[Congressional Record Volume 163, Number 111 (Wednesday, June 28, 2017)]
[Senate]
[Pages S3823-S3827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Ms. KLOBUCHAR. Mr. President, I thank the Senator from Missouri for 
her good idea and for her passion for this issue and for her correct 
statement that when people sign up for these exchanges, they don't have 
to go by train, plane, or automobile to Washington, DC, to get their 
insurance.
  I heard, when I was home this weekend, over and over, concern from 
people whom I was surprised to see come up to me. Several people in 
Winona, MN, came up to me and said: We are Republicans, but we don't 
think it is fair if seniors have to pay more when tax cuts are going to 
the wealthiest.
  I heard from people in Lanesboro, MN, small business owners who were

[[Page S3824]]

worried about what was happening with the proposal from the other side. 
In Northfield, MN, the town of ``Cows, Colleges and Contentment,'' I 
can tell you that they were not very content at the Northfield Hospital 
as they saw the devastating impact this bill would have on rural 
hospitals.
  So that is why I so appreciate my colleague from North Dakota, 
Senator Heitkamp, bringing people together today to talk about the fact 
that there is another way forward.
  There is another way forward, and the people in this Chamber have 
done this before. Senator McConnell negotiated with Senator Boxer on a 
major transportation bill. The last time we had an issue with doctors' 
fees, we were able to get that done on a bipartisan basis. So what we 
are simply asking our colleagues to do is to start afresh and to look 
at what we could do together to help the people of this country without 
sabotaging the current healthcare delivery system and without taking 
this out on the most vulnerable through Medicaid cuts.
  Here are some ideas. As to prescription drug prices, why would we not 
allow the 41 million seniors in this country to use their bargaining 
power--to harness their bargaining power--as my friend Senator Nelson 
from Florida understands because he knows there are a lot of seniors in 
Florida--to harness that bargaining power to negotiate for lower costs 
on prescription drugs. The current law bans us from doing that. So all 
we want to do is to lift that ban and let our seniors negotiate. That 
is not in this bill we are considering from the Republican side. This 
is something we can come together and work on.
  We can get less expensive drugs in the form of generic drugs. Yet, 
right now, we have a situation where major prescription drug companies 
are paying generic companies to keep their products off the market. It 
is called pay for delay. Senator Grassley and I have a bill to 
eliminate that. We can bring in less expensive drugs from other 
countries if, in fact, we have a situation where the prices have 
ballooned, as they have for the top 10 selling drugs in America. Four 
of them have gone up over 100 percent.
  The exchanges are another area where we have agreement. Senator 
Collins has been working on this. Senator Kaine and Senator Carper have 
a bill on this, and Senator Shaheen is working on the cost-sharing 
issue. We can work together to make insurance more affordable for 
people who are in the exchange.
  As to our small business rates, we must work on that.
  I truly believe we can come together.
  I will end with this. I got to be at that baseball game in the crowd 
with the 25,000 people who were watching the two teams play each other. 
Senator Donnelly of Indiana was on the field. At the end of the game, 
after the Democratic team won, they didn't keep the trophy. They handed 
the trophy to the Republican team and asked them to place that trophy 
in Congressman Scalise's office.
  We are not two teams. We are one team, and that is for our country, 
for America. So let's work together on this bill.
  Thank you very much, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, I love what the Senator from Minnesota 
just said. I am a retired Navy captain. For years we had healthy 
competition among the different branches of our services. I salute the 
folks in the Army, the Marines, the Air Force, and Coast Guard. I 
always say: The Navy salutes you. Then I also say: a different uniform, 
the same team. To the extent that we wear different uniforms, we really 
are on the same team, and I think the American people are anxious for 
us to start acting that way.
  What I hope we will do is to hit the pause button right now on the 
legislation that the Republicans have pulled off the floor and that we 
will use this time as an opportunity not to go to our separate corners 
and figure out how to do the other team in when we return here in 10 
days. I hope we will, as some of our colleagues have suggested, explore 
some ideas where we can work together.
  Some have talked about how to make the marketplaces work. It is not a 
Democratic idea. It is a Republican idea. There are the tax credits for 
the exchange, which is a Republican idea. The individual mandate and 
the idea that there cannot be prohibitions on insurers denying coverage 
are Republican ideas too. Those are all ideas from 1993, taken from 
Mitt Romney, who put them in RomneyCare in Massachusetts, and we put 
them in the Affordable Care Act.
  We didn't just do this and shut out the Republicans. We had 80 days 
where we worked on the legislation. I was on the Finance Committee with 
Senator Schumer and others, and we had, I think, a dozen or more 
hearings and dozens of amendments--over 300 amendments in all. Some 160 
Republican amendments were included in the bill. To somehow say that 
they were being shut out is nonsense. That is a reinvention of history.
  Let's do it the right way. At the end of the day, we will do what 
President Trump has been calling for, for the last 5, 6, 7, 8 months, 
as I recall. He said: Why don't we cover everybody, why don't we 
provide better coverage, and why don't we do it in a more affordable 
way.
  Unfortunately, what Republicans have offered and what they pulled off 
the floor doesn't do that. It provides less coverage for more money. It 
says to people--the least well off in our society: We are going to 
provide you less coverage in order to give folks who make a lot of 
money, and really don't need a tax break, a tax break.
  That is not consistent with the Golden Rule. The Presiding Officer 
knows it well. We are supposed to treat other people the way we want to 
be treated. That is an example of a failure with respect to the Golden 
Rule.
  I didn't come here to waste my time and other people's time. I came 
here to get things done. We tried hard to involve the Republicans 8 
years ago. They may not acknowledge that. The people in this country 
still want us to really bear down and work together, and we can do 
that. At the end of the day, we will be better as a party, we will be 
better as a body, and we will be better as a country.
  I want to thank Senator Warner for letting me speak before him. Thank 
you so much. I will say to Senator Kaine: Thank you for allowing me to 
be your partner on a great reinsurance plan that will help stabilize 
the exchanges. I am delighted to be your wingman. Thank you.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. WARNER. Mr. President, I urge my friend, the Senator from 
Delaware, to get to the train station.
  First of all, I wish to thank Senator Heitkamp for bringing this 
group together. There has been a lot of talk about what ideas can fix 
the Affordable Care Act, and here we are hearing some of the ideas that 
we will offer.
  Senator Kaine has had to hear this story before, but before I was in 
politics, I had a pretty long career in venture capital and invested in 
a lot of businesses. Some of those businesses managed to eke out a 
living, but the thing that was remarkable about the companies is that 
the companies that were the most successful weren't the ones that had 
the perfect business plan. They weren't the ones that had the newest 
ideas. The companies that were the most successful were the ones that 
were able to adapt and change. I never, ever invested in a business 
that ever met its business plan. Every one had to change in some way--
alter.
  The truth of the matter is, as to the Affordable Care Act, for all 
its good things, there were things we got wrong. I will be the first to 
acknowledge that. There have been a lot of us in this body who over the 
last couple of years--again, I thank the Senator from North Dakota, who 
has been a part of these efforts--have said that maybe we need to do a 
little less bureaucracy in the ACA in terms of reporting requirements. 
Maybe we ought to have a cheaper option. We have gold and silver and 
bronze. I remember working with the former Senator from Alaska on this. 
Maybe we ought to have a copper plan, as well, to try to get those 
young people invested in buying that first plan.
  We said that maybe we ought to take an idea that came from the other 
side of the aisle, and, as long as we have appropriate consumer 
protections, go ahead and let insurance products get sold across State 
lines so there is more

[[Page S3825]]

competition. Then, we saw more problems arise. Unfortunately, problems 
arose with the ACA, as we have seen this administration and others try 
to knock out some of the building blocks that built up the ACA--risk 
corridors, cost sharing, or more recently the administration saying 
that we may just ignore part of the bill that says there is an 
individual mandate. Consequently, that means the insurance company had 
to charge a heck of a lot more money because they weren't sure whether 
the law was going to be in force.
  We have had people like the Senator from New Hampshire say: Well, I 
had an idea on cost sharing that might fix it. My dear friends, the 
other Senator from Virginia and the Senator from Delaware said: Let's 
go out and do that reinsurance plan, so that if there are 
extraordinarily high-cost plans, maybe that will be a secondary 
backdrop so premiums will not have to be so high. I am proud to support 
and be a cosponsor on both of those pieces of legislation.
  Then, as only the Senator from Missouri can do, she came up with the 
most obvious of, at least, a short-term solution that says: My gosh, if 
for some reason, because there have been efforts to sabotage the ACA, 
we don't have enough offerings for at least some stopgap period, we 
ought to allow all the folks in our States, if they don't have any 
coverage, to at least get the same kind of coverage we get. That is 
kind of Harry Truman basic common sense--Missouri common sense.
  So I hope our colleagues, after they get out of one more secret 
meeting in one more basement or secret location, will come back and 
start talking about these solutions--solutions that don't start with 
the premise that we are going to give folks like me a tax cut or that 
we are going to take a meat ax to Medicaid or that we are going to come 
up with a proposal that will take 22 million Americans off of health 
insurance.
  The ACA didn't get it entirely right. There is a lot of room for 
improvement. We have asked our friends on the other side to meet us 
halfway and to try to bring the kind of bipartisan spirit we all talk 
about on this issue that affects each and every American and one-sixth 
of our economy. We can do it. We can do it right, but it is going to 
take the kind of cooperation and the kinds of good ideas that are being 
offered by my colleagues on the floor.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, all of the Florida people walk up to me 
and say: Bill, what is going on? Why can't Congress get together? Why 
can't we work together? We do in our committees. We usually work 
together. We certainly do with Senator Thune, who is the chairman of 
the Commerce Committee. This Senator is the ranking member. We get a 
lot of things out. We are going to mark up the FAA bill tomorrow. There 
are a lot of controversial issues. We are going to get that out. Why 
can't we do it with healthcare?
  So, last night, I had a telephone townhall meeting in my State of 
Florida and 6,000 people joined. They asked questions for an hour. 
Often, they would get through asking their question and they would say: 
I wish you guys could work together. So that is what we have been 
hearing in all of these speeches.
  Well, let me give one suggestion that would lower premiums in the 
existing law, the Affordable Care Act, 13 percent. I had it costed out 
in Florida. Every now and then, you are going to have a catastrophic 
loss. It is kind of like when I was the elected insurance commissioner 
of Florida, and I inherited the mess after the monster hurricane. 
Hurricane Andrew was such a monster hurricane that it took down a 
number of insurance companies because the losses were so big. So we had 
to try to get insurance companies to come back into Florida. We created 
a reinsurance fund. We called it the Florida Hurricane Catastrophic 
Fund, which would reinsure, or insure, the insurance companies against 
catastrophic loss.
  That is what we can do right here. We could be like my poor 
constituent, Megan, who fought cancer for 2 years, with two 
transplants, and ultimately lost the battle, but the bill was $8 
million. That is hard for any insurance company to swallow, but those 
are going to be limited, isolated cases.
  Why don't we create a reinsurance fund for the marketplace in the 
Affordable Care Act to help the insurance companies with catastrophic 
loss? I asked: If we did that in Florida, with the Florida marketplace, 
what would it mean? It would reduce the insurance premiums under the 
marketplace in Florida by 13 percent. That is just one suggestion.
  Every one of us has a suggestion. Put all of these suggestions 
together, and we are talking about really fixing the current law, 
instead of this roadway we see our friends on the other side of the 
aisle going down--a solution that is going to take coverage away from 
22 million people and is going to cut $800 billion out of Medicaid and 
eviscerate Medicaid or that is going to charge older Americans over 
younger Americans five times as much as the younger. We don't have to 
do that. Let's come up with a creative idea to fix the existing law.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise with my colleagues to speak in 
favor of commonsense solutions. I think the GOP leadership made a wise 
decision--and I thank them for it--to pull the vote on their healthcare 
bill this week when the CBO came out and said that 22 million people 
would lose health insurance, 15 million in the first year, and Medicaid 
cuts would be significant. Obviously, the public was very concerned, 
and I am glad the GOP has taken a step back. I think we now have a 
chance to get this right.
  I want to tell a personal story about my own involvement in this in 
the last few months. The story, to me, exemplifies an important 
principle, and that is a bad process will produce a bad product. This 
bill was the subject of a very bad process.
  The bill that was put on the floor was a bill that ignored and shut 
out all Democrats from participating. More importantly, it shut out the 
committees from participating. Most importantly, it shut out the public 
from participating. That led to a bill that was destined to be bad. So 
we ought to fix it.
  Our Democratic leader is just exiting the Chamber. He asked me after 
I came back from the national ticket--as a consolation prize, I guess--
can you be on the HELP Committee? This is the committee I have wanted 
to be on since I came to the Senate--Health, Education, Labor, and 
Pensions.
  I have been a mayor, and I have been a Governor. I have been in local 
and State government for 60 years. Education is the biggest line item, 
and health is the second biggest line item. This is what I actually 
know something about. I was so thrilled to join the committee. But, 
boy, was I naive. I assumed that being on the HELP Committee meant we 
would get to have a hearing about a healthcare bill.
  I got on the committee on the 3rd of January. On the 5th of January, 
with many of my colleagues, we wrote a letter to the Republican leader 
and to the Republican chair of Health and Finance--13 of us; we had 
been on the committee for 2 days--and said: If you want to talk about 
improving healthcare, we have ideas. We want to sit down with you right 
now and talk about improvements to healthcare.
  I guess I am a naive 58-year-old. I thought, now I am on the 
committee. Now I am where things will happen, and we will get to 
actually fix healthcare. But instead, since I have been on the 
committee--and I have committee colleagues here who will attest to 
this--we have had hearings on higher ed, we have had hearings on 
Cabinet nominees, we have had hearings on FDA reform issues. But the 
one taboo topic on our committee is that we are not allowed to have a 
hearing about the healthcare bill.
  We asked for one after the House passed their bill; we couldn't have 
a hearing. The Senate bill has been put on the floor; we haven't had a 
hearing, and as far as we know, there will be no hearing. So those of 
us who are focused on this issue have no opportunity, but, more 
important--it is not about committee Members. For those watching this 
and wondering what a hearing is about, a hearing is about hearing from 
the public. You have a witness table.

[[Page S3826]]

You get a patient and a doctor and a nurse. You get an insurance 
executive and a pharmaceutical executive. You get a small business 
having a hard time buying health insurance. You get them all to sit 
there and tell you what they like, what they don't like, and what can 
be fixed. All of that--all of that--has been shunted aside in this 
process, so the public isn't heard and the committees can't do their 
work.
  Our ranking member on this committee, the Senator from Washington--I 
had watched her as the Budget chair when I was a Budget Committee 
member work out a great bipartisan budget deal in December of 2013, 
with then-House Budget chair, now-House Speaker Paul Ryan. We worked it 
out. It was bipartisan.
  I watched our ranking Democrat on the HELP Committee work with the 
chair on the HELP Committee, Lamar Alexander, 2 years ago to do 
something most people thought was impossible: have hearings and rewrite 
No Child Left Behind into the Every Student Succeeds Act. It was 7 
years past the reauthorization date because it was too controversial. 
But I watched them use the committee process, entertain ideas from both 
sides, hear from the public, rewrite the bill, then conference with the 
House, and then get it to the President for signature.
  Why is healthcare taboo on the HELP Committee? Let the committees do 
their work. Let the greatest deliberative body in the world deliberate. 
Let the Senate be the Senate, and let us work together.
  My colleagues have mentioned that I put an idea on the table. It is 
not a fix-everything idea, but it is a particular idea with a lot of 
bipartisan cred, and it is the notion, as some of my colleagues have 
said, of reinsurance. Senator Carper and I have introduced the 
Individual Health Insurance Marketplace Improvement Act, and it is 
going to a very particular problem that I think Democrats and 
Republicans recognize as a significant challenge in the current 
healthcare law.
  President Trump, from the beginning of his administration, has 
injected uncertainty: We are not going to continue enrolling people--or 
we will reduce the market for enrollment. We are not sure we are going 
to pay the cost sharing. Maybe we should let ObamaCare crash and burn--
a tweet that he did recently. Because this has happened, the individual 
market has become very unstable, and many insurers pulling out of the 
market are citing this unpredictability as contributing to an 
instability in the individual market.
  Here is what Senator Carper and I proposed, and we have numerous 
cosponsors: We take the tool that Senator Nelson was describing, 
reinsurance, a tool that provides a backstop against very high-cost 
claims, and we put it into the Affordable Care Act as it was for the 
first 3 years of the Affordable Care Act. The Affordable Care Act in 
its first 3 years had a reinsurance mechanism to backstop high-cost 
claims. If an insurance company knows there is a backstop, they can 
actually set premiums at a lower and more affordable level for 
everybody. Having that backstop also gives some certainty, so you can 
actually write a plan in a market where, if you don't have certainty, 
you might choose not to write it.
  In the first 3 years of the Affordable Care Act, this reinsurance 
provision worked out very well, held premiums down, and kept insurers 
in the marketplace. It expired. But we actually know reinsurance works 
because it is part of a great bill that was passed during a Republican 
Presidency with overwhelming Republican support. Medicare Part D was 
passed during the administration of President George W. Bush. 
Reinsurance was made a permanent part of that bill to do exactly the 
same thing: to cover high-cost claims, seniors who had multiple high-
cost medications. Because reinsurance was included in that bill--it was 
put in the original bill, authored by Republicans--it enables pricing 
to be more affordable for our seniors who are on Medicare, and it 
enables pricing actually to be more affordable for the public treasury.
  Reinsurance is just one of a number of ideas that are out there, but 
it is an idea that has bipartisan bona fides. It has been demonstrated 
to work. You are not going to put reinsurance in this bill and have an 
unintended consequence that you didn't think would happen. We know how 
reinsurance works, and we know how it will work here.
  I would just conclude and say that I hope we will take a bad process, 
which produced a bad product, set that aside, and engage in a good 
process to find a good product on the most important expenditure anyone 
ever makes in their life--on their health--a good product in the 
largest sector of the American economy; one-sixth of our economy is 
health.
  The right process is this: When the Republicans get to the point that 
they think this bill is all they would want it to be, why not just put 
it in the Finance Committee, put it in the HELP Committee, and let's be 
the U.S. Senate. Let those of us who are on the committees do what we 
want to do. We have good committee chairs in these committees: Senator 
Hatch and Senator Wyden, the chair and ranking on Finance; Senator 
Alexander and Senator Murray on HELP. Put it in the committees; let's 
hear from the public about what works, what doesn't, and what can be 
fixed. Then let's dialogue and listen to one another and come up with 
solutions--just as in that budget deal, just as in the rewrite of No 
Child Left Behind.
  The Presiding Officer knows the next thing I am going to say, I bet. 
I am in the minority on those committees. I have some amendments like 
reinsurance that I want to put up, but I can't get them accepted unless 
I can convince some in the Republican majority that it is a good idea. 
I have to convince Republicans it is a good idea for my amendment to be 
accepted. Shouldn't I have that opportunity? Why would anybody be 
afraid of being open to an idea that might actually improve the bill?
  Just this morning, I came out of a markup that the Presiding Officer 
is very familiar with, the markup of the NDAA. We finished it this 
morning on Armed Services. We went back and forth across the table, 27 
Democrats and Republicans. We traded amendments, we voted some up, and 
we voted some down. We had Senator McCain and Senator Reed leading us 
in that. We got to the end of the day, and we had a committee vote. 
After that discussion and listening to one another across the table, 
back and forth, the committee vote was 27 to 0--27 to 0. We got all the 
Dems on board.
  I will not be naive enough to think healthcare is going to be simple 
and noncontroversial. I am sure we will have some tough discussions. I 
am sure I will offer an amendment that will be turned down. Maybe I 
will offer one that will be accepted. But we are much more likely to 
produce a good product and help people's healthcare if we actually will 
sit down in the committees that have jurisdiction and dialogue and 
amend before we bring this thing to the floor. It is just not worth 
rushing, because it is life and death.
  We have a chance to get it right. The step-back this week enables us 
to take that chance, and we should seize it and work together.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Ms. HEITKAMP. Mr. President, I wish to make some concluding remarks.
  No. 1, I share the concerns that Senator Barrasso expressed. I hear 
from ranch families and I hear from farm families about the 
unaffordability of their healthcare premiums. I hear about high 
deductibles. I hear about how what has happened in the health insurance 
market has made it more difficult for them to cover their families. I 
hear that.
  We have solutions we have been talking about that could lower those 
costs. I would include dealing with people with chronic conditions. 
Reports from the RAND Commission tell us that 12 percent of the people 
in this country who have five or more chronic conditions cost the 
healthcare system over 40 percent. Some of those people are on the 
exchanges, and when they are on the exchanges, that drives the 
healthcare costs up.
  But I have a question. I have a question for people who are advancing 
the Republican healthcare bill: Why do you have to give the richest 
Americans in this country a tremendous tax break to solve that problem? 
How does giving the top 0.1 percent of taxpayers in this

[[Page S3827]]

country over a $250,000 a year tax break--how does that fix the problem 
for my ranchers? How does that fix the problem for my farm families? 
You know the honest answer: It doesn't.
  I need to understand how taking billions of dollars out of the 
Medicaid system, driving sicker, older people who tend to be in the 
Medicaid population onto the exchanges into the individual 
marketplace--how does that help that farm family we talk about almost 
every week on the floor of the Senate, that farm family, that 
individual who is paying excess premiums? It does nothing for them.
  This is all some smoke-and-mirrors deal. What we have done today--
almost 15 of us have come to the floor, and what we are saying is: 
Let's fix the problems. We can all acknowledge that we have a 
healthcare system where really sick people have a hard time finding 
affordability. When you put really sick people into an insurance pool, 
it drives up the cost for everyone. How do we manage that? The 
insurance industry tells me the average time on the individual exchange 
is 10 months. How do you take someone with five chronic conditions and 
manage them in a 10-month plan? You know what, you don't. So they hop 
from plan to plan, costing more and more.

  If you want to reduce costs, you have to figure out how we can better 
treat the sickest among us. Until we do that, we will not achieve the 
common goal, which is reducing and bending the costs of healthcare in 
this country. We cannot achieve that goal. When all we are doing is 
saying: No, we don't want to pay, we are going to make the States pay 
or we are going to make people on the individual exchange pay or we are 
going to make people do what they have done before, which is not have 
coverage and put them into uncompensated care, that will not solve the 
problem.
  We have some great examples here for the immediate concern that we 
have about the premiums that are going to be expressed. In some ways, 
this reflects concerns about the increased costs of healthcare and what 
is happening in that individual market, but it is being driven by the 
failure to fulfill the statutory obligation--reinsurance, cost sharing.
  I do have to point out that I found it interesting that the objection 
to Senator Shaheen's bill was that, oh, we haven't had time to take a 
look at it, haven't had time to even considering this cost-sharing 
issue. Really?
  This is the last page of the Republican bill, page 145, stating in 
section 208, ``Funding for Cost-Sharing Payments.'' I will give you, it 
is a different schedule, different formula in the Shaheen bill, but 
this is not a new concept. If we wanted today to give the insurance 
industry the certainty they needed that would make sure that the 
premium increases reflected not uncertainty but reflected actual costs, 
we would do this: We would take up Jeanne's bill. The very bill that 
the Republicans have advanced says, ``There is appropriated to the 
Secretary of Health and Human Services, out of any money in the 
Treasury not otherwise appropriated, such sums that may be necessary 
for payments for cost-sharing reductions authorized by the Patient 
Protection and Affordable Care Act (including adjustments to any prior 
obligations).''
  The same provision was in the House bill. How can it be objectionable 
to have a debate about a provision that has been advanced in both 
Republican bills? How can that be objectionable when so much is riding 
on that, when the healthcare and availability of insurance to our 
families is riding on making sure we at least have some kind of stopgap 
measures in the exchanges that will guarantee a stability that will 
make insurance available.
  If we don't know what is going to happen with those counties--we know 
we have huge counties that don't even have uninsured in them. Senator 
McCaskill offered an opportunity. Guess what. How about they get their 
insurance where our staff get our insurance or some among us get our 
insurance? That is objected to because it is some kind of Washington 
solution.
  What is ironic about that is that provision that made Senate staff in 
our home States get their health insurance on the DC exchange came from 
Senator Grassley during the debate on the Patient Protection and 
Affordable Care Act, not a Democratic idea. It was a Republican idea 
and certainly something that bears at least a discussion, certainly 
something that ought to be talked about here.
  Let's not pretend there has been an outreach to people on the 
Democratic side. Today the Democratic leader offered to go to Blair 
House, offered to bring people together at Blair House, have a sitdown 
on healthcare, offered to go to the Senate--the Old Senate Chamber, no 
cameras, let's talk about healthcare. What we get is: You are not 
serious.
  I want you to know I am dead serious about sitting down and trying to 
fashion a healthcare plan that actually fixes the problems we have 
right now in affordability of health insurance.
  When someone says, well, you have to accept tax breaks as part of 
that for the richest Americans, think about this: 400 Americans will 
get a tax break under the Republican bill--400. Just 400 Americans will 
get a tax break under the Republican bill, equal to what it would cost 
for Medicaid expansion in four States.
  Make no mistake, this is not healthcare reform we are talking about. 
That bill is not healthcare reform. It is entitlement reform in 
Medicaid, shifting costs to States and patients. It is tax reform, 
making sure the wealthiest among us get a tax break.
  If we want to talk about healthcare reform, if we want to talk about 
fixing the ACA, let's not throw out what is working. Let's make sure we 
are fixing and addressing the problems that we here express every day 
that come in our mail and that we know we have to address in order to 
make the system fair; that is, younger, healthier people need a break. 
They need to find an affordable product.
  How are we going to do that? We have seen ideas here today, ideas 
that could take care of--even if we just made them temporary, even if 
we said this is only going to be there until 2019, we could stabilize 
all of this today and begin that today, but yet it is objected to.
  I think the message we want to send is we stand ready to fix the 
healthcare system. We stand ready to work with the other side of the 
aisle. We stand ready to address the concerns we hear from our 
constituents about the healthcare system.
  If we really want to respond to the concerns the American public has 
about the U.S. Congress, we better start working together. We better 
start finding a path forward to solve problems, real problems, not 
pretend problems but real problems in this country. That way we will, 
in fact, enrich and enhance our democracy. Until we do that, we 
continue to struggle to get credibility with the American public, and 
that is not, ladies and gentlemen and Members of the Senate, a formula 
for success for our democracy.
  With that, I yield the floor.
  The PRESIDING OFFICER (Mr. Tillis). The majority leader.

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