[Congressional Record Volume 163, Number 91 (Thursday, May 25, 2017)]
[Senate]
[Pages S3168-S3173]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CORNYN. Mr. President, I want to spend a little bit of time today 
talking about how badly ObamaCare is failing the American people and 
how my Republican colleagues and I are working to repeal and replace it 
with healthcare that works. I wish I could say that Democrats and 
Republicans were working together to replace it with healthcare that 
works. Unfortunately, our Democratic colleagues have taken a walk on 
this particular topic and, apparently, are not interested in 
participating.
  Even though 30 million Americans remain uninsured under ObamaCare, 
the individual market--where people buy their health insurance if they 
do not have employer-provided coverage or government-provided 
coverage--is in a death spiral. This was confirmed by a study by the 
Department of Health and Human Services. It was also the subject of a 
Wall Street Journal article today that makes the point that average 
premiums in the individual market have increased 105 percent since 2013 
in the 39 States in which the ObamaCare exchanges are federally 
run. This translates into $3,000 more out-of-pocket for middle-class, 
hard-working families--a 105-percent increase in premiums since 2013.

  I dare anybody to say ObamaCare is working as it was intended. All 
one has to do is look back to President Obama's very words, when he 
said: If you like your doctor, you can keep your doctor; if you like 
your health insurance policy, you can keep that. He also said: Oh, by 
the way, we are going to save you money too. A family of four will save 
$2,500 a year. Contrast that to the $3,000-a-year increase since 2013 
in the individual market--a 105-percent increase.
  As I said earlier, this week the Department of Health and Human 
Services released a report that underscores the negative impact 
ObamaCare is having on families across the country. The report 
highlights the incredible increase in annual premium prices since 
ObamaCare took effect, and I mention that in the aggregate.
  Let's look at places like Texas. In Texas, the average monthly 
premium jumped from $222 in 2013 to $404--about an 82-percent increase. 
If you are a young person buying health insurance, a young family or 
anybody, for that matter, spending $222 a month and it jumps 82 
percent, to $404, that is a big bite out of your disposable income. 
That is pretty bad, there is no question about it, but Texas wasn't 
close to being the hardest hit.
  For example, in Wisconsin, premiums have almost doubled. In Montana, 
they have gone up 133 percent. In some States, the premiums have 
actually tripled. As I said, the average individual premium has more 
than doubled in the 39 States using healthcare.gov--an increase of 105 
percent since 2013.
  That is not the only problem with ObamaCare. This year, one in three 
counties across the United States have just one insurer on the 
ObamaCare exchange. In other words, ObamaCare has gotten it so wrong 
that the risk pools are mainly people who are older and who need 
healthcare more, and many younger people--young, healthy people who are 
important in the risk pool to help bring premiums down for everybody--
are simply taking a walk. This isn't the mark of a healthcare law that 
is working for the American people or helping our country grow 
healthier. It is the mark of a law that is actually hurting families by 
giving them fewer options at a higher cost and failing to deliver on 
any promises. We wonder why people are cynical about their own 
government. Well, it is because of promises made and promises not kept, 
and ObamaCare--I have said it before and I will say it again--is one of 
the biggest examples of consumer fraud I have ever seen in my lifetime.
  We are talking about real-world consequences here. My colleagues on 
the other side of the aisle like to talk about how many people would be 
potentially hurt by repealing and replacing ObamaCare. Of course, that 
is purely speculative. They are making it harder because they refuse to 
participate in this process, but we are determined to make sure we 
bring premiums down and make health insurance more affordable for those 
who want to buy it.
  Let me talk about concrete examples of people terribly affected by 
the ObamaCare healthcare law. One of my constituents wrote me a few 
weeks ago and said she and her husband got their insurance from her 
husband's job, but since ObamaCare came into effect, their premiums 
have tripled, and she estimates their deductibles have doubled. What is 
also frightening is that her prescriptions have skyrocketed too. As an 
example, an inhaler that previously cost her $35 now costs almost 10 
times that amount--well over $300.
  Given the outrageous costs, this Texan decided to see if she could 
get a better deal on the exchange since her insurance costs kept going 
up and up and up. She said the deductible she would have gotten was 
$6,000 a year. Add that to higher premiums, and she said ObamaCare was 
too high to even think about changing to.
  ObamaCare has had so many negative ripple effects throughout our 
entire economy. It restricted the number of hours people can work 
because of the employer mandate. It raised taxes, depressing economic 
activity and growth--things like the medical device tax. The medical 
device industry is one of the most innovative, lifesaving industries in 
our country and literally in the world. Yet ObamaCare imposed a medical 
device tax and chased those jobs and the innovation that goes along 
with them offshore. I remember one of my constituents from Dallas, TX, 
said they had a location in Costa Rica, and as long as the medical 
device tax applied to things they did in Texas and in the United 
States, they were going to take their business and build it in Costa 
Rica for one reason and one reason alone; that is, to avoid this 
crushing tax.
  The result has not been good for the economy, and it has not been 
good for healthcare. Many folks can't find any reasonable insurance 
that will actually pay for what they want. They can't afford what 
insurance they do have, and they feel hopeless and helpless as the 
rates keep climbing.
  Because I know these stories apply not only in Alaska or in Texas, 
they apply all across the country, one would think we would have 
Senators on both sides of the aisle clamoring and working together to 
try to come up with some solutions, but, once again, it is stony 
silence from our colleagues across the aisle.
  As my constituent rightly pointed out, so much of their income is now 
going toward premiums and other healthcare costs, she said she and her 
husband feel like they are actually being robbed. That is why we 
believe, on this side of the aisle--I wish I could say on both sides of 
the aisle but certainly on this side of the aisle--that we need to find 
a solution that works for our country.
  So here is an open invitation to any of our colleagues in either 
House of Congress: Please come work with us, not for our benefit, not 
for any political gain or advantage but because it is the right thing 
to do. That is why we get elected. That is why we serve, not to engage 
in petty politics but to actually do things that help our constituents.
  This isn't just a red-State problem. I pointed that out earlier when 
I referenced Wisconsin and Montana. This is a problem that confronts 
our entire country.
  So we are going to continue to keep working on a bill that repeals 
this ObamaCare disaster and replaces it with patient-centered, 
accessible healthcare that make sense for the

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American people. I hope our colleagues on the other side of the aisle 
come around to join us because we do intend to get this done.
  I just want to read a couple of other excerpts from this Wall Street 
Journal editorial today. They talk a little bit about how to read the 
CBO report. The Congressional Budget Office, as the Presiding Officer 
knows, really has the final word on interpreting, from an official 
standpoint, what the impact of proposed legislation would be, but I 
have to say this is far from the holy writ.
  Here is a good example. In this article, they point out ObamaCare 
coverage estimates--CBO estimates for ObamaCare coverage by year in 
millions of enrollees. For example, in 2013, they projected that 7 
million enrollees would enroll in ObamaCare, and it was 6 million. That 
is not too far off, but let's look at 2015. In 2015, they said 13 
million would enroll, and 11 million enrolled. Again, that is ballpark, 
but then we go to 2016. They predicted that 21 million people would 
enroll in ObamaCare. Do you know how many enrolled? Twelve million. 
They missed it by almost 50 percent. That is not close. Then, in 2017, 
they projected it would be 15 million, and it was 10 million.
  I say that not to disparage the Congressional Budget Office because I 
know they are doing the best they can, but it is hard to predict the 
future, and it is also hard to predict how markets will work and how 
people will respond to the incentive of more choices and lower costs.
  This is not a red-State or a blue-State issue because, as I 
mentioned, in Missouri alone HHS has said that premiums have increased 
145 percent. So wouldn't we think we would have both Senators from 
Missouri on the floor working with us to try to solve the problem? I 
know Senator Blunt is working with us to try to solve the problem, but 
we would benefit from having a bipartisan effort to address the 
problem.
  They also point out that there are other things the CBO report talks 
about which is significant, particularly in terms of getting our 
economy growing again. They said, for example, that the House bill cut 
taxes by $992 billion, spending by $1.1 trillion, and reduced the 
deficit by $119 billion. Now, I know that is not the primary effort 
here when it comes to healthcare, but if we want to get our economy 
growing again, if we want to make it possible for more people to buy 
healthcare coverage at a price they can afford, it helps if they have a 
job, and it helps if the economy is growing.
  Here is the thing that, to me, is perhaps the most cynical argument 
by the critics of what we are trying to do in repealing and replacing 
ObamaCare. Despite the fact that there are 30 million people uninsured 
now--hardly a success, hardly the gold standard for providing access to 
healthcare coverage--the Congressional Budget Office points out what I 
think is pretty obvious. If you take the gun away from people's heads 
and you don't force them to buy a product they really don't want, fewer 
people are actually going to buy it because it doesn't suit their 
needs, and it is not available at a price they can afford. As the Wall 
Street Journal points out, without the threat of government to buy 
insurance or else pay a penalty, some people will conclude that 
ObamaCare coverage isn't worth the price, even with the subsidies.
  Sometimes I wish we would have honest and open debates about the 
problems that confront our country, and certainly healthcare is 
something near and dear to all of our hearts. Too often I feel as 
though we are ships passing in the night or reverting to our talking 
points rather than having an open and honest discussion. This is an 
area where we can benefit from an open and honest discussion and an 
acknowledgment that the status quo is unsustainable.
  If Hillary Clinton were President of the United States today, we 
would be revisiting ObamaCare because the individual market is, as I 
described earlier, failing. It is failing. I am confident our 
colleagues across the aisle would be eager to try to step forward to 
address that, but because the candidate they did not choose won the 
Presidency, then they are in full-blown resistance, not offering to 
lift even a finger to try to help us solve this problem, and it is a 
shame, but it is not too late.
  We invite them again to join us as we repeal and replace ObamaCare, 
providing people with more choices at a price they can afford, not 
because we are going to hold a gun to their head and say you are going 
to have to buy a product you don't want, at a price you can't afford, 
we are going to give people the freedom to choose. That is not a bad 
thing. That is a good thing. That is what America is all about--not 
having government force you to make decisions that you don't view are 
in your own economic self-interests.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Fischer). The Senator from Connecticut.
  Mr. MURPHY. Madam President, I rise to speak on the same subject as 
my friend from Texas.
  Listen, Democrats are ready to talk to Republicans about improving 
our healthcare system, but we aren't going to engage in a debate that 
presupposes that the end result is going to be millions of people 
losing care and rates going up for everybody in order to fund a tax cut 
for the wealthy. That is the plan Donald Trump and the Republicans are 
pushing.

  So my Republican friend is right: Democrats are not interested in 
having a discussion about how many people are going to lose coverage. 
We are not interested in having a discussion about how high the rate 
increases are going to be. We are not interested in having a discussion 
about big tax breaks for millionaires, billionaires, insurance 
companies, and drug companies.
  Let's be honest. If Republicans were serious about working with 
Democrats, we wouldn't be using an arcane Senate rule which allows them 
to push through a bill with 50 votes. If Republicans really wanted to 
work with Democrats on healthcare reform, they would do it through 
normal business. If Republicans were really serious about working with 
Democrats on healthcare reform, they would be going through regular 
order and going through the committee process.
  Whatever we want to think about the Affordable Care Act, it went 
through the committee process. I think 160 Republican amendments were 
accepted in the Health, Education, Labor, and Pensions Committee in 
2009. The Finance Committee held multiple meetings. The bill was on the 
floor of the Senate for a month. Republicans are jamming this bill 
through--no committee process, no committee meetings, no committee 
markups, no open-floor process.
  Even Senator Corker called out his own party and said that this is no 
way to rewrite one-sixth of the American economy--13 male Republican 
Senators, behind closed doors, in secret.
  Democrats are desperate to work with Republicans on fixing what is 
wrong with our healthcare system. Not every problem has been fixed, but 
we are not going to start with 17 million people losing healthcare or 
rates going up by 20 percent. And we want to do it in a way that is 
transparent to the American public, where everybody can see.
  On the second point my friend from Texas raised--this idea that CBO 
got the numbers wrong when they estimated how many people would be 
insured by the Affordable Care Act in 2009--as he mentioned, they 
weren't off by that much, but to the extent they were off, there is a 
simple reason for it: CBO did not take into account that Republican 
States would seek to undermine the Affordable Care Act in every 
conceivable way possible. CBO gave Republican Governors and State 
legislatures the benefit of the doubt that once this law was passed, 
once it was presenting an avenue to insurance for millions of people 
across the country, both parties would seek to implement it. That is 
not what happened. Republican States refused to set up State-based 
exchanges. Republicans brought lawsuit after lawsuit to try to stop the 
Affordable Care Act from going forward. Republicans, in control of the 
House and the Senate, jammed through legislation that reduced the risk 
insurance provided to insurance companies. CBO did not estimate that 
Republicans would wage a 6-year-long campaign to undermine and undo the 
Affordable Care Act.
  In States that implemented the act, such as Connecticut, numbers met 
or beat expectations. In States that didn't

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implement the Affordable Care Act, sought to undermine it, numbers 
didn't meet the expectations.
  Then comes President Trump, who openly telegraphs his desire to 
undermine the Affordable Care Act, cuts off all of the advertising, 
tells the IRS to stop enforcing the law, bleeds out payments to 
insurance companies one month at a time, teasing that this will be the 
last month they get their money.
  Finally, on this question of a gun to the head of consumers--I guess 
that is a reference to the provision of the Affordable Care Act that 
says: If you don't buy insurance, then you will pay a penalty. That is 
absolutely part of the Affordable Care Act. Why? Because if you want 
protection for people with preexisting conditions, then you have to 
have a mandate that people buy insurance, or else people just won't buy 
insurance until they are really sick, knowing they can't be charged 
more.
  Actuarially, the protection for people with preexisting conditions 
only works with the individual mandate. I remember Senator Cruz, during 
his marathon filibuster, admitting that. Republicans and Democrats know 
that. That is why the American Health Care Act, which just came out of 
the House of Representatives, includes an individual mandate. So let's 
not pretend like this is a partisan issue.
  The rightwing American Health Care Act that came out of the House of 
Representatives 2 weeks ago includes an individual mandate--it is in 
there--because they know the same thing: If they want to preserve any 
modicum of protection for people with preexisting conditions, they have 
to require people to buy insurance. They just put the mandate in a 
different place. In the Affordable Care Act, the penalty kicks in if 
you don't buy insurance. In the House bill, the penalty kicks in after 
you have lost insurance and you try to sign up again. It is the same 
mandate, the same penalty, just a slightly different timetable for 
payment.
  Here is what TrumpCare does: higher costs, less care, tax cuts for 
the rich.
  I want to talk about the CBO score that came out last night--not 
major adjustments from the first CBO score, but there are some 
important amendments that they make. But the bottom line is that if you 
care about costs, there are going to be higher costs. That is what CBO 
says. There is a 20-percent increase in cost the first year, 5 percent 
in the next year for good measure. There is less care--I mean 
significantly less care--23 million people. Big improvement--24 million 
people lost care in the first House bill; 23 million people lose care 
in the second House bill. And all of this is done in order to pass 
along tax cuts to the wealthy. We are talking about $662 billion of tax 
cuts for the wealthy.
  Here is what CBO says: Premiums are projected to rise 20 percent in 
2018. So our Republican friends who came down to this floor for 6 years 
and said we need to repeal the Affordable Care Act because costs are 
too high just passed a bill in the House of Representatives that CBO 
guarantees will raise premiums by 20 percent in 2018.

  And it got a lot worse. CBO says that if you are an individual with a 
preexisting condition and you live in a State that takes advantage of 
one of these waivers, the premiums, frankly, don't even matter to you 
because you won't be able to afford the catastrophic high cost 
associated with your illness.
  If you are an older American, especially an older American living on 
Social Security, then you are targeted by the American Health Care Act. 
A 64-year-old making $26,000--and I have a lot of 64-year-olds in 
Connecticut making $26,000, and I bet a lot of my colleagues here who 
live in lower cost and lower income States have even more of this 
population--today you are paying about $1,700 a year for healthcare. 
That is what your premium is after taxes. Under the American Health 
Care Act, your premium would go up to $21,000 a year. You are making 
$26,000, and your premium goes up to $21,000. You would receive about 
$5,000 in tax credits, but in the end, you would be paying $16,000 in 
healthcare premiums.
  Now, obviously you wouldn't be paying $16,000 in insurance premiums 
because you couldn't afford healthcare if you still want to pay your 
rent and you still want to pay your gas bill and you still want a few 
groceries.
  The reason why massive numbers of people lose insurance is because 20 
percent is just the average; for some people, premiums will go up 700 
to 800 percent, especially if you are older or if you are lower income.
  Here is what CBO says will happen if the Affordable Care Act stays: 
The number of uninsured will go up a little bit. It will tick up to 
about 28 million. But for all my colleagues on the Republican side who 
have been claiming that the Affordable Care Act is in a ``death 
spiral,'' CBO tells you that you are wrong. You are wrong. They state 
clearly that the marketplaces will remain stable. Now, again, they may 
not be counting on the kind of sabotage President Trump is engaged in. 
If President Trump continues to destabilize the markets, maybe this 
number will be wrong. But if you had an administration that was 
attempting to enforce and implement the Affordable Care Act, you would 
get about the same number of people who are uninsured.
  Here is what happens if you pass the American Health Care Act: The 
number goes immediately up to over 40 million uninsured and peaks after 
10 years at 51 million people.
  Senator Cornyn said: Listen, we still have 30 million people who 
don't have insurance; let's try to solve that problem. But CBO says 
that the House bill doesn't solve the problem. It turns a problem of 28 
million Americans without health insurance into a humanitarian 
catastrophe--more people uninsured at the end of this than were 
uninsured before the Affordable Care Act passed.
  So I guess what Senator Cornyn is saying is that whatever product 
emerges from these secret meetings will insure more people and that CBO 
will verify that. That is something on which we can work together. Let 
me guarantee, that won't be the case.
  To give a sense of how many people 23 million is, because I know that 
is kind of a hard number to get your head wrapped around, this is the 
number of people who lose insurance under the House bill, according to 
CBO. CBO's new numbers just came out last night. That is the equivalent 
population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, 
Nebraska, Nevada, New Hampshire, New Mexico, South Dakota, Rhode 
Island, North Dakota, and West Virginia. When we put up this chart a 
couple months ago, I think there was one additional State. So by moving 
from 24 million losing insurance to 23 million people losing insurance, 
one State came off this list. But that is the equivalent population of 
how many folks lose healthcare in this country. That is why I call it a 
humanitarian catastrophe.
  Then let's just think about what CBO says about who benefits. Here 
are 23 million people who lose insurance--and that is a pretty simple 
formula. The bill takes insurance from 23 million people in order to 
pass along a $173 billion tax break for the pharmaceutical industry and 
the insurance industry and a $230 billion tax break for very rich 
people. Some of it will go to people making above $200,000 a year, but 
most of it will go to people making over $1 million or $1 billion a 
year. The numbers actually work out pretty squarely. The cuts to 
healthcare in the bill roughly work out to be about the same amount in 
tax cuts for the wealthy.
  By the way, there is another chart here that is a great one. There is 
another chart that shows who benefits when we look at the tax breaks. 
If you make under $200,000 a year, you get zero benefit from the 
American Health Care Act. Every single dime of the tax cuts for 
individuals or families goes to those making over $200,000 a year. How 
about that--a $230 billion tax break, and not a dime of it goes to 
people making under $200,000 a year. So this bill was a nightmare 
before the CBO score, and it is even more of a nightmare today.
  Let me point out one more important thing that CBO says about this 
bill. Inside this bill, in a new amendment that allowed it to pass the 
House of Representatives, is a provision that allows States to get 
waivers from the essential healthcare benefits requirement that 
insurance actually provide you coverage for healthcare and the 
community rating requirement that you spread out the costs of 
healthcare across the entire population of people who are insured.

[[Page S3171]]

  What CBO says is that about one-sixth of the population--that is 
equivalent to about 25 States and Washington, DC--who might obtain 
waivers, including both the essential benefits requirement and the 
community rating benefit--that would result in insurance markets coming 
apart at the beginning of 2020.
  CBO states that ``less healthy people would face extremely high 
premiums, despite the additional funding that would be available'' 
under the bill to reduce premiums. CBO says specifically: ``In 
particular, out-of-pocket spending on maternity care and mental health 
and substance abuse services could increase by thousands of dollars in 
a given year for the nongroup enrollees who would use those services.''
  Let me put a finer point on this. The legislative jujitsu that 
Republicans did in the House to get this thing passed involved 
eliminating the requirement that people with preexisting conditions be 
protected from premium increases, combined with a high-risk pool that 
would have a bunch of money in it to help reduce premiums for those 
people.

  CBO tells you essentially that those high-risk pools are a fraud. CBO 
says there is not enough money in the high-risk pools in order to 
provide any meaningful benefit for people with preexisting conditions. 
In particular, they say, women going through pregnancy, families going 
through pregnancy, and individuals with mental health and substance 
abuse will see thousands of dollars in additional costs because the 
money in the risk pools cannot cover the cost of that care.
  We have an opioid epidemic raging throughout this country, and the 
House just passed a bill that will increase costs for people suffering 
from substance abuse by thousands of dollars. We can do better. 
Republicans can emerge from these secret meetings, set aside their plan 
to ram through this vote with no committee process through 
reconciliation, and we can start talking about what to preserve in the 
Affordable Care Act and what we need to change. That is what Americans 
want us to do.
  The majority of Americans do not want this bill repealed. The 
majority of Americans today support the Affordable Care Act. Yes, that 
number is different than what it was a few years ago. Maybe that is 
because, faced with this benefit, faced with these insurance 
protections being eliminated, Americans are rallying to the defense of 
the Affordable Care Act. That doesn't mean Democrats don't believe we 
can make some commonsense amendments, but it does mean we are not 
willing to participate in a process that presupposes that the outcome 
will be less people being insured, costs getting higher in order to 
finance tax breaks for the very wealthy and for insurance companies and 
drug companies.
  Republicans should come out from behind closed doors, work with 
Democrats. CBO tells you a humanitarian catastrophe is coming if you 
don't.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. MORAN. Madam President, I am here to visit about the topic of 
healthcare. I will be spending time in Kansas this week, and there 
probably will be no topic of conversation that will be greater than 
people's concerns about healthcare. I will tell you, as I have 
indicated to many of my colleagues, this is like no other issue I have 
ever dealt with as an elected official in how personal the consequences 
are of the decisions we make here.
  While I certainly admit there is plenty of politics and partisanship 
and too much back and forth that revolves around this concern about 
healthcare, what I do know is, the people who visit with me, in so many 
instances, are my friends, my neighbors, our kids' teachers, they are 
people I go to church with, and in many instances, as they have a 
conversation with me about what we are going to do in regard to 
healthcare, tears begin to stream down their cheeks as they worry about 
themselves but, more importantly, they worry about their family 
members, their sons, daughters, husbands, wives, and parents.
  This is a very personal issue. The concerns Kansans have about this 
and what we might do is sincere and real. I also know the Affordable 
Care Act--the law that is in existence today--is failing many Americans 
as well. In fact, just this week, yesterday, we learned the company 
Blue Cross and Blue Shield of Kansas City is exiting the market and 
will no longer provide a product in the Kansas City area of our State, 
which means, in most instances, individuals will no longer have an 
option in regard to the Affordable Care Act.
  What we have in place doesn't work, but I also know what has come 
from the House isn't the solution to this problem either. The work we 
have to do--you and I, Madam President, and our colleagues--is serious 
and one that has real and personal consequences for every American, and 
we must take our responsibilities seriously.
  I have indicated to my colleagues that neither the Affordable Care 
Act, which I voted against, nor what the House has passed, is anything 
I would vote for. I really wish we were doing something different than 
either one of those things.
  As I thought about my remarks today, I was about to say that I 
suppose I came too late to get my ideas adopted by Congress, but really 
I came to this issue early, and I think it was 2004, maybe 2006, in 
which, at least in my own mind, I penned on paper and worked on 
drafting legislation on what I called a 10-point plan to address the 
affordability and availability of healthcare.
  I can tell you that my ideas, which predate President Obama's, were 
nothing like the Affordable Care Act, and they really were nothing like 
the conversation we are having today. I wish we would be addressing the 
underlying reasons that healthcare costs so much rather than focusing 
so much attention on the issue of health insurance and its premiums.
  If we can drive the things out of healthcare that unnecessarily raise 
the price, the cost of access to healthcare, we can make a tremendous 
difference in healthcare premiums and the affordability of healthcare 
for all Americans, not just trying to figure out what kind of plan we 
can develop, what kind of insurance program, what kind of subsidy or 
tax credit we can provide, but we would be treating the underlying 
problem, not just the symptoms.
  I suppose, to give a little understanding of what I am talking about, 
in my view, the things we ought to consider are allowing more 
competition in the market, more free enterprise opportunities, allowing 
people to purchase insurance from coast to coast, expanding the support 
for community health centers. These centers are already in existence. 
They need to be more available in more places.
  We are a very rural State, and it is hard to find those community 
health centers, but they provide healthcare services to people who have 
no ability to pay and no insurance. We ought to be more supportive of 
community health centers, not less, providing, particularly, primary 
care for people in difficult circumstances.
  We also need to give small businesses and organizations the ability 
to organize and create larger pools so they can negotiate for better 
premiums. We need to utilize health savings accounts. We need to 
support medical research. If we can find a cure for cancer, the delay 
of the onset of Alzheimer's, we can save billions of dollars in our 
healthcare system as well as save lives and improve the quality of life 
of people who suffer from the diseases that are so prevalent.
  We need to address the issue of prescription drug costs. How do we 
make certain no drug company takes advantage of cornering the market or 
how do we make certain they don't utilize our current laws to extend 
the life of their patent, eliminating the chance for competition to 
come into play and the introduction of generic medicine that can save, 
again, consumers and patients lots of money.
  We need to promote preventive healthcare. Wellness, fitness, diet, 
and nutrition are the things that probably give us the biggest bang for 
our buck and don't necessarily need to be a government program, but 
people need to work at living healthier and healthier lives and prevent 
diseases from occurring in the first place.
  We need additional physicians and other healthcare providers--nurses 
and others--and we have not put the attention into developing programs 
to educate and train the next generation of medical providers. We need 
to make sure Medicare and Medicaid actually

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pay for the cost of the services they promised to pay for on behalf of 
low-income citizens as well as citizens who are seniors, instead of 
having the cost shifting that occurs as a result of the system we have 
today, in which Medicare doesn't pay or Medicaid doesn't pay sufficient 
amounts of money to actually pay for the services a patient receives 
under either one of those programs.
  Again, those are things that I think would be beneficial to every 
American, and it wouldn't be spending our time trying to figure out how 
we modify the insurance system, how we figure out about subsidies or 
tax credits for people within the system. Again, I don't come late to 
this issue, but it doesn't seem to be the direction we are going.
  Before my time expires, one of the items I wanted to particularly 
highlight is the value of medical research. I am proud this Congress 
passed an appropriations bill that includes an additional $2 billion 
for use in medical research for the National Institutes of Health, and 
perhaps something that we can even be additionally proud of is, we did 
that without spending more money. We simply--I shouldn't say 
``simply.'' Nothing is easy about it. I am on the Appropriations 
subcommittee that is responsible for the funding of NIH. We reallocated 
money that was being spent someplace else in support of medical 
research. Again, if we find the cure for cancer, if we reduce the 
onset, the time in which people suffer from Alzheimer's, if we can find 
the cure for diabetes and other diseases, the lifesaving changes that 
are being made through that medical research and the costs that will 
accrue to our healthcare delivery system are hugely important.
  I particularly commend the Director of the National Institutes of 
Health for working so closely with Members of Congress and the American 
people in support of medical research. Dr. Francis Collins is a 
national resource. I am not a scientist. I don't understand all the 
concepts that are spoken about when we talk about medical research--a 
long shot from that. One of the things Dr. Collins, the Director of the 
National Institutes of Health, has been able to do is explain to me and 
to my colleagues and to others across the country the value of medical 
research without getting me lost in the details of the actual science. 
He is someone who can talk to a layperson about medical research and 
science in a way that captures me, captures my attention, but I don't 
get lost in the medical or technical or scientific words and jargon 
that so often scientists use in having the conversations.
  Dr. Collins has been so bipartisan in his approach. I smiled when I 
read the story. He indicated that when he was being chosen to be the 
Director of the National Institutes of Health, he called his mother 
back home and indicated to her: Mom, I am going to become the Director 
of the National Institutes of Health.
  She said: But we are Republicans. I don't want you working for 
government.
  Here is a man who has used his time not working for government, 
perhaps working in government, but working for the American people and 
really for worldwide solutions to problems we all face in our families.
  There is no American, there is no one in this Chamber whose family 
has not been affected by the diseases I described and the other long 
list of afflictions we have as human beings that NIH is not working to 
make a difference in their lives.
  We need to continue that support for the National Institutes of 
Health as we pursue appropriations bills into the future, and our 
ability to do that together is important and a source of satisfaction 
that can come.
  I have indicated, from time to time, that it is sometimes difficult 
to find the things in the jobs that we have as U.S. Senators where you 
get the sense of accomplishment. There are a lot of challenges in 
getting things done, but the idea that we have come together to support 
medical research and find lifesaving cures gives us something to take 
great satisfaction in and gives us hope that what we have been able to 
accomplish in this regard, as Republicans and Democrats but really as 
Americans, can be a role model as we try to find solutions to other 
problems. I hope that will be the case as we try to find solutions with 
regard to how do we care for the American people when it comes to their 
affordability and availability of healthcare.
  You and I, Madam President, come from States that are very rural. In 
any kind of healthcare solution that we find, we need to make certain 
we are increasing the chances that hospital doors remain open in rural 
communities across our States, and we need to make certain there are 
more physicians, not less, there are more healthcare providers, that 
nursing home and healthcare services are more available, and that 
pharmacy remains on Main Street.
  In fact, in the cases of our States, you could find ways, I suppose, 
that reduce the cost of healthcare only to discover that you no longer 
have a provider, no longer have a hospital or a physician or a pharmacy 
in your hometown. Sometimes when you talk about the affordability, you 
must quickly couple that with availability. Whatever its price is, if 
it is not in your community, if it is not in your county, if it is not 
in your region of the State, it doesn't necessarily matter what it 
costs.
  Our work is serious, and I look forward to working with you and my 
colleagues as we try to find solutions to make certain healthcare is 
something every American has access to.
  I yield the floor.
  Mr. LEAHY. Madam President, just 1 week after a party-line vote in 
the Judiciary Committee, the Senate is about to vote on the nomination 
of Judge Amul Thapar to the Sixth Circuit Court of Appeals. It has been 
more than 16 months since the Senate confirmed a Federal appellate 
judge and almost 11 months since we voted on a circuit or district 
nomination. That is because of Leader McConnell's unprecedented 
obstruction, blocking any votes on President Obama's qualified, 
consensus nominees, all in an effort to leave as many judicial 
vacancies as possible for President Trump and the far right special 
interest groups who are charged with selecting his nominees.
  The 7 days Judge Thapar has waited for a vote is quite a contrast 
with the last circuit judge that Leader McConnell permitted to be 
confirmed. Judge Felipe Restrepo's nomination languished for 6 months 
on the Senate floor last Congress before he was finally given a floor 
vote. Of course, there was no good reason for that. Judge Restrepo had 
bipartisan support at every step of the process: positive blue slips 
from his Democratic and Republican home State Senators, a voice vote in 
the Judiciary Committee, and a bipartisan 82-6 confirmation vote. 
Likewise, there was no good reason for Leader McConnell to deny votes 
on other circuit nominees like Donald Schott and Jennifer Puhl. They 
were reported with strong bipartisan support in the Judiciary Committee 
and had bipartisan support from their home State Senators, but were 
left languishing on the Executive Calendar for months, without ever 
receiving floor consideration. We should not forget the 20 district 
nominees and the five Court of Federal Claims nominees, who were 
reported with bipartisan support and then fell victim to Senate 
Republicans' unprecedented obstruction and were denied a vote after 
waiting months or even years. Of course, we cannot overlook one of the 
most shameful inactions of the Senate--the treatment of Chief Judge 
Merrick Garland, who did not even receive a hearing for his nomination 
to the U.S. Supreme Court.
  So why are we now rushing to confirm Judge Thapar? It is only fair to 
note that the seat to which he has been nominated has been vacant for 
nearly 4 years. President Obama's nominee to that seat did not receive 
this expedited process. She did not even receive blue slips from the 
Kentucky Senators. Now, that is their right. Had I still been chairman, 
I would have honored that decision--as I did for both circuit and 
district nominees--however much I might have disagreed with it. We 
should not pretend that we are required to vote so quickly on Judge 
Thapar simply because the Republican leadership held this seat vacant.
  This is a nomination that requires thorough consideration by the 
Senate. It is no secret that Judge Thapar is a favorite of the same far 
right groups that handpicked Justice Gorsuch--in fact, Judge Thapar was 
on the same shortlist that they gave to President

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Trump. Given Judge Thapar's apparent views on campaign finance 
regulation, it is no surprise that these groups, who are some of the 
biggest opponents of any efforts to bring transparency to campaign 
financing, want to see him elevated to a circuit court. His answers 
during his hearing did not allay my concerns.
  I was also troubled by Judge Thapar's responses to my written 
questions. Like Justice Gorsuch, he dodged a very simple question about 
whether the First Amendment permits a religious litmus test for entry 
into the United States, but even that nonanswer was inaccurate. Judge 
Thapar responded that the constitutionality of a religious litmus test 
is an active question in pending litigation regarding the president's 
Executive order targeting Muslim-majority countries, and that he could 
not comment on it. That is not accurate. There is no question that such 
a religious litmus test is unconstitutional--even the Trump 
administration does not argue otherwise. Instead, they are arguing that 
the Executive order does not impose such a litmus test. Judge Thapar 
failed to get the facts right, and failed to show me that he 
understands one of the most fundamental principles of our Constitution. 
It will be very difficult for me to support any judicial nominee who 
fails to answer this question with adherence to both the Constitution 
and the facts.
  The role that far right interest groups have played in this 
nomination and the Gorsuch nomination is troubling. A President is free 
to consult with whomever he wishes on potential nominees, but the 
``advice and consent'' power belongs to the Senate, not the Federalist 
Society. For decades, Presidents of both parties have consulted with 
home State Senators, a requirement formalized through the Judiciary 
Committee's blue slip process. This tradition protects the role of all 
100 Senators in the confirmation process and helps ensure that 
Presidents work with Senators of both parties to find consensus 
nominees.
  During my nearly 20 years as either chairman or ranking member of the 
Judiciary Committee, I encouraged Republicans and Democrats to work 
with President Clinton, President Bush, and President Obama to find 
qualified, consensus nominees, and I protected the rights of Senators 
in both parties. As Ranking Member Feinstein noted in a memo that was 
circulated yesterday, no judicial nomination made by the last three 
Presidents was confirmed without the support of both home State 
Senators. I cannot recall a nominee being confirmed over the objection 
of his or her home State Senator. The blue slip is not a partisan 
issue; it is about constitutional checks and balances and the Senate's 
role in protecting the independence of our Federal judiciary. I 
encourage President Trump to follow the example of his predecessors 
from both parties and work with us to find consensus nominees to ensure 
that our Federal courts remain the envy of the rest of the world.
  The PRESIDING OFFICER. The Senator from Illinois.