[Congressional Record Volume 163, Number 102 (Thursday, June 15, 2017)]
[Senate]
[Pages S3548-S3550]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare Legislation
Mr. CASSIDY. Mr. President, one of the things we are debating right
now is, What is the future of the Affordable Care Act or, I should say,
healthcare in the United States? One thing we can all agree to is that
the individual market under the Affordable Care Act--or ObamaCare, as
it is commonly called--is not doing well.
I will put up this Facebook post from a constituent in Louisiana
named Brian. He wrote in to say:
My family plan is $1,700 a month. Me, my wife, and 2
children. The ACA has brought me to my knees.
He doesn't say this, but we know that, most likely, his family
deductible is $13,000.
I hope we can get something done. . . . The middle class is
dwindling away. Can everyone just come together and figure
this out?
So his family is putting out $20,000 a year for insurance. They most
likely have a $13,000 family deductible. They have two children, a
young family, $33,000 of out-of-pocket expenses before they would see
significant benefit from their policy. Clearly, we have a problem.
When he was campaigning, Candidate Trump recognized this, and he said
over and over that his contract with the voters was to maintain
coverage, lower premiums, address and care for those with preexisting
conditions, and to eliminate the ObamaCare mandates. This, if you will,
was his contract with the voters--a pretty good contract. I think it is
something both parties can get behind.
Candidate Trump and then President-elect Trump doubled down on this
just before taking the oath of office, saying: ``People covered under
the law''--meaning the law that he would support to replace the
Affordable Care Act--``can expect to have great healthcare. It will be
in a much simplified form. Much less expensive and much better.''
Indeed, the President of the United States seemed, again, to renew
this commitment this past week at a lunch with 15 Senators at the White
House, once more saying how we have to have a law that lowers premiums
and cares for those with preexisting conditions.
That is the baseline. Some would argue, has President Trump committed
himself to some right that previously did not exist that all Americans
would have healthcare?
I am a physician, a doctor. I worked in a public hospital for the
uninsured for so long. I can tell you, Congress created a right to
healthcare when it passed the Emergency Medical Treatment and Labor
Act. I think President Clinton was the one who signed it into law. This
said that anyone--whether they were a U.S. citizen or not--could come
to an emergency room and receive all the care they needed, and if they
could not pay, they would still receive care.
Whenever somebody says ``My gosh, folks don't have a right to
healthcare,'' I note that when I was in the emergency room at 2 o'clock
in the morning, as long as those emergency door rooms were open, there
were people coming through. They would have congestive heart failure,
COPD, diabetes out of control, gunshot wounds, or vomiting blood. They
could be schizophrenic or a drug overdose. As long as
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that patient or those patients came through the door, we treated them,
and someone paid.
I would say that it is the fiscally conservative way that if Congress
is going to say ``My gosh, everybody has a right to healthcare,'' then
we should come up with a considered way to pay for it, as opposed to
forcing the hospital to shift the cost of this care to other sources--
principally, by the way, small businesses paying higher premiums for
their employees, higher rates to pay for the uninsured. The fiscally
conservative way is ``Let's address these needs.''
As a physician, I will also say that the best business practice ways
to address somebody with chronic health conditions is to actually
manage the disease. If you have a diabetic who doesn't have insurance,
she may come to the hospital once a month with diabetes out of control.
You have to start an IV and put her in the hospital, perhaps overnight,
sometimes in the hospital for longer. This can cost thousands of
dollars. Contrast this with having that patient with a primary care
physician so that you can manage her disease. Not only is her health
better, but you spend a lot less money.
In fact, the wisest corporations in our country now consider the
health of their employees as a cost center. What can we do to have the
best outcomes at the lowest price? This is the most fiscally
conservative way. I think that is the approach we should take as a
country.
This brings us to the next point. How do we achieve that which
President Trump suggested, which was that we would maintain coverage,
lower premiums, care for those with preexisting conditions, and
eliminate mandates in a way that we could achieve it? Some folks say
that you cannot achieve this. I disagree with this.
The way to achieve it is to embrace each of President Trump's goals.
Susan Collins and four other Senators and I have put forward a bill
called the Patient Freedom Act. In the Patient Freedom Act, the
approach we take is to first maintain the coverage President Trump
spoke of, but we do it by eliminating mandates. We give the States the
options of doing something called automatic enrollment. It means it is
easy to be enrolled.
On our income taxes, for example, Republicans have always said: We
want to make it easy to pay your taxes--not 16 pages of forms that you
have to fill out with a CPA and an attorney but, rather, something you
can do on one page. We need to make enrollment in insurance easy.
The second thing--if you can expand the enrollment, we can take from
what we know works, which is on Medicare. When someone turns 65, he or
she is automatically on Medicare. They don't have to fill out a bunch
of forms online. Rather, they are just on Medicare. They get a card.
Here is your Medicare card. You are in unless you don't want to be.
If you don't want to be, we make it easy to get out. You just call up
and say: I don't want to be on Medicare. And you are not. It turns out
that 99 percent of Americans like this simple approach, and they stay
on Medicare.
We could expand coverage and make it simple, still eliminating
mandates by giving States the option to say to their residents, you are
in unless you are out. We are going to make it simple.
If you are eligible for this credit, you would get the credit. And
unless you call us up and say that you don't want it, you would be
enrolled in an insurance program.
In this way, we care for those with preexisting conditions. How is
that the case? If you have a few sick people in the insurance pool,
then the only people whom you can spread that risk among are the few
and the sick in the pool. Every year they pay higher and higher
premiums.
On the other hand, if you can expand the risk pool to include all the
young ``healthies''--the folks who think themselves immortal, who on an
average year may only have $500 or $800 worth of healthcare expenses--
if you can incorporate all of them in your risk pool, then the expense
of the few and the sick is spread out over the many and the healthy.
Instead of premiums rising because of one person's illness, premiums
hardly budge because the cost of that care is spread over so many.
We call it a risk pool for a reason. If you take a cup of water and
you pour it in a large swimming pool, the level of that swimming pool
does not change because that big pool absorbs the water. If you take a
cup of water and you pour it in a smaller cup of water, it overflows.
We need to make it where it is the former situation--where we have a
big risk pool with lots of young, healthy people with whom we can share
that risk over the many and not the few. In this way, we can lower
premiums.
It was modeled that if we did automatic enrollment in my State, still
maintain the enrollment of the older and the sicker who are already in,
we would lower premiums by 20 percent. That is the power of giving the
States the option to make it simpler for people to be enrolled in their
insurance.
The conservative way to approach our healthcare reform is to
recognize that President Trump's contract with the voter on the
campaign trail is the pathway to achieving his goals. As we do that in
a fiscally conservative way, we recognize that we should not move this
cost of care off to small businesses. We should go ahead and pay for
it. It is fiscally conservative to manage these patients' illnesses, as
opposed to have them going to an emergency room every so often for
emergency room care.
Lastly, we have to say that if we embrace Republican ideas of making
it simpler to be in a plan, as opposed to more complicated, we are more
likely to have that risk pool that is inclusive of many who are
healthy, not just a few who are sick.
I look forward to replacing the Affordable Care Act--the un-
Affordable Care Act as it has become--with something that embraces
conservative principles and fulfills President Trump's campaign
pledges.
I yield the floor.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. CARPER. Mr. President, it is nice to see the Presiding Officer
again today--again and again. I don't know if I will be your last
speaker, but I will try not to keep you here too long just in case.
I know the Presiding Officer has been through Delaware a time or two
and the Senator from Louisiana has been through my State. I have been
through theirs.
I am going to talk about a 14-year-old young man who lives in
Delaware. I used to say to my friend from Louisiana: Thanks for
working, trying to get us to pull together and do something across the
aisle on healthcare. We will see how it turns out.
If you come up I-95 on your way to Philadelphia, PA, Trenton, NJ, New
York City, Boston, or Maine, you pass through Delaware. As you cross
from Maryland into Delaware heading north, you cross into Delaware and
go through the toll plaza, and then almost immediately you are at the
intersection of a road called State Route 896, a north-south highway.
If you happen to go north on 896, you go into Newark, DE, and you go
right by the University of Delaware, which is there in Newark, DE. We
don't pronounce it Newark. We pronounce it New-ark, as if it were two
words--New-ark. Even though it is one word, we pronounce it as if it
were two words, New-ark.
If you go north, you go on 896, you go right into the University of
Delaware. I took that road over 40 years ago while I was still in the
Navy and on leave with the Navy, trying to figure out where to go to
graduate school. I went north on 896 and ended up falling in love with
the University of Delaware and applied to graduate school there, and I
made my life in Delaware.
If you go south on 896--when you intersect 896 and I-95, you don't go
to the University of Delaware. You don't go to Newark. You go south to
a town called Middletown. It is one word. There are some extraordinary
athletes, high school athletes in Middletown.
For many years, their principal high school was Middletown High
School. They have a couple of other schools there now, but one is
Appoquinimink High School. In Middletown, they are the Cavaliers. The
other is the Jaguars. The Jaguars have a new school; Appoquinimink is a
newer school. Middletown has been around forever. They have a history
of great athletes.
Year after year, they have won championships, including football--
State
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football championships--and men's sports and women's sports. The key to
their successes is that these kids grew up together, and they played
sports when they were Peewees. They played sports when they were in
middle school. By the time they got to high school, they had worked
together, trained together, and knew each other, and they did well as a
team.
I met another athlete from Middletown a couple of weeks ago. He came
by my office with, I believe, his mom. I think it was his mom. We have
a photograph of him right here. He is an unlikely athlete. He is 14
years old. He is from Middletown, DE. His mom's name is Jennifer.
They told me what it was like for Michael--Michael Davis--to grow up
in and live with a disease called cystic fibrosis. Before we talked
much about cystic fibrosis and his preexisting condition, we talked
about something we have a passion about, and that is running.
I am all of 70 years old. I still work out every day. I have been
doing this since I was a brandnew ensign in the Navy and on my way to
Pensacola, FL, to become a naval flight officer and serve our country
around the world.
I like to run every day. This guy does, too--almost every day. There
is a difference. The difference is that he has cystic fibrosis. I will
talk about what that means in a minute, but despite the lung condition
he has, he has defied the odds to be alive today--and not just to be
alive today, but to become quite an athlete.
I don't know how many people in the Chamber--I look at our new pages
who are here, their first week on the job, and I don't know how many of
them have run half marathons. I run have run quite a few in Delaware
over the years, but I don't have cystic fibrosis. This guy can run a
half marathon and beat me into the floor and beat me into the road, at
least. I need to yield to him when he goes by.
We have been joined on the floor today by the majority leader. When
he shows up, along with a guy who is a fast runner, I yield to them. I
will yield to the leader so he can take care of business, and then I
will pick up when he finishes.
The PRESIDING OFFICER. The majority leader.
Mr. McCONNELL. Mr. President, I thank my friend from Delaware.
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