Department Of Defense Appropriations Act, 2010

Floor Speech

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Mr. WYDEN. Mr. President, before he leaves the floor, I commend the distinguished Senator from Illinois for his statement and want to make sure the body recognizes that it has been Senator Sanders who has championed this cause relentlessly, making the case that, dollar for dollar, there is no better investment in American health care than these community health centers. I was going to spend my time talking about the opportunities for Democrats and Republicans to continue to team up on this health reform issue. I think it is worth noting that Senator Sanders, who has championed this effort in this bill, is actually picking up on work that a number of the most influential Republicans in this country have been interested in for years.

President George W. Bush was a great champion of community health centers. Bernie Sanders, now in this bill, is making sure we get a very significant increase so that there will be many new clinics across the country.

There are opportunities for Democrats and Republicans to work together. I will talk about a way we can create a new marketplace in American health care through health care exchanges and get more value for the health care dollar. This is an opportunity for Democrats and Republicans to team up, much like with community health centers. I thank my colleague.

I know because of our work together on health legislation the Senator shares my view that we can continue this effort to bring the Senate together on both sides around key principles of health reform. I want to do that again this morning by focusing on one of the most transformational and least understood parts of the health care debate; that is, the question of health insurance exchanges. My guess is across the country people are still trying to figure out what in the world these are and whether this is yet some other kind of health care lingo. It is fair to say, in basic English, these exchanges will be like farmers markets. This will be an opportunity for people to go to one place and to do what they can't do in the dysfunctional American health care system today; that is, actually shop and be in a position to compare various kinds of products and services. When you invest wisely, you can put the savings in your pocket. The reality is, that has not been possible in our country ever since the middle of the 1940s. During the 1940s, when there were wage and price controls, judgments were made about the delivery of American health care. The decision to tie insurance to someone's job made sense back then, when people went to work somewhere and stayed put for 30 years until their employer gave them a big retirement party and a gold watch.

But today's economy is very different. On average, people change their jobs 11 times by the time they are 40. We need to make sure that no longer is the consumer insulated from the health care system, no longer are most consumers incapable of being rewarded when they shop wisely. People understand that they lose out in terms of their wages if health care costs continue to rise as a result of inefficiency. So these health insurance exchanges are the key to making health care markets work, in effect, for the first time since the middle of the last century.

In the merged bill, Senator Reid, in my view, has laid an important foundation. There are three fundamental principles in Senator Reid's merged bill. Of course, we are going to continue to work on this. When the managers' package and this bill get out of the Senate, we are going to be working on this for quite some time. We are going to work on this long after 24/7 cable TV has moved on to other topics.

But in Senator Reid's merged bill, there are three important features of the exchange. The first is, it is going to be possible for consumers to make apples-to-apples comparisons of various health care plans. Consumers will be able to see that one plan will cost them $20 in copays for a physician visit, but perhaps another plan will cost them $30. It will be much like you can do in a store, a Costco, a grocery store, where consumers look at products on a shelf, look at the price, look at the various offerings, and choose the best product for themselves.

The second feature in the merged bill that Democrats and Republicans alike should appreciate is that it will be possible to keep low-quality plans out of the new marketplaces. This is especially important at the outset. I learned this back in the days when I was codirector of the Oregon Gray Panthers, the senior citizens group. One of the things the country learned in the early days of Medicare is a lot of the policies that were sold to supplement Medicare were just junk. They were not worth the paper they were written on, and people would buy 10, 12, 15 policies, literally wasting money they could have used for food and fuel and paying the rent. It took us until the mid-1990s to drain the swamp, and finally we were able to do it, standardize those packages, stop the ripoff of older people with products that literally were not worth the paper they were written on.

The consumer protection provisions Senator Reid has put in the merged bill, as it relates to exchanges, are going to keep low-quality plans out. This is going to offer customers the peace of mind of knowing that when they look at the plans, they can be certain they will have to meet minimum consumer protection standards. This is an important message to send in a new marketplace, and it will be an opportunity to have a very different start than we saw with Medicare, during those early days, when seniors were sold these policies to supplement their Medicare, private insurance policies that were a lot of junk.

Finally, under the merged bill, you are going to be able to see the value you are getting for your health care dollar, in an important respect, through what are called loss ratios that insurance companies will have to make public. What this means, of course, is consumers want to know that when they put out a dollar for premiums, they will get a significant portion of that dollar back in actual benefits and services. With the exchange, it is going to be possible to finally get this kind of loss information in one place and make it public.

So what I would like to do is talk about the steps from here and particularly build on principles the President talked to us about earlier this year in terms of ideas that bring Democrats and Republicans together; that is, more choice and more competition in the health care marketplace. What we are pointing to is the day when every consumer in America can say to their insurance company: I am giving you an ultimatum. You treat me right or I am taking my business elsewhere. That is what we are pointing to.

Here are some of the steps it is going to take in the days ahead to build to that future.

First, you have to have a big enough pool of people as soon as you can so as to maximize their clout in the marketplace. You have to make sure the exchanges are open to more than just folks who have been uninsured. If you open it just to folks who are uninsured, who have not seen a doctor, who have had chronic illnesses, who have not been able to get the preventive care they need, you have coming to the exchanges folks who are sicker and, of course, they are more expensive in terms of getting them good health care, and it is harder to hold down costs.

Once you have a big enough pool, where the risk is spread across a large group of people who have a wide range of health risks, you will be in a better position to force the insurance companies to compete and drive down costs for everybody.

In effect, in the days ahead, we will be in a position to put in place a cycle in the health care marketplace that will get more value for the American consumer. More and more people will come to the exchanges because the premiums are lower. More insurers will come into the exchange because they see that is the place you have to go in order to get business. Then you have what amounts to the beginnings of a revolution in the health care marketplace: get as many healthy people into the exchange; make it impossible for insurance companies to find loopholes and use slick marketing campaigns to cherry-pick just the youngest and healthiest; force them to compete on the basis of price, benefit, and quality and then you are on your way to taking a dysfunctional American health care system and getting the choice and competition that will finally pay off for the American consumer.

There are some additional interim steps I wish to mention briefly. The majority leader, Senator Reid, and Chairman Baucus and I have come to an agreement that will also provide the opportunity to get more choice and more competition into the health care marketplace. What we have agreed to is, folks who spend more than 8 percent of their income on health care but are not eligible for subsidies--in effect, folks with what is called the hardship waiver--they would be able to get a voucher from their employer and go into the marketplace. With that kind of approach, which would be tax free to them, our estimate is that it will be less than one-third as expensive, in terms of getting health care for those folks, as the alternative--the system of subsidies. Again, we get more people covered in a more affordable way, building on these time-honored principles of choice and competition.

Finally, Senator Collins, Senator Bayh, and I have a proposal, a proposal that has been endorsed by the National Federation of Independent Business, that would say that employers that are in the exchange can voluntarily say they want to give their workers more choices. In effect, it would say to those small employers in the exchange: You and your workers will have a choice to have a choice. No employer is required to do anything. But should they want to concentrate on making their widgets rather than being in the health insurance business, they would have the opportunity to do it.

What they would give their worker would be tax free to the employer, tax free to the worker. Once again, you bring the principles of choice and competition into the health care marketplace and move us closer to that day when the consumer can give the insurance company the ultimatum I have envisioned; which is: Treat me right or I go elsewhere.

I close by saying, in my view, the majority leader has laid the foundation for a new health care marketplace. I certainly would like to do more. As the distinguished Presiding Officer knows, as cosponsor of our bipartisan Healthy Americans Act, I would like to do more, and I would like to do it faster. But make no mistake about it, this is laying a foundation to create a new marketplace in American health care, where that concept has been foreign.

To let people make apples-to-apples comparisons, keep crummy products out of the exchange, make sure people can get information about loss ratios, that is a real foundation. Then we seek to go further. We have had the counsel of some of the country's leading thinkers about American health care.

Let's get more healthy people into the exchanges. Let's make sure we have these big pools. Let's make sure the insurers cannot try to steer the marketplace because we know they are going to try, in ingenious ways through advertising and market promotion strategies, to still find the best risks. Let's build on what Senator Reid has laid out with respect to the exchanges in the days ahead.

We are going to be at this a long time. You are not going to fix a dysfunctional health care marketplace in a matter of weeks. We are going to be at this the rest of this week, next week, well into 2010. I have been part of this debate since I was codirector of the Oregon Gray Panthers, going back 30 years now.

I continue to believe there is an opportunity for Democrats and Republicans to work together. Our party has been right on the issue of coverage. You cannot fix this unless all Americans have good, quality, affordable coverage because otherwise there will be too much cost shifting. But as I have said to my colleagues on the other side of the aisle--I see Senator Bunning, and he and I have worked together on the Finance Committee--our colleagues on the other side of the aisle make important points with respect to choice, with respect to markets, with respect to competition. This is an area we can work on together.

There is nothing partisan, in my view, about creating a new health care marketplace through these exchanges. This bill lays a foundation, and there will be opportunities for Democrats and Republicans to build on that foundation in the days ahead.

I yield the floor.

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