HEALTH CARE
(House of Representatives - November 19, 2013)

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[Pages H7247-H7250]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore (Mr. DeSantis). Under the Speaker's announced 
policy of January 3, 2013, the Chair recognizes the gentleman from 
Nebraska (Mr. Fortenberry) for 30 minutes.
  Mr. FORTENBERRY. Mr. Speaker, thank you for the time.
  I don't have to tell you all that there is a debate raging in our 
country about the future of health care. I want to share, first of all, 
a story that I received by email from Yvonne who lives in the town of 
Firth, Nebraska, right near me. She says this:

       We are a farming family of five in southeast Nebraska and 
     recently received notification from Blue Cross/Blue Shield of 
     Nebraska--an insurance company--that our insurance premiums 
     are increasing from $578 per month to $1,092 per month. That 
     is $514 more, resulting from the misnamed ``Affordable Care 
     Act.''

  Yvonne goes on and says:

       Even if I play with the numbers and drop our family income 
     to be eligible for subsidies, my family has never needed 
     government assistance in the past to pay for health 
     insurance. Why should we need it now, other than Washington's 
     interference? Would you please tell me how I am supposed to 
     find an extra $500 in my monthly budget to afford this new 
     improved policy.

  Mark, who lives in Lincoln, says he is 49. He said he had his 
insurance canceled, and he had a very good policy. And this is what he 
had to say:

       I had a $5,000 deductible policy; and after that, 
     everything was covered. My policy was not a junk insurance 
     policy. And it was canceled.

                              {time}  1845

  Mr. Speaker, many Americans are awakening to sticker shock and are 
feeling, frankly, very betrayed by the earlier comments that if you 
like your health care plan, you can keep it. Clearly, there is a 
significant problem here. And what has happened?
  Well, Mr. Speaker, we need the right type of health care reform--
health care that is actually going to reduce costs and improve outcomes 
while also protecting vulnerable persons. But what we have gotten 
instead through the new law is a shift of cost to more unsustainable 
spending by government, a shift of cost from one American to

[[Page H7248]]

another; and we also have a serious erosion of health care liberties.
  This is another email that I received from Joan. She talked about her 
son. She has maintained her son's policy--a young man--in case of a 
catastrophic event so it would not be a burden to the hospital.
  She said:

       He does not make enough money to file taxes, but his 
     premium goes from $85 to $220. So my son will no longer have 
     insurance of any kind. My son's new policy is required by law 
     to include things he can never, ever use--maternity for a 
     male and pediatric services for an adult. Please at least 
     allow the insurance carriers to call this what it is--an 
     insurance subsidy from my son to others.

  This young man is 30 years old. I don't know the circumstances of the 
family as to why they are providing a policy for their 30-year-old son, 
but clearly the family is trying to do the right thing and help one 
another; but they are being forced by escalating costs to reconsider 
the very idea of carrying health insurance themselves and doing the 
right thing.
  Mr. Speaker, when I was a much younger man in my twenties, I had an 
individual insurance policy that I bought. I thought it was the right 
thing to do. I didn't want to impose the risk of my own health care 
needs--in case something went wrong--on the rest of society. And I 
bought this policy. It was a pretty big burden to carry for someone in 
their twenties. It was fairly expensive. So I decided to raise the 
deductible to $1,000 to basically help better manage the costs.
  Well, one day I had a very severe headache, and it just didn't seem 
to go away; and as this went on, I decided it was necessary for me to 
seek medical attention.
  So thinking about it, I decided to simply bypass the family doctor, 
assuming that they would probably refer me to the ear, nose, and throat 
specialist. And so I made an appointment with the ENT doctor, probably 
saving myself about $50 by simply going to the specialist.
  When I got there, she examined me and they took an x-ray. Afterward, 
the doctor said, I really can't tell from the x-ray what the problem 
is. I'm going to need to do a CAT scan. I interrupted her at that 
moment and injected in the conversation and said, Doctor, I understand 
if you might be worried about liability and there might be this test 
that is normal protocol for you to run. She interrupted me and said, 
Why are you saying this to me? I said, Because I need to know if you 
really need this test. I'm actually paying for it.
  Again, I had the $1,000 deductible.
  She said, Oh, let's think about this. I'm only looking at your 
sinuses. So that means that we could probably ask one of the two 
entities in town with a CT scan machine if they will widen the cross-
section and let's see if they'll give you a discount for doing that.
  So she asked her assistant to help. They called both places in town, 
found out the price, found out if they would lower the price based upon 
a wider cross-section for this test, and one of them did. And I don't 
remember the exact amount, but I think it was $75.
  Mr. Speaker, I saved $75 by simply asking a simple question. The 
doctor got the test that she needed and the community resource was more 
properly allocated, all because I had the incentive to watch the cost.
  This is one of the problems here that we have in the whole health 
care debate. Because, again, the Affordable Care Act, sometimes called 
ObamaCare--and there are a lot of people who want to move away from 
that expression ``ObamaCare,'' and I respect that, because it has 
always seemed to me to be a bit disrespectful toward the President, so 
let's call it the Affordable Care Act. The Affordable Care Act shifts 
costs to more government spending and actually is moving costs from one 
individual to another.
  Now, how did we get here?
  Well, you remember in the Bush administration the number that was 
being talked about was that there were 50 million Americans who were 
uninsured. It has been a while now since I looked at that statistic. 
From memory, as I recall, that was actually an aggregate statistic that 
reflected the number of people within a year who had some trouble 
accessing affordable, quality health insurance. It was not necessarily 
a snapshot in time.
  So the number might have been bigger than what was suggested, but it 
laid the ground work for where we are now. Of course, President Obama 
and the administration used that number as well; but when you parse the 
number down and look at Americans who were having problems accessing 
affordable, quality health insurance, whether because of preexisting 
condition or some other issue, that number may have come down to 
perhaps 10 million to 15 million persons.
  Now that is a real problem. That is a lot of people who need help. 
And the right response is to engage in policy debate that will actually 
help them access affordable, quality health insurance; but we have done 
so by turning the entire health care system inside out. And it is 
creating havoc, sticker shock; and many Americans are feeling betrayed, 
particularly those who are buying their insurance in the open market, 
the individual market.
  Soon, many more will be receiving the price shock who have employer-
based insurance because of a couple of factors. And what are those 
factors?
  First of all, in the new law what has happened is there is a 
shrinkage of the age ratio. It used to be six categories, as I recall--
now it is three--by which you can price the product. That means younger 
people are actually subsidizing older people. You can have a debate 
about the merits of that, but that is one of the cost drivers.
  Secondly, there are all types of new mandated benefits. You heard it 
in the emails that I received. First of all, a very young man is having 
his insurance rates skyrocket simply because he is a young male. In 
Nebraska, we have one of the highest rate increases for single males. 
It is second only to Arkansas. It is 220-plus percent, as I recall.
  Why is that? We were somewhat a less regulated State, if you will. 
But what that created were market conditions whereby a young person who 
was relatively healthy could get an affordable, quality health 
insurance policy that protected them from catastrophic incidents. If 
they were in an accident or an unfortunate disease happened to strike 
them, they were covered; but now it is pushing those policies to a 
level where people are questioning as to whether or not they can afford 
it. A policy designed to help people is hindering those who have been 
doing the right thing from purchasing insurance.
  The mandated benefits issue: as the older gentleman writing me 
pointed out, I don't need maternity services. Again, those were 
incorporated into the law. An inability to customize an insurance 
policy based upon one's particular needs after us deciding what is a 
reasonable set of basic coverages that are necessary, which used to 
occur State by State.

  The third is no denials. Now, this one is a little bit more sensitive 
because, again, we do have Americans who are being held by this law and 
who had previously been either denied because of preexisting conditions 
or, for one reason or another, were having problems accessing 
affordable, quality health insurance.
  So as we move forward into a debate as to how we are going to reform 
the system and perhaps get this right, it is necessary that we carry 
forward either this way or another way. It used to be the government's 
subsidy of high-risk pools in which we allowed people to have access to 
more affordable insurance. Either that way or the way whereby we all 
absorb the cost across insurance policies and that we take care of 
people who rightfully need access.
  And so there are a few embedded policies in this Affordable Care Act 
that do make some sense. The first one was allowing young people to 
stay on their parents' policies a little bit longer--until the age of 
26. I supported that before the Affordable Care Act made sense. It 
replenishes your insurance pool, helps enculturate the concept of 
buying insurance at a young age, and hopefully that carries forward 
into creating a more robust, dynamic marketplace.
  Second is, again, dealing appropriately with people who have 
preexisting conditions. There are a lot of ways to do that--either, 
again, by subsidizing the market directly, since it was somewhat 
broken, or absorbing the cost across all insurance products.
  The third issue was removing insurance caps for those who actually

[[Page H7249]]

bumped up to their total maximum benefit.
  I know of cases where families were struggling with a severe disease 
condition that would meet their insurance cap. The response was they 
simply had to leave their job and go find another job and get employer-
based insurance to basically start the clock over. That doesn't save 
the system any money. It just burdens the family.
  So those are three aspects of the current health care bill that makes 
some sense, but we did not have to do so by turning the entire system 
inside out and harming disproportionately large numbers of Americans 
who have been doing the right thing: protecting themselves and not 
relying on society for the imputed costs of their own health care risk; 
who were trying in a marketplace to find the right product for 
themselves, but now who have lost access to basic products like good 
catastrophic coverage, which will lower costs for younger people. That 
is a very strong disincentive for young people to actually enter the 
insurance market, and that needs to be corrected.
  I think it is also part of our responsibility, for those of us who 
have said ``no'' to the Affordable Care Act and who have said there are 
better ways to reform the health care system to start laying out some 
specifics.
  Well, one of the specifics should be that we all ought to try to 
agree that the health savings account idea is a way in which we form a 
hybrid model that actually benefits the marketplace, benefits 
individuals, and retains the robustness of what private market 
competition can give you.
  Let's take, for instance, the case of the surgical procedure called 
LASIK. Now, I am not aware of insurance policies that regularly carry 
that procedure whereby the eye is operated on to correct vision. Large 
numbers of Americans have been helped by this extraordinary 
technological invention. And it appears to me from a cursory look at 
that market that prices have fallen, outcomes have improved, and the 
doctors who do this surgery seem to do pretty well with basically no 
insurance involved.
  So let's look at the health savings account model as a hybrid model 
whereby we retain the government subsidy in a certain sense by allowing 
people to set aside an account on a tax-free basis and they accumulate 
monies that go toward their first dollar of health care costs, taking 
better control over those first dollars that are expended.
  Now, Mr. Speaker, I recently had a medical issue. I had a sore spot 
on my ear. I didn't think much about it, but after about 3 weeks of it 
being there, I thought at my age maybe it is good to get that checked.
  So I went to the dermatologist, and he looked at it and he said, 
Jeff, I think this is 50-50 it may be a cancerous-type condition. I 
said, All right. He said, I'm going to put you on a medicine that we 
can go ahead and get started now while we wait for the biopsy to come 
back.
  So I went to the pharmacist to get the medicine. My co-pay was $5. I 
am very grateful for that. It was very easy for me, and I am thankful I 
had the insurance to be able to do this. It was $5.
  I asked the pharmacist, How much does this medicine cost? He said, I 
don't know. Let me check. He came back and said, It's $500. I said, 
Well, this is Friday. I'm not sure on Monday if I'm going to need this 
medicine or not. It's 50-50. Maybe we just ought to wait, And I chose 
to wait.
  So on Monday the doctor called back and said it was benign--not 
cancerous--nothing to worry about, and I didn't have to take the 
medicine.
  Well, I had no incentive not to take the medicine. The doctor didn't 
necessarily think through the question with me. He didn't have to 
because my co-pay was $5. Again, I am grateful for that. But the point 
being that $495 of waste would have occurred in the system had I not 
simply asked a question, and I didn't have an incentive to ask a 
question. I was simply trying to make sure that we weren't imprudently 
using that much medicine when it may go to waste; and I am glad I 
turned it down.
  Again, that is the point. If you have your own health savings 
account, which is coupled with a catastrophic policy, two things are 
occurring at once: first of all, you are controlling your first dollar 
costs. You have a normal conversation with your doctor about ordinary 
health care. Is this the pathway we need to go? What are our 
alternatives? Who can provide those in town--maybe at a cheaper rate, 
with the same quality?
  For that, we need price transparency in medicine. It is an important 
part of market reform that needs to occur. But if something really goes 
wrong and you are on the hospital gurney getting rolled into an 
operating room, you shouldn't have to pull off your mask and say, Can 
somebody give me the price of the anesthesia around here? That is not 
the point. That is different. That is a catastrophic condition. With 
catastrophic insurance, you should be protected from having to worry 
about those market dynamics.
  So I think this is a good hybrid model whereby, again, the government 
incents you to put a little bit of money aside in a tax-free account 
which, by the way, can accumulate over time. Most people don't get sick 
in their life, and a lot of this money could grow to a substantial 
amount over time and actually be a supplement in retirement or a 
supplement to Medicare. We have got long-term cost problems in the 
Medicare program.

                              {time}  1900

  So, again, it is thinking dynamically, creatively as to how we 
restructure health care and give improved opportunities for a robust 
marketplace for health insurance that doesn't just consolidate the 
marketplace into fewer and fewer companies. It has been suggested that 
what is happening now is this is becoming like a utility system whereby 
there are going to be a few insurance carriers that work with 
hospitals, and that is it. The government will have a role in setting 
certain rates, and that is it. So you lose the dynamic of the 
competitive model for the insurance market. We should protect people's 
access. We should allow people to have access to affordable, quality 
insurance and not simply be denied for preexisting conditions. There 
are a lot of ways to do that. If we do that, we can keep the market 
dynamic basis for controlling health care costs.
  We do this in all other areas of our lives, and it is normal to us. 
There is no reason that we have to put on blinders when we are dealing 
with ordinary health care costs and simply submit to the system 
whatever they tell us to do. There is no reason for that. What we could 
see--again, if we inject this sort of competitive marketplace for 
ordinary costs--is competition in the marketplace for ordinary 
processes and procedures in medicine, for drugs. Then you could see, 
like in the LASIK surgery example, prices falling, innovation 
occurring, and a health care system making reasonable returns for its 
efforts. Right now, we have a health care system that is very, very 
frightened. Doctors are very frightened of the next steps in terms of 
the evolving dynamic of the Affordable Care Act. You have many doctors 
who are saying they are not going to be able to afford to take on any 
more Medicare patients. You already have this problem in Medicaid. So 
you want a robust, dynamic market in which people are innovating, in 
which costs are falling, and in which health care outcomes are 
improving.
  Health Savings Accounts give people the opportunity to control that 
first-dollar cost, but if they are really sick or have an accident, 
they are protected and don't have to worry about those costs. That 
makes a lot of sense to me, Mr. Speaker. In the Affordable Care Act, 
unfortunately, though, what we have is a dampening of the marketplace 
for the Health Savings Account idea. It ought to be exactly the 
opposite. Now, there is a reasonable argument that some have made that 
this is not appropriate for people who are older, who have increasing 
health care costs, and who don't have the time to set enough money 
aside to meet their normal, ordinary expenses--fair enough--but it is 
an important model that we should be eagerly embracing for the young 
generation so that they can have affordable, quality catastrophic 
insurance, so that they have incentive to move into the market, and so 
that the market responds to their questions as to:
  Why does this cost this much? Who is providing the best service? Does 
this really make sense?
  With our simply trying with the diminished marketplace and with a 
lack

[[Page H7250]]

of incentive to actually watch those first-dollar costs that the Health 
Savings Account gives us, then there are not really those incentives 
to, again, force transparency and to ask simple questions as to how you 
best manage the resources that you have in partnership with the medical 
community, like I did when I was trying to reduce my own costs for that 
CAT scan. The doctor very willingly accommodated my request, and that 
community resource was better allocated.
  To me, that is a commonsense solution that we all ought to be 
embracing. Instead, what we have now is a huge shift of cost to more 
unsustainable government spending and to many Americans being 
disproportionately hurt because of skyrocketing premiums or because 
they are losing the health care that they were promised they could 
keep. Now, that is simply not fair. There is a better way to fix this 
system.
  In the last few weeks, because of the problematic rollout of the 
marketplace Web site--the ``exchange'' as it is called--it has brought 
more and more attention to this issue. It is my hope, Mr. Speaker, that 
we just don't get into finger-pointing and ``we told you so,'' for 
those of us who are against this, but that we actually sit down and try 
to construct something that is much more reasonable and fruitful for 
the entire system.
  Mr. Speaker, the formal definition of a ``law'' is: an ordinance of 
reason given by those in authority for the common good. You have a real 
question here as to the reasonableness of this law, because it is so 
unfairly and disproportionately hurting a lot of people, and whether 
that meets the definition of its being for the common good.
  As I suggested, there are aspects of the current law that we can 
retain--keeping young people on insurance longer, removing the caps on 
insurance, and protecting people who have preexisting conditions. Those 
should be retained, I feel; but as we move forward with a robust 
debate, we ought to keep in mind: let's do everything--let's do all we 
can--to give America a better path forward, the path that they deserve, 
so that any health care reform meets the true definition of a truly 
just law in that it promotes the common good, which means society's 
well-being.
  What does that common good look like?
  It is a vibrant marketplace for affordable, quality insurance. 
Persons who have had a condition shouldn't be denied. There should be a 
dynamic by which the person controls his first-dollar cost because he 
owns those dollars, and he is protected, if something really goes 
wrong, through catastrophic policies.
  That shift to the health care paradigm could lend itself to the right 
type of reform for the next generation for Medicare, for instance. If 
you have had a huge savings account accumulate over time because you 
are not one of the unfortunate--you are one of the majority of people 
who, fortunately, does not get stricken by something serious over your 
lifetime--then you will be able to potentially use that money for your 
own well-being and retirement or as a further supplement to the 
Medicare program.
  This is what is called ``thinking outside the box.'' Let's think 
dynamically as to how these programs can mutually reinforce one 
another--the current health care reform and our important health safety 
nets in retirement. That is what we ought to be thinking about.
  So, Mr. Speaker, I just submit these comments this evening because I 
think it is important to try to unpack what has gone wrong and why and 
to frame the debate in a manner that is actually constructive so that 
America gets the type of health care reform that we deserve--a robust 
health care system that leads the world, that improves health care 
outcomes while reducing costs, and that also protects vulnerable 
persons.
  Mr. Speaker, I yield back the balance of my time.

                          ____________________