[Congressional Record Volume 163, Number 89 (Tuesday, May 23, 2017)]
[Senate]
[Pages S3086-S3090]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. FRANKEN. Mr. President, I rise to talk about the healthcare bill 
the House of Representatives passed and is currently being considered 
behind closed doors by my Republican colleagues.
  I travel around greater Minnesota all the time, and when the 
Republicans' healthcare plan first came out, I traveled to rural 
Minnesota to meet with rural hospitals, nursing home providers, and 
constituents to hear how this bill would impact their lives and 
communities. They are upset and they are frankly scared.
  In Perham, MN, I heard from a woman who was in tears, not knowing 
where her mother would go if the Republican plan passed and she lost 
her nursing home coverage. This woman and her husband work full time, 
but together they cannot afford the around-the-clock care her mother 
needs.
  Later, at a nursing home in Moorhead--that is in Minnesota across the 
river from Fargo--I also heard from a resident, Chrysann, who said this 
new plan wasn't about taking care of people but about ``survival of the 
fittest.'' The hospitals and nursing home administrators I met with 
said the financial blow they would receive would cause them to cut 
services and in some cases even close their doors.
  What I heard, and the real panic that I saw, is a far cry from what 
President Trump promised this past January when he said: ``We're going 
to have insurance for everybody.'' He went on to say it would be ``much 
less expensive and much better.''
  Versions of these promises keep coming from President Trump, his 
Cabinet, and from his allies in Congress--coverage for more people, at 
lower costs, with better quality. Those things all sound great, things 
that might help people like Chrysann, but the fact is, the Republican 
bill does the exact opposite. It takes coverage away from people, it 
drives up costs, and it makes coverage worse. In other words, the GOP 
is selling this healthcare bill on false pretenses.
  Today I would like to explain how the Republican bill betrays each 
one of these three fundamental promises, and let's take them one by 
one. We can start by the number of people who will be covered. 
President Trump promised that everyone would have insurance, but an 
analysis of an earlier version of the healthcare bill--the first 
iteration of this, which is actually not as bad as this one--an earlier 
version analysis conducted by the nonpartisan Congressional Budget 
Office found that under current law the House Republican plan would 
leave 24 million fewer people with health insurance by 2026. That means 
by 2026, nearly 1 in 5 Americans under the age of 65 would be 
uninsured, compared to just over 1 in 10 today.
  One particular way the Republican bill cuts coverage is by gutting 
Medicaid, a program that covers more than 60 percent of all nursing 
home residents nationwide, covers kids with disabilities, and benefits 
nearly 70 million Americans. The Republican plan ends Medicaid 
expansion. It fundamentally undermines the structure of the Medicaid 
Program and cuts the program's budget by as much as one-quarter over 10 
years, a more than $800 billion cut.
  On May 7, journalist Jake Tapper of CNN asked Health and Human 
Services Secretary Tom Price whether the hundreds of billions of 
proposed cuts would result in millions of Americans not getting 
Medicaid. Secretary Price responded: ``Absolutely not.'' Well, that is 
absolutely false. When I say ``absolutely,'' I mean that literally.
  It doesn't take an expert to know that if you take funding away from 
this program, which provides health coverage for millions of Americans, 
the program will suffer, and the human beings who rely on Medicaid will 
suffer as well. Specifically, according to the

[[Page S3087]]

Congressional Budget Office, 14 million of those 24 million people who 
will lose coverage under the Republican bill would lose their health 
insurance because of cuts to Medicaid. ``Absolutely not,'' says the 
Secretary of HHS.
  It is bad enough to push a bill that will take away care from 
millions who need it; it is extra galling to be so fundamentally 
dishonest about it in the process. Look, the Affordable Care Act is far 
from perfect and we have problems that need to be fixed, but let's step 
back and review how far we have come because of the ACA. Since it came 
into effect, about 20 million Americans have gained health insurance 
coverage, producing the lowest uninsured rate in the history of this 
country.
  In Minnesota, the number of uninsured dropped by nearly half, with 
people in rural areas seeing the largest gain in coverage. As a result, 
we have eliminated the gap in coverage between rural and urban 
Minnesotans. These coverage gains have increased access to vital health 
services, including access to treatment for mental illness and 
substance use disorders, but the Republican healthcare plan throws all 
of these gains into jeopardy, which is particularly troubling given 
that the country is still in the midst of battling a devastating opioid 
and heroin epidemic. Researchers estimate that 2.8 million Americans 
with substance use disorders will lose some or all of their insurance 
coverage under the ACA repeal.
  Let's be clear. People will lose coverage as a result of the proposed 
Medicaid cuts; people will lose coverage because of the proposed 
insurance reforms; and tens of millions of more people will be 
uninsured and without care in the Republican plan than under current 
law.
  Let's move on to the second point; the assertion that is repeated 
constantly by President Trump and by others that their bill brings down 
costs. In his Rose Garden celebration after the Republican health care 
bill passed the House--not after signing it into law but sort of an 
unprecedented Rose Garden celebration after merely the House passed the 
bill--President Trump said: ``As far as I am concerned your premiums 
they are going to start to come down.''
  When Secretary Price was asked, again by Jake Tapper, if he stands by 
the President's statement, he responded: ``Absolutely.''
  On an earlier date, Secretary Price actually said: ``Nobody will be 
worse off financially'' under the Republican plan.
  This is just blatantly wrong. Republicans are actively sabotaging the 
individual market, needlessly driving up premiums in the short term, 
and in the long term what they are doing will result in exorbitant 
premium hikes for older, sicker people--so much so that CBO estimates 
some will eventually drop out of the market altogether.
  Let me explain. For years, Republicans have taken deliberate steps to 
sabotage the individual market. First, Senator Rubio ran through a 
last-minute change to the 2015 spending bill that undercut the Risk 
Corridor Program. The Risk Corridor Program, which was modeled after a 
similar program in the Medicare Part D Program, was included as part of 
the ACA to offset high costs incurred by insurers as they took on new 
enrollees in the early years of the ACA.
  Here is how it worked. The Federal Government would make payments to 
health plans that enrolled a group of people who were sicker than 
expected and had higher healthcare costs than the insurer predicted 
when it set its premiums. On the flip side, the Federal Government 
would receive payments from health plans that enrolled a group of 
people who were healthier than expected and needed less care. By 
limiting losses incurred by insurers, the Risk Corridor Program was 
designed to help make premiums more affordable for individuals and 
families who bought coverage on the exchange. Senator Rubio's provision 
undercut all of this. It severely curtailed the payments that could be 
made under the Risk Corridor Program, which meant that premiums soared 
and health insurers left the market.
  For example, Blue Cross and Blue Shield of Minnesota lost about $220 
million between 2014 and 2016 under the weakened Risk Corridor Program, 
which the CEO told me in a meeting late last spring was a huge setback 
for the company. I was dismayed but not surprised when I heard, shortly 
after our meeting, that the company was leaving the individual market, 
which affected coverage for more than 100,000 Minnesotans and 
contributed to average premium increases of 36 to 67 percent in 
Minnesota's individual market in 2017.
  Insurers across the country faced similar destabilizing losses, but 
that is not all. On top of that, for months, President Trump has been 
doing his part to sow uncertainty by repeatedly arguing that the 
individual market is in a death spiral. For example, on May 4, in 
response to Aetna's exit from the individual market in Virginia in 
2018, President Trump shouted on Twitter: ``Death spiral!'' This is 
similar to his post on March 13 in which he said: ``ObamaCare is 
imploding. It's a disaster and 2017 will be the worst year yet, by 
far!'' But he is wrong.

  Even the CBO noted in one of its scores that barring any significant 
changes, the individual market would probably be stable in most areas. 
This confirms what other research has found, which is that this year 
markets were starting to stabilize, which led Standard & Poor's to 
issue a report last December predicting that 2017 could see ``continued 
improvement, with more insurers getting close to breakeven or better.''
  But this didn't faze President Trump or any of the Republicans. 
Instead, they seem to have used these reports as a guidebook on what 
changes are necessary to actually cause the individual market to 
collapse. For example, President Trump has been playing games with 
payments that are due to insurance companies that reduce out-of-pocket 
costs for working families. On numerous occasions, he has threatened to 
stop these payments altogether, but in practice, he has been holding 
these payments hostage on a month-to-month basis to push forward other 
insidious reforms. Just yesterday, his administration announced that it 
would seek another short-term delay in the House's lawsuit, which aims 
to stop these payments permanently. These games are driving up the 
premiums for families and rattling health insurance markets.
  Lastly, the administration has stopped enforcing the individual 
mandate. As a result, we are seeing enrollment in the individual 
markets stall for the first time since 2010, and if this results in 
younger, healthier people dropping their coverage, we could see prices 
rise dramatically for those left behind.
  That is right. President Trump and the Republicans are actively 
attacking the insurance markets, causing premiums to go up. So if these 
markets falter and consumers suffer, it is because of what Republicans 
are doing right now and have been doing for years to undermine the 
individual market.
  Still, you will often hear Republicans talk about the need to reduce 
costs. They even claim that their proposed healthcare plan would lower 
premiums in the long run. For millions of Americans, that is not true, 
but the reasons why it is untrue are slightly complicated. It goes to 
the CBO report for the Republican healthcare plan.
  The March 13 CBO score says that average premiums for single people 
in the individual market would be 15 to 20 percent higher than under 
current law--than under the current ACA--in the first 2 years of its 
implementation. But it does say that they would be roughly 10 percent 
lower in 2026 under the House bill than they would be under current 
law.
  At first blush, this sounds like prices would be coming down for 
people, right? That is certainly what the Republican leadership wants 
you to think. That day, House Speaker Ryan stated: ``This report 
confirms that the American Health Care Act will lower premiums and 
improve access to quality, affordable care.'' House Majority Leader 
Kevin McCarthy got more specific. He said: ``After 10 years, premiums 
will be 10 percent lower than under ObamaCare.'' But Speaker Ryan and 
Majority Leader McCarthy are being deliberately misleading. One of the 
reasons that average costs go down is that the price for some people 
would go up so much that they couldn't afford any insurance at all. If 
the people facing the most expensive insurance

[[Page S3088]]

simply dropped out of the market, sure, average costs go down.
  Here is how this works: Under the Republican plan, insurers would be 
able to charge older enrollees five times more than younger ones, which 
would dramatically increase premiums for people aged 50 to 64 years old 
while decreasing premiums for younger people. Meanwhile, the tax 
credits that help older Americans afford their premiums would be 
drastically slashed. The result is that, especially for older people of 
modest means, coverage would become unaffordable, so they disappear 
from the market. If only younger, healthier people can buy insurance, 
average premiums go down, but you have actually made the system much 
worse and much more expensive for the people who really need it.
  But that is not all. The Republican plan would also allow States to 
waive crucial protections for patients with preexisting conditions, 
which means that in those States, we could go back to something like 
the old days when insurance companies could charge people with 
preexisting conditions much more--potentially as much as $25,000 more 
for their coverage, as estimated by the AARP.
  Republicans are quick to point out that their bill maintains a 
requirement that insurance companies have to offer plans to everyone, 
but it abandons the principle that the plans must be affordable, and an 
unaffordable plan does people about as much good as no plan at all.
  If you are young, if you have no preexisting condition, it might be 
true that your premiums will go down under the Republican plan. But for 
millions of Americans, though, if the Republican bill passes, insurance 
costs are going to go up. For many people, they will go up so high that 
they will be out of reach.
  That brings me to the third claim the Republicans are peddling--that 
their plan will result in higher quality coverage. In fact, Republicans 
want to open the door to junk insurance.
  In defending the House Republican plan, Secretary Price recently 
stated that the plan allows ``for every single person to get the access 
to the kind of coverage that they want.'' We have heard this before. 
This is a code for allowing insurers to offer garbage insurance plans 
that offer skimpy benefit packages and impose much higher deductibles 
and cost sharing on consumers.
  Under the Affordable Care Act, you cannot sell junk plans on the 
insurance exchanges. Plans have to cover the essential health benefits. 
This is key. Under the ACA, plans have to cover the essential health 
benefits--10 key categories of benefits such as prescription drugs, 
maternity care, and mental health services. On top of that, the law 
prohibits insurers from imposing annual or lifetime limits on these 
essential health benefits. The goal is to make sure that when people 
get sick or if they have a preexisting condition, they don't go broke 
getting the care they need because of fine print in their health 
insurance plan.

  The Republican bill would allow States to eliminate these essential 
health benefits. Consumers would be left with plans that leave them up 
a creek if they actually get sick. And plans for people who are sick--
the price of those plans will go sky high. No one would call that 
``better care,'' which is why Republicans aren't really being straight 
about it. What they call ``flexibility'' is actually just the removal 
of consumer protections.
  To review, the Republican plan covers fewer people, costs too many 
people more--in many cases, much, much more--and provides worse 
coverage, and it is being sold by misleading people on each of these 
points.
  It is not as though there aren't ways to cover more people, reduce 
costs, and provide better coverage. You could do a public option, for 
example. You could reduce prescription drug costs--an issue on which I 
recently introduced a comprehensive bill. You could improve coverage by 
increasing the number of healthcare providers in rural areas, as I 
proposed last year in my rural health bill. But the Republican plan 
does none of these things, which raises the question: What does it do? 
Why would anyone take the time to propose such a terrible bill? The 
answer is this: It gives a giant tax cut to the wealthy. That is the 
real point of this bill. It is not a healthcare bill; it is a ``take 
healthcare away from people who need it and use the money to give a tax 
break to the rich'' bill.
  As Chrysann in Moorhead, MN, said, it is about ``survival of the 
fittest.''
  The average tax savings for the 400 richest Americans under the 
Republican plan is $7 million each--again, $7 million each. For 
households earning $1 million or more a year, it is more than $50,000 
apiece, each year. But for households earning $50,000 a year, which is 
about the median income in the United States, the tax cut is next to 
nothing, or you could even face a tax increase. There are tax cuts 
specifically for insurance company CEOs. There are tax cuts 
specifically for drug companies. There is nothing comparable for the 
middle class. And all of those tax cuts are paid for by cutting 
healthcare programs that keep people alive, by cutting off funding that 
lets seniors age with dignity, and by cutting services for kids with 
disabilities.
  This bill would take us back in time and roll back our progress. It 
is up to us here in the Senate to stop that from happening. This bill 
is literally sickening. It is vicious, it is cruel, and it should never 
be passed into law. I urge my Republican colleagues to walk away from 
this cruel effort and work with us to actually improve healthcare for 
Americans. And I urge everyone considering this bill to be straight 
with the American people about exactly what it is that this bill will 
do to them.
  Thank you, Mr. 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. CASSIDY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Johnson). Without objection, it is so 
ordered.
  Mr. CASSIDY. Mr. President, obviously, a big problem before the 
country right now is, What do we do about rising healthcare premiums?
  What we know under the Affordable Care Act--or the un-Affordable Care 
Act--or ObamaCare, as some call it, is that premiums are rising more 
and more. One of President Trump's campaign pledges was that premiums 
would come down and, actually, come down with, as he said in one place, 
beautiful coverage--that it is actually good coverage and premiums are 
lower. So let's kind of set the stage.
  I just got a message on my Facebook page. I will read it. By the way, 
anybody can post on our Facebook page these sorts of stories, if they 
are interested in them.
  Brian from Louisiana sent a message saying: My family plan is $1700 a 
month for me, my wife, and two children--so roughly about $20,000 a 
year. The ACA, or the Affordable Care Act, has brought me to my knees. 
I hope you can get something done as my credit cards are all maxed out. 
And 80 percent of my friends are in the same situation. The middle 
class is dwindling away. Can everyone just come together and figure 
this out?
  Think about this: $1,700 a month. He did not write this, but what 
would be standard for this sort of policy is a $13,000 family 
deductible.
  I say that because I have an acquaintance in San Francisco. San 
Francisco is so expensive for housing, transportation, and food, and 
the premium for their young family is $20,000 a year, with each family 
member with their own separate $6,000 deductible. This is under the un-
Affordable Care Act, as I call it, or the Affordable Care Act, as 
others do.
  A friend of mine back in Baton Rouge, whom I have quoted many times, 
put this on my Facebook page because people would not believe it: He 
and his wife, 60 and 61, their quote for their insurance last year was 
$39,000. Their quote for their insurance was $39,000.
  Then I spoke to a fellow who is an insurance consultant here in 
Washington, DC--an insurance consultant. If anyone can get their 
premiums down, it would be he. For his family, their premium is $24,000 
a year with a $13,000 family deductible. If they get in a car wreck, 
their family will be out $37,000 before the insurance kicks in. Who can 
afford this? We must do something better.

[[Page S3089]]

  When President Trump ran for office, President Trump clearly 
recognized this. On the campaign trail, he said over and over that he 
wished to lower premiums. It is the President's genius, if you will, 
that he knew how to do so. You do so by expanding the risk pool. He 
said he wanted to continue coverage for all.
  He gets away from the ObamaCare mandates, which people hate. The 
American people don't like being told what to do.
  He also said he would care for those with preexisting conditions. 
This is how it works. When you cover many, you have a bigger risk pool. 
Those with preexisting conditions have the cost of their illness spread 
out over the many. So premiums come down for all.
  My hat is off to the President for coming up with that. In fact, 5 
days before he was sworn in, he echoed this, because one way to lower 
premiums is to give poor coverage. One way to lower premiums is to give 
folks such terrible coverage that it doesn't cost anything. On the 
other hand, it doesn't cover anything. The President seems to know 
this.
  Five days before he was inaugurated, he said to the Washington Post 
about people covered under his replacement for ObamaCare:

       [They] can expect to have great healthcare. It will be in a 
     much simplified form. Much less expensive and much better.
       We're going to have insurance for everybody. There was a 
     philosophy in some circles that if you can't pay for it, you 
     don't get it. That's not going to happen with us.

  I am a physician, a doctor. Again, I admire President Trump's 
insights. As a physician, I know that whoever wants healthcare gets 
healthcare. Twenty or so years ago, Congress said that if you walk into 
an emergency room, the emergency room has to take care of you. It 
doesn't matter if you are an American citizen. It doesn't matter how 
much it costs. The hospital has to take care of you.
  I told folks when I was practicing--it would be the middle of the 
night--that as long as that emergency room was open--and it was open 
24/7--in through the door came folks vomiting blood, heart failure 
patients, folks with drug overdoses, schizophrenics, diabetics, 
asthmatics--you name it. They came through that door, and we cared for 
them all--and somebody paid.
  President Trump understands that even if you say you can't afford it, 
everybody is going to be treated. That is our current system, and that 
is not going to happen under his watch.
  We mentioned that one way to lower premiums is to give poor coverage. 
I think everyone knows, or many people know, of Mr. Kimmel, the late 
night comedian who pointed out that when his child was born, instead of 
celebrating and handing the baby to the mother so the mother could kiss 
and the father, Mr. Kimmel, could cuddle the baby, the nurses and the 
doctors looked at the baby and immediately recognized that something 
was wrong. They recognized that this child was blue. He didn't have 
oxygen, and if something wasn't done immediately, this child would die.
  Folks criticized Mr. Kimmel for being emotional. I totally get it. 
Instead of cuddling, you are signing a release waiver so your child can 
be transferred across the city of Los Angeles for emergency surgery. In 
his emotion, he asked that all children--and I would expand to all 
Americans--have the ability to get that sort of emergency care done.
  Again, the President was about that. I came up with what I called the 
Kimmel test. Again, it echoes President Trump's contract with the 
American voter--that we would protect those with preexisting 
conditions, that we lower premiums, but as we lower premiums, we make 
sure that the coverage is adequate.
  The Kimmel test, making sure there is adequate coverage while 
lowering premiums and caring for those with preexisting conditions, is 
so compatible with what President Trump said, because Americans need 
lower premiums.
  Let me echo that one more time. We need to lower premiums. The 
President's approach, the contract he made with the voters on the 
campaign trail, is the right approach. You get a bigger risk pool, lots 
of younger people, so those who are older and sicker have the cost of 
their care spread out among the many.
  We have a plan, the Cassidy-Collins plan, or the Patient Freedom Act, 
which I introduced with Senator Susan Collins and four other Senators. 
We have a way to go about it. One way to get young, healthy folks 
involved is to do something that we do on Medicare. If you are 
eligible, you are enrolled unless you call up and say you don't want to 
be. That is what we do with Medicare. By the way, that is what Fortune 
500 companies do with their employees for 401(k) plans, and it works 
really well.
  Ninety-five percent of employees are likely to participate in a 
401(k), and they love it. As to people on Medicare, 99 percent stay on 
Medicare, and 1 percent call up and say: I don't want it. Usually they 
have better coverage someplace else. As a rule, no one feels coerced 
because they all know they can call up and say: I don't want it; I 
don't get it. As it turns out, most do.
  The plan we have taken with Cassidy-Collins, in our attempt to 
fulfill President Trump's contract with the American voter, is that we 
allow a State to automatically enroll for this, and you would be in. 
The credit you receive would be sufficient to pay for the annual 
premium.
  If you don't want it, call up. Make it easy. Get out of here. I don't 
want it.
  As a rule, we think folks would be in. By doing this, you expand that 
risk pool so those old and sicker, those with preexisting conditions, 
can have their conditions cared for, but we fulfill President Trump's 
campaign pledge. We also lowered those premiums.
  Ultimately, to lower the cost of insurance, you have to lower the 
cost of healthcare. Cassidy-Collins does that with some conservative 
approaches that even liberals will like. One way is that we put in what 
is called price transparency. You would know the price. A mother would 
know the price of a procedure--an x-ray, a blood test--before she gets 
it for her daughter, as opposed to finding out 6 months later when she 
gets the final bill.
  Let me give one example. We have all seen those urgent care centers. 
Some are run by hospitals. Typically, a visit there will cost you $500 
to $1,500. Others are run by a group of physicians, or maybe a small 
business decides to set up an urgent care center. The same visit might 
cost you as little as $75 to $150. The patient doesn't know that until 
she gets the bill.
  One door has exactly the same appearance and exactly the same type of 
facility with the same capabilities. In one door and it can cost $500 
to $1,500, and in the other door and it can cost $75 to $150, and the 
patient never knows.
  I think we can lower the cost of healthcare by giving the patient the 
power of knowing what is the price of healthcare.
  Think of it. You walk up to a French restaurant in a city you are not 
familiar with, and you look at the menu posted on the door. You see the 
prices of the food. Oh, the food is pretty good, but look how expensive 
it is. Let me go down the street. You go down the street. The food 
looks good, and it is less expensive.
  The power of price informs the patient of what is the best deal for 
both our health and for our pocketbook. One way we can lower the cost 
of health insurance is by lowering the cost of healthcare. There are 
other ways of doing so as well.
  Let me return once more to what I said earlier. Americans need lower 
premiums. President Trump, during the campaign--his contract with the 
voter, I think, is the right approach to get there.
  I will summarize with this. He said he wanted to maintain coverage 
for those who have insurance, lower premiums, that preexisting 
conditions would be cared for, and eliminate the ObamaCare mandates. If 
we fulfill President Trump's goals--and these are goals that folks on 
the right and left can get behind. By the way, if we do get behind 
them, premiums will be lower. If we can fulfill President Trump's 
campaign contract with the American voter, we will lower those 
premiums, and we will do so by achieving these other great goals.
  I yield back.
  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.

[[Page S3090]]

  

  Mr. CRUZ. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.