[Congressional Record Volume 163, Number 96 (Tuesday, June 6, 2017)]
[Senate]
[Pages S3258-S3260]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CASSIDY. Mr. President, I am here to speak about a topic which, 
wherever I go, people speak about--the replacement of the Affordable 
Care Act or ObamaCare, as people call it. Clearly, we need action.
  I had a Facebook post maybe a week or two ago from Brian in 
Covington, LA. He said: My family plan is $1,700. The quote goes on to 
say how his family cannot afford that $1,700.
  Rates are going up, which I have said time and time again. My friend 
back in Baton Rouge, he and his wife are 60, 61. The quote for their 
insurance last year was $39,000--for 1 year. That is clearly not 
affordable. This is not just in Louisiana; it is in Washington, DC, it 
is in California, it is across our Nation where individual market 
quotes are going up that they cannot support.
  Most recently, Connecticut insurers--there are two--are proposing 
rate increases that are 15.2 percent and 33.8 percent, on average, 
respectively. They are quoting 22 percent over 2017. In Maryland, some 
insurers are going to raise rates as much as 59 percent for those 
individual plans.
  I am a physician. I learned a couple of things in my 20 or 30 years 
of practice. One, to lower costs, the patient must have the power; and, 
two, the insurance must be affordable; and, three, that the insurance 
they receive must be adequate. President Trump totally got this. On the 
campaign trail, President Trump said time and again--what I call his 
contract with the voter. He wanted folks to maintain coverage with 
lower premiums, care for those with preexisting conditions, and 
eliminating mandates. I think President Trump just knew it. I shorthand 
this, if you will, saying, if we focus on lowering premiums and making 
sure it passes the Jimmy Kimmel test. The late-night comedian, when his 
child was born with a terrible heart problem, immediately got the care 
that child needed. So if we can have insurance that passes the Jimmy 
Kimmel test--lowering premiums, taking care of the rest of President 
Trump's goals, then I think we can accomplish it. We need to talk to 
experts, actuaries, those who

[[Page S3259]]

design insurance plans, to make sure we come up with something.
  There is something else the President said that I want to focus on. 
This is just before he took the oath of office. He said people covered 
under the law--meaning the Republican replacement--can expect to have 
great healthcare. ``It will be much simplified.'' One of the complaints 
about the Affordable Care Act is it is so complicated. Even online, 16 
pages online, with your W-2, if you don't get it, you get booted out. 
The President said we must have a much simpler way of going about 
this--much less expensive and much better.
  What could this look like? Let me propose some conservative solutions 
that could be in a Republican plan that would achieve the President's 
goal. First, the patient has to have the power. In my 30 years of 
practice, I found that if the patient has the power, the system lines 
up to serve her. One example is price transparency. If we can put in 
that a provider has to publish the provider's price, so the patient 
getting the blood test knows the cost of the blood test at that moment 
and can compare it to someone down the street, we will lower cost.
  One example just came up in a newspaper out of New Orleans. Nola.com 
is their website. A woman went in and got blood tests. She received a 
bill weeks later and her bill was for $324. She found she could have 
gotten the same blood test for $34 right down the street. A woman from 
Texas came up. She said she heard me speak of price transparency--the 
power of negotiating, if you will. The doctor ordered an MRI on her 
son's shoulder. She called up the different places where she could have 
it done and she got a price of $667. On my Facebook page is a little 
video of her speaking: I got it for $667. Then I remembered what you 
said: If you pay cash, you get a discount. I called them back. I said, 
if I pay cash, will you give me a lower price? They said: Pay us cash, 
we will cut that $667 to $400. The patient had the power. So she ended 
up paying far less for the procedure the doctor ordered. That is one 
conservative solution, give the patient the power.
  Secondly, let States innovate. We need to take all of this power that 
ObamaCare brought to Washington, DC, and push it back out to the 
States. If we do that, we are going to accomplish something. Let's just 
acknowledge that there are 700,000 people or so in Alaska. If you took 
a map of the State of Alaska and put it over the lower 48, it would 
stretch from roughly Georgia to the Pacific Ocean. Washington, DC, has 
almost the same population as Alaska, and you can walk across the city 
in a morning. Clearly, you need different solutions for an area you can 
walk across and an area you cannot fly across in the same time that you 
would walk across Washington, DC. We have to return power back to the 
patients. We have to engage doctors and patients so those patients with 
complex conditions get their healthcare managed. I use the example of a 
diabetic. She perhaps developed childhood diabetes, and now she is 35 
years old. If a doctor is managing her condition, she works, stays at 
home, her complications are minimal, and her life is much better. If 
her condition is not managed, she comes to the emergency room three 
times a month with diabetes out of control. That just shoots a hole in 
the bucket of fiscal responsibility and also in her health. Instead of 
working, keeping a family, she is coming to the hospital, getting care 
through the emergency room, which she cannot afford to pay for, and 
that cost is shifted to everyone else. That is not the way to manage 
that. We need to engage doctors with patients.
  Another conservative solution is we need more competition between 
insurers so there is not just one insurance company in the market that 
can therefore set prices but rather we have multiple. So if we give the 
patient the power by giving the patient a tax credit that she can use 
to purchase the insurance she wishes to have, that will create 
competition as more insurers enter the market. If we have that 
competition--those market forces--prices come down.

  When the President said we have to make things simpler, I think that 
also includes how we enroll people in insurance. We figured that out on 
Medicare. Under Medicare, if someone turns 65, they are on Medicare. It 
could not be simpler. They get a letter. They are on Medicare. If they 
don't want to, they can call: Hey, I don't want to be on Medicare. But 
as a rule, they are on Medicare.
  Fortune 500 companies have figured out the same thing. In order to 
enroll people into retirement plans they say: Listen, you are in the 
401(k) plan unless you choose not to be. That makes it simpler to get a 
95-percent enrollment in retirement plans. Now, you could say: Hey, 
listen, you have to fill out a bunch of forms. If you don't fill out 
these forms, you are not going to be enrolled. But that would not work 
for Medicare. It would not work for 401(k)s. It has not worked under 
ObamaCare.
  We need to take those same sort of solutions we have found for both 
Medicare and enrolling people in their retirement and do it for the 
Republican alternative.
  The Republican alternative would say: We make it easy to enroll. You 
are in unless you are out. So if you are eligible for a tax credit, you 
would receive it. You would then have the insurance. If you were 
passive about it, you would have a default policy. But if you are 
active, you could do more with it. But by doing so, you actually 
increase the number of people insured.
  Now, when you increase the pool of those insured, you lower premiums. 
We had Blue Cross look at our proposal to make it easy to enroll: You 
are in unless you are out. That would lower premiums by 20 percent, 
just by expanding the number of those who are insured--20 percent.
  So when President Trump says he wants to continue coverage, caring 
for those with preexisting conditions without mandates and lowering 
premiums, doing this feature where you are in unless you call us and 
tell us you don't want to be and making it simple achieves all four 
goals.
  We would increase coverage. By that, we would lower premiums, taking 
care of those with preexisting conditions. Now, again, it is using the 
mechanism that is already used in Medicare and in Fortune 500 
companies, making it easy to enroll. There are some who don't want to 
give States the options. They don't want to give patients the options. 
They don't want to make it simple to enroll. They want to replace, if 
you will, the tyranny of ObamaCare--where all of this power is taken to 
Washington, DC, and States and people were told what they had to do--
with a different sort of tyranny, telling States what they can't do.
  I think we ought to give as much power to the States, as much 
latitude to the patients to come up with the solutions that work for 
them. That is the conservative way to go.
  But I will say, in speaking with conservatives, that I very much 
invite our Democratic colleagues to come to the table. There are some 
of my Democratic colleagues who have said they just want Republicans to 
work through this, thinking that it might be a political train wreck 
that would work to their advantage. But in those States there are 
Americans whose premiums are becoming unaffordable.
  I mentioned earlier that in Connecticut premiums are rising 15 and 34 
percent this year. In Oregon, it is as high as 22 percent, and Maryland 
is as high as 60 percent.
  Now, who cares if the person is a Democrat or a Republican? If her 
premium is increasing 60 percent, she cannot afford it. So I challenge 
my Democratic colleagues to get off the sidelines and engage. Try to do 
something not for political purposes but for the purpose of that person 
who is at home struggling to pay the bills and deciding that she can no 
longer afford insurance, but, perhaps unbeknown to her, she has a 
cancer brewing inside her. Just when she decides she can no longer 
afford coverage because premiums have risen 60 percent, that is when 
her cancer is discovered.
  We have to address this. It will take us on either side of the 
aisle--both Democrats and Republicans--to work together. I will finish 
with a quote from a fellow from Covington, Brian, on my Facebook page. 
He said that his family plan is $1,700 a month, for him, his wife, and 
his two children. The ACA, the Affordable Care Act, or ObamaCare, has 
brought him to his knees. I hope we can get something done. The middle 
class is dwindling away. Can everyone just come together and figure 
this out?

[[Page S3260]]

  This is a cry for help. It is a challenge to Republicans and 
Democrats to come up with a plan that is not a red plan or a blue plan 
but an American plan to address his needs, his wife's needs, and those 
similar to him across the country.
  The PRESIDING OFFICER. The Senator from Louisiana.