Keep Student Loans Affordable Act of 2013 - Motion to Proceed

Floor Speech

BREAK IN TRANSCRIPT

Mr. CORNYN. Mr. President, what do you get when Congress passes a 2,700-page piece of legislation on a purely partisan basis that radically transforms one-fifth of our economy and impacts the lives of 319 million Americans? What do you get when you oppose the huge costs of this legislation, and this new bureaucracy that goes along with it, on an economy that is trying to recover from one of the biggest recessions our country ever experienced back in 2008? Well, two of the things you get for sure are higher unemployment and fewer jobs, and anemic economic growth. We have seen both of those in the daily news. I am afraid we now have a new normal when it comes to unemployment in America, which is at 7.6 percent, and that does not count the people who have quit looking for work.

The Bureau of Labor Statistics has a ranking of how they rate the number of people actually looking for work, and it is called the labor participation rate. It is on their Web site. We have the fewest number of Americans in the workforce than we have had in the last 30 years.

We didn't get many of the benefits that were promised when ObamaCare was passed at a time when we were essentially told: We are from the government. Trust us. It will all turn out OK.

One of the most important numbers in the recent job report is the number 8.2 million. That is the number of Americans who are now working part time instead of full time because the full-time jobs are simply not available. In other words, there are 8.2 million workers who are working part time even though they want a full-time job, but they cannot find one.

To give some perspective, the number was 7.6 million in March. So between May and June we have seen that number increase by 300,000. There are 300,000 Americans who were unable to find full-time work, so they had to accept part-time work. When we talk about numbers such as these, I know it is tempting to think of those numbers as just abstractions, but these are the American people. These are moms, dads, brothers, and sisters. These are young adults who are looking for work but simply can't find work on a full-time basis.

I would suggest--and I think the evidence is compelling--that one of the reasons for that is ObamaCare. The law requires all businesses with 50 or more full-time workers to provide their employees with government-approved health care coverage, and if they don't, then they have to pay a financial penalty. This requirement was originally scheduled to kick in next year, but last week the Obama administration announced that this so-called employer mandate would be delayed until 2015. In other words, the administration has implicitly acknowledged that the mandate is discouraging the creation of full-time jobs and is actually reducing working hours, which is relegating many American workers--300,000 more between May and June--to part-time work even though they want to work full time. The irony is that the ObamaCare bill passed in the Senate--and I still remember this--on Christmas Eve of 2009 at 7 a.m. in the morning. It was later reconciled with the House legislation in 2010. But we have had two elections occur before the full implementation of this bill. What we are going to see now is moving the implementation off again until after the 2014 election. In my view, that is dangerous because it means there is no electoral accountability for the true impact of this legislation even though we are beginning to see some of it.

Of course, the basic problem is that the mandate won't magically disappear in 2015, even after it has been delayed by unilateral action of the administration. But what strikes me as pretty simple is that when you penalize full-time work, what you are going to get is part-time work in order to avoid the penalty.

Of course, the employer mandate isn't the only part of ObamaCare that is hampering job creation. The law also contains $1 trillion in tax increases--including a new medical device tax that has already prompted several large manufacturers to close existing facilities or cancel plans for new ones. I remember a few months ago I had a medical device company located in Texas tell me that they were going to be expanding their operations in Costa Rica instead of Texas in order to avoid this tax.

The medical device tax has also discouraged health-care savings and lifesaving innovations. One of the great things about our country and our free enterprise system is that if somebody has a better way to do something, they can design it, build it, and consumers can benefit from it. In this case, this medical device tax has been destructive of each of those.

Indeed, this tax has been so counterproductive that 79 Members of this Senate--a supermajority on a bipartisan basis--rejected it during the vote on the budget resolution recently and effectively said that it should be repealed. A number of colleagues from across the aisle who supported this legislation initially have now seen that the way this is being implemented can be damaging and destructive not only to job creation but access to quality health care.

The same thing can be said of the 81 Members who voted to abolish ObamaCare's IRS 1099 reporting requirement back in 2011. The more we have learned about the implementation of ObamaCare, the less popular it has become.

For that matter, the administration itself has had second thoughts about key provisions of ObamaCare. In 2010, the Department of Health and Human Services began granting a series of waivers from ObamaCare's annual limit requirements. It eventually granted more than 1,000. In other words, the administration unilaterally said to some people: You don't have to comply with the law, while the rest of us were stuck with it.

In 2011, Health and Human Services Secretary Kathleen Sebelius suspended all work on the so-called CLASS Act, a portion of ObamaCare that was formally repealed earlier this year. And, a few months ago, Health and Human Services announced that ObamaCare's basic health program would be delayed until 2015--again, after the next midterm congressional election. Just last week, in addition to delaying the employer mandate, the administration also delayed another important provision in the ObamaCare oversight. In other words, it said, You don't even have to prove that you are financially eligible for taxpayer subsidies to get insurance in the health exchanges.

This is an invitation to fraud and abuse. We saw in 2008 when the bubble burst after the financial crisis came to a head, one of the root causes of that was companies writing loans to people who couldn't qualify for those loans, but they didn't require any financial disclosure or verification. Those came to be known as liar loans.

We are essentially now refusing to learn from that experience in the health care field, on the part of the administration, to see as many people as possible signed up for the health care exchanges, but based only on their unilateral declaration that they are eligible, not any real verification or proof. That is an invitation to fraud.

To add it all up, notwithstanding its aspirations and notwithstanding the hopes and perhaps dreams of those who thought we were going to somehow transform health care with this legislation, it has now become clear to me, and I daresay millions of Americans, that ObamaCare has simply not lived up to its promises. It is not working as advertised. I think there is a growing bipartisan consensus to that effect. I have mentioned some examples and some reasons why, including as well that for the past 3 years we have witnessed a nonstop parade of fix-ups, fumbles, delays, and broken promises.

For example, during the 2008 campaign, President Obama pledged his health care law would transform health care; it would make health care costs for a family of four go down by $2,500. What has actually happened is the cost of family premiums has actually gone up by nearly $2,400 between 2009 and 2012. According to the Wall Street Journal, healthy consumers could see insurance rates double or even triple when they look for individual coverage under ObamaCare, and that will happen this fall. Some of it is so-called age-banding where young people, such as my two daughters who are 30 and 31 years old, are going to be forced to pay higher premiums to subsidize health care coverage for older people.

There are also other provisions such as mandatory issue. For example, if a person finds out that unfortunately they have a disease and are not covered, under ObamaCare they can go out and buy insurance which is not actually insurance anymore. Someone said it is akin to waiting until your house is on fire to buy fire insurance. That drives up the cost and it distorts the insurance market. What we are going to see, and what consumers are going to see, is their health care premiums go up as a result of the implementation of ObamaCare.

What about the promise that ObamaCare wouldn't raise taxes on anyone making under $200,000 a year? In fact, the law raised taxes on everyone, from young people with health savings accounts, to middle-class workers with families, to senior citizens living on a fixed wage.

President Obama also promised that anyone who liked their existing health coverage would be able to keep it. Do my colleagues remember that? He said: ``If you like what you have, you can keep it.'' I know people like hearing that because most Americans--up to 80 percent and maybe higher--are satisfied with the health insurance they have now. So when the President said, ``If you like what you have, you can keep it,'' most Americans nodded and said that's good. The reality is, according to the Congressional Budget Office, at least 7 million Americans will lose their current health insurance because of ObamaCare.

A few months ago one of my constituents in Texas sent me a letter she received from her health care provider. The letter informed her that because of the new health care law--the so-called Affordable Care Act which is turning out to be more unaffordable than affordable--her current health policy would be terminated by the end of the year. The letter also said: ``Never have we experienced the uncertainty and immense challenges that confront the insurance industry during this time of health care reform.''

I don't think it is sufficient for people such as myself or anyone else to criticize this flawed legislation and to say: I voted against it; it is too bad it didn't work out; tough luck. That is not sufficient, and that is not doing our duty. There has to be a better way to reform our health care system, and indeed there is a better way, if we commit ourselves to five overarching principles.

No. 1: We must make health care more affordable. That was the promise of ObamaCare, but that is not the reality. It has made health care less affordable, not more affordable. But we must commit ourselves to policies that will make health care more affordable by reining in costs, and I have some ideas on how to do that which I will mention momentarily.

No. 2, the second principle: Individuals must have more choices in the health care market and they must be allowed to make their own choices and select whatever options fit their individual needs. The

idea of ObamaCare was one-size-fits-all, but we know that one size does not fit all. Different families, different individuals have different needs. We need to restore the choices to individuals and not to the government dictating what those choices should be.

No. 3: We must ensure that all individuals, including people with preexisting conditions, have access to high-quality health insurance and to high-quality care. This was a problem in the preexisting system, where people with preexisting conditions found it hard to buy insurance, and this was one of the noble promises of ObamaCare. But we don't have to buy the whole package in order to fix this problem. Indeed, there are many high-risk pools at the State level that if the Federal Government would help support those high-risk pools, people would be able to find health care coverage even if they had preexisting conditions, which otherwise would make that difficult to find.

Principle No. 4: We have to protect the doctor-patient relationship. No one wants to have the bureaucracy telling them what health care they can have and whether they can have it. So we have to protect the doctor-patient relationship. This is a bond of trust that most of us have with the individuals we entrust our health care to--our own doctor. We have to make sure people are able to make health care decisions in consultation with their doctor and their family that suit their needs.

No. 5: This is the fifth principle for reform that I think we now need to begin the discussion about undertaking. We need to save Medicare.

What kinds of policy reforms might these principles generate? Well, for starters, I would suggest we need to equalize the tax treatment of health insurance for employers and individuals. This is something we have discussed time and time again. But why do we favor, through subsidies under the Tax Code, certain types of health coverage and discriminate against people who buy insurance in the individual market?

Secondly, from a policy perspective consistent with the principles I mentioned, we need to expand access to tax-free health care savings. There is a company in Texas--actually, it has franchises here in the Northeast--Whole Foods. It is a great grocery store. I had an occasion a couple of years ago to meet with a number of the employees. They vote every year on what their health plan should look like. Year after year after year, they choose a high-deductible health insurance plan along with a health care savings plan so that if they get sick they are protected by the catastrophic coverage, but otherwise they can save and budget for their ordinary health care needs using a health savings account. One of the most amazing things about that is people then begin to take some ownership--have some skin in the game--in terms of their health care choices, and they tend to do what we do generally as consumers, which is they shop around. They say, OK, I have my money. I need procedure X, I need this or that. Where can I get that for the best price and the best quality service? These tax-free health savings accounts transform the health care relationship so people don't only just have some third party paying the bills--like getting a credit card and never getting the bill under much of our current health care system--so expanding tax-free health savings accounts like the employees have at Whole Foods in Austin, TX, is one great policy that would improve our health care delivery system.

Third, we need to let people and businesses form risk pools in the individual market.

Fourth, we need to improve price and quality transparency. There has actually been some good work done by Health and Human Services recently to release health care expenditures for some of the most common procedures and reasons people are hospitalized. I think it is kind of eye-opening, because some people have found out that for the same procedure--in one instance a person might see $1,000 being charged and in another, a person might see $5,000 being charged for essentially the same practice or procedure. Providing transparency indeed helps to create an opportunity for a market, so market discipline can help normalize and bring down those costs. Improving price and cost and quality transparency are very important to creating a true health care marketplace.

Fifth, in Texas we have found ways to curb frivolous medical malpractice lawsuits which don't shut the front door to the courthouse for truly legitimate claims but which have made medical malpractice insurance more affordable because our civil justice system is more predictable.

Sixth, we need to eliminate all the unnecessary government mandates that drive up insurance costs. What happens in Austin, TX, and in State capitals across the country is legislators come together and say companies can't sell insurance in our State unless they cover X, Y, and Z. Well, the fact is not every consumer, not every patient needs X, Y, and Z coverage, but by those mandates they end up driving up the cost of that health insurance. What we need to do is eliminate the unnecessary mandates that many people don't use anyway, because those drive up costs. By eliminating those mandates, we can help bring down the costs and make health care more affordable.

Seventh, this is an old suggestion, but one that I think is still very important. Why is it that a person can only buy health insurance in their own State? If I want to buy car insurance I can buy it anywhere in the country and I can--if the company is in Oklahoma or New Mexico or Indiana, they can compete for my business. That gives the market an ability to hold down costs and that gives consumers access to lower costs and better quality by allowing that competition to occur across State lines.

We don't need another government takeover of our health care system. When the wheels fall off of ObamaCare or, in the language of the distinguished chairman of the Senate Committee on Finance, if that train wreck of implementation that he predicted occurs, we don't need another big 2,700-page government program to substitute. We need to implement the types of reforms I talked about to give us lower costs, more accessibility, and greater fairness throughout our entire health care system.

Speaking of fairness and accessibility, we know the current Medicaid Program is broken when our most vulnerable citizens have a hard time finding a physician who will actually take a new Medicaid patient. This is one of the problems many of us had with the ObamaCare expansion of pushing a lot of people onto Medicaid which, in my State, is a broken program, where more than 60 percent of primary care physicians won't take a new Medicaid patient because the reimbursement levels are about 50 percent of what private insurance would pay a doctor to treat a patient. So many physicians say, I can't afford to work for 50 cents on the dollar, so I am not going to see a new Medicaid patient.

So what you have is this strange dichotomy where people actually have coverage under Medicaid, but they do not have access to health care because they cannot find a doctor to take it at that price, and that actually, I believe, is sort of the dirty little secret about Medicaid. All of us support a safety net program of health care for our most vulnerable citizens--all of us--but Medicaid, as currently constituted, is not the answer for the reasons I mentioned.

Each State must have the flexibility to design a program that will actually meet the needs of its residents. What works best in New York, I guarantee, does not work the same way in Texas and vice versa. States should be appropriated a certain amount of money, and I am not suggesting it be drastically cut--which would deny the States an opportunity to provide health care in their own way--but we need to block grant these Federal funds, not micromanage them. We certainly need to eliminate as many Federal strings as we possibly can and provide the States the flexibility to use the same amount of money to provide access to more health care for low-income people.

Speaking of access to physicians, this is a big problem in Medicare too. Of course, Medicaid is for the economically disadvantaged. Medicare is for people 65 and older. But in my State, only 58 percent of physicians will see a new Medicare patient. That means 42 percent will not. In other words, if you live in a rural area or you live someplace where physicians will not take a new Medicare patient, you are pretty much out of luck. This is a problem again about the way the Federal Government tries to save money in health care, not by using the discipline of the market--transparency and competition and some of the other reforms I mentioned--but rather by whacking reimbursements to health care providers. The truth is, if you whack reimbursement rates to Medicaid providers and Medicare providers, as we currently do, then fewer and fewer people are actually going to be able to find a doctor who will see them, even though they have the promise of coverage under Medicaid or Medicare.

We know, of course, the financial problem Medicare is currently suffering. The fact is--and this is something I wish we would talk more about from the President to the Halls of Congress--for every $1 that an average person puts into Medicare, they take out $3. That is why Medicare, in the long run, is unsustainable. If we are going to keep the promise of Medicare--and we should--to future generations, we need to fix it.

But when it comes to treating patients, physicians, I believe, know better than Washington bureaucrats. This is another reason why I support repeal of another provision of ObamaCare which is called the Independent Payment Advisory Board, so-called IPAB. There is actually bipartisan support for repealing this provision in the House because what it would do is appoint a group of 15 bureaucrats who would decide what sort of health care was going to be reimbursed under Medicare and what would not. There would be no real recourse to Congress or anybody else because these people would be the so-called Independent Payment Advisory Board.

It is not hard to predict what would happen if IPAB, as it is called, were implemented. When doctors are forced to accept lower rates, they will reduce the number of patients they see or else they will drop out of the Medicare Program altogether or the types of treatment people will be able to get from their doctor will be determined by the Federal Government's willingness to pay for it rather than their true medical needs.

I think we have learned the lesson in Medicaid and Medicare, as elsewhere, that price controls simply do not work, and they will not save Medicare either. It is time to try a new approach that will protect the doctor-patient relationship and expand individual choice.

Under the current model, seniors are forced into a one-size-fits-all plan developed in Washington. Under an alternative supported by Republicans and Democrats in different contexts--the so-called premium support model--the Federal Government would pay a designated amount, and then people could use that money to buy their own private coverage. They could supplement it if they wanted to, if they wanted more generous coverage, but that would have to come out of their pocket.

But under the premium support model alternative, private plans would be allowed to compete against traditional Medicare, much as Medicare Advantage does now, and seniors could simply pick the plan they want that suits their needs the most. If someone picks a private plan that is cheaper than traditional Medicare, they can keep the savings. Then again, if they want more generous coverage, they can pay the difference.

How do we know this sort of approach will work? You do not have to take my word for it. All we have to do is look at what is working now. One of the most successful government health care programs I have seen since I have been in the Senate, and that I know about, is the Medicare prescription drug coverage program. A national survey released in October 2012 found that 9 out of 10 seniors are satisfied with their Medicare prescription drug plan.

Similar reforms could be made to other parts of Medicare to help save the program. If these reforms are not made, Medicare will go bankrupt. The great thing about Medicare Part D, the prescription drug program, is it has actually come in 40 percent under projected costs. It is not hard to figure out why. Because when different companies compete in the marketplace for the business of seniors who qualify for Medicare, they are going to compete--you guessed it--on price, so they are going to try to provide it at a less expensive cost, and they are going to compete based on quality of service. That is the great genius of our free enterprise system and of competition. But if we do not make these reforms, Medicare will go bankrupt. That is something none of us should look forward to.

So the reforms I have just outlined will give us a health care system with lower costs, a system with greater choice and greater access to high-quality care, a system that upholds fundamental values, such as fairness and consumer choice, and a system that will provide affordable health care for everyone. That is the kind of health care system we all want for our families, for our children, and grandchildren.

Three years ago, Congress took a swing at the health care issue but ended up striking out and missed an opportunity to enact necessary reforms. We are still learning that as the implementation of ObamaCare continues to unfold. But the health care debate is not over by any means. It is just beginning in a way. By replacing ObamaCare with patient-centered reforms that reduce costs, improve transparency, and expand access, we can make it easier for all Americans to get the affordable quality health care they deserve.

I yield the floor and suggest the absence of a quorum.

BREAK IN TRANSCRIPT

Source