[Congressional Record Volume 163, Number 43 (Monday, March 13, 2017)]
[Senate]
[Pages S1758-S1760]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                       Republican Healthcare Bill

  Mr. DURBIN. Mr. President, last Friday, I went to Rockford, IL, and 
had a roundtable discussion about healthcare. There is a lot of debate 
about healthcare in the Congress and certainly in Washington. What I 
have tried to do is to take this issue home and ask the people who 
actually are responsible for providing healthcare, and the people I 
represent, what they think about the new Republican alternative to the 
Affordable Care Act. What I found is that with virtually no exceptions, 
they are all gravely concerned that the changes that are going to be 
made to the healthcare system in America, which represents a dramatic 
portion of our economy, could have a very negative impact on the real 
lives of people across my State and across the Nation.
  Hospital administrators were there to talk about this issue. Swedish 
Covenant is one of the hospitals well known and respected in the area; 
OSF as well, and the administrators of both of these hospitals talked 
about the negative impacts of cutting back Medicaid coverage.
  What the Republicans are suggesting in their proposal is that the 
expansion of Medicaid to provide health insurance for low-income 
Americans would continue until 2020 and then be cut off, and, they 
would argue, we will make it more cost efficient. We will let the 
Governors come up with alternatives. Well, the Governors aren't very 
happy with this because they know the cost of healthcare continues to 
go up and they are fearful that when you try to put this all together, 
the net result is fewer people covered by Medicaid.
  Over 600,000 people, because of ObamaCare--the Affordable Care Act--
in Illinois now have health insurance. Who are they? Well, I met Ray 
Romanowski. Ray, a big Polish American fellow from Chicago, is a 
musician, and he has made most of his income during his life doing work 
as a musician. Ray Romanowski, in his 60s today, has never had health 
insurance until now. Because of the Affordable Care Act, he qualifies 
for Medicaid, and because he has Medicaid--he patted his wallet and 
said: I finally have that card in my wallet where I can walk into a 
hospital or a clinic and get good treatment.
  It is the first time in his life, and he is in his sixties.
  Judy is a friend of mine in Southern Illinois, and she works at local 
motels there--in hospitality--at places where they serve breakfast to 
you. She gets up early in the morning. She is a hard-working lady. It 
is the kind of job she has had her entire life, and she never, ever had 
health insurance--not once. She worked 20, 30, 40 hours a week, 
sometimes two different jobs, but never with health insurance. Now she 
has it because of the Affordable Care Act, and thank goodness she does 
because she has been diagnosed with diabetes and she needs that kind of 
care.
  So what happened before, when people like Ray and Judy got sick? 
Before the Affordable Care Act, they would show up in the hospital, go 
to the emergency room, and they would get treatment, but they wouldn't 
be able to pay for it. What happens to those expenses at hospitals, 
under the old way of doing things? They are passed along. The rest of 
us pay. Anyone who has health insurance and goes in for treatment, part 
of it is going to be what your treatment is or for your family; the 
other part is to make up the difference for charity care, uncompensated 
care.

[[Page S1759]]

  Now the Republicans believe they have a new idea: Let's restrict 
access to Medicaid. Let's restrict the health insurance that is 
available to people like Ray and Judy. Well, they are still going to 
get sick, and they are still going to come to the hospital, and their 
costs are going to be passed along to others.
  The Speaker of the House, Paul Ryan, a neighbor from the State of 
Wisconsin, said that it is all about competition and choice. Well, when 
it came to competition and choice, Ray and Judy didn't have a chance. 
They just didn't make enough money. But they did get coverage under the 
Affordable Care Act, and they stand to see that coverage endangered, if 
not lost, under this new approach.
  We also had representatives of the nursing association in Illinois. 
These are women and men who are the most respected medical providers. 
Just take a look and ask whether people have higher respect for doctors 
or whomever; it is always the nurses, No. 1, because the nurses are the 
ones who are there day in and day out, hour after hour, in the hospital 
rooms with the people we love who desperately need medical care. The 
nurses are opposed to this Republican replacement plan as well.
  The doctors--the American Medical Association and the Illinois State 
Medical Society--are also opposed to it because they looked at the 
Republican competition and choice alternative and said that at the end 
of the day, fewer people will have health insurance and the costs will 
go up dramatically for some. We had a representative of the American 
Association of Retired Persons there, and they are especially opposed 
to it. Why? We had a provision in the Affordable Care Act which said 
that the disparity in premiums can never be more than 3 to 1. Well, the 
Republicans decided as part of their replacement to make that 5 to 1. 
Who is going to pay five times instead of three times the base premium? 
Seniors, those over the age of 55. The Republicans built this into 
their proposal, and AARP has come out against it.
  The second thing to go is--the Affordable Care Act has really brought 
some savings to healthcare; we wish there were more. But that savings 
in healthcare is translated into 10 more years of solvency for 
Medicare. Medicare is a lifeline for 40 million or 50 million 
Americans. So we gave it 10 more years of solvency with the changes in 
the Affordable Care Act. Now we are waiting for a score from the 
Congressional Budget Office, but the early indications are we are going 
to lose 4 years of solvency in Medicare because the Republicans want to 
bring in ``competition and choice.'' It turns out that phrase is not 
going to be good for the future of Medicare--one of the other reasons 
the American Association of Retired Persons opposes the Republican 
proposal to replace the Affordable Care Act.
  This bill will be scored this week by the Congressional Budget 
Office. It was interesting to watch the Sunday shows and watch the 
procession of Republicans calling themselves fiscal conservatives who 
came in and discounted any conclusions from the Congressional Budget 
Office. Interesting.
  When we wrote the Affordable Care Act, we waited sometimes for weeks 
for the Congressional Budget Office to give us a score: Is this bill 
going to add to the deficit or reduce the deficit? We had to wait to 
find out. Is this bill going to cover more people with health insurance 
or not? We had to wait to find out. But the Republicans went ahead with 
their proposal without a Congressional Budget Office score, and what 
they have done over the weekend is downplay the credibility of an 
office which Democrats and Republicans have relied on for decades. It 
shows that they are very concerned. I think they know what they are 
going to find. They are afraid it is going to add to the deficit and it 
is going to dramatically reduce health insurance for Americans.
  There are some who estimate that 10 million to 15 million Americans 
could lose their health insurance. That is half of all of those in the 
past 6 years who have gained health insurance. It would also increase 
out-of-pocket healthcare costs for the average person--the Republican 
plan would--by $1,500 a year, seniors paying approximately $5,000 more 
a year because of that 5-to-1 premium change that I mentioned earlier. 
It would basically end Medicaid as we know it.
  The Governors are telling us that this is a bad idea because it would 
shift the cost onto the families and to the Governors to find ways to 
save money.
  It would shorten the solvency of the Medicare trust fund by 4 years.
  It would allow insurers to once again charge older people 
significantly more than younger people for health insurance.
  And--Republicans added a little grace note there--they defund Planned 
Parenthood and cut 12 percent of the funding for the Centers for 
Disease Control and Prevention.
  Here is something my colleagues may not know. Because of family 
planning efforts in America, in the last 30 years, we are now at the 
lowest point in teenage pregnancies and the lowest point in unplanned 
pregnancies. So information and education are paying off to reduce 
unwanted pregnancies, unplanned pregnancies, and, I might add, the 
likelihood of abortions. So now, as the Republicans say we are going to 
defund Planned Parenthood for hundreds of thousands of women, that 
means stopping their access to the healthcare they trust across 
America. So in the name of choice, the Republican plan reduces choices 
for women when it comes to healthcare by defunding Planned Parenthood.
  To top it off, the bill cuts taxes for the very wealthy. Those making 
over $1 million a year in income get a $50,000 tax cut because of the 
Republican proposal for this new health insurance approach. If you 
happen to be in the wealthiest 0.1 percent of Americans, the average 
tax cut is nearly $200,000. They just can't help themselves.
  We put together a revenue source so that we could dramatically expand 
health insurance coverage in this Nation. We now have the lowest 
percentage of uninsured Americans in our history, and the Republicans--
because they are opposed to it--have said: We are going to cut the 
taxes that help people pay for their health insurance, and we are going 
to reduce the options that are available to them. So for Americans, it 
means less coverage, higher costs.

  We will see when it goes to the House of Representatives on the 
floor. The most conservative Republicans don't like it; certainly the 
Democrats don't like it. The question is whether Speaker Paul Ryan has 
enough votes. It has united America. The Republican approach has united 
America, in opposition. I don't know of a major health-providing group 
that supports it--not one; not doctors, not hospitals, not clinics, not 
AARP. Patients' groups all say the same thing about TrumpCare.
  The American Medical Association said:

       We cannot support the [bill] as drafted because of the 
     expected decline in health insurance coverage and the 
     potential harm it would cause to vulnerable patient 
     populations.

  The American Medical Association goes on to say:

       We are concerned with the proposed rollback of the Medicaid 
     expansion. . . . Medicaid expansion has proven highly 
     successful in providing coverage for lower income 
     individuals.
       The AMA cannot support provisions that repeal the 
     Prevention and Public Health Trust Fund . . . and we cannot 
     support provisions that prevent Americans from choosing to 
     receive care from physicians and qualified providers . . . 
     [including] those associated with Planned Parenthood 
     affiliates.

  The American Medical Association is saying to the Republicans that 
they reject their proposal for healthcare and is warning them not to 
cut off funding for Planned Parenthood.
  What does the American Hospital Association say?

       We cannot support the [bill]--

  the Republican bill--

     in its current form.
       In addition to the lack of a CBO score, we have some 
     additional policy concerns with the proposal.
       For example, it appears that the effort to restructure the 
     Medicaid program will have the effect of making significant 
     reductions in a program that provides services to our most 
     vulnerable populations.

  That is from the American Hospital Association. They estimate that in 
our State of Illinois, we could lose up to 90,000 jobs by repealing the 
Affordable Care Act without a suitable substitute--90,000 jobs in my 
State. President Trump made a lot of news when he went to visit one of 
the manufacturing companies after he was first

[[Page S1760]]

sworn in and saved a couple hundred jobs. Well, I am glad he saved 
those jobs. I hope he saves a lot more. But if he is going to eliminate 
90,000 jobs in my State--people who work at hospitals, some of the 
best-paying jobs in downstate communities--for goodness sake, that 
isn't hiring American. It isn't really focusing on creating jobs in 
this country. It is just the opposite.
  Here is what the American Nurses Association says about the 
Republican bill:

       [The bill] threatens health care affordability, access, and 
     delivery for individuals across the nation. . . . [T]he bill 
     changes Medicaid to a per capita cap funding model, 
     eliminates the Prevention . . . Fund, restricts millions of 
     women from access to critical health services, repeals income 
     based subsidies that millions of people rely on. These 
     changes in no way will improve care for the American people.

  What about the U.S. Conference of Mayors? Here is what they said:

       States will be forced to end coverage and eliminate health 
     care for low-income seniors, people with disabilities, 
     children, and working families.
       The GOP plan is bad for cities, bad for people who live in 
     cities and bad for people who provide healthcare in 
     cities.
  It is interesting. We had a representative at a Rockford meeting of 
the disabled community. They are scared to death of this Republican 
alternative because these folks many times are in serious need of very 
expensive healthcare. If they are pushed off into these so-called 
money-saving insurance plans that really are empty inside and don't 
provide coverage, it could be devastating to these families. They have 
been through it over and over.
  The American Association of Retired Persons said:

       This Republican bill would weaken Medicare's fiscal 
     sustainability, dramatically increase health care costs for 
     Americans aged 50-64 and put at risk the health care of 
     millions of children and adults with disabilities, and poor 
     seniors who depend on the Medicaid program for long-term 
     services and supports.
       It could hasten the insolvency of Medicare by up to 4 years 
     and diminish Medicare's ability to pay for services in the 
     future.

  I remember when Candidate Donald Trump was telling us he would do 
nothing to hurt Medicare. Now the first major piece of legislation that 
comes up threatens the solvency of Medicare.
  Here is what the National Committee to Preserve Social Security and 
Medicare said:

       [We] oppose the . . . bill to repeal the Affordable Care 
     Act because it would weaken Medicare's solvency . . . 
     threaten access to Medicaid long-term care benefits, and 
     require ``near seniors'' to pay more for less health care 
     coverage. The . . . bill puts seniors and people with 
     disabilities at significant risk of ending up uninsured or 
     losing access to needed care.

  In my own State, the Illinois Health and Hospital Association says:

       [This organization] has serious concerns with the direction 
     of the [bill]. It would cut coverage for hundreds of 
     thousands of Illinoisans and impose a cap on . . . federal 
     Medicaid funding--our state is unable to absorb funding cuts 
     without impacting healthcare for all patients.

  I was surprised last week when the Republican Governor of Illinois, 
Bruce Rauner, said of the Republican plan: ``My first blush read is 
Illinois won't do very well under the changes that they're 
recommending.''
  He is very careful not to say things about Federal legislation. This 
he understands: Cutting back on Medicaid is going to impose a new debt 
on our State and reduce coverage for hundreds of thousands of people in 
our State.
  So we said to the Republicans: You want to repeal the Affordable Care 
Act; you have been dead set on doing this for 6 years. Please come up 
with an alternative that at least expands the coverage of health 
insurance and makes it more affordable. They tried, and they failed. 
But now they are going to push it through as a matter of showing 
political purity. They don't care that there is not a single group of 
medical providers in this country who support their plan. They 
obviously don't care that the American Association of Retired Persons 
believes this is not good for seniors across the board.
  I heard the Director of OMB say: Oh, that group--they are going to 
end up opposing this and then they are going to ask people to donate. 
Well, it is true that they live on donations. But they are taking a 
bold position in saying that the Republican approach is going to hurt 
seniors across America. Talk to the disability community, and you will 
hear exactly the same thing. Talk to the advocates for children.
  I am really looking for the first group to stand up and say that this 
new Republican approach is good for this country or good for people 
when it comes to the cost or availability of health insurance, and I 
haven't found it yet. I don't know what they are waiting on, but they 
can't produce it.
  What we are looking for is just the opposite. If you will take repeal 
of the Affordable Care Act off the table, I will pull up a chair. It is 
not perfect, it can be improved, and I am ready to sit down and do it 
on a bipartisan basis. But it is ``our way or the highway'' when it 
comes to the Republican majority on this bill. I hope we can do better. 
I think the American people expect us to do better.
  At the end of the day, they want a better healthcare system, not one 
that is worse--not one that supposedly gives them ``competition and 
choice,'' yet they have less coverage in their insurance policies and 
end up paying more for it.