[Congressional Record Volume 163, Number 41 (Thursday, March 9, 2017)]
[Senate]
[Pages S1733-S1736]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  What I would really like to focus on is that I want to go back in 
time, if I could. I want to go back to 1993. I am

[[Page S1734]]

not sure what the Presiding Officer was doing in 1993, but I was a 
brand-new Governor in 1993. We had a brand-new President and a brand-
new First Lady. She was asked--I presume by her husband, or maybe she 
just decided on her own--to try to do what Presidents had talked about 
doing for a long time; that is, to try to make sure that everybody in 
our country had healthcare coverage. Her name was Clinton, and what she 
came up with, in consultation with a lot of folks, was something that 
was called HillaryCare--not always as a compliment, but sometimes, in 
some cases, derisively. I think our Republican friends, who were 
somewhat pointed in their criticism of it, were basically asked: Well, 
where is your idea?
  In 1993, a guy named John Chafee, whom the Presiding Officer knows--
we served with his son Lincoln in the Senate, and Lincoln went on to be 
Governor of Rhode Island--took up the challenge, along with at least 20 
other Senators--I think mostly Republican and a couple of Democrats--
and they offered legislation in 1993 that was the Republican 
alternative to HillaryCare.
  At the end of the day, HillaryCare did not survive, as we know, and 
the Chafee proposal from that time essentially went away in that 
particular Congress. What he had proposed had five major concepts to 
it. One of those was the idea that folks who didn't have healthcare 
coverage should be able to get their coverage in their own State--
unless they were very wealthy--and to be able to get coverage in a 
large group plan. They called them exchanges or marketplaces, which 
would be established in each State. If that sounds familiar, it should.
  They also said that folks who were going to get their coverage who 
didn't have coverage for healthcare in these 50 States would get some 
help in buying down the cost of their healthcare, and they would get 
that by the adoption of a sliding-scale tax credit which would buy down 
the cost of premiums for low-income people. The lower their income, the 
bigger the tax credit was; the higher the income, the lower the tax 
credit. And finally, it phased down.
  There were concerns raised by insurance companies that it would be 
hard to insure folks who were going to be getting healthcare coverage 
on these exchanges in each of these States because a lot of these 
people hadn't had healthcare in a long time. There was an expectation 
that they would have a high demand for healthcare, they would need a 
lot of healthcare, and they would be a hard group to insure because 
their need for healthcare was very large. The insurance companies were 
fearful that the group of people in each of the States they would be 
asked to insure on the exchanges would not be insurable--not in the way 
in which the insurance companies could break even or make money.
  This idea came along. Just to insure that we have a good mix of 
healthy and maybe not-so-healthy people in the exchanges to insure in 
each of the States, Senator Chafee and these folks came up with the 
idea that people would be mandated to get coverage in the States--
everybody. You can't make people get coverage, but under the Chafee 
plan, for folks who didn't, they would have to pay a fine, and the 
fine, over time, would go up and become stiffer. So finally, people 
might say: Well, I am paying all this money for no healthcare coverage. 
Maybe I ought to get coverage and stop having to pay this fine. At 
least I would have something for my money.
  The two other things in the original legislation from Senator Chafee 
and company were something called an employer mandate, the idea that 
employers were mandated to provide coverage. At least employers with a 
minimum number of employees would have to provide coverage--to provide 
a large group plan within their business or within their employment. 
That was the employer mandate in the Chafee proposal.
  The other thing that was in Chafee, as I recall, was something like a 
provision that said to insurance companies: You can't just stop 
providing coverage for people because they have a preexisting 
condition; you have to insure people.
  So those are the five major precipes: No. 1, creating exchanges in 
every State or marketplaces for people to get their coverage; No. 2, 
sliding-scale tax credits to help drive down the costs for low-income 
people for their coverage in their States; No. 3, individual mandates, 
or trying to make sure the mix of people insured was actually 
insurable, without the insurance companies losing an arm and a leg; No. 
4, employer mandates that employers of a certain size have to provide 
coverage for their employees; and, finally, the idea of knocking people 
off coverage because of preexisting conditions was a no-no.
  As we know, HillaryCare was not adopted, and neither was the Chafee 
plan. But it turned out the Chafee plan had legs, as they say in show 
business. It means it actually lasted beyond just being a bill 
introduced in the Senate in 1993.
  It surfaced in Massachusetts about 10 years later, thanks to Governor 
Mitt Romney, who was thinking about running for President. Some of the 
people advising him said: You know, Governor, you could probably help 
your chances of running for President if Massachusetts could be the 
first State to have universal healthcare coverage for its residents. 
That sounded pretty enticing.
  He said: How do we do this?
  They looked up the Chafee bill. They apparently knew about it, 
thought about it, and said: Let's take the Chafee proposal and do that 
in Massachusetts.
  That is what they did. Guess what. They found that they did a pretty 
good job in terms of covering more people on the coverage side. It 
worked pretty well. Where it didn't work very well was on the 
affordability side. As we might imagine, there were the young 
invincibles--like some of these pages we have down here and their older 
brothers and sisters who maybe say: I don't need healthcare coverage. I 
am young and invincible. I will never get sick and go to the hospital.
  They had a sliding scale. They had an individual mandate, but they 
had a fine people had to pay over time. Eventually, as more years went 
by, the young and healthy people said: I might as well get coverage. It 
helped provide for a better mix of folks in the exchange to provide 
insurance for. So they did a better job on the cost and, after a while, 
affordability.
  When we went to work in the beginning of the Obama administration in 
2009 on the Affordable Care Act, some people think Democrats just sat 
down in our caucus and just rolled out a plan and said: This is what we 
are going to do to provide healthcare coverage to people. That is not 
what we did. We spent a lot of time trying to figure out what we should 
do. We had, I want to say, dozens of hearings in the open, in public, 
on the Finance Committee. I am sure they had other hearings in the 
Health, Education, Labor, and Pensions Committee, which shares 
jurisdiction with Finance on this subject. We had dozens of hearings. 
We actually had the head of the Congressional Budget Office come and 
testify.
  We had a pretty good idea of what it would cost. We had a pretty good 
idea of what impact it would have on the Medicare trust fund. It turned 
out that the adoption of the Affordable Care Act extended the life of 
the Medicare trust fund by, I think, 12 years. It actually brought down 
the Federal budget deficit over the next 10 years by quite a sizeable 
amount, and over the 10 years after that by even more. The idea was to 
provide coverage for a lot of people who wouldn't have it--actually, 
using the Chafee plan.
  I think it is really ironic, sometimes almost humorous, when my 
Republican friends--and they are my friends--attack the Affordable Care 
Act. The piece that they attack is, I like to say, their stuff. They 
are the Chafee-Romney ideas.
  I studied economics at Ohio State and studied some more in business 
school after the Vietnam war. I like market approaches to problems. So 
I find real virtue and interest in what Chafee came up with and what 
Romney put to work. Romney provided kind of a laboratory in 
Massachusetts to see how that idea would work--maybe not on a national 
scale but at least on a statewide scale, with a lot of people involved.
  I am troubled by where we find ourselves today. During Presidential 
campaigns, I know people say things in campaigns that maybe they don't 
mean

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or maybe they exaggerate or something like that. But I think the 
campaign might have been over and Donald Trump had been elected 
President. He promised, I believe shortly thereafter, that his plan to 
repeal and replace the Affordable Care Act would lower the cost of 
health insurance, while providing better coverage for everyone. That is 
what he said. His plan to repeal and replace the Affordable Care Act 
would lower the cost of health insurance, while providing better 
coverage for everyone.
  I realize that the ink is barely dry on what the two House 
committees--the Ways and Means Committee and the Energy and Commerce 
Committee--have been working on. As best we can tell at this point in 
time, the bill they reported out of the committees--and I presume they 
are going to vote in the full House pretty soon, if they haven't 
already--but the House Republican bill to repeal the Affordable Care 
Act does just the opposite of what Donald Trump called for. It does not 
lower the cost of health insurance, as best we can tell, and it doesn't 
provide better coverage for everyone. The House Republican bill to 
repeal the ACA does nothing to slow down the growth of healthcare 
costs.
  One of the great virtues of the Affordable Care Act is the focus on 
value. How do we get better results, better healthcare outcomes, for 
less money? If we go back to where we were 8 years ago and compare how 
much we were spending in this country for healthcare as a percentage of 
gross domestic product, we were spending 18 percent. One of our major 
competitors in the world--a major ally but a major competitor--is 
Japan. In 2009, while we were spending 18 percent of GDP, Japan was 
spending 8 percent--less than half as much, 8 percent of GDP. They got 
better results, and they covered everybody.
  So as we were approaching the debate and eventually the markup on 
voting on the Affordable Care Act, we had this in the back of our mind. 
We looked around the world to see what seemed to be working to get 
better results for less money, and we looked at Massachusetts to see 
how that was working and what we could learn from what they called 
RomneyCare up there.
  But the House Republican bill to repeal the ACA does, as best we can 
tell at this point in time, very little--maybe nothing--to slow the 
growth of healthcare costs, and that is a shame. Apparently, fewer 
people will be insured. I think Standard & Poor's estimates as many as 
10 million people could lose coverage under the House Republican plan. 
Insurance markets will destabilize faster. I mentioned earlier that a 
great concern insurance companies had is that they would end up in each 
or in a number of States with a pool of people to insure in the 
exchanges that were uninsurable--the elderly, maybe the sick, people 
who hadn't gotten healthcare for a long time. It is hard to insure that 
group and stay in business if you are a health insurance company. There 
was a concern about destabilization and instability within the markets 
for health insurance.
  The individual mandate is replaced by something called the continuous 
coverage requirement. I would like to think it is going to work. I am 
not sure it would. But under this, I understand that people who go 
without a health insurance plan for more than 2 months will be charged 
a 30-percent surcharge when they are able to get back on and reenroll. 
People with expensive healthcare conditions will be willing to pay a 
penalty. But how about healthier people who often chose to stay out of 
the health insurance markets?
  Also, as best we understand, in the House Republican plan, health 
insurance plans will become less robust, and many Americans will only 
be able to afford rather skimpy insurance plans. Preliminary estimates 
of the House GOP plan shows that insurance costs for the average person 
would increase by roughly $1,500. By 2020, the average person would pay 
$2,400 more.
  I had the privilege of representing Delaware as Governor. One of the 
things I was responsible for in the treasurer's office was 
administering fringe benefits for State employees and teachers and a 
lot of folks. So this is something I have thought about over the 
years--about healthcare coverage for people.
  We have only three counties--unlike Missouri, where the Presiding 
Officer is from, which has probably hundreds of counties--maybe not 
that many. But we only have three. In our southernmost county, Sussex 
County, we have a lot of chickens, a lot of corn, and a lot of 
soybeans. We have five-star beaches. A number of people like to come to 
Delaware to retire. We have no sales tax. We have very low property 
taxes in Sussex County. And for people who are not making a ton of 
money, we have pretty low personal income tax.
  Take the example of a 60-year-old Delawarean in Sussex County who 
makes $30,000 a year. Under the Affordable Care Act, they get a tax 
credit. I mentioned earlier a sliding-scale tax credit. If you are 
lower income, it is a bigger tax credit. If you are a higher income, it 
finally fades out when your income goes up to a certain level. But for 
somebody making $30,000 a year in Sussex County, under the current 
law--the Affordable Care Act--the tax credit in 2020 will be about 
$10,000 to help buy down the cost of their coverage.
  As I understand it, under the GOP health plan, for their comparable 
tax credit for the same person in Sussex County--which, quite frankly, 
has a lot of people 60, 65, 70 years old who make this amount of money 
down there; a lot are retired or semi-retired--the tax credit in 2020 
would be $4,000. That is about $6,200 less. If you happen to be this 
person, you may want to think twice about which of these two paths you 
want to take.
  We have another chart here that might be helpful. This is something 
we got from AARP. When we are passing legislation or drafting 
legislation or debating legislation, we are always interested in what 
key stakeholders feel. AARP is a big stakeholder. They represent a lot 
of people 50 and older. We are interested in hearing from folks who 
represent seniors. AARP represents the views of a lot--not all. We are 
interested in the views of those like doctors, the American Medical 
Association, nurses, providers. We are interested in hearing from 
hospitals. As it turns out--again, while the ink is barely dry on what 
is coming out of the House of Representatives--AARP tells us they are 
not very excited. Well, maybe they are excited about it, but not in a 
good way.
  They say the change in structure will dramatically increase premiums 
for older consumers. That is what we have seen from the previous chart. 
In their example, AARP tells us about a 64-year-old person who is 
earning about $15,000. Their premiums go up $8,400. They are making 
$15,000 a year. I don't know how they pay for much of anything else 
with that kind of increase in their premium costs. That is a concern 
for me and certainly a concern for the folks at AARP and the people 
they represent, the millions of people they represent.
  TrumpCare. The House has come up with different names. Some call it 
ObamaCare light, ObamaCare 2.0 or .5. Some people call it TrumpCare. 
The House is working on it. The concern we are hearing from a lot of 
folks is that it forces women to pay more for basic care.
  Let's go back to the care for women. My wife and I have been married 
31 years. I don't know everything about healthcare needs for women, but 
I do know this. A lot of women I have known--including my own family, 
my sister, my mom, and my wife's family--their primary healthcare 
provider is their OB/GYN. I didn't know that for a long time--not for 
everybody, but for a lot of people that is who their primary care 
provider is. For millions of women, surprisingly, their primary 
healthcare provider happens to be an OB/GYN or healthcare provider who 
works at Planned Parenthood.
  For some people, Planned Parenthood is synonymous with abortions, but 
I think a very small percentage of what they do relates to abortions. 
What they do, for the most part, is try to make sure women get the 
healthcare they need, a lot of times in the OB-GYN realm but also in 
terms of contraception.
  Somebody told me the other day that the cost of contraception for a 
woman in a year could be as much as $1,000. It is not cheap. The cost 
of a single delivery of a child from an unplanned pregnancy that is 
paid for by Medicaid is over $10,000, if I am not mistaken.
  A lot of times, as we know, especially if a young person brings a 
baby into

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the world, maybe doesn't finish high school or whatever, the outcome 
can be not that good for that child. I heard Mary Wright Edelman of the 
Children's Defense Fund say these words. If a 16-year-old girl becomes 
pregnant, does not graduate from high school, does not marry the father 
of her child, there is an 80-percent likelihood they will live in 
poverty. The same 16-year-old girl who does not have a baby, finishes 
high school, graduates, waits until at least 21 to have a child, 
marries the father of the child, there is an 8-percent likelihood they 
will live in poverty. Think about that.
  That suggests to me that we should--particularly for young people and 
those not so young who are sexually active--we want to make sure that 
when they are ready to bring a child into the world they can do that, a 
healthy child, a child with a lot of promise in their life.
  For those who aren't prepared to bring that child, raise that child, 
prepare that child for success, contraception is needed. One of the 
things the Affordable Care Act does is provide access for that 
contraception. I am fearful the plan in the House of Representatives, 
however well-intentioned, will take away that opportunity for a lot of 
women and frankly for their children.
  We have other people who have arrived on the floor. I want to be 
mindful of their time.
  I don't know if we have another chart to look at before I yield.
  We have all heard of double whammy. This has been described as 
TrumpCare, ObamaCare light, whatever you want to call it. It has a 
triple whammy. One of those is higher costs, a second is less coverage, 
And for some people, particularly low- and middle-income folks, more 
taxes. For certain people whose income is over one-quarter million 
dollars, they get a tax break. It adds up to quite a bit for somebody 
who makes a lot of money, but this is not the kind of triple whammy we 
ought to be supporting.
  When the bill gets over here, if it gets out of the House, we will 
have a chance to slow down and hopefully do hearings in the light of 
day and bring in the folks from CBO, ask them to score this, let us 
know what is the real impact of what is being proposed in the House. 
Does it really save money? Does it do what President-Elect Trump said 
he wanted to do, which is make sure everybody gets coverage and be less 
expensive. Does it really do that? And we need to find out what the 
impact is on taxpayers. Is this the holy grail of better results for 
less money or is this something altogether different?
  The Presiding Officer, from Missouri, is somebody who is pretty good 
at working across the aisle. I would like to think I am too. We have 
worked together on a number of issues. When you are working on 
something that is this big and this complex and has this kind of impact 
on our country, we are always better off if we can somehow fashion a 
bipartisan compromise and something that would have bipartisan support.
  We tried to do that in the Affordable Care Act. I know my Republican 
friends feel we didn't, but I was there. I know we tried. In fact, the 
evidence that we tried was literally the foundation for what we do for 
the Affordable Care Act, a Republican proposal from Senator Chafee and 
20 other Republicans, including Orrin Hatch and including Chuck 
Grassley from Iowa. I think that was a pretty good effort.
  If this bill makes its way over here, we need to have at least a 
strong effort, maybe a better effort, maybe a more successful effort in 
the end.
  If we are not going to repeal the Affordable Care Act, actually find 
a way to repair it and make it better, there are things we can do. I 
know I can think of some--I know the Presiding Officer can as well--
that would move us closer to better coverage at a more affordable 
price.
  The last thing I would say is this. I have a Bible study group that 
meets here on Thursdays with Barry Black, who opens our session with a 
prayer every day that we are in session. We also have his Bible study 
group that meets for about a half an hour, 45 minutes in the Capitol--
Democrats and Republicans. We pray together, share things together. I 
describe it as the seven or eight of us who need the most help.
  He is always reminding us of our obligation to the least of these. 
There is a passage of Scripture in Matthew 25 that a lot of us have 
heard of, and I am sure you have heard this in Missouri too. It says: 
When I was hungry, did you feed me? When I was naked, did you clothe 
me? When I was thirsty, did you get me to drink? When I was sick and 
imprisoned, did you visit me? When I was a stranger in your land, did 
you take me in?
  It doesn't say anything about when I didn't have any healthcare 
coverage and my only access to healthcare was an emergency room to a 
hospital. It doesn't say that in Matthew 25. I think the implications 
are clear. They are the least of these as well. They need our help, and 
I think we have a moral obligation, as people of faith, to help them.
  We also have a fiscal imperative because while the Federal deficit is 
down from $1.4 trillion 6, 7, 8 years ago, down to about one-third of 
that, it is still high. We need to make more progress on that. We have 
a fiscal imperative to meet that moral imperative.
  With that, I think I will call it quits. I know my colleagues will be 
disappointed, but they are standing here, from all over the country, 
waiting to say their piece. I am going to yield to them and wish them 
all a good weekend, and I look forward to seeing you on Monday.
  I yield the floor.
  Before I do, I yield the remainder of my postcloture debate time to 
Senator Ron Wyden of Oregon.
  The PRESIDING OFFICER. The Senator has that right.
  The Senator from Arkansas.