[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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