[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
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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
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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.
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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.