[Congressional Record Volume 165, Number 186 (Wednesday, November 20, 2019)]
[Senate]
[Pages S6704-S6706]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Internet Exchange Act

  Mrs. BLACKBURN. Mr. President, it is so interesting to be here on the 
floor and to hear such a variety of ideas and to know that, across the 
country, people are logging on and they are tuning in and they are 
watching how we go about our business. And one of the things that is so 
interesting as we pull the Internet and online activity into our lives 
and stay connected, we sometimes enjoy the idea of just ``unplugging'' 
for a weekend, going to somewhere in the country that holds a really 
special appeal. Certainly at this time of year, people will talk about 
going away for Thanksgiving, or maybe they went away during the fall to 
look at pretty leaves.
  They see it as an escape and maybe even an opportunity to get just a 
little bit of smugness in their tone when they talk about how they have 
chosen a destination that has politely informed them to not expect WiFi 
and not to expect that Internet connection.
  But here is a question for you: How many would make that trip, but 
still knowing there is not that connection, they take the smartphone, 
the iPad, or the laptop anyway? Of course, we know we all do that.
  After all, we have been trained to respond to the buzzing, beeping, 
and the ringing of our device, and so eventually, what happens is we 
give up and we start wandering around, searching for a signal, and then 
declaring to all of the very unimpressed locals: Well, I don't see how 
y'all do it without being able to have access to high-speed Internet. 
How can you survive without broadband?
  Well, to my colleagues, let me say this: They do it because they do 
not have a choice. You know, these days, encountering so much as a 
spotty cell signal causes concern for those of us who are accustomed to 
high-speed Internet and broadband connectivity, but I will tell you 
there are millions of Americans out there for whom a broadband 
connection or even the pop and hiss of a dialup connection is 
completely out of reach.
  In a world where even simple online interactions require lightning 
fast connections, economies in rural America are falling behind. We 
read every day about entire industries setting up shop in budding 
metropolises like Nashville, TN, but to many, corporate America's 
glowing new hubs sound like remote outposts compared to the familiar 
crush that is here on the eastern seaboard.
  Our perspective is skewed. Even so, businesses move inward because 
they see potential for growth with minimal risk, but there is only so 
far that they can push it. Rural communities do not have much to offer 
in terms of operational support or a reliable customer base, and most 
of them lack a crucial resource: the funding and infrastructure to back 
reliable broadband services.
  It is true, ``the cloud'' needs a physical connection to Planet 
Earth, and broadband networks rely on physical ``Internet Exchange'' 
points. Without these hubs, subscribers of different Internet providers 
cannot communicate with one another.
  While many businesses are certainly capable of fronting the costs 
associated with building the actual exchange points and running 
connections to other hubs, there is no incentive for them to gamble on 
a stagnant economy, so they go elsewhere, and local businesses go 
nowhere, unable to expand into the global online marketplace.
  And just to think, a decade ago, we wasted an opportunity to bridge 
the digital divide, to even close the digital divide. Back in 2009, 
during the stimulus days, President Obama signed an economic recovery 
package that included 7.2 billion, $7.2 billion to expand broadband 
services in underserved areas.
  Well, predictably, those dollars began to flow into urban and 
suburban areas, leaving rural communities stranded on the far side of a 
gulf that Washington had ended up widening. Mistakes were made, but it 
would be an even bigger mistake to make rural residents suffer through 
it.
  This year, I introduced the bipartisan Internet Exchange Act in an 
effort to get the Senate talking about broadband accessibility. When 
passed, the bill will offset the start-up cost of establishing 
broadband connections via a series of grants reserved exclusively for 
unserved rural areas. That is unserved rural areas, those that have 
been left out, those that did not benefit

[[Page S6705]]

from the $7.2 billion that President Obama put in the stimulus for 
broadband expansion.
  They did not get any of that money. They got left further behind and 
pushed further out of the economic mainstream for the 21st century. As 
with any program, infrastructure alone is no guarantee of success, but 
the presence of new and expanded Internet exchange facilities will 
create a stronger and more competitive web. More hubs will enable 
faster data transmissions, allowing local businesses to expand and, in 
rural communities, e-commerce to flourish
  Farmers, manufacturers, miners, will gain access to state-of-the-art 
technologies that support safer and more productive operations. Medical 
practitioners will be able to care for neglected populations via 
telemedicine. Schools and libraries will have advanced tools at their 
fingertips and open the world to their students. The local law 
enforcement will add an important tool in their ``public safety 
toolbox.'' Businesses looking to lay down roots will notice that rural 
communities are investing in themselves and, hopefully, make the 
decision to bring jobs and business opportunities to local workers and 
to rural America.
  But perhaps, most importantly, rural residents and their guests will 
be able to decide for themselves whether they want to connect or 
unplug, and they will be able to do it on their own terms.
  Mr. President, 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.
  Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                   Unanimous Consent Request--S. 455

  Mrs. SHAHEEN. Mr. President, I come to the floor today to raise 
awareness about the open enrollment period for health insurance 
marketplace coverage.
  Between now and December 15, Granite Staters and Americans across the 
country can enroll in healthcare plans for 2020 through the Affordable 
Care Act's health insurance marketplaces. Tens of thousands of Granite 
Staters and millions of Americans will be eligible for Federal premium 
tax credits to help pay the cost of monthly premiums as well as 
financial assistance to reduce the cost of annual deductibles. I am sad 
to say the Trump administration refuses to be a reliable partner in 
helping to spread the word about open enrollment.
  For the third year in a row, we have an administration that has 
focused on sabotaging the Affordable Care Act instead of raising 
awareness for open enrollment. This administration is even focusing 
resources on promoting enrollment and junk health plans that don't 
provide coverage for preexisting conditions and that don't meet the 
Affordable Care Act's comprehensive coverage requirements.
  After failing to repeal the Affordable Care Act in the Senate, the 
Trump administration is making an end-run around Congress, trying to 
dismantle the ACA through regulations, administrative actions, and 
lawsuits in the Federal court.
  As we can see in this chart, 2 years ago, the administration cut 
funding for advertising and outreach efforts to promote open enrollment 
by 90 percent. The administration went from $100 million--we can see on 
that bar--down to $10 million in 2017 and $10 million in 2018 and $10 
million in 2019.
  These advertising cuts are pennywise and pound foolish. They are part 
of the administration's concerted attempt to keep Americans in the dark 
about what their insurance options are.
  Federal advertising on television and through digital platforms and 
other media is critical to drawing a healthy and balanced mix of 
consumers into the marketplace. In fact, research shows that 
California's State-level investments in marketing and advertising for 
open enrollment generated a 3-to-1 return on investment through lower 
premiums from a more balanced risk pool.
  By refusing to adequately promote open enrollment, the administration 
is forcing our insurance markets to miss out on an opportunity to 
improve the markets, to lower premiums for consumers, and to ensure a 
healthy health insurance market--no pun intended--throughout this 
country.
  That is why I introduced the MORE Health Education Act--to restore 
those health insurance marketplace advertising dollars and to increase 
outreach funding back to the $100 million a year. My bill would also 
prohibit the administration from using any of these funds to promote 
short-term plans or junk plans--plans that don't comply with the 
Affordable Care Act's requirements for preexisting condition 
protections among many other provisions that provide real insurance 
coverage for people who need it.
  The Congressional Budget Office projects that approximately 500,000 
more people would enroll in the health insurance marketplace or 
Medicaid coverage each year as a result of my legislation. That is half 
a million people who would be insured and be able to better take care 
of themselves and their families, and they would have access to primary 
care, to preventive services, and to a wide variety of other services 
they need and that they would be afforded under the essential health 
benefits of the Affordable Care Act.
  My bill would also result in a reduction in marketplace premiums 
thanks to the increased enrollment from a more balanced risk pool. It 
would be a win-win all around.
  Mr. President, at this time, as in legislative session, I ask 
unanimous consent that the HELP Committee be discharged from further 
consideration of S. 455 and the Senate proceed to its immediate 
consideration. I ask unanimous consent that the bill be considered read 
a third time and passed and that the motion to reconsider be considered 
made and laid upon the table.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Indiana.


                   Unanimous Consent Request--S. 913

  Mr. BRAUN. Mr. President, reserving the right to object, ObamaCare 
has failed because it is the classic example of Big Government getting 
in cahoots with a healthcare industry that is broken. It was doomed to 
fail because when has Big Government and Big Business ever resulted in 
something that is going to cost less and be more effective?
  Under ObamaCare, decisions are made by the healthcare industry 
executives and the Federal Government bureaucrats--not patients, not 
consumers. This program is authorizing millions of dollars we don't 
have to prop up a system that is not working. If ObamaCare was working, 
it would sell itself, but it doesn't work. Costs continue to rise, and 
Americans continue to be stuck with the bill.
  I believe there are things that ObamaCare does that we should keep. I 
actually incorporated it into my own business's plan back before the 
law required you to do it. I covered preexisting conditions and no cap 
on coverage. The pillars of ObamaCare--we should all accept that.
  When they added keeping kids on there until they are 26, that is fine 
too. Those ships have sailed. But the Affordable Care Act is not 
remotely affordable, and it is only going to get worse.
  I applaud the Trump administration for doing their due diligence on 
how healthcare policy changes are going to affect average Americans. 
They are taking the approach to not go deeper in the hole with 
something like ObamaCare but to reform the industry by making it 
competitive, transparent, eliminate the barriers to entry and, yes, 
encourage the healthcare consumer to get involved in his or her own 
well-being.
  I do believe President Trump is right. The Republicans can be the 
party of healthcare without involving more government, but we need to 
do that by putting more power back into the hands of the American 
people, not ceding total power to government bureaucrats and big 
healthcare executives.
  I have a better idea. The truth in pricing act--my bill I am 
countering with--encapsulates some of the ideas behind the proposed and 
final rules announced by the White House last week, which I fully 
support. The complex, opaque nature of healthcare pricing makes it 
difficult for consumers to anticipate, measure, and compare healthcare 
costs and coverage options.

[[Page S6706]]

Hospitals have a chargemaster that nobody can understand, which 
actually inflates retail prices billable to a patient or an insurance 
provider, but insurers usually negotiate steep discounts to these 
inflated prices that consumers and the employers who pay all the bills 
never see. It is done behind closed doors.
  More pricing transparency would address this market failure. 
Increased competition gives more decision making to the people who are 
supposed to use it.
  This is why I introduced the truth in pricing act, which requires 
health insurers to disclose negotiated rates, including any cost-
sharing obligations for consumers for healthcare services covered under 
their health plans. It is difficult for insured consumers to shop for 
healthcare services in our current, opaque, and broken market within 
which ObamaCare works, especially if they don't know actual prices. 
Insurers have the unique ability to provide this information to 
consumers.
  Why subsidize insurance companies to pay for navigators and insurance 
agents when we can instead make the market work better and be more 
consumer-driven and transparent? This is the way we break the 
stranglehold that government in big healthcare has on healthcare 
delivery.
  I ask unanimous consent that the Senator modify her request and 
instead, as in legislative session, the Committee on HELP be discharged 
from further consideration of S. 913, the True Price Act, and the 
Senate proceed to its immediate consideration. I ask unanimous consent 
that the bill be considered read a third time and passed and that the 
motion to reconsider be considered made and laid upon the table.
  The PRESIDING OFFICER. Does the Senator so modify her request?
  Mrs. SHAHEEN. Reserving the right to object, let me say that I agree 
with my colleague that we need more transparency in healthcare pricing. 
I would argue that one of the places we most need that transparency is 
when it comes to the price of prescription drugs.
  As I am sure my colleague knows, the cost of prescription drugs is 
probably the biggest cost driver right now in increases in 
healthcare. Yet we in Congress and the Centers for Medicare and 
Medicaid are stymied because they can't negotiate with the big drug 
companies to lower the prices of prescription drugs and to make that 
more transparent to consumers.

  The Veterans' Administration can negotiate for the cost of 
prescription drugs. If you talk to any veteran about the cost of their 
prescription drugs and compare them to what people are paying in the 
marketplace, there is a huge difference because they have that ability 
to negotiate.
  I am sure that at some point we could probably find some agreement on 
transparency that would make sense. I think what my colleague is 
proposing is not something that has had a chance to go through the HELP 
Committee and, therefore, would need a further look. I would want to 
know what hospitals in New Hampshire, the doctors, consumers, and the 
insurance department in my State would have to say about that. Until I 
find that out, I would have to object to what my colleague is 
proposing, but I hope we could work together to address the challenges 
that my constituents--and I am sure his constituents--are facing 
because of the cost of healthcare.
  He talked about the failure of the Affordable Care Act. Actually, in 
New Hampshire, we have over 90,000 people who have now gotten coverage 
for health insurance because of the Affordable Care Act. Through the 
expansion of Medicaid, we have reduced the number of uninsured in New 
Hampshire to half the number we had before we passed the Affordable 
Care Act.
  What my legislation would do is help people understand what the 
filing period is and how to sign up for the Affordable Care Act and 
health insurance.
  In fact, under the Affordable Care Act as it exists now, according to 
estimates from the administration, approximately 54 percent of Granite 
Staters who are shopping for coverage on healthcare.gov are eligible 
for a plan with net monthly premiums of less than $75, after accounting 
for tax credits, and nearly 40 percent of Granite Staters shopping on 
healthcare.gov can find a plan with net monthly premiums under $10.
  Now, the cautionary note is that when constituents of mine or in 
Indiana or anywhere else in the country are shopping for plans, they 
need to watch out for those short-term, limited-duration insurance 
plans--what are commonly called junk plans--because they are not 
required to cover preexisting conditions. I was pleased to hear my 
colleague from Indiana say that for existing conditions, coverage is 
important.
  Those junk plans are not required to provide coverage for essential 
health benefits, like maternity care, prescription drugs, and mental 
health services. If you don't pay very careful attention when you go on 
the healthcare.gov website, you can be redirected to third-party 
insurance broker sites that sell both junk plans and ACA-compliant 
marketplace plans. That creates further confusion for customers. What 
we heard is that those insurance brokers are able to charge multiple 
times the price for those plans for their fee than they are for plans 
under the Affordable Care Act.
  The administration has been allowing these links to redirect 
consumers to sites that sell junk plans, even though the ACA expressly 
prohibits any health insurance exchange from making available any plans 
that are not qualified health plans under the Affordable Care Act.
  A number of my colleagues and I have been pressing the administration 
to conduct better oversight of brokers to ensure that healthcare.gov 
customers are not being sold junk plans.
  I urge consumers, when they go on the website, to make sure they stay 
on the healthcare.gov website or their State's official health 
insurance exchange website when they are shopping for coverage. Be 
careful when you click on links that provide assistance from third-
party insurance brokers.
  I encourage Granite Staters and people across this country who need 
health insurance coverage to take a look at their options between now 
and December 15, during this year's open enrollment period. There is 
still time to enroll. It is important to tell your friends and 
neighbors and your family members who may not know about open 
enrollment because the amount of money available for outreach has been 
reduced so dramatically.
  When the administration was trying to repeal the Affordable Care Act 
and this Senate voted, Americans across the country made their voices 
heard. Now we need that same level of engagement to raise awareness of 
this year's open enrollment and overcome this administration's sabotage 
of the ACA.
  Thank you. And if it was not clear earlier, I object.
  The PRESIDING OFFICER. The objection is heard to the modification.
  Is there objection to the original request?
  The Senator from Indiana.
  Mr. BRAUN. Mr. President, reserving the right to object, we have made 
progress here this evening in the sense that my colleague has brought 
up another topic--transparency for prescriptions.
  Across the board, when it comes to hospitals and exposing their 
charge practices, drug companies becoming transparent and competing, 
health insurance companies getting rid of the secret agreements behind 
the scenes, and even practitioners, publish your prices in print or on 
the web so we as employers and consumers of healthcare can try to make 
the right decisions and bring costs down.
  I do object to the original request.
  The PRESIDING OFFICER. The objection is heard.
  The majority leader.