Congressional Record, Volume 163 Issue 106 (Wednesday, June 21, 2017)

[Congressional Record Volume 163, Number 106 (Wednesday, June 21, 2017)]
[Senate]
[Pages S3660-S3668]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

Healthcare Legislation

Mr. DURBIN. Madam President, it was about a month ago that the House
of Representatives, by a narrow vote, voted to repeal the Affordable
Care Act and to replace it with their own creation. That effort by the
House of Representatives passed by, I believe, 2, 3, or 4 votes. It was
very close, and it was a partisan rollcall--all Republicans voting for
it and no Democrats voting for it. So it came to the floor of the House
without any bipartisan preparation. It was only after the vote that the
Congressional Budget Office took a look at the measure and reported to
the American people its impact.
Now, that is unusual because, when you take a big issue like the
reform of America's healthcare system, historically, traditionally,
Members of the Congress--the House and Senate--will send their versions
of the bill to the Congressional Budget Office and ask for an analysis:
Tell us how much this will cost. Tell us the impact on the deficit.
Tell us what it will do in terms of healthcare coverage. But the House
Republicans chose to vote before the analysis.
Well, the analysis still came out, and when it came out, the report
was unsettling because it had a dramatic negative impact on healthcare
in America. The House Republican repeal, according to the Congressional
Budget Office, would mean that 23 million Americans would lose their
health insurance.
Remember, we started this debate 6 or 7 years ago because we were
concerned that too few Americans had health insurance and we wanted to
expand the reach of health insurance and make sure that it was good
health insurance, and that is why we passed the Affordable Care Act. We
fell short in some respects, but we certainly achieved our goal of
increasing the number of insured Americans with the Affordable Care
Act. In my home State of Illinois, the percentage of those uninsured
with health insurance was cut in half. In fact, it was even better than
that. So more and more people ended up with coverage through Medicaid,
as well as through private health insurance.
Now comes the repeal of the Affordable Care Act, and the Republicans
in the House decide to not only erase all of that progress in providing
more health insurance for more families but to make it worse--to make
the number of the uninsured even higher than it was. So if that is the
starting point of healthcare reform, you ask yourself: Is that really a
worthy goal? Why would you do that?
Well, they were forced to do it. They really were. The House
Republicans really, in fairness to them, had no choice, because they
made the initial decision that their highest priority was to give a tax
break of about $700 billion to the wealthiest people in America. So by
creating this tax break--giving this money back to wealthy people--they
took that same amount of money out of America's healthcare system. When
you take $700 billion out of America's healthcare system, here is what
happens. People who are currently receiving their health insurance
through Medicaid, a government program, will have fewer and fewer
opportunities to take advantage of Medicaid. In fact, they acknowledged
that. The Republicans said in the House: We are just cutting back on
Medicaid.
Secondly, you reduce or eliminate the helping hand we give to working
families who can't afford to pay their hospitalization premiums. If you
are in certain categories, we give you a subsidy to pay for your
premiums. So follow the logic: If you cut the taxes by $700 billion and
take $700 billion out of the healthcare system, you have less money to
provide Medicaid health insurance for those in low-income categories,
and you have less money to help working families pay for their health
insurance premiums.
The Congressional Budget Office looked at that and said that the net
result at the end of the day is that 23 million Americans will lose
their health insurance because of this decision by the Republican
House. In the State of Illinois, a State of about 12.5 million people,
1 million people would lose their health insurance because of this
action taken by the Republican House of Representatives.
Well, from basic civics we know that here we are in the Senate and we
get our chance once the House has acted. So we have been waiting--
waiting for almost a month for the process to begin. The sad reality is
it never even started--not the ordinary, open, public, transparent
process of debating a change in America's public health system.
Instead, Senator McConnell, the Republican leader, said: What I am
going to do is to take 13 of my male Republican Senators, put them in a
room, and let them write an alternative to the House bill. Why he
didn't initially include the women in his caucus, he can explain, but
it was 13 of the male Republicans who would sit in a room to write, in
secret, their alternative.
We think: Well, most legislative ideas start with that kind of a
meeting--a closed-door meeting in the quiet of a room, basic
negotiation. But it is the nature of a democracy and our form of
government that at some point this becomes public. Shouldn't it? If we
are going to change the laws about health insurance--basic fundamental
coverage for American families--shouldn't we know it? Shouldn't we know
what the changes will be before we vote on them?
Well, there is a pretty rampant rumor that tomorrow, for the first
time, there will be a limited disclosure of this Republican effort over
the last several weeks. We are told--and it is only a rumor--that the
Senate Republican leadership will sit down with the Senate Republican
caucus and show them for the first time what they want to propose that
we vote on.
One might say: Well, that sounds like the beginning of a good, long
process.
It is not. It is the beginning of a short process, because the
Republican leader has said that this time next week we will be into
debating that issue and voting on it to its conclusion--in 10 days.
That is 10 days, start to finish, to rewrite the healthcare system of
America, 10 days on a measure that has not been disclosed to the
Republican Senators--not all of them--let alone the Democratic Senators
and let alone the American people. That is what we are faced with.

When we wrote the Affordable Care Act, which was widely criticized by
the Republicans, let me tell you the process we followed with the
Affordable Care Act. In 2009, the Senate HELP Committee--or the Health,
Education, Labor, and Pensions Committee--held 13 public, bipartisan
hearings, 20 walk-throughs of various proposals, and a markup in the
committee that went on for 1 calendar month, and 160 amendments offered
by the Republicans were adopted. That was in 2009 with the Affordable
Care Act.
The Senate Finance Committee, which writes the tax laws, held 17
roundtables, summits, and hearings on the legislation, 13 Member
meetings and walk-throughs, and 38 meetings and negotiations.
Keep in mind that we still haven't seen the Republican proposal we
are supposed to vote on next week--this secret proposal.
The Senate Finance Committee on the Affordable Care Act held a 7-day
markup and adopted 11 Republican amendments. At the end of the day, not
a single Republican Senator voted for the measure, but they offered
amendments, and those amendments were debated and many of them were
adopted by the Democratic majority.
When the Affordable Care Act came to the floor of the Senate, we
spent--and I remember this well--25 consecutive days in session
considering that bill--25 days. As to what Senator

[[Page S3661]]

McConnell and the Republicans will offer to us in what we call
reconciliation, we will be lucky to get 25 hours. We spent 25 days on
the Affordable Care Act. In total, the Senate spent more than 160 hours
on the Affordable Care Act and more than 150 Republican amendments were
adopted, though not a single Republican Senator ended up voting for the
bill. We opened it to their amendments and adopted their amendments. It
was a bipartisan effort.
What has been the process this time around? No hearings, no markups,
no public input, no support from the medical advocacy community at all.
I don't have a single medical advocacy group in Illinois that supports
what the Republicans did in the House of Representatives--not one.
Hospitals, doctors, nurses, pediatricians, and disease advocacy groups,
like cancer and heart, are all opposed to what was done in the House of
Representatives, and we are being told, when it comes to the Senate's
turn: Get ready, it is going to be fast. Don't blink, you might miss
it.
Let me tell my colleagues what else we have. We have a record of
quotations from leaders on the Republican side who, even though the
Affordable Care Act went through all of these hearings and all this
deliberation, were very explicit in their criticism. Here is Majority
Leader Mitch McConnell, a Republican of Kentucky, in December of 2009,
on the Affordable Care Act. He said: ``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.''
I might say to Senator McConnell: How would you explain what you are
doing now when it comes to rewriting the healthcare system behind
closed doors without input from anyone? Is it an effort to ``jam it
past not only the Senate but the American people''?
Senator Marco Rubio last week was quoted as saying: ``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.''
I agree with Senator Rubio, but that is what they are trying to do.
Senator Lisa Murkowski, a Republican of Alaska, said: ``If we had
utilized the process that goes through a committee, I would be able to
answer not only your questions but my constituents' questions.''
Senator Murkowski, a Republican of Alaska, expressed what most of us
feel. How could we even answer an honest, legitimate question from
someone we represent when we can't even see the measure that is being
produced by the Republicans.
Senator Jerry Moran, a Republican from Kansas, said last month:

I want the committees of jurisdiction to hold hearings,
bring the experts who know about healthcare from across the
country, bring the constituents to tell us their stories.
Then I want every Senator, all 100 of us, to have the chance
to offer amendments.

Thank you, Senator Moran. I agree with you. That is how the Senate is
supposed to work, but that is not how it is working now.
Let me tell my colleagues what some of the groups have said about
this Republican effort to repeal the Affordable Care Act. You expect:
Oh, it is a partisan comment from a partisan Senator. These are
nonpartisan groups.
The American Heart Association, what do they say? They say: ``The
House bill would seriously erode preexisting condition protections,
including for patients suffering from cardiovascular disease.''
About a third of us on Earth--or at least a third of us in America--
have some preexisting condition. For the longest time, insurance
companies said: If you are a woman, it is a preexisting condition.
Go figure. But now, at least a third of us have some condition which,
in the old days, would disqualify us from insurance coverage or make it
too expensive.
So now we put in the Affordable Care Act a prohibition against
discriminating against any American because they have a preexisting
medical condition. I think that is pretty important. My family has
certainly had the same experience as other families when it comes to
preexisting conditions.
Now the Republicans have said: We are going to take that out. We want
to give you more choice. We want the insurance companies to give you
more choice. Choice means another reason to say no. Choice means
coverage that isn't there when you need it. Choice means restrictions
on your health insurance policy. That may not bother you at all today,
but tomorrow, when you go to that doctor for that diagnosis you will
never forget as long as you live or get involved in an accident and
finally take a close look at that health insurance policy, you want to
make sure it is there if you need it, don't you?
The Republicans say we need more choice. The American Heart
Association says that, when it comes to preexisting conditions, the
House Republican repeal bill would seriously erode protection of
Americans.
The American Medical Association, the largest group of physicians in
America, said: ``We cannot support [the bill] that passed the House as
drafted because of the expected decline in health insurance coverage
and the potential harm it would cause to vulnerable patient
populations.''
The American Diabetes Association said: ``It would give insurers the
ability to charge people with pre-existing conditions--such as
diabetes--higher prices [for health insurance] . . . and would allow
insurers to deny people with diabetes the care and services they need
to treat their disease.''
The American Association of Retired Persons has weighed in. Here is
what they say: ``This bill would weaken Medicare's fiscal
sustainability, dramatically increase health care costs for Americans
aged 50-64, and put at risk the health care of millions of children and
adults with disabilities, and poor seniors who depend on the Medicaid
program for long-term services and supports.''
AARP is working overtime to notify Americans over the age of 50 and
their kids that the repeal of the Affordable Care Act that passed the
House of Representatives is a bad deal for seniors and their families.
There is something else going on, too. For more than 6 years,
Republicans in Congress have been shouting ``repeal and replace'' from
the rooftops, and they voted more than 60 times to repeal the
Affordable Care Act. They never liked it from the start. They put
language into bills to make it more difficult for the Affordable Care
Act to work, such as funding needed to make individual insurance
markets work as intended. Then, on his first day in office, President
Trump signed an Executive order directing Federal agencies not to
enforce the Affordable Care Act.
The Trump administration cut the open enrollment timeframe in half,
making it harder for people to sign up for insurance--meaning fewer
people covered, fewer people in the insurance pools, and premiums going
up as a result. The President, to this day, continues to make
uncertainty in the insurance market. He refuses to say whether he will
continue providing cost-sharing reduction payments to help 7 million
Americans afford health insurance. Without the payments, insurers tell
us premiums will skyrockets 20 percent next year.
Let me mention one other thing that has happened as part of this
health insurance debate. We decided to make a historic change in
healthcare in America. I have told the story repeatedly, and I will not
tell it in detail, but it was Paul Wellstone, a progressive from
Minnesota, who sat right there, and Pete Domenici, a conservative from
New Mexico, who sat right there, who came together--these two unlikely
partners--because they each had members of their families who suffered
from mental illness. They said: Why is it that we don't treat mental
illness like an illness? Why is it that health insurance just covers
physical illness?
They were right. They fought the insurance companies for years, and
they won. We put it in the Affordable Care Act. We said: If you offer
health insurance, you have to cover mental illness. My friends, it is
time for us to step out of the shadows, where mental illness was
considered a curse and not an illness, and deal with it as something
that can be successfully treated. We put it in the bill, and most
Americans would agree that it was the right thing to do.
There was another part of it, though, that slipped my attention and
now I know it is critically important. It wasn't just mental illness.
It was coverage for mental illness and substance abuse treatment.

[[Page S3662]]

How important is substance abuse treatment in America today? Go to
Maine, go to Iowa, go to Illinois, and ask the question: Are there any
problems with opioids? Heroin? Overdosing? Death? Of course.
When you go to the rehab and addiction treatment centers and you ask
people: How is your family paying for this care to try to rescue this
young child in your family or someone dealing with addiction, they say
they are either under Medicaid, the government insurance program, or
their health insurance policy covers substance abuse treatment. Why?
Because Wellstone and Domenici effectively included that in the bill.
Now, under the bill that passed in the House of Representatives, an
estimated 1.3 million Americans with mental disorders and 2.8 million
seeking help with substance abuse will lose their coverage for
treatment. It is no longer a priority under the Republican idea of
giving you choice with your health insurance.
Choice--when you are a father buying health insurance for your family
and you are picking out a health insurance policy and you have a
choice, could you anticipate the teenaged daughter you love with all
your heart will one day face an addiction and desperately need
substance abuse treatment to save her life? Did you think about that
when you signed up for the right choice in a lower cost health
insurance plan?
I feel, and many feel, that this is essential when it comes to
services and health insurance. Republicans say: No, it is an option;
take it or leave it. People who leave it and then need it find
themselves in a terrible predicament. They can't provide the lifesaving
treatment their kids and other members of the family they love
desperately need.
I see my colleague on the floor, and I will not go any further other
than to say this: Why are we in this position when, 10 days before the
final vote on changing healthcare for 360 million Americans, it is in a
proposal that no one has seen and no one has read and no one has
analyzed? It is an embarrassment to this great institution, the Senate,
that we are not deliberating on this measure--this lifesaving, life-
and-death measure--with the kind of respect that it deserves, with the
kind of expertise that it deserves.
My Republican Senate colleagues have said it well--Senator Murkowski,
Senator Moran, and others: The Senate ought to do what the Senate was
elected to do. Take up an important measure like this, read it
carefully, debate it, amend it, bring in the experts, and don't move so
quickly on it that you could jeopardize the healthcare of millions of
Americans. I am sorry it has reached that point.
If 3 Republican Senators out of 52--if three of them--will step up
and say: This is wrong; we need to do this the right way, a transparent
way, a fair way, a bipartisan way. If three will step up and do that,
then we can roll up our sleeves and do the right thing for America.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Maine.
Mr. KING. Just a moment, Madam President. I am looking for the
healthcare bill. I know it is here somewhere. I haven't been able to
find it and have been looking all morning. I suspect maybe we will find
it in the next couple of days.
I wish to talk about Medicaid. Medicaid is often perceived as a
welfare program, and it isn't. It is essential medical support.
Now, let's talk about who receives Medicaid. Seventy-two percent of
the people who receive assistance from Medicaid are children, people
with disabilities, and the elderly. Indeed, 85 percent of the
expenditures for Medicaid, as opposed to enrollees--85 percent of the
expenditures--are for those same groups--the children, the disabled,
and the elderly.
Particularly, what a lot of people don't realize is that Medicaid is
one support--if not the principal support--for nursing home care
throughout the country, and especially in my State of Maine. I suspect,
if we surveyed people--perhaps some even in this body, but certainly in
the general public: How are you going to cover Aunt Minnie's nursing
home care when she has to have it later in her life, most people would
say: Oh, we have Medicare. People I talk to at home say: Medicare is
going to take care of me. No, except in very rare and limited
circumstances, Medicare does not cover nursing home care. It doesn't
cover long-term care. That is Medicaid.
Sixty-eight percent of all the Medicaid spending in Maine was for
elderly or disabled people in 2014. About one in three people
nationwide is going to require nursing home care--one in three.
Nationally, over three-quarters of nursing home residents are covered
by Medicaid. So if we are talking in this bill, wherever it is--if
anybody finds it, let me know--about significant cuts to Medicaid, we
are talking about people's ability to have long-term care in nursing
homes. Make no mistake about it. You cannot cut Medicaid by over $1
trillion in 10 years and not have it affect those people.
Now, some say we are giving the States flexibility. We are giving the
States flexibility to make agonizing decisions between disabled people,
children, and seniors. That is not flexibility. To quote the President,
that is ``mean.'' That is cruel. The States are only going to have two
choices. They are either going to have to cut people off and limit
services--and remember that three-quarters of the people are disabled,
elderly, and children--or they are going to have to raise taxes on
their own citizens.
Now, we are claiming we are going to help the Federal budget. We are
going to reduce the deficit by $800 billion over 10 years by passing
this bill. But we are just shifting the bill to the States. That is
nice work, if you can get it. Why don't we shift the cost of the Air
Force to the States? That would make the Federal budget look better.
But it is not a real savings to our citizens if they have to pay out of
their pocket at their home State or in their city, or if they have to
pay part in their income taxes. That is no savings. That is a fake
savings. That is a smokescreen to tell people: We are cutting
government expenditures. No, we are not. We are just shifting them to
another level of government where you are going to have to pay for them
there as well.
But to get back to Medicaid. Seventy percent of the nursing home
residents in Maine are covered by Medicaid. Who are they? They are
people who can't be cared for at home any longer. They require nearly
constant care and support. These aren't welfare recipients. These are
our former teachers, police officers, the people who looked after us,
the carpenters who built our houses, the nurses who cared for us in
hospitals, the wait staff who served us meals, the veterans who served
in times of trouble and fought for our freedom.
They and their families are simply part of our communities. They are
not welfare recipients. They are people who have paid their fair share
throughout their lives. They have worked hard. They have done all the
things they were supposed to do, all the things that were expected of
them. They stayed in their homes, by and large, as long as they
possibly could. But at some point, after their assets and ability to
pay were exhausted, they had Medicaid to help them in terms of long-
term care.
I often say when I talk about this that it really frustrates me that
we talk about this healthcare issue in terms of ideology and the free
market and all of these kinds of things. No, this is about people.
This is about Jim and Cora Banks from Portland, ME. They lived in
Portland. He was a State employee, and she was a beautician, who worked
out of her home and most of her energy went into raising four boys.
Cora was a den mother and Scout leader. They worked on projects and--
can you believe it--all four of their boys were Eagle Scouts. That is
an astonishing accomplishment, to have four sons as Eagle Scouts. They
were active in the Kiwanis and taught Sunday school. One of their sons
was involved in Little League. So Cora raised money to build a
concession stand on the field, which is still used today.
At 55, tragically, Cora began to have memory issues. Because they had
health insurance--because they had health insurance--she could get
great care at a geriatric practice in Portland. Friends and family were
helpful, and Jim was the principal caregiver for many years. But at 70,
it became clear that Cora needed full-time care, and Jim could not
provide that level of care. The doctors said she needed to be

[[Page S3663]]

in a residential setting. Her assets were exhausted. She qualified for
MaineCare, which is what we call Medicaid. Her nursing home care was
covered, and she lived for a year in that nursing home.
Two-thirds of the income for all of our nursing homes in Maine come
from Medicaid, from MaineCare. What happens to this resource of the
nursing homes if suddenly their revenues are significantly cut? What
happens? But, mostly, what happens to people like Cora?
There is also an idea--and I heard the head of the OMB talk about it:
We are not really cutting; we are just cutting the rate of growth.
Well, if the demand is growing, the cost is growing, and you cut the
rate of growth, you are cutting. Less money will be available than is
necessary to meet the need. That is a real cut.
All of us know we are facing a demographic bulge from the baby boom
generation, who are aging and are going to require more and more
medical treatment, and they are going to put a greater demand on our
nursing homes.
In Maine, we are projecting a 105,000-person increase in the next 10
years of people over 65. One in four Maine people will be over 65 in
the next two decades.
The Alzheimer's Association projects that 35,000 Maine seniors will
be afflicted with the tragic disease of Alzheimer's within 10 years;
25,000 had the disease in 2014. People with dementia are 10 times more
likely to live in a nursing home.
There is a lot in the bill, I am told. I don't know; I haven't seen
it. I have been looking for it. But the central premise seems to be, if
it is anything like the House bill, a massive cut in Medicaid and a
massive tax cut to the people in our society who least need it. The tax
cut is targeted at the very wealthiest Americans. Yet the results of
that decision will be to cut essential medical support for elderly
people, disabled people, and children. I don't understand that bargain.
I don't understand that equation--a gigantic tax cut to the wealthiest
and a substantial cut in support for those who most need it.
Maybe I will be pleasantly surprised when I see the bill, whenever
that is. I hope it is more than a few hours before we are called upon
to vote on it. Right now, what we are hearing and what we are learning
and what the House bill looked like would be a tragedy for this country
and a tragedy for real people.
I don't understand the impulse to give a tax cut and to hurt people
when we know that is going to be the case. And again, these are not
welfare recipients; these are your friends and neighbors.
In all of our States, almost two-thirds of the nursing home residents
are on Medicaid. We are not going to be able to cut Medicaid in the
dramatic way that has been proposed without affecting those people.
I hope this body will take the time necessary to analyze this issue,
to openly debate it, to argue about it, and to find solutions that make
sense and will work for the people of America, not try to ram something
through for the purpose of checking a box on a campaign promise made
years ago.
The reality is, we have an obligation, in my view, not only to solve
the problem in a compassionate and rational and efficient way but also
to develop and run a process here that respects the institution and
respects the American people.
This is not the way this place is supposed to run--to have a bill
drafted in secret, brought to the floor within hours or a few days of
voting, and then force a vote without the kind of consideration,
hearings, input, argument, and debate that is supposed to be the
hallmark of this institution.
This is a very important decision, I think one of the most important
any of us will ever make. I, for one, am going to be able to tell my
children and grandchildren that I stood for Maine, for our children,
for our elderly, for our disabled people. And when the chips are down,
the United States Senate is going to do the right thing.
I yield the floor.
The PRESIDING OFFICER (Mr. Tillis). The Senator from Iowa.
Mrs. ERNST. Mr. President, no choice and a proposed 43-percent
increase in premiums--that is what ObamaCare and its harmful impact
will bring to Iowa in 2018. This year, it brought premium increases up
to 42 percent. Last year, it brought increases up to 29 percent.
ObamaCare is not sustainable and not affordable for Iowans.
To anybody who has studied healthcare reform, this should come as no
surprise. In the past, many States have tried to reform their
individual market. Twenty-seven years ago, Kentucky made an attempt and
implemented the Kentucky Health Care Reform Act of 1994. This bill was
similar to ObamaCare in many respects. It contained more taxes, more
regulations, and more mandates. Within 3 years--3 years--insurers fled
the individual market and the State was hit with skyrocketing premiums.
What happened in Kentucky then is eerily similar to what is happening
in Iowa today as a result of ObamaCare. When it comes to affordability
and choice, my home State of Iowa has been hit particularly hard.
While traveling across the State, I hear from Iowans who are looking
for affordable coverage. Far too often, I hear that high monthly
premiums are squeezing pocketbooks and that soaring out-of-pocket
costs, such as deductibles and copays, make coverage unaffordable to
use for those who do have it. That is not what ObamaCare promised, but
that is what it has brought.
One Iowan who works at a small business in Hinton wrote to me and
said:

Over the past seven years, prices have jumped considerably
and the coverage employees are getting for the amount of
money spent is substantially less! We have tried to help our
employees by minimizing the changes in premiums, but these
last two years we had to start passing on some of the
increases in order to survive.
We can no longer absorb the constant rate increases, nor
can we not offer a health plan to our employees. Therefore,
we find ourselves between the proverbial rock and the hard
place. We certainly are not the only small business facing
the same dilemma.

Employees at this small business can breathe a small sigh of relief
because their employer still has the ability to offer coverage, even if
they are forced to pay more and more because of ObamaCare. Other Iowans
are on the edge because their options for coverage are shrinking.
In 2016, UnitedHealthcare left the individual market in Iowa. A few
months ago, Wellmark and Aetna both announced they would be leaving the
individual market in 2018. Medica is the only remaining statewide
carrier, and while they appear to be staying for the next year, it will
take a massive rate increase on Iowans for them to do so.
The Iowa insurance commissioner said:

Iowa has hit a point within our market's collapse that a 43
percent rate increase will drive healthier, younger, and
middle aged individuals out of the market. Iowa's individual
market remains unsustainable.

If Medica leaves after next year, there is a very real possibility
that tens of thousands of Iowans will have nothing to purchase on the
individual market.
To put this issue into perspective and show why it matters so much, I
want to share concerns I received from a constituent in Ames, IA. This
constituent is the parent of a child with a rare disease. The family
purchased a plan from Wellmark to cover the child for 2017, but now
that Wellmark plans to leave, the parents are unsure whether they will
be able to find a plan for their child. They find this whole experience
``disruptive and anxiety provoking.''
Disruption and anxiety are not being felt just in Iowa; all across
the country, premiums are skyrocketing and choices are limited and in
some places, nonexistent. Recent data from the Centers for Medicare and
Medicaid Services shows that 2.4 million people in 1,200 counties
across the country will have one option for insurance in 2018. That is
not an option at all. A recent report by HHS found that between 2013
and 2017, premiums more than doubled on the exchange--more than doubled
on the exchange. In some States, premiums tripled.
Across the country and in my home State of Iowa, we don't have the
option to continue with the status quo when it comes to our healthcare.
The reality is, the status quo is truly unsustainable.
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.

[[Page S3664]]

Mr. REED. 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. REED. As a proud resident of Rhode Island and proud resident of
Providence Plantations, I thank the Chair for the recognition.
Mr. President, I want to join my colleagues in expressing strong
opposition to the Republican efforts to repeal the Affordable Care Act
and to ask my Republican colleagues to abandon these efforts. They are
crafted behind closed doors, and they embrace a huge tax cut for the
wealthy at the expense of the most vulnerable among us.
Indeed, I implore Republicans to work with us on a bipartisan basis,
in good faith, to make improvements to our healthcare system. We can
make these improvements. I hope we can.
Just a couple of weeks ago, the nonpartisan Congressional Budget
Office told us that 23 million Americans would lose health insurance
under TrumpCare. Let me say that again: 23 million Americans will lose
health insurance under the Republican bill. That is more people than
live in Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, New
Hampshire, New Mexico, Nebraska, North Dakota, South Dakota, Vermont,
West Virginia, Wyoming, the District of Columbia, and my home State of
Rhode Island and Providence Plantations combined--a huge portion of
Americans. That is a shocking number.
What is worse is that my colleagues on the other side of the aisle
plan to dismantle our healthcare system--one-sixth of the country's
economy--without so much as a hearing to get input on the bill. Their
bill is being written in secret, and from what we can glean of the
process the Republicans are employing, we likely will not even see the
text in the near future, although I am encouraged that there is some
discussion of releasing the text tomorrow. Regardless of whether it is
released tomorrow, there has been no deliberate consideration in a
hearing. There has been no thoughtful interaction between Republicans
and Democrats.
In sharp contrast, I was a member of the HELP Committee while we
drafted the Affordable Care Act. The Senate spent 25 consecutive days
in session on consideration of the Affordable Care Act, the second
longest consecutive session in the history of the Senate. The Senate
Health, Education, Labor and Pensions Committee, which I served on at
the time, held more than 47 bipartisan hearings, roundtables, and
walkthroughs on health reform. In fact, the HELP Committee considered
over 300 amendments over the course of a month-long markup, one of the
longest in the history of the Congress.
Over half of the accepted amendments were from Republicans. This
bipartisan input, along with testimony and consultation from healthcare
organizations representing hospitals, doctors, nurses, and patients,
among others, over the course of a year led to a better, more informed
bill.
We have a lengthy legislative process for a reason. Yet the
Republican leadership--up until this moment at least--continues to
write their bill in secret as they look for ways to convince their
caucus to support a bill that nearly every major healthcare
organization opposes, to say nothing of the 23 million Americans across
all of our States who would lose their health coverage, and millions
more would seek increased costs because of TrumpCare.
I would like to remind everyone that these are real people who will
be hurt if we go forward as my Republican colleagues intend to. These
23 million people are all our constituents, our family members, our
friends and neighbors. In fact, since the beginning of this year, I
have heard from thousands of my constituents from all walks of life,
through phone calls, letters, emails, appearances at townhall events,
and even those I see out and about shopping around the State or on the
airplane to Washington and back to Rhode Island. They have all
indicated how they have benefited from the ACA and how TrumpCare could
have a devastating impact on their families.
For example, David from Providence, RI, wrote to me to tell me how
his life has been affected by the Affordable Care Act. He said:

I don't usually write Senators, actually I've never written
a Senator. I have great concerns about my healthcare. I have
a preexisting condition, two heart attacks and open heart
surgery, triple bypass. I had medical issues and needed to
leave my position at a full-time job 3 years ago to get
well. During that leave, the company went chapter 11. I
lost my healthcare and had no income. I was able to
acquire Medical Insurance through the Affordable Care Act.
I started my own design business as a sole proprietor and
worked a second job to make ends meet. My healthcare was
subsidized for two years. I am now successful in my design
business and will be paying back the subsidy for this year
and no longer need the subsidy going forward. I am able to
purchase affordable healthcare through the Health
Connection in RI. Affordable healthcare and the subsidy
were there when I needed it. This allowed me to start my
business and become a successful business/sole proprietor
in RI. It is critical for my continued success to have
access to affordable healthcare and not be judged by
preexisting conditions.

As David describes, the Affordable Care Act gave individuals and
families control over their healthcare for the first time. He was able
to get the care he needed, regardless of preexisting conditions, and
able to start a new business. This is something I have heard a number
of times from my constituents.
I have also heard from Andrew and his wife in Little Compton, RI, who
decided to strike out on their own and open a dairy farm after the
Affordable Care Act was implemented. Andrew said: ``We took this plunge
and started a business knowing that the stability of health care was
there--we have a four year old daughter--and if it goes away, we are
not sure what we will do.''
Time and again, I hear from Rhode Islanders who are now free to take
risks and start new businesses and other creative pursuits knowing that
they will be able to access affordable healthcare. I ask my Republican
colleagues: Do you want to go back to the days when people are locked
into their jobs for health insurance? The only reason they are there is
for health insurance. Their creativity, their ability to innovate and
to invigorate our economy is stifled literally because they need the
health insurance. Do you want to discourage your constituents from
starting new businesses? Under TrumpCare, people like David, with
preexisting conditions, would not have the option, and Andrew and his
wife may not have been willing to take on the risk of leaving a job
with health insurance to start a new business.
However, as we speak, my Republican colleagues are meeting in secret
planning to take away these opportunities. I encourage my Republican
colleagues to meet with their constituents, to hear their stories about
the ACA. They are not unique to Rhode Island.
It is not enough to just ban insurance companies from denying
coverage to people with preexisting conditions. The ACA eliminated
annual and lifetime limits. In fact, yesterday I bumped into a family--
two families--one with an adorable little girl who had a tracheotomy
and who was being pushed around in a stroller. She is about 2 or 3
years old. And I met some other children, another young boy named Tim
with a tracheotomy. Today I found out that their problem is lifetime
limits. These are very young children, 2 years, 3 years old. Most
insurance policies, except for the ACA, would have a lifetime limit.
Now, you might be able to go buy it, but before these youngsters are
10, 12, or 13 years old, they will not have health insurance for the
rest of their life.
So it is not just the preexisting conditions. The ACA eliminated
annual and lifetime limits. When I saw those darling children
yesterday, I just knew that has to be the law. Otherwise, it is just a
matter of time. Maybe in 5 years, maybe in 6 years, but the kind of
conditions they have, at some point, they will hit that limit and at
some point the insurance company will say: No thanks.
We made those changes in the ACA. They are going to be disposed of in
the proposals I have seen. The ACA requires coverage of basic
healthcare services like maternity care. That is not guaranteed.
Before the ACA, insurance companies would cut off coverage just when
it was needed most and priced people with health conditions out of the
market. These are not abstract concepts. I hear from constituents each
and every day about the importance of the critical consumer protections
under the ACA,

[[Page S3665]]

and TrumpCare would undermine all of these.
Susan from Warwick wrote me to say:

ObamaCare saved my life. Please keep fighting to make
affordable healthcare available to all Americans. I was
diagnosed with Acute Myeloid Leukemia in 2012. I have my own
business and pay for my own health insurance. We always
purchased what we thought was adequate, but I'd reached the
limit on my policy within just a few weeks of cancer
treatment. That left me with huge bills, a need for more
expensive coverage in order to obtain lifesaving treatment .
. . and technically with a ``preexisting condition--cancer.''

Susan knows that insurance doesn't mean much if you are sick and have
limits on your care. She goes on to say:

I am horrified by the Republican plan to replace Obamacare.
Health care is not a luxury. It should be available to all. I
never want anyone else to experience the fear I did when my
insurance ran out and I realized the care that could save my
life might not be available to me. Before we found additional
insurance--and jumped through hoops to get it--we looked at
selling the house, emptying our IRAs and savings account to
pay for my care. It would not have been enough.

Cynthia from Woonsocket, RI, wrote to me to tell me about how
TrumpCare would undermine care for people like herself with Parkinson's
disease. Specifically, Cynthia wrote about how patients with
Parkinson's rely on the essential healthcare benefits required under
the Affordable Care Act, including rehabilitative services, mental
healthcare, and access to prescription drugs. TrumpCare would do away
with these benefits.
Cynthia also points out that the average age of diagnosis of
Parkinson's is around 60 years old. However, TrumpCare creates an age
tax, leading to skyrocketing costs for this very population. Cynthia
also said in her letter that one-third of patients with Parkinson's
access care through Medicaid. She says TrumpCare puts all of those
patients at risk of losing care. As a patient, she knows better than
most that without these existing protections, health insurance will not
actually cover the care that is needed.

To add more detail on how critical Medicaid can be, especially to
seniors, a constituent living in a nursing home in Pascoag wrote to me
to say:

I am 101 years old and enjoy every day to the best of my
ability. I am petrified that many of the programs that I rely
on for my health and well-being, indeed my life, will be
reduced or even eliminated. Please protect my access to
Medicaid. DO NOT make Medicaid a block grant to the states.
My daughter is helping me to send this communication to you.
Please do not forsake me.

So I ask my colleagues: How do you intend to protect her access to
nursing home care while cutting Medicaid by over $800 billion? Block-
granting Medicaid, as Republicans have proposed to do, will reduce
Medicaid funding by at least 25 percent over the next decade and leave
States unable to maintain current Medicaid programs, leaving behind our
most vulnerable.
Indeed, the most significant costs for Medicaid in my State and every
other State is nursing home care. It is exactly those men and women,
like my constituent from Pascoag, a vigorous 101-year-old, who will be
forced to pay more, who will be forced because of cutbacks in service
at the facility not to have two or three people on duty but just one.
All of that we can foresee, and we only can prevent it if we reject
this attempt to replace, to repeal, to undercut affordable care.
Now, this Medicaid crisis is serious, and it is not just going to
affect the healthcare sector because we know the pressure is on the
States to make up some of this lost funding. It will not just be by
transferring funds within healthcare efforts. They will have to go
everywhere through their budgets: That is K through 12 education. That
is infrastructure. That is law enforcement. That is all the things
States and localities do but particularly States. They will try to plug
the gap because they will have people, like I have described who have
written me, coming and not just demanding but obviously in need of
healthcare, and they will try to respond, but the response will affect
our competitiveness, our education systems, our productivity, when you
can't fix infrastructure, and it will be a profound impact.
In fact, a significant number of jobs in my State and a significant
number of jobs projected for the future are in the healthcare industry.
When this significant reduction of resources to the healthcare sector
comes about, the jobs will go, too, because without the resources, you
will not employ people--you can't employ people.
Let me share a letter from one of my constituents because it
succinctly describes what TrumpCare will really mean for this country.
Glenn and Paula from Wakefield, RI, shared a letter from their
daughter, Gianna, who has type 1 diabetes, saying:

Let me offer you a translation of what your votes mean: I
will die younger and sicker. Probably much sicker. My kids
will have a mother for less of their lives. Your votes are
what will cause this. Because no matter how consciously I
care for myself, no matter how responsible I am, it won't
matter if my insurance refuses to cover me. And it won't
matter for you either, if you are one of the vast majority of
Americans who will end up with a pre-existing condition over
the course of your life. If you think you can simply pay the
costs yourself, you are in for a rude awakening.

These are only a few examples of the letters, calls, and emails I
have received from constituents. The response in opposition to
TrumpCare has been overwhelming by the very people whom it will impact
the most. I hope my colleagues will listen to these concerns, not just
the Rhode Island stories I am sharing today but also from their own
constituents. People's lives are at stake.
I urge my colleagues on the other side of the aisle to abandon this
effort to pass TrumpCare and start working with us on bipartisan
solutions to improve our healthcare system.
Mr. President, 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. BARRASSO. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Cotton). Without objection, it is so
ordered.
Mr. BARRASSO. Mr. President, I come to the floor today, having
returned from the weekend in Wyoming, talking to people as a physician,
and talking to former patients of mine. What I see is that the pain of
ObamaCare is continuing to worsen around the country for men, women,
families, and people who have been living under the Obama healthcare
law for a number of years now.
This is an important day, when insurance companies have to come up
with the filings and the plans on what they plan to do for next year
with regard to plans that meet the ObamaCare mandate. So very soon,
millions of people will find out if they are going to be able to buy an
insurance plan in their own communities, regardless of the cost. We
have seen that the Blue Cross Blue Shield group in Maryland has
proposed rate increases up to 58 percent for next year in the State of
Maryland. This is after they went up 24 percent last year. How many
families can afford such a thing? But that is what we are dealing with.
That is why it is so critical that we get involved in trying to
provide relief for American families at this time, with the Obama
healthcare insurance market, certainly, collapsing. The head of Blue
Cross Blue Shield in Maryland, which is the largest insurer in the
State, has said that they see their system is in the early throes of
what is known as the insurance death spiral. Prices are continuing to
go up, fewer people are signing up, and, as a result, prices are going
to have to be raised even more. We saw last year that they went up 24
percent, and this year the proposal, going forward to next year, is 58
percent. This is a terrifying reality for people on ObamaCare today.
One of the big reasons we have been working so hard on healthcare
reform is to improve access to healthcare--not empty coverage, but
actual healthcare. So what we want to do as Republicans is get rid of
some of the excessive mandates, the expensive mandates, things that are
driving up the cost of care and certainly driving up the cost of
coverage for that care.
When prices come down, people are able to afford insurance and
companies are ready to sell that insurance. I know we have people in
Wyoming who are ready to buy it. That is how you improve access to
insurance. It is how you also improve access to care. You don't do it
by forcing the prices up and

[[Page S3666]]

then requiring people to buy coverage, which is what the Democrats who
voted for ObamaCare did. They said: You have to buy it, it is a
mandate, whether you like it or not. We know better than you do. That
is what we heard from the Democrats during the debate on President
Obama's healthcare law. That is what they passed. They passed it. They
voted for it. They didn't know what was in it. Actually, it was the
Speaker of the House, Nancy Pelosi, who said: First you have to pass it
before you even get to find out what is in it.
President Obama gave a big speech to a joint session of Congress and
said that if people like their plans, they can keep their plans. One of
the newspapers called that the ``Lie of the Year.'' So millions of
Americans then got letters from insurance companies; over 5,000 in
Wyoming got that letter. It said: Sorry, your insurance plan isn't good
enough for government.
People ought to be able to make that decision for themselves.
Families ought to make that decision, not Democrats in Washington who
voted for the ObamaCare law. They shouldn't have the right to tell the
people of my State or any State what is best for them and their family.
It is interesting because the Democrats don't seem to want to remember
that anymore. They have selective amnesia.
It turned out that if people liked their plan, they weren't really
allowed to keep it. I heard about it again a week ago at a Wyoming
stock growers meeting--farmers and ranchers from around the State of
Wyoming who come together each year, an organization that has been in
existence longer than the State has been a State. These are hard-
working people who know what works best for them, what works best for
their families. Some of these outfits have been in those families for
100 years. We have something called the Centennial Ranch program where
they gather all the family members when an outfit has been in that
family for 100 years, and they have been able really to survive so much
over the years. Often they would say, you know, whether they deal with
floods, whether they deal with fire, the biggest problem they have is
often dealing with the Federal Government. We have seen it all across
the board, and healthcare is just one of the last things to add to a
long litany of Federal Government involvement in the lives of the
people of our State of Wyoming.
So here we are today with this incredible government overreach and
the failure of that overreach, and even the insurance companies, some
of whom supported the passage of the healthcare law, are saying that
this is not working. How they reflect the fact that it is not working
is they say: OK, we are not going to sell insurance anymore. You can't
make them sell insurance. The prices have to go up too much, and it is
just not worth the effort.
One of the big insurance companies, Humana, is dropping out of the
ObamaCare exchange entirely next year. They made the announcement.
Aetna said that it is quitting the internal markets in Delaware, Iowa,
Nebraska, and Virginia. Anthem is pulling out of Ohio. The list goes
on.
Now, so far, there are over 40 counties across the country that are
expected to have no one selling insurance on the exchange--no one. In
Wyoming, we are down to one company that sells it. We had two; one lost
so much money, they were pulled off of the market. The second one,
which does sell insurance in Wyoming, continues to lose money by
selling on the exchange. They are committed to stay, but they just
scratch their heads about what the potential future may hold. We are
now seeing over 40 counties across the country where no one is selling
insurance. That is the reality of ObamaCare.

Remember, President Obama said: If you pass this, there will be huge
competition, big marketplaces. If there is only one selling insurance,
it is not a marketplace; it is a monopoly.
Next year, the Centers for Medicare and Medicaid Services has said
that about 40 percent of all the counties in America will have just one
company selling on the exchange--just one--forty percent of the
counties all across America. That is a monopoly. What happens when
those companies decide to drop out?
Even for people who get an ObamaCare subsidy, if there is no one in
that community, in that county selling ObamaCare insurance, the subsidy
has no value whatsoever. It can't be used.
That is another part of the story that the Democrats refuse to talk
about. In fact, Democrats say a lot of things about insurance coverage
that aren't really telling the whole story. They have talked about the
Congressional Budget Office report; they talk about a number of things.
One of the interesting things about the Congressional Budget Office
report--the CBO report, kind of the scorekeepers that take a look at
things--on the bill that passed the House said that there will be
millions of people fewer who will have insurance if the Republican-
passed bill becomes law. Well, the news headlines screamed that the
House bill would mean millions of people lose their insurance. Well,
that is wrong. That is not at all what will happen.
According to the Congressional Budget Office, when you look at it and
see why is it that there will be fewer people with insurance under
ObamaCare if you eliminate the individual mandate--the part of the law
that says you must buy a government-approved program--the Congressional
Budget Office says that if you don't mandate it, a lot of people don't
want to buy it. They don't view it as a good benefit to them. They
don't view it as worth their money.
If people aren't required to buy insurance, millions of them will
choose not to purchase the insurance, especially when they believe it
is not a good deal for them personally. I believe Americans have that
right. Apparently, the Democrats don't believe that Americans have that
right. They like the mandate. They like making people do things. That,
to me, is the difference between a Republican approach, which provides
for freedom, and a Democratic approach of government and mandates.
We want to give people the right to decide what is right for them and
their families. That is what I hear in Wyoming at the Wyoming Stock
Growers Association and as I travel around the State. People know what
is best for them and their families. Then, when all of a sudden what
they had is taken off the market because the government says that you
can't sell it anymore, that is an affront to their ability to choose
what works for them and their family, and it is things they have had in
the past. Then they got stuck buying some very expensive plan that
covered a lot of things they didn't need, didn't want, and couldn't
afford, but the government said: We know better than you do, the people
of Wyoming, the people of America.
So the Congressional Budget Office says that 8 million people who get
coverage in the individual market will decide it is just not worth
buying. They also said that there will be 4 million people on Medicaid
next year, and if you eliminate the mandate, they aren't going to sign
up for it, even when it is free, because they realize that, for many
people, being on Medicaid--a failing system--isn't providing much for
them at all.
So insurance isn't being taken from people; these are people who are
making a decision as free individuals--Americans--of how they want to
spend their money and what they want to sign up for, or not.
So the legislation that passed the House really makes no changes in
Medicaid in 2018. Yet, the CBO says millions of people on Medicaid will
drop it when the mandate goes away.
The Senate is coming up with its own solution. We are looking at ways
to make sure that Americans have access to insurance that works for
them, not just what works for Democrats in Washington. We roll back
some of the worst parts of ObamaCare. Prices for health insurance will
go down. People will have better options than the one-size-fits-all
plans that Washington has forced on the American people. They will have
other options that will work better for them and their families.
Our goal is to not do what the Democrats did. ObamaCare actually
kicked people off insurance that worked for them, pulled the rug right
out from under them; Republicans don't want to pull the rug out from
anyone. Our goal is to reform the American healthcare system so that
insurance costs less and it meets the needs of the people who buy it.
Republicans' goal is to focus on care, not just useless coverage that
ObamaCare had provided for many,

[[Page S3667]]

with narrower networks so you can't keep your doctor, you can't go to
the hospital in your community, you can't get the care you need, you
can't see certain specialists, which is what we have seen with
ObamaCare.
If Democrats want to talk about people losing their insurance, they
need to look at what ObamaCare is doing to people right now. They need
to look at people who are losing their insurance because their insurers
are walking away from them. They need to look at people who are losing
their insurance because of the premium increases we are seeing
requested in Maryland; 24 percent is actually how much it went up last
year and 58 percent in certain areas requested for this year.
Now I hear the Democrats say that they are worried about whether
people with preexisting conditions get insurance. As a doctor, I will
tell you, my wife is a breast cancer survivor; we are absolutely
committed as Republicans to make sure that no one with a preexisting
condition is left out. Democrats can't make that claim. They have made
it over the years. But if there is no one selling insurance where you
live, there is no exchange being offered, and you live in those 40
counties right now with no one selling--none--zero, and that number of
counties is going to expand next year--if you have a preexisting
condition and you are living under ObamaCare, you cannot get insurance
no matter what any Democrat says, because no one is willing to sell it
to you, even if you get a government subsidy--no one. You are left out.
That is what the Democrats have given us in this country with their
failed ObamaCare system.
So ObamaCare continues collapsing. It is going to harm more Americans
who have preexisting conditions.
The other day, Senator Schumer admitted that ObamaCare isn't
providing affordable access to care. I think it is an important
admission from the minority leader. Now it is time for him and the
Democrats to join with Republicans in the Senate--join us in providing
Americans the care they need from a doctor they choose at lower costs.
Mr. President, I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. CORNYN. 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. CORNYN. Mr. President, as the Senate knows--and I suspect a lot
of people outside of the Chamber know--we will move forward on the
healthcare reform effort to repeal and replace ObamaCare very soon. A
bill will be released as early as tomorrow morning, representing a
discussion draft.
I think it is important to remind all of our colleagues of the
urgency that we face. We already know that insurance premiums have gone
up since 2013 alone for those in the individual market--those would be
individuals with small businesses--by 105 percent. This is 2013. Can
you imagine in 2013 paying a premium only to realize that over the next
4 years, it would quadruple in just a short period of time?
Most Americans can't absorb that additional cost. We know that many
people are struggling from the high cost and the lack of quality of
care and the choices available to them.
Again, on the cost issue, when ObamaCare was being sold to the
American people, I still remember President Obama saying that the
average family of four would see a decrease in their premiums of
$2,500. I think the correct figure is based on experience. They have
seen their premiums go up $3,000.
I shared a story last week about a small business owner in Texas who
had lost his healthcare. He lost his doctor, and yet he had to pay
astronomically more for what ends up to be less coverage. I would say
he is only one person who I have heard from. I have heard from many,
many more under similar circumstances.
Even those who receive their healthcare from their employer are
feeling trapped by ObamaCare. I had a constituent, for example, from
Needville, TX, and his story, yet again, is all too familiar. After his
employer renewed their healthcare plan, premiums rose 50 percent, and
his current doctors refused to accept his plan from the ObamaCare
marketplace. While his healthcare costs rose, of course, his salary did
not follow suit.
He has been forced to dramatically cut back on his standard of living
and is living from paycheck to paycheck. In his letter, he said he is
worried about being able to provide for his family. Can you imagine
what that must be like? And not thinking of himself, but what this
means for his coworkers, as well, and his community.
This is one of the endless stories that my constituents have sent me
over the past few years, and I know Texas isn't alone, which causes me
to wonder who our colleagues are listening to or not listening to in
their States.
I mentioned yesterday that I had one colleague, whose name I won't
mention out of respect for his confidential communication--this is a
Democratic Senator--who has a son who has seen his insurance premiums
go up to $7,500. Sorry, that is the deductible. But his premium has
gone up $5,000. He told me that his son's out-of-pocket costs for
healthcare was $12,500 a year.
That is another casualty of ObamaCare. Yet, when we are looking
around to see how many Democrats are willing to join us to come to the
rescue of people who are being hurt by the destruction of the
healthcare markets, we see no one raising their hand or coming forward.
For our Democratic friends to attack us for trying to fix the havoc
that they wreaked in our healthcare system is really ridiculous. Our
friends on the other side of the aisle had their chance. They passed
ObamaCare by a party-line vote. In the interim, it demonstrated that
this is an experiment in big government and massive spending that has
simply failed.
Our friends on the other side know that. They also realize that,
regardless of who won the election in November, we would be moving
towards a new, better healthcare alternative, but they are simply
unwilling to participate and are sitting on their hands and waiting.
Indeed, they are hoping that we will fail in our efforts to save many
Americans--millions of Americans--from a healthcare system they were
promised but one that was not delivered.
Instead of working with us, they effectively are throwing what could
only be called a temper tantrum. They are trying to shut down any
productive activity in the Senate, including bipartisan committee work.
I was in three committee hearings this morning, one involving the
Intelligence Committee and our investigation into Russian active
measures involving the 2016 election. I was in another important
Finance Committee hearing where we talked about the importance of
modernizing the North American Free Trade Agreement, or NAFTA, and then
another one in the Judiciary Committee, where we talked about the
influx of dangerous gangs into the United States, including MS-13, from
Central American countries. Yet our Democratic colleagues are so bent
out of shape over the healthcare debate that they are willing to shut
down legitimate bipartisan concerns for each of those issues by not
letting our committees operate as they should.

Here is the rub. If they actually had a better plan, we would be more
than happy to listen. We would be more than happy to work with them.
But the only thing they have offered has been offered by the Senator
from Vermont--one of their Presidential candidates--Mr. Sanders, who
said that what he wants is nothing less than a complete Federal
Government takeover of healthcare, the so-called single-payer system.
That would wipe out all private insurance, and you would be looking to
the government for all of your healthcare.
We know that hasn't worked particularly well in places like Canada
and England and elsewhere. We also know that it is completely
unaffordable. The Urban Institute, which did a study of Senator
Sanders' single-payer healthcare system, said that just in 2017 alone,
it would add more than a half trillion dollars to Federal spending, and
it would add trillions and trillions of dollars more over ensuing
years. This isn't a solution. This is creating a bigger problem.
Unfortunately, our Democratic colleagues have let the far left
faction of

[[Page S3668]]

their own conference hold them hostage to pushing for a single-payer
system that would make ObamaCare look like a wild and resounding
success.
As I said, we need only look to our neighbors to the north, who under
a single-payer system have their healthcare decisions decided for them
by the government, while they see their taxes go up every single day.
Canada is marketed as an affordable outcome, but only if your
procedure is deemed necessary by the government. In other words, if the
government doesn't think the procedure you need is necessary, good luck
with that.
Would you want somebody in the government making your medical
decisions for you or your family without considering your individual
medical history? I certainly wouldn't. Under a single-payer system,
this could lead to many families having to buy supplemental health
insurance on top of the taxes they have already paid or simply pay
cash, rewarding high-income individuals with a better level of
healthcare above that offered to the rank-and-file citizens under a
government program.
Single-payer systems are not a solution, certainly not in this
country. Not only is choice and cost threatened under a single-payer
system, but so is quality of care.
Just last year in Canada, it took an average of 20 weeks for patients
to receive medical care that was deemed necessary--the longest recorded
wait time since wait times began to be tracked. One report estimated
the Canadians are waiting for nearly 1 million healthcare procedures.
Can you imagine having to wait up to 38 weeks for some medical
procedure, the whole time worrying about your health or the health of
your loved one?
Single-payer is a costly, inefficient, and unfeasible option, and,
perhaps because of that, we are not hearing many people on the floor
stating what I believe to be the case, which is that it is the only
choice being offered by our friends across the aisle. They are not
willing to come here and debate the merits of what we are proposing,
which is a market-driven, individual-choice system, which is designed
to keep premiums down in a way that makes it more affordable. They are
not willing to debate that and a government takeover known as a single-
payer option with all of its assorted problems.
The reforms we are seeking are patient-centered and market-driven.
These are the sorts of things that many of our colleagues across the
aisle said they would like to see as well, but they have somehow fallen
in line with part of their political base, which makes it impossible
for them to have an open, rational discussion about the merits of each
proposal.
We are left with no option but to finalize our discussion draft and
introduce that tomorrow so that the world can see it and so it can be
put on the internet, so we can have a fulsome debate and we can have
unlimited amendments in the so-called vote-arama process, which I know
is very popular around here. We will vote dozens of times or more on
proposed amendments to the bill. That is the kind of transparency and
openness that I think are important when you are dealing with something
as important as healthcare.
Here are the goals of what we are going to propose tomorrow in this
discussion draft.
First, we need to stabilize the markets that have left millions in
the country with no choices when it comes to insurance providers. Under
ObamaCare, insurance markets have collapsed. In Texas, one-third of
Texas counties have only one option for health insurance, which is no
choice whatsoever. Of course, in addition to threatening competition,
it also lowers quality while doing nothing about rising costs.

Second, we have to address the ballooning price of ObamaCare premium
increases. I mentioned, just in the ObamaCare exchanges since 2013,
they have gone up 105 percent. If we do nothing about it, they are
going to go up by double digits again next year, so doing nothing is
not an option. Again, without competition, there is no room for these
prices to go anywhere but up, and we have to come to the rescue of the
millions of Americans who are simply being priced out of the health
insurance market.
Third, something our Democratic colleagues have repeatedly called for
is that we have to protect people with preexisting conditions. If we
want our healthcare system to work, we must be able to provide
coverage, particularly for preexisting conditions, for all Americans.
We will do that in the discussion draft proposed tomorrow.
Lastly, I believe we need to give the States greater flexibility when
providing for the low-income safety net known as Medicaid, in a way
that is more cost-efficient and effective. For example, in my State, we
have asked for a waiver in order to provide managed care for people on
Medicaid. More than 90 percent are on managed care, which means if you
have a chronic illness--if you have a particularly complicated medical
problem--you have a medical home and somebody keeping track of your
treatment, making sure you get the treatment you need and are entitled
to.
Now we have the opportunity to make Medicaid a sustainable program.
We know that it is not, as currently written. What we are proposing is
to spend more money each year on Medicaid but to do so at a cost-of-
living index that will be affordable and sustainable by the American
taxpayer. We have the opportunity to address the quality issues and
redtape issues and provide this important entitlement to make sure that
it remains on a stable path.
The American people have made clear, time and again, that the status
quo of ObamaCare is not working. All you have to do is look around.
There were 60 Democratic Senators in 2010 who voted for ObamaCare. They
were in the majority--a big majority. How many are there today? Well,
there are not 60 anymore. They have gone from the majority to the
minority, I believe, in large part because of the unfulfilled promises
of ObamaCare.
I encourage our colleagues across the aisle--indeed, I encourage all
of us to listen to the stories from our constituents. There are too
many families asking us to step up and come to their aid. We need to do
more than just give floor speeches or loft impossible single-payer
options, which simply won't work. We need to actually deliver on the
promises we made to deliver healthcare reform and to do so to the best
of our ability.
I am under no illusion that this will be perfect. Indeed, when you
are operating under the constraints of the budget rules, with Democrats
taking a walk and sitting on their hands, it is impossible for us to
come up with the best possible product we could under the
circumstances. But I dare say, it will be better than the status quo,
which is a meltdown in the insurance markets, and we will take large
steps forward in not only stabilizing the markets but bringing premiums
down, while assuring coverage for preexisting conditions and putting
Medicaid on a sustainable path forward.
We invite our Democrat colleagues to join us, if they will. But under
present circumstances, it doesn't look as though they plan to do so.