A picture of Senator Richard Burr
Richard B.
Republican NC

About Sen. Richard
  • Executive Session

    by Senator Richard Burr

    Posted on 2013-12-11

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    BURR. I rise to address the nomination of Cornelia Pillard to the DC Circuit Court. This nomination is a good example of government overreach that has led to things such as the ObamaCare debacle.

    Let me say to my colleagues who have been on the floor speaking about Newtown, I had an opportunity to spend an hour with parents of Newtown children. It is a compelling personal story that they shared.

    No parent should have to watch a child die. No parent should have to live and a child die. My heart still goes out to those who lost children at Newtown.

    Today, with the Affordable Care Act fresh on my mind, I venture back to think about when I came to the floor in 2009 and said in front of my colleagues of the Senate and the American people--I wish to spend the balance of this second half of the hour rehashing some of the things I came to the floor to talk about.

    There were numerous opportunities before the legislation was passed. I remember it was very close to Christmas in December of 2009.

    I said premiums will increase for younger and healthier individuals because of the new federally mandated rating rules. Over 40 percent of the uninsured are ages 18 to 34, the same group that will be hit with the highest increases if this bill passes.

    What do we hear Americans are focused on today? Young people. Are they going to join? Today their insurance is three times lower than what it will be in January of 2014. Why? Because of the Affordable Care Act.

    No. 2, premiums will increase because of new federally mandated insurance standards. Experts estimate many of the health plans purchased today by individuals and small businesses will not meet the minimum requirements mandated by this bill, which means that all Americans will be forced to buy richer plans.

    Let me remind those who are listening that this was in 2009 on the Senate floor. Listening to the comments of those today who say we never anticipated some of these things would happen--if they didn't anticipate, it is not because people weren't on the Senate floor. It wasn't because we made this up. It is because people who were experts, CMS actuaries, CBO administrators, were sharing with us what would happen if this legislation became law.

    Premiums will increase because of new federally mandated benefit packages. The bill empowers the Secretary [[Page S8644]] of Health and Human Services to decide which benefits are covered and which benefits are not.

    What are Americans learning every single day? When they can get on the exchange, they are finding that they are 65 years old and they have to have maternity coverage.

    I turned 58 and my wife has pretty much informed me we are not going to have more children, but I can't buy coverage without maternity coverage. Why? Because they want to charge me more to shift that cost.

    We didn't have health care reform. We just changed where we are shifting the cost from. Now we are embedding the premium versus charging more at the delivery point of health care and shifting it within the delivery system.

    We are shifting it within the population by charging those of us who are a little bit older more--because we mandate that we have to have services we are never going to use--and younger people who are healthy who probably are never going to need to go to the doctor. I hope they do because prevention is actually one of the most beneficial things we can promote. Now we are going to charge them three times what they were paying, and we believe they will take it? Premiums will increase because of the new excise tax on medical devices. Innovation is what saves health care dollars. Yet in the Affordable Care Act, or what some call ObamaCare, we actually put new taxes on medical devices.

    Every time we have a stent that is inserted, every time a medical device is used on a person, their health care bill goes up because we have now taxed the device they are using. If the device price goes up, and the reimbursement goes up, the premium goes up.

    It is starting to make some sense. Again, this was in 2009 before we passed the bill. Premiums will increase because of a new excise tax on health plans.

    We actually taxed the same health plans that are in the exchange that we told everybody would save them money. Premiums will increase because of the new excise tax on prescription drugs. Wait a minute. I thought we were bringing down the cost of health care.

    In 2009, again, new taxes on devices, new taxes on health plans, new taxes on prescription drugs, these were all things that we all knew. The President knew it. My colleagues who voted for the plan knew it, but everybody seems to have amnesia today: Oh, my gosh. How could the costs go up? I never knew this was going to require people to buy a health insurance policy that had benefits they would never use.

    Premiums will increase because of a new fee to sell plans in the mandated exchanges. This phenomenal exchange market that created competition, we now created a new fee on the part of insurers to enter the exchange. Premiums will increase because of a new tax for comparative effectiveness.

    Comparative effectiveness means we are trying to bring new generics, whether they are in pharmaceuticals or biologics to the marketplace. We have decided to tax that process. Premiums will increase because the bill forces 15 million more Americans to enroll in Medicaid.

    Why is that happening? It happens because doctors are paid so little on Medicaid that they have to charge more for everybody else. We are cost shifting when we purchase the premium, and all of a sudden we are learning we are cost shifting even when the service is delivered. Reform? No.

    In 2009, again I came to the floor and I talked about the Affordable Care Act, ObamaCare. Zero times did it mention provisions prohibiting the rationing of health care--zero. Nine times it mentioned new taxes created in the bill. Thirteen pages are in the table of contents. The bill weighed 20.88 pounds and it took 36 pages for the CBO to estimate the pricetag of ObamaCare; 70 government programs authorized by the bill, and 1,697 times in the Affordable Care Act the Secretary of Health and Human Services was given the authority to create, determine, and define things in the bill. This is a bureaucrat whom we allowed 1,697 times to determine what Congress's intent was in the legislation through almost 3,000 pages; 3,609 times the word ``shall,'' not ``may,'' was in the bill. It cost $6.8 million to taxpayers per word.

    Let me remind you. This is what I came to the floor and talked about in 2009 before the Senate passed this legislation in the dark of night.

    Twenty-four million people left without health care. This is the bill that was supposed to insure everybody. Twenty-four million people without health insurance; a $1.2 billion cost to the taxpayer per page, and $5 billion to $10 billion of additional funding needed for the IRS' implementation of the bill.

    In other words, we are going to fund $5 billion to $10 billion for the IRS to chase down people who owe a penalty because they made the determination they couldn't afford or they didn't need health care insurance.

    There are $8 billion in taxes levied on uninsured individuals. There is a way to make health care affordable--tax people who don't have it.

    So $25 billion of additional Medicaid mandates placed on States; $28 billion in new taxes on employers not providing the government-approved plans; $100 billion estimated annually of fraud in Medicare and Medicaid; $118 billion in cuts in Medicare Advantage--to seniors all across this country who found this product to be the one that provided the most security and benefits for them; $465 billion in cuts to Medicare--cuts to Medicare. This was the health care system that was at that time projected to be insolvent by 2017.

    There are $494 billion in revenues from new taxes, fees, levied on American families and businesses; a $2.5 trillion cost for full implementation of the legislation.

    At that time we had a $12 trillion debt. Today, we have a $17 trillion debt. Health care was supposed to be more affordable because we reformed it. We didn't reform it. We took it over. The Federal Government took it over.

    Let me go to another process I talked about in 2009. This is all marked up. It has been in my desk drawer since then. It is a word search of the bill. There are 4,677 times where the legislation said shall, must or require; 899 times it said tax, fee or revenue; 470 times it said agency, department, commission, panel or bureau; 196 times it said regulate or regulation; 134 times it mentioned treatment; 180 times it mentioned prevention; 40 times it mentioned choice; 25 times it mentioned innovation; and 13 times it mentioned competition.

    If we listen to those who are out selling this awful plan today, what are the three words we hear? Choice, innovation, competition--those things that are mentioned the least in the almost 3,000 pages of health care legislation in 2009. This bill wasn't reform. This bill spent trillions of dollars at a time of record deficits and debt. When fully implemented, I said then, this bill is projected to cost $2.5 trillion over 10 years. CBO said at the time that this bill will increase Federal health costs, not lower it.

    What have we heard from the President? It is going to lower health costs. It is going to bring it down. It is going to be more affordable. Middle class, this is the greatest deal for you.

    The bill raised taxes by more than $500 billion at a time of record unemployment. The bill violated the President's own pledge to protect the middle class. Who gets taxed in this bill? Again, this is from 2009 on the Senate Floor, right here, before the vote. Uninsured Americans, insured Americans, families with high-value insurance plans, high health costs, small business, individuals who need medicines or medical devices, and employers that provide retiree drug coverage. Employers that provide retiree drug coverage, we tax them.

    The bill cut $466 billion in Medicare to fund new government programs. Medicare faced at that time a $38 trillion underfunded liability and insolvency that was projected to occur in 2017. Instead of fixing those problems, this bill raided Medicare to start a new government entitlement. The bill cut Medicare Advantage. It cut hospitals, it cut nursing homes, it cut home health, and it cut hospice.

    Nobody in the administration can go out today and say: Oh my gosh, we didn't know this was going to happen. We talked about it right here day after day after day.

    These are not things we made up. If we did, we would be prophets, because they are all coming true. Everything is aligning with what we said.

    The bill would increase premiums, making care more expensive, not less. I mean let's get past what was the easy [[Page S8645]] part, and that was setting up the exchange, setting up the Web site. Or at least it should have been.

    New taxes in this bill will get passed on to consumers, increasing yearly premiums--this is what I said then; listen to this--by $488 a year, according to some estimates. The average premium would increase by $2,100 for a family policy in the individual market.

    There are individuals who are seeing $488 a month in increase, and in addition to that a deductible they have never had applied to them before.

    This bill imposed costly new burdens on struggling States. The bill threatens health care choices millions now enjoy with a tangled web of new rules, regulations, and government-run plans. The government will require you to purchase insurance or face a fine and will tell you what kind of insurance you have to have, even if you like what you currently have.

    I am not a prophet. I was going by what the experts said in reading the bill. So for everybody who went out and said: If you like your insurance, you can keep it; if you like your doctor, you can keep him; if you like your hospital, you can keep it--we were on the Senate Floor saying: That is not what the bill says. It is not going to happen.

    This bill cut $135 billion from hospitals, $120 billion from 11 million seniors on Medicare Advantage, nearly $15 billion from nursing homes, nearly $40 billion from home health agencies, nearly $7 billion from hospice. Cutting Medicare to fund a new government program in my book is not reform. It is ignorance.

    The CMS Office of the Actuary--let me tell you, the Actuary is like the gold standard. The CMS Actuary is like the guy who puts that stamp of approval on it, and there is nobody higher from the standpoint of what the actuary says. He says the bill increases national health expenditures. National health expenditures under this bill would increase by an estimate of a total of $234 billion, 0.7 percent, during 2010 and 2019.

    That is exactly the opposite of what everybody is out saying today. Despite promises that reform would reduce health care spending growth, the bill actually bends the health care curve upward. According to the analysis, the national health expenditure as a share of GDP is projected to be 20.9 in 2019, compared to 20.8 percent under current law.

    How could you go out and make a claim this was bending the cost curve down? How could you promise the American people it was going to be cheaper? The total number of persons with employer coverage in 2019, according to the CMS Actuary pre-2009, when the bill was passed, was projected to be 5 million lower under the reform package than under current law. Let me say that again. The CMS Actuary told us in 2009, before we passed this bill, that employer-based coverage would drop by 5 million individual covered lives. I might say that some estimates are coming in at 100 million employees losing their health care under employer plans right now.

    The new fees for drugs, devices, and insurance plans in the bill will increase prices and health insurance premium costs for consumers, and this will increase the national health expenditure by approximately $11 billion per year.

    The bill funds $930 billion in new Federal spending by relying on Medicare payment cuts which are unlikely to be sustainable or permanent. As a result, providers could find it difficult to remain profitable; and absent legislative intervention, they might end their participation in the Medicare program, possibly jeopardizing the care to beneficiaries.

    See, it wasn't Republicans who talked about rationing, it was the Actuary at CMS in his analysis of the Affordable Care Act. He said: Here is what is going to happen. It is seniors who are going to get hosed on it because they are not going to have access to the doctors anymore.

    The bill is especially likely to result in providers being unwilling to treat Medicare and Medicaid patients, meaning that a significant portion of the increased demand for Medicaid services would be difficult to meet.

    How could anybody listen or read what the CMS Actuary said and remotely go out and tell the American people: Geez, this is going to increase coverage for everybody.

    The CMS Actuary noted that the Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. He also found that roughly 20 percent--20 percent--of all Part A providers--hospitals, nursing homes, et cetera--would become unprofitable within the next 10 years as a result of these cuts, meaning they are going to go out of business.

    You know, pretty soon it is not going to be the network the insurance provider put together, it is going to be the fact the hospital went out of business because they couldn't withstand what this bill has done to them.

    The CMS Actuary found further that reductions in Medicare growth rates through the actions of the Independent Medicare Advisory Board-- now, that is going to sound a little odd to some because prior to the bill passing it was called the Independent Medicare Advisory Board, but it is now called the Independent Payment Advisory Board--IPAB--an entity that when set up and it is kicked in--16 members picked by the President--will determine reimbursements and scope of coverage. It is not the Congress of the United States. If we don't legislatively do something with their recommendation, it becomes law. It goes into effect.

    The bill would cut payments to Medicare Advantage plans by approximately $110 billion over 10 years resulting in less generous benefit packages and decreasing enrollment in Medicare Advantage plans by about 33 percent. So 33 percent of seniors would lose their Advantage plan. Again, this is 2009. This is not today.

    The President, in 3,000 pages said it would reduce costs. The chief actuary says that is not the case.

    Let me read a letter I got in the last couple of weeks from Lori Perez from Willow Springs, NC.

    I am a divorced mom of three. I received insurance through my employer. My rate has increased $100 a month. This is a huge difference that will have to be budgeted by reducing groceries and foregoing my son's braces I had planned for 2014. I looked into dropping my company provided insurance to join an exchange but I do not qualify to receive a subsidy because my insurance rate is less than 9\1/2\ percent of my income. It is 9 percent. My yearly income qualifies. Apparently, Obama thinks I can afford an additional $1,200 a year. I am considering dropping my insurance, paying out of pocket as needed for health care, and paying the fine at the end of the year. It would be less expensive. This is ridiculous. What can we do? What do you say to Lori? Oops. That is the law. Here is somebody who was 100 percent satisfied, an employer doing the right thing, and the Federal Government has now put her in a situation where she is considering just giving up her health care, doing away with it. Why? Because she can't afford it. This is a woman with a job. She is thinking about giving up her groceries and delaying her son's braces. Why? Because of ObamaCare.

    Where are we today? Let me speed forward. I said we have the health care exchange, the healthcare.gov Web site. There are companies every day that get Web sites set up. This one is complicated. They had 3 years to do it. It still is not right today. But I am convinced they will get it right.

    For the first time the American people are getting on the Web site and they are able to look at the health care options they have. And what are they finding? They are finding that the premium costs for something equal to what they had are two times, three times more expensive per month. They are finding this new thing they have never had before called deductibles. And I am not talking about a $100 deductible that you pay before you get participation in a doctor's visit or an emergency room visit; I am talking about $1,000, $3,000, $5,000. I have heard from friends who have now signed up for plans and have a $15,000 deductible.

    I say to my colleagues--especially my colleague from Florida--it sounds like a health savings account, doesn't it? You have insurance, but you are responsible for the first $15,000. The guy who shared that with me, his premium is $1,444 a month with a $15,000 deductible. I don't think he is going to drop it, but sticker shock is rampant.

    Benefit package. How many people have come up to me and said: I am not going to have any more children, but I have to have maternity coverage. Something is wrong.

    [[Page S8646]] They are right--something is wrong.

    How many kids would like to have a scaled-down version that allows them to have a set of benefits, and they are willing to roll the dice, and if something bad happens, they will pay out of pocket? No, they don't get that option. The choice does not exist--unless it is a choice of the things created in the Affordable Care Act.

    Networks. This is one the American people haven't gotten to yet, and I can't wait until it happens. I have gone through getting on the DC exchange and going through the process of trying to figure out whether my doctor in North Carolina is available in this plan or that plan. Wait until the American people go onto healthcare.gov and they start picking a plan and look to see: Is my primary doctor on there? Is my hospital on there? Is the specialist I see on there? Are the drugs that I take on this plan? This is incredibly complicated. The American people were used to calling their insurance broker and saying: Here is how much coverage I want, here is how much I have to spend, and here is my health condition. And they designed a program to meet their health condition, their income, and their age. Now we penalize you for your age--if you are old or young--and we force everybody to take the same benefit package regardless of whether they can afford it, and we say: If you don't get it, we are going to charge you this year a 1-percent penalty on your income, and that goes up to 2\1/2\ percent at the end of the transition period.

    We are going to get past this period which I call the enrollment plan period. Next, we get to the part the President delayed. We never understood that something that was in statute, the executive branch could just decide, no, it is not going to go into effect. But for large and small employers, they had a 1-year delay. All of a sudden, in 2015, their employees are going to be in the same marketplace that we are.

    What makes that particularly difficult is we extended the enrollment period for individuals in healthcare.gov until March 31, 2014. They can still enroll. Well, April 1, 2014, through April 27, 2014, insurers will have to decide what their premium cost will be in 2015. So given that they have no real experience on what the mix of ages and health conditions in their plan is, what are they going to do? They are going to err on the side of higher premiums; that is, higher than we will see in 2014, which a majority of the American people say are higher than they can afford. Imagine what it is going to be like in 2015. And in that group is the 80 percent of America, not the 5 to 10 percent who are provided for by employers today.

    I see my colleague here, and I am infringing on his hour, but I do want to stress one last thing. I mentioned only once the Independent Payment Advisory Board, IPAB. At the end of the day, mark my word, everything that I commented on I read from my 2009 notes--notes that I came to the floor then and said: This bill shouldn't become law, and here is why. I spent 5 minutes talking about that today.

    But I am going to make this statement, and I will come back to the floor 2 years from now when IPAB is up and running and the benefit packages have been cut down and the reimbursements have been cut to doctors and hospitals, and I will point to the statement that I made here that picking a 16-member advisory panel that has the authority and the power to set the scope of coverage and, more importantly, the reimbursements will have a most devastating effect on health care in this country.

    It will ration health care because of the doctors who choose not to participate in plans that participate in the exchange. It will force hospitals out of accepting plans that participate in the exchange. And for those of us forced by government to be in the exchange and to choose, our choices will be gone. Our costs will go up. We will get care--when we are queued in line or at the emergency room or from a doctor we don't know or don't trust or from a hospital we have to drive to. It is not going to be reassuring to that mother who now has maternity coverage but no obstetrician and no local hospital to deliver a child because, you see, we didn't reform health care. We didn't do anything to liability. We just changed the pocket we pay out of. We taxed everybody we could find to pay for it. And still--as I said in 2009 and I believe will be true today--at the end of the process, there will be 24 million people without health insurance. Why? Because of ObamaCare. Because of the choice--or the lack of choice--we gave them.

    I yield the floor.

    The PRESIDING OFFICER (Mr. Manchin). The Senator from Florida.

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