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Harkin Fights Efforts to Dismantle Health Care Law

Harkin Fights Efforts to Dismantle Health Care Law

WASHINGTON – Today, Senator Tom Harkin (D-IA), Chairman of the Senate Health, Education, Labor and Pensions Committee, submitted testimony to the House Energy and Commerce Committee’s hearing, titled “Setting Fiscal Priorities in Health Care Funding.” As the first anniversary of the Affordable Care Act nears, Harkin emphasized both the budgetary and consumer benefits that the law provides, making the case for protecting and implementing the new law.

“Today I am here to reaffirm this consensus: each of these programs, and their reliable funding streams, promotes a healthier nation and ensures all Americans have access to key protections and crucial care.  We must not deprive states and communities of the start-up funding they need to make get health reform off the ground.  Millions of Americans who will benefit from this law are looking to us to move steadily ahead, not to pick apart the foundation we’ve already laid,” Harkin said.


The full text of Harkin’s testimony as prepared for submission is below:

On March 23 of last year, President Obama signed into law the most comprehensive and humane reform of our health care system since Medicare.  The Affordable Care Act (ACA) will give 94% of Americans access to affordable health coverage that can never be taken away; protect consumers against insurance company abuses; make unprecedented investments in prevention, wellness, and quality of care; aggressively control runaway health care costs; and transform the health care delivery system. 

For all the rhetoric about debt and government spending, the bill’s opponents seek to dismantle our most effective deficit reduction tool.  The nonpartisan Congressional Budget Office has certified that health reform reduces the deficit by $210 billion in the first decade and more than $1 trillion in the next.  It achieves these reductions through commonsense reforms that Congress has been trying to effect for years – like reducing Medicare overpayments to private insurance companies and paying hospitals and doctors for how well they treat patients, rather than how often. 

Over the last year, millions of Americans have seen the tangible benefits of health reform.  Specifically, the Patients’ Bill of Rights, effective in late September of last year, expands the quality and scope of health coverage for all Americans.  Everyone who pays a health insurance premium is now protected against some of the most infamous and abusive practices of the insurance industry;  put another way, because of reform, Americans now have protections that members of Congress have enjoyed for years.

To ensure the success of the Affordable Care Act, we needed to guarantee that reliable and predictable funding would be available for key programs.  As the Chairman of both the Senate Committee on Health, Education, Labor, and Pensions and the Appropriations Subcommittee for Labor, Health and Human Services, and Education, I understand the implications of this guarantee – that Congress should mandate appropriations for certain programs in the Affordable Care Act that are fundamental to its success.  This is a process that Congress has done many times in the past in various areas and there has been no controversy.  It is now clear that those who want to repeal the Act are seeking to starve these important elements of funds in an effort to derail health reform.  The legislation being discussed in this Committee today is evidence of their determination.  Let me assure you, these funding decisions were not taken lightly and involved careful consideration by representatives of the authorizing and appropriations committees, in conjunction with the Budget Committee.  But let’s be clear -- this debate is not really about the difference between mandatory and discretionary funding – it is about whether we are going to cut funding for the most important health care reforms since Medicare. 

For example, the legislation the Committee is considering today would eliminate funding for one of the linchpins of the Affordable Care Act’s coverage expansion – the American Health Benefit Exchanges.  As a “one-stop shop” for health coverage, the exchange will give millions of individuals and small businesses currently locked out of the market access to affordable coverage.  Qualifying individuals and small businesses will receive tax credits to make premiums affordable.  Small businesses, whose premiums have increased 85% on average just in the last decade, will be able to give their employees unprecedented choice among plans.  According to the nonpartisan Congressional Budget Office, small businesses coverage purchased through an exchange will “have lower administrative costs, on average, than the policies those firms would buy under current law, particularly for very small firms.”

I have firsthand experience with standing up new programs, and I know how vital start-up capital is in the early years.  The law requires exchanges to be financially self-sustaining by 2015 but also provides important seed funding so that states can build the infrastructure necessary for success.  Careful investments are required so each exchange is specifically adapted to the state it serves.  The exchanges, in many ways, give state authorities more power than they previously had to serve citizens’ unique needs.  To cite just one example, the Secretary has already awarded “Early Innovator” grants to seven states to develop innovative eligibility and enrollment systems for citizens entering the exchange.  These systems will replace redundant and outmoded methods of enrollment, allowing the exchange to determine a person’s eligibility for Medicaid or exchange subsidies in real time and get them signed up quickly.  The proposed legislation would require states to return these funds.

We can’t afford to pull the rug out from under states just as they have begun such vital work.  That’s why mandatory funding that isn’t subject to the vagaries of the budget cycle is so important.  Without certainty of funding, states will not make the investments they need to ensure that exchanges are self-sustaining in four years.

In addition to these crucial grants, the proposed legislation would eliminate the Prevention and Public Health Fund, a component of the health reform law that is absolutely critical to the transformation of our Nation into a genuine wellness society. For the first time in history, we have decided not just to pay lip service to wellness and prevention, but actually to invest in these national priorities in a very robust way.  Already, this commitment has provided essential resources to communities to prevent obesity, diabetes, heart disease, and other very costly conditions and diseases.

The Prevention Fund provides us not only with a tremendous opportunity to improve the health of the American people, but also to restrain health care spending. In a budget environment like the one we face today, we can’t afford not to make this investment.  Prior to the Prevention Fund, for every dollar spent on health care, 75 cents went to treating patients with chronic diseases, while only four cents were spent on prevention of those diseases.  This has had devastating consequences: chronic diseases are one of the main reasons why health care costs have increased so dramatically over the past several decades. Two thirds of the increase in health care spending between 1987 and 2000 was due to increased prevalence of chronic diseases. The Prevention Fund gives us an unprecedented opportunity to bend the cost curve: overall, the return on investment in community-based prevention interventions is six dollars for every dollar invested.

The provision creating the Fund was drafted with great care to guarantee funding while maintaining the decision-making authority of appropriators.  Contrary to misperceptions that it evades the appropriations process, the Fund was established – in conjunction with all the relevant committees, including the Budget Committee-- in such a way that appropriators direct how monies from the Fund are spent.   The current misperception that the Fund is not subject to the appropriations process stems from the unfortunate reality that Congress has not been able to pass an appropriations bill this year, thus requiring the Administration to make these decisions.  I can assure that this was not our intent; it is imperative that appropriators maintain this authority, as required by Affordable Care Act.

Finally, I would like to mention briefly the other provisions being examined by the Committee today.  The proposed legislation would cut funding made available in health reform for the establishment of school-based health centers.  These centers will play a critical role in providing access to school-aged children and their families once they receive quality, affordable health insurance, especially in medically underserved communities where it is difficult to find providers.  The proposal would also eliminate funding for teaching health centers, a grant program that ensures continued training and development of providers, particularly in rural areas, to meet significant future demand. 

Each of the Affordable Care Act provisions I have described was drafted in consultation with all relevant committees, each of whom concurred that the programs required mandatory appropriations to be sustainable.  Today I am here to reaffirm this consensus: each of these programs, and their reliable funding streams, promote a healthier nation and ensure all Americans have access to key protections and crucial care.  We must not deprive communities of the start-up funding they need to make get health reform off the ground.  Millions of Americans who will benefit from this law are looking to us to move steadily ahead, not to pick apart the foundation we’ve already laid.