Service Members Home Ownership Tax Act Of 2009

Floor Speech

SERVICE MEMBERS HOME OWNERSHIP TAX ACT OF 2009 -- (Senate - December 23, 2009)

BREAK IN TRANSCRIPT

Ms. KLOBUCHAR. I want to thank you, Senator Merkley and Senator Harkin, for your work on is issue. I have observed the same problems with Medicare reimbursement in my home State. We represent States and regions that have demonstrated true leadership in lowering costs to Medicare while increasing the quality of care patients receive. The high-efficiency areas we represent are known for utilizing integrated health delivery systems and innovative quality measures to provide Medicare beneficiaries with better value. Research shows that these efficient delivery practices can save the Medicare Program upwards of $100 billion a year while also providing beneficiaries better access to the care they need. Unfortunately, the current Medicare payment structure penalizes those who provide efficient care while rewarding those who order unnecessary tests and services. It is critical that this is addressed in conference, and it will be-a-priority as we move forward through this process.

BREAK IN TRANSCRIPT

Ms. KLOBUCHAR. Mr. President, I come to the floor in support of the Patient Protection and Affordable Care Act. It is an honor to follow my friend from Washington, Senator Cantwell, who has been such a leader on the Finance Committee in focusing on the very issue that is key in my State; that is, cost reform, delivery system reform, because for too long the people in cost-efficient States, such as Minnesota, Washington, and Wisconsin, have been seeing other States not quite offering that kind of quality care we would like to see all over the country.

I think it always shocks people. If you go to a hotel and you say you want to get a room, usually if you spend more money you have a bigger room and you have a better view. That is not true with health care.

Time and again, we see studies across this country--academic, bipartisan studies--showing, in fact, some of the highest quality health care comes with some of the lowest costs.

As the Senator from Washington talked about how we can save that $700 billion year that is wasted in our system, a lot of it comes not at the cost of care but actually at getting better care, because if you reduce unnecessary waste, if you stop having people running around to 20 different specialists who are giving them conflicting advice and not conferring and not knowing about the medications they are taking, when you have those disorganized systems, they not only cost too much money for everyone, they also give worse care. That is why the Mayo model, an integrated care model with one primary care doctor working with a team of specialists is a model we would like to see all across this country.

We cannot simply keep pushing our problems to another day. Rising health care costs are unsustainable, busting the budget of families and businesses alike. If we do not act, these costs are going to break the backs of the American people.

This country spends $2.4 trillion on health care alone. That is $1 out of every $6 in the American economy. It is projected to be 20 percent of our whole economy in 2020 if we do not act. Despite spending 1 1/2 times more per person on health care than any other country, we all know there are many problems in our health care system.

Wages simply do not keep pace with premiums. Peoples' wages have been stagnant or maybe gone up a little, gone down some or they lost their jobs, but health care costs continue to skyrocket.

I always tell the people in my State there are three numbers we need to remember--6, 12, and 24. Ten years ago, the average American family was spending $6,000 a year on their health care. Now they are spending $12,000, with many people spending a lot more. What will they be spending in 10 years if we do not act? Mr. President, $24,000, up to $36,000 a year on their health care premiums.

When I go around my State, I hear these stories all the time. Granite Gear, a little backpack company up in Two Harbors, MN, makes backpacks for our soldiers. They have done well. They built their business. The guy in charge of it said he would not have started that business if he knew then what he knows now; that is, for his family of four, a small little business in Two Harbors, MN, he is spending $24,000 a year on his health care.

I have heard from doctors at Gunderson Lutheran in La Crescent, MN. They told me the story of how at one of their hospitals in their region they had three patients in a 1-month period come into the emergency room with severe stomach problems. They had ruptured appendixes. Do you know what they said as to why it got to that point? For two of them, they worked at small businesses and they were afraid it was going to blow up the premiums for health care coverage for that little company. The third one could not afford the copays. They waited and waited and waited. They got a doctor and that doctor was the emergency room, some of the most expensive care in this country.

I heard from a mom in Bemidji, MN, who has a daughter named Micki. The mom's name is Sheryl. She wrote me a letter. She said:

I just got off the phone with my daughter Micki. At first, I couldn't understand her because she was sobbing so hard. Her husband had just been told by his boss that they wouldn't be carrying health insurance on their employees any longer. They are a small company and it was costing them $13,000 a month. For her, this is a matter of life and death. She has cystic fibrosis. Her medications can run anywhere from $7,000 to $13,000 a month. Because it is a preexisting condition, the insurance companies won't touch her unless it is under a group plan like the one her husband just lost.

She went on to say in her letter:

You need to stand and be my voice, be Micki's voice. Micki is a fighter but she can't keep fighting a system that is so against her. Micki has already lived longer than any of her doctors expected. We need you to be her voice.

That is why this bill is so important. The status quo is simply not sustainable, not for families, not for small businesses, not for big businesses that are trying to compete internationally against other companies and countries that have more efficient health care systems.

Despite claims from my friends on the other side of the aisle, we have spent months debating this issue. The C-SPAN viewers know what I am talking about. If you look at the input the Republicans have had on this bill, you can see that over 160 amendments were accepted in the HELP Committee. Dozens of bipartisan meetings and roundtable discussions were held in the Senate Finance Committee.

They have engaged across this country--so many people, sadly--in a campaign of misinformation. I know a lot of people in Minnesota and across the country are left trying to wade through all the ads, misinformation, and scare tactics to find out what this bill is about. Well, this bill is not perfect, as so many of my colleagues have said. We will work to make changes and work forward. I would like to see more cost reform in this bill. But what we do with this bill is a beginning not an end. We work to reduce cost, we work to expand coverage and increase choice and competition for American consumers.

First, and very important to me and to my mother--who is 82 years old--this bill protects Medicare and our seniors. Medicare is one of the most valued social programs our country has produced in the last half century. Yet it is also a program in dire need of reform if it is to survive on sound financial footing and continue to provide the fine medical care our seniors have come to expect.

By 2011, the first baby boomers will enter the Medicare system. Without action, if we sit and put our heads in the sand, it will go in the red by 2017. So think of people such as my mom--82 years old. She wants to live well into her 90s and beyond. Think of people who are 55 and who want to be on Medicare when they are 65. It is going to go in the red by 2017 if we don't do something to make sure it is on strong financial footing.

With this bill, we start to do that. We extend Medicare solvency by 10 years. I am encouraged that my legislation can create a value index, which the Senator from Washington discussed, as part of the formula that is used to determine Medicare's fee schedule. That was included in the Senate's bill. This indexing will help reduce unnecessary procedures because those who produce more volume will also need to improve care or the increased volume will negatively impact fees. Doctors will have a financial incentive to maximize the quality and the value of their services instead of just the quantity.

My favorite story along these lines is not from Minnesota but from Geisinger, PA. They were trying to figure out: How do we best treat diabetes. We are not happy with the results. They realized with the routine cases, those were the people they wanted someone to see more often, to check in on them. So they had them assigned to nurses and the more difficult cases to the endocrinologists. The endocrinologists would review the nurses' work and make sure there was proper followup if there had to be adjustments. At the end of year, they had much happier patients. The quality of care went way up, and they saved $200 per month per patient.

What does our system in America do now? What does the Medicare system do? It punishes them for that good work. So that is what we are talking about, actually getting that higher quality. You can save money if you have the right incentives in place.

With this legislation, we also stop paying for care that doesn't result in quality patient outcomes. Who wants to go into the hospital to be treated and get sick from something else during that hospitalization? When you have to go back again, that is called a hospital readmission. In 1 year, hospital readmissions cost Medicare $17.4 billion. A 2007 report by the Medicare Payment Advisory Commission found Medicare paid an average of $7,200 per readmission that was likely preventable. This practice must stop. This isn't good care for patients, and it is not a good investment for taxpayers.

The bill also establishes an independent, 15-member Medicare Commission tasked with presenting Congress with comprehensive proposals to reduce health care costs and improve quality of care for Medicare benefits. The current Medicare payment policies are not working well for patients, doctors, and hospitals. We have to control costs and we have to get that high-quality care we see in Minnesota throughout the country.

In this bill, we also work to stop fraud and abuse. Law enforcement authorities estimate that Medicare fraud costs taxpayers more than $60 billion every year--$60 billion going to con men, $60 billion going to storefronts that say they are a doctor's office, when all that is behind it is a bunch of fraudsters and rip-off artists who are getting checks meant to go to providers of care to our seniors--$60 billion a year. Finally, we have a bill that puts the tools in place--enhanced criminal penalties--that allows for direct deposit of those payments from the government to those providers, so we don't have people ripping us off with an antiquated system of bad and false checks. With this change, we put a stop to criminals running phony businesses to steal Medicare checks from our seniors.

We are also working to help our seniors with the cost of their prescription drugs. Millions of Americans depend on prescription drugs to help them manage chronic disease or other illnesses. But drug prices continue to skyrocket. That is why I voted for reimportation, to allow these safe drugs to come in from places such as Canada. We are not afraid of getting our medications from Canada. Canadians come to shop and to vacation and to fish in Minnesota, and we go to Canada to shop and to work and to fish. We don't have a problem with their drugs. Sadly, that proposal did not pass the Senate, but I will continue to advocate for that.

What does this bill do so far? What it does is to help fill that doughnut hole, that point where seniors who had been getting help with paying for their prescription drugs stop getting that help. That doughnut hole is now filled.

This legislation provides relief for our small businesses. Right now, small businesses pay 20 percent more than large businesses for the cost of care. In a recent national survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as a reason. Beginning in 2011, with this legislation, small businesses will be eligible for tax credits worth up to 35 percent of their contribution to their employees' health insurance plans. In 2014, these tax credits will even increase more.

This legislation, as we all know, also creates insurance exchanges known as small business health option programs--or SHOP programs--where small businesses can finally pool their numbers and do what big businesses do--negotiate for better rates for their insurance.

Beginning with the passage of this bill--and this is one of my favorite parts--kids can't be denied coverage due to preexisting conditions. So if your son or daughter gets sick, an insurance company can't look at you and say: I am sorry your kid got sick, you don't have any insurance.

Look at the story I just read with Micki, the woman whose husband lost her insurance. She has cystic fibrosis, and she is not sure if she is going to be able to get insurance. This puts an end to that and for kids it does it the minute the bill gets signed into law.

Insurance companies will be barred from limiting the total benefits Americans can use over the course of a year or over their lifetime. Affordable insurance coverage options will also be made immediately available through a high-risk pool for Americans who have been uninsured and have been denied coverage because they have a preexisting condition.

With this bill, insurance companies immediately must fully cover regular checkups and tests that help prevent illness, such as mammograms or eye and foot exams for diabetics.

In addition, children would continue to be eligible for family coverage through the age of 26.

I see my friend, the Senator from Pennsylvania, is here. Maybe he has four children who will soon be 26. I know many people are glad this bill has contained in it a provision that says you can keep your kids on your insurance until they are 26.

We know this bill isn't perfect, no big piece of legislation ever is. There is still work that needs to be done in conference committee. There are still negotiations that will take place. There are still things that need to be fixed. We know this is only the beginning of reform, not the end, but we must keep looking to the future. For too long, health care costs have been spiraling out of control. That is why we can't afford to hold off any longer on reforming health care.

I am going to close by reading something Vicki Kennedy--Ted Kennedy's widow--wrote for the Washington Post. This is what she wrote this weekend:

The bill before Congress will finally deliver on the urgent need of all Americans. It would make their lives better and do so much good for this country. That, in the end, must be the test of reform. That was always the test for Ted Kennedy. He's not here to urge us not to let this chance slip through our fingers. So I humbly ask his colleagues to finish the work of his life, the work of generations, to allow the vote to go forward and to pass health-care reform now. As Ted always said, ``When it's finally done, the people will wonder what took so long.''

After all the work and debate that has gone into this bill over the past year, we are finally having the votes the American people deserve. Tomorrow morning, Christmas Eve, will be the vote.

I yield the floor.

BREAK IN TRANSCRIPT

Source