[Congressional Record Volume 162, Number 139 (Wednesday, September 14, 2016)]
[Senate]
[Pages S5686-S5687]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AFFORDABLE CARE ACT

  Mr. CARPER. Mr. President, I like to tell the story about a Senate 
Finance Committee hearing about 2 years ago when we had a bunch of very 
smart people who came in to talk to us about this: What are we going to 
do about reducing the deficit?
  We continue to reduce the deficit. We peaked out at $1.4 trillion 
about 6 or 7 years ago. We are down to about $400 billion now; it is 
still way to high. But the hearing was designed to ask: What are some 
things we can do to further reduce our budget deficit?
  One of our witnesses was a fellow who used to be Vice Chairman of the 
Federal Reserve, Alan Blinder. At the time he testified 2 years ago, he 
was back at Princeton teaching economics.
  As a witness before our committee on reducing Federal budgets, he 
said: The 800-pound gorilla in the room on health care, on deficit 
reduction, is health care costs. That is what he said. That is the 
biggest one--Medicare, Medicaid, the VA system, and so forth. He said 
that is where the money lies; that is where we have to focus.
  When it came time to ask questions of our witnesses, I asked Dr. 
Blinder: You mentioned that health care is the 800-pound gorilla in the 
room on deficit reduction. What do you think we ought to do?
  He sat there for a while, he sat there for a while, and he sat there 
for a while. Finally, he said these words: I am not an expert on health 
care. I am not a health economist, but if I were in your shoes, here is 
what I would do. I would find what works and do more of that.
  That is all he said.
  I said: Do you mean to find out what doesn't work and do less of 
that?
  He said: Yes.
  If you go back--oh, Lord, this is 2016. If you go back about 22 years 
in our Nation's history, there was a big debate on Capitol Hill on an 
idea actually proposed and put forward by the First Lady of our 
country, Hillary Clinton. She proposed--not ObamaCare; she worked on 
something that was called HillaryCare. But the idea we had--like a lot 
of people in this country who were not covered by health insurance--
millions, tens of millions of them--we spent way more money in America 
on health care costs than just about any other developed Nation. We 
didn't get better results.
  Every President since Truman has basically said that we have to do 
something about extending health care coverage to people who don't have 
it and trying to make sure it is affordable. Nobody really came up with 
anything. So the First Lady of this country, of all people, said: Well, 
I am going to work on this.
  And she went to work on it. She came up with a proposal called 
HillaryCare. It was ultimately not adopted, but our Republican friends, 
as they should have, came up with an alternative to HillaryCare.
  One of the key components of their proposal was something that 
actually looks a lot like ObamaCare. What they came up with was this 
idea of creating health care exchanges or purchasing pools, large 
purchasing pools, that people who don't have health care coverage could 
elect to join.
  As with thousands, maybe tens of thousands, even hundreds of 
thousands of people from their States, these State-by-State purchasing 
pools or exchanges could provide the opportunity for people who don't 
get health care coverage, are not part of a large purchasing pool, and 
don't work for a big employer who provides health care coverage--they 
could derive the same advantages as those who do have that kind of 
employment opportunity. That was the Republican alternative.
  At the end of the day, it didn't go anywhere. But at the time I 
thought that was a good idea.
  I wasn't here at that time. I was Governor of my State and very 
active in the National Governors Association. I said: I think these 
Republicans have a good idea, creating these exchanges, these large 
purchasing pools, and maybe providing a tax credit from the Federal 
Government to buy down the cost of premium coverage.
  But neither idea ended up flying. HillaryCare ended up going away. 
The Republican alternative, which was a lot like ObamaCare today, was 
not enacted.
  Fast forward to 2009, with a new President who wanted to finally do 
something about reining in health care costs, covering people who 
didn't have coverage--tens of millions of people--and trying to figure 
out: How do we bring down not only the cost of health care, but how do 
we get better results?
  At the end of the day, a white paper was issued for those of us on 
the Finance Committee to consider as we took up our debate in 2009. The 
way negotiations ended up proceeding, in order to try to find a 
starting point, was to work from the white paper on health care reform 
but then have three Democrats and three Republicans who would join one 
another. These were senior members of our committee who were very good 
at finding the middle, very good at finding consensus. The idea was for 
them to try to negotiate an agreement, a bill. They tried not just for 
days, not just for weeks, but for months.
  I am a pretty bipartisan guy around here, but I am not sure there was 
a real bipartisan intent to get to a compromise. I would not cast 
aspersions, but I think there is probably a little more blame to lie on 
the other side of the aisle than on this one.
  As Democrats, we pretty much decided to put something together, and 
we took two good Republican ideas. One of those is these large 
purchasing pools, these exchanges. We said every State should have one 
and give the opportunity for people to be part of a larger purchasing 
pool if they don't have health care coverage--if they don't work for an 
employer that provides health care coverage--to get the advantage of 
buying health care coverage in bulk, if you will, and having a stronger 
negotiating position, more leverage.
  That was the Republican idea. I thought it was a good idea in 1994, 
and, frankly, as a member of the Finance Committee, I thought it was a 
good idea in 1999.

  Another good Republican idea that was put forward at the time was the 
individual mandate. That is not a Democratic idea; that was an idea 
that came from Governor Romney in Massachusetts, where they put in 
place their

[[Page S5687]]

own RomneyCare plan, which has actually worked pretty well. They have 
purchasing pools just as we do in States across the country--these 
exchanges. But they also have something in place that is an individual 
mandate if somebody didn't get coverage. They want everybody in 
Massachusetts to be covered. But if they elected not to be covered, 
after 1 year or 2 years or 3 years, people just said: I am not going to 
get coverage. I am young, I am invincible, and I don't need health care 
coverage. I can't afford it--even with the tax credit they received 
through RomneyCare. They said: You are going to have to pay a tax or a 
fee if you don't get coverage, if you will not sign up. You can't just 
get away with it. You are going to have to pay something.
  The idea was to have an escalating fee so that eventually people 
would say: You know, it is one thing to be fined or taxed a $100 tax if 
I don't sign up for health care coverage, but how about when it is 
$300, $500, $700, $800 a year? So eventually people signed up.
  In this country, as well, we have the exchanges, which actually were 
a gift from our Republican friends. I think it was a good idea then and 
now.
  We also have the individual mandate, which is gradually ramping up so 
that the young invincibles, the young people who are not getting health 
care coverage, will get coverage. As more younger, healthier people 
join the purchasing pools, the idea will be that it will bring down the 
cost of health care coverage overall so it is not just the sick, the 
elderly, but it is a healthier group of people.
  That is sort of where we are today. The idea of pulling the plug on 
the Affordable Care Act or significant parts of it because a principal 
component of it--and that is the purchasing pools, these exchanges--is 
not working as advertised would be a mistake. If it isn't perfect, make 
it better.
  We had a chance in 2009 to negotiate a real bipartisan health care 
reform plan. Unfortunately, we didn't do that. We are going to have a 
chance again in the early part of next year with a new President and a 
new Congress to again take up that which is flawed, which is imperfect, 
and that is the Affordable Care Act, to make it better--not to get rid 
of it, but to make it better.
  Senator Alexander is a very wise and highly regarded colleague. He 
may have a very good idea. I just heard about it here on the fly today. 
But my hope is that Lamar and the rest of us who want to get things 
done, to do our job, will seriously take this challenge that is before 
us and take that original good Republican idea from 1994 on the 
exchanges, create purchasing pools, and make it better. We should take 
a look at the individual mandate that Governor Romney adopted in 
Massachusetts and see how that is working and look at other exchanges 
as well.
  The long-and-short story is that when we took up the Affordable Care 
Act in 2009, here is where we were as a country: We were spending 18 
percent of GDP for health care costs. In Japan they spent 8 percent. We 
were spending 18 percent of GDP; they were spending 8 percent. They 
were getting better results, longer life, longevity, lower infant-
mortality rates, and they covered everybody. They covered everybody in 
2009.
  Where were we? We were spending 18 percent of our GDP. We didn't 
cover--we had 40 million people going to bed at night without any 
health care coverage at all. One of the reasons the cost of coverage 
has gone pretty high right now for people in these new exchanges and 
purchasing pools is that a lot of the people who are signing up--not 
all of them, but a lot of them--haven't had health care coverage for 
years. They have been sick, and they have just not had access to 
doctors or nurses, except for going to an emergency room doctor.
  This is not a time to just throw up our hands and walk away. This is 
a problem. This is a problem we can fix. I would say we can fix it by 
embracing what I call the three Cs: communicate, compromise, and 
collaborate. We need to embrace those when this Congress is over.

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