[Congressional Record Volume 163, Number 89 (Tuesday, May 23, 2017)]
[Senate]
[Pages S3083-S3085]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. UDALL. Mr. President, today many of my colleagues will come to 
the floor to speak about the devastating impact that TrumpCare will 
have on rural communities. I rise to join them in speaking on this 
topic and on the many other serious flaws in the Republicans' bill to 
replace ObamaCare.

[[Page S3084]]

  When he was elected, President Trump promised he would provide 
healthcare for everyone, but President Trump and our Republican friends 
have turned their backs on that promise. The Republican healthcare 
proposal would put insurance companies back in the driver's seat, and 
that means less quality and more costs for all of us. Rural 
communities, working families, and people with medical conditions would 
be hit the hardest.
  Today, we got a taste of how devastating TrumpCare would be. The 
President's budget proposal slashes billions of dollars for Medicaid 
and the Children's Health Insurance Program. President Trump takes 
direct aim at bipartisan programs that have made historic progress for 
kids, for the disabled, and for the elderly.
  Former Senator Hubert Humphrey once said: ``The moral test of 
government is how it treats those who are in the dawn of life, the 
children; those who are in the twilight of life, the aged; and those in 
the shadows of life, the sick, the needy and the handicapped.''
  When Senator Humphrey spoke those words, he had been diagnosed with 
terminal cancer. He died a few months later. His words are just as 
meaningful today.
  TrumpCare fails Senator Humphrey's moral test. It doesn't cover more 
people or more services or improve healthcare. It raises costs and 
reduces quality. Compared to the ACA--or ObamaCare--TrumpCare would be 
a disaster for families in my home State.
  In New Mexico, tens of thousands of people have healthcare, thanks to 
ObamaCare and the Medicaid expansion. Before the Affordable Care Act, 
New Mexico had one of the highest rates of uninsured in the country. It 
was almost 20 percent, at 19.6 percent. That rate has been cut in half 
to 8.9 percent.
  Approximately 300,000 more New Mexicans now have healthcare. And each 
one of these 300,000 people has a story about how having healthcare has 
made a difference--even saved lives.
  Thanks to the Affordable Care Act, hundreds of thousands of New 
Mexicans now have essential health benefits, including doctor visits, 
hospital care, prescription drugs, pregnancy and childbirth, and mental 
health services, and a range of preventive services, like mammograms 
and other cancer screenings, are available at no cost.
  I am not saying that the ACA is perfect. Premiums are still too high, 
deductibles are increasing too much, and we still must bring down the 
cost of prescription drugs. We absolutely need to work to bring down 
costs. But, on balance, the Affordable Care Act passes all tests--many 
with flying colors. TrumpCare does not come close. TrumpCare gets an F.

  Test No. 1: Does TrumpCare increase the number of Americans who will 
have healthcare? No, it decreases coverage and decreases it 
dramatically.
  According to the most recent figures from the CBO, 24 million 
Americans will lose healthcare coverage under TrumpCare over the next 
decade. TrumpCare would dismantle the Medicaid expansion provisions 
that help so many working Americans, including 265,000 people in New 
Mexico, and TrumpCare would hit rural communities the hardest.
  The National Rural Health Association has said that TrumpCare ``does 
nothing to improve the health care crisis in rural America, and will 
lead to poorer rural health outcomes, more uninsured and an increase in 
the rural hospital closure crisis.''
  Rural areas like the ones we have in New Mexico have more elderly and 
disabled people, and fewer people have insurance through their jobs. 
TrumpCare is the hardest on these groups.
  Rural hospitals are already struggling. They will have an even harder 
time keeping their doors open.
  Many New Mexicans would have to drive an hour or more if their local 
hospital closed. And not only would closed hospitals mean less access 
to healthcare, it would also hurt the economy. In rural areas, 
hospitals are a big employer. If they close, the rural economy takes a 
hit too.
  The administrator of the Guadalupe County Hospital in New Mexico, a 
fine woman by the name of Christina Campos, fears what might happen if 
TrumpCare becomes law. She is urging me to protect access to care in 
rural areas.
  Guadalupe County is one of our smallest counties by population. The 
hospital's uninsured payer rate declined from 14 percent to 4 percent 
from 2014 to 2016, thanks to the Affordable Care Act, and its 
uncompensated care increased 23 percent in that same period.
  I can tell my colleagues that I will fight tooth and nail to keep 
residents in our rural areas insured and to keep rural hospitals in New 
Mexico open.
  Test No. 2: Does TrumpCare increase coverage of healthcare services? 
No, it fails this test too. Under the ACA, insurance companies must 
cover essential healthcare services, period. But under TrumpCare, 
starting in 2020, States can get a waiver and define their own 
essential benefits for individual and small group plans. So States 
would be able to cut the benefits that people count on--and that are 
making patients healthier.
  Test No. 3: Does TrumpCare make healthcare more affordable? It 
doesn't. It takes aim at the most vulnerable working and low-income 
families and seniors--the people most in need of care--and it cuts 
access to healthcare out from under them. If you are older and poorer, 
you lose big under TrumpCare. If you are young and wealthy, you win.
  What is wrong with this picture? What is wrong is that it is unjust. 
And it is bad for healthcare costs over the long run. Trump and the 
Republicans are proposing drastic changes to our healthcare system--and 
they are changes for the worse. They want to go backward to a time when 
insurance companies could decide who gets healthcare and who doesn't.
  Finally, TrumpCare would hurt anyone with a preexisting condition. 
One of the most popular provisions of ObamaCare is that it prohibits 
insurance companies from dropping you if you get sick and from refusing 
to cover you because of a preexisting condition. A preexisting 
condition could be something serious like cancer, but insurance 
companies have considered everything from childbirth to hand warts a 
preexisting condition.
  Under TrumpCare, States would be able to decide whether to get a 
waiver from those patient protections. And then we would go back to 
that time when insurance companies decided who could get healthcare and 
who couldn't. States would have to set up high-risk pools to provide 
people with the option of insurance in catastrophic situations. But in 
the best cases, high-risk pools wouldn't protect many people from going 
bankrupt just to get healthcare, and TrumpCare wouldn't provide nearly 
enough funding for States to run them successfully.
  Take Alexis from Albuquerque. Alexis is here in the photograph with 
her husband. Alexis had a stroke and brain surgeries when she was 28 
years old. Even though she had no lingering effects, she was denied 
insurance in the private market and had to get insurance in New 
Mexico's high-risk pool. According to Alexis, ``It broke us 
financially.'' Alexis now has affordable health insurance with the help 
of the Affordable Care Act subsidies. Like most people, she doesn't 
want to risk going broke just to get healthcare. She shouldn't have to.
  Finally, I want to tell you about a 1-year-old from Albuquerque, NM, 
whose name is Rafe. Rafe was born with cortical visual impairment--a 
kind of legal blindness--and significant developmental delays. His 
parents--Jessica, his mom, and his father, Sam, a veteran--have been 
able to access the intensive medical care, early intervention services, 
medical equipment, and therapy he needs through a combination of the 
military's insurance and Medicaid. But TrumpCare jeopardizes Medicaid 
by turning it into a block grant for States, which will most certainly 
result in deep cuts to Medicaid. It threatens Rafe's chances of a 
better life.
  The President promised he would keep protections for people with 
preexisting conditions--people who are sick. His broken promises can 
hurt tens of millions of Americans.
  In the end, TrumpCare is not a real healthcare bill. It is a tax 
relief bill for the richest 1 percent. The CBO estimates that TrumpCare 
would cut taxes by $346 billion over 10 years, at the expense of the 
healthcare of working families and seniors.

[[Page S3085]]

  Our priorities for healthcare reform should be increasing coverage, 
increasing the services provided, making people healthier, and 
providing affordable healthcare. I strongly and unequivocally support 
all Americans having healthcare.
  Let's get to that goal, and let's get to that goal now. Ninety-one 
percent of the American people are insured, thanks to the steps taken 
under the Affordable Care Act. Rather than repealing it, let's build on 
its strengths so 100 percent of people can afford to see a doctor when 
they are sick. We can do this. We can do better. Let's ensure that 
Americans in the dawn of life, the children; those who are in the 
twilight of life, the aged; and those in the shadows of life, the sick, 
the needy, and the disabled, have the right to healthcare so that 
America meets the moral test of good governance.
  I yield the floor.
  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. THUNE. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. THUNE. Mr. President, if there is one thing that has become 
clear, it is that the ObamaCare status quo is not sustainable.
  Prices continue to soar while choices are rapidly dwindling. Between 
2016 and 2017, the average premium for a midlevel ObamaCare plan on the 
Federal exchange went up 25 percent--25 percent for just 1 year. Let's 
remember that this is on top of years--year after year--of premium 
increases under ObamaCare.
  How many families can easily absorb a 25-percent premium increase? I 
would submit that not many. Again, that is just for 1 year. ObamaCare 
rate hikes aren't going anywhere. Numbers for next year are starting to 
emerge, and they are not looking good. Connecticut's ObamaCare insurers 
are requesting average premium increases in the double digits. One 
Connecticut insurer has requested an average rate hike of 33.8 
percent--33.8 percent. In Virginia, one insurer has requested an 
average rate increase of 38 percent. Another has requested an average 
45-percent rate hike. In Maryland, average increases range anywhere 
from 18 percent to almost 59 percent. One insurer has requested a 
staggering 150-percent rate increase--150 percent.
  Obviously, these kinds of price increases are unaffordable for most 
families, but ObamaCare isn't leaving them any options. Along with 
soaring prices, choices on the exchanges are rapidly dwindling. Roughly 
one-third of U.S. counties have just one choice of health insurer on 
their exchange for 2017. Several States--including Alabama, Oklahoma, 
Alaska, and Wyoming--have just one choice of insurer for their entire 
State, and things are only getting worse.
  In 2018, a number of counties may lack an ObamaCare insurer at all. 
In February, health insurer Humana announced its decision to completely 
withdraw from the ObamaCare exchanges for 2018, and 2 weeks ago, Aetna, 
which had already sharply reduced its participation in the exchanges 
for 2017, announced its decision to fully exit and completely get out 
of the market in 2018. That leaves the Nebraska and Delaware ObamaCare 
exchanges with just one insurer for 2018.
  UnitedHealthcare is leaving Virginia, and Wellmark Blue Cross Blue 
Shield is withdrawing from Iowa. In the wake of Aetna and Wellmark's 
decision, Medica, the last ObamaCare insurer for most of Iowa, 
announced it will likely leave the State in 2018. That would leave 94 
out of 99 counties in Iowa with no ObamaCare insurer next year--all but 
five counties in the State of Iowa with no ObamaCare insurer. Iowa 
families with ObamaCare subsidies would have no place to spend them. As 
my colleague Senator Alexander likes to point out, that is like having 
a bus ticket in a town where there are no buses running.
  Dwindling healthcare choices aren't limited to the ObamaCare 
exchanges, either. Aetna is not only withdrawing from the exchanges. It 
is also withdrawing from the non-ObamaCare individual health insurance 
markets in several States. More than one insurance CEO has suggested 
that ObamaCare is in a death spiral, and I would have to say it is 
pretty hard to disagree. Combine soaring premiums with a steady insurer 
exodus, and sooner or later you get a partial or complete exchange 
collapse.
  Then there are the other ObamaCare problems--like deductibles which 
are sometimes so high people can't afford to actually use their 
healthcare plans; or, narrow plan networks with few provider choices.
  ObamaCare may have been well-intentioned, but good intentions don't 
make up for a lack of good policy--and ObamaCare was not good policy. 
ObamaCare took a healthcare system with problems and it made things 
worse. It is time to repeal this fatally flawed law and replace it with 
real healthcare reform.
  Three weeks ago, the House of Representatives passed an ObamaCare 
repeal and replacement bill. The House's legislation repeals 
ObamaCare's tax increases, penalties, and mandates, and starts the 
process of restoring control of healthcare to States and individuals. 
My colleagues in the House have made a good start, and I am looking 
forward to building on their bill here in the United States Senate. We 
have a lot of Members with good healthcare ideas, and we are going to 
work hard to produce a bill that will start the process of giving the 
American people real healthcare reform.
  ObamaCare is failing, and it is failing rapidly. Our Democrat 
colleagues need to stop pretending this law is ever going to do what it 
was supposed to do and come to the table to work with us on real 
healthcare reform. There is no question our healthcare system has 
problems, but ObamaCare is not, and it never has been, the solution.
  Real reform is possible, though, and that is what we are focused on 
now here in the United States Senate--the kind of reform that will 
actually drive down prices, that will put patients and their doctors--
not the government--in charge of healthcare decisions, that will 
empower States to embrace the solutions that are right for the citizens 
in their States and will give Americans more choices and real 
healthcare freedom.
  That is the kind of healthcare reform Republicans are committed to 
delivering for the American people.
  I yield the floor.
  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.
  Ms. CANTWELL. 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.