[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.