Floor Updates

Barasso, Cornyn

Highway bill (S. 1813)

Mar 07 2012

02:14 PM

Colloquy: (Senators Barrasso, Cornyn)
  • Doctor's 2nd Opinion: IPAB, Medicare
Senator Barasso: (1:44 PM)
  • SUMMARY "In the lead up to the second anniversary of the law, I'm going to talk about specific ways that the law has actually made it worse for the American people, something that I believed from the beginning would happen, and now two years later we're seeing is specifically the case. It's hurt jobs, driven up costs, given Washington more control over Americans' health care and I believe it's weakened Medicare. Today Senator Cornyn and I are going to focus on how the law threatens Medicare, and specifically our seniors trying to get a doctor, our seniors trying to get health care, and how this new Washington board called the independent payment advisory board has had that impact. it's an unaccountable bar, it's unelected, it's a group of unelected bureaucrats that will decide how to fund the care that is covered by Medicare."
Senator Cornyn: (1:48 PM)
  • SUMMARY "The purpose of this 15-member unelected, unaccountable bureaucracy to actually set prices for health care, what happens if to the exclusion of all other health care reform that's IPAB or the federal government generally cuts reimbursement to providers. It would seem to me that you'd get a phenomenon where you have the illusion of coverage but you have no real access to health care. The experience we've had in Texas, is, for example, Medicaid and the president's health care bill puts a whole lot of people into Medicaid. Only about a third of Medicaid patients can find a doctor who will see a new Medicaid patient in the Dallas, Fort Worth area, one of the most populous parts of our state. I know in many rural areas many doctors don't want to see a Medicare patient because the rates are so low."
Senator Barrasso: (1:50 PM)
  • SUMMARY "When the President talked about the health care law, so often he wasn't actually talking about care. he was using the word "coverage" and he was trying to use those words interchangeably but coverage is not care. Because someone has a card that doesn't mean they can actually see a doctor. we see that with Medicaid now with its low levels of reimbursement. and with seniors already having trouble getting in to see a physician, this has a significant impact when an independent - when a board, an independent payment advisory board, 15 unelected bureaucrats decide they're going to decide how much to pay for a doctor's visit, how much they're going to pay a hospital for bypass surgery or for a hip replacement, which is an area of my specialty. That hospital gets to decide if they're going to continue to provide that service. that doctor gets to decide whether they're going to see that patient. in rural communities, If the reimbursement is so low - and I've heard this from hospital administrators in Wyoming. if the reimbursement is so low for a procedure that is primarily, if not exclusively done on people of Medicare age, and you can think of those things more likely to happen with people over the age of 65, the hospital may ultimately decide that we cannot continue to afford to provide those services and keep the doors open to the hospital. so that seniors in a community will then be denied access to care in their own community because the hospital will no longer do or provide that service.
Senator Cornyn: (1:53 PM)
  • SUMMARY "I'd like to ask the senator from Wyoming, it seems to me that what the intent is behind this independent payment advisory board and the President's health care law, sometimes called the patient protection and affordable care act, I think it needs to be named "unaffordable care act" for reasons we can go into later but the purpose behind it, we can all understand, and that is to try to contain health care costs and spending by the federal government. Because, of course, health care inflation is going up much faster than regular inflation, the consumer price index. It strikes me that as in a lot of the policy debates we have here in Washington in congress, we all agree that we need to do something to contain costs, but we disagree about the means to achieve that affordability that we all know we need and to contain the inflation of health care costs. and I just would like to ask my colleague rather than have congress outsource its responsibility in this area to an unelected, unaccountable group of 15 bureaucrats from which there is no appeal and which would have the consequence, as you say, of limiting people's access because if all you're going to do is cut provider payments to hospitals and doctors, then fewer and fewer doctors and hospitals are going to be able to see those patients. Do you see an alternative that would perhaps help contain costs more by using transparency, patient choice, good old-fashioned American competition. I'm thinking in particular about the rare success we've had in the health care area containing costs in the Medicare Part-D program. To me, perhaps a model even where seniors have a choice between competing health care plans"
Senator Barrasso: (1:55 PM)
  • SUMMARY "I think the two key words I heard the senator from Texas say are "choice" and "competition" because those things put the patient at the center. It is patient-centered care. Not government-centered care. Not insurance company-centered care but patient-centered care. It's something we've been talking about for years on the senate floor, at least on this side of the aisle, to put the patient at the center, to give them the choice as well as have the availability of the competition ... The American public did have concerns from the beginning, which is what generated the whole discussion about health care and reform and what patients are looking for is the care that they need from the doctor that they want at a cost they can afford and under the President's health care law, they're losing all three."
Senator Cornyn: (1:57 PM)
  • SUMMARY "The IPAB - the independent payment advisory board - there is support to take out that particular provision because people now, on further examination, have seen why it could actually backfire limiting people's access to health care and I would ask my colleague, do you see a way for us to, on a bipartisan basis, to narrowly address that provision while we continue to wait on the supreme court of the united states to rule on the constitutionality of the individual mandate?"
Senator Barrasso: (2:01 PM)
  • SUMMARY "We see bipartisan support in the House. I'd like to see bipartisan support in the Senate, because when you look fundamentally at what this board does, it - they make recommendations, and it's practically impossible for the recommendations not to automatically become law and we were elected to make laws, not have an independent party make the laws. American patients are going to be forced to accept whatever this unelected board's recommendations are, very hard for congress to override. So I would expect in a bipartisan way, people would say, let's go and completely eliminate this board, which i know your piece of legislation is designed to do. the - American patients, people all across the country, if they suffer from the recommendations of the board the way that the law is written, they can't challenge this unelected board in court. Americans variety to challenge things, but not this unelected board, as was written into the health care law. So those are the sorts of things that I hear about, when people say, well, what if I can't get a doctor, what if I can't get the care I need because of the decisions made by the board? And this fundamentally gets to the issue of the whole health care law, which took $500 billion from our seniors on Medicare, not to save and strengthen Medicare but to start a whole, new government program for someone else and this board that I think we should eliminate."
Senator Cornyn: (2:03 PM)
  • SUMMARY "I would like to ask the senator from Wyoming, a medical doctor by profession, whether Medicare as we know it, as currently constructed under the President's health care bill with this IPAB provision in place, does it have any chance of survival as it currently operates now, with this new board of unelected, unaccountable bureaucrats setting prices and limiting access because doctors and hospitals simply can't afford to provide the service at that compost? - At that cost? Does that have the potential to radically change Medicare as people have come to know it?"
Senator Barrasso: (2:04 PM)
  • SUMMARY "My view is that people will still get a Medicare card in the mail but whether there are people in hospitals, doctors in hospitals, nurse practitioners and others who will accept that card is another concern. Because what this board may do, and is likely to do under the demands of the health care law, those on Medicare and those coming on Medicare may have a harder and harder time Finding a doctor and hospital to care for them. Let's face it. About 10,000 baby boomers will turn 65. Yesterday about 10,000 baby boomers turned 65. Tomorrow about 10,000 baby boomers will turn 65. we need to make sure that Medicare is there and secure for the current generation as well as the next generation, generations to come, and my concern is that this board that I know you're trying to repeal - I'm trying to repeal - is going to make it that much harder for our seniors to receive the care that they need, the doctor that they want, at a cost that they can afford."