[Congressional Record Volume 165, Number 115 (Wednesday, July 10, 2019)]
[Senate]
[Pages S4749-S4752]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. BARRASSO. Mr. President, I come to the floor because Democrats
out on the campaign trail continue to spin their one-size-fits-all
healthcare plan that they call Medicare for All. The name itself is
misleading. I will state that as a doctor who has practiced medicine in
Wyoming for 24 years.
Even many Democrats in the first Presidential debate sounded confused
about their own proposal. The candidates were asked a simple question.
They were asked to raise their hands if they supported eliminating
private health insurance. That is the health insurance people get from
work. ``Just four arms went up over the two nights,'' but ``five
candidates who kept their hands at their sides,'' the New York Times
has now reported, ``have signed onto bills in [this] Congress that do
exactly that''--take health insurance away from people who get it from
work.
On one point, though, they all raised their hands. That was on the
question that was asked of all 10 Democrats in round 2 of the debate.
They all endorsed taxpayer-funded healthcare for illegal immigrants.
Every hand went up.
It seems Democrats have actually been hiding their real, radical
agenda. ``Most Americans don't realize how dramatically Medicare-for-
all would restructure the nation's health care system.'' That is not
just me talking; that is according to the latest Kaiser Family
Foundation poll. We need to set the record straight, and I am ready to
do that right now.
The fact is, Democrats have taken a hard left turn, and they want to
take away your health insurance if you get it from work. The proposal
abolishes private health insurance, the insurance people get from work.
In its place, they would have one expensive, new government-run system.
Still, Democrats know most of us would rather keep our own coverage
that we get from work. Even the people on Medicare Advantage--20
million people--would lose it under the Democrats' proposal. The Kaiser
poll confirms Americans' top concern is, of course, lowering their
costs or, as the Washington Post ``Health'' column put it, people
simply want ``to pay less for their own health care.''
That is what we are committed to on this side of the aisle.
Many Democrats running for President continue to promote and support
this radical scheme by Senator Sanders. The Sanders legislation would
take away healthcare insurance from 180 million people who get their
insurance through work, through their jobs. In addition, 20 million
people who buy their insurance would lose coverage as well.
You also need to know that the Democrats' proposal ends the current
government healthcare programs. Medicare for seniors would be gone.
Federal employees' health insurance would be gone. TRICARE for the
military would be gone, and the children's health coverage also would
be gone under this Democratic healthcare, one-size-fits-all plan. That
is confirmed by the Congressional Research Service.
The Congressional Research Service recently sent me a formal legal
opinion. I requested it from them. It is a formal, legal opinion,
stating: Medicare for All ``would . . . largely displace these existing
federally funded health programs'' that I just mentioned--Medicare,
Federal employees' health insurance, TRICARE, children's health
coverage. It would largely displace these existing Federal health
programs as well as private health insurance, the insurance people get
from work.
Mr. President, I ask unanimous consent to have printed in the Record
the
[[Page S4750]]
Congressional Research Service memorandum, dated May 29, 2019.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Memorandum
To: Senator John Barrasso, Attention: Jay Eberle.
From: Wen S. Shen, Legislative Attorney.
Subject: Effect of S. 1129 on Certain Federally Funded Health
Programs and Private Health Insurance.
Pursuant to your request, this memorandum discusses the
legal effect of S. 1129, the Medicare for All Act of 2019
(MFAA or Act) on various public and private health care
programs or plans. Specifically, the memorandum analyzes
whether the MFAA would authorize the following programs or
plans to continue in their current form:
Medicare (including Medicare Advantage and Part D);
Medicaid (including the Children's Health Insurance
Program);
TRICARE;
Plans under the Employee Retirement Income Security Act;
and
Individual, Small and Large Group Market Coverage.
For reasons discussed in greater detail below, the Program
created by the MFAA would, following a phase-in period and
with some limited exceptions, largely displace these existing
federally funded health programs as well as private health
insurance. This memorandum begins with a description of the
key provisions of the MFAA before turning to its legal effect
on the programs and plans that are the subject of your
request.
Medicare for All Act of 2019
The MFAA aims to establish a national health insurance
program (Program) that would ``provide comprehensive
protection against the cost of health care and health-related
services'' in accordance with the standards set forth under
the Act. Specifically, under the Program, every resident of
the United States, after a four-year phase-in period
following the MFAA's enactment, would be entitled to have the
Secretary of Health and Human Services (Secretary) make
payments on their behalf to an eligible provider for services
and items in 13 benefits categories, provided they are
``medically necessary or appropriate for the maintenance of
health or diagnosis, treatment or rehabilitation of a health
condition.'' Except for prescription drugs and biological
products, for which the Secretary may set a cost-sharing
schedule that would not exceed $200 annually per enrollee and
meet other statutory criteria, no enrollee would be
responsible for any cost-sharing for any other covered
benefits under the Program. The bill would direct the
Secretary to develop both a mechanism for enrolling existing
eligible individuals by the end of the phase-in period and a
mechanism for automatically enrolling newly eligible
individuals at birth or upon establishing residency in the
United States.
All state-licensed health care providers who meet the
applicable state and federal provider standards may
participate in the Program, provided they file a
participation agreement with the Secretary that meets
specified statutory requirements. The Secretary would pay
participating providers pursuant to a fee schedule that would
be set in a manner consistent with the processes for
determining payments under the existing Medicare program.
Participating providers would be prohibited from balance
billing enrollees for any covered services paid under the
Program, but providers would be free to enter into private
contracts with enrollees to provide any item or service if no
claims for payment are submitted to the Secretary and the
contracts meet certain statutory requirements.
With respect to payment for covered pharmaceuticals,
medical supplies, and medically necessary assistive
equipment, the Secretary would negotiate their payment rate
annually with the relevant manufacturers. The bill would
further direct the Secretary to establish a prescription drug
formulary system that would encourage best practices in
prescribing; discourage the use of ineffective, dangerous, or
excessively costly medications; and promote the use of
generic medications to the greatest extent possible. Off-
formulary medications would be permitted under the Program,
but their use would be subject to further regulations the
Secretary issues.
With respect to the Program's administration, the bill
would authorize the Secretary to develop the relevant
policies, procedures, guidelines, and requirements necessary
to carry out the Program. The Secretary would also establish
and maintain regional offices--by incorporating existing
regional offices of the Centers for Medicare & Medicaid
Services where possible--to assess annual state health care
needs, recommend changes in provider reimbursement, and
establish a quality assurance mechanism in the state aimed at
optimizing utilization and maintaining certain standards of
care.
To fund the Program, the bill would create a Universal
Medicare Trust Fund. Funds currently appropriated to
Medicare, Medicaid, the Federal Employees Health Benefits
Program (FEHBP), TRICARE, and a number of other federally
funded health programs would be appropriated to the new fund.
The MFAA also includes a number of other provisions related
to the administration of the Program, including an
enforcement provision aimed at preventing fraud and abuse,
provisions relating to quality assessment, and provisions
concerning budget and cost containment.
Effect of the MFAA on Certain Federally Funded Health Programs and
Private Health Insurance
Federally Funded Health Programs
The federal government currently funds a number of health
programs, including (1) Medicare, which generally provides
health insurance coverage to elderly and disabled enrollees,
(2) Medicaid, which is a federal-state cooperative program
wherein states receive federal funds to generally provide
health benefits to low-income enrollees, (3) the Children's
Health Insurance Program (CHIP), which is a federal-state
cooperative program that provides health benefits to certain
low-income children whose families earn too much to qualify
for Medicaid but cannot afford private insurance; (4) the
FEHBP, which generally provides health insurance coverage to
civilian federal employees, and (5) TRICARE, which provides
civilian health insurance coverage to dependents of active
military personnel and retirees of the military (and their
dependents). Following an initial phase-in period, the MFAA
would prohibit benefits from being made available under
Medicare, FEHBP, and TRICARE while also prohibiting payments
to the states for CHIP. These payment prohibitions would
effectively terminate these programs in their current form.
This reading is confirmed by Sec. 701(b)(2) of the MFAA,
which redirects funding for these programs to the national
Program.
With respect to Medicaid, the MFAA would significantly
limit its scope. After the MFAA's effective date, Medicaid
would only continue to cover services that the new national
Program would not otherwise cover. Thus, Medicaid benefits
for institutional long-term care services (which are not
among the 13 categories of covered services under the MFAA)
and any other services furnished by a state that the Program
would not cover, would continue to be administered by the
states. The bill would direct the Secretary to coordinate
with the relevant state agencies to identify the services for
which Medicaid benefits would be preserved and to ensure
their continued availability under the applicable state
plans.
Private Health Insurance
Currently, private health insurance in the United States
consists of (1) private sector employer-sponsored group
plans, which can be self-insured (i.e., funded directly by
the employer) or fully insured (i.e., purchased from
insurers), and (2) group or individual health plans sold
directly by insurers to the insured (both inside and outside
of health insurance exchanges established under Section 1311
of the Affordable Care Act). The MFAA would prohibit
employers from providing, and insurers from selling, any
health plans that would ``duplicate[]the benefits provided
under [the MFAA].'' Given that the benefits offered under
many existing private health plans would likely overlap
with--i.e., be the same as--at least some of the benefits
within the Program's 13 categories of covered benefits, those
existing health plans would likely ``duplicate'' the benefits
provided under the MFAA. Thus, this prohibition of duplicate
coverage would effectively eliminate those existing private
health plans. Employers and insurers, however, would be
allowed to offer as benefits or for sale supplemental
insurance coverage for any additional benefits not covered by
the Program. As a result, employers and insurers could offer,
for instance, coverage for institutional long-term care
services, which are not among the 13 categories of covered
services.
Mr. BARRASSO. Mr. President, this report details how the bills cut
off funding.
The CRS memo concludes: These payment prohibitions would effectively
terminate all of those programs I mentioned in their current form.
The Congressional Research Service finds that Medicare for All
actually terminates Medicare in this country. So Democrats want to turn
Medicare, currently for 60 million seniors, into Medicare for None. It
will become Medicare for None, not Medicare for All. Plus, 22 million
people would lose Medicare Advantage. I know many of my patients who
signed up for Medicare Advantage because there are advantages to doing
it--coordinated care, working on preventive medicine. There are reasons
for signing up for Medicare Advantage. That would all be gone under the
one-size-fits-all approach that the Democrats are proposing.
That is not all. This report says the Sanders bill ends Federal
employee health insurance. There are more than 8 million Federal
workers, families, and retirees who rely on this Federal Employee
Health Benefits Program.
The Congressional Research Service says that this bill, sponsored by
over 100 Members who are Democrats in the House of Representatives and
sponsored by a number of Democrats in this body, will abolish TRICARE,
the insurance for the military. More than 9 million military members,
their families,
[[Page S4751]]
and retirees rely on TRICARE for their healthcare.
The report says the bill ends the Children's Health Insurance
Program. Nine million of our Nation's children rely on the CHIP
program.
Interestingly, ObamaCare would end as well, according to the CRS
report. After less than a decade, Democrats want to repeal and replace
their failed ObamaCare healthcare law with a one-size-fits-all system.
Again, the Congressional Research Service says the bill bans private
health insurance. One hundred eighty million people get their insurance
through work.
To sum up, hundreds of millions of American citizens--American
citizens--stand to lose their insurance, and I believe that is just the
start of the pain for American families. In the new system, we would
all be at the mercy of Washington bureaucrats. That means we would be
paying more to wait longer for worse care--pay more to wait longer for
worse care. The Democrats' massive plan is expected to cost $32
trillion. That is trillion with a ``t.'' That is a 10-year pricetag.
Guess who is going to pay for that mind-boggling bill--of course,
every American taxpayer. Senator Sanders admitted in the Democratic
debate the other night that his proposal would raise taxes on middle-
class families. His proposal will raise taxes, he said, on middle-class
families.
In fact, even doubling our taxes wouldn't cover the huge cost of what
they are proposing. So Washington Democrats are planning to drastically
cut payments to doctors, nurses, hospitals, and to people who are
providing care. The bureaucrats would ration care, restrict care--the
care you get that you need--and it would be restricted in terms of
treatment as well as technology. People would lose the freedom to
choose the hospital or doctor they want.
As a doctor, I am especially concerned about the impact on patient
care. Patients could wait weeks, even months, for urgently needed
treatment. Keep in mind care delayed is often care denied. So the
Democrats' grand healthcare vision is to force you to pay more to wait
longer for worse care.
As a Senator and a doctor, of course, I want to improve your care,
make it less costly. You should get insurance that is appropriate for
you and affordable. You should be free to make your own medical
decisions. That is what it is like in America.
No question, healthcare needs to be more affordable, and Republicans
are working to lower costs without lowering standards. To me, that is
the big difference. Democrats are proposing the reverse. Their plan
would lower your standard of care and raise your costs. Democrats can
keep campaigning hard left on healthcare. That is where they are
headed.
Republicans are going to stay focused on real reforms that promote
more affordable healthcare, cheaper prescription drugs, protections for
patients with preexisting conditions, and, of course, the end of
surprise medical bills. President Trump recently took Executive action
that increases price transparency to lower the costs that patients pay.
You just need to know the facts about the Democrats' one-size-fits-
all healthcare. Don't let far-left Democrats fool you. Radical
Democrats want to take away your current healthcare. There would be no
more Medicare or private plans, just a one-size-fits-all Washington
plan.
Why pay more to wait longer for worse care? Instead, let's give
patients the care they need from a doctor they choose at lower costs.
That is our goal. That is our objective, and that is what we are going
to accomplish.
I yield the floor.
The PRESIDING OFFICER (Mr. Romney). The Senator from Illinois.
Mr. DURBIN. Mr. President, I ask unanimous consent to speak as in
morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
prescription drug costs
Mr. DURBIN. Mr. President, just a few minutes ago, four young people
from the State of Illinois visited my office. They were a variety of
different ages, from 10 years of age to the age of 17. They all came
because they had a similar life experience, and they wanted to share it
with me. Each one of them had been diagnosed with type 1 diabetes.
Ten-year-old Owen from Deerfield told a story--the cutest little kid;
great reader; read me a presentation that he put together--and the
young women who were with him all talked about how their lives changed
when they learned at the age of 7 or 8 that they had type 1 diabetes.
For each one of them, from that point forward, insulin became a
lifeline. They had to have access to insulin, and they had to have it
sometimes many times a day, in the middle of the night. It reached a
point where, through technology, they had continuous glucose monitoring
devices and pumps that were keeping them alive, but every minute of
every day was a test to them as to whether they were going to get sick
and need help.
It was a great presentation by these young people, whose lives were
transformed, and their parents, who were hanging on every word as they
told me their life stories.
They brought up two points that I want to share on the floor this
afternoon. The first is the importance of medical research. As one
young woman said--she is about 17 now. She has lived with this for 8 or
9 years. She said she is a twin, and her brother told her when she was
diagnosed that he hated the thought that, as an old woman, she would
still be worried about her insulin every single day. She said: I told
my brother ``We are going to find a cure before I am an old woman.''
Well, I certainly hope that young girl is right, but she will be
right only if we do our part here on the floor of the Senate and not
just give speeches. What we have to do is appropriate money to the
National Institutes of Health. It is the premier medical research
agency in the world.
We have had good luck in the last 4 years. I want to salute two of my
Republican colleagues and one of my Democratic colleagues for their
special efforts. For the last 4 years, Senator Roy Blunt, Republican of
Missouri; Senator Lamar Alexander, Republican of Tennessee; and Senator
Patty Murray, Democrat of Washington, have joined forces--I have been
part of that team too--to encourage an increase in medical research
funding every single year, and we have done it.
The increase that Dr. Collins at NIH asked for was 5 percent real
growth a year. That is 5 percent over inflation. Do you know what we
have done in 4 years? NIH has gone up from $30 billion to $39 billion.
Dramatic. A 30-percent increase in NIH research funding.
We are going to have a tough time with this coming budget, as we have
in the past, but I hope we really reach a bottom line, as Democrats and
Republicans, that we are committed to 5 percent real growth in medical
research every single year so that we can answer these young people who
come in dealing with diabetes, those who are suffering from cancer,
heart disease, Alzheimer's, Parkinson's--the list goes on and on--that
we are doing our part here in the Senate; that despite all the
political battles and differences, there are things that bring us
together, and that should be one.
The second point they raised--one of the young girls there, Morgan of
Jerseyville, started telling me a story about the cost of insulin. As
she was telling the story about the sacrifices being made by her family
to keep her alive, she broke down and cried. What she was telling me--
her personal experience, her family experience--was something that
every family with diabetes knows: The cost of insulin--charged by the
pharmaceutical companies--has gone up dramatically, without
justification, over the last 20 years.
In 1999, one of the major insulin drugs--called Humalog, made by Eli
Lilly--was selling for $21 a vial. That was 20 years ago. In 1999, it
was $21 a vial. The price today is $329 a vial. What has caused this
dramatic increase? There is nothing that has happened with this drug.
It is the same drug. And, I might add, Eli Lilly of Indianapolis, IN,
is selling the same insulin product--Humalog--in Canada for $39. So it
costs $329 in the United States and $39 in Canada.
These families told me they were lucky to have health insurance that
covered prescription drugs. That sounds good, except they each had
large copays--$8,000 a year. And what it meant was that for this young
girl, this beautiful little girl who was in my office and who has
juvenile diabetes,
[[Page S4752]]
they would spend $8,000 a year at the beginning of the year for 3
months of insulin before the health insurance kicked in and started
paying for it. Of course, there are families who aren't so lucky--they
don't have health insurance to pay for their drugs.
So what are we going to do about it? It happens to be something the
Senate is supposed to take up. We are supposed to debate these things
and decide the policy for this country. We will see. Very soon, we will
have a chance. A bill is coming out of the Health, Education, Labor,
and Pensions Committee, and we will have a chance to amend it on the
floor and to deal with the cost of prescription drugs. I will have an
amendment ready if my colleagues want to join me--I hope they will--on
the cost of insulin, and we will have a chance if Senator McConnell,
the Republican leader, will allow us--it is his decision. We will have
a chance to decide whether these kids and their families are going to
get ripped off by these pharmaceutical companies for years to come.
It isn't just insulin; it is so many other products. It is time for
us to stand up for these families and their kids, to put money into
medical research, and to tell pharma once and for all: Enough is
enough. Insulin was discovered almost 100 years ago. What you are doing
in terms of increasing the cost of it for these families is
unacceptable and unconscionable.