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Landrieu Outlines Support for Senate Health Care Bill

December 22, 2009

WASHINGTON — United States Senator Mary L. Landrieu, D-La., today spoke on the Senate floor detailing her support for the Senate health care reform bill, the Patient Protection and Affordable Care Act.


The Senator highlighted the bill's many provisions that benefit Louisiana families and small businesses, and outlined important improvements to the legislation that she fought for during the Senate's consideration of the measure.

Below are Sen. Landrieu's full remarks, as prepared for delivery:

Mr. President, I rise today in support of the Patient Protection and Affordable Care Act. I have served in public office for 30 years as a State Representative, State Treasurer and a U.S. Senator. But it doesn't take 30 years of experience to know that our health care system is entirely too expensive and does not adequately cover enough Louisianians. From my visits with doctors and nurses, to seniors on Medicare to recent college graduates struggling to afford coverage, it is clear to me that reform now is essential.

In Louisiana, the average family spends more than $12,000 each year for health insurance, or almost 100 percent of earnings from a full-time job paying minimum wage. Since 2000, the amount that working families are charged for health insurance has risen by 91 percent. And if Congress stood by and did nothing, those costs would nearly double in the next 6 years, with economists predicting that Louisiana's families will pay a whopping $23,133 for insurance in 2016 -- an 85 percent increase. To state that in a different way, that means that if we do nothing, the average family in my state will be paying 60 percent of their income for healthcare -- leaving only 40 percent of their wages to cover food, education of children, housing, transportation and everything else. This is not unique to Louisiana -- these skyrocketing costs are burdening families in every state in the union.

Small businesses are also struggling to remain competitive and to turn a profit. In the face of highly unstable, unpredictable health care costs this gets harder and harder. As Chair of the Senate Small Business Committee, I have held 23 hearings and roundtables this year and several of them have been focused on how the current health care system and volatile health care costs are hurting the nation's small businesses. Today, small businesses are seeing their health care costs increase faster than the prices of the products and services they sell -- four times faster than the rate of inflation since 2001. Premiums for single policies increased by 74 percent for small businesses in the last eight years, according to a 2009 Kaiser Family Foundation survey. Nationally, 40 percent of small businesses say that health care costs have had a negative impact on other parts of their business.

Even though families, businesses and government budgets are being mercilessly squeezed by unsustainable health care costs, Senate Republicans are doing everything they can to preserve the status quo. Why? Each day, they find a new excuse for their obstruction. I wish they had put the same amount of passion, energy and creative thinking into contributing policy ideas to this debate as they have into their delaying tactics. Every amendment they offered was to send the bill backwards, not forwards. They were hellbent on defeating, not improving, this bill.

Senate Republicans have charged that we are rushing into voting for this bill. That is simply not true. We have been debating this issue for most of this year and on and off for the last 40 years.

Republican President Theodore Roosevelt made national health insurance a plank in his party platform when he sought the presidency as a Bull-Moose Party candidate in 1912. President Harry Truman, in 1945 and then again in 1948, called on Congress to pass reform legislation that would expand quality health care coverage to more Americans. President Truman believed we needed a stronger system and that the federal government must play a role in establishing a more robust system of care. His critics called his approach "socialized medicine." Sound familiar? Only in Washington would 87 years be considered rushing.

Instead of coming to the table and working with Democrats to write a bipartisan health care reform bill, Republicans chose to put partisan politics first. Fabricating "death panels", distorting Medicare cuts and undermining and disrespecting the role of government in protecting its citizens, they have engaged in a relentless misinformation campaign aimed solely at using fear to sway public opinion against this bill. Recently, Senator McCain has been claiming that the American people are opposed to reform and speaking about "the will of the majority." I would remind my colleague from Arizona that the will of the majority was heard loud and clear last November.

While Republicans have tried to paint a picture of a nation opposed to health care reform, recent polls show otherwise and tell us a lot about the current "will of the majority." When we cut through all the misinformation and scare tactics and Americans hear what is in the bill, they overwhelmingly support it. According to a recent CNN poll, 73 percent of Americans support expanding Medicaid to the poor. That same poll showed providing subsidies for families that make up to $88,000 a year is favored by 67 percent of Americans. Additional regulations on insurance companies, such as banning denial of coverage for those with preexisting conditions are favored by 60 percent of the American people.

A poll by the Mellman Group shows that this support exists in each state, as well. In my own home state of Louisiana, when the provisions of the bill were actually read to voters, 57 percent of Louisianians supported the bill, with 43 percent strongly supporting reform. And, most importantly, 62 pecent Louisianians oppose using the filibuster to stop health care reform.

The American people elected President Obama to bring about change. A big part of the change President Obama and Democrats promised during the campaign was improving health care for all Americans. Thanks to the President's leadership and the leadership of Senator Reid and many others, we are taking several meaningful steps toward fulfilling that promise.With the exception of our two colleagues from Maine, Republicans have failed to negotiate in good faith. I am disappointed that not a single Republican could support an end to the filibuster. I suppose it is easy to stay unified when the only word in your vocabulary is "NO". Although Democrats did not initially agree on exactly how to get there, we were united in saying "YES" to the common goal of delivering meaningful health care reform to America's families and small businesses. I do hold out hope that when we take our vote on final passage, they will recognize this historic opportunity and vote in favor of this bill that will reduce costs and increase access to health care for millions of Americans.

Last month, I stood here on the floor of the Senate to announce my intention to vote in favor of bringing Leader Reid's melded bill to the floor. At the time, I was very clear that my vote was not an indication that I supported that particular version of the bill. My vote was to bring the bill to the floor so we could do the legislative work the American people sent us here to do. Through weeks of floor debate, amendments and round-the-clock negotiations, we have produced a health care bill that is significantly improved.

Through tough negotiations, Senate Democrats have developed a consensus that blends the best of private and public approaches to reduce cost, expand coverage and increase choice and competition for Americans, and have done so without a government-run public option. Since I continue to hear distortions from my colleagues on the other side of the aisle and confusion from my constituents, let me be clear: There is no government-run public option in this bill.

Instead, we reached agreement on a provision to allow private health insurance plans to be sold nationwide. The Office of Personnel Management will negotiate lower premiums -- just as they negotiate the plans currently available to Members of Congress. Importantly, we ensured that at least one non-profit plan will be offered in every state and that states cannot opt out of. These national plans will be available to every state in the nation, which is a monumental achievement and a reform asked for by my constituents, regardless of political ideology. For the first time in our nation's history, Americans will have an opportunity to have the same kind of insurance that federal employees have, including members of Congress. That's a promise the president made. And we're keeping it. There has been a lot of talk about the cost of this bill to the government and taxpayers. There have been a number of false claims about how this bill will add to the deficit and be a burden to our children and grandchildren. The fact of the matter is that the bill is completely paid for and will reduce the deficit by $132 billion over the next 10 years and as much as $1.3 trillion in the following 10 years. I joined almost 20 Democratic colleagues to insist on strong cost containment measures.

Based on our efforts, the Congressional Budget Office and the nation's premier economists have confirmed that premiums will go down or remain stable, so that wages for millions of Americans can increase. When this bill is passed, 31 million uninsured Americans will have access to quality health care coverage. This bill is a big step toward fiscal responsibility and a stronger economy.

The bill achieves this goal by streamlining the health insurance market, ensuring efficiency and limiting insurance company administrative costs and profits. It also imposes an excise tax on insurance companies with high-cost plans. This encourages employers to become more value-conscious purchasers of health-care insurance. Employers are expected to choose cheaper plans, and as less capital is spent on health care, wages will go up for hard-working families. Economists predict this gives American workers a $223 billion pay raise, amounting to $660 per household. We have also created administrative savings through the health insurance exchange, and during Senate consideration of the bill strengthened the Independent Medicare Advisory Board to find more ways to reduce cost growth and improve quality.

The bill has improved in several key ways since we voted to bring it to the floor. The final Senate bill includes a substantial investment in Community Health Clinics and will provide funding to expand access to health care in rural communities and underserved urban areas as well. In Louisiana, the federally supported health clinics have saved the state $354 million in emergency room visits by the uninsured. The legislation also expands access by funding for rural health care providers and training programs for physician and other health care providers.

There are many parts of the current bill that I am proud to have fought for. The bill creates health insurance exchanges that will provide individuals, families, and small businesses with a wide variety of affordable choices and ensure that they will always have coverage, whether they change jobs, lose a job, move or get sick. These state-based exchanges will enable consumers to comparison shop online for health insurance which will drive down costs by increasing choice and competition.

The exchange will help the uninsured obtain needed coverage and will also help the more than 200,000 Louisiana residents who currently do not have insurance through their employer to get quality coverage at an affordable price. Many of these Louisianians in the exchange will qualify for a tax credit to help them purchase the insurance of their choice.

For example, in Calcasieu Parish, the median household income is $39,713. In the exchange created by this bill, the average family in Calcasieu would receive an affordability credit that limits what they spend on their premium to around 5.6% of their income or $2,225. Considering, right now the average Louisiana family is spending up to 28 percent of their income on health care, this is a huge improvement.

This version of the bill that we improved on the Senate floor now includes much-needed help for small business owners. While small businesses make up 74 percent of Louisiana's businesses, only 37 percent of them offered health coverage benefits in 2008. Of those, 62 percent say they are struggling to do so. Of the 64 percent who do not provide insurance, 87 percent say they cannot afford it.

I worked closely with Sen. Stabenow to improve affordability and choices for small businesses and amended the bill to make the "Bridge Credit" available immediately to help small businesses afford health insurance for their employees, and improve the tax credits for small businesses. This means that small businesses who want to offer quality health insurance to their employees will get tax breaks right way, rather than waiting until 2011. I also worked with Senator Lincoln to expand the number of small businesses that will be eligible for tax credits so that more small businesses get help in offering health insurance coverage for their employees -- allowing more small business workers to benefit. In all, these changes bring an additional $13 billion in tax relief -- on top of the $27 billion already in the bill -- to small businesses.

If you are a small business with 25 employees or less here is how reform will help you: Businesses with 25 or less employees whose average annual wages are less than $50,000 will get immediate help through a three-year bridge credit. The creation of exchanges and a two-year exchange tax credit will lift the burden of excessive paperwork and administrative costs. The exchanges will create more stable, secure choices for your employees. In Louisiana, more than 50,000 small businesses could be helped by this small business tax credit proposal.

This will help small business owners like Mary Noel Black and her husband, who own a UPS franchise store in Baton Rouge. They offer their four employees group coverage and are willing to pay half the cost, but the premium rates have gone up so much that neither the workers nor the business can afford to pay the $3,600 a year per employee for insurance. To help Mary pay for the health insurance of each employee, beginning in 2011, Mary could get a $1,260 bridge credit per employee under this bill for three years. Then, in 2014, if she purchases coverage through the exchange, her business is eligible for an exchange credit of $1,800 per employee for an even more generous tax credit for another two years. This savings could mean the difference between offering insurance or dropping coverage because instead of costing her business $14,400 a year now for her four employees -- a cost that is just unaffordable -- the tax credit could initially bring her cost down to $9,360 and later to $7,200.

Through our work on the Senate floor during this public debate, we have made this good bill better for small business. Not only have we extended and expanded the small business tax credits, the legislation includes several amendments I authored to ensure small businesses continue to have a seat at the table once this bill is implemented.

The bill requires small businesses receive information regarding reinsurance for early retirees, small business tax credits, and other issues specifically for small businesses regarding affordable health care options. It lists Small Business Administration resource partners as eligible recipients of Exchange public awareness grants. And, it will include all Small Business Administration partners in the program, including: Women's Business Centers, SCORE, Minority Business Centers, Veteran Business Centers, and others.

The legislation now requires the Government Accountability Office to specifically review the impact of exchanges on access to affordable health care for small businesses to ensure that exchanges are indeed making a difference for small business owners.

It also clearly states that agencies cannot waive the Federal Acquisition Regulation, which requires them to report small business contracting numbers and meet small business contracting goals of 23 percent.

There is a provision that modifies the definition of a full-time employee to take into account fluctuation in employee hours, and reduce the impact of employer responsibility requirements for industries with high turnover and that rely on part-time employees.

The bill eliminates penalties for businesses that wait up to 60 days to provide health insurance to their full-time employees.

Finally, the Patient Protection and Affordable Care Act establishes a national workforce commission to gather information on the health care workforce and better coordinate and implement workforce planning and analysis. The manager's amendment ensures that small businesses and the self-employed will be represented on the commission.

These are important considerations for small businesses and I was proud to ensure these concerns were addressed through the amendment process.

Despite claims from opponents of the bill, we have taken important steps to strengthen Medicare, not weaken it. The Senate health care reform bill creates an Independent Medicare Advisory Board to find ways to reduce cost growth and improve quality and moves to a system that rewards quality care over quantity. It reduces payments for preventable hospital readmissions in Medicare, and cuts waste, fraud, and abuse by screening providers, enhanced oversight, and identifying areas prone to fraud, and by requiring Medicare and Medicaid providers and suppliers to establish compliance programs.

As much as Republicans have tried to scare seniors into opposing this bill, the fact is that Louisiana's 650,000 Medicare beneficiaries stand to benefit from the Democrats' health care reform bill. The bill lowers premiums by reducing Medicare's overpayments to private plans. All Medicare beneficiaries pay the price of excessive overpayments through higher premiums -- even the 78 percent of seniors in Louisiana who are not enrolled in a Medicare Advantage plan. Without reform, a typical couple in traditional Medicare would pay nearly $90 in additional Medicare premiums next year to subsidize these private plans.

Our bill extends the life of the Medicare Trust Fund by 9 years and lays the groundwork for a more sustainable health system. Thanks to these reform efforts, there will be no additional cost for preventive services under the Medicare program. Beneficiaries will not pay anything extra for things like mammograms and colonoscopies. This includes a free wellness visit and personalized prevention plan designed to help give beneficiaries the resources they need to take better care of themselves in these important years.

This legislation puts taxpayers' dollars above insurance company profits by forcing insurers to bid competitively for the business of Medicare beneficiaries and makes changes to the Medicare Advantage payment structure that will give insurers an incentive to deliver more value for taxpayers' money.

Another critical aspect of the bill is that it increases the amount of drug coverage for Medicare Part D beneficiaries before they have to begin to pay out of pocket for their prescriptions. Right now, roughly 116,000 Medicare beneficiaries in Louisiana hit a wall in Medicare Part D drug coverage that will cost some of them an average of $4,080 per year. This reform legislation will provide a 50 percent discount for brand-name drugs.

Some of the bill's most important provisions will benefit the most important population -- children. I was proud that Leader Reid included a provision, at my request, that will ensure that youth who age out of the foster care system will be able to stay on Medicaid until the age of 26. Almost 30,000 young people age out of the foster care system every year, having never been adopted or reunified with their birth parents. The fact that they "aged out" is our failure as government. We have failed them once and we just cannot fail them twice. We must support their transition to adulthood. Guaranteeing quality health care will go along toward helping this transition.

When this legislation is signed into law, insurance companies will not be able to drop children for preexisting conditions beginning immediately. This is crucial for families with children who have battled cancer or diabetes. When a parent loses a job, they may struggle to get insurance when they find new employment. Once this bill becomes law, no insurance company will be able to deny a child with preexisting conditions.

Another critical provision is that this bill will require insurance companies to allow children to stay on their parents' insurance until the age of 26. According to the latest data from the Census Bureau, in 2007 there were an estimated 13.2 million uninsured young adults. This provision will help reduce that number by allowing young people to stay on their parents' coverage for a bit longer.

This health care reform bill also holds insurance companies' feet to the fire to ensure they are accountable to their customers. By 2014, insurers will not be able to deny coverage due to preexisting conditions. That means they will not be allowed to drop you from coverage if you get sick or are in an accident.

Because of Sen. Rockefeller's and Sen. Ben Nelson's work, this bill requires insurance companies to disclose the pricing of their benefits to ensure that premiums are spent on health benefits, not profits, and gives consumers rebates, putting the insurance companies' excessive profits back into your pockets. It contains new requirements ensuring that insurers and health care providers report on their performance, empowering patients to make the best possible decisions. Under this bill, a health insurer's participation in the exchanges will depend on its performance. Insurers that jack up their premiums before the exchanges begin will be excluded -- a powerful incentive to keep premiums affordable.

Finally, I was also proud to work with Leader Reid and Finance Committee Chairman Max Baucus to address an inequity in the formula that determines the federal match of Medicaid dollars. As we all know, in 2005 Hurricanes Katrina and Rita ravaged the Gulf Coast and destroyed homes, neighborhoods, and even full communities throughout South Louisiana. In an effort to aid the recovery, Congress approved a much-needed aid package for Louisianans that infused grant dollars and direct assistance to speed our recovery.

Some necessary one-time recovery dollars, in addition to labor and wage costs going up because there was a constriction in the market, were calculated into our State's per capita income. The result has been that Louisiana's per capita income was abnormally inflated, and put us in a category with richer states like Connecticut, Massachusetts and Maryland.

The result is that our federal match for Medicaid dropped pretty dramatically. I worked with my colleagues to correct this formula. I never asked for special treatment for Louisiana, but only for understanding of the unintended consequences of our state's unique situation. We only wanted to be treated fairly and not to get penalized because we have been forced to rebuild following the worst natural disaster in the United States' history. Our federal Medicaid match rates should reflect the reality on the ground in Louisiana, not the cold calculations of inflexible federal formulas.

An important note is that this Medicaid funding fix was supported by every member of our Congressional Delegation, and specifically and repeatedly requested by our Republican Governor Bobby Jindal. Some politicians in my state may run and hide when the heat gets turned up, but that is not the way I was raised. I never have and never will run from what I think is right. I was sent here to fight for my state and that is exactly what I am doing.

Those who have dubbed this provision the "Louisiana Purchase" know little about lawmaking and even less about my views on health care reform. This Medicaid fix alone would not have been enough to earn my vote on this legislation. This was one of literally a dozen priorities I had as the Senate considered health care reform. I am voting for this bill because it achieves the goals I laid out at the beginning of this debate: it drives down costs and expands affordable health care choices for millions of families and small businesses in Louisiana and around the nation. Any claim to the contrary, is a pathetic lie meant to derail this bill, a tactic that was all too common during this debate.

These are just some of the ways that this bill will reduce costs and expand access to health care for millions of Americans. Today, we stand on the verge of history, with an opportunity to support a bill that will provide health insurance to 31 million more Americans, reducing the deficit by $132 billion over the next 10 years.

The bill is not perfect. It is not the exact health care bill that I would have written. I think the same could be said for each of my colleagues. It was a long, difficult process and during the course of completing this landmark bill there were a lot of twists and turns. But, as former President Clinton was fond of saying, we should never let the perfect become the enemy of the good.

And, this is a good bill that will improve health care for the local grocery store owner in Jennings, the 22-year old in Lake Charles who has just left the foster care system, the single mother of three in Monroe, the nine year old boy in Natchitoches who was just diagnosed with diabetes and the 70 year old Medicare recipient in Houma who worked for three decades in the offshore oil industry. The Patient Protection and Affordable Care Act makes a difference in these lives and millions more across America, and I urge my colleagues to support it. I yield the floor.

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