[Congressional Record Volume 163, Number 121 (Tuesday, July 18, 2017)]
[Senate]
[Pages S4038-S4041]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. HATCH. Mr. President, the final pieces of ObamaCare were signed 
into law a little over 7 years ago. Since that time, Republicans--not 
just in Congress but throughout the country--have been united in their 
opposition to the law and our commitment to repeal it. This hasn't been 
simply a political or partisan endeavor. We are not just trying to take 
a notch out of President Obama's ``win'' column. The simple truth is 
that ObamaCare is not working.
  The law was poorly written, and the system it created was poorly 
designed. Even a number of ObamaCare supporters have come to 
acknowledge that it hasn't been working the way it was promised to 
work. As a result, millions of Americans have suffered astronomical 
increases in their health insurance premiums and fewer and fewer 
insurance options to choose from. That is ObamaCare's great irony: The 
law requires people to buy health insurance while also making it 
impossible to do so.
  For 7\1/2\ years, Republicans have fought to expose the failures of 
ObamaCare and have pledged time and time again to repeal it. Every 
single Republican Member of the Senate has expressed support for 
repealing ObamaCare. Most of us have made promises to our constituents 
to do just that. And those promises, coupled with the obvious failures 
of ObamaCare, are a big reason why we now find ourselves in control of 
both Chambers of Congress and the Presidency.
  For the last 6 months, Republicans have worked in good faith to find 
a path forward to both repeal and replace ObamaCare. The released 
discussion drafts attempted to bridge the divide between our more 
conservative and moderate Members, so the products were never going to 
be perfect. Such is the inherent nature of compromise. The draft 
released last week included additions to address Member priorities and 
was likely the best chance we had at a compromise bill to repeal and 
replace ObamaCare with significant entitlement reform. But last night a 
handful of our Members announced they would not support the compromise 
bill, even though it would have repealed ObamaCare's taxes, reformed 
Medicaid by putting it on a sustainable path for future generations, 
and included the largest pro-life protections on Federal spending I 
have ever seen.
  This was the opportunity we had been working toward. All we had to do 
was come together and compromise, and 7\1/2\ years of promises would 
have been much, much closer to being fulfilled. But last night we 
blinked. And, frankly, I think the Members who opted to scuttle the 
compromise bill will eventually have to explain to their constituents 
why they left so many ObamaCare fixes on the table and walked away from 
this historic opportunity.
  So where does that leave us? The majority leader has announced his 
intention to shelve the effort to repeal and replace ObamaCare with a 
single piece of legislation. Instead, the Senate will move forward to 
vote on legislation to simply repeal ObamaCare, with a 2-year delay. 
So, long story short, we have one more chance to do what we have all 
said we wanted to do.
  I am aware that some Members have already expressed their skepticism, 
if not their opposition, to this approach. I hope they will take the 
time to reconsider. As Senators contemplate this path, they should keep 
in mind that the upcoming vote is not about the next 2 years, nor is it 
about the past 6 months. We are not going to be voting to approve a 
specific process for drafting and enacting an ObamaCare replacement, 
and we are not voting to approve the way this effort has moved forward 
during this Congress.
  I know some of our colleagues have doubts about the path forward. 
Others have complaints about the path that got us here. But this vote, 
in my view, will simply be about whether we intend to live up to our 
promises. Do we want to repeal ObamaCare, or are we fine with leaving 
it in place? That is the question we have to ask ourselves.
  Keep in mind, the vast majority of Republican Senators are already on 
record having voted 2 years ago in favor of a full ObamaCare repeal 
with a 2-year delay. Of course, in 2015, we knew that the President 
would veto that legislation, and we now know that the current occupant 
of the White House would surely sign it. That is really the only 
difference between then and now. Was the vote in 2015 just a political 
stunt? Was it just pure partisanship? I know some of our Democratic 
colleagues claim that was the case. Were they right? I sure hope not. 
On the contrary, I sincerely hope that any Member of the Senate who 
voted for the 2015 bill and who has spent the last 7\1/2\ years 
pledging to repeal ObamaCare hasn't suddenly decided to change his or 
her position now that the vote has a chance to actually matter.
  If we vote to pass a full repeal, will we be solving all of our 
healthcare problems with a single vote? Certainly not. But that was 
never going to be the case. Anyone who thought repealing and replacing 
ObamaCare would be easy once we had the votes was likely not paying 
attention to the problems plaguing our healthcare system. However, if 
we act now to pass the full repeal, we will be taking significant steps 
toward accomplishing our goal and keeping our promises.
  If we pass up yet another opportunity, if we can't muster the votes 
to pass something we have already passed, I have a hard time believing 
we will get another shot to fulfill our promise and repeal this 
unworkable law anytime soon. What does that mean? Among other things, 
it means a congressional bailout of failing insurance markets, probably 
before the end of 2017. Frankly, that ship may have sailed on that one 
after last night's developments. We are probably looking at an 
insurance bailout one way or another. Those who will be interested in 
moving an insurance bailout later this year should be ready to explain 
how they want to pay for it.
  Failure would also mean premiums will continue to skyrocket and 
people will be left with few, if any, available insurance options, even 
though they

[[Page S4039]]

will still face penalties if they don't make a purchase. It would mean 
that the ObamaCare taxes and mandates remain in place, and it would 
keep Medicaid expansion on the books indefinitely, most certainly 
creating a scenario for Governors to advocate for the Federal 
Government to continue paying close to 100 percent of the share for 
able-bodied adults.

  We already know what happens if we leave ObamaCare in place. That 
scenario is playing out before our very eyes. That downward spiral of 
broken promises--the one the American people have to deal with every 
day--is the reason we have all committed to repealing ObamaCare.
  Don't get me wrong. I wish the path that got us to this point had 
been easier, with less melodrama and acrimony. To be honest, I wish we 
had simply moved to this full repeal strategy at the outset because, as 
I noted several times earlier in this year, it is probably the most 
feasible path forward if we want to achieve our goals.
  It would be nice if things had gone differently. But this is where we 
are, with only 52 Republicans in the Senate and a minority that from 
the beginning has wanted no part of this process.
  Right now, we have essentially two choices. We can keep talking about 
repealing ObamaCare and wishing for a better future, one with more 
Republican votes or more Democrats willing to acknowledge the reality, 
or we can press forward with the numbers we have and make good on the 
commitments we have made to the American people.
  To quote the old Scottish nursery rhyme, if wishes were horses, then 
beggars would ride. Translation: More talking and more wishing will not 
get us anywhere.
  We can either take a significant step forward to undo ObamaCare's 
mandates and taxes, which have collectively wreaked havoc on our 
healthcare system, or we can dither about some more and leave them in 
place for the foreseeable future. In my view, the choice is an easy 
one.
  I urge all of my colleagues to once again vote with me to repeal 
ObamaCare. We have blown a number of opportunities already in recent 
weeks. Last night, we blew a big one. I hope we can avoid doing the 
same with this upcoming vote. If not, we will have to answer to the 
American people and explain to them why we failed.
  I yield the floor.
  I suggest the absence of a quorum.
  Mr. CARPER. I ask the Senator to withdraw that suggestion, please.
  Mr. HATCH. I withdraw it.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, good to see you and our friend from Utah. 
I feel compelled to go back in time, if I could. This is a question a 
lot of people ask me back home and around the country: Where did 
ObamaCare come from? The part where most people think of ObamaCare is 
when they think of the exchanges that have been established in all 50 
States, where people who don't have healthcare can get coverage as part 
of a large-group plan. That was an idea that came from RomneyCare.
  In 2006 in Massachusetts, when Mitt Romney was the Governor and was 
running for President, they came up with a really smart idea: Governor 
Romney, you have a much better chance of being elected President if you 
have done what no other Governor has done; that is, to cover everybody 
in your State for healthcare.
  Well, that is an interesting idea. They looked around for ideas, and 
what did they come up with? They came up with an idea that was actually 
suggested by the Heritage Foundation. The Heritage Foundation found its 
way to this body in 1993 in legislation introduced by Republican 
Senator John Chafee of Rhode Island that called for doing five things:
  No. 1 was creating exchanges or marketplaces in every State, where 
people who didn't have coverage could be part of a large group and get 
coverage.
  No. 2, folks who bought coverage on the exchange might be eligible 
for a sliding-scale tax credit. Lower-income people would get a better 
tax credit, reducing their premiums, than people whose income was 
higher.
  No. 3 was the idea of an individual mandate. People had to get 
coverage. If they didn't, they would have to pay a fine. You can't 
force people to get coverage, but in Massachusetts they said: Well, at 
least we will fine them, and, eventually, maybe over time, the fine 
will go up and most people--including young, healthy people--will elect 
to get coverage and be part of a group that is actually insurable, as 
opposed to people who are just sick or who are anxious to get an 
operation or are needing to get an operation.
  The fourth principle, which was the idea underlying the Chafee 
legislation, which would later become RomneyCare, was the idea that 
employers of a certain magnitude, or with a certain number of 
employees, had to cover their employees.
  The fifth principle in that original idea was brought to us from the 
Heritage Foundation, by 23 Republican Senators in 1993--as an 
alternative, by the way, to HillaryCare--and later became RomneyCare. 
The fifth principle was the idea that if you are an insurance company 
and you want to deny coverage to people because they have a preexisting 
condition, you cannot do that.
  That was it. When a number of us in this body worked on the 
Affordable Care Act, we took the Heritage Foundation idea, the idea 
from those 23 Republican Senators who introduced it, cosponsored it--
including Senator Hatch, including Senator Grassley. Some of the folks 
who are complaining the most about ObamaCare or the exchanges are the 
people who supported the original legislation introducing the idea. I 
don't know if that seems ironic to other people. It certainly does to 
me.
  I spent part of Saturday--invited up to Providence, RI, to do 
something I used to do for 8 years--meeting with the National Governors 
Association. For 8 years, as Governor of Delaware, I was privileged to 
be a part of the National Governors Association, at one time vice chair 
and later on as the chairman of the group. They invited me to come back 
and talk about healthcare, healthcare reform, and what was going on 
here in the Senate. I was happy to do that, and we made it work on my 
schedule.
  There, to speak on behalf of the administration, was the Vice 
President of the country, the Secretary of Health and Human Services, 
the OMB Director, and the Administrator of the Center for Medicare and 
Medicaid Services, explaining to the Governors why they should support 
the administration's position and why they should support the 
Republican position here in the Senate.
  Today the Republicans sent out a strong letter--not just Republicans. 
Republican Governors and Democratic Governors sent out a joint letter, 
a bipartisan letter, saying to us, basically: Do these things.
  Their advice to us was this: Hit the pause button; stop what we are 
doing. No. 2, pivot and stabilize. Stop destabilizing the exchanges.
  This administration is trying to destabilize the exchanges, which 
were a Republican idea, and I think, actually, a good idea. But the 
administration has sought to destabilize the exchanges, through a 
variety of tricks that they are pulling.
  The third thing we should do is to stabilize the exchanges. It is not 
all that hard. Make it clear that the individual mandate, or something 
very much like the individual mandate, is going to continue to be the 
law of the land so that we end up with young, healthy people in the 
exchanges and not just a lot of sick people and older people.
  No. 2 is reinsurance. One of the keys to the success of Medicaid Part 
D, the drug insurance program for folks on Medicare, is reinsurance. A 
number of us, led by Senator Tim Kaine and myself and others, said: Why 
don't we take that tried-and-true idea and use it to help stabilize the 
exchanges? I spoke here earlier today on how that would actually work. 
It is not a Democratic or a Republican idea. It is just a good idea.
  The third thing we need to do to stabilize the exchanges--an idea 
actually suggested by a number of Senators, including Senator Jeanne 
Shaheen of New Hampshire--is to say that we are going to continue to 
fund and authorize something called CSRs, or cost-sharing reductions, 
which actually reduce the copays and the deductibles for lower income 
people who buy their coverage in the exchanges.

[[Page S4040]]

  Those three things, we are told by health insurance companies, would 
reduce the cost of premiums in all the States by anywhere from 25 
percent to 35 percent. It would stabilize the exchanges, and it would 
get other insurance companies to say: I don't know if I want to insure 
in Ohio, Delaware, or Utah. Insurance companies would say: Well, I 
think I can offer insurance products there and not lose my shirt. Then, 
they would get back into the exchange. They would offer coverage. Then, 
when more than one or two offer coverage, guess what happens. You have 
competition. And do you know what flows from competition? Better 
diversity of products to choose from and lower costs.
  Those are three things we can do to stabilize the exchanges and, 
frankly, they are not all that hard.
  The fourth thing the Governors suggested we do is, basically, regular 
order. Around here, regular order means that if people have a good 
idea, they introduce it. We turn it in up here at the front desk, and 
the legislative idea goes to the committee of jurisdiction. There is a 
discussion of whether there should be hearings about that particular 
bill. If it is a good bill, there may well be hearings. You have 
sponsors. It could be bipartisan. But, eventually, the idea will have a 
hearing in committee, and those who like that idea or those who don't 
like that idea show up in daylight, in the light of day, and say: Here 
is why I like it; here is why I don't like it. They let their voices be 
heard.
  On issues as important as healthcare, why we are not fully involving 
the Governors is beyond me. I just don't get it. Who runs the Medicaid 
Programs? The Governors in their States. That is a big part of what we 
are debating in this battle.
  I will close with this. I said it before earlier today, and I want to 
say it again. As I travel around Delaware, talking to people in my 
little State--we have a lot of Democrats, we have a lot of Republicans, 
and we have a lot of Independents--they speak to me with one voice, and 
here is what they say: Work together. Solve some problems together. 
Democrats and Republicans, take off your hats and work together. That 
is what they want us to do.
  It is not just Delaware. A Kaiser Permanente national survey released 
last week said 71 percent of the people in this country surveyed said 
we ought to work together and get this done.
  If we are smart, before we leave for the August recess, we will 
stabilize the exchanges with the three things I talked about. The 
administration just needs to stand down and just be quiet on this 
point. If they don't like this Republican idea of the exchanges, just 
be quiet. But we come back here in September, and we go to work, with 
regular order, hearings--bipartisan hearings--bipartisan roundtables, 
and the chance for us to debate legislation in committees in the House 
and in the Senate, and on this floor, and to debate amendments. That is 
the way we ought to do this.
  Anytime in this country when we have done really big things--Social 
Security comes to mind, the GI bill comes to mind, and the 1986 tax 
reform comes to mind--we didn't do it with just Democratic votes or 
Republican votes. We did it together. If we do that, we will be 
stronger together.
  I will close with an old African proverb. It goes something like 
this: If you want to go fast, go alone. If you want to go far, go 
together.
  We need to go far. If we do, we and the American people will get a 
lot further along toward the three things we have sought ever since 
Harry Truman was President: No. 1, cover everybody; No. 2, quality 
healthcare; and No. 3, affordable price. That is the ``holy grail,'' 
and we should strive to get there together.
  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. CORNYN. 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. CORNYN. Mr. President, after weeks--make that months, make that 
years of discussions about the path forward to rescue the American 
people from ObamaCare, we find ourselves at an important fork in the 
road.
  We have talked among ourselves about the necessity of keeping our 
promises to repeal and replace ObamaCare. We are coming down to the 
reality that, without the Democrats being willing to participate in the 
process and given the strictures of the budget reconciliation process, 
it is not going to be possible for us to do as much as we would like to 
do. We will continue to talk, and my hope is that we will continue to 
make progress with some sort of consensus on how best to proceed.
  In the meantime, we do have a bill that 51 Republicans voted for in 
2015 to repeal ObamaCare and leave 2 years available for a transition 
on a bipartisan basis. Here is my concern. Under ObamaCare, there are 
massive amounts of money being paid to insurance companies for 
something called cost sharing in order to try to help bring the 
premiums down, in order to try to help bring the deductibles down to 
make them affordable. It is pretty clear it is not working, given the 
105-percent increase in premiums since 2013 alone under ObamaCare. 
Right now, we know the individual market, which is the insurance market 
where individuals and where small businesses buy their health 
insurance, is in a meltdown mode. That is after 7 years of ObamaCare.
  Our friends across the aisle would like to convince you that in the 6 
months or so President Trump has been in office, he has been the cause 
of that. It is not true.
  Many of us, myself included, would love to see us stabilize the 
individual insurance market while we get some important reforms done to 
try to help bring premiums down in order to reassure people that we are 
going to protect preexisting conditions and while we do some additional 
important work on Medicaid reform.
  I would be lying if I said that this is easy. Frankly, people didn't 
send us here to do easy stuff. They sent us here to do the hard stuff, 
and we need to continue to use our best efforts to keep our commitments 
and to deliver something better than the broken status quo of 
ObamaCare.
  My concern is, if we are unsuccessful in doing that--we have already 
seen, for example, our friend, the distinguished Senator from New 
Hampshire, propose some additional mandatory cost sharing for insurance 
companies. According to the Kaiser Foundation, these are direct 
payments from taxpayers to insurance companies. Rather than working 
with us to try to make a course correction in ObamaCare and to put it 
on a sustainable path--our friends across the aisle want none of that. 
What they want is the cash. They want the billions of dollars that are 
going to go to insurance companies and no reform.
  I personally find that to be an unacceptable alternative. We do need 
to do something to protect people who are being hurt right now from the 
sky-high premiums and the deductibles that render their health 
insurance unaffordable. My concern is, to be absolutely candid with 
you, right now the President is authorizing on a month-to-month basis 
the cost-sharing payments, which are sustaining the market as it 
currently is--not well enough, given the structural problems, but at 
least keeping some insurance companies available in most places, 
although not all.
  My concern is, unless we pass something like the Better Care Act, we 
are left with an untenable alternative. The President's statement that 
he may decide not to make those cost-sharing payments would provoke an 
immediate crisis in the marketplace, which would force us to act. I 
don't think that is inherently bad, but I want to make sure that we act 
in a constructive way, that we are not just throwing billions more 
dollars at a broken system, but that we actually implement the reforms 
to put it on the right path.
  I know in Washington people tend to think in terms of Republicans and 
Democrats, and this is all about Obama, this is about Trump, this is 
about personalities. It is not. It is not even about politics. It 
shouldn't be, ultimately. This should be about the people we represent 
in our States and the people we represent across the country. How can 
we do the best job, given the difficult hand we have been given, to try 
to help make things better?

[[Page S4041]]

  This is not going to be the end of the process. This is another step 
along the journey toward helping to make healthcare more affordable and 
more accessible.
  There is a lot of great work that has been done. As the Presiding 
Officer knows, he has been at the forefront of trying to make sure we 
address things like the opioid crisis, which is devastating communities 
across the country. I was here showing a chart yesterday that the 
Presiding Officer has seen, showing HIV deaths going way down thanks to 
modern drugs, car wrecks were still in the 30,000 range, but deaths as 
a result of overdoses were up around 52,000 a year, I think, is the 
rough number. That is a public health crisis.

  We need to do everything we can to make sure we are delivering 
services to the people who need it most who are suffering, but if all 
we do is bail out insurance companies, we will not have done our job, 
especially toward the communities hurt by the opioid crisis.
  We are going to continue to work, but at some point we are going to 
have to vote, and, yes, people are going to have to be put on record. 
Now, we are all grownups. Most of us have held political office for a 
fair time now. We know how to explain our votes to the voters back 
home, to whom we are accountable.
  If you don't vote, then nobody is accountable, and everybody can 
blame each other for the outcome. I really do worry, unless we redouble 
our efforts to come up with meaningful reforms to the broken ObamaCare 
system, that we will be left with an untenable choice, either an 
insurance company bailout of the same flawed structure of ObamaCare or 
an immediate crisis that is going to force us to act and do the bailout 
without any reforms.
  Mr. President, the other thing I just want to point out, in the 
closing minutes I wish to speak, is the process by which our Democratic 
friends have dragged their heels to the point of almost bringing this 
place to a halt, particularly when it comes to a new President getting 
votes on his nominees for Cabinet positions and sub-Cabinet positions. 
They are the first to criticize the President for not getting things 
done that he wants to get done, but when they sabotage his ability to 
try to populate these important positions in the Cabinet and sub-
Cabinet positions by dragging their heels on nominations, they are 
causing a large part of the problem.
  To put this in perspective, in 2009, 90 percent of President Obama's 
confirmations happened by voice vote. That is without a recorded vote, 
and that is without 30 hours expiring after voting and closing off the 
debate. This was just essentially an agreement in 90 percent of the 
cases.
  Democrats in the Senate under the Trump administration have allowed 
only 10 percent of his nominees to be voice-voted. We allowed 90 
percent for President Obama. We didn't agree with President Obama on a 
lot of things, but we agreed that he won the election, and he was 
entitled to populate his Cabinet and sub-Cabinet with people of his 
choice, assuming they weren't disqualified for some other reason.
  Well, this week, we have considered Patrick Shanahan, nominated to be 
Defense Secretary of the Department of Defense, which is a role vitally 
important to the Department as it works through readiness, 
modernization, and of course the service to our men and women in 
uniform, providing them the tools and equipment and the training they 
need in order to protect the country. In order to accomplish that, the 
Defense Department needs a full team.
  We spend more than $600 billion a year on national defense, and yet 
the President can't get his full team put in place on a timely basis 
because of partisan foot-dragging.
  Well, it serves another purpose, I suppose, because the more we are 
tied up on nominations, the less time we have to deal with legislation. 
These kinds of tactics remind me of the former majority leader, Harry 
Reid, whose political schemes cost his party a 60-vote, filibuster-
proof majority.
  I know the distinguished senior Senator from New York, my friend, the 
Democratic leader, remembers that when Members of his own party can't 
bring back home any record of accomplishment for what they have done 
during their time here in Washington, it is pretty hard to make the 
case you should be reelected. After Harry Reid blocked participation, 
not just from the minority but also from the majority so they couldn't 
go back home and demonstrate that they had fought and accomplished 
things for their constituents, their party suffered a very tough 
political price.
  So I would urge our colleagues to end this perpetual obstruction on 
nominations, legislation, and everything else. Noncontroversial 
nominees should not require days to get confirmed or judges, for that 
matter, should not require a 30-hour postcloture vote in order to get 
confirmed by more than 90 votes. That indicates it is not a 
controversial vote so why burn up the time except out of spite or 
desire to slow down this administration or this Congress in terms of 
getting things done.
  The American people sorely want leaders at every level of our 
government. They are hungry for us to lead and to demonstrate we are 
listening to them and doing what we believe to be in their best 
interest, and they deserve a Senate that fulfills one of our most 
fundamental responsibilities, which is to consider and vote on 
Presidential nominees.
  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. UDALL. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Hoeven). Without objection, it is so 
ordered.