Service Members Home Ownership Tax Act Of 2009 - Resumed
Floor Speech
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Mr. DURBIN. Mr. President, there is a saying in Iowa; that is, that any old mule can kick down a barn door, but it takes a carpenter to build one. I would modify that slightly and say any old elephant can kick down a barn door, but it takes a carpenter to build one.
We are debating health care reform. The American people are following us closely because it affects every single one of us in this room, everyone in the galleries, and everyone watching. This is one of the few issues we will debate which you can bet is going to affect you and your family personally. It is rare that an issue comes before us of this gravity and an issue that reaches every single person in America. It may be the biggest single issue we have ever tackled on the floor of the Senate in terms of its scope and its impact on the future of every single one of us.
For more than a year, a lot of people have been working hard to come up with a piece of legislation that will have a positive impact on health care in America. It has involved lengthy committee hearings. The Presiding Officer is a member of the Senate Finance Committee. They sat in meetings hour after weary hour, day after weary day, considering amendments before they produced a bill that is part of what we have before us today.
The Senator from Iowa is part of that same committee. I understand he met personally over 60 times with Democratic Senators and a few from his own side trying to see if we could come up with some kind of bipartisan approach. I commend him for his good-faith effort in doing that.
There is another committee, the Health, Education, Labor, and Pensions Committee, that spent even more days in deliberation on a bill, considered over 100 different amendments, adopted over 100 Republican amendments to the bill, and not one single Republican Senator would then vote for the bill--not one. One Senator, Senator Snowe of Maine, voted for the Senate Finance Committee bill. One Republican Senator voted for that version of the bill.
What we have today--and I wish to slightly modify the remarks of my friend from Iowa--is a 2,074-page bill with a 1-page add. This is Senator Reid's amendment to use it as a substitute. So it is 2,075 pages, created by these two committees in the Senate and a similar endeavor taking place in the House.
For at least 10 days, this bill, in its entirety, has been available for public review. I ask anyone interested who wants to read this bill, as every Member should, to go to the Senate Democratic Web site. If you Google ``Senate Democrats,'' you will find it and you will find this bill in its entirety, every single word of it, sitting out there to be read and reviewed, as it should be.
Then I invite you, for comparison's sake, to go to the Senate Republican Web site to look at the bill produced by the Senate Republican side. Take a look at the Senate Republican health care reform bill. Take a look at what they propose to change--the health care system in America. Look at the Senate Republican proposals for making health insurance more affordable. Look at the Senate Republican proposals for dealing with health insurance companies which deny you coverage because of preexisting conditions. Take a look at the Senate Republican approach to pass health care reform and not add to the deficit. I am afraid you will be disappointed because, as the Senator from Iowa knows, when you go to the Senate Republican Web site, there is no Senate Republican bill. In fact, what you will find on the Senate Republican Web site is the Democratic bill.
For more than a year, while we have labored to produce this monumental, historic legislation, our Republican colleagues on the other side of the aisle have not broken a sweat to produce their own answer to this challenge facing America. All they can do is come before us and criticize this bill. Any old mule can kick down a barn door, but it takes a carpenter to build one.
We have been working for over a year--almost a year--to build this health care reform package. Here is what we know. We just received a report from the Congressional Budget Office, which is akin to the referee up here. This is an agency that takes a look at what we do and tells us whether it is going to reduce the deficit, add to the deficit, reach its stated goal or fail to reach it.
It is maddening sometimes to have this separate agency kind of looking over your shoulder, but they do. They reported just yesterday that this bill will make health insurance more affordable for many Americans and will not add to the costs for many others.
I wish it would do more. I wish it would bring down costs dramatically, even more. But for weeks and months we have heard from the Republican side that our health care reform proposal would run premiums sky high. It turns out they were wrong. This bill we have produced moves us toward more affordable health insurance. Every American who pays any attention to the cost of health insurance knows that is absolutely essential. In the last 10 years, health insurance premiums have gone up 131 percent in America. Ten years ago, a family could have bought health insurance for about $6,000 a year. Now they buy it on average for about $12,000 a year. In 7 or 8 years it will go up to $24,000 a year in premiums, projecting it will eat up 40 percent of your income for health insurance in just 8 or 10 years.
That is an impossible situation. We know it is. It is unsustainable. Businesses can't offer health insurance that expensive. Individuals can't buy health insurance that expensive. So if we do nothing we will reach a situation where the current health care system in America will start to collapse. I do not want to stand idly by and let that happen; neither does President Obama. He has challenged us to address it and address it honestly.
On the other side of the aisle, the Senate Republicans have not produced a bill, a proposal, an alternative which will make health insurance more affordable--nothing. They come before us in criticism of what we have done, and yet they cannot produce a bill.
I might also tell you the same Congressional Budget Office tells us the bill we put together will actually reduce the Federal deficit over the next 10 years by at least $130 billion. This bill, this 2,075-page bill, will cut more deficit than any piece of legislation we have ever enacted in Congress.
The Senator from Iowa is concerned about our national debt. So am I. Where is the Senate Republican proposal for health care reform that is going to reduce America's deficit? Incidentally, the same Congressional Budget Office says in the second 10 years--think that far in advance--this approach will reduce the Federal deficit by another $650 billion.
I ask the Senator from Iowa, with all his concern about the Federal deficit, where is the Senate Republican bill that will reduce the Federal deficit by $750 billion over 20 years?
The answer, I am sorry to tell you, is it does not exist. They either have not or cannot write a bill. They are legislators, but frankly they have come here to be critical of what we have done and will not offer a substitute or an alternative.
There is something else this bill does. It is a travesty in America today that almost 50 million people do not have health insurance. A lot of these folks are children. A lot of them are people in low-wage jobs with no benefits. A lot of them are the newly unemployed. These are 50 million of our neighbors in America who go to sleep at night without the peace of mind of having health insurance protection.
In my life it happened once: newly married, college student, baby on the way, no health insurance, and our baby had a problem. I ended up carrying, for 8 years, medical bills that I slowly paid off year after year. That goes back many years ago, as you might imagine, but it was troubling and heartbreaking to be the father of a child and not have health insurance; to sit at Children's Memorial Hospital in Washington, in the room that was set aside for people without health insurance, and wait until my number was called to bring my wife and my baby in for a checkup. I didn't have health insurance. I never felt more helpless in my life.
Fifty million Americans go to bed each night with that feeling. They don't have health insurance. What does this bill, this 2,075-page bill, do about it? It extends the coverage of health insurance, the peace of mind and protection of health insurance to 94 percent of Americans. It is the largest extension of health insurance in our history.
Where is the Republican alternative that offers coverage for 94 percent of Americans? It doesn't exist. They have not written that bill. They don't know how to write that bill. They do know how to come and criticize this bill, but they cannot produce a bill which covers 94 percent of Americans and provides tax credits and tax assistance to help those Americans pay their premiums.
If you are making under poverty wages, let's say you are making less than $14,000 a year--and I have friends of mine in my State who are--you are covered by Medicaid. You don't pay premiums. The Federal Government compensates the States and pays the premiums. All the way up to about $80,000 for a family of four, we provide credits and help to pay the premiums, as we should, because premiums can break the bank not only for businesses but for families.
There is also something we do in this bill I never hear from the other side of the aisle--and I will tell you why in just a second. We give consumers across America a fighting chance when the health insurance company goes to war with you. Do you know what I am talking about? If somebody in your family gets sick, you know it is going to require a hospitalization or surgery and you know the cost is going to go sky high, and you say: Thank goodness, I have health insurance. You make the claim and the health insurance company comes back and says: We dispute the claim. We are not paying. People say: Wait a minute, I have been paying health insurance premiums for years just for this day, and you are telling me I don't have coverage?
It happens thousands and thousands of times each day. Do you know why? Health insurance companies are profitable when they say no. What are the reasons for saying no? ``You failed to disclose a preexisting condition when you applied for the insurance.'' It turns out they go to ridiculous extremes to find an excuse not to provide coverage.
We also know what happens when you lose a job. You can't take your insurance with you, by and large. We know when your child reaches the age of 24 they are no longer carried on your family health insurance. Those are the realities of health insurance companies saying no. I have yet to hear the first Republican Senator come to the floor and say that is outrageous and it has to change. We have to tackle the health insurance industry because the health insurance industry opposes this bill.
The health insurance industry believes their profitability and their future depend on saying no. This bill starts saying to these companies: You can't say no based on a preexisting condition, based on lifetime limit, based on losing a job. And we cover kids through the age of 26. We extend the family coverage to children of that age, and you know that is only sensible because a lot of kids are going to college and getting out without jobs. You want them covered by your family health insurance plan. This bill does it.
Republicans have yet to produce one bill, just one, on health care reform to take on the health insurance industry. Instead, what they have come to do, and the pending amendment by the Senator from Arizona leads with this, is to protect the health insurance companies. The first thing the motion to commit does, from the Senator from Arizona, is to instruct the committee, the Senate Finance Committee, to protect a program called Medicare Advantage.
This is a great idea for health insurance companies and not a great idea for most seniors or taxpayers in America. Allow me to explain. The health insurance companies came to us several years ago and said Medicare is a bureaucratic mess. The government cannot run these programs. We are in the private sector. We understand competition. Let us compete with Medicare.
They were given the right to do that. Private health insurance companies were given the right to write health insurance that provides Medicare benefits. They said they could do it more cheaply and, in fact, some of them did. But at the end of the day, after years of watching them, it turned out these Medicare Advantage policies cost 14 percent more--not less, 14 percent more--than government-administered Medicare Programs. In other words, we were subsidizing health insurance companies, paying them more for the same Medicare coverage people already had received.
They loved it. Thousands and thousands of Americans are now covered by Medicare Advantage with these great subsidies coming from the Federal Government. Talk about an earmark, Senator, 14 percent--what an earmark that is, a subsidy given to the private health insurance companies.
Mr. McCAIN. Will the Senator yield for a question? Since the Senator mentioned my name, will he yield for a question?
Mr. DURBIN. What the basic problem with the amendment of the Senator form Arizona is--and I will yield in just a moment--what the basic problem with his amendment is, he is protecting these health insurance companies with Medicare Advantage. First thing he does. He is protecting this subsidy, this big fat earmark we put in legislation, 14 percent bump in premiums is protected by this motion to commit.
It is understandable the health insurance companies want to keep this. It is a sweet deal. They are getting paid for something they promised us would never happen. Also, there is a provision in the motion to commit of the Senator that says we should take out the conflict-of-interest sections in Medicare. Do you know what that is? That is when your doctor also owns the laboratory which does your blood test and the imaging center which does the x rays and says: I am not sure what is wrong with you, but I know there are two things you need: You need a blood test and you need an x ray.
Maybe you do; maybe you don't. We say in this bill you have to disclose to your patient that you have a personal financial interest in this laboratory and this processing operation, and you have to give them an alternative to shop for another place if they want. Is that unreasonable? It is one of the provisions the Senator from Arizona wants to take out. It is a savings in Medicare.
That is unfortunate. We have to do our best to eliminate the waste and fraud and abuse, as terrible as that old cliche is, in Medicare. Why is it that the same medical procedure offered in Rochester, MN, to a Medicare recipient costs twice as much or more in Miami, FL? Do you think maybe we ought to take a look at that? I think we should. I think maybe there is some price gouging. I want to know.
Does that mean we are going to reduce the benefits for someone living in Miami? Not necessarily. But it means the taxpayers will not be ripped off. Medicare would not go broke. We are doing what we need to do to be responsible. So taking money out of Medicare means shutting off the subsidy to the private health insurance companies for Medicare Advantage. It means stopping the self-dealing of some doctors who are sending Medicare patients to their own labs and their own processing companies. It means finding out where the waste is taking place.
The Senator from Arizona says we instruct the Finance Committee to take out those provisions in the bill. Keep Medicare Advantage there, with the 14 percent subsidy for private health insurance companies, don't engage these doctors when it comes to these conflicts of interest. I don't think that is right.
It was not long ago that my friend from Arizona was a candidate for another office. During the course of his campaign for President, he suggested we have a pretty substantial cut in Medicare and Medicaid. In fact, during the campaign the Senator from Arizona called for $1.3 trillion in reforms in Medicare and Medicaid, more than twice as much as we are calling for in Medicare, 2 1/2 times as much.
Douglas Holtz-Eakin, who worked for the Senator from Arizona, said the campaign planned to fund tax credits in their health care proposals with savings from Medicare and Medicaid. So the idea of saving money in Medicare is certainly not something with which the Senator is unfamiliar. We all understand there are possibilities for savings that don't jeopardize basic services for seniors. We also understand that left untouched, Medicare is going broke. Ignoring the problem will make it worse. If we want to put Medicare on sound footing we have to tackle this issue foursquare. We cannot afford these subsidies for private health care companies for Medicare Advantage, and we cannot afford the waste that is going on in the system today.
I might also tell you the increase in payroll taxes for those individuals making over $200,000 a year and families over $250,000 a year--that is the increase in the Medicare tax--is going to be buying 5 years of solvency for Medicare. So when they talk about our raising taxes--true, at the highest income levels--what they don't tell you is the other side of the coin. The money brought in goes straight to the Medicare trust fund to keep it solid.
What else does this bill do? It starts filling the doughnut hole. You may not know what that means until you happen to be a senior or have one in your family, but Medicare prescription drug coverage stops paying at a certain point. This bill starts coverage in the doughnut hole, in the gap in coverage that currently exists in Medicare prescription Part D.
Where is the Republican bill to fill the doughnut hole? It doesn't exist--at least I have not seen it. It is not on their Web site. Here is ours. That is why AARP has endorsed this bill. The American Association of Retired Persons knows this bill is a good bill for seniors.
I urge my colleagues to oppose the McCain motion to commit.
If we take this bill off the floor, which many Republicans want us to do, it will take us days, maybe a week, to bring it back to the floor. They want to delay this as long as possible. They want us to fail. They want us to stop. They want us to adopt the Senate Republican approach to health care reform which is do nothing, leave the system the way it is. We cannot continue the system the way it is. This is a responsible bill. It makes health insurance affordable. It reduces the deficit, according to the CBO, and covers 94 percent of Americans. It finally tackles the health insurance companies for the first time in a long time, and it buys at least 5 years more for the Medicare Program. I wish I could compare it to the Senate Republican approach, but that doesn't exist. Any mule can kick down a barn door. It takes a carpenter to build one.
I yield the floor.
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Mr. McCAIN. I regret that the Senator from Illinois did not observe the courtesies of the Senate, particularly when a person's name is mentioned, as he continued to mention my name throughout and totally falsifying my position both in the Presidential campaign and the position that we have on this side and this amendment. I have always extended that courtesy to the Senator from Illinois. I deeply regret that even this comity of the Senate is no longer observed.
I say to the Senator from Illinois, I regret you would not respond to a question I had posed, when you had said: I will respond in a minute. Again, even comity is not observed here.
Mr. DURBIN. Will the Senator yield for a second?
Mr. McCAIN. I will go ahead with the--the Senator did not provide me with the courtesy of allowing me to respond to a question. Now you want me to respond to a question from you? I will display more courtesy than you displayed to me. Go ahead.
Mr. DURBIN. I apologize. I planned on yielding to you. I would be happy to yield to you. I always do, and I failed to. I apologize.
Mr. McCAIN. Well, I guess my questions were, one, did the Senator, who claimed that no Republican has done anything to curb the health care insurance industry, was the Senator in the Senate when Senator Kennedy and I fought for weeks and months for the Patients' Bill of Rights? Was the Senator here then? Was he engaged in that debate? Senator Kennedy and I fought for the Patients' Bill of Rights, and the majority on that side of the aisle opposed it. The fact is, there have been efforts on my part to curb the abuses of the health insurance industry by sponsorship of the Patients' Bill of Rights.
Second, during the campaign, yes, I said that we could reduce and eliminate waste, fraud, and abuse in spending, and I said it because of Senator Coburn's Patients' Choice Act which would save $1 trillion in the States in Medicaid savings, $400 billion over the next 10 years in Medicare savings. I wish the Senator from Illinois would examine the Patients' Choice Act, as proposed by the Senator from Oklahoma. Maybe he would learn something. The Coburn bill wants to preserve the best quality health care in America and not eliminate $12 billion in the Medicare Advantage Program, which 330,000 of my citizens who are enrollees like and want to keep, not eliminate $150 billion to providers, including hospitals, hospice, and nursing homes, $23 billion in unspecified decreases to be determined by an independent Medicare advisory board, as well as billions of additional cuts to the Medicare Program.
There is no relation between what I tried to do in my campaign and what is being done in this legislation, I tell my friend from Illinois. I would be glad to hear the Senator's response. I would be glad to extend him that courtesy.
Mr. DURBIN. I thank the Senator from Arizona. I commend him for his work on the Patients' Bill of Rights which I joined him in with Senator Kennedy and would do it again. The point I was making----
Mr. McCAIN. Your statement was that no Republican had done anything. You just said no Republican had done anything to curb the health insurance industry. The Patients' Bill of Rights certainly would have done it.
Mr. DURBIN. My point was that there are provisions in this bill dealing with the rights of consumers against health insurance companies which I have not heard the Senator or others----
Mr. McCAIN. That is not what you said.
Mr. DURBIN. I ask you, do you support the health insurance reforms in this bill that give patients rights against health insurance companies; preexisting conditions, for example?
Mr. McCAIN. My record is very clear of advocating for patients and against the abuses of insurance companies across the board.
Mr. DURBIN. Thank you.
Mr. McCAIN. I ask unanimous consent to yield to the Senator from Oklahoma to describe the Patients' Choice Act and the way we could truly save money and reduce fraud, abuse, and waste in the system and at the same time preserve quality health care.
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Mr. DURBIN. Mr. President, today, all day, we have been debating the health care reform bill, which has been a matter worked on in the Senate and the House for a solid year. I wish to salute the Senator from Wyoming, Mr. Enzi, who joined with several other Senators in, I understand, 61 separate meetings talking about this bill, in an effort which did not bear fruit as they hoped but was a bipartisan effort to come up with some solution to our health care situation in America. I hope we can still reach some bipartisan accommodation before this bill passes.
At this point in time, only one Republican Senator has voted for any form of Senate health care reform and that was Senator Snowe in the Senate Finance Committee. We hope others will join us before this bill comes to final passage in the Senate, but that is the reality of the political situation.
The bill before us is over 2,000 pages long. Some have criticized its length. I defy anyone to write down, in 2,000 pages or less, a description of the current medical system in America. I think it would take many more pages to explain the complexity of the situation. But people across America understand a few basics.
Health insurance is reaching the point where it is not affordable. Families cannot afford to pay for it anymore, businesses cannot. Fewer people have coverage at their workplace, and many who go out into the open market cannot afford to pay the premiums. Today we have reached a point where our COBRA plan, which is health insurance for those who have lost their job--we provided a helping hand to many unemployed people across America--it expired today. It picked up two-thirds of the premiums. I ran into people who said, even with the two-thirds picked up by the Federal Government, I still cannot afford it. So it is understandable that health insurance is no longer affordable, and it is not getting any better.
In the last 10 years, health insurance premiums have gone up 131 percent. We estimate that, in the next 8 years, the cost of health insurance will double. In 8 years, it is anticipated that families will spend up to 45 percent of their income on health insurance. That is not sustainable.
So the starting point is to find ways to bring down cost. The Congressional Budget Office gave us a report yesterday and said we are on the right track. I can come up with other ideas which I think might be more helpful, but this is the art of the possible. I think we are moving toward a model which will start to bring down costs.
The second thing we do that is critically important is, we expand coverage so it reaches 94 percent of Americans. Currently, there are about 50 million Americans without health insurance. These are people who are unemployed, folks who work at businesses that cannot afford health insurance or folks out on their own who cannot afford to pay for their own health insurance. We now reach a point with this bill where 94 percent of Americans have coverage. That is a good thing.
We also do it in a fiscally responsible way because this bill, according to the Congressional Budget Office, which is the neutral referee in this battle, according to that office, we will save, in the first 10 years of this bill, $130 billion or more from our deficit. It will be the biggest deficit reduction of any bill considered by Congress. In the second 10 years, they estimate $650 billion in savings. To think we have $ 3/4 trillion dollars in deficit reduction in this health care reform says to me, in the eyes of the Congressional Budget Office and most observers, it is a fiscally responsible bill.
There is a section of the bill which I think is critically important too. Many people with health insurance find out that when they need it the most it is not there. The health insurance companies will deny coverage, saying they are dealing with preexisting conditions that were not covered, there is a cap on the amount they will pay, your child is now age 24 and is not covered by your family plan. All these things are excuses for health insurance companies to say no. When they say no, they make more money. We start eliminating, one by one, these perverse incentives for health insurance companies to say no.
We give consumers and families across America a fighting chance, when they actually need health insurance, that it will be there. Two out of three people filing for bankruptcy today in America file because of medical bills. That reflects the reality, that we are each one accident or one diagnosis away from a medical bill that could wipe out our life savings. The sad reality is 74 percent of people filing for bankruptcy because of health care bills have health insurance, and it turns out it is not worth anything.
When they needed it, it failed them.
We need to move to a point where the health insurance companies are held accountable, where when you pay premiums for a lifetime, the policy is there to cover you when you need it. That is what this is about.
We eliminate some of the most egregious discrimination in insurance premiums. The insurance industry is one of two businesses in America exempt from antitrust laws. So they literally get together, they collude and conspire when it comes to setting premium costs and allocating markets, and they can do it legally under the McCarran-Ferguson Act. Because of that, what they have done is to create discrimination against some people--women, certain age groups, people living in certain places--when it comes to premiums. We eliminate, by and large--not completely but by and large--this type of discrimination.
The other point that has been raised repeatedly is about Medicare. There is a pending amendment by Senator McCain. As a Democrat, we take great pride in Medicare. It was a Democratic President, Lyndon Baines Johnson, who led a Democratic Congress in passing it. Very few, if any, Republicans supported it. Over the years, it has been a program we have stood behind as a party because we believe it has provided so much well-being for 45 million American, now today, seniors.
This bill starts to move us toward a place where you can basically say there is a sound economic footing for Medicare in the future. If we don't do something today, in 7, 8, or 9 years, the Medicare Program could go bankrupt. If we wait 5 years to do it, imagine what we will have to do then.
This bill moves in the direction of making Medicare more sound by eliminating some of the waste that is currently in the program.
There was a time when our friends on the other side joined us in saying this program could be more efficient. But now the McCain amendment says basically there should be no cuts in Medicare, even if the cut is in wasteful spending. Senator McCain has a strong record on the Patients' Bill of Rights, but I think his amendment goes too far when it comes to Medicare. I hope that we can defeat it or that he will reconsider it.
The last point I want to make is that this debate will continue. We hope to move to amendments. If we get to a point where we are dealing with filibusters and slowdowns in an effort to run out the clock and make us all leave on Christmas Eve with the job not finished, many of us are going to get tired of that approach. If there are honest amendments offered in good faith, debated, and brought for a vote, that is what the Senate is about. But if we continue to delay indefinitely the consideration of these amendments, our patience will grow thin, and we will have to move this toward a point where the bill is honestly considered.
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