[Congressional Record Volume 163, Number 116 (Tuesday, July 11, 2017)]
[Senate]
[Pages S3906-S3911]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. President, I am here today to talk about healthcare. That is a 
subject we have talked a lot about, not just on this floor this week, 
this month, and this year but for years. A lot of times, when we talk 
about it, we seem to forget that this involves real people, people who 
live in our home States. They are moms and dads; they are parents. They 
are children. They are grandparents, aunts, and uncles. They are young, 
and they are old. They are people from different walks of life. They 
are real people.
  I want to talk today about one of them. Delaware is a little State. I 
like to kid my colleagues that a lot of days in the week I visit all 
the counties in Delaware. We have only three. Yesterday I got to go to 
all three of them.
  In the southern part of our State is Sussex County, which is the 
third largest county in America. I think there are 3,000 counties in 
America. The third largest is Sussex County, DE. The county seat for 
Sussex County is called Georgetown.
  Before I came over here yesterday afternoon to be here for the 
convening of the Senate, I stopped off and hosted a roundtable. There 
were about 20 patient advocates from organizations across the State of 
Delaware. We were in Georgetown at a place called the CHEER Community 
Center, which is a gathering place for seniors in the southern part of 
our State. A lot of good activities happen there for seniors from all 
over Southern Delaware.
  Some of the organizations on the frontlines of our healthcare system 
were there. I am going to mention a couple of them. They include the 
Mental Health Association, the National Alliance on Mental Illness in 
Delaware, the Leukemia & Lymphoma Society, Autism Delaware, the 
American Heart Association, the Juvenile Diabetes Research Foundation, 
the Alzheimer's Association, and atTAcK addiction. The folks at the 
roundtable explained to me and to others how the new plan that was 
presented several weeks ago would dramatically diminish their ability 
to care for the Delawareans they serve.
  During our roundtable, we heard directly from representatives of 
these organizations, and we heard directly from patients. These 
Delawareans shared with us just how devastating a repeal of the 
Affordable Care Act would be for them and for their families.
  One person's story stood out to me. She is a woman I have met before. 
Her name is Jan White. She is pictured here with her husband Mike. They 
live in Newark, which is at the other end of the State. If you drive up 
I-95 from Washington through Baltimore, on up to the Delaware line, the 
first town you come to in Delaware is Newark. That is where the 
University of Delaware is located. That is where they live.
  Jan and her husband were college sweethearts. This October they are 
going to celebrate their 30th wedding anniversary. They run a 
successful small business in Delaware. It involves setting up meetings, 
running them, organizing and running special events.
  Together they have one child, a son named Ethan. This September, 
Ethan will start his senior year at the University of Delaware, which 
is one of my alma maters. I went to graduate school there after the end 
of the Vietnam war on the GI bill. It is a wonderful school. He will be 
a senior there this fall.
  Jan, depicted here with her husband, was doing everything she was 
supposed

[[Page S3907]]

to do to stay healthy. She ate right. She exercised. In fact, she was 
studying martial arts.
  I eat right too. I exercise almost every day of my life and have 
since I headed to Pensacola, FL, as a newly minted ensign in the Navy. 
I still work out, just like Jan. One thing she has done that I 
haven't--she has studied martial arts and achieved her third-degree 
black belt. She did it a couple of years ago, in April of 2015.
  Jan also worked hard at their business and helped to raise Ethan. 
Jan, Mike, and their son Ethan were living the American dream, but 
their lives were irreparably changed in April of 2016--a year after she 
earned her third-degree black belt.
  Something happened. What happened was that Jan was diagnosed with 
aggressive stage IV non-Hodgkin lymphoma. It had invaded her chest and 
her spine. She went from teaching kickboxing and studying for her 
fourth-degree black belt to relying on a walker.
  Jan underwent over 5 months of intense chemotherapy. I am told it was 
102 continuous hours every 3 weeks. Think about that: 102 continuous 
hours of intense chemotherapy every 3 weeks. She had two injections 
into something called--I think it is a cavity in our brain--the Ommaya. 
She had two injections every 3 weeks for her spinal tumor, a high 
dosage of inpatient chemotherapy, and a month of radiation.
  Jan was pronounced in remission earlier this year. Thank God. She 
desperately hopes to stay there, and our prayer is that she will.
  When Jan was sick, she and her husband Mike kept working. There was 
no quit on that team. They kept working at their business, although it 
certainly wasn't possible to keep up with everything. That business had 
its usual pace that they followed.
  As Jan has said, the bills don't stop just because you have cancer. 
That is true. Today she continues physical therapy repair damage from 
spinal cord compression from the tumor and the chemotherapy for the 
spinal tumor. She continues this therapy, even though her insurance-
approved visits ran out a long time ago.
  Jan monitors daily for relapse, hoping and praying it will not 
happen. She and Mike have worked hard to keep their business doors open 
and to try to put their lives back together.
  The current debate in Washington over the Affordable Care Act makes 
Jan and Mike wonder if they will be able to afford the premiums that 
they face. Their current premiums now--not including deductibles, out-
of-pocket expenses, or denials--are double their mortgage payments.
  Jan told me that they wonder if they will have to forgo Jan's medical 
care. They wonder if they will have to choose to pay for care and maybe 
put their family in bankruptcy. What if the treatments don't work?
  Most of us know that cancer is a hard battle. In my own family, we 
know that my grandfather, his wife, and others who have fought cancer 
ultimately succumbed to it. It is a hard battle. Jan shouldn't have to 
fight for the chance to fight and survive. That is what she is doing.
  We are encouraged that she has had better than a fighting chance. Jan 
and her family hope that those of us in this body--in the Senate--and 
our friends in the House of Representatives will do the right thing. 
That is why she is now involved with the Leukemia & Lymphoma Society as 
a patient advocate.
  It is up to those of us in Washington to do the right thing by Jan--
not only to do the right thing by her but by the 1.2 million people who 
have blood cancer, including roughly 400 Delawareans and the 50,000 
cancer survivors who live in my State.
  I will close by saying this: Last week we had the Fourth of July 
recess. The place was closed, and most of us were in our States. I 
covered the State of Delaware almost every day. I saw thousands--
probably tens of thousands--of people during the course of that time. I 
am amazed at how many people talked to me about healthcare legislation. 
They called on us to do the right thing.
  The other thing they called on us to do was to work together. Any 
number of people said to me: This shouldn't be all Republicans trying 
to solve this; this shouldn't be all Democrats trying to solve this. 
This should be everyone working together.
  I couldn't agree more. I think we have a great opportunity right now 
to hit the pause button and not retreat to our different corners around 
here but to figure out how we can engage and do three things with 
respect to the Affordable Care Act: Figure out what in the Affordable 
Care Act needs to be fixed and let's fix it; figure out what in the 
Affordable Care Act needs to be preserved and let's preserve it; and if 
there are provisions in it that should be dropped, let's figure out how 
to drop them.
  I talked with one of my colleagues, a former Navy guy from Arizona on 
the other side of the aisle. We came to Congress together in 1982. We 
served in the Navy together before that. We were talking yesterday 
about a path forward for us. We both said almost at the same time: What 
we should do is regular order.
  I don't know if our new pages have heard that term, ``regular 
order.'' What it means is pretty much this: If someone has a good 
idea--or maybe a not-so-good idea--on an important issue, introduce it 
as a bill. It gets assigned a committee, and the committee chair, 
ranking member, senior Republican, senior Democrat talk about 
scheduling a hearing. They hold a hearing--maybe not just one hearing 
but maybe a series of bipartisan hearings. Sometimes they actually 
schedule some roundtables in addition to hearings, which are more of an 
informal discussion, which are sometimes helpful in working out 
consensus around the very difficult issues like healthcare.

  The regular order is that after there has been a lot of testimony, a 
lot back-and-forth, a lot of questioning, they have a markup in the 
committee on jurisdiction. The markup is to vote on the bill before we 
vote on the bill. We have the opportunity for members--Democrats and 
Republicans have the opportunity to offer amendments to the 
legislation, amendments for and against, amendments that would change 
and hopefully improve the underlying bill.
  After the amendments are offered, there would be a vote on the 
underlying bill, to keep it in committee or report it out. In regular 
order, if it is reported out, then it competes for time on the floor. 
That is something our leaders, Senator McConnell and Senator Schumer, 
would need to work out amongst themselves.
  If the bill makes its way to the floor, in regular order, we would 
have time for debate, especially for something this important. As I 
recall, when we debated the Affordable Care Act in committees, 
hearings, and roundtables, I think we spent 80 days. All told, I think 
over 300 amendments were offered. There were 160 Republican-sponsored 
amendments adopted to the Affordable Care Act. Is it perfect? No. 
Anything that big, that complex, should have been even more bipartisan 
than it was. This is something we need to get right.
  I will close with this thought: If you go back 8 or 9 years ago, we 
had a new administration. I was a brandnew member of the Finance 
Committee, which has jurisdiction over Medicaid and Medicare. We share 
jurisdiction in the Senate on healthcare legislation; the other 
committee is the Health, Education, Labor, and Pensions Committee, 
which is led by Senator Lamar Alexander of Tennessee and Senator Patty 
Murray of Washington State, two very able people and leaders. I would 
suggest that they are the kind of leaders who can help us actually 
figure out what is the right thing to do.
  I don't know that either party is smart enough to figure it out by 
themselves, but if you ask a lot of people around this country, 
including people like Jan and her family or folks who are providers, 
such as doctors, hospitals, and nurses, and folks who work in 
pharmaceuticals, health economists--if you ask a lot of people ``What 
do you think?'' there is a much better chance to ultimately get this 
right.
  I will add a P.S. as a former Governor of Delaware, as some of my 
colleagues know. I call myself a recovering Governor. We have a new 
page here from Ohio. One of the guys from Ohio is now a pharmacist. 
John Kasich, my old colleague from the House, is now Governor of Ohio. 
He has been a strong voice in favor of just what I am talking

[[Page S3908]]

about doing, and that is to hit the pause button and figure out how we 
can do this together, and we need to.
  In closing, I will paraphrase something Mark Twain used to say. Mark 
Twain used to say: ``When it doubt, tell the truth. It will confound 
your enemies and astound your friends.'' Think about that.
  In this case, maybe we should paraphrase Mark Twain: When in doubt, 
try regular order. When in doubt, try working together. When in doubt, 
try a bipartisan approach that is focused on getting this country and 
our healthcare delivery system a lot closer to where it needs to be.
  Every President since Harry Truman said as President that we need to 
change our healthcare delivery system so that everybody in this country 
has access to healthcare. By the time we took up the Affordable Care 
Act in the Finance Committee and the Senate, we were spending, as a 
nation, 18 percent of the gross domestic product on healthcare in this 
country. I have a friend, and if you ask him how he is doing, he says: 
Compared to what? We are spending 18 percent GDP. What were they 
spending 8 years ago in Japan? They were spending 8 percent of GDP for 
healthcare in Japan. Did they get worse results? No. They got better 
results--higher rates of longevity, lower rates of infant mortality. In 
Japan they covered everybody. They still do. They are getting better 
results for less money.
  Frankly, what we did in writing the Affordable Care Act was we looked 
around the world, including Japan, and we looked around this country, 
including at places like Mayo, the Cleveland Clinic, and others, to see 
what they are doing to get better results. We tried to put a lot of 
that in the legislation, in the law. Wonder of wonders, some is 
actually delivering good results--better value, better results for less 
money. That is part of the Affordable Care Act we want to maintain and 
preserve.
  I have probably stood here long enough talking about this today. This 
is an important issue. It is one-sixth of our economy, and healthcare 
eventually affects us all. People who get sick will eventually get 
care. For too long, the care they have gotten has been in the emergency 
room of a hospital. By the time they get sick enough to go there, 
sometimes they are very sick. It is very expensive. They don't spend an 
hour or two in the emergency room of a hospital; they may spend a week 
or two in the hospital and really run up the tab. That is a hugely 
expensive way to provide healthcare. Who pays for it? The rest of us. 
We have to be smarter than that.
  I am hoping that in the days ahead, particularly as our Governors 
gather up in Providence, RI, later this week to discuss, among other 
things, providing healthcare for their constituents in 50 different 
States, my hope is that some of what I said here today will be on their 
minds: Hit the pause button. Fix the things in the Affordable Care Act 
that need to be fixed. Preserve the aspects that need to be preserved. 
Let's do it together.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Rubio). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. DURBIN. 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. DURBIN. Mr. President, I represented the congressional district 
of Springfield, IL, for 14 years, and this is my 21st year in the 
Senate. It is a big State with 102 counties. We are proud of our 
diversity in our State, which runs from the great city of Chicago, to 
deep, deep Southern Illinois, to a town of Cairo, IL, which is 
literally south of Richmond, VA, by latitude. They grow cotton down 
there in the State. So it is a very big and diverse State. I am proud 
to represent it.
  I have spent some time doing my best to understand the challenges 
that businesses, individuals, and families face and to measure their 
sentiments on issues over the years.
  For the last several months, I have spent my time visiting every 
corner of downstate Illinois, which is the more rural, smalltown area 
of our State outside of Chicago. It is more conservative politically. 
President Trump ran well in some parts of downstate Illinois. And I 
have been in this area--representing it, growing up in it--to measure 
what I consider to be the topic and issue of the day, and that is the 
issue of healthcare in America. It is an issue which each of us takes 
very seriously and personally because each of us is called on in a 
variety of different ways in our lives to have healthcare for ourselves 
and our family--the people we love--at critical moments.
  We are now engaged in a national debate about the future of 
healthcare in America. The Republicans control the House, the Senate, 
and the White House, and have been from the beginning opposed to the 
Affordable Care Act, which was passed under President Obama. I voted 
for it. I think it was the right vote. I think it has achieved a great 
many things. I hope we can build on it to make an even better 
healthcare system for our Nation. It is not perfect. There are areas 
that need to be changed, improved, and areas that I think need to be 
strengthened over the long haul to make sure America has more fairness 
when it comes to healthcare for our people.
  Last week, I visited about a half dozen healthcare facilities in 
Illinois. I jokingly said to my staff that I have come to know hospital 
administrators in my State far better today than I ever have.
  Here is what they told me. They told me the healthcare bill that 
Senator McConnell has proposed in the U.S. Senate would be devastating 
to the families, the patients, the employees, and the healthcare 
facilities in our State. They told me that nearly $800 billion in 
Medicaid cuts would cripple rural hospitals and health clinics. Not 
only would this harm patients in rural communities, but 35 percent cuts 
in the Medicaid Program would also cost jobs in Illinois. The Illinois 
Hospital Association in my State estimates that the Republican bill, 
which passed the House and now is being considered in the Senate, would 
cost us 60,000 healthcare jobs.
  I went to Granite City, IL, which is near the St. Louis area. I met a 
young woman named Sam, who has Down syndrome and her mother Missy. They 
are worried about the Republican plan to cap Medicaid spending. Sam's 
health needs can't always be anticipated. There are not some that can 
be capped in terms of future needs, and the amount of care can hardly 
be determined in advance for this young woman who is doing her best to 
lead an active and involved life facing this disability, which she 
does. This is so true for so many people nationwide.
  Some of my Republican colleagues in Illinois have said: We just don't 
understand why Medicaid as a program has grown so much. Well, it may be 
hard to understand until you look inside the program and realize what 
it does. Medicaid may have started as a small idea, but it has really 
grown into a major provider of healthcare in America. In my State of 
Illinois, it is responsible for paying for the prenatal care, birth, 
and care of mothers and their children after they have been born for 
more than 50 percent of the kids.
  It is an important provider of healthcare resources to our school 
districts in Illinois, which count on Medicaid to help them take care 
of special needs students--counselors, psychologists, transportation, 
even feeding tubes for those who are severely disabled. It is a 
critical program as well for the disabled community, like Sam and young 
men and women who are victims of autism or Down syndrome who want to 
lead a full life but need health insurance. Medicaid is their health 
insurance.
  One woman said to me in Champaign, IL, my 23-year-old son is 
autistic. He counts on Medicaid, and, Senator, if I don't have 
Medicaid, my only recourse is an institutional program that would cost 
us over $300,000 a year. It is impossible for us to even consider that.
  So those who would cut back on Medicaid spending in the name of 
flexibility and saving money or generating enough to pay for a tax cut 
for wealthy people would leave people just like those I have described 
in a terrible circumstance.
  I haven't described the largest cost of Medicaid. The largest cost in 
Illinois and across our Nation is the Medicaid services and benefits 
provided to those who are older--mothers, grandmothers in nursing 
facilities and care facilities

[[Page S3909]]

who count on Medicaid along with Medicare and Social Security for the 
basics in life.
  I heard from Kevin. He is a worker from Urbana, IL, who is worried 
that the Senate Republican bill is going to increase his out-of-pocket 
expenses by thousands of dollars. He is worried because he fits into an 
age category which would see premiums go up dramatically in costs under 
the Republican bill. The Affordable Care Act, which we passed under 
President Obama, set limits on the increases in premium costs so no 
premium paid would be more than three times the cost of the lowest 
premium that is paid for health insurance in our country. Well, 
Republicans have changed that. In both the House and Senate, they have 
raised that to five times. So it means for people, particularly between 
the ages of 50 and 64, they are going to see a substantial increase in 
their premiums because of that Republican provision. People are 
following this closely enough to know that when premium costs go up for 
many of them, it becomes impossible to buy the coverage they need.
  As I returned to Washington, I once again face the reality of what 
this Republican healthcare plan would mean. The nonpartisan 
Congressional Budget Office told us the bill would cost 22 million 
Americans health insurance coverage--cutbacks in Medicaid as well as 
cutbacks in private insurance. Think of that. I don't know how the 
Republicans in our State can go home and explain why a million people 
in Illinois are about to lose their health insurance in the name of 
healthcare reform.
  I can tell you the notion of repealing the Affordable Care Act may 
have had some surface political appeal until you realize you might be 1 
of the 1 million people in my State who ends up with no health 
insurance when it is all over. It would cut Medicaid dramatically, as I 
have mentioned, and then keep cutting--a 35-percent cut over the next 
20 years--with devastating impacts on hospitals, clinics, and many 
other facilities.
  By 2020, average premiums in the individual market would increase by 
76 percent under the Republican plan. Costs would skyrocket even higher 
for seniors, rural communities, and those with medical needs.
  What happens to people with preexisting conditions under the 
Republican repeal bill? One out of three Americans has a preexisting 
condition. In the old days, they couldn't buy insurance or, if they 
could, couldn't afford it because they had a history of cancer in their 
family, diabetes, heart disease. Well, this Republican plan would take 
away the protections of the Affordable Care Act. It would allow States 
to waive essential healthcare benefits, like maternity care, mental 
health treatment, substance abuse treatment. People in need of these 
services would be left to fend for themselves.
  The Congressional Budget Office analyzed the Republican bill, and it 
said: ``People who used services no longer included in the Essential 
Health Benefits would experience substantial increases in out-of-pocket 
spending on health care, or would choose to forgo the services. 
Moreover, the ACA's ban on annual and lifetime limits . . . would no 
longer apply.''
  With this scathing analysis from the Congressional Budget Office, 
what did the Republican leadership decide to do? Instead of addressing 
these challenges straight on, they retreated. They shut themselves off 
behind closed doors and tried to cut a deal within the 52 Republican 
Senate Members here to pass this measure, as bad as it is. There was 
not one hearing on this bill--on the Republican healthcare bill--no 
markups, no amendments, and no support from medical advocates in any 
part of our Nation. There was no input in the Senate from any Member 
outside the Republican caucus.
  They want to call this bill right away, and it is understandable. The 
longer it sits out there and the longer people get to know it, the less 
they support it. You know we still haven't seen the final language. 
Why? Because Republicans continue to work in secret on a bill that 
literally impacts one-sixth of the American people and every single 
person in our country.
  This measure affects everybody. Even if you get your insurance 
through your employer or Medicare, this bill would make Medicare go 
insolvent sooner and allow employers to, once again, impose annual or 
lifetime limits on care under their health insurance plans.
  Now, the latest we have heard is that the Republicans are meeting in 
secret, making some changes to this bill. They may be throwing some 
money at the opioid crisis facing America, but that will not make up 
for kicking 15 million people off of Medicaid. The amount of money they 
are talking about to deal with the opioid crisis is literally 
inadequate to deal with the seriousness of that issue or to provide the 
substance abuse treatment people currently receive from Medicaid who 
will be cut off under the Republican plan.
  Cutting Medicaid, our best tool to fight the opioid epidemic, and 
offering a coupon for drug treatment is a cruel step backward. If it 
ends up buying a vote on the Republican side, shame on my colleagues 
for selling out so cheaply.
  Republican Gov. John Kasich of Ohio is not fooled. He called this 
idea of a special opioid fund to win some votes on the Republican side 
``like spitting in the ocean.'' I called Governor Kasich this last 
week. He and I came to Washington together many years ago. I have known 
him, and I like him. We disagree on some political issues, but he is 
very forthright and frank. He has warned us that what is going to 
happen to Ohio is going to happen to the Nation, if the Republicans 
have their way with their healthcare bill.
  We have also heard the Republicans are considering adding provisions 
that allow insurers to offer bare-bones plans. I have just heard some 
more about this today, and I believe the author of this idea is the 
junior Senator from Texas, Mr. Cruz.
  Here is what he says: If your State offers a health insurance plan 
that complies with the requirements of the Affordable Care Act, then 
you may offer it to other consumers in the State insurance plans that 
do not. He says it gives consumers choice. Well, it sure does, but look 
at the choice it gives them because if he is aiming for lowering 
premium costs by offering health insurance plans that are junk plans, 
health insurance plans that are fake insurance, the net result is going 
to be people paying a lot more in copays and deductibles and a lot less 
coverage when they definitely need it.
  There are a couple other things it will do. Because these younger 
healthier people will buy the cheaper plans believing they are 
invincible, it will end up raising the cost of premiums for those who 
buy other insurance. The discrimination, in terms of premium costs, 
will be dramatic, and that, in and of itself, could be damaging to 
people all across the United States.
  So Senator Cruz believes that offering junk insurance plans and 
telling the consumers we are giving you a choice is going to answer the 
needs across America. It will not. It will raise premiums on everyone 
else. It will provide inadequate coverage for those who buy these 
plans, and sadly many of them are going to be facing deductibles and 
copays they just can't handle. That is no answer. It may be a political 
answer to get his vote, but it is certainly not a credible answer.
  We have had this before the Affordable Care Act, and do you remember 
what it was like? People got sick and found out their insurance didn't 
cover what they needed. Women who were pregnant found out their plans 
didn't cover maternity or newborn care. People who were diagnosed with 
a mental health condition found out their insurance covered no 
treatment for mental illness. So what good is insurance if it doesn't 
care for the most basic and essential needs of Americans?
  Thanks to the Affordable Care Act, we changed it. We required that 
policies provide real insurance for real families. Do you know what 
happened, in addition to providing more care for people across America? 
The number of bankruptcies, personal bankruptcies, have been cut in 
half since the Affordable Care Act passed. Why? The No. 1 driver of 
personal bankruptcy and family bankruptcy in America was medical 
bills--medical bills that were beyond the payment of an ordinary 
person. There are fewer of those today because of the Affordable Care 
Act.
  Senator Cruz's plan for selling fake insurance or junk insurance 
plans that will not be there when you need them,

[[Page S3910]]

I can just tell you it means more business for the bankruptcy court. It 
would banish those with preexisting conditions to the world of sky-high 
premiums, all in the name of Senator Cruz's freedom of choice. Well, 
freedom isn't free when it comes to relegating so many Americans to 
such a precarious state when it comes to health insurance. No matter 
how much the Republican Senators tinker around the edges, they are 
dealing with a flawed, unfixable bill.
  The American people oppose any bill that rips health insurance away 
from millions of individuals and families, they oppose any bill that 
causes nearly 1 million people nationwide to lose their jobs, and they 
are also opposed to a Republican health insurance plan that would cost 
coverage for half a million American veterans.
  The American people oppose any bill that hurts those with preexisting 
conditions. They oppose a bill that throws millions of people off 
Medicaid and slashes billions in Federal funding to hospitals, 
healthcare clinics, and schools.
  The American people oppose any bill that is rejected by every major 
medical and patient group. The Republican bill is opposed by the 
American Hospital Association, the American Medical Association, 
nurses, pediatricians, AARP, heart, diabetes, and lung associations. 
How can you write a bill that draws that much opposition? They did it. 
They did it behind closed doors, and they don't want you to see what 
they are doing with it now.
  Finally, the American people oppose any bill that takes away nearly a 
trillion dollars in healthcare in order to provide hundreds of billions 
of dollars in tax breaks to the wealthiest Americans and large 
corporations. Case in point: Of the 145 pages of the Senate repeal 
bill, 94 pages are devoted to slashing Medicaid and providing tax 
breaks to the wealthiest Americans and pharmaceutical companies.

  Last week, one conservative writer penned an article which said that 
it gives conservatism a bad name when we are giving tax breaks to the 
wealthiest people in order to cut and eliminate health insurance for 
the poorest people in America. That is exactly what this bill does.
  I am glad the Senate Republicans have delayed their vote on this 
repeal, but many have not given up. In all of my townhall discussions, 
the plea from Illinois people has been clear: Improve the Affordable 
Care Act; don't repeal it.
  So where do we go from here?
  First, Republicans need to take repeal off the table. We need 3 
Republicans out of the 53 to say this is the wrong way to go about it.
  Second, President Trump must stop undermining the stability of the 
marketplaces with his uncertainty and sabotage.
  Third, we need to work together on a bipartisan basis to strengthen 
our current system. We need to address the price of pharmaceutical 
drugs. The current bill and law does not. That is the biggest driver, 
according to Blue Cross in Illinois, of premium increases--the cost of 
pharmaceutical bills. We need to build competition through a Medicare-
like public option available to everyone who chooses it across the 
United States.
  Some Republicans, including Senator McConnell, have said that the 
Republicans have to do this by themselves because the Democrats refuse 
to work with them. That is simply not true. We are here. We have been 
here all along, and we want to have a hearing. Bring in some experts. 
Let's just have a meeting. That would be a breakthrough.
  Democrats have asked the Republicans to join us. Let's sit down 
together, informally, like grown-ups, and address this issue in a 
responsible fashion. We are ready and willing to work on legislation to 
improve the individual market for the 6 percent of the people who 
purchase their insurance there. I fail to see how gutting Medicaid and 
throwing 22 million Americans off of health insurance in order to 
provide tax breaks for rich people does anything to help that 6 
percent.
  This is a critical moment when it comes to healthcare across America. 
It is unfortunate that we are now considering a bill that was revealed 
only 2 weeks ago, a bill that has never been subject to a hearing 
before any committee, a bill that has never been amended in an open 
process.
  When it came to the Affordable Care Act, over 140 Republican 
amendments were adopted. The Republicans haven't offered us an 
opportunity to offer one amendment to their proposal--not one. It is a 
take-it-or-leave-it, closed-door deal. That is not the way the Senate 
was designed to work. It is not the way the American people want us to 
work. They expect us to work in a constructive fashion on a bipartisan 
basis to solve the problems facing our Nation. The biggest single 
problem is giving peace of mind to Americans and American families 
across the Nation that they have healthcare they can count on and 
afford.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Mr. President, I have joined my colleague in coming to 
the floor to talk about how we need to make progress on healthcare and 
make sure that we don't pull healthcare out from millions of Americans. 
I thank the Senator from Illinois for talking about his constituents. 
Like the Senator from Illinois, I was at home this past July recess 
talking to my constituents, and I heard many of them talk about their 
individual healthcare needs and their concerns about what is happening 
in Washington.
  I met a young woman who told me about her daughter who was born 
prematurely and weighed less than 2 pounds. Her daughter required 
specialized, expensive treatment as a newborn. She was concerned that 
if we keep moving ahead with the repeal of the Affordable Care Act, she 
and her husband would be overwhelmed with crushing hospital debt if, in 
fact, we hadn't covered preexisting conditions. She is one of millions 
of Americans who are scared that they are going to lose their health 
insurance under the proposal that is being talked about, that has been 
talked about for the last several weeks, and from what we can tell--
because, obviously, there is a lot of secrecy--may still include 
details about reducing coverage for those who have access to care 
through Medicaid.
  I have come to the floor tonight to talk about the latest idea 
because I think one of the things that is clear--and probably why the 
Senate majority leader said that he wanted, basically, to cancel the 
first 2 weeks of the August recess--is that my colleagues don't want to 
go home and talk about the proposal that was brought before them. In 
fact, they are now trying to bring up a new proposal, thinking that, 
again, with a very limited time period, without floor discussion, 
without committee debate, without an amendment process, somehow our 
colleagues on the other side of the aisle will fall prey to the notion 
that there is a silver bullet, a magic solution. I have come to the 
floor knowing that an amendment or a discussion piece or the new 
behind-closed-doors discussion proposal being advanced by my colleagues 
from Texas and Utah is basically to allow junk insurance into the 
marketplace.
  What do I mean by junk insurance? I mean a proposal that basically 
offers less than the essential benefits, such as hospitalization, 
prescription drug benefits, lab costs, and all of those things; that, 
basically, by offering a market where you can get junk insurance, you 
can say: Oh, well, you have to have one offering of insurance that does 
cover all the basics and essentials, but then you can have junk 
insurance.
  I say ``junk insurance'' because this is the wrong idea for the 
marketplace. It is basically mixing good and bad and not having 
adequate risk spread across--so basically it means that you don't have 
to have compliant plans for the market. I know this firsthand because 
we had this in Washington. We had this same experiment in Washington in 
the 1990s, and people tried to do the exact same thing--basically, have 
a compliant plan, and then say that you have a bunch of less-than-
adequate proposals for insurance in the market that really aren't 
giving individuals coverage. What happened? It drove up the cost of the 
compliant plans that covered most of healthcare and basically drove the 
insurers out of the market. That was the experience in Washington 
State. This same idea was tried, and it failed because basically it ran 
up the price, and insurers didn't stay around to offer options. They

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couldn't make the mandate of the required plan work because it 
basically took the risk out of the system.
  The notion that somehow this new idea by my colleagues is going to be 
the silver bullet is, in my opinion, not an answer at all. People who 
would be the ones who could get that kind of coverage for a short 
period of time would then end up leaving the rest of the people without 
adequate coverage. As I said, what happens is, the costs then just go 
up, and then the market has to adjust. I would say that in our State--
because a lot of people are talking about leaving the individual 
markets over the proposals that we are talking about today because they 
are concerned about the costs and who is going to be covered--you would 
see a very rapid collapse of the individual market exacerbated by what 
my colleagues from Texas and Utah are proposing.
  There are numerous nonpartisan health experts who seem to be saying 
the same thing. There is the American Academy of Actuaries, where one 
individual said:

       People who are healthy now would tend to choose 
     noncompliant plans with really basic benefits. People who 
     want or need more comprehensive coverage could find it out of 
     their reach, because it could become unaffordable.

  Another individual from the American Enterprise Institute wrote that 
``the main effect of the Cruz-Lee amendment would be to shift costs 
from healthy consumers to less healthy consumers and households with 
lower incomes.''
  Douglas Holtz-Eakin, a Republican and former Director of the 
Congressional Budget Office called the amendment by my colleagues from 
Texas and Utah ``a recipe for a meltdown.''
  Larry Levitt, senior vice president at the Kaiser Family Foundation, 
summed it up best when he called the amendment ``a recipe for 
instability and discrimination.''
  So you can see that many people already understand the idea of junk 
insurance is not a market solution at all. It is not really even 
healthcare coverage. In its May 24 score of the House proposal, the CBO 
provided a definition of health insurance, saying that they would 
``broadly define health insurance coverage as consisting of a 
comprehensive major medical policy that, at a minimum, covers high-cost 
medical events and various services, including those provided by 
physicians and hospitals.''
  To me it seems pretty clear that the types of plans that could be 
sold under this proposal don't meet that definition.
  What are essential benefits that we expect to be covered in a plan? 
Obviously, hospitalization, emergency services, ambulatory services, 
mental health, prescription drugs, rehabilitation, if needed, 
laboratory services, like lab tests, and we have moved toward some 
preventive, health, and wellness measures. Those are the essential 
benefits that are supposed to be in a plan, and I want my colleagues to 
know that this experiment was tried. It failed. It drove insurers out 
of the marketplace because it just made the plans that were covering 
essential benefits so costly by distorting--really tearing the market 
apart.
  The second point about the proposal we are hearing about is that it 
is still a war on Medicaid. In my opinion there are cost-effective ways 
for us to continue access to healthcare. I have brought them up on the 
Senate floor. One would be looking at rebalancing from nursing home 
care to community-based care or, as I have mentioned, a basic health 
plan that bundles up a population and serves them up to get a discount 
so that individuals would have as much clout as a large employer would 
have in the marketplace.
  I hope that my colleagues will stop the focus on capping, cutting 
Medicare--because it would throw so many people off of the system--and 
focus on rebalancing people to the type of healthcare that will help us 
save costs, keep people in their homes, and give consumers the ability 
to compete cost effectively in the individual market.
  These are the problems I still see with this proposal. To think, 
basically, that junk insurance will be the way for us to get a proposal 
and to see that Medicaid is still the target in a war on Medicaid, to 
me, is not the proposal to move forward on. I hope our colleagues will 
realize that both of these have severe faults and will sit down and 
talk about the proposals that will help us in establishing a more 
robust individual market.
  I thank the Presiding Officer.
  I yield the floor.
  The PRESIDING OFFICER. The majority leader.

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