[Congressional Record Volume 163, Number 120 (Monday, July 17, 2017)]
[Senate]
[Pages S4010-S4012]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. CORNYN. Mr. President, on Thursday, after two additional weeks of 
consultation and input from Senators, we released an improved version 
of the bill we call the Better Care Reconciliation Act, which 
represents our efforts to address the failing status quo of ObamaCare.
  We have said all along that even if Hillary Clinton were elected 
President, we would have to revisit ObamaCare because we have seen in a 
number of States that insurance companies are fleeing, leaving people 
with few, if any, options. People in the individual and small group 
market are seeing their premiums skyrocket 105 percent, nationwide, 
since 2013 alone--a 105-percent increase in premiums.
  For many of these folks, even though they paid the higher additional 
premium, their deductibles are so high that, effectively, they are 
being denied the benefit of any insurance whatsoever. I guess, perhaps, 
it is no surprise that 28 million Americans would simply be willing to 
pay the fine that goes along with the individual mandate for not buying 
government-approved health insurance or claim some sort of hardship 
exemption.
  ObamaCare was sold under the premise that, if you like your policy, 
you can keep your policy, and, if you like your doctor, you can keep 
your doctor and, oh, by the way, your premiums are going to go down 
$2,500, but what people have experienced has been the opposite of that, 
with premiums going up on average $3,000.
  We simply believe that we have to act to save the millions of people 
who are being hurt by the status quo. That would be true whether 
Hillary Clinton were President or Donald Trump were President.
  Our first goal in the Better Care Reconciliation Act is to stabilize 
the insurance markets, to make sure that people actually have an 
insurance company they can buy from.
  Our second goal is to get premiums down. The reasons premiums are not 
down are mainly twofold. One is that you have younger, healthier people 
simply forgoing insurance, leaving only sicker, older people in the 
risk pools. Under adverse selection, that means everybody pays higher 
premiums when younger, healthier people simply don't purchase the 
product because they can't be part of that risk pool. The second reason 
why premiums are so high is the mandates. People are simply being 
ordered by their own government to buy coverage they don't want or 
need, which drives up premiums, not to mention the fact that young 
people are subsidizing older people's health insurance premiums the way 
that ObamaCare was constructed.
  We are going to do everything we can to get the premiums down. The 
first Congressional Budget Office report said that long term you would 
see premiums go down by as much as 30 percent by the year 2020, but we 
want to do even better than that if we can.
  The third thing we said we wanted to do was that we wanted to protect 
people with preexisting conditions. When

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people are forced to keep a job they really don't want because they 
don't want to lose their employer-provided health coverage due to 
preexisting conditions, we don't want people to be stuck at a job they 
don't want or be unable to quit their job and look for something else 
because they are worried about not being covered due to preexisting 
condition exclusions. We maintain the current status of the law with 
regard to protecting people with preexisting conditions.
  The fourth thing that we try to do in this bill is that we try to 
take one of the large entitlement programs, Medicaid, which is an 
important safety net for low-income Americans, and we put it on a 
sustainable path. There are some people who think you can spend 
hundreds of billions of dollars more for Medicaid over time and we can 
continue to deliver those services to the poor people in our country, 
and we don't need to worry about crowding out defense spending or 
education or some other priority. We simply cannot do it. What we have 
done is put it on a responsible growth rate and delegate more of that 
authority to the States to come up with innovative programs.
  Our plan will remove costly mandates and will help provide more 
options and drive down some of the exorbitant costs. We will soon have 
a chance to rescue the American people from the failures of the 
ObamaCare experiment. This is a critical moment for the Senate.
  I want to go over a few updates to the discussion draft, perhaps in 
the hopes that some of my colleagues on both sides of the aisle will 
realize that, when faced with the choice of our reform plan or the 
status quo, the choice is clear.
  After listening to a number of Senators, we made some important 
updates. For example, to combat the opioid epidemic that is ravaging 
the country, our new draft includes an additional $45 billion for 
substance abuse and recovery.
  As this chart indicates, the number of people with HIV has gone down 
to 6,400, thanks to innovations and drug therapy, principally. As to 
car accidents, 37,000 people a year die in the United States as a 
result of car accidents, but 52,000 people--and growing--lose their 
lives due to opioid and other drug overdoses.
  This is an epidemic that has to be dealt with. The abuse of heroin 
and prescription painkillers is devastating families and communities 
all across the country, but, particularly, we hear from our colleagues 
in Ohio, West Virginia, and Kentucky that this is an urgent and unmet 
need.
  These additional resources will be critical for providers, for 
advocates, and for families on the front lines of this crisis. As I 
said, our colleagues from Ohio, West Virginia, New Hampshire, and other 
places advocated for something called the Comprehensive Addiction and 
Recovery Act last year, which we were able to pass to address this 
crisis, and we passed additional legislation called the 21st Century 
Cures Act in December, which, again, added additional resources. But 
this represents the single largest allocation or appropriation of 
Federal dollars to deal with this crisis than has ever occurred before. 
I think it is because it is necessary, and I thank our colleagues for 
bringing this to our attention. This is a shocking statistic, when you 
think about it--that more people die of drug overdoses in America today 
than die in car accidents--and we are going to do something about that 
in this legislation.

  We are also introducing a provision that, for the first time, would 
allow people to use pretax dollars to pay for their insurance premiums. 
Let's say you paid 25 percent of your income to taxes. If you can use 
pretax dollars, then, basically, that effectively lowers your out-of-
pocket cost if you can use pretax dollars rather than the net of tax.
  We expand the use of health savings accounts to give people that 
ability, which effectively lowers the cost of their premiums, again, 
and provides them more flexibility in terms of determining how to 
provide for their healthcare. Some people may decide--and we want to 
give them the freedom to do so--to say: Maybe, all I need is a 
hospitalization policy in addition to a health savings account, where I 
will put pretax dollars in there and save them and use those to pay for 
doctors' visits.
  That is the kind of thing that we have seen in States like Indiana 
and elsewhere, which have been used very effectively to provide 
additional choices for consumers and their physicians on how they 
address their healthcare needs and their costs. As I say, allowing 
consumers to use pretax dollars to pay for their health insurance 
premiums will help bridge the coverage gap.
  Both the Congressional Budget Office and the Joint Committee on 
Taxation have affirmed that this will help boost access to healthcare 
coverage.
  Another improvement this latest discussion draft brings forward is 
more options to buy lower premium plans. Under the Better Care Act, 
anyone in the individual market is allowed to purchase a lower premium 
health insurance plan, like the one I mentioned.
  While those plans have lower monthly costs with a higher deductible, 
they will still cover up to three primary care visits a year and, 
ultimately, limit an individual's out-of-pocket costs. Coupled together 
with the health savings account, this may well be the most affordable 
way for people to address their healthcare.
  Not everybody is the same. That was part of the problem with 
ObamaCare. It treated us all like we were widgets and not human beings 
with unique needs, depending on our family circumstances or our health 
condition or what part of the country we lived in. This allows people 
to personalize and individualize their own healthcare plan.
  I think this is great news for otherwise healthy adults previously 
barred from purchasing these plans under ObamaCare. Young people, whom 
we need in the insurance pool in order to bring down premiums for 
everybody else, don't want to have to subsidize older folks' health 
coverage. They want to pay the freight for their own costs, but this 
will allow them access to a lower cost plan that will allow them to be 
covered for an unexpected hospitalization or other catastrophic event.
  In addition to this freedom of choice, these plans will now also be 
eligible for tax credits. In other words, what we provide is a 
refundable tax credit, which essentially is a check from the Federal 
Government to the insurance company to pay your health insurance 
premium.
  Under ObamaCare, people enrolled in these sorts of catastrophic plans 
were prohibited from receiving tax credits like the ones we are 
offering, even when they met all other eligibility requirements. That 
doesn't make any sense, and our legislation fixes that.
  We have also made several revisions to Medicaid. I might mention that 
there is a lot of discussion about whether we are cutting Medicaid. I 
have said before that only in Washington, DC, can you spend more money 
year after year and be accused of cutting.
  Honestly, fairly, what we do is to reduce the rate of growth for 
Medicaid, this uncapped entitlement program that contributed more than 
$20 trillion to the national debt. We put it on a reasonable budget and 
a rate of growth. Actually, from the beginning until the end, we will 
see Medicaid spending go up by the Federal government by $71 billion.
  Ultimately, for Medicaid to work more efficiently for the people it 
is intended to serve--primarily, the children, the blind, the disabled, 
and the elderly frail--we need to give the States more flexibility to 
implement Medicaid spending based upon the unique needs of people in 
their States.
  One of the big problems with ObamaCare is that it expanded Medicaid 
to otherwise healthy adults. We have a better way to deal with that, 
using the tax credit, the State innovation and stability funds, and 
something called the 1332 waivers, where the Centers for Medicare and 
Medicaid Services essentially is giving the States the opportunity to 
innovate and use the money and the tax credit to come up with something 
that suits the needs of their population.
  Really, what we need to do is to get Medicaid focused again on the 
most vulnerable populations, which are the disabled, the blind, the 
frail elderly, and children. To improve the management of vulnerable 
populations such as this, now States can apply for a waiver

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to utilize existing funds as they see fit to improve community-based 
services that these folks rely on.
  Our Medicaid provisions allow the States flexibility to route funds 
to regions impacted by public health emergencies, which include 
disastrous weather events like hurricanes. Instead of being applied as 
a block grant or based on per capita caps, under our legislation, 
emergency funding will be applied where and when it is needed.
  Lastly, under our Medicaid revision, States can add expansion 
populations under existing block grants if they choose to do so. 
Medicaid will always be as it has been--a Federal-State shared expense. 
By allowing States to be flexible in their Medicaid application, we can 
help them fill the gaps that the mandates under ObamaCare chose to 
merely gloss over. For example, in Texas, we were not a Medicaid 
expansion State. So young adults between 100 percent of poverty and 138 
percent of poverty will now get access to a tax credit with the 
innovation and stability funds and these waivers, which will allow 
them, for the first time, to get access to private health 
insurance. That is good for them, and I think represents a vast 
improvement on the status quo--about 600,000 in Texas alone.

  Our new draft includes an additional $70 billion to encourage States 
and help them implement these new reforms. What I have come to learn 
is, people don't really trust Washington, DC. Certainly, based on the 
experience of ObamaCare--this failed experiment where people were 
promised certain things that ended up not being true and created the 
problems we now are having to fix--I think people will have a lot more 
confidence in a plan that lets the Governors and lets the State leaders 
manage this money and address the healthcare needs of their population 
by people who are closest to those people rather than out of 
Washington, DC.
  Our bill does that in a dramatic way. It takes that authority and 
power grabbed by ObamaCare and gives it back to the Governors and the 
States to manage. Based on the polling I have seen, people certainly 
have greater confidence in the States and their leadership at the local 
level to deal with this than they do under ObamaCare. If Governors want 
to try to come up with unique healthcare products to drive down 
premiums, cost sharing, or increased funding for health savings 
accounts, this legislation gives them greater flexibility and gives 
them additional funding through the Innovation and Stability Fund to do 
just that.
  Many of us have quoted Louis Brandeis, who served on the U.S. Supreme 
Court, who said: States are the ``laboratories of democracy.'' It is 
true. You don't see any innovation at the Federal level. It is more 
like dealing with the Politburo. It is all command and control--central 
planning, which we know doesn't work very well. The States are the 
laboratories of democracy. If we give them the freedom to innovate and 
the resources to do so, I think we can expect our healthcare system to 
move forward.
  Soon we are going to have a critical vote, one that has been 7 years 
in the making. While our plan is not perfect, it is certainly better 
than the status quo, which is why we call it the Better Care Act. This 
is not the end, as Dr. Tom Price, of Health and Human Services, points 
out. This is just the next step. We know we are going to have other 
opportunities to address healthcare, most notably in September, when we 
reauthorize the Children's Health Insurance Program, but this, by any 
measure, represents an improvement over the status quo.
  I think there are some very useful parts of this bill that people 
will like if they look at it objectively and consider it fairly, but if 
we don't take up the bill, well, it can't be changed, and millions of 
Americans will continue to be harmed by the status quo. That is a 
decision we all have to make when we move to the bill.
  Do we have enough confidence that we can make it better or are we 
simply going to throw our hands up and say, ``Well, I give up,'' before 
we even start, leaving people with the failure of the status quo?
  I would like to encourage our colleagues to work with us to make this 
legislation better. It is unfortunate that healthcare has become such a 
polarizing and partisan issue. It doesn't need to be that way, but it 
started off with ObamaCare, which was passed along purely party lines, 
creating a situation where there is not bipartisan support for 
healthcare, generally, which is a real tragedy, given the importance 
this has to all of us and all of our families. Given the hand we have 
been dealt, we are going to plow ahead and do the best we can.
  I sat down at my computer this morning, and I started to write a list 
of things I liked about the Better Care Act that perhaps most people 
haven't heard much about. No. 1, it repeals the individual mandate. 
This is the fine that has been imposed on people for not buying 
government-approved health insurance. It repeals the job-killing 
employer mandate. This bill will lower premiums, repeal burdensome 
taxes, and restore choices. It will help stabilize insurance markets 
and protect people with preexisting conditions. It will allow people to 
use pretax dollars to pay for their healthcare costs, including 
insurance premiums. It provides substantial resources to fight opioid 
and other substance abuse. It provides better quality coverage to low-
income Americans that will improve medical outcomes for low-income 
Americans, and it puts Medicaid on a sustainable path.
  I would like to encourage all of our colleagues to work with us to 
help make this legislation even stronger. Everybody will be able to 
offer an amendment and get a vote on the amendment when this bill comes 
to the floor. I believe the alternative is a disaster for our country, 
and we simply can't afford to let it stand.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Florida.
  Mr. NELSON. Mr. President, I came to speak on a different subject and 
will not speak at length about the healthcare bill because this Senator 
has spoken on a number of occasions about the healthcare bill. Suffice 
it to say, in light of what the majority whip has just said; that if we 
really did want to seek a bipartisan solution to the healthcare 
situation in expanding healthcare for as many people as we possibly 
can, then what we do, in a bipartisan way, is start saying: We have a 
current law. Let's fix what needs fixing.
  This Senator can say there are a number of discussions going on 
between Democratic Senators and Republican Senators about doing just 
that--about such items as a reinsurance fund to ensure companies 
against catastrophe, the likes of which, in a proposal this Senator has 
filed, has been costed out. In my State of Florida, it would reduce 
insurance premiums for health insurance 13 percent. Ideas like that--in 
a bipartisan way--will solve and bring stability to the marketplace. 
That is why insurance companies, in fact, are being vigorous in their 
opposition to the Senator Cruz part of the bill that basically 
destabilizes the market by taking all of the older and sicker people 
and putting them in one pot and putting the younger and healthier 
people in another pot, which is exactly the opposite of what the 
principle of insurance is. The principle of insurance is, you spread 
the risk over as many people as you can and thereby can bring down the 
per-unit cost.
  If we really wanted to fix it in a bipartisan way, we would be able 
to, but still, as you can see, there is not the appetite for that in 
this highly polarized, highly ideological, and highly partisan 
atmosphere we find ourselves in on this particular topic.