[Congressional Record Volume 163, Number 151 (Tuesday, September 19, 2017)]
[Senate]
[Pages S5827-S5831]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. SCHUMER. Mr. President, there is a possibility that by the end of
next week, the Senate will have a vote again on a Republican healthcare
bill assembled in the dark of night by one party, without a full
account of what the bill would do. It will be a shameful return to the
same process the majority used to try to ram a bill through in July,
unsuccessfully.
To consider a bill like this without a full CBO score is worse than
negligent; it is grossly irresponsible. We were told yesterday that CBO
may be able to provide a baseline estimate of the cost of the bill but
not the coverage numbers or a detailed analysis of how the bill would
affect Americans' healthcare choices.
We are talking about one-sixth of the economy; we are talking about
the healthcare of the Nation; we are talking about the lives, day in
and day out, of millions of Americans who need healthcare; and we are
not going to really know what the legislation does.
Senators will be voting blind. They say justice is blind, but the
Senators on the other side of the aisle should be walking around here
with a blindfold over their eyes because they don't know what they are
voting on. Maybe they don't care. I don't know how any Senator could go
home to his or her constituents and explain why they voted for a major
bill with major consequences to so many of their people without having
specific answers about how it would impact their State.
What we do know is that this new TrumpCare bill, the Graham-Cassidy
legislation, is worse in many ways than the previous versions of
TrumpCare. The new TrumpCare would devastate our healthcare system in
five specific ways.
First, it would cause millions to lose coverage.
Second, it would radically restructure and deeply cut Medicaid,
ending the program as we know it. It has been the dream of the hard
right to get rid of Medicaid, which could happen, even though it is a
program that affects the poor and so many in the middle-class--nursing
homes, opioid treatment, people who have kids with serious illnesses.
Third, it brings us back to the days when insurance companies could
discriminate against people with preexisting conditions. The ban on
discriminating against people with preexisting conditions would be
gone. We have had a lot of promises from the other side that they would
never vote for a bill that didn't protect people with preexisting
conditions. That seems to be going by the wayside in a headlong rush to
pass a bill so that they can claim a political victory. What about that
mom or dad who finds out his or her son or daughter has cancer, and the
insurance company says: Yes, we will cover you; it will cost you
$50,000. And they don't have it, so they have to watch their child
suffer. This was an advance that almost all Americans supported. It was
an advance most people on the other side of the aisle believe in--gone.
Fourth, the bill gets rid of the consumer protections that guarantee
Americans' access to affordable maternity care, substance abuse
treatment, and prescription drugs. All of those could be out of any
plan. You can pay a lot for a plan and not get much for it in this
bill.
Fifth, it would throw the individual market into chaos immediately,
increasing out-of-pocket costs for individual market consumers and
resulting
[[Page S5828]]
in 15 million people losing coverage next year--15 million people.
On the first point, the new TrumpCare would cause millions to lose
health insurance in two ways: first by undoing the Affordable Care
Act's major coverage expansion under Medicaid and premium and cost-
sharing assistance, instead putting that into an inadequate and
temporary block grant, and, second, by radically restructuring and
cutting the traditional Medicaid Program through a per capita cap.
We don't have a CBO score yet, and we may not get one in time. But
previous CBO scores of similar schemes have shown that 30 million
Americans could lose coverage under this bill--30 million Americans--10
percent, approximately, of our population.
On the second point, the new TrumpCare would end Medicaid as we know
it by converting Medicaid's current Federal-State financial partnership
to a per capita cap, which cuts current Medicaid funding levels on an
annual basis. This is a direct blow to nursing home patients and folks
in opioid treatment, and CBO has said that 15 million fewer people
would receive Medicaid under similar proposals.
On the third point, the new TrumpCare actually brings back the
ability of insurers to discriminate against folks with preexisting
conditions, as I mentioned.
Fourth, the new TrumpCare would no longer guarantee consumers
affordable access to maternity care, substance abuse, and prescription
drugs.
Fifth, like previous repeal and replace, it would immediately
eliminate the individual mandate, which would raise the number of
uninsured by 15 million, relative to current law, in 2018 and increase
market premiums by 20 percent.
So vote for this bill, and right away 15 million will lose coverage,
and premiums will go up by 20 percent. People who vote for this bill
are not going to be happy with its results. Each one of these five
things represents a major step backward for our healthcare system,
bringing back discrimination against folks with preexisting conditions
and ending Medicaid as we know it. These are overwhelmingly popular
with Democrats, Independents, and Republicans. The hard right doesn't
like it. The big financiers of the other party don't like entitlements,
but Americans do. We are going to go backward--backward. We are going
to go backward and not even know the effects.
Why is the other side rushing this through? They are ashamed of it.
They need to have that political scalp: See, we abolished ObamaCare.
But what they are putting in its place, even for those who don't like
ObamaCare, is worse. They don't want to know that. The joy they will
have--misplaced joy, in my opinion--of abolishing ObamaCare will
evaporate quite soon when their constituents feel the effects of this
bill and they hear about it from average folks who are so hurt.
The Washington Post summed up Graham-Cassidy yesterday. They said the
bill ``would slash health-care spending more deeply and would probably
cover fewer people than the July bill--which failed because of concerns
over those details.''
Republicans couldn't garner the 50 votes for their various healthcare
plans earlier this year because of how much damage those plans did to
Medicaid, how they rolled back protections for preexisting conditions,
and some opposed it because the process was such a sham. Well, all
three conditions are here again with this bill: cuts to Medicaid, no
guarantee for preexisting conditions, a sham of a bill.
There is a better approach. Right now, Chairman Alexander and Ranking
Member Murray are working in a bipartisan way--holding hearings,
working through committee, coming back and forth between the parties
with discussions. Each side is going to have to give; that is how it
works around here--or should work--in trying to get a proposal that
will improve things. That is the kind of legislating many Members of
the Senate have said they want to get back to. That is the kind of
process worthy of the world's greatest deliberative body.
After a rancorous and divisive healthcare debate, which took up the
better part of this year, Democrats and Republicans have been working
in good faith to come up with a bipartisan agreement on healthcare in
the HELP Committee. The Republican majority would toss all of that away
if they pursue Graham-Cassidy next week the way they are pursuing it--
returning to reconciliation, not working in the committees, no CBO
report, making a mockery of regular order.
I hope, for their sake and the country's sake, my Republican friends
will turn back from this new TrumpCare and join us again on the road to
bipartisanship. We have seen bipartisan sprouts bloom in the last
month. Graham-Cassidy would snuff them out. Nobody wants that--nobody.
I yield the floor.
The ACTING PRESIDENT pro tempore. The assistant Democratic leader.
Mr. DURBIN. Mr. President, what is the business of the Senate this
morning?
The ACTING PRESIDENT pro tempore. The Senate is considering the
Francisco nomination.
Mr. DURBIN. I ask unanimous consent to speak as in morning business.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. DURBIN. Mr. President, I wish to say that the comments made by
the Democratic leader, the Senator from New York, really touched me
because they go to the heart of this institution.
It was only a few weeks ago, in a dramatic moment, when Senator John
McCain returned from Arizona to come to the floor of the Senate and
cast a historic vote to move forward on the debate on healthcare. He
asked for 15 minutes after that vote to say a few words about his
experience as a person and his observations as a Senator, and I stayed
in my chair because I wanted to hear him.
John McCain came to the House of Representatives the same year I was
elected. Our careers have at least been close or parallel in some
respects, though I couldn't hold a candle to him in terms of his
personal life experience and his experience in the military, as well as
being a candidate for even higher office.
I listened carefully as he reminded us of what it takes for the
Senate to work. What it takes, of course, is the determination of both
political parties to solve a problem. He reminded us that means sitting
down in committee, with experts, working through some of these issues,
particularly the more complex issues--the give-and-take of the
legislative process.
He pointed specifically to the effort to repeal ObamaCare as a
failure by those standards. He used as an example the fact that
ObamaCare, during the period of Republicans' efforts to repeal, was
actually gaining popularity in this country--exactly the opposite of
what the other party might have expected. It was an indication to him
that we needed to do things better in Senate. Just a few days later, he
cast a critical vote to stop what was a flawed process on the
Republican side--to repeal ObamaCare without a good alternative,
without a good substitute.
I remember that vote early in the morning, right here in the well of
the Chamber, and I remember what followed when I saw Senator Lamar
Alexander and Senator Murray behind me in front of the cloakroom in a
bit of a huddle after that historic vote. I later learned that they had
decided it was their turn to step up on a bipartisan basis and find a
way to strengthen our healthcare system, not what we had just seen but
a different way--a way that kind of relied on experts at State levels
to give us advice and experts in Washington to really cull through the
ideas to find the very best. They invited other Members of the Senate
to join them, even those of us not on the committee.
Senator Alexander and Senator Murray have had several meetings, which
I have attended and which were very productive meetings--bipartisan
gatherings over coffee and donuts with insurance commissioners from
States all across the Nation, commissioners from both political
parties, bipartisan meetings of Governors from States all across the
United States. They were basically sitting down and saying: What can we
do now? What can we all agree to do, regardless of party, that will
reduce the increasing costs of health insurance premiums, provide
coverage for more people, and provide better healthcare--quality care?
It was a good-faith effort, and it was encouraging, after 7 wasted
months of political debate on the floor of the Senate.
[[Page S5829]]
I went to those meetings and came away feeling very positive. It was
clear that some very basic ideas were emerging from all over the United
States. One of the ideas was cost-sharing reduction so that health
insurance companies that took on sicker, older patients and had worse
loss experiences would be able to be compensated so they could reduce
premium costs, bring the cost of health insurance down, and make sure
more people had it available.
Another proposal was reinsurance. That is the same basic idea. Let's
find a way to make the increase in health insurance premiums slow down.
I remember the commissioner from the State of South Carolina, a
Republican, who said that his experience was that in the next year,
health insurance premiums in the individual marketplace were going up
30 percent.
He said that, if you bring in the cost-sharing reductions, which the
Federal Government can do, it would only be 10 percent. Ten percent is
bad enough. Thirty percent is painful.
Here is something we can do on a bipartisan basis to reduce the cost
of health insurance premiums. It struck me as obvious that this is what
we should be doing as the Senate.
I applauded Senator Alexander personally and publicly, and Senator
Murray, as well, for doing what the Senate was supposed to do. Little
did I know that at the same time they were making this bipartisan
effort, there was another Republican effort under way to derail them,
to stop them, to end the bipartisan conversation that was under way in
the HELP Committee.
The Cassidy-Graham proposal, which may come to the floor as early as
next week, is an effort to repeal ObamaCare, but it is a flawed effort.
Earlier this morning, the Republican leader came to the floor and
spoke of the debate that we have had over and over about what we are
going to do in the future, and he talked about the failed ideas of the
past. I can tell you that the Cassidy-Graham proposal is a return to
failed ideas--ideas rejected once by the Senate but certainly by the
American people.
In this morning's Chicago Tribune, one of the business writers,
Michael Hiltzik, wrote an article entitled ``The GOP's last-ditch
ObamaCare repeal bill may be the worst one yet.''
Mr. President, I ask unanimous consent to have printed in the Record
this article in its entirety.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Chicago Tribune, Sept. 16, 2017]
The GOP's Last-Ditch Obamacare Repeal Bill May Be the Worst One Yet
(By Michael Hiltzik)
The Republican effort to repeal the Affordable Care Act is
back, a zombie again on the march weeks after it was declared
dead. The newest incarnation is Cassidy-Graham, named after
chief sponsors Bill Cassidy of Louisiana and Lindsey Graham
of South Carolina.
Compared with its predecessors, the bill would increase the
ranks of America's medically uninsured more--by millions of
people--cost state governments billions more and pave the way
for the elimination of all protection for those with
preexisting medical conditions.
Among the biggest losers of federal funding would be the
states that had the foresight to expand Medicaid under the
Affordable Care Act and the resolve to reach out to lower-
income residents to get them coverage; they'd be punished
with draconian cuts in healthcare funding. Among the big
winners would be states that have done nothing of the kind
for their residents--refusing the Medicaid expansion and
interfering with outreach efforts. They'd be rewarded for
their stupidity and inhumanity with an increase in federal
funds.
Over the last week or so, reviews of the measure have been
pouring in from healthcare experts, and they're almost
unanimously negative. Major health provider and consumer
organizations have turned thumbs down, as have analysts
looking at its economic effects.
Fitch Ratings, which keeps an eagle eye on the fiscal
condition of states issuing bonds, judges Cassidy-Graham
``more disruptive for most states than prior Republican
efforts.'' Fitch finds that ``states that expanded Medicaid
access to the newly eligible population under the Affordable
Care Act (ACA) are particularly at risk under this latest
bill.''
The bill surfaced just as the political tide seemed to be
shifting away from the GOP campaign to roll back the gains in
health coverage experienced by Americans over the last seven
years under the Affordable Care Act. Democrats are coalescing
around universal health coverage--``single-payer,'' as it's
typically termed--teeing up the issue for the 2018 election.
It's notable that the rise in public support for this
approach, at least in the abstract, has coincided with the
GOP's so-far unsuccessful repeal effort. The emergence of the
new bill also comes as other Republicans are scheduling
hearings and reaching across the partisan aisle to craft a
sensible plan to shore up the Affordable Care Act
marketplace.
Despite those drawbacks, Cassidy, Graham and their co-
sponsors are trying to push the measure through by Sept 30,
the last day it could be passed with only 50 votes (plus a
tie-breaker cast by Vice President Mike Pence) under Senate
reconciliation rules. After that, it would need a filibuster-
proof count of 60 votes, meaning it could--and presumably
would--be blocked by Democrats. The deadline places more
pressure on the Congressional Budget Office, which must
analyze the bill before it can come to a vote, to move fast.
In recent days, the sponsors have claimed that their vote
count is edging toward 50. But Sen. Rand Paul (R-Ky.) has
stated that he's a ``no,'' since the bill isn't conservative
enough for his taste. Sen. Susan Collins (R-Maine), whose
``no'' vote helped to scuttle the last repeal effort in July,
isn't expected to change her mind on this one. Sen. Lisa
Murkowski (R-Alaska), who also voted it down, hasn't been
quoted on her position, but there don't seem to be compelling
reasons for her to shift to the ``yes'' column now. The
position of Sen. John McCain (R-Ariz.), who also voted
against the last bill, isn't clear, but he's a close friend
and frequent ally of Graham's. In any event, the backers
still seem to be a vote or two short.
Those are the procedural issues. Now let's turn to the
text, and the issue of why anyone would think Cassidy-Graham
would improve America's healthcare system.
In broad terms, the measure would terminate the Affordable
Care Act's Medicaid expansion, premium and cost-sharing
reduction subsidies, tax credits for small businesses, and a
host of other pro-consumer provisions by 2020. It would
eliminate the act's individual and employer mandates
retroactive to Dec. 31, 2015.
The bill provides for no replacement of these provisions,
beyond a capped block grant to states. In effect, it's a
repeal-and-no-replace bill. The Congressional Budget Office,
as it happens, analyzed that approach in July in connection
with a different bill. It found that by 2026 the number of
uninsured Americans would increase by 32 million, compared
with under current law. That's about 50% more people
uninsured than it estimated for other Republican repeal-and-
replace measures, which the budget office said would cut
enrollments by 20 million to 22 million.
The block grant to states, which Cassidy and Graham portray
as one of their bill's chief virtues, is in fact a poisoned
chalice any governor would be a fool to accept. The proposal,
Cassidy said in unveiling the bill, ``gives states
significant latitude over how the dollars are used to best
take care of the unique healthcare needs of the patients in
each state.'' That papers over its significant drawbacks.
By their nature, when block grants are proposed to replace
existing programs, they're almost always back-door mechanisms
to reduce federal spending. That's the case here. The
Cassidy-Graham block grants would replace the money now being
spent on Medicaid expansion and the premium and cost-sharing
subsidies, and a couple of other spending provisions. But the
existing spending is pegged to demand--Medicaid funding
adjusts automatically to enrollment and the medical needs of
the enrollees, and the subsidies are pegged to enrollee
incomes and the premiums charged by insurers for benchmark
Obamacare plans.
Block grants would be fixed, changing only according to a
complex formula. And that formula would be ``insufficient to
maintain coverage levels equivalent to the ACA,'' the Center
on Budget and Policy Priorities calculated last week. Between
2020 and 2026, the center reckoned, the grant would provide
$239 billion less than projected federal spending for the
existing Medicaid expansion and subsidies. In 2026 alone, the
shortfall in Medicaid and subsidy funds together would total
$80 billion.
What's worse is that the grant would be unable to respond
to real-world conditions. Consider how healthcare costs are
likely to rise in Texas and Florida in response to this
summer's floods, which drove thousands of residents out of
their homes and increased the threat of water-borne disease.
They'd get no help from the block-grant formula. To provide
needed care to their residents under Medicaid or any other
state programs, they'd have no choice other than to limit
enrollments, cut benefits, charge higher premiums or co-pays,
or drain funds from other federally funded programs.
As set forth in the bill, the formula would ``over time
move money away from states, predominantly Democratic, that
have expanded Medicaid and aggressively pursued enrolling
their lower income populations in Medicaid and exchange
coverage,'' observes healthcare expert Timothy S. Jost.
``Money would move toward states, predominantly Republican,
that have not expanded Medicaid.''
Some Medicaid expansion states would lose as much as 60% of
what they would be due under current law. According to the
numbers crunched by the Center on Budget and Policy
Priorities, among the states that went all-in on Obamacare,
including expanding Medicaid and mounting aggressive
enrollment support
[[Page S5830]]
for the marketplaces, California would get $27.8 billion less
in federal funding in 2026, New York $18.9 billion less, and
Massachusetts $5.1 billion less.
States that shunned the Affordable Care Act would make out
like bandits: Texas, which showed absolutely no regard for
its ACA-eligible population, would get $8.2 billion more in
2026, and Mississippi, another black hole for healthcare
reform, would get $1.4 billion more. This is how carrot-and-
stick approaches to healthcare reform work--in the Bizarro
world. (Apologies to Jerry Seinfeld.) In any case, all the
federal funding would disappear after 2026, According to
Fitch, ``over time even non-expansion states will face
budgetary challenges given the proposed changes to Medicaid,
which will likely accelerate for all states over time.''
Another provision of Cassidy-Graham that is significantly
worse than its predecessors is the latitude it gives states
to eviscerate consumer-protection rules in the Affordable
Care Act. The bill would allow states to request waivers from
the federal government allowing them to nullify the act's
requirement that all policies include 10 essential health
benefits, including maternity care, hospitalization, mental
health and substance abuse treatment, and prescription
coverage. This is an invitation to states to allow insurers
to market junk insurance to their residents.
The states could also request waivers of the act's all-
important protections for people with preexisting medical
conditions. The law forbids insurers to charge anyone more
based on their medical condition or history, except for a
modest increase in premiums based on age and a surcharge for
smokers. Previous GOP repeal bills have substituted a
``continuous coverage'' provision, which protects applicants
who haven't let their coverage lapse for a month or two from
being surcharged when they renew.
Cassidy-Graham throws out that protection. It would allow
states to request a waiver allowing insurers to charge more
``as a condition of enrollment or continued enrollment . . .
on the basis of any health status-related factor.''
Translation: Under such a waiver, insurers could check
applicants' health or medical histories before setting
premiums--even for renewals.
Finally, there's that crucial Republican litmus test--
abortion. The bill bars any insurance policy receiving
federal funds--that is, a policy whose enrollees get
subsidies or that is subject to payments under the Affordable
Care Act's reinsurance rule--from offering coverage for
abortions except when the mother's life is in jeopardy or in
cases of rape or incest.
Remarkably, this bill's sponsors are pitching it as a
moderate, common-sense alternative to its predecessors. They
may also be hoping that opposition fatigue has set in, and
that they'll be able to steamroll the measure through while
the public is distracted by other issues. As with other
repeal efforts, this one is being brought out without a
minute of hearings.
Cassidy asserts that this measure is a blow for equality.
The measure ``treats all Americans the same no matter where
they live.'' He's right, in a way: It treats all Americans as
potential victims of insurance company profiteering.
Mr. DURBIN. Let me quote a few sentences from this article because I
think they make the case dramatically about how bad the Cassidy-Graham
substitute would be. Here is what he said:
Compared with its predecessors, the bill would increase the
ranks of America's medically uninsured more--by millions of
people--cost state governments billions more and pave the way
for the elimination of all protection for those with
preexisting medical conditions.
He goes on to say:
Among the biggest losers of federal funding would be the
states that had the foresight to expand Medicaid under the
Affordable Care Act and the resolve to reach out to lower-
income residents [and provide health insurance] coverage.
He goes on to say that, under this Cassidy-Graham bill, ``they'd be
punished with draconian cuts in healthcare funding.''
He goes on to write:
Among the big winners would be the states that have done
nothing of the kind for their residents--refusing the
Medicaid expansion and interfering with outreach efforts [to
bring more people into health insurance coverage].
They would be rewarded, perversely, for doing the wrong thing.
He writes:
Over the last week or so, reviews of the measure have been
pouring in from healthcare experts, and they're almost
unanimously negative. Major health provider and consumer
organizations have turned thumbs down, as have analysts
looking at its economic effects.
He talks about the impact of this bill beyond increasing Federal
funding for States that did not help their residents and cutting
Federal funding for States that did. The bill provides no replacements
for the tax credits available for small businesses and the subsidies
for health insurance premiums currently in the law beyond a capped
block grant to States.
He writes:
In effect, it's a repeal-and-no-replace bill. The
Congressional Budget Office, as it happens, analyzed that
approach in July in connection with a different bill. It
found that by 2026 the number of uninsured Americans would
increase by 32 million, compared with under current law.
That's about 50% more people uninsured than it estimated for
other Republican repeal-and-replace measures, which the
budget office said could cut enrollments by 20 million to 22
million.
Honestly, can my colleagues on the other side of the aisle in good
conscience go home to their States and say: I voted to repeal ObamaCare
and you are going to lose your health insurance as a result of it.
I can tell you what it means in my State. A million people would lose
their health insurance because of this Republican repeal effort. I
don't know how Members of Congress--House or Senate--from Illinois
could in good conscience vote to take health insurance away from
massive numbers of Americans.
We are blessed here. Those of us who serve in Congress have access to
good health insurance. It is not cheap. It shouldn't be. But it is
there. It is always there, and we don't have to worry about it. Some
Members are wealthy enough that they take care of it in other ways. For
most Members of Congress, we use the insurance marketplace and pay our
share of the premiums. The government pays a share of it, just as it
does for Federal employees.
We have access to health insurance. How then could we turn and say to
the people we represent: I just voted for a bill to take away your
access to health insurance.
That is what this Cassidy-Graham bill does. That to me is hard to
imagine--that a Member can believe they were elected to the Senate for
that purpose.
What does it do to the States with this capped block grant in terms
of their loss of Federal funds? It is amazing. Some States would lose
as much as 60 percent of what they currently receive under the current
law.
According to the numbers crunched by the Center on Budget
Policy Priorities, among the states that went all-in on
Obamacare, including expanding Medicaid and mounting
aggressive enrollment support for the marketplaces,
California would get $27.8 billion less in federal funding in
2026, New York $18.9 billion less, and Massachusetts $5.1
billion less.
I looked at the list for my State of Illinois. It would lose $1.4
billion in Federal funding by 2026. Just to show the contrast, as for
the State of Texas, which did not expand Medicaid and which did not
cover low-income individuals with health insurance, what would the
Cassidy-Graham bill do for the State of Texas? They wouldn't lose a
penny. They would add in Federal funding $8,234 million.
They would be big winners because they turned their back on low-
income individuals and didn't expand Medicaid or increase the number of
enrollees. What a perverse incentive for Governors and governments on a
State basis to turn down coverage knowing that at some point they will
be rewarded for that approach.
Another provision of Cassidy-Graham that is significantly
worse than its predecessors is the latitude it gives states
to eviscerate consumer-protection rules in the Affordable
Care Act.
One of the most important parts of the Affordable Care Act was a
reform that said: If you are going to buy health insurance, it is going
to be there when you need it. First, you will be able to buy it, even
if you have someone in your family with a preexisting condition. That
is one of the first casualties of Cassidy-Graham--going back to a
failed idea in the past, which said if you have a sick baby or if you
have a spouse who survived cancer, you either can't buy health
insurance or you can't afford it. We got rid of that once and for all.
At least we thought we did. Cassidy-Graham brings it back to life. It
says: Let the insurers decide if they want to cover you or not.
Another thing we said is that the disparity in premium costs between
the most expensive policy and the least will be 3 to 1. Cassidy-Graham
tosses it out and says it is 5 to 1. What it means--and AARP knows this
better than any other organization--is that senior citizens are going
to end up paying more for their health insurance under Cassidy-Graham
than they currently do under the Affordable Care Act.
[[Page S5831]]
When you look at the other protections that we built in to provide
that your policy, when you bought it, would cover mental illness and
substance abuse treatment, that is considered revolutionary but
important. Finally, after all of these years in America, we are looking
at mental illness as an illness rather than a curse. We are looking at
it as something that can be successfully treated. Yet here comes
Cassidy-Graham tossing out that requirement as well.
Let the insurers decide what they want to offer. I was talking to one
of the Republican Senators the other day, and he said: Well, you know,
some people just may not want to buy certain coverage.
I can understand that, but I can also understand the reality of life.
Who can predict that next year or next month you would learn that
perhaps your high school daughter has been taking opioids and now is
addicted to heroin? You didn't know it before, not when you bought your
health insurance policy. Now that you know it, who is going to cover
the substance abuse treatment?
Under the Affordable Care Act, it is built into your health insurance
policy. Under the Cassidy-Graham approach, it is an option. Try it if
you like it. It doesn't work in a lot of circumstances. We buy
insurance for things we pray will never happen, but we want to be
covered in case they do. Cassidy-Graham walks away from that. They are
for what they call ``flexibility.'' It is flexibility to buy insurance
that isn't there when you really need it.
When you look at the litany of all of the States that are winners and
losers under Cassidy-Graham, you have to shake your head. Why would we
be richly rewarding States that have not done their part to expand
Medicaid coverage? Why would we devastate the Medicaid Program, which
is so important for so many people?
Medicaid is a program that many people didn't understand until we got
into this debate, but it is a program that is essential if you have a
disabled child.
A woman in Champaign, IL, with a young son in his twenties suffering
from autism told me that without Medicaid coverage he would have to be
institutionalized, and there is no way her family could afford it.
We know that Medicaid is there for that family and for many low-
income families when it comes to pregnancies, to make sure that mom has
a successful pregnancy and that the baby is born healthy and ready to
thrive.
Is that an important asset? Of course it is, and it is an important
element of Medicaid. The one thing that costs the most in Medicaid is
something the Republicans don't want to acknowledge, and that is the
fact that two out of three people in nursing homes--seniors who are
under medical care--rely on Medicaid. Without that Medicaid assistance,
who is going to pay that bill? The family reaching into their savings?
Some can, but most will not be able to afford it.
How will the Republicans explain that away as just one of the
benefits of flexibility--that Medicaid is not there when your parent or
grandparent desperately needs it?
So now we have this debate before us, which will come up by the end
of next week, and it is one that really will affect a lot of people
across America. I, for one, will do everything I can to stop this. Any
program that is going to take health insurance away from a million
people in Illinois and up to 30 million nationwide is a bad start, a
bad idea, a failed idea.
I yield the floor.
I suggest the absence of a quorum.
The ACTING PRESIDENT pro tempore. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. DURBIN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.