[Congressional Record Volume 163, Number 117 (Wednesday, July 12, 2017)]
[Senate]
[Pages S3948-S3951]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CORNYN. Mr. President, as we continue to discuss the Better Care 
Act, which is an alternative bill that we will propose next week and 
vote on, which takes the disaster known as ObamaCare which for millions 
of Americans has led to sky-high premiums and unaffordable deductibles, 
if they can even find an insurance company that will sell them an 
insurance product--we will propose a better care act, as we call it, 
not a perfect care act but a better care act.
  It would be even better if our Democratic colleagues would join us 
and work with us in this effort, but as we have come to find out, they 
are unwilling to acknowledge the failures of ObamaCare. So we are 
forced to do this without their assistance. It would be better if it 
were bipartisan, if they would work with us, but they have made it very 
clear that they are not interested in changing the broken structure of 
ObamaCare. What I predict is that what they would offer is an insurance 
company bailout, throwing perhaps hundreds of billions of dollars at 
insurance companies in order to sustain a broken ObamaCare that will 
never work--no matter how much money you throw at it. So people will 
continue to suffer from the failures of ObamaCare unless we will have 
the courage to step forward and to say we are going to do the very best 
we can with the tough hand we have been dealt to help save the American 
people who are being hurt right now.

  Basically, there are four principles involved. One is we want to 
stabilize the individual insurance market, which is the one that 
insurance companies are fleeing now because they are bleeding red ink. 
They can't make any money, and they are tired of losing money so they 
basically pull their roots up and leave town, leaving customers in the 
lurch.
  Secondly, we want to make sure we actually lower insurance premiums. 
Under the original discussion draft bill that we introduced about a 
week or so ago, the Congressional Budget Office said we will see 
premiums go down as much as 30 percent over time. Now, I wish I could 
say we were going to be able to have an immediate effect on those 
premiums, but the truth is this is much better than our friends across 
the aisle have offered us with the offer to basically sustain a broken 
ObamaCare system.
  The third thing we want to do is protect people who might have their 
health insurance hurt or impeded by preexisting conditions. We want to 
maintain the current law so people are protected when they leave their 
work or when they change jobs.
  The fourth is, we want to put Medicaid on a sustainable path. 
Medicaid is one of the three major entitlement programs, and now we 
spend roughly $400 billion on Medicaid in this country. Our friends 
across the aisle don't want to do anything that would keep that from 
growing higher and higher and higher, to the point where basically the 
system collapses. We believe that is not the responsible choice. What 
we propose is to spend $71 billion more on Medicaid over the budget 
window and to work to transition those States that have expanded 
Medicaid and offer their people a better option in the private 
insurance area, but I just want to mention that I have shared a number 
of stories about, for example, a small business owner in Donna, TX, who 
was forced to fire their employees so they could afford to keep the 
doors open and provide health insurance for the remaining people. You 
have to ask: What in the world could lead us to a system which would 
discourage people from hiring more folks and basically put them in a 
position where they had to fire them in order to make ends meet? But 
that is what the employer mandate did under ObamaCare. If you have more 
than 50 employees, you are subject to

[[Page S3949]]

the employer mandate. You get punished unless you make sure your 
employees are covered with insurance, and many times it is unaffordable 
so it had the perverse impact of small businesses saying: We can't 
afford to grow the number of people who are working in our business or 
we are going to need to shrink it in order to avoid that penalty. 
Stories like this remind me of just how important our efforts are to 
repeal and replace ObamaCare.
  The status quo is not working. In fact, every year ObamaCare gets 
worse for the millions of people in the individual market in 
particular. It is important that ObamaCare is not just about insurance. 
ObamaCare is about penalties that are being imposed on businesses that 
hurt their ability to grow and create jobs. That is one reason I 
believe that since the great recession of 2008, where ordinarily you 
would see a sharp bounce up in the economy, that the economy has been 
largely flat and has not been growing, in part, because of the 
penalties, mandates, and regulations associated with ObamaCare.
  Not only has ObamaCare made health insurance more expensive while 
taking away choices, it also has compounded fundamental problems with 
important safety net programs like Medicaid. I wish to share a story 
from an emergency room employee in Lake Granbury, TX, who wrote to me 
about the alarming trend she has noticed in the hospital where she 
works. She says, because fewer and fewer physicians will see a Medicaid 
patient, she has seen an influx of these Medicaid patients who 
ostensibly have coverage coming to the emergency room for their primary 
care. As she points out, this is not a good situation for patients and 
hospitals. In my State, according to the latest survey of the Texas 
Medical Association that I have seen, only 31 percent of doctors in 
Texas will see a new Medicaid patient. That may sound crazy, but let me 
explain why. Because Medicaid basically pays a physician about half of 
what private insurance pays when it comes to see a patient, many of 
them simply say: Well, I can't afford to see a lot of Medicaid 
patients. I need to balance that or at least make sure I see enough 
private insurance patients to make sure I can keep the doors open and 
meet my obligations. What happens when fewer and fewer doctors actually 
see Medicaid patients is, people end up showing up in the emergency 
room for their primary care because they can't find a doctor to see 
them. The truth is, medical outcomes based on many studies that have 
been done in recent years are that Medicaid coverage in those instances 
can be no worse and no better than not having insurance at all. 
ObamaCare was put in place ostensibly to avoid reliance on emergency 
rooms for access to care, but as we all know, ObamaCare hasn't lived up 
to many of its promises and unfortunately making stories like this one 
commonplace.
  I mentioned this earlier, but just to see the trend line, in 2000, 60 
percent of Texas physicians accepted new Medicaid patients; today that 
number is 34 percent. I think I may have earlier said 31 percent. It is 
actually 34 percent, due to lower rates of provider reimbursement, 
leaving places like Lake Granbury in the lurch and causing them to have 
to turn to the emergency room for their primary care as a last resort.
  Every 2 years, Texas doctors fight with the Texas legislature to 
raise payments for the Medicaid system, but the reality is, there is 
not enough money to go around, even though it is the No. 1 or No. 2 
budget item in the Texas legislature's budget every year, and it is 
growing so fast it is crowding out everything from higher education to 
law enforcement and other priorities.
  Across the country, Medicaid spending has ballooned out of control. 
In Texas, 25 percent of the State's budget, as I indicated, is 
dedicated to this program, 25 percent of its overall budget--usually 
No. 1 or No. 2.
  So we have to be honest with ourselves and the people we represent 
that this situation is not sustainable. We owe it to the millions of 
people to make sure the people who really need it--the fragile, 
elderly, disabled adults and children--that it is there for them, not 
only now but in the future. That is why we have been discussing ways we 
might strengthen the sustainability of Medicaid to ensure that families 
who actually need it can rely on it, and they don't have the rug pulled 
out from under them. This requires doing some hard work of reforming 
the way States handle Medicaid funding.
  For example, Medicaid, as is currently applied, States are only 
allowed to review their list of Medicaid recipients once a year, but a 
lot can happen in a period of a year. Somebody can get a job, and they 
may be no longer eligible based on the income qualifications for 
Medicaid. If they can only check once a year, then people remain on the 
rolls, even though they may no longer qualify. Regardless of whether 
somebody gets a job or moves or passes away or no longer needs 
Medicaid, they are still in the system, and there is nothing the States 
can do about it. We would like to change that. While it sounds like a 
simple matter, when the average Medicaid patient costs the State more 
than $9,000 each and as high as almost $12,000 per elderly individual, 
it adds up.
  One of the things we saw that ObamaCare did in the States that 
expanded Medicaid coverage is that those States decided to cover single 
adults who are capable of working. This bill would also allow States to 
experiment with a work requirement as part of the eligibility for 
Medicaid. We are not mandating it, saying they have to do it, but if 
the State chooses to do it, then they can do so. We need to give the 
States the flexibility they need so they can use the Medicaid funding 
they have more efficiently so more people can get access to quality 
care.
  I want to be clear: 4.7 million Texans rely on Medicaid. Of course, 
those rolls tend to churn based on people's employment and their family 
circumstance, but it is not going anywhere. We want to make sure we 
preserve Medicaid for the people who actually need it the most. We are 
working to make it stronger, more efficient, and, yes, more 
sustainable. I guess some people live in a fantasy world, where they 
think we can continue to spend money we don't have and there will never 
be any consequences associated with it. The fastest items of spending 
in the Federal budget are entitlement programs including Medicaid. 
Right now we are at $20 trillion. We have done a pretty good job--I 
know we don't get much credit for it--we have done a pretty good job of 
controlling discretionary spending, but the 70 percent of mandatory 
spending, including Medicaid, has been going up, on average, about 5.5 
percent a year. That can't happen in perpetuity. Right now, we know we 
have $20 trillion, roughly, in debt--$20 trillion. It is frankly 
immoral for those of us who are adults today to spend money borrowed 
from the next generation and beyond because somebody ultimately is 
going to have to pay it back, and it is going to have real-world 
consequences.
  We know that since the great recession, the Federal Reserve has kept 
interest rates very low through their monetary policy, but we know as 
well that as the economy tends to get a little bit better and 
unemployment comes down, they are going to begin inching those interest 
rates up little by little, which means we are going to end up paying 
the people who own our debt, our bondholders, more and more money 
strictly for the purpose of giving them a return on their investment 
for the debt they buy. This is an opportunity for us not only to put 
Medicaid on a sustainable path, to do the responsible thing, to give 
the States ultimate flexibility in terms of how they handle it, it is 
also a matter of keeping faith with the next generation and beyond when 
it comes to this unsustainable debt burden.
  I hear people talk about slashing Medicaid despite the fact that the 
Congressional Budget Office estimates that Medicaid spending will grow 
by $71 billion over the next 10 years. Only in Washington, DC, is that 
considered a cut, where spending next year exceeds what it is this year 
and the next and so on, and it goes up by $71 billion. Yet you will 
hear people come to the Senate floor and say that is a cut and that we 
are slashing Medicaid. It is nothing of the kind.
  To me, the choice is clear. Do we want to continue with the failures 
of ObamaCare or do we want to do our very best to try to provide better 
choices and better options?
  Do we want to continue to allow the status quo, which is hurting 
families,

[[Page S3950]]

putting a strain on doctors and our emergency rooms and hospitals like 
I mentioned in Lake Granbury or do we actually want to address the 
fundamental flaws of our healthcare system?
  I wish we could do something perfect, but certainly with the 
constraints imposed by the fact that our Democratic friends are not 
willing to lift a finger to help, and given the fact that we have to do 
this using the budget process--those are some pretty serious 
constraints. We basically have to do this with one arm tied behind our 
back, but we are going to do the best we can because we owe it to the 
people we represent. I encourage our colleagues on both sides of the 
aisle to try to take a fresh look at this and figure out how we can be 
part of the solution, not just to compound the problem.
  There is one thing I haven't mentioned that I am particularly excited 
about in the Better Care Act; that is, for States like Texas that did 
not expand Medicaid to cover able-bodied adults in the 100 to 138 
percent of Federal poverty level, in the Better Care Act, we provide 
them access to private health insurance coverage and access for the 
first time. About 600,000 Texans--low-income Texans--who, for the first 
time under the provisions of this bill, will have access to a tax 
credit, and States, using the Innovation and Stability Fund and 
something called the section 1332 waivers, will be able to design 
programs which will make healthcare more affordable in the private 
insurance market.
  One reason people prefer the private insurance market to Medicaid is 
for the reason I mentioned earlier, that Medicaid reimburses healthcare 
providers about 50 cents on the dollar compared to private health 
insurance. This actually will provide them more access to more choices 
than they have now, certainly. Certainly, for that cohort of people 
between 100 percent of Federal poverty and 138 percent of Federal 
poverty in those States that didn't expand.
  I am excited about what we are trying to do here and its potential. 
Again, to stabilize the markets, which are in meltdown mode right now 
and we all know are unsustainable, our friends across the aisle will 
say: We will talk to you if you take all the reforms off the table, 
which translates to me: We will talk to you about bailing out a bunch 
of insurance companies but doing nothing to solve the basic underlying 
pathology in the system. So we are going to do that in our bill, the 
Better Care Act.

  Secondly, we want to make sure that we do everything in our power to 
bring down premiums. I know the Presiding Officer cares passionately 
about this. This may well be the litmus test for our success. Under the 
discussion draft we released earlier, the CBO said that in the third 
year, you could see premiums as much as 30 percent lower, but we would 
like to see even more choices and premiums lower than that and more 
affordable.
  The third thing our Better Care Act will do is to protect people 
against preexisting conditions. Right now, people sometimes refuse to 
or are afraid to leave their jobs in search of other jobs because, if 
they have preexisting conditions, then they cannot get coverage with 
the new insurance companies for a period of time. That is called the 
preexisting condition exclusion. We would like to protect people 
against that eventuality so that people do not have to be worried about 
changing jobs or losing their jobs and losing their coverage.
  Fourth, as I have taken a few minutes to talk about here today, we 
want to put Medicaid--one of the most important safety net programs in 
the Federal Government--on a sustainable path, one that is fair to the 
States that expanded Medicaid under the Affordable Care Act and to 
those that did not. I think any fair-minded person who is looking at 
what we have proposed here would agree with me that it is not perfect 
but that it, certainly, fits the name that we have ascribed to it. It 
is a better alternative than people have under the status quo.
  I urge all of our colleagues to work with us in good faith to try to 
improve it.
  Here is the best news of all, perhaps, to those who would have other 
ideas. We do have an opportunity to have an open amendment process, and 
sometimes that does not happen around here. People say: Here it is. 
Take it or leave it. You cannot change it. All you can do is vote for 
it or vote against it.
  That is not what we are going to do. We are going to have an open 
amendment process. As long as Senators have the energy to stay on their 
feet and offer amendments, they can get votes on those amendments. I 
cannot think of a better way to reflect the will of the Senate and to 
come out with the very best product that we can under the 
circumstances.
  We are on a trajectory next week to begin this process and will have, 
probably, some very late nights and early mornings come Thursday and 
Friday.
  I yield the floor.
  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. REED. 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. REED. Mr. President, I would like to take a moment today to talk 
about the ongoing efforts by the Senate Republicans to take away health 
insurance from millions of Americans by repealing the Affordable Care 
Act.
  I was here on the floor just a couple of weeks ago reading letters 
from my constituents about how they have benefited from the ACA and 
what TrumpCare would mean for them based on what we had seen of their 
bill so far. Since then, my colleagues on the other side of the aisle 
have continued forging ahead in their effort to repeal the ACA, in 
spite of overwhelming opposition. Indeed, nearly every major healthcare 
organization representing patients, doctors, nurses, and hospitals, 
among others, is opposed to this misguided effort, and that is on top 
of the millions of Americans who know firsthand how devastating 
TrumpCare would be for them and their families.
  Senate Republicans are working on tweaks to convince their colleagues 
to vote for this disastrous bill. Unfortunately, their so-called 
``fixes'' are not improvements. That is because, in my view, TrumpCare 
is fatally flawed and cannot be fixed. My constituents know better and 
have continued to write and call--even stopping me in stores and on the 
streets--to express their opposition and fear, quite frankly, of all 
versions of the Senate TrumpCare bill.
  For example, my Republican colleagues are looking to add a provision 
that would bring us back to the days when insurance companies could 
deny coverage or charge exorbitant amounts for those with preexisting 
conditions. The Affordable Care Act ended this practice once and for 
all, we hope, and I can't imagine why my colleagues want to bring back 
those discriminatory policies. However, the amendments that several 
Senators have proposed would do just that. They would allow insurance 
companies to sell plans on the marketplace with no protections for 
those with preexisting conditions, which would create a death spiral in 
the marketplace, so that the very people who need health insurance the 
most would be priced out entirely.
  Just last week, I heard from Anne in North Smithfield, RI, about this 
very issue. Anne said:

       I am the parent of a childhood cancer survivor. The last 11 
     months of my life have been fighting alongside my warrior, my 
     hero, my 9-year-old osteosarcoma survivor, Julia. She loves 
     unicorns, horses, the beach, and going for walks. Due to no 
     fault of her own, she hasn't been able to walk for the past 
     11 months.
       I am writing to ask for your support to ensure that all 
     children fighting cancer have access to affordable, quality 
     healthcare. If enacted into law, the current proposal for the 
     healthcare bill will have devastating impacts on the hundreds 
     of thousands affected by childhood cancer. Without quality 
     health insurance and access to treatment, my child would not 
     have survived.

  Anne went on to explain that the Republican efforts to undermine 
preexisting conditions protections would be devastating for childhood 
cancer survivors. Even parents who get their insurance through their 
employer would be at risk. Anne pointed out that nearly half of 
families of children with cancer will experience gaps in coverage 
because one or both parents often need to stop working or reduce their 
hours to care for the child.
  Further, TrumpCare erodes other critical consumer protections by 
allowing annual and lifetime limits on care.

[[Page S3951]]

  Anne continues her message:

       Additionally, childhood cancer patients must be assured of 
     access to essential health benefits without the threat of 
     lifetime or annual caps that would effectively price patients 
     out of lifesaving treatments. Two-thirds of childhood cancer 
     survivors will develop serious health conditions from the 
     toxicity of treatment. My child's future is already uncertain 
     enough. We should not have to worry about annual or lifetime 
     caps on coverage.

  I agree with Anne. What use is healthcare coverage that expires just 
when you need it the most? Why would anyone think it makes sense to 
sell a health insurance policy for thousands of dollars that doesn't 
actually cover anything--or nothing--when you need it? This is a step 
in the wrong direction, and I continue to urge my Republican colleagues 
to reverse course.
  I would also like to talk about what this bill would do to those 
suffering from opioid addiction, a public health crisis that has taken 
a tremendous toll on our country and particularly on my home State of 
Rhode Island.
  I, along with many of my Democratic colleagues, have been talking 
about how the Senate TrumpCare bill would pull the rug out from many of 
those who are suffering from substance use disorders, like opioid 
addiction, by decimating Medicaid, which is how many people suffering 
from the opioid crisis access treatment.
  News reports suggest that Republicans are considering adding a fund 
for opioid addiction treatment as another so-called fix to the 
TrumpCare bill. While we absolutely need more Federal funding to expand 
access to drug treatment--in fact, I have been urging Republican 
leaders to do just that for years--what they are proposing cannot make 
up for the bill's nearly $800 billion in cuts to Medicaid with a $45 
billion opioid fund. The math simply doesn't work.
  Second, short-term drug treatment programs do not provide a full 
spectrum of healthcare coverage over the long term, like Medicaid or 
other health insurance coverage. The Medicaid expansion under the ACA 
has provided the security of reliable healthcare coverage and long-term 
stability to help people with chronic conditions such as substance use 
disorders seek treatment and turn their lives around. TrumpCare takes 
that away.
  In addition, people with opioid addiction suffer from other mental 
health conditions at twice the rate of the general population and 
higher rates of physical health conditions as well, which would still 
go unaddressed in this so-called fix. We will be setting people up for 
failure if we provide immediate drug treatment services but cut access 
to the other mental and physical healthcare services they need.
  An opioid fund alone will not solve this public health crisis and, in 
fact, would be a drop in the bucket compared to how the rest of this 
bill would worsen the crisis.
  The cuts to Medicaid under the Senate TrumpCare bill are beyond 
repair. The Senate TrumpCare bill fundamentally changes the structure 
of the Medicaid Program, making massive cuts, representing a 35-percent 
cut over the next two decades. Simply put, this will end the Medicaid 
Program as we know it, which will hurt not only those suffering from 
the opioid crisis but also seniors, children, and people with 
disabilities. We may see Republicans try to spread out this harm over 
more years to hide the damage, but do not be fooled. Whether they make 
massive cuts to Medicaid in 2021 or 2022 or even 2026, for that matter, 
the cuts will be devastating.
  In short, no fix can undo the damage this bill will cause. This bill 
is a massive tax break for the wealthiest Americans at the expense of 
everyone else. No amendment or tweak to the bill will change that.
  Sharon from Wakefield, RI, wrote to me just a couple of days ago and 
summed this up very well. She said:

       I do not support the so-called American Health Care Act 
     because it is not a health care plan, it is a tax cut for the 
     rich. I am 67 years old, and I have a mild version of 
     muscular dystrophy, and I have Medicaid. Since the GOP wants 
     to end Medicaid, I am asking you to vote NO on the bill.

  Republicans must abandon this effort and come to the table to work 
with Democrats on a new path forward. Let's have productive 
conversations about how we can improve access to care and bring down 
costs. Let's harness this interest in improving access to drug 
treatment and work together on those efforts. But, coupled with the 
TrumpCare bill, those efforts will not mitigate the damage this bill 
will inflict on my constituents and those across the country.
  I hope those on the other side of the aisle who have expressed 
misgivings will oppose TrumpCare in all of its forms so that we can 
work together on a bipartisan solution and attempt to do something 
positive for our constituents.
  With that, Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant bill clerk proceeded to call the roll.
  Mr. WHITEHOUSE. 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. WHITEHOUSE. Mr. President, I ask unanimous consent to speak for 
up to 10 minutes as in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.