Departments of Labor, Health and Human Services, and Education Appropriations Act, 2008
Floor Speech
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION APPROPRIATIONS ACT, 2008 -- (Senate - October 19, 2007)
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Mr. BURR. Mr. President, I thank my colleague, Senator Coburn. This is an important debate. I think some in the body have suggested this is sort of a dilatory tactic. It is not. I think the future of health care in this country is one of the single most important topics this body should talk about.
Senator Coburn went down the list of earmarks we find in the bill. The incredible thing is it didn't seem odd hearing those on this floor because we hear it all the time. But to the American people, when you hear about a field trip costing $500,000 to the Chesapeake Bay, America thinks that is probably a field trip for Members of Congress. I am not sure we could find the Chesapeake Bay. I am not sure we can get outside of the 30-square miles surrounded by a reality called Washington, DC. Therein lies a lot of the problem.
All we are asking our colleagues to do is express your view through a vote as to whether children are more important than the personal interests of the earmarks. I have some in this bill. I would give them up, as long as I know the money is going to where it can do some good. We have debated children's health, and I voted against the extension of the SCHIP bill. My Governor lobbied extremely hard for me to support that bill. Now, all of a sudden, we are talking about covering 177,000 kids in America with this bill. I haven't gotten a call from my Governor. The Governor is willing to take it if it is a lump sum with no conditions and they can use that however they want to, but when you target it on kids, what is this about? This is about prevention. This is about creating a medical home for kids versus delivery of care in the emergency room because both of them don't cost them anything.
The misunderstanding about the American health care system today is that if you can't pay and you walk into an emergency room, every emergency room is required to provide that care for you. Well, that creates a tremendous cost shift, and for those of us who pay out of our pocket or we pay because we have insurance coverage, our insurance goes up.
And the rate out of pocket goes up because we are having to compensate for the people who don't pay, who don't have coverage, for the people who we have not changed our health care system to reflect what their conditions are.
We have an opportunity to begin to chip away at it. We have an opportunity to insure at least 170,000 people. If this were only North Carolina, the $2,300 Dr. Coburn talked about for the cost of a policy would be closer to $1,342. We could actually insure more children in North Carolina, and he probably could in Oklahoma.
We know people will call and question our numbers, so we take the most expensive rate it could cost. I remind my colleagues that under the SCHIP program we passed, if the Federal Government is to provide this care, it was allocated somewhere between $3,400 and $4,000 per child. There is the reason you never want the Federal Government negotiating your health care. I came here 13 years ago. My insurance was with a company of just over 50 employees, and when I became a Federal employee and accessed my care with the same plan of coverage, only one thing changed: My premium went up because the Federal Government had negotiated my plan.
I learned this last year when my oldest son turned 22. I got a notice from BlueCross BlueShield that the Federal plans drop our children at age 22 regardless of whether they are in school. My son happens to still be in school. I hope this year he will graduate. I was faced, like every Federal employee, with the fact that I had a child who was no longer going to be insured under my family plan. I thought for sure that if I called the Federal Government, they would tell me they had already negotiated a plan that I could step him right over into, and they had. It was the same BlueCross BlueShield plan he was under. What was the annual cost? It was $5,400 a year for a 22-year-old healthy bull. What did I do? I went back to North Carolina and checked with the school and said: Have you got a negotiated plan? They said: We have a negotiated plan with BlueCross BlueShield, which was identical to what he had under me--the one OPM negotiated, which was $5,400--and I paid $1,428 for that. It had the same deductible, same copay, same coverage, with one big difference: One was negotiated by the private sector, or by the university, and the other by the Federal Government.
We don't negotiate deals in the best interest of the people we are trying to cover. That is one of the reasons expansion of SCHIP is a bad thing. Actually, changing the health care system to cover 47 million Americans--children and adults who today don't have insurance--is a good thing. I would vote today for the current SCHIP to be reauthorized, for us to put in enough money to make sure nobody is dropped from the rolls, to change the formula for the States so those who were cheated were treated fairly, and I would vote for it today. But why would I expand a program that pays 30 percent too much to 50 percent too much to cover our kids when the answer to health care is to fix the system?
The reality is that we are here about this amendment. This amendment would force Congress to prioritize between children's health, rather than parochial pork projects of over 700 projects, almost $400 million, that we could redirect from this one appropriations bill and devote it fully to the 9.5 million uninsured children in this country. And 9.5 is the number in total; 3.9 of those have been without insurance for over a year. So, as you can tell, you have the majority of the children's population that is considered uninsured that at some point in the last 12 months has actually been insured.
Going back to SCHIP expansion, one of the clear facts about expanding SCHIP--not just the numbers of kids who are on it but the income level--is that I don't think Americans believe that an income at $82,000 needs to be subsidized by the Federal Government. That is where they were driving the income limits for SCHIP.
Probably more important than that is that we were actually taking kids off of their parents' insurance and putting them on the Federal Government's insurance. We were taking kids who ride for free on their parents' insurance and now paying $4,000 to put them on the Federal Government's plan. The taxpayers looked at us and thought we were crazy that we were even debating this. There wasn't an exclusion in the expansion that said we are going to take the ones who are only uninsured today; no, we are taking all of them. We will take the ones who are insured and flip them over, and clearly the only thing that achieves is growing the size of the Federal system.
Mr. President, I hope when we come back on Monday that more of our colleagues will listen and that many will express their preference that we put children's health in front of projects. I actually believe that today, if it passed, it would never come out of conference, the earmarks would show back up, and children's health would go away, and it would happen at some point in that process. Quite honestly, who would lose? The kids. The kids are losing today because we are not debating what we should be debating, which is health care reform. The uninsured are losing today because we should be debating health care reform. Every American is losing today because, for those who are insured, those who have seen their premiums rise in high single and double digits every year for the past 10 years--and they have asked why. I can tell you why. It is because we won't fix health care. It is because your premium increase is reflective of those who are not covered.
Tom Coburn and I are here today saying we should cover them and we have a plan to do it. It doesn't distinguish between adults and children. Through covering those 47 million--or whatever the number is--we will save $200 billion a year in cost shifting. That $200 billion a year will begin to bring everybody's premium in America down for the first time in the last decade. So it is not just an effect on the uninsured, an effect on children, an effect on adults; it is an effect on every American who currently has private insurance and the reality of the impact on their premium cost.
I know the occupant of the chair today is a big proponent of prevention. He is outspoken on it. You cannot have prevention without coverage. You cannot have real prevention that individuals buy into unless there are rewards on the other end. The reward of healthy decisions is that you're less risky for illness. When you are less of a risk, your premium cost goes down.
Eventually, I would like to see every American own their health insurance policy. I would like to see the ability to take an insurance policy from one employer to another because we have negotiated, not an employer. I would love
to see every American in a position where they are not holding onto a job they hate in a location they dislike because they cannot afford to give up health insurance. I want to see them have ownership with health insurance, like with a 401(k) plan. They can make the decision about what is best for their family and future and occupation without health care being the pivotal piece of that decision.
We are held hostage by the employer-based system. That is not to say I am proposing we get away from it. I am only suggesting that a partnership between individuals and employers, between individuals and insurance companies, an effort by Congress to restructure health care and reform insurance products, to provide America with an unlimited basket of options for coverage, is a good thing.
We created Part D Medicare. For the first time, we extended prescription drug coverage to seniors in the country. It was not an oversight in 1965. Medications at that time weren't really used widely to treat patients. Today, it is part of every office visit--some type of medication. So we didn't know exactly where we were headed when we created Part D--something targeted just for Medicare individuals.
Today, 84 percent of the population that is eligible has signed up. What is our experience in the first year? It is important to look at outcomes. Our experience is that premiums dropped 28 percent. This year, the costs every Medicare-eligible person paid last year dropped 28 percent, on average, for Part D coverage. What about the drug cost? What about the pills they are buying every month or every quarter? The first year, the reduction in the cost of services delivered and pharmaceuticals is 33 percent. Why? One, we extended the offer to all seniors. We didn't exclude anybody. Two, we created real competition, which means that if there is a Federal piece, we had private sector plans and options that competed. We made sure there was a robust basket of competition. Third, and probably most important, for the first time we forced transparency in health care. We actually made plans and pharmacies list the price of certain drugs online so that we could do what we do best in America: shop where the price was the most advantageous for what it was we wanted to purchase. You know what. We learned that seniors are very aggressive at it. I knew that about my grandparents before they died. I am finding out that, as my parents get older, they get a little tighter and they want to make decisions that are financially to their benefit.
We have extended that opportunity to millions of Medicare-eligible individuals in this country. What are we talking about? Creating the same model, taking that positive experience we had with Part D and extending it over to the entire population that is under private insurance, giving them options--options that deal with real competition, transparency in dealing with prices, the opportunity for those covered by employers to have reductions in premiums, and over some period of time, for those Americans who want to take advantage of it, to actually have ownership in a plan they have negotiated that doesn't lock them into an employer, but they are able to use that in a portable way, to switch jobs without having to renegotiate their coverage.
Well, I think I have presented to you where we are today and where I think we need to go over some period of time in the Senate. It won't happen if Members take this opportunity to insure 177,000 children who are currently uninsured, who currently cause a cost shift in America, who currently receive emergency care and are not provided prevention, who don't have a medical home to go to, a doctor they know they can call, whether it is for a sore throat or an earache or, Heaven forbid, the current staph infection that is going around, which has killed now one out of five individuals who have been infected with it.
We live in a very dangerous world, which should take what is best about our health care system--and that is prevention and diagnosis--and make sure every American has it. You cannot have it without coverage. You have to start somewhere, and these 177,000 children is the perfect place for us to start.
I yield the floor.
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