[Congressional Record Volume 171, Number 207 (Tuesday, December 9, 2025)]
[Senate]
[Pages S8557-S8562]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. CRAPO. Mr. President, this week, we are going to spend a lot of
time discussing problems with our healthcare system. To do that, we
need to understand just how we got here.
Concerns about the rising healthcare costs are not new. In 2009,
Democrats highlighted shortcomings in the American healthcare system as
proof that the Federal Government had to intervene.
President Obama told us how to judge his healthcare plan. He told us
that Americans would be able to keep their insurance plans and their
doctors, and he also told us that insurance premiums would go down. As
everyone knows, these predictions did not come true.
But there were signs from the start that ObamaCare would not work,
which is why not one single Republican voted for it. That is also why
the Democrats created the premium tax credits in the first place. They
did not trust the one-size-fits-all nature of ObamaCare to lower costs
and expand options.
Instead of decreasing, over the last 15 years, ObamaCare premiums
have increased over 220 percent. A family of four pays $10,000 more for
coverage today than they did before ObamaCare, and their deductibles
have doubled. Insurance providers have dried up, and rural hospitals
are struggling. ObamaCare has undermined healthcare in America.
In 2021, the Democrats again decided that premiums were too high and
that a Federal response was necessary. But rather than fix the
structural flaws in ObamaCare, they created an even bigger subsidy with
fewer guardrails to entice more people into a broken program. Not only
did they make the subsidy bigger, they made everyone eligible,
regardless of their income. So families making $600,000 a year began to
qualify. Democrats also temporarily eliminated reviews to confirm
accurate payments and allowed individuals to continuously enroll
throughout the year.
Because those changes were made under the premise of responding to
the pandemic, the enhancements were only supposed to last for 2 years.
But before they expired, the Democrats extended them for 3 more years--
again, without a single Republican vote.
With those expanded subsidies again about to expire--and by the way,
on a date set by my Democrat colleagues--the pattern has become clear:
Democrats respond to rising premiums by throwing taxpayer dollars at
the problem. Their supposedly ``short-term'' fixes only drive premiums
higher and make the problem harder to solve, leaving us with apparently
no choice other than to do the same thing again and again and again.
ObamaCare is broken, and throwing good taxpayer money after bad
policy is not going to fix it.
The enhanced premium tax credits account for only about 4 percentage
points of next year's projected 20 percent increase in insurance
premiums.
Let me say that again. These enhanced premium tax credits that we are
talking about only account for about 4 percentage points of next year's
projected 20 percent increase in insurance premiums.
Extending them will not solve the crisis. What it will do is cause
tens of billions more dollars to be paid directly to insurance
companies without improving patient care or choice. With taxpayers
footing the bill, these subsidies give insurance companies every single
reason they need to keep hiking premiums.
Even the Washington Post just yesterday explained in their words that
``Obamacare subsidies make it too easy to scam the system.''
Last year, the Centers for Medicare and Medicaid Services found that
1.6 million Americans were enrolled in both Medicaid and ObamaCare
plans. This year, 6.4 million Americans were improperly enrolled in the
enhanced premium tax credits, at a cost of $27 billion. Another 12
million subsidized plans reported no claims in 2024, suggesting that
many of them were opened on behalf of people who did not even know they
were insured.
Because insurance companies receive the subsidies regardless of
whether a plan is used, there is no incentive on their part to check
the enrollment status. In 2024, $35 billion was paid out for these
unused plans.
My colleagues in the House asked the Government Accountability Office
to look into the fraud surrounding the ObamaCare tax credits. Their
findings, the findings of the GAO, were shocking.
The GAO created fake identities and attempted to enroll them in
ObamaCare plans. All four of their fake applicants in 2024 received a
subsidy. This year, 18 out of 20 fake applicants received subsidies.
GAO also found tens of thousands of cases of apparent identity theft
and hundreds of thousands of cases where insurers or brokers changed
people's plans or enrolled them in new ones without their consent.
Perhaps worst of all, they found that over $21 billion worth of
subsidies--nearly one-third of all subsidies paid in 2023--had not been
double-checked against enrollees' income. That means that there was
nothing stopping these enrollees from misrepresenting their incomes to
receive higher subsidies than those for which they were eligible.
Ultimately, it is not just the taxpayers that are hurt by this fraud,
although taxpayers should not be on the hook for it to begin with; the
other Americans who rely on Federal health programs suffer as these
program dollars go to waste.
Republicans addressed some of these program integrity issues in the
One Big Beautiful Bill--the Working Families Tax Cut Act--when we
tightened eligibility and verification standards for Federal healthcare
programs, but no degree of oversight and enforcement is as effective as
addressing the basic incentives in the system that result in fraud.
I appreciate that some of my Democratic colleagues have finally
acknowledged these issues, but the fact remains they have not offered
any ideas on how to solve them. Extending these expensive, fraud-ridden
subsidies for another 3 years with no reforms--I repeat, no reforms--is
a nonstarter. Continuing to pour billions of dollars more into the
pockets of big insurance companies and fraudsters will not lower
healthcare costs for American families, especially when you consider
that the vast majority of Americans are not insured through the
ObamaCare Marketplace and are therefore not even eligible for these
subsidies in the first place.
Senator Cassidy and I have a different plan. The motivating principle
[[Page S8558]]
is simple: Patients should decide where their healthcare spending goes,
not insurance companies.
In line with President Trump's call to direct money to patients
instead of insurance companies, this approach builds on the success of
the Working Families Tax Cut Act, which expanded health savings
accounts and their eligibility to be paired with more affordable
insurance plans.
These prefunded, patient-driven accounts will help Americans pay for
the out-of-pocket costs that are making healthcare unaffordable. Our
plan would take some of the money that otherwise would be spent on the
COVID bonuses and direct it to health savings accounts attached to
ObamaCare bronze or catastrophic plans as monthly deposits totaling
$1,000 to $1,500 per year. Families can use that money to cover costs
not handled by their insurance policies without waiting for insurance
companies to approve their treatment decisions. Because families want
the best value for their money, they will seek out the most appropriate
treatment. Over time, this should result in lower healthcare costs as
providers compete for patients.
Our plan would also fund cost-sharing reduction subsidies, which
mitigate out-of-pocket costs for low-income enrollees, reducing
premiums by over 10 percent and saving taxpayers money. I will repeat
that. Our plan will reduce premiums by 10 percent and save taxpayers
money. These cost-sharing reductions would finally change the notion
that Americans should simply accept ever-escalating premiums as the
norm. In contrast, the Democrats' temporary COVID bonuses do not lower
costs or premiums at all. They throw billions of dollars at insurance
companies, up to 20 percent of which can go into profit and overhead.
Our plan avoids that issue and empowers patients to control their own
healthcare.
We cannot transform our broken healthcare system overnight, but we
can make real progress. We still have a chance to enact reforms that
will do more than paper over the cracks in our healthcare system. We
should take that opportunity instead of making the enhanced premium tax
credit mistake all over once again. It is time to lay the groundwork
for giving Americans more control over their healthcare choices and
making quality healthcare more affordable.
I yield the floor.
The PRESIDING OFFICER. The Senator from Louisiana.
Mr. CASSIDY. Mr. President, this is a really interesting debate.
Right now, Democrats are advocating to send $26 billion to insurance
companies so that you subsidize plans--silver-level plans--which have a
$6,000 deductible.
I have asked people who have asked me about this: Do you have $6,000
in your bank account to spend on healthcare before the insurance
actually kicks in?
Not one has yet raised his hand.
I think some of those advocating for this among Democrats just don't
realize the financial situation American families are in when we ask
them to pay $6,000 before the insurance kicks in--$6,000 beyond the
premium that they are paying for their health insurance. So people--
patients--are going to see their doctors, and they can't afford the
deductible.
When I was practicing, I would say to my patients: What about this
procedure? this test? this medicine?
Doctor, I am in my deductible. I cannot afford that.
So, to have a $6,000 deductible is, for many, the same as having no
insurance at all.
By the way, it goes without saying, under your traditional medical
insurance plan, you don't get eyeglasses, and you don't get your teeth
cleaned. Why not, instead of sending 100 percent of the money to the
insurance company, of which they take 20 percent for profit and
overhead, we send 100 percent to the patient. Then she can spend it on
the services that she knows she needs. This is kind of, if you will,
the Republican plan, and I will tilt it this way so those in the
audience can see because they represent the American people.
Under the Democratic plan, they want to send 100 percent of the money
to the insurance company that takes 20 percent for profit and overhead,
and only 80 percent goes for patient care, but to get that 80 percent,
you have got to ask permission.
We, the Republicans, want to give the money to the patient so that
she can pay for her physician, her dentist, her drugs, her eyeglasses.
She gets the money, and she can get the healthcare that she knows she
needs as opposed to the healthcare that she gets permission from her
insurance company to get. To put it simply, we want power to the
patient, not profit to the insurance company.
Now, the other side is going to claim: ``Oh, no. Wait. No, no, no,
no''; that, in some way, the plan we are proposing does not work out
financially for the American people. You are not lowering their
premiums. You are not helping them with their first-dollar cost.
So here is a prospective plan for my State for a couple 55 years old,
with a 20- and 21-year-old on their insurance policy, at 500 percent of
the Federal poverty level. The bronze plan is $2,250 per month. The
silver plan is significantly more expensive. It is $6,000 more
expensive a year. It is almost $3,000. Under our plan, everybody up to
age 49 gets $1,000 into their health savings account. If it is a family
account, it goes into the family account, and those over 49 get $1,500.
So this family of four, with those ages, gets $5,000 into their health
savings account. It is $5,000 so that, when I go to the doctor and I
have got an earache and I need medicine, the health savings account
pays for the doctor's visit, and the health savings account pays for
the medicine.
Contrast that with what Democrats want. They want a plan which is
$6,000 more a month. The net deductible is higher, and you don't have
$5,000 to begin paying for your medical bill. You have got no money
whatsoever, and on that first trip to the doctor, you are paying out of
your purse; you are paying out of your pocketbook.
This is the plan that works for the American people? ``Not.''
When I was a physician--but no. As somebody who had three children,
this is not the plan that would have worked for my family.
Republicans are trying to meet the American people where we know they
are, not some theoretical ``oh, that is where they should be.'' Most
Americans don't have $6,000 to pay for healthcare before they get it
billed by the insurance.
So let's do just kind of a side-by-side comparison. Here is the
difference between the two accounts.
Who gets the money?
Under their plan, the insurance companies. Under our plan, the
patients and families.
What can the money be used for?
Well, here it is subsidized premiums, which means that the insurance
company gets it and takes 20 percent for the deductible and copay.
Under our plan, you can use it for your doctor visit, your x rays, to
see your dentist, your glasses, or your prescriptions. This is real
medical care, not something the insurance company permits you to have.
Who makes the decision?
Under their plan, the insurance company. Under our plan, power to the
patient.
We want that patient--we want that mama; we want that wife because
they are the ones who always make the decisions on healthcare--to be
the one who has the power.
Contributes to lower cost?
Under their plan, no, because it goes to the insurance company that
continues to pay those higher rates.
To the patient, if you give her this money, you have got $5,000 to
spend it wisely. She is going to say: Wait a second. The x ray is $150
here and $500 there. I am going to where it is cheaper, not more
expensive.
I can tell you, when that begins to happen, the people who are more
expensive will begin to lower their prices. This is a plan that by
sending it to the patient for real care, to the patients with the
power, you empower the patient to shop, driving competition and
lowering healthcare costs.
We just heard from Senator Crapo. Under the plan that my Democratic
colleagues support, we have seen widespread fraud and unauthorized
enrollment.
Under our plan, if you have got a health savings account, it is
pretty easy. I just signed up for a similar type of account on my
healthcare. You have got to show who you are. It is not really hard. It
took me about 5 minutes,
[[Page S8559]]
but the banks that manage this money are going to require that you
identify that you are a real person. This is an anti-fraud program.
What is not to like? The money goes to the patient, not to the
insurance company. It is used for real care. It gives the patient the
power to shop and find a better price, which lowers healthcare costs,
and along the way, we have mechanisms which cut out the fraud. This
should be the basis of a bipartisan deal.
So I have called some of my Democratic colleagues. Let me start over.
I have been asked by the press: Why wouldn't Democrats want this? I
mean, why would they not want 100 percent of the money going to the
patient instead of 100 percent of it going to the insurance company,
and the insurance company takes 20 percent for profit and for overhead?
Why wouldn't Democrats want to give power to the patient so that she
can shop for a better deal, instilling competition, which ultimately
lowers costs? Why would Democrats not want a system which begins to
squeeze out the fraud that Senator Crapo pointed out is so rampant in
this program?
I just shrugged my shoulders. I am not sure. As I say in my Spanish
language class, ``digame.'' I am not quite sure I follow.
Then I heard Minority Leader Schumer explain that this is all about
Hyde. They are afraid that our plan will not allow abortions, so they
are going to continue to send the money to the insurance companies,
subsidizing premiums, profit for the insurance companies, contributing
to healthcare inflation and with unchecked fraud--all because of what
is called the Hyde amendment.
By the way, what is the Hyde amendment?
For those watching, the Federal Government, consistent with the will
of the American people, has made a decision not to spend Federal
dollars to pay for abortion. That is what the Hyde amendment is. For
most Republicans, that is an important part of our position, and
Democrats have decided that they are willing to forgo all of these
advantages in order to protect insurance companies paying for abortion.
Let me tell you the ultimate irony in that. When ObamaCare passed,
President Obama made a deal in which these plans were not supposed to
pay for abortion. Section 1303 of the ObamaCare law, if I remember
correctly, said that these dollars are not supposed to pay for
abortion.
Democrats are defending dollars paying for abortion. Either they are
going to acknowledge that insurance companies are ignoring the law, in
which case--wait--we are going to enable insurance companies to break
the law or they are attempting to introduce a source of funding for
abortion that President Obama himself did not include.
Now, if your rationale is to send 100 percent to the insurance
companies instead of 100 percent to the patient to subsidize premiums
instead of paying for real doctor care--they let the insurance
companies make the decision instead of the patient--and to not
contribute to lowering costs versus empowering patients to shop for a
better deal and, with competition, lowering healthcare costs--and, by
the way, did I point out they can get a lower premium with $5,000 in a
health savings account for that family that otherwise could not afford
care because you are trying to introduce a new right to abortion in a
Federal insurance policy? Be honest with the American people. Either
the original ObamaCare law is being ignored or you are trying to
establish a new right.
I have said before that we need to find a way that the American
people can afford their insurance. Absolutely, we need to find that
way. I have said repeatedly I don't want a Republican plan; I don't
want a Democratic plan. I want an American plan, a plan that works for
our fellow Americans so that they can afford the insurance that this
Republican absolutely wants them to have, but we have got to do it in a
way in which they have real insurance, not a policy with a $6,000
deductible, with lots of fraud associated with it, and which does
nothing to achieve the goals that we know we need.
I don't see why Republicans merely pointing out that under the
ObamaCare law this was not to pay for abortion in the first place
should be the reason that we cannot protect Americans from these $6,000
deductibles.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, when the Affordable Care Act became law,
President Obama promised affordable healthcare. Contrary to Obama's
promises, in reality, ObamaCare has spiked health insurance premiums
and led to higher costs.
Instead of fixing ObamaCare and lowering costs, Democrats established
a new, temporary COVID subsidy for wealthy households--temporary. That
``temporary'' ends December 31. Democrats want to extend it way beyond
that. It is another example of a temporary program never being very
temporary. So this temporary subsidy has driven more taxpayer dollars
into broken systems where premiums keep going up and more money is
shoved to insurance companies.
Now, remember the promises of 2010--ObamaCare's passage that year. It
promised to bring down healthcare costs by $2,500, and we see now, 15
years later, it is up at least $5,000. So you can see the promise in
2010 by President Obama was off by $7,500.
I want to explain how we got here, discuss my concerns about fraud,
waste, and abuse in ObamaCare, and provide some commonsense solutions
to bring down healthcare costs.
When ObamaCare became law, it established taxpayer-funded subsidies
through the Federal Health Insurance Marketplace to reduce a
household's monthly insurance premiums. However, these subsidies go
directly to insurance companies, not to the consumer.
In the United States today, the median household income is $84,000 a
year. Permanent law gives ObamaCare premium subsidies to a family of
three making up to four times the Federal poverty line, which is about
$106,000 a year. That means that someone making $20,000 more than the
median household income is eligible for a subsidy under permanent law.
I assume the ObamaCare authors probably figured households making
much more than the median household income made enough money to buy
insurance without taxpayers subsidizing it.
Nothing in this debate takes away middle-income households'
subsidies. A family making up to $106,000 is at 400 percent of the
poverty line. Let me make it very clear, those families are eligible
for a subsidy today, next year, the year after, and so on until the law
is changed, and I don't expect it will be changed.
In 2021, things changed. It was supposed to be temporary. As I
pointed out, temporary laws in this country soon become permanent. In
2021, the Democrats passed their partisan reconciliation law that
temporarily lifted the income cap on ObamaCare subsidies. Now, that was
supposed to be temporary. The cap, which was at four times the poverty
line, was removed temporarily in the name of COVID. In other words, the
country was facing a very dramatic health issue. The Federal Government
shut down the economy, 22 million people were unemployed, and we didn't
really know what it was all about.
Now, we learned a lot of lessons from that, and those lessons will
not be repeated hopefully. But this temporary program was set up in
this time of great distress about what the future held.
Now, as a result of this temporary program because of ObamaCare and
COVID, wealthy households making $600,000, which is well above the
median household income, are eligible for the temporary taxpayer-funded
ObamaCare subsidies or better known as COVID bonuses. The expansion of
ObamaCare subsidies for wealthy earners has cost billions, and the
Congressional Budget Office, CBO, projections for its costs keep going
up.
In 2021, anticipating some of these problems, I wrote a letter to the
then-Health and Human Services Secretary and also the IRS Commissioner.
In that letter, I expressed concern about the lack of fiscal
responsibility in the ObamaCare subsidy expansion and how that
expansion would lead to more waste, fraud, and abuse. At the time, the
DHS Secretary responded saying:
HHS and the IRS take program integrity seriously.
[[Page S8560]]
The Health and Human Services Secretary outlined all the ways that
the Agency was preventing fraud, waste, and abuse.
I can only conclude that the Biden administration's response was just
empty rhetoric. Since my letter to the HHS Secretary, the Government
Accountability Office has found ongoing fraud risks in these ObamaCare
subsidies.
In the last 2 years, the Government Accountability Office
successfully enrolled 96 percent of its fictitious applicants in
ObamaCare. I really mean fictitious people. This was a test by the
Government Accountability Office to see how easy it was to defraud.
Now, when they started it out, they didn't know that that might be
the result, but I am going to tell you that that is the result. For
example, the Government Accountability Office succeeded in enrolling
these fake people despite rules requiring documentation to confirm
citizenship status and income. The Government Accountability Office
also found that HHS had let Social Security numbers be misused by
allowing the same number to be used more than once. The Agency also
failed to match enrollment data with Social Security's death data and
chose not to reconcile tax credit overpayments with IRS tax data.
Fraud, waste, and abuse don't stop with those examples. This summer,
the Trump administration found that 1.6 million people were dually
enrolled in 2024 in Medicaid and ObamaCare, leading to billions in
waste. Now, understand, 1.6 million people having 2 sources of
healthcare and then, at the same time, we keep telling the public how
many people in this country--the millions that don't have any insurance
at all, and here we have 1.6 million people who were enrolled in 2
healthcare systems.
My own oversight has shown how billions in ObamaCare subsidy
overpayments were not collected and--can you believe this?--rules let
billions go uncollected.
The COVID bonuses created incentives to misestimate income to qualify
for larger ObamaCare subsidies, leading to billions of wastes--yes,
higher income people reporting lower income than they actually had just
to get a government subsidy.
Lastly, insurance agents are using targeted internet ads to
fraudulently enroll consumers with false income verification extension
requests.
Extending the COVID bonus permanently increases the deficit by $350
billion and lets billions more go to fraud, waste, and abuse.
CBO has found that 3.9 million Americans would lose their employer-
sponsored health insurance if we make these subsidies for wealthy
earners permanent. In other words, because of a government program that
was supposed to be temporary--if it is continued, employers are smart
enough to stop their healthcare program, health insurance program, and
turn it over to the government and the government subsidy that goes
with it.
My colleagues on the other side of the aisle will suggest that they
are only asking for another ``temporary'' extension of the COVID
bonuses for wealthy households. Yet their bill will cost taxpayers
nearly $300 billion, and there are no reforms to stop fraud, waste, and
abuse.
Despite warnings from the Government Accountability Office, the
Centers for Medicare and Medicaid Services last issued a comprehensive
fraud risk assessment of ObamaCare subsidies in 2018. Now, the law
doesn't require that report every year, but the Government
Accountability Office said it ought to be issued every year. So by not
issuing that on a regular basis--the Agency failing to update its fraud
risk assessment plan--it doesn't surprise me that we have a lot of
fraud.
My oversight in 2013 found the Obama administration at that time
tried to exempt ObamaCare from certain Federal anti-fraud provisions.
Yes, the administration at that time wanted anti-fraud provisions to be
ignored. So any wonder why you have an environment for fraud.
The full arsenal of civil and criminal anti-fraud protections must be
used. I have introduced the Fraud Risk Assessment of ObamaCare
Subsidies Accountability Act. My bill simply requires the Agency to
update its fraud risk assessment of ObamaCare and update it yearly.
I am glad the Agency is already working to update its fraud risk
assessment, but we must hold the Agency accountable to complete this.
I am glad the Republican-led Congress and the Trump administration
have begun cracking down on ObamaCare fraud, waste, and abuse, thanks
to the One Big Beautiful Bill that the President signed on July 4. The
new law stops resources from going to illegal immigrants and those not
here permanently, establishes improved preenrollment verification, and
requires excess subsidies to be repaid. It is a start, but more work
needs to be done.
We can lower healthcare costs and increase quality. It starts with
expanding access and competition to high-quality, affordable health
insurance through health saving accounts, association health plans, and
other consumer-driven health plans.
Lowering healthcare costs requires action to reduce prescription drug
prices through pharmacy benefit managers and reforming that program. I
have been leading the charge to hold PBMs accountable and put sunshine
on their opaque business practices.
We also need price transparency. I am a cosponsor of a bill that is
entitled Patients Deserve Price Tags Act and supported the Trump
administration's efforts to establish price transparency on hospitals
and health insurance companies through regulations.
Just like all of my colleagues on this side of the aisle, I am
committed to finding solutions to bring down healthcare costs for
American families and not extending government handouts to insurance
companies.
I yield the floor.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. MARSHALL. Mr. President, it seems like it was just yesterday. The
year was 2010. I was in the surgeons' lounge, and what I remember on
the headline news of the day was Nancy Pelosi saying something to the
effect of this: We have got to pass the bill so we can read it.
And I knew this bill had something to do with healthcare. They were
calling it the Affordable Care Act--ObamaCare, as we now know it by--
the ``Not So Affordable Care Act.''
So the doctors and I scrambled, and we said: We better see what is in
this bill.
And we said: First of all, gosh, it looks like the insurance
companies wrote this bill. The Federal Government is going to give
direct subsidies--corporate welfare--to health insurance companies.
It was supposed to max out at $50 billion a year. Today, it is $150
billion a year.
The next thing, when we looked at that bill, we said: My goodness,
there is so much in rules and regulations, and we are going to have to
take nurses off the floor and turn them into data entry. We are going
to have to stay hours at a time, after practice, after office hours,
just to do these electronic medical records.
We said that this overregulation was going to lead to consolidation
of industry. Here we are 15 years later, and that is exactly what
happened.
We have three PBMs controlling 85 percent of prescription drugs. Most
every State has one or two healthcare insurance companies controlling
the market. There are typically one or two hospital systems controlling
healthcare in a large geographical area. The smaller companies can just
never keep up.
So what we have seen is 15 years of failed policies. But families
deserve real reform, and that is what we are trying to do. We are
trying to reform, to fix the ``Not So Affordable Care Act,'' ObamaCare.
And of all the things we saw coming, we thought it would be fraud.
But when fraud really spiked is when we added these enhanced premium
tax credits--the Biden enhanced premium tax credits. And just like the
original ACA, these enhanced premium tax credits were voted for only
with Democrat votes. And what it allowed is for patients to have health
insurance without paying anything toward the premium.
So we had headhunters who went across the country. They got a
person's name. They got their birth date. They enrolled them in
ObamaCare, and the
[[Page S8561]]
patient never even knew they were on it. But the Federal Government has
been sending money to these insurance companies. In fact, one out of
three people on ObamaCare, in a given year, never makes an insurance
claim.
One out of three people on ObamaCare never makes an insurance claim.
That is because most of them don't even know they are on it. And when
there is no money coming out of one of their accounts, they have no
idea that they are on it.
I think that to Americans, it is like shoplifting--shoplifting at a
grocery store. We all end up paying for that. The rest of the consumers
have to pay for the shoplifting. That is what is happening in
ObamaCare. Everybody else is paying for that increased premium.
So the first thing that we want to do is to stop the fraud in the
Affordable Care Act, and we do that in several ways. How about
something as simple as checking IDs? I can't get a hotel room tonight--
when you apply for Medicare, for Social Security, you need an ID. We
need to have job verification. We need to check IDs. We need technology
to figure out when dead people should have the stipends stop.
The recent GAO report showed that 58,000 dead people were having
premiums paid to these insurance companies for an average of about 9
months each. So think of the cost of that to the Federal Government and
to taxpayers--58,000 dead people having an insurance premium paid
monthly for 9 months before the Federal Government realizes that they
are dead.
Probably, a third of that $150 billion a year we are spending on
ObamaCare right now is in fraud, waste, and/or abuse.
The next thing we want to talk about is price transparency. Could you
imagine--let's just say that, boy, you had a great year, and you are
living that American dream, and you are going to go buy a new pickup
truck. And, you know, maybe your family usually drove Fords, and maybe
your family drove Chevys, but you want a Dodge. So you know you want
four-wheel drive. You know you want a nice V-8 engine to be able to
pull your boat and to get unstuck when you are out hunting and fishing,
but you would like to know the price. So what is the difference between
a Dodge four-wheel drive truck, eight-cylinder engine--maybe a HEMI--
versus that Chevy or Ford model which are similar? Could you imagine
making that decision without knowing the pricetags?
Could you imagine going into the McDonald's, and you are trying to
decide if you want the Big Mac or you want the Filet-O-Fish and not
knowing the difference in the prices on that? So why, in healthcare,
are we satisfied with not knowing the prices?
So one piece of our solution to solve this riddle of healthcare is to
force all healthcare providers to provide prices. So if your doctor
says that you need your knee scoped or your doctor says you need an
MRI, they can give you a code. You get on your technology, and what the
technology shows you, within 60 miles, is all the different facilities
that are covered by your insurance and what the cost would be for that
procedure and some outcomes as well.
You would be amazed. You can save thousands of dollars on an MRI by
doing a little shopping, with the same quality.
You need a joint replaced. You might save $40, $50, $60,000 for
having the hip replaced at a surgical hospital as opposed to a
traditional hospital setting. And guess what. The infection rates are
lower here at this surgical hospital.
So our bill forces, again, all healthcare providers to show you the
true costs. This turns patients back into consumers. It is the only
industry in America where we don't allow consumerism, and the ACA is
just complicating this.
So what our bill does is require, again, all healthcare companies--
healthcare providers--to show you the true costs, no excuses.
Think about the savings of this. Even I underestimated the savings of
this. This will mean $1,000 a month per family. If we adopt our
pricetags bill, it will save the average American family a thousand
dollars a month.
America spends $5 trillion a year on healthcare now--$5 trillion a
year. If we give the American consumers pricetags, it is going to save
a trillion dollars.
Just like Black Friday, when we had people out there shopping, what
is the first thing you want to know? You want to know the prices. And,
by the way, 80 percent of healthcare decisions are made by women. And I
know these women are expert shoppers. If you give them the technology,
if you give them the prices, then they can figure out what they want to
buy and where the best place to do it is.
Our third pillar is to bridge the subsidy issue for families. Look, I
don't have to tell any American the challenges with the cost of
healthcare. I never cared for the subsidies--the Biden-era subsidies.
Again, they were passed with all Democrat votes. But here we are, and
they are going to expire. The Democrats set them up to expire December
31. It was really a COVID-era extra bonus.
Remember, the other 80 percent of the premiums are still going to be
covered. The original Biden-era subsidies are not expiring, and they
typically cover about 80 percent of the premiums.
So I am willing to extend those for a year, as long as we get some of
these other things, as long as there is long-term reform. We get our
pricetag bill. We address the fraud. And then what we would do is
slowly start putting money into your healthcare savings account.
Let me say that again. The Federal Government, rather than sending
money to the insurance companies, we are going to put money in your
healthcare savings account to pay toward your deductibles.
Remember, your deductibles under ObamaCare went from $1,000 a year to
$15,000 a year. So our bill would start taking part of that money and
turning you into a consumer. You combine our pricetags bill, putting
money into your savings accounts, and then we are going to see true
consumerism, and we are going to see the cost of healthcare come down
20 percent.
Our next pillar that I would like to talk about is high-risk pool
protection. Now, what does that mean? Certainly, ObamaCare did some
good things, and one of them was to protect people with preexisting
conditions.
You may know, but I was an obstetrician. I delivered a baby every day
for 25 years. And the most common preexisting condition that wasn't
covered was pregnancy. Less than half of pregnancies are covered--are
planned. Excuse me. Less than 50 percent of pregnancies are covered,
and people buy their health insurance. They didn't think they needed
maternity coverage. But guess what. They did.
So I want to make sure everyone's preexisting conditions are covered.
I want everyone to have meaningful, affordable access to healthcare,
and I want to make sure we protect this. But one way we protect that
issue and drive the cost of healthcare down is a reinsurance pool--a
high-risk, invisible reinsurance pool--so that when any person in
America hits a certain spending amount, they would go into this high-
risk pool. They would be State run. We need State money in the game as
well.
Everybody that is getting insurance through that State needs to be
contributing--probably $3, $4 a month--to that high-risk pool as well.
And if the insurance companies knew that you were going to be able to
grasp out those outliers, it is going to bring the premiums down for
everybody else.
So we talk a lot about CSRs. You could take half of the money that we
would save by funding the CSRs and put that money into the start of
high-risk pools, and all of a sudden, you have got something going
here. If you would implement our plan, I really do think you are going
to see healthcare costs go down by a third, maybe 50 percent, but at
least by a third. Between pricetags, between funding your HSAs, by
making patients consumers, by setting up these high-risk pools, we are
going to start decreasing the costs of healthcare for everybody.
So those are our five pillars. Let's stop the fraud. Let's give
patients pricetags. Let's bridge the subsidy. I am willing to include
the subsidy for a year longer if we start bridging to a better future,
where we are not throwing good money after bad money. We set up the
high-risk pools, and you end up with lower costs for patients.
We are fighting for patients. We are fighting for hard-working
Americans.
[[Page S8562]]
We are not fighting here for big business. We are not here fighting for
insurance companies. Small businesses are in desperate need to lower
the cost of healthcare. For every business I talk to, every union I
talk to, every self-employed person I talk to, the cost of healthcare
is a top-three issue. And these pillars will help address that.
This plan was not made overnight. This plan, as I said, started
really back in 2010 in a surgeons' lounge.
And when I was elected to come here in 2016, this is one of my three
or four issues that I wanted to address. And I have continued to revise
and refine and improve this plan from year to year to meet this moment.
In fact, it was 2018 that now-Speaker Mike Johnson and I put together
a comprehensive replacement bill for the ACA.
And here we are today, no better off. Prices are skyrocketing, and we
continue to struggle.
I am encouraged. I think we have some momentum. I continue
discussions across the aisle. And what I hear my friends across the
aisle saying is that we share a lot of the same goals. We want
Americans to have affordable, meaningful healthcare.
And by the way, again, a $15,000 deductible for a family making
$120,000 a year--that $15,000 deductible is not the same as access to
care.
This is not a conclusive list. There needs to be more. There are more
things we can do. We need to expand healthcare association plans. We
need to allow insurance to be sold across State lines. We need to take
on the PBMs. This is just the start, but this would be a backbone. And
I don't know why any of my friends across the aisle would be opposed to
any one of these particular pillars.
Our text for our bill is out. The legislative text is out there now.
We welcome cosponsors. We welcome this as an opportunity to build
toward a bipartisan bill in January.
Americans deserve transparency. They deserve accountability. They
deserve affordability. And this plan delivers it.
I yield the floor.
The PRESIDING OFFICER. The Democratic whip.