[Congressional Record Volume 163, Number 132 (Thursday, August 3, 2017)]
[Senate]
[Pages S4806-S4809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HEALTHCARE
Mr. CARPER. Good afternoon, Mr. President. It is good to see the
Presiding Officer and to hear my colleague Senator Perdue, as he
prepares to probably head for home for the next several weeks.
A number of our Senators are heading for their home States this
afternoon and tomorrow to begin what is traditionally called the August
recess. I am fortunate to live in Delaware, and I can go home every
night. Some people see it as a blessing, others as a curse. I see it as
a blessing to go home and stay a while. I am looking forward to that.
We have three Senate office buildings here on Capitol Hill that
Senators share and where they have their office space. The oldest is
Russell. The next oldest is Dirksen. The newest is a building they call
the Hart Senate Office Building. For 16 or 17 years, my staff and I
have been in the Hart Building--and by choice. Every 2 years we can
change offices, but we always want to stay in the same office, which is
sort of unusual when you have been here for 16 or 17 years.
Sometimes a lot of people say the names Russell or Dirksen or Hart.
Russell and Dirksen are pretty famous folks, even now. Hart is less
well known. I will not take a lot of time to give a deep history of who
Philip Hart was, but he was a Senator from Michigan and he was a
Democrat. His time here preceded my time.
I was elected State treasurer for Delaware in 1976, a Congressman in
1982, and Governor in 1992. Then, I came to the Senate in 2001. But for
Philip Hart and me, as far as I know, our service never crossed. If we
did, I am not aware.
I don't know a lot of the things he was famous for. There are some of
his famous quotes, but one of my all-time favorite quotations are the
words I believe he said when he left this place. He left the Senate and
retired. Some say he left too soon, but when he retired, he said these
words: ``I leave as I arrived, understanding clearly the complexity of
the world into which we were born and optimistic that if we give it our
best shot, we will come close to achieving the goals set for us 200
years ago.''
That is what he said. Aren't those wonderful words? At a time when we
could actually use a little bit of encouragement, I hope that, maybe,
his words provide at least a small measure. For me, they always
provided a large measure.
If you go back to the beginning of this Congress, January 3, and the
inauguration of the President on January 20 of this year, there were
high hopes
[[Page S4807]]
on both sides to immediately get to work on comprehensive tax reform;
on transportation and infrastructure policy for roads, highways,
bridges, rails, ports, broadband, and maybe our electric grid. There
was the idea of doing something for our Republican friends to repeal
the Affordable Care Act.
As it turns out, we have in some cases disappointed, and in other
cases we probably have pleased the folks who elected us to serve them,
in developing and creating some of the policy for our country.
I spent a fair amount of time on healthcare. I know the Presiding
Officer, the Senator from Wisconsin, has as well. I spent a fair amount
of time thinking and working on healthcare before, as a Governor and
even as a Congressman. I am not a doctor. I have never pretended to be
and have never wanted to be, but I think one of the credos for the
folks in the medical field and physicians is ``do no harm.'' I hope
that, at least on the healthcare front, in these 7 months here of this
legislative session, we have not done a great deal of harm. I don't
think we have.
We had a robust debate on whether the Affordable Care Act should be
repealed, with a special focus on the section called ObamaCare, and not
much of a debate on how we get better healthcare results for less
money, although it is a goal we all share, as Democrats and
Republicans, in the executive branch and in the legislative branch. I
think that we all share the goal of trying to figure out how to provide
better healthcare for less money to everybody so everybody has
coverage. I think that is a shared goal.
Lamar Alexander, my Senate colleague from Tennessee, likes to say: A
pilot wouldn't take off in an airplane without knowing what his or her
destination is. Think about that. With respect to our destination on
healthcare, I think we know what the destination is; that is, as I said
earlier, to make sure we provide better coverage for less money and
cover everybody. That is the destination.
Just as a guy who spent a lot of time as a naval flight officer in
airplanes for about 23 years, I know there are different ways to get to
places. Sometimes it is a straight line; sometimes it is not. Sometimes
you have to go around turbulence, around storms, or under them. You may
run short on fuel, and there may be mechanical malfunctions. It is not
always a straight line to get to where we want to go in an airplane. It
turns out that it is not a straight line--that destination that we want
to get to with respect to healthcare, for better results, less money,
and covering everyone.
One of the efforts to reach that destination has its roots in 1993.
In fact, here in Washington there were two ideas for reaching that
destination in terms of healthcare. Our shared goals go back to 1993,
where you had here in Washington two different ideas that were put on
the table.
One idea was from our First Lady, Hillary Rodham Clinton. She worked
with really smart people to come up with a healthcare plan called
HillaryCare, to essentially try to achieve those three goals I
mentioned. Our friends in the Republican Party were not always kind in
characterizing her proposal. I think, when they called it
``HillaryCare,'' it was not meant to be a compliment. Even now, in
television commercials, I remember seeing them kind of denigrating her
efforts.
One of the responses from the folks who supported it--at least,
something that First Lady Hillary Clinton proposed--or one of the
things that the Democratic side said to the Republicans was this: What
is your idea? At least we have an idea.
Then, some really smart people over at the Heritage Foundation went
to work and they came up with what turns out to be a good idea--several
very good ideas--to draw on market forces in order to try to meet those
three goals I stated earlier on healthcare.
The first great idea of the five ideas was to create exchanges in
every State for people who don't have coverage under Medicaid or
Medicare or they don't work for an employer that provides healthcare
for them. These are large purchasing pools in every State where people
can get healthcare coverage and be part of a large group plan and
realize the benefits of being a part of that large group plan.
The second aspect or pillar of their five ideas was the idea of a
sliding-scale tax credit for people whose income was low. They would
get a tax credit to lower the cost of a premium in the exchange in
their State. As that person came up and up, at least to a certain
level, the tax credit would go away. It is a sliding-scale tax credit.
That was a Heritage Foundation idea.
Their third idea was something called an individual mandate, which
said that, if you don't have coverage, you have to get it.
Particularly, you have to sign up for it in the exchange. If you don't
want to sign up, you are going to be fined. You can't actually make
people sign up and get coverage, but the idea behind Heritage was that
we would incentivize people to get coverage, because, eventually,
people who don't have coverage will have to get care. Unfortunately, it
is really expensive if they go to the emergency room. A lot of times
they are so sick that they end up getting admitted. That costs a
bundle, and the rest of us end up paying for it. So the third pillar
was the individual mandate.
The fourth pillar was the employer mandate, because we want employers
to cover their employees. That may not be absolute full coverage or
Cadillac coverage. You don't have to necessarily cover their family,
but we want you to offer coverage to your employees--hopefully, decent
coverage.
The last part dealt with preexisting conditions. The Heritage folks
said that there should be a prohibition against insurance companies
being able to say to people who are sick or have some kind of
preexisting conditions: We are not going to insure you because you have
a preexisting condition. Heritage said that should be verboten. You
shouldn't get away with that if you are an insurance company.
Those were the five ideas. Our friends here on the Republican side of
the aisle said: We want to take those ideas.
They did. The lead sponsor was John Chafee. I think he had 22
Republican sponsors in 1993, including Senator Hatch, who was the
senior Republican on the Finance Committee and chaired the Finance
Committee, and Chuck Grassley, a senior Republican on Finance who was
also the chairman of the Judiciary Committee. They were some of the 22
cosponsors of the Republican bill, which really reflected the Heritage
Foundation's ideas. Neither HillaryCare nor the Chafee legislation went
forward and was adopted.
But about 13 years later, in 2006, a fellow Governor of Massachusetts
was thinking about what were some things he could do to really
differentiate himself in the field for running for President in 2008.
His advisers came up with this idea: Why don't we try to cover
everybody in Massachusetts and be the first State with everyone having
healthcare coverage? They dusted off the Heritage Foundation's five
ideas and introduced the legislation in Massachusetts. They amended it
and changed it a little bit, but, in the end, they passed the
legislation. They implemented legislation in 2006, I believe, that
reflected Heritage's ideas from 1993 and reflected the legislation that
was written in this Chamber by John Chafee in 1993. It worked. It
worked in Massachusetts.
They fairly quickly were able to cover a lot of extra people in their
State who hadn't been covered before. One of the things they wrestled
with early on was portability. As it turns out, the folks who are young
and invincible, like our pages here with us--I think this may be the
last day or two before they head back for home.
The Presiding Officer may not know this, but the pages are here on
overtime. Most of the pages returned to their home States across the
country, but there are a half dozen or so volunteers that are still
sticking with us to the bitter end. Hopefully, it is not too bitter an
end. We hope that someday you will come back here as interns or maybe
staff Members, and, who knows, maybe even as Presiding Officers or just
mortals--mere mortals like me. Thank you again for your service.
Anyway, the Romney folks found out that they had this fine setup. So
if people didn't get coverage in Massachusetts, they would have to pay
a fine. It went up over time. It was later that they decided that if
they had to do this over again, they would have had the fine start
higher and escalate faster in order to send a clear message to the
[[Page S4808]]
young invincibles and others who didn't have coverage that you have to
get serious about getting coverage. They wanted a mix of people in
their exchanges so that insurance companies would be able to insure
them and not lose their shirts--to make money off of it.
Anyway, when we were working on the Affordable Care Act in 2009, my
first year on the Finance Committee, we were trying to figure out what
to do. We proposed a lot of ideas to sort of keep our eye on the ACA.
The Affordable Care Act was a way to just sort of pivot away from sick
care, where we just spend money on people when they are sick, and do
more to invest on how we help people stay healthy through prevention
and wellness, by doing screenings for colorectal cancer, breast cancer,
and prostate cancer, in ways that, if you take away the copays for
people and they can go ahead and get the screenings, they save
themselves a lot of money and a lot of pain and maybe from dying, which
otherwise wouldn't be the case.
There are a lot of aspects of the Affordable Care Act. We raised the
eligibility for folks for Medicaid.
When I came back from Southeast Asia in 1993, I went to business
school in Delaware and got an MBA. The next year, I became State
treasurer. I was 29. At that time, I thought of Medicaid as healthcare
coverage for poor women with children. At the time, that was pretty
much what it was, but not today.
Almost two-thirds of the money we spend on Medicaid is for people who
are in nursing homes--our parents, our grandparents, our aunts, our
uncles. A lot of them are veterans. I think 2 million are veterans. We
spend a lot of money on Medicaid today to treat addiction for heroin
and opioids, and we spend money on poor families, including women and
children, but the nature of the coverage has changed a whole lot.
For many years, it has been a 50-50 yield. Largely, States pay 50
percent, and the Federal Government pays 50 percent. We changed that in
the Affordable Care Act because we wanted the States to cover more than
just the people up to 100 percent of poverty. The Federal Government
stepped in and said to the States: If you would go along with this, we
would like to cover people from 100 percent to 135 percent of poverty.
The Federal Government, at least for a while, would pay for that
marginal increase in coverage up to 135 percent of poverty. It is a
pretty good deal for the States, and about 31 States have signed up to
do that. So a lot of people have coverage today who did not have it
before through Medicaid.
The other thing we did in writing the Affordable Care Act was to take
the idea that they have sort of glommed onto in Massachusetts with
RomneyCare--which has its roots back to the 1993 proposal from Heritage
and that was proposed here in the Senate by Senator Chafee--and put
that into the Affordable Care Act. I know that there are some people
who wanted to have a single-payer system in that their idea of
healthcare reform was to cover everyone under Medicare who did not have
coverage. We were just not ready to go there, so we said: Let's try
something that has been put in place in one of our States, maybe with
the idea that Massachusetts could be the laboratory of democracy--to
find out what works and do more of that--and that was what we did.
We passed legislation that created exchanges in all 50 States, and we
had an individual mandate to encourage people to get coverage and
incentivize them but fine them if they did not. A lot of people say
that we started too slowly, as Massachusetts did not implement it fast
enough to get people signed up in the exchanges, but we learned, maybe,
from our mistakes. We had the employer mandate, and we had the sliding
sales tax credit in the Affordable Care Act.
Then we had the prohibitions against insurance companies that refused
to cover people because they had some kind of preexisting condition.
That was the part of the Affordable Care Act that had its roots,
really, in Heritage and Republican Senators--really good ones. Some of
them are still here. Somehow, this has turned out to be that part of
the Affordable Care Act with the exchanges and so forth. It ended up
being called ObamaCare, which is really ironic because he did not have
anything to do with creating it. It was not his idea, but, somehow, it
has been deemed to be ObamaCare. It is the part of the Affordable Care
Act that has been most attacked by our Republican friends. It was their
creation, their suggestion, and now they want to get rid of it.
We have had some tough debate here in recent weeks, and the Senate
has decided not to repeal that part of the Affordable Care Act. I think
that we are smart not to repeal it, but the idea is to help make it
work. One of the best ways is to sort of calm down the exchanges--quit
disrupting and destabilizing the exchanges. When the President says
that we do not know if we are going to enforce the individual mandate
or the subsidies that we provide for low-income people, who get their
coverage in the exchanges, to help cover their co-pays or deductibles--
they do not know if they are going to keep doing that. They are
basically saying of the ObamaCare exchanges to just put them in a death
spiral. Let them just die. Then, maybe, the Democrats will come to the
table.
I think all of that would be a huge mistake. Most of the people would
suffer. As a matter of fact, a lot of the folks who voted for them are
in rural States, and a lot of them are in red States around the
country. I think it is cruel, and I do not think it is very smart.
Last Friday morning at 2 a.m., three Republicans--Lisa Murkowski, of
Alaska; Susan Collins, of Maine; and John McCain, of Arizona--joined 48
Democrats in saying: Let's hit the pause button on degrading, further
bringing down, the Affordable Care Act. Let's hit the pause button. It
is not because the Affordable Care Act is perfect, because we know
there are things in it that need to be fixed, but there are portions
that need to be preserved as well.
We said: Let's see if we can't hit the pause button--kind of pivot--
and stabilize the exchanges, first of all, then do the fix, and do the
repair that needs done in the ACA. We would keep the stuff that is
really good and that everyone says is good and move on. Let's not just
do it as Republicans by themselves or Democrats by themselves. We have
tried that. Let's try working together.
Now we have a chance to do that, and people, like the Presiding
Officer, who have very good ideas will have a chance to present those
ideas in hearings that will be held by Senators Lamar Alexander and
Patty Murray right after we come back here, just after the Labor Day
holiday.
I learned in our Finance Committee today that Chairman Orrin Hatch
and Senator Ron Wyden, who is the senior Democrat on the committee,
will also be holding a hearing or hearings on how do we stabilize the
exchanges and how do we, maybe, find some ways to improve on what we
have done in the Affordable Care Act. I can think of any number. I am
sure that the Presiding Officer can as well.
I do not leave here discouraged. This is a country about which people
say: You must be miserable serving in the U.S. Senate.
I say: Oh, no, not at all. I am sort of energized by what has been
going on, not discouraged.
A long time ago, we fought the Civil War. One hundred fifty years
ago, we fought the Civil War. My friend here from Mississippi remembers
that. I grew up in the last capital of the Confederacy--Danville, VA. I
remember that. One hundred fifty years ago, hundreds of thousands of
people were killed, maimed, or wounded. When it was over, our President
was assassinated, and his successor was impeached.
Somehow, we got through that and made it to the 20th century and
fought, not one, but two World Wars. We won them both and led them
both. We fought the Cold War--won it, led it. We led the world out of
the Great Depression and into the 21st century.
The 21st century emerged, and the Sun came up that January day in
2001. America had the strongest economy on Earth and the most
productive workforce on Earth. We are a nation of peace. We had four
balanced budgets in a row. We had not balanced a budget since 1968.
Then we figured out how to do that four times in a row during the last
4 years of the Clinton administration. In 2001, we were the most
admired Nation on Earth and the most admired force for justice on
Earth.
[[Page S4809]]
I like to remind people that if we can get through the 150 years
after the Civil War and end up where we were on January 1, 2001, we
will get through this as well.
The last thing I would say is this: When we come back, there is
plenty to do. One of the things we have to do is deal with our
financial plan, our budget, and figure out what to do with respect to
the debt ceiling. We will be coming back and holding the hearings that
I described on the Affordable Care Act and trying to stabilize the
exchanges. We will begin to figure out what we ought to do beyond
stabilizing the exchanges and do it as Democrats and Republicans
working together.
When we passed Social Security, Medicare, the Civil Rights Act, and
the GI bill, those were not all Democratic ideas or all Republican
ideas. Some of the best work we do is when we work together.
We will also have the opportunity to tackle our Tax Code. We have a
tax code that, in some cases, discourages companies, especially larger
companies, from staying in the United States and continuing to do
business here and employing people here. In some cases, we encourage
them to look for other places around the world in which to locate their
businesses. We need to make sure we have a tax code that encourages
innovation and that encourages companies to expand and grow here. My
hope is that we can, especially on the Finance Committee, really focus
on that and work with our colleagues, work with the House, and work
with the administration.
I am a really optimistic person about most things, but the last time
we did comprehensive tax reform in this country was in 1986. At that
time, we had Republican President Reagan, who was for it. He had a
great Treasury Secretary, Jim Baker, who was for it. Dan Rostenkowski,
the chairman of the Ways and Means Committee in the House, was for it.
Tip O'Neill, the Democratic Speaker of the House, was for it. We had
Bob Packwood and Bill Bradley, a Democrat and a Republican--brilliant
people on the Finance Committee. They were for it, and it still took 5
years to do it--really hard stuff.
We need to get serious about it, and we need to get going. My hope is
that we will end up being revenue-neutral. We could use some revenues,
but I hope it will be revenue-neutral. At the end of the day, I hope
that what we do will answer these four questions: Is it fair? Does it
foster economic growth? Does it make the Tax Code less complex or more
complex? Finally, how does it affect our fiscal situation--our budget
situation? My hope is that we can keep those questions in our minds as
we formulate tax reform and answer them in an appropriate way.
I see my colleague here with whom I serve on the Finance Committee
and on the Environment and Public Works Committee. He is waiting his
turn, and I have talked long enough.
I will close where I started, with the words of the late Senator
Philip Hart, of Michigan, who was admired by a lot of people here in
this body before we came here. He said these words:
I leave as I arrived, understanding clearly the complexity
of the world into which we were born and optimistic that if
we give it our best shot, we will come close to achieving the
goals set for us 200 years ago.
Boy, those words ring true today, don't they?
As we are about to leave, unlike our friend Philip Hart, who left the
Senate, those who serve today in the Senate are going to come back in 4
weeks. My hope is that when we come back, we will come back determined
to work together. That is what people want us to do. They want us to
work together because, if we do, we will get a lot more things done.
My wife and I went to Africa and actually met up there with one of
our sons and a friend of his two summers ago in August--2 years ago
this August. I learned more about Africa in, actually, a week to 10
days than I had learned in all of my life. One of the things I learned
was an African proverb that some of you already know. It goes something
like this: If you want to go fast, travel alone. If you want to go far,
travel together.
Think about that: If you want to go fast, travel alone. If you want
to go far, travel together.
We have tried going it alone, and we have not gotten that far. My
hope is that when we come back, we will travel together, and we will go
a long, long way and make everyone proud of us.
I say again to my colleagues and the pages and our staffs, thank you
for the good work that you have done. It is a pleasure serving with all
of you.
I bid you adieu. Thank you.
I yield the floor.
The PRESIDING OFFICER. The Senator from Mississippi.
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