[Congressional Record Volume 163, Number 151 (Tuesday, September 19, 2017)]
[Senate]
[Pages S5842-S5847]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. KAINE. Mr. President, I rise to talk about a topic that is 
consuming much attention--our efforts to improve healthcare for 
Americans. Before the passage of the Affordable Care Act in 2010, 
Americans with preexisting conditions faced serious barriers. Since 
2010, the rate of uninsured Americans has declined to a historic low, 
with 20 million more Americans--the combined population of 16 or 17 
States--getting access to health insurance coverage.
  Over 410,000 Virginians have received care through individual 
marketplaces just last year. An additional 400,000 would be eligible to 
receive Medicaid if Virginia ever chooses to expand it. Since being put 
on the HELP Committee or being notified I would be put on it in 
December, I visited community health centers, medical schools, 
behavioral treatment centers, nursing programs all across Virginia 
talking to people about their healthcare needs. I am committed to 
working together with my colleagues to improve the healthcare of 
Virginians and Americans. There is a right way and a wrong way to do 
it.
  After there was the failure of an effort in late July or early August 
to pass a partisan repeal and replacement of ObamaCare using the budget 
reconciliation process, the success of which would have taken health 
insurance away from 20 million Americans, I am disappointed that we 
haven't learned the lesson about the right way to do this and are 
apparently poised to explore yet again doing it the wrong way.

[[Page S5843]]

  There is a proposal on the table that is designated the Graham-
Cassidy proposal, and it is just as threatening as the ACA repeal we 
voted on just 2 months ago. It restructures traditional Medicaid 
funding using per capita caps and block grants. The core of this bill 
is an effort to dramatically go after, restructure, and shrink 
Medicaid, which is critical to so many people.
  It ends protections for people with preexisting conditions by 
allowing States to essentially rewrite essential health benefits. It 
would eliminate Medicaid expansion and the Affordable Care Act 
subsidies and replace them with a block grant that would be 
insufficient to cover the needs of Virginians. Even that block grant 
funding would end after 2026--as if the need to help low- and moderate-
income people afford coverage would dramatically disappear overnight.
  The proposal is new and is newly on the floor. There isn't a full CBO 
analysis of it, but initial indication has led groups like the American 
Medical Association and the AARP to come out against it. They are 
worried it will leave insurance out of the reach of millions of 
Americans. In Virginia alone, more than 301,000 marketplace enrollees 
would have their tax credits to help them afford insurance jeopardized.

  What would it mean for the healthcare system? We are not completely 
sure. At least on the earlier versions we voted on, we had CBO scores 
telling us how many millions might lose insurance. There seems to be a 
desire to rush this through prior to a full CBO analysis. I can't 
understand why. But we do know it would be devastating to those on 
Medicaid. Sixty percent of those on Medicaid in Virginia are children, 
but the majority of spending on Medicaid is for our parents and 
grandparents, the elderly, and folks with disabilities.
  I was just in Bristol, VA, on the Virginia-Tennessee border this 
weekend. I heard very palpable requests for the need for better 
healthcare, especially in rural Virginia.
  Here is what we know about the Graham-Cassidy proposal, at least 
based on the analysis of it thus far by my State healthcare officials. 
We will see a $1.2 billion cut in Medicaid under this plan over the 
next number of years, and the cuts would impact families like those I 
visit as I travel around Virginia.
  I recently had a roundtable in Northern Virginia with parents of 
children with severe disabilities who, though they have disabilities, 
are doing some remarkable things because they receive support from 
Medicare for assistive technologies and in school programs.
  A mother, Corinne, told me about her son Dylan. Dylan has a very rare 
neuromuscular condition SMARD--spinal muscular atrophy with respiratory 
distress. He has a tracheostomy tube and relies on a ventilator to 
breathe. He also gets all of his nutrition through a G-tube. He 
requires in-home skilled nursing services, and he also requires a nurse 
to attend school with him. But he goes to public school, and he is a 
successful student because Medicaid funding enables him to go. Medicaid 
helps reimburse the school system for the services they provide him.
  ``For us, affordable and quality healthcare means that Dylan can lead 
a fairly normal life despite his medical issues.'' That is what his mom 
said. He can lead a fairly normal life on a ventilator with a 
tracheostomy tube in a wheelchair with a nurse. He can lead a fairly 
normal life, despite his medical issues. He can live at home, go to 
school, and participate in activities any kid his age enjoys. Without 
the assistance of Medicaid, he wouldn't be able to do those things.
  Reducing Medicaid spending would limit States' abilities to provide 
waivers for medically complex kids. The mother adds that ``the possible 
return of lifetime caps and limitations on preexisting conditions would 
be devastating.''
  I also met with a mother, Amy, from Richmond, who has a son, Declan. 
Medicaid covers her son's care, therapy, and medical supplies. Medicaid 
helps her son have the best quality of life possible and helps him with 
the prospect she prays deeply for--that one day, despite his medical 
condition, he can live independently as a productive adult. The Graham-
Cassidy funding cuts to Medicaid could take away this protection for 
countless Virginians, especially these children.
  Here is what I ask for: Why don't we have an open process to truly 
debate improvements to our healthcare system, instead of a rushed, 
closed, secretive process that threatens mothers like Amy and children 
like Declan?
  After the efforts last summer, I hoped that the colleagues in the 
world's greatest deliberative body would stop a secretive, harmful rush 
and, instead, embrace dialogue, hearing from experts and witnesses as 
we would improve healthcare, attempting to stabilize the individual 
marketplace, lower premiums, and expand care rather than reduce it.
  We gave a standing ovation on the floor of the Senate in late July 
when our colleague, Senator John McCain, returned from a very difficult 
diagnosis of brain cancer. We gave him a standing ovation after he 
spoke to us, and here is what he said. He talked about the fact that we 
had a challenge on healthcare. He talked about the skinny repeal bill 
that was on the floor of the Senate. He said:

       We've tried to do this by coming up with a proposal behind 
     closed doors in consultation with the administration, then 
     springing it on skeptical members, trying to convince them 
     it's better than nothing, asking us to swallow our doubts and 
     force it past a unified opposition. I don't think that is 
     going to work in the end. And it probably shouldn't.
       Why don't we try the old way of legislating in the Senate, 
     the way our rules and customs encourage us to act. If this 
     process ends in failure, which seems likely, then let's 
     return to regular order.
       Let the Health, Education, Labor, and Pensions Committee 
     under Chairman Alexander and Ranking Member Murray hold 
     hearings, try to report a bill out of committee with 
     contributions from both sides. Then bring it to the floor for 
     amendment and debate, and see if we can pass something that 
     will be imperfect, full of compromises, and not very pleasing 
     to implacable partisans on either side, but that might 
     provide workable solutions to problems Americans are 
     struggling with today.

  To my great satisfaction, after the skinny repeal bill went down--and 
this body decided that it didn't want to precipitously take healthcare 
away from 20 million people--that is the course that this body 
embraced. It is what our heroic colleague suggested that we embrace. 
The HELP Committee--which, as a member of this, I am very aware had 
refused to hold a hearing on any of the proposals in the House or in 
the Senate around the repeal of ObamaCare--decided finally to do what 
the HELP Committee should do. The ``H'' is for ``Health.'' To pass a 
bill reorienting one-sixth of the American economy around the most 
important expenditure that anybody ever makes in their life without 
letting the HELP Committee hear from it was foolish to start with.
  So now we have embraced doing it the right way. Under the leadership 
of Senator Alexander and Senator Murray, we have had four robust 
bipartisan hearings. We invited Governors to come from around the 
country. They had to turn their schedules topsy-turvy to do it--
insurance regulators, insurance executives, patients, doctors, 
hospitals. There were four hearings, each with multiple witnesses. We 
turned their schedules topsy-turvy. We had them here. We had coffees 
before each hearing and invited all Members of the Senate, not just 
those on the HELP Committee, to interact and hear from these experts. 
We have gotten advice from them on what we need to do to stabilize the 
individual insurance market and what we can do in the long term to make 
healthcare better for everyone. We should take advantage of those 
recommendations.
  When the fourth hearing was completed last week, the chairman of the 
Committee, Senator Alexander, and the ranking member, Senator Murray, 
with the support of this very diverse committee--left, right and 
center, Democrats and Republicans--have embarked on a bipartisan 
process to find, after a full and transparent airing of the issues, a 
way to stabilize the individual insurance market. We are on the verge 
of doing that.

  Yet what we are told is, instead of going through our committee 
process and hearing and airing it before the public, now there is a new 
bill that has just recently come out with no full CBO score. The idea 
is to force that through, with no CBO score, with no full committee 
process that would enable us to hear from witnesses, with no

[[Page S5844]]

opportunity for members of any of the committees--Finance or HELP--to 
offer amendments, with no meaningful floor debate, and with no 
opportunity for amendments on the Senate floor.
  Why did we give Senator McCain a standing ovation just 6 weeks ago 
when he suggested that when it comes to something as important as 
healthcare, we should treat it with seriousness, so we can get it right 
and not rush and get it wrong?
  I stand here--and I hope I am on my feet a good bit more between now 
and the end of the month--to ask this question: Why backslide? Why go 
backward when we had embraced a process of bipartisan discussion?
  I am fully aware that as a Member of the minority party, I have no 
power except my ability to convince Republicans that I actually have a 
good idea. But a one-party process on the floor that tries to end run 
the relevant HELP Committee is guaranteed to fail. It might pass, but 
it is guaranteed to fail because it is guaranteed to hurt people. It is 
guaranteed to have some consequences that are harmful and known and 
other consequences that are harmful and unknown because it has been 
rushed, and it hasn't been done in the view of the public with the 
ability to fully listen to them. Just think about it this way: What 
does it say about your commitment to your legislation if you are not 
willing to have it subjected to a normal review by the committees that 
have jurisdiction over it?
  The Graham-Cassidy bill has some provisions in it that are relevant 
to the Finance Committee's jurisdiction, but Finance is apparently not 
going to do a markup of the bill, and they are not really going to hear 
from experts about the bill.
  There are other provisions in Graham-Cassidy dealing with essential 
benefits that are squarely within the jurisdiction of the HELP 
Committee, but the HELP Committee isn't going to have a hearing either. 
So in spite of the good recommendation we were given by our senior 
colleague who was just on the floor--who was characteristically here to 
talk in kind words about the public service of someone who has worked 
with his staff for 30 years--we gave him a standing ovation, and we are 
prepared to violate everything that he just suggested we do.
  As I conclude, I will just say this. This isn't about healthcare. 
Healthcare is important enough. No one ever spends a dollar on anything 
that is more important than their health. It is the most important 
thing that anyone ever spends a dollar on--health, my health, the 
health of my family. I think we can all share that. Nothing is more 
important. It also happens to be one of the largest sectors of the 
American economy. Between 15 and 20 percent of America's GDP is 
healthcare. This is a very important issue. If you are trying to 
reorient one-sixth or one-fifth of the economy, if you are touching the 
expenditure of priority that is the single most important priority in 
anyone's life, that is important enough.
  I would argue, in closing, that there is something I think is equally 
important; that is, this body. We celebrated the 230th anniversary of 
the Constitution this past Sunday. James Madison and others in 
Philadelphia, tried to figure out how this government should work. They 
made a very unusual decision that would be different from the decisions 
that are made in many countries; that is, they put the legislative 
branch first.
  There are three coequal branches. In most societies, the executive is 
first, but not here--first among equals. We are meant to really play an 
A game. We are really meant not to be an article-II-and-a-half branch 
reacting to a Presidential tweet or encouragement; we are supposed to 
be an article I branch.
  In the legislative branch in article I, the Senate is given a very 
particular role. We are called the world's greatest deliberative body. 
We are the saucer into which the partisan heat of the day is poured and 
allowed to cool, so the decisions made in the Senate are supposed to be 
more careful and more deliberate.
  This is a great body that has been sadly hobbled by partisan 
gridlock, and we have not achieved what the Senate should achieve. We 
learn in math as we grow up that the whole is equal to the sum of the 
parts, but what you find in life is that often the math doesn't work 
out. Sometimes the whole can be equal to or greater than the sum of the 
parts in life if teams work well together. But sometimes--and this 
describes the Senate now--there are 100 wonderful, accomplished people 
in this body. Yet again and again, and now for years, the whole has 
been equal to less than the sum of the parts.
  We have done very little of meaning, very little of substance. Yet 
now we are poised to tackle the most important issue that most affects 
people and the biggest sector of the American economy. If we get it 
right, we can send a message to the public that the Senate will once 
again be the Senate. We will once again be a deliberative body. We will 
once again do what we are supposed to do.
  I think this country now needs to see some adults in the room, some 
group of people willing to work together--Democratic and Republican--to 
solve problems and do the right thing for the American public. If we do 
this right, we can send that message. If we do it wrong, we will hurt 
people, and we will also hurt the credibility of this institution in a 
way that I think will last for years.
  We have a choice. It is up to us. We either follow the advice that 
our colleague gave us on the floor 6 weeks ago, which we gave him a 
standing ovation for, and we gave him the ovation because we knew he 
was right--we either follow that advice or we decide to ignore it and 
continue the downward spiral of a great body.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Mr. President, in May, Jimmy Kimmel shared the story of 
his newborn son Billy, who was born with a life-threatening condition 
that required open-heart surgery. Kimmel said that he was fortunate to 
have had good health coverage and was able to pay for the care that his 
son needed, something he believed every American deserved.
  A few weeks later, as efforts to repeal ObamaCare were gaining steam, 
Senator Bill Cassidy explained that the bar he believed any healthcare 
bill had to clear to get his vote was what he called the Jimmy Kimmel 
test. He said: ``Will a child born with congenital heart disease be 
able to get everything she or he would need in the first year of 
life?''
  When Kimmel interviewed Senator Cassidy a few days later, Kimmel 
explained the test this way: ``No family should be denied medical care, 
emergency or otherwise, because they can't afford it.'' Well, I am here 
to report that this latest version of TrumpCare, offered by none other 
than Senator Cassidy himself, fails the Jimmy Kimmel test miserably.

  Over the past few weeks, there have been two ongoing conversations 
about the future of healthcare in the United States. The first has been 
conducted in an open, bipartisan manner in the Senate Health, 
Education, Labor, and Pensions Committee in full accord with the 
traditions of this body. In the HELP Committee, Republicans and 
Democrats alike have been talking with Governors, insurance 
commissioners, and other experts on ways to address concerns of States 
and consumers by stabilizing the individual market and lowering premium 
costs. That is how the Senate is supposed to work, and the bill that 
emerges from that process will be one that makes things better, not 
worse. It will create certainty. It will bring down costs for 
consumers. It is a bill that any Senator should be proud to vote for.
  The second conversation is a model of how things shouldn't work. It 
has occurred behind closed doors between Senate Republicans and party 
operatives. It is not about making the system work; it is about passing 
something--anything that can be said to repeal and replace the 
Affordable Care Act, and along the way, it destroys the Medicaid 
Program as we know it. As many of us have argued before, this 
conversation is an affront to the traditions of this body and, more 
importantly, to the will of the American people.
  I urge my Republican colleagues to oppose the Graham-Cassidy bill--
the newest iteration of TrumpCare--which will rip healthcare coverage 
from tens of millions of people, create higher

[[Page S5845]]

costs for consumers, and ensure the destabilization of the individual 
health insurance market.
  While I have worked closely with Senators Cassidy and Graham on other 
bills, and I respect them, I have grave concerns with this legislation.
  First, the bill undermines protections for people with preexisting 
conditions.
  States could apply for waivers that would allow them to charge people 
more based on their health status, age, or any other factor other than 
race or ethnicity. This means premiums would be higher just for being 
older or sicker or having had an illness in the past. In other words, 
there would be no protection for people with preexisting conditions.
  Additionally, States can also seek waivers to remove the ACA's 
essential health benefit requirements, which mandate that insurers that 
are offering plans on the exchanges include coverage for vital 
services, such as prescription drugs, maternity care, mental health, 
and substance use disorder services.
  While the bill technically requires States to describe--just simply 
describe--how they will ``maintain access to adequate and affordable 
health coverage for individuals with preexisting conditions,'' there is 
no definition of what that means, and there are no enforcement 
mechanisms. Insurers would still be able to charge people with 
preexisting conditions more for their care or exclude services 
altogether. Under this plan, millions of people with preexisting 
conditions could face much higher costs, if they can get coverage at 
all. Again, this bill rips away protections for people with preexisting 
conditions.
  Second, the bill would undoubtedly reverse the significant coverage 
gains we have seen in recent years and drive up the number of Americans 
without health insurance.
  The Graham-Cassidy proposal eliminates the ACA's premium subsidies, 
eliminates the Medicaid expansion, eliminates cost-sharing reduction 
payments, and more. Instead of funding these critical aspects of the 
ACA, the bill would return some but not all of this funding to the 
States in the form of block grants, which are authorized in this bill 
from 2020 to 2026.
  The bill also proposes to dramatically reduce funds for States that 
have expanded Medicaid and have successfully enrolled more adults in 
ACA exchanges--States like Minnesota. Instead of incentivizing success, 
the bill will reward failure, initially increasing funds for States 
that refuse to expand Medicaid and have done little to encourage 
enrollment. But even these States lose out in the end. In fact, the 
funding stops completely after 2026, resulting in enormous losses for 
every State, and even prior to 2026, the Center on Budget and Policy 
Priorities estimates, most States will receive significantly less 
funding from the Federal Government under this block grant than they do 
under current law. Minnesota could lose $2.7 billion. Other Senators 
who have expressed various levels of concern with this legislation 
could see their States lose significant sums. Those include Arizona, 
which would lose $1.6 billion; Alaska, $255 million; Maine, $115 
million; Colorado, $823 million; and the list goes on. Healthcare isn't 
free. These shortfalls will mean that families don't get the services 
they need.
  On top of all that, the Graham-Cassidy proposal caps and cuts 
Medicaid--a program that provides coverage to seniors, families with 
children, and people with disabilities. In Minnesota alone, that is 1.2 
million people facing cuts to their benefits or losing coverage 
altogether.
  I believe many of us truly want to help our constituents access the 
care they need. As I have said before, the ACA is far from perfect, but 
it has resulted in significant improvements in millions of people's 
lives.
  I have heard from countless Minnesotans who have literally had their 
lives or the life of a loved one saved by the ACA--the same way that 
Billy Kimmel's life was saved by the treatment he was able to receive 
at the beginning of his life. Take Leanna, for example. Leanna's 3-
year-old son, Henry, has been diagnosed with acute lymphoblastic 
leukemia. His treatment will last until April of 2018. He often needs 
round-the-clock care to manage his nausea, vomiting, pain, and 
sleepless nights--a 3-year-old.
  Henry's immune system is so compromised that he is not supposed to go 
to daycare, so Leanna left her job to care for him. Leanna and Henry 
are supported by her spouse, but they couldn't pay for Henry's 
treatment on one salary.
  Leanna says:

       It is because of the ACA that Henry gets proper healthcare. 
     Henry can get therapy and the things he needs to maintain his 
     health and work towards beating cancer. Henry is still with 
     us because of the ACA.

  Let me say that again: Three-year-old Henry is still with us because 
of the ACA.
  Consider Maria's story. Maria enrolled in Minnesota's Medicaid 
Program after finishing her graduate degree and while looking for full-
time employment. Maria was grateful for the coverage because she needed 
access to treatments for her endometriosis, which was diagnosed a few 
years prior while she had insurance through her employer.
  Soon, Maria found her dream job, but it came with a catch: no health 
insurance. Days before she was set to move and start work, she decided 
to go in for one last big checkup. The results were unnerving. At the 
age of 35, Maria was diagnosed with bilateral breast cancer. Maria had 
to give up her job offer and aggressively pursue treatment for the 
cancer.
  Fortunately, because Minnesota had expanded Medicaid, all of Maria's 
treatments were covered, and lucky for her, they worked. Maria's cancer 
is in remission. Maria said: ``The Medicaid expansion of the ACA 
literally saved my life.'' She told me that anyone could find 
themselves on Medicaid. She said: ``Without that comprehensive, 
affordable, accessible health insurance, I wouldn't be here.''
  But now that all of these programs are in jeopardy, my constituents 
are generally scared. They have come to me in tears, explaining that if 
the Affordable Care Act is repealed or if draconian changes and cuts to 
Medicaid go through, they don't know how they will care for their 
elderly parents, keep their rural hospital open, or afford treatments 
they or their children need.
  I believe it is legislative malpractice to pass partisan legislation 
that would undermine this progress, people's economic security, and 
their livelihood, all to achieve a destructive political end--to do it 
without holding thorough hearings in the committees of jurisdiction, 
without hearing from experts, and without a complete assessment from 
the Congressional Budget Office on how this legislation would affect 
the American people.
  I urge my Republican colleagues to once again abandon their efforts 
to ram through dangerous legislation that would fundamentally 
restructure our healthcare system. This new iteration of TrumpCare 
fails the Jimmy Kimmel test. It is the result of a horrible process 
that is not worthy of this body.
  We have a better option. Over the past few weeks, Chairman Alexander 
and Ranking Member Murray have held four bipartisan hearings on 
individual health insurance market reforms and are working to forge a 
legislative compromise to reduce premiums for consumers. We have heard 
from Governors, we have heard from insurance commissioners, and we have 
heard from experts--all of whom span the ideological spectrum. This is 
what regular order looks like, and this is the way the Senate is 
supposed to work.
  I have worked with all of my colleagues on this committee in good 
faith, and I am proud of what we have been able to accomplish so far, 
but all of that work is in jeopardy because of a destructive, partisan, 
last-ditch effort to repeal the Affordable Care Act and end the 
Medicaid Program as we know it.
  Do not shortchange those important legislative developments. Do not 
shortchange the American people. Think of the millions of children and 
families who need our help right now. Oppose TrumpCare, and, instead, 
let's work to improve care, lower costs, and ensure access to 
healthcare when people need it the most. It is within our reach.
  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.
  Ms. HASSAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.

[[Page S5846]]

  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. HASSAN. Mr. President, I rise today to oppose the latest 
disastrous iteration of TrumpCare, the Graham-Cassidy proposal.
  It is disappointing that we are here once again. In July, Granite 
Staters breathed a sigh of relief when the Senate defeated a proposal 
that would have raised healthcare costs and stripped health insurance 
away from millions. When that bill failed, I was hopeful that we would 
move forward on a bipartisan process to make key improvements to the 
Affordable Care Act. That is exactly the process we have started on in 
the HELP Committee, focusing on bipartisan solutions to stabilize the 
health insurance market.
  Now, in direct conflict to this important bipartisan work, some of 
our colleagues are making one last-ditch effort to pass partisan 
legislation. Make no mistake, Graham-Cassidy is more of the same, and 
it is every bit as dangerous as the TrumpCare plans we saw this summer, 
if not worse.
  Granite Staters and all Americans should be concerned if this bill is 
rushed into law. My colleagues are moving so quickly to try to get this 
bill passed that the CBO says it will not be able to score it by 
September 30, but it is clear that this bill would make things worse 
for most Americans.
  If you have a preexisting condition, including cancer, asthma, or 
diabetes, you could once again be discriminated against with higher 
costs that make health coverage unaffordable. This bill would end 
Medicaid expansion, a program that Democrats and Republicans in New 
Hampshire came together on to pass and reauthorize. Medicaid expansion 
has provided quality, affordable health insurance coverage to over 
50,000 Granite Staters. Experts on the frontlines of New Hampshire's 
heroin, fentanyl, and opioid crisis say it is the one tool we have to 
combat this epidemic. Ending Medicaid expansion would pull the rug out 
from under those who need its coverage. It would put thousands of 
people at risk.
  In addition, Graham-Cassidy would cut and cap the Medicaid Program. 
Those words, ``cut'' and ``cap,'' are really just code for massive cuts 
to the funding that States receive, including New Hampshire, losing 
hundreds of millions of dollars in Federal funding for Medicaid over 
the next decade. This cut would force States to choose between slashing 
benefits, reducing the number of people who can get care, or, in some 
cases, having to do both. It would impact some of our most vulnerable 
citizens--children, seniors who need in-home care or nursing home care, 
and people who experience disabilities.
  Graham-Cassidy would allow States to get rid of important protections 
in current law--protections called essential health benefits, which 
make sure that all insurers cover things like maternity care, 
prescription drugs, and substance use disorder services.
  Finally, this bill would continue Republican efforts to roll back 
women's access to healthcare by defunding Planned Parenthood, which 
provides critical primary and preventive healthcare services to 
thousands of New Hampshire women.
  As we continue to debate the future of our Nation's healthcare 
system, we have to understand how things would actually play out on the 
ground for the people we are trying to serve. Over the course of this 
year, the people of New Hampshire have laid themselves bare and shared 
story after story of how they would be impacted by these dangerous 
attempts to roll back access to healthcare.
  It is people like the Keene resident who has a preexisting condition 
and had health insurance through his job, but when he lost that job, he 
was able to start a new successful small business all because he knew 
he would be able to get quality health insurance under the Affordable 
Care Act. It is people such as the Granite Staters who experience 
disability but are able to live independently in their home and 
community as a result of the personal care services they receive 
through Medicaid and people like the mom from Rochester who is 
benefiting from substance use disorder services that are included in 
Medicaid expansion and would be taken away under this bill.

  It really shouldn't be necessary for people to have to come forward 
and share their most personal stories, all in an attempt to get their 
elected representatives to work together in a bipartisan manner and not 
take coverage away. We actually should be able to do that in the U.S. 
Senate on our own.
  Now, just as we are starting to work on a bipartisan basis, as our 
constituents asked us to do, the American people are faced with another 
harmful, partisan TrumpCare bill that will destabilize our healthcare 
system, drive up premiums, and make care less affordable.
  We must come together to build on and improve the Affordable Care Act 
and ensure that every American has meaningful, truly affordable access 
to the type of care each of us would choose for our own family. We must 
reject this proposal and continue moving forward on the bipartisan path 
we have started on in the HELP Committee.
  I am going to keep standing with my Democratic colleagues, and I urge 
the people of New Hampshire and all Americans to continue to speak out 
and to share their stories. Together, we will, once again, defeat this 
attempt to undermine the healthcare of millions of Americans, and we 
will make clear that in the United States of America, all of our people 
must be able to get quality, affordable care.
  Thank you, Mr. President.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Rubio). The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. BLUNT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BLUNT. Mr. President, I want to talk about healthcare and what it 
means to families and what it means to communities. It is the most 
personal thing that families deal with. Every family knows that at some 
point they are going to deal with not one but multiple healthcare 
issues as life progresses, as things happen in life--at times you don't 
expect them to happen in life--and nothing is more riveting or focusing 
than healthcare.
  Somebody told me one time--and I have said this on the floor of the 
Senate before because I think it is such a good observation about what 
happens in healthcare. Somebody told me that when everybody in your 
family is well, you have lots of problems. When somebody in your family 
is sick, you have one problem.
  So it is not like tax policy or energy policy or the intricacies of 
this or that; it is something that every family and every individual 
identifies with in a unique way. It is one of the reasons the debate is 
so passionate, and I think it may be one of the reasons why sometimes 
we see exaggerated claims about how a plan I may be for is going to 
cause more people to have healthcare problems than if that plan didn't 
pass. I certainly wouldn't intend for that to be the case. What we are 
all looking for is the best plan that addresses this problem in the 
best way.
  In the debate we had 6 weeks ago, I remember looking across the 
Senate floor at one of my colleagues who stood up and said: If the plan 
passes that many of my colleagues are going to vote for--he may have 
said the people across the aisle are going to vote for--health 
insurance rates are going to go up next year by 20 percent. Missourians 
have already seen a 145-percent increase, under the plan we have now, 
in 3 years. The rates that were just filed have ranged from a 35-
percent increase to a 47-percent increase. So it is a pretty safe 
prediction by my friend on the other side who said that if the plan I 
was for passed, health insurance rates would go up 20 percent.
  The plan he had been for--the plan they were defending--is out of 
control. There is no argument that what we have now is not working.
  Families who have coverage don't really have access. So many families 
with coverage have these high-deductible policies with insurance rates 
that, first of all, they can't afford the premium. If they are somehow 
able to scrape the money together to afford the premium--I think the 
average deductible in the bronze plan was $6,000 per individual, and 
for almost all of those plans, if you had more than one individual in 
your family, you had to hit the per individual rate twice if two

[[Page S5847]]

people got sick. So you were paying maybe $1,000 or more a month, and 
that was for insurance coverage. Then, if somebody got sick, you had 
another $12,000 that potentially would kick in before your insurance 
plan helped at all.
  Not only was that not real coverage, but it clearly wasn't access. It 
clearly didn't provide the opportunity to go to the doctor and have the 
kind of healthcare you need so you don't have a tens of thousands of 
dollars healthcare crisis that arises needlessly. Some of us will have 
those problems no matter how well we take care of ourselves, but access 
to healthcare matters, and healthcare that works where you live 
matters. Frankly, that is the plan Senators Cassidy and Graham have 
come up with--a plan that would take the decision making for 
government-assisted healthcare out of Washington and put it back in the 
States.
  When one of my Congressmen from Southwest Missouri was a freshman 
Congressman, decades ago in the House of Representatives, he was on the 
committee at the time that wrote the laws and regulations for 
Washington, DC. Somebody asked him why he thought he was smart enough 
to write the laws for Washington, DC. His hometown happened to be 
Sarcoxie, MO.
  He said: In my hometown, almost everybody knows where Washington, DC, 
is, but here in Washington, almost nobody knows where Sarcoxie is. Does 
that mean the people in Sarcoxie are a lot smarter than the people in 
Washington? Maybe not, but it meant they probably knew what was better 
for Sarcoxie than the people in Washington did.
  So what Senators Graham and Cassidy are talking about is looking at 
taking all the money we are currently spending in this government-
assisted healthcare world and divide it up among the States in a more 
equitable way. Right now, four of the States get about 37 percent of 
all the money. You don't have to be a math genius to figure out that 
means the other 46 States must get about 63 percent of all the money. 
Now, if 37 percent of all people in the country lived in those four 
States, that might be a reasonable way to divide up the money or even 
if 37 percent of people with income and health needs that were so 
significant they needed more help than everybody else lived in those 
four States, that might be a reasonable way to divide up all the money, 
but neither of those things are true. What this plan would do would be 
to look for a new way to more fairly allocate the money we spend on 
healthcare and then let State governments experiment with what to do 
about that.
  Jefferson said, in our system, the States had the unique ability to 
be laboratories for change because they could try things and see if 
they worked and then share with the other States what worked, but there 
was no vision at the time that the Federal Government was the best 
place to do everything. This is really sort of a debate between are you 
for federalism or are you for government-run everything.
  I guess 30 percent of the Democrats in the Senate, just a few days 
ago, said they were for government-run everything in healthcare. They 
were for single-payer healthcare. I am not for that. I don't think that 
is the best way for our system to work or to find the healthcare 
innovations we need or the access to healthcare people in desperate 
moments should always have, but I do think we could do a better job 
serving healthcare needs for people in the 50 States and the 
territories if, in fact, we gave them more authority to do that.
  First of all, in all likelihood, you will get your healthcare in the 
place you live, and you are more likely going to be able to get access 
to the same healthcare your local State representative gets, where it 
is not just me arguing for what is good for Missouri or my colleague in 
the Senate arguing for what is good for our State or the eight people 
we have in the House. It takes all 163 house members in our State, the 
34 senators, and the Governor leading to have a real understanding of 
where 200 legislative families get their healthcare and where 200 
people who are making that decision--who see people at school and the 
grocery store--that is a lot different than just seeing 10 people, 
sending them to Washington, and saying: Why don't we adjust the one-
size-fits-all system so it serves our State better.
  If you have ever bought any one-size-fits-all clothes, you are a very 
unique person if they actually fit you. One-size-fits-all almost never 
fits anybody. Even in a State, it is hard enough to come up with a plan 
that fits everybody in the State in the best possible way, but we would 
be much more likely to do that than we would to suggest what happens in 
Manhattan and what happens in Marshfield, MO, are the same thing 
because they are not. People in New York are going to come up with a 
more likely way to address those issues and figure out what healthcare 
is there, what they need to do to augment it, what they need to do to 
be sure it is available to the most people in the most cost-effective 
way, and in Jefferson City, MO, they are more likely to answer all of 
those questions for our State than, frankly, they are at the Department 
of Health and Human Services in Washington, DC.
  Even if they want to do that--even if they are all Missourians who 
take over the Department of Health and Human Services, their goal would 
not be to figure out what is best for where I live. Their goal would be 
to come up with one plan that is best for the whole country, and it is 
just not working very well.
  First of all, it is not working very well because it is clearly not 
divided in an equitable way. No matter what formula you put in place, 
four States having that much of the money spent in their States is not 
the right kind of system to have. There are ways to adjust for need, 
there are ways to adjust for location, but those ways are not going to 
be found in waivers Governors would ask for but are more likely to be 
found in State capitols than they are here.
  This is the classic example of why our government has worked as long 
as it has in so many areas, but every time we try to become responsible 
for everything at every level, we mess up. Every time we think 
different regulations have to be passed by city government, county 
government, State government, Federal Government, that never works very 
well.
  This is an opportunity to say to States: We are going to let you be 
responsible for devising a system for people in your State that meets 
the needs of people in your State, and we are going to do that in a 
more effective way than has been done in the past. The growth of 
healthcare programs has never been allowed to be looked at in a way 
where you look at all the programs and put them together in a way that 
really works.
  So we are going to have an opportunity to make a big decision about 
the future of healthcare. We are going to be deciding, among other 
things, do we trust people to make that decision who are closer to the 
problem or do we think it is better to try to solve the problem further 
away from the problem. I think the right answer here is, clearly, what 
we are doing isn't working.
  Let's take advantage of the Constitution and the Federal system of 
government, and let's come up with a plan that uniquely can work--in 
Florida where you live, in Missouri where I live, in Louisiana where 
Senator Kennedy lives--that has a unique opportunity to serve the 
families where the No. 1 thing they take most personally is the health 
and welfare of their family. Everybody has to deal with this. Let's try 
to create an environment where everybody gets to deal with this where 
there is the greatest opportunity, greatest sensitivity, greatest 
availability, and greatest understanding of how, if those things aren't 
working, to uniquely come up with a solution to the problems in that 
State that are very likely not the problems that need to be solved in 
the entire country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.