[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.