law that now allows little 3-year-old Maya to be treated for her epilepsy:
The health care law allows parents to wait until their
child is sick before buying a policy. When only sick people
buy health insurance, premiums have to go up. As the rate
increases, more people drop their coverage.
That is why we have the mandate. The mandate is crucial if you want to do things such as getting rid of denials for preexisting conditions. And, by the way, the mandate has been a Republican idea. The mandate was a Republican idea in their 1993 health reform bill. Let me tell you why. The health care law is like a three-legged stool. The first leg is accessibility. Everyone needs to be able to buy insurance so that when they get sick or hurt, they can access the care they need.
So we banned insurance companies from discriminating against people with preexisting conditions. Banning discrimination against people with preexisting conditions is something that both parties say they like. In fact, in its Pledge to America, the document that Republicans ran on in 2010, in the health care section there is the heading ``Ensure Access for Patients with Preexisting Conditions.''
It goes on to say that they will ban insurance companies from discriminating against patients with preexisting conditions. That is their pledge.
That makes sense. Over one-third of all Americans have a preexisting condition. Actually, at the Minnesota State fair, a woman in her early 70s came up to me and said: You know, at my age, everything is preexisting. She was enrolled in Medicare, but Maya was not. And Maya's family should not have to choose between going without the care they need and going into bankruptcy.
But as my colleague indicated, there is a risk that this provision would incentivize people to buy health insurance only after they get sick or hurt which would drive everyone's costs up. So because of this, this second leg of the stool is personal responsibility. We have an individual mandate to make sure that people don't wait until they get sick to go get insurance and to create a pool of insured people that is large enough to support all the folks who had previously been unable to get insurance. If everyone has health insurance, everyone will be able to access care when they need it.
By the way, the rest of us who have insurance will benefit because today we are paying almost $1,000 a year per family in premiums to cover the emergency room visits of people who don't have insurance.
But for some people, buying health insurance is too expensive. So the third leg of the stool is affordability. We provide assistance to those families who need to buy health coverage on a sliding scale, all the way up to 400 percent of the Federal poverty level.
So that is our three-legged stool: accessibility, accountability, and affordability. We don't discriminate against people with preexisting conditions, and so we have a mandate so people don't wait until they get sick or hurt to get insurance. Because you are mandated to get health insurance, we make sure everyone can afford it. A three-legged stool. If you take any leg out, the stool collapses.
When I have explained it this way to Minnesotans, I find they are no longer confused about the law. They know how important it is to have access to health insurance regardless of preexisting conditions, to take responsibility for themselves and their families, and to have health care they can afford. But some of my colleagues have been advocating that we cut off a leg or even two legs of the stool. But a two-legged stool collapses. And a one-legged stool? Maybe at best it is a spinning plate.
The arguments for repealing this law remind me of an old Shalom Aleichem story I heard from my dad when I was growing up. You don't hear much about Shalom Aleichem on the Senate floor. I will tell you a little bit about it.
Shalom Aleichem was a beloved 20th century writer who wrote stories, novels, and plays in Yiddish. The Broadway hit ``Fiddler on the Roof'' was based on his writings. In the story my dad told me, a man borrows a plate from his neighbor. The man takes the plate home and drops it accidentally and breaks it. He sneaks back into his neighbor's house and replaces the broken plate. The neighbor comes home, finds the broken plate, and goes over to the guy's house. He basically says: What is the deal with the broken plate?
The guy says: Well, in the first place, I didn't borrow it. In the second place, when I borrowed it, it was already broken. And in the third place, when I returned it, it was in one piece.
That is what I am hearing from the opponents of this bill who want to repeal it. In the first place, we are for banning discrimination against people with preexisting conditions. In the second place, we are against banning discrimination against people with preexisting conditions because then no one would buy health insurance until they get sick or hurt. That would drive up the cost of health insurance. And in the third place, we want to repeal the law because it makes healthy people buy health insurance or pay a fine in order to keep the cost of health insurance down. This is what I hear every day from the opponents of the health care bill.
Opponents of the bill, my colleagues on the other side, pledge that they won't discriminate against people with preexisting conditions but then they say they don't want to ban discrimination because they don't want to encourage people to wait until they are sick to buy insurance. But they don't want to mandate that people take personal responsibility by buying health insurance. Then they stand up and say the American people are, to quote a colleague, ``sick of spin.''
I would like my colleagues to stand and admit that they broke the plate. We owe it to the people who elected us to this body to tell the truth about the health reform law. We owe it to the millions of Americans whose lives will be changed by the provisions in this law, such as Isaac, such as Maya.
Already we have seen the positive changes that such reform can bring. Look no further than the State of Massachusetts which, in 2006, passed its own set of health reforms. Its reforms were similar to what the Affordable Care Act is doing at the national level, including an individual mandate, subsidies, and even an exchange. The result has been a huge increase in the number of people with health insurance, including an increase in the number of people who get insurance through their jobs. Let me put that another way: Because of the State's health care reform, more people have health insurance from their employer.
At the same time Massachusetts has seen a decrease in the rate at which premiums are going up when compared to the rest of the country. As the rest of the country saw insurance premiums go up by 6.1 percent from 2007 to 2008, premiums in Massachusetts only went up by 5.0 percent. That is more than 20 percent less than the rest of the country just a year after its health care reform was passed. That is not a silver bullet, but it is certainly a step in the right direction for small business owners and for families. More than 98 percent of Massachusetts residents have health insurance, as compared to less than 84 percent nationally.
The effects of health reform in that State are pretty clear. More people are insured. Premiums are not going up as quickly as around the country. More people are getting their insurance through their employer.
The health reform law is not a silver bullet but hopefully a series of steps in the right direction. You have to question the claims of my colleagues who say that health reform will cause the sky to fall, because there is good evidence to believe they are crying wolf. Yes, you heard me right, Chicken Little is crying wolf.
Ask the people of Massachusetts. In a recent poll, nearly 80 percent of Massachusetts residents said they wanted to keep the health reform law they passed in 2006; nearly 80 percent.
Here is another one. I have heard a colleague urging repeal of this law say:
We need to allow small businesses to join together, to pool
together, in order to offer affordable health insurance to
their workers, get better deals with insurance costs.
He said this as if it weren't in the law. In fact, he has said these exact words repeatedly here on the floor, each time creating the clear implication that the health reform law does not allow small businesses to pool together to get better deals on health insurance. But in fact this is exactly why we passed a health reform law that includes health insurance exchanges.
We owe it to the American people to tell the truth about this. The truth is that health reform created State insurance exchanges so that health care will be available to the 43 million workers employed by the 5.9 million small businesses around the country. The exchanges will also make affordable health insurance available to 22 million self- employed Americans. Within these exchanges, insurance companies will compete and offer multiple plans so that everyone can choose a plan that works best for their family. And in all cases, they will be negotiated on behalf of the combined pools of all participating businesses with fewer than 100 employees in the State. This will give unprecedented negotiating power and competition that will directly benefit workers at small businesses. And not just the workers but especially the owners of those businesses who, by the way, are already receiving tax credits to help them pay for their employees' insurance.
The fact is, the majority of Americans are supportive of what this law is trying to do, and they don't want to go back to the broken system we had before it passed. They know it is crucial that American families have health care when they need it. They know this law will give millions more American families access to this care while creating jobs and saving money.
The truth is, the people have spoken on health care. Unfortunately, some of my colleagues have not been listening.
When you are talking about legislation, it is easy to fall into the trap of either promising the world or warning that it will cause the sky to fall. Neither is right, and the reality is far more complex. The truth is, the Affordable Care Act will change millions of lives but will not fix a very broken health care system overnight. It was the result of a lot of negotiation and compromise.
The truth is, the American people want us to move forward and implement this law. They know some parts of it will work better than other parts. They want us to change what does not work and build on what does. They know provisions like the ban on discrimination against children with preexisting conditions are already helping families across this country, including Isaac, including Maya.
I challenge my colleagues to talk to families with children like Isaac and Maya. Americans are experts on the health care needs of their own families. I have talked to families all over Minnesota, and they tell me they need accessible health care, they need affordable health care, and they want to take personal responsibility to insure their families. But the truth is, they need our help. They need us to make sure the stool keeps standing.
Thank you, Mr. President. I yield the floor and suggest the absence of a quorum.