[Congressional Record Volume 163, Number 172 (Wednesday, October 25, 2017)]
[Senate]
[Pages S6783-S6785]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mrs. MURRAY. Mr. President, I come to the floor today to talk about 
what my bipartisan healthcare bill with Chairman Alexander means for 
the people we are all here to serve, what it means for patients and 
families in my home State of Washington and across the country who are 
worried about being able to afford the healthcare they need, and what 
it means for States and communities and hospitals that are 
administering and providing care.
  Negotiations of this magnitude are always tough. There are some 
things you agree on, and sometimes there is common ground that emerges 
early, but there is no question that you also find areas of strong 
disagreement. You have to work your way to each answer step by step.
  One issue that Chairman Alexander and I agreed on from the very start 
of our negotiations, where we worked our hardest, and what we had the 
most discussions on was the goal of putting patients and families first 
and that it would be families who would benefit as much as possible 
from our efforts to restore stability to our markets. That was the crux 
of our debate. It was our guiding star.
  I am very proud to say that our bipartisan bill does just that. Here 
is what is at stake. Here is what we know. Patients and families across 
the country are looking ahead to next year. They are rightly worried 
about their healthcare--premiums, benefits, and coverage--and they are 
realizing that they are about to pay the price for the uncertainty and 
partisanship we have seen on healthcare over the last 9 months.
  Like all of my colleagues, I have listened and I have talked with 
many of these families in my home State, at hospitals, schools, 
roundtables, and in meetings with patients, doctors, providers, and 
veterans. They have all made it very clear that enough is enough with 
playing politics with people's healthcare.
  Here is how our bipartisan bill would protect those families and 
restore certainty to the markets. I will not go into all of the 
details, of course, but I do want to focus on some really important 
points.
  First of all, this bill would restore the out-of-pocket cost 
reduction payments that President Trump has announced he will be ending 
for this year as well as for 2018 and 2019. This means that some 
serious sabotage--something that experts say would raise premiums by 
double digits for millions of families--would be off the table.
  Second, this bill would make significant investments when it comes to 
healthcare outreach and enrollment to make sure that families know 
about their insurance options.
  Third, this bill makes some changes to give our States more 
flexibility when it comes to developing plans and offering options 
while maintaining essential health benefits, like maternity care and 
protecting people with preexisting conditions or protecting the 
elderly--and all of this while making sure that costs go down for 
families and preventing insurers from doubledipping and padding their 
profits with both cost reduction payments and higher premiums.
  Put simply, this bill is an important step in the right direction of 
preventing premium increases, stabilizing healthcare, and pushing back 
against President Trump's recent actions.
  This bill reflects the input of patients, Governors, State 
commissioners, experts, and advocates, and it has strong support from a 
majority here in the Senate. So far, 24 Senators--12 Democrats and 12 
Republicans--have cosponsored this bill. I know there are a lot of 
others who agree that we need to act and that we must do so in our 
working together under regular order, as with our bill, rather than 
doubling down on partisanship and dysfunction.
  I am focused on moving our bill forward as quickly as possible, and I 
certainly hope that the majority leader will listen to the Members on 
both sides of the aisle who also want this bill to be brought up for a 
vote without delay.
  Let me be clear. As this bill moves forward, I am certainly open to 
changes that expand access to quality care, put families ahead of 
insurers, and maintain those core patient protections that I have been 
clear all along have to be protected. I am certainly not interested in 
changing our bipartisan agreement to move healthcare in the wrong 
direction.
  Chairman Alexander and I have a record of seeing tough legislation 
through to the end together, whether that is K-12 education, FDA user 
fees, mental health reform, or opioid use disorders, which is why I am 
confident that we can do the same with this stabilization bill.
  We have negotiated a strong agreement that has the support of 60 
Senators, and the support is growing. The President has also expressed 
his support for our effort, so I see no reason why we should not move 
this bill through the Senate, get it signed into law, and then continue 
the bipartisan discussion on healthcare in the country.
  I will also take some time to talk about another pressing healthcare 
challenge, and that is the immediate need to extend Federal funding for 
the historically bipartisan, expired primary care cliff programs, like 
the Community Health Center Fund, the National Health Service Corps, 
and, of course, the Children's Health Insurance Program, or CHIP.
  It has now been almost 25 days since the Federal funding of these 
primary care cliff programs and CHIP were allowed to expire by the 
Republican majority, and in that time, I have heard from thousands of 
people in my State and nationwide who are urging Congress to act. Each 
day that passes is a day that we are failing to meet our commitment to 
these families and putting the health and well-being of nearly 9 
million children, including more than 60,000 children in my home State 
of Washington and the 25 million patients who, at great harm and great 
risk, get care from the community health centers.
  In Washington State, as in so many other States, notices to families 
about gaps in their children's healthcare are about to go out as soon 
as December 1, and in my State, we will run out of Federal funds for 
CHIP in November.
  Let me be clear. Parents in my home State and across the country 
should not be up at night, worrying about their children's healthcare 
because Congress cannot get the job done. That is so unacceptable.
  There is a bipartisan deal in the Senate right now that was 
negotiated between the chairman and ranking member of the Finance 
Committee that would provide certainty for this vital program. I 
understand that extreme House Republicans have chosen, instead, to take 
an irresponsible path in their trying to ram through a partisan bill 
that will jeopardize the efforts in the Senate and in the House to come 
to an agreement as soon as possible.
  To be clear, this delay has not been without serious consequences, 
but we can still act. It is up to Republican leaders now to reverse 
course, come to the table, and join with Democrats to get this done. It 
should not have to be said, but there should not be any place for 
partisanship or politics when it comes to protecting the children and 
families we represent. I hope that we get this done and get it done 
quickly, and I hope that all of our Members will move forward on this.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

[[Page S6784]]

  

  Mr. ALEXANDER. Mr. President, I see the Senator from New Hampshire on 
the floor. I ask through the Presiding Officer if she is about to speak 
or if I may speak after her. What I would like to do is to give a brief 
report on the Congressional Budget Office's report of the Alexander-
Murray proposal, of which the Senator from New Hampshire is a 
cosponsor. I would like to do that either before or after she speaks. 
Either way would be fine.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, my understanding is that Senator Cornyn 
was about to come to the floor, but I would be happy to have the 
Senator give the CBO report on this legislation, which I very 
enthusiastically support.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, in respecting Senator Cornyn's 
prerogative, I will stop when he comes to the floor.
  I believe that Senator Murray has come to the floor and has reported 
that the Congressional Budget Office has just finished an evaluation of 
the Alexander-Murray proposal to the U.S. Senate that would be for the 
purpose of reducing premiums and avoiding chaos in the individual 
insurance markets during the years 2018 and 2019.
  The Senator from New Hampshire is a strong sponsor of that 
legislation. It is unusual, in fact, that it has 12 Republican Senators 
and 12 Democratic Senators. Not many pieces of legislation come to the 
floor with that support. The reason we accelerated work on it was that 
President Trump called me and asked me to work with Senator Murray to 
try to develop such a proposal. So now it is being considered by the 
President, by the House of Representatives, and by other Members of 
this body.
  An important piece of information, as Senator Murray has said, is 
what the Congressional Budget Office writes about the impact of our 
proposal on the Federal taxpayers and on the consumers across the 
country.
  President Trump has been very clear on one thing he wants, which is 
that we do not bail out insurance companies if, in 2018, we pay cost-
sharing payment reductions, which are payments to pay for deductibles 
and copays for low-income Americans.
  I 100 percent agree with President Trump on that, and Senator Murray 
100 percent agrees with President Trump on that. We have language in 
our proposal to make sure that benefits go to consumers and to 
taxpayers and not to insurance companies. We asked the Congressional 
Budget Office to review that, and this is what it wrote: ``On net, CBO 
and the staff of the Joint Committee on Taxation (JCT) estimate that 
implementing the legislation would reduce the deficit by $3.8 billion 
over the 2018-2027 period relative to CBO's baseline.''
  In other words, the Alexander-Murray proposal would reduce Federal 
spending by $3.8 billion. Not only does it not cost anything, but it 
saves the taxpayers money.
  They then wrote a second thing, and this is quoting the Congressional 
Budget Office: ``CBO and JCT expect that insurers in almost all areas 
of the country would be required to issue some form of rebate to 
individuals and the federal government.''
  Let me say that again. This is the CBO talking, the nonpartisan 
Congressional Budget Office, with respect to the Alexander-Murray 
proposal that has been cosponsored by a total of 24 Senators--12 
Republicans, 12 Democrats: ``CBO and JCT expect that insurers in almost 
all areas of the country would be required to issue some form of rebate 
to individuals and the federal government.''
  The Congressional Budget Office has found that our proposal benefits 
taxpayers and consumers, not insurance companies. The specific benefit 
to the taxpayers is $3.8 billion. The exact benefit to consumers has 
not been determined yet because that will be done State by State. Under 
our proposal, every State would come up with a plan to say, in 2018, 
because of the cost-sharing payments, premium rates need to be lower 
than they are already set. Then, in that State, they would be, and as a 
result, there would be rebates to individuals.
  The CBO also found that there is a provision in the law for a 
catastrophic plan. That is a new insurance plan for people over the age 
of 29 that would have lower premiums and higher deductibles, but it 
would allow people to afford an insurance policy so that a medical 
catastrophe would not turn into a financial catastrophe.
  ``CBO estimates that making catastrophic plans part of the single 
risk pool would slightly lower premiums for other nongroup plans, 
because the people who enroll in catastrophic plans tend to be 
healthier, on average, than other nongroup market enrollees.''
  A major objective, I think, of all of us is to attract more young, 
healthy people into the pool as a way of lowering rates for everybody.
  ``As a result of the slightly lower estimated premiums, CBO and JCT 
expect that federal costs for subsidies for insurance purchased through 
a marketplace established under the ACA would decline by about $1.1 
billion over the 2019-2027 period.''
  We have already said what the Congressional Budget Office has 
reported earlier; that if we don't pass something like the Alexander-
Murray proposal, this is what happens: If the cost-sharing payments are 
not paid, premiums in 2018 will go up an average 20 percent. They are 
already up. Our proposal will take them down. The Federal debt will 
increase by $194 billion over 10 years, if we don't pass our proposal, 
due to the extra cost of subsidies to pay higher premiums, and up to 16 
million Americans may live in counties where they are not able to buy 
any insurance in individual markets. The 350,000 Tennesseans in 
individual markets in Tennessee would be terrified by the prospect of 
not being able to buy any insurance or by the skyrocketing premiums.
  I thank Senator Cornyn and the Senator from New Hampshire, Mrs. 
Shaheen, for allowing me to interrupt and make a brief statement.
  Let me go to the bottom line once more. The President has said 
repeatedly, Senator Murray has said repeatedly, and I have said 
repeatedly that the Alexander-Murray amendment, the short-term 
bipartisan plan to reduce premiums and avoid chaos, must not bail out 
insurance companies. We have written language to make sure it does not, 
and now the Congressional Budget Office says it does not. It does not 
bail out insurance companies. It does benefit consumers. It does 
benefit taxpayers to the tune of $3.8 billion. That is very important 
information.
  I am encouraged by the President's comment yesterday. He thanked me 
at the luncheon for working in a bipartisan way on this. I am 
encouraged that Senator Hatch and Kevin Brady have introduced a bill 
recognizing the importance of continuous cost sharing. The ball is in 
the hands of the White House right now. They have our recommendations. 
They made some suggestions. That is the normal legislative process.
  I am hopeful that something that has this kind of analysis; that it 
doesn't bail out insurance companies, that avoids a big increase to the 
Federal debt, that makes certain that people will be able to buy 
insurance for the next couple of years, that begins to lower premiums, 
that almost all Democrats want and that Republicans in the House have 
all voted for once this year when they voted for their repeal-and-
replace bill--something like that sounds like something that might 
become law before the end of the year, and I believe the sooner the 
better.
  I thank the Presiding Officer, Senators Cornyn and Shaheen.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Mrs. SHAHEEN. Mr. President, I am delighted to follow Senator 
Alexander and was very pleased to hear the news from the CBO that this 
Alexander-Murray proposal not only doesn't bail out insurance 
companies, as we all agree we should not do--we want to make sure 
savings go to consumers--but it also will save taxpayers $3.8 billion.
  This is a bipartisan agreement. I applaud the work of Senator 
Alexander and Senator Patty Murray to craft this bipartisan agreement 
to address the challenges we have in the short term with healthcare. 
Senators Alexander and Murray have given us a template for bipartisan 
negotiations not just on healthcare but on other critical matters that 
are going to come before this Senate--tax reform, reauthorizing 
community health centers and the Children's Health Insurance

[[Page S6785]]

Program, reaching an agreement on the 2018 budget. These are all major 
issues facing this country and issues we should be working on in a 
bipartisan way. The Senate is at its best when we observe regular order 
and we follow the committee process, when we work across the aisle and 
make principled compromises to get things done for the American people. 
I believe that is exactly what this health insurance bill does.
  In a Senate that is nearly equally divided between Republicans and 
Democrats, this is the only productive way forward for us to address 
the challenges that face this country. Too often we have seen people 
use bipartisan negotiations as a last resort, but bipartisanship should 
be the Senate's first resort, not the last resort. It should be the 
foundation of our work in this body. This is how the great majority of 
Americans want us to conduct the Senate's business.
  When I travel around New Hampshire, this is the consistent comment I 
hear everywhere I go: Why can't you all work together to get things 
done for this country? This is especially true on matters like 
healthcare and tax reform, which affect families throughout the 
country.
  I am encouraged that the Alexander-Murray bill has earned strong 
bipartisan support and, as Senator Alexander said, has 24 original 
cosponsors. That number is equally divided between Republicans and 
Democrats. This is a balanced agreement that has been negotiated by 
both parties over many months, and I think it is our best bet for 
stabilizing marketplaces in the short run so we can continue to work on 
long-term issues around healthcare.
  I am especially pleased this agreement provides for the continuation 
of cost-sharing reduction payments for 2 years. These payments are 
necessary to keep premiums, deductibles, and copayments affordable for 
working people. Without these payments, the cost of coverage will 
skyrocket, insurers will leave the marketplaces, and millions of people 
will lose their healthcare coverage. I have been working on this issue 
of cost-saving reduction payments since earlier this year, when I 
introduced a bill that would permanently appropriate funds for the 
CSRs.

  As the CBO said, the language in the Alexander-Murray bill ensures 
that these CSRs are not a bailout to insurance companies, but they are 
a way to help people with the cost of insurance. They are orderly 
payments that are built into the law that will go directly to keeping 
premiums, copays, and deductibles affordable for lower income 
Americans. Both Democrats and Republicans recognize that these payments 
are an orderly, necessary subsidy that keeps down the cost of health 
coverage for everyday Americans. As Senator Alexander said, we saw that 
these payments were in the bill the House voted for around healthcare, 
and they were also in the Senate bill earlier this year.
  In recent months, I have heard from hundreds of people across New 
Hampshire about the enormous difference healthcare reform has made in 
their lives. We are a small State; we have just about 1.3 million 
people. Nearly 94,000 Granite Staters have gotten individual healthcare 
coverage through the marketplaces. Nearly 50,000 have gotten coverage 
thanks to the Medicaid expansion program in New Hampshire. That has 
been a bipartisan effort, with a Republican legislature and a 
Democratic Governor, to get that program in place, and it continues to 
enjoy the support of the Republican legislature and the Republican 
Governor.
  Because of the Affordable Care Act's increased access to care, we 
also have 11,000 Granite Staters who have substance use disorders and 
who have been able to get treatment for the first time. New Hampshire 
has the second highest rate of overdose deaths from the heroin and 
opioid epidemic. Having treatment available through the expanded 
Medicaid Program has made a difference for thousands of people in New 
Hampshire and their families. Hundreds of thousands of Granite Staters 
with preexisting conditions no longer face discrimination resulting in 
denial or sky-high premiums. These are important achievements, and this 
legislation will allow us to continue down that road to make sure 
people have healthcare coverage they can afford.
  For people across New Hampshire and across this country, healthcare 
coverage is often a matter of life or death. It is about being able to 
take a sick family member to a doctor. It is about knowing that a 
serious illness will not leave a mountain of debt.
  I am very pleased to be able to join in the bipartisan efforts led by 
Senators Alexander and Murray to strengthen the parts of the healthcare 
law that are working and to fix what is not working. The other 
provisions in this legislation will allow States more flexibility 
through the 1332 waiver process. The Alexander-Murray agreement 
expedites waiver approval so States can implement smart fixes to 
stabilize their marketplaces, for instance, by establishing a State-
based reinsurance program. The agreement also includes a restoration of 
funding for open enrollment outreach in educational activities, and it 
protects four protections related to insurance affordability, coverage, 
and plan comprehensiveness. All of these changes are positive steps 
forward, steps that I hope will set us on a bipartisan path, 
strengthening elements of the Affordable Care Act that are working well 
and fixing elements that need to be changed.
  I am hopeful the Alexander-Murray agreement can gain the bipartisan 
support it needs to pass in Congress, that it can gain the President's 
signature, and I am encouraged by Senator Alexander's comments about 
the President's comments yesterday because we need to restore certainty 
and stability to the marketplaces. Instead of partisan efforts to 
undermine the law and take health insurance away from people, we should 
embrace the spirit of the Alexander-Murray agreement. Let's work 
together in a good-faith, bipartisan effort to build a healthcare 
system that leaves no American behind.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The majority whip.