[Congressional Record Volume 163, Number 123 (Thursday, July 20, 2017)]
[Senate]
[Pages S4103-S4106]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. President, it is my sense that if you thought the TrumpCare 
debate in the Senate had met its end on Tuesday, it is pretty obvious 
you ought to be thinking again. The zombie stirs once more.
  The latest attempt by the majority to cobble together 50 votes, 
according to reports, comes down to waving a $200 billion slush fund in 
front of Senators from States that expanded Medicaid under the 
Affordable Care Act.
  As the ranking Democrat on the Senate Finance Committee, I am very 
pleased that the Presiding Officer joined the committee this year. We 
have studied this one-time slush fund, and the theory, of course, is 
that it is supposed to be enticing enough for a Senator to vote for a 
bill that still slashes Medicaid to the bone.
  Let's be realistic about what the slush fund represents in the 
context of

[[Page S4104]]

the overall plan. Senate Republicans are steering tens of millions of 
Americans toward a cliff and are offering the world's smallest pillow 
to break the fall.
  Before I go further on the specifics of what the majority has on 
offer, I want to step back and take a look at what the American people 
have been subjected to over the course of this debate. The reason I 
want to do this is that, even by Beltway standards here in Washington, 
this is the absolute worst of this city.
  In the crusade to repeal the Affordable Care Act, the ACA, there has 
been the AHCA--the House TrumpCare bill. That is the one that earned 
the big victory ceremony with the President of the United States in the 
Rose Garden. Next, we had the BCRA--the Senate TrumpCare bill. Then, 
there was a second version of the BCRA. Then, along came something 
called the ORRA, the bill I have called ``repeal and ruin,'' which got 
its start back in 2015. Then, this morning, the public got a look at a 
third version of the BCRA. My sense is, if you are having coffee in 
Coos Bay, OR, or in Roseburg over lunch or something like that, your 
head is going to be spinning as you hear this news.
  I also want to make sure folks know about the strategy that has come 
out of the White House over the last few days. The President first 
endorsed the Senate's TrumpCare bill, but then it was repeal only. 
Then, while the country watched the administration sabotage the 
Affordable Care Act, the President said that everybody ought to just 
sit back and watch what happens. Then it was back to calling for the 
Senate majority to pass TrumpCare.
  Nobody in this Chamber, with the possible exception of Senate 
Majority Leader Mitch McConnell, can claim to really know what is 
coming down the pike on American healthcare. So with the health and 
well-being of hundreds of millions of Americans at stake, this shadowy, 
garbled, and wretched process really just leaves your jaw on the floor.
  Senate Republicans seem to be speeding toward a vote on something. As 
I mentioned, there is the prospect of this $200 billion slush fund 
being dangled out there to help round up votes. My sense is that this 
slush fund is of zero consolation to the millions of Americans who live 
in States that didn't expand Medicaid. It is of zero consolation to the 
tens of millions of middle-class families who are going to have their 
tax cuts or healthcare ripped away and see their premiums skyrocket. It 
will be of zero consolation to middle-class families who are panicked 
over whether they are going to be able to take care of elderly parents 
and grandparents when long-term care through Medicaid is cut.
  Make no mistake about what this slush fund really does; it just 
delays a little bit of the pain for a short time in States that 
expanded Medicaid. But the slush fund is going to run dry. That is a 
fact. State budgets are going to get hit like a wrecking ball. That is 
the reason so many Governors are so unhappy with what is on offer.
  There is no escaping the consequences of whatever the Senate passes. 
If you had objections to TrumpCare or a repeal-only bill yesterday, 
this doesn't change a thing.
  A few hours ago, the nonpartisan Congressional Budget Office--for 
folks who don't follow the lingo and CBO, those are our nonpartisan 
umpires. They put out an analysis of the third version of the Senate 
Republican healthcare bill. If you were hoping that was the charm, the 
news doesn't exactly help your cause.
  The CBO found that it is still going to send premiums through the 
roof. The new version is going to kick 22 million Americans off their 
healthcare. It is still going to make healthcare unaffordable for 
millions of Americans with preexisting conditions. That is especially 
troubling to me--and I know the Presiding Officer is very interested in 
the policy foundations of these big issues. Before the Presiding 
Officer came to this body, I worked with one of our former colleagues, 
and we put together what is still the only comprehensive bipartisan 
health reform--seven Democrats, seven Republicans--that has been 
introduced in this body. One of the priorities that those Senators--and 
some of those colleagues on the other side of the aisle are still here; 
they were cosponsors of this bill, and many of the Democratic sponsors 
are still here. There was bipartisan agreement that there should be an 
airtight, loophole-free commitment to protecting people with 
preexisting conditions. As I said, seven Democrats, seven Republicans 
signed off on that bill. A number of them from both sides still serve 
in the U.S. Senate today.
  Now what is being discussed is an approach that would make healthcare 
unaffordable for millions of people with preexisting conditions, really 
taking a big step back--and I have heard my colleague speak about this, 
commenting on TV shows and the like--toward the days when healthcare in 
America was for the healthy and the wealthy. That is what you get if 
you don't have airtight protections for those with preexisting 
conditions, if you don't have what we had in our original bill by seven 
Democrats, seven Republicans--airtight protections, loophole-free 
protections for those with preexisting conditions. If you don't have 
it, you are marching back to the days when healthcare was for the 
healthy and wealthy, where you could not move to another job if you got 
a great opportunity because you had a preexisting condition. You were 
immobilized. That is where this is going with the proposal to make 
healthcare unaffordable for millions of people with preexisting 
conditions, turning back the clock, moving away from what has strong 
bipartisan support in this Chamber with Senators on both sides who are 
still here.
  For those who care about the affordability of health coverage, there 
is a statistic that really leaves you without words. Under the Senate 
Republican bill, in 2026, a middle-aged American who brings home 
$26,500 annually will face a deductible of $13,000--$13,000. If you are 
watching this, remember that figure the next time you hear that the 
Senate Republican bill lowers costs or puts the patient at the center 
of care. If this bill becomes law, that individual with a $13,000 
deductible is one bad injury or diagnosis away from personal 
bankruptcy. How does that figure compare to the system on the books 
today, you might ask? Under the Affordable Care Act, that same 
individual's deductible is $800.
  The other option being put forward by Senate Republican leaders is a 
repeal-only strategy, and they claim it would have a 2-year transition. 
But the numbers from the Congressional Budget Office make clear that 
the idea of a transition after a repeal bill passes is a fantasy.
  ``Repeal and run'' means that 17 million Americans lose coverage in 
the first year; 32 million Americans lose coverage within a decade; 
premiums in private market plans double. It is easy to see why. My 
colleague in the Chair, the Presiding Officer, knows so well about the 
signals that are sent to the private marketplace; we are talking about 
the marketplace. If you are pouring gasoline on the fires of 
uncertainty in the private insurance sector and people can't plan and 
they can't calculate, what will happen during this 2-year transition? 
You are going to have bedlam in the marketplace. It is a prescription 
for trouble, and premiums and private market plans will double.
  The numbers I am talking about are real lives. I was the director of 
the Gray Panthers senior citizens group for almost 7 years before I was 
elected to the Congress. This is my background. As I started to see 
government reports and the like, I came to realize that those reports--
all those facts and figures on pieces of paper, long sheets of paper, 
figure after figure--are not really what this debate is all about. This 
is a debate about people, about their hopes and aspirations and what 
they want for the future. Families are worried, for example, about how 
they are going to pay for the care of an older parent. I think about 
those seniors I met as director of the Gray Panthers. They did nothing 
wrong. They scrimped and saved, and they didn't go on the special 
vacation. They didn't buy the boat. They did everything right. They 
educated their kids and tried to sock away a little money. What we know 
is, growing old in America is expensive. In spite of being careful 
about costs all their lives, when a spouse needed extra care or they 
had early onset of healthcare problems, they went through all the money 
they saved. Then they needed Medicaid.

  Medicaid now picks up the costs of two out of three nursing home beds 
in

[[Page S4105]]

America. What is not known is very often seniors need not just that 
care, but they need home and community-based care. They need a 
continuum of services so they get the right kind of care at the right 
time.
  They are looking at this bill. They are saying this is going to make 
my prospects for being able to afford care--whether it is nursing 
homes, home and community-based services--an awful lot harder to figure 
out in the days ahead.
  We have young people who have been through cancer scares. We have 
single parents who work multiple jobs to put food on the table. This is 
what I am hearing about at home. When I had the good fortune of being 
chosen Oregon's first new Senator in almost 30 years, I made a pledge 
that I would have an open meeting, open to everybody in every one of my 
State's counties. We have 36 counties in Oregon.
  This year, so far, I have had 54 open-to-all town meetings. Each one 
of them lasts 90 minutes. There are no speeches. People say what they 
want. They ask a question. It is the way the Founding Fathers wanted it 
to be. They are educating me, and I am trying to respond. I am trying 
to take back to Washington, DC, which often strikes them as a logic-
free zone--I am trying to take their thoughts back to Washington, DC. 
Frankly, my highest priority has been to find common ground with people 
of common sense on the Finance Committee, especially in the healthcare 
area, because long ago I decided if you and your loved ones don't have 
your health, nothing else really matters.
  At those 54 town meetings--they have been in counties where Donald 
Trump won by large numbers or Hillary Clinton won by large numbers--
each one of those meetings has been dominated by the fears of Americans 
of all walks of life, of all political philosophies worried about what 
is going to happen to their healthcare.
  Frankly, their worry seems to be just as great in rural communities 
that President Trump won by large majorities because Medicaid expansion 
in my State has been enormously helpful. So many Oregon communities, 
under 10,000 in population, have been able to use Medicaid expansion at 
a hospital to maybe hire another person. It has really been a lifeline. 
They have an awful lot of people between 55 and 64. They are going to 
be charged five times as much as young people here, and they are going 
to get fewer tax credits to deal with it.
  In all of these counties--counties won by Donald Trump, counties won 
by Hillary Clinton--fear about healthcare has been front and center. 
People are fearful and obviously would like some clarity, some sense of 
what is coming next.
  One of our colleagues whom I do a lot of work with, Senator Thune--a 
member of the Finance Committee and his party's leadership--spoke to a 
reporter a little bit ago. He couldn't say what the Senate would take 
up, if the first procedural vote passes next week, whether it would be 
TrumpCare or a straight repeal bill.
  My sense is, everybody is being asked to walk into this abyss on 
healthcare but particularly colleagues on the other side of the aisle. 
To be in the dark about what is on offer a few days before a vote that 
affects hundreds of millions of Americans, one-sixth of the American 
economy--for them to be in the dark, someone like myself, the ranking 
Democrat on the Senate Finance Committee that has jurisdiction over 
Medicare and Medicaid and tax credits, strikes me as very odd, even by 
the standards of the beltway.
  The American people are now left guessing about what comes next. The 
only guarantee, should the first procedural vote succeed, is that both 
options Senate Republican leaders put on the table are going to raise 
premiums, make care unaffordable for those with preexisting conditions, 
and leave tens of millions of Americans without health coverage.
  I want to repeat a message that I and other Democratic Senators have 
been delivering for days. The choice between TrumpCare and straight 
repeal of the Affordable Care Act is false. Nobody is being forced to 
choose between calamity and disaster.
  Democrats and Republicans absolutely can work together on the 
healthcare challenges facing the country. As soon as there is a 
willingness to drop this our-way-or-the-highway approach--this partisan 
approach known as reconciliation--there will be a good-faith effort on 
our side to find common ground.
  I heard enough of the back-and-forth in this debate to know there is 
a bipartisan interest; for example, in flexibility for States. I know 
the President of the Senate is especially interested in this issue--
flexibility for the States. He has given it a lot of thought. I want 
him to know I am always open to talking to him about this issue.
  In the bill I described earlier--seven Democrats, seven Republicans--
we had a special section which became law in the Affordable Care Act 
that in effect provided for what are called innovation waivers. The 
theory--and I am sure my colleague in the Chair has been thinking about 
these issues as well--is based on the idea we both have heard for 
years, conservatives have said, if those folks in Washington will just 
give us the freedom, we can find better ways to cover people, hold down 
the costs, and make what works in Louisiana work for us, and folks in 
Oregon can pursue what works for folks in Oregon.
  I said, at the time, that every single bill that I would be part of 
in this debate about fixing American healthcare would have a provision 
that would respond to this argument that the States are the 
laboratories of democracy. We would have a provision that would allow 
considerable flexibility for States to take their own approaches.
  I continue to feel very strongly about it. I wrote an entire section 
of my comprehensive bill to give States flexibility, and fortunately it 
was included in the Affordable Care Act. There ought to be room to work 
on these kinds of issues, State flexibility. There ought to be room to 
work on a bipartisan basis with respect to bringing down prescription 
drug costs.
  I have indicated to the President of the Senate, I think the lack of 
transparency in the pharmaceutical market has really been a major 
factor in the reason that our people get hammered by escalating drug 
prices.
  We have heard for so long that some of the middlemen--they are called 
pharmaceutical benefit managers. They came into being a few years ago. 
They said: We will negotiate for businesses or States or labor unions. 
We will negotiate a better deal for the consumer.
  Consumers said: Hey, we will see that in our pocketbook. At home we 
would see that at a pharmacy, at Fred Meyer or Rite Aid or Walgreens or 
any of our pharmacies. These are all big pharmacies around the country. 
Right now, as of this afternoon, we don't know what these middlemen put 
in their pocket and what they put in our pocket.
  There ought to be an opportunity to find common ground. I think there 
ought to be a chance for Democrats and Republicans to work together on 
approaches like my SPIKE bill, which says that when a big 
pharmaceutical company wants to drive up the prices, they should have 
to publicly justify why they are doing so.
  There ought to be ways for Democrats and Republicans to work together 
and bring down prescription drug costs. There certainly is bipartisan 
interest in getting more competition and more consumers into the 
insurance markets. That means more predictability and certainty.
  My view is, if you are serious about really helping to make the 
private insurance market robust, you have to stop this crusade to 
repeal the ACA. Insurers are making decisions right now. All eyes are 
on this body to bring certainty back to the marketplace.
  The reality is, there is only a very short time with respect to 2018 
premiums. I know there are Republican Senators who would like to tackle 
challenges on a bipartisan basis. The message my colleagues and I are 
sending on this side of the aisle is, there are a lot of open arms 
here. Instead of taking the partisan route and causing devastation in 
our healthcare system, let's work together to make healthcare better 
and more affordable for all Americans.
  I consider that kind of bipartisan cooperation to be the premier 
challenge of my time in public service, to work with colleagues, common 
sense, looking for common ground. I have heard one after another of my 
colleagues on this side of the aisle state that in just the last few 
days.

[[Page S4106]]

  Let us set aside this partisan our-way-or-the-highway approach, opt 
for the alternative, which is more sunshine and more bipartisanship. I 
will pledge to you everything in my power on the Senate Finance 
Committee to bring that about.
  Mr. President, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BLUNT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.