[Congressional Record Volume 163, Number 43 (Monday, March 13, 2017)]
[Senate]
[Pages S1762-S1764]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        American Health care Act

  Mr. CORNYN. Madam President, last week our colleagues in the House of 
Representatives introduced the American Health Care Act--legislation 
that will deliver on a promise we made to repeal ObamaCare and to 
replace it with healthcare options that won't force people to buy an 
insurance product just because the government tells them to do so or 
penalize them if they don't but will replace it with one that actually 
fits the needs of their families at a price they can afford.
  It is no secret that ObamaCare was oversold back in 2010 when the 
President said: If you like your policy, you can keep your policy. If 
you like your doctor, you can keep your doctor. And by the way, an 
average family of four, he said, would save $2,500. That has not proven 
to be true.
  ObamaCare, to boot, has wreaked havoc on our economy and on American 
families just trying to stay healthy. In my State of Texas, it has led 
to fewer healthcare options, skyrocketing premiums, and deductibles so 
high that insurance plans are rendered almost useless. By one estimate, 
about one-third of Texas counties have only one insurance option, and 
that is the case throughout the Nation. Nearly one-third of all 
counties in the country have only one insurance company offering plans 
on their States' exchanges.
  The truth is, ObamaCare has never added up to better coverage at a 
more affordable price; it has never delivered more options--just the 
opposite; and it never kept its promises when it was being sold to the 
American people.
  Now is the time for us to do right by the American people by 
delivering more access to quality healthcare at a price Americans can 
afford.
  The American Health Care Act doesn't just tinker around the edges of 
ObamaCare; it is a complete do-over.
  This bill, for example, repeals ObamaCare's individual mandate, the 
requirement that you buy government-approved insurance, and if you 
don't, we are going to fine you. That is repealed.
  It repeals the employer mandate. I still remember being in Tyler, TX, 
and talking to a gentleman who owned a restaurant and who said he had 
to lay

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off some of his full-time staff, putting them on part time, just to 
avoid the penalties that go along with the employer mandate. And by the 
way, he introduced me to the single mom who now, instead of working one 
full-time job, had to work two part-time jobs just to keep food on the 
table for her family.
  This bill also repeals the medical device tax. This was an incredible 
tax on medical innovation which wasn't on income but literally on gross 
receipts, forcing jobs to move from the United States to places like 
Costa Rica and Central America.
  This bill repeals ObamaCare's Medicare payroll tax increase, the net 
investment tax increase, the ObamaCare tax on prescription drugs, and 
the ObamaCare health insurance tax.
  This is the full repeal of ObamaCare that we have been promising for 
years now.
  I want to point out that this bill also provides unprecedented 
entitlement reform. Some of the main cost drivers for the Federal 
Government are not the 30 percent of Federal funds that we appropriate 
each year that are largely divided between defense and nondefense 
spending. Entitlements are driven by the fact that they are not capped 
or pegged to an inflation rate for Medicare, Social Security, and 
Medicaid.
  This legislation actually begins to put Medicaid--the healthcare plan 
for the most vulnerable in our country--on a reasonable path to 
sustainment. This bill also makes sure that the States that share in 
the cost of Medicaid can manage their own State budgets in a much more 
responsible way.
  This bill is the first real Medicaid reform since the program was 
created which, perhaps most importantly, gives more authority, more 
flexibility to the States to manage the dollars they spend, to manage 
not only the dollars they come up with through their own tax rolls but 
the Federal portion as well. And as I said, it puts the Medicaid 
Program on a path toward fiscal responsibility.
  I believe this legislation is critically important across the country 
and for my State of Texas, too. In Texas, every other year, when the 
legislature meets and tries to determine how to allocate its budget, 
they work very hard to try to make sure that Medicaid isn't the single 
largest expenditure in the State budget. Right now, about a third of 
that total budget is spent on Medicaid alone, and the Federal 
Government essentially ties the hands of the State in terms of managing 
the healthcare delivery system to help those most vulnerable low-income 
folks in our State.
  With this legislation, not only do States like Texas have the ability 
to manage the expenditure of the money to focus on chronic diseases--
people who are using our healthcare system a lot because of the nature 
of the illnesses they have--but also to help encourage medical homes so 
that people have ways of managing their healthcare to stay healthy 
longer and to reduce healthcare expenditures.
  This legislation will help Texas and the rest of the country have a 
way to rein in spending while serving those who need Medicaid the most. 
You will hear some of our friends across the aisle saying that this is 
about kicking people off of Medicaid. Well, that is not true. For those 
people currently on Medicaid, Medicaid expenditures will not change at 
all as long as they remain on the rolls. That includes those who live 
in States that expanded the Medicaid coverage from 100 percent of 
Federal poverty to 138 percent. Those people will stay on Medicaid as 
long as they are eligible. Under this new legislation, Medicaid is put 
on a sound fiscal footing so the program is still around for our 
children and grandchildren.
  Another important feature of the American Health Care Act is that it 
establishes a patient and State stability fund to equip Texas and other 
States to meet the specific healthcare needs of their patients, 
particularly those, as I have said, with low incomes and those 
suffering from chronic illnesses.
  It will provide more money to community health centers that do a lot 
of heavy lifting to make sure that families are healthy and that people 
get access to the treatment they need regardless of whether they 
actually have health insurance. In Texas, we have hundreds of community 
health centers serving more than 1 million Texans each year. Under the 
American Health Care Act, they will be able to do their job more 
effectively and keep more Texans healthy.
  Responsible entitlement reform is something we should be all about. 
It serves the American people not just for tomorrow but for decades 
down the road. Most importantly, I believe what this legislation does 
is it finally delivers on the promise we made back during the debate 
over the Affordable Care Act.
  Now that the Affordable Care Act has proven itself to be 
unsustainable and does not deliver on the basic promises, the 
fundamental promises upon which it was sold to the American people, I 
believe it is important that we keep our promise to repeal it and 
replace it with more choices of affordable healthcare at a price people 
can afford. It is the conservative answer to healthcare that will 
empower individuals, provide more options and competition, and 
responsibly help those who need care have more access to it.

  Madam President, I yield the floor.
  Mr. LEAHY. Madam President, as the Senate continues to consider 
nominees to lead Federal agencies, I am concerned that once again there 
is a nominee before us with a stunning lack of expertise to run an 
agency that affects so many American lives. Seema Verma is another such 
nominee.
  The Administrator of the Centers for Medicare and Medicaid Services, 
CMS, has an incredible responsibility to ensure some of America's most 
important programs run smoothly. For decades, Medicare and Medicaid 
have offered coverage to some of our Nation's most vulnerable 
populations. Medicare and Medicaid currently cover more than 100 
million Americans--nearly one in three patients. The Administrator is 
responsible for overseeing more than $1 trillion in annual spending and 
a staff of about 4,000 people. This is a position of vital importance 
where a new Administrator should hit the ground running, instead of 
learning on the fly.
  And learning on the fly is what she will have to do, as evidenced by 
her testimony before the Finance Committee. When asked to name a 
specific program she would commit to improving as Administrator, she 
could not identify even one. She also demonstrated a lack of commitment 
to protect healthcare for women, saying that coverage for prenatal and 
maternity care should be optional and paid for separately. Does Ms. 
Verma really want to return us to a time when women are discriminated 
against in healthcare solely because of their gender? It appears so. 
When asked about provider payment systems, she stumbled to answer, 
showing little knowledge about a system that directly impacts millions 
of providers across the Nation. Furthermore, the only fact she could 
name about Medicare Part D, a benefit that supports more than 40 
million seniors, was about an online plan finder tool.
  Supporters of her nomination point to her involvement and design of 
Indiana's Medicaid program as her qualification to run CMS. Directed by 
then-Governor Mike Pence, Indiana's plan requires even the poorest 
patients to pay a monthly fee in order to access health insurance. The 
plan also restricts those who miss a payment to be locked out of care 
for 6 months. Instead of working to find ways to help Indianans gain 
insurance coverage, she contributed to a system that bars access to 
vulnerable patients. Conversely, Vermont also has a Medicaid waiver 
that, combined with Vermont's All Payer Waiver, has a goal of insuring 
all Vermonters. Vermont's is the standard that we should all be trying 
to meet. I am not confident that Ms. Verma is up to the task.
  What is more concerning is how Ms. Verma fits into a world where 
Republicans are engaged in an effort to not only rip apart the 
Affordable Care Act, but also to end the Medicaid Program as we know 
it. The current proposals before the House of Representatives would cut 
hundreds of billions of dollars from Medicaid, leaving States in the 
lurch and causing millions to go uninsured or to have substandard care. 
As Republicans continue these efforts, it will be critical for the 
Administrator of CMS to understand and care about the impacts of such 
efforts on the millions of Americans who rely on these health 
protections day to day.
  Confirming someone with such a lack of experience to run a trillion-
dollar

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agency would be unfair to the American people. And as a core player in 
the effort to unravel the Affordable Care Act, she demonstrates values 
that are counter to the very agency which has been supported and 
improved by key provisions in the law. I do not believe Seema Verma is 
qualified or fit to serve as the Administrator of CMS, and I encourage 
all Members to join me in opposing her nomination.
  Mr. VAN HOLLEN. Madam President, the Centers for Medicare and 
Medicaid Services, or CMS, is a major part of the Department of Health 
and Human Services. A third of the Nation--more than 100 million 
Americans--get access to quality healthcare through CMS's programs--
Medicare, Medicaid, the Children's Health Insurance Program, and the 
Affordable Care Act Marketplace. CMS also includes the Center for 
Medicare and Medicare Innovation and several other activities to 
improve access and affordability in our Nation's health system for all 
Americans--regardless of income, gender, or health status.
  President Trump, Secretary Price, and congressional Republicans seek 
to drastically restructure our Nation's healthcare, threatening to 
leave millions without coverage. In the face of that threat, we need a 
CMS Administrator who knows how to lead CMS and is willing to do 
whatever she can to protect Americans' healthcare. After hearing from 
several organizations that deal directly with CMS and familiarizing 
myself with President Trump's nominee, I cannot support the nomination 
of Seema Verma for this important role.
  Ms. Verma does not have the experience or appropriate knowledge 
needed to head this vital agency. Her limited scope of experience with 
just Medicaid, lack of familiarity with Medicare, and willingness to 
restructure CMS's rules that protect millions are cause for deep 
concern.
  If confirmed, Ms. Verma would manage 85 percent of the HHS's $1 
trillion budget, which in turn is more than a quarter of the Federal 
Government's, and Ms. Verma would oversee 4,000 employees. Running CMS 
requires significant experience with healthcare and is best done by a 
person who has held significant positions in private industry and 
government.
  But nothing in Ms. Verma's career shows her to have the skills to 
operate a budget or team of this magnitude. She has never managed a 
large organization and has little experience with Medicare. Ms. Verma 
has operated a small, 10-person company, SVC, Inc., and consulted on 
various State Medicaid programs. Her experience is inadequate for the 
important role for which President Trump nominated her.
  The next CMS Administrator will have an important voice forming 
healthcare policy. HHS Secretary Price has been on the forefront of 
efforts to slash Medicaid and turn Medicare into a voucher program. 
President Trump, Secretary Price, and congressional Republicans have 
made it a priority to repeal the Affordable Care Act. We need a CMS 
Administrator who will provide a reality check in the face of these 
reckless proposals. We need a CMS Administrator who will work to uphold 
President Trump's promise that ``there will be no cuts to Social 
Security, Medicare, and Medicaid.''
  Ms. Verma, however, could not make that commitment during her Senate 
Finance Committee confirmation hearing. To the contrary, during her 
hearing, Ms. Verma expressed openness to block-granting Medicaid or 
instilling per-capita caps--putting the coverage of nearly 70 million 
vulnerable Americans at stake. These policies would end the Federal 
guarantee of matching funds to States and would dramatically cut 
Federal funding to States. Analyzing a 2012 congressional Republican 
block grant proposal, the nonpartisan Congressional Budget Office found 
that, for States to manage their Medicaid programs at reduced funding 
levels, they would have to limit Medicaid eligibility, reduce benefits, 
cut payment rates, or increase out-of-pocket costs for beneficiaries. 
These proposals would result in the denial of healthcare and long-term 
care to millions of vulnerable Americans.
  We need a leader at CMS who will defend the historic gains of the 
Affordable Care Act The Affordable Care Act set standards for consumer 
protection and significantly expanded coverage. Repeal could cause 22 
million Americans--and 400,000 Marylanders--to lose quality, affordable 
health coverage. Repeal would imperil new access to life saving 
substance-use-disorder and mental health treatment Repeal would 
endanger coverage for children who now have access to comprehensive 
health services. Repeal could significantly raise premiums and erode 
consumer protections for Americans who have coverage outside of the 
Marketplace.
  Under the Affordable Care Act, insurance plans must provide maternity 
care as an essential health benefit. But during her nomination hearing, 
Mrs. Verma said that, while some women want maternity coverage, ``some 
women might not choose that,'' signaling her view that the law should 
not require insurance companies to provide this critical coverage. This 
is unacceptable. Ms. Verma's position would put the health of mothers 
and families at risk and drive up costs for plans that did provide the 
coverage. We will not turn back the clock to when maternity coverage 
was optional. We need an Administrator who will stand with mothers and 
families on this issue.
  Because of Ms. Verma's lack of adequate healthcare experience and her 
willingness to consider rash policies that are far out of the 
mainstream, I do not believe that she is equipped to appropriately 
advise the President and Secretary on these policies that affect 
millions of Americans. I will not support her nomination to head CMS.
  The PRESIDING OFFICER. The Senator from Arkansas.