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Public Statements

Repealing Mandatory Funding for Graduate Medical Education

Floor Speech

Location: Washington, DC


Mr. COURTNEY. I rise in opposition to the underlying bill, which, by the way, is a bill that would repeal a provision of the Affordable Care Act that was aimed at trying to strengthen the primary care infrastructure of this country, which is in fact a huge challenge for the Medicare program, but for some reason over the last couple of months or so, Medicare just seems to be the target.

I think it's important for people to remember that in 1965 when Medicare was passed and signed into law on Harry Truman's front porch, only half of America's seniors had health insurance.

Part of it was because of the cost, but part of it was because the insurance companies would not insure that demographic. It was just simply too high a risk to write insurance policies by individual companies for people who, again, because of nature carried the highest degree of risk in terms of illness and disease. Over time, the genius of Medicare, which was to pool risk, to create a guaranteed benefit, to fund it through payroll taxes, to fund it through Medicare part B premiums, demonstrated that we could raise the dignity and quality of life for people over age 65 and in fact extend life expectancy.

But the Republican Party has been targeting this program over and over again. In the 1990s, they came out with Medicare part C, Medicare Plus Choice, which was again giving insurance companies a set payment who promised to provide a more efficient, lower cost product for seniors. And what happened? Insurance companies enrolled millions of seniors in Medicare Plus Choice products. And realizing in a short space of time that they did not in fact have the funds to create a sustainable product, they canceled coverage for seniors all across the country.

I was at hearings in Norwich, Connecticut, in 1998, where seniors who had signed up for these programs suddenly got notification in mid-policy year that the insurance companies changed their minds, and they dropped them like a hot potato. In many instances, seniors who were in the middle of cancer treatments and chronic disease treatments were left high and dry without coverage. So that program failed.

Later, we had Medicare Advantage. Medicare Advantage was sold on, again, the premise that it would provide coverage for seniors cheaper than regular Medicare. And what in fact happened? The Department of Health and Human Services had to offer insurance companies 120 percent of the baseline costs for Medicare in order to entice insurance companies to participate in the Medicare Advantage program; a ridiculous overpayment, treating unfairly seniors who were in traditional Medicare and paying for Medicare supplemental insurance.

Last year we did something about that unfairness by equalizing the payments to seniors on traditional Medicare and Medicare Advantage. And today what we have is the Ryan Republican plan, which says you get an $8,000 voucher if you are under age 55, and good luck in terms of trying to find coverage, again, in a market that is going to be very, very careful about not extending actual coverage because of the risk that's attached to it.

Now, the rank unfairness of saying that we are going to create a two-tiered system for people over the age of 55 and people under the age of 55 is obvious even in my own family. I am 58 years old. My wife Audrey, who is a pediatric nurse practitioner, is 51. I get one version of Medicare; she gets stuck with the loser version of Medicare under this proposal. Again, the unfairness of it is so obvious to all families across America. And again, it is one that is why I think the public is turning so quickly against the Republican agenda.

And we are told and we are asked: What's your alternative? Well, look at the trustees' report that came out last week. Look at it. What it said was that the Affordable Care Act in fact extended solvency for the Medicare program by 8 years. We did suffer some reductions, but that was because of the economy. Read the trustees' language. The smart efficiencies which were introduced into the Medicare program through the Affordable Care Act in fact have made the Medicare program healthier.

And if you look at the Ryan Republican budget plan, they took every nickel of those savings from the Affordable Care Act. Even though that caucus demagogued all across the country, campaigning about so-called Medicare cuts in the Affordable Care Act, well, the Ryan Republican plan incorporated every single one of those changes in the Affordable Care Act.

But at the same time, it took away all the benefits of the Affordable Care Act in terms of helping seniors with prescription drug coverage, annual checkups, cancer screenings, smoking cessation, all of the smart changes which the Affordable Care Act made to provide a better, smarter, more efficient Medicare benefit for seniors.

The fact of the matter is that the Democrats do have an alternative. We have a program which we passed last year which, for the first time in decades, extended the solvency of the Medicare program.

Let's not abandon it. Let's preserve the guaranteed benefit for seniors. Let's reject the Ryan Republican Medicare plan.


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