[Congressional Record Volume 163, Number 51 (Thursday, March 23, 2017)]
[Senate]
[Pages S1959-S1961]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        American Health Care Act

  Mr. MURPHY. Mr. President, at this hour, we still don't know what the 
House of Representatives is going to do. They are amending and changing 
and modifying the reform of one-sixth of America's economy under the 
cover of darkness, trying to secure the votes necessary to fulfill a 
political promise. We await their decision as to how much havoc they 
wreak.
  I wanted to come down to the floor today to address for a moment the 
exceptional process that is occurring right now, as we speak, in the 
House of Representatives and to talk about one of the reported changes 
they are considering before sending the product over to the Senate.
  Just to review for a minute, Speaker Ryan likes to talk about his 
approach to healthcare as a three-pronged approach. Well, the 
Congressional Budget Office, headed by a gentleman handpicked by the 
Republican House conference, agrees that it is a three-pronged 
approach; they just have a little bit different interpretation of those 
three prongs.
  First, they say higher costs--15 to 20 percent spikes in premiums for 
everybody right off the bat and then dramatically higher costs, 
especially for older people, sicker people, and poorer people. If you 
are young and if you are relatively affluent and healthy, you may make 
out a little bit better under this proposal, but if you are not in that 
category, you are going to pay a lot higher costs and get less care.
  This is the headline from the CBO report: 24 million people lose 
health coverage. That is catastrophic. That is the total population of 
17 U.S. States. We just kick them off health insurance without anywhere 
to go other than our emergency rooms.
  Remember, all of this is in order to finance a giant tax cut for the 
rich. I had a chart up here yesterday that showed that in this bill, if 
you make zero to $200,000, you get no tax cut, but if you make over 
$200,000, you get a nice, healthy tax cut. It could be up to $7 million 
on average for some of the wealthiest taxpayers. So there will be 
higher costs for everybody, except for maybe a very small slice of the 
population, but with less care. I mean, it is a nightmare when it comes 
to the number of people who lose care under this bill, all in order to 
finance tax cuts for the wealthy.
  That is the background on what TrumpCare is and what the American 
Health Care Act is. People hate it. I mean, people hate it. There is a 
new poll out by Quinnipiac University that shows stunning numbers. The 
approval numbers for this bill are under 20 percent.
  Republicans kicked the living you know what out of the Affordable 
Care Act, and they never got its approval ratings down to under 20 
percent, as has happened to the American Health Care Act in its third 
week of existence. That is pretty impressive, for 18 percent of 
Americans to approve of a bill that has only been out there for a few 
weeks. And it is not because they don't know anything about it; over 50 
percent of Americans don't like it, 18 percent support it, and 56 
percent don't support it. Across demographic groups, across age groups, 
everybody hates this thing because they get it. They are not dumb. They 
know that this is taking healthcare from them and passing along higher 
costs to them in order to finance a tax cut for the rich. It is pretty 
simple. People really didn't need a lot of time to understand it.
  Republicans in the House know that as this thing hangs out there, it 
is getting less popular. It is hard to get less popular than 18 
percent. Those are tough numbers to do worse than. The reason 
Republicans are racing this bill through the process is because they 
know how deeply unpopular it is because they know it is a scam. They 
know it is essentially just taking healthcare from Americans and 
forcing them to pay more in order to finance a tax cut for the rich.
  What is happening today in the House is they are blowing up their 
rules in order to push a bill through that no one will have looked at. 
It is possible that they are going to file a gigantic reform to the 
entire American healthcare system and then call a vote on it within 
hours. Come on.
  In 2009 and 2010, Republicans were blistering critics of Democrats, 
who they said were forcing the Affordable Care Act through the process 
too quickly. But in 2009 and 2010, the House held 79 bipartisan 
hearings and markups on the health reform bill over the period of an 
entire year. House Members spent nearly 100 hours in hearings, heard 
from 181 witnesses from both sides of the aisle, considered 239 
amendments, and accepted 121 amendments.
  This bill was introduced 2 weeks ago. The first time the American 
public ever looked at it was 2 weeks ago, and the House is rushing it 
through today. Two weeks. Fourteen days. Twenty days. Not a year. Not 
79 hearings. Not 100 hours of hearings. And we are talking about 
bringing it up before the Senate for a vote next week, with 20 hours of 
debate on a reordering of one-sixth of the American economy.
  It is really extraordinary how this bill is getting jammed through 
the process because Republicans know that every day it hangs out there, 
more people figure out what it is--a massive transfer of wealth from 
regular, ordinary Americans, through less care and higher costs, to the 
very rich and also insurance companies and drug companies, which get a 
big tax cut.
  On today's modification of the bill, the talk today is that in order 
to make the bill a little bit meaner and a little bit crueler, the 
House is going to remove from the underlying law the requirement that 
insurance companies cover a basic set of what are called essential 
benefits. This change is being demanded by the very, very conservative 
wing of the House Republican conference. They call themselves the 
Freedom Caucus. This is a group of sort of the most radical Members in 
the House of Representatives. They are demanding that these essential 
healthcare benefits be stripped out of the law in order to get their 
votes.
  Let's talk about what these essential healthcare benefits are. 
Basically the law now says that if you are offering an insurance plan 
and you want to call it health insurance, then you have to actually 
offer to cover healthcare. So the essential healthcare benefits--what 
every plan today has to offer in order to be able to call itself 
insurance in this country--are ambulatory patient care, which means 
outpatient care, emergency care, hospitalizations; pregnancy, 
maternity, and newborn care; mental health and substance abuse care; 
prescription drugs; rehabilitation if you get injured; lab services; 
tests; chronic disease management--management for diabetes or heart and 
liver conditions; and pediatric services, services for kids. That is 
it. Those are the essential healthcare benefits.
  Frankly, if you are buying a health insurance plan, wouldn't you 
expect that it would cover your emergency care if you were to go to an 
emergency room? If you are buying healthcare in this country, what good 
is it if it doesn't cover a hospitalization when you get very sick? If 
you are buying an insurance plan in this country, don't you think it is 
going to cover your kids when they need basic pediatric services?

[[Page S1961]]

  So what is happening now is something different from healthcare 
reform in the House of Representatives. What is happening now is a 
radical rethink of what healthcare insurance is. If all of a sudden 
health insurers don't need to cover the cost of your hospitalizations, 
don't need to cover mental illness at all, don't need to cover 
addiction coverage at all, then is it really insurance any longer? If 
it is not covering that list of things, what is it covering?
  CBO has an answer for this. CBO says that if there is an insurance 
plan that doesn't cover this list of benefits, they won't count it as 
insurance. So when they are giving you the numbers of people who will 
have insurance or not have insurance after this bill, the nonpartisan 
Congressional Budget Office says: We don't really count it as insurance 
if it doesn't cover basic stuff, such as hospitalizations, outpatient 
services, prescription drugs, and pediatric services.
  So what is happening now in the House of Representatives is really a 
radical rethink of healthcare insurance. Under the law they are 
contemplating passing, healthcare insurance wouldn't need to cover 
anything. You could buy an insurance plan, pay your premium, and then 
be told that it doesn't cover your kid when he gets diagnosed with 
schizophrenia, that it doesn't cover your daughter when she gets in an 
accident and has to go to the emergency room, that it doesn't cover 
your spouse when they get really sick and are hospitalized for 3 days. 
What kind of coverage would that be any longer if it didn't cover that 
list of things?
  Let's be honest. This would be a massive transfer of cost to 
individuals. The No. 1 prong of TrumpCare is higher costs. If insurance 
companies don't need to cover any of these things anymore but you still 
have to buy them, then it is just a massive shift of costs to 
individuals because, remember, TrumpCare penalizes you if you don't buy 
insurance.
  The Affordable Care Act did the same thing, admittedly. The 
Affordable Care Act said: If you don't buy insurance, you are going to 
pay a penalty. But that is why the Affordable Care Act said that 
insurance has to really be insurance. It has to cover stuff because if 
we are going to require you to buy it or we are going to penalize you 
if you don't buy it, then insurance should really be insurance.
  Well, TrumpCare penalizes you if you don't buy insurance. You would 
pay a massive penalty. For a lot of people, the penalty could be $5,000 
if they don't buy insurance. But now the change they are considering in 
the House of Representatives means the insurance product you will be 
forced to buy won't cover diddly.
  By the way, when your insurance company doesn't cover it and you have 
to pick up the cost, it is going to cost you way more money. Everybody 
has probably seen a bill from a hospital. Let's say you had to go in 
and get a colonoscopy. You get your bill, and you always sort of 
scratch your head because you see two numbers--you see the number the 
hospital bills and then you see the number your insurance company pays. 
Often, the number the insurance company pays is like one-third of what 
that hospital billed. Why is that? It is because the insurance company 
is negotiating with the hospital on behalf of thousands of patients, so 
they get that price way, way down. The insurance company only pays a 
fraction of the cost that is billed. If you don't have insurance 
coverage for it, if all of a sudden it is not a benefit in your plan 
because the American Health Care Act told insurance companies they 
didn't have to cover a hospitalization, then you will pay that higher 
price. You don't get the insurance company discount. You will pay that 
higher number. That is going to bankrupt people.
  The families in my State, when their child gets hooked on heroin, 
they are going to find a way to pay for that care so that their child 
doesn't become another statistic, another one of the 900 who died in my 
State last year from overdoses. They are going to do everything 
possible to get that child care for that addiction. They will mortgage 
their house, they will sell their house, they will drain their savings 
account, they will sell off every possession they have to make sure 
their child does not die from an overdose and so that child gets the 
care they need. If their insurance company won't cover it, then they 
will do everything necessary to cover it, and you will have a rapid 
increase in the number of people whose lives are ruined, who go 
bankrupt because of their medical costs--something that doesn't happen 
right now because the Affordable Care Act gives you real subsidies to 
afford care. It gives you real help to be able to buy insurance, and it 
requires that insurance companies actually provide you with insurance.

  This is an extraordinary thing that is happening in the U.S. House of 
Representatives right now. Nobody likes this bill. Healthcare experts 
think it is a joke. The American public has roundly rejected it. It is 
getting meaner and crueler every day in order to round up the votes 
necessary to get it passed. Why? Because this bill is not about solving 
any problem in the healthcare system. It doesn't solve a single 
problem. Again, except for this narrow group of younger, healthier, 
affluent people whose premiums will be a little bit less, everybody 
else is worse off. It only solves one problem, a political problem--the 
promise that the Republicans made to repeal the Affordable Care Act. 
But they didn't spend any time thinking about how to actually do it. So 
they are stuck now with an awful bill that nobody likes, that doesn't 
solve a single problem, and that is getting meaner and meaner every 
single day.
  It was bad enough, and now this bill is frankly getting into some 
really radical territory--talking about totally rethinking insurance 
and letting insurance companies offer you a product that covers nothing 
and then it requires you to buy it. Think about that. We are going to 
require you to buy insurance, but the insurance isn't going to cover 
anything. TrumpCare, the American Health Care Act--whatever you want to 
call it--has three prongs: higher costs, less care, and tax cuts for 
the rich.
  We will have an opportunity here in the Senate to get this right. As 
to the House of Representatives, I don't know if they are going to pass 
this. I don't know if it is going to fall apart. But we will have a 
chance to get this right. Republicans and Democrats coming together, we 
can admit together that there are still a lot of things that are wrong 
in our healthcare system.
  In the Affordable Care Act, there are some good parts of it, but 
other parts need improvement. We can come together and decide to tackle 
this problem--the high drug costs, whatever it may be--together and 
reject this partisan, rushed approach in the House of Representatives. 
It does nothing except give us higher costs and less care in order to 
finance tax cuts for the wealthy.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. REED. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.