[Congressional Record Volume 163, Number 80 (Tuesday, May 9, 2017)]
[Senate]
[Pages S2830-S2833]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CASSIDY. Mr. President, the topic before us is clearly the repeal 
and replacement of the Affordable Care Act, and that is what I rise to 
speak about today. In part I will speak as a Senator, and in part I 
will speak as a doctor, as I am a physician. My wife is also a 
physician. I worked in a hospital for the uninsured for many years.
  First, let's just describe the state of play. It is so interesting, 
President Obama's healthcare law, the Affordable Care Act, ObamaCare.
  I had two different communications yesterday, one from a sister-in-
law in San Francisco. I think her husband voted for Bernie Sanders. She 
is, you know--but she said: This is incredible. Speaking of herself, 
she said: I am paying $20,000 a year in premiums, and each of my family 
members has a $6,000 deductible.
  They have to pay San Francisco prices for everything, and they make 
good money but not exorbitant money. They are paying $20,000 a year for 
a premium, for a young couple in good health, with a family deductible 
probably of $13,000.
  The next communication was in a phone call with a consultant here in 
Washington, DC, who does healthcare. He knows his stuff, and at some 
point, he breaks out of sort of a professional kind of ``this is the 
way I talk,'' and he says: You don't see my insurance. I am paying 
$24,000 a year for premiums, and I have a $13,000 family deductible. If 
my family gets in an accident, it will be $37,000 my family puts out 
before we see any benefit from our insurance.
  I reminded him he would have preventive services, such as a 
colonoscopy, but that was cold comfort for him.
  The reality is that middle-class America can no longer afford the 
now-ironically named Affordable Care Act. So where does that leave us?
  President Trump--I like to say because I think he would say it--
established a contract with the American voter. President Trump said 
that he wanted to continue the number of folks who were covered under 
ObamaCare, he wanted to take care of those with preexisting conditions, 
he wanted to eliminate mandates because Americans hate to be told what 
to do by the Federal Government, and lastly, he wanted to lower costs. 
I think the average voter took lower costs to mean lower premiums, not 
a better CBO score, and lower premiums are really what those two 
communications are about.
  The second thing I will note is that he was very passionate about a 
particular preexisting condition that the Presiding Officer here in the 
Senate cares about, which is opioid addiction. And he would go to 
counties where

[[Page S2831]]

there was a high incidence of opioid addiction and speak to how he 
wished to address their needs.
  So I think President Trump's proposals--his contract with the voter--
really give us hope. The question is, How do we achieve that? Well, 
first we have to acknowledge a couple of things.
  Rich Lowry is a conservative author for National Review, and he wrote 
a column: Basically, coverage is important. We cannot deny--no one can 
deny that it is important to have coverage. And if we speak--as the 
Presiding Officer did at lunch--about the family whose son is addicted 
to narcotics and the fact that now he has coverage and he is able to 
get off of the opioids instead of either dying, living in a gutter, or 
being incarcerated--that is a sign of hope. And when President Trump 
spoke of the forgotten man or the forgotten woman, in my mind, I think 
in his mind, he was referring to someone such as that.
  So we have to acknowledge, as Rich Lowry did, that coverage is 
important. My own experience as a physician supports that. I am 
actually going to quote somebody from my wife's experience. My wife is 
a retired breast cancer surgeon, and she once told me about a patient 
who lived in a nice section of my hometown, Baton Rouge, had a nice car 
and children in parochial school, paying tuition. But her husband died. 
He always managed the family affairs, and he died, and she ended up 
uninsured. She had a nice car and nice home and kids in parochial 
school, but she didn't have insurance.
  Going back to coverage being important, she began to develop breast 
cancer--something that is described in medicine as fungating, which 
means the cancer begins to eat through the skin on the chest--and she 
didn't know where to go because she didn't have coverage. And when the 
breast cancer was actually coming out of her skin is when she came to 
see my wife. My wife operated on her for free. The hospital wrote off 
the cost. But that is not the end of it because then she needed 
radiation therapy, she needed breast reconstruction, and she needed 
chemotherapy. And her only hope for survival is if she had this 
coverage.
  So we can acknowledge two things--that coverage is important but also 
that premiums under the Affordable Care Act have become unaffordable.
  I will go back to what President Trump said. President Trump said he 
wants everyone to be covered, care for those with preexisting 
conditions, without mandates, and lower premiums. That is something, 
whether Republican or Democratic or Independent, we should be able to 
get behind.
  How do we have a path forward? Some folks say: Well, President 
Trump's promise cannot be kept. There was a good article recently by 
Jim Capretta, a conservative economist, and he says that, basically, we 
can achieve these goals. The way we do it is we automatically enroll 
folks in the insurance program so that if you are a young person, you 
get a credit, and that would be sufficient enough to pay for your 
annual premium. You don't have to take it, but if you do, you are 
automatically enrolled in insurance. By automatically enrolling these 
young people, we expand the risk pool, which is to say that we now have 
a lot of healthy young folks, most of whom will not get sick, but the 
fact that they are in the insurance pool means that those who are older 
and sicker will have lower premiums because the cost of their care is 
spread out over the many. That is a good thing. That would increase 
coverage and it would lower premiums without mandates, taking care of 
those with preexisting conditions.
  I think Candidate Trump's genius was to recognize that the only way 
you get to lower premiums is if you expand coverage, and the only way 
to care for those with preexisting conditions is to expand coverage.
  I am pleased to say we have a proposal that is called the Patient 
Freedom Act, which I have cosponsored and introduced with Susan 
Collins, and four other of our Republican Senators have cosponsored it. 
The six of us propose this: that every State be given the right to 
choose their path forward. If you are a blue State, you can continue 
with the status quo; you just have to reimpose penalties and mandates. 
If you are a red State, you can go in a different direction where folks 
in your State get a tax credit, again, sufficient for the premiums. Not 
everybody will be eligible--typically, lower income folks--and this 
credit can only be used for health insurance or healthcare. If you do 
nothing, you end up with a health savings account, prefunded. You have 
first-dollar coverage.
  If you have to take your daughter to the urgent care center--instead 
of an ObamaCare $6,000 deductible, when your daughter has her earache, 
you have first-dollar coverage to pay that $150 to get your child seen 
and to buy the antibiotics. If the mother instead wishes to pool her 
family's health savings accounts together, their tax credits together, 
she could buy a richer family policy or she could assign it to her 
employer as the employee's contribution on employer-sponsored 
insurance. The patient has the power.
  I should say, in my medical practice, I found that if the patient has 
the power, the system lines up to serve the patient.
  By the way, just a rule of thumb: If you ever go to a hospital that 
delivers babies and you walk in, it is clear who has the power. The 
walls are painted mauve or powder blue or pink. There is a concierge to 
park your car because women don't like to walk in parking lots at 
night. And if you are pregnant, you really don't want to walk at all, 
so someone parks your car for you. There is a coffee shop as you walk 
in, and a floral shop. It is all a therapeutic experience that 
addresses not just the physical need but the emotional and 
psychological need, and that is because that system is lining up to 
serve her, that patient. The Patient Freedom Act incorporates that.
  By the way, we also have a third option. If a State doesn't want to 
have anything to do with this, the State can say: Take a hike; we don't 
want you. But generally, States have three options, and that recognizes 
a conservative principle that States should have the right to do what 
they want to do and what works best for the State. But we do require 
the patient have the power.
  Now, I will be frank. I am not sure we are going to pass meaningful 
reform as good as it could be with only the Republican side of the 
Senate. So aside from asking my Senators to join with me and my 
Republican Senators to promote something that fulfills President 
Trump's pledge, I ask my Democratic colleagues to look beyond 
partisanship and to say: Wait a second; wouldn't it be good if a blue 
State could do a blue thing and a red State could do a different plan 
for themselves? Wouldn't it be good if President Trump, in his contract 
with voters, said: Eliminate mandates but also lower premiums, which 
are so much of a problem for so many Americans now, while at the same 
time covering and caring for those with preexisting conditions.
  I ask my Democratic colleagues to move beyond partisanship--or 
perhaps they are not liking the results of the election--and into a 
spirit of cooperation that puts patient before party. We don't need a 
red plan or a blue plan, a Democratic plan or Republican plan. We need 
an American plan.
  I will finish by saying this. There is another way to lower premiums, 
and that is to give lousy coverage. I coined the phrase, and I didn't 
realize it would become so instantaneously recognized, but we should 
also have the Jimmy Kimmel test. I think people understand that Mr. 
Kimmel's child was born, and instead of being a celebration as a new 
life emerges into the world, all of a sudden it quickly became that the 
child was blue and would die. The whole medical staff comes in, 
recognizing that the child has a rare cardiac condition that, if not 
immediately operated on, would be fatal. The child was transferred, and 
after several surgeries already in its first week of life, apparently, 
is doing well.
  I raise that because, again, we can lower premiums by having lousy 
coverage. But whatever we do to lower premiums, it should pass what I 
call the Jimmy Kimmel test, which is that someone you love has adequate 
coverage for the care he or she needs when they need it. In that way, I 
think we can be fiscally responsible, and we can help someone like my 
family or the man I talked to yesterday, paying $20,000, $30,000, 
$40,000 for their insurance. We have to do something about

[[Page S2832]]

that and at the same time fulfill the rest of President Trump's 
contract with the voters which is to care for those with preexisting 
conditions, to continue coverage, and to eliminate mandates.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Hoeven). Without objection, it is so 
ordered.
  Mr. WYDEN. Mr. President, after some chaotic weeks of hush-hush 
deliberating, a lot of arm-twisting, and more than a few obvious buy-
offs, the House has handed the Senate a healthcare bill that will 
plunge tens of millions of Americans into suffering. With it, the 
debate now comes to this side of the Capitol, and my Republican 
colleagues seem to be competing to find out who can put the most 
distance between themselves and the House bill.
  The message is that they are starting from scratch with a partisan 
working group and a new bill under construction. But I want to make 
sure that everybody is realistic about where this debate stands. There 
is not a shred of actual hard evidence that the Senate Republican 
conference is objecting to nearly $1 trillion in tax breaks for the 
wealthy and the special interests, paid for by slashing middle-class 
tax benefits and cutting more than $800 billion out of Medicaid. The 
dates, the numbers, and the waivers might look a little different when 
Senate Republicans write a bill, but the underlying framework will be 
the same.
  This process, in short, is leading America back to the days when 
healthcare worked only for the healthy and wealthy. It is clear, when 
we look at the particulars, that the bill passed by the other body 
doesn't care whether you are young or old. It poses a threat of pain 
across all generations.
  So this afternoon, as I begin what will be a series of discussions 
here on the floor in the days ahead to discuss these issues, I want to 
talk about what we are dealing with now.
  Under the House bill, the youngster who needs special education 
services could see that set of opportunities disappear with cuts to 
Medicaid, a key source of funding for special ed school programs.
  Are the tax breaks in this bill for the wealthy worth depriving kids 
of the opportunities they need to get ahead in life?
  Under this bill, the young adult at 18 or 20 who has been through a 
cancer scare could wear that preexisting condition like a scarlet 
letter. They could face discrimination by insurance companies for life 
if their coverage ever lapses for more than a few weeks.
  Are the tax breaks in this bill worth exposing Americans with 
preexisting conditions to this danger?
  The 45-year-old who thought she was home free with an employer-
sponsored plan that avoids the worst insurance company abuses could 
once again face a lifetime limit on certain health coverage. They would 
be at risk for personal bankruptcy if they suffer the wrong kind of 
injury or come down with the wrong kind of illness.
  Are the tax breaks in this bill worth putting insurance companies 
back in the driver's seat? The 60-year-old, still years from 
retirement, would get clobbered by what I call the age tax, charged up 
to five times as much as a young person for insurance coverage. Are the 
tax breaks in this bill worth reviving insurance company abuses like 
this?
  Not even the most vulnerable seniors are spared under this bill. 
Medicaid helps cover the tab for nearly two out of three seniors in 
nursing homes. They are people who have done everything right. They 
worked hard, they scrimped, and they saved. They raised their kids and 
put them through school. You see them in Ohio communities, and you see 
them in Oregon communities. But colleagues, growing older in America is 
not cheap, and these are people who spend down their savings, and that 
is when Medicaid steps in. But if Medicaid funding is slashed, the 
nursing home benefit and other critical long-term care services like 
home-based care are going to be in danger.
  Every one of us wants their loved ones to be cared for. But the fact 
is most families are already walking an economic tightrope in this 
country, balancing their mortgage and their gas bills and struggling to 
save for college and retirement. Where would working mothers and 
fathers today possibly find the money to pay for nursing home care for 
their elderly parents, perhaps $90,000 or more? Are the tax breaks in 
this bill worth putting seniors' nursing home care at risk?

  I spent this weekend holding townhall meetings in Oregon, holding 
healthcare roundtables at home in Oregon. It would be hard to overstate 
the fear and the tears I heard in conversations about this legislation.
  Oregonians recognize that in many ways, this proposal is a return to 
an era when insurance companies had more power and the typical American 
had less, when women were penalized simply because of their gender, 
when for many a preexisting condition was a death sentence, when 
insurance companies deciding what preexisting conditions they would 
cover constituted a real death panel. Even worse, the system would 
invite young and healthy people not to buy insurance unless they needed 
it at that particular moment, which would drive up costs for everybody 
else.
  Bottom line: You cannot revive a failed, abusive health insurance 
system and expect Americans to be very pleased and excited about it, 
especially when it is part of a scheme to pay for tax breaks for the 
wealthy. That is what my Republican colleagues are attempting. I 
understand why they are doing it. What they want to do is, in effect, 
get these tax breaks for the wealthy in a health bill so they can have 
it teed up to get more tax breaks for the wealthy in a tax bill. That 
is what this is really all about. Even casual watchers of the debate 
understand that this bill--the tax cuts, in particular, are stacked in 
favor of the fortunate few.
  Every time you get a paycheck in North Dakota or Oregon or anywhere 
in America, a little bit for Medicare is taken out of that paycheck. 
Working people can see it; it is right there on their paychecks. A 
little bit is taken out. Under this bill, the only people who get a 
break on that contribution are at the very top of the income scale.
  Furthermore, the tax break on investment income will be swallowed up 
by the wealthy almost in its entirety. People with incomes over $1 
million will get an average break of more than $50,000--almost as much 
as a typical family earns in an entire year. Most of that tax break 
goes not to just the millionaires but to those at the uppermost slice 
of the income scale. They are the fortunate individuals who make money 
from wealth, not from wages like most Americans.
  The 120,000 wealthiest families in the United States--those who bring 
in around $2 million a year, mostly from capital gains, interest, and 
dividends--would get an average tax handout under the House bill of 
$207,000. This is according to the Tax Policy Center, a well-respected 
group who analyzes these matters. I can tell you, even conservative 
health policy experts are looking at this bill and scratching their 
heads, trying to determine how this constitutes an improvement over the 
system that is on the books today.
  Aside from the wealthy individuals and corporations lining up for 
these tax handouts, it is hard to see who will be helped by this 
approach Republicans have taken.
  It is a worrying sign for anybody who believes in bipartisanship to 
see that Republicans in this body have decided they don't want any 
Democratic input. I have been involved in writing bipartisan health 
bills in the past, and there are more than a few cosponsors of those 
bills in the Republican conference today. A number of our colleagues on 
the other side of the aisle have joined me in efforts, for example, to 
have loophole-free, air-tight protection against discrimination against 
those with a preexisting condition.
  It is important to understand that a lot of us on this side of the 
aisle--and my colleague, the President of the Senate, knows it from our 
work on infrastructure--would very much like to work with colleagues on 
the other side on bipartisan issues. It can be done. In fact, just 
today, under the leadership of Senator Schumer, our whole caucus said 
to the Republicans: Drop reconciliation so we can all come together and

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get serious about working in a bipartisan way on an issue that ought to 
be tackled in a bipartisan way for the American people and that I have 
a long history, in particular, of wanting to be part of.
  For the next several weeks, I will be on the floor drawing on our 
past experiences and underlining why the partisan approach underway 
right now is wrong.
  People ought to know that TrumpCare is a betrayal of the promises 
they have heard time and time again. They heard it through hundreds of 
TV commercials all through the election period, and what they are now 
seeing is a betrayal of those promises they watched on campaign 
advertisements over the last year.
  People ought to know that this is not a real effort at fixing our 
healthcare system. This is a masquerade. It is a masquerade to try to 
pretend that what is going on is about healthcare when it really is 
about making sure taxes can be cut for the most fortunate, while 
healthcare benefits for the middle class are slashed. TrumpCare is the 
opposite of good health policy. There is no grassroots campaign I know 
of clamoring for the Congress to pass another round of the same old 
handouts to special interests, donors, and powerful individuals.
  The American people are counting on the Congress to improve the 
health system and make their care more affordable. Congress ought to be 
working together on injecting more competition into the insurance 
markets and reducing out-of-pocket costs for families. We ought to be 
working especially on bringing down prescription drug prices. In my 
view, you can't really build a modern health system unless you address 
the challenges posed by chronic conditions such as diabetes, cancer, 
and Alzheimer's.
  We want it understood that Democrats want to work in a bipartisan way 
to improve the Affordable Care Act. That is the heart of the letter 
that all Senate Democrats signed today--we all went together--making it 
clear that we would like to see Republicans drop reconciliation and 
come together so we can find common ground. That would be in the 
country's interests, rather than using this go-it-alone process that is 
called reconciliation but specifically rejects bipartisanship.
  I am going to be on the floor a lot over the next several weeks. I 
promised my constituents night and day over the course of last 
weekend--and people kept saying night and day, day and night--because 
the country feels that strongly about this.
  I and others are going to hold our colleagues on the other side of 
the aisle accountable because we all ought to agree that this country 
cannot go back to the days when healthcare was for the healthy and the 
wealthy. Those preexisting conditions could be a death sentence. And 
that is because if you were healthy, you had no problem. If you were 
wealthy, you could write out the checks. But if you had a preexisting 
condition, you were in very serious straits. People told us about 
losing their homes and everything they had. We are not going back to 
the days in America when healthcare was for the healthy and wealthy.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.