[Congressional Record Volume 163, Number 150 (Monday, September 18, 2017)]
[Senate]
[Pages S5796-S5799]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. DURBIN. Mr. President, the Senate has spent a great deal of time
over the last 6 or 7 months on healthcare in America. For years after
the passage of the Affordable Care Act, the Republican Party--the House
and Senate--has called for repeal of the bill. Yet, when the time came,
with the majority of Republicans in the House and the Senate and, of
course, a Republican President, and the task was immediately before
them, they faltered because they didn't have a replacement. They didn't
have something to propose that was better. As a consequence, their
efforts stopped short--one vote short--on the floor of the Senate
several weeks ago.
We still face some significant challenges. Some of those are very
immediate.
Before the end of September, we will face the prospect of needing to
reauthorize the Children's Health Insurance Program, known as CHIP.
This program provides health insurance coverage for more than 9 million
children and pregnant women across the country--350,000 in my State.
This vital program, the CHIP program, has had two decades of broad
bipartisan support, and it is going to expire in 12 days.
The good news is that the Finance Committee chairman, Orrin Hatch of
Utah, and his ranking member, Ron Wyden of Oregon, have reached a
bipartisan agreement on a 5-year reauthorization of the CHIP program.
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The bad news is that instead of preserving healthcare for low-income
children and pregnant women, the Senate Republican leadership seems
more interested in the next 12 days in calling a different issue--a
different bill--altogether, the Graham-Cassidy bill, relating to health
insurance across America. That bill would take health insurance
coverage away from millions of Americans, including 1 million in the
State of Illinois.
From where I am sitting, reauthorizing the CHIP program is a priority
to not only serve the 9 million children and pregnant women across our
country but 350,000 in my State.
There is another bill we need to reauthorize before the end of
September: the funding of our Nation's community health centers. Like
CHIP, funding for community health centers expires at the end of this
month--in just a few days. Also like CHIP, community health centers
have enjoyed decades of broad bipartisan support. We have 10,000
community health centers across our country. They serve 26 million
Americans. Community health centers serve 1 out of every 10 children, 1
in 6 Americans living in rural areas, and more than 330,000 of our
Nation's veterans.
Illinois' 52 health center organizations receive $150 million in
Federal funding in order to provide care to the 1.3 million people in
360 locations in the State of Illinois. I have been to many of these
locations, and I have said in real candor and honesty that if I had a
medical issue or if there were one in my family, I would enter the
community health centers in my State with confidence that I and my
family would receive the very best of care. They are outstanding
organizations.
If Congress doesn't act within 12 days, community health centers in
my State and across the Nation will see their funding cut by 70
percent. That dramatic funding cut would result in 2,800 community
health centers closing across America, 50,000 jobs lost, and 9 million
people losing access to healthcare.
Well, there is good news here as well. Because of Senators Blunt and
Stabenow taking the lead, they are pushing for swift reauthorization of
community health center funding. But the problem is that there is
another bill--the Graham-Cassidy bill--which has captured the attention
and apparently the calendar time for the Senate--at least that is the
possibility we hear. So why shouldn't Congress be spending the next 12
crucial days reauthorizing the Children's Health Insurance Program
across America and making certain our community health centers don't
lose the critical Federal funding they need to serve so many people?
Right now, we know we face some challenges when it comes to the
health insurance market in America. Approximately 6 percent of
Americans--3 percent of people in my State--purchase their health
insurance in the individual marketplace, with more than 50 percent of
these people receiving some subsidies to help pay for costs. However,
many of these people are seeing dramatic increases in premiums. We know
that, and we know it is a challenge and one we need to address.
Here is the good news--and it is time for some good news when it
comes to healthcare. Almost from the minute that the critical vote was
cast ending the repeal of ObamaCare, meetings started taking place. I
can recall, as the Senate was adjourning, I looked back by the
cloakroom, and there was Senator Lamar Alexander and Senator Patty
Murray talking in the middle of the night--about 3 o'clock in the
morning. I later learned that they had reached an agreement between
them--a Republican, a Democrat--on the HELP Committee to start a series
of hearings about what we could do as a Senate to actually strengthen
the healthcare system in America. That was before our August recess.
When we got back from recess, they had kept their word. I attended
three or four of the Member hearings, which they held before the
official public hearings a little later in the morning. These were good
meetings. At the first one, I recall Senator Alexander saying 53
Senators--Democrats and Republicans--showed up for coffee and doughnuts
to meet with insurance commissioners from five different States. Just a
few days after that, there was another coffee-and-doughnut session,
another good bipartisan turnout of Senators as we sat down with five
Governors, Democrats and Republicans, who talked about health
insurance. A few days later, another meeting took place where experts
came in and talked about the subject.
I felt there was more accomplished in those 3 hours with those
outstanding witnesses from across the country than all of the time we
had spent giving speeches to one another on the floor of the Senate in
the previous 7 months. It was interesting. We brought in these people
from different States, different political parties, and they virtually
had the same thing to tell us. There were a handful of things which we
could do that could make an immediate, positive impact to make the cost
of health insurance a lot more predictable--not to say we are going to
bring it down--I don't want to be overpromising--but to slow the rate
of growth in health insurance costs as well as provide stability in the
insurance market.
Here are the things that came out loud and clear from these
bipartisan Senate meetings.
First, they told us to stop playing games with cost-sharing reduction
subsidies. These are subsidies to insurance companies that take on
individuals with expensive health histories. These insurance companies
are given support by subsidies so that they can keep the premium costs
for these individuals under control.
These cost-sharing reduction subsidies help 7 million Americans
afford their copayments and deductibles on their health insurance
policies. The current Trump administration has repeatedly threatened to
stop the payments. As a result, individual market premiums keep going
up because of the uncertainty of whether the government is going to
keep its promise to make these cost-reduction subsidies.
I remember the commissioner from the State of South Carolina told us,
I say to the Senator from Oregon, who is our ranking Democrat on the
Finance Committee--he said: I am going to announce a 30-percent
increase in health insurance premiums. If I knew that these cost-
sharing reduction subsidies were coming, it would be 10 percent. I can
eliminate 20 percent of the anticipated increase in premium costs if
these subsidies come through.
It is pretty clear to me, this is sound policy, on a bipartisan
basis, which would have a dramatic impact in reducing the cost of
premiums to many individuals. That came through loud and clear in every
meeting we had with Senators Murray and Alexander.
The second thing they talked about was State reinsurance. I don't
understand that as well as some, but it has worked in States where the
State picks up a share of the liability for health insurance between
certain dollar amounts so the private insurance companies don't end up
with that burden. Because of this reinsurance, they are able to keep
premium costs down.
The third thing is to provide States with more flexibility without
undermining some really fundamental issues--without undermining, for
example, the preexisting condition protection we currently have.
I left those meetings feeling encouraged. After 7 months of bitter
political rhetoric, which led to nothing on the floor of the Senate, we
were finally sitting down, on a bipartisan basis, with Democrats and
Republicans all across our country with specific suggestions which
could help our healthcare system. That, to me, is the way to move
forward. That, to me, is the lesson learned from much wasted time so
far this year. Unfortunately, this whole effort may be derailed.
Senators Cassidy and Graham have come up with a legislative
alternative they want to move forward. Unfortunately, the measure they
have proposed has not been scored by the Congressional Budget Office
nor carefully measured to find out what impact it would have on the
American healthcare system, which accounts for one-sixth of the
American national economy.
Here is what we know about the Cassidy and Graham proposal. What they
are suggesting is basically eliminating the subsidies which help
individuals pay for private health insurance and bringing to a halt the
Medicaid expansion which has covered millions of Americans and given
them health insurance.
What they say instead is something which has been said many times on
the
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floor: We will just give all the money to the Governors, and they will
figure it out. They will figure out how to save money in their States.
It turns out, Governors of both political parties warn us: If you are
going to give us a set amount of money as the cost of healthcare
continues to go up, don't expect us to cover as many people or provide
as good a coverage if we do it on a State-by-State basis.
So who supports this new Cassidy-Graham approach and who opposes it?
Every single medical advocacy group--the hospitals, the doctors, the
nurses--all across America oppose this Cassidy-Graham approach, as well
as the medical advocacy groups, because they understand their approach
would allow discrimination against individuals insured based on a
history of preexisting conditions--going back to the bad old days
before we passed the Affordable Care Act.
The Cassidy-Graham approach, which they brought to us, doesn't add
up. If you take $300 billion or $400 billion out of this healthcare
system, dump it into the laps of Governors across this country and say,
``Good luck. Do it on a local basis. I am sure it will all work out,''
they will quickly tell you, as they have had in the bipartisan meetings
we have had, it will not work. It does not compute. It may be able to
check the box from some things to repeal the Affordable Care Act, but
they certainly didn't replace it with anything of equal or better
value. The opposite is true. That is why I think we ought to think
twice.
There is a mad dash now in the last 12 days to do many things. From a
political viewpoint, there is a limited opportunity for this repeal
effort. That 12-day period is a limited window under the Senate rules
of reconciliation. It is a mistake, as far as I am concerned, for us to
move toward Cassidy-Graham--concepts which have been roundly opposed in
my State and across the Nation, concepts which have failed on the floor
of the Senate.
Let us roll up our sleeves and do three things that do make sense:
Let's reauthorize the Children's Health Insurance Program. Let's make
sure those kids and their pregnant moms are going to have the basic
coverage they have enjoyed for almost 20 years.
Let's also reauthorize the community health centers. We know they
work. We know when people have a medical home, they are less likely to
let medical conditions get worse and more expensive. That, to me, is a
good investment to make sure they continue.
Finally, let's turn toward a real bipartisan effort, a measure which
can emerge soon--I hope within days--from Senators Murray and Alexander
on a bipartisan basis. I know they are still working on it. They
haven't reached a final agreement on what they are doing, but I hope
all of us, in both political parties, will encourage them to do the
right thing.
Remember when John McCain came to the floor after he had been
diagnosed with the cancer he is battling now. He came here and cast a
crucial vote to proceed to debate this whole issue of healthcare. Then
he asked to speak for 15 minutes, and I stayed in my chair. I wanted to
hear it. He reminded us of the importance of doing things on a
bipartisan basis and doing them thoughtfully when it comes to something
as important as healthcare. Let us keep that speech by John McCain and
that lesson in mind. Let us resist this Cassidy-Graham approach, which
has no support when it comes to the medical community, and instead work
on the bipartisan approach from Alexander and Murray, together with the
Finance Committee--which I know Senator Wyden is going to address
next--so we can have a bipartisan solution.
The American people sent us here to solve problems, not to create
them. Cassidy-Graham creates problems. Let's find solutions which solve
problems.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, before the Senator leaves the floor, I just
want to draw attention to the central point the Senator from Illinois
has been making tonight. He has been focused on what our duties to the
American people are all about, which is to make their lives better and
particularly to improve the quality of their healthcare, which is a
lifeline for millions of families.
Now, instead of looking at bipartisan approaches to make the lives of
our people better--Chairman Hatch and I introduced the children's
health bill today. Nine million youngsters with that program get better
health. Instead of focusing on that, as my colleague from Illinois has
said, we are going to be looking at a bill that will hurt our people,
will give them worse healthcare, will go backward with respect to the
march in our country to make sure we recognize that all our people--all
our people--deserve quality and affordable healthcare.
I particularly appreciate my colleague pointing out the contrast
between where we ought to go with a bipartisan proposal like the
children's health plan and where we shouldn't go--which is the Graham-
Cassidy-Heller proposal which is going to go backward with respect to
the healthcare needs of our people.
The fact is, Graham-Cassidy-Heller has been exposed to sunlight for
just a few days, but it is already clear this legislation is a bad deal
for the American people.
Now, Senator Cassidy has introduced healthcare bills before. Earlier
this year, he introduced a bill with our colleague from Maine, Senator
Collins, as an alternative to what the Senate Republican leadership put
on offer. Now, I had my concerns with that proposal, but the first
thing I want the Senate to understand is this Cassidy bill, which we
will soon be considering, is much worse. The reason I say that is, this
bill lowers the bar for legislation which has been hastily written and
ill-considered. I want to be clear. This Cassidy bill will flunk the
Jimmy Kimmel test of not hurting kids in America with preexisting
conditions.
To make matters worse, just this evening, I have been informed that
the Senate Finance Committee will shortly announce a hearing for next
Monday on the Graham-Cassidy-Heller proposal. Contrary to the norms of
the Senate Finance Committee, I was not consulted in this matter as the
ranking Democrat. I am all for debating major legislation, but talking
about a piece of legislation which will not have the Congressional
Budget Office--our independent arbiter of these matters--give us their
thoughts on coverage or premium matters less than 48 hours before a
vote is scheduled to happen is a sham process, which makes a mockery of
the very eloquent words of our colleague from Arizona Senator McCain,
who appealed for the regular way in which the Senate handles
legislation.
This means Senators will not know how many millions of Americans are
going to wake up not knowing if they have healthcare, how many seniors
would get kicked out of a nursing home or see their core healthcare
needs not met. How much will Americans' premiums go up? Senate
Republicans have no answers on any of these matters.
What Graham-Cassidy-Heller does do is give a super block grant blank
check to the States. They can do whatever they want--whatever they
want--in terms of Americans' healthcare, and it guts the funding for
those block grants over a very short period of time. This will mean a
whale of a lot of pain for vulnerable people and an open door to some
of the worst abuses of insurance companies, the abuses we thought we
had gotten rid of. Democrats and Republicans thought we had gotten rid
of them back when I introduced a bill with seven Democrats and seven
Republicans. Now we are talking about bringing them back. This bill
amounts to the largest healthcare devolution, moving power without any
accountability at all to the States.
Now, if I might get into some of the specifics. This bill does
especially serious damage to Medicaid. In fact, it really hollows out
the Medicaid Program.
This year's debate over healthcare made one thing quite clear:
Medicaid matters. It pays for the healthcare of our most vulnerable. It
serves as a safety net for those who might not think they are ever
going to need it. It covers nursing home care for older people who
spend down hard-earned savings. It pays for critically needed addiction
treatment services for those who struggle with opioids. We know that is
what millions of Americans are facing now. It helps Americans with
disabilities and kids with special needs
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live a healthier, more productive life in their communities rather than
in institutions.
That is just a little bit of the good Medicaid does for folks from
Portland, OR, to Portland, ME. Under the Graham-Cassidy-Heller
proposal, that is gone--simply gone. The plan ends expanded Medicaid
coverage which 11 million Americans count on right now. It caps
Medicaid and guts hundreds of billions of dollars in support from the
Federal Government. In effect, it is like telling States, good luck,
and telling them you can make the hard decisions about which Americans
are going to get adequate healthcare and who are going to be those
unfortunate souls who go without.
My view is, this is going to lead to destitution for older Americans
who count on Medicaid for nursing home care. It also represents a
massive transfer of dollars from States which expanded Medicaid to
States which chose not to.
History tells us that the most vulnerable Americans without a voice
or a powerful lobby are the ones who are going to be the worst off.
Now, I have heard my colleagues--Senator Cassidy, in particular--claim
that this bill is modeled on the Children's Health Insurance Program--
which is a block-granted program--and that means all supporters of CHIP
should support Graham-Cassidy-Heller.
Nothing could be further from the truth. The Children's Health
Insurance Program has been an extraordinarily successful program for
more than 20 years, now covering 9 million youngsters. Part of that
success is due to its reliance on a strong Medicaid Program. If
Medicaid and the rest of the healthcare system is block-granted and
slashed by hundreds of billions of dollars, the pillars that support a
successful Children's Health Insurance Program will crumble. They will
lose their structural support. A vote in favor of Graham-Cassidy is a
vote to demolish successful healthcare programs like the Children's
Health Insurance Program and its promise of affordable healthcare for
millions of kids and their families.
There is one more step that the Graham-Cassidy-Heller bill takes that
is different from previous versions. Rather than reducing the tax
credits that help Americans get help--similar to earlier Republican
approaches--again, this bill just chucks them out, gets rid of them,
gone. That means asking States to use their Federal health block grant
for a whole host of competing healthcare priorities, in effect, pitting
vulnerable Americans against each other and not having enough at the
table to meet the critical needs of some of our most vulnerable
people--people who, day in and day out, are walking on an economic
tightrope, trying to balance their food costs against their medical
costs and their medical costs against housing.
Graham-Cassidy-Heller is a recipe for disaster. This proposal, again,
opens loopholes for insurance companies that, as I described, we
thought we had closed, thought we had finally closed the book on the
days when healthcare wasn't just for the healthy and wealthy. That is
what happened when we had discrimination against those with preexisting
conditions. If you had a preexisting condition and you were wealthy--
just pay the bill. If you didn't have any preexisting conditions, there
was nothing to worry about.
For the millions of people who finally got some peace of mind at
night when we eliminated discrimination against those with preexisting
conditions, this brings back that ugly prospect that a key consumer
protection, the protection that bars discrimination against those who
have preexisting conditions, is just tossed aside--just as what looks
to be the setting aside of essential health benefits that all Americans
are entitled to receive.
It was pretty obvious during the TrumpCare debate that unraveling the
consumer protections that our people count on today leads to the entire
system falling apart, and the vulnerable bear the brunt of the pain.
Many of our friends and neighbors have spent the year raising their
voices and showing up to stop bad healthcare legislation. Thanks to
their grassroots efforts, the partisan approach that I have described
as being used here again has been stopped multiple times.
I wanted to come on the floor tonight to say to people in every
community across our great country that, once again, we need people
power. Once again, we need them to stand up and say that we don't want
to turn back the clock on the healthcare needs of the most vulnerable,
like seniors and the disabled and our kids. Once again, we hope they
will speak out all across the country.
I am going to be having townhall meetings this upcoming weekend after
the Jewish holiday. You can be sure that I am going to hear a lot from
the people of Oregon about this. I am very hopeful that, once again,
people power around America is going to come forward and say to those
who are talking about supporting Graham-Cassidy-Heller that this is a
mistake, that they don't want to turn back the clock with respect to
healthcare; they want to move forward. Instead of turning back the
clock, what they are looking for is leadership, for example, that will
hold down their prescription drug costs.
I have introduced legislation to require these companies to publicly
justify raising their prices. We have had Senators introduce a host of
bills. That is what we ought to be doing--talking about how we are
going to improve American healthcare.
My colleague from Illinois mentioned the Children's Health Insurance
Program, which Chairman Hatch and I worked with our Finance colleagues
to get introduced, and there is the Community Health Center Program. I
could go on and on about opportunities for bipartisanship to take the
country in the right direction rather than in the wrong direction.
Instead, it doesn't look as though that is going to be on offer any
time soon. What is going to be on offer is a proposal that turns back
the clock, guts Medicaid, harms seniors, harms the vulnerable, and I
think would be a major mistake.
My bottom line has long been that for changes to the healthcare
system to be sustainable and lasting, they have to be bipartisan. That
is why I mentioned an effort that I was involved in. Several of my
colleagues who cosponsored the bill I am talking about have been
supportive of that for quite some time.
We know Republicans and Democrats know how to write bipartisan
legislation. But what the Graham-Cassidy-Heller bill seeks to do is
just the opposite--to use the most deeply partisan process the Senate
knows, called reconciliation. It basically says: Our way or the
highway--not interested in trying to find common ground.
I will point out that didn't end too well earlier when we talked
about healthcare. I came to the floor tonight to make the case that we
cannot let partisan reconciliation tactics win on this key issue. We
ought to be working together to improve healthcare on a bipartisan
basis, in a way that helps people all across the country.
I have mentioned--this is particularly important to me--a number of
bills that colleagues on both sides of the aisle have worked on that
would help improve the lives of the American people. Graham-Cassidy-
Heller does not meet that test. I hope my colleagues will reject it,
and I hope that all across the country, from one corner of America to
every other, people will step up and they will say, as I have said on
this floor: The political change doesn't start in Washington, DC, and
then trickle down; it is bottom up. It is bottom up, as people come
forward and say ``That is not the way to go'' and say ``Here is the way
that really would make sense and make our lives better.''
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. LANKFORD. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Perdue). Without objection, it is so
ordered.
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