Sam Brownback on Health Care Republican Sr Senator (KS)

Refusing ObamaCare like declining a discount on the Titanic

Of the 23 state exchanges established under ObamaCare, a majority have failed, at a cost of billions including significant hits to state budgets. As major insurers abandon the few remaining state exchanges, the decision to refuse early adoption looks increasingly like declining a discount ticket on the Titanic.

The same holds true for the policy choice not to take the bait on Medicaid expansion. You've heard the promise--hundreds of thousands more beneficiaries at zero cost to the state--all paid for with 'free' federal money. It would be foolish to endorse the ObamaCare expansion of Medicaid now--akin to airlifting on to the Titanic. Kansas was right. Kansas should stay the course.

KanCare at state level better than ObamaCare

Expand Health Savings Accounts

A: This is a real problem. It’s real people that are involved in this type of situation. I think the question you have to ask is: Which is the best way to go, then? Do you do it with more government or do you do it with more markets? Because these are real people experiencing this. And I pick more markets and real markets with it. Because I have not seen, in this country, ever, when the government enters into something on a bigger basis, do we get higher quality service or more of it? We don’t. It doesn’t work that way. One thing that hasn’t been talked about up here is Health Savings Accounts. We need to expand that so people can save money, tax-exempt, from their work, the employers putting that in so they can have some money for their health care coverage.

Insurance reward for avoiding tobacco, alcohol, obesity

• HUCKABEE: Yes.
• TANCREDO: Yes.
• COX: Yes.
• BROWNBACK: Yes.
• PAUL: Yes.
• HUNTER: Yes.
• KEYES: Yes.

Market-based solution over socialized government-pay system

A: Well, that’s why I voted against the bill. But it wasn’t just that. The piece of it that I think you have to recognize is that you’ve got a fundamental decision to make here on health care, which is 16% of the economy, going north fast, probably headed to 20% of our total economy. Do you think the solution to providing more and better health care is (1) that we should have more government solutions involved, or (2) should there be more market-based solutions involved? And I think clearly the answer here is you need more market forces in health care. That’s what we need to do. Instead, you’ve got the Democrats doing a step-by-step march toward a socialized government-pay system. And they’re very happy to do it that way. But we can get better health care going this way. And we can hold the price of it down and not bust the federal treasury at the same time.

Eliminate death by cancer in 10 years

Eliminating death by cancer is one of my favorite things to talk about. I had melanoma, and my father had colon cancer. We’re like most families in this country, where cancer is a familiar topic and a dreaded word.

In some of my speeches [I describe my] plan to end deaths by cancer in ten years. There are a lot of things we could give back to the world, but if the number-one fear is death from cancer, then giving them back the gift of life would be a wonderful gift. It would be a gift that only this country could give the world. We have everything needed to make this a priority.

Supports competitive marketplace with price transparency

What happened with Lasik could be instructive for the rest of the health care system. First, Lasik has a market and price competition. It’s open pricing, so we see what costs are involved, up front. Second, we’re using our own money, so we shop for the best product at the best price.

The problem with the current health care system is that it’s not generally seen as using our own money, and we have no price transparency. We don’t know what we’re paying for. Frequently a third party pays the bill.

The patient needs more information, and we need more price transparency. I’ve cosponsored a bill requiring the disclosure of the amount Medicare reimburses on typical procedures [made] available over the Internet.

Supports Health Savings Accounts, not government control

That way you become more involved in the decision-making. You decide when it’s appropriate to seek treatment and how far you want to go with it.

The big danger at the moment, however, is that the other side is pushing hard for more government control over health care and a bigger government-funded system. The big push for the Democrats is nationalized health care on the order of the failed Clinton health care proposals of the 1990s. I don’t think they’ve lost the appetite for doing that now.

The market-engaging solution is the one that can actually work. Our way is to restore market mechanisms to the system, not simply yo have more and bigger government in health care.

Offset Third World drug costs by extending US patents

What if we allowed up to a 2-year patent extension on another medicine, as an incentive for these companies to fund research and development of treatments for the diseases of the developing world? It's a way for us to use the dynamics of the marketplace to come up with treatments for pernicious diseases in other parts of the world. We get research on ancient diseases affecting 100s of millions of people globally. They get short patent extensions. That sounds like a winning, market-based solution to a tough, global problem.

Tragedy to make "right to die" legitimate

But there are incredible, beautiful things that can happen at the end of life, even amid the pain and difficulty. The transition of the soul from a physical home to a spiritual one is a sacred time. One person's trial can be an incredible testimony to those around him who survive, particularly family and close friends. I think it would be a terrible tragedy for the government to legitimate the act of taking one's own life.

Voted NO on regulating tobacco as a drug.

Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

Voted NO on expanding the Children's Health Insurance Program.

• Reauthorizes State Children's Health Insurance Program (SCHIP) through FY2013 at increased levels.
• Gives states the option to cover targeted low-income pregnant women
• Phases out coverage for nonpregnant childless adults.

Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.

Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.

Voted NO on overriding veto on expansion of Medicare.

• Extends Medicare to cover additional preventive services.
• Includes body mass index and end-of-life planning among initial preventive physical examinations.
• Eliminates by 2014 [the currently higher] copayment rates for Medicare psychiatric services.

I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:
• It would harm beneficiaries by taking private health plan options away from them.
• It would undermine the Medicare prescription drug program.
• It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.

Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

Voted YES on means-testing to determine Medicare Part D premium.

SUPPORTER'S ARGUMENT FOR VOTING YES: Sen. ENSIGN: This amendment is to means test Medicare Part D the same way we means test Medicare Part B. An individual senior making over $82,000 a year, or a senior couple making over $164,000, would be expected to pay a little over $10 a month extra. That is all we are doing. This amendment saves a couple billion dollars over the next 5 years. It is very reasonable. There is nothing else in this budget that does anything on entitlement reform, and we all know entitlements are heading for a train wreck in this country. We ought to at least do this little bit for our children for deficit reduction.

OPPONENT'S ARGUMENT FOR VOTING NO: Sen. BAUCUS: The problem with this amendment is exactly what the sponsor said: It is exactly like Part B. Medicare Part B is a premium that is paid with respect to doctors' examinations and Medicare reimbursement. Part D is the drug benefit. Part D premiums vary significantly nationwide according to geography and according to the plans offered. It is nothing like Part B.

Second, any change in Part D is required to be in any Medicare bill if it comes up. We may want to make other Medicare changes. We don't want to be restricted to means testing.

Third, this should be considered broad health care reform, at least Medicare reform, and not be isolated in this case. LEGISLATIVE OUTCOME:Amendment rejected, 42-56

Voted YES on allowing tribal Indians to opt out of federal healthcare.

TRIBAL MEMBER CHOICE PROGRAM: Members of federally-recognized Indian Tribes shall be provided the opportunity to voluntarily enroll, with a risk-adjusted subsidy for the purchase of qualified health insurance in order to--
1. improve Indian access to high quality health care services;
2. provide incentives to Indian patients to seek preventive health care services;
3. create opportunities for Indians to participate in the health care decision process;
4. encourage effective use of health care services by Indians; and
5. allow Indians to make health care coverage & delivery decisions & choices.

SUPPORTER'S ARGUMENT FOR VOTING YES:Sen. COBURN: The underlying legislation, S.1200, does not fix the underlying problems with tribal healthcare. It does not fix rationing. It does not fix waiting lines. It does not fix the inferior quality that is being applied to a lot of Native Americans and Alaskans in this country. It does not fix any of those problems. In fact, it authorizes more services without making sure the money is there to follow it.

Those who say a failure to reauthorize the Indian Health Care Improvement Act is a violation of our trust obligations are correct. However, I believe simply reauthorizing this system with minor modifications is an even greater violation of that commitment.

OPPONENT'S ARGUMENT FOR VOTING NO:Sen. DORGAN: It is not more money necessarily that is only going to solve the problem. But I guarantee you that less money will not solve the problem. If you add another program for other Indians who can go somewhere else and be able to present a card, they have now taken money out of the system and purchased their own insurance--then those who live on the reservation with the current Indian Health Service clinic there has less money. How does that work to help the folks who are stranded with no competition?

LEGISLATIVE OUTCOME:Amendment rejected, 28-67

Voted NO on adding 2 to 4 million children to SCHIP eligibility.

Proponents support voting YES because:

Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:

1. It terminates the coverage of childless adults.
2. It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
3. It contains adequate enforcement to ensure that only US citizens are covered.

Opponents recommend voting NO because:

Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:

• On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
• On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
• On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.

Veto message from President Bush:

Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.

Voted NO on expanding enrollment period for Medicare Part D.

Voted NO on increasing Medicaid rebate for producing generics.

Voted YES on negotiating bulk purchases for Medicare prescription drug.

Voted YES on $40 billion per year for limited Medicare prescription drug benefit.

Voted NO on allowing reimportation of Rx drugs from Canada.

Voted NO on allowing patients to sue HMOs & collect punitive damages.

Voted YES on funding GOP version of Medicare prescription drug benefit.

Voted NO on including prescription drugs under Medicare.

Voted YES on limiting self-employment health deduction.

Voted NO on increasing tobacco restrictions.

Voted YES on Medicare means-testing.

Rated 0% by APHA, indicating a anti-public health voting record.

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

Establish a national childhood cancer database.

Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.

Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of:
1. activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
2. activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and
3. direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.

Opposes government-run healthcare.

The Christian Coalition voter guide [is] one of the most powerful tools Christians have ever had to impact our society during elections. This simple tool has helped educate tens of millions of citizens across this nation as to where candidates for public office stand on key faith and family issues.

The CC survey summarizes candidate stances on the following topic: "Federal government run health care system"

Loosen "one-size-fits-all" approach to Medicaid.

As Governors, we are writing to you regarding the excessive constraints placed on us by healthcare-related federal mandates. One of our biggest concerns continues to be the Maintenance of Effort (MOE) provisions of the Patient Protection and Affordable Care Act, which prevent states from managing their Medicaid programs for their unique Medicaid populations. We ask for your immediate action to remove these MOE requirements so that states are once again granted the flexibility to control their program costs and make necessary budget decisions.

Every Governor, Republican and Democrat, will face unprecedented budget challenges in the coming months. Efforts to regulate state operations impose greater uncertainty on our budgets for oncoming years and create a perfect storm when coupled with the current state of the economy.

Health and education are the primary cost drivers for most state budgets. Medicaid enrollment is up. Revenues are down. States are unable to afford the current Medicaid program, yet our hands are tied by the MOE requirements. The effect of the federal requirements is unconscionable; the federal requirements force Governors to cut other critical state programs, such as education, in order to fund a "one-size-fits-all" approach to Medicaid. Again, we ask you to lift the MOE requirements so that states may make difficult budget decisions in ways that reflect the needs of their residents.

Provide for treatment of autism under TRICARE.

A bill to amend title 10, United States Code, to provide for the treatment of autism under TRICARE. Revises TRICARE (a Department of Defense [DOD] managed health care program) to authorize treatment of autism spectrum disorders, if a health care professional determines that such treatment is medically necessary.