Congressional Record, Volume 163 Issue 105 (Tuesday, June 20, 2017)

[Congressional Record Volume 163, Number 105 (Tuesday, June 20, 2017)]
[Senate]
[Pages S3634-S3641]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

Healthcare Legislation

Mr. THUNE. Mr. President, it is hard to argue that ObamaCare is not a
failing law. Seven years after it became law, its laundry list of
problems continues to grow: higher premiums, higher deductibles,
customers losing healthcare plans, patients losing doctors, fewer
choices, failed co-ops, unraveling exchanges. And, unfortunately,
without action, that list will only get longer and the consequences
will only become more severe. Republicans know that. Democrats know
that. Unfortunately, many Americans know it firsthand.
The American people deserve better, and they rightly expect us to
act. That

[[Page S3635]]

is why choosing to watch from the sidelines as ObamaCare fails is not
an option.
To say that ObamaCare has created significant problems for the
American people is an understatement. That is why Senate Republicans
are working to fix the mess created by ObamaCare to provide real
solutions to this failed law. We want to save the millions of hard-
working families who are trapped by ObamaCare's taxes and mandates.
Average annual individual market premiums have increased by $2,928--
an increase of 105 percent--since 2013 in the 39 States that use
healthcare.gov. And 62 percent of States using healthcare.gov,
including my home State of South Dakota, saw premiums double between
2013 and 2017. We will help stabilize these collapsing insurance
markets that have left millions of Americans with little or no options.
Today, one in three counties has only one insurer on its ObamaCare
exchange. According to CMS, 47 counties nationwide are projected to
have no insurers, which means Americans in these counties could be
without coverage on the exchanges for 2018. As many as 1,200 counties--
nearly 40 percent of counties nationwide--could have only one issuer in
2018. It is hard to argue that you have a market, that you have
competition, when you have one option. That is 40 percent of the
counties in America in 2018.
We will improve the affordability of healthcare by eliminating the
ObamaCare taxes and mandates that are causing premiums to increase the
most. These taxes and mandates have cost the American economy $1
trillion--a cost that was ultimately incurred by patients in the form
of higher costs and larger tax bills. Reversing these taxes will
provide millions of American families and businesses with much needed
tax relief.
We will also preserve access to care for individuals with preexisting
conditions. There has been a lot of debate and misinformation, I might
add, about this issue over the past few months. In the Senate, we will
ensure that individuals with preexisting conditions continue to have
access to the care they depend upon.
We will also safeguard Medicaid by giving States more flexibility,
while ensuring that those who rely on this program will not have the
rug pulled out from under them. States should have the flexibility to
design and operate Medicaid programs in a fiscally responsible way and
not be stymied by the Federal Government.
Making these critical reforms to Medicaid will empower States with
the tools they need to implement healthcare programs that best meet
their residents' needs.
We must also ensure that those Americans who already rely on this
program will not be left in the lurch. Republicans recognize our
responsibility to make sure that Medicaid continues to provide quality
care for these vulnerable citizens. We will balance the needs of the
individuals who have Medicaid coverage, while ensuring sustainability
of the Medicaid Program.
Finally, we will free the American people from the onerous ObamaCare
mandates that, in some cases, forced them to purchase insurance they
don't want or can't afford. These mandates have resulted in burdensome
taxes that have been levied against most small businesses and the
American people. The Republican healthcare plan will revoke these
burdensome mandates and put the American people--not Washington--back
in charge of their healthcare. This will be a huge leap in the right
direction for hard-working families and small businesses.
Reforming America's healthcare system isn't easy, but that doesn't
mean we shouldn't try. We have spent years--literally years--debating
this issue, and we have had lots of ideas along the way. Now it is time
to take action.
The core principles of the Republican healthcare plan are as follows:
helping to stabilize collapsing insurance markets; improving the
affordability of health insurance; preserving access to care for those
with preexisting conditions; safeguarding Medicaid for those who need
it the most; and freeing the American people from onerous ObamaCare
mandates.
Without meaningful action, ObamaCare's problems aren't going
anywhere. Without action, the individual market will continue to
collapse, and more and more Americans will be without insurance
options. Without action, Americans will continue to experience rising
healthcare costs because of the law's costly taxes and mandates.
Without action, States will continue to be hamstrung by Medicaid's
bureaucracy, and we will not be able to put this critical program on a
more sustainable path for the folks who need it the most. Without
action, the ``Washington knows best'' approach to healthcare will live
on.
We cannot let that happen, which is why we plan to deliver patient-
centered healthcare reforms that lower costs and increase access to
care for the American people.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. TESTER. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. TESTER. Mr. President, we are about to embark on something that
is pretty amazing to me. Next week, I am told, we are going to take up
the Senate healthcare bill that is going to be the first cousin of the
House bill. There are a lot of things that are referred to as putting
lipstick on a pig, but this is truly putting lipstick on a pig, where
we are going to take healthcare away from millions of Americans.
We might make it a little better by extending some Medicare or
Medicaid monies, but in the end that will go away. We will potentially
set up some high-risk pools for people with preexisting conditions. I
will tell you, from my time in the State legislature when we dealt with
high-risk pools, that gives access to healthcare for the rich folks.
In essence, what we are going to do next week, because some folks in
this body forgot to read the Affordable Care Act when it came up, is we
are going to repeal it and we are going to replace it with a piece of
garbage.
Today I rise on behalf of the 48 rural and frontier hospitals in
Montana--48 rural and frontier hospitals that are the backbone of our
State.
I rise for the 77,000 hard-working Montanans who now have healthcare
because of Medicaid expansion, and the 41,000 jobs of our State of 1
million people sustained by our healthcare industry today.
I rise on behalf of every Montanan who deserves to know what is going
on in Washington, DC. What is going on back there? Are you guys really
talking about jerking my healthcare away from me? Are you guys actually
talking about taking something up that is really not going to do much
for the 30 million Americans getting pounded by high premiums and high
deductibles? Are you doing this to give the top one-tenth of 1 percent
of the Americans in this country a tax break?
Right now, the Senate majority in this body is playing Russian
roulette with people's lives. A handful of Washington politicians are
crafting a secret healthcare bill in a smoke-filled room, probably a
little whiskey is involved, a few steaks. They are crafting a bill that
will impact every man, woman, and child in this country.
I heard earlier today, they said these meetings were open. It would
be nice to know where they are. I would love to go in and give my two
bits on what rural America feels about how we need to move forward with
healthcare in this country. This is a problem that is not going away
unless we address it in a commonsense way.
So they are crafting this bill in secret. We don't know what is in
it, but we have indication it is going to be very similar--a first
cousin--to the American Health Care Act passed in the House so we
should be deeply concerned. This is irresponsible legislation that
jeopardizes healthcare for over 250,000 Montanans, denying coverage to
over 150,000 Montanans who have a preexisting condition like cancer,
heart disease, even high blood pressure, and, quite frankly, would put
many of our rural hospitals at risk--at risk of closure; at the very
best, changing the methods by which they deliver healthcare to these
rural communities, by the way, that are hanging on by

[[Page S3636]]

their fingernails. This House bill is creating uncertainty in Montana,
it is creating uncertainty across this Nation, it will fundamentally
change our lives forever, and I do not believe it will be for the
better.
My office has received over 3,600 pieces of correspondence related to
the American Health Care Act. Many Montanans are terrified of the
implications of this horrible bill. As elected officials, we are
obligated to answer the tough questions, defend our positions, and
advocate for our constituents. That is not what is happening here. As a
result, the Senate, through their secret meetings and through a
potential rushed-through healthcare bill next week--and I see no reason
why it will not be--we are not doing right by our constituents.
The process and this bill are a disservice to folks like Julie
Williams from smalltown Montana--Shepherd, MT. Julie was diagnosed with
multiple sclerosis, MS, in 2011, 5 months before the Supreme Court was
set to make their decision on the Affordable Care Act. She spent those
5 months terrified that she was in for a constant fight with insurance
companies over coverage, but the Supreme Court upheld the ACA, and
Julie has insurance and doesn't have to worry about being denied
coverage if she moves, changes jobs, or--God forbid--becomes unemployed
because she now has a preexisting condition. Julie also doesn't have to
worry about insurance companies cutting off her treatments because she
happens to hit a lifetime cap, which is a very real concern for a
healthy young woman with a disease like MS. She didn't have to worry--
she didn't have to worry until now. If a bill like the American Health
Care Act passes, Julie could be charged more because of her disease.
She is unable to afford that coverage. The plan may not pay for the
healthcare services she needs.
This legislation is also a disservice to a lady with the same last
name, no relation, Jennifer Williams, of East Glacier, MT, one of the
most beautiful parts of the world. Thanks to the preventive care
provisions in the current healthcare system, Jennifer and her husband
have been able to catch a few conditions early and avoid bigger
problems in the future. That is going away.
Unfortunately, their premiums are rising. Congress needs to address
that problem head on. I couldn't agree more. This bill that passed from
the House doesn't do that. It will send folks like Julie and 250,000
Montanans on Medicaid out into the cold, no access to affordable care,
jack up the cost of healthcare for folks with health insurance, and
jack up the cost of healthcare for folks in their fifties and sixties.
We can and should be working together to lower those costs for folks
like Jennifer, Julie, and other Montana families. Instead, we are here
scoring political points--or trying to--upending all the good things in
the ACA and the current healthcare system. Instead, we should be
working together in Congress. The Senate should be working together--
not in some back room but right here on the floor--to lower premiums,
copays, and deductibles, while increasing access to lifesaving medical
care.
Look, we have said it before, we will say it again: The Affordable
Care Act isn't perfect, but it has a lot of good things. Let's fix the
things wrong with it and keep the progress we have made, but instead,
we hear in Washington, particularly the Republican majority, is
creating chaos in the marketplace and driving costs up. This chaos is
putting our rural hospitals and community health centers at risk. That
is not just the statement. That is a statement of fact.
Every day, folks in rural communities rely on their local hospitals,
clinics, everything from basic checkup to emergency treatments. Thanks
to Medicaid expansion, in Montana, these hospitals and community health
centers have seen a reduction in charity care, and they have been able
to keep their doors open, but the American Health Care Act puts those
funds at risk and puts these frontier medical centers on the chopping
block. These medical professionals are sworn by oath to provide
healthcare for folks. If Medicaid expansion goes away, the hospital
will be forced to absorb those costs.

Over the last 10 months, I have held over a dozen listening sessions,
eyeball-to-eyeball listening sessions with Montanans. We are going to
be holding some more. The sessions have been over health. I have heard
one thing loud and clear from people: If Medicaid expansion goes away,
these rural frontier hospitals will have to fundamentally change how
they deliver healthcare or they may be forced to shut down altogether.
These hospitals operate on razor-thin margins, and they cannot afford
to see these funds disappear.
Take my hometown, Big Sandy, MT. Back in 1910, my grandfather came
out, took a look around, saw grass as tall as the belly on a horse, and
said: ``This is where we are going to homestead.'' He went back and got
my grandmother. The farm that Sharla and I farm today was started,
patented back in 1915. They worked together with their neighbors, the
homesteaders of that area. They built barns, they built businesses, but
it took them 50 years to build a hospital. In the mid-1960s, a hospital
was finally built in Big Sandy, MT--50 years of people working together
to get that hospital built.
I am going to tell you, if we don't do smart things in this body, if
we take steps backward and not very many--and this bill I have seen
from the House is horrible, and I don't think the bill in the Senate is
going to be much better because it is a low bar. Hospitals like the
hospital in Big Sandy will go away. I am going to tell you something,
when that hospital goes away, Big Sandy goes away. Rural America goes
away.
Big Sandy is just an example of hundreds of small towns in Montana
and throughout this country that depend upon rural hospitals for
healthcare. Without hospitals, Montana frontier communities will be
forced to drive 100 miles to deliver a baby or take an expensive
ambulance ride after an accident. People are not going to be able to
afford or they are not going to choose to live there because of a lack
of healthcare. They are not going to take that risk. They are going to
move out of those small towns, and they are going to move to places
where they have healthcare. In some cases, families who have lived in
those house and on that property for generations will be forced to
move. These hospitals just don't keep patients alive, they keep
communities alive. The House bill would kill those rural hospitals and
would be the death of rural America.
That is not the only uncertainty facing rural America. In Montana,
insurance companies filed their proposed rates with the insurance
commissioner last year, but these insurers are left without vital
information for their proposals. They don't know if this administration
will continue the cost-saving reduction payments that help make
healthcare more affordable. Insurers have said if these payments go
away, consumers will face double-digit rate increases. Montanans
deserve to know from their elected officials what kind of impact this
action has on premiums, and yet the insurance commissioners are leaving
consumers and Montanans in the dark.
Transparency builds a more effective government. Hiding important
information from the public is unacceptable at any level of elected
official. We live in a country where citizens can hold their government
accountable, and the American people make good decisions when they have
good information, but right now, a select few in this body are
shielding the American public from what is really going on. We hear
about a bill that is going to impact one-sixth of the economy, we hear
about a piece of legislation that will rip healthcare away from 23
million Americans, we hear about a bill that will take us back to the
days when Montanans couldn't afford to get sick, but we haven't seen
it.
Families across Montana are sitting at the kitchen table wondering if
their healthcare coverage is going to go away. Folks are walking out of
the doctors' offices with newfound conditions and wondering: Will I be
able to get treatment if something similar to the American Healthcare
Act is passed by the Senate? Children are being born prematurely, with
asthma and cerebral palsy, and parents are left fearing their son or
daughter will never be able to afford insurance.
These families deserve more from Congress. At a bare minimum, they
deserve hearings. They deserve a panel of

[[Page S3637]]

experts discussing how we can lower premiums, reduce healthcare costs,
and put transparency into prescription drugs. They deserve smart
action, not political action. They deserve a Congress that will work
together to improve the lives of all Americans, not one that works
behind closed doors to draft secret legislation that will send shock
waves through homes across this country.
Our Founders expected more from this body. Quite frankly, I expected
more from this body before I got here. Montanans expect their U.S.
Senate to work for them.
I am going to leave you with one story. I was in Butte, MT, at one of
my listening sessions. A gentleman was sitting at the table. He was
probably 45 years old. He said: You know, I have two kids and I can't
work. I have had diabetes since I was a teenager. I have had some
issues with mental health for a good portion of my adult life.
He said: I haven't been able to work, haven't been able to support my
family, and then the Affordable Care Act came along, and the State of
Montana was wise enough to pass Medicaid expansion. I was able to go to
a doctor. I was able to get my diabetes handled because of Medicaid
expansion. I was able to see a psychologist and get my mental health
issues under control, and I was able to go back to work. I was able to
support my family.
He said: And now you guys in Washington, DC, want to take all that
away from me.
I will tell you, I will fight like hell to make sure that never
happens. And if the majority leader wants to try to ram this down the
people's throats, I will spend the rest of my life telling them why and
who did what to them.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from New Jersey.
Mr. MENENDEZ. Mr. President, I come to the floor, like many of my
colleagues, shocked at the Republican majority's brazen, secretive
effort to hijack the legislative process and pass a bill that would
hurt millions of Americans.
I have served in public office for more than four decades, and never
once in my 45 years as a mayor, a State legislator, a Congressman, or a
Senator has it been so hard to understand the motivations of an
opposing party. What kind of problems are Republicans trying to solve
with legislation that raises premiums, reduces coverage, decimates
Medicaid, and increases costs for everyone? Certainly not any of the
concerns I have heard in New Jersey. Never has someone come up to me at
the local diner to say that their premiums are too low or that Medicaid
covers too many children or that cancer patients don't pay enough out
of pocket.
There is only one place in America where these bad ideas have any
traction, and that is behind closed doors in Washington, where 13
Republican men are working on a secret bill to take healthcare away
from millions of people and raise costs on millions and millions more.
They want no transparency, no bipartisan input, no hearings.
Those are the same Republicans who in 2009 and 2010 accused Democrats
of ramming healthcare reform through Congress too quickly. In fact, it
was the majority leader who said at the time: ``This massive piece of
legislation that seeks to restructure one-sixth of our economy is being
written behind closed doors without input from anyone.'' Even the Vice
President--a Congressman at the time--said it is ``wrong for
legislation that'll affect 100 percent of the American people to be
negotiated behind closed doors.'' Mind you, all of these complaints
came during what was a far more open, transparent process.
I sit on the Senate Finance Committee. I remember the process quite
well. I remember our chairman at the time, Senator Baucus, bending over
backward to get Republican input. We held 53 meetings--hearings,
roundtables, briefings, and negotiations--on healthcare reform.
Afterward, we held the longest Finance Committee markup in over 20
years--a markup that led to the adoption of nearly a dozen Republican
amendments, on top of the two dozen amendments we accepted before the
markup began.
Democrats also made huge bipartisan overtures on the Health,
Education, Labor, and Pensions Committee. They, too, held a transparent
process and adopted over 160 Republican amendments--160 Republican
amendments.
Then and only then did we bring the bill to the floor of the Senate,
and when we did, we spent 25 consecutive days in session debating the
bill on the Senate floor in front of the American people.
In short, Democrats spent months making compromise after compromise
in the hopes of getting Republicans on board, only to learn that they
never had any intention of working with us at all. They never cared
about expanding access to care or reducing prescription drug costs for
seniors or making insurance affordable. They didn't work with us then,
and they certainly are not working with us now.
Behind closed doors, 13 Republican men are debating just how many
millions of Americans will lose their coverage under this bill. Is it
23 million? Is it 20 million? Is it 16 million? Behind closed doors,
they are discussing just how high the age tax should be on middle-aged
workers. Is it $8,000 a year or $10,000 a year or $12,000 a year?
Behind closed doors, they are picking and choosing which consumer
protections to gut. Should they bring back lifetime limits on coverage,
which is a real problem if you have a serious disease? Before, there
were lifetime limits. So you had coverage, and then all of a sudden,
you hit that ceiling. If you had challenges, for example, with cancer,
and you expended all of your coverage, you still had an illness that
needed to be treated. Now you were one illness away from bankruptcy.
Would you let patients with preexisting conditions sink or swim in
high-risk pools, allowing insurers to once again charge women more than
men simply because they are women? Same age, same bracket, same
geography.
It is easy to see why Republicans want to keep this bill out of the
public eye. If it is anything like the House version passed earlier
this year, it is going to be a terrible, mean-spirited bill--a bill
that the Congressional Budget Office said would take insurance away
from 23 million people. It would raise premiums by 20 percent a year
and price middle-aged consumers out of the market. It is a bill that,
according to reports, even President Trump said is too mean. I have to
tell you something. If a bill is too mean for President Trump, it is
certainly too mean for New Jersey.
Today, I understand that a comment was attributed to the President.
He was meeting with a group of business leaders. He says he wants a
health bill with heart--with heart. I can tell you, it is not this bill
because the House bill--and, from what I am hearing, behind closed
doors, the potential Senate bill--is a heartless bill.
I am not the only one with that view. I was glad that most of my New
Jersey colleagues in the House of Representatives rejected this bill in
a bipartisan way. Indeed, every House Democrat and nearly every House
Republican in our delegation understood why this bill would devastate
New Jersey.
This bill will price thousands of New Jerseyans out of the private
health insurance market, especially those nearing retirement age.
According to the Kaiser Family Foundation, premiums for a 60-year-old
worker who earns $20,000 a year in Monmouth County will see their
premiums increase by 900 percent--900 percent. That is an increase of
nearly $9,000.
Every day, New Jerseyans are reaching out to tell me what is at stake
in this debate and what this secretive effort will mean for their
health and their financial security. Take Dr. Howard Fredrics, a 54-
year-old constituent from Park Ridge who emailed to say:

Without subsidies provided under the ACA, my 51-year-old
wife and I would have no insurance. . . . We could not afford
premiums in excess of $1100 a month. . . . Without these
subsidies, millions will go uninsured and many of these
people, myself included, will die.

Of course, my Republican colleagues like to say their plan will give
Americans more choice. We don't know what the plan is, but they keep
saying--at least the House plan--we are going to give Americans more
choice. But if all the choices are unaffordable, what good are they?
What good is it to have ``more choices'' if you can't afford any of the
choices?

[[Page S3638]]

If they provide significantly less coverage, what good is it to say I
have insurance when the moment I get sick, I don't have the coverage
for it? So I have been paying for a policy that doesn't really help me
at the moment I need it.
They also say their plan will give States more choice on how to run
Medicaid. When you cut Medicaid by $800 billion, you leave States no
choice but to scale back the health services they provide. That is not
choice. That is not choice.
Leaving nursing home patients out in the cold, ending respite care
for children with disabilities, denying low-income children a fair shot
of the American dream--that is not choice.
New Jersey alone will face $30 billion in cuts to Medicaid over the
next decade--cuts that will not only leave thousands of families
uninsured but, according to the Milken Institute, will cost New
Jerseyans more than 41,000 jobs. It is no wonder Senate Republicans are
terrified of having to defend this bill. It is a terrible, mean bill,
and they don't have the guts to tell the American people what is in it,
even though they want to pass it next week. If only they had the
courage that so many New Jerseyans have shown me in recent weeks as I
have toured our State--hard-working Americans who have been willing to
share their personal healthcare stories.

It is not easy to share a serious illness you have with everybody in
the world, but so compelled are they and so courageous, I would add,
that they do. People like Irma Rivera, a constituent I recently met in
Jersey City, told me about her battle with uterine cancer nearly a
decade ago. She was fortunate to survive, but without the Affordable
Care Act, she would be blacklisted by health insurance companies for
the rest of her life, simply because she is a survivor of that cancer.
Today Irma is covered and receiving world-class care.
I also met with Samantha Williams, a young mother in Burlington City.
She told me about her son's brush with a life-threatening asthma
attack. They were uninsured so they avoided going to the emergency
room, as so many people do. The illness gets worse and worse, more
consequential to your life, more consequential to the cost, but
eventually his breathing got so bad, she had no choice. The doctor said
if they had waited any longer, her son might have never made it. She
credits Medicaid with saving his life.
I also want to know how my Republican colleagues can reconcile their
concern with the opioid epidemic with their plan to end the Medicaid
expansion that is saving so many lives. Just yesterday, I received an
email from Irene in Oakhurst, NJ. She writes:

My daughter is a recovering drug addict on the Medicaid
program which pays for mental health care and services. . . .
She's part of the opioid epidemic that has taken the lives of
so many young people like her. She's been drug free for
almost a year. Taking money from this program would be
disastrous not only for her but for so many people who cannot
afford any other healthcare.

So I listen to those compelling stories. They are courageous to tell
their stories to the whole world--very personal stories. Yet there
isn't the courage here to come forth with a bill and let's debate it
open, in public. This bill leaves millions of low-income Americans who
depend on Medicaid expansion with no options at all. And for what? To
give insurance health executives, real estate moguls, and hedge fund
managers a massive tax cut they don't need. If there was ever such a
thing as class warfare, this is it.
In my home State of New Jersey, 250 millionaires are slated to get a
collective tax cut of $14 million. You heard it right--250 millionaires
get a tax cut, while over half a million New Jerseyans lose their
healthcare coverage. That is a pretty awesome thought--an incredible
thought. It is totally mean-spirited. It is certainly without heart.
Many of them are people who work in some of the toughest jobs, but they
don't get healthcare benefits at the job where they work, from
dishwashers and cashiers and home health aides, just to mention a few.
These were my neighbors growing up in the tenement in Union City--
people who worked tirelessly to give their children a better life and
so often put their own health on the back burner.
Many of us thought the cruel legislation Republicans passed through
the House would be dead on arrival in the Senate. Instead, an
incredibly unpopular bill has a new lease on life. Why? Because padding
the pockets of the health insurance industry, capping Medicaid
spending, and cutting taxes for millionaires have been at the top of
Republican wish lists for years.
The notion that the GOP can pass this secret bill with no debate is
insulting to our democracy, and the idea that they can dismantle this
historic law without hurting millions of people is just not true
because, make no mistake, when you take $800 billion out of Medicaid,
everyone feels the pain. When you add 23 million people to the ranks of
the uninsured, everyone feels the pain. When you send more people back
to the emergency room as their way of getting healthcare, saddle
consumers with higher out-of-pocket costs, and end protections against
insurance company abuses for patients, everyone feels the pain.
What really boggles my mind--what I just can't understand is, there
is no shortage of problems in our healthcare system--real problems that
need real solutions. Ask anyone, and I mean anyone, about our
healthcare system. I will guarantee you will get an earful about what
is wrong with it. You will hear from parents about deductibles that are
too high, from workers about how hard it is to find in-network doctors,
from seniors about generic drugs that suddenly cost thousands of
dollars, police officers about the opioid crisis tearing apart our
communities, and hospital staff concerned about the nursing shortage,
business owners, like the group I met from Cumberland County, NJ,
yesterday who want Congress to work in a bipartisan way to lower
employees' healthcare costs.
Imagine, just for a moment, how thrilled Americans would be if
Republicans actually had a bill that solved some of their problems
instead of bringing back old ones. Imagine how excited my Republican
colleagues would be to show off a bill that improved, instead of
endangered, people's lives, but my Republican friends are not excited
to show off this bill because when you are excited to show a bill--when
you have a great product, you want the whole world to know about it.
When you have a terrible product, you don't want anyone to know about
it, and they don't want to defend it because they know it is
indefensible.
For 7 years, my Republican colleagues put politics over policy. For 7
years, they demonized ObamaCare, with no substance behind their
rhetoric. Now their poll-tested platitudes have caught up with them,
and they know it. That is why they let 13 Senators, who represent less
than one-quarter of the country, meet behind closed doors, and that is
why their hope is to keep this bill a secret until the very last
minute.

So today I have come to the floor with a message for my Republican
colleagues: If you want to have a debate about how to improve our
healthcare system and about how to help more families get covered and
about how to lower costs more and create a healthy, more productive
nation, these are issues Democrats have been ready to have that debate
on. I have said it in the Senate Finance Committee. We did remarkable
things under the Affordable Care Act, but there is still room for
improvement. We are ready to have that debate because Democrats know
that while the Affordable Care Act was a historic law--a law that
stopped insurance companies from dropping your coverage if you got
sick, that covered 90 percent of Americans for the first time in our
history, that required healthcare plans to cover essential health
benefits like visits with specialists, prenatal care, mental health and
addiction treatment, hospital stays, and more--despite all of the
positive steps forward, in spite of all the good the Affordable Care
Act did, Democrats have never stopped believing we could even make it
better.
Before we can make our health system better, we must stop Republicans
from making it worse. We cannot go back to a time when healthcare was a
privilege granted only to those who could afford it, when it was
always, I think, a right afforded to all Americans. The only way we can
go forward is by working together with bipartisan input, with open
debate, with full transparency on an issue that affects virtually every
American, in full view

[[Page S3639]]

of the American people we were elected to serve. They deserve no less,
but they are getting a lot less by the majority as it relates to this
bill--behind closed doors, in secret, that even the President of the
United States says is mean. The only thing I can agree with President
Trump on is we need a bill with heart, and from what I have seen and
heard so far, this is pretty heartless.
I yield the floor.
The PRESIDING OFFICER (Mr. Rubio). The assistant Democratic leader.
Mr. DURBIN. Mr. President, let me thank my colleague from New Jersey
for his excellent remarks on the Affordable Care Act and its future and
really spotlight the point he made. He and I have been around
legislatures for a long time, both at the local level, State level, and
here in Washington. If you have something you are really proud of--a
bill--you can't wait to roll it out. We have a place for a press
conference about every 15 feet in the corridors around here. We have a
press corps that fills the Gallery when they all show up, and they are
anxious to hear our story. If you have something you are proud of--and
each of has had that legislation--you put it in a press release and do
the social media and the whole number.
If you are unfortunate to be in the position to bring a bill to the
floor you are not very proud of--you don't know how you can explain it
back home--you keep it secret. You do it behind closed doors.
What the Senator has said is exactly the truth--and we know it, as
our colleagues on the other side know it. They have, for the past
several weeks, since the House passed their bill, been meeting behind
closed doors. So 13 male Senators--why they couldn't invite the women
Republicans in the Senate--it is their decision--I can't understand.
They have not produced one thing for public consumption--nothing. Yet,
Senator McConnell, the Republican leader, tells us: Well, you have 10
days. We are going to pass the new healthcare system for the United
States of America in 10 days, and pretty soon we are going to show you
what we are going to propose.
It tells you the whole story. There is something in there that is
painful, that hurts them politically, and that they can't really
explain. After all these years--``Repeal ObamaCare, repeal ObamaCare,''
they can't come up with an alternative they can sell to the American
people.
I thank the Senator for pointing out his experience, and the
experience he is finding in New Jersey. I am finding the same thing
back in Illinois.
I thank my colleague from New Jersey for his statement.
This last Saturday, I was invited to debate a Republican House Member
from my hometown of Springfield, IL, on his vote in favor of
TrumpCare--if you want to call it that--the Republican healthcare plan
in the House. We were invited by the Ministerial Alliance of
Springfield, the African-American ministers. I accepted the invitation
on a Saturday afternoon, and he did as well.
He put conditions on it. No. 1, no media coverage. This is not open
to the public. Really? We are going to debate a healthcare system
change for America that is going to affect millions of people, and we
will not talk about it in public? But that was his ground rule. And
then in the midst of it, he thought someone was taping him while it was
going on and stopped full sentence and said: I don't want this taped.
Well, here is a bill he voted for to change the healthcare system for
the people he represents, including the folks in that room, and he
didn't want to be on the record or public about that discussion. That
tells me a lot as well.
It isn't just a secret bill we haven't seen, it is a lot of
Republican House Members who voted for it--and they were all
Republicans--passed by, I believe, two or three votes, and now they
don't want to talk about it. Well, there is a message there.
Here is what I have concluded after looking at this in a lot of
different ways. Where you stand on healthcare in America depends on
where you start on the question: Do you believe every American has a
right to affordable, quality healthcare? If the answer is, no, that is
for people who are lucky or rich or have the right job, then you can
reach the same conclusion they did in the House when they passed the
Republican measure because, you see, their bill removed health
insurance coverage from 23 million Americans, instead of expanding the
percentage of Americans with health insurance coverage, which we set
out to do with the Affordable Care Act. The Republicans have reversed
field. They are taking away health insurance from more people than the
Affordable Care Act gave.
Is that a press release from the Democratic National Committee I just
quoted? No. It was the Congressional Budget Office--a bipartisan group
here, an agency in Washington that analyzes our legislation and gives
us their analysis. They looked at the Republican bill and said it will
cost 23 million people in America their health insurance.
If you started with the position that healthcare is a right, you
would stop at that point and say: Well, this bill clearly doesn't work
because it takes away healthcare coverage instead of creating
healthcare coverage.
Where you start is where you stand.
The second question is this: If you believe the highest priority of
this effort is to cut taxes on wealthy people, then, of course, you
would vote for what they passed in the House--$700 billion in tax cuts.
Now, that tax cut came right out of the healthcare system of America.
That is the tax revenue that is used to expand Medicaid insurance
coverage to those who are lower income workers. That is the money that
is used to help subsidize the premium payments of middle-income workers
who can't afford the monthly premium.
But they believed--the Republicans who voted in the House--that there
is a higher priority than helping those people to have health
insurance, and that is cutting the tax burden of the wealthiest people
in America. So if you start with that premise--that you have to cut
taxes by $700 billion regardless of what happens--this is what you end
up with, the measure that came over from the House of Representatives.
I don't know what the Senate Republicans will come up with in response
to that, but clearly it must be parallel or close to what the House of
Representatives did.
Let's take a close look at this measure and take a look at the
history that brought us to this moment. As I mentioned, we still don't
have the text of the Republican secret bill to repeal the Affordable
Care Act. Six years and counting, they can't produce a replacement. It
looks like we are going to vote on this in a few days. By congressional
standards, this is a high crime and misdemeanor. To think that we are
going to consider a bill within 10 days affecting every American,
affecting one-sixth of the American economy--a bill that will say to
some people: You are going to lose your health insurance, and to
others: We are going to offer you a health insurance policy that really
isn't worth the paper it is written on, and we haven't seen the bill.
Well, what is the history of this? Is this the way the Republicans
always operate? Not really. In December 2009, Republican Senator
McConnell, their leader, said, when we were debating the Affordable
Care Act: ``This massive piece of legislation that seeks to restructure
one-sixth of our economy is being written behind closed doors without
input from anyone in an effort to jam it past, not only the Senate, but
the American people.'' That was Senator McConnell about the Affordable
Care Act when it was being proposed by President Obama.
Well, what is the fact? During the passage of the Affordable Care
Act, the Senate held over 50 bipartisan hearings on the bill. How many
bipartisan hearings have we held on the new Republican healthcare
proposal? None, not one.
At that time, 6 years ago, we had a week-long markup in the Finance
Committee and a month-long markup in the HELP Committee. The Senate
spent--and I remember this well--25 consecutive days in session on the
floor of the Senate debating this bill. It is the second longest
consecutive period of time ever spent on a bill in the Senate.
We considered on the floor of the Senate hundreds of amendments. You
know, we ended up adopting 150 Republican amendments to the Affordable
Care Act. Not a single one of them would vote for it, but we took their
proposals to make it better seriously and adopted 150 changes.

[[Page S3640]]

How much of a chance will we have to amend the Senate Republican bill
that may come before us as soon as this week? It remains to be seen. It
could be what we call a vote-arama around here, which is a corruption
of what this grand institution really established as a standard of
operation for generations and centuries. The vote-arama lets you vote
on an amendment offered to the bill, with 2 minutes of debate.
You are changing the healthcare system and you have 1 minute on each
side to debate your amendment? Is that a serious undertaking with
something that is that consequential for so many Americans? No one has
seen this secret bill--not Democrats, not many Republican Senators.
I asked Secretary of Health and Human Services Tom Price last week in
a hearing: Have you seen the bill? You are the one that is going to
have to implement it.
He said: No, I haven't seen it either .
This weekend the Presiding Officer, Senator Rubio, a Republican from
Florida, said:

The Senate is not a place where you can just cook up
something behind closed doors and rush it for a vote on the
floor.

Mr. President, I couldn't agree more.
Senator Ron Johnson, a Republican from Wisconsin, said:

I want to make sure the American people, I want to make
sure the members of Congress have enough time to evaluate it.
I want to have enough time to really take a look at what
we're voting on.

That was Republican Senator Ron Johnson of Wisconsin.
Senator Bob Corker, a Republican Senator from Tennessee, said:

I've said from Day 1 and I'll say it again: The process is
better if you do it in public. Obviously, that's not the
route that is being taken.

I didn't pull these quotes from months and years ago. They are from
the weekend. The comments were made over the weekend by Republican
Members about their very own leadership and the process they are
following in preparing to change America's healthcare system.
Let's talk about some numbers. Let's start with zero. How many
hearings have we had on the Senate bill to repeal the Affordable Care
Act? Zero. How many markups have we had? Zero. How much time has the
Secretary of Health and Human Services, the man responsible for
implementing this bill, spent on it to review it? Zero. How much
Democratic input has been allowed for this secret negotiation? Zero.
How many women Senators have been involved in crafting the bill? Zero.
How many medical organizations or patient groups support the secret
Senate bill? Zero. And most concerning of all, how much time has the
public had to even read this bill? Zero.
Let's take a look at another number: 23 million. The Congressional
Budget Office estimates that 23 million Americans will lose their
health insurance under the House-passed repeal bill--1 million in
Illinois.
I have said it before, but I will say it again--and this is a driving
factor in terms of my views on the subject: If you have ever in your
life been the parent of a seriously ill child and didn't have health
insurance, you will never forget it as long as you live. I know. I have
been there.
I was a law student, newly married, with a brand new baby girl with a
really serious health issue, and I had no health insurance. My wife and
I sat in the charity section at Children's Hospital waiting for them to
call our name so we could take our little girl in to the latest
resident, with a hundred questions and who wanted to go through them
all over again. I thought to myself: Durbin, how did you ever reach
this point where you don't have health insurance?

I fixated on health insurance from that point forward. From the time
I got out of law school, for years afterwards while my daughter was
growing up, I not only had health insurance, but I sometimes had two
health insurance policies. I was so worried about having coverage if I
ever really needed it.
So we want to take health insurance away from 23 million Americans?
Do you want it to be your family, your son, your daughter? I sure
wouldn't.
Here is another number: 750. Lower income older Americans would see
their premiums increase 750 percent under the House-passed repeal bill,
from $1,700 under ACA to $14,000 under the Republican plan. Now, how
can that happen? How can you see the premiums go up that fast? We built
into the affordable care bill a guaranteed protection for disparity in
premium payments of no more than three to one. The most expensive
health insurance policy cannot be more than three times the lowest cost
policy. The Republicans changed that to five to one. Well, who does
that affect?
If you are between 50 and 64 years of age, you are in a category of
people not yet eligible for Medicare. If you are now facing chronic
illnesses that could make health insurance more expensive, you will pay
the higher premiums. The higher premiums, when calculated, are
dramatically higher for this group. That is why the American
Association of Retired Persons has come out foursquare against the
Republican TrumpCare, the Republican repeal bill. It is just unfair to
those between the ages of 50 and 64.
Some 130 million, that is how many people nationwide have preexisting
conditions. Almost half of the people in Illinois have a preexisting
condition. Several weeks ago, I had a procedure for an atrial flutter.
It worked out just fine. Now I have a preexisting condition. I am in
that category. What does that mean? If you went out to buy health
insurance with a preexisting condition, you are charged more, if you
could buy insurance at all.
So when the Republican bill that passed the House does not guarantee,
as the Affordable Care Act, that you cannot be discriminated against
because of a preexisting condition, it makes millions of Americans--130
million--more vulnerable.
Is that what they wanted to achieve?
Where you stand depends on where you start. If you think everyone is
entitled to health insurance, then you can't be standing for something
that allows preexisting conditions to be used against you. A lot of the
people whom I am talking about have employer insurance, but what about
those who shop on the individual market or purchase individual
insurance in the future? Under the House repeal bill, insurers would,
once again, be allowed to charge people with preexisting conditions
more money for insurance.
The next number is 33,000. Senator Menendez referred to it. That is
how many people are dying every year because of the opioid or heroin
overdose--33,000, and 1,800 a year in Illinois.
Now, listen to this. The Republican bill dramatically cuts the
Medicaid Program, the Nation's largest provider of substance abuse
treatment services, and it allows insurers, once again, to refuse
coverage for those needed services.
I have been here a few years, and I can remember that desk because
that is where Paul Wellstone of Minnesota sat, and I remember that desk
because that is where Pete Domenici of New Mexico sat. You couldn't ask
for two more polar opposites politically. Paul Wellstone was a
garrulous, proud liberal. Pete Domenici was a proud conservative. One
was from Minnesota, and one was from New Mexico, and they came together
on an issue.
Do you know what the issue was? Each of them had someone they loved
in their family who suffered from a mental illness, and they said: Why
in the world will health insurance companies refuse to write coverage
for people with mental illness? They fought for years against the
insurance companies, and they finally won.
We included, in the Affordable Care Act, the requirement that your
health insurance policy cover not only physical illness but mental
illness. It was a breakthrough. For the first time, we stopped treating
mental illness like a curse and treated it like an illness that could
be treated.
They added a section at the end that most of us didn't even notice:
mental illness and substance abuse treatment. I didn't know it was
there until the opioid crisis, and I started going to these rehab
facilities and saying to these people there: How are you paying for
this care? Some of them were under Medicaid, but those under private
health insurance said: My policy covers it. It covers it because
Wellstone and Domenici insisted on putting it in.
After that historic victory, you would think the Republicans would
include mental illness and substance

[[Page S3641]]

abuse treatment as one of the basic essential services for health
insurance, but they don't.
When they say we are going to write a bill that gives Americans more
choice in their health insurance--oh, that sounds appealing--the choice
is whether you want mental illness and substance abuse treatment or you
don't.
Well, from where I am sitting, that is the kind of insurance coverage
that should be basic to everyone. You never know whether that little
girl that you are raising--that beautiful little girl--6 years from now
is going to be struggling with an addiction. At that point, you better
hope that your health insurance policy has some coverage so that you
can save her life and bring her back from that addiction.
Now, 280,000 is the next number. That is how many children in
Illinois depend on Medicaid for school-based health and medical
services, from feeding tubes and handicapped buses to special education
teachers. I made a point this last week when I was home to visit the
schools in Chicago and Bloomington and hear firsthand what cuts in
Medicaid meant to local school districts.
Many Senators don't realize this, but the kids with whom you are
dealing who have learning disabilities and other disabilities, many of
them are supported at your local schools by Medicaid dollars. The
Medicaid dollars pay for the counselors, pay for the special buses, and
pay for the feeding tubes for these kids to survive. So when you make a
dramatic cut in Medicaid, as the Republican bill that came out of the
House does, you endanger the very services and the very benefits that
these special ed kids need. The school districts are mandated by law to
help these kids, but if the money is cut off from Medicaid, what are
they going to do?
The Republican repeal bill that every Republican Congressman in my
State voted for slashes $40 billion in Medicaid funding to Illinois,
including money to school districts.
Three--this is the most important single number in the next 10 days
in the Senate--3. That is the number of Republican Senators needed to
stop this. Surely, there are three Republican Senators who are
concerned enough about this secret, behind-closed-doors process that we
are witnessing when it comes to rewriting healthcare in America--at
least three Republican Senators who want to take time to properly
review this legislation that affects one-sixth of our economy.
Just the Senators who have publicly stated their personal concerns
about this process--if the three of them would come together, we could
stop this and do it the right way.
I said privately to a Republican Senator last week, after the tragedy
where a Republican Congressman was shot at a baseball practice: Isn't
this the moment when we ought to get together quietly--Democrats and
Republicans--when we ought to sit down and write a bill we can both be
proud of? I am hoping he was listening.
I am hoping that three Republican Senators, if they stand up for it,
will help us achieve that goal. Surely there are three Republican
Senators who are worried about the kids in their States like I am
worried about the kids in mine, who do not want to make the opioid
epidemic any worse, who want to make certain--underline the word
``certain''--that they are protecting the people they represent from
discrimination because of preexisting conditions. Surely there are at
least three Republican Senators who do not want to throw millions of
Americans off of health insurance coverage. Maybe some of the Senators
who represent States that have been ravaged by the opioid epidemic will
step forward. There are a lot of them. It only takes three to change
this.
To Republican Senators, I say: Do not do this. Do not do this secret
process. Democrats are willing to work with you to improve our
healthcare system. I have said before that the only perfect law that I
know of was carried down a mountain on clay tablets by Senator Moses.
All of the other efforts can use some work, and in this case, we are
willing to work with you. Take repeal off the table, and we will put a
chair up to the table.
Over the past week, I have received thousands of emails and letters
from Illinoisans who are worried about what is happening in the Senate
today.
Helen, from River Forest, IL, is 47 years old. She is a primary
caregiver for her parents. Her mom has Alzheimer's and is in a nursing
home.
Here is what Helen writes:

Just before Thanksgiving, my dad's health deteriorated. He
is now in hospice in the same nursing home. I have spent all
of their savings--my mom and dad's savings--on healthcare. My
mom is finally eligible for Medicaid. Without Medicaid, I
would need to bring my parents to my home and quit my job to
personally nurse them myself because I don't have the money
myself to keep them in the nursing home and pay for private
care. Please protect ObamaCare and Medicaid.

Here is Madeline from Chicago, who writes:

My younger sister is disabled. Before the Affordable Care
Act went into effect, she was just about to hit the maximum
lifetime limit on her private insurance policy.

That used to be the case. You would sign up for insurance, and you
would say: Oh, great coverage--no copays, no extra charges. Then you
would find in the fine print that there is a limit to the coverage of
$100,000. My friends, I can tell you that we are--each and every one of
us--one diagnosis or one accident away from having more than $100,000
in medical bills. It happens pretty quickly. That used to be built into
insurance policies. We outlawed it under the Affordable Care Act. Now,
in the name of ``choice,'' the Republicans want to bring that back.
Madeline writes:

Before the ACA went into effect and my daughter was about
to hit the maximum lifetime limit on her private insurance
policy, she was going to have to apply to be part of a high-
risk pool, but that was going to involve a long wait, without
any insurance, plus high premiums if and when she was
accepted into the pool. The Affordable Care Act came just in
time for my sister and for our family.

When the Republicans in the House say not to worry about people with
preexisting conditions, that they have set aside $8 billion to take
care of them in private risk pools, it is sad and, in a way, tragic
that they would say that. That is not nearly enough money, and there is
no guarantee that private risk pools that never worked before the
Affordable Care Act would work in the future. It is a way to give an
answer to the obvious question of why they are dropping so many people
with preexisting conditions from guaranteed coverage.
The last note is from Erin of Chicago, who writes:

I implore you to force a public hearing on the ACA repeal
that the Republicans are trying to sneak through. If this
bill passes, many of my friends and family will lose coverage
either due to preexisting conditions or because the
deductibles are too high. Additionally, my parents are self-
employed and getting older. Under the proposed act, their
health insurance premiums will likely increase to $14,000 a
year. They cannot afford it. They just can't. They will not
have coverage, will get sick, and be unable to afford care.

If the Republicans have a better idea than the Affordable Care Act,
for goodness' sake, stop hiding it from the American people. Stop
talking about it behind closed doors. If it is such a good idea, bring
it out for the world to take a look at. There will be critics. There
were certainly critics with regard to the Affordable Care Act. I
remember that very well. Yet that is what this body is all about.
The Senate is supposed to be a place where we deliberate on the
important issues of our time. Is there anything more important than
your health, the health of the people whom you love, and your
opportunity to get basic healthcare so that you can protect them?
I implore the Republicans and those who know that this is the wrong
way to go to stand up and say so. It only takes three Republican
Senators to do this a much different way so as to bring credit to this
institution and create a bill--create a change--that makes healthcare
more affordable, more accessible, and more fair to more Americans.
I yield the floor.
The PRESIDING OFFICER. The Senator from Mississippi.