[Congressional Record Volume 163, Number 84 (Tuesday, May 16, 2017)]
[Senate]
[Pages S2938-S2939]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. DURBIN. Mr. President, I had a meeting last week in Illinois, and 
I asked hospital administrators, doctors, nurses, pediatricians, those 
who are in the substance abuse treatment area, what they thought of the 
Republican bill. It was all Republicans who passed the healthcare 
finance act, whatever the name of it is--their version of the 
healthcare system that they are calling for reform in the House of 
Representatives. It was interesting. They were unanimously opposed to 
it, all of them--hospital administrators, doctors, nurses, 
pediatricians, across the board.
  Why would all the medical providers in my State be opposed to the 
Republican plan that just passed the House of Representatives? Well, 
because they have read it. Here is what they found. It threatens the 
survival of downstate and inner city hospitals. The Illinois Hospital 
Association came out against the Republican plan and said we could lose 
60,000 jobs in Illinois, and we could see cutbacks in services in our 
hospitals.
  I know the Acting President pro tempore from the State of Oklahoma 
knows what rural hospitals mean to these small towns. It is not only 
life and death to have access to quality healthcare, they are some of 
the best paying jobs in town. The thought that those hospitals are 
going to see services cut back, people laid off is worth sitting up and 
taking notice.
  They also are worried because the Congressional Budget Office never 
gave an analysis of the Republican plan that passed the House of 
Representatives. That is unheard of. When we passed the Affordable Care 
Act in the U.S. Senate, we waited week after weary week for the 
Congressional Budget Office to analyze each of the major changes. We 
didn't want to make a mistake, and we felt obligated to tell the 
American people what we were doing to the healthcare system, which is 
one-sixth of the national economy.
  Somehow the Republican leaders in the House of Representatives paid 
no attention to that and passed a bill without a Congressional Budget 
Office analysis. Possibly it is because the first version of that bill, 
which was analyzed by the CBO, found that it was devastating. Twenty-
four million Americans would lose their health insurance under the 
Republican plan in its first phase. Twenty-four million Americans lose 
their health insurance.
  In Illinois, 1 million people--in a State of 12\1/2\ million people, 
1 million people living in my State would have lost their health 
insurance coverage by the plan proposed initially by the Republicans in 
the House, and we also know it would shorten the lifespan of Medicare, 
for one thing. We know it allowed for waivers by Governors to eliminate 
what they call nonessential services in health insurance.
  One of them hits close to home. I can remember as a new Senator 
coming to the floor and watching Paul Wellstone, who used to be at that 
desk, and Pete Domenici, who used to be at that desk, get up on a 
bipartisan basis and argue again and again that every health insurance 
plan in America should cover mental illness and substance abuse 
treatment. It seems so obvious, and yet they had to fight the insurance 
industry for years before we finally achieved it. Now when you buy 
health insurance in America, it covers mental illness and substance 
abuse treatment. Thank goodness. We need it. We desperately need it. 
Yet that becomes one of the nonessential elements in the Republican 
analysis of health insurance.
  What are they thinking? Have they listened or read recently about the 
opioid and heroin crisis in America? I have sat at tables with victims, 
addicts who, thank goodness, had an intervention, had an opportunity, 
and now can speak of their addiction in the past tense.
  These are amazing young people whose lives were compromised and 
threatened because of addiction. How did they turn the corner? They 
turned the corner because of loving families, their personal 
determination, and the availability of medical treatment under their 
health insurance plans.
  Now the Republicans are arguing in the House of Representatives that 
we don't need that coverage, we don't need that protection. We do now 
more than ever.
  When I hear the Republican leader come to the floor and criticize the 
Affordable Care Act, I basically have to ask him, Is this a problem 
that is of your own creation?
  The Republicans, including the leader, have refused to sit down with 
Democrats and work on a bipartisan solution. In fact, when the 
Republican leader sat down to determine how the Senate would respond to 
the House action, he put together a group of, I believe, 12 Republican 
Senators--no Democrats allowed--to sit down and write the alternative. 
That is not a good way to start this.
  What we ought to do is to say, first, we are not going to repeal the 
Affordable Care Act; we are going to improve it, and we will do it on a 
bipartisan basis. If the majority leader wants to suggest that, I would 
like to be part of it. Many Democrats would like to be part of it. Take 
repeal off the table before the conversation on repair begins. I think 
that is essential. Let's make sure that within health insurance in 
America we have some basics.

  First, if you have a preexisting condition, you shouldn't be 
disqualified from

[[Page S2939]]

health insurance or you shouldn't have to pay twice the premiums. That 
is something that is now built into the law that the Republicans want 
to repeal. Well, I want to make sure that preexisting conditions are 
protected.
  As I have said on the floor before, a couple of weeks ago I had a 
heart procedure, a catheter procedure, an outpatient procedure. 
Apparently it worked pretty well. I am standing here talking to you 
today. I feel good. But a lot of people go through this, and I became a 
statistic the day that happened. I guess I now have a preexisting 
condition; so be it. One out of three Americans fit that category. Why 
would we not protect them in any health insurance reform bill? That 
seems like the starting point in our conversation. Yet the bill that 
passed the House, the Republican bill that passed the House allows 
Governors to basically ask for waivers so that health insurance plans 
in their States will not cover people with preexisting conditions or 
allow people with those conditions to have the same premiums. That is 
not a good starting place. It is a terrible starting place.
  Let's try to make sure that if we are going to move forward on real 
healthcare reform, we do it in a sensible fashion. Let's put forward a 
bill not like the one that passed the House, but let's put together a 
bill that has the support of hospital administrators across the Nation. 
Let's put together a bill that protects the Medicaid expansion that is 
part of the Affordable Care Act.
  Medicaid is an essential part of healthcare in America for tens of 
millions of people. Medicaid--most people think, oh, that is health 
insurance for poor people. Really? That is not an accurate description. 
For example, in the State of Illinois, Medicaid provides health 
coverage for half of the children who are born in my State--prenatal 
care, postnatal care, and the actual delivery of half of the children 
in my State, under Medicaid.
  That is not the most expensive part of Medicaid. The most expensive 
part in my State and across the Nation is the fact that Medicaid is 
there to help your mother or grandmother or your dad or your 
grandfather when they are in a situation in life where they need a 
helping hand. They may be in an assisted care facility, and the Social 
Security check is not enough; Medicare is not enough. Medicaid steps in 
to make sure they have the quality of care they need. Are we going to 
eliminate that kind of protection?
  Ask disabled people and ask the organizations that represent them 
what it means to have a good strong Medicaid system. These people rely 
on Medicaid for maintaining their health through disability, day in and 
day out.
  So when the Republicans propose an $840 billion cut in Medicaid 
protection across America over 10 years, sadly, they are setting out on 
a path that could compromise the basic care we need for babies and new 
moms, for the elderly in assisted care facilities and nursing 
facilities, and for the disabled who live in our States. We don't want 
to see that happen.
  It is interesting that my Republican Governor in the State of 
Illinois seldom comments on Federal legislation. He came out in 
opposition to the bill that passed the House of Representatives. He 
said that this is a significantly bad bill for the State of Illinois, 
and I agree with him. I am glad he spoke up. I don't know how the seven 
Republican Congressmen who voted for it in my State can ignore that 
reality. Our Governor--our Republican Governor--believes it is bad for 
our State in cutting back Medicaid. The hospitals believe it is bad for 
our State in the impact that it will have on down-State hospitals. 
Doctors, nurses, and pediatricians also oppose it.
  What can we do? What should we do? First, we ought to try to see what 
we can do to make the Affordable Care Act work better. We can do that 
on a bipartisan basis. We want to make sure, as the Senator from 
Kentucky said earlier, that there are available health insurance 
programs in every county of every State. Certainly, one thing we can do 
is make sure that a public option is there for everyone if they choose 
it--something that looks like Medicare.
  People respect Medicare. Medicare is a great program for millions of 
Americans who are seniors and disabled. Why wouldn't we create a 
program like Medicare--a not-for-profit, government-operated program 
like Medicare for people who wish to have it? Those who don't can stick 
with private insurance if that is their choice, but I believe more and 
more people will move toward the Medicare option. That is something I 
would like to put on the table in reforming the Affordable Care Act.
  Secondly, we need to address the cost of pharmaceutical drugs in 
America. The costs are out of control.
  This week I received a publication from the AARP, the American 
Association of Retired Persons, and they are talking about what is 
happening to pharmaceutical prices across America. You don't have to 
tell seniors or those who buy prescription drugs what the reality 
happens to be.
  Let me give you a few numbers to demonstrate why we need to have a 
new program to make sure drug prices don't go out of control. According 
to AARP, Americans spent $457 billion on prescription drugs in 2015, up 
about 8 percent over the previous year--$457 billion. The rise in 
prices for the most popular brand name drugs from 2008 to 2016 is over 
200 percent. They have more than doubled in that 8-year period of time 
for the most popular drugs.
  The median salary of a pharmaceutical firm's CEO in 2015 was $14.5 
million, more than any other industry; $6.4 billion is the amount drug 
companies spend advertising directly to consumers in the U.S. annually; 
$24 billion is the amount drug companies spend per year marketing to 
doctors. We are one of only two nations in the world that allows direct 
consumer advertising. Think about what that means.
  When you see all these ads on television for drugs with names you 
can't pronounce, why are they doing it? It is because the drug 
companies know that consumers across America will write down the name 
of the drug and go ask the doctor to prescribe it. Many times, the 
doctor, rather than debate the issue with the patient or suggest they 
don't need it or should use a generic, will just write out the 
prescription. What happens? More expensive drugs get into the system, 
raising the cost of healthcare, raising the cost of premiums for health 
insurance. It doesn't make us healthier; it just means healthcare is 
more expensive.
  I love to listen to the warnings on these drugs that go on and on and 
on. One of my favorites was this: Be sure and tell your doctor if you 
have had a liver transplant. I am thinking to myself, yeah, I think I 
would probably mention that somewhere along the way to a doctor.
  These warnings should give us fair warning that this is inflating the 
cost of healthcare across America. It is not making us healthier, and 
it is running up profits dramatically for pharmaceutical companies. Why 
is it that exactly the same drugs made in the United States sell for a 
fraction of their cost in America in places like Canada and Europe? It 
is a legitimate question. We ought to address it. Do we have the 
political nerve to do it? I hope so, as part of the Affordable Care Act 
reform. I hope we sit down and do something on a bipartisan basis to 
deal with the challenges we face, but first, take repeal off the table.
  Let's make the Affordable Care Act stronger. Let's do it on a 
bipartisan basis. Let's set out to come up with a solution that doesn't 
do what the House version did, which could eliminate health insurance 
for millions of people across America and a million people in my State 
of Illinois.
  Mr. President, I yield the floor.