[Congressional Record Volume 163, Number 86 (Thursday, May 18, 2017)]
[Senate]
[Pages S3029-S3031]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. LANKFORD. Mr. President, we are still dealing with some of the 
same issues we have dealt with before. It is interesting to me the 
number of people who have asked: Is Congress obsessed right now with 
all of the press reports and all of the things that are happening 
around the Presidency and everything else? I have said to them that is 
one of the things on our list, but that is not what we are talking 
about the most. We are working on issues like tax reform and healthcare 
issues and regulatory issues.
  I just had three bills that went through the markup process just 
yesterday that deal with small business regulation and how we are going 
to be able to manage getting things back in order. We spent all day at 
lunch on Tuesday and we spent all day at lunch on Wednesday with our 
entire conference in a working lunch together and talked about 
healthcare policies. We are still working on trying to finish these 
issues that absolutely need to get done.
  Healthcare is one of those issues that has been one of the prime 
conversations now for years, and we are in the final stretch of 
actually working through an actual repeal and replace of multiple 
sections of the Affordable Care Act that have caused the greatest 
amount of damage, but I still have people who will catch me and ask: 
Well, there are beneficial parts. What are you going to keep, and what 
is going to go, and why do we need to replace it?
  I will typically smile at folks and say: Let me give you a quick 
recap as to why we need to replace this and what is really happening. 
It may be different in your State than it is in mine, but let me lay it 
out as to where we are and what has been said.
  Remember, back in the earliest days, the Affordable Care Act being 
passed, it was all about premiums decreasing. In my State, premiums 
went up just last year--in 1 year--76 percent in the individual market. 
It was a 1-year increase of 76 percent. The year before, under the 
Affordable Care Act, they went up 35 percent in 1 year. Premiums not 
only have not stabilized, but they have accelerated out of control.
  It was all about deductibles decreasing. Deductibles have also 
skyrocketed. It was about, if you like your doctor or if you like your 
healthcare, you can keep it. Doctors have moved to other hospitals. 
Doctors' offices have stopped being independent. They have to be able 
to work with other facilities so as to maintain the compliance 
requirements there. Most of the independent doctors in Oklahoma are no 
longer independent doctors. They now work under a corporate structure 
or they cannot survive.
  As to this whole thing about competition on the open market, we used 
to have multiple companies in Oklahoma that provided insurance. We now 
have one. Every other company has left. There is one company left. 
There is no competition driving down prices. It is a monopoly. It is 
the same thing that is happening all over the country. Just this year, 
there are one-third of the counties in America that now only have one 
insurance provider. In my State, all 77 counties only have one 
insurance provider.
  To tell you where things are really headed in this area of 
competition, United, which is one of the largest providers of 
healthcare, dropped out of all

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of the exchanges nationwide--everything. It is doing none. In the past 
couple of days, Aetna announced it will no longer do competition in any 
State anywhere in the country. The number of companies even willing to 
try to live up to these regulations continues to drop off. That is what 
is really happening in our States.
  If you want to know what that actually means to real families, let me 
give you a taste as to what comes into my office regularly because I 
have many people who call my office and say: Protect this. Protect 
this. Protect whatever it may be in the healthcare coverage. You have 
to make sure you guard it.
  I will typically say to them: Let me introduce you to some other 
people who are also calling in and who are also writing in.
  I will leave their names out, but let me give you just some of the 
situations:
  A single mom, who has children and is from Norman, OK, contacted us 
and said her family has seen its premiums triple over the last 2 years. 
Currently, its premiums are $1,500 a month, with a deductible for the 
family of $24,000.
  Another family contacted me who has a disabled child. The federally 
mandated health insurance under ObamaCare for 2016 was $895. For 2017, 
it is $1,553 a month for this family with a disabled child.
  A husband and wife in Tulsa, OK, wrote me. Their current monthly 
expense for just insurance is $1,500--twice the amount of their house 
payment. They have a relative who is working three part-time jobs and 
cannot get a full-time job because, under ObamaCare, a full-time job 
also requires all of the benefits. No one is hiring in that full-time 
area because of the additional requirements for ObamaCare. He is 
working three part-time jobs, and because he is working three part-time 
jobs and has no health insurance, he is also paying the penalty--fine--
on his taxes for not having insurance. Not only can he not get a full-
time job because of the ObamaCare requirements, but he is paying a 
penalty because of it as well.
  A husband and wife from Newkirk, OK, wrote me. For their insurance 
alone, not including out-of-pocket medical expenses, the husband and 
wife will spend $21,965 this year on healthcare coverage.
  Another family wrote me from Stillwater, OK. Their healthcare 
coverage used to be 5 percent of their family income. Now their 
healthcare coverage is 22 percent of their family healthcare income.
  I have another family who wrote to me, and it is very interesting. 
They are from Oklahoma City, and they wrote me and just gave me a 
breakout--a chart--that they had created. In 2015, their monthly 
premium had skyrocketed to $1,400. In 2016, it was $1,500. Now, in 
2017, it is $2,042 a month. Let that soak in for a moment.

  Then they made the statement that there are financially strapped 
families who will not go to the doctor due to this out-of-pocket 
expense. That is the additional deductible that is on top of their 
$2,000 premium. Individuals buying private insurance have no recourse 
because we have no other option that we are allowed to go to. There is 
only one insurance provider available to us. We need competition in 
this State in order to take away the financial burden on our families.
  All they want are options. Yet right now what the Federal Government 
has told them is: No. We have a policy, and you have to buy that 
policy. If you do not buy the policy we pick for you, we will fine you 
on your taxes.
  They are stuck. Thousands of Oklahomans are stuck.
  Why is it such a big issue? Because of how it affects individuals. 
Why is it such a big issue? Because of what is still coming.
  There is this false belief that the Affordable Care Act is fully 
implemented. That is not true. Many of the aspects of the most onerous 
parts of the Affordable Care Act did not go into implementation until 
after President Obama left office. Let me give you some examples of 
some things they had back-loaded that would not start until after he 
had left office:
  There is the Cadillac tax. Every union family across the country will 
start to face much higher costs on their insurance because their 
insurance is considered too good under the Affordable Care Act. So all 
of those great union families who have great healthcare insurance 
across the country are about to start facing additional taxes and fees 
for their insurance being better than their next-door neighbors' 
insurance as the Affordable Care Act tried to push down healthcare 
insurance to be the same for everyone.
  There are increased penalties that are still coming because the full 
penalties have not been rolled out yet on all of the taxes. They have 
gone up a little bit each year, but they will accelerate now over the 
next several years.
  There are increased taxes. The medical device tax, which has been 
sitting out there, has been delayed, but it now will go into full 
implementation. There is also a tax, which is a health insurer tax, 
that adds an additional tax to every insurance company that of course 
they will then pass on to every single premium.
  There are still all of the costs that are associated with the 
expansion of Medicaid. Now, there has been a lot of conversation about 
the expansion of Medicaid. As many people know, this was an expansion 
of Medicaid for people from 100 percent of poverty to 138 percent of 
poverty. It is just in that small bracket that there had been an 
expansion of Medicaid. Initially, the Federal Government covered all of 
the costs of that expansion. Then, starting this year, the States pick 
up the additional cost. My State, like several others, chose not to do 
the expansion, and my State legislature and my Governor have taken a 
lot of heat for that. Yet what they said several years ago is, once the 
State has to pick up the additional bill, we will not be able to afford 
that expansion. We cannot do that.
  Let me tell you what that would mean to my State. Because we did not 
expand, we do not have an additional cost this year, but let me give 
you a parallel. The State of Oregon is almost exactly the same size as 
the population in the State of Oklahoma. It will now start taking on an 
additional $257 million a year in its State budget because of the 
expansion of Medicaid it took on.
  Now, that may not seem like a big deal to some people in this 
Chamber, but in my State right now, our State legislature and our 
Governor are struggling to balance a budget, and we are going through 
all kinds of issues because, right now, our State is about $800 million 
behind budget, and this is after being $800 million behind budget last 
year. If the people in my State will imagine what is going on right now 
in the State capitol, if we had an additional $257 million added to 
that hole, then that is what it would mean for our State.
  There are real effects that are out there, and I understand 
healthcare is extremely personal. That is why it has always been 
something that has been decided by individual families, not by the 
Federal Government and, in my State, by someone 1,000 miles away who is 
trying to make healthcare decisions for them.
  What we are really trying to do with this is to deal with the issues 
I just laid out. This is not about partisan politics. This is about 
people and families who have been hurt by what is happening in the 
Affordable Care Act--by someone 1,000 miles away who is trying to tell 
them what policies they can and cannot buy, by the skyrocketing costs, 
by the actual effect that has happened. While I have some people who 
say that is not real, I could line up the families in my State who used 
to have coverage but who no longer have coverage because they cannot 
afford it anymore.
  Then there are the simplistic answers to, Why don't we just cover 
everybody in the country? Why don't we just do a single-payer system? 
People do not understand. They know how bad it has become now and how 
hard it has become now. You would accelerate that multifold if you were 
to just slip into a single-payer system.
  What do we need to do? Let me give you a couple of quick thoughts. We 
are going to need transition time. Whatever you hear about all of the 
conversation we have about the Affordable Care Act or replacing the 
Affordable Care Act, please know that all of the conversations for us 
begin with how do we do a good transition from where we are now to 
where we need to be.
  I have folks who say: Well, next week, this ends. Well, next year, 
this suddenly goes away.

[[Page S3031]]

  No, there will have to be a transition process, and it will be over 
several years.
  We are also still looking at some of the most basic elements. For 
instance, I have had folks say: I want to be able to keep my kids on my 
insurance until 26. That has been assumed, quite frankly, by the House 
and by the Senate, but the House bill that has been passed already 
keeps that. There has been a lot of conversation about preexisting 
conditions. Most of the conversation we have had as Senators, behind 
closed doors, is about taking care of people with preexisting 
conditions.
  Those are very real issues.
  We understand the dynamic of what happens back and forth with 
insurance companies and families and the struggles families have, 
whether they are cancer patients, diabetic, have rare blood diseases or 
Alzheimer's. There are so many struggles that are out there. We 
understand that. That is in our conversation as well. Yet we have to be 
able to find practical ways to start leveling out the cost of 
insurance. We cannot survive with rates skyrocketing like they are, and 
people need to know the safety net is going to actually be there.
  We have to resolve these issues. We have to work for the benefit of 
our States, which cannot afford these overwhelming cost increases. We 
have to work for the benefit of families who are facing the issue and, 
quite frankly, for the Federal taxpayer as well.
  While my State struggles with an $800 million hole that it is facing 
right in the budget, by the end of our session, it will have had that 
resolved. It is constitutionally required to have that resolved. The 
Federal Government is facing a $20 trillion budget hole right now--$20 
trillion. For all the folks who say: Just add more to it, it will be 
fine, may I remind you, there is a day all of that has to be paid. We 
have to be able to be responsible with our Federal budget at the same 
time we are helping our States to be able to manage theirs and at the 
same time we are helping our families to do the same.

  No, this is not simple, but it has to be done. We have to be able to 
find a way to restore it. This is not about returning healthcare back 
to where we were years ago. That, quite frankly, is gone. As I 
mentioned before, all of those private doctors that used to function in 
my State, they don't function in my State anymore. They are all under 
corporate structures. The insurance companies have left or have merged. 
Hospitals in my State have merged because they couldn't survive the 
last few years of ObamaCare. Even if we wanted to go back to how 
healthcare was--and we don't--but even if we wanted to, we can't 
because there has been so much change in the last few years. We have to 
be able to actually fix where we are.
  So I would encourage continued communication. Lots of folks have 
contacted my office on every side of this issue. Keep doing that. Lots 
of folks in this Chamber have had dialogue, and though it looks like a 
partisan exercise, it is actually a pretty open conversation among our 
conference to try to figure out how we are going to actually help 
families, help our States, help our Federal budget, and help us to be 
sustainable on these critical issues.
  I have gotten lots of other letters I can bring. There are lots of 
other stories out there. I think we know enough now to be able to know 
this is something that needs to be done. So while the Nation is 
distracted, we cannot be distracted. Let's finish the healthcare 
conversation. Lots of families are counting on us.
  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. CORNYN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.