[Congressional Record Volume 163, Number 116 (Tuesday, July 11, 2017)]
[Senate]
[Pages S3902-S3905]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CORNYN. Mr. President, as we move forward in our efforts to 
repeal and replace the failed ObamaCare law, it is worth remembering 
the reasons why this work is so urgent and why it is so important. The 
Affordable Care Act has left many American families paying far more for 
healthcare than they did beforehand, and it has taken away their 
freedom to choose the doctor they want or the health plan they want. 
That is, of course, all contrary to what was promised at the time 
ObamaCare was passed back in 2009 and 2010.
  We all remember what the President said, and none of it has proven to 
be true in terms of your plan, your doctor, or the costs. In fact, as I 
mentioned before, the cost has gone up 105 percent for people in the 
individual market since 2013 alone. So rather than seeing a $2,500 
decrease in the cost to their health coverage, they have seen a $3,000 
increase, and the prices continue to go up. It is actually getting 
worse by the day, which is another reason for the urgency of what we 
are about to do. A report from the Centers for Medicare and Medicaid 
Services, or CMS, released yesterday, found that 40 percent fewer 
insurers have applied to participate in

[[Page S3903]]

the ObamaCare exchanges next year. The reason why that is important is 
because when fewer insurance companies choose to participate, of 
course, consumers have less choice and there is less competition in 
terms of quality of service or the price they charge. The damage goes 
far beyond the damage to the doctor-patient relationship and the damage 
to our pocketbooks, when we are told things will cost us less and they 
cost us more. The damage of the Affordable Care Act has literally 
permeated our entire economy and has led to a lot of people losing 
their jobs along the way.
  ObamaCare consists of a number of mandates, government coercion, and 
punishment if you didn't comply with the mandates that forced many 
Americans to buy a product they would not have bought of their own 
volition and in many instances simply could not afford. But if you 
refused to do it, the government fined you, punished you. That 
represents a radical change in the nature and guiding philosophy of 
this country. This country was founded on the concept of individual 
freedom, not on Big Government coercing you to buy something that you 
don't want and you can't afford. But that is the theory behind 
ObamaCare.
  In addition to that, for small business owners, it included a penalty 
for any business that exceeded more than 50 employees who did not 
provide government-approved health insurance policies. It cost them at 
least an additional $70,000 a year, in addition to other increases in 
healthcare costs.

  Let's say you are a small business of 50 or so employees. You are 
sure not going to hire over the cap and subject yourself to the 
additional $70,000 a year in costs. What you are likely to do is to 
hire fewer than 50 employees in order to protect yourself from that 
expense, and that is exactly what happened.
  I still remember, after the Affordable Care Act passed, having lunch 
in San Antonio, TX, with a friend of mine who was an architect at the 
particular time. When I described to him the nature of the employer 
mandate and its effect, he made it clear to me that he would rather lay 
off some of his employees in order to avoid that additional expense 
under the employer mandate. In fact, that is just what he did.
  This is just another bit of evidence about the pernicious impact of 
the Affordable Care Act. It is not just about premiums. It is not just 
about deductibles. It is not just about freedom of choice. Literally, 
it has been a wet blanket on our economy.
  This damage reaches across many different sorts of industries. 
According to a recent study by the Mercatus Center, an estimated 
250,000 jobs nationwide were lost due to this mandate. That strikes me, 
frankly, as too small a number, but that is the number they projected. 
A quarter of a million people lost their jobs because of this mandate 
because small employers were motivated to keep their numbers under the 
cap in order to avoid the extra expense. This does not even take into 
account the consideration of businesses that were forced to shut their 
doors altogether.
  In other words, ObamaCare was, in part, premised on this idea that 
businesses could endlessly absorb additional taxes and new costs and 
mandates and somehow continue to keep their doors open and do business 
as usual, but that is not the real world.
  It also does not take into consideration the many businesses that 
choose to cut the hours their employees can work instead of firing 
them. This is another one of those stealth characteristics of 
ObamaCare, in which employers are judged on the number of full-time 
employees they have.
  I remember talking to a restaurant owner in East Texas--in Tyler, 
TX--who told me he had to lay off a single mother who was working as a 
waitress in his restaurant. He could not afford to have her work full 
time. He had to put her on part time in order to avoid the penalties 
that are associated with ObamaCare. What that meant for this single mom 
is that she essentially had to go out and get two jobs in order to fill 
the gap that was left by her going from full-time work to part-time 
work. That is not the only story I can tell you.
  A small business owner in Donna, TX, epitomizes this reality in a 
letter that was written to me a few weeks ago. This gentleman said he 
and his wife are both on Medicare. Of course, they are unaffected 
directly by ObamaCare because Medicare covers people who are 65 years 
and older while ObamaCare covers people who are younger than that. 
While they were left unaffected personally by ObamaCare's changes, on 
behalf of his 54 employees, he wrote that after ObamaCare went into 
effect, he was faced with a choice, either he could buy his employees 
expensive health insurance that his business could not afford or he 
could pay fines totaling more than $100,000. Instead, he made the 
painful choice to lay off six of his employees in order to remain under 
the ObamaCare-imposed threshold. As he pointed out, this meant more 
than just simply laying off six people; it also meant risking the well-
being of each of those families represented by those six people.
  Small business owners should not be forced to choose between growing 
their businesses and providing jobs or risking the financial 
livelihoods of their entire companies and their employees just to 
satisfy the demands of Big Government. Even beyond causing layoffs, 
ObamaCare has effectively ensured that many businesses cannot grow and 
that existing businesses will not hire any more employees.
  ObamaCare did not just lead to a new form of healthcare coverage, as 
some have claimed, as two-thirds of the small businesses that were 
surveyed by the Mercatus Center report already offered insurance. Two-
thirds of the businesses affected by ObamaCare already had healthcare 
coverage, but that was effectively displaced and replaced by 
government-approved healthcare, which proved to be far more expensive.
  Instead of having the choice to shop around for the insurance that 
best meets their needs and the needs of their employees, these 
businesses have been forced to either pay the penalty or to pay the 
piper--that is the Federal Government--when it comes to these mandates 
and these demands.
  It ought to be clear by now--7 years into the implementation of 
ObamaCare--that this kind of one-size-fits-all mandate should not be 
applied to a country of 320 million people, especially when it comes to 
something as personal as healthcare. Each of us is a unique human 
being. Each of our families has its own unique needs and desires. 
Frankly, we ought to be able to choose the sort of healthcare coverage 
that best suits our needs as well as our incomes and our desires to buy 
health insurance. Some people want policies that provide purely for 
catastrophic coverage when they go to the hospital. Maybe they prefer 
to have savings accounts that use pretax dollars under health savings 
accounts in order to save money so as to pay for their doctors' visits, 
and they combine that with a high deductible health insurance plan. You 
literally cannot do that under ObamaCare, but you will be able to do 
that under the Better Care Act, which we will be voting on next week.
  What we have tried to do is to look at the meltdown of ObamaCare and 
say that we need some emergency measures to take place because of the 
phenomenon I mentioned earlier in which insurance companies are pulling 
out, people's premiums are going through the roof, or deductibles are 
so high that they are effectively being denied the benefit of their 
health insurance. We need to do something quickly and urgently.

  What we are going to do is take measures to stabilize the insurance 
markets because if insurance companies continue to pull out of the 
insurance markets and deny people a choice or competition or even 
access to a qualifying policy at all, that is going to put people in an 
impossible situation. So the first thing we are going to do is to 
stabilize the marketplace.
  The second thing we are going to do is to repeal the mandates that 
have made health insurance so unaffordable and restore the freedom to 
choose the sorts of policies and create a marketplace in which people 
can choose the policies that best suit their needs and at prices they 
can afford. It will literally bring down the cost of what people are 
charged in order to buy healthcare coverage.
  Because we understand the importance of protecting families against 
preexisting condition exclusions, we are going to make sure the current 
law

[[Page S3904]]

remains in effect that protects people from exclusions when they change 
jobs or lose jobs based upon preexisting conditions.
  The fourth thing we are going to do in the Better Care Act is put 
Medicaid on a sustainable growth rate. Medicaid is an important 
program. It provides the healthcare safety net for the Nation, but 
unfortunately it is unsustainable at the current rate of spending. Over 
the next 10 years, we propose to spend $71 billion more than we do 
today on Medicaid. In other words, it is going to continue to grow but 
at a more controlled and fiscally responsible rate.
  We are also going to provide people with tax credits who have an 
income between zero and 350 percent, including those people who are 
left out in the event that the Medicaid expansion is not embraced by 
their States and States like Texas--people who are now at 100 percent 
of the Federal poverty level up to 138 percent who were left out 
because of the fact that Texas did not expand Medicaid to able-bodied 
adults. They are going to be able to use that tax credit to buy private 
insurance. Private insurance provides much better access to coverage 
because, right now, Medicaid pays doctors and hospitals about 50 cents 
on the dollar when it reimburses them. Private insurance pays them much 
better so it improves the range of choices available to consumers.
  Our bill continues to be a work in progress. We have done our best to 
try to work with everybody who has been willing to work with us and to 
use their ideas. What we have tried to build is a consensus bill, but 
the fact is, our friends on the other side of the aisle have simply 
refused to participate in the process, thus leaving it up to us to save 
people and help people who are currently being hurt by the status quo. 
We are going to do our duty. We are going to fulfill our responsibility 
to our constituents the best we can under these circumstances. In 
recognizing that no bill is ever going to be perfect, certainly, we 
have to do what we can in order to help the people who are being hurt 
now under the status quo.
  Let me just close by saying that I have heard my friend the Senator 
from New York--the Democratic leader--talk about this bill. If we are 
unsuccessful in getting this bill passed next week, he wants to engage 
in a bipartisan negotiation in order to address healthcare. Yet what I 
predict is this: What he is really talking about is a massive, 
multibillion-dollar bailout of insurance companies without there being 
any reform. To me, that is an exercise that, frankly, I am not willing 
to participate in. I will never support a multibillion-dollar bailout 
of insurance companies and not be able to reform the system that 
created the problem in the first place.
  I urge all of our colleagues to work together with us. Bring us your 
best ideas. Work with us. Try to figure out a way to be constructive in 
this process and help us to achieve a result. It is not going to be the 
final result. We will have other opportunities, for example, in the 
Children's Health Insurance Program, which is a bipartisan program that 
expires by the end of September. We will have another opportunity to 
come back--hopefully, then on a bipartisan basis--to do additional 
things that we were unable to do because of the constraints of the 
budget reconciliation process and the fact that our Democratic 
colleagues simply refuse to participate in saving the people who are 
being hurt today by ObamaCare.
  I encourage my colleagues not to be lured by the seductive message of 
our friends across the aisle about doing something bipartisan after 
this bill is unsuccessful. They are not interested in changing anything 
about the structural defects in ObamaCare. If all we are going to do is 
propose to pay insurance companies billions of dollars more in order to 
bail them out--in order to support the same flawed structural program 
known as the Affordable Care Act--you can count me out.
  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. CARDIN. 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. CARDIN. Mr. President, I take this time to share with my 
colleagues the experiences I had in the State of Maryland during our 
most recent work period and shortly before that, when I took the 
opportunity to meet with different groups with regard to the healthcare 
debate.
  I had a townhall meeting this past week at Atrium Village, which is a 
senior living place in Baltimore County. We had a robust discussion 
primarily with seniors, but not just seniors, about their concerns as 
to whether the changes in the healthcare law would affect their ability 
in the Medicare system as well as relating to long-term care and 
Medicaid.
  A little bit earlier than that, I had a townhall meeting at one of 
our local hospitals where we had a chance to talk with lots of people. 
It was an open townhall meeting, and a lot of people from the community 
showed up. They expressed their concerns about what would happen under 
the changes being suggested in healthcare on coverage and quality of 
coverage, and we had a very robust discussion.
  I also had a chance to meet with leaders of the faith community as we 
talked about our responsibility to make sure healthcare is a right and 
not a privilege in the United States.
  I met with the leaders of the community health centers in Park West, 
in Baltimore City, to talk about the impact on the viability of health 
centers if the Medicaid Programs were cut.
  I had a chance to visit with Mosaic Behavioral Health Center, which 
deals with behavioral health in Baltimore, and their concern is, if we 
eliminate the essential health benefits of mental health and addiction, 
what impact that would have on access to care.
  There was a consistent message from each of the places I met with, 
with regard to whether we would be able to maintain coverage--under the 
Affordable Care Act, we expanded coverage by tens of millions--and 
whether that coverage would be compromised under the legislation being 
considered in the Senate.
  We also had a chance to talk about whether there would be a weakness 
in what benefits would be covered. I already mentioned mental health 
and addiction. There were also concerns expressed about reductions of 
benefits regarding obstetrics and how it would affect women, and 
pediatric dental care, which is a particular concern in Maryland after 
the tragic death of Deamonte Driver.
  They also raised many issues concerning discrimination in healthcare 
that was present before the Affordable Care Act and whether these 
conditions would be returning. A young father told me a story about how 
his daughter was born prematurely and, as a result, the baby was in the 
neonatal intensive care unit for 4 months. When his daughter was 4 
months old, she had reached her lifetime limit of what the insurer 
would pay for healthcare if we returned to lifetime limits. Whether we 
would be returning to the predatory-type practices of the insurance 
companies that were present before the Affordable Care Act and whether 
we would be returning to preexisting conditions or doing that 
indirectly through what benefits would be covered--that was expressed 
at several of my healthcare meetings.
  I already mentioned the concerns that the elderly expressed, 
including the discrimination of the near elderly, if we go to a 5-to-1 
ratio on health premiums, so that those who are 60 or 62 years of age 
paying five times higher premiums than younger people are paying. All 
of that was brought out during my townhall meetings.
  The one message I just wanted to leave with my colleagues is that 
there was a strong interest that we work together--Democrats and 
Republicans--because we all acknowledge that the Affordable Care Act 
can be made better. We don't want to repeal it. We want to improve it.
  Before we left for the July 4th break, I introduced legislation that 
deals with some of these issues. The legislation would improve 
competition by putting the so-called public option in the exchanges so 
that we know there would be at least one governmental option without 
subsidies, without any additional breaks over private insurance 
companies, to guarantee more competition in the marketplace.

[[Page S3905]]

  I also included in my legislation a solution to deal with the two 
major problems that we have under the Affordable Care Act. For some 
people, the insurance premiums are too high. Why? Well, I asked 
CareFirst, which is the major health insurer in Maryland, about the 
uncertainty as to whether President Trump is going to fund the cost-
sharing issues. My legislation makes it clear that those funds will be 
made available, as was anticipated under the Affordable Care Act.
  I also provide predictable subsidies for lower income families, up to 
400 percent of poverty, so that we can help bring down the cost of 
premiums in that marketplace, and we reimpose the reinsurance program 
so that we can spread the risk so the insurance companies know that 
they have a more predictable risk when they set their premiums.
  All of this would make a big difference. CareFirst said that, in the 
individual marketplace in Maryland, if you do that and endorse the 
individual mandate, we could reduce our premium increases by 50 
percent.
  So I am trying to work, I hope with Democrats and Republicans, to 
deal with the problems that have been brought to our attention on 
higher premiums and then to deal with healthcare costs generally.
  More and more people talk to me about bringing down the costs of 
prescription drugs. It is outrageous that Americans pay twice what our 
friends in Canada pay for the same medicines that are manufactured here 
in the United States. So why don't we have a more competitive 
marketplace? Why don't we have the rebates that we have in the Medicaid 
and the Medicare systems, and why don't we allow for more collective 
bargaining for prices in the pharmaceutical industry? My legislation 
would do that, and I know there is bipartisan support for that.
  Lastly, we deal with more integrated care. I mentioned Mosaic, a 
behavioral health facility in Baltimore City. They have an integrated 
care model. If you come into their community health center, they will 
treat whatever your problems are. They are not going to say: Well, come 
in one day and we will deal with diabetes, and the next day we will 
deal with high blood pressure. Let's deal with the whole patient in a 
coordinated and integrated care model, and that would help save on 
costs.
  My bottom line is this. No, I am not going to support weakening the 
Affordable Care Act. I am not going to support legislation that would 
diminish those who currently have coverage or the quality of their 
coverage. Let's work together--Democrats and Republicans--to deal with 
the real problems of bringing down costs in our healthcare system--
everybody benefits from that--and to make sure there is more 
competition in our exchanges and to make sure there is better premium 
support for those who cannot afford their premiums. If we do that, 
then, I really think we would be carrying out what the people of 
Maryland were asking me to do during the recess; that is, not to go 
back on the progress we have made under the Affordable Care Act. Let's 
build on that. Let's make healthcare more affordable, and let's deal 
with more competition on the premium costs.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.