[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3528-S3529]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



        Individual Health Insurance Marketplace Improvement Act

  Mr. KAINE. Madam President, I rise to speak about the ongoing debate 
in the body concerning the next chapter in healthcare and what we can 
do about it together and, especially, to address one part of the 
healthcare market--the individual market.
  As most know--and this has been an item about which we are deep into 
discussions, the people and the Members of this body--before the 
passage of the Affordable Care Act, Americans with preexisting 
conditions faced unfair barriers to accessing health insurance 
coverage, and healthcare costs had risen rapidly. Prior to the passage 
of the Affordable Care Act, my own family, which is probably like the 
healthiest family in America because the five of us have only had three 
hospitalizations for three childbirths--all for my wife--we had twice 
been turned down for insurance coverage for at least one member of our 
family because of preexisting conditions.
  Since 2010, the rate of uninsured Americans has declined to a 
historic low. More than 20 million Americans have gained access to 
health insurance coverage--many for the first time in their lives. In 
Virginia, over 410,000 Virginians have accessed care on the individual 
marketplace and another 400,000 would be eligible if Virginia decided 
to expand Medicaid.
  Many Virginians use the individual market, and they have shared their 
stories with me on my website. I have on my Senate website ``ACA 
Stories,'' where I encourage people to share their stories.
  The individual marketplace, as folks know, is if you are buying 
health insurance, not through an employer, and you are buying 
individually--you may or may not be qualified for a subsidy--that 
particular marketplace is really important for people who aren't 
employed by companies that offer group plans, but it also has its 
challenges.
  One of my stories was from Lauren Carter, who lives in Lovingston, 
VA, in Nelson County. She wrote in to say:

       My 39-year-old son has cerebral palsy and a blood clotting 
     disorder. His ``pre-existing conditions'' started at 
     conception. Three years ago, he lost his full time job with 
     health insurance benefits.
       The ACA allows him to continue receiving medical care and 
     purchase his life saving medications. He supports himself 
     through multiple part time jobs--

  This young man with cerebral palsy--

     employer based insurance is not an option for him at this 
     time.

  Laura Kreynus from Mechanicsville, VA, near Richmond wrote:

       My daughter was diagnosed with Crohn's Disease in April of 
     2013. That September, my husband was diagnosed with 
     Parkinson's Disease. We are farmers, we raise the food for 
     America. As such, we are independently insured.


[[Page S3529]]


  They have no large employer to cover them.

       Prior to finding a plan through the ACA in January 2015, 
     our monthly insurance premiums were to increase to nearly 
     $3,000 a month . . . yes, each MONTH! On top of that, our 
     health insurance had an annual cap on prescription coverage 
     of $5,000. The Humira that my daughter takes to combat her 
     Crohn's Disease retails for $3,800 a month, and that is not 
     the only medication she requires. So basically, after one 
     month, we reached the prescription coverage cap, meaning we 
     would have to pay $3,800 a month for medication on top of 
     $3,000 a month premiums. Who has an extra $6,800 a month to 
     pay for this? That is way more than we earn monthly as 
     farmers.
       With the health insurance plan we got through the ACA, our 
     premiums for 2015 were $1,500 a month, less than half of what 
     we would have been paying under the previous plan. But the 
     real saving grace was no prescription cap, so my daughter's 
     medications are covered with a copay after we reach the 
     deductible. This is still a lot of money, but at least we can 
     treat our daughter's disease and hopefully keep her healthy. 
     And even though our premiums have gone up to nearly $2,000 a 
     month from $1,500 a month under the ACA, at least we can 
     still have insurance.

  For families like Lauren's and Laura's, the individual marketplace is 
critical. But like Laura said, premiums are frequently too high. You 
have to have robust enrollment, competition, and certainty for premiums 
to come down.
  Unfortunately, there has been increasing uncertainty in the 
individual market due to actions taken by the current administration. 
On January 20, 2017, President Trump signed an Executive order 
directing relevant agencies not to enforce key provisions of the 
Affordable Care Act. Later in January, the administration terminated 
components of outreach and enrollment spending, including advertising 
to encourage people to enroll in the individual marketplace.
  The administration has also repeatedly threatened to end cost-sharing 
reduction payments, which reduce costs for approximately 6 million 
people with incomes below 250 percent of the poverty level. These 
actions, these statements, these inactions, and this uncertainty have 
created uncertainty in the individual marketplace, leading to 
instability for insurance carriers, higher premiums, and reduced 
competition.
  In Virginia, we have seen Aetna and United leave the individual 
marketplace, and they have cited this uncertainty created by this 
administration as the principal reason. In other States, there are 
counties that are at risk to have no insurers offering coverage on the 
marketplace in particular States or sometimes in regions in the States.
  So this is a problem we can address, and we don't have to repeal the 
Affordable Care Act to do it. We just need to improve the Affordable 
Care Act, using a tool that has had bipartisan support in this body for 
some time.
  So yesterday Senator Carper and I introduced the Individual Health 
Insurance Marketplace Improvement Act, and I want to thank the other 
original cosponsors of the bill: Senators Nelson, Shaheen, and Hassan.
  One way to address uncertainty is to use a common insurance tool, 
reinsurance--a permanent reinsurance program to help stabilize premiums 
and increase competition. The Affordable Care Act originally had a 
reinsurance program. It was temporary. It lasted for the first 3 years 
of the program, and it did hold premiums down. What we would do is that 
we would take that idea, which worked, and we would make it permanent. 
We would make it permanent and modeled after a very successful and 
bipartisan program: Medicare Part D. Medicare Part D provides a 
prescription drug benefit for seniors. It was passed with bipartisan 
support during the administration of President George W. Bush, now more 
than a decade ago, and the reinsurance program has helped hold down 
costs.
  This reinsurance program would provide funding to offset larger than 
expected insurance claims for health insurance companies participating 
in State and Federal marketplaces. It would encourage them to offer 
more plans in a greater number of markets, thereby improving 
competition and driving down costs for patients and families. 
Basically, if reinsurance can cover high costs, an insurance company 
will know it has a backstop, which gives it a measure of stability, and 
also can set premiums at a more reasonable level for everyone.
  The bill would also do one other thing that is important. It would 
provide $500 million a year from 2018 to 2020 to help States improve 
outreach and enrollment for the health insurance marketplaces, 
especially to draw in new members and educate the public--especially 
young people who are maybe moving just past their 26th birthdays and 
can no longer be contained on family policies--about the need to be 
insured. The outreach funding prioritizes counties where there are 
limited insurers left in the marketplace.
  This is not the only improvement that is needed for our healthcare 
system. We need to do more to keep costs down, figure out a way to have 
prescription drugs be more affordable, and we can certainly use 
technology and data to drive better health outcomes, but this is a fix. 
It is a fix of an important part of our system, the individual market. 
It is a fix using an idea that has already worked and has already 
compelled the support of both Democrats and Republicans--reinsurance in 
Medicare Part D. This should be something Democrats and Republicans can 
agree to.
  My worry is that we are participating now in a secretive effort to 
write a healthcare bill behind closed doors and possibly put it on the 
floor for a vote without hearing from a single patient, without hearing 
from a single provider, a hospital, a business that has a hard time 
buying insurance for its employees, an insurance company, or 
pharmaceutical company.
  We ought to be debating these bills in the world's greatest 
deliberative body and proposing amendments and hearing from 
stakeholders and then doing the best job we can when we are dealing 
with the most important expenditure that anybody ever makes in their 
life, healthcare. Healthcare is also one of the largest segments of the 
American economy, one-sixth of the economy. Why would we want to pass a 
bill in secret?
  Senator Carper, my colleagues, and I have introduced this bill as a 
good faith effort to say what I actually said when I first got on the 
HELP Committee in early January of 2015. There is a huge group of us 
just waiting for the door to open so that we can have a meaningful 
discussion about moving our system forward, and I believe this bill 
could be a very good part of stabilizing and improving the individual 
market and bringing relief to many Americans.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Sasse). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. PETERS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.