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tv   Key Capitol Hill Hearings  CSPAN  December 12, 2013 12:30pm-2:31pm EST

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and our children have yet to see a physician for anything more than a well child checkup. our health history is flawless. our previous premiums were anything but cheap, making this 43% premium increase unbelievable to us and unaffordable. from argosville, north dakota, self-embroiled having their policy -- self-employed having their policy canceled. about a year ago my husband left his job and started his own computer software company. contrary to what we've been led to believe we found a family policy for about $480 a month, about and this past year, 2013, it was moderately increased to about $520 per month, which we thought was a reasonable increase. we were very happy with the
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insurance. however, today i received a letter stating that due to the new health care law, our insurance premium for the next year would go up to $918.21." so they're going from $520 a month to $918.21 a month. this means we're facing a $400-per-month in our insurance premium. this amounts to a $4,800 tax increase for a family, for a middle-income small business owning family. this is an outrageous intrusion by the federal government into an area that had ha it had no bs going. it was possible for the self-employed to get their own insurance. there was a safety net and state and federal programs for people who couldn't get insurance. the affordable care act is not affordable and it was not ever necessary.
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from inderlin, north dakota, small business loses employee coverage. and what you're seeing is people in all different walks of life in different situations, some working for themselves, some working for small businesses, some working for large companies, some retired, some with kids, some elderly. but what's the consistent theme? what's the consistent theme? higher cost, less choice, and not being able to get policies that fit their needs because of this standardization. from inderlin, north dakota, constituent writes -- quote -- "my husband is a veterinarian who's been in practice for over 40 years. we have five employees for which we provide the best health coverage that money can buy. we pay all their premiums. last week we received a cancellation letter from the insurance company. wwe believed president obama because we had insurance for our
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employees and we had less than 50 employees, we could keep our insurance. at no time did we receive information by letter or e-mail or on the internet of the fact that if you changed anything in your policy, you would not be grandfathered in. we had one person retire, hired a new employee, an employee's husband came on to the policy, changing the deductible, which has meant that we now have lost our insurance. this will mean a much larger premium. we work. we are not happy about this situation. the president lied. this will mean no raises and we will not be able to hire anyone else." park river, north dakota. this is about rising costs for some young people. "our family has had health insurance all of our adult liv lives. my son, aged 28, also had his own health insurance with blue cross/blue shield of north dakota. is he single. his policy was canceled because
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of obamacare. his premiums are now tripled and his deductible will be over $6,400 a year. that's unacceptable. no person can afford to pay a $6,400 deductible. he fell into the poverty level to be eligible for the tax subsidy, then he could get better coverage for less money under this law. that is also unacceptable. we all have worked to afford health insurance on our own and now it is not affordable nor are the deductibles affordable. he was happy with his old policy, one that he could afford, and with better coverage for him. now the government is mandating what he can afford. how is this acceptable?" i've got one more that i'm going to read. this is from a young family in thompson, north dakota, and in this case, the family's policy was canceled just before they had a baby that was going to be born.
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quote -- "my dair daughter and r husband are expecting their first child in january and on friday they received a letter from their insurance carrier stating that due to the new health reform law, they would no longer be covered. so in january when the baby is to be born, they may have no health insurance. our president stated on more than 28 different occasions that if you liked your health insurance, you could keep it. my question to you is: what are you going to do about it? will you hold him accountable for his word?" mr. hoeven: that's why we're -- you know, as you listen to all these real-life stories from people in my state and they reflect stories from people across this country, that's why it's so important that we do -- that we do get the kind of health care reform that this country needs, that these citizens so very much want. and i think it truly makes a difference as we debate this
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important issue, i think it makes an incredible difference. this isn't me just saying okay, we need to do it, or any one of us saying okay, this is what we need to do, you're hearing from americans. in this case, from my state in north dakota. but as members come down and speak on the floor on this iss issue, you're hearing from 300 million americans across this great country. you're hearing real stories about real hardship and what they're going through. and so i -- i go back to where i started this discussion and that is why it is so important that as we approach these issues, we take a hard look at obamacare and the affordable care act. it was passed with only democrat votes. no republican votes whatsoever. and as i said before, if we're going to get the kind of policies that truly work for the american people, we have got to come up with policies that can
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garner bipartisan support, support from both sides of the aisle. and i truly believe they have to be the kind of policies that empower our people. they empower our people to choose their own health care provider, that empower them to choose their own health care insurance. and i go back to the types of solutions that i talked about earlier. these are the kinds of solutions that we have put forward in legislation and that we will continue to put forward in legislation and ask for members of this body and the house to join us, to join us on a bipartisan basis and pass market-based solutions that truly empower people. things like expanded health savings accounts combined with high-deductible policies. think about young people. think about young people going out into that market and buying health care insurance maybe for the very first time. maybe they've been operating without health care insurance and they say, you know what? i've got to get health care
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insurance. but think about it. think about what works for them. you take a health savings account, a high-deductible policy, low premium, they're healthy, don't think they're going to get sick. that's the kind of thing that will encourage them to buy health insurance. and if you have more choice and more competition, not only are they going to get it at a more affordable price, but they're going to have more options to choose from. likewise, let's make sure that we provide for more competition across state lines so they're not just then looking at the companies in their state but companies from across the country. more choice, more competition, brings down prices. as we look at health care costs, let's look at tort reform. no question that lawsuits are driving the cost of health care higher. we can do something about that. affordability is a huge issue that we've got to address as part of the right kind of
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reforms for health care. and when we talk about reforms, we have got to reform medicare to create the right incentives. what do i mean by that? right now under medicare, if you live in a state where you have high costs, then regardless of outcome, the federal government provides more reimbursement under medicare in that state than they do in a state that has lower costs even though they may have better outcomes. does that make sense? think about it. think about that for a minute. so you've got medicare, right? vitally important. vitally important health care for our seniors across this nation. but the incentive is not to reduce costs under the way the program works. it actually increases costs because states with higher costs, regardless of outcome, get higher reimbursement under medicare than states with lower costs. even if the states with the
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lower costs have better outcomes. let's reform medicare to have the right kind of incentives to encourage savings, to encourage better outcomes, to encourage preventive care. we can do that. that's a win-win. you get better care at a more affordable price and you help address the deficit and the debt of this nation. those are the kinds of reforms that work for all americans. or medicaid. medicaid provided for individuals with low income. let's empower the states, let's give the states more flexibility, more control rather than a federal one-size-fits-all, give those states more control to not only improve health outcomes but control costs and reward them for controlling costs. these are the kinds of solutions that will not only produce better health care that i believe our providers can get behind and support, because it rewards them for managing costs and good outcomes, which is what we want. but it also truly is how we
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address the deficit and make sure that we save these progra programs. medicare and medicaid. and keep them sound for the future so that we not only can rely on them today but for years and years to come. we make sure that we save and protect those programs by creating the right kind of reforms. those are the kind of reforms that truly empower people, that truly empower people and give them the opportunity which i think we all want to choose our own health care providers and our own health care insurance. as we go through these issues, again i want to emphasize the needs. and i come back to the reason that i'm here on the floor today, not only to talk about the right kind of health care reform but back to the issue before us on the senate floor today, the nominations that we face and determining how we come
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together as a senate, as a body. and we get members on both sides of the aisle to come together and say, okay, how do we make sure that we have bipartisan solutions, that we create a bipartisan senate where we're not only making sure that as we look at confirmation of these nominees, that there's an investment from both sides in getting it right. and that there's input and deliberation and consideration and debate on getting it right for the american people. but whether it's health care, whether it's energy, whether it's good ag policy, whether it's law enforcement, whether it's support for our military, whether it's anything else, how do we make sure that all of us, because it's incumbent upon all of us, how do we make sure that
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we've protected what this institution has provided for since the inception of our country? and that's bipartisan consideration, deliberation and debate that produces the best outcome for the american people. and we have nominations that we're going through now and that we will continue to go through. we have important policy matters that we need to get done now for the american people, the budget, defense reauthorization, defense of our nation, a farm bill that needs to be passed, energy policy. we need to address all things that can truly move our country forward. as we do that, we need to -- mr. president, we need to come forward with solutions that will truly be bipartisan.
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and to do that, we need to have a very sincere and direct dialogue, as a body and member to member to come up with solutions, to determine how we're going to -- how we're going to make sure that we're doing the very best job for the american people. that's what this is all about. this is -- we're here to do the work of the american people, and, you know, as we look across this vast wonderful nation, there are people who are democrats and there are people who are republicans and there are people who are independents and we serve that whole spectrum. we serve them all. and we -- we are faced with a real challenge right now to make sure that that bipartisanship continues in this senate. and in this congress. i'm going to turn to another matter that i think is incredibly important that is
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before us. it's a matter that i'd hoped -- it's a matter that is truly that is bipartisan. it is bipartisan. i'm going to use this as an example of how bipartisanship can and does work in this body and in the house. it's a matter that i think we should be voting on right now and it's a matter that i'm -- that i sincerely hope we're voting on in a few short weeks when we return and that's the farm bill -- farm bill. i am a member of the ag committee, a member of the ag appropriations committee. i'm also a member of the conference committee that is working to reconcile the differences between the farm bill that's been passed in the house and the farm bill that has been passed in the senate. and i bring this example up purposely because -- because we are focused on how we operate in a bipartisan manner to meet the challenges this nation faces.
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and we're at this point where we need to renew the farm bill. we need to put a new long-term five-year farm bill in place. right now, we're operating under an extension. and i use this as an example of truly a bipartisan approach, and i use it for another reason, too. as we go through this process where nominations -- where confirmation of nominations are now being done essentially on a partisan basis, not a bipartisan basis but on a partisan basis, as we talk about obamacare which was passed on a partisan basis, not a bipartisan basis, i want to bring up an example of how it should work on a bipartisan basis. when you look at the farm bill, the breakdown in terms of how the vote goes hasn't been republican and democrat. you've had both. you've had some republicans and democrats voting against it, some republicans, some democrats voting for it. it really is focused on what is the policy and what best serves
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this great nation. and here is the other thing. here's the other reason i bring it up right now. we are trying to address the deficit and the debt that this country faces, right? this year, c.b.o. says that the deficit's going to be somewhere between $650 billion and $700 billion. the deficit. the debt, $17.3 trillion. we must address the deficit and the debt. so as we work on a new farm bill, we're not only reforming the farm bill, the current farm bill which is operating under an extension, we not only make reforms that make for a better farm program, but we're going to save on the order of $25 billion to $30 billion to help reduce the deficit and the debt. isn't that what we should be doing across government, across government on a bipartisan basis, coming up with better policy that actually reduces the deficit and the debt, controls spending, reduces spending and helps our economy grow. that's what we're doing with the farm bill, and that's what we
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should be doing in these other areas as well. so as we continue to work on the farm program, i had hoped that we could be to the point where we're voting this week or next on this senate floor, and in the house as well. it doesn't look like that's going to happen, but we are very close, and i believe we can have a framework in place this week or next so that we can vote on it as soon as we return in january, and that's what we need to do. current farm bill, current extension expires at the end of the year, meaning we need to get a new farm bill in place. not an extension. a new farm bill. and we have put the framework in place, we are there. we now just need to get people to agree, and we need to get the bill to the house and the senate floor. i believe we are absolutely there. we just have to have the will to make it happen. and we have to have the will to
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make it happen on a bipartisan basis. and i believe not only is it vitally important that we pass this farm bill but that it truly can be an example in terms of how we approach other policy as well on a bipartisan basis. at this point, mr. president, i -- i see that the leader is here, and i would ask of the chair as to my time allotment and also the time for the next vote. the presiding officer: all time has now expired. the question is on the mccafferty nomination. is there a sufficient second? there appears to be. the clerk will call the roll. vote:
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vote:
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the presiding officer: is there anyone wishing to change their vote or to vote? if not -- the yeas are 79. the nays are 19. the nomination is confirmed. the clerk will report the motion
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to invoke cloture. the clerk: cloture motion. we the undersigned senators in accordance with the provisions of rule 22 of the standing rules of the senate hereby move to bring to a close the debate on the nomination of patricia m. wald of the district of columbia to be a member of the privacy and civil liberties oversight board signed buy 19 senators. the presiding officer: pursuant to rule 22, the chair now directs the clerk to call the roll to ascertain the presence of a quorum.
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quorum call:
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the presiding officer: a quorum is present. the question is is it the sense of the senate that debate on the nomination of patricia m. wald of the district of columbia to be a member of the privacy and civil liberties oversight board shall be brought to a close. the yeas and nays are mandatory under the rule. the clerk will call the roll. vote:
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vote:
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the presiding officer: are any senators in the chamber wishing to change their vote or to vote? if not, the ayes are 57, the nays are 41. the motion is agreed to. the clerk will report the nomination. the clerk: privacy and civil liberties oversight board, patricia m. wald of the district of columbia to be a member of the privacy and civil liberties oversight board. the presiding officer: pursuant to the provisions of s. res. 15 of the 113th congress, there will now be up to eight hours of postcloture consideration of the nomination equally divided in the usual form. mr. durbin: mr. president? the presiding officer: the assistant majority leader. mr. durbin: mr. president, i yield back the majority's time
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on this nomination. the presiding officer: time is yielded back. the senator from ohio. a senator: i rise to speak on the nomination. the presiding officer: the senator is recognized. mr. portman: mr. president, i'm glad to have this opportunity to come to the floor of this great body and spend a few minutes talking about issues that are of great concern to the people of ohio that i represent and to our country. we're facing a lot of challenges right now. certainly health care costs are on the rise, as we've seen, but jobs are also hard to come by, and there's a middle hiv-class s squeeze going on out there with health care costs are up and wages are down and the american dream is on the decline. people think that future generations are not going to be as well off as we are. this is sad and there are things we can and should do to address this. it starts by dealing with some of the gridlock here in washington actually and getting some things done, and one of my concerns about what the majority
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has done in terms of taking away the rights of the minority to be heard on nominations is creating a -- a very tough environment to break through that gridlock and get things done. i think about the judiciary. today we're talking about a court judge who is up for a nomination and the question is whether she is going to be confirmed or not. right now under the current rules that exist, republicans have no voice, in essence, because the 50 votes and there are 55 democrats, can put up a judge and get the votes and put anybody through they want. under the system that has prevailed in this body for decades and one that's consistent with the intention of the founders, you have to get 60 votes, in other words, that the minority would have some voice, and specifically republicans, in that there are 45 of us, would have to supply about five votes. that makes a big difference in terms of the kinds of judges who are nominated and ultimately are
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confirmed. so there's a lot of discussion about what's going on here on the floor in terms of ending the ability of the minority to have their voice heard. i think we also need to focus a little on what impact will this have on the judiciary. recall, these are lifetime appointments. so when someone's appointed to the d.c. circuit court, somebody was recently confirmed i think yesterday and the day before for -- for that body, these are lifetime appointments. and instead of having to go through a process where you've got to figure out at least how to get some members of the other party to support you, right now under the new rules that were done by breaking the rules -- and, again, inconsistent with the intent of the founders to have the minority allow their voice to be heard -- you don't need to get 60 votes, you can do it with just 50. and again, with 55 democrats, there's no need to consult are republicans or to get any support. in fact, you can allow five democrats to vote the other way. i worry that this will polarize the judiciary. i think we're polarized enough iin this place. i think washington is becoming
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dysfunctional for a lot of reasons but one is this increased polarization. and now to have this rule change here not only creates a difficult environment to get work done here but, again, it also will be putting on the judiciary with lifetime appointments judges who, frankly, are more liberal under the democrats and more conservative under the republicans than they would otherwise be. in our states, particularly in states like mine, where you have a republican senator and a democrat senator, we work together to try to put some judges forward. frankly, democrats realize in the majority that they have now, they have to get some republican support so they work with us. you tend to get center-left judges right now nominated and confirmed. again, under these new rules that leader reid and the democrats have insisted on, that won't be required. why would you have to consult with and work with your republican counterpart in your state or republicans on the other side of the chamber? because with the mere 50 votes, you can put forward any judge that you want. and i do think this will result in judges who are not
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center-left but left, who are not center-right but right. i do think that will polarize the judiciary more and this concerns me. so i -- i hope, as we're thinking about how we deal with our own procedures here -- and i know this is an issue that, again, has been debated a lot in the last few weeks because of the decision that the leadership made here, the democrat leadership, to take away this right -- i hope we're also thinking about, what is the impact on our constituents, what is the impact, in this case, on the judiciary. do we want to have a more polarized judiciary where some of these ideological differences make it difficult for them to operate just as it makes it difficult for the united states congress to operate? i don't think so. i don't think that's what the american people want. i know it's not what the founders intended when they gave the minority a voice in this body. and i do hope that we can get back to a regular order where, yeah, we have a limitation on amendments that is reasonable, reasonable time limits. that's true, we need to get our work done. but let's allow amendments to be offered. let's allow the voices to be heard. let's allow, in case of these
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nominations, to have some input from the other side. i'm very concerned about where this is headed. the logical extension of what the democrats have done, of course, would be to extend this to legislation as well, which i, again, i think creates even more of a problem than we have already in terms of legislation being passed here that is not reflective of the will of the people, that is not subject to the kind of checks and balances that we would have under a rule where you have to get 60, not 50 votes to be able to pass legislation. a prime example would be obamacare. let's be honest, the reason it got through the united states senate was because a special provision was used called reconciliation, which is supposed to be for budget matters, revenues and spending. i believe that that was an inappropriate use of reconciliation. so do many other observers who are objective observers who have followed this place for a long time. and obamacare was pushed throu through, not with 60 votes, because after the election of scott brown in massachusetts a few years ago, they didn't have 60 votes to get obamacare done
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because not a single republican would support it because republicans supported an alternative plan. so without a single republican supporting it, democrats chose to ram it through with 50 votes. that's all they needed because they used this so-called reconciliation provision that, again, is supposed to be for budget issues, not for health care. i think the results are now plain to see. we have law in place that is affecting my constituents, affecting the constituents of every senator in here, that has very negative consequences. do we need to do -- did we need to do something to reform the health care system? absolutely. was the status quo acceptable? no. is it acceptable now? absolutely not. but there are smart reforms to reduce costs, smart reforms to add more choice, to allow markets to work better in health care, to not only provide for better quality and better choice but also lower costs. those were not pursued. and we still have the opportunity now to do that. i talked earlier about the fact that health care is a big concern of the american people right now. it certainly is among my
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constituents in ohio. we do a tele-town hall meeting periodically so we had a couple of them last month where i'll get maybe 25,000 ohioans on the phone at any one time on the phone and talk about the issues the of the day and hear their questions and concerns. and during those meetings, we ask a poll question. what's the most important issue you think is facing the country? and we ask about whether it's national security and terrorism, whether it's energy policy or costs at the pump? whether it's their health care and health care costs or whether it's jobs and the economy or some other issue. and it's interesting, every single tele-town hall i've had over the past few years, it's always been that jobs and the economy is the number-one issue, that these -- again, there may be 25,000 people on at any one time or thousands of people on when we ask the poll question, and that's been the number-one issue. usually the number two issue is debt and deficit and spending. the last two tele-town halls we did last month, guess what the
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number-one issue was? it wasn't jobs and the economy, it wasn't debt and deficit -- it was health care. and it was health care because people are so concerned about what obamacare is doing to them and to their families. i'm going to let them speak for themselves. some of us were out here on the floor a couple weeks ago talking about this. but since that time, i've received a whole lot of stories from people i represent. here's one from susan from botavia which is in southern ohio. susan says, "i'm a single mom. i pay for my own health insurance. i'm active and fit. i've cycled over 4,000 miles this year." good for you. "i'm seldom sick. in the three years i've paid for my own insurance, i went to the doctor once for illness. my rate was 146 bucks a month. in september, i received a letter from anthem saying my plan does not meet the requirements of the affordable care act and would be discontinued as of january 1, 2014. i was offered the same coverage i had not for 146 bucks a month but for $350 a month."
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so to susan from botavia, thanks for your story. thanks for letting us know what's really happening, how this is actually affecting you as a single mom who's trying to take care of herself, was using a plan that's right for her and was told, no, government knows best, top-down washington know best, you can't have your plan. you have to have comparable plan and we're going to raise your rates. mike says, "i own a small business. our health insurance rates for single employees under 30 went from $198 per month last year to $650 per month this year. that's a 260% increase thanks to obamacare. this bill is going to put small businesses out of business." here's one from william from columbus, ohio. "we were paying 540 bucks per month but received a letter from anthem saying the rates would increase to $636 a month beginning in september and then
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$1,114 per month in september 2014 as a result of the requirements per obamacare. if that wasn't bad enough, our family doctor of 25 years informed us that he will end his practice on january 1, 2014. reason being? the government requirements of obamacare," he said, "made it just d too difficult to continu" that's william from columbus talking about an issue of price, obviously, going from 540 bucks per month to $1,014 per month but also about choice, that his doctor is stepping out because of obamacare. rachel from northeast ohio. rachel says my family and i own a small business. we were notified that our current health care plan is substandard at $860 per month. to comply, we must now pay pay $1,880 a month. this is beyond outrageous. that's what rachel says. i agree with her. $860 a month to $1,880 per
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month, more than double, in order for her to have health care as a small business owner with she and her husband. john from dublin outside columbus, we currently have a high deductible plan through anthem and pay $330 per month. we're happy with our plan. it provides wellness visits for free, which is really what we need, and then catastrophic coverage in case something happens. when i reviewed our -- our coverage and tried to renew it, i asked what an equivalent plan would cost under the exchange. the quote i received was $833 per month. remember, he was paying $331 per month, liked his plan. it provided wellness visits. it had a catastrophic in case he got in trouble. it goes from $331 to $833. back to his letter. and the deductible even went up from $11,000 to $12,700. so this notion that people have to get out of these plans because their deductibles are too high, the one that's acceptable based on obamacare and this topdown approach is now
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a higher deductible. john says my family simply can't afford this plan. here's rachel. i'm sorry. here's sara from raymond, ohio. so sara writes -- and these are painful. these are painful. but sara writes i am literally crying right now because of our insurance. my family's new monthly costs starting january 1 is $323.82 biweekly and $647.64 a month, a difference of $420 from what we currently pay, and the new plan offers less with more out-of-pocket expenses. the a.c.a. has failed and it is hurting my family, not helping. here's chuck from westchester. i tried to give this health care thing the benefit of the doubt. i went to the web site and all the estimates are more expensive than my canceled policy. my canceled policy was not only
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cheaper, it was better, and i don't qualify for any subsidies. do i have any choice besides paying more money? chuck, i'm not probably qualified to give you advice, but i will anyway. your choice is to pay a penalty or pay more. that's what the government's telling you. that's what obamacare is telling you. cynthia from canton, ohio. i'm a substitute teacher. recently, i received notice that i was not getting jobs every day like i have been for most of the past 13 years. i'm a good, dependable sub and work for $70 a day before taxes. i contacted the school system and was told that they were watching any sub to prevent over 30 hours a week because of the affordable care act. now, cynthia's letter to me, unfortunately, is something that i am hearing all over the state of ohio, which is people are being told, you know what, we need to keep you under 30 hours. she is finding out as a
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substitute teacher in canton, ohio, that she can't get the jobs she used to get because they are telling her they want to watch the subs to prevent anybody getting more than 30 hours per week because of the affordable care act. you probably know this but under the affordable care act, if you work over 30 hours a week, you're considered full time, and therefore the company has to provide you with the health care insurance that again this topdown approach insists on, not the health care insurance that you may want or your employer may think is appropriate but the health care insurance that the affordable care act thinks is appropriate. so companies are telling folks, as in the case of this substitute teacher, private and public sector, you know what, we need to keep you under 30 hours because we simply can't afford that kind of health care. here's mark from urbana, ohio, in champagne county. my wife and i are farmers. we have our own private health insurance plan, which is not cheap. we just learned that our insurer is canceling our plan and that the obamacare plan will double our premiums to more than $1,000 per month. my wife is 55 years old.
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we do not need maternity coverage or free birth control or so much other coverage mandated by obamacare. we are modest, middle-class people. what we need in this country is a policy to make health care more affordable. we can do this if we let americans determine their own health care needs and shop for the best and most affordable care. why not medical savings accounts for everyone? they would be privately owned so that no one is chained to their employer-sponsored plan. why not require that health care providers post prices of their services. we can come up with much better alternatives to obamacare. please help us, mark says. i agree with him. we can koch up with much better alternatives, including legislate people save more for their own health care. why should we discourage that? in obamacare, by the way, those who don't know this, those h.s.a.'s, those health savings accounts that mark is talking about that heed like to see for everyone, these are made less attractive because they take away some of the health care tax
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benefit. so we're moving the wrong way. we're moving away from people taking care of their own health needs, encouraging them to focus on wellness and prevention, understanding that it's their dollar at stake and allowing them to build up a little nest egg if they are healthy and if they are able to avoid a health problem. and if they have a problem, they have got coverage, a high deductible, they have got coverage to take care of them. people should be able to make that decision on their own if that's what's best to them and their family. here's brian from mentor. my family's aetna plan is being canceled due to obamacare. my old plan was $554 per month with a $5,000 per person deductible. the same deductible policy to buy a new plan is $1,038 per month. again, more than double for brian. dean from sandusky. ever since i left my job in 2009, ever -- ever since i lost my job in 2009, i have been purchasing my own health care insurance. last month, i received a letter in the mail stating that my plan
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is being canceled due to the a.s.a. -- a.c.a. i was told to look at plans on the exchange which i did and found a comparable plan that is over twice the cost of what i now have. in addition, this is over half of my monthly pension. i simply cannot afford this. i've always been a responsible, hardworking, self-dependent person. now, due to the actions of our government, for the first time in my life, i will not have health care coverage. i'm 59 years old now, and i need this coverage. i'm outraged, to say the least. how can our government do this to us? i will remember this come election time. that's dean from sandusky. lost his job, picked up a plan, in the individual market that worked for him. he is now told it doesn't work. he is now going to have to pay twice. he can't afford it. he is not covered. he is on a fixed income. it sounds like he is going to go without coverage. by the way, new polling data has come out showing that a lot of young people are going to go
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without coverage. one number is 38 -- or 28% of them are. another number is closer to half. i don't know how many, but i will tell you a lot of young people i talked to are saying you know what? i would rather pay the penalty or take the risk than be covered. that's a problem for them, but it's also a problem for the affordable care act because it is based on those people coming into the system and, frankly, providing the ability for others to get coverage under the risk pools that are set up under obamacare. so the stories that i've told you are real people facing real problems. and they are problems that washington created for them and their families. they were fine with their coverage, they liked their coverage. now, i know my colleagues on this side of the aisle have their own stories about how people are getting coverage who didn't have it, particularly those with preexisting conditions. i understand that. but these stories really obscure the question we should be
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debating on the floor. i agree, we should cover people with preexisting conditions. so do most republicans. the question is how do you do it? so when democrats come to the floor and tell me, rob, you have got all these stories of people who cannot afford health care insurance having a real hard time in the individual market but we'll give you our stories of the folks with preexisting conditions, my answer to that is you know what? i also police chief we ought to cover people with preexisting conditions, i don't dispute that. we want to get coverage for more americans. that's not the question we're debating. the question is whether obamacare with its mandates, it's topdown centralized control, is a way to accomplish those goals. if the president and my friends on the other side of the aisle believe the only way to increase coverage is to make everyone pay more, to force millions of americans to give up their insurance, to make people lose their doctors, then they should say that's what their plan is because that's what's happening. a lack of honesty and transparency, in my view, is one of the great failures of the
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affordable care act. i believe obamacare was told to the american people on false pretenses. president obama said, famously now, if you like your health care, you can keep it. in fact, i think he said if you like your health care, you can keep it, period. but the one thing he could not do then was keep his word. he had to have known it then. all the information coming out indicates that that was knowledge that he should have had. and yet he kept saying it. so what began as a broken web site and cancellation notices has turned into sticker shock for millions of americans who are seeing their health care costs soar under obamacare. by the way, as i said earlier, these rising costs are not a mistake in obamacare. they were intended in obamacare. under obamacare, millions of americans have to pay more for insurance in order for the program to work. the web site can be fixed. i assume it will be at some point although they are certainly having a tough time with it.
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but this basic premise is at the heart of obamacare that other people's costs have to go up and go up pretty dramatically cannot be fixed. the reason goes back to a critical choice that was made at the beginning of the health care debate. there are different approaches to covering the uninsured, covering those with preexisting conditions. the approach favored by republicans, at least many republicans, including me, would create real economic incentives to bring the insured into -- uninsured into covered access while taking critical steches to reduce the costs of health care. number one reason people aren't covered, the costs. the best way to lower the number of uninsured is to make it easier and less expensive for people to get insurance in the first place. the president chose to take a very different approach, not to focus on the costs which have gone up, not to focus on providing incentives for more people to get coverage, but instead a topdown centralized approach. he turned to mandates. obamacare requires that all americans purchase insurance, it mandates what type of coverage that insurance includes and it
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requires that private insurance accept all commerce. again, we all want to ensure that those with chronic conditions receive health care, but it also changes the way health care insurance underwriting works. normally, insurance works by pooling resources for some future harm. so for those that have preexisting conditions, obviously, the harm is already present and their premiums are not going to be able to pay for their care for the most part. this is why these high-risk pools in states is something i support and others support, providing tax incentives for that. but the president needed a pool of cash to offset these often astronomical costs. that's how obamacare was designed. so this notion that, gosh, costs are going up, we didn't intend that, of course they intended it. it's exactly, exactly the way they intended it. obamacare needed more money than those policies would provide, so these plans -- these private plans we talked about earlier, peep in the individual market had, many of which are high deductible, low-cost
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catastrophic plans. many of the people who have these plans are young people who are relatively healthy. these folks were forced to buy insurance they didn't need because obamacare needed the money. the plans that they had met the needs of those people, met the customers' needs but frankly didn't meet the government's needs. so those plans were regulated out of existence, padded with extra benefits and consumer protections that many of those who chose those policies didn't want, as mark said from urbana and will never use. sometimes these new policies as i said are double, sometimes they are triple. we have heard cases where they are five or ten times more. but what we have seen in the individual market is only the beginning. next year the same mandates of the government overreach is going to move beyond the individual market and is coming into effect where the vast majority of us get our health care, which is through our employer. so at some point, 80 million americans will likely see their insurance plans canceled, we're told, and replaced by policies that cost more than they are
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currently paying. when the employer-based market comes under the obamacare mandates, which as you recall is going to happen about a year from now because it was put off for a year, that was a delay that the president put in effect, we're going to see much, much more of this. and again, there is a better way. there is a way to put this partisanship behind us and do this together. we talked earlier about the fact that when you cram something through, it all goes on -- all votes on one side of the aisle and ignore the other, you tend to get a policy that doesn't work for the american people. that's exactly what we have seen here. there is a better way, and we still need to pursue that better way. instead of having fewer choices and higher costs for all americans, there is a way to put together a plan that actually makes sense for the american people. this is something that republicans and democrats alike need to focus on. instead of a topdown, centralized government knows best solution, we need to go to solutions that actually reduce the costs of health care and provide more choice in health care, and it can be done. obamacare should be repealed and
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replaced, in my view, but it should be replaced. the status quo is not acceptable. and i think the failures of obamacare point the way as to what we should do. reduce the costs. there are steps we could take today. for instance, remove the shackles of government regulations from the market. let heal -- let health care insurance be less expensive. let it be sold across state lines. that will provide more competition. it will lower the costs. there are some areas of my state with only a couple of plans. i'm told under obamacare in some states there's only a couple of plans. you want to have more competition, not less. we should give people the ability to get health care on their own. we talked about health savings accounts. we should help create a healthy, vibrant individual health care market. incentives they would receive with employer-provided coverage where there is tax incentives to provide health care coverage. let's deal with these frivolous lawsuits. that reduces the costs.
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so i appreciate the fact that one of my colleagues joined me on the floor and is going to continue this discussion but i want to go back to where we started. it doesn't have to be this way. what we're doing here in the united states senate by taking away the rights of the minority is not going to help us with regard to getting better judges. it didn't help us in terms of cramming obamacare through with 51 votes rather than the normal 60 that should have been required. it doesn't help for us to now continue down this track of a government one size fits all approach to health care. we've heard the stories, we see what's happening and we haven't hit most americans yet because they get their coverage from their employer. instead let's work together. let's provide more choice. let's reduce the cost. let's ensure that everybody has access to health care that works for them and their families. if we do that, the american people might regain a little bit of trust in this institution and in this town.
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madam president, i'd like to yield the floor, if i could, to my colleague and your colleague from north dakota. a senator: madam president? the presiding officer: the senator from north dakota. mr. hoeven: i'd like to thank the esteemed senator from ohio for his remarks and express my remarks as well. myself and other colleagues have been on the floor today talking about the need to work in a bipartisan way. obviously the business before the senate right now is nominations. we want to emphasize again the importance of advise and consent in the nomination process but that it needs to be on a bipartisan basis. and the change that of course has been made is that now the majority party can vote to confirm a nomination without really any input, any consent,
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any debate from the minority party. and that's an issue not only in terms of the nomination process, confirmation process, advise and consent, but that's also very much an issue in legislation. and the importance of bipartisanship, whether it's in advise and consent, in the confirmation process, or whether it's in passing legislation is seen because we've got a country of more than 300 million people, republicans, democrats, independents. but at the end of the day if we're going to have broad-based public support for the work we do for the legislation that we pass, it's got to be done in a bipartisan way. and my colleagues have been pointing that out in terms of the confirmation process and also they have been pointing that out in the context of the
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affordable care act and obamacare. that's legislation that was passed on a partisan basis. one party and one party only voted for that legislation. and to get broad-based support for any legislation, let alone something as important as reform of health care, both parties have to be part of that work product. and that's the only way that we are going to get broad-based support across this great nation on the important issues that we face. earlier today i read story after story from people from our great state expressing real challenges, real difficulty, higher costs, higher co-pays
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that they're facing as a result of the affordable care act. and i talked about the need to engage in the right kind of health care reform, the kind of health care reform that truly empowers individuals to pick their own health care insurance and their own health care provider. the need to pass the kind of legislation that will help us provide expanded health savings accounts tied with higher deductible policies that will encourage our young people to purchase health care insurance because they'll be able to do so with lower premiums. the need for tort reform to help bring down health care costs. the need to increase competition across state lines so people have more choice and with that competition lower prices when it comes to choosing their health care insurance. and talked about the need to reform medicare. as you well know, to provide the right incentives. look at our great state of north dakota. we have lower health care costs than most of the other states.
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and we have very good outcomes. for that we get not more medicare reimbursement but less. that is the wrong incentive, providing more reimbursement to states that have high costs regardless of outcome and lower reimbursement for states that, even with lower costs and better outcomes, in essence, getting less reimbursement, getting penalized for good performance. that is exactly the wrong approach and why we so desperately need to create reforms that create the right approach. these are solutions that we are advocating that we will continue to advocate to put in place for the american people. and we need members on both sides of the aisle to come together with a step-by-step, comprehensive approach, market-based approach that will truly create more choice, more competition and empower people, empower people, great citizens of this country, to take control
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of their health care decisions and make the decisions that best suit them and their families. madam president, i see at this point my colleague from the great state of south dakota is here. as always, i'm very pleased to see him. and at this time i would yield the floor. mr. thune: thank you, madam president. the presiding officer: the senator from south dakota. mr. thune: i thank my colleague from north dakota, both colleagues from north dakota here on the floor and appreciate his leadership as a former governor and understanding of these issues like health care which do profoundly impact the people that we all represent in the dakotas. and some unique challenges obviously of meeting the health care needs of people in our state because we have a big geography, lots of wide open space. we don't have a big population centers that our, in other places in the country. and so health care delivery and coverage of health care, health
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care insurance and access to it are enormously important to the people that we all represent. madam president, i would say that it is, has become abundantly clear that the american people are rejecting obamacare, which is the law that was passed several years ago here in the united states senate, in the united states house, signed into law by the president. and i remember being here at the time and voting on that on christmas eve. we were actually here. it was december 24, four years ago i think now; 2009. and we were right up here till the end. and this was, i would say jammed through the united states senate. the majority had the votes. they weren't all that concerned about having participation or input from those of us who serve in the other party. and as a consequence of that, just shoved this thing through really right on christmas eve.
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and i think that was an unfortunate way in which to conduct the business of the senate to enact major legislation. it's very rare around here that legislation of that consequence that literally impacts one-sixth of the american economy is shoved through on a partisan party-line basis. that's the way it was done, and we said at the time, many of us were down on the floor over and over and over again predicting that because of the way this was structured it was going to lead to higher insurance premiums, that it was going to lead to fewer jobs in our economy, a lot of stress on employers trying to create those jobs. and all of that is coming to fruition as we hear now reports day after day after day across this country from my state of south dakota, other states across the country, from people who are feeling the very real and harmful impacts of the obamacare legislation both in terms of higher premiums, also canceled coverages, higher deductibles, things that affect
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the pocketbooks of millions of americans and issues that are discussed and debated at kitchen tables. but they are profoundly important to the economic well-being of people in this country. when you're seeing the dramatic increases in premiums, the dramatic increases in deductibles, the losses, loss of coverage, the canceled coverages we're seeing across the country right now is very disturbing to people. and that's why i think you have seen this widespread rejection of obamacare. interestingly enough, yesterday health and human services released new enrollment numbers for the exchanges for october and november. over the course of those two months, in my state of south dakota, just 372 south dakotans, or less than one half of one-tenth percent of my state's residents signed up for health care on the exchanges. ten other states also had fewer than 1,000 people sign up.
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oregon, which embraced obamacare very early on, had just 44 enrollments. think about that, 44 enrollments to show for two months thaofrpbgz their web site -- thanks to their web site which suffered a more catastrophic failure than the federal web site. there were over 3,000 enrolled in the exchanges during the months of october and november, not even a quarter, not even a quarter of the number the administration here projected after two months. to meet its goal of 3.3 million signups by december 31, the administration would have to sign up almost three million people in the next three weeks or more than 145,000 every single day. considering that the administration has averaged fewer than 6,000 enrollments a day over the past two months, i wouldn't want to put a lot of money on them being able to meet that goal. it's obvious from the sluggish enrollment numbers that the
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american people are rejecting obamacare. but if anyone needs more proof, three new polls came out last week reporting strong opposition to the law from the american people. the pew research poll suggests 54% of the american people disapprove of the president's health care law. according to pew's most recent survey the percentage of americans who think the health care law had a negative effect on the country rose 11% just since september of this year. the "wall street journal"-nbc news poll released yesterday, the president's disapproval rating reached an all-time high of 54%. when asked what issue shaped their view of the president this year, 60% cited obamacare. the same "wall street journal" poll also found the number of americans who think the president's health care law was a bad idea reaching an all-tie high. quinnipiac university released a poll yesterday which found 67% of the american people oppose obamacare. the president's health care law
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has never enjoyed strong popular support. but democrats and the president argue that public support for the law shouldn't be judged until the law's benefits were in effect. the law is now in effect. people can buy insurance on the exchanges, yet opposition to the law isn't declining. it's the opposite that is happening. it's actually rising. opposition to the law is increasing over time as more and more people become aware of the impacts on their personal economic well-being. quinnipiac reported that 10% jump, a ten-point jump in opposition to the law between october 1 of this year and december 11. meanwhile, support for the law already law dropped a further six points over this same time period. worse for the president, it is not just republicans and independents who are fleeing the president's signature law, most of the president's strongest supporters, those who initially
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supported his health care and helped reelection last year are deserting the president. the pew research center found a 10% drop in support among african-americans and hispanics, both groups who strongly supported the president in the last election. the "wall street journal"-nbc news poll also found -- and i quote -- "faith in mr. obama has dropped in recent voters among young people and hispanics. the question is why are the american people and even the president's strongest supporters rejecting obamacare? why now that the law is mostly in effect is opposition growing rather than declining? i think the answer is very simple. it's because the law has failed to deliver on the president's promises. from rising premiums to canceled health plans to lost doctors, obamacare is doing the exact opposite of what the president
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promised that it would do. the president said his new law would reduce the cost of health care. and in fact he claimed families would see their premiums fall by an average of $2,500 a year. but that promise fell apart almost immediately after obamacare was enacted. in fact, what we're seeing out there is the average family has seen its health care premiums rise, rise by more than $2,500 since the law's passage. and now that the law is being implemented, those numbers are only going higher. those families who are lucky enough to keep their plans have been receiving insurance renewal notices with staggering, staggering premium increases. premiums are doubling or even tripling for many families, and deductibles are increasing as well. imagine getting a $600 a month increase in premiums. that's $7,200 a year. how on earth is a working
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family, a middle-class family in this country supposed to be able to afford that? the president would like you to believe that these americans'up dated health plans are far superior to what they had before, but, in fact, many of these plans were as good or better than what these families are getting now. many of these plans are falling short of people's expectations because they don't have -- they've got higher deductibles and of course with all the mandated coverages that are in many of these plans, there are all kinds of things that people who are subscribing, trying to get on the exchanges are finding that they don't need. i've had people in my state of south dakota who are in their 50's and 60's who are asking, why do we need to have things like maternity coverage? and you see that as these letters and e-mails and -- and phone calls come in to your office and people are finding out about the specifics, the
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particulars, the details, if you will, of these various plans, they're rejecting them because not only are they creating higher premiums but they're also plans that are not sufficient or adequate to what they are currently experiencing with the plans that they had before. now, thousands of families around the country are going to be struggling to pay huge premium increases without receiving any additional benef benefit, and the situation is no better on the exchanges. while there are certainly plans with low premiums on the exchanges, many of these plans have deductibles that are so high, barring some catastrophic illness or injury, the family might as well not have insurance at all. a family without insurance who typically pays $8,000 a year in health care costs may see no benefit at all from an insurance plan with a $12,000 deductible. in fact, they may spend more on health care because now they have to pay high insurance premiums as well.
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so you've got higher insurance premiums, higher deductibles, meaning in many cases they're not going to reach the threshold that would trigger a payment from their plan, and so they're getting no additional benefit but they're paying way more for the same or -- or worse coverage. so in addition to promising a new era of affordable health care, the president also promised that nothing would change for people who already liked the health care that they have. and he repeated many, many tim times -- we've all seen the videos of this -- that if you like your health care plan, you can keep it. and he even went on so far as to say, you can keep it, period, to make it even more emphatic. if you like your doctors, you can keep your doctor, period. but americans are now finding out that that wasn't even close to being true. millions of americans have seen the health care plans that they like canceled by insurance companies in response to new obamacare regulations. so far, more than 5 million
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americans have lost their health care plans as a direct result of obamacare. in fact, to date, millions more americans have lost health care than have gained it under the president's signature law. millions of americans are also realizing that they can't keep their doctors or their hospitals. obamacare put in place scores of new regulations on insurance companies and the plans that they offer. to meet all of the obamacare requirements while still getting their plans approved, insurance companies have been forced to drastically shrink their networks of doctors and hospitals. as a consequence, many families are finding that their new health care pla plans force theo give up doctors they've been seeing literally for years. that may not sound so terrible to some of us if we don't have a close relationship with our doctors, but what if you're a cancer patient who relies on your network of doctors and
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oncologists to coordinate your lifesaving care? more than one cancer patient has spoken openly in the press about the struggle to find a replacement health care plan after having their original plan canceled as a result of obamacare. a plan that covers all the doctors and the medicines that they're currently using. joan, a nurse from michigan, and a cancer patient published a heartbreaking column on cnbc yesterday, updating readers on her struggles to find a health care plan that covers all of her care. i'll let her words speak for her and the other americans in her position. i quote -- "i can't begin to describe how devastated i am," she writes. "many people like me who are in a difficult health crisis and fighting to regain good health are finding it very difficult,
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if not impossible, to make sure that we keep our doctors and receive the chemotherapy and other treatments and medicines that are keeping us alive. i'm scared and wondering what surprises are around the corner." well, miss careso brings up another thing people may lose under aircraft. besides their doctors and their -- under obamacare. besides their doctors and their health care plans, and that's their medications. "forbes" published an article this week outlining the reasons obamacare may cause millions of americans to lose access to the medications that they're currently taking. the author points out that many exchange plans have steep cost-sharing requirements for prescription drugs. purchasing a bronze plan, for example, the article points out, means that you will likely be responsible for 40% of a drug's cost. now, that may not be so bad if we're talking about a common
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antibiotic, but that gets very, very expensive, we're talking about more complicated drugs like cancer medications. the other reason some people may lose their prescription drug coverage is that some plans may not cover the prescription drugs that the person's been taking. out-of-pocket limits, the article notes, don't apply if the drug you're taking is not on your new insurance company's approved list of drugs. you may find yourself paying for a very expensive drug without any benefit at all from your new insurance plan. in addition to higher costs and the loss of their doctors and health care plans, there's another reason that americans are rejecting obamacare. obamacare isn't just bad for health care, it is bad for the economy. new health care regulations are
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discouraging businesses from hiring and expanding their businesses. a cbs news article earlier this week reported -- and i quote -- "nearly half of u.s. companies said they're reluctant to hire full-time employees because of the law." let me repeat that. "nearly half of u.s. companies said that they are reluctant to hire full-time employees because of the law." "the hill" reported in a recent survey by the national association of manufacturers that found that 77% of manufacturers site soaring health care costs as the biggest issues facing their business. the title of "the washington post" article on the health care -- health law's impact on small businesses says it all. "health care law's aggregation rules pose a compliance nightmare for small businesses." "health care law's aggregation rules pose a compliance nightmare for small businesses."
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that's the headline in "the washington post." small businesses are responsible for a majority of the job creation in this country, and if you look at some states around the country, my state of south dakota being a good example, most of the jobs huge majority, proportion of the jobs created in states like mine, are created by small businesses. but the health care law is discouraging them from hiring. drowning them in regulations and promising stiff, new requirements if they have 50 or more employees. now, i can't tell you, madam president, how many times when i'm traveling in my state of second-degree, or, for ma -- of south dakota, or, for that matter, traveling outside my state but specifically inside my state of south dakota, that i don't run in, when i'm talking to businesses, people who are creating jobs, investors, the uncertainty associated with this health care law and the new costs because of its mandates and its requirements is -- is making it more difficult and more expensive for them to create jobs.
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and so what are we seeing as a result of that? we're seeing a slower, much more sluggish economy, chronic high unemployment, fewer jobs, particularly for people who are coming out of college, younger americans in particular are paying a dear, dear price because of the slow economy. and when businesses don't hire, the economy suffers. and every american who spent weeks, months or years strug struggling to find a job suffers too. and i know my democrat colleagues here in the senate know all of this and that's why some of them are starting to run away from obamacare, too. democrats in congress may have supported the law but now that they have seen how it looks in reality, some of them, particularly those running for reelection, are eager to distance themselves from it. no one running for reelection wants to be too closely associated with a law that is raising americans' health care costs, taking away their health care choices, and hurting an
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already struggling economy. madam president, the american people have spoken. they don't like obamacare. they don't want obamacare. they can't afford obamacare. it is time for democrats in congress to start listening. madam president, i always think that it's never too late to do the right thing, and i hope that as more americans start to weigh in and start to engage in the discussion about how this is impacting them personally, that will have such a profound impact on members of congress here in washington, d.c., that they will come to the conclusion that many of us reached a long, long time ago and that is that this is a bad, flawed bill built upon a faulty foundation that is destined to fail and that the best thing that we can do is pull it out by the roots and start over in a way that makes sense for the american people, that addresses the challenges
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that we have in our health care system in america today but does it in a way that doesn't require the government to take over literally one-sixth of the american economy and -- and create political control, command and control from here in washington, d.c., over literally one-sixth of the american economy. $1 out of every $6 in our economy today is spent on health care. think about that. there are very few areas where you can say that complete, total government intervention impacts that big of a swath of our economy. unfortunately, government intervention is impacting way too much of our economy and as a consequence of that, we're paying a price in the form of fewer jobs, chronic high unemployment and slower, sluggish, anemic economy which is making it more difficult for people to find jobs and more difficult for us to get ourselves out of what is a very, very difficult economy. but my hope would be that before this is all said and done --
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and, you know, i don't know when this happens, hopefully sooner rather than later because i think the sooner we make that adjustment and decide that this was the wrong course and reverse course and go in a different direction -- the less damage we will do to people's livelihoods, to their personal economic circumstances, and the less damage we'll do to the overall economy in this country. and so i hope that that realization comes sooner rather than later. but i think what will drive it -- and i've maintained all along that ultimately the only thing that can really change this is the american people, because clearly you have a president of the united states for whom this is his signature achievement and unless he starts hearing from the american peop people, he's unlikely to change. we have a lot of people here in the united states senate, every democrat here today that was here in 2009 voted for this. not a single republican who was here in 2009 voted for it. that's probably one of the reasons i think that this is
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such a -- a failed policy. it didn't have input or buy-in from the other side. you didn't get the -- some of the best ideas coming to the forefront. there was a much, much better way to do this and many of us who've been around here for very long have been proposing solutions to address health care challenges in this country that have been rejected by democrats here in congress. we've talked a lot in -- over the years about allowing people to buy insurance across state lines. why wouldn't you you create interstate competition, competition in a free market economy generally -- generally -- as a matter of principle and a matter of practice drives down price. and so if you create more competition, give people more choices, that tends to drive down prices. that's a fairly basic economic principle. why wouldn't you allow small businesses to join larger groups where they can get the benefit of group purchasing power and thereby put downward pressure on
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the cost of health care in this country? why wouldn't you allow for expanded opportunities for people to care -- take care of their own health care circumstances by allowing for expanded, larger health savings accounts, opportunities for people to put money aside in an account, perhaps buy a catastrophic policy with a high deductible but tax-free, you can put money aside that allows them to cover some of those health care costs that don't reach that -- that catastrophic level? how about finally, finally doing something to reduce the costs of defensive medicine, which means we would have to reform our medical malpractice laws in this country and weed out a lot of the junk lawsuits that clog up our legal system and make it so much more expensive to deliver health care. i talk to physicians all the time for whom concern about liability is a major issue. it

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