Defending Public Safety Employees' Retirement Act

Floor Speech

BREAK IN TRANSCRIPT

Mr. TILLIS. Mr. President, there is a lot of talk about the imminent decision of the Supreme Court ruling in King v. Burwell. I will get to that a little bit later in my speech, but I wish to start by talking about how we got here.

I would like to review what Americans were told were the reasons for ObamaCare. It was supposed to help the 15 million people who are currently uninsured to get covered with quality, affordable insurance. Everyone else, we were promised, would be left alone. Remember that promise: If you like your doctor, you can keep him. If you like your health care, you can keep it. That is the first of several broken promises ObamaCare has ultimately produced. I will go through a few this afternoon.

Let's take a look at what has happened since ObamaCare was implemented and where we stand. Most of the uninsured nationwide are--and they were prior to ObamaCare--working families; 71 percent in 2013. They either couldn't afford the cost-sharing of their employer plan or their employer didn't offer a plan. Of those who got insurance under ObamaCare, too many were working families who actually didn't get private insurance under ObamaCare; they were ultimately forced into Medicaid, which is supposed to be a safety net, not a permanent solution for working families.

Is Medicaid the quality, affordable insurance that we all want for Americans and that people thought they were getting with ObamaCare? I don't think so. The provider payment rates in Medicaid are so low that many doctors refuse to see patients and participate in the plans. I don't really begrudge the doctors and the health care providers for this because the cost of care oftentimes exceeds the Medicaid reimbursement rates, and the redtape that comes with it absolutely is destroying the administrative side of health care. That is why doctors don't participate in the plan. That is why the doctors are not available for the people who actually need good, quality health care.

It is not for lack of investment though. States are drowning in unaffordable Medicaid Programs that eat more and more of their budgets at the expense of other essential services. States are throwing everything they can and then some at Medicaid, but it is still unacceptable in terms of cost, quality, and access. That is exactly why North Carolina refused to participate in ObamaCare's Medicaid expansion. I was speaker of the house in North Carolina at the time.

We know that if we are going to solve the health care problem, it has to be a real solution. We have to bring back a vibrant, robust, patient-centered, private insurance system, customized for our State rather than dictated by bureaucrats in Washington.

My constituents deserve a plan that pays doctors fairly so that provider networks are big enough to ensure that people don't get turned away at the door. Herding more of our hard-working, proud neighbors into a substandard welfare plan designed to be a temporary safety net is no solution at all, but that is exactly what ObamaCare has done. The President even brags about it.

In North Carolina, prior to the implementation of ObamaCare, there were some 1.9 million of our citizens who were uninsured. Who are these people? Ten percent were already Medicaid eligible before ObamaCare. Most of them are children. We could have enrolled them without ever passing ObamaCare and disrupting and destroying health care for everyone else. About a third were people who were eligible for subsidies on the exchange--almost half a million.

So did all of those folks get help? It might look as though they did. After all, 459,000 have signed up through the Federal exchange in North Carolina. But wait. Are those the same people, the same ones who were insured before ObamaCare? It turns out that even more than that--473,000 people--had their plans canceled by ObamaCare. Again, 473,000 North Carolinians received a letter saying: The Affordable Care Act has determined you can't keep your plan. They didn't like it, even though those who were insured were satisfied with their plans.

This was a nationwide trend. The Associated Press reported that 4.7 million people had their plans canceled because of ObamaCare. There was such an outcry that the President, by Executive fiat, actually instructed the insurers to continue to allow the plans for a period of time. So how many people lost their plan this time is still not clear. But what is clear is that the individual mandate is going to cause problems down the road because those who lost their plan or who will lose their plan, are going to be required by law to buy a Washington-approved insurance plan no matter how unaffordable ObamaCare has made insurance.

Again, in North Carolina, more people received cancellation notices for plans they liked than have actually signed up for ObamaCare. Between the half million whose plans were initially canceled by ObamaCare and the 1.9 million people who were already uninsured prior to ObamaCare, we should end up with a wash--with no change in the uninsured figures for my State of North Carolina, but, actually, we don't. The uninsured rate has gone down 2.7 percent--from 19.9 percent in 2013 to 17.2 percent in 2014--after the first full year of the ObamaCare implementation, so roughly equivalent to about 200,000 people in North Carolina. But were all of those people getting quality, affordable plans on the exchange as promised by ObamaCare? Hardly. The reason is Medicaid enrollment. The majority of the people who the administration claims ObamaCare covered have been those who went to the exchange to get insurance but were then forced to enroll in Medicaid. And when I say forced, I mean forced. The law requires them to have insurance, but the exchange doesn't allow them to buy a private plan if they are eligible for Medicaid. It shows them one option: Medicaid.

Well, wait. You said North Carolina didn't expand Medicaid, so how did this happen? It is true. Medicaid enrollment for my State has increased by 300,000 people--the biggest enrollment increase of any of the States that didn't expand Medicaid. What that means is much if not all of the drop in the uninsured rate is due to North Carolinians enrolling in Medicaid through the exchange. These are the same people who were eligible before ObamaCare was ever passed.

Nationally, last year, nearly 90 percent of ObamaCare's net coverage gain was through Medicaid. A study from MIT released in April found that Medicaid enrollees receive much less value from the program than the cost of paying for services.

So far, I have been talking about people who were targeted by ObamaCare, including the population of previously uninsured, as well as those who became uninsured because ObamaCare forced them into the exchange.

Again, ObamaCare didn't really make a dent in our uninsured numbers--not to this point in North Carolina--and it actually harmed many who were forced onto the exchange. It turns out that ObamaCare is an equal opportunity wrecking ball. It hurt the people it was supposed to help. It forced working families who needed quality, affordable, permanent care into a program that provides the lowest quality access there is--Medicaid.

ObamaCare took over and removed the insurance options, the individual market for people who didn't have employer coverage, leaving those Washington-approved ObamaCare plans with increased premiums, increased deductibles, and increased copays. You see, increased coverage doesn't necessarily mean better health care. If you can't afford your plan or you can't find the doctor, then your health care suffers.

But that is not all. ObamaCare broke health care for everyone else. Those of us who were supposedly happy with our doctors and happy with our health plans have been affected and will continue to be negatively affected.

What about the majority of Americans who actually have insurance through their employer? They haven't necessarily lost coverage yet, but they have been harmed. Despite the President's promise to lower insurance premiums, the average family premium for employer-sponsored coverage has risen $3,500 a year between 2009 and 2014.

In North Carolina, during the first full year of the exchange rollout, premium price increases outpaced increases in wages and inflation, losing ground to the working family. Even worse, premium prices in individual insurance markets--a market my daughter was a part of--went up 147 percent as a result of a plan that promised to reduce our health care insurance costs.

I know I am not the only one who remembers what President Obama said about ObamaCare. He said the average premiums would go down $2,500. The reality is they have gone up an average of $3,500 a year. All of this leads to the problem of people having insurance they can't afford, and they are not able to use it because their deductibles and copays are simply too high.

Between this group and the people who are now on Medicaid who can't get appointments with the small number of doctors who accept Medicaid, what one gets is a dramatic increase in the use of emergency rooms. That is exactly the opposite of what supporters of ObamaCare predicted. They predicted that emergency room visits would go down. We were told that once everyone was insured under ObamaCare, people could go to their doctors in outpatient settings and not show up at the ER. Instead, people can't afford the copays and deductibles or they can't get an outpatient appointment, so they wait until their problem is critical and end up in the ER.

In fact, Kaiser Family Foundation reports that emergency room utilization is up significantly among ObamaCare participants. In a survey of more than 2,000 emergency room doctors, three-quarters of them said emergency room visits have risen since January 1, 2014. Medicaid recipients covered under ObamaCare are struggling to find doctors who will accept their coverage, so they have no choice but to end up at an emergency room, where the costs skyrocket.

A spokesman for the Emergency Room Doctors Association, Dr. Howard Mell, noted:

There was a grand theory the law would reduce emergency room visits. Well, guess what, it hasn't happened. Visits are going up despite the ACA, and in a lot of cases because of it.

One of the most troubling elements of ObamaCare to me is the intergenerational wealth transfer from the young and the poor to the older and the wealthier. When I say ``older,'' I don't mean elderly and frail or the population who may be on Medicare; I am talking about a wealth transfer from young people in their twenties to people like me in their fifties. I would never ask my daughter, who is about to start a career in nursing, to pay for her mother's insurance or for my insurance, neither would any of you or any other American. That is not how parents are wired. But an impersonal law that empowers an impersonal bureaucracy does not have the same moral compass as a parent.

For example, ObamaCare's mandates have jacked up premiums for young people to keep premiums down for older people like me. I am not sure ``let's fleece our children and grandchildren'' is a winning talking point, so the supporters of the bill try to hide the truth in Washington-speak. They call this ``age rating bands.''

Another talking point that tends to not fly too well with folks is ``Let's kick seniors off of their Medicare Advantage plans.'' That is exactly what happened in North Carolina late last year. Many who know about Medicare Advantage plans know they are very important and popular among seniors. In my State last year, 57,000 seniors--more than any other State in the Nation--were sent cancellation letters from the Medicare Advantage plans they liked. Many of these seniors were offered a minimum benefit plan with

[Page: S4578]
higher copayments and higher premiums instead, all because ObamaCare cut reimbursement for Medicare Advantage plans out of some bizarre but longstanding aversion to the program on the part of some of our friends on the other side of the aisle. I have never understood it. Does Medicare Advantage somehow give seniors too much control, stability, and convenience in their Medicare benefits? I suspect my mom is watching me right now in Nashville, TN. I bet if she was asked that question, she would say no.
Just when you think it is really bad, realize that some of the toughest ObamaCare hits haven't even been taken yet.

First, the individual mandate penalty. The penalty for not having insurance increases next year to almost $700 per adult or 2.5 percent of one's annual income, whichever is greater. This is a penalty which many people will be surprised to see when they get their tax return and they are expecting this amount and it is $700 or $1,000 less to pay for the mandated care. If an individual's income is $50,000, they will pay a penalty of $1,000. A family with two adults with an income of $50,000 will pay $1,400. When adding a college kid to the mix, the penalty is $2,100. A lot of people are in for a shock when they open up that tax refund and they see the additional hidden costs of ObamaCare on working families. That penalty, however, is still dramatically lower than the out-of-pocket costs of an ObamaCare plan. So we are forcing Americans to pick between bad and worse.

Second, the employer mandate and penalty. President Obama knows the devastation the employer mandate will cause not only for businesses but, more importantly, for workers. Employers will be forced to cut workers. They will be

forced to reduce wages and drop employer-sponsored health plans altogether and pay the penalty because the penalty will cost less than the mandates will to provide the care, and many employers simply can't afford it.

So far, people with employer-sponsored coverage have been harmed only by rising costs and shrinking provider networks, but they haven't for the most part lost their plans yet. The day is coming when the President can no longer delay the employer mandate, and that is when the plans they were promising you can keep will be canceled. We will see a massive disruption in the group market where most North Carolinians get their health insurance.

Premiums are going up every year because fewer younger, healthier people are enrolling than projected. This was completely predictable. Young people are no dummies. They know this is a terrible deal for them. As a result, insurance companies recalculate premiums based on the cost of the pool actually enrolled. The largest insurer in my State announced premium hikes for next year in the individual market of at least 26 percent. You know it is a bad thing when I felt better about the fact that our premium increases in North Carolina were only 26 percent because in some States they were upwards of 50 percent, and there is more to come.

ObamaCare relies on people paying into the pool to subsidize the sicker and poorer members of the pool. That is how insurance works. But virtually no one is signing up who isn't eligible for the subsidies.

CMS released data yesterday showing that 2015 exchange enrollment is 30 percent below projections made just 3 years ago. And of those who do enroll, they are doing it because of the lure of the subsidy. Ninety-three percent of the North Carolinians who are on the exchange have received those subsidies. That means the plans are unaffordable without massive subsidies. Those ineligible for the subsidy don't bother to sign up. That is why we have seen almost no movement in our State for uninsureds.

ObamaCare is forcing employers to cut jobs and move full-time workers into part-time positions. New data show a decline in the average hours worked per week by lower wage employees, and many workers are just below that 30-hour threshold, 30 hours per week.

I was at a restaurant in North Carolina a couple months back, and I was talking with a manager, who said it was heartbreaking for her to go and talk to a single mom who was able to make ends meet between the tips and her salary at 40 hours a week and tell her that she can now only work 30 hours a week because the restaurant simply cannot afford to be exposed to the mandates.

Now you have people who may have been able to make it on 40 hours a week or 45 hours a week having to get two jobs to make ends meet. I hear employers talking about how they are having to call each other to try to work out the schedules for these hard-working folks.

The CBO projects that ObamaCare will reduce employment as a result of all this by 2 million full-time equivalent jobs in 2017.

President Obama campaigned saying he wouldn't raise taxes on families making less than $250,000 a year. Let's talk a little bit more about that. ObamaCare broke that promise as well by creating or raising 20 different taxes amounting to more than $1 trillion in the first decade. Several taxes directly punished families making less than $250,000 a year.

University of Chicago economist Casey Mulligan modeled the macroeconomic effects of ObamaCare and estimated that the damage would be twice as large. He expects Obamacare to cause a 3-percent drop in employment and work hours and a 2-percent drop in our gross domestic product and worker income. If he is right, the total loss of worker compensation caused by the President's health care law will exceed $2 trillion between 2017 and 2024.

Now let's talk about the King v. Burwell case that has everyone's attention, with the Supreme Court imminently in a position to issue a ruling, probably sometime next week. The question for the Supreme Court is this: Did the President break the law by going around the will of the people in the States that wanted to opt out of establishing a State exchange, like we did in North Carolina?

Mr. President, what I just finished was a very long list of broken promises and the fiscal disaster we call ObamaCare. But now I want to talk about the King v. Burwell decision.

The question is this: Did the President break the law by going around the will of the people in the States that wanted to opt out of establishing a State exchange, such as North Carolina?

I am not interested in litigating this. I am not an attorney; I am a businessman. I will leave the lawyering to others. When I look at King v. Burwell, I don't see a legal battle; I see an opportunity. It may sound trite, but I see hope. The Court may give us the chance of a generation--the chance to fix health care once and for all. We can't fix ObamaCare, but we can fix health care.

But here is the thing. We don't come up with the solution ourselves. The press is counting on us to come up with a solution. Others are pressuring us on the other side of the aisle. But here is what I think we need to do. I think we need to look beyond the traditional way of trying to solve health care to a new way, and it starts with something fairly simple--humility.

I won't read the definition, but I think it is something that is sometimes missed in Washington. The solution is that we take the power out of Washington and we let the States do it. We give States, which are closer to the people, the chance--the privilege, really--to offer health care solutions that are local, accountable, and affordable.

Every State is different. Let's respect those differences. I believe the solution is one that will give States the flexibility, the funding, and the control to decide how best to serve the people of their particular State.

I just went through the long list of problems with ObamaCare. It has been problematic from the start, with higher costs, lower quality, less freedom, and people losing their coverage. It is a badly written law, and it hurts almost everyone.

Washington had its chance. Now it is time to let the States decide what is best for their people, and let the people decide what is best for their health care. To do that, we are going to have to do something we don't always do up here. We are going to have to jump on this opportunity and work together--Republicans and Democrats, the Federal Government and the States--to find commonsense solutions that are truly patient-centered.

That is the type of patient-first approach that will give patients more freedom, more choice, and control over their health care. That is what will expand coverage--not bureaucratic power. That will promote genuine quality and innovation. It is also what is going to bring costs down. I do not think my responsibility is to my party. I do not think our responsibility is to the institution of the Senate or the prerogatives of the Federal legislative branch.

I think our responsibility is to the patients who deserve the highest quality care; to the patients who want the best treatments for their children; to the nurses and doctors who deserve freedom to heal according to their wisdom, their experience, and their conscience; and to the businesses that deserve the freedom to design affordable coverage that fits their workforce.

Finally, I think we are responsible to the seniors who have paved America's road to prosperity before us and who deserve a strong, secure Medicare program. The Court may just give us the opportunity to firmly and finally reject ObamaCare so that we can deliver what everyone in America deserves--a health care solution.

The law has not worked. It cannot work. It is time we return the power of medicine to the people. It is time to stop fighting and to start cooperating and to find a permanent solution.

Patients deserve portability in their health insurance, and they deserve affordability. They deserve their peace of mind when their parent or their child or they themselves are in their hour of crisis and when they can count on getting the best health care America has to offer.

Sometimes politicians in Washington forget that health care is not about systems or rules and structure or even markets. It is about real people and real families and real lives. So my commitment is simple. Our commitment should be simple. No one who has ObamaCare-subsidized care today will lose that coverage tomorrow. We are equally committed to providing long-term, State-designed, patient-empowering solutions that deliver better long-term results, and safe, secure, and affordable health care and an improved economy.

We commit that every patient with a preexisting condition will be able to find affordable coverage. No one will hit a cap on benefits. Anyone can renew their health plan. That is our commitment. Health care is about patients, not politics. It is about doctors and nurses, not politicians. For the millions who have been affected, from the cancelled plans to the higher costs, we are committed to real solutions to protect patients and make health care genuinely personal and genuinely affordable.

Hard-working taxpayers deserve certainty, stability, and peace of mind when it comes to health care. A temporary extension of subsidies alone would not be enough. It would just be another Washington gimmick. It would not address the very real problems with the President's health care law. Let's commit to each other--Republicans and Democrats--that we will show a little modesty. We won't assume we know what is best for every American, and we will let the States come up with solutions. We will work together to return power to the States, to the people, and really to the kitchen table, where most health care decisions are made.

I know what you are thinking: I am new and have been here for 6 months. Maybe I am a little bit naive. But I have herded a lot of cats in the North Carolina legislature. I have stepped up to very serious challenges, and we produced a lot of good results for my friends and colleagues and citizens in North Carolina. I know it can be done at the State level when policies are on the line that have a real impact on our neighbors--neighbors we have to face in the checkout line and in the church pews.

I am looking forward to providing a solution to the health care problems in the United States. I am looking forward to seeing bipartisan cooperation, to delivering on the promises that we make here, and to fulfilling the promise of fixing health care for our great country.

BREAK IN TRANSCRIPT

Source