[Congressional Record Volume 165, Number 171 (Tuesday, October 29, 2019)]
[Senate]
[Pages S6256-S6259]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 MEASURE READ THE FIRST TIME--H.R. 4334

  Mr. CASSIDY. Madam President, I understand there is a bill at the 
desk, and I ask for its first reading.
  The PRESIDING OFFICER. The clerk will read the title of the bill for 
the first time.
  The bill clerk read as follows:

       A bill (H.R. 4334) to amend the Older Americans Act of 1965 
     to authorize appropriations for fiscal years 2020 through 
     2024, and for other purposes.

  Mr. CASSIDY. I now ask for a second reading, and in order to place 
the bill on the calendar under the provisions of rule XIV, I object to 
my own request.
  The PRESIDING OFFICER. Objection is heard.
  The bill will receive the second reading on the next legislative day.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.


                               Healthcare

  Mr. CASEY. Madam President, I rise tonight to talk about healthcare, 
which is an issue that obviously commands a lot of attention, but 
lately, frankly, not enough attention here in the Senate. I will focus, 
in particular, on one report that we are issuing today that will talk 
about one aspect of some of the problems we are having in our 
healthcare system right now that a lot of Americans might not be aware 
of. They probably will be more aware when they hear more about the 
report that I have.
  I think we should start from the basic premise that we have made 
tremendous progress in the last number of years in access to 
healthcare, in healthcare coverage. We know, for example, that between 
the years 2010, the year that the Patient Protection and Affordable 
Care Act was passed, and the end of 2016--so, basically, just a matter 
of 6 years--something on the order of 20-plus million Americans gained 
health insurance coverage. We went from roughly the number of uninsured 
in the country being a little more than 47 million in 2010 to a little 
more than 27 million in 2016.
  Over the course of just 6 to 7 years, 20 million fewer people were 
uninsured. That is a great measure of progress on an issue where most 
people said there was no way you could get 20 million more people 
insured. Very few Americans thought that was possible until it actually 
happened.
  Unfortunately, that progress--the progress being the diminution or 
the reduction of the uninsured population--is, unfortunately, not just 
flattening out, but it is actually getting worse. The number of 
uninsured Americans is actually going up now. That is a giant step 
backward in a country that not only reduced the uninsured number by 20-
plus million but provided, in the same bill, the Patient Protection and 
Affordable Care Act.
  The patient protection part of that ushered in all kinds of reforms 
for those with insurance--those who had insurance before 2010 and those 
who were paying their premiums but had their lives and their coverage 
in the hands of insurance companies that had power over their lives, to 
the extent that an individual with a preexisting condition would not be 
treated and would not be covered because of that preexisting condition. 
The Patient Protection and Affordable Care Act changed that for tens 
and tens and tens of millions of Americans, in addition to the coverage 
gains that I just mentioned.
  Just for a point of reference, I will mention the recent numbers. The 
Census Bureau, back in just September of this year, said--and I am 
quoting from a report from Kaiser Health News, by Mr. Phil Galewitz, 
who is talking about the census report. He said the following:

       For the first time in a decade, the numbers of Americans 
     without health insurance has risen--by about 2 million people 
     in 2018--according to the annual U.S. Census Bureau report 
     released Tuesday.

  This ``Tuesday'' means a day in September.


[[Page S6257]]


  

       The Census found that 8.5 percent of the U.S. population 
     went without medical insurance for all of 2018, up from 7.9 
     percent in 2017.

  What he was referring to is that the Census Bureau had said that the 
number of uninsured went up by 1.9 million people. That didn't happen 
just by accident. It happened because of some of the steps taken by the 
administration and by those that support the administration.
  We have to be focused on reversing that decline, getting the number 
of uninsured down, getting more Americans covered, and making sure that 
more Americans have basic protections.
  What is particularly egregious and disturbing about this trend is 
that those suffering the most tend to be children. For example, in 
another analysis by Georgetown University, it says that ``4.3 million 
kids were uninsured in 2018--a statistically significant increase of 
425,000.''
  What Georgetown was telling us in that analysis is that that 
diminution of those who were insured or who have insurance is rising by 
more than 400,000 among children. So the United States of America made 
great strides in the mid-1960s, when the Medicaid Program was enacted 
into law, which helped to reduce the number of children who were 
uninsured and helped to reduce the number of children who did not have 
access to quality healthcare and ushered in a brand-new healthcare 
program for children and people with disabilities and seniors needing 
long-term care. That is the Medicaid Program. You could call it the 
``Kids, Seniors, and Disability Program for Healthcare.'' The same 
country, the United States of America, then made greater progress 
decades later when the Children's Health Insurance Program came into 
effect. It was voted on here in the 1990s with bipartisan support, 
sustained over time by bipartisan support, and sustained in many States 
by Republican and Democratic Governors. But despite the Medicaid 
Program and the advances for children, despite the Children's Health 
Insurance Program and the advances for children, and despite the 
advances brought about by the Patient Protection and Affordable Care 
Act and the advances for children in that, now we are seeing a 
reversal.
  Are we going to be satisfied? Are we going to say that we are the 
country that we want to be and that we claim to be if now we are moving 
backward on children's health insurance, and 425,000 fewer children 
have healthcare in 2018, and that that is what we are going to settle 
for in the United States of America?
  That is an abomination. That is a stain on our country. Anyone who is 
not in the business of reversing that and getting that number up--
covering more children and making sure that children have healthcare 
coverage--shouldn't be involved in any government and shouldn't run for 
public office if that is what your attitude is. Either you don't care 
about that or you think that is actually a measure of progress.
  We have some work to do in the U.S. Senate and the U.S. House of 
Representatives and in the administration to make sure that when they 
measure this again later in 2019 or in 2020, that number is coming 
down, that we are reducing the uninsured, and that we are reducing the 
number of children who are uninsured.
  It is going to be difficult to do that and to make progress on that 
when you consider what the administration, supported by Republicans in 
the House and the Senate, have done lately. They have done three things 
that are setting us backward.
  One is supporting a lawsuit in the Fifth Circuit Court of Appeals, 
which will destroy the Affordable Care Act. It will destroy it. We 
should be arguing against that lawsuit. It is highly likely, or at 
least likely, I will say--I don't want to be that pessimistic--that 
that lawsuit will prevail and the Affordable Care Act will be wiped 
away and declared unconstitutional by the circuit court or maybe by the 
Supreme Court down the road if the Supreme Court were to take that case 
up on appeal.
  That is not good for America for lots of reasons. All those 
Americans--more than 130 million--who have a preexisting condition will 
be out of luck if that lawsuit prevails. The protections for 
preexisting conditions will be taken away after having been granted for 
the first time, basically, a decade ago, to tens and tens of millions 
of Americans. A lot of other adverse consequences come from that 
lawsuit succeeding, so every Member of the Senate should be against 
that lawsuit.
  Now, some say: Well, we have a better idea. Well, come forward with 
your better idea and figure out a way, if you can, to provide coverage 
for 20 million people, to provide protections for those who have a 
preexisting condition--provide the same protections in a different way, 
if you can, but don't say to the country that we are supporting a 
lawsuit that will take all those protections away when you don't have 
anything to replace it with, you have nothing that has been enacted 
into law or nothing that has been proposed that will be commensurate 
with the coverage gains and protections of the Patient Protection and 
Affordable Care Act. We can be weeks away from that lawsuit succeeding. 
That is problem No. 1--threat No. 1, I call it.
  Threat No. 2 are the proposed cuts to Medicare and Medicaid. The 
administration proposed cutting the Medicaid program that I just 
referred to a couple of minutes ago, the children's disability and 
long-term nursing home care program--that is what Medicaid does, helps 
people get into nursing homes. It helps a lot of middle-class families 
afford long-term nursing care. It helps about 40 percent of American 
children with healthcare and helps a lot of children, especially 
children with disabilities, have the therapies, treatments, and the 
protections they need because they have a disability or sometimes more 
than one disability. That is the Medicaid program.
  What does the administration want to do? They want to cut it by $1.5 
trillion. No one here should support that kind of a cut, but not only 
do some people here support it by their silence, by their assent, many 
here are champions of that, strongly advocating for that kind of a cut, 
so we have to fight against that, too--the cuts to Medicare and 
Medicaid.
  Then there is threat No. 3--No. 1 being the threat of the lawsuit, 
No. 2 being the threat of the cuts to Medicare and Medicaid--the third 
threat is the sabotage that has been undertaken from day one of the 
administration. On the Republican side, I would hope that someone would 
speak up against this. I haven't heard much. I have been listening. I 
haven't heard much about those who might claim to not be in favor of 
sabotage.
  Here is one example of sabotage in the report I referred to earlier. 
We just issued this report today: ``HEALTH CARE SABOTAGE ONLINE: A 
WARNING TO CONSUMERS.'' Here is what we did: We started calling all 
over Pennsylvania and doing research on what was advertised for these 
short-term duration healthcare plans known in the vernacular here in 
Washington by the phrase ``junk plans.'' Why do we say they are junk? 
Well, we say that because these plans were only allowed to be in place 
for 3 months, but the administration changed that rule. Now, these 
plans are available. You can purchase a plan like this for 1 year, and 
then you can renew it for up to 3 years. What happens? Well, often, 
people are deceived into signing up for plans that don't have the 
protections that they thought they would have. They don't have the 
protections that I think most Americans have come to expect.
  Here is the first finding in the report: ``When searching online for 
health insurance plans, it is difficult to differentiate between paid 
advertisements and search results.''
  Now, we just had an example today of a man in Pennsylvania who told 
us that, when he went online and did some investigation and then was 
talking to someone on the phone who was selling him insurance, they 
said: ``It's got all the protections of the Affordable Care Act.'' But, 
of course, it didn't, and he was deceived.
  There are a lot of stories of people being deceived by false 
advertising and by misleading advertising. Even if going to a page 
after having done a search and on that page it might say 
``healthcare.gov,'' which is the right place to go if you want to 
enroll, but sometimes, healthcare.gov has nothing to do with it. It is 
advertised as what healthcare.gov offers, but it doesn't offer that. It 
offers a junk plan, and people are in real trouble when they sign up 
for the wrong plan.

[[Page S6258]]

  So the first thing folks should do is make sure that they carefully 
examine these paid advertisements so they don't get into a plan that is 
going to prevent them from getting the coverage they need.
  The second finding that we concluded is: ``Paid advertisements for 
health insurance are often misleading and fail to fully disclose very 
important information.''
  The third and final finding is the following: ``Advertisements often 
use `HealthCare.Gov' in the website title and descriptions despite 
having no affiliation with HealthCare.Gov.''
  So people see that on the top of the page, and it is not designated 
in the correct way so that you can actually get to the correct site. 
You are sent to some other site, and before you know it, you are 
clicking on to plans that don't give you the coverage you think you are 
getting.
  So there is a lot of misinformation. There is a lot of scam artistry 
or a lot of other ways to describe it because they have more time to do 
it. They used to only have a 3-month time period. It wasn't really a 
good business model to try to mislead people into your junk plan if you 
only have 3 months. Now, they have 1 year or they may have more than 1 
year if the individual were to reenroll for a total of 3 years. So 
instead of having 3 months for this short-term insurance, which was 
never meant to be permanent, which was only meant to be an interim 
policy, now these scam artists, these purveyors of fraud in many 
instances, have a lot more time to rip you off and get you on to a plan 
that doesn't provide the kind of protection that you and your family 
need.
  So what are we going to do about it? We should do a couple of things. 
We, first and foremost, should remind people that this is the time, 
starting this Friday, November 1, for open enrollment. Folks will have 
6 weeks in that open enrollment period. That is good, and we should 
make sure people are aware when that open enrollment starts; but while 
they are searching and making this very consequential decision for 
themselves or their family, they should be warned about and be educated 
about what can happen to them if they are on a site that will not 
provide the care and the coverage that they need.
  There is an old expression: ``Forewarned is forearmed.'' We want to 
forewarn people so they are ready and they will be vigilant.
  Here are a couple of things that we can do. We provide a couple of 
tips to avoid enrolling in one of these junk plans. No. 1: ``To get 
help picking the health insurance coverage that fits your needs, visit 
HealthCare.Gov.''
  In fact, when you type in to do a search, you should type 
www.HealthCare.Gov. That is the best way to get to the right site. So 
just make sure you are on HealthCare.Gov and not something that looks 
like HealthCare.Gov. Some will go on a site, and some people don't 
realize they are not on HealthCare.Gov. They are on healthcare.org. 
That is an old way of referring to the site. HealthCare.Gov is the 
correct one. That is tip No. 1. Be careful of that.
  No. 2: ``Be aware of how the search engine designates 
advertisements.'' Be aware that something that looks official is just 
an advertisement. Be careful about that.
  No. 3: ``Always look at the website address, typically displayed in 
green font, before clicking on a link.'' So be careful about the 
website address.
  No. 4: ``Pay attention to the words used in the website title and 
description.'' Title and description. For example, the difference 
between HealthCare.Gov and healthcare.org.
  So folks can take a look at these tips and be ready to enroll through 
HealthCare.Gov in a way that will give them the coverage they want when 
they are making that basic choice.
  This is what sabotage looks like. When you change a rule from one 
administration to the other, instead of having a 3-month rule giving 
these interim plans a chance to operate in a shorter timeframe and you 
enlarge that to a year, you are sabotaging the system when you do that. 
You are not providing people a chance for better healthcare, you are 
making it much more likely that folks will be deceived because those 
who are trying to make money here saw this opportunity. As soon as they 
saw that 3 months going to 1 year, they saw a golden opportunity to 
make money and rip people off, and it is working. A lot of people are 
becoming victims of it. So that is sabotage.
  The other sabotage is limiting the enrollment period. I just 
mentioned that open enrollment period starts on Friday, but it is 6 
weeks. It used to be longer than 6 weeks. So you are limiting the time 
within which someone can avail themselves to get healthcare, the 
opportunity to change a plan or do anything like that.
  Another way that sabotage has played out is a limitation on the 
advertising. Guess what, if you limit the advertising by cutting the 
advertising budget--at one point, it was cut by 90 percent--guess what, 
fewer people know about their opportunities to enroll by way of 
HealthCare.Gov or to have the opportunity not just for coverage but 
often to have a subsidy that will help you pay for the coverage. So 
that is another way that the administration is engaged in sabotage, and 
it is working because, as I mentioned, 1.9 million Americans or fewer 
Americans are insured today than 2 years ago, so it is working, 
unfortunately.
  I mention the coverage loss that is hitting children. There is a New 
York Times story dated October 22, just last week. The headline is: 
``Medicaid Covers a Million Fewer Children. Baby Elijah was one of 
them.''
  The subheadline says ``Officials point to rising unemployment, but 
the uninsured rate is climbing as families run afoul of new paperwork 
and as fear rises among immigrants.''
  So a series of steps taken by the administration has caused the 
number of children who are uninsured to go up. That is and should be 
unacceptable to any American.
  Finally, I want to conclude with one thought about preexisting 
conditions. When we vote this week, we will have an opportunity to push 
back against some of the sabotage, to make it less likely that people 
will be misled, to make it less likely that people will be enrolled in 
some junk insurance plan. One of the adverse consequences of being in 
the wrong plan, getting the wrong information, and being misled, being 
deceived, is a lack of coverage for a preexisting condition. So if you 
have asthma or diabetes or arthritis or high blood pressure under the 
old rules, under the old law, you could be discriminated against 
because you had a preexisting condition. So an insurance company can 
legally discriminate against you.
  The law changed in 2010, fortunately, so that discrimination was 
pushed back against, and we finally had a circumstance for families who 
didn't have to worry about preexisting conditions--or at least didn't 
have to worry about coverage for treatment for a preexisting condition.
  Lo and behold, you find examples in your home States. A couple of 
months ago, I was with one of my constituents, Rev. Shirley Cornell. 
She told me about how the Affordable Care Act had completely changed 
her husband's life. She told me that her husband's $8,000 deductible 
dropped by about one-third after enrolling in insurance under the 
Affordable Care Act. She said: ``We were one experience away from chaos 
and possibly bankruptcy.'' Because of the protections in place for a 
preexisting condition, Reverend Cornell doesn't have to worry about 
that. She may have to worry about a lot of other things, but that is 
one thing she doesn't have to worry about.
  Unfortunately, if this sabotage keeps marching forward, she may have 
to worry. A worry that was lifted from so many families just less than 
a decade ago now may burden them once again. There is no reason why we 
have to go back to those days when an insurance company could deny a 
child coverage because that child had a preexisting condition or could 
deny an adult treatment or coverage because they had a preexisting 
condition. There is no reason why we have to go back to those days; yet 
some around here seem to want to go back to those days.
  The best way to make sure that we don't is to fight against what the 
administration has been doing, to fight against the lawsuit, to fight 
against the sabotage, and to fight against the budget cuts. I know some 
don't want to do that. They seem to want to continue to support what 
the administration is doing.

[[Page S6259]]

  I hope that folks will take advantage of this opportunity in the next 
6 weeks, starting on Friday, November 1, and use the open enrollment 
period and examine these issues with an eye towards not being deceived, 
not being brought down a road where you won't get the coverage you 
need. Maybe we can have some success in putting the junk plan artists 
out of business so that they can't deceive people into getting 
insurance that they expect would provide them more coverage.
  I yield the floor.

                          ____________________