[Congressional Record Volume 163, Number 124 (Monday, July 24, 2017)]
[Senate]
[Pages S4125-S4127]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. CARDIN. Madam President, first, let me thank the Democratic 
leader for his statement on a better deal for all Americans.
  I had a chance over the weekend to travel throughout my State, and I 
heard over and over again the people of Maryland talking about what we 
need to do on a better deal. I had an interesting forum on healthcare, 
and Marylanders want a better deal on healthcare. They want to make 
sure healthcare is affordable, that they can get access to quality 
care, and they can make sure we maintain the highest quality 
healthcare.
  What they don't want to see is us moving in the wrong direction. I 
heard over and over again their concerns about what is happening with 
the consideration of the bill the Republican leadership is anticipating 
having a vote on later this week. That bill would proceed on 
legislation that would eliminate healthcare coverage for, at least, 22 
million Americans, maybe as high as 33 million Americans. I must tell 
you that is not a better deal for Americans on their healthcare needs. 
We could do much better moving in the opposite direction and making 
healthcare more affordable, not cutting people out of healthcare 
insurance.
  In my State of Maryland, in 2018 alone, 221,000 people in my State 
would lose coverage under the proposals the Republican leadership is 
suggesting, including 4,200 veterans, 164,000 people in the Medicaid 
system, and 62,000 people in the individual marketplace. That is going 
to hurt. These are people today who have healthcare coverage who would 
lose their healthcare coverage. It would hurt our seniors in the 
coverage they get under the Medicaid system for long-term care. It 
would hurt those who are working to try to end this opioid drug 
addiction issue.
  Under the current law, mental health, behavioral health, and drug 
addiction is covered under the essential health benefits. It is covered 
under private insurance. It is covered under the Medicaid system. That 
is in danger of being lost under the legislation being considered.
  I heard from public health and law enforcement over the weekend how 
that would move our community in the wrong direction if those bills 
were considered.
  I also heard from the majority leader that all he wants to do is get 
on this bill, and then we can offer amendments. Well, that is not 
accurate. You can't offer any amendments you want on a bill that is 
under reconciliation instructions, and we certainly aren't

[[Page S4126]]

going to get a fair shot at trying to make this bill a better bill 
under the restrictions we are operating under: We had no committee 
hearings. We had no committee markups. That is not the way legislation 
should be considered.
  The other issue I heard about from people in Maryland--I think you 
will hear this from people around the country--is they want to bring 
down the cost of their healthcare coverage. They want to bring down the 
cost of their healthcare. They want to reduce the high growth rate in 
healthcare costs in this country. Yet the Senate Republican bill 
increases the average premium by as much as $1,700 in Maryland by 2020 
and preserves what we call the age tax--a 5-to-1 difference.
  So if you happen to be 55 years of age, you are going to pay a lot 
more than that in increases in your health insurance premiums. That is 
not what people in Maryland want to see. That is not what people in 
this country want to see. They are concerned that we should be building 
on the Affordable Care Act to bring down the cost of their premium 
increases, not to increase it by that dramatic amount of money.
  The increase in deductibles in Maryland could be as high as $3,300 
for a person making $42,000 per year and $5,600 for a person making 
about $18,000 a year. Those are increases in deductibles. They can't 
afford that. The concerns we have--people like the Affordable Care Act, 
and they want us to improve it. They want us to improve it. They don't 
want us to add to their costs, and the bill the majority leader is 
asking us to consider would have people in Maryland and around the 
country paying more--not less, which they want.
  The people in Maryland and around this country like the consumer 
protections we have under the Affordable Care Act. They like the idea 
that there is no annual cap or lifetime cap. I had several people who 
came up to me to tell me about their own personal circumstances. One 
father explained to me that his child was born with serious issues and 
that they reached their cap within a matter of months. Without the 
protection in the Affordable Care Act, they would have had no other 
insurance coverage. Yet, under the bill being considered by the 
Republican leadership, that family could lose that protection because 
you could see the imposition of caps.
  All of us know of people who are very concerned about preexisting 
conditions. The bill that is being considered under the Republican 
leadership weakens those protections against discrimination of 
preexisting conditions.

  Let me just remind my colleagues of what we saw before the Affordable 
Care Act in discriminatory practices by private insurance companies. We 
had reined much of that in under the Affordable Care Act. All of that 
could be lost if we proceed on legislation--and move it forward--that 
doesn't provide the consumer protections, allows the elimination of 
caps, allows discriminatory practices in regard to preexisting 
conditions, restricts the amount of money going into the Medicaid 
system so our States are forced basically to cut back on the Medicaid 
system. We lose the expanded coverage--the Congressional Budget Office 
has already told us that--and we go back to the days of job lock. I 
want to talk about that for one moment because I think this is one of 
the untold stories. We haven't had a lot of discussion on the floor.
  If you go in the wrong direction and you do what the Republican 
leadership is talking about doing and repeal the Affordable Care Act 
and either repeal and later replace or replace it now with a program 
that will eliminate a lot of coverage and once again eliminate these 
consumer protections we have in health insurance, what you do is people 
get locked into employment. They are afraid to leave their job because 
they have insurance that covers their family--they have a spouse with 
cancer or they have a child with a major disability. Yes, they would 
like to do what this country is best known for, and that is set out 
with an entrepreneurial spirit, start a company or go and take risks, 
but they can't do it because they know they are jeopardizing their 
family's healthcare because they can't get the type of insurance they 
need to cover their risks. That is called job lock and that works 
against the growth of our economy.
  There are so many reasons to be concerned about what the majority 
leader is asking us to do--to proceed on this bill that all the options 
we have seen will cost tens of millions of people their coverage, take 
away a lot of the consumer protections we have seen in the law, and 
discriminate against our elderly, discriminate against minorities and 
women. That would be returning to our old healthcare system. No, that 
is not the right way to do it.
  I am frequently asked: Well, what should we do? The Affordable Care 
Act, doesn't it have problems? Doesn't it need to be fixed?
  The Affordable Care Act has done a lot of good. It has given people 
coverage who never had coverage before. It has reined in the 
discriminatory practices of health insurance companies. It has made a 
dramatic improvement on dealing with minority health and health 
disparities. It has provided essential health benefits so we deal with 
mental health and addiction. It has done a lot of really good things, 
but, yes, we could improve it. There has never been a major law passed 
without us going back and revisiting.
  Why haven't Democrats been part of this process? Well, we could not 
get engaged in this process because the way this bill came to the 
floor, it didn't come through the Health, Education, Labor, and 
Pensions Committee, it didn't come in through the Finance Committee, 
the two committees of jurisdiction that deal with the healthcare system 
in this country. Instead, it came in through the majority leader using 
the rule XIV process to bring out a reconciliation bill that can be 
jammed through, with limited time and no open amendment process, from 
the point of view that amendments have to be germane to the 
reconciliation instructions so we don't have an opportunity to fix this 
bill.
  We weren't part of the process to develop the bill. You are not 
giving an opportunity for the democratic system to work. There was no 
on-ramp for Democrats to get engaged in the process.
  About 2 weeks ago--maybe 3 weeks ago now--I filed legislation and 
sent letters to my Republican colleagues telling them: I want to work 
with you. I do. I have worked with Republicans in the Finance Committee 
on healthcare bills. We have gotten some good things done. Democrats 
and Republicans want to work together, so let's work together.
  The legislation I filed dealt with the two major problems that I hear 
about, as I travel throughout Maryland, regarding what we need to fix 
on the Affordable Care Act and how we can make it better.
  Problem No. 1, we need more stability and competition within the 
individual marketplace. Yes, we have seen large proposed increases in 
premiums in the individual marketplace--not in the group plans where 
most Americans have their insurance but in the individual marketplace. 
Why? Because we don't have enough people who have signed up in the 
exchanges. Younger, healthier people, because there really hasn't been 
a penalty imposed, have chosen not to join. They will say: Look, we 
will join if we have a need.
  We have also found that with President Trump indicating he may not 
fund the cost-sharing provisions that go directly to the insurance 
carriers that keep the premiums low and the deductibles and copays low, 
this also has a lot of insurance companies nervous. As a result, the 
premium increases are larger than what we had anticipated. We need to 
do something about it.
  How can we keep those premium increases at a more reasonable growth 
rate rather than what we have seen? One way we could do it is a 
proposal that, I believe, has bipartisan support; that is, deal with 
what is known as reinsurance. Reinsurance is a way we spread the risk 
over a greater group of people, therefore dealing with those high-risk 
pools in a way in which their premium costs are much more affordable.
  Another way we can do it is by Congress mandating that the President 
fund the cost-sharing with the insurance carriers so we don't have the 
threat that they are going to pull out those funds that are used to 
keep copays and deductibles low.
  Another way we can do it is to increase our support for those who are 
of

[[Page S4127]]

modest income and the funds they have to lay out for their premiums 
because we know you can make a good salary, but because of the cost of 
healthcare, if you don't have an employer providing part of those 
benefits, it is very hard for you to be able to afford that without 
some help. We can do all of that.
  Another thing we could do is bring more competition into the 
individual marketplace. We have had those who have suggested a Medicare 
for all. We have had those who have suggested Medicare for the near 
elderly--the 55 to 65 age group or something similar to that. We have 
others who have suggested that we have a public option under the 
exchanges. All those, to me, make sense because it just brings in more 
competition. There is no additional government cost here because they 
are not subsidized any differently than any other insurance plan, but 
it gives more options, more choice, more competition, and therefore 
more stability in the individual marketplace. We could do all that and 
all that can help.
  The other thing we really need to deal with is to deal with the 
overall cost of healthcare. Here, again, Democrats and Republicans have 
had ideas. Why don't we take on the pharmaceutical industry? Why do 
Americans pay twice what Canadians pay for the same medicines that are 
manufactured here in the United States? Why don't we have rebates in 
the Medicare system like the rebates we have in the Medicaid system? 
Why don't we organize our purchasing power in a larger pool so we can 
get greater discounts for the government taxpayers? All those things 
will bring down the cost of prescription medicines. The President has 
talked about it. Democrats and Republicans have talked about it. It is 
time we act.
  We have acted in several areas to try to deal with more value-based 
reimbursements in our healthcare system, recognizing we should treat 
the person, not the particular disease. Many people have more than one 
ailment, and they have to go back to the doctor multiple times. Why 
don't we have a more coordinated, integrated care model?
  I talked on the floor about 2 weeks ago about the coordinated care 
model between Sheppard Pratt Hospital in Baltimore and Mosaic, which 
deals with behavioral health issues and how they deal with it in an 
integrated, coordinated care model, which saves money. It saves money. 
There are fewer tests, more timely interventions.
  How can we use telemedicine? They are using telepsychiatry. How can 
we use that to bring down the cost of care? When I am asked in my 
district, asked in my State as to what I can do--where is my plan, and 
how can we fix the Affordable Care Act--my answer is quite simple: I am 
proud of the progress we have made under the Affordable Care Act. I 
invite Democrats and Republicans through our committees to work 
together to improve it. Yes, we can improve it. We can provide more 
stability in the individual marketplace. We can bring down the high 
annual growth we have seen in premiums in the individual marketplace. 
We can continue to bring down the growth rate of healthcare costs by 
working together on some of these commonsense approaches in order to 
deal with healthcare in America. All of this I think we can do, with 
Democrats and Republicans working together. But the first order of 
business--and I urge my colleagues--the first order of business is to 
stop this process of trying to jam a repeal of the Affordable Care Act 
and a replacement that would cost tens of millions of people in this 
country their health coverage and would move in the wrong direction on 
how we should improve healthcare in America. Let's get that off the 
table.

  Let's reject this motion to proceed that the majority leader is 
talking about voting on later this week. Let's do what Senator 
Alexander, the chairman of the Health, Education, Labor, and Pensions 
Committee has suggested. Let's have hearings in our committees. Let's 
work together, and let's bring legislation that stabilizes the 
Affordable Care Act and deals with the two major problems that the 
people in this country are talking about; that is, bringing down the 
growth rate of premium costs and bringing down the overall growth rate 
of healthcare costs in America. I believe we can do both by working 
together. There are suggestions I have made, and I am sure other 
Members have. Let's work on those. Let's work together and get it done. 
Let's do what is in the best interest of the people in this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.