[Congressional Record Volume 163, Number 13 (Tuesday, January 24, 2017)]
[Senate]
[Pages S412-S414]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
REPEALING THE AFFORDABLE CARE ACT
Mr. DURBIN. Mr. President, I was listening carefully to the comments
made by my colleague from West Virginia. I thank her for coming to the
floor and expressing her feelings about the Affordable Care Act. It is
truly an article of political faith on the Republican side that we must
repeal ObamaCare. We have heard that for 6 years, maybe longer, and
each and every time, Democrats have asked: And then what?
We have asked Republicans: What would you replace ObamaCare with?
Until some of the most recent moments, there was never an answer. Now
they are starting to put at least some ideas forward, but repealing
ObamaCare and then talking about the possibility of replacement is a
disaster. It is an invitation to uncertainty and chaos. We might expect
that from a Democratic Senator who voted for the Affordable Care Act,
but what I ask my colleagues in the Senate to do is, please go home.
Please go back to your States. Do as I did yesterday. I called together
the administrators of hospitals in Central Illinois, smalltown rural
hospitals and larger hospitals such as Memorial Medical Center in my
hometown of Springfield. I asked them, in a nonpressurized setting:
What would you do? What is wrong with the Affordable Care Act? How
would you change it? What would be the impact of repeal?
I knew, and they did as well, that there had been some reports from
the Congressional Budget Office. Just last week, the nonpartisan
Congressional Budget Office told us exactly what repeal without replace
would look like: 18 million Americans would lose health insurance in 12
months, 32 million within 10 years. According to the Congressional
Budget Office, if they went through with the Republican repeal plan,
premiums in the individual health insurance market would increase by 20
to 25 percent the first year and double within 10 years.
Despite this, on his first day in office, President Trump signed an
Executive order that began to dismantle our health care system. We
still haven't seen the President's secret replacement plan, even though
he has repeatedly said he wants to replace the law at the same time he
repeals it, and we are going to be so proud of what he does.
Let's talk about what repeal without replace means in Illinois, now
that I have taken it home and asked the people who are actually running
the hospitals. With repeal, 90,000 young people
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in Illinois would be thrown off their parents' health care plans. More
than 7 million Illinoisans with health insurance through their employer
would once again be subject to discriminatory health insurance
practices, like discrimination based on preexisting conditions, annual
and lifetime caps on coverage, and discrimination against women. In my
State, the Republican repeal plan would have an impact statewide
because insurance plans statewide could once again decide not to cover
maternity or newborn care, mental health, or substance abuse. Those
things are required under the Affordable Care Act. That would be
removed with this repeal.
In my State, more than 1 million people would lose their health
insurance--in fact, 1.2 million, to be exact. According to the Illinois
Hospital Association, my State would lose $11 billion to $13 billion in
annual economic activity with Republican repeal, translating to a loss
of up to 95,000 jobs. Let me talk about those jobs in towns like
Taylorville and Pana, IL, near my hometown of Springfield. Those are
good-paying jobs. Sometimes they are the best paying jobs in the
community. Those would be the jobs lost by the Republican repeal of
ObamaCare.
For years, we have been hitting back against misguided and misleading
claims about the Affordable Care Act. Who is hitting back now?
Hospitals. And not just hospitals. Health care providers across the
board are pleading with the Republicans: We know you have some campaign
promise you want to keep, but keep first your promise to the people you
represent to provide quality, affordable health care.
Senator Tammy Duckworth and I have sent letters to every single
Illinois hospital--over 200 of them--asking about the impact of
repealing the Affordable Care Act without enacting a replacement to
prevent total chaos. Just yesterday morning, I met with these hospital
administrators and heard firsthand. I met at Memorial Medical Center in
Springfield, IL, representatives from Hopedale Medical Center, Pana
Community Hospital, Carlinville Area Hospital, and Warner Hospital and
Health Services.
Memorial Health System is a nonprofit, community-owned health care
organization. When I asked about the impact of repealing the Affordable
Care Act, here is what they told me: ``Repeal without replacing the ACA
would adversely impact patients' access to care and our hospitals' and
health systems' ability to provide services as well as potentially
result in job losses.'' They went on to say that Memorial Medical
Center in Springfield, with Republican repeal of ObamaCare, could lose
over $140 million over the next 6 years, and their uncompensated care
costs would ``rise dramatically due to both a rise in charity care and
decline in Medicaid coverage and reimbursement.''
They cautioned:
We would be forced to cut spending by reducing services,
reducing staff, and delaying investment in new technology and
facility improvements. . . . Losses of this magnitude with
repeal of the [Affordable Care Act] coverage simply cannot be
sustained and would adversely impact patients' access to care
and our hospitals' and health systems' ability to continue to
provide services.
This is not the only hospital telling me in our State. I am from
downstate Illinois, proud to represent Chicago, but I have represented
in the Congress and in the Senate smalltown rural America, communities
where the hospital makes a difference. If you don't have a hospital
nearby, you could be an hour's drive--if you are lucky--from quality
medical care, not to mention the impact that hospital has on the local
economy, keeping and attracting new businesses.
According to the Illinois Hospital Association, the 15th
Congressional District of Illinois stands to lose $470 million under
Republican repeal of the Affordable Care Act. That means 3,400 jobs
lost in that congressional district in Central Illinois with repeal of
affordable care. We talk about good jobs and creating them in this
State. The President goes and makes trips, as he should, to try to save
American jobs. Yet the first congressional action by the Republican
majority this year is to threaten 3,400 jobs in the 15th Congressional
District.
Washington County Hospital in Nashville, IL, is a 22-bed critical
access hospital 50 miles from St. Louis. They provide acute care,
surgical service, and gynecological services. When I asked them what
Republican repeal of the Affordable Care Act would mean to Washington
County Hospital in my downstate area, they said the following:
To eliminate [the ACA] would be detrimental to the
thousands of people in our county that were previously
uninsured either because of part-time work or serious health
problems.
I guarantee that [repealing the ACA] without a strategic
healthcare replacement plan, will result in more downsizing
and more staff reductions at Washington County Hospital. Our
community cannot continue to lose these good paying jobs and
I believe our county residents will continue to move to
neighboring states with more favorable job markets, better
job security and stable benefits.
They ended their response with this warning:
I truly fear that many Illinois communities will lose their
Critical Access Hospitals--the only sources of healthcare in
many of our rural counties and a vital part of infrastructure
in our communities.
As you know, our rural areas have vulnerable populations of
elderly folks that have many chronic healthcare needs and
limited ability to travel long distances for emergency care.
. . . I sincerely hope that you heed the warnings of our
physicians and hospitals--do NOT repeal the ACA in a hurried
political rush.
Washington County is not a blue county, it is not a Democratic
county. It is a county that votes regularly for the other party. It is
a conservative-voting populous, representing a lot of farmers and small
businesses, and this is their hospital administrator warning the
Republicans here in the Senate and the House: Be careful what you do in
eliminating the Affordable Care Act.
According to the Illinois Hospital Association, the 16th
Congressional District in Illinois stands to lose $453 million under
Republican repeal of ObamaCare, and that means the loss of 3,300 jobs.
SwedishAmerican Hospital in Belvidere, IL, in the northern part of my
State, provides health care to Belvidere, Boone, western McHenry, and
northern DeKalb Counties. When asked how the hospital has fared since
the passage of the Affordable Care Act, the administrator of
SwedishAmerican said the following:
The passage of ACA has afforded our health system with
significant benefit related to [compensation] of patients
with uncompensated care. . . . SwedishAmerican experienced an
average annual increase of $43 million in Medicaid payments,
and a $10 million reduction in uncompensated care.
When asked about the impact of the Republican repeal of the
Affordable Care Act, SwedishAmerican Hospital of Belvidere, IL, said
the following:
The impact would be significant . . . it would create an
unsustainable financial result and we would be forced to make
significant reductions in staff and curtail future plans for
capital expenditures.
Yesterday, at my roundtable in Springfield, I asked some of these
hospital administrators: What is wrong with the Affordable Care Act?
And they told me. Let me add quickly, I believe--as they do--there are
things which need to be changed in that law. It is not perfect, by any
means. They talked about the cost of care, and they should. In some
areas, premiums have gone up too quickly, and the availability of
insurance is not as it should be.
I have talked to the health insurance companies, including the big
companies like Blue Cross Blue Shield. They have told me specifically
that the method of enrollment now under the Affordable Care Act leaves
loopholes for people to jump in and out of coverage as they need it.
You cannot run a viable insurance risk pool if people are only forced
to sign up when they are facing a health care crisis. You have to have
healthy people paying premiums to cover those who get sick and need to
be compensated.
So there are things certainly within the Affordable Care Act which
need to be changed, and these administrators told us.
So I said: I hear commonly from my Republican friends, if we would
just allow people to buy health insurance over State lines, there would
be more competition.
They laughed. They said: You mean to say, if you heard that there was
a health insurance plan in Alabama and you lived in Illinois, that you
would buy health insurance there; is that the idea?
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I said: I suppose. I hear it over and over again, if we could just
buy policies across State lines.
They laughed. They said: Do you know what is going to happen? Do you
know what happens when you buy insurance in Illinois and they tell you
the hospitals and doctors who are eligible? You certainly want to have
doctors in your home area eligible who may not be eligible under an
Alabama plan. That makes sense.
Secondly, they said: If people outside the State who are truly sick
start buying into Alabama to get lower premiums, the premiums are going
to go up. They are going to engineer the risk pool to make sure that it
is viable.
That is a notion that they rejected out of hand. I asked them about
health savings accounts. That is another thing you hear over and over
again. If people could just set aside nontaxable income and leave that
in a pool of money to pay their copayments and other expenses, then
there would be a disincentive to overutilize health care. These
administrators said: But people who are living paycheck to paycheck
don't have money to set aside--even non-taxable money to set aside at
that point--and, ultimately, many of them would put off care they
desperately need until they become even sicker.
Each one of these approaches has its critics. There are people who
think we ought to look at it more carefully. I think that ought to be
the bottom line. To my Republican majority, look at this carefully. It
is not a matter of keeping a campaign promise; it is a matter of
keeping a promise to the people you represent not to leave our health
care system in chaos.
I hope President Trump and my congressional Republican colleagues are
listening to what my constituents back home told me yesterday, things
that they will hear themselves if they will go back home and listen to
people who run the hospitals in the communities where the voters they
represent live.
I wish to conclude with a quote on the subject from Dr. William
Gorski, president and CEO of SwedishAmerican, who wrote to me. He said:
I must also speak forcefully as a former practicing
physician. Irrespective of any financial impact of repeal,
real lives are at stake here. President Obama's vision
recognized a great understanding of the importance of health
care access to the quality and outcomes of care. Any
diminishment of this access threatens the health and well-
being of millions of our fellow citizens. . . . My strong
view is that rather than repealing the ACA, we should be
looking for ways to refine and expand it.
That comes from a doctor. I solicited his view. I don't know him
personally, but it represents the feelings of many.
Mr. President, I ask unanimous consent to have printed in the Record
the State Journal-Register article from Springfield, IL, on my meeting
yesterday.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the State Journal-Register, Jan. 23, 2017]
Durbin Hears Hospitals' Concerns About Obamacare Repeal
(By Dean Olsen)
Executives fromfrom Springfield-area hospitals and health
systems told U.S. Sen. Dick Durbin Monday morning that a
threatened repeal of the Affordable Care Act by Congress
would jeopardize local patients' access to medical services
and harm their organizations' finances.
``We'd just hate to see this go away,'' Memorial Health
System chief executive officer Edgar Curtis said of the law,
also known as Obamacare, during a meeting at the Memorial
Center for Learning and Innovation with Durbin and leaders
from other hospitals.
Tina Casner, chief executive officer of Pana Community
Hospital in Christian County, said Illinois' expansion of
Medicaid eligibility--funded by the ACA--and reduced-price
private insurance sold through the state's health insurance
exchange have reduced the number of uninsured patients and
improved the 25-bed hospital's bottom line.
``There are now folks in our community who are seeking that
care,'' she said.
Durbin, D-Springfield, said he doubted that congressional
Republicans pledging a comparable replacement of the ACA
would be able to fulfill their promise without big gaps in
coverage for many Americans.
Instead of ``repeal and replace''--the plan for the ACA
supported by local congressmen Rodney Davis, R-Taylorville,
and Darin LaHood, R-Dunlap--Curtis said he is ``very afraid''
that Congress instead will ``repeal and delay'' a decision on
a permanent replacement.
Action to repeal without a replacement is likely to cause
disruptions in care because more insurance companies would
pull out of the exchange and increase the prices of plans
even more, health-care industry officials have said.
Durbin, the No. 2 Democrat in the U.S. Senate, was told by
hospital administrators that the federal law isn't perfect
and needs to be tweaked, especially when it comes to the high
cost of private coverage and excessive paperwork.
``I'm for that,'' he said.
But he and the administrators expressed concerns about
Republicans' plans to change Medicaid from a federal
entitlement program to a block grant given to individual
states as a way of getting control of Medicaid's rising cost
to the federal government.
The Illinois Health and Hospital Association has said block
grants for Medicaid could lead to reductions in funding in
Illinois, a state that already spends less per Medicaid
patient than almost all other states.
Dr. Jerry Kruse, dean and provost of Southern Illinois
University School of Medicine, said the expansion of Medicaid
eligibility ``has been really great for us.''
The expansion has decreased the uninsured rate by 80
percent for patients of SIU's federally subsidized outpatient
primary care clinic, the SIU Center for Family Medicine, he
said.
With insurance coverage, formerly uninsured patients are
less likely to worry about incurring medical bills they can't
afford to pay and more likely to seek care, Kruse said.
``It's that peace of mind,'' he said.
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