[Congressional Record Volume 163, Number 117 (Wednesday, July 12, 2017)]
[Senate]
[Pages S3936-S3941]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. BARRASSO. Mr. President, I come to the floor today to talk about 
what I saw happen over the Fourth of July in Wyoming while visiting 
with people, visiting with patients, doctors, and nurses. What I am 
seeing is that the pain of ObamaCare continues to worsen. The 
healthcare crisis we are seeing across this country continues to grow. 
The crisis is rising, the choices are disappearing, and the American 
people are desperate for Congress to step in and do something to help 
rescue them from the rising costs and collapsing choices of the Obama 
healthcare law.
  It is interesting. When the Democrats passed ObamaCare, the 
Democratic leader at the time, Harry Reid, said that we would all get 
an ``earful of wonderment and happiness.'' Those were his words about 
how great the law was. Well, every weekend at home in Wyoming and I am 
sure in the Presiding Officer's State of North Carolina, we get an 
earful, too, and it is not about wonderment and happiness over 
ObamaCare. What I hear from patients, doctors, and nurses at home is 
that ObamaCare is hurting them, hurting our communities, hurting our 
State. I hear about the rise in premiums. I hear about the declining 
number of options, the collapse of ObamaCare. We have one choice in 
Wyoming. We used to have two. Both lost money in spite of very high 
premiums. What we saw is that one ended up going out of business, and 
the one we have in business--the only one we have--is still losing 
money.
  We are fortunate because we have at least one provider providing 
coverage. There are now 40 counties across America where no one will be 
selling ObamaCare insurance next year--no one, not a single company 
will be selling ObamaCare insurance.
  In Nevada, where prior Senator Harry Reid is from, only three 
counties are going to have anyone selling on the ObamaCare exchange--
only three of the counties in the entire State, the State that Harry 
Reid represented in the Senate for many years. People living everywhere 
else in his home State will have I think one choice, maybe more, but in 
terms of these counties, no one is selling ObamaCare insurance at all. 
The State health insurance exchange put out a statement in his home 
State that said that the people living in the rest of the State face 
what they described as a healthcare crisis.
  Democrats predicted wonderment and happiness about ObamaCare, but 
there is a healthcare crisis all across the country. People in that 
State are going to have no access to the insurance plans the Democrats 
promised them under ObamaCare. A lot of Americans are not much better 
off or in better shape right now.
  There was a headline in the Independence Day edition of USA TODAY 
that said ``1,370-plus counties have only one ACA insurer.'' The 
article was about a study that was done by the Robert Wood Johnson 
Foundation. They found that people living in 1,300 counties have no 
choice when it comes to the ObamaCare plan; there is just one company 
offering the mandated coverage. Washington says you have to buy it; not 
many people want to sell it. Washington doesn't seem to care.
  Democrats don't seem to care about the fact that what they promised 
was a marketplace and what we have ended up with is a monopoly. 
Remember when Democrats promised there would be more competition? 
Essentially there is none. When there is none, we end up with less 
competition and generally with higher prices, which is what people 
across the country are seeing. Prices have essentially doubled in 
ObamaCare marketplaces over the last 4 years. That is why a lot of 
people are finding out that while they may still have access to 
coverage, it is so expensive, they can't afford to buy it--because they 
are down to one choice.
  Health insurance companies keep releasing information about how much 
higher they expect rates to go next year, which continues to be a 
problem. I have seen the headlines. ``Another ObamaCare Rate Shock.''
  Look at what is happening in Tennessee. Earlier this year, Aetna and 
Humana both said they were dropping out of ObamaCare exchanges 
completely. Cigna is one of the last big companies that are still 
willing to sell these plans. Well, they say they are going to have to 
raise premiums by 42 percent next year.
  Look at what is happening in Georgia, just across the border from 
Tennessee. Blue Cross Blue Shield is asking for an average rate hike of 
41 percent in Georgia. The Atlanta Journal-Constitution had an article 
about it just last week. They said Blue Cross might charge as much as 
75 percent more for one plan next year. That is ObamaCare.
  Remember President Obama saying that if you like your plan, you can 
keep your plan? Those plans are gone.
  Remember President Obama saying that rates would drop by $2,500 a 
year for people? That is not what we saw. What we are seeing is what is 
continuing today.
  The Atlanta Journal-Constitution is saying that Blue Cross Blue 
Shield may charge as much as 75 percent more next year. They quoted one 
man as saying: ``That's a breath taker.'' Another woman quoted in the 
article responded to these price increases by saying simply ``Yikes!'' 
That is what people are facing all across the country.
  I remember President Obama, leaving office, forcefully defending it 
and being proud. There is very little to be proud of here.
  People all across America are having the exact same reaction as they 
see how much their own insurance companies are raising their rates all 
across the country. That is not the wonderment and happiness the 
Democrats said we would be hearing about when this was passed. The high 
prices are a big

[[Page S3937]]

reason so many people are dropping their insurance coverage. They can't 
afford it. The people most likely to drop out, we find out, are, of 
course, the young people.
  Gallup came out with the results of a recent survey on Monday, just 2 
days ago, with big headlines all across the country. What they found is 
that 2 million fewer Americans, under ObamaCare, have insurance today 
than they did at the end of last year, just 6 months ago. There have 
been 2 million fewer over the last 6 months.

  So, in just 6 months, 2 million people have gone off insurance. Most 
of them are young, and according to the survey by Gallup, they 
basically say they dropped it because it was just too expensive. They 
do not feel that they are getting value for their money. These 2 
million people are not talking about the wonderment and happiness of 
ObamaCare. They are just leaving it behind.
  Democrats said people would love ObamaCare. They said ObamaCare would 
bring down prices. It has not. They said it would increase competition, 
but they did not get that one right either. None of this is happening. 
Now the Democrats are starting to say that having Washington-mandated 
health insurance is not enough. They say we need health insurance to be 
run entirely by Washington. Apparently, they did not learn the lesson 
that said that the Washington-mandated insurance--having to buy a 
Washington product--would be good enough. Now they are recognizing that 
it is not good enough. They are saying that we need Washington in 
charge of all of it.
  They call it single-payer healthcare, but let's talk about what it 
is. It is government-controlled healthcare--government-mandated, 
government-controlled, government-run, one-size-fits-all healthcare. It 
is a single payer, with the American taxpayers paying the bill.
  We see what happened in California when its legislature passed a 
similar thing in the State senate. They asked: What is the cost? $400 
billion. What is the budget of the entire State of California? $190 
billion. So what they proposed in the State senate has passed in the 
State of California and costs twice what the entire budget is in the 
State of California. To give what the people of California have been 
promised by the State senate, they are going to have to raise taxes on 
people, and then you will get the rationing of care and the lines and 
the waiting time. It is what happens around the world with government-
mandated, government-run insurance. We see that in Canada, and we see 
that in England.
  I was practicing medicine prior to coming here to the Senate. I was 
an orthopedic surgeon in Wyoming. I knew we needed to do healthcare 
reform, but ObamaCare was the very wrong reform. Democrats were wrong 
then, and all of the talk about government-run healthcare is wrong 
today--wrong today for the people of this country.
  Look, we understand that we need a better solution than ObamaCare. 
That is what I hear about every weekend in Wyoming. We need to put 
patients in charge, not the government. With the Democrats and the 
speeches they are giving and the bills that have been cosponsored in 
the House by a majority of the Democrats, they want to put the 
government solely in charge of healthcare in this country.
  We need to have people at home making their own decisions, making 
their own choices, and not have Washington, DC, imposing its one-size-
fits-all approach. We need to give people options, not mandates. People 
deserve choices. That is what the American people want. That is what 
Democrats promised years ago, but they never delivered. That is what 
Republicans are committed to giving the American people today--doing it 
now so that patients can get the healthcare they need from doctors whom 
they choose and at lower costs so that patients can make the decisions, 
not Washington. That is where we are today as we continue to debate and 
discuss healthcare in this country at this time.
  Just coming back from Wyoming, I visited with many folks--many former 
patients, a number of doctors whom I had worked with over the years, 
and nurses. I was at several hospitals. I just heard, unilaterally, 
across the State of Wyoming that ObamaCare continues to be a burden on 
the people of the State. They want freedom. They want choice. They want 
flexibility. They want to make decisions for themselves, not have 
Washington dictate to them and, certainly, not have government 
controlling healthcare in this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. MURPHY. Mr. President, I have had the good fortune of being in 
both the House and the Senate during the period of passage and 
implementation of the Affordable Care Act and now the debate over 
repeal, and I have heard consistently from my Republican colleagues two 
things. One is that they did not think the Affordable Care Act was the 
right approach to fixing the problems of America's healthcare system. 
There were 60-some odd times that the House or the Senate voted to 
repeal all or parts of the Affordable Care Act. The second thing I 
heard consistently over that period of time, dating from 2009, is that 
the Republicans were prepared to offer a replacement to the Affordable 
Care Act that would be better, that would be an improvement over the 
Affordable Care Act--indeed, over the status of the American healthcare 
system when the Affordable Care Act was passed. The ground has shifted 
mightily since then.
  The Congressional Budget Office tells us that, under the Republican 
plan either passed in the House or in the Senate, a humanitarian 
catastrophe will result in this country. Tens of millions of people 
would lose their healthcare. That is not what Republicans said their 
replacement would do. They said their replacement would be better than 
the Affordable Care Act.
  The CBO says that rates will go up immediately by 20 percent on 
almost everybody. Then, after that, if you are young and healthy, rates 
will probably go down, but for everybody else, the amount of money you 
have to pay in premiums, copays, and deductibles will go up. There is 
nothing in the Republicans' bill about cost--nothing that addresses the 
underlying issues with an American healthcare system that, procedure by 
procedure, costs twice as much as in most other countries--and nothing 
about quality. There is not a single provision in the bill that 
encourages higher quality.
  As we get ready for Republican repeal bill 3.0 or 4.0--whatever this 
next version will be that will be released secretly to Republicans 
tomorrow--I think it is just worth reminding everybody what Republicans 
said would happen. I will just use our President's words. I understand 
that many of my Republican colleagues here do not ascribe to all of the 
beliefs and statements of our President, but he is the leader of the 
Republican Party. All of my colleagues did support him, and they stood 
with him in the House of Representatives, arm in arm, when they passed 
the Republican House's repeal and replacement bill.
  President Trump wrote this:

       I was the first and only potential GOP candidate to state 
     there will be no cuts to Social Security, Medicare, and 
     Medicaid. Huckabee copied me.

  So no cuts to Medicaid was the promise. Yet the bill that the 
President has endorsed and is trying to help Leader McConnell push 
through the Senate involves debilitating cuts to Medicaid--$700 billion 
to $800 billion worth of cuts to Medicaid--resulting in millions of 
people being pushed off of that benefit. The cut to the State of 
Connecticut would be $3 billion. We are a tiny State. Our Medicaid 
Program is somewhere in the neighborhood of $8 billion. We would lose 
$3 billion of that. The promise was that we would not cut Medicaid. 
This bill cuts Medicaid.
  President Trump wrote:

       If our healthcare plan is approved, you will see real 
     healthcare, and premiums will start tumbling down. ObamaCare 
     is in a death spiral!

  There is always one long sentence and then one very short sentence.
  Here are the two claims: ``Premiums will start tumbling down.'' That 
has been the promise, and that has been a consistent promise--that 
costs will go down if the Affordable Care Act is repealed and replaced 
with a Republican plan. The CBO debunks this from beginning to end. It 
says that premiums will go up. They will start tumbling upwards 
immediately at rates of 20 percent. If you are older or if you have any 
history of preexisting conditions, your premiums will continue to go 
up. The danger, of course, is in thinking

[[Page S3938]]

that the only thing that you pay in the healthcare system is premiums. 
I could pretty easily construct a healthcare reform proposal in which 
your premium would go dramatically down. How would I do that? I would 
just shift all of the payments onto deductibles, onto copays, and I 
would give you nothing with regard to the actuarial benefit of the 
plan. It is easy to get premiums to go down if you do not care about 
what you are actually covering and the size of your deductibles and the 
size of your copays.
  Then, ``ObamaCare is in a death spiral!'' The CBO debunks that as 
well. The CBO says that, if you leave the Affordable Care Act in place 
over the course of the next 10 years, 2 or 3 million people will lose 
healthcare insurance. If you pass the Republicans' healthcare bill, 
that is where the death spiral occurs. There are 23 million people who 
will lose insurance if you pass the Republicans' bill, but 2 to 3 
million people will lose insurance if you do not pass it.
  Again, President Trump writes:

       Healthcare plan is on its way. Will have much lower 
     premiums and deductibles--

  Here, he is making a commitment on deductibles. Once again, the 
Congressional Budget Office says that premiums will go up and 
deductibles will go up, especially for individuals who are older or 
individuals with preexisting conditions--

     while at the same time taking care of pre-existing 
     conditions!

  This bill does not take care of people with preexisting conditions. 
Why? Because it allows for any State to allow insurance companies to 
get out from the minimum benefits requirement. If you have cancer, 
technically, the Senate Republicans' bill says that you cannot be 
charged more, but you may not be able to find a plan that covers cancer 
treatments. So that is not protecting people with preexisting 
conditions. The CBO says this specifically. It says that, especially 
for people with preexisting mental illness and preexisting addiction, 
they will be priced out of the marketplace because they will not find 
plans that cover their illnesses. You cannot just protect people with 
preexisting conditions by saying that insurance plans have to cover 
them. You actually have to require insurance plans to offer the medical 
benefit they need.
  Once again:

       Our healthcare plan will lower premiums and deductibles--
     and be great healthcare!
       Insurance companies are fleeing ObamaCare--it is dead.

  I have already covered the part about premiums and deductibles, but 
let's remember that insurance companies were not fleeing ObamaCare 
until President Trump was sworn into office. The period of open 
enrollment covered a period prior to his inauguration and a period 
after his inauguration. Before President Trump's inauguration, open 
enrollment was on pace to enroll a record number of Americans in 
exchange plans and Medicaid plans--record enrollment. Enrollment fell 
off a cliff after President Trump was sworn into office and signed an 
Executive order that told all of his agencies to unwind the Affordable 
Care Act. People listened to President Trump, who said that he was 
going to kill the Affordable Care Act, and they stopped signing up for 
those plans.
  It got worse when he refused to pay insurance companies. Right now, 
the President will not commit to paying cost-sharing subsidies to 
insurance companies more than 30 days ahead of time. He stopped 
enforcing the individual mandate, and it is no surprise that insurance 
companies are saying they do not want to participate in these exchanges 
because the President is trying to kill them. He has made it very clear 
from day one.
  I have had the benefit of being on the floor a number of times with 
Senator Barrasso, who often came down to the floor, following my 
remarks, during the period of the implementation of the Affordable Care 
Act. I heard him talk about the fact that there will be freedom for 
Americans to have or not to have insurance if this piece of legislation 
is passed. It is a wonderful idea that people will be free to not be 
able to afford insurance. The reality is that, yes, some individuals 
buy insurance today because they are compelled to by the individual 
mandate, but there is a reason for that. If you do not compel people to 
buy insurance who are healthy, then you cannot protect people who are 
sick.
  I sat where the Presiding Officer is during Senator Cruz's 24-hour 
filibuster. In the middle of that filibuster, he said exactly that. 
Senator Cruz, in the middle of the his filibuster, said that we all 
understand that you have to have the individual mandate in order to 
prohibit companies from charging higher premiums for people who are 
sick, and my Republican colleagues know that because they kept the 
individual mandate in their bill.
  So this nonsense about no one's being required to buy insurance is 
belied by the text of the legislation we are considering. There is a 
mandate in this bill. There is a penalty in this bill. It is just a far 
meaner and crueler penalty than was included in the Affordable Care 
Act.
  What do I mean by that?
  So the Affordable Care Act doesn't mandate that you buy insurance in 
the sense that if you don't buy it, you will be locked up in jail; it 
says that if you don't buy insurance, you will pay a penalty on your 
income tax. If you don't buy insurance, there will be a penalty.
  That is exactly what the Republican Senate bill says. It says that if 
you don't buy insurance, you will incur a penalty. In their bill, the 
penalty is that you will be locked out of buying insurance for 6 
months. If you are sick, or even, frankly, if you are healthy and you 
need to go see a doctor for something, you will have to pay for that 
out of your pocket for those 6 months. If you are sick, and you have a 
serious condition and you are legally refused healthcare because of 
this legislation, the consequences could be dire, but whatever the 
scope of the consequences, it is still a penalty, just like there was a 
penalty in the bill that the Democrats supported and passed in 2009 and 
2010.
  So it is just not true to say that now Americans have the freedom not 
to have healthcare. You don't because you are going to be penalized if 
you let your health insurance lapse. If you don't make payments for a 
couple months, you are locked out of the insurance market. That is just 
a different kind of penalty than the one that is in our bill.
  The truth is that while I admit there are some people who buy 
insurance today because they fear that penalty, it is necessary, as 
Republicans realize, in order to make sure the markets don't spiral out 
of control, because if you say that you can't charge people with 
preexisting conditions more and you don't require healthy people to buy 
insurance, then why would any healthy person buy insurance? They will 
just wait until they are sick because they know that once they are sick 
and need very expensive care, they can't be charged any more for it.
  The nature of insurance is that people who have the good fortune to 
be healthy or to be free of accident or natural disaster subsidize 
individuals who are not so fortunate--who are sick, who do have an 
accident occur to their home or who are subject to a natural disaster. 
That is how insurance works.
  Republicans realize that because they put a penalty in their bill, 
but for as many people who buy insurance because they are forced to, 
most people buy insurance because they want it because they recognize 
it is better to have insurance in the case that they or a loved one 
gets sick, and that is whom we are talking about here. Of the 23 
million who lose insurance, according to CBO, under the Republican 
bill, millions and millions of those are those people who want 
insurance but will not be able to get it because they are priced out by 
the Republican bill. I can see there will be some people who will make 
that choice, but there will be millions more who had insurance today 
who will not be able to get it moving forward.
  As Republicans finish up this latest round of secret negotiations, I 
just want to make sure we are on the same page about what this bill 
does. It mandates that you buy insurance, just in a different way. It 
has a penalty just like the Affordable Care Act has a penalty.
  I want to make sure we remember what Republicans stated as their 
goals for this replacement. The goals were that the system would be 
better, but by every single metric, this proposal will result in worse 
healthcare for people. Less people will have insurance. Rates

[[Page S3939]]

will go up for everyone except for young, healthy people. Costs will 
continue to spiral out of control, and no additional measures will be 
taken to make quality better. Every single problem that Republicans 
address in the existing healthcare system gets worse.
  Senator Barrasso complains mercilessly about these exchanges. CBO 
says the exchanges will shed even more people. The costs will go even 
higher. Senator Cornyn regularly tweets out that the Affordable Care 
Act still left 28 million people uninsured, but this bill you are 
debating will double the number of people who don't have insurance.
  For all of my Republican colleagues who rightly come to the floor and 
talk about the fact that the cost is too high for individuals in our 
system, there is not a single provision in this bill that deals with 
the actual cost of the service, of the procedure, of the visit, of the 
surgery.
  I am deeply worried that this next version of the Republican repeal 
and replace bill will result in premiums going up by 15 percent and 
only 17 million Americans losing healthcare and it will be declared a 
victory, but that is not what Republicans promised. They promised to 
repeal the Affordable Care Act and replace it with something that is 
better, not something that is less bad than the original version of the 
replacement plan they introduced.
  I think the reason that to many people it appears this bill is 
falling apart is because when my colleagues went home this weekend, 
they heard an earful from their constituents--from real folks who will 
be affected by this piece of legislation.
  Alison is 28 years old. She is from Milford, CT. She was in my office 
this week. She came to DC this week, she and her boyfriend, I think--I 
don't want to ascribe an engagement to them that is not true; I think 
her boyfriend. They came down here this week. They were supposed to be 
on vacation this week, and they decided to spend some of their vacation 
coming to Washington so Alison could tell her story to Members of 
Congress.
  When she was 9 years old, she was diagnosed with a rare liver 
disease. At the time, she and her family were told that they would need 
to find a liver transplant in roughly 10 years or she wouldn't survive.
  At the start of her sophomore year at Sacred Heart University in 
Connecticut, she was starting to have symptoms of a condition that 
results from a buildup of ammonia in her brain. She was having a hard 
time concentrating, abdominal pain, nose bleeds, nausea, vomiting, and 
joint pain. Her doctor said it was time for her to get that transplant, 
that she was at that critical moment when she needed it.
  Unfortunately, none of her family or 8 other candidates--friends, I 
think, of the family--were a match. So in desperation, her parents 
wrote an email and just sent it out to people who lived in Trumbull and 
in the Sacred Heart University community. From that email, an anonymous 
young man stepped forward. He was tested and determined to be a match. 
The surgery was a success. When she walked on stage to receive her 
diploma from Sacred Heart University, she was joined by that anonymous 
donor, and her fellow graduates gave her a standing ovation.
  Now, her family was lucky because she had insurance through her 
father. She is, because of the Affordable Care Act, allowed to do that, 
at the time being under 26 years old. Her insurance paid for virtually 
everything that was necessary, but, she says, had my dad not had the 
healthcare benefits he did, I know my family would not be in the place 
we are today because my parents would have lost everything they worked 
so hard for. There was no way we could have afforded to pay for all of 
those burdens.
  Today she worries that if this bill is passed, she, as a young woman 
with a preexisting condition, will be destined to a life of 
discrimination because she may not be able to find a plan that covers 
her condition because of the withdrawal of protection with respect to 
the minimum benefits requirements. Even in Connecticut, she is 
vulnerable to that withdrawal of protection, not because Connecticut is 
likely to allow insurance plans to offer coverage that doesn't include 
the minimum benefits but because if you work for a big company, and 
even if you are housed in Connecticut, if that company anchors their 
plan in a State that does strip away the insurance protections, then 
you lose the protections even as a resident of Connecticut.
  Alison is now a nurse in the neonatal intensive care unit at Yale 
University Children's Hospital. She is contributing in a big way to our 
State and to the healthcare system. Yet she is living in fear of this 
legislation being passed. So she took some of her vacation to come to 
Washington to share her story with us.
  I am with Senator Collins. I think the Republicans should scrap this 
garbage piece of legislation. I hope they understand our offer is 
sincere--it is not political--that Democrats do want to sit down with 
Republicans and try to provide some reasonable fix to what still ails 
our healthcare system.
  I will end with this thought: It doesn't have to be like this. 
Healthcare does not have to be a political football that is just tossed 
from one side to the other every 10 years. That is what has been 
happening here for my entire political lifetime. I was elected to 
Congress in 2006, in part because of the tempest of popular frustration 
with the way in which Republicans passed the 2003 Medicare 
Modernization Act, which included the new prescription drug benefit 
that Democrats saw--and sold--as a giveaway to the drug and insurance 
industries. Democrats used healthcare as a political cudgel to bludgeon 
Republicans after the 2003 Medicare Modernization Act. Its 
implementation was very rocky, just as the implementation of the 
Affordable Care Act was. The Democrats used it against Republicans.
  In 2009, it was the Republicans' turn to bludgeon Democrats. 
Democrats lost a lot of seats in 2010, in part because Republicans used 
the passage of the Affordable Care Act to politically harm Democrats. 
Now, once again, it is the Democrats' turn to politically bludgeon 
Republicans.
  Whether this bill passes or not, the fact that Republicans have 
walked out on a plank with a partisan piece of legislation that takes 
insurance from 23 million people across the country and, as every poll 
shows, is widely unpopular will be a political liability for 
Republicans.
  What if we decided to stop tossing healthcare back and forth? What if 
we decided to jointly own one-fifth of our economy? What if we decided 
to sit down and give a little bit, from our side to yours, from your 
side to ours? What if I said that I understood you cared about 
flexibility in these marketplaces, that I understood your desire for 
more flexibility for Governors and State legislatures under Medicaid? 
What if you said you understood our interest in providing long-term 
stability in these marketplaces, that you understood our desire to try 
to get at some of the costs of the actual services and devices and 
prescription drugs that are sold? What if we sat down and fixed the 
things that aren't working, kept the things that are working, and held 
hands together and said that we are going to jointly own the American 
healthcare system?
  It would leave plenty of things to fight over. There would still be 
no shortage of disagreements that we could run elections on. Whether it 
be immigration or taxes or minimum wage, there will still be lots of 
things we could disagree on, but for as long as I have been in 
politics, this issue has just been thrown back and forth, to hurt 
Democrats, to hurt Republicans. In the process, we have injected so 
much uncertainty into the healthcare system and into the economy at 
large, that we make it impossible for private sector reform to take 
hold.
  Hospitals and healthcare providers have been doing really innovative 
things since the Affordable Care Act went into effect because they got 
a signal from the Federal Government that we wanted them to start 
building big coordinated systems of care, that we were going to reward 
outcomes rather than volume. So they started making all of these big 
changes, and then, about a year ago, they stopped because Republicans 
said they were going to blow up that model and pass something new. We 
frustrated innovation because we telegraphed that healthcare policy is 
just going to ping-pong back and forth between left and right. We hurt 
ourselves politically, we frustrate the

[[Page S3940]]

private sector innovation, and get no benefit to us on the economy.
  My offer, and I think the offer from most of my colleagues, is 
sincere. If my Republican friends do choose to throw away this piece of 
legislation because it doesn't comport with the goals that Republicans 
have long said were at the heart of their effort to repeal this bill, 
there is an important bipartisan conversation about keeping what is 
working in our healthcare system and admitting together that there are 
big things that aren't working and fixing them together.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. MERKLEY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Cotton). Without objection, it is so 
ordered.
  Mr. MERKLEY. Mr. President, the most important three words in our 
Constitution are the first three words: ``We the People.''
  Our Founders chose to write those words in supersized font so that we 
could, from some distance away, know exactly what the mission statement 
was. Their goal wasn't to write a structure for government that would 
repeat the governments of, by, and for the powerful of Europe but to 
pursue differently a vision in which the will of the people would be 
enacted; that government would work not just for the benefit of the 
citizens at large but also empowered by the citizens at large. This is 
a vision we have been very concerned about as we see the influence of 
the concentration of money in American politics.
  Indeed, we have five members of the Supreme Court who don't 
understand the basic, fundamental nature of the first three words of 
our Constitution. They adopted a court case, Citizens United, which was 
the opposite of the vision of our Constitution. That vision was 
articulated by Thomas Jefferson, who said that the will of the people 
will be enacted only if each and every citizen has an equal voice. But 
Citizens United gives a dramatic, stadium-sized megaphone to the 
individuals who are the richest and most powerful in the country, at 
odds with that fundamental vision that Lincoln so well summarized as 
government of, by, and for the people.
  We have certainly seen the case of government by and for the powerful 
in the context of the recent TrumpCare bill--the Senate version 
thereof--crafted in secret by 13 of my colleagues from across the 
aisle, hiding from the press, hiding from the healthcare stakeholders 
and experts, hiding from their own citizens. In fact, during this last 
break, of the 52 Members of the Republican caucus, apparently--
reportedly--only a couple had townhalls because they were terrified of 
what their citizens would say about the bill they have been crafting in 
secret--the secret 13.
  This bill is also known as the zero, zero, zero bill--zero committee 
meetings, zero amendments considered in committee, zero months of 
opportunity for Senators to go back and consult with their citizens 
back in their home States.
  Then what do we find as a result of this secret process of government 
by and for the powerful? A bill to rip healthcare from 22 million 
Americans in order to deliver hundreds of billions of dollars to the 
richest Americans. In fact, if you want to summarize it, you can say 
that this bill gives $33 billion--not $33,000, not $33 million but $33 
billion--to the richest 400 Americans while ripping healthcare away 
from 700,000. That is the number who could be funded by that same $33 
billion. That would cover all of the Medicaid recipients in Alaska and 
Arkansas and West Virginia and Nevada. This has incredibly grave 
consequences for the peace of mind and the quality of life for these 
millions of Americans. It rips $772 billion out of Medicaid.
  We know the Medicaid expansion in Oregon has enabled 400,000 people 
to acquire healthcare in my home State--400,000. If they were holding 
hands, they would stretch from the Pacific Ocean to the State of Idaho, 
across the entire east-west breadth of my State.
  Think about how much of an impact this has on rural Americans. One 
out of three Oregonians in rural Oregon are on the Oregon Health Plan, 
Oregon's Medicaid Program. It has a big impact on our seniors--our 
seniors in long-term care.
  Oregon is a leader in helping families, helping individuals stay in 
their homes as their healthcare deteriorates. But when they can no 
longer stay in their home because of the extensive nature of their 
care, many then are, through Medicaid, able to go and get care--long-
term care--in a nursing home. That long-term care, paid for by the 
Oregon Health Plan, covers about 60 percent of the individuals in long-
term care, but in rural Oregon, it is much higher.
  I was in Klamath Falls at a nursing home. I was citing the national 
statistic, 60 percent, and the head of the nursing home said: Senator, 
here, it is virtually 100 percent.
  I looked at those residents down that long hallway who needed 
intensive nursing healthcare, and one woman asked why I was there. Her 
name was Deborah. When I explained it, she said: I am paid for by 
Medicaid. If Medicaid goes away, I am out on the street. That is a 
problem because I can't walk.
  It is not just a problem for Deborah. It is a problem for all of our 
residents in long-term care who need extensive nursing care. It is a 
challenge. It is a real challenge. It is a real problem for our 
mothers. One out of three women in maternity care are paid for by 
Medicaid. Don't we want our children to get a good, strong start in 
life? Don't we want maternity care from the moment a woman knows she is 
expecting a child? Don't we want that? Then why do so many of my 
colleagues support a bill to tear that care away from our expecting 
mothers?
  It is a problem for our older Americans, our older Americans whose 
rates would go way up. For example, a man who is 60 years old, earning 
$20,000 a year, who currently pays about $80 a month for healthcare--an 
affordable policy. Under the Republican TrumpCare bill, that would go 
to $570 a month.
  I challenge my colleagues, find me someone earning $20,000 a year who 
can pay $570 a month for healthcare. Find that individual and defend 
your plan on the floor of the Senate as to why that isn't equivalent to 
just taking healthcare away from that individual.
  Then, of course, we have the issue of preexisting conditions. People 
sometimes have an injury in high school football or maybe it is in 
softball or gymnastics or in wrestling that they carry with them their 
entire lives. Maybe it is something that develops further on in life. 
Maybe it is asthma, diabetes, or an episode of cancer. Now they have a 
preexisting condition. Under our old healthcare system, prior to 2009, 
2010, they couldn't acquire insurance unless they were fortunate enough 
to get it through that job, which millions of Americans do not get it 
through their workplace. They were out in the cold, out on the ice.
  Now we have this Republican TrumpCare bill. They want to throw those 
citizens back on the ice who have preexisting conditions, not their 
friends who are wealthy enough to buy healthcare on their own or heads 
of corporations who get big benefit packages--not them, no, just the 
struggling working Americans.
  Don't we care about struggling working Americans? Aren't we a ``we 
the people'' nation, not a ``we the privileged'' nation? I encourage my 
colleagues to read up on the first three words of our Constitution and 
what it means.
  Then we have the plan my colleague from Texas has presented. It is 
referred to as the Cruz amendment. The Cruz amendment--the Cruz 
amendment for fake insurance. It works like this. It says, if an 
insurance company provides one policy with extensive benefits--that is, 
benefits essential to ordinary healthcare like maternity care and the 
ability to go to a hospital, the ability to get a broken bone repaired, 
the ability to get affordable drugs, just the basics of healthcare--
they have one policy with these essential benefits. They can offer 
policies that cover virtually nothing. These are known as fake 
insurance.
  We have a President who likes to talk about fake news virtually every 
day. Why do we have a President who

[[Page S3941]]

hates fake news but loves fake insurance? Why do I have 52 colleagues 
here who apparently love fake insurance?
  Here is what it does. It means the young and the healthy get those 
policies because they cost very little, and they make a bet that they 
aren't going to get hurt and they are not going to get sick. That means 
that those who are older and those who have preexisting conditions have 
to go for the policy that has those essential benefits, but now because 
only the older individuals and the sicker individuals are getting that 
policy, it is way beyond reach.
  Earlier I described how a 60-year-old at $20,000 has a policy that 
increases seven times, from $80 a month to $570 a month. The Cruz 
amendment would make that much worse. It makes fake insurance for the 
young or the wealthy and unaffordable policies for those who are older 
and have preexisting conditions.
  Our President said the House bill is mean, but the Senate bill is 
meaner. The House bill would knock 14 million people out of healthcare 
within a single year. The Senate bill, that is 15 million people.
  The American Medical Association has long operated under the precept 
of, first, do no harm. Wouldn't that be a good principle for 
legislation on healthcare? Is it any wonder that the USA TODAY poll 
says only one out of eight Americans likes this Republican TrumpCare 
bill. We can turn to the PBS NewsHour poll, 17 percent. That is quite a 
small number of Americans who understand that ripping healthcare from 
22 million people in order to give hundreds of billions of dollars to 
the richest Americans is one of the biggest takings this country has 
ever seen proposed and one that so deeply and profoundly damages the 
quality of life for these Americans.
  Our Presidents--Republican and Democratic--over time have understood 
this. President Eisenhower said:

       Because the strength of our nation is in its people, their 
     good health is a proper national concern; healthy Americans 
     live more rewarding, more productive and happier lives.

  He continued:

       Fortunately, the nation continues its advance in bettering 
     the health of all its people.

  Today, on the floor of the Senate, we have a different philosophy, 
not the Eisenhower strategy of advancing the bettering of the health of 
all of our people but in fact the Trump policy echoed by so many of my 
colleagues that is about destroying the healthcare for millions of 
people, taking us back in time to a place where peace of mind was 
missing for millions of Americans because they couldn't either afford 
healthcare or because their policies didn't cover anything. Other 
Presidents over time have weighed in with very similar sentiments to 
that which President Eisenhower put forward.
  Let's hear it from the citizens back home. Kathryn, from Springfield, 
has battled cancer three times over the last 12 years. Kathryn says 
that during her last two bouts with cancer, in 2010 and 2011, she was 
``blessed enough to have qualified for the Oregon Health Plan'' and 
that without it she would not be here today.
  Indeed, healthcare coverage has been a blessing to so many. Let's not 
rip those blessings away.
  Let's go to Beth in Bend and her 34-year-old son who is living with a 
rare genetic condition and relies on the Oregon Health Plan to survive. 
In 2012, doctors found tumors along his spine and areas of concern in 
his brain and his lungs. They are benign now but could turn into cancer 
at any time. Beth's son's life depends on regular, expensive MRIs to 
monitor them. He is only able to afford those MRIs because of the 
Oregon health plan.

  As Beth says, ``If the ACA is repealed and replaced with TrumpCare, 
my son will most likely lose his current health insurance . . . the 
loss of access to affordable insurance is a potential death sentence 
for my son.''
  Medical professionals like Caitlin, a nurse in Portland, tell us how 
significant this is, and she writes:

       With the passage of ObamaCare, I saw people were finally 
     able to come and be seen by our medical teams. Often their 
     disease processes were so advanced that we would have to take 
     very extreme measures to try to halt or reverse these disease 
     processes.
       But as time has passed, we're able to catch things sooner 
     and people can actually go to primary care rather than 
     waiting until it's a matter of life or death and having to be 
     seen in the Emergency Department.

  I am struck by Liz from Enterprise, who works at a clinic and told me 
that the clinic has expanded in this very small, remote town in 
Northeast Oregon from 20-something employees to 50-something employees. 
It has doubled in size, which means an incredible improvement in 
healthcare. She went on to say that they have been able to take on 
mental health as well, which they never were able to do before. Why 
could they afford to do this? Because the uncompensated care dropped so 
dramatically that their finances improved, and they were able to hire 
more staff.
  Let's ask about John in Sherwood. John wrote about his grandmother. 
He lost his grandmother to Alzheimer's a few months ago, but thanks to 
the Oregon Health Plan, his grandmother was able to live in a nursing 
home and get the care she needed 24 hours a day right up until the end.
  As John says, ``I'm forever thankful for the work of President Obama 
and Congress for passing the ACA. If they wouldn't have passed this 
bill, my grandmother wouldn't have gotten the care she needed from 
those great men and women at the nursing home.''
  These stories go on forever. Over this last weekend, I did a series 
of townhalls in rural Oregon, parts of Oregon that would be painted red 
on a political map. I held those townhalls and then went to a series of 
other Main Street walks with mayors and small incorporated cities. What 
I heard everywhere I went--inviting the entire community to come to the 
townhall and talk--was enormous anxiety, enormous anxiety and 
disappointment that the leaders they are counting on here to make our 
healthcare system work better care more about giving more American tax 
dollars away to the richest Americans than they do about fundamental 
healthcare for struggling working families across our Nation.
  Let's listen to those individuals. I know most of my colleagues 
didn't go home and listen to their constituents. As I mentioned, it has 
been reported that only a couple of my Republican colleagues held a 
townhall, even though this bill would affect them so profoundly. Still, 
their voices are echoing through this building, through the emails, 
through the phone calls, through the individuals who are coming and 
visiting our offices both here and back home. Let's listen to those 
voices. Let's be a ``we the people'' nation that works in partnership 
with the American people to make this world, this Nation, provide a 
foundation for every family to thrive.
  That means we have to take an oak stick and pound it through the 
heart of TrumpCare and bury it 6 feet under and then work together in a 
bipartisan fashion. Think of all we could do. We know that when you 
strip away reinsurance, you destroy the market for insurance companies 
to go into new areas and compete. Let's restore that reinsurance.
  We know that when the President holds on to the cost-share payments 
and will not say whether he is releasing them, our companies don't know 
how to price their policies, and they are dropping out of the exchanges 
across this Nation. County after county health insurance companies are 
fleeing because the President will not tell them whether he is 
releasing these cost-share payments. We can fix that.
  We know we have a meth and opioid epidemic across this country. I 
have heard my colleagues on both sides say we have to take this on in a 
more courageous, more substantial fashion. We passed authorizing 
legislation, but let's put funds behind that. Let's do that, and let's 
take on the high cost of pharmaceuticals.
  These four things we can do together. The country would love to see 
Democrats and Republicans working together to make our healthcare 
system work better. That is exactly what we should be doing in 
representing the citizens of the United States of America in a ``we the 
people'' democratic republic.
  The PRESIDING OFFICER. The Senator from Utah.