Statement on H.R. 3590, The 'Patient Protection And Affordable Care Act'

We have reached a defining moment for the Senate and for the American people.  The bill we are considering will rank alongside other major decisions such as the creation of Social Security and Medicare and the Civil Rights Act.  Health insurance reform has been talked about and attempted for seven decades.  The American people for years have named health insurance as among the greatest concerns in their daily lives.  Now, here at hand, is the opportunity to act.    

An Arduous Process

This has been an arduous process.  The President has rightly noted that if health insurance reform were easy, it would have been done long ago.  The defenders of the status quo have spared no expense – nor have they been sparing in their distortions – to keep the system that pays them so handsomely.  Health reform will benefit every American of today’s generations.  But let us especially think ahead one, two or three generations.  If we were to abandon our responsibility now, saying “It was too difficult,” that would be an excuse for doing nothing that our children and grandchildren would never accept.

Friction, A Byproduct Of Reform

For many reasons, including the health of public discourse on the most pressing issues we face as Americans, it is regrettable that the defenders of the status quo, doing their utmost to influence this debate from their comfortable perches outside the Senate, have stooped to new levels to obstruct health insurance reform.   Friction is a byproduct of reform, especially when well-funded and entrenched special interests rally to protect the status quo.  The heat of this debate is a measure of the cozy setups that these reforms will unsettle.  This year alone Senate Democrats have been forced to contend with 101 filibusters by the Minority Republicans.  Even on an issue this important, health insurance reform is still being subject to filibuster and parliamentary delay to a level I have not seen in 35 years in the United States Senate.   

Opponents of reform unfortunately have wasted much of the public’s time by provoking arguments over their distortions about what health reform really means.  The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives.

The arguments that we hear today to prop up the status quo by knocking down challenges to the way things are seem eerily similar to those made against creating Medicare nearly 45 years ago.  Opponents then tried to demonize the plan and claimed it would never work.  During the debate decades ago on Medicare, one Senator said:  “It would achieve little for those who need it, while subjecting the very fabric of American life to the strain of severe and unnecessary sacrifices.”

Eventually during that historic debate, Members from both sides of the aisle worked together to pass a bill that is one of the most successful, purposeful and popular programs today.  The Medicare program, like Social Security, was not perfect when it began, but improvements have been made over time.  Vermonters can be proud that our State’s congressional delegation, all Republican at the time, supported passage of that landmark legislation.    

The Senate has overcome the stalling and delay tactics, the filibusters and the roadblocks to the consideration of health care reform, and now we are closer than ever to passing comprehensive and meaningful health insurance reform.  

Is the Senate health care bill without any problems?  No.  Is the bill before us the one I would have drafted, or the one that any other member of the Senate would have drafted?   Of course not.  Extensive negotiations and refinement were needed to produce a bill of this scope and importance, as it should be in the legislative process.  The difficulty was magnified by the Minority’s calculated decision to spend their efforts to undermine, instead of to constructively engage.  Not only majorities but supermajorities were required at several steps in the Senate’s work on this bill.  There are 100 Senators and 435 members of the other body who will have to stand up and be counted in this historic process.  The votes of most, I believe, will be tallied on the right side of history and of the real-life, everyday needs of the American people for real health insurance reform.

The Peril Of Doing Nothing

Some say the bill before us does not go far enough.  Others say it goes too far.  What everyone can agree on is what will happen if we do nothing.

In the next decade, without reform, half of all non-elderly adults will find themselves without coverage at some point.  The number of people without insurance will jump by more than 30 percent in 29 States, and by at least 10 percent in every State.  American families will continue to pay a hidden tax of $1,100 on their health insurance premiums to pay for the costs of care for the uninsured.  The very same insurance coverage a family has in 2008 is projected to nearly double to $24,291 by 2016, consuming a whopping 45 percent of projected median family incomes.  Premiums will continue to double every several years, making health insurance vastly unaffordable for many Americans.  Economists project that if health insurance reform fails, the resulting lower Gross Domestic Product (GDP) will reduce family incomes by $10,000 by 2030.  Small businesses will continue to struggle and fewer and fewer will be able to offer coverage to their employees.

Furthermore, as our population ages, Medicare is projected to be insolvent within ten years, jeopardizing coverage for millions of American seniors.  Each day that passes without reform, 14,000 Americans lose health insurance coverage.  These are not minor problems to be brushed aside or kicked yet again down the road for another generation of Americans to tackle.  These problems are on the Senate’s doorstep, right here, right now.  Keeping the status quo guarantees a struggling economy in the future, with more Americans unable to afford life-saving treatments because of the rising cost of insurance.   

In 2001, 46 percent of all bankruptcies were attributable to medical costs.  By 2007, that number had grown to 62 percent.  While hard-working Americans were losing their jobs, homes and savings simply because they got sick, insurance and pharmaceutical company executives were making record profits.  In 2000, the ten largest publicly traded health insurance companies had profits of $2.4 billion.  By 2007, profits at those firms had jumped to $12.9 billion, a 428 percent increase.  In 2007, CEO salaries at these firms were $118.6 million, or $11.9 million for each CEO.  In 2007, prescription drug companies had a profit margin of 15.8 percent.  The same year, profit margins at all Fortune 500 firms were 5.7 percent.  

Since the Nation’s last attempt to pass health reform 16 years ago, millions of Americans have lost their insurance and costs have skyrocketed.  In the absence of a fair and sensible health insurance system, families, businesses and taxpayers have been dragged along by an inflationary curve that only worsens with time.  Next year, small businesses — already suffering from skyrocketing medical costs — will see their premiums rise by an average of 15 percent -- twice the rate of last year’s increases.  Drug companies have boosted prices of brand-name drugs by about 9 percent over the last year, the steepest increase in years.

Vermonters’ Experiences

Even though Vermont has long recognized the importance of building a health care system that includes all Vermonters, individual States acting alone cannot make enough progress without comprehensive health insurance reform.  Tens of thousands of Vermonters still lack basic health insurance.  Workers nationwide are losing insurance for their families when they change or lose jobs.  Insurance companies can and do discriminate against sick people.

I know so very many of these Vermonters.  Many of them are my neighbors, my friends.  Some of these Vermonters without health insurance went to school with me.  Some grew up as I did in Montpelier, Vermont.   Some are people I have known all our lives.  They are hardworking, good, honest, decent people.  It is a travesty that after working so hard and playing by the rules they still cannot begin to have the kind of health coverage that federal employees – including those of us in this Chamber – are able to have because of earlier reforms of the federal workforce health insurance system.

Too many Vermont families live in the shadow of constant insecurity because they know that if they have an illness or if they lose a job, it might mean the end of their health insurance.  Too many Vermonters are forced to sell their homes or file for bankruptcy to pay their health insurance bills.  In no other modern society are families confronted with such heartbreaking dilemmas.  

Let me give a personal example.  I heard recently from a Vermonter who only periodically had health insurance throughout his life and now goes without prevention and screenings and pays for everything out of pocket because he cannot afford any health care that is not urgently needed.  Tragically, his wife was in a car accident, and even though the couple paid thousands in treatments, they “had to stop short” in giving her the necessary physical therapy and medications her doctors recommended, because of the costs involved.

Another Vermonter, who is lucky enough to have insurance, says her family pays almost $1,100 each month in premiums, and yet they have to reach a $3,000 deductible before the insurance company will pay a dime.  She told me that “as the cost of health insurance continues to rise, it feels like we will be swallowed whole by it.”  

These should not be stories heard in today’s America.  We remain the only industrialized Nation in the world that lets its citizens fend for themselves without health coverage.   

Long-Overdue Reforms

The bill before us would make giant leaps toward reforming our health insurance system.  Under the Senate bill, 31 million more Americans would have health insurance, bringing coverage to 94 percent — the highest level of insured Americans ever in our history.   More low-income Americans will be able to access the State Medicaid programs, and middle income families will get enough help to be able to buy health insurance through State-based health insurance Exchanges, which will be closely monitored.  Insurance companies will never be able to drop your coverage, charge you more, or deny you or your children coverage because of a preexisting health condition.  This bill also sets standards for qualifying health insurance so the insurance companies can no longer sell you coverage that does not actually help when you are sick.  The legislation also contains a Patient Bill of Rights, long championed by Senator Kennedy, which guarantees that patients have a right to appeal denials or decisions by their health insurance companies.   

Holding Down Costs

The insurance industry will no longer be allowed to pay excessive executive bonuses and salaries on the backs of their customers.  All insurance companies will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits – or else they will have to pay rebates to policyholders.  This change will improve quality of care and will hold the insurance industry accountable for their spending.   

Small businesses, which make up more than 80 percent of the businesses in Vermont, at long last will have access to affordable care under this bill.  This bill will make tax credits available to small businesses to help them offer health insurance to their employees.  These tax credits will make health insurance more affordable both for small businesses and for their workers.

The nonpartisan Congressional Budget Office confirmed that the reforms in the bill -- including lower administrative costs, increased competition, and better pooling for risk -- will lower premiums for American families.  CBO estimates premiums for the overall population will be reduced by 8.4 percent.   

In addition to the consumer protections and industry accountability provisions, this bill also takes significant strides to slow the growth of the spiraling health spending that has the potential to cripple our economy in the years to come.  A substantial portion of the Senate bill is devoted to testing ways to reduce health care costs while improving quality over time.  The bill contains pilots for efforts like Vermont’s Blueprint for Health, under which patient care is coordinated to reduce unnecessary hospital visits and to keep patients healthy.  Other programs will test various ways to pay doctors and hospitals that could be more efficient than the current fee-for-service structure.  A greater emphasis on prevention -- long supported by Senators Kennedy and Harkin in the Health, Education, Labor and Pensions Committee -- will reduce preventable deaths and hospitalizations.     

Falling Short

While these improvements to our health care system are significant and noteworthy, I am disappointed that the bill no longer includes a public insurance option to compete with private plans, nor does it include a provision I have proposed to repeal the antitrust exemption for health and medical malpractice insurers.  Though there are differing views on the best ways to inject competition into the health insurance market, we can all agree that health and medical malpractice insurers should not be allowed to engage in blatantly anticompetitive practices, such as colluding to set prices and allocating markets.  My legislation would ensure that basic rules of fair competition apply to insurers.  I believe that repealing this antitrust exemption, combined with the public option, would go far in providing fair competition and choice in the health insurance marketplace.   

With all the progress the Senate’s health care bill makes in the area of women’s health -- such as prohibiting insurance companies from discriminating against women through higher premiums and by allowing women free access to vital preventative services -- it is unfortunate the bill also threatens to chip away at women’s reproductive choices.  Before a restrictive provision was added in the managers’ amendment, the bill would have maintained current law by restricting federal funds for abortions.  The original Senate bill would have required insurance companies to segregate public and private funds to ensure no public funds would go to abortion services.  Now, instead, the Senate bill would require women who purchase insurance on the Exchanges to make two payments if they wish to have a wide range of choices.  States could also opt-out of allowing abortion to be covered at all on their Exchanges, leaving women with fewer choices than they have now on the individual insurance market.  While this language is far less restrictive than the language in the House-passed legislation, there is legitimate concern that despite the interest of women to have this choice available in the marketplace, this language would prompt private insurers to stop offering such options at all.  I hope a better solution comes in conference.     

Senate Can Be Conscience Of The Nation

After one of the cliffhanger votes over the course of this long Senate debate, I spoke privately with Vicki Reggie Kennedy, the courageous and insightful widow of our beloved friend, Senator Edward Kennedy.  This is a bittersweet time for her, and for all who know how fully he was committed to winning this battle to lighten the load for the ordinary Americans who are struggling so mightily today.  Health reform was the first of the many causes of his life and of his work in this body.  

We talked about how he would have relished this moment.  And we talked about how he would have pressed his shoulder to the tiller to steer the Senate toward the right outcome for the American people.  Though Senator Kennedy strongly supported including a public option, as I have, along with other reforms such as ending health insurers’ antitrust exemption, Vicki Kennedy knows, as I do, that he would be fighting to pass this bill.  This is the Senate’s opportunity to advance real reform.  This is a bill that reflects the core principles the President outlined in beginning this debate early this year.  

This is reform based on the existing system of employer-based insurance, offered by private insurers with health services delivered largely within the private sector.  But any objective reading of this bill makes crystal clear that this is real reform.  This is a bill that will improve the lives of every American.  This is a bill that is a credit to this good and great Nation and its people.

At its best, the Senate through our history has been able to act as the conscience of the Nation.  Those moments were forged amid fervent debate, and with the purpose of advancing a pressing national interest.  This is such a time, and my hope and belief is that the Senate again will rise to the occasion.

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