[Congressional Record Volume 163, Number 90 (Wednesday, May 24, 2017)]
[Senate]
[Pages S3118-S3121]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. HATCH. Mr. President, I rise today to speak about the continuing 
effort to repeal and replace ObamaCare. This effort has essentially 
been going on since the day the bill was signed into law. I think most 
of us on the Republican side recognize the overwhelming consensus 
surrounding the

[[Page S3119]]

failures of ObamaCare as a major reason we currently find ourselves in 
the majority.
  As you know, the House passed the American Health Care Act, a bill 
that would repeal and replace ObamaCare, earlier this month. This is an 
important step in the process. Later today, we expect to hear from the 
Congressional Budget Office about the House bill. The CBO score will 
lay down an important marker for the repeal and replace efforts in the 
Senate. It will allow us to work to ensure that the House bill fits 
into the constraints of the reconciliation rules in the Senate, while 
we continue to strive toward our own policy goals to implement patient-
centered healthcare and healthcare reforms that address cost and 
promote choice and competition.
  I am very interested in what they say. These changes are more 
important than ever. Just today, we received a report from HHS that, 
from the time ObamaCare took effect through 2017, there was an average 
premium increase of 105 percent across the 39 States using 
healthcare.gov. This is just one snapshot of the runaway costs of 
ObamaCare, and it is just one of many examples indicating why we need 
to act as quickly as possible to repeal and replace the misguided law.
  As the Senate continues to discuss the policy matters related to this 
effort, we will need to confront a number of different issues as we 
work to provide enduring reforms for our beleaguered healthcare system. 
As chairman of the Senate committee with jurisdiction over most of the 
salient issues under discussion, I want to make my views on these 
matters very clear.
  First, it is my view that all of the ObamaCare taxes need to go. We 
should not be treating the ObamaCare taxes as a smorgasbord, picking 
and choosing which ones to keep and which to discard. I don't think 
there is a single tax increase in ObamaCare that has enjoyed support on 
this Republican side.
  When all is said and done, the tax provisions of the Affordable Care 
Act represented a trillion-dollar hit on the economy in just the first 
10 years. That is nearly 1 percent of the projected gross domestic 
product over the same period. In my view, it would be inappropriate, 
after spending the better part of a decade railing against ObamaCare's 
burdensome job-killing taxes, for us to then turn around and say that 
some of them are fine so long as they are being used to fund Republican 
healthcare proposals.
  It is very simple. We need to repeal all of the ObamaCare taxes--the 
medical device tax, the health insurance tax, the so-called Cadillac 
tax, the taxes on healthcare savings and pharmaceuticals, and several 
others. They all have to go.
  Second, we need to fully repeal the individual mandate. There has 
been some talk about keeping the mandate around temporarily, if nothing 
else, to help shore up the new system. But as I said with the ObamaCare 
taxes, Republicans have spent years condemning the individual mandate 
as an unconstitutional assault on individual liberty. We have also 
argued that it was ineffective and that it has failed to draw enough 
younger and healthier consumers into the insurance market in order to 
offset the cost of ObamaCare's draconian market reform mandates.
  I don't see how we can now turn on a dime and say that the individual 
mandate is now somehow acceptable because we are using it to prop up a 
system that Republicans have designed. Like the taxes, the individual 
mandate, in my view, needs to be repealed. Lastly, we need to resist 
any temptation to alter the tax treatment of employer-provided health 
insurance as part of this particular exercise. Don't get me wrong. 
There have been a number of health reform proposals over the years that 
have dealt with this issue, including a legislative framework that I 
drafted, along with two of my colleagues. However, given the 
limitations we face in this current exercise and the fact that we are 
not starting from a blank slate but rather attempting to repeal a law 
that has been implemented for a number of years, we should be wary of 
the impact of pulling employer-sponsored insurance into this current 
debate.
  The purpose of this budget reconciliation exercise to repeal and 
replace ObamaCare is to address costs in the individual markets. I 
believe it is important that everyone, whether they are Members of 
Congress, stakeholders in the business community, or living elsewhere 
in the country, manage their expectations about the possible outcomes 
of this process given the limitations we are facing.
  While the constraints inherent to the budget reconciliation process 
may be inconvenient at the specific moment, they serve a number of 
important purposes. Under this process, the Senate will need to reduce 
the deficit by at least as much as the House bill. There is no way 
around that. The process for determining what provisions of the House 
bill will need to be changed is still ongoing. Of course, we will have 
to take a good long look at the numbers we get from CBO later today.
  Not only do we need to take into account the CBO numbers and the 
budget rules, but we also need to consider what the best policy is, 
and, at the end of the day, what approach is doable. We can do a lot in 
this exercise, but we should not make this the be-all and end-all of 
our healthcare reform effort.
  As I said before, everyone should be managing their expectations at 
this point. While we can and should be ambitious in our efforts, we 
need to be realistic about the limitations that exist and be willing to 
practice the art of the doable, to compromise, and to really recognize 
what issues will need to be set aside for another day.
  None of this is going to be easy, but I believe we are up to the 
challenge. I look forward to working with my colleagues on these issues 
and to finding solutions that will help us keep the promises we made to 
our constituents.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, I want to follow the comments made by the 
President pro tempore of the Senate--the Senator from Utah--talking 
about problems that people have and problems that grow every day with 
their future look at healthcare and what it may mean for their 
families.
  This is a top-of-the-mind issue for families in Utah, or Missouri, 
where I am from, or Montana, where the Presiding Officer is from, or 
Massachusetts. Anywhere in the country, anyone who is looking at this 
system and hoping to have a system they could rely on is finding that 
it is just not working. This is a plan that clearly has failed. It was 
a plan that gave all kinds of assurances, virtually none of which have 
been kept.
  In our State today, we got some bad news in Missouri about what that 
health insurance exchange looks like next year. Blue Cross Blue Shield 
serves 30 counties in our State. Another Blue Cross-related group, 
Anthem, serves the rest of the State. But today, Blue Cross Blue Shield 
announced that it is going to pull out of the exchanges next year. Some 
31,000 people in 25 counties around Kansas City will have no insurer at 
this moment who is willing to sell policies on the individual exchange. 
This is devastating news for those families--maybe they are already on 
their second or third insurance company in as many years--trying to 
wade through yet another individual plan that tells them what might or 
might not be covered. This is certainly a long way from the assurances 
that you would be able to keep your plan and you would be able to 
continue to see the doctors you like. It seems a long way from that 
pledge. Remember that pledge? If you like your plan, you can keep your 
plan. If you like your doctor, you can keep your doctor. It didn't turn 
out to be that way at all.

  In fact, in the five other counties that Blue Cross is leaving in our 
State--and I don't say this with any disrespect toward that nonprofit 
company--they are losing money. This system won't work, and that is why 
we are down from multiple companies willing to offer insurance in all 
kinds of counties around the country to now States, like Iowa, having 
no insurance company at all that will offer an individual policy 
anywhere.
  In the five metropolitan counties in the Kansas area, they have three 
competitors this year in those five counties. Humana announced in 
February that they would be leaving next year. Blue Cross announced 
today that they would be leaving. So 5 metropolitan counties at this 
moment, at least, have only one company that will even offer

[[Page S3120]]

a policy, and 25 counties have no company that will offer a policy 
based on that announcement. If you only have one choice, do you really 
have any choices at all?
  Under this plan, unless we go in a very different direction, the 
choice is to buy the policy or pay the penalty. This exchange that was 
promised where the average family would see their insurance costs go 
down $2,500 a year--this is as far from that promise as you could 
possibly get. Not only has your policy likely gone up more than $2,500, 
but your deductible has gone up in even higher percentages than that.
  Certainly, 30 percent of the counties in America right now only have 
one company that will offer insurance. As I said earlier, our 
neighboring State to the north, Iowa, has no company that will offer 
insurance to anybody on the individual market. What kind of system is 
that?
  In my State, we have 114 counties and the city of St. Louis in 
addition to those 114 counties. At this moment, 97 of them have only 
one company that will offer insurance. Unless things change 
dramatically, in January, 25 of those 97 will have no company that will 
offer insurance. Now, 77 counties--unless the one company offering 
insurance decides it can't participate in that market either--would 
have only one choice. I think it is likely that those 77 counties will 
see some change in whether they have one choice or no choice.
  Last week, I came to the floor to talk about Missourians who have 
problems and who are seeing their out-of-pocket costs skyrocket under 
this. Let me share another story about one of the several people we 
heard from this week.
  Holly is a cancer survivor. She lives in Southeast Missouri. She was 
forced again this year to switch insurance policies when the insurance 
company she had left the individual exchange, the ObamaCare exchange. 
That left Holly with only one choice. Again, people in the vast 
majority of our counties have the same option--they have one option. 
Holly had one option, and that carrier didn't cover any of her four 
cancer doctors. Now, remember, this is a cancer survivor who literally 
has been in a fight for her life, and now she can't get a policy that 
allows her to see the doctors in whom, in that fight for her life, she 
developed confidence. So that means she can't see her oncologist under 
any policy she can get. She can't see the radiation oncologist, the 
surgical oncologist, and the reconstructive surgeon. None of those 
people are now available to her.
  This is in a world where Holly, you, me--all of us were told: If you 
like your doctor, you can keep your doctor. Well, she liked all four of 
her doctors, and she can't keep any of those doctors. We were told: If 
you like your policy, you can keep your policy. If it weren't so 
serious, looking back at that promise, it would be like it was some 
cruel joke that somebody is coming up with that couldn't have been 
further from the truth. When you are battling cancer and you lose 
access to the doctors you know and trust, no reasonable person can 
argue to you that the system we have is working. The status quo is 
unacceptable. It is clearly unsustainable.
  There is a lot of discussion about what kind of change we are going 
to have. The ``why'' here is more important than the ``how.'' The 
``why'' here is the most important part of this debate because the 
reason we have to change is that the system we have is absolutely not 
working.
  Americans like Holly and all the families in the Kansas City area who 
are certain to lose this year's coverage next year may or may not have 
coverage at all. No company besides this one company that left was 
willing to be there this year. They deserve better. That is why I am 
going to continue to work with my Senate colleagues to give families 
more choices to expand their access to the healthcare providers they 
want and the kind of insurance coverage they would like to have.
  This plan simply hasn't worked, it isn't working, and it is going to 
get worse before it gets better. That is why we are debating how to 
change it, not debating the effort that has totally failed. Now we need 
to get in and figure out how to stabilize this marketplace and answer 
those important questions for families all over this country who not 
only don't have the coverage they want, but they also don't have access 
to the healthcare they need.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Mr. President, I congratulate my colleague from 
Missouri for the excellent comments he made.
  I bring to the floor a report that came out last evening, which is 
essentially the analysis that the Obama administration never wanted the 
American people to see, and it has to do with ObamaCare from 2013 to 
2017. This report that the Obama administration would love to hide from 
the American people makes the point that my colleague from Missouri 
just made.
  In those years, from 2013 to 2017, once ObamaCare came into place, 
premiums around the country in the States that are buying on the 
Federal ObamaCare exchange went up 105 percent on average--more than 
double. It more than doubled in 20 States, and it tripled in three 
States: Oklahoma, Alaska, and Alabama. In Wyoming, it went up 107 
percent in just 4 years. Tell me something else that has gone up by 
that price in our lives anywhere over that short period of time. Those 
are the numbers that are out today.
  More than 7 years ago, the Washington Democrats wrote an enormously 
costly and complicated healthcare law. They forced it through the 
Senate, and they made lots of promises. They promised it would provide 
care for less money. They promised that you could keep your doctor and 
that you could keep your insurance. They promised that if you just 
allowed Washington to have more control, everything would be better for 
you. It hasn't worked out that way. These are the numbers we are 
looking at today, and it looks as if prices are going to go up again 
next year because of the mandates and the requirements of the Obama 
healthcare law.
  In Connecticut, insurance companies say they want an average increase 
of about 24 percent; in Maryland, the average is 45 percent; and in 
Oregon, 17 percent. Americans are again facing double-digit increases 
in their ObamaCare premiums next year, just like this past year.
  Some companies simply said: Hey, I am done. I am not going to sell 
anymore. It is just not worth it.
  That is what Aetna has done--pulled out entirely. The thing that is 
so interesting about Aetna's decision is that they were one of the 
major cheerleaders early on back in the beginning of ObamaCare. They 
said: Oh yeah, we want to do this. We want to sell insurance all around 
the country. Well, now they are pulling out of ObamaCare all across 
America. What that means for people at home is that they have fewer 
choices.
  People living in two-thirds of the counties in this country--and in 
every county in my home State of Wyoming--are down to fewer and fewer 
choices. We have one choice of a carrier to buy from on the exchange in 
Wyoming. In two-thirds of the counties, people have only one or two 
choices. There are now places where people have no choices. Even if 
they get a subsidy under ObamaCare, there is no place they can use it, 
so it is useless to them.
  The companies that remain--what are they doing to help try to control 
costs? Well, they are cutting back on access to doctors and to 
hospitals, as we just heard is the situation of the patient in 
Missouri.
  Democrats say that people have to buy the insurance anyway because 
they say they put a mandate on it. Americans, like it or not, you have 
to buy ObamaCare insurance. If you don't like it, we are going to fine 
you. That is what the Democrats said. Well, in spite of the mandate, 20 
million Americans said ``No, thank you,'' and about 8 million paid a 
fine. Another 12 million got an exemption because there are actually 41 
different ways you can get exempted from ObamaCare. People realize it 
is not a good deal for them. They know ObamaCare has made insurance so 
expensive that it is not a good value for their hard-earned dollars.
  It is astonishing to hear Democrats now say that basically the 
problem was that Washington didn't have enough control. We need more 
government control, they are saying. There are a number of Democrats 
who want a single-payer healthcare system. Some call

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it Medicare for all. They can call it what they want--it means higher 
costs and more Washington control over the healthcare American families 
need.
  The State of Vermont looked at this idea a couple of years ago. Even 
in this very small, very liberal State, they dropped the idea almost 
immediately. Why? Because they said it was too expensive.
  That didn't stop other States from looking at it. Recently, this 
occurred in the State of California. Democrats in California recently 
offered a plan to have the State take control of all healthcare for 
everyone who lives there. Universal healthcare for all, they call it--
doctor visits, hospitals, inpatient care, outpatient care, emergencies, 
dental, vision, mental health, nursing homes, everything, cradle to 
grave, universal health coverage.
  So what do the stories in the California papers say about this? Well, 
they did a budget analysis. The budget office of the State of 
California did a budget analysis and said: What would such a thing 
cost? They came up with a cost of $400 billion a year. That sounds like 
a big number, but how do you put that in perspective? What else can you 
do? Four hundred billion dollars. So they said: Well, let's compare it 
to the budget of the entire State of California. The entire budget for 
the State of California today is $190 billion, so the cost of universal 
healthcare alone is twice the budget of the whole State of California. 
That includes teachers, firefighters, police, everything. They are 
proposing to spend twice the amount that they spend on everything on 
universal healthcare.
  So what do the Democrats say? Well, we will just have to raise taxes. 
That is their answer to so much of everything. I guess they figure that 
hard-working families in California would need to pay these taxes every 
year--not just once but every year because that price tag is $400 
billion each and every year.
  Democrats have no good ideas on how to deal with this collapse of 
ObamaCare. Republicans are offering real solutions. We are looking for 
ways to bring costs down, to give people more freedom, and to give 
people more control over their own healthcare. We are working to make 
sure people can get the care they need from a doctor they choose at a 
lower cost. We don't have that with ObamaCare.

  The Democrats are pushing the exact opposite approach. They are 
offering higher costs, higher taxes, more government control, more 
government say in your family's life.
  ObamaCare has failed. Republicans are committed to finding long-term 
solutions to our Nation's healthcare needs.
  Thank you. 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. CARPER. 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. CARPER. Thank you, Mr. President. Good afternoon.