Congressional Documents and Publications

December 18, 2009

Kerry Rebuts Republicans on Health Care, Urges Democrats to See Bigger Picture

WASHINGTON, D.C. - Senator John Kerry (D-Mass.) today went to the floor of the United States Senate to speak directly to colleagues on the urgency to deliver health reform to Americans.

The full text of his speech as prepared is below:

Mr. President, on an issue like health care, which has been something dozens of our colleagues have worked on for years and years, an issue that's enormously important to our country and to our constituents, I have to acknowledge that we've too often accepted a debate that misses the big picture.

Too many of us are closing our eyes to what we need to do - what we need to do now - to fix a health care system that we acknowledge values profits over people, a health care system that favors those who can buy over those who are in need.

What's worse - some of those who oppose reforming our health care system are relying on crude but effective demagoguery - emotionally laden buzzwords, tried and tested in focus groups and funded with millions of dollars from the insurance industry - to discourage us from moving even one step forward. It seems to have won some alarming traction: some of the staunchest advocates of health care reform - even among progressives- seem ready to toss in the towel just because the bill we're debating is not all they want it to be.

Well, that is exactly what the opponents of this bill would like you to do - throw your hands up in frustration and say, as Howard Dean said yesterday - let's "kill the bill" and start all over. Or as Keith Olbermann said Wednesday night - "this is not health, this is not care, this is certainly not reform."

I can promise you, if we follow that kind of advice and give up now, just because the bill is not all we want it to be, we surrender the very reforms that people have spent their lives working for, reforms that the Democratic Party has been proposing for decades, reforms that many of us in the Senate today ran on and promised we would work together to achieve.

What we are trying to do here is not easy. It wasn't easy for Franklin Roosevelt when he tried, it wasn't easy for Harry Truman when he tried, it wasn't easy for Bill Clinton when he tried. But you don't sound the retreat, especially when you are so close to achieving many of your objectives.

Some of our liberal friends have suggested we should kill the health care reform bill because it doesn't have a public option.

This week, for example, Howard Dean wrote in a Washington Post op-ed that real health care reform needed a public option that would "...give all Americans a meaningful choice of coverage." I was surprised to read that because back in 1993, then Governor Howard Dean called Medicare "...one of the worst federal programs ever and a living advertisement for why the federal government should never administer a national health care program.

Well, I am a strong supporter of the public option and I've fought to see it included. But if it cannot be included, I'm not willing to walk away. I'm not willing to tell someone five years from now that when I had a chance to guarantee that insurance companies couldn't discriminate against pre-existing conditions - which will save lives - that I walked away.

We need to step back here and see the forest not just the trees. In the totality of this bill, there are real reforms we've fought to win for decades that will make peoples' lives better -- that will lower costs and encourage the development and proliferation of nonprofit and consumer-oriented health insurance plans.

* The Senate bill includes a provision that would allow states to establish health care coverage for people between 133 percent and 200 percent of poverty. States could contract with directly plans and have the authority to negotiate the premiums, cost-sharing, and benefits for these individuals.

* The Senate bill provides $6 billion in start-up funding under the Consumer Operated and Oriented Plan (CO-OP) program. This money would foster the creation of new nonprofit member-run health insurance issuers that offer coverage in the individual and small group markets.

* The press has reported that one of the options being considered in the Manager's Amendment is the creation of an Office of Personnel management-administered plan. When I ran for President, I proposed allowing everyone to have access to same health care coverage offered to federal employees and Members of Congress. And I think leveraging the role of OPM to encourage the creation of national non-profit plans is a key way to lower health care costs and to enroll more Americans in plans that devote a higher portion of premium dollars to medical care.

Some of our liberal friends have said we should kill the bill because it has age-rated premiums.

Well, the Senate bill requires insurers to abide by important new rules to protect consumers. Insurance companies will be prohibited from denying coverage or charging you more because of a pre-existing condition or because you are a woman. I introduced the Women's Health Insurance Fairness Act which would prevent insurers in the individual market from charging women higher premiums than men. And I'm happy that this critical legislation is included as part of reform. Insurance companies will also be prohibiting from dropping coverage once someone becomes seriously ill and they will be required to renew your coverage each year. Insurance companies will be prohibited from imposing lifetime caps or unreasonable annual limits on coverage.

I wish the bill would also eliminate age rating so that insurers could not charge older Americans vastly higher premiums simply because of their age. The Senate bill imposes a three-to-one limit on age rating, which means that insurers can not charge older Americans more than three times what they charge younger Americans.

During the Finance Committee mark-up on health care legislation, I offered an amendment to impose a two-to-one limit on age rating with the ultimate goal of eliminating the discrimination of older Americans.

Charging older Americans nearly three times as much for health insurance is by no means ideal. But, let me remind my colleagues of current state rules. The vast majority of states have no rating structure in place in the individual market and they have obscenely high rate bands in the small group market. For example, in Kentucky rate bands in the small group market can be as high as twenty-five to one. In Utah, rate bands in the small group market can be as high as thirty-four to one.

As I said, I believe a three-to-one limit is too high. But, it is a vast improvement over current law that allows older Americans in some states to be charged a premium that is twenty-five times higher than younger Americans.

Some of our liberal friends have said we should kill the bill because the exchanges aren't strong enough.

Well, I have been working on strengthening the state exchanges for the past several months. Those who claim that the exchanges in the Senate bill aren't strong enough clearly haven't read the bill. You don't even need to get past the first 200 pages of the bill to see how the exchanges have been strengthened.

In the Finance Committee, I offered an amendment to make to allow the state exchanges to engage in prudent, selective purchasing of insurance. Under my proposal, exchanges would negotiate with plans for lower bids, encourage plans to form select networks, and exclude plans that do not offer good value and cost-effectiveness.

The Senate bill provides exchanges with robust authority to certify whether or not a plan can participate in the exchange based on a number of criteria including, whether the plans meet certain marketing requirements, have broad provider networks, and deliver quality benefits for the price. The exchanges have the power to approve the participation of plans if they are determined to be "in the best interests of qualified individuals and qualified employers in the State."

I have advocated for these provisions because in Massachusetts, the Health Connector's ability to negotiate contracts for Commonwealth Care has placed pressure on carriers to keep rate increases low overall. Over the 3 years of the program, average premium increases have been only 4.7% compared to 8% average premium increases for private insurance. The language in the Senate bill is modeled after the strength of exchanges in Massachusetts and I believe it will to ensure that taxpayer dollars are wisely spent on insurance policies that provide consumers with a good value.

The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. The Congressional Budget Office (CBO) has determined that it is fully paid for, will provide coverage to more than 94 percent of Americans while staying under the $900 billion limit that President Obama established, bending the health care cost curve, and reducing the deficit over the next ten years and beyond.

The bill includes immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance. Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage. New health insurance Exchanges will make coverage affordable and accessible for individuals and small businesses. Premium tax credits and cost-sharing assistance will help those who need assistance. Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.

The bill improves the quality and efficiency of health care. Congress is committed to protecting and strengthening the Medicare program for America's seniors. Medicare is a sacred trust with seniors and people with disabilities, and the Patient Protection and Affordable Care Act will ensure that trust is preserved. The cost of inaction is unacceptable for seniors and the Medicare program that serves them; without action, the Medicare hospital insurance trust fund is expected to go broke in just over seven years.

The Patient Protection and Affordable Care Act will make Medicare a stronger, more sustainable program and extend solvency by nine years. Medicare currently reimburses health care providers on the basis of the volume of care they provide rather than the value of care. For each test, scan or procedure conducted, Medicare provides a separate payment, rewarding those who do more, regardless of whether the test or treatment contributes to helping a patient recover. The Patient Protection and Affordable Care Act includes a number of proposals to move away from the "a la carte" Medicare fee'for'service system toward paying for quality and value and reducing costs to America's seniors.

The Patient Protection and Affordable Care Act promotes preventive health care and improves the public health to help Americans live healthy lives and help restrain the growth of health care costs over time. It will eliminate co-pays and deductibles for recommended preventive care, provide individuals with the information they need to make healthy decisions, improve education on disease prevention and public health, and invest in a national prevention and public health strategy.

Currently, 65 million Americans live in communities where they cannot easily access a primary care provider, and an additional 16,500 practitioners are required to meet their needs. The Patient Protection and Affordable Care Act will address shortages in primary care and other areas of practice by making necessary investments in our nation's health care workforce. Specifically, the Patient Protection and Affordable Care Act will invest in the National Health Service Corps, scholarship and loan repayment programs to expand the health care workforce. The bill also includes incentives for primary care practitioners and for providers to serve underserved areas.

But don't just listen to me describe the transformational changes in this bill. Jon Gruber, a respected and renown economist from MIT writes:

"The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the House and a parallel bill before the Senate would cover most uninsured Americans, saving thousands of lives each year and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. Moreover, the bill would accomplish this aim while reducing the federal deficit over the next decade and beyond. They would reform insurance markets, lower administrative costs, increase people's insurance choices, and provide "insurance for the insured" by disallowing medical underwriting and the exclusion of preexisting conditions. And the Senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society."

These are not minor things. These are things we have been striving for decades, certainly in the 25 years I have been in the Senate. I see colleagues who were here with me back when the Clinton administration tried to enact health care reforms, and I think everyone of us would have been more than happy back then to accept what we have a chance to pass now.

Now is the time for all of us to re-examine just what we have promised our people and decide where we really stand.

We know where the Republican Party stands. Rumors, fear-mongering and deliberate misinformation have been the core of the arguments they have presented us in a desperate attempt to stop us from curing the ills of our country's health care system.

They also are continuing to use procedural tactics to block the enactment of the Department of Defense Appropriations bill. As the Chairman of the Senate Foreign Relations Committee, I know how important the funding included in the Defense Appropriations bill is to insure our troops in Iraq, Afghanistan and elsewhere have everything they need to carry out their mission. As a veteran, I know our troops deserve to have an up or down vote on the funding that assists their noble efforts without delay. I ask my colleagues for their help to expedite a final vote on the Defense Appropriations bill as soon as possible.

Mr. President, we have heard repeatedly from Republicans that our health care reform bill will drive insurance premiums sky high for families. But the Congressional Budget Office says the 134 million Americans who get their insurance through their employer would end up paying three percent less for their premiums if we pass the reform measure before us. In addition, the CBO says the subsidies that are included in the measure would result in a 59 percent reduction in costs for the nearly 18 million Americans who purchase their own insurance. Health reform has dramatically reduced the average costs of premiums in the individual market in Massachusetts. Premiums fell by 40 percent from $8537 at the end of 2006 to $5143 in mid-2009, while the rest of the nation was seeing a 14% increase.

Mr. President, we have also heard repeatedly from Republicans that this bill will add billions of dollars to the federal budget deficit. CBO analysts conclude that the bill would add not one dime to the federal deficit. Not one dime.

Mr. President, from the very beginning of this debate, Republicans have tried to make the case that seniors' Medicare benefits are jeopardized by our reform measure. Such statements are patently false and yet they have been repeated over and over. The bill before does just the opposite - it actually adds benefits for seniors. For example, there are the new screening benefits. Another example is the bill shrinks the so-called doughnut hole in the Medicare prescription drug benefit and Senate leaders have vowed to close the doughnut hole in conference.

The nonpartisan National Committee to Preserve Social Security and Medicare sent a letter to every Senator a few days ago, and it says: "Not a single penny in the Senate bill will come out of the pockets of beneficiaries in the traditional Medicare program." In fact, the letter adds that our reforms "will positively impact millions of Medicare beneficiaries by slowing the rate of increases in out-of-pocket costs and improving benefits, and it will extend the solvency of the Medicare trust fund by 5 years. To us, this is a win-win for seniors and the Medicare program." Since sending that letter, the CMS Actuary released a report saying the solvency of the Medicare trust fund would be extended by nine years as a result of the Senate bill.

It's been interesting to watch Republicans speak about protecting Medicare, a program their party has opposed from its very beginning. And while claiming to be trying to protect Medicare, they have simultaneously warned of the evils of government-run health care programs. If they are so opposed to government-run health care programs, they should propose to abolish Medicare. They won't, of course, because Medicare prevents millions of seniors from falling into poverty due to health care costs.

Similarly, Republicans always promote the idea that competition is good for the marketplace. And yet, they adamantly oppose including a public option as part of the cure for our health care system. A public option would, in fact, keep the private plans "honest," as President Obama has said. I couldn't agree more.

Like some of our liberal friends, Republicans now want us to start over. But I can promise you this - if we start this process over, we're not going to get any more support from Republicans than we've already gotten, which has been nothing in the Senate.

Ted Kennedy often said his biggest political mistake was turning down a health care deal with Richard Nixon in 1971 that, for the first time, would have required all companies to provide a health plan for their employees, with federal subsidies for low-income workers.

Teddy backed away from the deal under heavy pressure from fellow Democrats who wanted to hold out for a single-payer system once the party recaptured the White House in the wake of the Watergate scandal. Well, thirty-eight years have passed and single-payer is still a dream.

The lesson Teddy learned is this - that when it comes to historic breakthroughs in America, especially in social policies, you make the best deal you can, then immediately start pushing for ways to improve the deal. The journey never ends, as we've seen repeatedly as we've moved closer and closer to providing all Americans with adequate and affordable health care.

On this ever-winding journey, we developed Medicare and Medicaid - two programs that are the foundation of health coverage and currently serve about one in three Americans. These were bold steps - both programs were opposed by the America's medical establishment and by the predecessor's of today's Republicans. In fact, when former Senate Majority Leader Bob Dole ran for president in 1996, he boasted that the vote he was most proud of was the one he cast against Medicare and Medicaid.

Since 1965, when Medicare and Medicaid were created, they have evolved and improved over the years. When Medicare first passed, it did not cover individuals with disabilities or individuals with end-stage renal disease. Now it does. Similarly, Medicaid evolved to allow states to cover additional services like home and community based care. Now, both Medicare and Medicaid are an indispensable element of the social contract in the United States.

Mr. President, our march to this point has been too long and too slow - almost a century, in fact It began in 1912 when Teddy Roosevelt ran for president promising government protection against, as he put it, "the hazards of sickness." And there have been fits and starts ever since - through the shouting and distortions and big interests clinging to status quo that just can't continue much longer.

We know the legislative process is a long one. But 97 years is way too long - way too long - for America to finally join all the other major industrialized nations in guaranteeing health care for all of our people. That we are here today, with an opportunity to take a giant step, shows not only what a challenge this undertaking has been but also the hard work, skill and dedication of our leadership.

The bill is not perfect. But tell me - what bill is" All of us still would like to change it here and there.

But none of us can credibly claim that we did not get a chance to have input into this bill. The Finance and Health committees of the Senate spent months of study, and the bills that came out of those committees included more than one hundred amendments by the minority. Unfortunately, even with those changes, the bills that came to us from the committees did so with virtually no support from the minority. Still, we are hopeful that some Republicans will join us in this historic moment.

Make no mistake. This is legislation that, with cooperation and bipartisanship, can make history and improve the lives of Americans for decades to come. It can help change who we are as a country - 94 percent of Americans would have health insurance. If we do nothing, things are only going to get worse - more expense, more bankruptcies, more people without coverage.

These kinds of opportunities do not come often. Many of us here recall how we let a moment like this pass in 1993. We learned hard lessons back then. But later, we did much better with the Children's Health Insurance Program, which, as the minority's co-sponsor, Senator Hatch, said was "the mark of a compassionate, caring Congress."

Compassion can also be the mark of this Congress, if we only act, with cooperation, respect and courage. We simply can't stop now. We are closer than we've ever been before.

Contact: Jodi Seth/Whitney Smith, (202) 224-4159

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