[Congressional Record Volume 163, Number 82 (Thursday, May 11, 2017)]
[Senate]
[Pages S2898-S2901]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Madam President, I also want to address an issue that came up in 
debate last week in the U.S. House of Representatives; that is, the 
question of the repeal of the Affordable Care Act. This is an issue 
where reasonable people can disagree about how exactly to run our 
healthcare system.
  But at the end of the day, I hope that, as with medical research, we 
can all come together with some basic issues. Congress should not pass 
a law taking away health insurance coverage from Americans. Let's start 
there. Congress should work together on a bipartisan basis to find ways 
to reduce the cost of healthcare and health insurance premiums. I think 
we should agree on that too.
  Third, we have to find a way to make sure that consumers and families 
across America are protected with health insurance that is there when 
they need it. Now, it was a little over a week ago when I became a 
statistic--not just a Senator but a statistic--in healthcare. I went 
through a heart catheter procedure in Chicago last week on Tuesday. 
After that procedure--which turned out just fine; thank you--I am a 
statistic. I am a person in America with a preexisting condition. I 
have to check that box that says I have had a heart procedure.
  It used to be if you checked a box like that--diabetes, asthma, 
whatever you checked--it ended up having a direct impact on what you 
paid for health insurance or whether you could even buy it. There were 
people who survived cancer--children, adults--who could not buy health 
insurance because they were too big a risk for health insurance 
companies.
  Well, we changed that. The Affordable Care Act changed that and said: 
Just because you have a preexisting condition--and one out of three 
Americans has one--you should not be denied coverage. Now, the House of 
Representatives passed a bill that allows Governors literally to take 
away that requirement in health insurance plans. What are they 
thinking?
  Do they think they are so darn lucky that they will never have an 
accident, never have a diagnosis where they end up with a preexisting 
condition? It can happen to anybody, and it does. So what the House of 
Representatives did in this regard is a step backward.
  They also changed the Medicaid system. People have this image, when 
you say Medicaid: Oh, that is the same as Medicare. No, Medicare is for 
seniors and disabled people. Medicaid is a policy of health insurance 
that is available for people who do not have a lot of money. Well, who 
qualifies for that? Well, it turns out that the largest number of 
people who qualify for Medicaid are children and their moms.
  In my State of Illinois, half of the kids who are born in the State 
are covered by Medicaid. So the moms, when they need prenatal care to 
make sure the babies are healthy, and the babies, when they need care 
after the hospital, rely on Medicaid. But that is not the most 
expensive thing when it comes to Medicaid. The most expensive thing in 
Medicaid are your moms, your grandmoms, and granddads who are in 
nursing homes. You know what happens? They reach a point where they 
need to be in a place where folks can watch them and help them.
  They have medical issues and age is taking its toll. But many of them 
get there, and all they have is Social Security and Medicare, and it is 
not enough. So Medicaid steps in and supplements it so that your mom, 
your dad, or your grandmother can stay in that place, which is good for 
them, secure, safe, and with the right kind of healthcare. The other 
group that relies on Medicaid the most in their daily lives are 
disabled people, folks who are born with a disability or have acquired 
one in life and they need ongoing medical care they cannot personally 
afford.
  Children and their moms, elderly folks in nursing homes, and disabled 
people depend on Medicaid. So what does the Republican bill that passed 
the House of Representatives do to the Medicaid Program across America? 
It ends up cutting over $800 billion in coverage. What it means in 
Illinois is that 1 million people--out of our 12.5 million population--
are likely to lose their health insurance because of the action taken 
by the House of Representatives.
  Even my Republican Governor in Illinois came out publicly and said 
what they did in the House of Representatives is disastrous for our 
State. It has a significant negative impact on the cost of healthcare 
and the coverage of health insurance. So why would we want to do that? 
Why would we want to take health coverage away from the groups I just 
mentioned?
  Do we want to put less money in prenatal care? Well, if we do, we run 
the risk that children will be born with problems and challenges that 
could

[[Page S2899]]

cost us a fortune and compromise their lives.
  Do we want to put less money into supporting elderly people who are 
in nursing homes? Well, what are they going to do? What are they 
supposed to do? If they can't stay in a place that is good for them and 
with the right kind of care, does that mean the family now has to find 
a spare room for grandma or your mom? I hope not. These folks want to 
live in dignity, and they don't want to be in a situation where they 
have to look for charity or beg for help from their families.
  The third group is disabled people. For goodness sakes, we are lucky. 
We have people with disabilities who are doing amazing things today. 
But many who are in lower income categories need the help of Medicaid.
  I had a group of hospital administrators come in to see me this week 
from Illinois. They were from every part of the State. If you go down 
to our beautiful Southern Illinois area, there are some great towns. 
One of them is Anna, IL, right near Cobden, IL. It is down in the 
southern end of our State. It is a very rural area with smaller towns.
  Then I had administrators in the same group from Quincy, IL, from 
Springfield, IL, my home town, and from the city of Chicago. They all 
came here to tell me the same thing: The bill that passed the House of 
Representatives last week is a disaster when it comes to Illinois 
hospitals. They estimate they are going to lose up to 60,000 people who 
are currently working in hospitals in Illinois, because of that bill, 
and they are also going to see closures and reductions in services at 
these same hospitals while we see the Medicaid cutbacks take place.

  Now, why is that? Let's assume you have a small rural hospital in a 
town that you live in. If you do, you value it very much because that 
means there is healthcare there, right next door, when you need it. You 
don't have to drive 50 miles or more. You have it right there. You also 
know it is a great employer in your area. You also know, as well, that 
that is the way you keep a lot of businesses in your town and attract 
new ones.
  So what these hospitals are telling us is that the bill that passed 
the House of Representatives to repeal the Affordable Care Act is a 
threat to the future of those hospitals. If the patients don't come in 
covered by Medicaid and pay for some of their services, the hospitals 
will still treat them, but they are charity patients, then, and the 
hospitals have to charge every other patient more because of it.
  So that is a terrible way for us to approach healthcare reform in 
America. That is the reality of what we face today. I am troubled by 
the fact that this bill, which passed the House of Representatives by 
two votes--two votes--if two Congressmen had voted the other way, this 
bill would not have passed. This bill was never reviewed by the 
Congressional Budget Office. Well, who cares? I care.
  For everything we do that is supposed to be that important to affect 
the American economy, we are supposed to go to the nonpartisan experts 
and ask them: Well, what does this really do? We have been held to that 
standard--Democrats have and Republicans, too--until now. Now, we have 
this decision by the House of Representatives to pass this bill 
affecting America's healthcare system--one-fifth of our economy, I 
might add--and they never went for an analysis to the Congressional 
Budget Office.
  That has never happened before. They did it anyway. You know why they 
did it? Because the first version of this bill was a disaster. They 
sent that bill in for an analysis--24 million Americans losing their 
health insurance over the next 10 years. It was a disaster. They were 
afraid they would get the same analysis on the second bill. So they 
never sent it in for the analysis. In 2 weeks, we are going to have the 
numbers.
  But it really gives you fair warning that this bill could be very 
hurtful to a lot of people across America, and yet it passed the House 
of Representatives. So today people say to me in Illinois, when I have 
town meetings: Well, we are listening to you, Senator. But what do you 
want to do about healthcare today? What would you change in the current 
system? Well, let me tell you first. I voted for the Affordable Care 
Act. I believe in it. The number of uninsured people in America--the 
percentage--has been cut in half because of the Affordable Care Act. Is 
it perfect? Of course not. Does it need to be changed? Yes.
  I can give you two or three specifics, and I will. First, we have to 
do something about the price of drugs in America--pharmaceuticals. You 
see what is happening. Hedge funds are buying the rights to drugs and 
raising the prices two, three, four, and ten times because they have an 
exclusive drug. There is a family I have come to know who has a young 
son who is in high school in Chicago. He has diabetes. He is an amazing 
kid. He is going to be a great success in life. He has fought diabetes 
for years and years. His mom and dad have stood behind him.
  They came in to tell me: Do you know what has happened to the cost of 
insulin--insulin--which diabetics need dramatically? It has gone up 
two, three, four, and five times in the last few years for no reason 
other than that they can charge it. Of course, a person with diabetes 
may be dependent on that insulin even to survive.
  So the first thing we ought to do when we look at the healthcare 
system is figure out how to make sure that we have reasonable pricing 
when it comes to pharmaceuticals. Of course, I want them to make a 
profit. Those pharmaceutical companies, with a profit motive, will keep 
doing research to find the next drug. But do I want these hedge funds 
and others--investment bankers--to buy out the rights to those drugs 
and drive their prices through the roof? That is not fair. It adds 
dramatically to the cost of healthcare.
  Blue Cross Blue Shield is one of the biggest insurers in America. It 
is the biggest in my State of Illinois. My wife and I have a plan with 
them. So the head of Blue Cross Blue Shield came to me, and she said: 
Senator, did you know that last year Blue Cross Blue Shield paid more 
for pharmaceuticals than they paid for inpatient hospital care? What? 
Inpatient hospital care, people who have to come in for surgeries and 
things--you paid more for pharmaceuticals?
  Yes.
  Well, there are things we can do about it. I have legislation that I 
have introduced that reviews the pricing on pharmaceuticals, holds the 
pharmaceutical companies accountable. I take a position on an issue 
that all of my colleagues don't share, but I want to share it with you. 
There are only two nations in the world--only two--that allow 
pharmaceutical companies to advertise on television. The United States 
and New Zealand.
  Well, what difference does it make? Have you turned on the TV lately 
and tried to find a show that did not have ads about pharmaceuticals? 
Have you tried to write down the names of some of those pharmaceuticals 
so that you might remember them if it is something of interest? Have 
you tried to listen to the warnings that they give you about all of 
these pharmaceuticals?
  Well, some of the warnings are amazing: If you have had a liver 
transplant, be sure and tell your doctor. Well, yes, that explains that 
incision. A liver transplant? Why do they do that? Why do they buy all 
of those ads on television? Real simple. If you have some condition, 
and they talk about it in one of those ads, you are going to ask your 
doctor about that drug, and it is likely, in many cases, that doctor, 
then, will end up prescribing that drug.
  Is it necessary? It may not be. Is it the cheapest form of the drug? 
It may not be. So, then, why does the doctor write the prescription? 
Because it is easier to do that than a 10-minute stop in the office for 
him to sit down with you and patiently explain: You don't need this 
drug, or you can use a generic, or we ought to wait a while before we 
go into this.
  The result of it is that more and more pharmaceutical companies have 
their drugs being prescribed and more and more profits coming their 
way. So I, for one, think that this direct consumer advertising is 
really hurtful in terms of the cost of healthcare in our country, and 
it is something we ought to deal with. I would make that part of the 
reform of the Affordable Care Act.
  The second thing we need to do is to make sure, I believe, that in 
every place in America, if you so choose, you can choose a Medicare-
type public plan

[[Page S2900]]

to cover your family. Right now, it is private health insurance 
companies. You may choose to stick with the private health insurance 
company. That should be your choice. But you also ought to have a 
Medicare-type plan.
  Over 50 million Americans are covered by Medicare, and most of them--
the overwhelming majority of them--are happy with Medicare. What if we 
had a Medicare-type plan, a public option, available to every American 
to choose if they wish? I think that could reduce the cost of 
healthcare, and I think it is an option we ought to consider.

  The third point I would make is that when we are dealing with 
reforming the healthcare system, we have one group in particular who is 
giving us a real challenge: individuals who are buying health 
insurance. The vast majority of Americans get their health insurance 
through their employment and many others through Medicaid--a program I 
described earlier--and then there is that group out there buying 
insurance on the open market. They are the ones who are seeing the 
runup in premiums and costs and overruns that they have to face, seeing 
copayments going up and the like. We need to find a way to deal with 
this group to give them affordable health insurance. There are a lot of 
ways to approach that, but that ought to be a target of what we do for 
the ones who are facing the toughest increases in health insurance.
  I will just say this too: The good news about this conversation in 
the Senate is that it is finally reaching a new level. Now there are 12 
Republican Senators who are meeting with Senator McConnell, and they 
are setting out to draw up a plan and try to pass it with just 
Republican votes. I hope that does not succeed, and I will tell you 
why. If we can do this on a bipartisan basis and sit down in good faith 
and work out these improvements to the Affordable Care Act, that is the 
best option for this country. Senator Collins of Maine and Senator 
Cassidy of Louisiana are trying to start that conversation. I have said 
to them that if this is a good-faith effort not to repeal the 
Affordable Care Act but to repair it, I want to pull a chair up to the 
table.
  Let's have this conversation. We may not agree, we may not be able to 
come up with the best solutions, but the bipartisan approach of solving 
the current problems with the current healthcare system is a much more 
sensible thing to do than to have an all-Republican bill trying to 
force its way through here. I hope that doesn't happen. It is far 
better to do this on a bipartisan basis, and I hope that is what will 
be done.
  I will be going home, as I do regularly, to talk about the impact of 
the bill passed by the House of Representatives. I have just touched on 
some of the major points of it.
  There is one thing I do want to mention, though. It has an age tax in 
it that many people between the ages of 50 and 64 may not be aware of.
  Currently the law says that there cannot be a disparity of difference 
in premiums charged of more than 3 to 1; that is, the most expensive 
premium charged to someone for health insurance, no matter what their 
health or condition, cannot be more than three times the lowest premium 
charged. That is current law. The bill passed in the House of 
Representatives changed that dramatically. It says: Instead of 3 to 1, 
let's make it 5 to 1. Who is going to pay the difference? Folks who are 
older and those facing chronic illness.
  If you are between the ages of 50 and 64, watch out for your health 
insurance premiums under this measure that passed the House of 
Representatives. That is something which should not have been included. 
That is why the American Association of Retired Persons has come out 
against this bill. It is another reason we have to ensure that the bill 
that passed the House of Representatives does not become the law of the 
land. To have this discrimination against people because of their age 
is unfair, and I agree with the American Association of Retired Persons 
on that particular issue.
  Let's hope we can find a bipartisan path to making healthcare even 
better in America. I don't care who takes the credit for it. If at the 
end of the day more families have peace of mind with health insurance 
that they can afford, that provides them quality care when they need 
it, that is something we need to achieve.
  As I said earlier, I again learned this lesson last week. The lesson 
is simply this: If you go in for a diagnosis and learn that you need 
quality healthcare, you want to have health insurance. You want to have 
access to the best doctors and hospitals. Everyone in America wants 
that. That shouldn't be a privilege which is reserved just for the rich 
and lucky; that ought to be there for every single American.
  I believe healthcare is a right, not a privilege. If we start off 
with that premise, we can build a healthcare system in this country 
that is still the envy of the world.
  Mr. McCAIN. Madam President, today I come to the floor in opposition 
to the nomination of Robert Lighthizer to be United States Trade 
Representative, USTR. After close examination of the confirmation 
process for Mr. Lighthizer, I have come to the conclusion that Mr. 
Lighthizer does not adequately understand the positive economic 
benefits the North American Free Trade Agreement, NAFTA, has had and 
will continue to have on Arizona and our Nation. His advocacy for 
protectionist shifts in America's trade policies, including his support 
for the withdrawal from the Trans-Pacific Partnership, TPP, and the 
Trump administration's incoherent and inconsistent trade posture, have 
only solidified my opposition to his nomination to be USTR.
  As I wrote in a February piece in the Arizona Republic, coauthored by 
my colleague Senator Flake and Arizona chamber president Glenn Hammer, 
NAFTA has delivered enormous economic benefits to the United States 
since its inception in 1994, especially for the citizens of Arizona. In 
just two decades, Arizona's exports to Canada and Mexico have increased 
by $5.7 billion, or 236 percent. Mexico stands as Arizona's No. 1 
trading partner, with bilateral trade accounting for 40 percent of our 
State's exports to foreign markets in 2015 and totaling $9.2 billion. 
Arizona's trade relationship with Mexico also directly supports more 
than 100,000 Arizona jobs.
  While I understand NAFTA could be strengthened and modernized, any 
efforts by this administration to withdraw from NAFTA or impose new 
restrictions or barriers on our ability to trade with Mexico and Canada 
will have serious consequences for Arizona, including massive job 
losses for workers and dramatically higher costs for consumers. 
Furthermore, I am troubled by the need for and the process by which 
Congress recently granted Mr. Lighthizer a waiver to serve as USTR 
given that he previously represented a Brazilian and Chinese client in 
trade litigation matters. As part of the Lobbying Disclosure Act of 
1995, Congress adopted my amendment to prohibit an individual from 
serving as U.S. Trade Representative or Deputy U.S. Trade 
Representative if that person has ``directly represented, aided, or 
advised a foreign entity'' in ``any trade negotiation, or trade 
dispute, with the United States.'' Ultimately, the waiver was tucked in 
the must-pass omnibus spending bill, with no chance to debate or vote 
on such an important trade related policy.
  As Senator Sasse and I recently wrote in a letter opposing Mr. 
Lighthizer, the administration's incoherent and protectionist message 
on trade ``is especially troubling because confirming a USTR grants the 
Administration additional legal authority to negotiate trade deals that 
Congress must consider under `fast track' procedures. Given these 
circumstances, granting the Trump Administration additional legal 
powers through your confirmation without understanding how you or the 
Administration intend to use those powers would be irresponsible.''
  I plan to vote against the nomination of Mr. Lighthizer, and I urge 
colleagues to join me.
  Mr. VAN HOLLEN. Madam President, I support the nomination of Robert 
Lighthizer to be the United States Trade Representative.
  Trade agreements should meet two tests: Does the agreement improve 
worker wages? And does the agreement add American jobs? For far too 
long, U.S. Trade Representatives have prioritized profits of large 
multinational organizations over the interests of the American people 
and our country as a whole.

[[Page S2901]]

  The USTR should be someone who negotiates on behalf of the American 
worker and advances labor and environmental protections, and the USTR 
should be someone who works to enforce agreements. While I don't agree 
with everything in Mr. Lighthizer's resume, his record suggests that he 
will be a USTR who will approach trade policies in the ways I have 
outlined. I hope the approach he takes going forward will reflect the 
positions he has taken in the past. I expect him to ask: Does it 
improve worker wages? And does it add American jobs?
  I believe that Mr. Lighthizer will bring fresh eyes to trade policy. 
I hope that he will focus on increasing transparency at the USTR. I 
hope that he will stand up for worker rights, both domestically and 
internationally. I hope that Mr. Lighthizer will work to enforce trade 
policies that protect the environment.
  Mr. DURBIN. Madam President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. MORAN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.