Mr. President, thank you for the opportunity to be here this evening. I thank Senator Cardin for a great presentation on the real facts behind this bill. You know, being from Alaska, we see a lot of storms. We saw a great blizzard here…
Mr. President, thank you for the opportunity to be here this evening. I thank Senator Cardin for a great presentation on the real facts behind this bill.
You know, being from Alaska, we see a lot of storms. We saw a great blizzard here which brought a lot of snow. I see a lot of blizzards and storms in Alaska. But I have to be honest with you, I have never seen anything like the blizzard of misinformation I have seen in Washington regarding this bill.
Over the course of the next few minutes, I want to talk about the general bill and what it means for all Americans, including Alaskans, and then specifically about the effect on Alaska.
First, I want to walk through a couple of large issues. I know people watching are hearing this over and over while we are on this bill, and the details of it, but I think it is important that we repeat it enough for people to be reminded of the positive impacts the bill will have on America and my State of Alaska. It is not a perfect bill. There are pieces I would like to have improved, and I am sure everyone in this Chamber feels the same. But it is a step in the right direction--a significant step.
On the financial end, in the first 10 years, the bill reduces our deficit by $130 billion. In the next 10 years, with the improvements in the managers' amendment and what it did for the deficit reduction, it is now $1.2 trillion--a significant impact on the national debt.
People call my office and say: How does it reduce the debt? I remind them that between Medicare, Medicaid, the VA, Indian Health Services, and many
other health care programs that we deliver, anything we do to improve the system will mean taxpayers will save money. So, again, $130 billion in the first 10 years, and the next 10 years, $1.2 trillion in deficit reduction.
The other issue--and again these are broad sweeps--is stronger medical loss ratios. This is important because this starts now, 2010, once this bill is passed, a few months after implementation. Health insurers will be required to spend more of their premiums--which really are your premiums--on clinical services and quality activities, with less going to administration--advertising, profits, excessive pay packages. If they do not adhere to the new limits, they will have to pay rebates to the policyholders. These stricter limits will continue even after the exchange starts in 2011 and apply to all plans, including grandfathered plans. That is a significant benefit to the individual--the person who has to pay the premium.
Accountability for excess rate increases: The health insurer's participation in the exchange will depend on its performance. Insurers that jack up their premiums before the exchange begins will be excluded--a powerful incentive to keep premiums affordable.
There is an immediate ban on preexisting conditions for children under the age of 18. This is in the managers' package. To me, this is unbelievable. Many families struggle, and sometimes the parents will forego their health care in order to make sure their child is as healthy as possible. But when a child has a preexisting condition, just to get coverage for them is sometimes almost impossible. So this makes sure that no insurance company can ban or deny them access to health care with preexisting conditions.
Ensuring the needy have access to care: The use of annual limits on benefits will be tightly restricted, ensuring access to needed care. And those limits will be prohibited completely by 2014. Starting in 2010, new policies will eliminate the lifetime caps.
Also, on the broader scheme, there will be innovation. Medicare will be able to test new models. I can't tell you the number of times I have had a public hearing or a public meeting in Alaska, or I have had phone calls come in from people who have asked me: Can we do something different? How can we improve Medicare? This creates some new incentives to move forward on innovation within our Medicare system.
When you look at the small business end of it, the package improves, including starting the health insurance tax credit in 2010, with almost $40 billion of tax credits. Tax savings to small business will be available.
Transparency: New requirements will ensure that insurers and health care providers report on their performance, allowing patients to make the best possible choice.
The next issue--multistate options. This is something during my campaign I talked a lot about--a program we all have in Congress, and so do almost 4 million Federal employees and their dependents. How do we replicate that to give a benefit to the taxpayers of this country, if they want to access something similar? Well, now we have the multistate option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees the health plans of Members of Congress and for Federal employees. At least one plan must be a nonprofit, and the plans will be available nationwide. This will truly promote competition and choice for individuals.
Another new idea, which Senator Wyden had sponsored for many months and talked a lot about, is free choice vouchers, giving more choices to individuals with their money.
As mentioned earlier, the community health centers: It is estimated this bill will now be able to put in place almost 10,000 community health centers throughout this country, providing easy and affordable access for folks.
On the small business end, I want to again just broadly sweep on this. The credits will be available on a sliding scale to small businesses, those small businesses with fewer than 25 employees, and average annual wages of less than $50,000. All small businesses will truly benefit, but if you are a small business with 50 or less employees, you will be exempt. If you want to provide insurance to your employees, and you are in a small group of 25 employees or under, there will be credits available for you.
The bill also clarifies part-time because we have so many part-time employees who work within the seasonal businesses in Alaska--retail, fishing, tourism. It makes sure that small businesses are not hampered by this legislation but enhanced. Again, 96 percent of the small businesses will be exempt from this law, unless they decide to provide health care, and then they can get some benefits through tax credits-- up to $40 billion available.
I am a member of a group of freshmen who came to Washington this cycle. We came with all kinds of ideas on how we wanted to change Washington in short order. We sat down with this bill in mind, and as a group of freshmen, we put together a cost containment package with many ideas--very technical in a lot of ways, but just in the broader sense, it creates administration simplification. It helps ensure we go after health care fraud. With regard to Medicare system upgrades, we make sure that as we develop new systems for Medicare and for the providers, we do some pay-for-performance testing, which will save individuals, save Medicare, and save the Medicare system over time.
The freshmen spent many weeks on the cost containment package we put together, and I want to give credit to Senator Warner for leading the charge, though everyone participated to try to make a difference and bring cost containment to the issue of health care.
I want to go through a quick list on this broader perspective of the legislation and what happens now, because we hear always from the other side that so many things are delayed way out; that they will not happen right away. Let me walk through several items that happen right away.
The Senate bill will make it illegal for insurance companies to drop coverage for Americans who are sick--basically, they call them rescissions--beginning 6 months after the date of enactment. Insurance companies will be barred from limiting the total benefits Americans can use over the course of a year--otherwise known as lifetime caps-- beginning 6 months after the date of enactment. Affordable insurance coverage options will be made available for high-risk pools of Americans who have been uninsured and have been denied coverage because they have preexisting conditions, effective 90 days after enactment.
Early retirees between 55 and 64: I hear from a lot of them who are trying to figure out, as they are now retired and still have some coverage from their former employer, but it is expensive. What this does is set up a new program, and access to a program that will reduce their premiums beginning 90 days after enactment. Insurance companies will be required to start posting their overhead costs on a public Web site so consumers can better compare the deal they are getting effective July 1, 2010.
Insurance companies will have to start providing external review processes beginning 6 months after the date of enactment. Dependents will be able to receive coverage up to the age of 26 on their parents' policy, beginning 6 months after the date of enactment.
This is one again I hear so much when I am back home and from e-mails and letters, people wanting to keep their kids on their policy. Again, coverage up to the age of 26.
The insurance companies will be required to begin covering preventive services and immunization without copays on payments beginning 6 months after the date of enactment. Seniors will have access to dramatic discounts in the purchase of name brand prescription drugs in the Medicare Part D Program beginning July 1.
As I said earlier, children under age 18 cannot be denied for preexisting coverage.
There will be free preventive services for seniors--$500 reduction in the doughnut hole for seniors.
Again, the issue with Medicare, I want to say, when we started this effort to reform health care, Medicare was in trouble and could be in serious trouble by 2017. This legislation adds 10 more years to Medicare.
To be specific to Alaska--and I will be brief on this but I think it is important--many of these issues I laid out
are important to Alaska, but there are quite a few very specific. First, I remind folks what the impact is currently in Alaska--133,000 Alaskans do not currently have insurance; 27,000 residents who now buy expensive individual premiums will now get affordable coverage. We double enrollment in Alaska's Kid Care, what we call here in Washington SCHIP, to more than 15,000 young people, ending the hidden tax on families. About $119 million is spent on uncompensated care, averaging about $1,900 per year. By creating a larger program as we are doing here, we can eliminate that cost.
I have heard over and over about Medicare Advantage. Let me tell you how that works for Alaskans. What we will be doing, we have 60,000 Medicare beneficiaries paying a price for excessive overpayments in higher premiums, even though 99 percent of our Alaskan seniors do not participate in Medicare Advantage.
What you hear when you hear about Medicare Advantage--and those who have it I am sure enjoy it--but in my State we are subsidizing that even though 99 percent of Alaska seniors do not take that program. So we pay an extra approximately $90 to subsidize that program for those extra things they claim they have. The reality is that was supposed to be run by the private sector, saving money to Medicare. It is now costing us more, it is costing my State $90 per Medicare family.
About 10,600 Alaskans hit the doughnut hole in Alaska through the Medicare drug coverage, which can cost some of our seniors up to $4,000 additional a year. They will see a 50-percent reduction.
As I mentioned under early retirees on the national program, 7,300 Alaskans will be affected in a positive way; 8,600 Alaska small businesses could be helped by the small business tax credit. Again, Alaska is benefiting a great deal from this legislation.
Even more specific--and these are items I added specifically in the bill to focus on Alaska's specific issues. I thank Senator Harkin on this next one, which is important. It is providing more primary care providers. It is a loan repayment program. I know he has been an advocate of getting more primary providers within the system-- physicians, nurse practitioners, physicians assistants--from $3,500 to $5,000 for the National Health Service Corps in this country. It serves health professional shortage areas, including 77 in Alaska.
In part, because of this, and due to other major expansion, the Senate HELP Committee has estimated the bill will attract 24,000 new primary care providers. If you want to make a difference to the health care system, this is one critical piece. Again, Senator Harkin, I know, has been an advocate for this for many years. To see us get to this state and be able to move this forward is significant. It will have a positive impact.
Another one which is a program that is a great benefit for hospitals in Soldotna, Juneau, and Sitka, is an amendment which reauthorizes a Medicare project supporting hospitals in rural communities in smaller States, extending that for an additional 5 years, moving it from 10 States to 20 States and creating another 15 hospitals that can participate.
Alaska health care task force--specifically in this legislation, to deal with our Medicare provider issue in Alaska but also our TRICARE, making sure we deliver the right kind of hospital and medical care to our veterans.
More physicians assistants--we inserted specific language to make sure we allow loan repayments for physician assistant teaching faculty, to be also included in loan forgiveness. Last year we had 375 PAs who handled 1.2 million office visits in Alaska.
After 21 years, the Indian Health Service is now in this bill to be reauthorized. For 21 years it has not been reauthorized.
There are many great things in this legislation, from a broader perspective, as I mentioned earlier in my comments, but also very specific to Alaska.
Could it be better? Absolutely. But do we think we have a piece of legislation that is going to make an impact on people's lives? Yes, we do. If we want to keep it the same old business as usual, I guarantee, in 5 years or 10 years from now we will be in this hall, trying to figure out what to do at a bigger crisis.
This is the right decision. It will be an honor for me later this evening to make a vote in the affirmative to move past the cloture vote, getting on to voting for this bill.
I yield the floor.