[Congressional Record Volume 163, Number 118 (Thursday, July 13, 2017)]
[Senate]
[Pages S3973-S3975]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mrs. SHAHEEN. Mr. President, I am pleased to be here with my 
colleagues--Senator Klobuchar, from Minnesota, and Senator Heitkamp, 
from North Dakota--to talk about the most prominent issue facing us 
right now; that is, what happens to healthcare for millions of 
Americans.
  At a town hall in Kentucky last week, Majority Leader McConnell said 
that if he can't secure the votes to repeal the Affordable Care Act, he 
will have no choice but to work in a bipartisan way with Democrats on 
legislation to repair and strengthen the law. Well, I was encouraged to 
hear the majority leader say that because I don't think bipartisanship 
should be a last resort. I think it should be the starting point. It 
should be the beginning of the work we do in this Chamber because that 
is what the American people want and that is the best way to make 
lasting public policy.
  This is especially true with healthcare legislation, which impacts 
families all across America. As we have been hearing--and I have had a 
chance to hear it directly from my constituents in New Hampshire--the 
American people have wanted all along for to take a bipartisan 
approach. It is unfortunate that our colleagues on the other side of 
the aisle have spent months trying to pass a partisan, deeply unpopular 
bill.
  Now, I think we would all agree that there are changes we need to 
make in the Affordable Care Act, something for which I have advocated 
since we passed the law. I have had the opportunity to work with our 
colleague Tim Scott from South Carolina. In 2015, we worked together to 
make modest changes to the law to protect small businesses from 
excessive premium increases. I think that bipartisan approach is 
something with which, if we started today, we could make changes in the 
Affordable Care Act to improve it and to make sure that Americans could 
get better access to healthcare.
  We all understand that there are problems currently in the market in 
terms of premium increases, and we know why these premium increases are 
happening. In their 2018 rate request filings, insurers justified the 
increases because of the uncertainty surrounding the repeal of the ACA 
and because this administration refuses to commit to making what are 
called cost-sharing reduction payments.
  These payments were included as part of the Affordable Care Act to 
address premiums, deductibles, and copayments and to make them more 
affordable for working families, basically, to be able to help people 
afford insurance. The payments have been built into the rates that 
insurers are charging for 2017. But as we look ahead to 2018, there is 
a big problem because, if there is uncertainty around those payments, 
it means premiums will skyrockets, insurers will leave marketplaces, 
and people will lose their health coverage. Now, we could fix this 
today if we were willing to work together, because we know what we need 
to do.
  I think New Hampshire offers a vivid example of what we are seeing 
across the country. Last year, insurance markets were stable, health 
insurance premiums increased an average of just 2 percent in New 
Hampshire--the lowest annual increase in the country and in our State's 
history. Unfortunately, today, because of the uncertainty in the 
market, it is a very different story.
  Insurers in New Hampshire are raising premiums for 2018. The same 
thing is happening across the country. In some cases, insurers are 
filing two different sets of rates--one premised on the 
administration's continuing to make those cost-sharing payments that I 
talked about earlier, and the second set with higher premiums to 
account for continuing uncertainty and the possibility that the Trump 
administration, which is legally charged with implementing the 
Affordable Care Act, is going to renege on making the payments that 
have been promised to insurers and, ultimately, to families so that 
they can get healthcare.
  This uncertainty is completely unnecessary. The instability in the 
ACA marketplaces is a manufactured crisis, and we could put a stop to 
it today. That is why I have introduced the Marketplace Certainty Act, 
a bill to permanently appropriate funds that would expand the cost-
sharing reduction payments and ensure that we can count on those 
payments being made.
  I am pleased to be joined by 25 other Senators who have already 
cosponsored this bill, and we can pass this right now if we had 
agreement with our colleagues on the other side of the aisle.
  The Marketplace Certainty Act is also supported by a broad spectrum 
of provider and patient advocate groups--including the American Cancer 
Society, the American Heart Association, the American Diabetes 
Association, and the National Association of Community Health Centers, 
just to name a few.
  We can end the artificial crisis. We could immediately restore 
certainty and stability to the health insurance markets. In turn, this 
would give us the space we need to come together on a bipartisan basis 
to improve the Affordable Care Act, to strengthen what is working, and 
to fix what is not working. That is what we were sent to Washington to 
do.
  Bipartisanship should be our first choice, not a last resort. The 
American people want us to stop bickering over healthcare, to work 
together, and to make the commonsense improvements to the law that we 
should be making.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota--North Dakota.
  Ms. HEITKAMP. That is OK. I am from the better Dakota. I just have to 
tell you.
  Mr. President, I am always perplexed when the opposition party, the 
Republican Party, says: We are the party of business. We are the party 
that believes that government should function more like a business. We 
are the party that believes that we have to make the tough decisions, 
we have to do the work that needs to get done, and we have to do it in 
a timely fashion.
  OK, I get that. There is not a corporate board in America confronted 
with the challenge that we have in healthcare that would not shore up 
the

[[Page S3974]]

cost-saving payments. When you look at those of us who have served on 
corporate boards, those of us who have spent some time in the private 
sector, and, certainly, those of us who have been county officials or 
State officials, where we have actually had to make decisions, we look 
at how you make those decisions. The first thing you do is to try to 
make sure that while you are deliberating and while you are making 
decisions, you don't create market disruption. You don't do the things 
that create more uncertainty. You stabilize what you can, triage what 
you can, and then take a look at what the advantages are and what the 
experience you can bring to bear is to resolve bigger, broader, and 
more systemic issues.
  If we look today at where we are right now with our constituents or 
our customers, if we can put it in a business sense, our customers are 
Americans and American families. Guess what. As for those of us who 
have been in our States and who have spent time looking at healthcare, 
talking to people about healthcare, talking to providers about 
healthcare, I will tell you that there are two emotions they have. They 
are mad, and they are scared. They are probably more scared than mad 
because under the bills that are being deliberated here, the Republican 
healthcare bills, they don't know if they can continue to keep their 
disabled children at home with them. They don't know if they can 
continue to provide for their parents in a nursing home. They don't 
know if their rural hospital is going to be able to survive the kinds 
of reductions in payments that are anticipated under this bill.
  Today in North Dakota, $250 million is the value of Medicaid 
expansion. I have institutions in North Dakota, providers in North 
Dakota that are operating on razor-thin margins. They can't make ends 
meet without making sure that they keep that amount of uncompensated 
care greatly reduced. They need the cash flow.
  If we raise uncompensated care, two things will happen. The first 
thing that will happen under this bill is that they will have a hit to 
their bottom line. The second and obvious consequence of that is that, 
when they negotiate with the private insurance market on what those 
next payments are going to be, they are going to ask for more money to 
put back on the private insurance market the cost of uncompensated 
care.
  Let's also take a look at the growing issue in this country of 
opioids. I have a facility in southwestern North Dakota. Their new 
hospital anticipates that Medicaid is going to be about 14 to 17 
percent of the billings they have. As they are trying to respond--as 
responsible healthcare providers would--to the opioid crisis, they are 
looking at converting the old hospital into a long-term facility, a 
facility where people can go and get healthcare when they are addicted.
  They anticipate that the facility will have to rely on about 60 to 70 
percent Medicaid reimbursement. When people tell you that these issues 
aren't intertwined, that the population that is going to need 
assistance in recovery from addiction is not our Medicaid population, 
they are wrong. Every person who has looked at this has come to the 
same conclusion.
  The other thing I am going to tell you about the people whom I talked 
to is that most of them have never been involved in politics. They are 
not partisans. They don't really even care about politics, but they 
wonder why they are caught up in this tidal wave of political rhetoric 
when people are scaring them about whether they are going to have 
health insurance. They are wondering: What kind of responsible leaders 
would ever do that? What kind of responsible leaders would not do what 
they could today to provide some assurances in the near term that the 
health insurance is going to be available, that their Medicaid is going 
to be available, and that they are going to be able to take care of 
their kids?
  I am telling you that, instead of continuing to release bad bill 
after bad bill, I hope the Republicans will come and honestly take us 
at our word. We stand ready to work with Republicans on a truly 
bipartisan bill that is going to deliver quality healthcare to North 
Dakotans and quality healthcare to the people of this country.
  People think bipartisanship can't happen. That is not true. Yesterday 
I held a press conference on a completely separate issue that involves 
clean coal. Standing side by side when we announced that bill, we had 
Senator Sheldon Whitehouse, one of the most vocal advocates for 
aggressive action on climate, and Senators Barrasso, Capito, and me, 
the most vocal advocates in support of coal. We all stood together 
introducing this bill because we wanted to offer a real solution on 
45Q. We wanted to find out where that lane is where we can all coexist 
and solve the problems of the American people.
  It is not impossible to do this. It is not impossible if we park the 
partisanship, if we park the ideology, and if we start examining what 
the true problems and the true issues with our healthcare system are.
  The answer is usually in the middle. Has Medicaid worked to get more 
people with chronic conditions, to manage care, and to lower costs? The 
answer is yes. Are there too many people on Medicaid? The answer is 
yes.
  We need to grow our economy. We need to help people move them into a 
workplace where they have workplace insurance. Instead of talking about 
how we are going to grow the economy, instead of talking about how we 
are going to raise wages, instead of talking about how we are going to 
help people get set, we are talking about shifting the responsibility 
of the sickest among us, shifting that responsibility to the States and 
back to the patients.
  Just 2 weeks ago, I joined 15 of my colleagues trying to bring some 
commonsense bills forward. I thought we made a great case. We have been 
challenged: You really don't want to work with us.
  That is all facade. That is not true. We are back here again, saying: 
Please, please, work with us. Let's just for a moment do what Senator 
McConnell suggested we do. Let's take care of what is happening with 
the 2018 plan year. Let's remove the uncertainty as we are looking at 
premiums going up and skyrocketing because of that uncertainty. Let's 
remove that uncertainty and solve this problem.
  That is why I am supporting my colleague Senator Shaheen's 
legislation that makes cost-sharing payments permanent and increases 
the eligibility and generosity for that benefit.
  I also cosponsored Senator Carper and Senator Kaine's bill to make 
the reinsurance program for the individual marketplace permanent and to 
devote resources to outreach and enrollment efforts. As a result, it 
would encourage insurance companies to offer more plans in a greater 
number of markets, improving competition, and driving down costs.
  Isn't that what we all want? Everyone can agree that is the 
consequence of this legislation.
  Also, earlier this week I introduced another commonsense bill--the 
Addressing Affordability for More Americans Act. That helps make 
healthcare more affordable for middle-class families. What does that 
mean? We know that right now on the exchanges--when we look at 
subsidization of families on the exchange--we have what we call a cliff 
event. You are either in or you are out, and there is no stepdown. Many 
of our middle-class families could experience a joyous event called a 
pay raise, only to find out that the pay raise evaporates because they 
lose some of the tax advantages that they received because they bought 
health insurance on a private exchange.
  Why don't we glide that out? The same is true, actually, for 
Medicaid. Is there an opportunity to take that slide out, or that glide 
out, and moving more people into the workplace who are on Medicaid?
  I share concerns that people have that the subsidization on both 
Medicaid and on the individual marketplace may result in people not 
taking economic opportunities that are available to them because, in 
the long run, it doesn't pencil out, given where they will be with 
healthcare. Let's take that incentive out. Let's work together. Let's 
solve that problem.
  I think our bill is the starting point. If people have a better idea 
on how to address that concern, I stand willing and ready to make that 
work. I want to say that we are here saying: Let's work together. We 
are here saying: We do not believe that, on this side of the aisle, we 
have all the answers.
  Guess what. I don't believe that, on that side of the aisle, they 
have all the

[[Page S3975]]

answers. I believe we could learn an incredible amount from a hearing 
with a bipartisan group of Governors who are going to be responsible. 
They are going to get this heaped into their lap if this passes. That 
is why you see a bipartisan group of Governors saying: You know what, 
keep it, because that is not a path forward.
  If you want to hear some good ideas, I think we could hear some great 
ideas from the corporate America that has become self-insured--as they 
look at wellness programs, as they look at using big data metrics to 
help keep their population healthier and drive down costs, and as they 
negotiate for better deals with providers.
  There are hundreds of ideas out there. There are hundreds of 
opportunities to learn more before we take this step, but what is the 
process we are in? The process we are in is this: Don't confuse me with 
the facts. Don't confuse me with a new idea. Don't confuse me because, 
politically, we have to do this.
  Do you know what? No one, politically, has to do this. What we have 
been sent here to do is not to fulfill political promises. We have been 
sent here to legislate in the best interest of the American people and 
the people of our States. That is our job--not to represent a partisan 
political idea. Let's do it.
  Let's bring in a whole lot of ideas, and let's park the ideology at 
the door. Everybody, park the ideology at the door. As so many people 
on the other side of the aisle would say, let's start acting in a 
business, yeoman-like manner and start working through these problems.
  We have to do what Senator Shaheen has suggested, and that is to buy 
some time by making sure that we don't disrupt the marketplace today.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I am honored to be here today with 
Senator Heitkamp, from North Dakota--my friend from across the border, 
the prairies--and also Senator Shaheen, from the Granite State. I don't 
think it is a coincidence that the three of us are here today. We have 
worked on a number of bipartisan issues over the years.
  As I was sitting here, I was remembering when Senator Collins stood 
during the government shutdown and asked for people who would be 
interested in working with her on a bipartisan plan to get ourselves 
out of that mess. And all three of us were involved in that effort, 
which was, I note, half women in the group. I think it is time to do 
that again when it comes to healthcare.
  I appreciated it when last week Senator McConnell said it may be time 
to work to strengthen the exchanges and to work across the aisle. Like 
Senator Shaheen, I didn't see it as a last option, I saw it as a first 
option.
  I certainly appreciate the work my colleagues have done to propose 
some smart ideas that could help us improve the Affordable Care Act, 
including the Marketplace Certainty Act. When I talked with our small 
businesses and our citizens in Minnesota, they want that kind of 
certainty to help with cost sharing.
  The idea of doing something more with reinsurance, which we just 
passed on a State basis in Minnesota with a Republican legislature and 
a Democratic Governor--we are awaiting a waiver from Health and Human 
Services here in Washington. We think we should do it in a bigger way 
on a national level, so I also support the Kaine-Carper bill.
  The work that I have been doing on prescription drugs--much of it 
across the aisle with Senator Grassley--to stop this unprecedented 
practice of big pharmaceutical companies paying off generics to keep 
their products off the market--it would save billions of dollars for 
our taxpayers if they stopped that practice.
  Unleash the power of 41 million seniors who are currently barred from 
negotiating for less expensive drug prices. Bring in less expensive 
drugs from Canada--a bill that I have with Senator McCain. There is 
nothing in this new proposal we have seen today that would help in any 
way with prescription drug prices, and that is just wrong.
  That is why we are here to welcome our colleagues to work with us on 
some improvements in a bipartisan way to this bill, because the bill we 
saw this morning would again not do anything--minor tweaks but nothing 
about these major Medicaid cuts that have brought so many people 
together against this bill.
  Minnesota seniors organizations have said that these proposals we are 
seeing that are not bipartisan--it feels like we are pulling the rug 
out from underneath families and seniors. That is why we have seen AARP 
so strongly opposed to a number of the proposals that have been 
circulating around with no Democratic input.
  Many, many people have come up to us across our States. I was in 
northern Minnesota over the Fourth of July and was there among the Lawn 
Chair Brigade in one of my favorite units in the Ely parade and the 
clowns and the Shriners and everything else in the five parades that I 
did. I was so surprised, as I know my colleagues were, at the number of 
people who came up--especially parents of kids with disabilities--in 
front of a whole crowd on the side of the road and said: This is my 
child. He needs Medicaid. He needs help. We need you to stand with us.
  So it is about people like that mom with that child with Down 
syndrome who needs Medicaid. It is about the senior who knows they are 
going to need nursing home help. Thirty-two percent of our seniors use 
Medicaid funding for their nursing home help. A woman told me about her 
mom, who died 2 years ago at 95 after suffering from dementia for more 
than 20 years. She had worked her whole life, but she couldn't afford 
that nursing home and needed that help. It is about our seniors, who 
don't want to see the age tax. It is about our rural hospitals that 
know how important it is to have healthcare not an hour away but 15 
minutes away. That is what we are talking about.
  So we would welcome any efforts to work on these commonsense bills we 
have out there, many of which have had Republican support in the past.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, I thank my colleagues who are here this 
afternoon for their eloquence, their remarks, their passion for making 
sure the people in this country can get healthcare when they need it, 
and for their hard work and legislation to try and make that happen.