Nomination of Sylvia Mathews Burwell to be Secretary of Health and Human Services

Floor Speech

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Mr. MURPHY. Madam President, I come to the floor to speak in support of Sylvia Burwell's nomination to lead our efforts at HHS and to follow up on the comments of her great friend Senator Manchin.

I would like to add two points to what I think was a great presentation by the Senator from West Virginia. We rarely get someone who has this kind of background in both the public and private sector and of course who is perfectly suited for a tour of duty at the helm of the Nation's largest public-private partnership.

HHS is obviously the payer for our Medicare Program and for much of our Medicaid Program, but they are doing business with literally hundreds of thousands of private entities and private companies all throughout the country--primarily health care practitioners from the east coast to the west coast--and the Affordable Care Act is an enormous private-public partnership. We expanded coverage through both the traditional Medicaid Program and also through millions of people--8 million and counting--who have signed up for private insurance with a little bit of help from their government through tax credits. It is this background that she has on both sides of the public-private divide that I think will put her in a perfect position to lead this agency.

When she came before the HELP Committee, I was particularly pleased that she was very willing to be flexible and aggressive in her work with Governors throughout the country who have not yet expanded Medicaid. I think there is growing willingness on behalf of many Republican Governors to look at some innovative ways to expand Medicaid, and Sylvia Burwell is the perfect Secretary to work with Governors to find a way--perhaps with subsidies--that will help people in the lower income brackets afford private insurance that could capture those 5 million individuals across the country who do not have access to Medicaid because their States have not expanded it.

I wish to spend a few minutes in the context of this debate answering what I imagine will be a growing chorus of concerns and criticism from our Republican friends regarding some of the new rate announcements from exchanges all across the country. It has been hard to follow a lot of the criticism of the Affordable Care Act because it seems as though it mutates on a pretty regular basis. It started out with claims that the Web site could never work given its initial rollout problems. Of course it is working very well today.

Another criticism was that nobody would sign up for this new benefit because it was not affordable. We hit 8 million in terms of those who signed up for private insurance.

They said young people would not sign up. Private insurers are telling us their mixes of enrollees are exactly as they hoped, especially with respect to the young people signing up.

Then they said people would not pay their premiums. In a House hearing about 1 month ago, the private insurers said that in fact 80 to 90 percent of people were paying their premiums, which is comparable with the non-ACA plans.

Of course, there was the general claim that it will bankrupt the Treasury, even though it is saving us trillions in terms of deficit savings as well as savings to the overall health care spending line items of the Federal Government.

Now the critique is that these rate increases are unjustifiable as insurers are getting ready to offer rates on the new exchanges coming out for open enrollment at the end of this year.

First of all, it is important to note that there are a lot more insurance companies offering health care on these new exchanges. Connecticut will get at least one new entrant. New Hampshire, for instance, went from one insurer to five insurers. There is very good news coming with the new exchanges. There will be a lot more options because the insurers have figured out it is a pretty good deal for them as well as their consumers.

It is important to have a little bit of context. I have a couple of examples of the kind of premium increases that have been asked for by private insurers all across the country in the last several years. In 2010, Anthem in California proposed a 25- to 39-percent increase in premiums. Again in 2010, Anthem asked for a 23-percent increase in Maine. The year before in Michigan, Blue Cross Blue Shield asked for increases up to 56 percent for some populations.

The reality is that on average we have seen a premium increase for the individual market of 15 percent or above over the last 10 years. That is not good news, but it does provide some context for the requests for premium increases we are going to see in the exchanges this year. Actually, the reality is that since the law passed, there has been a fairly precipitous decline in the number of premium increases above 10 percent that have been requested by private insurers. There are less requests for premium increases above 10 percent today than there were in the corresponding period before the Affordable Care Act was passed.

Just because the rate increases that are being requested--or may be requested--as we roll out the next year of open enrollment for the State-based exchanges may be below the historical averages of the last few years, that certainly is not any reason for people to jump for joy. Fifteen percent is unaffordable, fifty-six percent is unaffordable, and 10 percent is still unaffordable.

It is also important to note some of the protections that are in the bill. For instance, one of the most important provisions of the Affordable Care Act that very few people have noticed is the provision that says that an insurer has to spend 80 percent of all the money it takes in on care. If at the end of the year they have not spent 80 percent of the money they have taken in from ratepayers and premium payers on direct care, then they have to rebate money to consumers.

Thus, if these premium increases are above what is justified based on the actual experience, there is going to be a rebate paid to ratepayers. Those rebates thus far have saved patients and consumers all across the country $5 billion, and it is a significant, historic protection against unjustifiable premium increases that are not backed

by actual experience in terms of claims paid.

The protections are even broader. While rate increases are not new, what is new is that consumers are back in charge of their health care again. Ten years ago insurers were charging 15 percent, 20 percent increases and they were also denying health care to millions of Americans who were sick. In some parts of the country they were charging women 50 percent more than what they were charging men. They were putting annual limits on health care coverage that ended medical insurance for many of the sickest individuals and families all across the country. All of those abuses, under the Affordable Care Act, are history.

While I will admit we still have work to do to bring down the cost of health insurance in this country, at the very least today consumers are back in charge of their health care, the worst excesses and abuses of the insurance industry are no longer permitted.

While I want to see a day when health insurance premium increases are 2, 3, and 4 percent, what we are seeing thus far in the wake of the passage of the Affordable Care Act is premium increases that are less than the historical average before the law was passed.

Those are the facts. I know that is not solace for individuals who are receiving these premium increases, but what we have seen are premium increases coming down and not going up since the Affordable Care Act was passed.

There is still an enormous amount of work to do. The news is generally very good. More people are being enrolled in the Affordable Care Act than what was expected. Over the last 6 months alone, the rate of uninsured individuals in this country has come down by 20 percent. Medical inflation is at a near-term historic low. Whether it be infection or readmission rates, outcomes are getting better.

Our next Secretary of Health and Human Services will have a lot of work to do to continue to perfect this law, but she is going to have a lot of good work and a lot of good outcomes upon which to build, based on her experience in both managing private sector entities and large public sector entities. Even with these challenges, Sylvia Burwell is the right choice for HHS, and I hope we will confirm her in a big vote tomorrow.

I yield back.

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