December 23, 2009

FLOOR STATEMENT ON THE PATIENTS PROTECTION AND AFFORDABLE CARE ACT

It won't be long now until we achieve universal health coverage, affordable care for all Americans. I want to thank Senator Baucus for making this moment possible. I know how hard he's worked for so many weeks - so many months- so that we could bring very different views together. We have all been focused on the goal of achieving affordable health care for every American.  Senator Baucus never lost sight of that goal. As a result, we are now just hours away from the last procedural hurdle before we'll have a chance in the Senate to vote on this bill. 
 
For the 23 years that I have been in Congress, I've told the people -- first of the third congressional district of Maryland, then the people of Maryland -- that I'm going to fight to change our health care system so that every American has access to affordable, quality health care. We're going to take a giant step forward to reaching that goal in the legislation that we have before us today.
 
Senator Baucus, I want to thank you very much for your extraordinary patience and leadership to bring us to this moment. There is a lot of discussion here, on both sides, as to what the facts of the bill are, so I'm going to use the Congressional Budget Office as the basis for considering this bill because that's what we agreed to. They are the objective scorekeeper. They are not partisan. I think everyone agrees to that.
 
The Congressional Budget Office tells us that for the under 65 group, we're going to increase the number of insured from 83% to 94%. For all Americans, we're going to have 98% covered by insurance. That's universal.
 
We're going to have a framework so that -- at long last -- America joins every other industrial nation in the world with a health care system where everyone is included.
 
To me, this is a moral issue. It is an issue of whether health care is a privilege or a right. Well, I believe that the values of America teach us that health care should be a right for all Americans, and the bill that we will be voting on will take us very close to achieving that goal.
 
Today in America, too many people fall through the cracks. Too many people, families are literally destroyed because they can't afford access to health care and therefore they don't get the tests that they need, and perhaps a disease that could have been caught earlier, prevented is lost and the person has to go through tremendous health care treatment, perhaps even losing their life.
 
We have seen too many families go through bankruptcy because they can't afford the health care that they need. We see too many people literally cutting their prescription call pills in half in hopes to be able to stretch out medicine for a longer period of time because they can't afford it, knowing full well that they are compromising their health.
 
Many times I have mentioned the case of Deamonte Driver, who for me is representative of so many tragedies in our community that could be avoided. Deamonte driver was a 12-year-old who lived in Prince George's County, Maryland, just seven miles from here. He had a tooth ache. His mom tried to get him to a dentist but they had no insurance and couldn't find a dentist who would help Deamonte. They went to a social worker, made dozens of calls, but still couldn't find a dentist. He started to complain of severe headaches. After weeks of not being able to get to a dentist he went to the emergency room, the only option that was still available. They found out that the tooth had become abscessed and it had gone into his brain. He had emergency surgery. He lost his life.
 
Deamonte Driver lost his life because our health care system didn't provide access to affordable quality care for all Americans. Well, that's about to change and I'm proud to be part of it.
 
I have been asked by many in recent days as to what's in it for the people of Maryland? What are they going to get out of this? Well, the people of Maryland are going to get a national health care system that makes a lot more sense, a rational system for care in America.
 
In the current system, too many people are being left out. Small employers have a hard time finding an affordable product. I have gotten many letters from my constituents over the course of the last several months. We have all read many letters that we received, but I must tell you about the letter I received from a small business owner in Montgomery County. She and her husband had to take out two separate policies to cover their family of four because the private insurance companies discriminated and say that each have pre-existing conditions. The only way they can get full coverage is to have two policies with two separate deductibles that the family cannot afford. They have two separate premiums that the family cannot afford because there is no competition to provide coverage to small businesses in America.
 
Small businesses in Maryland want to have the opportunity to cover their employees. They know competition is important and this bill provides for a lot more competition.
 
This bill will help those who are losing coverage today. So many people in Maryland are losing their health coverage. Every day, hundreds of people lose their health insurance in my state today. We live in the wealthiest nation in the world and Maryland is the wealthiest state, and we're losing health coverage today.
 
Our Medicare beneficiaries also are finding their program under attack. They want to have the stability of knowing that Medicare will be there, not just this year but for the decades to come. This bill starts to reform Medicare by reforming health care so that we can sustain it and to fill in the prescription drug doughnut hole which so many seniors are finding it very difficult to afford their medicines.
 
For the people of Maryland, this bill is going to provide a rational way in which they can maintain their existing coverage and find it more affordable. We certainly will be able to sustain coverage for our Medicare population and provide competition for small business owners to find affordable health care.
 
This bill also brings down health care costs and Marylanders are very interested in that. Now, again, let me use the Congressional Budget Office, the objective scorekeepers, and repeat what they say: for the overwhelming majority of Americans, their health premiums will go down -- will go down -- because health care costs are going to come down.
 
This legislation invests in prevention and wellness, and we know that prevention and wellness works. We know that if you can detect a disease early, you can not only save lives, you can save health care costs because the preventative services cost a couple hundred dollars, but an operation that you avoid could have cost tens of thousands of dollars.
 
Screening and early detection work. Management of diseases work. We know that most of our health care costs in America are spent on the leading diseases like cardiac care and diabetes. We know that we spend a lot of money, but if we can manage those diseases more effectively, we can save a lot of money, and this bill takes us down that path.
 
We know we can save money by investing in health information technology. Think about that. Think about how much paper each of us receives every year from our health care system. Think about our own medical records and how that could be used to help us each manage our own health care and take more responsibility. But we're not doing that today. We know that we could use a card to go anywhere in the world, and they can track our financial records, but for health care, that's not true today. By investing in health information technology, we can reduce a significant amount of the administrative costs of health care and better manage each of our own health
Care needs. That's what this bill does.
 
This bill will cover 31 million more Americans. Thirty-one million more will be insured. That's not what I'm saying as a Democratic Senator from Maryland. That's what the Congressional Budget Office is saying that this bill will achieve. Thirty-one million more Americans that won't have to go to an emergency room to get their primary care needs met.
 
Think about how much it costs each one of us when that person -- who's only option basically, is to go to an emergency room -- needs such care. How much does that cost us? Many of those individuals can't afford those hospital charges so the bills go unpaid and it becomes uncompensated care. It's added to the rates of hospitals that you and I pay -- those of us who do have health insurance.  For the people of Maryland who have health insurance, they have a hidden tax every year of $1,100 to pay for such uncompensated care. It's not only a waste of money that we have to pay; it's not the efficient way our system should work.
 
There should be facilities available so that everyone who needs care can get it in a much more cost-effective way. This bill moves us towards that goal. It provides competition so that we can bring down the cost of health insurance through the local exchanges. Another provision in this bill that I'm very excited about is the ability to cross state lines for competition so that if you're an in Maryland and you hire workers in Maryland, Virginia and Pennsylvania, you're able to get the regional and national competition. You'll have more choice of health insurance companies, which will bring down cost and increase quality.
 
This bill also will help to reduce the federal deficit. How many of us have talked about that? I know that people who watch us say, gee, I hear a Republican senator and then a Democratic senator, "is this the same bill they're talking about?" Well, let's talk about the Congressional Budget Office again, our objective scorekeeper. The Congressional Budget Office says that this bill will reduce the federal deficit by $132 billion. Billion, that's a "b," billion.
 
That's quite an accomplishment when you realize that to get everyone covered; the federal government is providing subsidies which will cost us additional investments. So that small businesses can afford it, we provide tax credits. That costs revenue. More people will be insured. They have tax preferences. Yet, the Congressional Budget Office has confirmed that this bill brings down the deficit by $132 billion in the first 10 years.
 
Look at the second 10 years. Many of us want to look at long-term impact. In the Congressional Budget Office, the objective score keepers tell us that it will reduce the deficit by .5% of 1% of the GDP or $1.3 trillion. That's quite an accomplishment to get everybody covered and reduce the deficit and have that confirmed by the congressional budget office. That helps the people of Maryland. And that's why the people of Maryland benefit from this bill as do the citizens of every state in the nation.
 
I want to talk about protecting consumers. I want to make sure that people
Understand what's involved here. Senator Baucus mentioned a lot about how the provisions in the bill about preexisting conditions and pediatric care for children take effect immediately. Also the caps that we bring in, the elimination of lifetime caps, covering children under the age of 26, the reinsurance program for 55 to 64-year-olds, the lost ratios to make sure that the insurance companies are using your premium dollars to pay for benefits, the independent review of a decision made by an insurance company whether to cover a charge or not.
 
Let me talk about the Patients' Bill of Rights because I think the people of this nation would be surprised to find out that we haven't yet enacted the Patients' Bill of Rights. It was 1997 that we started talking about enacting a Patients' Bill of Rights. We had national protection against the arbitrary practices of insurance companies in 1998 President Clinton by executive order applied the Patients' Bill of Rights to the government insurance companies.
 
I'm pleased that the managers' amendment added important provisions -- very important provision that's I authored by -- that I've been working with Democrats and Republicans over the last decade to get in federal law.
 
Let's talk about access to emergency care for a moment. Today there are people who live in New Mexico and live in Montana and live in Maryland who go to their emergency rooms and they read the fine print of their insurance plan. They say, well, before you go to an insurance room, you've got to call for preauthorization. Or you need to go to the emergency that's in network. Or we may second guess whether you really needed to go to that emergency room if, in fact, your final diagnosis was that you didn't have an emergency need or condition. You may have been sweating, the traditional chest pains, the traditional symptoms for a heart attack, you did exactly what a prudent lay person would do, get to the emergency room as quickly as possible and find out it wasn't a heart attack. And they, the insurance companies, can second guess your coverage.
 
Thanks to the managers' amendment that Senator Baucus helped us put together, we now are going to cover access to emergency care as a requirement for every private insurance company. We will have prudent lay person's standards; no preauthorizations; get to the closest emergency room as quickly as you can. That's an important protection to get into federal law.
 
Also included in my amendment is the ability to choose your primary care doctor. Your primary care doctor is a person you should have confidence in. If you're a woman and you want it to be OB/GYN, you should have that right. If you're a parent and want a pediatrician, you should have a pediatrician. This legislation will make sure that those protections are in law.
 
For all of those reasons, I'm pleased -- and I know that the people of Maryland will be pleased -- to know that at long last we get the Patients' Bill of Rights protected.
 
There are many groups who supported this over the years. I want to acknowledge the long list of people and groups -- bipartisan groups -- that have worked on this from AARP to the Consumers Union, to … the list goes on and on of those who have supported the Patients' Bill of Rights against private insurance companies. At long last we have the ability with the passage of this bill on the senate floor to move it one step closer to passage and to be the law of the land.
 
I'd like to talk about minority health. Another provision that I authored establishes minority health protections within the different federal agencies. The amendment that I filed established a minority health office at the Department of Health and Human Services and NIH and others. It is in the underlying bill in the managers' package, which has been adopted. This is an important moment.
 
Today our health care delivery system in America has huge disparities among different ethnic communities. African-Americans, for example, their life expectancy is 5.3 years lower than whites. When we look at diabetes in America, the incidents of diabetes is two times greater among minorities than the general population. I also mention heart disease -- African-Americans have 33% more deaths due to heart disease. The list goes on and on and on.  We need to have a strategy to deal with it.
 
How can we reach out to minority communities to deal with their special needs? Unless you have a focus within the department of health and human services, unless you have a focus within NIH and other agencies, you won't deal with it as effectively as we should.
 
I want to, again, thank Senator Baucus and Senator Dodd who understood this, and Senator Reid, because we can develop a national strategy to help deal with the health issues facing minorities.
 
This bill codifies the Office of Minority Health in the Office of the Secretary of Health and Human Services; it establishes an Office for Minority Health at the Centers for Disease Control (CDC), Health, Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Health Care Research and Quality (AHRQ), Food and Drug Administration (FDA), and the Centers for Medicare and Medicaid Services (CMS); and it elevates the Center on Minority Health and Health Disparities at NIH to an Institute.
 
I also want to compliment Senator Sanders. As we deal with the disparities of health care in America, one of the problems is, yes, we have to get people health insurance, we have to get people the financial wherewithal to have health care, but you need to have the facilities in place to provide for the health care needs. It's one thing to say we'll cover the costs; it's another thing to say that we'll have the doctors available to you.
 
I met with one of the leaders at Johns Hopkins University located in the urban part of Baltimore City. They said, look, we need help. We need more community health centers, we need more primary care doctors, and we need more nurses. We need help with those seeking care through traditional channels rather than emergency rooms. It's great news that individuals will be able to afford care, so let's have the facilities.
 
There are many underserved areas around the nation and in Maryland that just need facilities. Thanks to the Sanders Amendment, which I'm proud to be a cosponsor, that's in this bill, we will see $10 million to expand community health centers. Twenty-five million more Americans will get access to care through community health centers. That's good news. We invest in creating more primary care doctors which is a valuable part of this bill.
 
Let me point out other ways this bill will help families in America. The choice is whether we pass this bill, which sets up the framework for America to finally become a nation that provides universal coverage, or we maintain the status quo. What happens if we maintain the status quo?
 
These are the numbers: right now, the average cost for a family for health insurance is $13,244. If we don't take action by 2016, that's not too many years away, it will be $24,291. If people are able to maintain their existing coverage, we have to act. That's why the American Medical Association supports the bill.
 
This bill will help the Medicare population because it strengthens Medicare. That's why the AARP supports it. It will provide annual physicals for our seniors.
 
This bill is important for our business owners who will no longer be discriminated against by paying 20% more than the comparable large companies pay for an insurance product.
 
This bill is good for Marylanders. It's good for every American. It moves us toward universal coverage.
 
The bill is not perfect. I'm disappointed by some of the things that are in the bill and some of the things that didn't make it into the bill. But this bill establishes the framework for universal, affordable quality care for every American. It speaks to the values of our nation.
 
I'm proud to support this legislation and I know that we will look back that the day as being one of the bright moments for America where we said to the people of our nation, that, indeed, we will provide affordable, quality health care for every American.