[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3533-S3536]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. President, it is ironic that this conversation takes place at a 
moment where we really have a unique process underway designed to limit 
political discourse. Everything I am saying about participation assumes 
you will have a chance to weigh in, whether you are elected or whether 
you are a citizen.
  We have a process in the Senate that is designed to prevent the 
citizens of America from weighing in and to prevent debate by the 
Members of the Senate. That is not acceptable. It is not acceptable 
that in a ``we the people'' constitutional republic, a democratic 
republic designed to facilitate conversation and dialogue to produce 
decisions that reflect the will of the people, that work for all 
Americans--instead, we have a secretive process, more the type of 
process you would expect in a kingdom where the King and the counselors 
hide themselves away, with no public input, and make decisions for the 
masses. That is not the design of our government. Our government is 
designed for public input.
  Here is a phrase that should resonate: no public input, no vote; no 
hearing, no vote.
  I am speaking specifically about the dialogue on TrumpCare. 
TrumpCare, which was passed by just a few votes in the House and came 
to the Senate, doesn't reflect a process of the people, by the people, 
and for the people. In fact, it is by the privileged, for the 
privileged, and by the privileged.
  The House deliberately excluded the public. They had their own 
consolidated, confined process to make sure it was difficult to have a 
full debate and an amendment process, for folks to weigh in and 
consider alternatives and improvements.
  Here we are in the Senate, and it is even worse because we have the 
secret 13 crafting a plan, planning and plotting to bring it to the 
floor of the Senate probably 2 weeks from today in order to hold a 
vote, with only a few hours of debate and no committee process of any 
kind--not a single committee hearing, not a single committee 
opportunity to consider amendments--and no chance for the public to get 
a copy and read through it and weigh in with their Members of the 
Senate. There is no chance for healthcare stakeholders and experts to 
examine it and point out the difficulties and the flaws. What I think 
is most egregious

[[Page S3534]]

of all is the complete exclusion of the United States of America. It is 
unacceptable.
  I was fascinated by the fact that the majority decided to have this 
secret 13 committee. Thirteen is considered to be an unlucky number by 
much of America--Friday the 13th or buildings that don't have a 13th 
floor. In this case, I hope that having 13 Members meet in secret is 
unlucky; that is, unlucky in terms of trying to fulfill their mission 
of passing a bill with no input by the public.
  Last week, the majority leader started the process to make this 
happen without a committee. It is called the rule XIV process. It is a 
process designed to bring up a healthcare bill that would rip 
healthcare coverage from millions of Americans and, by the way, give 
away billions of dollars to the richest Americans, all in the same 
bill, straight to the Senate floor without a committee being involved--
not the Finance Committee, which certainly has many elements related to 
the financing of healthcare in America, and not the HELP Committee, 
which has Members of both parties who have worked for years to develop 
expertise and consult with stakeholders to understand what works and 
what doesn't work, and they benefit from each other's input.
  I was part of the HELP Committee in 2009. For 5 weeks we sat in a 
room with a television camera operating so the public could see what we 
were doing, and we proposed amendments and debated them around this big 
square set of tables. There was full public scrutiny. There was 5 weeks 
of bipartisan dialogue about what should go in healthcare. That was 
2009. The Finance Committee had a very similar process.
  But now we have a different objective by the majority leader wanting 
to bring this bill with no Finance Committee involvement, no HELP 
Committee involvement, and no citizen involvement. In fact, there is no 
chance for Senators who aren't in the secret circle to participate and 
see the bill and hold townhalls and ask people what they think of this.
  I do a lot of townhalls. I am doing a couple more this weekend. I 
have had 20 townhalls this year. I have had a townhall an average of 
every 10 days since I was elected in 2000 and came to the Senate in 
2009. I am going to keep holding these townhalls.
  I know that my citizens would like to see this bill and be able to go 
through the elements and give me feedback on what makes sense and what 
doesn't. That is a ``we the people'' democratic republic. This secrecy 
strategy--that is not. That is not. That is a strategy for 
nonconstitutional governments. That is a strategy for dictators. That 
is a strategy for Kings and Queens. That is a strategy for people who 
hate democracy.
  Let's not have that process in the United States. Let's have 
colleagues from both sides of the aisle go to the leadership and say: 
This is unacceptable. I want my citizens to have a chance to see this 
bill. I want to benefit from talking to the hospitals in my community 
and my State and get their feedback. I want to talk to the healthcare 
clinics and get their feedback. I want to talk to the doctors and find 
out what they think. I want to hear from the nurses because they are so 
respected in their understanding of the direct delivery of healthcare.
  That is what every Member of the Senate should be saying to our 
majority leader. This process of secrecy, no debate, and the public 
being excluded is totally unacceptable.
  Why is this process going on? In fact, earlier today, the secret 13 
went into a room off a hallway where the press is not allowed so they 
couldn't be seen coming and going from the room. When they were coming 
and going from the room, they couldn't be talked to by the press. Why 
all this secrecy? It boils down to this: They know the American people 
don't like what is in this bill. They are terrified of getting that 
feedback. If they get that feedback, they might lose a majority in 
passing this bill.
  How much public support is there for the TrumpCare bill? Just 21 
percent, according to a recent Quinnipiac poll. That is not very much 
support for it.
  Even President Trump said TrumpCare is terrible. He said it this way: 
That bill from the House is ``mean.'' That was his exact quote, that it 
is ``mean.'' Then he used another phrase, which I won't repeat on the 
floor of the Senate, to say just how absolutely awful that bill is.
  Today in committee, I asked the Secretary of Health, Tom Price: Do 
you share, as Secretary of Health, the President's opinion that his own 
bill, his own TrumpCare bill passed out of the House, is an absolutely 
terrible bill, a mean bill?
  He didn't want to answer the question. Certainly, I found that 
curious, that the Secretary of Health will not tell us whether he 
shares the President's opinion.
  Then I asked him: Why did the President call it a mean bill? Is it 
because it throws 20 million people out of healthcare?
  The Secretary didn't want to answer.
  Did the President say it was a mean bill because it eliminates the 
guarantee of essential health benefits so that an insurance policy is, 
in fact, insuring you when you get sick rather than perhaps not even 
being worth the paper it is printed on?
  There were a lot of healthcare insurance policies before we had an 
essential care package, essential benefits package. You paid the 
insurance company, but when you got sick, they didn't cover anything. 
Those policies weren't worth the paper they were printed on.
  So I asked the Secretary of Health: Is that the reason the President 
said this is a mean process or a mean bill? Is that the reason he 
described this bill in terms that I won't repeat on the floor?
  The Secretary of Health wasn't interested in relaying or giving 
insights into why the President said it was a mean bill.
  I asked: Is it because the bill destroys the guarantee that if you 
have preexisting conditions, you can still get a policy at the same 
price as everyone else?
  Again, there was no answer.
  I said: Or is it a mean bill because if you are an older American, 
you have to pay perhaps up to eight times more for the same policy as 
you pay under current law?
  You know, an individual who is 64 years old, a man who is earning 
$26,500 a year, currently that individual would pay about $140 a month 
for a policy under current law. The same policy under TrumpCare would 
cost $1,200 a month. Is there anyone in this Senate Chamber who thinks 
an individual earning $26,500 a year can afford a healthcare policy 
that costs $1,200 a month?
  Let me translate this. If you are earning $26,000 a year, you are 
earning a little over $2,000 a month. Is there anyone in this Chamber 
who believes--please come to the floor and tell us if you do--that 
individual can buy a healthcare policy costing $1,200 a month? Is there 
anyone who thinks it is an egregious mistake to use high pricing to 
force older Americans out of our healthcare system? I believe in 
treating our citizens of all ages graciously, not forcing them out of 
healthcare through an eightfold increase in their premiums. Is that the 
reason the President said that this healthcare bill, this TrumpCare 
bill from the House, is a mean bill and spoke of it in derogatory 
terms?
  The TrumpCare bill isn't even popular in the President's own party. 
Just 48 percent of Republicans surveyed in the same poll supported 
President Trump and Speaker Ryan's healthcare plan. But when asked if 
they like the current healthcare plan, 55 percent said they do.
  Right now, regular order, the regular legislative, deliberative 
process that makes sure there is a full debate before a significant 
bill comes to a vote, that makes sure there is significant and 
substantial time for the citizens of America to weigh in, that regular 
order or regular process is being run over by a steamroller. It is 
being crushed. It is being demolished. Why would my colleagues support 
destroying the fundamental principles of legislative debate? I would 
love to hear the answer. Perhaps it is because, like President Trump 
said, the bill is mean. Perhaps it is because it is extremely unpopular 
with the American people, who believe there should be affordable, 
quality healthcare available to every single American.
  We have heard that the secret 13 have a plan to sweeten the bill, a 
little spoonful of sugar to make the medicine go down. What is that 
plan? Well, we are hearing that maybe they will put

[[Page S3535]]

in extra funds to help take on the opioid addiction epidemic. That is a 
good thing. Why have they fought so hard against supporting such 
programs to help Americans on this crucial question?
  We have heard they want to slow down the process of throwing people 
off healthcare so it will not hurt them in the 2018 elections and maybe 
not even hurt them so much in the 2020 elections. But if you are 
destroying something piece by piece, you are still destroying it. If 
you are cooking a lobster and you turn up the heat fast or you turn up 
the heat slowly, you still kill the lobster. And this bill is still 
going to kill healthcare for millions of Americans. Doing it more 
slowly doesn't make it a good thing. Putting in a spoonful of sugar 
doesn't make a diabolical act better.
  Franklin Roosevelt once said:

       Let us never forget that government is ourselves.

  And he continued:

       The ultimate rulers of our democracy are not a President 
     and Senators and Congressmen and Government officials but the 
     voters of this country.

  And isn't that what ``we the people'' means--government of, by, and 
for the people? But nowhere in the Republican secret 13 process can the 
voices of the people of the United States be heard. How about if one of 
the 13 comes to the floor now and distributes the bill? I mean we 
should have weeks to consider this. We should have maybe a month to 
consider it. We had a whole year of process in 2009.

  Wouldn't that be the right thing to do, to clue in folks about what 
is in this bill so we can get the stakeholders engaged and the citizens 
engaged and hold those townhalls and get that feedback? Wouldn't that 
be the right thing to do?
  Well, unfortunately, we are still waiting. We are still paused, 
saying: Please, bring the bill to the floor. Distribute it. Maybe it is 
not your final draft, but that is OK.
  We had draft after draft after draft of the healthcare bill in 2009. 
We had, in the Senate Finance Committee, 53 hearings on healthcare 
reform. They spent 8 days marking up their version of the ACA--the 
committee's longest markup in 22 years. During those 8 days, 135 
amendments were considered--amendments from both Republicans and 
Democrats. Then, there was the HELP Committee, which I served on, and 
it held 47 bipartisan hearings, roundtables, and walkthroughs. There 
were 300 amendments during a month-long markup--one of the longest in 
the history of Congress. More than 100 Republican amendments, minority 
amendments, were accepted into the committee's version of healthcare 
reform.
  Right here in this Chamber, we spent 25 days considering the bill 
before we voted--25 days considering a lot of floor amendments, a lot 
of floor time. Is there a single member of the majority party who will 
commit to having at least 25 days of debate on the floor of the Senate 
so we can get a full vetting of the issues, so we can get full input by 
the citizens of the United States of America?
  Well, I am concerned that we are not on the path that values the 
construction of our government, our constitutional ``we the people'' 
government. I am concerned and afraid we are on a path where powerful 
special interests meeting secretly with 13 Members of the Senate are 
crafting a bill that is great for the powerful and the privileged but 
in fact is terrible for Americans, and that is why they are so afraid 
to show us the bill.
  So this is unacceptable, and we need the citizens of America to pay 
attention because why is this happening right now? Well, because the 
fact that this secret process is going on, it can be camouflaged by all 
the conversation about Russiagate--how much did the Russians interfere 
in our elections, and what about all those secret meetings by members 
of the campaign team, were they coordinating or collaborating? We don't 
know the answer, but that question is central to whether there was 
treasonous conduct undermining the integrity of our elections.
  So let's do this now, the secret healthcare plan, with no debate 
while America is trying to fight for the fairness and integrity of our 
elections. Let's do it now when schools are out of session and we are 
in summer and people are on vacation. Let's sneak it through now, this 
act that strips healthcare for millions of Americans.
  Here is the principle we should come back to: No hearing; no vote. No 
hearing; no vote. No vote on a piece of legislation that affects the 
lives of millions of American families if we haven't had due 
deliberation by the key committees. No vote on a bill that destroys 
healthcare for millions of families if we haven't had the chance to 
consult with the experts in healthcare--the nurses, doctors, hospitals, 
and clinics.
  No hearing; no vote. No vote if we haven't had a full chance for the 
citizens of America to weigh in, to see the full details, and say what 
they like and what they don't like and share that with their respective 
Senators. On an issue of this magnitude, one that will affect the peace 
of mind and the health of millions of Americans, we need a full, 
thorough legislative process.
  The choices that are made in this Chamber over the next few weeks 
will have a big impact on the quality of life of millions of American 
citizens. A provision that eliminates Medicaid expansion, the Oregon 
health plan expansion in my State, whether it is implemented slowly or 
implemented fast is going to rip healthcare from 400,000 Oregonians. 
That is enough Oregonians that if they were holding hands, they would 
stretch from the Pacific Ocean to Idaho, 400 miles across the State. 
That is a profound impact.
  In addition, those folks who are going to the clinics and hospitals 
who don't have healthcare, they will not be able to pay for it. So the 
finances of the clinics and the hospitals will be dramatically hurt. I 
asked Secretary Price today: Is that the reason the President said the 
TrumpCare bill out of the House is a mean bill? Is that the reason he 
used a derogatory phrase to attack the TrumpCare bill out of the House? 
Is it because of the fact it will undermine the finances of the clinics 
and the hospitals.

  He said: You know, I don't accept the premise that will happen.
  Well, covering your eyes and covering your ears and pretending, on 
such an important issue, is not a responsible act by a Secretary of 
Health. The clinics have been coming to us and saying this is how our 
finances improved when our citizens were able to pay for the services 
because our rate of uncompensated care dropped dramatically and, with 
that income, we hired a lot more people.
  I have a clinic in the northeast corner of our State where the number 
of people employed, they told me, doubled from 20-something to 50-
something. They are able to provide a lot more healthcare in that 
local, rural community, and that is true in clinic after clinic after 
clinic.
  If one would take their hands off their ears or off from in front of 
their eyes and listen to the presidents or the executive directors of 
rural hospitals, they would hear them say: This will really hurt us. 
This will hurt, not just our ability to provide care to those who will 
not have insurance, it will hurt our finances. It will diminish our 
care for everyone in this rural community. Everyone will be hurt by 
TrumpCare.
  Is that what the President meant when he said this bill is mean? 
Well, if that is what he meant, if what he meant is it is mean because 
it rips healthcare from 20 million Americans, then I agree with the 
President. If when the President criticizes the TrumpCare bill as being 
mean, if he meant that because it was going to destroy the guarantee of 
access by folks with preexisting conditions, then I agree with him. If 
he said it because it will destroy essential benefits and allow there 
to be insurance policies that aren't worth the paper they are written 
on, then I agree with the President.
  If it does, it is going to greatly increase the cost of insurance for 
older Americans, up to eightfold times. If that is why the President 
said it is mean, I agree with the President.
  The President should weigh in and say: No secret process on a bill so 
important to the healthcare of millions of Americans. President Trump 
should weigh in and say: I don't want a bill that looks anything like 
that House bill because it is defective in this area, in this area, and 
in this area, hurting everybody in the communities, undermining the 
clinics, undermining the

[[Page S3536]]

hospitals, destroying insurance, destroying the opportunity of access 
for preexisting conditions, and ripping away the guarantee that 
essential benefits will be covered. That is what the President should 
do.
  He thinks the bill is terrible because he finally looked at it. Well, 
he is going to think the bill crafted by the secret 13 is terrible too. 
He has a chance to stand up and fight for the American people and say: 
I will never sign a bill that goes through a secret process that 
excluded the insights from our rural hospitals, insights from our rural 
clinics, insights from our nurses, and insights from our doctors. I 
will never sign a bill in the Oval Office that excluded the American 
people from being allowed to weigh in on the conversation. I will never 
sign a major bill that hurts so many people in my Oval Office if it 
never had a committee hearing and never had amendments, never had a 
chance to go through the legislative process the way envisioned in our 
``we the people'' Constitution. That would be the right thing for 
President Trump to do.
  He has recognized the bill is profoundly flawed. He has a chance to--
not only a flawed bill but a profoundly, unacceptable process in our 
constitutional democratic Republic.
  Former Chief Justice Hughes said: We are here not as masters but as 
servants, not to glory in power, but to attest our loyalty to the 
commands and restrictions laid down by the people of the United States 
in whose name and by whose will we exercise our brief authority.
  Each one of us is here for a short period of time, but we take our 
constitutional roles as Senators from the foundation of the power of 
the American people, the ``we the people'' Constitution. To exclude 
them from the process is to violate the very premise on which our 
Nation is founded.
  So we have to stop this process. We have to stop it in its tracks. 
Whether you are a Democrat or Republican, whether you come from a rural 
State or a highly populated State, it is a responsibility to stop this 
process, return to regular legislative deliberation so that we can, in 
fact, have a ``we the people'' conversation, fully honoring the experts 
and the feedback from ordinary citizens across our Nation.
  No hearing, no legislative deliberation, no vote. No hearing; no 
vote.
  Thank you, Mr. President.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from South Dakota.
  Mr. THUNE. Mr. President, once again, we have more bad news about 
ObamaCare. Last week, Anthem announced it will pull out of Ohio's 
health insurance exchange for 2018. That means that a minimum of 18 
Ohio counties will be without an exchange insurer next year. Twenty-
five Missouri counties are in the same boat, and more Americans are 
likely to find themselves in the same situation.
  On June 2, the Omaha World-Herald announced that 100,000 Nebraskans 
could end up with zero options for individual coverage in 2018. 
Insurers have been pulling out of the exchanges right and left.
  In February, Humana announced its decision to completely pull out of 
the exchanges for 2018. Three months later, Aetna, which had already 
sharply reduced its exchange participation in 2017, also confirmed it 
would pull out completely in 2018.
  In 2016, 7 percent of U.S. counties had just one choice of insurer on 
their healthcare exchange. In 2017, this year, roughly one-third of 
U.S. counties have just one choice of insurer. Based upon the 
information available so far, the New York Times is currently 
estimating that about 45 percent of U.S. counties will have one or no 
insurer next year.
  One thing is for sure, Mr. President, Americans are facing fewer and 
fewer health insurance choices, and the prices of those choices are 
going up.
  Proposed rates, proposed rate increases for 2018 are emerging, and 
once again they are not looking good. Some of the average rate hikes 
facing Americans around the country include 17.2 percent, 33.8 percent, 
30 percent, 45 percent, 38 percent, 58.8 percent.

  Three weeks ago, the Department of Health and Human Services released 
a report comparing the average individual market insurance premium in 
2013, which is the year that most of ObamaCare's regulations and 
mandates were implemented, with the average individual market exchange 
premium in 2017 in the 39 States that use healthcare.gov. What they 
found is that between 2013 and 2017, the average individual market 
monthly premium in the healthcare.gov States increased by 105 percent--
105 percent.
  In other words, on average, individual market premiums more than 
doubled in just 5 years. That is from HHS in their report that just 
came out in the last couple of weeks. Three States saw their premiums 
triple over the same period--triple in just 5 years.
  I don't know too many families who can afford to have their premiums 
triple over 5 years. What we know is that the ObamaCare status quo is 
unacceptable, and it is unsustainable.
  More than one insurance CEO has suggested that ObamaCare is in a 
death spiral, and it is pretty hard to disagree. Combine soaring 
premiums with a steady insurer exodus, and sooner or later we get a 
partial or complete exchange collapse, which is what we are facing 
today, not to mention all the other ObamaCare problems, such as the 
deductibles that are so high that sometimes people can't actually 
afford to use their healthcare plans or narrow plan networks with few 
provider choices. We have higher premiums, higher deductibles, higher 
costs, fewer options, fewer choices.
  Republicans are currently working on legislation to help Americans 
struggling under ObamaCare. My colleagues in the House made a good 
start, and in the Senate we are working to build on the bill they 
passed.
  We are committed to helping Americans trapped on the ObamaCare 
exchanges. We are committed to addressing ObamaCare's skyrocketing 
premium increases. We are committed to preserving access to care for 
Americans with preexisting conditions, and we are committed to making 
Medicaid more sustainable by giving States greater flexibility while 
ensuring those who rely on this program don't have the rug pulled out 
from under them. We need to make healthcare more affordable, more 
personal, more flexible, and less bureaucratic.
  My colleague from Oregon was just talking about the complaints they 
have about the healthcare process, the discussions that are going on, 
and how much pain, if this passes, it is going to cause the American 
people. I can tell you one thing: Today, it is pretty darn painful for 
families I have talked to in my State of South Dakota, hard-working 
farm and ranch families who are having to pay $2,000 a month, $24,000 a 
year for insurance coverage--in some cases with $5,000 deductibles, 
assuming they can even afford to use that expensive policy by being 
able to cover the deductible. There are people across this country who 
are hurting because of this failed healthcare insurance program. It is 
high time for us to fix it.
  I believe the American people want to see Congress act in a way that 
will make healthcare insurance more affordable to them, more personal, 
so that they will have more choices, greater options, and more 
competition that will help bring those premiums down to a more 
reasonable level. They need to have more than one choice. When 45 
percent of the counties in America have one choice or no options on the 
exchanges, that is an unacceptable situation and one that we have to 
fix.