Tax Extenders Act Of 2009

Floor Speech

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Mr. DURBIN. Mr. President, last night, I met the mayor of Kankakee, IL. She told me about a problem she has. Kankakee has 28,000 residents. The economy has hurt them. They have lost sales tax revenues. They do not have the income they had just last year. Their annual budget is $20 million for the city of Kankakee. That is for all the services they provide.

Ten percent of that budget--$2 million--goes for the health insurance of the workers in that town; about 200 of them--10 percent, $2 million. So they went to their insurance company and said: What will the insurance cost us this year? The health insurance company said: Your rates are going up 83 percent--83 percent. What had cost them $2 million last year will cost them almost $4 million this year.

When I listened to the speech from the minority leader, the Republican leader, who says: Start over, go slow, baby steps, we do not want to do anything that is big or addresses this problem in any kind of comprehensive way, I think to myself: Does he understand the reality of what businesses, families, small towns, and large cities are facing across America? The Kankakee example is not unique. Just a couple weeks ago, in California, Anthem Blue Cross and Blue Shield announced a 39-percent increase in health insurance premiums next year.

If you look at what the average family paid for health insurance 10 years ago, it was about $6,000 a year--$500 a month. It is a lot of money. But that was 10 years ago, and it has doubled in the last 10 years. It is now $12,000, the average premium paid by a family of four across America.

But what will happen in the next 8 to 10 years? It will double again. Can you imagine the job you will need 10 years from now that will generate $2,000 a month just for health insurance premiums, before you take the first penny home to pay your mortgage or feed your family or provide for your kids' college education? That is the reality of the call by the Republican side of the aisle to go slow, start over.

No. Their go slow, start over can be translated into two words: ``Give up.'' We are not going to give up. They call for common sense. Our approach to health care reform is grounded in common sense. Let me tell you what the basics are.

The basics are, small businesses across America need to have choice and competition. We create insurance exchanges. I went to the President's health care summit last week, and I listened to the Republicans say: Do you know what is wrong with the health care reform bill? No. 1, it is a government-run program. Well, it is not. It is private health insurance companies brought together by the government to compete for the business of individuals and small businesses. They said: Do you know what else is wrong? They put minimum requirements on health insurance plans, minimum requirements of what they will cover. You ought to let the health insurance companies offer whatever they want. If they want to offer something that is virtually worthless, that is their business. Let the consumers decide.

I said at that health care summit meeting: Isn't it amazing that Members of Congress, who are part of the Federal Employees Health Benefits Program, including the Republican House and Senate Members who sat in that summit, have their families protected by a government-run health care plan, which establishes minimum requirements for health insurance to protect our families? Yet when we suggest doing that for the rest of America, the conservative Republicans say: You have gone too far. That violates some basic values and principles.

If they were honest about it, they would have walked right out of that summit and turned in their Federal Employees Health Benefits Program cards and said: We are out of here. This is socialism. We are not going to be part of it. But, no, they want to enjoy the benefits of a government-run plan, with minimum benefits outlined and described for their families. They do not want other people to have it. That is wrong. It is not only wrong, but it is unfair. It is unfair to the families across America who deserve the same kind of protection in health insurance Members of Congress have.

So the first commonsense part of our health care reform is insurance exchanges, where private companies compete for the health insurance business of small businesses and individuals--competition and choice.

The second commonsense part of health care reform says, it does no good to own a health insurance policy which isn't there when you need it. You pay a lifetime of premiums, and with one accident, one diagnosis, you are stuck with a huge amount of medical bills, and the health insurance company says: We took a close look at your application for health insurance, and you failed to disclose you had acne as a teenager--I am not making this up--so we are going to deny you coverage for the cancer therapy you are going to need--I am not making this up--or they say: You didn't tell us you had an adopted child in your family. That is another preexisting condition. Did you know that? It is. In the list of preexisting conditions, it includes things such as that, and that is what happens--the tricks and traps in health insurance that yank coverage from you when you need it the most.

This bill, the health care reform bill we are working on, starts to change that relationship and gives the consumers across America a fighting chance to fight back when they are denied coverage for a preexisting condition, to fight back when they say there is a cap on the total amount they are going to pay in your lifetime, to fight back when they say you cannot take your insurance with you when you leave a job, to fight back when parents realize when their kids get out of college, the family health insurance plan cannot cover them anymore.

Those are basic health insurance reforms that embody common sense. The Senator from Kentucky, Mr. McConnell, comes here and says: We have to junk this big government plan. It is so wildly unpopular. Is it unpopular to offer choice and competition to small businesses? Is it unpopular to give consumers a fighting chance against health insurance companies?

There is a third aspect too. We asked the Republicans at the health care summit: If you accept the obvious--that 50 million uninsured Americans get sick, go to hospitals, are treated, and the cost of their care is then passed on to everyone else--if you accept that, what are you going to do about it? They said: Oh, we have an answer to that. Fifty million uninsured Americans? We will deal with that. We will take care of 3 million of them--3 million of them. Six percent of them we will take care of.

Well, the bill we are supporting, the health care reform bill we are supporting, takes care of 30 million. I wish it were 50 million, but it takes care of 60 percent, over half of them. The hospital administrator at Memorial Medical Center in Springfield, IL, said to me: Senator, if I don't have to give out all this charity care, I can contain my costs and build the hospital and even make it greater for this community. But I have to absorb charity care for uninsured people because we do that in America. Put more of them on insurance and we will have more revenue coming in. I would not have to transfer their cost burden to other families. I will do better as a hospital. We will do better as a community.

I think he is right. It is common sense. The Senator from Kentucky says we need common sense. That is part of it. I think we also need common sense when it comes to Medicare. Medicare, of course, was created almost 50 years ago. Those who opposed it said: Too much government. Those who supported it said: How else can we provide for the elderly and retired, giving them basic health care protection, if we do not have an insurance plan across America that we contribute to as we work and is available for us when we retire?

What happened when Medicare was passed? Senior citizens started living longer, better, more independent lives. The record is there. It is clear. It worked. We want it to continue to work. But the problem is, as the costs of health care skyrocket because of baby steps and no steps recommended by the other side of the aisle, as the costs skyrocket, Medicare costs do as well. It only has about 9 years left before it goes into the red.

Well, the bill we are proposing, the health care reform bill, will extend the life of Medicare another decade. I wish it were longer. But it certainly is a step in the right direction. How do we extend the life of Medicare? We look at the waste in Medicare today, and there is waste. Let me give you a couple numbers to compare. These numbers reflect the average cost for each Medicare recipient annually in each community. In my hometown of Springfield, IL--central Illinois, small town America I am honored to represent--$7,600 a year, average cost per Medicare recipient. Rochester, MN--home of one of the greatest hospitals in America, the Mayo Clinic, a place I dearly love and respect for the treatment they have given to my family--it is about the same, $7,600 a year, average cost for Medicare recipients. Now go to Chicago--a big city--$9,600 a year, average cost for Medicare recipients.

Now go to Miami, FL. The average cost for Medicare recipients, $17,000 a year. It costs more to live in Miami than it does in Springfield or even Rochester, MN, but twice as much? No. Something is wrong. Overpayments are obvious in Miami, FL, in McAllen, TX.

We can pick them out, and we can see we are wasting our tax dollars with too many tests, too many procedures, not focusing on quality but quantity. Can we make this a better system? Can we keep seniors healthy and reduce costs? Of course we can. We can eliminate a lot of the waste. We can raise questions about self-dealing by doctors who make sure they send their patients to their own laboratories, using their own machines over and over again. We can do that. In doing so, we are not going to compromise the basic care Medicare recipients want.

So the Senator from Kentucky says: Too big. It is a big government program. We need to go step by baby step here. No. We need to take a look at the obvious. If we do not address Medicare and reform it the right way, in 9 years it will be in the red, going broke. We cannot let that happen. Baby steps from the other side of the aisle will not take us on this important journey to the goal we all share.

I also wish to say a word about the deficit. President Obama said to us when we started this debate: I know what our goals are, but in reaching those goals, do not add to America's debt. We came up with ways to reduce health care costs, to increase taxes on people making over $200,000 a year; not dramatic increases but, in fact, increases in taxes for them. The Congressional Budget Office says that as a result, in the first 10 years, our bill, the health care reform bill, will reduce the deficit by $130 billion, and in the second 10 years it will reduce it by $1.3 trillion, the largest deficit reduction in the history of the United States. This approach is fiscally sensible, fiscally sound.

A word before I close--I see my colleague from Iowa is on the floor and I wish to yield to him--about reconciliation. Senator Grassley is on the Finance Committee. He has served on that committee for a number of years and he understands how the Senate works. When President Reagan wanted to initiate his tax cuts, he used a process called reconciliation. Reconciliation basically says no filibuster; you come to the floor, you offer your amendments and, ultimately, it is a majority vote. That is what reconciliation says.

So President Reagan used reconciliation for tax cuts. Speaker Newt Gingrich used reconciliation for his Contract With America. We have used reconciliation to create the COBRA program to provide health insurance for unemployed workers across America. Time and again we have used reconciliation for major issues involving taxes and revenue. It has been done 21 times in the last couple decades. More often, it is used by the Republican side of the aisle than the Democratic side of the aisle. To brand this process as somehow un-American and unfair is to suggest that all of the efforts by the Republicans to use this process have been un-American and unfair. I don't think that is true. It wasn't true then; it isn't true now.

What we have is a bill that has passed the Senate, the health care reform bill, which is now over in the House. The House of Representatives will decide whether they can enact the Senate version of health care reform. The follow-on bill is likely to be the reconciliation bill which will make some changes in that health care bill. It is not the total health care bill, but it will include changes. Some of the changes that are being contemplated are ones that I think most Members on both sides agree to. Should we close the doughnut hole? Well, what is the doughnut hole? It is a gap in coverage in Medicare prescription drug coverage for seniors. Should we close that gap? I think we should. That is part of it.

Second, should we try to make health insurance more affordable? Our underlying bill puts almost $450 billion in tax cuts on the table for small businesses and for individuals who cannot afford their premiums. The reconciliation bill will try to make it even more affordable.

Can we help the States with their Medicaid burdens? We should. In my State of Illinois, in Iowa, and in New Mexico, Governors are struggling. With folks on unemployment, more and more people need Medicaid. We should help to pay for it.

None of these ideas behind reconciliation--and there are other aspects to them; we are working out details on them--is radical. None of them is comprehensive in terms of changing health care dramatically in America, but they do improve on a bill that has already passed in the Senate.

The Republican leader comes to the floor and tells us this is un-American and unfair. I couldn't disagree more. Every time we hear the Republican side of the aisle say start over, I ask them, how much longer should America wait? We have been at this in the Senate now almost nonstop for over a year. The Senator from Iowa, Senator Grassley, was part of a bipartisan effort, with Senator Baucus, a Democrat, that went through 61 separate meetings to try to find bipartisan agreement, and it didn't. I salute Senator Grassley and others for trying, but it didn't. We had to move forward.

So should we start over? Should we give up the things I have talked about? Should we give up this effort to give small businesses choice and competition? Should we give up on the effort to make sure we have a fighting chance against insurance companies? Should we give up on the effort of trying to make sure that a substantial number of uninsured Americans have that protection? Should we give up on the effort of extending the life of Medicare for 10 years? Should we give up on the effort to reduce our deficit by reducing health care costs, not only for our government but for businesses and families? No. We cannot give up. We cannot give up on America. We cannot give up on this challenge. I urge my colleagues to stay the course.

I yield the floor.

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