[Congressional Record Volume 164, Number 168 (Wednesday, October 10, 2018)]
[Senate]
[Page S6767]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              S.J. RES. 63

  Ms. COLLINS. Mr. President, earlier today I voted in support of the 
resolution offered by Senator Baldwin to roll back rules adopted in 
August by the Trump administration that would allow individuals to 
purchase so-called short-term, limited duration health insurance plans 
for up to 1 year. The Obama administration had previously limited the 
duration of such plans to 3 months. I rise now to explain why I chose 
to support the resolution and, beyond that, to note the critical need 
to take action to protect individuals who have no other affordable 
health insurance option.
  First, as proponents of the resolution have noted, short-term limited 
duration plans do not provide protections for enrollees who suffer from 
preexisting conditions. As I have often emphasized, it is essential 
that individuals who suffer from preexisting conditions are covered. In 
June of this year, I wrote to Attorney General Sessions urging him to 
reconsider his decision not to defend provisions protecting individuals 
with preexisting conditions in ongoing litigation challenging the 
Affordable Care Act in Federal court in Texas. As I noted in my letter, 
striking down these protections is no small matter:
  ``In 2016, the Kaiser Family Foundation estimated that 27 percent of 
American adults under age 65 have pre-existing conditions that would 
leave them uninsurable in the individual market. More recently, 57 
percent of Americans responding to a poll said that they, or someone in 
their household, suffers from a pre-existing condition. These numbers 
include 590,000 Mainers, roughly 45 percent of the state's 
population.''
  Mr. President, I ask unanimous consent that my letter be printed in 
the Record immediately following my remarks.
  At the same time, we cannot ignore the fact that many individuals 
lack an affordable health insurance option. For example, individuals 
who earn more than 400 percent of the Federal poverty level--about 
$49,000--are not entitled to the ACA's premium tax credits and must 
shoulder the full cost of plans they purchase in the exchange. For a 
64-year-old male living in Caribou, ME, this amounts to about $9,500 
for the cheapest bronze plan--or nearly 20 percent of his income--far 
too expensive. Based on the statistics I have already cited, there is a 
better than even chance that this individual suffers from a preexisting 
condition.
  Individuals who lose their jobs and their healthcare coverage along 
with it may also benefit from these plans. If someone is struggling to 
pay rent or a mortgage and trying to keep up with other bills, a short-
term plan can help them achieve some measure of coverage without 
compounding their financial worries. There is a role for these plans, 
and I believe that we should work together to address these real-world 
situations.
  The underlying flaw in the Affordable Care Act is that it does not 
provide affordable coverage, but I believe this flaw can be addressed 
without jeopardizing protections for individuals with preexisting 
conditions. In fact, earlier this year, I offered legislation with my 
good friend Lamar Alexander that would have done exactly that. Our 
bill, would have funded cost-sharing reductions, reformed the section 
1332 waiver program, and provided $30 billion over 3 years to support 
State reinsurance or invisible high-risk pools--methods proven to 
reduce rates without discriminating against those with preexisting 
conditions. Furthermore, healthcare experts at Oliver Wyman projected 
that our bill would have lowered individual health insurance premiums 
in the individual market by as much as 40 percent compared to what 
people would otherwise pay, while also expanding coverage to an 
additional 3.2 million individuals.
  Unfortunately--and incredibly--when we tried to advance this 
legislation, the Democratic leaders blocked it.
  I remain deeply disappointed that members on the other side of the 
aisle chose to derail legislation that could have lowered rates for the 
18 million Americans who get their health insurance coverage from the 
individual market. I am also disappointed that we again find ourselves 
in an ``all or nothing, take it or leave it'' situation. I can only 
hope that some of the energy now stoking partisan animosity will be 
redirected soon toward finding healthcare solutions that work for all 
Americans.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                                  U.S. Senate,

                                    Washington, DC, June 27, 2018.
     Re Texas v. United States, No. 4:18-cv-00167-O (N,D. Tex.).

     Hon. Jeff Sessions,
     Attorney General, U.S. Department of Justice,
     Washington, DC.
       Dear Attorney General Sessions: I am writing regarding the 
     Department's recent decision not to defend critical consumer 
     protections in ongoing litigation challenging the Affordable 
     Care Act (ACA) before the United States District Court for 
     the Northern District of Texas. I urge you to reconsider your 
     position and to defend these critical protections for 
     individuals with pre-existing conditions like asthma, 
     arthritis, cancer, diabetes, and heart disease.
       In your June 7, 2018. letter to Speaker Ryan explaining the 
     Department's decision, you argue that the ACA's provisions 
     protecting people with pre-existing conditions are not 
     severable from the individual mandate, and cannot survive if 
     that provision is struck down as unconstitutional. 
     Respectfully, I disagree,
       This is no small matter. In 2016, the Kaiser Family 
     Foundation estimated that 27 percent of American adults under 
     age 65 have pre-existing conditions that would leave them 
     uninsurable in the individual market. More recently, 57 
     percent of Americans responding to a poll said that they or 
     someone in their household suffers from a pre-existing 
     condition. These numbers include 590,000 Mainers, roughly 45 
     percent of the State's population.
       I want to make clear that my concern is to protect 
     individuals with pre-existing conditions, not to defend the 
     individual mandate. Data show that the individual mandate is 
     highly regressive--80 percent of those who pay the fine make 
     less than $50,000 per year. The Supreme Court was right to 
     find that the individual mandate is not within the powers 
     granted to Congress under the Commerce Clause, and Congress 
     was right in eliminating the individual mandate's penalty 
     through the passage of the Tax Cuts and Jobs Act, P.L. 115-
     97.
       I do not dispute your contention that the individual 
     mandate will cease to be constitutional as a tax when it no 
     longer produces revenue, beginning in 2019. But it does not 
     follow that eliminating this penalty requires that important 
     consumer protections--such as provisions ensuring that 
     Americans with pre-existing conditions have access to health 
     insurance--must also fall. In my view, the severability 
     argument you outlined in your letter is focused on the wrong 
     period of time: severability should not be measured by 
     Congress's intent in 2010, when the Affordable Care Act was 
     passed into law, but rather by Congress's intent in 2017, 
     when Congress amended it through the Tax Cuts and lobs Act. 
     It is implausible that Congress intended protections for 
     those with pre-existing conditions to stand or fall together 
     with the individual mandate, when Congress affirmatively 
     eliminated the penalty while leaving these critical consumer 
     protections in place. If Congress had intended to eliminate 
     these consumer protections along with the individual mandate, 
     it could have done so. It chose not to.
       Your letter states that it is ``rare'' for the Department 
     to forgo defense of duly enacted statutes. The Department 
     should do its duty and defend the important consumer 
     protections in the ACA, particularly those that ensure that 
     people with pre-existing conditions can secure insurance.
           Sincerely,
                                                 Susan M. Collins,
     United States Senator.

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