Affordable Care Act

Floor Speech

Mr. DURBIN. Madam President, it is interesting that we face one of the toughest economic recessions in modern history and a world in turmoil, as many countries are challenging their leadership and assessing the future, and the focal point of the Republican legislative effort appears to be the repeal of health care reform.

If you look at what the American people think about this, they don't agree. They think that if there are ways to improve the bill, we should do it; that if there are changes we can make in the bill to make it more effective, we should. But the notion that we would repeal this law and walk away from the basic provisions in it is not acceptable by the majority of the people.

The House Republicans, new to the majority this year, decided they needed to keep faith with their followers and repeal health care reform as their highest priority. As the whip in the Senate who counts votes on this side of the aisle, I sense that we are not going to repeal this law, nor do I think we should.

It appears Republicans want us to spend some time debating whether health care reform is good for America. I welcome that debate because, as you know, when we reflect on what we have achieved so far, in a little over 1 year, with this health care reform and what is to follow, it strikes me as unusual that there are people who want to walk away from all that. The important starting point in this debate is government-administered health care. If you listen to the other side--the Republicans--the issue they object to the most is the fact that the government has some hand in this health insurance industry. They call it government-run health care. Those who would take the time to read the bill--and I have--will realize that at the end of the day, the only entities offering health insurance in America are private companies, aside from Medicare and Medicaid. So what the Republicans are objecting to is a government effort to extend the availability of private health insurance to more and more Americans.

I know every single Republican and Democratic Senator is protecting their own families with government-administered private health insurance. The very thing they are condemning in the health care reform bill is the source of their own personal health insurance for their families. You see, Members of Congress are part of the Federal Employees Health Benefits Program, a program that covers 8 million Federal employees and their families. My wife and I, each year, have an open enrollment where we can choose from nine different private health insurance companies in Illinois. We pick the plan we like the best. At our point in life, we have more coverage than younger people might, and more money is taken out of my paycheck because of that decision, but it is our decision to pick this private insurance company in a plan administered by the Federal Government.

As the Republicans stand and criticize the notion of extending this availability of options to more Americans, they are criticizing the same insurance plan they are using to protect their own families. If it is good enough for a Member of the Senate, should it not be good enough for most Americans? The insurance exchanges we are creating will offer the option for people to choose from private health insurance plans in the future. That, to me, is a good thing. It has certainly been good for my family, in terms of the Federal Employees Health Benefits Program.

There are other parts of the health care reform bill the Republicans want to repeal, which I know the American people think are very valuable. Right now, young adults up to the age of 26 would lose their insurance coverage through their parents' health plans if the Republicans prevail. This would affect 47,200 people in Illinois and 1.2 million nationally. Who are these young people, age 25? They are graduates of college looking for jobs. They are finished with their education and maybe had student health insurance and they are looking for a job and maybe the first one they find doesn't offer benefits. So mom and dad say: Don't worry. We still have you under the family health insurance plan.

That is part of the health care reform bill these people--the Republican side of the aisle--want to repeal. I remember going through this with our kids, as I am sure others do. You called them after college and said: Jennifer, how are you doing?

I am fine.

Do you have health insurance?

Dad, I don't need that yet; I will get it later. At which point you say: Girl, you have to have it, even if we have to pay for it. We know we are just one diagnosis or accident away from needing health insurance.

That worry is relieved for those through the age of 25 under health care reform and would be repealed by the Republicans.

How about lifetime limits? People with private insurance coverage, if the Republicans have their way and repeal this measure, would find themselves suddenly vulnerable again to having lifetime limits placed on how much insurance companies will spend on their health care. This affects 7 1/2 million people in Illinois and 165 million nationally.

I talked to a retired firefighter in Chicago. He happened to be a man who volunteered and went to New York on 9/11. He came down with leukemia. I said: How are you doing?

He said: I'm feeling good. I'm getting a lot of treatment, and it's working, but I'm worried. I'm not old enough to qualify for Medicare yet, and I have a $1 million limit. I had no idea I would come down with cancer, and I have already spent $150,000. If I need additional medical care, it will be taken out of my savings if I go past this limit.

We eliminate the limits on health insurance policies. Repeal of the law will reestablish those limits.

How about rescissions? Insurance companies, if the Republicans have their way and repeal our Affordable Health Care Act, would once again be allowed to cut off someone's coverage unexpectedly when they are in an accident or become sick because of a simple mistake on their application. That would leave 612,000 people in Illinois and 15.9 million nationally at the risk of losing their insurance at the moment they need it the most. One of the worst abuses of the insurance industry would become legal again if the Republicans have their way and repeal affordable health care.

How does this work? Well, I can tell you what happens. We have seen it. People have contacted our office. The most notorious example was a woman who said when she needed coverage for a surgery, the health insurance company went through her application and said: You failed to disclose a preexisting condition. We rescind the policy.

She asked: What preexisting condition?

You had acne as a teenager.

Think about it. Would you ever put that down as a preexisting condition when you are applying for health insurance? It was enough for the health insurance company to turn her loose and refuse to cover her.

Also, nearly 7.5 million residents in Illinois and 165 million nationally would not know if they are receiving value for their health insurance premium dollars because the Republican repeal of health care would remove the requirement that insurers spend at least 80 to 85 percent of premium dollars on actual health care--not on bonuses, not on salaries, not on advertising, and not on administrative expenses but actually on health care. It is an effort to have the States monitor these health insurance companies and make sure when the rates go up the money being collected is actually going to health care. That would be eliminated if the Republicans have their way in repealing the Affordable Health Care Act.

How about preventive care? Nearly 1.8 million seniors in Illinois who have Medicare coverage and 44 million nationally would be forced to pay a copay to receive important preventive services such as mammograms and colonoscopies, and they wouldn't receive a free annual wellness visit. We know what happens when a person doesn't have a lot of money and is in their senior status and they are faced with the possibility of getting a test. They put it off. The longer you put it off, unfortunately, it is more likely something bad will occur. The Republican repeal of health care would mean that this preventive care currently offered under the bill for Medicare recipients would be eliminated.

Then there is the doughnut hole, or the gap in coverage, for Medicare prescription drugs for which 109,421 seniors in Illinois and 2.7 million nationally would see significantly higher prescription drug costs if the Republicans are successful in repealing health care. Last year, these beneficiaries received a one-time, tax-free $250 rebate to help fill the gap for prescription drugs in the doughnut hole coverage gap.

Medicare beneficiaries who fall into the doughnut hole in 2011 will be eligible for 50 percent discounts on covered brand-name prescription drugs. Without this law, the burden of high prescription drug costs will hurt millions of Medicare beneficiaries across the country. That is the reality.

What the Republicans would do with the repeal of health care is to say to seniors on fixed incomes: Turn to your savings; pull more out of your savings for the prescription drugs your doctor tells you that you need to stay well. We are filling that gap, that hole. They want to go back to the old days when seniors were on their own.

There is the Early Retiree Reinsurance Program, where 279 employers in my State and 4,748 nationally wouldn't receive help from this program. It is a program that provides businesses, schools, unions, State and local governments and nonprofits much needed financial relief to help early retirees and their families continue to have quality affordable health care coverage.

Who are these people? One was in my family. My brother retired from working for a major corporation before he reached the age of 65. He had a heart attack and needed surgery and couldn't get insured. He had to wait until he was qualified for Medicare. This plan allows early retirees to find insurance before they qualify for Medicare and provides an incentive for that to happen. The repeal of this law by the Republicans would basically eliminate that program.

So when they stand before us and tell us they are just doing the right thing--what Americans really want--I am afraid that isn't the case. Most Americans want us to keep health care reform--change it, modify it, if necessary, but not repeal it--because when we repeal it, these basic things I have described will be in trouble.

What about this court case yesterday in Florida? It is getting a lot of attention today. A judge in Florida issued a decision in a case filed by 25 Republican attorneys general and Governors striking down the Affordable Health Care Act. This ruling is out of the mainstream of judicial reasoning in its treatment of precedent and in the type of analysis employed. I don't think it is likely to be upheld.

Twelve Federal judges have already dismissed challenges to the constitutionality of the health reform bill, and two judges in the Eastern District of Michigan and Western District of Virginia have upheld the law. In one other case, a Federal judge in the Eastern District of Virginia issued a very narrow ruling on the constitutionality of the health reform law's individual responsibility provision and upheld the rest of the law.

The ruling yesterday in Florida issued by Judge Vinson in the Northern District is a plain case of judicial overreaching. The judge declared the entire law was null and void, even though the only provision he found unconstitutional related to the individual responsibility provision. This decision is at odds with decades of established Supreme Court law which has consistently found that courts have a constitutional obligation to preserve as much of a statute as can be preserved.

Under this view of the law, the estimated 4 million seniors who fall into the Medicare prescription drug coverage gap I mentioned earlier will pay higher prices for prescription drugs. If the judge from Florida has his way, 44 million seniors on Medicare will be denied access to preventive care, up to 4 million small businesses will not be eligible for tax credits to make health care more affordable, and new provisions that prevent insurance companies from denying coverage and the like will not become part of the law.

History is on our side when it comes to this measure, Madam President. Tomorrow, the Senate Judiciary Committee, at my request, is going to hold a hearing on the constitutionality of the Health Care Reform Act. It is the first congressional hearing on this issue. As a person who is aspiring to be the chairman of the Constitution Subcommittee, I asked this be the first subject we take up. The reason I am still aspiring is we haven't closed all of

the negotiations about funding of committees, so nothing has become formal yet, but it is likely to occur.

What we will look at tomorrow is article I, section 8 of the Constitution. That is the article that specifically cites the powers that Congress--the Senate and the House--have. It is spelled out. In the course of spelling it out, it cites, among other things, that we have the power to tax, and we have the power related to provisions relating to commerce. It came to be viewed in the courts as interstate commerce--commerce between the States or between the United States and other nations.

Those who are arguing that the health care reform bill is unconstitutional first argue that the health care insurance industry is not commerce. If the health care insurance industry--which offers industry across State lines to millions of Americans--is not commerce, and it affects 18 percent of our economy, then I don't know what commerce might be. I think that position is particularly weak.

When it comes to the individual responsibility, or individual mandate system that is in the bill, the question is being asked of the court: Why is this necessary? Well, here is why it is necessary. If we say to insurance companies they don't have to insure anyone with a preexisting condition, then of course they are going to exclude people. But if we tell them they have to insure everybody, even those with preexisting conditions, then the obvious question is, when will a person buy insurance?

If we don't have a responsibility on individuals to buy insurance, two things will occur: They will wait until they are sick to buy insurance, which completely destroys the risk model that insurance companies use, or they will present themselves, as they do today, to many hospitals for coverage and care, the cost of which is passed on to other people. So the individual responsibility section says: If you don't have insurance coverage, then you have to pay a tax penalty. And that is what many are objecting to. You cannot eliminate exclusions for preexisting conditions and not move more and more people into the risk pool at an earlier stage. If people can wait until the last minute to get into the risk pool, then the insurance model is destroyed. That is why it is in there.

I think we will find, ultimately--and I hope we do--from the Supreme Court that what we have passed is entirely consistent with the regulations or powers given to Congress under article I, section 8 of the Constitution to deal with issues of commerce. Secondly, I think we will find that the imposition of a tax in this health care reform bill is clearly enumerated in the powers given to Congress to levy taxes, and what we have done is necessary and proper to reach the goal where we eliminate discrimination because of preexisting conditions in health insurance plans.

That debate is ahead of us, but it is a debate we need to take up. I am happy to talk about the health care reform bill because I think it is moving in the right direction. It is not perfect--it can be improved--but if the Republicans want to repeal it, they are in for a fight because the important provisions we have to protect families and businesses need to be protected.

What we want to bring up as soon as we can--when we get beyond this debate on health care repeal--is the reauthorization of the Federal Aviation Administration. We have been struggling with this issue for a long time, and we believe this bill, which our majority leader Harry Reid has asked to bring to the floor, creates and protects more than 280,000 jobs by modernizing the air travel infrastructure and reducing costly delays. I think this is an important step forward not just to create jobs--and we need them very badly--but also to make certain our airplanes and airliners and all those who are serving us at the airports have a safer environment, establishing new standards for safety when it comes to the operation of our airlines.

I think this is a critical issue, and I hope we can move to it soon. I am sorry we are going to be diverted into a debate on health care reform. But as I said, I think it is a welcome debate. It is time we brought some of these facts before the American people so they understand health care reform has real value to families and businesses across the United States, making health care insurance more affordable and more accessible.

Madam President, I yield the floor, and I suggest the absence of a quorum.

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