[Congressional Record Volume 156, Number 133 (Wednesday, September 29, 2010)]
[Senate]
[Pages S7673-S7693]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONGRESSIONAL DISAPPROVAL OF RULE RELATING TO GRANDFATHERED HEALTH
PLAN--MOTION TO PROCEED
Mr. ENZI. Mr. President, I move to proceed to S.J. Res. 39.
The PRESIDING OFFICER. There will be 2 hours of debate equally
divided.
The Senator from Wyoming is recognized.
Mr. ENZI. Mr. President, the resolution we are debating today is
about keeping a promise. The authors of the new health care law
promised the American people that if they liked their current health
insurance, they could keep it. On at least 47 separate occasions,
President Obama promised: ``If you like what you have, you can keep
it.''
Unfortunately, the Obama administration has broken that promise.
Earlier this year, the administration published a regulation that will
fundamentally change the health insurance plans of millions of
Americans. The reality of this new regulation is, if you like what you
have, you can't keep it. The new regulation implemented the
grandfathered health plan section of the new health care law. It
specified how existing health plans could avoid the most onerous new
rules and redtape included in the 2,700 pages of the new health care
law.
This provision was a critical part of the new law. It allowed
supporters to argue that current health insurance plans would be exempt
from all of the rules and regulations created by the new law. Employers
and health plans were told that the grandfathered protections would
mean if you have coverage on the day the law passed, you could keep
that coverage without having to make any major changes.
Employers and employees thought the bill would have cost-cutting
measures, but now they find only cost increases. The new law will
provide no relief to increasing costs until at least 2014. But this
rule and its higher costs kick in now. Unfortunately, the regulation
writers at the Departments of Treasury, Labor, and Health and Human
Services broke all those promises. The regulation is crystal clear.
Most businesses--the administration estimates between 39 and 69
percent--will not be able to keep the coverage they have.
Under the new regulation, once a business loses grandfathered status,
they will have to comply with all of the new mandates in the law. This
means these businesses will have to change their current plans and
purchase more expensive ones that meet all of the new Federal minimum
requirements. For the 80 percent of small businesses that will lose
their grandfathered status because of this regulation, the net result
is clear: They will pay more for their health insurance.
The Wall Street Journal recently reported costs as going up between 1
and 9 percent because of the mandates included in the new health care
law. Couple this increase with inflation, and small businesses are
looking at a 20-percent cost increase. I actually know something about
small business; I used to run one.
I ran a shoe store in Wyoming. I stocked the shelves, worked the
customers to fit shoes, ran the cash register. I placed the orders with
suppliers. I did the accounting, I swept the sidewalk, I cleaned the
toilets. I knew what it was like to worry about making payroll at the
end of the month. I know firsthand about the struggles and challenges
America's small businesses face. I understand what this regulation will
do to small businesses across the country. Small businesses are
struggling every day to find the resources to provide health insurance
to their employees. Rather than making it easier for those businesses
to continue to provide this coverage, the new regulation will mean that
employers will simply drop their health coverage altogether. That is
why I am so concerned about this grandfathered health plan regulation,
and that is why I introduced the resolution we are debating today.
My resolution would force the administration to actually keep their
promises. The resolution would overturn this grandfathered health plan
regulation and allow tens of thousands of businesses across the country
to keep their current plans. If we pass the resolution, millions of
Americans will be spared from paying higher health care costs as a
result of new Federal mandates. If we pass the resolution, small
businesses across the country will not have to drop health insurance
for their workers.
Congress created the Congressional Review Act we are using today
specifically to overturn Federal regulations such as the one we are
discussing. The sponsors of the Review Act recognized that too often
Washington bureaucrats impose sweeping new regulations with little
thought to the impact these changes will have in the real world. In
particular, the Review Act was intended to protect small businesses
across the country that are often most vulnerable to new government
mandates and regulations.
That is precisely what happened with the grandfathered health plan
regulation. The regulation writers went above and beyond what the law
said and came up with a whole slew of requirements businesses must
comply
[[Page S7674]]
with if they want to keep what they have. The regulation includes a
long list of things that will disqualify businesses from being able to
keep what they have. If a business does anything to try to keep costs
under control, they lose their grandfathered status.
Earlier this year, when the grandfathered regulation was first
published by the administration, I came to the Senate floor and warned
of the negative impact this regulation would have on small businesses.
This new regulation appears to ignore the impact it will have in the
real world. It will drive up costs and reduce the number of people who
have insurance.
I recently heard from Jim, an insurance agent in Illinois, who wrote
to me and said:
My experience in the last few months is--maintaining
grandfather status to my group plans is all but impossible.
All my clients' renewal rates in September and October are in
excess of thirty percent. To keep grandfather status, the
group is limited in deductible changes and contribution
levels. The only option is for the employer to accept the
premium increase at the worst economic time in forty years.
They can't afford to keep the grandfather status and soon
won't be able to afford insurance at all. In my opinion, the
legislative goal was to make maintaining grandfather status
so restrictive, companies are forced out. It's working.
I have a whole slew of similar stories and I ask unanimous consent to
have some of them printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
How the Grandfathered Health Plan Regulation Is Impacting Americans--
Real Life Stories From America's Health Insurance Agents
I recently helped a couple in their 50's who each had their
own individual policy. I signed them up with their policies
about a year ago and they gave me a call when their annual
rates increased the usual 15%. They wanted to look for
something more affordable even if it was a higher deductible
plan. They settled on a plan. I went to meet with them and
began to explain grandfathering and that if they do choose
the new plan, they will lose the chance to keep their
grandfathered status and either way will have to pay more.
They decided to stay with their ``grandfathered plan''
because the benefits are ``better'' than what they would have
been if they went to a new plan where they would have more
out of pocket costs.
Really, either way, it's a lose-lose. At least if things
would've remained the same, the benefits would be better.
But, now we have to tell our clients and prospects that
prices are still going to go up, and benefits are still going
to go down, but just at a faster pace. It's been kicked into
high gear with ObamaCare. So, kudos to the people that are
making these drastic decisions. I'm glad I'm just the
messenger, because I wouldn't want to be responsible for
killing our healthcare.
Tressa Girt,
Health Insurance Agent,
Milwaukie, OR.
____
Several of the insurance companies doing business in Utah
have announced that they will not allow ``grandfathering''
plans for groups under 50 lives because of the expense to
them to maintaining multiple plans on their books. This
basically leaves those who had coverage with these carriers
without any possibility of grandfathering and thus avoiding
the expense of new mandates.
Charles Cowley,
Charles H. Cowley Employee Benefits,
Salt Lake City, UT.
____
I am an agent in Lafayette, IN. My specialty is small group
health insurance. I work with many farmers and builders.
These are hardworking, honest Americans just trying to make a
decent living. Many of my clients struggle to make ends meet
and desperately want to continue providing health insurance
to their employees. With the healthcare reform, they are
extremely confused and disappointed when it comes to being
able to grandfather their plans. In particular, I insure a
local builder. He has ensured throughout the years that his
employees have good health coverage. He has absorbed many of
the renewal increases in the past few years. With the
downturn in new home sales, his business has struggled. His
group health plan renewed Sept 1, 2010. He received a 15%
increase. In years past, he was able to absorb the increase
and keep the health plan ``as is.'' Financially, this year,
that wasn't an option. He had to increase his deductible
amount or risk being unable to offer health insurance at all.
I explained that this small change would in fact cause his
group to lose their grandfathering status. He was upset and
concerned about the loss. He didn't want to make the change
but it was either that or offer no coverage at all. I believe
that a group should be able to retain their grandfathered
status when making changes in deductibles such as raising by
$500 or adjusting contribution levels. It is unrealistic to
believe a small group can absorb 15+% increases for the next
4 yrs to maintain their grandfathered status.
____
My client is a 22-life group in Ft. Lauderdale, FL.
Currently with Aetna. They received a large increase which is
driving all my clients--not just them--out of a grandfathered
plan! They feel forced to get a new plan because they made
their current plan so expensive. Now, the new plans have much
higher deductibles, more out-of-pocket and the affordable
plans only offer to pay 50% coinsurance! The options are very
limited.
Jennifer L. Eisler.
Mr. ENZI. Folks all over the country are just like Jim. Insurance
agents are explaining to small businesses that they will be forced to
choose either to absorb premium increases in excess of 15 percent or
lose their grandfathered health plan status. By the administration's
own estimate, up to 80 percent of small businesses will lose the right
to keep what they have. Lots of companies pay 90 percent of the cost of
their employees' and families' insurance. They were hoping to be
grandfathered at least until 2014, to see exactly how damaging the
whole bill would be. But we are experiencing 2014 now, with no help in
cost cutting.
The Small Business and Entrepreneurship Council says it pretty
succinctly. In a letter they wrote to me supporting S.J. Res. 39, they
write:
Rather than helping small business owners and their
workforce keep their plans, it appears the rule has been
rigged to force most small businesses and their employers out
of grandfathered status.
The letter also reads:
The rule, as written, is in clear violation of President
Obama's promise that Americans would be able to keep the
health plans they currently have upon passage of the Patient
Protection and Affordable Care Act.
As the Chamber of Commerce, the National Association of
Manufacturers, the National Retail Federation, and other business
groups supporting this resolution have said: This rule will make it
harder for employers to make changes that will hold down their health
care costs. Large and small businesses will have few options for both
keeping costs in check and maintaining the grandfathered status.
If employers do almost anything to help slow the growth in their
health insurance costs, they will lose the limited protections against
the expensive new mandates in the bill. It is worth noting that two
pages in the law that create the grandfathered plans give infinite
leeway to the bureaucrats who are writing the rule, and they took it.
The law doesn't say anything about cost-sharing requirements or
coinsurance rates. The administration made up all of these provisions
and requirements. They didn't have to write these rules in a way that
precludes half of Americans from keeping what they have.
Our economy is already struggling. It doesn't need more job killing.
It doesn't need cost increasing government mandates. We are hearing
from small businesses across the country which are already being forced
to swallow large premium increases that will prevent them from hiring
more workers. It is about the jobs. We need to create more jobs, not
write more regulations that lead to less jobs. This bill was sold as
letting people keep what they have. But the devil is in the details. Do
a little digging and it is clear; Americans would not be able to keep
what they have.
The simple truth is, because this new rule will drastically tie the
hands of employers, few employers are expected to be able to pursue
grandfathered status. I even have letters from people who have
individual situations, and they are concerned as well. That means more
than half of Americans who like what they have would not be able to
keep it.
The final result of the new regulation will be that all Americans
will eventually be forced to buy the kind of health insurance the
Federal Government thinks they should have. Never mind they can't
afford it. Never mind that employers will be less likely to hire new
workers and probably even lay off workers. Simply put, this rule
states: Washington knows best.
This new rule is pretty clear. If you like what you have, you can't
keep it.
Later today, the Senate will have the opportunity to vote on the
resolution that will help small businesses actually keep what they
have. I urge my colleagues to support this resolution and keep the
promise that if Americans like the insurance they have, then they can
keep it. That should be the bare minimum until at least 2014, so
businesses and employers can assess the
[[Page S7675]]
damage from all the regulations combined--and there is a pile of them
coming. Help is not in the bill until 2014, but the rule is for now.
The big question is, Why weren't the cost-cutting measures included in
the regulation?
I yield the floor and reserve the remainder of my time.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, what is the parliamentary situation?
The PRESIDING OFFICER. The Senate is considering the motion to
proceed to S.J. Res. 39.
The Senator from Iowa.
Mr. HARKIN. Mr. President, I have 1 hour?
The PRESIDING OFFICER. That is right.
Mr. HARKIN. I know the Senator from Montana wants to speak. If he
could just withhold for a few moments for my opening comment, and then
I will yield to him.
Mr. BAUCUS. Sure.
Mr. HARKIN. Mr. President, I listened to the statement made by my
good friend--and he is my good friend--Senator Enzi from Wyoming. We
are in the seventh month since the Affordable Care Act became law. Ever
since the day President Obama signed the bill into law, my friends on
the Republican side have made it clear they intend to use every
conceivable opportunity they have to repeal it. This resolution,
regrettably, is another attempt to make good on that pledge by undoing
some of the law's most critically important patient protections.
The resolution offered by Senator Enzi claims to protect small
businesses by repealing the grandfather regulation, which defines which
insurance plans and businesses have to comply with certain consumer
protection provisions of the Affordable Care Act. However, if passed,
the businesses and Americans could be in the worst of all worlds,
losing the clear rules that allow them to keep the plans they have
while not gaining additional consumer protections that apply when their
plan changes.
I have a letter from the Main Street Alliance, which strongly opposes
this resolution. This is an alliance of small businesses. Let me read
an excerpt from that letter. They say:
Opponents of the health law's insurance market reforms
continue to hide behind business arguments and claims about
increasing costs. But independent analyses show that all the
new protections in the law should contribute a mere one to
two percent increase to costs next year, a number easily
offset by provisions like the small business tax credits--
That we have given small businesses--
in the short term and savings from increased bargaining power
and investing in prevention in the longer term. Let's be
clear: those who seek to block implementation of the new
grandfather regulations are acting in the best interests of
the insurance industry, not Main Street small businesses.
Mr. President, I ask unanimous consent that letter be printed in the
Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
The Main Street Alliance,
Seattle, WA, September 28, 2010.
Re Small business opposition to S.J. Res. 39, attempting to
block implementation of health law's grandfathering
rules.
Honorable Senators: On behalf of the Main Street Alliance,
a national network of small business coalitions that brought
the voices of real small business owners to the national
dialogue over health reform, we write to urge your opposition
to S.J. Res. 39, filed in the Senate on September 21. This
resolution of disapproval would prevent the implementation of
the grandfathering regulations that are critical to fostering
an orderly transition to a reformed insurance market under
the Patient Protection & Affordable Care Act.
Some of the health care law's new protections apply to all
health plans, regardless of grandfathered status, including
the prohibition of rescissions, ban on lifetime coverage
limits, and end to exclusion of children based on pre-
existing conditions. Still, other market reforms that are
impacted by the grandfather provision are among the new
protections most important to small businesses.
Small business owners want their health plans to cover
basic preventive care at no cost so they can maintain a
healthy workforce. We want an end to premium discrimination
based on our employees' health status. And we want stronger
review of premium increases and a meaningful third-party
appeals process to make sure we get a fair shake. What we
don't want is to be stuck indefinitely with plans that,
because of their grandfathered status, allow insurers to
continue ``business as usual'' without fulfilling new
protections or submitting their rate increases for meaningful
review--that would not be reform.
Opponents of the health law's insurance market reforms
continue to hide behind business arguments and claims about
increasing costs. But independent analyses show that all the
new protections in the law should contribute a mere one to
two percent increase to costs next year, a number easily
offset by provisions like the small business tax credits in
the short term and savings from increased bargaining power
and investing in prevention in the longer term.
Let's be clear: those who seek to block implementation of
the new grandfather regulations are acting in the best
interests of the insurance industry, not Main Street small
businesses.
Health reform needs to lower costs for small businesses. It
also needs to end the slide toward junk health insurance. The
regulations drafted by the Administration to implement the
grandfather provision create a reasonable transition to a
reformed insurance market. We urge your opposition to S.J.
Res. 39.
Sincerely, on behalf of the Main Street Alliance,
J. Kelly Conklin,
Foley-Waite Associates, Inc., Bloomfield, NJ.
Leanne Clarke,
Haleyanne Jewelry, Seattle, WA.
David Borris,
Hel's Kitchen Catering, Northbrook, IL.
Mr. HARKIN. One of the things we put in the health care bill when we
designed it was the protection for consumers to keep the plan they have
if they like it; thus, the term ``grandfathered plans.'' If you have a
plan you like--existing policies--you can keep them. Well, then we left
it to the Department of Health and Human Services to craft regulations
to define exactly what a grandfathered plan is.
On the one hand, you want to give some flexibility to plans to be
able to make reasonable changes. For example, if costs go up, they can
increase their premiums somewhat. They can do certain things. But they
cannot change the fundamental kind of nature of the plan and still call
it a grandfathered plan. You want to protect consumers to make sure
that what plan they signed up for is the grandfathered plan and not
something else.
For instance, if the regulations are overturned, which is what the
Senator from Wyoming wants, insurance plans could change immensely. Yet
that is not what you signed up for; for example, the grandfathering
rule that says the insurer cannot significantly cut your benefits.
Let's say your insurer decides to cut from your plan conditions such as
cancer or diabetes or heart disease. Let's say they cut that out of
your plan. Well, that plan would no longer be considered grandfathered
because that is not what you signed up for.
The second one says they cannot raise your coinsurance charges. For
instance, if you are required to pay 20 percent of the cost for all
hospital visits, your insurer cannot raise that to 50 percent because
that is not what you signed up for.
They cannot significantly raise copayments. If your plan is
grandfathered, you are protected from drastic increases in copays.
Copays would be allowed to rise nominally each year, but if they
changed significantly, that is not what you signed up for.
Grandfathered plans cannot significantly raise deductibles. Let's say
your plan is grandfathered. You are protected from large increases to
your deductible. That keeps your insurance company from shifting more
cost to you because that is not what you signed up for.
Grandfathered plans cannot significantly increase your premiums.
Well, for example, if 20 percent of your insurance costs are currently
deducted from your paycheck, and your employer pays the other 80
percent, under the rule that cannot be changed by more than 5
percentage points a year. Well, what if a company came in and said: You
were paying 20 percent; now you have to pay 40 percent? If they did
that, that is not what you signed up for, so that should not be a
grandfathered plan.
Also, grandfathered plans cannot add or tighten an annual limit on
benefits. If your plan is grandfathered, your insurer cannot add a new
cap on the amount they will pay for covered services each year. Why?
Because that is not what you signed up for.
Grandfathered plans cannot change insurance companies. If your plan
is
[[Page S7676]]
grandfathered, you get to keep your plan. This means you will keep your
insurance company and with it your network of doctors. Because if that
is changed on you, that is not what you signed up for.
So basically the rule my friend from Wyoming is seeking to overturn
protects you, the consumer. It protects you in keeping the plan you
like; we said, if you like a plan, you get to keep it, and you can
grandfather it in. What if they change the caps on certain annual
limits? What if they raise your copays? What if they raise your
deductibles? What if they sell out to another insurance company that
has a different kind of a policy? Why should that be grandfathered?
Because that is not what you signed up for.
We want to make sure if you signed up for a plan and you like that
plan, it can be grandfathered. What cannot be grandfathered is
something drastically different, which puts you at a disadvantage.
So it is clearcut on this issue before us: You either stand with
consumers and you stand with Main Street businesses--which I just read
a letter from, which recognizes that if they want grandfathered plans,
they also want to be protected, they want some certainty out there to
know what those plans are going to be; and that is what these rules
provide. On the other hand, if you vote to overrule this rule, you are
obviously standing with the insurance companies one more time, letting
them continue what we closed the door on, some of these terrible abuses
of cutting people off, putting caps on what you can get, changing your
policies midstream.
Well, the rule says: Yes, insurance company, you can do that, but you
are no longer a grandfathered plan. That is exactly what this rule is
about, to protect consumers and to provide certainty out in the
marketplace for small businesses so they know what the grandfathered
plans are and what they are not. Without this, if you do not have a
rule, who knows what a grandfathered plan is. It is up in the air.
So with that, I yield 15 minutes to my friend from Montana who did
such a great job as chairman of the Finance Committee in shepherding
the health care reform bill through. He is one of our great experts in
this area, and I know he feels strongly about these grandfathered plans
too. So I yield 15 minutes to my friend from Montana.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I thank my friend from Iowa, the chairman
of the HELP Committee, for his excellent service.
A weather vane shows when the wind is blowing and in what direction
it is blowing and a resolution such as this shows when it is election
season.
This resolution is a political stunt. It is an election-season effort
to take potshots at the new health care reform law. Before the Senate
now is a joint resolution of disapproval under the Congressional Review
Act of 1996. Colleagues will recall that the Congressional Review Act
is part of what some folks called the Contract with America.
This particular resolution would nullify a regulation that is
essential to implementing the new health reform law. The resolution is,
thus, a transparent effort to undermine the new law. I urge my
colleagues to oppose the resolution.
From the beginning, the new health care reform law has been about
ending the worst insurance company abuses. That is why the new law
requires insurance companies to end lifetime limits on coverage. That
is why the new law prevents insurance companies from canceling coverage
when you get sick. That is why the new law requires insurance companies
to allow parents to put their children up to age 26 on their insurance
policy, and that is why the new law prevents most insurance companies
from discriminating against kids with preexisting conditions.
These important new protections took effect just last week. From the
beginning, the law has been about preserving what is good about
American health care. That is why one of the central promises of health
care reform has been and is: If you like what you have, you can keep
it. That is critically important. If a person has a plan, and he or she
likes it, he or she can keep it.
Now some on the other side of the aisle have tried to pick apart that
promise. They have tried to find some rare example to the contrary. But
despite what some folks might say, we stuck to that promise. If you
like your health care plan, you can pretty much keep it.
Then the question becomes: How can we be sure that what you have is
still the same health care plan? What changes can the insurance plan
make and still remain the same plan? That is what this new regulation
is all about.
The Departments of Health and Human Services, Labor, and Treasury
promulgated this regulation on June 17. The regulation defines what
changes an existing health care plan can and cannot make in order to
retain what is called the ``grandfathered'' status.
The new health care reform law gives grandfathered plans special
treatment. This treatment ensures that satisfied consumers can continue
to get their current health care plans, and this treatment ensures that
dissatisfied consumers can get access to a fairer marketplace.
Plans with grandfathered status get more time to incorporate some of
the consumer protections guaranteed in the new health care reform law.
Grandfathered status is valuable to the health insurance plans. In some
cases, it exempts plans from having to make particular changes until
the year 2014.
Some fundamental consumer protections, however, are so important that
all plans have to comply with them right away. Many of those
protections are the ones that became effective just last week. The new
regulation strikes a careful balance. It protects consumers from some
of the insurance companies' most egregious abuses. At the same time, it
recognizes the realities of what insurers are able to do. That balance
is important to maximizing consumer choice, and that balance is
important to minimizing insurance market disruption.
The new regulation spells out coverage changes that would cause
insurance plans to lose this special grandfathered status. For example,
plans cannot significantly reduce benefits and still retain their
grandfathered status. It makes perfect sense to require plans to
maintain their benefits as a condition of their preferred status. After
all, if a plan significantly reduces its benefits, it is not the same
plan anymore. If a plan significantly reduces its benefits, the plan is
not truly letting you keep what you have.
Another example under the new regulation is that plans cannot
significantly increase cost sharing and retain their grandfathered
status. In other words, plans cannot significantly increase
deductibles, copays or coinsurance that are more than nominal.
Once again, the new regulation is only fair because plans should not
be increasing the financial burden on consumers and still qualify for
this special status. If a plan significantly increases the financial
burden on consumers, it is not the same plan. If a plan significantly
increases the financial burden on consumers, the plan is not letting
you keep what you have.
A third example under the regulation is that plans cannot add new or
more restrictive limits on coverage and remain grandfathered. This,
too, makes sense, because imposing or lowering annual limits has the
same effect as reducing benefits, and that is not something for which
plans should be rewarded.
Once again, if a plan adds new or more restrictive annual limits on
coverage, it is not the same plan and the plan is not letting you keep
what you have. These examples demonstrate how reasonable the new rules
for grandfathered status are. Plans basically have to offer the same
coverage. They have to offer the same cost sharing and annual limits as
they do today.
The resolution before us would allow health insurance plans to leave
the path to full compliance with new, commonsense consumer protections.
The resolution would leave consumers relying on the kindness of the
insurance industry, and we have seen how well that works. That is the
effect of the resolution before us.
The resolution before us would strike down disincentives for plans to
cut benefits, increase consumers' out-of-pocket costs, or reduce how
much health care a consumer may use in a year. The resolution before us
would
[[Page S7677]]
thus free the health insurance companies to cut benefits, to increase
out-of-pocket costs, and to reduce annual limits.
The new health care reform law aims to eradicate these abusive
practices, and the grandfathering regulation ensures a successful
transition to a fully reformed insurance market.
The new health reform law puts consumers and their doctors--not
insurance companies--in charge of their health care.
This resolution would put consumers at risk. It would put consumers
at risk of paying more and getting less. This resolution is the exact
opposite of health care reform.
This resolution is a political stunt. It is about repealing health
care reform in an election season. This resolution is an attempt by the
other side to dismantle the new health care reform law piece by piece.
This time, they are sending a message to their friends in the insurance
industry. This resolution invites the insurance companies to continue
to put profits before patients. So I ask: What is next?
The other side says they want to repeal and replace the new health
care law, but we saw what happened before health care reform. Before
health care reform, insurance companies could discriminate against kids
with a preexisting health condition. Before health care reform, health
insurance companies did not have to let adults under 26 stay part of
their parents' health insurance plans. Before health care reform,
health insurance companies could kick people off their rolls when they
were sick and needed coverage the most. That is what the law was before
the new health care reform law. Is that what the other side wants to go
back to?
The bottom line is this resolution would take away consumer
protections that the new health care reform law guarantees.
I urge my colleagues to reject the proposition that insurance
companies know best. They don't know best. I urge my colleagues to
maintain the commonsense consumer protections that have just come into
effect, and I urge my colleagues to reject this election season
resolution.
I yield the floor.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, I appreciate the comments by both of the
leaders on health care from the other side, but you can't have your own
facts. You can't show significant changes as being the only thing that
eliminates grandfathering.
If you look at the Federal Register, page 34,568, the last few
paragraphs say: Any increase in a percentage cost-sharing requirement
causes a group health plan or health insurance to cease to be a
grandfathered health plan.
Another part says: Any increase in a fixed-amount, cost-sharing
requirement other than a copayment--any increase in a fixed amount
copayment. It doesn't say significant changes, it says any change.
I yield up to 10 minutes to my friend, the Senator from Wyoming,
Senator Barrasso.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. BARRASSO. Thank you, Mr. President. As my colleagues know, I have
come to the floor week after week after this bill was signed into law
with a doctor's second opinion based on my nearly quarter of a century
practice in Wyoming, taking care of families there. I go home every
weekend and talk to people.
The people of Wyoming remember when the President of the United
States spoke to a joint session of Congress and he told the American
people about the plan that was later signed into law. During that
speech the President said:
. . . if you are among the hundreds of millions of
Americans who already have health insurance through your job,
or Medicare, or Medicaid, or the VA, nothing in this plan
will require you or your employer to change the coverage or
the doctor you have.
Let me repeat:
Nothing in our plan requires you to change what you have.
I think I heard the chairman of the Finance Committee say that if you
like your plan, you can pretty much keep it. That is not what the
President said. Pretty much keep it? With those words, the President--
and congressional Democrats--made a vow to 170 million people who get
health coverage through their employer. The President and congressional
Democrats promised that if you like what you have, then the health care
law would let you keep it. What a difference a year makes.
On June 14 of this year, the Obama administration released a 121-page
``grandfathered health plan'' rule. It is a rule that clearly
violates--clearly violates--the President's promise.
Let me explain how. ObamaCare included a provision allowing existing
insurance plans to be ``grandfathered'' under the new law.
Theoretically, that means that employers and individuals would not have
to give up the coverage they have and they like to comply with onerous
government rules and mandates.
So you have to make sure, though, that you read the fine print. Look
at the chart. The chart in the new administration rules estimates
between 39 and 69 percent of businesses will lose their grandfathered
health plan status.
The picture is even worse for small businesses in America, and it is
small businesses that are the engines that drive this economy. The same
chart in this report estimates that by the year 2013, up to 80
percent--80 percent--of small businesses will lose their grandfathered
status. This means American businesses will not be able to keep their
current insurance plans. That is what this means. They will be required
by the Federal Government to comply with all the new mandates which are
very expensive and are contained in the new health care law. This only
serves to drive employer health care costs up, making it even more
difficult for them to offer health insurance to their workers.
I am sorry. Maybe the American people are confused. The American
people believed the goal of reform was to lower health care costs.
America's small businesses struggle each and every day to find a way to
provide health insurance to their employees. The government should be
making it easier for businesses to keep providing the coverage.
Instead, this bureaucratic regulation drives prices up. This is going
to increase the odds that employers are going to simply choose to stop
offering health care insurance coverage completely.
Additionally, this so-called grandfather regulation makes it much
harder for employers to make health insurance changes that would
actually help to keep down the cost of care, to keep down the cost of
coverage. Today, businesses have very few options if they want to keep
costs in check, as well as keep their grandfathered status. Businesses
that lose their grandfathered status are then forced to comply with all
the new rules, all the mandates in the health care law, and now, even
by the White House's own admission, we are talking about up to 80
percent of the small businesses in this country.
Subjecting employers to these mandates forces them to change and to
expand their insurance plans. What does that mean? Well, it means costs
are going to go up. No surprise. It is obvious this administration
doesn't want the American people to be able to keep what they have if
they like it. The law wasn't written that way, and certainly the
regulations were written in a way that violates--and this is the White
House--the White House regulations were written in a way that violates
the pledge the President made to the American people.
President Obama and congressional Democrats certainly like using
their talking points, but the American people know it is just spin.
That is why this bill was unpopular when it was signed into law and
now, 6 months later, it is even more unpopular, with 61 percent of the
American people wanting this bill and this law repealed and replaced.
That is why I come to the floor today to support the efforts of my
friend, the senior Senator from Wyoming, the ranking member of the
Health, Education, Labor and Pensions Committee, who has introduced
Senate Joint Resolution 39, a resolution of disapproval that would
overturn the administration's so-called grandfather rule. It is an
honor to stand with Senator Enzi and fight against this job-killing
Washington mandate. I appreciate his leadership but, more importantly,
his dedication to make sure the President
[[Page S7678]]
keeps his promise--a promise that if you like the health insurance you
had before the new health care law was passed, then you can actually
keep it.
That is my second opinion. That is why we need to repeal and replace
this health care law.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The minority leader.
Mr. McCONNELL. Mr. President, I wish to proceed under my leader time.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCONNELL. Mr. President, first, I had an opportunity to hear the
remarks of Dr. Barrasso, the Senator from Wyoming, about health care,
and I wish to thank him for the ongoing contribution he has made in
this very important debate. This is an issue that is not over and we
will keep on revisiting the flaws in the coming years. So I thank the
Senator from Wyoming for his important contribution.
I also thank the other Senator from Wyoming who is sitting to my
left, who is the author of this measure we will be voting on--a
necessary step. I thank the Senator from Wyoming for his important
contribution as well.
Voices Grow Louder
Mr. President, for the past year and a half, Americans have witnessed
something truly remarkable here in Washington. They have watched a
governing party that was more or less completely uninterested in what
the governed had to say about the direction of the country. In a nation
where the government's power is derived from the consent of the
governed, that is a pretty risky governing philosophy. That is why the
voices of the American people have grown louder and louder.
Republicans have listened to those voices. We heard the concerns
Americans had with the stimulus bill that was based on the discredited
premise that having bureaucrats and Democratic lawmakers spend $1
trillion on their favorite programs would revive the economy, and we
opposed it. We heard the concerns Americans had about a health spending
bill that was built on the discredited premise that spending more money
and growing the Federal bureaucracy would make health care less
expensive, and we opposed it. We heard the concerns Americans had about
a financial regulatory bill that was built on the discredited premise
that hiring more of the same kind of bureaucrats who missed the last
crisis was a good formula for preventing the next one, and we opposed
it.
Again and again, Democrats were faced with a problem, and their
solution was to ram through some costly, big government solution
Americans did not want, but that they are now expected to pay for. And
they are still not finished.
In order to fund even more programs, more government, our friends on
the other side now want to raise taxes. Nearly 15 million Americans are
looking for work and can't find it. Another 11 million are
underemployed, meaning they have settled for part-time work instead of
a full-time job. Household income is down for the second year in a row,
and Democrats want to take more money out of people's pockets.
Just yesterday, the nonpartisan Congressional Budget Office said
these tax hikes will hurt the economy and slow the recovery. So what
did we do here over the past week in the Senate? An ill-conceived bill
the chairman of the Finance Committee said would put U.S. companies at
a competitive disadvantage, and a campaign finance bill, the entire
goal of which was to give Democrats an electoral advantage in the
upcoming elections by muzzling their opponents.
If Americans need any further proof that Democrats haven't been
listening to them, this past week has provided all the evidence they
need. Americans want us to focus on jobs, and our friends on the other
side focused on preserving their own jobs and spending more taxpayer
dollars.
It has to stop.
That is why earlier this month I proposed a bill that would prevent a
massive tax hike from going into effect on anyone at the end of the
year, and that is why Republicans put forward an appropriations cap
that would cut $300 billion from the President's budget, even as our
friends on the other side neglected to bring a single appropriations
bill to the floor.
Sometime today or tomorrow, we will be leaving Washington to head
back to our States and when we do, Democrats will have a lot of
explaining to do about how they have spent their time here in the last
year and a half. As for Republicans, we will be able to say we
listened.
Tribute to Larry Cox
Mr. President, in the reception area of my office in the Russell
Building, there is a framed copy of a page from my hometown newspaper
hanging on the wall. It is from section B, the front page, and the date
reads January 21, 1985, just days after I was first sworn in as
Kentucky's newest Senator.
There is a picture of me sitting in my new Senate office, talking on
the phone, with quite the head of dark hair. Behind me you can see a
man in a sport coat lifting some boxes. And he looks like he can lift
them quite easily, too. The caption under that photo reads:
``McConnell made a few telephone calls while aide Larry Cox moved
boxes in on the first day.''
The first day.
Now, in too many ways, it feels like an era has reached its final
days. Because after more than 25 years of Senate service, and nearly 30
years of setting his own ego aside to help me and my career, on
September 2 of this year, Larry Cox retired.
No other single person worked as hard or did as much for Team
McConnell as Larry has. And because Larry was there from the
beginning--when on any given day, he could serve as driver, security
detail, advance man, political operative, caseworker, legislative
advisor, and my eyes and ears all at once--no other single person
probably ever will.
We have heard the phrase ``jack of all trades,'' but Larry is a
master of all trades--not only because of the many roles he filled in
my office, but for the fullness of his life outside the office as well.
As the State director in my office beginning in 1985, Larry was my
chief representative in Kentucky. He oversaw an 18-member field staff,
spread out amongst six offices in the State, and led my efforts in
constituent casework, project development, and outreach.
Beyond that, however, Larry was the picture of the perfect Senate
staffer. Content to stay in the background, for years he happily worked
without seeking credit. He is a man of fairly strong opinions, and was
somewhat our resident keeper of the ideological flame--but he would
never force his opinion on you if you didn't ask for it.
Most of all, for the hundreds of staffers that have been through my
offices, he served as a role model, an example of good character, and a
true friend.
Larry and I have more in common than just our Senate service. We were
both born in Alabama, just a year apart, and after a little traveling,
we both ended up about as Bluegrass as one can get. Additionally, both
Larry's father and mine served in World War II.
After the war, Larry's father, Lawrence E. Cox, Jr., worked for Gulf
Oil, and that job took him and his family all across the southern
United States. Larry spent time growing up in Louisiana, Arkansas, and
Tennessee.
He attended George Peabody College of Vanderbilt University, and
earned his master's at the University of Tennessee. A city planner by
trade, he finally moved home--that is to say, to Louisville--in 1972.
My friendship with Larry began in 1981, when Larry began working for
county government as the deputy secretary for community development. I
was the county judge/executive, and I successfully lured Larry away
from his old job. By 1984, he was with me as I made by first run for
the Senate.
I can't talk much longer about Larry without mentioning his lovely
wife Joanie. Larry came to start working for me just 3 months after he
and Joanie got married. It is lucky for me it wasn't 3 months before.
Joanie didn't know just how much I would take her husband away from her
over the years.
Elaine and I have to thank Joanie for sharing Larry with us, because
as we all know, sometimes Larry's work obligations have gotten the
lion's share.
Sometimes Larry served as a one-man security detail. It was like
being staffed by Clint Eastwood. You could call him ``Dirty Larry,''
and he was
[[Page S7679]]
just waiting for someone to make his day.
Larry is not a guy you want to make mad, even though those of us who
know him know that under that tough exterior is a very kind and caring
man. I am probably going to get in trouble with him for saying that out
loud.
In the old days, Larry and I crisscrossed every county in the State,
in a car that Larry faithfully had service every 3,000 miles. Every
event, he had planned precisely down to the minute. Executing Larry's
plans was like executing a military maneuver.
This was also when I first learned about Larry's honest-to-gosh
superpower. He is a walking, talking human GPS. Ask him how to get
anywhere, and he can give you landmarks, travel time, distance and
cardinal direction.
Naturally, a fellow like that became one of my very first Senate
staffers after we were victorious in the 1984 election. And he was the
perfect choice to be my State director.
In that job, he has been to every town parade and county festival. I
believe he could name the sitting judge/executive in all 120 Kentucky
counties, or tell you which counties towns like Eighty Eight or Grab
are in. Since 1985, there have been 14 commanding generals at the Fort
Knox Armor Center, and he has known and worked with every one of them.
And in the hundreds of thousands of hours I have spent with Larry, if
he ever had a bad day, he did it pretty well.
Maybe that is because Larry never got bored. I have already described
how he did everything in my office, no job too big or too small. And
the rich and complete life he leads has given him plenty else to do as
well.
Larry knows a lot about a lot of things. If you are on the road with
him, and you point out a nice looking Corvette, he will be able to tell
you it's a ZR1 with 638 horsepower and over 600 pounds of torque that
can pull one `G' in a turn and goes zero to 60 in 3.5 seconds.
Larry once stopped me from boarding a plan because he could smell
that it had been filled with the wrong kind of fuel. Despite the so-
called experts telling him otherwise, he insisted they double check.
Turned out he was right. Larry's nose saved some lives that day.
Larry's favored method of transportation, however, is not by air, but
by land--specifically, by motorcycle. You can catch him driving across
Kentucky on his Suzuki Bandit 1250, and he is usually with friends. In
fact, Larry's got so many friends in the biker community that I have
benefited from having a fleet of motorcycles roll in to many of my
events. Larry's also a strong supporter of the second amendment. He
believes in gun control--gun control being a firm hand and a steady
grip.
I don't know how many guns Larry has, he may not even know, but I
believe the number is somewhere north of 50. Years ago, Larry used to
shoot skeet competitively.
You could even say Larry is one of those ``bitter'' people, the type
who clings to his guns and his religion. He is a devout Christian who
has been attending St. Matthew's United Methodist Church in Louisville
since 1978.
He has faithfully volunteered countless hours over the years,
including time spent at Susannah House, a daycare center run by the
church. He has held every church leadership position, including serving
on the board of trustees.
In what is becoming a recurring theme for Larry, he is always willing
to do whatever is asked, and whatever it takes. On top of his church,
he gives his time generously to the Kiwanis, and to the State
Republican Party.
Larry is a great lover of the outdoors. He and Joanie have a farm in
Hart County, KY, that is just shy of 100 acres. Now that Larry is
leaving us I know he will be spending a lot more time there.
Larry generously opens up his farm to the McConnell Scholars,
students at the University of Louisville who are part of a scholarship
program for kids that I helped establish in 1991. He has held retreats
for them there, mentored the students, and helped bring in speakers for
other McConnell Center events. His contribution is so great that Dr.
Gary Gregg, the center's director, puts it this way: ``Simply put . . .
we would be impoverished without Larry.''
Dr. Gregg has a 15-year-old son, and Larry has helped encourage his
interest in deer hunting, by letting him use his farm and his fields
and educating him about shooting and gun safety. Whenever he has a
chance to share his love of nature and the outdoors, Larry shines.
Anyone who thinks Republicans can't be conservationists, I want them
to meet Larry and go visit his farm. The Green River runs through it,
and Larry participates in the CREP program--a Kentucky conservationist
effort to preserve and protect the river.
A third of the farm is planted with warm-season native grasses, to
prevent soil erosion into the river and enhance the local wildlife. A
third of the property is in timber, and a third in hayfields. You may
have noticed what's missing on this farm--Larry has to abide by
Joanie's rule, ``No crops, no critters.''
Larry is so well known throughout the State for his conservation
efforts, he was honored this year as the Kentucky Association of
Conservation Districts Person of the Year. He is also the first person
to receive the Award for Distinguished Service from the Natural
Resources Conservation Service.
My wife Elaine is also close to Larry and Joanie, and I know she is
going to miss them a lot. Larry was one of the first Kentuckians she
met when she came to the State, and he was so knowledgeable and
friendly he made her feel just at home. She liked going to Larry and
Joanie's home, where she knew she would always find good food and good
company.
During my 1996 campaign, Elaine's sister Angela came to Louisville to
volunteer, and Larry and Joanie generously put her up in their home.
They have done that many times for other volunteers and staffers
through the years. The McConnell Team has always been grateful to stay
at their home.
I have wondered often over the years how a man as unique and special
as Larry Cox came to be, and how I was lucky enough to find him.
To the second question, I can only credit providence. But the first
question, that I can take a stab at answering.
I know Larry learned a lot about living from his mother. So did I. So
did everyone lucky to know her. Beryl O. Cox was a spirited,
adventuresome woman--in other words, she was a lot like Larry.
She raised three boys, and she was like one of the boys. She knew her
priorities: She loved her family, her church, her motorcycles, and her
bourbon--not necessarily in that order.
She and Larry would go riding together. She had her own motorcycle, a
Honda Valkyrie. She didn't drive it--Larry would drive, and she would
sit on the back.
Beryl was a delightful woman--``a real kick,'' according to Joanie.
And may I say she was a close friend of mine as well. I remember how
much she volunteered on many of my campaigns.
She was about the same age as my own mother. She lived a full and
robust life, until her passing at the age of 95 in 2007.
A full and robust life, well lived. Larry obviously learned that from
his mother as well. And just like her, he has made countless friends
along the way.
Those friends will get to see a lot more of Larry now. So will his
family. Whether it is time spent on the farm or on the back seat of his
motorcycle, if it is time spent with Larry, I am sure they are
grateful.
The Cox family includes Larry's wife Joanie; his daughter and son-in-
law Lisa C. and Steve Pieragowski; his son and daughter-in-law J.
Randall and Kristen A. Cox; his grandchildren Alexa Brooke Pieragowski,
Erin Phoebe Pieragowski, Hayden Lawrence Cox, and Hadley Marie Cox; his
brother and sister-in-law Alvin J. and Cammie Cox; his brother and
sister-in-law Davis S. and Lynn C. Cox; his nieces and nephews
Christopher L. Cox, Carter Cox, Lindsay F. Cox, and Stephen Cox; and
many more beloved friends and family members.
Larry, your family's gain will certainly be our loss. It is a loss
for my office, and a loss for the entire State of Kentucky that you
have faithfully served for so many years.
As for me, I am going to miss my old friend.
[[Page S7680]]
After 30 years, there is too much to be said, so I simply say, thank
you, Larry. For your dedication, your service, and your friendship, I
don't think you can ever be thanked enough.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. HARKIN. Mr. President, before I yield to the Senator from
Connecticut, I listened to my friend from Wyoming before the minority
leader spoke. He was reading from the Federal Register, if I am not
mistaken, saying that any change--and he kept repeating ``any change,''
``any change,'' any increase because we have been talking about there
had to be significant increases and changes. My friend from Wyoming was
reading from the Federal Register and said ``any increase.''
After reading through this, it reminds me of an example I have often
used about not taking things out of context. It comes from Psalm 14 in
the Bible. There is a sentence in the Bible that says, ``There is no
God.'' I say to a lot of people, it cannot be true. Yes, there is a
sentence in Psalm 14. It is right there. The problem is the sentence
before that says: ``The fool in his heart says there is no God.'' You
can take things out of context. I started reading this and saw how this
was taken out of context.
First of all, my friend from Wyoming said ``any increase in fixed
amount cost sharing requirement.'' But, it says--he did not read on--
``if the total percentage increase exceeds the maximum percentage
increase,'' as defined in another paragraph over here, which is
basically expressed as a percentage of inflation plus 15 points. So it
is not any increase, it is any increase based on whether it is
inflation plus 15 points.
Then my friend said: ``Any increase in fixed amount copayment.'' But
you have to read on because it says ``determined as of the effective
date if the total increase in the copayment exceeds the greater of an
amount equal to $5 or the maximum percentage increase,'' as I mentioned
before, which is medical inflation plus 15 percentage points.
I ask unanimous consent to have printed in the Record this chart to
show that it is not any changes, as my friend was saying.
There being no objection, the material was ordered to be printed in
the Record, as follows:
CHANGES THAT DISQUALIFY PLANS FROM GRANDFATHERED STATUS
------------------------------------------------------------------------
Plan Element Disqualifying Change*
------------------------------------------------------------------------
Copayment................................. The greater of an increase
of more than $5 (adjusted
for medical inflation since
March 23, 2010) or an
increase above medical
inflation plus 15
percentage points.
Deductible................................ An increase above medical
inflation (since March 23,
2010) plus 15 percentage
points.
Out-of-Pocket Limit....................... An increase above medical
inflation (since March 23,
2010) plus 15 percentage
points.
Co-Insurance.............................. Any increse in the co-
insurance rate after March
23, 2010
Annual Limit.............................. Any decrease of an annual
limit that was in place on
March 23, 2010,
disqualifies a plan.
Adoption of a new annual
limit for plans that did
not have one on March 23,
2010, also disqualifies a
plan.**
Employer Premium Contribution Rate (in A decrease of more than 5
group plans). percentage points below the
existing employer
contribution rate as of
March 23, 2010
Benefits Package.......................... The elimination of all or
substantially all covered
benefits to diagnose or
treat a particular
condition after March 23,
2010.
------------------------------------------------------------------------
*See the interim final rule on grandfathered plans, listed under
``Additional Resources,'' for information regarding exceptions to the
March 23, 2010 date. Exceptions may apply to plans that had already
filed pending changes at the time that health reform was enacted.
**If a plan had a lifetime limit but no annual limit on March 23, 2010,
it may replace its lifetime limit with an annual limit while
maintaining its grandfathered status, as long as annual limit has a
dollar value that is equal to or greater than the previous lifetime
limit.
Mr. HARKIN. Mr. President, you have to read the whole paragraph.
There is one where there is any change at all would disqualify a
grandfather plan, and that is any increase in the percentage cost
sharing. You can understand that. If you have a percentage cost
sharing, let's say it is 20 percent, if the cost of the plan goes up,
medical inflation goes up, then your total cost will go up because 20
percent of $100 is $20; 20 percent of $120 is $24. Your out-of-pocket
will go up.
The only thing that would deny a plan from being grandfathered is if
they changed the percentage of your copay. But if they have a fixed
amount of copay, say $20, they can go above that by the maximum
percentage increase of inflation plus 15 points.
I wanted to try to clear that up, that there is only one case in
which any change at all denies grandfathering, and that is if, in fact,
the plan changes your percentage of what you have to pay in. I wanted
to make that clear.
Now I yield to my good friend, Senator Dodd, who was the leader on
our committee in getting the Affordable Care Act through and who knows
the importance of making sure we keep these protections, not only for
consumers but for small businesses.
I yield whatever time he wants.
The PRESIDING OFFICER. The Senator from Connecticut is recognized.
Mr. DODD. Mr. President, I express my gratitude to my friend and
colleague from Iowa and his terrific work. He, along with so many
others, brought us to the point that has defied administrations and
Congresses for more than half a century. Together, we were finally able
to expand access, try to stabilize costs, and increase the quality of
health care. It is no easy task. These efforts, obviously, consumed a
great amount of this Congress's time and attention.
Despite the rigid opposition of those opposed to these changes,
without an alternative ever being offered, for the first time the
American people can look forward in the years to come to having
increased access to health care, improved quality, in my view, but also
stabilizing costs. Without these changes, we would put our great
economy in this country at significant risk, beyond the other problems
we are grappling with today.
I say respectfully--because my friend from Wyoming knows he and I
have worked together on many issues over my tenure and his--it is with
a deep sense of respect for him that I rise today in opposition to what
his resolution would attempt to achieve and to associate myself with
the remarks of Senator Harkin, Senator Baucus, and others who worked
day to day, along with their staffs, to achieve this health care reform
package.
We are told health reform is not popular. I listened to one of my
colleagues give a presentation that this is not terribly popular in the
polls, as if somehow that is going to determine whether what we are
doing is right or wrong.
I recall 1948, the Marshall Plan. If popularity in the polls had been
the deciding factor as to whether we passed the Marshall Plan, it would
have failed miserably. About 17 percent of Americans thought we should
rebuild Europe. The Civil Rights Act and the Voting Rights Act--I can
guarantee to this day there were those who said this was not a terribly
popular idea. I am not sure how it would fare in certain quarters. I do
not think anybody in this Chamber would disagree we are a better
country today because of what we did in the Marshall Plan, what we did
with the Voting Rights Act, the Civil Rights Act, and others.
I think it is disturbing that we ought to determine the outcome of
trying to make America achieve its great potential by the results of
polling data. I know that has become the standard some people use. It
ought not be the standard by which the Senate determines its course of
action.
Health reform is the culmination of more than a half century--in
fact, arguably going back to Teddy Roosevelt's day, almost a century
ago--a struggle by Democrats, Republicans, and Congresses to try and
get to a point where we can get our arms around this very important
issue. At long last, we set ourselves on a course to manage this issue.
At the center of that struggle was the question: Who would control a
person's health care? On this issue there seems to be unanimity. I
think all of us would like individuals and their health care providers
to be in control when it comes to deciding what a person's health care
coverage would be, and not the insurance industry that has a history of
abusing those who fall ill and need coverage.
Just 6 months ago, we answered this question definitively. Americans
should be able to control their own health care, and the insurance
industry should not. This resolution before us today would take us
backwards once again on that fundamental, underlying question at the
heart of the long debate that consumed this Congress: Who would control
whether a person had good health care, the insurance industry or the
individual, their family, and their providers?
The law we passed phases in many new protections over several years
protecting Americans' rights while ensuring stability of the health
care system.
[[Page S7681]]
Just last Thursday on the 6-month anniversary of the passage of the
health care reform bill, many consumer protections came into effect
making up what we call the Patients' Bill of Rights.
This Patients' Bill of Rights, which my colleagues and I fought so
very hard to include in our final bill, provides that sense of security
to people across the Nation and in each of our respective States by
prohibiting the worst of the insurance companies' abuses and practices.
These abuses went on year in and year out, disadvantaging average
citizens in our country. As a result of that bill of rights we adopted
in our health care reform bill and as a result of last Thursday, the
following rights became the law of this land:
All insurance plans must end lifetime limits on coverage. How long
have we heard that debate and how important is it today that protection
exists?
All insurance plans must stop canceling coverage when you get sick.
How many of my colleagues at townhall meetings heard the frustrations
expressed by our constituents that just when they needed the coverage
the most, they would be dropped by the insurance industry?
And, today, parents who have adult children but under the age of 26
know they can carry those kids on their plan. How many families,
because of the economy we are in with high unemployment, particularly
among younger people, go through sleepless nights worrying about their
children who have been dropped from their plans, knowing they are
struggling to get on their feet? The law today protects those families
and those young adults.
New insurance plans must offer additional benefits and protections to
consumers under our bill such as preventive services--which Senator
Harkin championed day in and day out to be included as part of this
bill--covered with no cost sharing, an increased choice of providers,
and no prior authorization requirement for emergency care. Those
protections benefit millions of people across this country.
If they knew what was at stake with this kind of a resolution, which
can throw these back and change these plans in such a way, I suspect
those using polling numbers to identify a reason for being for this
resolution or against the health care bill might have second thoughts.
When we began to debate the health care reform bill, the President of
the United States made clear that part of having control of one's
health care was having the right to keep what you have. We enshrined
that in the bill during the HELP Committee markup, the Finance
Committee markup, and the Senate debate on this bill.
No matter how important we thought those protections were, we said
you can keep what you have, if that is what you want. But this was not
carte blanche for the insurance industry to ignore the new law and
continue abusive practices that have been in place for too long. They
can continue their old plans as long as they did not dramatically
increase the cost to their customers.
It made no significant negative changes to the coverage consumers
were paying for. In other words, you can keep what you have. But if the
insurance companies try to take away what you have, the law will
protect you. In the parlance of Washington, this is called
grandfathering.
To clarify to businesses, insurers, and all Americans what this meant
in practice, the administration released a regulation on June 17. This
regulation strikes an important balance of keeping our businesses
strong while ensuring that employees and their families are able to
weather difficult economic times, such as the ones we are in.
Under the regulation adopted on June 17, grandfathered plans are not
required to offer the additional benefits included in the Patients'
Bill of Rights. I wish they were, but they are not. The grandfather
regulation provides insurers and businesses flexibility to continue to
innovate and to grow and still maintain their status.
Businesses' health plans will not lose their grandfather status
unless significant changes are made to policies which unduly burden
employees and average American families.
For example, if a health plan increases co-payment charges for a
working mother in Hartford, CT, as has been pointed out by Senator
Harkin, by more than 15 percentage points, it will lose the grandfather
status. Or if a health care plan significantly reduces benefits for a
family in New Haven, CT, it loses its grandfather status, as it should.
These are not unreasonable requirements as we strive to protect
average families in our country.
My colleague from Wyoming and I disagree about this new law. We sat
together day in and day out during those long markup periods. He is a
good man, a good Senator, and a good friend. But I disagree with him
strongly on this resolution. In my view, he wrongly claims this repeal
would benefit small businesses. I say today that adopting this
resolution would not only hurt small businesses but also roll back the
important consumer protections that ended some of the worst insurance
industry abuses across our country.
If we repeal the grandfather regulations, we will harm small
businesses and their employees because nothing would protect them from
the insurance companies raising premiums by double digits each year,
without offering any new and better benefits to the very people who
would suffer.
Nothing would protect them from insurance companies deciding to drop
benefits or price them out of reach for these very employees.
This resolution would not guarantee the right to keep what you have.
What this resolution does guarantee is that the insurance industry can
decide what you are going to get from them--not what you want. That is
the fundamental difference if we adopt this resolution.
Health reform changed that by handing control, as we all agreed on,
back to you and your family. If we adopt this resolution we
fundamentally shift that equation once again. In order to help small
businesses more easily provide coverage to their workers and make
premiums more affordable, the law provides tax credits for that
coverage. In Connecticut alone, there are 54,000 small businesses that
will benefit from these tax credits. This is just the first step toward
bringing health care costs down, as we all want, and ensuring quality
care, as we all want as well, for coverage of average Americans and
their providers.
This resolution is not about small businesses and harming them. This
is another effort to dismantle health reform, and I believe it is
fundamentally wrong for thousands of small businesses and employees
across the country. It is a gift to the insurance industry, which all
of us agree should no longer be the ones to decide what you get based
on what they want to charge you, but whether you have insurance and
confidence you are going to get for your family what you need not what
they decide you get.
For those reasons, I strongly oppose this resolution and hope my
colleagues will join us in that effort.
I yield the floor.
The PRESIDING OFFICER. The Senator from Wyoming is recognized.
Mr. ENZI. I yield up to 10 minutes to the Senator from Iowa.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. GRASSLEY. Mr. President, Congress meets in the District of
Columbia. The District of Columbia is an island surrounded by reality.
Only in the District of Columbia could you get away with telling the
people if you like what you have you can keep it, and then pass
regulations 6 months later that do just the opposite and figure that
people are going to ignore it. But common sense is eventually going to
prevail in this town and common sense is going to have to prevail on
this piece of legislation as well. I support the resolution of Senator
Enzi, disapproving the regulation on grandfathered health plans.
The partisan health care overhaul enacted last March and subsequent
implementation represents so many broken promises that I hardly know
where to begin. But the resolution of Senator Enzi certainly sheds some
light on one of the most glaring broken promises we have seen so far,
and is as good a place as any for us to start.
Time and again throughout the health care debate, supporters of the
health care overhaul assured voters that even after their proposal
became law, ``If you like what your current health plan is, you will be
able to keep it.''
[[Page S7682]]
The administration's own regulations prove this is not the case.
Under the grandfathering regulation, according to the White House's own
economic impact analysis, as many as 69 percent of businesses will lose
their grandfathered status by 2013 and be forced to buy government-
approved plans.
The estimates are even more troubling if you are a small business.
Again, according to the administration's own estimates in the
regulation, as many as 80 percent of small employers will be forced out
of their current plan and into a more expensive government-approved
plan. It is no wonder that the grandfathering regulation is opposed by
pretty much every employer organization in the country. The National
Federation of Independent Businesses, the Chamber of Commerce, the
National Association of Manufacturers, and the National Retail
Federation have all weighed in against this burdensome and disruptive
policy. In every one of those cases, businesses that are members of
those organizations want to provide health insurance and have been
providing health insurance for their employees, and they want to keep
it. They were believing Congress when they said if you have what you
like you can keep it, and now they are finding out otherwise.
It is true our economy is in a fragile place right now. Yet the
implementation of the new health care law is creating more uncertainty
and higher costs for American businesses. How can we ask them to go out
and create jobs and hire new people when each new health care
regulation adds another layer of bureaucracy and uncertainty? The White
House should be making it easier to do business in this country, not
harder.
This is not just about confusion, it is also about costs. When
employers and individuals make even modest changes to their benefits
and lose grandfathered status, they are forced to buy a new government-
approved health care plan that in most cases will cost more than their
current plan. That means the government will tell employers what
benefits they have to cover, to whom they have to offer coverage, and
how much they are going to have to contribute.
We have already seen data from health plans saying that the
requirement in the new law could drive up premiums by about 9 percent.
This is in line with the Congressional Budget Office's estimate that
the overall increase in premiums could be as much as 10 percent to 13
percent. When you factor in medical inflation, some people are still
seeing premium increases of 20 percent or more after the passage of the
health care law.
What happened, then, to President Obama's promise about lowering
premiums by $2,500? Are we supposed to add that to the list as another
broken promise? Each day it seems as if another news story comes out
that shows why the partisan health care overhaul was the wrong
approach. Health plans are being forced out of the child-only market.
Some have stopped selling in individual markets entirely. Premiums
continue to go up at twice the rate of inflation.
The White House's own actuary is telling us that health care
inflation will be worse now than it was before the health care reform
bill became law. Over 1 million seniors are being forced out of their
current national Medicare Advantage or Medicare prescription drug
plans, and this is only going to get worse. Businesses are considering
dropping retiree health care benefits and possibly dropping health care
coverage altogether.
With these kinds of stories coming out on a daily basis, it is no
wonder that polls are showing close to 60 percent of the American
people opposed to this new law. I support the efforts of Senator Enzi
and appreciate that he is willing to shed some light on this issue.
There is a lot of misinformation out there and people need to
understand what this health care overhaul means for them.
The grandfathering regulation is a clear violation of the promises
made by supporters of the health care law that, if you like what you
have, you are able to keep it. We owe it to our constituents to fix
that misrepresentation.
I urge my colleagues to support the resolution.
I yield the floor.
The PRESIDING OFFICER. The Senator from Wyoming is recognized.
Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from
Nevada, Senator Ensign.
The PRESIDING OFFICER. The Senator from Nevada is recognized.
Mr. ENSIGN. Mr. President, many Americans may be wondering what this
huge stack of paper is that I have on my desk. Over 2,000 pages of this
stack of paper represent the actual health care bill. The rest of the
stack consists of the regulations that have been written to this point.
From what we understand, once the whole health care bill and
regulations are written, this stack of paper will grow much higher;
estimates are as much as 20,000 pages total. The complexity of the
health care law is incredible. The resolution we have before us today
concerns grandfathered health plan status. This regulation is one of
those regulations that many of us believe is going to do damage to our
health care system. I want to talk a little bit about the regulations
under discussion today.
Over the last couple of months, I have gone around to many businesses
in my home State of Nevada, to talk about many of these regulations as
well as the health care bill. Let me tell you, many small business
owners in my State are very concerned about what this health reform
bill is going to do to their businesses. A lot of small businesses
struggle to do the right thing by giving their employees health care. A
lot of them cannot afford the Cadillac plans that a lot of big
businesses have, but they are trying to do the right thing. Some
businesses cover half of what their employees pay. Some businesses have
slimmed-down plans. The vast majority of the health plans that small
businesses offer would not meet the minimum standards that this health
care bill is going to require.
Why is that important? The President said during the health care
debate that if you like your plan you can keep it. If you like your
doctor, if you like your plan, you will absolutely be able to keep it.
There is a small detail he left out. The detail is this: If you change
your health plan--and it does not have to be in a significant way--or
if you change your copays--you could lose your grandfathered status. If
you lose your grandfathered status you now have to comply with the
minimum standards in the Federal law. That is a problem because, for
most small businesses, these standards will dramatically increase the
cost of their health insurance for their employees and a lot of them
are barely keeping their doors open today. A lot of small businesses I
talk to are actually putting pencil to paper and figuring out whether
they are even going to be able to keep the plans they have today.
The advocates will say: Well, don't change your plan. The reality is
that every single year, businesses look at the health care plans that
they offer and almost every year they make changes to those health care
plans. Under this regulation, if you make changes to your health care
plan you could lose the grandfather status. That is a major problem.
According to the government's own statistics, by 2013 as many as
almost 70 percent of all employer plans and 80 percent of small
business plans will relinquish their grandfathered status. Those are
the government's own estimates. Based on these numbers, it doesn't
sound like everybody is going to be able to keep their plan, as the
President talked about in his promises about this health care
legislation.
In my view--and I think this view is shared by a lot of experts who
are studying this health care plan, this bill is going to raise costs
for those who currently have insurance. Think about it; if you are
going to cover 30 million people there will be costs associated with
that coverage. There was a $500 billion cut in Medicare and there was
an increase in taxes. We know that a lot of different taxes were
increased to pay for this bill. But the other pay-for in this bill,
that was not officially scored as a pay-for, is that for people who
have insurance--it is going to become more expensive for them because
of a lot of the mandates in the bill.
We have seen recently, insurance company after insurance company,
when they are going to their State commissions bringing forward fairly
large increases.
I was talking to a small business owner the other day in Nevada. He
told
[[Page S7683]]
me his plan is going up 38 percent. That was the lowest bid he could
get; a 38-percent increase for this year. The insurance companies told
him it is because of this health care bill.
I was on a telephone call yesterday. I did a telephone townhall
meeting back in my State. A senior citizen was on the phone. He was
telling me about his Medicare supplemental insurance that is covered by
his union. The copays and the premiums for that were going up
dramatically. He was wondering how he was going to be able to pay his
rent. He has virtually no discretionary income, so any premium increase
is going to make it tough for him. He is actually figuring out how he
is going to be able to make his rent payments. Those are some of the
unintended consequences with this bill and the regulations that are
being written.
I think we need to take a second look at health reform. First of all,
obviously I wish to see the health reform bill repealed and replaced
with real health insurance reform that makes insurance more affordable.
I support things such as buying insurance across State lines--similar
to how we buy car insurance across State lines. I also wish to see us
enact real medical liability reform that would lower the costs of
health care in this country. All of these things would be good to make
health care more affordable and accessible for more Americans as
opposed to what we have today. But let's at least start this process by
rejecting the regulations that are going to hurt the grandfathered-in
status of a lot of these plans. If you take away grandfathered status
from a lot of plans, a lot of small business owners are going to be
hurt and a lot of people who work for small businesses are going to
lose their health insurance. This is because the small businesses will
not be able to afford to comply with this health care bill and the
regulations that are associated with it.
I urge support of this resolution of disapproval. I appreciate
Senator Enzi for bringing this resolution of disapproval of these
regulations forward. I think this resolution is something the Senate
should support and support in a bipartisan way.
I yield the floor.
The PRESIDING OFFICER. Who yields time?
The Senator from Wyoming.
Mr. ENZI. Mr. President, I yield up to 8 minutes to the Senator from
Kansas.
The PRESIDING OFFICER. The Senator from Kansas is recognized.
Mr. ROBERTS. Mr. President, I rise in support of Senator Enzi's
resolution of disapproval and thank him for that. It seems every day a
new story comes out about the negative consequences of the health care
reform law, and I cannot keep up with them. I know people involved in
the health care industry are having a very difficult time also.
Do you remember the campaign pledge that health care reform would
immediately reduce family's premiums by $2,500? Well, last week a slew,
a slew of new mandates on health insurers, including coverage of
preventative services without any cost sharing, restrictions on annual
limits on coverage, and coverage of children up to age 26--I guess a
child 25 is a child--took effect.
Many of them, in fact, may be beneficial to some Americans, but they
will not come free. Health insurers have begun alerting their customers
to the fact that these new mandates cost money, money that has to be
charged in additional premiums. I think most Americans understand you
cannot get something for nothing.
But instead of admitting that their policies are causing health
insurers to raise their rates, the Obama administration has unleashed
Health and Human Services Secretary Kathleen Sebelius to silence its
critics by intimidation.
In a letter to America's health insurance plans, the Secretary
explicitly threatens health insurers that do not toe the line on
ObamaCare with exclusion from the State health insurance exchanges,
which start in 2014. ``There will be zero tolerance for this type of
misinformation and unjustified rate increases,'' she has warned. ``We
will also keep track of insurers with a record of unjustified rate
increases: those plans may be excluded from health care exchanges in
2014.''
Well, let's be clear about what the Secretary, on behalf of the
President, is saying. She is threatening to shut down private companies
for exercising their first amendment right to free speech, and she is
keeping a list. Some have called this gangster government in the press.
As a former newspaper man, I am shocked. I am stunned by my former
Governor's actions. First, it was the gag order on Humana Insurance for
daring to describe the consequences of slashing more than $100 billion
from Medicare Advantage to the customers, now this.
This administration says it wants transparency. Well, transparency is
a two-way street. It does not mean muzzling dissenting opinions or
inconvenient facts because they are not advantageous to the
administration. As the Wall Street Journal opinioned: ``They're more
subtle than this in Caracas, Venezuela.''
Not only are the actions of the Obama administration
unconstitutional, they are also extremely hypocritical in light of
their own highly misleading rhetoric. For example, the President and
Secretary Sebelius have been touting the recent decision of health
insurer Blue Cross Blue Shield in North Carolina to issue rebates to
its customers in the individual market as a supposed ObamaCare victory.
President Obama claimed this victory at a recent campaign stop in
Virginia, saying that the insurance commissioners are newly empowered
to look after consumers, that we are already seeing ObamaCare's new
levels of accountability pay off.
Well, aside from the fact that most State insurance commissioners
have had the ability to review rate increases for years, a fact that
Secretary Sebelius, as a former Kansas insurance commissioner, knows
all too well, they are leaving out another very important fact, the
rest of the story.
What they are not telling you is, the reason why the insurer is
paying out rebates is, because of ObamaCare, their plans in the
individual insurance market will cease to exist in 2014. This means the
reserves they have stored to protect their solvency are no longer
necessary.
That is where the rebates are coming from, not some well of hidden
profits. The insurer is paying the rebates out of their reserves
because the plans will no longer exist. This is hardly a victory for
the thousands of people enrolled in those plans. If that is not
misleading, I do not know what is.
What about the Secretary's taxpayer-financed mailer regarding
Medicare Advantage that was recently sent to seniors all across the
country? This mailer misleadingly claims that Medicare Advantage
enrollees will not see any changes to their benefits under ObamaCare.
That is a claim that is demonstrably false.
Already we are seeing insurers such as Harvard Pilgrim drop their
Medicare Advantage plans altogether as a result of these huge cuts. So
actually thousands of seniors will see changes in their benefits. They
will not have any. I urge the President and the Secretary to reconsider
their use of these tactics which only serve to further erode the
government's credibility with the American people and to insult their
elected representatives.
In the United States of America, private citizens are not only
allowed to disagree with the government, it is a cornerstone of our
democracy. So I say to the Department of Health and Human Services and
the administration, stop the gag orders and the intimidation. To HHS,
do not tread on the first amendment.
I yield the floor.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, while I am waiting for another speaker to
come, I will make some additional comments.
Mr. HARKIN. Mr. President, can I ask how much time is remaining?
The PRESIDING OFFICER. There is 27 minutes on the Senator's side and
21 minutes on the other side.
Mr. ENZI. Mr. President, I just wish to get a few things read into
the Record. I have a list of 54 organizations that are supporting my
resolution. They include the Latino Coalition, the Chamber of Commerce,
the Coalition of Affordable Health Coverage, the Health Care Leadership
Council, the National Federation of Independent Business, the National
Restaurant Association, the Small Business and Entrepreneurship
Council, to name just a few of the 54.
[[Page S7684]]
I ask unanimous consent to have printed letters of support from the
Chamber of Commerce, the National Association of Health Underwriters,
the National Association of Manufacturers, the National Federation of
Independent Business, the National Retail Federation, the Small
Business Entrepreneurship Council, and the Associated Builders and
Contractors, all of which are in support of this and I suspect will be
key voting this particular resolution.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1).
Mr. ENZI. The Chamber of Commerce, for instance, says:
The administration released an extremely complex regulation
that makes it virtually impossible for plans to maintain
grandfathered status, instead subjecting them to many
expenses and burdensome new requirements. In our view, this
regulation violates Congressional intent, and does not live
up to the promises of proponents of the new law.
NFIB, a small part of their letter says:
If required to comply with the administration's interim
final rule, millions of small businesses will be forced out
of the plans they know and like--
Which means their employees lose the plans they know and like.
The Associated Builders and Contractors say:
The grandfathered rule demonstrates a fundamental failure
of the Federal Government to understand the needs of small
businesses. With the current unemployment rate of 17 percent,
the construction industry cannot endure another cost increase
at the hands of the Federal Government. It is unfortunate
that the Federal Government continues to fail to provide
employers and their employees with health care solutions that
are practical or affordable.
Earlier, there were some mainstays of health care that--I think there
was an aspersion I was getting rid of with my resolution. I want you to
know that if the resolution passes, businesses will still be prohibited
from discriminating against someone with preexisting conditions,
businesses will still be prohibited from imposing annual limits on
benefits, all plans will still be prohibited from imposing lifetime
limits on benefits, all plans will still have to cover kids under the
age of 26 on their parents' plan, all plans will still be prohibited
from canceling coverage because of a paperwork error.
All those things will exist when this resolution passes, and this
resolution needs to pass. All those things that I mentioned,
preexisting conditions, annual limits, lifetime limits, children under
the age of 26, and canceling coverage for paperwork errors, all those
cost money. That is why the price is going up at the present time.
The price is going up at the present time. This was supposed to be
cutting costs. Help does not arrive until 2014. But small businesses,
particularly small businesses, are going to be required to meet this
grandfathering rule now. They cannot afford the grandfathering rule
now. Another thing I am objecting to is watching television and seeing
an old favorite of mine, Andy Griffith, getting paid, at taxpayer
expense, to tell us that this whole deal is excellent.
You saw the stack of regulations over there. They estimate there will
be 100 pages of regulation for each page of that bill. There are 2,700
pages in the bill. That means there are going to be 270,000 pages of
regulations. We do not legislate that way. We try and fill in those
blanks. You do not even know what those blanks are going to hold yet,
neither does small business.
They already know these are things that are going to drive up cost in
the beginning, with no cost-cutting opportunity, and then the
grandfathering rule kicking in right away, which means for 3 years,
before they even know what some of those regulations are going to be,
they are going to have to constrain everything in their organization
within 15 points, as is pointed out, and we can expect the first year's
increases to be even greater than the 15 points.
But they will try and stay with that grandfathered plan because it is
what they can afford and it is what their employees like. So we are
trying to keep people in the insurance they like. It is an employee
request. I also noticed one of the Senators mentioned the Marshall Plan
that was not liked when it was first passed; and the Civil Rights Act
that was not liked when it was first passed.
I would like to point out those were both very bipartisan acts that
were passed--bipartisan. It was not a partisan bill. You would have to
notice that a lot of these people have been mentioning this was all
passed by one side of the aisle, and there was a lot of warning before
that if you do things in a hurry and you do it just partisan, that you
do not devote the time that is necessary or put it in a small enough
package that people can understand it.
There are vast parts of this that people did not get to read before
they passed it. It is particularly noted on the House side. That leads
to the kinds of difficulties we have now. We also turn over to
bureaucrats writing the rules, and this is one of the examples, and we
have a chance to overturn that at this point. They can go back and
rewrite it again.
But, at this point, we can say: No, enough is enough. You cannot put
all these things into place. You cannot kick people out of their
insurance and let's see what happens in 2014 when we have all the
regulation. So I think we have put a lot onto businesses that does
increase cost. Because we do--even when this passes, we will still
prohibit discriminating against someone with a preexisting condition,
we will still prohibit imposing annual limits on benefits, we will
still prohibit imposing lifetime limits on benefits. All plans will
still have to cover kids under the age of 26. Although, I have noticed
a whole bunch of the companies now are not going to write some of the
plans that would do this, and they are getting out of the business. But
all plans will still be prohibited from canceling coverage because of a
paperwork error. Those drive up costs.
Relief is not in sight until 2014.
I yield the floor and reserve the remainder of my time.
Exhibit 1
List of 54 Organizations Supporting S.J. Res 39
Aetna; American Council of Engineering Companies; American
Osteopathic Association; American Rental Association;
American Road & Transportation Builders Association; AMT--The
Association For Manufacturing Technology; Associated Builders
and Contractors; Association of Clinical Research
Organizations; Assurant Health; Automotive Recyclers
Association; Chamber of Commerce; Cigna; Coalition for
Affordable Health Coverage; Communicating for America;
Furniture Dealers Association; Health Equity; Healthcare
Leadership Council; Independent Electrical Contractors; Inc;
International Franchise Association; International
Foodservice Distributors Association.
International Housewares Association; Manufacturers' Agents
Association for the Foodservice Industry; National
Association for Printing Leadership; National Association of
Health Underwriters; National Association of Insurance and
Financial Advisories; National Association of Manufacturers;
National Association of Mortgage Brokers; National
Association for the Self-Employed; National Association of
Wholesaler-Distributors; National Club Association; National
Federation of Independent Business; National Office Products
Alliance; National Restaurants Association; National Retail
Federation; National Roofing Contractors Association;
National Tooling and Machining Association; Northeastern
Retail Lumber Association; NPES The Association for Suppliers
of Printing, Publishing and Converting Technologies; Office
Furniture Dealers Alliance; Pediatrix.
Pharmeceutical Research & Manufacturers Association;
Plumbing-Heating-Cooling Contractors--National Association;
Precision Machined Products Association; Precision
Metalforming Association; Printing Industries of America;
Self-Insurance Institute of America; Service Station Dealers
of America; Small Business & Entrepreneurship Council; Small
Business Coalition for Affordable Health Care; Specialty
Equipment Market Association; Textile Care Allied Trades
Association; Tire Industry Association; Turfgrass Producers
International; The Latino Coalition.
____
The Spirit of Enterprise,
U.S. Chamber of Commerce,
Washington, DC September 27, 2010.
To the Members of the United States Senate: The U.S.
Chamber of Commerce, the world's largest business federation
representing the interests of more than three million
businesses and organizations of every size, sector, and
region, urges you to support S.J. Res. 39, a resolution of
disapproval that would repeal the onerous grandfathering
regulations promulgated pursuant to the Patient Protection
and Affordable Care Act.
The President and many other proponents of the new health
care law repeatedly promised, ``if you like the plan you
have, you can keep it,'' and the grandfathering provision was
meant to ensure this promise. The statute contained a few
short paragraphs specifying that a plan operating when the
bill was
[[Page S7685]]
enacted could continue to operate as before; new employees
and dependents of employees could also be added to the plan.
The provisions demonstrate Congress clearly intended to
preserve maximum flexibility for employer plans and those
currently in operation.
However, the Administration released an extremely complex
regulation that makes it virtually impossible for plans to
maintain grandfathered status, instead subjecting them to
many expensive and burdensome new requirements. Rather than
allowing plans to continue operating in the manner they are
accustomed to, the regulation specifies numerous ways by
which such plans would lose grandfathered status. Thus, many
existing plans would be forced to change in order to comply
with an array of new mandates. In our view, this regulation
violates Congressional intent, and does not live up to the
promises of proponents of the new law.
Due to the critical importance of this issue to the
business community, the Chamber strongly urges you to support
S.J. Res. 39. The Chamber may consider votes on, or in
relation to, this issue in our annual How They Voted
scorecard.
Sincerely,
R. Bruce Josten.
____
National Association
of Health Underwriters,
Arlington, VA, September 28, 2010.
Hon. Michael B. Enzi,
Ranking Member, Committee on Health, Education, Labor and
Pensions, U.S. Senate, Hart Office Building, Washington,
DC.
Dear Senator Enzi: On behalf of the National Association of
Health Underwriters (NAHU), which represents more than
100,000 health insurance agents, brokers and employee benefit
specialists involved on a daily basis in the sale and service
of private health plans, I am writing to convey our support
for your resolution of disapproval (S.J. Res. 39) to overturn
the so-called grandfather rule in the Patient Protection and
Affordable Care Act (PPACA).
As you know, throughout the legislative debate on health
system reform, President Obama and congressional leaders
repeatedly stated that ``if you like the coverage you have,
you can keep it.'' Unfortunately, the proposed interim final
rule (IFR) on grandfathering issued this past June follows a
rigid path in defining the requirements for ``keeping what
you have,'' which our professional benefit specialist members
conclude will have a negative impact on employers large and
small, their employees and their families. The complex and
inflexible requirements could ultimately undermine the
ability of employers to continue to provide existing health
coverage for their employees.
The current grandfather IFR has not provided adequate
guidance on various scenarios employers and consumers may
encounter and, as such, there are many questions about the
allowable changes that may be made to employer plans and the
risk of losing grandfathered status. Once grandfathered
status is lost, employers will be forced to follow a number
of expensive new insurance rules, which will increase costs
for employers and employees, threatening the coverage
Americans currently have.
The Departments of Treasury, Labor and Health and Human
Services own estimates indicate that the complex and
restrictive IFR regime would effectively make grandfathering
temporary: More than half of all employers, and two-thirds of
all small employers, will relinquish their grandfathered
health plans by the end of 2013.
Barring employers from changing insurance carriers or
increasing cost sharing percentages of any level, for
example, severely limits the ability of employers to maintain
their grandfathered status. Other requirements to maintain
grandfathered status, such as limits on the increases for
fixed-amount cost sharing, are simply out of touch with
the individual and small-group insurance markets since
most employers have little control over the plan designs
offered in the small-group and individual market.
In addition, the current grandfather rules do not afford
protections for individuals and employers who lose their
grandfathered status through no fault of their own. For
example, if an individual or employer's health insurance
carrier pulls out of a state marketplace, the only option the
consumer has is to buy a new non-grandfathered policy or
cease to be covered altogether. Unfortunately, our members
report that a number of carriers are vacating many health
insurance markets as a result of PPACA provisions,
particularly in the individual and limited benefit plan
markets, and that millions of their clients will be affected.
Our members also report that many large health insurance
carriers are reorganizing all of their policy offerings as a
means of streamlining administrative expenses. So while an
individual or employer may be offered identical benefits
through the carrier, their contractual dates may shift and
they may technically be sold a new policy offering. Such
administrative simplification moves may inadvertently cause
millions to relinquish their grandfathered status.
We are very concerned that a great number of individuals
and employers will be left with even less choice and
flexibility and will be faced with the difficult choice of
paying more to maintain grandfathered coverage, shopping for
a new (and more expensive) plan or possibly dropping it
entirely.
A workable and sustainable grandfathering protection
framework should be aimed at achieving a number of important
health reform objectives: (1) to promote stability during the
transition to full health care reform by ensuring that
Americans have a choice of keeping their current coverages;
(2) to allow individuals to better control their health care
costs; (3) to preserve affordable coverage options and limit
disruption of coverage for currently insured individuals; and
(4) to lessen the potential for regulatory uncertainty.
Unfortunately, the current grandfather rules fall short of
these objectives on a number of levels. As such, we very much
support your resolution of disapproval of the current
grandfather rules, and hope that Congress and the
Administration can work together toward a more sensible and
sustainable policy moving forward.
Sincerely,
Janet Trautwein,
Executive Vice President and CEO.
____
National Association
of Manufacturers,
Washington, DC, September 23, 2010.
Hon. Michael Enzi,
Ranking Member, Committee on Health, Education, Labor and
Pensions, U.S. Senate, Washington, DC.
Dear Ranking Member Enzi: The National Association of
Manufacturers (NAM)--the nation's largest industrial trade
association--urges you to support S.J. RES. 39, a
``resolution of disapproval'' to prevent implementation of
the Interim Final Rule defining grandfathered health plans
under the Patient Protection and Affordable Care Act.
The grandfather rule, as currently drafted, does not meet
the standard on which the push for reform was predicated--
insure the uninsured and allow those with coverage to keep an
existing plan. The Department of Health and Human Services'
own analysis determined that up to 80 percent of existing
small plans will lose their grandfathered status. Employers
are proud to offer their employees health insurance, and
freezing this benefit limits employers' ability to provide
quality coverage.
Currently, 170 million people receive insurance from their
employers. Under the new law, the health plans covering these
employees were to have grandfathered status and were not to
be subjected to the broad insurance market reforms necessary
for newer plans. This exemption was intended to allow
employees to keep the coverage they currently have and with
which they are most comfortable. However, the Interim Final
Rule limits the ability of these plans to make routine
modifications that will control the rising health care costs
crippling many manufacturers.
The rule also removes grandfathered status from those who
are fully insured if they change issuers. This eliminates the
ability of many smaller businesses to negotiate with insurers
to obtain lower rates. Those that are fully insured should be
able to negotiate with competing issuers and maintain
grandfathered status if they change issuers. This would allow
for a competitive marketplace, keep costs down and create
parity for smaller businesses that, without a large pool of
insured to manage costs like most self-insured plans, use the
competition of an open market to lower costs. As a result,
the current rule places small businesses at a significant
disadvantage.
Ninety-seven percent of NAM members provide health
insurance to their employees. Manufacturers are proud to
provide health care to their employees and would like to
continue that benefit. The rule, as it stands, will decrease
competition and create a stagnant, uncompetitive and more
expensive insurance market.
The Senate should disapprove this rule because it will
unnecessarily disrupt the current employer-based system,
which provides coverage to millions of Americans. As
manufacturers face tremendous uncertainty in these
challenging economic times, Congress should not allow a
federal agency to issue regulations that harm manufacturers'
ability to create and retain jobs.
On behalf of manufacturers, we urge your support for S.J.
RES.39 and look forward to working with you on our shared
goals for a strong economy and job creation.
Sincerely,
Joe Trauger,
Vice President,
Human Resources Policy.
____
September 28, 2010.
Hon. Mike Enzi,
Russell Senate Office Building,
Washington, DC.
Dear Senator Enzi: On behalf of the National Federation of
Independent Business (NFIB), the nation's leading small
business advocacy organization, I am writing in support of
S.J. Res 39, the Enzi disapproval resolution regarding the
Interim Final Rule on grandfathered plans under the Patient
Protection and Affordable Care Act (PPACA). The vote in
support of the motion to proceed to S.J. Res 39 will be
considered an NFIB Key Vote for the 111th Congress.
NFIB believes the Administration has overstepped its legal
authority under PPACA in writing regulations that go beyond
the legislative authority embedded in the statute. A strict
reading of Section 1251 in the Act clearly outlines what
defines a grandfathered plan. However, through its Interim
Final Rule the government inappropriately reinterprets the
intent of Congress by narrowing the scope of how plans
qualify to retain grandfathered status.
[[Page S7686]]
The Interim Final Rule appears to be based on an assumption
that coverage choices should be narrowed in the run up to
2014. Nothing in the statutory language of the PPACA supports
this assumption. In fact, interpreting the PPACA so that it
narrows the range of coverage choices is inconsistent with
the spirit of the Act, as well as the letter of the law.
If Congress is unable to overturn the Interim Final Rule,
NFIB remains deeply concerned that the new regulations will
most heavily impact small, rather than large businesses. As
written, the Interim Final Rule is so restrictive that the
rule provides small businesses with little to no flexibility
to keep their plan.
The precedent set forth by this Interim Final Rule is
especially detrimental for the men and women who currently
have coverage through small businesses. Millions of Americans
rely on small business plans for their health coverage, and
must continue to rely on those plans until at least 2014 when
new purchasing options become available. However, if the
Interim Final Rule is not overturned, the government's own
analysis confirms what many small businesses fear most--that
upwards of 80 percent of small employers could lose the plan
they have today by 2013.
NFIB strongly supports the Enzi resolution of disapproval.
As the 111th Congress comes to a close, Congress must restore
the true meaning of ``if you like what you have today, you
can keep it.'' If required to comply with the
Administration's Interim Final Rule, millions of small
businesses will be forced out of the plans they know and
like. Thank you for your hard work on behalf of small
business, and NFIB looks forward to working with you to
address this critical issue.
Sincerely,
Susan Eckerly,
Senior Vice President, Public Policy.
____
September 27, 2010.
Hon. Mike Enzi,
Russell Senate Office Building,
Washington, DC.
Dear Senator Enzi: I write to lend the support of the
National Retail Federation (NRF) to the resolution of
congressional disapproval (S.J. Res. 39) you have recently
introduced to block the ``grandfathered plan'' regulations.
We strongly support and endorse your effort and urge that the
resolution be promptly adopted.
We are also concerned that regulators have taken too narrow
a view of the grandfathered plan regulation. NRF's formal
comments (submitted on August 16, 2010) noted in part that:
``[o]ur concern is that the [interim final regulation's]
rigid, trip-wire rules make it entirely too possible (if not
probable) that a plan that elects grandfathered plan status
will not be able to maintain that status for long. Many plans
may not even bother to elect grandfathered plan status.'' Our
letter recommended several specific steps to improve the
grandfathered plan regulation:
1. Allow employers to change insurance carriers without
losing grandfathered status provided that: The coverage is
actuarially equivalent or better, and that provider networks
are substantially equivalent; prohibiting a change in
carriers will needlessly inhibit competition bases on price
and quality of service.
2. Allow for improvements in prescription drug formularies
and provider networks without jeopardizing grandfathered plan
status. New drugs come onto the market with great regularity
and medical practice changes quickly. Formulary changes in
the interest of plan beneficiaries are appropriate and
necessary. Provider networks require regular maintenance to
allow for retirements, addition of new providers and to
maintain network quality. Reasonable changes that do not
compromise ongoing treatment should be allowed.
3. Provide greater flexibility to manage future medical
inflation. Changes in fixed dollar cost sharing should be
made on a year-to-year basis rather than be based on March
23, 2010 and percentage increases from that.
We strongly concur with your view that a formal resolution
of congressional disapproval is the appropriate next step
under existing law. We urge its prompt adoption. Again, NRF
commends you for introducing this legislation.
Sincerely,
Steve Pfister,
Senior Vice President, Government Relations.
____
Small Business &
Entrepreneurship Council,
Oakton, VA, September 23, 2010.
Hon. Mike Enzi,
Ranking Member, Health, Education, Labor and Pensions
Committee, Senate Russell Office Building, Washington,
DC.
Dear Senator Enzi: On behalf of the Small Business &
Entrepreneurship Council (SBE Council), I am writing to
applaud you for introducing a Resolution of Disapproval (S.J.
Res. 39) relating to the rule on ``grandfathered plans''
issued by the U.S. Department of Health and Human Services
(HHS). The rule, as written, is in clear violation of
President Obama's promise that Americans would be able to
keep the health plans they currently have upon passage of the
Patient Protection and Affordable Care Act (PPACA). In
addition, we believe that HHS has taken creative license in
its interpretation of PPACA, bringing an ideological bent
that is not supported by the statutory language.
SBE Council strongly supports your Resolution. Without its
successful passage most small business owners and their
employees will lose the health coverage they currently enjoy.
Small business owners and the self-employed were promised
by President Obama and supporters of PPACA that they could
keep the plans they currently have under the legislation.
However, this promise has turned out to be false and small
business owners feel betrayed by what transpired during the
rule-making process, as well as what is occurring in the
insurance marketplace. In order to qualify for grandfathered
status, small business owners must stay with their current
carrier and not significantly alter their current health plan
or coverage. If their current carrier significantly raises
their premiums, small business owners cannot shop around for
more affordable plans or they will risk losing grandfathered
status. The alternative is to move to another carrier and
face more costly coverage mandated by the new health care
law. In sum, small business owners are rendered helpless by
this catch-22 rule.
Rather than helping small business owners and their
workforce keep their plans, it appears the rule has been
rigged to force most small businesses and their employees out
of grandfathered status. We are aware that HHS estimates,
worst case, 80 percent of small business owners will lose
their current health plans. SBE Council believes 80 percent
is the likely scenario, if not a conservative figure.
The consequence of the rule is obvious--more small business
owners will drop coverage. Hiring will remain weak and jobs
will be lost. This was not the promised outcome of PPACA.
Senator Enzi, SBE Council shares your desire to overturn
this unjust rule. We applaud your leadership, and will do
what it takes to see that S.J. Res. 39 advances into law.
Sincerely,
Karen Kerrigan,
President & CEO.
____
Associated Builders
and Contractors, Inc.,
Arlington, VA, September 28, 2010.
Hon. Mike Enzi,
United States Senate.
Dear Senator Enzi: On behalf of Associated Builders and
Contractors (ABC), a national association with 77 chapters
representing 25,000 merit shop construction and construction-
related firms with 2 million employees, we are writing to
express our strong support for S.J. Res. 39, which would
overturn the recently issued rule relating to status as a
grandfathered health plan under the Patient Protection and
Affordable Care Act (PPACA).
Throughout the health care reform debate, ABC advocated for
policies that reduce the cost of health care for employers
and their employees. ABC called on Congress to advance
commonsense proposals that would address the skyrocketing
costs of health insurance, especially for employer-sponsored
plans, and the rapidly rising number of uninsured Americans.
ABC believes true reform should provide greater choice and
affordability and allow private insurers to compete for
business.
Unfortunately, the new health care law will do nothing to
reduce the cost curve; instead it simply will enroll more
Americans into a broken and unsustainable health care system.
Specifically, the recently issued grandfather rule will
increase, rather than decrease, costs for small businesses.
On June 17, the Departments of Health and Human Services,
Labor and Treasury issued an interim final rule relating to a
plan's status as a ``grandfathered health plan'' under PPACA.
As part of the Small Business Coalition for Affordable
HealthCare, ABC and several other organizations filed
comments expressing concern that the grandfather rule is
overly restrictive and could make it even more likely that
small businesses will choose to drop their plans prior to
2014 as they are faced with unsustainable premium increases.
Instead of lowering the number of uninsured Americans, the
rule could actually increase the number of uninsured before
the health care law is fully enacted.
The coalition also pointed out that neither PPACA nor the
grandfather rule address the core problem facing small
businesses: the rising costs of health care. Instead, the
rule strips small employers of the ability to exercise
flexibility in adjusting to cost increases in order to
maintain their current plan.
The grandfather rule demonstrates a fundamental failure of
the federal government to understand the needs of small
businesses. With a current unemployment rate of 17 percent,
the construction industry cannot endure another cost increase
at the hands of the federal government. It is unfortunate
that the federal government continues to fail to provide
employers and their employees with health care solutions that
are practical or affordable.
Once again, ABC strongly supports S.J. Res. 39 and we
commend you for introducing a resolution that is intended to
reduce health care costs for a struggling sector of our
economy: small businesses. We look forward to working with
you in the future on commonsense health care initiatives.
Sincerely,
Brewster B. Bevis,
Senior Director, Legislative Affairs
The PRESIDING OFFICER. The Senator from Iowa.
[[Page S7687]]
Mr. HARKIN. Mr. President, I yield myself such time as I may consume.
I have to say to my friend from Wyoming: Where did that come from--
100 pages of regulations for every page that is in the bill? That is
going to be 200,000 pages of regulations. Where did that come from? It
sounds like it came from the health insurance industry to me. Boy, I
tell you, that is quite a figure. Well, obviously, it is a bogus
number, and I do not know where that figure came from. I would like to
ask my friend where that did come from.
But I say to my friend from Wyoming, the Senator just said there is
no help--I wrote it down here as fast as I could--no help for small
businesses until 2014.
Wait a minute. Wait a minute. In the Affordable Care Act, we
attached--in the tax bill that Senator Baucus got through the Finance
Committee, small businesses, beginning this year, 2010, will receive a
tax credit--a tax credit, not deduction, a tax credit--of up to 35
percent of the cost of an employee's health insurance.
So you have a small business, prior to this year, that did not get a
tax credit, I say to my friend from Wyoming. I mean, the Republicans
ran this place for 8 years under George Bush--8 years. They had a
Republican President, Republican Senate, Republican House. They did not
give small businesses any tax breaks for health insurance. We did. It
is in the bill, a 35-percent tax credit this year for small businesses.
That would cover 83.7 percent of all small businesses in the country.
That is quite a bit of help for small business.
I have heard from small businesses in my State that can get that tax
credit this year that they have never had before. A lot of these small
businesses are small businesses that employ just a few people--10, 12.
They know their employees. They go to the same churches, schools. They
are neighbors. I can't tell my colleagues how many small business
owners in Iowa have told me: I feel so bad. Because of the increasing
costs of health insurance, whether they are increased copays or
deductibles, cutting out benefits, I have had to increase the cost of
health insurance to my employees to the point that it is almost not
worth it anymore because of high deductibles.
They feel badly about it because these are their friends, neighbors.
They are related a lot of times. I have had them come to me and say:
Finally, this year I can get a tax credit, up to 35 percent.
Quite frankly, in my State, 90.8 percent of small businesses will get
the maximum 35 percent tax credit. Small businesses don't have to wait
until 2014 to get help; they are getting that help right now.
Mr. DURBIN. Will the Senator yield for a question?
Mr. HARKIN. I am delighted to yield to my friend from Illinois.
Mr. DURBIN. I would like to ask the Senator from Iowa, if the Senator
from Wyoming prevails in what he is seeking to do this morning, it is
my understanding that almost half the people in America who currently
have health insurance through their employers, people who are so-called
grandfathered in under this bill, would not get the new protections
that are coming in the law, protections that say that under their
health insurance, they will not be subject to a lifetime limit. For
example, if someone gets into long-term cancer therapy that is going to
be very expensive over a long period and the insurance company decides
halfway through they will cut them off, we now protect people so that
they can continue to get the care they need. They can't be limited.
Isn't it also true that the effort of the Senator from Wyoming would
protect the right of the insurance companies to literally cancel one's
policy because of an error made in the application for the policy, to
rescind the policy?
I might add, it is my understanding that this rescission is abused in
my State more than any other in the Nation. The rescission rate on
health insurance in Illinois is three times the national average. We
have had over 5,000 people who have had their health insurance
canceled. When they went to the company and said: I am facing surgery,
I am facing cancer therapy, and I need coverage and want to make sure I
have it, they ended up getting their policies canceled.
I ask the Senator, would the effort by the Senator from Wyoming take
away these protections we are now building into the law to make sure
health insurance is there when people need it the most?
Mr. HARKIN. Mr. President, we have two things here. We have the
Patients' Bill of Rights which just went into effect. That covers
everybody. That covers all plans. That covers grandfathered plans. They
can't escape that. However, if a plan wanted to be grandfathered, we
left it up to the Department to write rules and regulations as to what
grandfathered means. For example, let's say the Senator from Illinois
and I have a contract. We both have agreed to it. We say we are going
to let that contract go into the future. After a certain date, you are
grandfathered in that contract.
What the Senator from Wyoming would say is that if you are the
insurance company and I am the individual covered, we will grandfather
it, but you can change it any way you want. You can raise my copay. You
can raise my deductible. You can reduce the annual limit on claims you
will pay. You can eliminate benefits, such as the Senator just pointed
out, for cancer or diabetes. And guess what. You would still be
considered grandfathered. But I am stuck with that. That is what is so
important here. That is what people have to understand about what the
Senator from Wyoming is trying to do. He is saying that basically we
will grandfather it in, but the insurance companies can change it
however they want, and you are stuck with it.
Mr. DURBIN. So if the Senator from Wyoming prevails and I am one of
the grandfathered plans--in other words, I have my health insurance
plan that I like through my employer--my health insurance company on my
grandfathered plan can literally cut me off when I need health
insurance the most, can literally put a limit on the amount they are
going to pay on an annual basis?
Mr. HARKIN. That is right.
Mr. DURBIN. Can really take away my health insurance protection.
I ask the Senator from Iowa, hasn't he heard, as I have from people
in my State, how vulnerable they are when you empower health insurance
companies to bail out when you need them the most? If we voted with the
Senator from Wyoming, we would empower the health insurance companies
at the expense of vulnerable people who may face an accident or a
diagnosis tomorrow that changes their lives. Isn't that what this gets
down to in its most basic form? Do we want to give power to the people
who are insured or power to the health insurance companies? As I
understand the Senator from Wyoming, he thinks the health insurance
companies should have the power and we should not be providing
protection to the people who need it most.
Mr. HARKIN. That is the way I see it. It just seems that we have
rules and regulations. What the Department has said is that, OK, to be
a grandfathered plan, you have to fall under these items: You can only
raise your copayment a certain amount. By the way, it is quite a bit.
You can raise your copayment either the greater of 5 bucks or medical
inflation plus 15 percent. That is pretty good. It says you can change
different things but within certain limits. They can't, for example,
raise your coinsurance charges--that is, if you have a percentage. For
example, if it is 20/80, they can't just raise that. It has to stay the
same percentage. They could raise the copayment if it is a dollar
amount.
That is why the Senator from Illinois is so right. If this resolution
passes, all of the protections for consumers are wiped out.
Mr. ENZI. Will the Senator yield for a question?
Mr. HARKIN. On whose time?
Mr. ENZI. I am about out of time.
Mr. HARKIN. How much time remains?
The PRESIDING OFFICER. The Senator from Iowa has 17 minutes, and the
Senator from Wyoming has 13\1/2\ minutes remaining.
Mr. HARKIN. Mr. President, I will be glad to yield time if he will
yield me time if I have a question.
Mr. ENZI. Certainly.
The Senator from Iowa is not answering the same question the Senator
from Illinois is asking. I did say that when the resolution passes,
they would
[[Page S7688]]
not be able to discriminate on preexisting, they would not be able to
impose annual limits. They will not be imposing lifetime limits. They
will have to keep people until age 26, and they will not be able to
cancel it for paperwork error. I think that is the question the Senator
from Illinois was asking, not the copays and those things.
Mr. HARKIN. I did respond that the bill of rights applies to all
plans.
Mr. ENZI. All plans, even if the grandfathering clause is taken out?
Mr. HARKIN. Absolutely. I made that very clear. The bill of rights
that came into effect stays for everything. But what I am saying is
that the Senator is right, and I responded that way concerning the bill
of rights. But what doesn't apply to grandfathered plans are preventive
services that are covered with no cost. That is not covered. The right
to an appeal to a third party is not covered. Restrictions on annual
limits is not applied. They can put annual limits on coverage under
these grandfathered plans. Direct access to OB/GYNs without a referral
is not part of the Patients' Bill of Rights. No higher cost sharing for
out-of-network emergency services, no prior authorization requirement
for emergency care--none of that is in the bill of rights. So all of
that is wiped out by the resolution of the Senator from Wyoming.
Again, for emphasis, you have a contract. You work for an employer.
They have a plan. You are part of that plan. If you like that plan, you
can stay with it. My friend from Wyoming said: Only in Washington, DC,
could they say, if you like your plan, you can stay with it, and then
they change it. No. Only in the health insurance industry, perhaps in
the Republican philosophy, would you say that you can grandfather a
plan, but you the consumer are stuck if the insurer wants to change it
any way he wants to change it, with the exception of the bill of
rights. They could raise your copayment, they could take away your
right of access to an OB/GYN without referral, and all the other things
I mentioned.
If your insurer dramatically raises your copayment, that is not what
you signed up for. That was not the plan you signed up for. If your
insurer dramatically raises your deductible, that is not what you
signed up for. If your insurer reduces the annual limit on claims they
will pay, that is not what you signed up for. If your insurer
eliminates covered benefits, such as cancer or diabetes, that is not
what you signed up for.
We are saying: You have a plan here. You signed up for it. You like
it. You can keep it.
But what if your insurer comes along and says: Guess what. We are not
going to cover it if you get diabetes, and we are going to put an
annual limit on claims we will pay, and we are going to raise your
deductible by a huge amount. Is that the plan you signed up for? No. So
why should you be stuck with that? Why should that be a grandfathered
plan?
A grandfathered plan means a plan that was in existence before April
of this year that you like but which is not changed dramatically on you
by your insurer. So if you have a grandfathered plan, you are fine.
What the Department did is that they issued regulations to define what
that is. Quite frankly, I thought they were very lenient. For crying
out loud, they can raise your copayment by the greater of $5 or medical
inflation plus 15 percent. Fifteen percent of medical inflation sounds
like a lot to me. That is quite lenient.
Again, my friend had a lot of letters he included for the Record. I
would like to insert letters in opposition from the Small Business
Majority, from the Center for Budget and Policy Priorities. Here is a
letter signed by the American Cancer Society Cancer Action Network, the
American Diabetes Association, the American Heart Association, Families
USA, the National Partnership for Women and Families, National Women's
Law Center, SCIU, and U.S. PIRG. I also have letters from Health Care
for America Now, Service Employees International Union, the AARP, and
Trust for America's Health. I ask unanimous consent to have these
letters printed in the Record.
All are in opposition to the Enzi resolution.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Small Business Majority,
Sausalito, CA, September 28, 2010.
Hon. Tom Harkin,
Chair, Senate Committee on Health, Education, Labor and
Pensions, Senate Dirksen Office Bldg., Washington, DC.
Hon. Mike Enzi,
Senate Russell Office Bldg.,
Washington, DC.
Dear Senators: Small Business Majority strongly opposes
S.J. Res. 39--a resolution of disapproval that would prevent
implementation of the grandfathering regulations under the
Patient Protection and Affordable Care Act. This unnecessary
resolution would impede the orderly and responsible
implementation of comprehensive reform--which would deny
small businesses and their employees the protections reform
provides, and make it more difficult for them to access
affordable care.
The passage of healthcare reform was a huge victory for
small businesses, many of whom are being crushed under high
healthcare costs and were looking to reform to give them some
relief. However, there are small businesses that like their
existing plans and want to keep them. The legislation allows
them to do so. But these plans must continue to resemble
their current form and also must work in the context of
overall reform.
The regulations issued by Health and Human Services on June
15 strike the right balance. They require that the existing
plans don't increase costs more than 15% above medical
inflation and that they don't disturb reforms that will be
put in place in 2014--such as prohibiting insurance companies
from denying coverage due to preexisting conditions. We found
from extensive opinion polling that these requirements
address small business owners' biggest concerns: controlling
costs and the elimination of preexisting condition rules.
While we believe the regulations make sense, they aren't set
in stone; HHS is open to making additional changes based on
small business input.
Small Business Majority continues to support healthcare
reform. Small businesses are the lifeblood of our nation's
economy and shouldn't be denied the benefits reform provides,
which is why we urge you to vote against this
counterproductive resolution.
Sincerely,
John Arensmeyer,
Founder & CEO.
____
[From Off the Charts, Center on Budget and Policy Priorities, Sept. 29,
2010]
Enzi Proposal Would Threaten Market Reforms in Affordable Care Act
The Senate is expected to vote today on a proposal from
Senator Mike Enzi (R-WY) to overturn federal regulations
related to some of the Affordable Care Act's key health
insurance market reforms that took effect last week.
The regulations define ``grandfathered plans.'' Here's why
this definition matters. Among other things, the new health
reform law would require health plans to cover preventive
care without cost-sharing, undergo reviews to see if their
premium rate increases are unreasonable, and offer enrollees
the choice of their primary care provider. But plans that
existed when the law was enacted on March 23, 2010--known as
``grandfathered'' plans--aren't required to comply with these
reforms.
The regulations define how much a grandfathered plan can
change before it is considered a new plan that must abide by
these new reforms and consumer protections. As we explained
in a recent fact sheet, they strike a good balance for
consumers, allowing people to keep the plans they have while
ensuring that consumer protections kick in if an insurance
company reduces a plan's benefits or raises consumers' out-
of-pocket costs significantly.
Repealing the regulations, as Senator Enzi is proposing,
would confuse consumers, employers, and insurers about which
plans are grandfathered and which plans have to comply with
market reforms. As a result, it would threaten the
implementation of the immediate market reforms, thus making
the insurance market less stable and would likely leave many
consumers without access to critical protections the
Affordable Care Act provides.
In short, the Enzi proposal--which would require just 51
votes to pass--would be a significant step backward.
____
September 29, 2010.
Dear Senator: The undersigned organizations write to you to
express opposition to Senate Joint Resolution 39, Disapproval
of Grandfathered Health Plans, filed by Senator Mike Enzi.
The resolution would block key insurance reforms included in
the Affordable Care Act that protect consumers and ensure
high quality, affordable care.
Specifically, the resolution would eliminate an interim
final rule issued by the Departments of Health and Human
Services, Labor and Treasury in June that clarified important
consumer protections. Many provisions in the Affordable Care
Act apply to all plans, new and existing. However, some
provisions only apply to new plans. The rule outlines how
health insurance plans could maintain or lose their
``grandfathered'' status.
The rule, issued by the Administration, strikes the right
balance between protecting consumers and providing stability
and flexibility for employers. Specifically, the rule
[[Page S7689]]
prohibits plans from significantly cutting or reducing
benefits, increasing copays by an excessive amount,
dramatically raising deductibles or decreasing employer
contributions that result in an increase in workers' share of
premiums. If plans significantly raise out-of-pocket costs
for consumers, they lose their ``grandfathered'' status and
would be considered a new plan, subject to further
requirements in the law. Senator Enzi's resolution would
completely eliminate the rule, making it impossible to
enforce important consumer protections against potential
insurance company abuses. If enacted, the resolution would
put consumers' rights in jeopardy.
We strongly urge you to stand up for American families and
vote ``no'' on SJ Resolution 39.
Sincerely,
American Cancer Society Cancer Action Network.
American Diabetes Association.
American Heart Association.
Families USA.
National Partnership for Women and Families.
National Women's Law Center.
SEIU.
U.S. PIRG.
____
Health Care
for America NOW!,
Washington, DC, September 28, 2010.
Dear Senator: On behalf of Health Care for America Now, we
urge you to oppose the Joint Resolution of Disapproval of the
``grandfathering rules'' filed by Senator Enzi. We understand
this could come up for a vote as early as Wednesday,
September 29. The Enzi resolution would nullify the interim
final rule defining grandfathered plans. In striking the
rule, Senator Enzi's resolution potentially allows any health
plan to be grandfathered--shielding plans indefinitely from
complying with important new consumer protections that
benefit millions of Americans.
Like the Affordable Care Act (ACA) itself, the interim
final rule issued by the Departments of HHS, Labor and
Treasury sought to strike a balance that allows consumers to
keep current plans they like, while also ensuring that plans
evolve to incorporate new consumer protections. To do this,
the rule laid out the circumstances under which a health plan
loses grandfathered status, and therefore must comply with
certain new consumer protections. Factors that result in a
plan losing grandfathered status include significant benefit
cuts, cost-sharing hikes, lower employer contributions, a new
or tightened annual limit, or switching insurance carriers.
The Enzi resolution wipes away the rules that define
grandfathered plans, potentially allowing any plan to assert
its permanent non-compliance with consumer protections. This
would invalidate many benefits of the ACA for people that
currently have insurance and indefinitely lock them into
plans that fail to meet basic consumer protections. Though
claiming to help small business, the resolution will plunge
many small business health plans into a maze of litigation.
This resolution is a transparent attempt to gut some of the
most important provisions of insurance reform.
Consumers lose under the Enzi resolution. Plans would not
have to cover preventive services at no cost. The right to
internal and external appeals could be stripped. A trip to
the emergency room could again require prior authorization
and result in enormous out-of-network costs. These
protections are so basic, popular and bipartisan that there
can be no explanation for this resolution other than
pandering to an insurance industry that lost the battle but
is still gunning to win the war against consumers on health
reform.
On September 23, people all around the country celebrated
the arrival of key consumer protections. Advocates hosted
hundreds of events nationwide, including 87 sponsored by
Health Care for America Now and the Main Street Alliance.
This spiteful resolution threatens to rip away those hard-won
consumer benefits. We urge Senators to vote no on the motion
to proceed and no on the resolution.
Sincerely,
Ethan Rome,
Executive Director.
____
Service Employees
International Union.
On behalf of the more than 2.2 million members of the
Service Employees International Union (SEIU), I urge your
boss to oppose S.J. Res. 39 filed by Senator Enzi. This
resolution of disapproval would strike the interim final rule
submitted by the Departments of Health and Human Services,
Labor and Treasury on the grandfathered health plans under
the Affordable Care Act (ACA).
Many of the new protections under the ACA apply to all
health plans, both those in existence known as grandfathered
plans and new health plans or non-grandfathered plans. Those
provisions covering all health plans include a prohibition of
rescissions, a ban on annual lifetime coverage limits,
coverage of children until age 26, and an end to exclusion of
children based on pre-existing conditions. There are certain
provisions that do not apply to grandfathered plans,
including the requirement to provide preventive health
services with no cost sharing and the new internal appeals
and external review process. Senator Enzi's resolution seeks
to disapprove the interim final rule which states that health
plans would cease to be the same plan that was in effect on
March 23, 2010 and therefore no longer maintain grandfathered
status if they significantly cut benefits, raise deductibles
or co-pays or lower employer contributions.
This resolution would give insurance companies free reign
to change the structure of a health plan such as increasing
co-pays and deductibles and not be required to provide
stronger consumer protections/benefits enacted under health
care reform designed to increase access and affordability. In
short, S.J. Res 39 is a blatant attempt to erode the
protections provided to consumers under health care reform.
SEIU strongly urges you to oppose S.J. Res. 39. SEIU will
add votes related to this issue to our Congressional Score
Card located on our Web site at www.seiu.org. Should you have
any questions or concerns, contact Desiree Hoffman, Assistant
Director of Legislation, at desiree.hoffmanaseiu.org.
____
September 29, 2010.
AARP: Senate Resolution Would Weaken New Health Insurance Patient
Protections
Association Urges Senators to Oppose S.J. Res. 39.
Washington.--AARP Legislative Director David Certner
released a statement in advance of today's expected vote on
S.J. Res. 39, a Senate resolution of disapproval that would
weaken the patient protections put in place under the health
care law. Certner's statement follows:
``The rules created earlier this year strike a good balance
between preserving the rights of individuals to keep their
existing coverage, while also honoring the purpose of the
Affordable Care Act in providing for patient protections and
important insurance reforms that safeguard individuals from
practices that lead to denials of coverage or to
underinsurance in the event of serious illness or accident.
``As I stated in AARP's letter regarding the Interim Final
Rule (IFR) to implement the grandfather status rules, `AARP
supports the general thrust of the IFR that plans not lose
their grandfather status for changes that are modest in
nature. This is consistent with the need to balance the
objectives in the ACA of preserving the right of individuals
to keep their existing coverage with the goal of ensuring
access to affordable essential coverage and improving the
quality of that coverage.' AARP agrees with the IFR's
determination of what would cause plans to lose their
grandfather status (e.g., cannot significantly cut or reduce
benefits, cannot significantly raise co-payment charges,
cannot significantly lower employer contributions) as
important consumer protections and consistent with the
statute.
``As a result, AARP urges Senators to oppose this
resolution to ensure critical new protections and rules
remain in place so that the vast majority of Americans who
get their health insurance through employers will have clear
guidelines on how their plans comply with the new law.''
AARP is a nonprofit, nonpartisan social welfare
organization with a membership that helps people 50+ have
independence, choice and control in ways that are beneficial
and affordable to them and society as a whole. AARP does not
endorse candidates for public office or make contributions to
either political campaigns or candidates. We produce AARP The
Magazine, the definitive voice for 50+ Americans and the
world's largest-circulation magazine with over 35.1 million
readers; AARP Bulletin, the go-to news source for AARP's
millions of members and Americans 50+; AARP VIVA, the only
bilingual U.S. publication dedicated exclusively to the 50+
Hispanic community; and our website, AARP.org. AARP
Foundation is an affiliated charity that provides security,
protection, and empowerment to older persons in need with
support from thousands of volunteers, donors, and sponsors.
We have staffed offices in all 50 states, the District of
Columbia, Puerto Rico, and the U.S. Virgin Islands.
____
Trust for America's Health,
Washington, DC, September 29, 2010.
U.S. Senate,
Washington, DC.
Dear Senator: The Trust for America's Health urges you to
oppose S.J.Res 39, a resolution of disapproval of the interim
final rule that stipulates what actions health plans are
precluded from taking if they wish to be considered a
``grandfathered'' health plan under the Patient Protection
and Affordable Care Act (ACA).
Among the many benefits of this critical law enacted
earlier this year is the renewed focus of the law on the
importance of prevention. As a result of ACA, patients and
consumers who enroll in new health insurance plans will have
access to recommended preventive clinical services for little
to no cost. This represents a tremendous opportunity to
encourage Americans to seek out and receive recommended
preventive services, which will have a real impact on
improving health outcomes. Furthermore, guaranteed coverage
of preventive services is a critical component of
establishing a national culture of prevention and wellness.
While we hope that one day all Americans will be guaranteed
this access, a certain category of ``grandfathered'' health
plans are exempt from this requirement. As released
[[Page S7690]]
in June, the rule requires that health plans not make
significant changes to plan benefits, premiums, or cost-
sharing requirements should they wish to maintain their
``grandfathered'' status.
Enactment of this resolution would block the Department of
Health and Human Services from implementing this rule and
effectively permit any existing health plan to avoid the
important affordability and benefit protections created under
health reform, including coverage of preventive health
services.
Once again, we urge you to vote against this resolution to
ensure that ``grandfathered'' status does not become a route
to curtailing the important prevention components of health
insurance reform. We hope you will stand on the side of
ensuring that patients have access to clinical preventive
services and other important insurance reforms contained
within ACA.
Sincerely,
Jeffrey Levi,
Executive Director.
I yield the floor and reserve the remainder of my time.
The PRESIDING OFFICER. The Senator from Wyoming is recognized.
Mr. ENZI. Mr. President, I yield up to 10 minutes to the Senator from
Arizona, Mr. McCain.
The PRESIDING OFFICER. The Senator from Arizona is recognized.
Mr. McCAIN. Mr. President, I ask unanimous consent to engage in a
colloquy with the Senator from Wyoming.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN. I would say to my friend from Wyoming, this seems like
old times--what we tried to stop for over a year, and now our
predictions came true, beginning with they turned 2 pages of this
2,733-page bill--2 pages--into 121 pages of regulation. Is that
correct, I would ask my colleague from Wyoming?
Mr. ENZI. In one of the instances, that is correct.
Mr. McCAIN. So in a 2,733-page bill, if we have 121 pages of
regulation for every 2 pages, that is going to be pretty interesting,
isn't it? And the fun has just begun. The fun has just begun.
If the Senator might recall, I ask my friend from Wyoming, President
Obama--quote after quote, time after time:
And if you do have health insurance, we'll make sure that
your insurance is more affordable and more secure.
We know that is not true from every estimate. It is neither
affordable nor secure.
If you like your health care plan, you can keep your health
care plan. This is not some government takeover. . . . I
don't want government bureaucrats meddling in your health
care. . . . That's what reform is about.
I quote from the President of the United States.
So now they have taken 2 pages of a 2,733-page bill, and that is 121
pages of regulation.
Now, isn't it true, I would ask my colleague from Wyoming, who knows
as much or more about this than anyone, that it will result in 50
percent of all employees being in plans ineligible for grandfathered
status? Is that a correct statement?
Mr. ENZI. That is not only a correct statement, the estimate is a
little low, according to the administration.
Mr. McCAIN. According to the administration.
Mr. ENZI. According to the administration, in small businesses, 80
percent of the people--unless this is passed--will lose the insurance
they have and like, and in all businesses 69 percent will. Those are
not my numbers; those are the administration's numbers.
Mr. McCAIN. But isn't it also true that is the case for small
business and people and entrepreneurs all over America except the
unions? Isn't that true? Isn't this a carve-out again, part of this
sleaze that went into putting this bill together, part of the
``Cornhusker kickback,'' the ``Louisiana purchase,'' the buying of
PhRMA--all that went into this--the ``negotiations'' that were going to
take place on C-SPAN that the President said during the Presidential
campaign that went from one sweetheart deal cut to another. Part of one
of those sweetheart deals was the unions are exempt; is that correct?
Mr. ENZI. That is correct. And so were the other parts that were done
in order to buy the bill in a bipartisan way.
Mr. McCAIN. So what you are saying is that unless a health care
policy provided by an employer is absolutely unchanged totally for an
unspecified period of time, then that health insurance policy can be
declared invalid by the Department of Health and Human Services, and
they will have to go to a government-mandated health insurance policy
or pay a fine. Is that a correct assessment?
Mr. ENZI. It is a correct assessment in most of the parts. They will
have to give up the insurance they have now, even if they like it,
which the President did mention 47 times in public speeches. And there
are some requirements on how much of a change there can be.
But I have been talking to small businessmen traveling across
Wyoming, talking to them and visiting them, because Congress thinks
``profit'' is a bad word, and a lot in Congress think every business is
simple to run. But they have never been out there and scratched the
surface a little bit to see just how tough it is.
I have had businessman after businessman whom I have visited and ones
who have come to Washington because they have been so concerned who
have said: I am going to do everything I can to keep my plan just
exactly the same because this regulation is so difficult to understand,
and I am pretty busy anyway, so I don't think I dare make any changes.
That is not true. They could make a few changes, but if they do, they
will lose their status, and they will have to pay more.
Mr. McCAIN. So an employer, a small businessperson provides health
insurance for their employees. That employer sees health care costs go
up,--as everybody knows, and that is every objective estimate--so that
employer says to its 10, 50, 60, whatever, employees: Look, we are
going to have to increase your copay. We are going to have to increase
your copay because, simply, the costs are prohibitive, and we would
like to sit down, and I think you would probably agree to it given the
overall situation across health care. And the employees agree with that
and they change the copay, and then automatically they are finished. Is
that correct?
Mr. ENZI. Yes, that is correct. That is correct. If they change the
copay, they are no longer grandfathered.
Mr. McCAIN. So even though it is obvious that the cost of health care
is going up, continues up dramatically--that is estimates of OMB, of
literally every objective observer; the curve has not been bent down--
that unless employers keep exactly, with very little wiggle room,
basically the same health insurance policy for their employees, then
they will then have to comply with a government-mandated health
insurance policy. Is that correct?
Mr. ENZI. That is correct. The Federal bureaucrats have figured out
what the minimum amount of insurance is that you ought to have and
everybody else in America ought to have, and even if you like what you
have, you are going to have to go to that if there are certain changes
in your policy.
The small businessmen are worried about any changes. Because this
thing is so complicated, they do not even know what the rest of the
rules are going to be. They have talked about this tax credit, but a
number of them have looked at the requirements on the tax credit and
said: How in the heck do I ever comply with that? So they are a little
worried about being able to get that too.
Mr. McCAIN. So I guess it was one of our colleagues and the President
who intimated: Well, the American people really don't pay attention.
The American people don't really--they are deceived by FOX News, et
cetera.
The American people knew this was a bad deal then, and they know it
is a bad deal now. The majority of the American people want it
repealed. And all of this is suspicions confirmed when you take 2 pages
of legislation and turn it into 121 pages of regulation--a 2,733-page
bill.
Mr. ENZI. Yes, it will be dramatic. We have not begun to touch all of
the regulations that have to be written on this yet. We looked at the
Medicare bill and how many pages of regulations came out of that, and
it was 100 per page, which would be 270,000 pages on this one. That is
where that number came from.
Mr. McCAIN. So here we are with an economy that the administration,
the President, and his crack economic team said that if you pass this
stimulus bill, maximum unemployment will be 8 percent. What is the
problem with
[[Page S7691]]
investment and hiring and economic growth in America today? The total
uncertainty. We have just punted on the extension of the tax cuts or an
Obama tax increase. We have just punted on a number of issues, and the
American people now are going to have to--this small businessperson the
NFIB represents is going to have to thumb through 121 pages of new
regulations in order to understand. Big businesses and small businesses
are going to say: What are the next 121 pages of regulations that are
coming down for 2 pages of the bill? I guess the title page probably
would not have regulations associated with it, but the other 2,732
would.
Mr. ENZI. And the Senator from Arizona has not even mentioned the
1099 problem that is supposed to help pay for part of this bill.
Mr. McCAIN. Yes, which our colleagues just voted down. They voted
down a resolution by the Senator from Nebraska that would allow them
not to have to report every single transaction of $600 or more. No
wonder small and large businesses in America are reluctant to invest
and hire with this kind of foolishness going on.
Mr. ENZI. Right.
Mr. McCAIN. The CPAs come to me in Arizona and say: I can't advise my
clients. I don't know what the tax structure will be.
So here we are with a new 121 pages of regulation which obviously
will affect 50, 60, 80 percent--let's say it only affects 50 percent of
businesses in America--and we are going to vote down, probably, with
the big-government majority here, this effort to not have this
regulation implemented.
All I can say to my colleague from Wyoming is, thank you for your
leadership. Thank you for your thoughtful dissertation on this issue.
And I guarantee you, maybe next January, we can take this up again.
Mr. President, I yield the floor.
Mr. KYL. Mr. President, last June, President Obama promised on
national television that ``Government is not going to make you change
plans under health reform.''
In his September 2009 address to Congress he told Americans, ``If you
have health insurance through your job, nothing in our plan requires
you to change what you have.''
Many Americans doubted this would be the case, and they have been
proven right.
In the months after the health care law was passed, the
administration wrote the regulations for plans with grandfathered
status. Grandfathered status was supposed to allow employers to
continue offering current health plans, even if those plans don't meet
all of the government's new cost-increasing mandates and requirements.
And we were told it was intended to help protect Americans enrolled in
these plans from ``rate shock,'' or significant premium increases, as a
result of the new government mandates.
The consulting firm Mercer has bad news for people hoping to keep
what they currently have. It released a new survey of employers on the
impact of the health care law. One-quarter of employers surveyed
estimate that the law would raise premiums by at least 3 percent. That
increase is beyond this year's normal rise in costs due to medical
inflation.
A majority of respondents--57 percent--said they will ask employees
to pay a greater share of the cost of coverage in 2011, meaning higher
deductibles and copays.
As the Mercer study notes, ``The rules for maintaining grandfathered
status were tougher than many employers expected. As they start to get
a clearer picture of projected costs for 2011, many are finding they
need more flexibility to get their cost increases down to a level they
can handle.''
Yet the administration's regulations expose employers and employees
to extensive bureaucratic redtape just so they can keep their current
plans.
In fact, the administration's own experts at the Department of Health
and Human Services estimate that between 39 and 69 percent of
businesses won't be able to keep the health plans they have now.
Small businesses will fare even worse. By 2013, up to 80 percent of
small businesses could lose their grandfathered status. All of this
means that few health plans will qualify for grandfathered status, so
many Americans will not get to keep what they have.
Employers that lose grandfathered status for their health plans will
be forced to comply with all of the new mandates included in the health
care law and all of the administration's regulations.
Subjecting employers' health plans to these mandates will either
force them to change their plans and increase their costs of insurance
or pay a fine and dump their employees into the Federal Government's
new insurance exchange.
I do not support the health care law at all, but I believe Americans
should get to keep what they have, as promised, so I support the Enzi
resolution of disapproval. The resolution would nullify these
regulations and direct the administration to develop true
grandfathering protections that allow Americans to keep their current
coverage.
These latest developments are consistent with the pattern that has
emerged ever since this bill passed and was signed into law--one of
broken promises. Americans never liked or wanted this bill, and we are
continually reminded why they opposed it in the first place.
Mr. WARNER. Mr. President, I ask unanimous consent to have printed in
the Record, the following letter to Secretary Sebelius which discusses
my thoughts on the interim final rule, ``Rule'', regarding
grandfathered plans--75 Fed. Reg. 34538--as part of the Affordable Care
Act. While I will vote against the motion to proceed on Senator Enzi's
joint resolution of disapproval, S.J. Res. 39, I do have concerns that
the rule itself is overly restrictive. I look forward to working with
the administration and my fellow colleagues on continuing to develop
guidance on this issue.
There being no objection, the material was ordered to be printed in
the Record, as follows:
U.S. Senate,
Washington, DC, September 29, 2010.
Hon. Kathleen Sebelius,
Secretary, U.S. Department of Health and Human Services,
Washington, DC.
Dear Secretary Sebelius I write regarding the Interim Final
Rule (``Rule'') regarding grandfathered plans (75 Fed. Reg.
34538).
While I understand that the Rule seeks to balance consumer
protections while still allowing consumers to keep their
existing plans, I am concerned that as currently written, the
Rule is overly restrictive. In some places the Rule places
significant restraints on the ability of employers and health
plans to make adjustments to their existing plans that
contain costs while maintaining the overall benefit structure
and value for plan participants.
As a starting point for more flexibility, I urge you to
reconsider the provision that automatically revokes
grandfathered health plan status if an employer-sponsored
health plan changes insurance carriers. This provision, as
written, is overly restrictive and unfairly locks in
employers to a specific carrier. For instance, changing
carriers should not trigger a loss of grandfathered status if
the benefit coverage under a different insurer remains the
same. In fact, many new carriers have shown that they can
offer lower cost-sharing to employees due to a better rate.
I hope to work with you to refine and adjust this and other
aspects of the regulation as we further define grandfathered
plans to ensure appropriate stability in the marketplace. I
appreciate the opportunity to assist the Agencies in
continuing to develop guidance on this important issue.
Sincerely,
Mark R. Warner,
United States Senator.
Mr. HARKIN. Mr. President, how much time do we have?
The PRESIDING OFFICER. Eleven minutes 12 seconds.
Mr. HARKIN. How much time does the other side have?
The PRESIDING OFFICER. Three and a half minutes.
Mr. HARKIN. Mr. President, I yield 4, 5 minutes to the Senator from
Illinois.
The PRESIDING OFFICER. Without objection, it is so ordered.
The Senator from Illinois.
Mr. DURBIN. Mr. President, I just listened to the Senator from
Arizona, who is my friend and whom I respect. I cannot remember how
many pages were in the McCain-Feingold bill. I voted for it. I believed
in it. I did not count the pages. I thought he was on the right track
to change campaign financing in America. It was a bipartisan bill, and
I supported it.
Has that now become the measure in the Senate--we will count the
pages, and if it goes over 1,000 pages, we are not going to pass the
bill? I hope not because this bill, the underlying bill on health care
reform, to make it more affordable and more accountable, took on
[[Page S7692]]
one of the major industries in America, where the cost of health
insurance has gone up 10, 15, 20 percent a year.
We know the health insurance industry and the companies behind it are
not going to go down without a fight. They are going to hire the
lawyers and the lobbyists--and they did--to fight the passage of the
bill and to fight its implementation in court and everyplace you turn
because what is at stake is their money, their profit. What is at stake
is the way they do business, and they know it. So when this
administration writes the rules and regulations to make sure that when
we are challenged in court, this is going to stand up under the law, it
is the reasonable thing to do, and I think even the Senator from
Arizona would acknowledge it.
Now, I know the Senator from Wyoming does not feel this way because
he told me personally this morning that he does not favor repeal of the
bill. I do not know what the position of the Senator from Arizona is.
But I would say to those who want to repeal the health care bill that
the President signed into law, this is what they want to repeal. They
want to repeal the consumer protections which we have finally put into
the law which say the health insurance companies cannot cancel your
coverage when you need it the most. They cannot deny you coverage
because of a preexisting condition. They cannot deny to children under
the age of 18 coverage under health insurance for a preexisting
condition. They cannot deny to you the right to keep your kids under
your health insurance policy, your family's policy, until they reach
the age of 26.
In that bill was also a new deduction for the cost of health
insurance for small businesses so they can afford to find health
insurance for the owners and the employees of the businesses. In this
bill was closing the doughnut hole on the Medicare prescription Part D,
sending a $250 check to the seniors who needed it this year and
increasing that amount over the year and still not adding to the
deficit overall with this bill. That is what they want to repeal.
Well, I am not going to stand before you and tell you that the bill
we voted for was a perfect law. The only perfect law I am aware of was
carved in stone tablets and carried down a mountain by Senator Moses.
All the other bills that have been passed are going to need some
changes over the years. But the change the Senator from Wyoming brings
to the floor is a bad change--a bad change--because what he wants to do
is empower the health insurance companies to increase the amount of
money Americans pay for their coverage. That is it. Give them more
protection so they can raise costs.
The Senator from Wyoming said we should not be embarrassed to say
these companies are in business for a profit. I understand that. But
this underlying bill limits the profits of the company and says that 80
percent of the premiums they collect need to be spent on health care.
That leaves them 20 percent for their bonuses, for their salaries,
whatever they want. But we want to make sure people across America have
a fighting chance to have health insurance protection when they
absolutely need it the most.
I see my colleague on the floor, the Senator from South Dakota. He
and I had an unexpected experience in the month of August. We were both
in a hospital for surgery. Lucky for us, Senator Johnson and Senator
Durbin--and also the Senators on the other side of the aisle--are
protected by the best health insurance in America. Shouldn't the people
of this country have that same kind of peace of mind so that when they
need medical care, even expensive medical care, their health insurance
is there to protect them?
All of the people standing on the floor railing against government-
administered health care are covered by government-administered health
care. Our health insurance plans in Congress are administered by the
Federal Government, and not a single Senator on the other side of the
aisle has said: In principle, I am going to give up my health insurance
to show you how much I hate government-administered health care. They
have not done it because the plans are too darn good. We want to give
every American the same peace of mind Members of Congress have.
We have to defeat the Enzi approach today. It empowers health
insurance companies at the expense of people who need health insurance
when they face a diagnosis, a surgery, a cancer treatment that could
literally bankrupt their family unless they have health insurance
protection. I urge my colleagues to oppose Senator Enzi's effort on the
Senate floor today.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, how much time do we have remaining?
The PRESIDING OFFICER. The Senator has 6 minutes remaining.
Mr. HARKIN. Mr. President, again, I don't know where all of these
figures come from, how many pages of regulations per page on the bill,
and all that kind of stuff.
I have in front of me the Federal Register of Thursday, June 17,
2010. What we are dealing with today are grandfathered plans, right?
The resolution offered by the Senator from Wyoming has to do with what
is a grandfathered plan and the regulation of the grandfathered plan.
Well, I looked at the rules in the Register. It is one page and not
even a half, about a page and one-third--well, not actually even a page
and a third, a little over a page, a page and a third. I have it right
here. Page 34,568 and page 34,569: Maintenance of Grandfather Status.
That is what it is, and that takes into account all of the things to
which the Senator from Wyoming referred.
It is a page and a quarter, right there. There is a bunch of other
stuff in this regulation that comes through there, including accounting
tables and all kinds of things, but the actually rule, regulation, is a
page and a third. I don't know what all this other stuff is in here. It
is probably make work for somebody, I don't know. But it is a page and
a third.
But getting to the crux of it, we provided in the health reform bill,
which is now law, that if you had a plan you liked, you could keep it.
If that plan was in effect prior to April of this year, you can keep
it. It is called grandfathering. Many of the things we provided for new
plans don't apply to those grandfathered plans, things such as
preventive services. As my colleagues know, all new plans now must
cover certain preventive services without any copays or deductibles,
that type of thing. All new plans have a right to an external appeal to
a third party, if you want. There are restrictions on annual limits and
coverage in the individual market. There is direct access to OB/GYNs
without a referral. You can't charge a higher cost sharing for out-of-
service emergency services. You don't need a prior authorization
requirement for emergency care. Those are just some of the elements
that apply to new plans that will not apply to a grandfathered plan.
So then you have to ask, well, what is a grandfathered plan? A
grandfathered plan is a plan that was in existence prior to April of
this year on which the insurer and the insured agreed, like a contract.
What if that grandfathered plan--what if that insurer then says:
Well, we agreed on a certain coinsurance charge. It was 20 percent. But
now we are going to raise it to 40 percent. Well, that is not what you
agreed to. That is not what you signed up for.
Let's say they want to raise deductibles. Let's say your deductible
was $1,000, and they say now they are going to raise your deductible to
$2,500. That is not what you agreed to. That is not the plan you liked
or you signed up for. Or let's say the plan wants to significantly
increase your premiums or they want to tighten down on your annual
limits. That is not what you signed up for.
So the rules and regulations say: Look, there are certain limits. You
can raise your copayment, but not more than $5 or 15 percentage points
above medical inflation. So there are certain restrictions put on what
an insurer can do and still claim to have a grandfathered plan. That
seems to me to make infinitely good sense because they leave the
consumer with nothing. They are at the whims of the insurance company.
That is what it was like before we passed the health care reform bill.
That is what my friends on this side of the aisle want to go back to:
Giving the insurance companies the wherewithal to define everything and
tell the consumer what it is that a consumer has to have. They call the
shots.
[[Page S7693]]
Well, quite frankly, what this regulation does is it gives more
empowerment to consumers. It says to an insurer: You can't just willy-
nilly change your plans that you had prior to April and call it a
grandfathered plan. If you change it, if you make all of these big
changes, guess what. You are going to have to cover preventive services
without copays and deductibles. If you do all of these big changes,
well, your insurer is going to have the right to appeal that. Quite
frankly, I think that has a lot to do with this. We said for any new
plans, the insurer has the right to appeal to a third party--not the
grandfathered plans but the new plans. That is why a lot of the old
plans don't want to become new plans. They don't want to give you that
right of appeal.
There are restrictions on annual limits, which I mentioned before, in
the individual market.
So, again, if you want to have a grandfathered plan, fine, but you
can't just change it dramatically. I say again to my friend from
Wyoming, read it in full. It doesn't say any changes; it says any
changes based upon certain things.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. HARKIN. So I say to my friends, we should vote this down and move
ahead with health care reform and protect the consumers of America.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, when we talk about 121 pages, we are talking
about what the small businessman has to access. He has to go on the
Internet and print out the pages. There are 121 pages. Yes, if he could
get it in the format of the Federal Register, he would have 34 pages.
But you can't ignore everything but 1\1/2\ pages. You have to do the
whole thing.
Small business is upset about this. That is why I listed the 54
different organizations that are opposing this bill. I have gotten, and
I am sure everybody has gotten--even though I only brought this
resolution up last week, there are hundreds of letters coming in with
examples of what this will do to them.
From Fort Lauderdale, FL: They received such a large increase of
people being grandfathered out of the plan, they will be forced to get
a new plan because they made their current plan so expensive. Now the
new plans have much higher deductibles, more out-of-pocket costs, and
more affordable plans only offer to pay 50 percent coinsurance. So the
options are limited.
The options are limited to all of the businesses. I have letter after
letter that shows how it isn't just the business that has to absorb
these costs. The individuals who have the insurance who have been
pleased with their insurance are going to have to go out on the open
market because the company is going to say it can't afford to do it
anymore. They are trying to keep the insurance, but that has been the
problem for small businesses all along.
Our economy is already struggling. It doesn't need more job-killing,
cost-increasing government mandates. We are hearing from small
businesses across the country which are already being forced to swallow
large premium increases that will prevent them from hiring more
workers. That is jobs. We need to create more jobs, not write
regulations that lead to less jobs.
The bill was sold as letting people keep what they have, but the
devil is in the details. Do a little digging. It is clear. Americans
would not be able to keep what they have. The simple truth is, because
this new rule will drastically tie the hands of employers, few
employers are expected to be able to pursue grandfathered status.
The Enzi resolution is about protecting small business and the people
who work there. Anytime an individual doesn't like what they are
getting, they can go out on the open market and get something, but most
of the help on getting that doesn't arrive until 2014.
Where is the cost cutting they were promised in the bill? Now we are
going to add this regulation to it, and small businesses are telling me
they can't afford it. If this becomes the grandfathered thing, 80
percent of small businesses are going to have to change unless my
resolution is passed. Sixty-nine percent of all businesses are going to
change unless my resolution is passed. People out there who like what
they have--listen to this. Help your small business and help get this
grandfathered thing passed.
As I mentioned, there are several organizations that are key voting
on this one because it is so critical to their members and the people
who work for them.
I ask my colleagues to support the resolution.
I yield the floor.
Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Alaska (Ms. Murkowski).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 40, nays 59, as follows:
[Rollcall Vote No. 244 Leg.]
YEAS--40
Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Isakson
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker
NAYS--59
Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Goodwin
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden
NOT VOTING--1
Murkowski
The motion was rejected.
____________________