Moving Ahead for Progress in the 21st Century Act

Floor Speech

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Mr. BARRASSO. Mr. President, I come to the floor, as I do week after week, as a physician who has practiced medicine in Wyoming for almost one-quarter of a century to give a doctor's second opinion about the health care law, a law that I believe is bad for patients, it is bad for providers--the nurses and the doctors who take care of those patients--and terrible for taxpayers.

March 23 of this year, a little over 2 weeks from now, will mark the second anniversary of the President's health care law being signed. Two years ago at this time, Democrats in Congress said the Americans would learn to love this law. As a matter of fact, on March 28, 2010, the senior Senator from New York Mr. Schumer said: As people learn what's exactly in the bill, 6 months from now by election time--the election of 2010, remember--this is going to be a plus. Because the parade of horribles, particularly the worries that the average middle-income person has that this is going to affect them negatively, those will have vanished and they will see it will affect them positively in many ways.

Here we are 2 years later. We know that is definitely not the case. The health care law is more unpopular today than it was when it was passed and Nancy Pelosi famously said: First, you have to pass it before you get to find out what is in it. The more the American people have learned about the President's new law, the less they like it. Maybe that is why the White House and Democrats in Congress are hoping this 2-year anniversary of the health care law passes quietly and without great fanfare, while Republicans believe the American people deserve to know exactly how this law is going to impact them as well as the health care they receive.

So in the lead-up to the second anniversary of the law, I am going to talk about specific ways the law has actually made it worse for the American people--something I believed from the beginning would happen and now, 2 years later, we are seeing is specifically the case: It has hurt jobs, it has driven up costs, it has given Washington more control over Americans' health care, and I believe it has weakened Medicare.

Today, Senator Cornyn and I are going to focus on how the law threatens Medicare and specifically our seniors trying to get a doctor, our seniors trying to get health care, and how this new Washington board, called the Independent Payment Advisory Board, has had that impact. It is an unaccountable board. It is a group of unelected bureaucrats who will decide how to fund the care that is covered by Medicare.

So I come to the floor with my colleague Senator Cornyn. He has been traveling around the State of Texas as I have been traveling around the State of Wyoming talking with seniors, visiting with them, asking about their needs. They have great concerns about what is happening with this health care law, to the point that this week the House of Representatives is actually working in a bipartisan way to repeal this Board, these unelected, Washington-appointed bureaucrats. To me, it is the commission that is going to ration seniors' care and make it harder for our seniors to see a health care provider and get the care they need.

I know Senator Cornyn is leading the effort in the Senate to work with the House in an effort to repeal this payment board. I know Senator Cornyn is doing this in an effort to protect our seniors, to make sure our seniors get the care they need. So I would ask that the Senator possibly share with me and others the concerns he has and the concerns he has heard and ways he is hoping to address them.

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Mr. BARRASSO. My experience is exactly what the Senator describes. He said the words ``the illusion of coverage.'' When the President talked about the health care law, so often he wasn't actually talking about care; he was using the word ``coverage,'' and he was trying to use those words interchangeably. But coverage is not care, because someone having a card doesn't mean they can actually see a doctor. We see that with Medicaid now, with its low levels of reimbursement. With seniors already having trouble getting in to see a physician, this has a significant impact when a board, an independent payment advisory board--15 unelected bureaucrats--decides they are going to decide how much to pay for a doctor's visit, how much they are going to pay a hospital for a bypass surgery or a hip replacement, which is an area of my specialty. That hospital has to decide if they are going to provide that service. That doctor gets to decide whether they are going to see that patient.

In rural communities, if the reimbursement is so low--and I have heard this from hospital administrators in Wyoming. If the reimbursement level is so low for a procedure that is primarily, if not exclusively, done on people of Medicare age--and we can think of those things that are more likely to happen with someone over the age of 65--the hospital may ultimately decide they cannot continue to afford to provide those services and keep the doors open to a hospital. So seniors in that community will then be denied access to the care in their own community because the hospital will no longer do or provide that service, whether it is bypass heart surgery, whether it is total joint replacement. That senior then has to travel greater distances to try to find someplace to do that. The hospital may look at reimbursement for a procedure or different kinds of technology and say: The reimbursement is so low we are not going to upgrade our x-ray equipment or our MRI machine. Again, that community would suffer.

Even during the debate of the health care law, we heard in many rural communities that 1 in 10 hospitals was likely to actually be so financially stressed by the health care law that they may end up having to close their doors over the next 10 years. I am hearing that in Wyoming. But it is because of this Board that the President wants to be the one to essentially, it looks to me, do the rationing of care.

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Mr. BARRASSO. I think the two key words I heard the Senator from Texas say are ``choice'' and ``competition'' because those things put the patient at the center. It is patient-centered care, not government-centered care, not insurance company-centered care but patient-centered care. It is something we have been talking about for years on the Senate floor, at least on this side of the aisle, to put the patient at the center to give them the choice, as well as have the availability of the competition.

The concern I have--and I was at a statewide meeting in Wyoming with a number of our veterans and their families and I asked the simple question: How many believe, under the health care law as passed, that they are actually going to ultimately end up paying more for their health care? Every hand went up, every hand. Over 100 people there in Casper and over 100 hands went up. They all believe they are going to end up paying more under the President's health care plan than they would have had it not been passed. That is what we are seeing from a lot of the research as well, the admittance that the costs are going up even faster under the health care law than if it hadn't been passed.

Then we ask the critical question the Senator from Texas has referred to about the availability of care, the quality of care. If we asked the question: How many believe the availability of their care and the quality of their care under the President's new health care law will go down, again, every hand in the room went up.

These are all people who believe this health care law, crammed through Congress, crammed down the throats of the American public at a time when they were shouting: No, we don't want this--the American people believe it made it worse and that they are going to end up paying more and getting less for something they didn't ask for at all.

The American public did have concerns from the beginning, which is what generated the whole discussion about health care and reform. What patients are looking for is the care they need, from the doctor they want, at a cost they can afford. Under the President's health care law, they are losing all three.

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Mr. BARRASSO. I believe there is going to be bipartisan support. We see bipartisan support in the House. I would like to see bipartisan support in the Senate. When you look at what fundamentally this board does, they make recommendations, and it is practically impossible for the recommendations not to automatically become law. We were elected to make laws, not having independent parties make the laws. American patients are going to be forced to accept whatever this unelected board's recommendations are. It is very hard for Congress to override. I expect, in a bipartisan way, people would say: Let's completely eliminate this board, which I know the Senator's legislation is designed to do.

If American patients, people all across the country, suffer from the recommendations of the board, the way the law is written, they cannot challenge this unelected board in court. Americans have a right to challenge things but not this unelected board, as was written into the health care law.

Those are the sorts of issues I hear about when people say: What if I can't get a doctor? What if I can't get the care I need because of the decisions made by the board?

This fundamentally gets to the issue of the whole health care law, which took $500 billion from our seniors on Medicare not to save and strengthen Medicare but to start a whole new government program for someone else. This board, which I think we should eliminate and which I think is going to be hurtful for our seniors, is the group responsible for making the sorts of very challenging cuts from our seniors on Medicare--again, not to help save Medicare but to start a program for someone else, which is why this program is even more unpopular today than it was the day it was passed.

I do believe we have a bipartisan reason to eliminate this, and that is why I am supporting this legislation.

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Mr. BARRASSO. My view is that people will still get a Medicare card in the mail, but whether there will be doctors or hospitals or nurse-practitioners or others who will accept that card is the bigger concern. Because of what this board may do and is likely to do under the demands of the health care law, those on Medicare today and those coming onto Medicare may have a harder and harder time finding a doctor and a hospital to care for them.

Let's face it, today about 10,000 baby boomers will turn 65. Yesterday about 10,000 baby boomers turned 65. Tomorrow about 10,000 baby boomers will turn 65. We need to make sure Medicare is there and secure for the current generation as well as the next generation and generations to come.

My concern is that this board, which I know my colleague is trying to repeal and which I am trying to repeal, is going to make it that much harder for our seniors to receive the care they need from a doctor they want at a cost they can afford.

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