[Congressional Record Volume 163, Number 86 (Thursday, May 18, 2017)]
[Senate]
[Pages S3025-S3027]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. MURPHY. Mr. President, I am on the floor to talk about the status 
of America's healthcare system. As we speak though, the country is 
obsessed with the question of the firing of FBI Director Comey and the 
appointment last night of a special counsel who is going to seek to get 
to the bottom of this question as to whether there was coordination 
between the Trump campaign and the Russian Government and their 
attempts to influence an American election.
  There have been secret meetings happening in the Senate among 
Republicans--reportedly 13 Republicans, to be specific--attempting to 
craft a new version of legislation that passed the House of 
Representatives, now, I guess, 2 weeks ago, that would rob healthcare 
from 24 million Americans. According to the Congressional Budget 
Office, it would drive up costs for everyone immediately by about 15 
percent to 20 percent and jeopardize the protections that are built 
into the law for people with preexisting conditions.
  There is no CBO score on the latest House proposal because 
Republicans decided to ram the bill through without the ability of 
anyone to read the legislation. No one read that bill. Let's be honest. 
It was filed hours before it was voted on, and no one knows the cost of 
that bill because they didn't wait for a CBO score.
  It is simply unbelievable that the House of Representatives decided 
to reorder one-fifth of the American economy without reading the 
proposal or without understanding its cost, but Republicans in the 
Senate are attempting to pass their own version of a repeal-and-replace 
bill. We await the results of these secret partisan meetings.
  I think Democrats have been pretty clear that we would like to be in 
this conversation. We want to preserve what works in the Affordable 
Care Act, and there is a lot that works. A new report out just a couple 
of weeks ago shows an astonishing decrease in the number of people who 
face personal bankruptcy in this country. Why? Because half of personal 
bankruptcies in the United States of America, prior to the Affordable 
Care Act being passed, were due to medical debt. So the reason that 
less people than ever before are having to declare personal bankruptcy 
is because medical bills don't bankrupt them anymore because of the 
Affordable Care Act. Let me guarantee you, that number will spike back 
up if anything approximating the House bill passes.
  We think there are good things in the Affordable Care Act. Our 
constituents agree. Polling now routinely tells you the majority of 
Americans want to keep the Affordable Care Act, not replace it, but we 
want to be part of a conversation in which we talk about keeping the 
things that work and addressing the parts of the healthcare system that 
don't work. Costs are still way too high. We would like more 
competition on these exchanges. So let's have a conversation about 
that.
  As of today, Democrats are being shut out of the process. If you are 
represented by Democrats in the U.S. Senate, you have no voice in this 
process because Republicans have chosen to do it just amongst their own 
party. I think that is a shame. I understand in the end, Democrats 
passed a product in 2010 with Democratic votes, but anybody who was 
here remembers that there was a long process by which President Obama 
and Democrats in Congress tried to work with Republicans and brought 
the bill through the committee process. The HELP Committee and the 
Finance Committee had exhaustive meetings, hearings, and markups. In 
the end in the HELP Committee, upon which I sit today, there

[[Page S3026]]

were over 100 Republican amendments that were accepted and included in 
the piece of legislation that eventually passed on the floor of the 
Senate.
  As far as we know, this secret process happening behind closed doors 
will include no Democrats now and will not go through a committee 
process. If they ever come up with something that can come up with 50 
votes, it will be rushed to the Senate floor. That is outrageous. We 
want to be part of this process.
  I am on the floor not to talk about what will happen if a bill 
robbing healthcare from millions of Americans, jeopardizing protections 
for people with preexisting conditions, comes to the floor of the 
Senate, I want to talk about what is happening right now because 
President Trump made it very clear, just a few days after he was sworn 
in, that his desire was to kill the aspects of the American healthcare 
system that are affected by the Affordable Care Act. By the way, that 
is almost the entirety of the American healthcare system because that 
bill did--in addition to extending coverage to 20 million Americans--
grant protections from insurance abuse to hundreds of millions more.
  A January 20 Executive order issued by the President said that ``it 
is the policy of my Administration to seek the prompt repeal'' of the 
law. It said:

       To the maximum extent permitted by law, the Secretary of 
     HHS and the heads of all other executive departments . . . 
     shall exercise all authority available to them to waive, 
     defer, grant exemptions from, or delay the implementation of 
     any provision or requirement in the Act that would impose a 
     fiscal burden on any State or a cost, fee, tax, penalty, or 
     regulatory burden on individuals, families, healthcare 
     providers.

  President Trump made it clear that his motive from the start was to 
destroy the Affordable Care Act. My colleagues, he has consistently 
kept up that attack. I am often bringing President Trump's tweets to 
the floor because, well, they continue to exist on social media. It is 
nice to be reminded of the fact that, over the course of the first 100 
days in office, President Trump has been routinely--routinely--
attacking the American health care system, saying: ObamaCare will fall 
of its own weight; be careful--i.e., if you are thinking of signing up, 
be careful--discouraging people from signing up for these exchanges.

  Once again, ObamaCare is dead, says the President of the United 
States, despite the fact that 19 million people rely on the exchanges 
for their healthcare coverage. Here is another one: ObamaCare will 
explode. Do not worry; he has it taken care of, he says. Finally, 
ObamaCare is in a death spiral.
  So these are the routine, almost daily attacks, rhetorically, that 
this administration has waged against the Affordable Care Act. He has 
commanded his agencies to pick it apart in any way that they can. So, 
to the extent there is any diminution in the health of these exchanges, 
to the extent that insurers are thinking about not participating or are 
pushing up their rates, there is only one reason for it. It is the 
active sabotage campaign that the Trump administration is engaged in to 
try to destroy the Affordable Care Act.
  This is purposeful. This is intentional. This is planned. That 
Executive order, unlike some other Executive orders, was not just an 
exercise in political and public relations, because the next month, in 
February, the IRS announced that it would not reject tax forms from 
people who failed to answer the question of whether they had health 
insurance. So the IRS took a definitive step to undermine the 
Affordable Care Act by telling consumers they were not going to enforce 
the individual mandate.
  Now, here is a news flash: Republicans think the individual mandate 
is a good idea. After attacking it for the last 6 years, the House bill 
they passed includes an individual mandate. It does. It is in a 
slightly different place. Instead of the penalty applying when you lose 
healthcare, in the House, all they did was just shift the penalty to 
when you sign up for healthcare again. All they did was move the 
mandate from when you lose healthcare to when you repurchase 
healthcare. But it is still there.
  The administration is seeking to undermine the existing mandate. 
Insurance companies have noticed. Senator McConnell came to the floor a 
week or so ago to take note of the pretty serious premium increases 
that were requested in Maryland, in part, by Blue Cross Blue Shield. 
But the head of Blue Cross Blue Shield in Maryland was very clear about 
why they were increasing rates.
  He said the uncertainty around the individual mandate plays a 
significant role in the company's rate filing because failure to 
enforce the mandate makes it far more likely that healthier, younger 
individuals will drop coverage and drive up the costs for everyone 
else.
  Insurance companies are noticing that the administration is picking 
apart the protections that can keep rates down in the exchanges and, 
thus, they are filing higher rates. But with less people in the 
exchanges than anticipated, insurance companies are also rethinking 
participation. This is intentional as well. Shortly after taking 
office, the HHS Secretary pulled the advertising for the Affordable 
Care Act in the last week of open enrollment. We know exactly what 
happened here because we have the data on who was signing up before 
Trump took office and after Trump took office.
  Before Trump took office, open enrollment was exceeding open 
enrollment for the prior year. After that decision was made to pull 
funding for advertising, open enrollment cratered. The former marketing 
chief for healthcare.gov estimates that 480,000 people did not sign up 
for coverage in the last week because the ads were pulled and because 
the President of the United States was out their actively telling 
people that they should ``be careful'' before signing up for the 
exchanges because he was going to kill it.
  So almost half a million Americans did not sign up for these 
exchanges. A half million Americans don't have health care today, 
potentially, because the Trump administration stopped advertising the 
exchanges and because the President of the United States told people, 
essentially, not to sign up.
  Finally, let me talk about what is happening right now with respect 
to something called cost-sharing reduction payments. A big part of the 
Affordable Care Act--and really the foundation of the Affordable Care 
Act--is subsidies that are given to individuals, often passed straight 
through to insurance companies, in order to help folks who are lower 
income buy insurance.
  Guess what. Republicans think this is a good idea too. I know that 
because we stole the idea from Republicans. This was initially a 
Heritage Foundation plan that was adopted by Mitt Romney in 
Massachusetts. It was the Republican alternative to the Clinton 
healthcare bill in 1993. So this idea of individuals getting subsidies 
is a Republican idea that Democrats stole.
  Republicans included it in the House bill. The subsidies are lower, 
but they are still there. The subsidies come in two forms. One, there 
is a tax credit to individuals based upon their income, and, two, for 
lower income individuals there is a payment that goes to the insurance 
companies that mitigates the amount of money that you have to pay out 
of pocket--just two different kinds of subsidies.
  These subsidies are relied upon by the insurance companies to 
continue to offer these products. The Trump administration is paying 
the subsidies but is trickling them out 1 month at a time, constantly 
making public pronouncements that question whether they will continue 
to make those payments.
  Here is what OMB Director Mick Mulvaney told reporters. He said the 
administration could pull the plug on subsidies at any time. He said: 
We haven't made any decisions. The payments are due, I believe, the 
20th or the 21st of every single month. We have not made any decisions 
at all on whether we will pay in May.
  Think about if you are an insurance company executive deciding, A, 
whether to put a plan on an exchange or, B, if you put a plan on an 
exchange, how much to charge, and the White House is telling you: You 
may not get the subsidies that are called for under the law, and we may 
give you no warning in pulling those subsidies. We are going to pay 
them for May. We might not pay them for June. Maybe we will pay them 
for July and August. Maybe we will pull them for September.
  How would you make a decision on how much to charge consumers? Why

[[Page S3027]]

would you enter into a contract with a State or Federal-based exchange? 
So whether it is the attack on the individual mandate, whether it is 
the decision to pull advertising, or whether it is the games being 
played with cost-sharing reduction payments, there is a coordinated 
effort inside the White House today to destroy the American healthcare 
system to the extent that much of the system has the Affordable Care 
Act at its foundation.
  President Trump was pretty clear about this the day of the failure of 
the first healthcare bill in the House of Representatives. He 
essentially telegraphed that he was going to try to undermine the 
Affordable Care Act as punishment to Democrats, and that if he hurt 
enough people, eventually Democrats would come to the table and 
negotiate with him. Well, I have a message for the President of the 
United States: That is not how it is going to work. You are not going 
to blackmail Democrats by hurting our constituents by undermining the 
Affordable Care Act.
  We want to be part of this discussion about improving the healthcare 
system. We do. We want to work with Republicans. It will be a much 
smaller and likely less revolutionary bill than Republicans are 
considering today, but it will have both party's fingerprints on it. We 
are not going to be part of a bill that strips healthcare away from 
tens of millions of Americans, and we cannot support this 
administration while it seeks to undermine the Affordable Care Act on a 
daily basis.
  If these exchanges fail--I don't think they will, but if the 
exchanges fail--or if rates go up, there is only one place to put the 
blame--on an administration that is actively, regularly, and on a daily 
basis trying to sabotage the Affordable Care Act.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi.
  Mr. WICKER. Mr. President, are we in morning business?
  The PRESIDING OFFICER. We are not. We are on the Brand nomination.