[Congressional Record Volume 163, Number 46 (Thursday, March 16, 2017)]
[House]
[Pages H2143-H2146]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  DISMANTLING THE AFFORDABLE CARE ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2017, the Chair recognizes the gentleman from Oregon (Mr. 
Blumenauer) for 30 minutes.
  Mr. BLUMENAUER. Mr. Speaker, this has been a fascinating 2 weeks here 
on Capitol Hill. We have had, last week, all night sessions in our Ways 
and Means Committee and on the Energy and Commerce Committee dealing 
with the Republican plan to dismantle the Affordable Care Act. At 
times, Mr. Speaker, it is really hard to process all of the claims and 
counterclaims that are going on. I feel occasionally like I am in an 
alternative universe, and it is not just because we were up until 4:30 
in the morning debating this.
  People have lost track of how we got to this point--what was 
happening earlier, what has been the benefit and accomplishment of the 
Affordable Care Act, and what is going to happen moving forward were we 
to adopt a really disastrous proposal advanced by my Republican 
friends.
  Twenty-five years ago, I was in a different role as Portland's 
commissioner of public works. And one of the elements in my portfolio 
for several years was to deal with personnel and benefits and health 
care. I am fully aware of trying to deal with our 6,000 employees to 
provide them with affordable health care that the city, as the 
employer, could afford, and that wasn't too burdensome on our 
employees. We were caught in a situation with rapidly escalating costs, 
inflation for medical care twice the rate of the ordinary inflation; we 
were having problems with employers maintaining coverage in an 
affordable fashion; and the individual market was, frankly, very 
chaotic and troublesome.
  I have with me here a report from the Kaiser Family Foundation from 
March of 2009. They talked about these challenges--how the United 
States healthcare spending had risen from 1970 from 7.2 percent of the 
gross domestic product to where they projected that it was going to 
cost us by 2018, next year.

[[Page H2144]]

It would be $4.3 trillion, $13,100 per resident, and account for over 
20 percent of the gross domestic product.
  Mr. Speaker, I am pleased to say that, as a result of the 
unprecedented reforms that were incorporated in the Affordable Care 
Act, we were able to deal with this problem. We began 10 years ago, 
when Democrats gained control of Congress, working on expansion of the 
CHIP program, children's health, and it was one of the first actions 
signed into law by President Obama when he assumed office and we 
weren't facing a veto from the Bush administration.

  We have been working for over 3 years trying to lay the foundation 
for moving forward with a comprehensive approach for healthcare reform. 
And it should be noted, for all of the hyperbole about socialized 
medicine and government dictating outcomes and taking control away from 
the American people, that is the furthest thing from the truth.
  In fact, the program that was developed by President Obama and the 
Democrats, with no help from Republicans, was actually a middle ground. 
It relied upon the private insurance that most Americans had through 
work, and be able to expand that coverage, to be able to improve the 
quality of care, to be able to rein in medical inflation, to be able to 
deal with some of the most needy of us, and to be able to have a 
healthcare system that performed better.
  The simple fact is we spend about twice as much as any other 
developed country in the world. And our outcomes, on average, are worse 
than what happens in those countries that my friends on the other side 
of the aisle derided--Canada, Great Britain, France, Germany. As a 
practical matter, those people get sick less often, they get well 
faster, they live longer, and they do so for a fraction of what we pay.
  So what we did, through a very extensive process--multiple public 
hearings, meetings, seminars, position papers that were generated from 
a wide variety of areas--was to assemble a program to deal with that. 
One of the elements that drew the scorn of my Republican friends, and, 
in fact, is part of their repeal that is one of the centerpieces, is to 
repeal the mandate that people have health care.
  It is ironic that that has become a target from Republicans because 
the mandate came from Republican alternatives to HillaryCare in the 
Clinton administration. In fact, 19 Republican Senators, including 
Senator Grassley and Senator Hatch, supported a healthcare mandate to 
be able to expand and stabilize the health insurance market.
  Well, what we have done through those 2 years that it was enacted, 
March 23, 2010--we are approaching the seventh anniversary--it went 
live in the fall and was fully in effect in 2014. So in the 3 years 
that the Affordable Care Act has been in place, it has had remarkable 
achievements.
  You recall I mentioned what the studies showed that we were facing 
with rapidly escalating healthcare costs, where it was estimated that 
we would be having over 20 percent of the gross domestic product, we 
would be approaching over $13,100 per resident. Well, that didn't 
happen. Despite the dire predictions of the Republican opposition, 
healthcare costs did not skyrocket.
  In fact, we anticipate now that instead of being over $13,000 per 
resident, it is under $10,000 after a couple years of operation of the 
Affordable Care Act. Not over 20 percent of the gross domestic product, 
but 18 percent. We have found that these are the lowest rates of 
medical inflation since we have been keeping track.
  The Affordable Care Act, by any stretch of the imagination, has been 
a success. We have seen coverage expand dramatically to the lowest rate 
of uninsured in the United States in our history while we have 
contained costs. That success is all the more remarkable because there 
has been a concerted effort on the part of the Republicans, from the 
moment they seized control of the House in 2011, to make it worse.
  Bear in mind, the Republicans attacked the Affordable Care Act in 
court, on the floor of the House, and in terms of trying to muddy the 
waters on the State level. The Supreme Court challenge to the 
constitutionality of the Affordable Care Act failed. The Supreme Court 
decided that the Affordable Care Act was constitutional and would 
remain.
  But the Supreme Court made a devastating decision that allowed 
individual States to opt out of Medicaid expansion. That was part of 
the program that was so important to be able to extend care on a cost-
effective basis to some of the lowest income people in the country. 
Thirty-one States did. Nineteen States refused to do so. That undercut 
the coverage, made huge problems, created situations where there were 
people in the Republican-controlled States that refused to extend 
Medicaid, despite the fact that the Federal Government was paying for 
it, that we had people who were too poor to qualify for assistance. 
Shocking, embarrassing, and to the detriment of those States, they had 
much worse outcomes.
  But it is ironic that some of the people who started attacking the 
Congressional Budget Office projections about the impact of the 
Republican plan pointed to the calculation on the part of the CBO that 
they underestimated the number of people who would be uninsured.

                              {time}  1930

  Well, that was precisely because there was no expectation that States 
would not expand Medicare, and if that unfortunate decision hadn't been 
made, we would, in fact, have seen them hit their target numbers.
  Despite the claims of outrage on the Republican side that there would 
be employers dropping coverage for their employees en masse, we found 
that, in the main, employers retained coverage. Now, this is not the 
case going forward with the Republican proposal.
  I think there was a reason why my Republican friends insisted on 
jamming this through the Ways and Means Committee and the Energy and 
Commerce Committee before we had a chance for the scorekeeper, the CBO, 
to give the results of their analysis: because they knew how bad it 
would look.
  The CBO anticipates that there will be 14 million more uninsured 
Americans, including 2 million who will lose coverage provided by their 
employer because of the way their alternative tax credit for health 
insurance would be structured. In my State, it is estimated that as 
many as 465,000 Oregonians could lose coverage. The uninsured rate will 
triple in our State.
  One of the areas that has been most successful with the Affordable 
Care Act has been for older Americans. They benefit from the 
protections against discrimination, and they are going to see a return 
to much higher premiums and higher costs.
  The Republican plan would take the requirement that seniors pay no 
more than three times the rate of insurance for premiums for younger 
people, that will be five times greater. And instead of the subsidy 
that is based on income, there will just be a flat subsidy across the 
board. This means, in practice, that older Americans are going to face 
steeply higher premiums, and they are going to pay far more out-of-
pocket because of the less generous subsidy.
  One example that ought to get, I think, everybody's attention: In 
2026, a 64-year-old with an income of about $26,500 would pay $14,600 
for their health insurance as opposed to $1,700 today, an increase of 
almost $13,000.
  Now, there are winners and losers under the Republican approach. The 
healthy, young people will catch a break, but older Americans will pay 
a lot more at precisely the time when they need health insurance.
  Now, our Speaker appeared to be confused when he was describing the 
difference between the Republican approach and the Affordable Care Act, 
when he talked about how all of these people are being subsidized by 
the majority, who aren't sick. As many commentators rushed to point out 
to the Speaker, that is what insurance is about. Many people pay some 
to subsidize those who suffer loss. You pay a couple of hundred dollars 
a year for auto insurance so that, when you have a $10,000 loss, that 
is picked up by the people who don't suffer a loss but paid the 
premiums nonetheless.
  Think about what the Republicans have put in place. They are doubling 
down on what the Trump administration has done trying to discredit the 
efficacy of the program, casting it in

[[Page H2145]]

doubt. The administration has already stopped enforcing the mandate.
  The IRS is supposed to check and enforce to make sure that people 
sign up for the ACA and everybody is part of the insurance pool, just 
like States have mandatory auto insurance. You are not allowed to run 
the risk of harming your fellow motorists by not having insurance. That 
is widely accepted and understood that it is necessary to have the 
system work right.
  Now the Republicans are increasing the damage that Trump has imposed, 
unilaterally, by not enforcing the mandate. They are going to repeal 
the mandate. In place of the mandate, they are going to have a 30 
percent surcharge in case people drop coverage and decide to reenter 
the insurance pool.
  Well, think about that for a moment. The people who are young, 
healthy, who feel invincible and don't have healthcare problems now are 
very likely not to get insurance at all. They figure that when they get 
sick, they can go ahead, pay the 30 percent premium. If they find out 
they have got cancer, some serious disease, then they can sign up 
later. It is designed to destabilize the insurance system that we have.
  By the same token, we are looking at the other end of the spectrum 
where the people who are lower income, older, and sick are going to pay 
a disproportionate burden. That is why the CBO determined, in their 
analysis, that in 2026, actually, there will be a drop in terms of 
insurance premiums, in terms of the cost. They will start to go down. 
They will go down because older Americans will be unable to afford the 
premium. They will drop the coverage.
  It is not that they don't need health care. It is not that they are 
going to somehow avoid becoming sick or having accidents, but they are 
not going to have insurance coverage. That means the care that many of 
them are going to experience will be what we were fighting against 
before the Affordable Care Act. It will be in the emergency room. It 
will be when it is too late. It is not in a clinic before things get 
worse. It is after the fact, and it is in a setting that is not nearly 
as effective.
  Mr. Speaker, it is really disappointing that part of the assault is 
on the Medicaid program itself. Medicaid is this program that provides 
care to the elderly, disabled, pregnant women, children, poor people. 
It is part of the bedrock safety net of this country. Republicans were 
against the expansion of Medicaid and making the qualifications to have 
Medicaid be more generous.
  Under the Affordable Care Act, it is 138 percent of poverty, so lower 
and middle-income families are able to access this care. Prior to that, 
there were widely varying requirements across the country, and many of 
the States, particularly in the South, the States that declined to 
expand Medicaid, were facing really onerous restrictions--$10,000, 
$12,000, $7,000 family income--making it very, very hard and for only 
the most desperately poor to qualify for it.
  Now, the Republican plan will eliminate the Medicaid expansion in its 
current form. It would cap Medicaid funding, and, ultimately, we are 
going to watch, reverting to what we had before--in effect, de facto 
rationing.

  In Oregon, the Republican plan would shift $2.5 billion back to the 
States over the next 6 years. States are going to be left with 
impossible decisions: reducing benefits, cutting people off of 
Medicaid.
  This is what has happened historically when people ran into difficult 
financial times in the States. They didn't raise taxes to make sure 
that the poor were provided coverage; they cut back coverage even more.
  Sadly, under the Republican plan, 14 million Americans would lose 
Medicaid coverage by 2026, and it would start having its impact in less 
than 3 years.
  The policy would also severely set back efforts to combat opioid 
addiction and improve mental health treatment.
  In my community, as I visit health centers, find out what is going on 
in clinics, in local government, officials that deal with the homeless, 
the drug addicted, the mentally ill, we found that they are using the 
opportunity to enroll people in Medicaid to give them proper care and 
not put that burden on local governments that they simply can't cope 
with.
  The Republican plan would prevent that. We won't be able to have 
people most in need provided with the mental health, the addiction 
services, the health care that they need.
  The Republican plan would put 2.8 million people with substance 
disorders, including over 200,000--about 220,000 is the estimate that I 
have seen--with opioid disorders, at risk of losing their coverage, 
including the coverage of addiction treatment, continuing the tragic 
cycle that we see played out in our streets across the country, but 
particularly in Appalachia. Some of the areas that actually were most 
opposed to the Affordable Care Act have received the greatest benefit.
  In a time of concern about budget deficits, repealing the Affordable 
Care taxes--which we approved in the Ways and Means Committee in the 
middle of the night last week--would create an immediate windfall tax 
cut for the highest American taxpayers. The Affordable Care Act was a 
balanced plan that actually reduced the deficit while it improved 
healthcare outcomes across the country.
  This approach is going to provide--for example, the top 400 earners 
would see an average tax break of about $7 million a year, and people 
who are millionaires will be receiving tax cuts averaging $57,000 
apiece; but, as it plays out, we will find taxes would raise 
significantly on about 7 million low- and moderate-income families.
  Mr. Speaker, it also puts in jeopardy Medicare coverage for 57 
million Americans by cutting the Medicare trust fund resources. Because 
of the total impact of what we have done with the Affordable Care Act, 
we have watched the Medicare trust fund have its life extended 2 years. 
The Republican tax proposal will cut $170 billion from the Medicare 
trust fund, moving it closer to being insolvent.
  It is fascinating. Donald Trump promised not to touch Medicare or 
Medicaid. This plan violates both those promises. And as I had 
mentioned, the Trump promise that everybody would be covered under the 
Republican plan rings false. That is simply not the case.
  Mr. Speaker, it was interesting, in the course of our deliberations, 
we received correspondence from the American Association of Retired 
Persons. They represent 38 million members in all 50 States, in the 
District of Columbia, Puerto Rico, and the Virgin Islands. It has a 
proven track record of being nonpartisan, a nationwide organization 
that helps people turn their goals and dreams into real possibilities 
for older Americans. They have a wide range of issues for which they 
have championed and gained notoriety; but, most significantly, we have 
watched them be involved with healthcare decisions, and they have been 
proven nonpartisan. In fact, I took issue with them when we were 
dealing with the Medicare part D prescription drug program in 2004.

                              {time}  1945

  It was unfortunate, I thought, that they kind of threw their weight 
to an inadequate program that was not paid for, that added to the 
deficit, and didn't do anything to fight to reduce prescription drug 
costs. But they made the judgment that this was the best they could do 
for the people they represented, and they didn't hesitate for a moment 
to work with Republicans to be able to enact that.
  They wrote on March 7 to the chairs of our Energy and Commerce 
Committee and our Ways and Means Committee to express their opposition 
to the American Health Care Act. They did so because it would weaken 
Medicare's fiscal sustainability. They said it would dramatically 
increase the healthcare cost for Americans age 50 to 64 and put at risk 
the health care of millions of children and adults with disabilities 
and poor seniors who depend on Medicaid programs for long-term 
services, supports, and other benefits.
  They have long fought to protect Medicare, and they pointed out in 
their correspondence that the 2016 Medicare trustee report said that 
the Medicare part A trust fund is solvent until 2028. This is 11 years 
longer than the projection immediately before the Affordable Care Act. 
Because of the changes in the Affordable Care Act, we gained solvency, 
11 years longer.
  Now, they have serious concerns about the Health Care Act that 
repealed provisions that strengthen the

[[Page H2146]]

fiscal outlook, specifically the repeal of the .9 percent payroll tax 
on higher income workers. According to their analysis, this provision 
would hasten the insolvency of Medicare by up to 4 years and diminish 
Medicare's ability to pay for services in the future.
  Think about it, Mr. Speaker, we are dramatically increasing the 
number of uninsured Americans. We are going to give them more expensive 
insurance of a lower quality. They will have higher deductibles and 
copays. At the same time, we are jeopardizing the future of Medicare, 
which so many American seniors rely upon.
  They pointed out that about 6.1 million Americans age 50 to 64 
purchase their insurance in the nongroup market, and that over half of 
them were eligible to receive subsidies for health insurance coverage. 
They note the significant reduction in the number of uninsured since 
passage of the ACA, with the number of people in that age bracket 
dropping by half.
  Yet, according to CBO, what is going to happen if the Republican plan 
is enacted, that that number is going to go back up again, it is going 
to be unaffordable for a number of seniors, and they are going to be 
paying a much higher cost.
  Mr. Speaker, it is troubling that we are having a debate where we 
really have tried to discredit independent sources, where we have had 
no hearing dealing with the legislation that is rushing toward the 
House floor.
  It is ironic that there was debate and discussion criticizing 
Democrats for the 3 years we spent developing the framework for moving 
the legislation forward. And after 6 years of my Republican friends 
being in power in the House, chipping away, undermining the Affordable 
Care Act, trying to make it worse, discrediting it, and voting over 60 
times to repeal it, they do not have a plan in place to replace it.
  Now, this is the best we can come up with. It is a program that is 
widely discredited.
  Mr. Speaker, I yield back the balance of my time.

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