[Congressional Record Volume 163, Number 183 (Thursday, November 9, 2017)]
[Senate]
[Pages S7145-S7147]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Ms. HEITKAMP. Mr. President, I rise today to discuss a couple of 
pressing issues regarding our healthcare system and to ensure that 
Americans are aware of some critical deadlines for their health options 
in the marketplace.
  It is that time of year. Healthcare open enrollment has started, and 
Americans across the country can sign up or change their healthcare 
plans to make sure they are getting a plan that works best for them and 
their families.
  I have long said that the health reform law, otherwise known as 
ObamaCare, is not perfect, and I have been pushing since I have been 
here to make it work better for North Dakota families and small 
businesses. But there are many pieces in that healthcare law that are 
helpful, and I wish to make sure that Americans and North Dakotans take 
advantage during this open enrollment period.
  Every individual and family should be able to get access to 
affordable, quality healthcare, and no one should have to go bankrupt 
to pay for healthcare for a child with a disability, a sick family 
member, or just an emergency that you never thought could happen. That 
is why I am encouraging everyone to please make sure you explore your 
options and sign up for healthcare coverage.
  It is more important than ever that folks take advantage of this open 
enrollment period early because there are many changes this year that, 
unfortunately, make it more difficult for individuals and their 
families to sign up for health insurance. Even if you already have a 
plan, it is worth checking out healthcare plans, as these prices change 
from year to year.
  First, open enrollment today is a month and a half shorter this year 
than it has been in the past. Open enrollment is from November 2--right 
now--until December 15. That is just 45 days. Do not wait to check this 
out. It is best if you go today to find out if there is a better plan 
for you or if you need to secure health insurance on the marketplace.
  Second, the administration has significantly reduced funding for in-
person assistance, called navigators, who help individuals and families 
sign up for healthcare coverage. This action is leaving millions of 
Americans and thousands of North Dakotans without the critical help 
they need to understand their options and enroll in meaningful 
healthcare coverage.
  I want to make a point here. For those of us who in the past have 
always had the option of getting healthcare coverage through an 
employer, there is always someone in that employment office, in the 
payroll office, or in human resources who helps you through. This is 
not unique in needing this assistance. It is not unique to the 
marketplace. It is access and information that you have through your 
employer, if you are getting your insurance through your employer. The 
idea was that the same opportunity for information should be made 
available in person on the marketplace, but it is not. So we have to 
try and fill in those gaps. Because we have these gaps, we are in many 
ways seeing a number of cutbacks and a number of folks not getting 
access to the information they need.
  In fact, the Great Plains Tribal Chairmen's Health Board does not 
have enough funds to operate as a navigator, and they will not be able 
to help North Dakotans sign up for coverage as they have done in 
previous years. Another navigator in my State, Minot State University, 
has had its Federal funds cut by over 96 percent.
  Since 2013 the uninsured rate in North Dakota has been reduced from 
11 percent to 8 percent, in large part because of the work of these 
navigators. The navigator grantees in my State have provided an 
invaluable service by guiding families through the process of 
determining the best private health insurance coverage for them, as 
well as through traditional Medicaid and Medicaid expansion application 
processes. Many North Dakotans who sign up for coverage qualify for 
Federal assistance to help afford that coverage. So it is vitally 
important that they understand Medicaid, that they understand Medicaid 
expansion, and that they understand the tax implications of the plans 
they are selecting.
  But even those numbers that show the decrease in uninsured in North 
Dakota don't tell the full story. Not only have navigators responded to 
daily inquiries both during and outside of the open enrollment period, 
but they have identified and responded to the challenges of increasing 
enrollment, particularly in rural and hard-to-reach areas of the State 
that are less likely to have access to coverage through an employer.
  Slashing funding for navigators also has implications for Indian 
Country. The Indian Health Service has had challenges delivering 
quality care to Native Americans in my State and certainly in our 
region. But those issues have lessened as more Native Americans have 
enrolled in traditional Medicaid, Medicaid expansion, and private 
health insurance, enabling these families to access quality, affordable 
healthcare to stay healthy. Thanks to the increase of third-party 
payments, we are no longer limited to life-or-limb care at Tribal IHS 
facilities in the Great Plains service area.
  Adding to the turmoil of the enrollment process, the administration 
also announced that it is cutting off Federal funding that helps make 
healthcare affordable for families, known as cost sharing reduction 
payments. As a result, many individuals and families will see their 
premiums skyrocket by double digits. Due directly to this decision and 
the uncertainty it has injected into our healthcare system, one insurer 
has exited the healthcare marketplace in North Dakota and another has 
reduced its health insurance plan offerings, leaving many counties in 
my State with only one insurer for consumers to choose from. 
Ironically, North Dakota was one of the best covered States in terms of 
options and choices. That option and that source of pride has been 
diminished as a result of the lack of consistency with cost sharing 
reduction payments.
  A recent report from the nonpartisan Congressional Budget Office said 
that if the administration stopped paying the cost sharing reduction 
payments, as it has now done, there would be serious consequences for 
individuals and families across the country. The report said families' 
premiums would jump about 20 percent, many families would be left 
without health insurance options as the lack of payment would force 
many insurers to leave the market, and it would also add $194 billion 
to the deficit over a decade.
  Despite these efforts to sabotage the marketplaces and jeopardize 
access to coverage for families, we have fortunately seen a surge of 
encouraging enrollment numbers in the first week of enrollment. But the 
American public deserves better, and I will do everything I can to 
ensure that consumers know their options, that consumers are connected 
with opportunities for meaningful coverage, and that they are provided 
certainty in the future about healthcare costs.
  On November 1, I had launched a new page on my website, 
heitkamp.senate.gov, to help provide resources and enrollment 
information to North Dakotans. I sincerely hope folks who are looking 
to buy health insurance on the marketplace in North Dakota take 
advantage of that website.
  Access to affordable quality healthcare is a must, and I am proud to 
have worked with a group of Republican and Democratic Senators, led by 
Senators Alexander and Murray, to reach a deal to offer some immediate

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fixes to make healthcare more affordable and accessible in North Dakota 
and across the country. Our bill would specifically address many of the 
new challenges that face folks during open enrollment.
  The deal we unveiled last month would provide certainty for insurers 
and customers by restoring the cost sharing reduction payments for 2 
years and restoring Federal funding for outreach and enrollment efforts 
in States, including the navigator services that I talked about 
earlier. It incorporates an idea that I have been championing for many 
years, which is to create a lower cost copper plan with lower premiums 
and higher deductibles to increase coverage options for young, healthy 
families, where they aren't so much worried about the day-to-day costs 
of healthcare but that catastrophic event that could throw them into a 
lifetime of poverty.
  The agreement would also provide flexibility for States to continue 
to explore their options to deliver the best healthcare options to 
their citizens. This recognizes that one size does not fit all and that 
we need to have more flexibility for States to experiment and to 
provide the kind of quality of care and the kind of care options that 
work best for their State.
  On top of having significant bipartisan support, there is a bonus. 
The bonus is that CBO and the Joint Committee on Taxation estimate that 
enacting the legislation would reduce the deficit by $3.8 billion 
without substantially changing the number of people with health 
insurance coverage.
  Now Congress needs to pass our bill. I have long said there are good 
parts of the healthcare reform act and parts that need to be fixed. Our 
bipartisan deal is an important step to help families afford healthcare 
coverage so the health reform law works better for North Dakotans.

  How rare is it in this body to have this many people come together to 
propose one piece of legislation? I know that if you put this bill on 
to the floor tomorrow, it would easily pass with over 60 percent of the 
Senate. We need to get this done. We need to get it done to ensure the 
American public that we are serious about responding to their concerns 
about healthcare but that we are also serious legislators who can, in 
fact, fix the problems that we have in this country.
  This isn't everything that we have been working on, but it certainly 
is the most important and the highest priority to pass the Murray-
Alexander bill. But there are other proposals to improve healthcare 
that I am working on. I recently introduced a bill to delay the health 
insurance tax for 2 years and make coverage more affordable for the 156 
million consumers across the country impacted by the fee. It would also 
make the tax deductible moving forward, providing more certainty for 
families to plan into the future.
  Reducing the impact of the health insurance tax--a fee that directly 
impacts the healthcare affordability for families and small 
businesses--has had broad, bipartisan support. In 2015 Congress passed 
a 1-year delay of the fee. This delay benefited consumers, seniors, 
employers, State employees, and Tribes. The average premium reduction 
from that delay of the fee was 3 percent.
  If we think about the health insurance tax and we think about the 
sales taxes that many States enact, many States will tell you we don't 
enact sales tax on the necessities of life, whether it is food or 
whether it is electricity. Clearly, this is a necessity of life, having 
this health insurance. This health insurance tax is nothing more than a 
regressive sales tax on premium costs, and I believe we need to find a 
better and more commonsense alternative.
  Another commonsense bill that I have introduced to help make 
healthcare more affordable for middle-income families is a bill that 
would address what I call the current cliff problem on premium 
assistance that many middle-class families and seniors face when they 
earn above 400 percent of the Federal poverty level, putting affordable 
care out of reach.
  Right now, those earning just a nominal sum over--$1 over 400 percent 
of the Federal poverty level, which is $47,550 for an individual and 
$97,200 for a family of four--are no longer eligible for any premium 
support to make health insurance more affordable. This perhaps is one 
of those issues that I have heard more about than almost any other 
issue in the Affordable Care Act.
  What my bill would do is to get rid of the cliff and instead insert a 
slope. The bill would enable more young, healthy families to be able to 
obtain affordable healthcare coverage while diversifying the insurance 
pools, and it would make sure seniors with high medical costs aren't 
forced to lose those hard-earned retirement savings or go without care. 
Smoothing out that cliff will make health insurance more affordable, 
will make this bill more responsive to our middle-class taxpayers and 
middle-class families, and will provide some certainty for these 
families as they look at the high cost of healthcare and insurance 
premiums into the future.
  I also cosponsored a bill to provide stability in the insurance 
marketplace by making the current reinsurance program for individual 
health insurance market permanent. It would be similar to the 
successful programs used to lower premiums and spur competition in the 
Medicare Part D Program. This reinsurance program would provide funding 
to offset larger than expected insurance claims for health insurance 
companies participating in State and Federal insurance marketplaces, 
and it would encourage them to offer more plans in a greater number of 
markets, improving competition and driving down costs for patients and 
families.
  It is that catastrophic cost, which is unpredictable for the 
actuaries, that drives up high cost. If they know that catastrophic 
cost above a certain amount is subject to a reinsurance plan and those 
costs are shared more broadly than just within that system, the 
healthcare that they can provide and the insurance commissioners can 
secure with a reasonable rate would be greatly reduced.
  Lastly, another critical program that ensures access to coverage 
throughout the country and in North Dakota is the Children's Health 
Insurance Program, or CHIP. I have to tell you, I know many, many 
families who, without CHIP and without their ability to find that 
temporary opportunity to use CHIP to insure their children, would be 
bankrupt today. They would have incurred healthcare bills just from a 
simple fall off a swing set, and they would be spending a lifetime 
trying to figure out how they are going to pay or they would be finding 
their way into the bankruptcy court.
  CHIP is a program that has been used since the late 1990s, and more 
than 2,000 North Dakota children currently rely on it for affordable 
healthcare. It provides a critical bridge between Medicaid and private 
insurance coverage for children. We have to act fast to reauthorize 
CHIP and let thousands of children across the country who are on CHIP 
and their families know that we care about them, that we are standing 
up for them, and that we are not going to leave them behind.
  Unfortunately, the authorization for this critical and lifesaving 
program expired at the end of September. Without action from Congress, 
some States will already run out of Federal funding before the end of 
the year. Some already have and require emergency funding from the 
Centers for Medicare and Medicaid Services to shore up their programs 
so that they can still provide that continuous coverage while we fail 
to act here in the Congress.
  While my State of North Dakota is not scheduled to run out of funding 
until April of next year, this is not a way to administer an ongoing 
and critical healthcare program. We need to get this program 
reauthorized now before it is too late and we have unnecessarily hurt 
American children and have created unnecessary unpredictability for 
families who need and have found some incredible benefit in covering 
their children with this program.
  The Senate Finance Committee has marked up bipartisan legislation, 
the Keep Kids' Insurance Dependable and Secure Act, to extend 
authorization for the program for 5 years. Congress needs to act now to 
make sure these families know their children have dependable and secure 
coverage. No parent and no family member should have to wonder if their 
children will get critical care. Put yourself in their shoes.
  Since I came to the Senate in 2013, I have said there are parts of 
the healthcare law and the healthcare system that need improvement to 
make sure it is working for hard-working

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North Dakotans and hard-working Americans. As I have outlined, these 
are some tangible, commonsense policy proposals that have strong 
bipartisan support, and we can, in fact, make this system better. We 
can, in fact, tackle this challenge of healthcare, and then we can roll 
up our sleeves and reduce costs and make healthcare more affordable and 
less costly in this country.
  We can do all of that. We have a country and a group of American 
citizens who are counting on us to do our job to make sure that, into 
the future, they will have the certainty that they need, the 
predictability that they need, to get their healthcare coverage and to 
make sure that their families will never have to worry about having to 
file bankruptcy because a child has fallen off of a swing set.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. PETERS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.