Preserving Medicare Beneficiaries’ Access to Quality Care | Opposing ObamaCare in Congress and the Courts | Fighting Against Health-Care Rationing | Promoting Targeted Solutions to Health-Care Problems
I believe in health-care policies that promote access to quality, affordable care for every American, preserve individual choice, and protect the doctor-patient relationship from inappropriate government intrusion. To promote these objectives, I support legislation that would:
- Reform the tax code to enable more small businesses and self-employed individuals to provide coverage for themselves and their workers;
- Improve Health Savings Accounts and Flexible Spending Accounts, and make them accessible to more people;
- Develop a fairer and more predictable payment system for physicians who serve Medicare beneficiaries;
- Reform medical-liability laws to help reduce health-care costs; and
- Drive down the cost of health insurance by permitting the sale of insurance across state lines.
In 1997, Congress approved what has become known as the Sustainable Growth Rate (SGR) formula, which was intended to control the growth in total Medicare spending on physician services. It wasn’t long, though, before Congress realized that the SGR would lead to reimbursement rates so low that they wouldn’t even compensate doctors for the cost of the care they provide.
Obviously, if doctors are not properly reimbursed for the cost of the care they provide to seniors, the quality of that care may suffer, or doctors may simply choose to see fewer Medicare patients or none at all. Out of the 50 states, Arizona ranks 42nd in the number of doctors per 100,000 people, so our state has fewer doctors than average for Medicare patients as it is. Declining reimbursements could aggravate this already bad situation by forcing many doctors to abandon their Medicare practices, thus creating a crisis for our state’s seniors.
Congress should have promptly reformed or repealed the flawed SGR formula, but instead it merely adopted temporary measures to freeze reimbursement rates or provide small updates on a year-by-year basis. Because it left the flawed formula in place, the cuts required by the SGR are still mandated, and because they have been accumulating over time, the cuts could now amount to nearly 30 percent if Congress fails to act. That cannot happen without jeopardizing seniors’ access to quality health care.
There is no question that Congress must act to avert this crisis. We need a system that pays doctors in a predictable, reasonable, stable, and fair manner for the valuable services they provide. I am working now for repeal of the flawed SGR formula and in favor of a permanent solution.
Congress Considers Legislation to Repeal the Law
I voted against ObamaCare when it originally came before the Senate, and I have since cosponsored legislation to repeal it.
The U.S. House of Representatives approved a repeal bill early last year, voting overwhelmingly, 245 to 189, to block the new law. Unfortunately, with the president’s party still in control of the Senate, the repeal bill failed when the Senate subsequently took it up. The vote was 47 to 51 against repeal.
Since then, those of us opposed to the law have tried to deny funding for its implementation, or change or repeal specific parts of it. We succeeded in repealing the so-called “1099 provision” that would have required businesses to report every purchase of $600 or more to the Internal Revenue Service, something that would have created a costly new burden on employers at a time when they should be devoting scarce resources to job creation. The House voted this year to repeal the CLASS Act, an expensive new long-term care entitlement that was buried within ObamaCare. I hope the Senate will also vote to repeal the CLASS Act, as well as other provisions of the law, including a $60 billion tax on insurance, limitations on physician-owned hospitals, and the Independent Payment Advisory Board that ObamaCare set up to squeeze Medicare even more than the law already does.
U.S. Supreme Court to Decide the Constitutionality of ObamaCare
More than half of our 50 states have filed suit against the president’s health-care law, a challenge that will reach the U.S. Supreme Court this spring. The court has already allotted five-and-a-half hours for oral argument over two days, with this unusually long time allotment signaling the court’s interest in the profound issues at stake in the litigation.
The central issue in the legal challenge is the law’s “individual mandate,” which requires all Americans to buy government-approved health insurance, whether they want it or not. If the individual mandate is upheld, it will mean that the federal government’s power has been expanded far beyond what the Founding Fathers ever imagined. Never before has the federal government compelled Americans to buy a product from any company.
A federal district court judge who heard one suit against ObamaCare put it this way: “If they decided that everyone needs to eat broccoli because broccoli is healthy, they could mandate that everybody has to buy a certain amount of broccoli each week.” Obviously, such an all-powerful government would threaten liberty as we know it.
Forty-two of my Senate colleagues and I have filed a friend of the court brief with the Supreme Court, arguing against the constitutionality of the individual mandate. Thirty-six of us have also filed a brief arguing that, if the individual mandate is struck down, ObamaCare in its entirety must fall because the mandate is the cornerstone on which the rest of the law is built.
Perhaps the most important reason to fight ObamaCare is the very real threat that it will lead to health-care rationing through government rules and decision-making that subordinate the interests of physicians and patients.
The stalking horse for this dangerous shift in policy is what is known as “comparative effectiveness research.” In the hands of doctors, medical researchers, and other health professionals, comparing the effectiveness of various treatments can help patients and their doctors make informed health-care decisions. However, in the hands of government, so-called comparative effectiveness research can become a tool to delay or deny care (and, since private insurers tend to follow the federal government’s lead, this research has significant implications for all patients). The Patient Centered Outcomes Research Institute, which was created by ObamaCare, will fund comparative effectiveness research.
Such a system empowers government bureaucrats to decide whether you get the care you need based on an arbitrary cost-benefit analysis and the amount the government is willing to spend. Consider that the National Institute for Health and Clinical Effectiveness (NICE) in Britain uses “cost-effectiveness research” to make health-care decisions; examples of NICE rejecting cutting-edge treatments for not being “a cost-effective use of NHS resources” are numerous. The chairman of NICE summed it up this way: “If we spend a lot of money on a few patients, we have less money to spend on everyone else.” Obviously, such rationing of care is not something we should replicate in the United States.
Listed below are a set of proposals that can solve specific problems in our health-care system without upending it and without creating undue government interference in health-care decisions.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be improved in a number of ways to expand coverage. For example, current law requires employees to forfeit any money left in their FSAs at the end of the year, and that provides an incentive for them to spend the money whether or not they need medical products or procedures. That, in turn, needlessly drives up costs. Workers ought to be able to roll over savings from year to year for truly necessary medical care.
We should also allow people to make larger contributions to their FSAs, and let them use the money to pay health-insurance premiums.
A May 2011 report published by the Arizona Commerce Authority found that small businesses in Arizona accounted for nearly 92 percent of all job growth (from 1998 to 2008). One of the most important things we can do is make it easier and more affordable for these businesses to provide health-care coverage for their employees. We can do that by providing them with some of the same tax incentives that are already available to larger businesses, including those that encourage companies to purchase health insurance for their employees, and those that promote the use of high-deductible plans paired with Health Savings Accounts.
Congress should repeal the Sustainable Growth Rate formula and replace it with a fair and predictable system for reimbursing doctors for the care they provide to Medicare beneficiaries. I have proposed such a plan, including specified updates to reimbursement rates for the next 10 years.
Medical-liability reform must be a part of any serious health-care reform effort. While malpractice suits serve a valuable purpose for those who have truly been wronged, malpractice law in its current form is too often abused by trial lawyers who flood courts with baseless suits.
Many lawsuits hinge, for example, on an attorney’s claim that a doctor should have ordered extra diagnostic testing and imaging. This, logically, forces doctors to practice “defensive medicine” – for example, ordering tests that are not medically necessary, but that will help protect them in case of a lawsuit. A recent study of orthopedic surgeons found that nearly 35 percent of all the imaging ordered was for defensive purposes.
There is evidence that malpractice reform helps reduce some of this defensive medicine. For example, a study published in the American Journal of Emergency Medicine found that the rate of ER neurologic imaging was much lower in states with tort reform laws in place.
Arizona has enacted some malpractice reforms that have already been successful. For example, it heightened the evidentiary standard in malpractice suits so that plaintiffs now have to prove by “clear and convincing evidence” that a defendant was negligent.
Limits on non-economic damages have also proven successful in some states. Capping non-economic damages at the federal level can help limit health-care costs nationwide.
According to the Council for Affordable Health Insurance (CAHI), the number of state-mandated benefits grew to 2,156 in 2010, up from 2,133 the previous year. These mandates can drive up the cost of coverage for everyone who purchases health insurance in a state by requiring them to pay premiums for services they may not need or want.
At least 10 states now allow some individuals to purchase policies that are subject to fewer mandates and better tailored to their needs and financial situation. These are positive developments, but we should also consider allowing the sale of insurance across state lines so that Arizonans can find the coverage they need and can afford – whether it’s offered in Arizona, Kansas, or elsewhere. Allowing individuals to purchase only the insurance products they need will drive down premiums in the only manner that works: free-market competition.
