[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3539-S3541]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. President, when our friend from South Dakota, Senator Thune--a 
great friend for, I think, all of us and admired by both sides--was 
talking about how deplorable ObamaCare was and how it is in a death 
spiral and so forth, I just wanted to stand up and ask him to yield to 
me so I can say that when Barack Obama and Joe Biden stepped down as 
President and Vice President of the United States, my recollection was 
that every county of every State in this country had access to 
healthcare through the health exchanges.
  Where did the idea for health exchanges come from? It came from the 
Republicans in 1993, from the Heritage Foundation, the rightwing 
Republican think tank.
  They came up with an idea that says: Let's create exchanges in every 
State, where people who don't have healthcare coverage can get their 
coverage through large purchasing pool. There would be one in every 
State. The legislation said: Let's have a sliding scale tax credit to 
make sure low-income families who do not have coverage can afford that 
coverage in the

[[Page S3540]]

exchanges. As their income goes up, the tax credit buys down the cost 
of coverage. The exchange goes down, and it eventually goes away.
  The Republican legislation in 1993, fashioned by Heritage, said there 
was going to be an individual mandate. People would have to get 
coverage in this country. If they did not, they would have to pay a 
fine. One could not make people get coverage, but there would be a 
fine. There was the idea that employers of a certain size and with a 
certain a number of employees would have to get coverage. We call that 
an employer mandate. Finally, the health insurance companies could not 
deny coverage to people in this country because of preexisting 
conditions.
  Those are all concepts that were in the 1993 legislation that was 
introduced by Senator John Chafee and was cosponsored by, among others, 
Senator Hatch, of Utah, Senator Grassley, of Iowa, who are now two of 
the most senior Republicans in the Senate, including being the two most 
senior Republicans on the Finance Committee on which Senator Cardin and 
I are privileged to serve.
  I said as recently as last week, when the Secretary of Health and 
Human Services was before our committee to defend the President's 
budget, that I applauded Senator Hatch and I applauded Senator Grassley 
for cosponsoring that 1993 legislation, which became the foundation for 
healthcare coverage in Massachusetts, which is where they cover 
everybody. It is called RomneyCare. It was adopted when he was the 
Governor, and it was fashioned very much under the same foundation.
  Senator Cardin and I are on the Finance Committee, and when we were 
debating the Affordable Care Act, we literally took those Republican 
ideas from Heritage, from Senator Chafee, from the 23 Republican 
cosponsors for RomneyCare and sort of made them the foundation of 
ObamaCare. It is ironic just to hear my friend Senator Thune talk today 
about the tale of horribles from the Affordable Care Act. Actually, the 
things my Republican friends are criticizing the most were their ideas 
from 24 years ago. Personally, I think they were pretty good ideas, and 
if they were given a fair chance, they could be very effective.
  One of my Republican friends said the other day that when the 
Affordable Care Act was debated and voted on and so forth, the 
Republicans were pretty much shut out of the process. So it is too bad 
the Democrats are shut out of the process now as we revisit healthcare 
coverage with the terrible legislation that has come out of the House 
of Representatives. I think, if I am not mistaken--correct me if I am 
wrong, Senator Cardin--they adopted it without a hearing. I think they 
adopted it on a straight party-line vote. I think they did it without 
any kind of score from the Congressional Budget Office and just sent it 
over here.
  While they were doing that, I will just go back in time, if I can, to 
the year of 2009, when we debated the Affordable Care Act here. We had 
two committees of jurisdiction. One was the Health, Education, Labor, 
and Pensions Committee. That committee held no fewer than 14 bipartisan 
roundtables. A roundtable is very much like a hearing, but it is not 
quite as formally structured. It held 14 bipartisan roundtables, which 
were designed to try to build a consensus around the Affordable Care 
Act, or healthcare coverage, in this country. Again, this was in 2009.
  In 2009, the same committee--the Health, Education, Labor, and 
Pensions Committee, the HELP Committee--held 13 bipartisan hearings. So 
there were 14 bipartisan roundtables and 13 bipartisan hearings in all 
during the actual time they were debating on and voting on the 
legislation itself. During the HELP Committee's debate and in actually 
marking up the bill, some 300 amendments were considered that were 
offered by Democrats and Republicans. More than half of those were 
accepted. Of the more than half of those 300 accepted--we turned down 
160 or so--160 of them happened to be offered by Republicans. Think 
about that. There were 14 bipartisan roundtables and 13 bipartisan 
hearings. There were 300 amendments offered, and over half of those 
were Republican amendments. Over half of those 300 were actually 
adopted, and 160 in all were Republican amendments. That does not sound 
like they were shut out on the Health, Education, Labor, and Pensions 
Committee.
  On the Finance Committee, on which Senator Cardin and I serve, we had 
17 roundtables and hearings. We held 13 member meetings, 38 negotiation 
meetings, and a 7-day-long actual business meeting and markup in 
public, during which we offered amendments and voted on amendments. I 
think, roughly, a dozen Republican amendments were offered and 
accepted.
  I have a friend who, when you ask him how he is doing, always 
answers: ``Compared to what?''
  I would say, as to the process right now that we are looking at with 
the Republicans' belated response, if you will, to the Affordable Care 
Act that came out of the House and is now being negotiated in private--
not debated but negotiated and some would say in secret. It is hard to 
keep a secret around here, but it is certainly in private. To my 
knowledge, there are no bipartisan roundtables and no bipartisan 
hearings. To my knowledge, there will not be an opportunity for markups 
or business meetings at which hundreds of amendments could be offered 
and debated and voted on--none of that. And it will use a process 
called reconciliation, where they will bring whatever they come up with 
in these closed meetings, and we have a chance to vote on it up or 
down.

  The House never had it scored. The Congressional Budget Office never 
had a chance to say: This is how many people will lose coverage. This 
is what it is going to cost if people don't get help through Medicaid. 
This is what is going to happen to folks losing their coverage 
altogether.
  They never did that in the House. I don't know if we will see that in 
the Senate either.
  (Mr. CASSIDY assumed the Chair.)
  There is a right way and a wrong way to do this stuff. Our Republican 
friends will probably never agree that we were trying to do it the 
right way in 2009. What we came up with was the Affordable Care Act at 
the end of the day, and I would be the first to say it is not perfect. 
There are things I would like to change. I am sure Senator Cardin feels 
that way. I am sure the Presiding Officer who is with us today knows a 
lot about healthcare. He probably would be willing to change a number 
of things. For years, I have said: Why don't we just figure out as one, 
as a bipartisan group--as we were today on the sanctions legislation 
for Russia and Iran--why don't we try working together on this stuff? 
And we are sort of waiting to see if we might have a taker.
  The Presiding Officer has been very good about reaching out, and I 
applaud him for that. I think he and I will be in a forum together 
maybe next week to talk about some of this stuff in public, but I 
applaud his efforts to reach out and see if we can't foster a better 
way forward.
  Let me close with this: Some of you know I spent some of my years of 
life in uniform. For a while, I was a civil air patrol cadet growing up 
in Virginia. I wanted to go to the Air Force Academy, but I just didn't 
know how to apply. I applied too late and missed it. I learned about 
the Navy ROTC and applied for a scholarship, was fortunate enough to 
win it, and went to Ohio State. I became a midshipman and 4 years later 
a naval flight officer and then off to Pensacola. I spent 5 years in 
Active Duty in Southeast Asia and after that in the Cold War as a P-3 
Navy aircraft commander. I loved the Navy. I feel privileged that it 
helped me go to undergraduate school and, after Active Duty, to move to 
Delaware and get an MBA thanks to the GI Bill. I was privileged to be 
elected Governor and serve as the commander in chief of the Delaware 
National Guard for 8 years beyond that. Over half of my life has been 
involved in the military.
  A lot of times when I was younger, I would think about who is helped 
in healthcare under Medicaid. I used to think that folks who are helped 
the most by Medicaid are women, poor women, and their children. As it 
turns out, today, especially as the baby boomers get older, more and 
more of them are being covered by Medicaid. They receive their coverage 
because they spend down their assets. A lot of them have dementia and 
have other

[[Page S3541]]

disabilities, and they end up in nursing homes. More than half of the 
money we are spending on Medicaid these days is on those folks. A lot 
of them are part of my generation and older--our parents, uncles, and 
aunts.
  As it turns out, unbeknownst to me, about 2 million of the roughly 23 
million veterans we have in this country--22 million veterans we have 
in this country are served by Medicaid.
  The day I showed up at Ohio State to be a Navy ROTC midshipman, we 
had only White males in our ROTC. It turned out that is what they had 
in the Army ROTC and in the Air Force ROTC at Ohio State. When I got to 
my squadron on Active Duty--in the many years I was in my Active Duty 
squadron, I think we had just two or three African-American officers. I 
don't remember ever having an Asian-American officer. There were no 
women who were officers or even among our enlisted personnel. That has 
all changed now. The face of our military officer corps and enlisted 
corps looks a whole lot more like America today than it used to.
  As it turns out, the folks who are veterans in this country--those 22 
million people--look a whole lot more like America today than maybe was 
the case a number of years ago. They are Caucasian, they are African 
American, they are Latino, they are Asian American--all of the above. A 
number of those 22 million veterans who are depending on Medicaid are 
minorities. They are going to be adversely affected if we are not 
careful of what we do in the House or if we in the Senate replicate 
something like that or similar to that and ultimately in a conference 
try to represent a compromise between what we do in the Senate and what 
they have done in the House.
  I will close with this: This story can end badly, or it can end in a 
better way. We have just gotten a good example of how to do it right 
with the legislation we just passed earlier today, the sanctions 
against Russia and Iran. My hope is that we will use that as a template 
to come back and make changes to the Affordable Care Act and that we 
will do it in a way that fixes what needs to be fixed and preserves 
what needs to be preserved.
  I thank my friend from Maryland for his leadership on this and God 
knows how many other issues.
  If I could have one more moment to say that Senator Kaine and I have 
offered legislation that I think has probably been shared with the 
Presiding Officer's office that seeks to help stabilize the exchanges 
and the ability of the health insurance companies to have some 
additional predictability and certainty through reinsurance. My hope is 
that we will have a chance to share what we have offered and maybe see 
if that is something the Presiding Officer would be interested in 
joining us in supporting.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia.