[Congressional Record Volume 169, Number 21 (Wednesday, February 1, 2023)]
[Senate]
[Pages S188-S189]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          AFFORDABLE CARE ACT

  Mr. CARDIN. Mr. President, I take this time to celebrate the success 
of the Affordable Care Act. We just completed the open enrollment 
period for 2023. Over 16 million Americans signed up for health 
coverage under the Affordable Care Act. That is about a 100-percent 
increase from the first year's enrollment in 2014. In less than 10 
years, we have doubled the number of enrollees under the Affordable 
Care Act.
  It has contributed to a substantial reduction in the number of 
uninsured, which, in and of itself, is an important goal in healthcare. 
Uninsured individuals have less ability to access quality

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care in this country. That is something we all need to be concerned 
about and do our best to make sure everyone has access to healthcare.
  But they also contribute to what is known as cost-shifting, and it 
causes a dislocation of healthcare facilities in the proper locations 
in our community. It also makes our healthcare system less efficient. 
If an individual does not have coverage for preventive healthcare and 
diseases are discovered later, it makes it more expensive and less 
likely a successful result.
  We all can celebrate the numbers but recognize we also are taking a 
big bite out of the uninsured medical population in this country. My 
numbers in Maryland are very impressive: 180,000 Marylanders enrolled 
in our State insurance exchange under the Affordable Care Act. That is, 
by the way, for minorities, a 9-percent increase in the Hispanic 
population and a 3-percent increase in the Black population. We are 
committed to eliminating health disparities in America.
  There are many provisions in the Affordable Care Act. I want to 
mention one I am particularly proud of because I had something to do 
with its creation, and that is elevating the National Institutes of 
Health with the National Institute on Minority Health and Health 
Disparities. We made it a full Institute under NIH. We set up an office 
for minority health within the Health and Human Services Agencies. We 
did this so there would be a focus on dealing with the systemic 
challenges we have to medical care in this country. And the research 
that is being done by the National Institute on Minority Health and 
Health Disparities is cutting edge on reasons why we have disparities 
in this country, and it is leading to corrective action being taken.
  I will just give you one example: NIH UNITE Program, which deals with 
incentives to create a more diversified workforce in healthcare, which 
is critically important to access, as well as to make sure that 
clinical trials include all of our population so that the results are 
meaningful for all communities in America.
  The results that we have been able to move forward in bridging the 
disparities for access to healthcare in America, all this has been done 
under the Affordable Care Act.
  But we didn't stop there. We recognized we had to improve the 
Affordable Care Act. I am very proud of the leadership of President 
Biden and the Democrats in our initiatives under the American Rescue 
Plan and the Inflation Reduction Act. We enhance the subsidies to make 
it affordable for all Americans to be able to purchase their insurance 
through the health exchanges. We made that a commitment so every 
American could have access to affordable, quality healthcare.
  We need to make those enhancements permanent so we still have work to 
do. I want to thank our colleague Senator Shaheen for her leadership in 
legislation, which I strongly support, that would make the enhancements 
in the subsidies under the Affordable Care Act permanent so that we can 
keep having these impressive numbers of Americans enrolling in health 
insurance.
  Americans are benefiting from the Affordable Care Act, not just in 
having comprehensive, affordable insurance coverage but also the 
quality of that coverage. No longer do they have to worry about 
exclusions for preexisting conditions. It wasn't too long ago that just 
about everyone in this country was concerned as to whether their 
insurance coverage would cover their entire healthcare needs because 
they had a prior episode sometime in their life. Women were concerned 
whether childbirth was a preexisting condition. Well, we eliminated 
that fear with the Affordable Care Act in that insurance companies 
cannot exclude coverage or limit coverage based upon preexisting 
conditions.

  And as you recall, the leading cause of bankruptcy in America was 
unpaid medical bills. But under the Affordable Care Act, we eliminated 
lifetime and yearly caps on the coverage that you have--again, helping 
American families deal with their healthcare needs.
  There is still more to be done. I want to acknowledge that. We need 
to do some things.
  I want to say, first, that I was pleased that under the Inflation 
Reduction Act, we were able to reduce the cost of prescription drugs. 
Insulin, starting last month--January--was limited to $35 a month. That 
was a game changer for millions of Americans to know they have an 
affordable supply of insulin to deal with their needs. That has already 
taken effect. And included in the Inflation Reduction Act will be a cap 
on Part D out-of-pocket expenses of no more than $2,000 a year. So we 
are also capping today the unlimited exposures seniors had on 
prescription medicines.
  I must tell you, we passed legislation--as I think everybody here is 
aware of--under the Inflation Reduction Act, to start, by 2026, doing 
something that most Americans would be shocked that we are not doing 
today: negotiate prices with the pharmaceutical industry, using our 
market share to bring down the cost of medicines so American consumers 
are not gouged compared to the international marketplace. Starting in 
2026, we will have negotiated the price, starting with the 10 most 
expensive drugs in this country.
  I want to mention an area where I think we need to do more. I have 
been very much engaged in oral healthcare. Most people know that when I 
came to the Senate in 2006, a year later, Deamonte Driver, a youngster 
in Prince George's County, lost his life because he couldn't get access 
to oral healthcare. I made that a crusade with my former colleague, the 
late Elijah Cummings, in trying to do something about that. I am 
pleased that both the Affordable Care Act and the Children's Health 
Insurance Program require coverage for pediatric dental care. That is a 
step in the right direction, but we haven't completed the needs that 
are out there.
  If you neglect your oral healthcare, you are likely to be neglecting 
your general healthcare. It is an area where we can prevent a lot of 
illness and problems. Most dental problems are preventable if you have 
access to dental care.
  I have introduced legislation that would remove any annual or 
lifetime limit on oral healthcare under the Children's Health Insurance 
Program, the CHIP program. I want to thank Senator Stabenow for joining 
me in this effort. To me, this is something that is very consistent 
with the Affordable Care Act, and I hope that we will be able to get 
that passed.
  But we also have to expand coverage. Medicaid coverage for dental 
care is primarily determined by the States, and many States limit 
coverage to emergency dental care, which means people, many families, 
can't afford their normal checkups for the adults who are in the 
family. We must do better as a nation. We need to expand Medicaid to 
cover oral healthcare. And for the 37 million seniors who are on 
Medicare, many cannot afford their dental annual visits. We need to 
expand Medicare to cover dental care as well. I want to thank my friend 
Senator Sanders for his leadership, also, on that particular issue. The 
bottom line: Let us all work together so that we can achieve the goal 
of the Affordable Care Act. We have achieved a great deal to date by 
the passage of that bill, but we still need to do more to make sure 
healthcare is a right and not a privilege and that every American has 
access to affordable, quality care. Working together, we can achieve 
that goal.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. VAN HOLLEN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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