[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1730-S1732]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                       Republican Healthcare Bill

  Mr. HATCH. Mr. President, I rise today to speak once again on the so-
called Affordable Care Act and the ongoing effort to repeal and 
replace. We all know the House of Representatives has produced a repeal 
and replace package, and both the Ways and Means and Energy and 
Commerce Committees have been marking it up. We don't know what it is 
right now. In other words, the endeavor to right the wrongs of 
ObamaCare is moving steadily forward on the other side of the Capitol, 
and soon it will be the Senate's turn to act. I commend my colleagues 
for introducing this legislation and moving it forward. This is an 
important step, and I don't think I am alone when I say that I am 
watching the progress in the House very carefully to see how things 
proceed and what the final House product will look like.
  Of course, virtually all Republicans in Congress want to repeal and 
replace ObamaCare. We are in unison there. While there are some 
differences of opinion on how best to do that, there is generally 
unanimity on that point. I am confident that whatever differences exist 
among House Members will be worked out through the House's legislative 
process.
  In addition, whatever passes in the House will be subject to the 
input and review of the Senate and to the rules of the budget 
reconciliation process. I want to note that I have heard from a number 
of Senators who have items they would like to see included when the 
bill comes before the Senate. I actually have several ideas of my own. 
However, there are limits as to what we can do under the budget 
reconciliation rule. Many of the proposed policy changes I have heard, 
although they have merit, would be banned by the rules and subject to 
the 60-vote threshold. That said, I am committed to working with my 
colleagues on both sides of the floor to ensure that the

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Senate process on this bill is productive and that it yields a result 
we can support.
  Long story short: This process is far from over. We have a lot more 
work to do. It is worth pointing out that the vast majority of the 
policies at play in this discussion and virtually all of the spending 
fall under the exclusive jurisdiction of the Senate Finance Committee, 
which I chair. Make no mistake. The Finance Committee is already hard 
at work and has been for some time. In many respects, I suppose you 
could say we have been working on this effort since the day ObamaCare 
was signed into law. However, for obvious reasons, our work has 
intensified over the past several months.

  In working through this process, I have been in constant contact with 
Chairmen Brady and Walden, who head up the relevant committees in the 
House. I have also been working closely with the Speaker's office, and 
I have been gathering input from Governors around the country. In 
addition, I have been working closely with the distinguished chairman 
of the Senate Budget Committee, Senator Enzi, who has the chief 
responsibility of navigating the budget process and shepherding a final 
repeal-and-replace bill through all the necessary rules and 
restrictions.
  In all of those conversations, we have been talking about the 
process, and we have been talking about the timing. Most importantly, 
we have been talking about the substance of the healthcare reforms and 
how we can best serve the interests of the American people.
  Throughout this effort, we have been reminded that Republicans 
currently control the White House and both Chambers in Congress due, in 
large part, to our stated commitment to repeal and replace ObamaCare, 
and we intend to deliver on that promise.
  I would like to take a few minutes to talk about some of the policies 
we will need to tackle as we take up the House healthcare bill in the 
coming weeks.
  Once again, the vast majority of the policies and virtually all of 
the spending involved in this effort fall under the Finance Committee's 
exclusive jurisdiction, and I intend to make sure all of my colleagues 
are well informed on the issues and that in the end whatever version of 
the bill we pass in the Senate reflects the collective will of a 
majority of Senators.
  All told, there are five major policy areas that are addressed in the 
House bill that fall under the Finance Committee's purview.
  First, there are the provisions to repeal the ObamaCare taxes. This 
is big. If one recalls, I came to the floor a few weeks ago and pointed 
out how misguided it would be, in my view, to start picking and sorting 
through the ObamaCare taxes to decide which to keep and which to leave 
in place. The House bill repeals them, along with the individual and 
employer mandates, both of which reside in the Tax Code. I have been 
working with Chairman Brady on this issue. In the end, I believe the 
Senate version of the bill should do the same, and I am going to 
continue to push to ensure it does.
  Second, there is the issue of premium tax credits. Chairman Brady and 
I have been working extensively on this issue as well. The House bill 
replaces the ObamaCare premium subsidies with a refundable tax credit 
for the purpose of State-approved health insurance, limited to those 
who do not qualify for other governmental healthcare programs and who 
have not been offered insurance benefits from their employers. Most 
major ObamaCare replacement proposals that we have seen contain some 
version of health insurance tax credits. The House approach represents 
a significant improvement over the ObamaCare premium subsidies. The 
Senate, when it takes up the bill, will have to consider how best to 
implement the tax credits. I will continue to work with my House and 
Senate colleagues to ensure that the tax credits are designed to help 
those lower and middle-income Americans who are the most in need.
  Third, there are the issues surrounding Medicaid. Chairman Walden and 
his predecessor, Chairman Upton, and I have been working extensively on 
this matter. As we know, the vast majority of the newly insured people 
who the proponents of ObamaCare have cited as proof that the system is 
working have been covered by the expanded Medicaid Program.
  The problem, of course, is that the Affordable Care Act did not do 
anything to improve Medicaid, which was already absurdly expensive for 
States, and ultimately unsustainable, not to mention the fact that it 
provides substandard healthcare coverage.
  The House bill draws down the ObamaCare Medicaid expansion and makes 
a number of significant changes to the underlying program. Most 
notably, it establishes per capita caps on Federal Medicaid spending, 
which are intended to give States more flexibility and predictability 
while also controlling Federal outlays related to the program.
  We have received substantial input on this matter from Governors 
around the country, and virtually all of them agree changes need to be 
made. Given these concerns and the sheer vastness of the Medicaid 
Program under ObamaCare, the Senate will have to tackle this issue when 
it takes up the budget reconciliation legislation in the next few 
weeks.
  I am confident that in working with my colleagues in the House and 
Senate and with the Governors, we can find the right solution.

  Fourth, there is the issue of savings accounts for healthcare costs. 
I have long been an advocate for the expanded use of HSAs and FSAs. 
Needless to say, I was particularly opposed to the ObamaCare provisions 
that limited the use of these savings accounts and essentially 
marginalized their usefulness for consumers and patients.
  The House bill removes a number of restrictions on these accounts 
that have been imposed by ObamaCare, and it goes further to remove 
longstanding restrictions on HSAs in order to expand their use and give 
patients and consumers more options to pay for health expenses.
  I am very supportive of this approach. In fact, the language from the 
House bill mirrors the legislation I introduced this year--the Health 
Savings Act of 2017.
  Fifth, there are some important transition issues that need to be 
addressed.
  To get at these issues, the House bill creates a Patient and State 
Stability Program, under the Social Security Act, that would distribute 
$100 billion to States over 10 years to enhance flexibility for States 
in how they manage healthcare for their high-risk and low-income 
populations.
  For example, the funds could be used to, among other things, help 
individuals with cost-sharing. This program was proposed with the idea 
of giving States an expanded role in the healthcare system, a goal that 
is shared by most Republicans in Congress and something that almost all 
of the Governors have told us they want to see.
  There are other issues from the House bill in the broader healthcare 
debate that will demand some attention when we consider the bill in the 
Senate. However, almost all of them fall under these general 
categories. Once again, the vast majority of them fall under the sole 
jurisdiction of the Senate Finance Committee, the primary committee.
  There are other critical issues out there which do not involve the 
Tax Code, the Social Security Act, or Federal health programs. Yet they 
are extremely important.
  The biggest mistake made by those who drafted ObamaCare and forced it 
through Congress was their failure to address healthcare costs in any 
meaningful way. After all, cost is the largest barrier preventing 
people from obtaining health insurance coverage, and the increasing 
healthcare costs are among the most prominent factors leading to wage 
stagnation for U.S. workers. Yet ObamaCare did little to address this 
problem, and in fact it has made things worse.
  If we are going to fully keep our promises to the American people 
with regard to ObamaCare, we are going to have to eventually address 
these issues. After all, most people's negative interaction with the 
Affordable Care Act has come in the form of increased healthcare costs. 
If we are going to truly right all of ObamaCare's wrongs, we need to 
tackle the costs head on.
  This will mean, among other things, fixing the draconian regulatory 
regime in our health insurance markets and giving individuals the 
ability to select only the coverage they want and need.

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Many of these types of issues fall far outside of the Finance 
Committee's jurisdiction and are under the watchful eye of the 
distinguished chairman of the Senate HELP Committee.
  The House bill also includes some provisions that are intended to 
address these concerns. I assume our distinguished colleague running 
the HELP Committee is working tirelessly to address the issues, and 
others, both through the reconciliation exercise or some alternative 
means.
  Ultimately, if our goal is to place the healthcare system in a better 
position than it has been under ObamaCare, costs will have to factor 
heavily into the equation. I am looking forward to receiving guidance 
and leadership on the HELP Committee on these important market reform 
issues.
  Overall, I believe we can and will be successful in this endeavor to 
fix our broken healthcare system. The American people are counting on 
us to do so. At the end of the day, success in that endeavor is, in my 
view, going to require a robust Senate process that allows this Chamber 
to work its will.
  We have two Chambers in Congress for a reason. The House 
reconciliation bill needs 218 votes to pass. The Senate will also have 
to act when we receive the bill, and we will need to produce a package 
that can get at least 51 votes in this Chamber and hopefully more. That 
may mean some differences between the Senate and the House versions of 
the bill, but that is not problematic in my view. It is not 
particularly novel or unusual for different views and ideas to be 
resolved through the legislative process rather than simply dissipating 
when a bill is introduced. It seems to me that is not novel, and I am 
not the only one who has this view.
  Earlier this week, Secretary Price sent a letter to the chairmen of 
the House Ways and Means and Energy and Commerce Committees. The letter 
commended the chairmen for their work and praised the legislation they 
unveiled to repeal and replace ObamaCare.

  The Secretary also noted that this was not the end of the process but 
that the introduction of the House bill was a ``necessary and important 
first step'' and that the administration anticipated that the Congress 
would be ``making necessary technical and appropriate changes'' to get 
a final bill to the President that he can sign, which reminds us of the 
other important advocate in this endeavor. President Trump ultimately 
needs to support the bill that is passed by each Chamber of Congress, 
and his support for our efforts is paramount.
  While, at this point, it may not be entirely clear what the final 
bill will look like, we do know two things for certain. First, we know 
that ObamaCare is not working. As the majority leader said yesterday, 
ObamaCare is a direct attack on the American middle class. Thanks to 
skyrocketing premiums, shrinking options in the health insurance 
market, burdensome mandates, and harmful taxes, millions of Americans 
are dealing with the failures of ObamaCare on a daily basis. We need to 
act now to fix these problems.
  Second, we know that by introducing its bill and moving it through 
the legislative process, the House has taken significant steps in 
advancing this effort, and the leaders in the House should be commended 
for doing so.
  Long story short, I have nothing but praise for the leaders in the 
House this week for the work they have done on these issues. Remember, 
this is just the beginning. I look forward to working with my 
colleagues in both Chambers to get this over the finish line so the 
Republicans can collectively make good on our promises with regard to 
ObamaCare.