A Second Opinion

Floor Speech

Mr. BARRASSO. Madam President, I come to the floor today having listened to my colleagues and looking at the most recent job data, which shows the effects of our struggling economy. Unemployment is going up, wages are going down, and there are concerns all around the country with jobs, the economy, the debt, and spending.

I have to say, I certainly believe, as somebody who has practiced medicine for 25 years in Wyoming and taken care of families all around the Cowboy State and been very involved in the debate over the health care law, that the President's health care law makes matters worse, absolutely makes matters worse.

The President's health care law makes matters worse by forcing employers to either offer government-approved health insurance or pay higher expenses. Each day it becomes obvious to me the new health care law is designed to ultimately end employer-provided coverage altogether and to encourage Americans to join government-run exchanges. That is why, as a doctor, I come to the floor week after week with a doctor's second opinion about the health care law. Under this law businesses are permitted to drop out of paying for employer-provided coverage as long as they pay a fine. The fine is about $2,000 per employee. This number is far smaller than what it would actually cost the business to provide family health benefits to each of their employees.

So what happens with small businesses in this country? Well, they are
going to face an ever-clearer incentive to drop coverage for the people they employ. They are not required to pay this fine for the first 50 workers who lose coverage. So the question is, Where are these people supposed to go? Where do they go for their insurance? How does it work?

The President promised them if they like what they have, they can keep it. Yet the incentives built into the health care law seem to be encouraging employers to drop their employees. So where do they go?

Well, the new health care law sets up what are called health care exchanges for these people to enter. Whether they want to or not they will be forced to go that way. These exchanges are shorthand for insurance markets where as much as 80 percent of the cost of the family's insurance could be actually borne by taxpayers. Under these circumstances, the natural response is for businesses to drop coverage for their employees altogether and then simply offer them some less expensive cash benefits.

Meanwhile, what happens to the employees who are going to lose the coverage they may like and then try to replace it because that is what is going to happen? They will have to replace it with a plan Washington mandates. That is of concern to a lot of Americans, and this may be very bad news for the patient and is really bad news for taxpayers.

Experts predict the annual cost to provide government insurance subsidies could cost up to nine times more than what the White House originally claimed. If that isn't proof enough the health care law is the wrong prescription to help America's job creators continue offering coverage to their workers, let's take a look at some of the things that have just come out in the last week.

This week, on Monday, July 25, the National Federation of Independent Business--a group that represents small businesses all around the country--released an astonishing new report. The NFIB surveyed 750 small businesses. These are small businesses of less than 50 employees. The survey asked these small businesses if they planned to drop health insurance coverage should their employees become eligible for this government subsidy to buy health insurance in the so-called exchange. More than one-quarter of the small businesses who offer coverage today--over one-quarter of the small businesses that offer coverage today--said they were very likely to drop coverage. I repeat: Very likely to drop coverage. Another 31 percent said they are somewhat likely to drop coverage; that they needed to look into it to find the specifics.

When we take a look and add the ones who are very likely and somewhat likely to drop coverage, we are looking at over half the small businesses in this country dropping insurance coverage and effectively dumping their employees into the government-run exchange.

The small business group in the survey and the response from these small businesses prompted the Wall Street Journal to print an editorial highlighting this data. It is entitled ``The Flight to the Exchanges.'' When I read this, I said: Gee, I couldn't have said it better myself.

The President's health care law wraps businesses in reams of bureaucratic redtape and uncertainty. Adding insult to injury, on Monday, July 11, of this year, the Department of Health and Human Services released yet another proposed regulation mandated by the health care law. The Obama administration issued its proposed insurance exchange regulation. What the rules do is give the States the specific framework they must use to set up a program or an exchange with this Washington-approved and mandated insurance. Here we go again, another example of where this administration takes roughly 30 pages from the health care law and turns it into 340 pages of bureaucratic Washington rules and regulations.

Of course, the Secretary of Health and Human Services is trying to sell this new rule as offering competition and uses the word ``flexibility.'' But nothing could be further from the truth. How flexible can a 347-page Washington rule be when it is a rule that contains the word ``must'' 580 times and includes the word ``require'' 811 times? How flexible can that Washington rule actually be?

Well, after examining all the rule's ``musts'' and ``requires,'' one thing is very clear: This administration is paying lipservice to State flexibility while their policy is promoting a Washington-mandated, Washington-dictated, Washington-enforced approach. This regulation details a very complex and confusing process that States are going to have to follow. The States have to follow these confusing rules in an effort to prove to the Department of Health and Human Services they meet its Washington mandates to set up and run the insurance exchanges, and they have very little time to do it. So this administration creates onerous new mandates and then fails to give States ample time to meet their overwhelming set of requirements.

Let's put this into context for the States. Comments of the administration's proposed rules are due this September 28. Typically, it can take the Department of Health and Human Services 6 months to review those comments about the rules and issue a final rule. That means we would likely
see a final rule in March of 2012. Remember, there are significant details missing from these exchange regulations. This regulation is only part of the details States need to review before they can decide whether to run a health insurance exchange on their own or let the Federal Government do it.

The administration has yet to release rules explaining the health care law's essential health benefits package, the individual eligibility to participate in the exchanges, quality standards for the exchanges, and quality standards for the participating insurance plans. Those details may not come out until October or November of this year. This means States still do not know what the minimum set--the minimum set--of health services individuals, small businesses, and insurers will have to offer in the exchange. Pending missing details and further rules expected to come from the administration this fall, final rules--final rules--may be in place finally in May or June of 2012. States would then have to be prepared to submit their plan in June of 2012 to Health and Human Services to be certified.

But what happens if the rules aren't out by then? Many State legislatures end their sessions by June, making complying with this tight time line extremely difficult, if not impossible. It seems to me this administration will have had 2 years to post their final regulations while the States may have only 2 months to comply.

What happens if a State isn't ready? They say have no fear; Washington is here to help. That is what they say. If the Department of Health and Human Services says a State's insurance exchange is not in compliance, then Washington will swoop in and set up its own program. This is often called the Federal fallback or the federally facilitated exchange, big fancy words for Washington bureaucrats telling States what they have to do.

The irony of all this is the administration's rules offer very few details explaining what this Federal fallback exchange will look like, so the States don't even know what happens if the Federal fallback comes into play.

Is the Department of Health and Human Services creating a stealth, back-door Federal exchange? If a State doesn't have adequate time to meet all the operational program requirements and the burdensome review process, it sounds to me like the Obama administration will then take control of the States.

Why should a State such as Utah, for example, that has created an especially designed insurance marketplace be forced to comply with onerous and costly requirements of this rule? If they are not willing to comply, will they face the consequences that Washington will make the final decision? States should be encouraged to create innovative solutions that meet the unique needs of their constituents, not forced to follow a one-size-fits-all laundry list of Washington mandates.

This is why I returned to the floor today, as a physician who has practiced medicine for a long time, with a doctor's second opinion, to tell you I believe this health care law is one that is bad for patients, it is bad for providers--the nurses and the doctors who take care of those patients--and it is bad for taxpayers. It is why I believe it is important we repeal and replace this health care law.

Madam President, I yield the floor.

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