Tax Extenders Act Of 2009

Floor Speech

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Mr. DURBIN. Madam President, we have before us a number of issues. On the floor today is a jobs bill. It is a critically important bill because so many Americans are out of work, and we are trying to find ways to keep families together while they are unemployed, but also to provide health care, which is one of the first casualties of losing one's job. This bill also tries to help several States facing disasters by providing assistance on an emergency basis. It extends tax relief to individuals and businesses and helps workers to plan for their futures by helping businesses afford their pensions. It is a good bill. It should pass. Yesterday we had a series of amendments filed, eight different amendments. There are others that will be pending soon. I hope this particular bill will not be filibustered by the Republican side of the aisle. There ought to be at least bipartisan agreement that if we allow amendments on both sides and everybody gets their chance, at the end of the day we will actually vote for the bill. I am afraid, though, that we are facing another filibuster such as the Bunning filibuster on unemployment.

What that does is drag this out additional days, additional weeks. While the people of this country are impatient, if not angry, with Congress, unfortunately these filibusters from the other side of the aisle just add to the frustration. I hope the Republican leadership will join us now in a bipartisan effort to help create jobs. We need to have help for small businesses. Most of us understand that is the engine that will help bring us out of the recession. These small businesses, if they can stay in business and add an employee, can make a significant difference in terms of whether this recession is long or short. I hope the Republicans will decide to work with us in good faith on this jobs bill. It is in the best interest of all Americans, regardless of party. If we are going to get our country moving again--and we get moving again--we have to stop these filibusters such as the one that tied us up for 5 or 6 days over the weekend and literally cut off the unemployment checks for thousands of Americans who are out of work through no fault of their own.

We also have to look at the issue which is perhaps one of the major challenges facing us between now and the next few weeks, and that is the issue of health care. Yesterday the President came forward, after his health care summit, and said to Republican leaders: We will accept four major provisions you brought up at the health care summit in a good-faith effort to bring you into this conversation so that we can have a bipartisan bill, a good dialog, and a bipartisan vote.

Unfortunately, the President's gesture did not lead to this kind of Republican cooperation. It is never too late. I hope some will still consider joining us. I think they should understand the President believes, as I do, that there are good ideas coming from the other side of the aisle and that the sooner we can bring them into one bill for the good of the country, the better.

Only this morning, I received an e-mail from a member of my family. She told me about a situation in Texas where one of the workers at an office where she knows some people was diagnosed with a serious cancer and is now facing an extraordinary effort to save her life. Chemotherapy and radiation are going to be her lot in life for some time as she struggles with this dread disease which has affected the lives of so many of us and our families. It is going to cost about $5,000 a week for the therapy she needs to save her life.

She was notified not only of this diagnosis and the need for this extraordinary care, she was also notified that her health insurance had been canceled. It is a situation which, sadly, faces too many people. People who have paid their health insurance premiums for a lifetime find out when they need this health insurance the most, it is canceled for a variety of reasons. One of the most common is the argument of the insurance company that one has a preexisting condition which they failed to disclose. I saw a list recently of preexisting conditions. It is a very long list. It includes things which most people would be surprised to read. Did you have acne as a teenager? Is there an adopted child in your household? Things such as this are used by insurance companies to deny coverage to people. The health care reform bill we are working on wants to put an end to these outrageous practices by health insurance companies. It makes it clear that to deny coverage for a preexisting condition is going to become a thing of the past.

I would say that any and all of us should take heart in knowing that protection will be there for us when we need it.

It also will stop health insurance companies from putting limits on the amount of money they will pay out. We know what happens when you pay $5,000 a week for cancer therapy. It runs into large amounts of money, and some insurance companies at some point just walk away from you.

We also try to expand the coverage of young people under health insurance. My wife and I raised three children. When they reached the age of 24, our family health insurance no longer covered them. We want to extend that to age 26. That will mean many young people who are coming out of college--out of work and looking for a job--will at least have the health insurance protection of their family while they are looking for their first job and their own health insurance protection. I think that is reasonable.

When some argue, as we have heard from the other side of the aisle, that we are really going too far and too fast when it comes to health insurance, I would say these basic facts I have given you are the realities that face Americans, and if we do not deal with these health insurance injustices, if we do not deal with this unfairness, then, frankly, we will continue to pay huge amounts for health insurance and it will not be there when you need it.

This week, the mayor of a downstate city in Illinois--Kankakee--told me that this city of 28,000 people, with 200 employees and an annual budget of $20 million, 10 percent of which goes for the health insurance for their employees, was rocked to learn they are not only facing a recession, which has cut back on city revenues, but they face an 83-percent increase in their health insurance premiums next year. They are going to try to negotiate with the health insurance company, increase the copays and deductibles individuals have to pay, cut the coverage. That is their only way out of this terrible situation.

But they are not alone. Blue Cross and Blue Shield's Anthem policies for individuals in California recently announced they were going to increase annual premiums by 39 percent. Another friend of our family was notified yesterday her insurance premiums are going up 35 percent next year.

How long can families and businesses deal with this? The answer is, not long at all. And the larger question is, What are we going to do about these health insurance companies? Most companies in America--virtually all companies in America, save two categories--are bound by antitrust laws. What it means is, if you make an automobile or provide a service, you are bound by laws in terms of fair competition. There are two exceptions. One exception is organized baseball. Do not ask me why, but it is. And the second one is insurance companies.

It started back in the 19th century when insurance companies said: We are not national companies. We are regulated and chartered by States. We do business in States. Therefore, national antitrust laws should not apply.

Then, in the 1940s, someone took note of the fact that insurance companies were now doing business across State lines and therefore involved in interstate commerce and should be subject to antitrust laws. A law was passed, which started here in the Senate, called McCarran-Ferguson, which exempted insurance companies from antitrust law.

What it means is that insurance companies--like no other companies in America--can literally collude and conspire on the premiums they charge. They can legally sit down and decide how much they will charge for life insurance, casualty insurance, medical malpractice insurance. It is legal because of this McCarran-Ferguson exception. They can also parcel out territory: Insurance company A is going to take over Los Angeles; insurance company B will do New York; insurance company C will focus on Chicago--perfectly legal under current law but perfectly wrong.

To allow this sort of thing to occur is to fly in the face of our free market capitalism and competition. I am heartened by a vote that took place just a week or so ago in the House of Representatives where the vote to repeal the McCarran-Ferguson Act received more than 400 votes--435--a strong bipartisan voice.

I spoke to Senator Patrick Leahy of Vermont, the chairman of our Senate Judiciary Committee, this morning and said: I hope you will call this bill soon in the Senate. We need to repeal this antitrust exemption for health insurance companies and medical malpractice carriers to stop this collusion when it comes to pricing and this allocation of markets which we do not allow for any other businesses. I think if we do that, it is going to create a more competitive atmosphere, so insurance companies will compete with one another. Consumers win if there is real competition. Currently, it is perfectly legal to stifle competition in insurance, to limit the availability of insurance, and to dictate prices by industry, not by company. That has to come to an end. I hope we can either include it in health care reform or pass it separately. We need to do that.

Another element on which we need to focus is these increased costs. How do we start to bring down the costs of health insurance? For those who suggest premiums are going to drop precipitously in the passage of this bill, they are just wrong. What we are trying to do is to slow the rate of growth, the steep climb in prices. We want to try to flatten it out. There are many reasons to do it. We know as a government we cannot deal with our deficit as a nation as long as health care costs are skyrocketing for Medicare and Medicaid and Veterans' Administration care and so many other areas where we provide health care. We also understand that States face the same budgetary pressures, and the increasing costs make it difficult for them, as well as for local governments, not to mention the impact on businesses and families.

We now estimate that some 50 million Americans have no health insurance. They are not the poorest of the poor--those people are covered many times by Medicaid--and they are not the fortunate ones like Members of Congress who have the best health insurance in America. Many times, they are people who get up and go to work every single day and their small businesses cannot afford to pay the premiums and, of course, their children at home who may be denied coverage just because the parent works in a place where health insurance is not available.

There are things we can and should do about this. This health care reform bill, when it is signed by the President, will say immediately that there will be a tax credit available for all businesses with fewer than 50 employees that offer health insurance to their employees. We understand a lot of people work for these small businesses. If the owners of the businesses are really trying to provide basic coverage for their employees, we want to help them. We want the Tax Code to help them. The same thing is true for individuals. If the amount of health insurance premium you need to pay exceeds a certain percentage of your income, you will be eligible for a tax credit.

The critics of this bill talk about how much it costs. Well, it is an expensive undertaking, but more than half of the money that is raised for this bill is used in tax breaks and tax cuts for businesses and individuals to help pay for their health insurance, trying to get people through this difficult time so they have coverage and can afford to pay for that coverage. That is an essential part of what we are trying to do with this health care reform bill.

We also create insurance exchanges. The idea behind an exchange is to bring together private insurance companies--private companies--that will compete with one another for your business. We know how this works in Congress because those of us who are Members of Congress are under the Federal Employees Health Benefits Program. For over 40 years, this program has offered to Federal employees and Members of Congress the option of health insurance bought on an exchange.

I think we are the luckiest people in America when it comes to health insurance. As Federal employees and Members of Congress, each year we have open enrollment. My wife and I take a look at the private plans available through the State of Illinois and choose what we think fits us best. We have nine different choices of private health insurance companies--companies that are competing for our business. If we do not like the way we were treated last year by our insurance carrier, come September we will change, and we can pick another carrier and see if the coverage is better.

This is something every Member of Congress currently has, but when we went to the health summit, some on the other side of the aisle argued that the creation of these exchanges was too much government. Well, if it is not too much government for their health insurance and my health insurance, why is it too much government when it comes to the people of this country? They are entitled to competition and choice from private insurance companies, just as we are as Senators and Members of the House of Representatives.

One other criticism that was said: Well, you know what is wrong with this bill, this bill will not allow us to buy insurance across State lines. Now, that is a way we can save some money.

That does not tell the story. This bill does allow the purchase of insurance across State lines, multistate compacts, multistate efforts to offer insurance, but with one important element: we establish in this bill the minimum standards for coverage.

Incidentally, that is exactly what we do with the Federal Employees Health Benefits Program. If you want to be one of the companies competing for the business of Senators, you have to offer certain minimum protection. Some of it is based on State law, some by national standards. Why do we do that? Because many people cannot sit down and carefully go through every line and every page of an insurance policy and try to imagine whether the coverage is adequate.

I recall, years ago when I was an attorney working in the State senate in Springfield, IL, a case came to my attention where health insurance was being sold to expectant mothers--family health insurance--but it excluded coverage for newborn infants for the first 30 days. Think about that for a second. If you and your wife have a baby and the baby has an immediate, costly medical problem, this health insurance plan excluded you, would not pay for it. So we said, as a matter of law in Illinois, if you are going to cover mother and child, you cover that baby from the moment of birth. That is part of the law. Maybe you can buy a health insurance plan somewhere in America that does not have that coverage, but what is going to happen when you have that sick baby and huge medical costs? You may end up in bankruptcy court. You may end up on a government health insurance plan.

So we try to establish basic minimum standards for the health insurance that is offered across America. I think that is the only right way to deal with this issue that challenges us.

We also expand coverage for uninsured people in America. There are 50 million uninsured people in America. We would provide coverage for over 30 million of those 50 million people. These are people who literally have no health insurance at all. What happens when they get sick? They go to the hospital or to the doctor and they are treated. Who pays for it? The cost is shifted. The hospital cannot collect from them because they cannot pay for it, so the hospital increases the cost for those who are paying, those who have health insurance. We estimate the average family pays $1,000 a year in extra premiums--almost $100 a month--just to cover the uninsured. If we bring more people into insurance coverage, fewer charity cases will be at the hospital, fewer dollars in cost will be transferred to the policies of the rest of us who have health insurance. It is a good thing to bring more and more people under this tent of coverage.

The Republican proposal takes a look at those 50 million uninsured Americans, and instead of covering 30 million, as we do, they cover 3 million. That is a far cry from 30 million. If our bill passes, it will mean that the largest percentage of Americans will have health insurance in our history. That is a good thing for our Nation. It is a good thing for our medical system.

We also, in our bill, try to move forward to encourage new innovative and productive medical practices. One of them is wellness. We have met with companies that have come to us and said: When we incentivize our employees to be mindful of their weight, the food they eat, their cholesterol, their blood sugar, their blood pressure, and to stop smoking, it makes a dramatic difference. They feel healthier, they live longer, and they need less medical attention.

So we are creating incentives for wellness. For example, one of the things we do is provide, under Medicare, a free annual exam for every senior citizen so they will be able to come in and be checked out, so little problems will not become big problems. I think that is sensible and responsible.

We have to move toward more primary care. Across America, we have community health clinics. These clinics are primary care clinics in cities and small towns across America. For many people, they are the only source of primary medical care. This bill we will pass--I hope we will pass--will double the number of those clinics and increase the number of people working there. Is it a good idea? Well, it certainly sounds good. But it is also economically smart. Where do sick people go today if they have no health insurance and they do not have a regular doctor on their child has a fever of 106 degrees?

We know where they go. They go to the emergency room and they wait in a queue and eventually get treatment and it costs a fortune, dramatically more than it would cost if they went to a local clinic or primary care physician. So we are trying to provide good care, affordable care, cost-efficient care, and reduce some of the costs within the system. I think that is a move in the right direction.

The same thing is true when it comes to Medicare. Some of our critics on the other side of the aisle have said: They are going to cut hundreds of billions of dollars out of Medicare, and the simple answer is, yes, because we believe there is money there that can be saved without compromising in any way the basic benefits of the Medicare Program. This program for seniors and the disabled across America has been a godsend for over 45 years. People live longer and they are healthier and they are more independent because Medicare is there. Social Security and Medicare have given to this modern retired generation things that others just dreamed of. There was a time--and I can remember it in my own family--when your grandparents, after they had quit working either because of retirement or because of physical health problems, ran out of money, and what did they do? They moved in with the family. It was not unusual. It happened in our family and others. Along came Social Security which said: We are going to have a check for you, a monthly check. You will not get rich on it, but you will be able to get by on it, in most cases, and you can live in your own place, independent, the way you want to. Medicare said: We will help pay for your health care bills as part of this. Right now, if we do nothing to Medicare, in a matter of 9 years it goes broke. It starts running in the red. Doing nothing is not an option. So our bill, the health care reform bill which we passed in the Senate and which the President supports, will add another 10 years of solvency to Medicare. That is essential.

How do we achieve this by making savings within Medicare? One of the ways is to look at how care is provided. I took a look at the average Medicare cost per recipient in some of the major cities in America. In my hometown of Springfield, IL, with two great hospitals and great doctors, it is about $7,600 a year for every Medicare recipient. If you go up to Chicago, it is $9,600 a year. Over in Rochester, MN, at the Mayo Clinic it is in the range of $7,600, $8,000 a year. But if you go down to Miami, FL, the average is $17,000 a year for each Medicare recipient. I will concede Miami may be a little bit more expensive than the other cities I mentioned but twice the cost? I don't think so.

There are savings we can find in the Medicare system and still provide quality care that seniors need and are entitled to. We have to find ways to do that. If we don't enter into this conversation, in very short order, we are going to see the Medicare system basically facing insolvency. That is one of the real realities we face.

How are we going to reach this goal politically? That has become a major item of discussion. The President made it clear yesterday he feels that after the supermajority vote in the Senate for health care reform, we need to move this to conclusion and it should face an up-or-down vote. Let me translate what that means. It means, if the House enacts the Senate health care reform bill, they can also turn to something called reconciliation. Reconciliation is a process that is used in both the House and the Senate to deal with budgetary questions. We have not invented it. It has been around for decades and it has been used some 22 different times. That, to me, is an indication that reconciliation is an accepted practice and procedure in the modern Congress. We have seen as well that the Republicans have used it more than half those times for issues that are important to them; issues important to many of us. Children's health insurance was enacted through reconciliation. The COBRA program for health insurance for the unemployed was enacted through reconciliation. President Bush's tax cuts were enacted through reconciliation. In addition, Newt Gingrich's Contract With America, parts of it were enacted through reconciliation. So we know it has been used.

Some of the people on the other side have argued it is unfair to use it to modify any basic health care reform. It is interesting the critics of the reconciliation process have voted for it many times. Out of the 17 opportunities to vote for reconciliation since he has been in the Senate, the Republican leader, Senator McConnell, has voted 13 times out of 17 for reconciliation. Senator Grassley has had 20 occasions to vote for or against reconciliation. He has voted for it 18 times. Senator McCain, 13 votes on reconciliation, he voted for 9 of them. Senator Kyl, 11 opportunities to vote for reconciliation, and he voted for them every time. So these Republican Senators who are now saying there is something flawed or wrong or sneaky about this process have used it over and over to achieve legislative goals.

I have voted for it myself. We had some provisions relating to reform of student loans, for example, that I thought were good for families of students across America. Through reconciliation I voted for it. There is nothing sinister about it. It was right there. What it basically means is this: Under reconciliation, you can bring a bill to the floor and it cannot be filibustered. We all know what a filibuster means. We just went through one with the Senator from Kentucky, Mr. Bunning, who put a hold on a bill, and for 5 days we couldn't vote for unemployment benefits for people across this country. Eventually, the Senator agreed to a vote and we moved forward on it. So that kind of procedure is allowed in the Senate.

It takes literally days, if not weeks, to work our way through the deadlines and schedules to get to a final vote. Reconciliation says we are going to set the delay tactics and obstruction aside and we are going to have a majority vote. We bring the issue to the floor, 20 hours of debate are equally divided, and then any Senator can offer an amendment for a vote. That can be abused too. I hope it isn't if we move to reconciliation. But at the end of the day, there is a majority vote, up or down. Fifty-one votes will be necessary, I believe, for this to pass, and we will see if we move forward on health care reform in this country.

I hope we do move forward. I hope, if we can't get cooperation on the Republican side of the aisle to tell us they will not use filibusters and delays and obstruction to help do reform, that we do it through the reconciliation process.

Health care reform and the cost of health care is an issue in my home State of Illinois which is topical. A recent press release is entitled ``Illinois consumers to pay up to 60 percent more'' on individual health insurance policies. Individual health insurance policy premiums are soaring in the State of Illinois. It says:

Consumers in Illinois who lose their jobs and have no other option but to buy their own health insurance will get socked this year with premium increases of up to 60 percent, according to state records.

That group of consumers has been growing, as the recession has created more uninsured Americans looking for ways to protect themselves and their families. Now, Illinois consumers will get a glimpse into just how wide-ranging rate increases among individual health plans can be. The data, obtained by the Tribune, also provide a window into the overall trend of premium increases at large and small employers.

For the state's more than half-million consumers in individual health plans--

We are a State of 12 million--

base rates will go up from 8.5 percent to more than 60 percent, according to state data. Base rates do not take into consideration health status, gender, age, place of residence and length of a policy--all factors that could affect the premiums further.

The individual insurance market is relatively small compared to consumers who get their insurance through their employers, but it has become the fastest growing group in this economy.

I might add, that is going to happen as fewer and fewer businesses offer health insurance and people are on their own, people who might have their own medical history or history in the family that precludes an opportunity for this health insurance protection.

The Illinois director of insurance, Mike McRaith, says:

This information is important because the individual market is where an increasing number of people fall when they lose their jobs and become unemployed. Individuals need insurance more and more and they are struggling to hang on to it now more than ever. Because fewer people are employed and fewer employers are offering health insurance, we would expect to see increased applications for individual health insurance.

When we hear from the other side of the aisle that we need to start over on this debate, it basically means to put an end to it. We are not going to start over. We have been at this for 15 months. We have had the most lengthy committee hearings in our history. The Senate Committee on Health, Education, Labor, and Pensions accepted 150 amendments from the Republican side of the aisle--150. Yet not a single Republican Senator would vote for the bill when it came out of committee. We have tried our best to not only have open and transparent hearings and an amendment process but to engage the other side of the aisle to bring forth their best ideas so we can try to put them together and do a package that does address the needs in America. But for those who say start over, end it, put it behind us, how do you ignore the obvious? The cost of health insurance is going through the roof. People know it, businesses know it, families know it, and we know it as a government. If we don't address this issue and address it openly and honestly, it will just get worse. That is something families understand and I think we all understand.

We have talked about jobs through the bill before us on the floor today. I happen to think health insurance is an important part of this conversation. When I met with some unemployed people in Chicago a couple months ago, I asked each one of them, and they were struggling to continue the health insurance for their family. I remember one mother who said: My problem is this. If I lose the health insurance I had where I worked, if I can't make these COBRA payments to keep up this health insurance and I am dropped, I don't think they are ever going to insure my diabetic son.

That is the reality of what people face. They lose costly health insurance, and they may never be able to find replacement. That reality needs to be addressed, and we can address it.

I sincerely hope many of my Republican colleagues will accept President Obama's invitation to join us in this effort. We can do this together, and we should. If we do it together, it will be a stronger bill and a better bill, but we can only invite our colleagues to the prom so many times and be turned down until we stop asking. This invitation was sincere yesterday. The President brought up four major elements Republicans have asked for and said we will include all of them in our health insurance reform bill. I hope they will join us in this effort. If they do not, we owe it to the American people to move forward, to make certain we are ending discrimination against people because of preexisting conditions; to make certain we are starting to bring down costs and increase choice and competition for small businesses and individuals; to bring into the coverage and protection of health insurance 30 million more Americans than we have today; to give Medicare another 10 years of longevity; to bring down the deficit in the process as health care costs start to come down. All these positive issues argue we need to get this job done.

I look forward to working toward that goal and getting it done in a matter of weeks and not months.

I yield the floor.

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