[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

[[Page S3549]]

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

[[Page S3550]]

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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