[Congressional Record Volume 163, Number 159 (Wednesday, October 4, 2017)]
[Senate]
[Pages S6299-S6301]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. KING. Mr. President, I rise today to talk about a subject that 
has been on our minds in recent weeks and months and, in fact, years; 
that is, healthcare--one of the most complex and confusing but 
important topics that we have to consider.
  Before I get into the bulk of what I want to address, I want to make 
the point once again that as we are debating healthcare and debating 
who pays, how much they pay, whether it is the ACA or Medicare or 
Medicaid or private insurance or private pay, we also

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have to begin a serious discussion about the underlying cost of 
healthcare.
  Regardless of who is paying, it is going to break us. If healthcare 
continues to grow in cost as it has over the last 20 years, it is going 
to eat the Federal budget, family budgets, individual budgets, and it 
is going to be something we absolutely have to address. Usually around 
here we don't address something until it is a crisis.
  I would argue, as we are approaching 20 percent of GDP, with $1 out 
of every $5 in the country being committed to healthcare costs--more 
than twice as much as most other countries in the world, far more than 
any other country in the world--we have to address this issue.
  Arguing about who pays is not going to solve the problem. That is 
important because in the interim, that is what is going to protect our 
citizens' coverage and what is going to protect our citizens from a 
healthcare disaster, a healthcare crisis.
  I want to preface my remarks with--I think this is something we all 
need to be thinking about--how do we move beyond the discussion we are 
having now, not that it is unimportant, but we also need to move beyond 
the discussion and start talking about the underlying cost and why is 
it that Americans are paying virtually twice as much as anyone in the 
world for healthcare per capita--or as a percent of GDP or however you 
want to calculate it--without noticeably better results? In fact, most 
worldwide studies indicate the results of our healthcare system are not 
as good as those in many other countries.
  It would be one thing if we were paying a lot of money and getting 
absolutely superior care across the board in our country, but that is 
not the case. In measurements such as infant mortality, longevity--
standard basic healthcare indicators--we are not doing very well. Yet 
we are paying twice as much. There is something wrong with that, and we 
have to address it.
  I want to talk about the Affordable Care Act. I want to start with 
the point that it is the law of the land. It is the law of the land.
  I am rising today in sadness but also in anger because there is a lot 
of talk about the Affordable Care Act collapsing, imploding. It is not 
collapsing. It is being mugged. It is being stabbed in the back. It is 
being sabotaged deliberately and consciously by the actions of the 
administration.
  I want to emphasize that this isn't about ideology. It is not about 
politics. It is not about who wins and who loses or which party is up 
or who voted or who didn't. This is about people. It is about people in 
Maine. It is about people, many of whom got care for the first time 
under the Affordable Care Act; lobstermen, small farmers, small 
businesspeople, individuals finally had a shot at reasonably priced 
healthcare.
  It is not perfect by any means. I would never argue that. In fact, I 
have been working on proposals since the day I got here on how to 
improve it, how to fix some of the problems, how to make it better, how 
to have the effects be less intense on some parts of our economy. It is 
the law of the land. The impacts of what we do here or don't do here 
fall on real people--real people, in my case, in my home State of 
Maine.
  The Affordable Care Act is not collapsing; it is being sabotaged. 
Here is a partial list.
  In January, during the period of the last open enrollment, one of the 
first acts of the new administration was to cut the advertising on 
television, advising people that they had this healthcare option. Cut 
the ads, that is No. 1. That was in January.
  Then they announced they were going to minimize the enforcement of 
the personal mandate. If you tell somebody you are not going to enforce 
something, that is an invitation to not abide by it, to not pay any 
attention to it. People can argue about whether that is desirable, but 
that is the law. To announce that administratively you are not going to 
enforce it, again, what does that do? It reduces the number of people 
who are going to get healthcare. That, in turn, undermines the 
individual market, and that, in turn, makes it less financially viable. 
That is a deliberate act that will undermine the viability of this law.
  In April, there began a series of what turned into seven different 
threats from various people in the administration to not make the 
legally mandated CSR payments--the cost-sharing reduction payments--
which are not bailouts to insurance companies but which were designed 
as part of the law to hold the rates down and to hold the deductibles 
down for those people buying coverage under the Affordable Care Act. 
Continuously threatening the reduction or the elimination of these 
payments has created an uncertainty in the marketplace that is now 
coming home to roost.

  Just last week, Anthem announced they are leaving the Maine 
marketplace. They cited a number of reasons, but one of the chief 
reasons was the uncertainty created by whether these payments are going 
to be made.
  Recently, the HELP committee had a series of hearings on this 
subject. They had a bipartisan group of Governors. They had a 
bipartisan group of insurance commissioners, health experts from across 
the country. I was at all but one of those hearings. I believe I am 
right in saying it was unanimous that we must ensure the continuation 
of the CSR payments in order to stabilize the market and reduce 
premiums projected to increase this coming year.
  The number nationally is estimated to be about 20 percent--a 20-
percent increase attributable to the failure to ensure that the CSR 
payments will be made because an insurance company, if they are setting 
rates, has to factor into their rates the risk of these payments not 
being made. The testimony is--it depends somewhat on the State, but 
roughly a 20-percent increase is attributable to just this fact.
  If we could pass legislation here--unfortunately, we missed the 
deadline, but we may be able to work on that because the deadline was 
just last week. But if we could simply ensure those payments are made, 
that in itself would lower rates by 20 percent next year on a silver 
plan.
  By the way, if those CSRs aren't made and the rates go up, 
ironically, that means the mandatory payments of subsidies to 
individuals under the Affordable Care Act will also go up. So it will 
cost the Treasury money--additional money not accounted for, roughly 
$200 billion over the next 10 years.
  What else has gone on? In May, there was another one from the head of 
the Office of Management and Budget. The administration has not decided 
whether to pay the CSRs. That is a big red signal to the insurance 
companies: You can't count on this, so you better raise rates. In May, 
the budget was released. In the budget, there were drastic cuts in the 
call centers for the Affordable Care Act, in the in-person assistance, 
and in marketing. And just for good measure, they announced they were 
cutting the enrollment period in half, from 3 months to 6 weeks. What 
possible reason can there be to do that, except that you want fewer 
people to sign up? That is called sabotage--reducing from 3 months to 6 
weeks.
  Then, all along, the Health and Human Services Department has been 
monkeying around with the website, taking down explanatory material 
about the Affordable Care Act, taking down material indicating why this 
would be a good deal for people and, instead, putting up critical 
material.
  On August 31, the administration announced reductions in outreach of 
90 percent and cuts in assistance to people trying to navigate this 
system by 40 percent. This is complicated material. Any of us who have 
signed up for insurance--we all have the Affordable Care Act. Most 
people don't know that. But we had to go on the website and choose a 
policy for ourselves. It is hard, it is complicated, and to take away 
the people who are in the communities helping people work through these 
various decisions and weigh the different policies, the deductibles, 
and how to compare them is the same as taking away the coverage. It is 
an act of sabotage.
  The most recent one I just learned about this morning. This is 
amazing. The Affordable Care Act is based on a website, healthcare.gov. 
We all know it had terrible problems when it started. There is no 
excuse for that. I was critical of it at the time. Those were problems 
that were not intentional.
  Now intentional problems are being created. This is the one that 
really gets me. I just learned this morning that every Sunday during 
the bobtail enrollment period, the 6-week enrollment period, the 
website is going to be closed

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for 12 hours for maintenance. Isn't that amazing? For 12 hours on the 
one day of the week when many working people are going to have an 
opportunity to try to understand this system and enroll, they are going 
to be down from midnight Saturday night until noon on Sunday, the 
middle of the day on Sunday.
  I want to go back to the beginning. This isn't about ideology. This 
is about seeing that the laws are faithfully executed. That is why they 
call it the administration. The administration is supposed to 
administer the laws, not unadminister them.
  We are talking about people. Why does anyone want to have fewer 
people with insurance? I am at a loss to understand the motivation. I 
can understand if you don't like the ACA. If you don't like the ACA, 
let's work together and find ways to improve it and change it, but 
figure out how to keep people with health insurance.
  The uninsured rate in America has fallen 50 percent because of the 
Affordable Care Act. That is an enormous achievement. It is one that 
should be celebrated, not sabotaged. That is what is so puzzling to me 
about this: fewer people with coverage and higher costs to the 
Treasury.
  We can do better than this. These are all things the administration 
in good faith can say: OK, we don't like the ACA, but we are going to 
move beyond the politics of this and try to help people get the 
coverage they desperately need.
  This is about real people's lives. This is about lifting the threat, 
the cloud of a healthcare disaster, both physically and financially, 
from families across America. We are talking about millions of 
families--not tens of thousands but millions of families. I don't get 
why we are deliberately trying to undermine and sabotage something that 
is so meaningful to so many people. As one can tell, it makes me angry. 
Mostly, it makes me sad because I know people in Maine who have 
benefited, who have gotten coverage, who did not have it before and who 
will not have it if this is taken away--people who need those 
navigators to help them, people who need to be able to use the website 
on a Sunday morning, people who need to have rates that are lower 
because the CSRs have been funded, and we are not continuously raising 
the uncertainty of that piece of this law.

  We can do better. This is about the health of our people. I cannot 
think of anything more important. We can have different ways of getting 
there, but right now we have a law that is in place, and until we 
change it--and we should change it; we should fix it--we should 
administer it straight up, straightforwardly, as it was written and as 
it was intended. This is too important for politics, and it is too 
important for ideology. This is all about people and their health.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER (Mrs. Ernst). The Senator from Utah.