Moving Ahead for Progress in the 21st Century Act

Floor Speech

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Mr. CORNYN. Mr. President, I am happy to respond to my colleague from Wyoming Senator Barrasso, who has been not only a Senator but a medical doctor and who has been on the receiving end of government policy, that while it may be well intended, backfires, particularly this bipartisan support now we have seen in the House of Representatives Energy and Commerce Committee yesterday, where they voted to repeal this Independent Payment Advisory Board--Independent Payment Advisory Board, IPAB--not iPOD, IPAB.

The reason this is so important, and I would like to ask my colleague, from his long experience as a medical practitioner, the purpose of this 15-member, unelected, unaccountable bureaucracy to actually set prices for health care, what happens if, to the exclusion of all other health care reform, the IPAB or the Federal Government generally cuts reimbursement to providers? It would seem to me we get a phenomenon that we get the illusion of coverage, but we have no real access to health care.

The experience we have had in Texas is, for example, Medicaid and the President's health care bill puts a whole lot of people into Medicaid, but only about one-third of Medicaid patients can find a doctor who will see a new Medicaid patient in the Dallas-Fort Worth area, one of the most populous parts of our State. I know, particularly in many rural areas--and I know Wyoming has a big rural population as well--many times it is hard for seniors to find a doctor who will see a new Medicare patient, again, because reimbursement rates are so low.

So I would like to ask the Senator from Wyoming what his experience has been in that area.

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Mr. CORNYN. Mr. President, I ask the Senator from Wyoming, it seems to me that what the intent is behind this Independent Payment Advisory Board and the President's health care law, sometimes called the Patient Protection and Affordable Care Act--I think it needs to be named ``Unaffordable Care Act'' for reasons we can go into later.

But the purpose behind it we can all understand; that is, to try to contain health care costs and spending by the Federal Government because, of course, health care inflation is going up much faster than regular inflation of the Consumer Price Index.

It strikes me that, as in a lot of the policy debates we have in Washington and Congress, we all agree we need to do something to contain costs, but we disagree about the means to achieve that affordability that we all know we need and to contain the inflation of health care costs. I would like to ask my colleague, rather than have Congress outsource its responsibility in this area to an unelected, unaccountable group of 15 bureaucrats, from which there is no appeal and which would have the consequence, as he said, of limiting people's access--because if all they are going to do is cut provider payments to hospitals and doctors, then fewer and fewer doctors and hospitals are going to be able to see those patients. Does he see an alternative that would perhaps help contain costs more by using transparency, patient choice, and good old-fashioned American competition? I am thinking, in particular, about the rare success we have had in the health care area containing costs in the Medicare Part D Program, to me, perhaps a model even where seniors have a choice between competing health care plans and where they get their prescription drugs. But because of the choices they have and the natural competition that occurs, we get market forces disciplining costs. Indeed, it is a very popular program, but the projected costs for Medicare Part D have come in at about 40 percent less than what was originally projected. It strikes me that is one of the missing elements with outsourcing of this responsibility to this unelected, unaccountable group of bureaucrats, where the only thing they try to do is cut provider payments.

Does the Senator see any alternative along the lines of Medicare Part D or otherwise?

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Mr. CORNYN. Mr. President, I thank the Senator from Wyoming for his response. I think that shows there is an alternative to this outsourcing of our responsibilities to try to make care more affordable to this group of unelected, unaccountable bureaucrats and cutting provider payments, which actually limits access to health care.

But I tell my colleague from Wyoming, I had an experience a couple years ago visiting with some folks at Whole Foods, the grocery chain that is headquartered in Austin, TX, where I live. John Mackey, the CEO, is very proud of this. They vote each year on their health care plan. What they have chosen--the employees choose year after year--is a high-deductible insurance coverage for catastrophic losses, but then to cover the rest of their care it is a health savings plan that actually Whole Foods makes contributions into, which is owned by the worker and could then be used to pay for their health care for their regular sort of routine needs.

I remember sitting at the table with a number of the workers and talking about why they like this alternative so much, and it is clear: Because it gave them the choices we all would want for ourselves and our families in terms of the doctor we want and the kinds of treatment we want, and it provided incentives because people were spending not the government's money, some sort of a credit card they would never see the bill for, but they were spending their own money in their health savings account; thus, realigning incentives for not only providers but also for consumers in a way that creates more transparency, more choices, and the kind of market discipline to hold down the costs.

I ask my colleague, my impression is, while there was great division in Congress over the passage of the Patient Protection and Affordable Care Act, what some people call ObamaCare--60 Democrats voted for it, 40 Republicans voted against it in the Senate--that on this issue, on the IPAB, Independent Payment Advisory Board, there actually is bipartisan support, particularly in the House Energy and Commerce Committee, to take out that particular provision because people now, on further examination, have seen how it could actually backfire in limiting people's access to health care.

I would ask my colleague, does he see a way for us, on a bipartisan basis, to narrowly address that provision while we continue to wait on the Supreme Court of the United States to rule on the constitutionality of the individual mandate? We don't know how things, such as the State-based insurance exchanges, will operate and the subsidies and whether those are going to be affordable. But on the narrow issue of repealing the Independent Payment Advisory Board, does he see the possibility for bipartisan support for that?

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Mr. CORNYN. I would like to ask my colleague one final question. Whenever we talk about reforming, saving, and securing Medicare so we can keep the promise we made to seniors that when people reach the appropriate age, they can actually qualify for this benefit and it actually will be there for them--and people do, in fact, pay into this fund, and they expect to get their money's worth back--sometimes the charge is made that various reform proposals will destroy Medicare as we know it.

I would like to ask the Senator from Wyoming, a medical doctor by profession, whether Medicare as we know it, as currently constructed under the President's health care bill, with this IPAB provision in place--does it have any chance of survival as it currently operates now with this new board of unelected, unaccountable bureaucrats setting prices and limiting access? Because doctors and hospitals simply cannot afford to provide the service at that cost. Doesn't that have the potential to radically transform Medicare as people have come to know it?

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Mr. CORNYN. Mr. President, as we approach the 2-year anniversary of the Patient Protection and Affordable Care Act--otherwise known as ObamaCare--there are a lot of things you are going to hear from across the street at the Supreme Court of the United States on the constitutional challenge to this individual mandate, which is a very important constitutional question for the Supreme Court to decide--whether there is any limit to the power of the Federal Government when it comes to forcing you to buy a product approved by the government and penalizing you if you do not do it, whether that is within the constitutional power of the Congress under the commerce clause. Then there are other important questions about the workability of the law, the affordability of the law.

I think today we can just see if we could work together in a bipartisan way to repeal the IPAB requirement. Senator Reid is the only one, as the majority leader, who can bring it to the floor, but hopefully, in light of the bipartisan support this has on the House side, he will see fit to do that. I certainly encourage him. I know Senator Barrasso will encourage him to do that. I hope we can do this and help ensure that people, when they qualify for Medicare, do not just get a card but actually have a good chance--I should say better than a good chance--they will be able to find a doctor who will treat them for the price the government is willing to pay.

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