[Congressional Record Volume 171, Number 208 (Wednesday, December 10, 2025)]
[Senate]
[Pages S8594-S8597]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Healthcare
Mr. LANKFORD. Mr. President, the Senate is talking a lot about
healthcare right now for good reason. There are major cost increases
going up on insurance all across the country but especially for some
folks that are in ObamaCare Marketplace plans.
I talked earlier this week with a gentleman from my State who is in
his early sixties. He runs a small business, works his tail off. His
insurance plan that he has taken on, he took on in the last few years
because of the enhanced premium tax credit subsidies that were added in
2021. Those temporary tax gifts to insurance companies expire in just a
few weeks.
Now, he knew that they would expire. As he told me in our
conversation we had this week, he said he knew they were temporary, but
now he is trying to figure out what to do to find affordable healthcare
options for himself because his healthcare is going to go up about $500
a month. That is an enormous amount.
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And his frustration was pretty clear. He is just looking for a plan
that he can afford. He is just looking for an option. He is not asking
for something unrealistic. He is just trying to figure out what to do.
He asked me the question: How did we get here? How did this happen?
Well, let me just walk through that because the interesting thing
about all of this is how confusing it has really been in the process.
Everyone that I talked to about healthcare, they all say: It is
incredibly confusing. I can't figure out any of this.
Let me try to explain just a couple of things we are talking about.
My Democratic colleagues are asking for a multibillion-dollar
extension, not of ObamaCare but of a subsidy that was put on top of
ObamaCare. And it doesn't apply to 320 million Americans. It applies to
about 20 million Americans. If I want to make it even more specific
than that, it is not just 20 million Americans because most of those
qualify for the full subsidy; it is just for a certain group--
typically, folks that are 50 to 64--that it applies to.
It is that particular group that are on the ObamaCare Marketplace
that are in that age bracket that are facing very high premiums that
are coming up very, very soon. It is a big deal to them, as well it
should be for any American.
Let me set the context for this. The Kaiser Family Foundation lists
the average cost for healthcare insurance on the individual market--the
average cost for healthcare insurance on the individual market--at $215
the year before ObamaCare came into effect. Let that set in for a
minute. People in this room know how much your health insurance is now.
If we went back to prior to ObamaCare's passage, the average cost for
the individual marketplace for health insurance was $215. Not so any
more. It has more than doubled--more than tripled for many people.
President Obama said at that time that ``it will cut the cost of the
typical family's premium by about $2,500 a year.''
It has not been reduced for the typical family by about $2,500 a
year. It has dramatically increased. It has become more and more
complicated. There are more and more entities that are involved in
healthcare decisions.
And the challenge for healthcare right now is the absolute complexity
that has been created in the cost that continues to overwhelm. That is
where we are as the baseline that every American is facing right now.
In 2021, my Democratic colleagues saw the skyrocketing costs. And in
what they called the American Rescue Plan during COVID, they added in
an additional subsidy on top of ObamaCare for about 10 million people.
That was called the enhanced premium tax credit that got added on top
of ObamaCare because the ObamaCare costs were skyrocketing so fast.
They called it, at the time, a temporary plan to be able to help
during COVID. But then a year later, they added another 2 years on top
of it. That is now what is expiring at the end of this year, their
temporary COVID extension. The problem is, the price continues to go up
so rapidly that now no one can afford the plan anymore.
In my State in Oklahoma, we asked our insurance commissioner to take
a 6-year snapshot and tell us what is happening to the Marketplace, the
ObamaCare Marketplace, without the subsidies. If the subsidies went
away, what was the increase? And for the commercial insurance from my
State, what changed during that time period?
For ObamaCare, the rates had gone up 198 percent in 6 years. In
commercial insurance in my State, it has gone up 29 percent--apples-to-
apples comparison.
There is a very real problem with the structure of how ObamaCare
actually works. The request has been: Let's put more subsidies on top
of it, more subsidies on top of it and add billions and billions more
in taxpayer dollars to cover up the problem that is underneath. There
is a problem in the way that ObamaCare was actually created and how it
is actually operating and what it is causing not just for that group in
the Marketplace but for what it is causing for everybody else, even
people that are not in the Marketplace at all--how that is driving up
premiums.
We are debating the next 24 hours, trying to be able to come to two
sets of solutions here. My Democratic colleagues are bringing a
proposal tomorrow to say: Let's just take the subsidies that we did
during COVID and let's extend those 3 more years, and we will just do
that, no reforms, no changes, no anything else. Let's just do that for
3 more years.
It was interesting. I asked about the 3 more years and the exact
timing on that, how that would work. It is fascinating. When you pull
back the politics of that 3-year extension, the 3-year extension goes
through the end of 2028. But what they don't tell you is, it would
actually set up to announce the new insurance rates for 2029 that would
not have the subsidies anymore in it the week before the Presidential
election in 2028.
Well, that was clever. They set up a little political timebomb for
the Presidential election in 2028, saying they chose this certain date
in this certain time to do it so that right before the next
Presidential election, we would have the same argument all over again--
no reforms, no changes, political date-setting.
Republicans are actually bringing forward a proposal and saying: We
see you. We see what has been dropped on you. We see individuals in my
State and all over the country that have now fallen prey to what has
happened in ObamaCare that they can't get options for different
healthcare insurance, they can't get cheaper rates, and they certainly
can't go back to what the rates were in 2010 at $215 a month anymore
because under ObamaCare, if you are in the individual market, that is
not allowed anymore. That is absolutely prohibited in Federal law now.
So we have a very simple proposal: We do want to assist folks who are
stuck in this ObamaCare Marketplace to try to figure out how we help
them through this, but we don't want to send the dollars to the
insurance companies. That is a hole. We want to send it to the
individuals who are there and give them some greater choice on it.
So our main proposal is, yes, we want to help them, and we want to
help them immediately, but we don't want to send dollars to insurance
companies and trust in them that it is going to be taken care of. We
want to get the dollars to those particular individuals and say: Let us
help you in this process and get through this next year as we,
hopefully, reopen this whole debate about healthcare.
The second thing that we want to do is increase the options for
coverage for those individuals and increase them right away so that
they get greater flexibility in what they can choose. We trust the
American people as they are shopping in the marketplace for healthcare
insurance to be able to make better decisions.
Long term, what I would love to see is let's open up the conversation
about how we have associations of healthcare plans. Right now, the
small business owner I talked to earlier this week is limited to only
choosing things in the ObamaCare Marketplace, and the price is
absolutely skyrocketing for him. He doesn't have the option to actually
join together with other small businesses to negotiate for a better
rate. A big company can do that. If you are Walmart, you can do that,
and if you are JPMorgan Chase, you can do that, but if you are my small
business owner in Oklahoma, you cannot. They are prohibited from doing
that. Well, that is ridiculous. They should be allowed to join together
and be able to negotiate for better rates so they can get greater
options on that.
We want to help expand health savings accounts. Health savings
accounts allow individuals to actually talk to their physicians or
their hospitals and say: How much does this cost, and actually try to
find a way to be able to compete for cost on it. Greater price
transparency allows people to choose, if they have got to get an MRI, a
CT scan, or whatever it may be, to say: What are the best options to be
able to do this that actually bring the cost down?
Most of the time when people go to the hospital, they never know what
the cost is for anything. They have no idea because ``insurance'' is
covering that until, suddenly, they don't, and then it becomes a big
issue. That should be something we can all agree on as greater
flexibility and greater options on plans do nothing but help people.
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There is an issue that I have worked on with several of the folks in
this room, and that deals with pharmacy benefit managers. We have got
to be able to actually land this. We all know of the rising costs of
pharmaceuticals that are out there. We all experience that, and
everybody says: What is the problem? It is the middleman in the middle
of this who is actually controlling the formulary and controlling a lot
of the pricing, and that completely hides the cost of everything on it.
The pharmacy benefit managers are destroying our independent
pharmacies in our rural areas all around the country as they continue
to make more and more profits on Wall Street. We have got to say: We
are not trying to destroy you, but you have got to stop destroying our
independent pharmacies around the country, and you have got to actually
be more transparent in the process on this.
We have a bill that is a bipartisan bill that has come out of the
Finance Committee that we have unanimous support for--tell me how often
that happens in this body--but that we can't seem to get to the floor.
We should be able to agree that, if someone is trying to dramatically
jack up the cost of pharmaceuticals on our individual constituents and
on the families in our neighborhoods and is destroying our independent
pharmacies, we should all be able to agree that that is
anticompetitive. That has got to stop. We should be able to do that.
Listen, we already passed this last July--a $50 billion amount going
to rural hospitals to stabilize those rural hospitals. We have already
engaged in ways to be able to stabilize Medicaid in the long term and
make sure that the program continues to work well. We have already
taken on some of these things to be able to make things better. We have
got to deal with the issue of individuals and their healthcare options
and their opportunities to find better insurance to be able to take
care of their healthcare.
Let's increase competition, and let's increase options for
individuals in the days ahead; but in the short term, let's at least
get immediate assistance to those folks who need the help right now by
giving dollars to those individuals, not by sending cash to the
insurance companies and setting up a political timebomb right before
the Presidential election. That doesn't sound like that is actually
helping people. That sounds like that is perpetuating the same problem
that we have dealt with already. These are options that we should be
able to have grownup conversations about and resolve. There is a way to
resolve this. Let's get busy doing it.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Tennessee.
Mrs. BLACKBURN. Mr. President, I am so pleased that my colleague from
Oklahoma is on the floor and is talking about this issue that affects
so many Americans. Indeed, in Tennessee, we have seen the impact of
this.
As my colleague mentioned, our friends across the aisle have done
what we call kicking the can when it comes to healthcare. ObamaCare is
too expensive to afford--that is something that has been proven--but
instead of dealing with root causes, they are saying: Let's just extend
the COVID-era subsidies for another 3 years, and then we will talk
about it.
He also mentioned triggering that date during a Presidential
election--doing nothing to reform the abuse that you are finding in the
system and just kicking the can and saying: Let's do these subsidies.
Let's not worry about it.
Well, you know, that is not something that Tennesseans are wanting to
see, and as many have reminded me, they are the exact same subsidies
that the Democrats used as a smokescreen to carry out their 43-day
government shutdown. But at the end of all of this, they don't want to
do anything about it even though we have information and have seen
research that, by extending these pandemic-era subsidies--and by the
way, COVID is over; the pandemic is over, but they want to continue to
fund it like it is still going on. These subsidies have been plagued by
waste, fraud, and abuse, and what they are doing would cost taxpayers
$35 billion a year to do nothing more than line the pockets and the
profits of insurance companies.
We know that there is an incredible amount of fraud. There are 6.4
million people fraudulently enrolled. We know that it is hard-working
taxpayers who are paying for this and that the Democrats' solution
would do nothing to clean up the program. It would do nothing to lower
the cost of healthcare. It would continue the status quo, and
individuals who are enrolled in ObamaCare would continue to see their
costs go up.
So what we have said is, the original ObamaCare subsidies--by the
way, I want to be very clear on this. Those subsidies are law. They do
not go away. The only things that are going away are the Biden-era
COVID subsidies. The Democrats put those in place in 2021. They were to
expire in 2022, but then they decided, no, let's make them expire on
December 31, 2025. So they created this problem. They created the
problem with ObamaCare. Not one Republican voted for it in either the
House or the Senate, and now they have created another problem.
They have done all of this because they didn't want to address the
flaws that were in the program. Well, under the Biden COVID-era
credits, people who were making over $500,000 a year could benefit from
the taxpayer-funded subsidies. Originally, with the original ObamaCare
subsidies, you get the credit up to 400 percent of poverty, but the
Democrats said: No. Let's make it a free-for-all. Let's just get these
out here, the zero premiums--yes, that sounds great; that is what they
wanted to push for some people--and up to $500,000 a year in income,
$500,000 a year. You, too, could get a taxpayer-funded subsidy to help
pay for your insurance. Maybe 80 percent was paid or 90 percent was
paid, but this is not what the American people want. Instead of
lowering costs, these subsidies are continuing to prop up a very broken
system, and that is why the cost continues to go up.
Since 2013, the ObamaCare benchmark plan premium has increased by
more than 200 percent. In Tennessee, you have seen about a 20-percent
increase. Now, this ObamaCare plan is going up more than 300 times the
rate of employee-sponsored plans, so the taxpayers are on the hook for
this.
So why is it that they continue to go up? It is because of government
interference and the mandates that Democrats passed when they passed
ObamaCare. It is too expensive to afford.
During the Schumer shutdown, I spoke in this very Chamber about the
fraud that was connected to the Biden COVID credits. Last week, the
U.S. Government Accountability Office actually released findings that
showed just how easy it was to commit fraud with these subsidies. The
GAO conducted an undercover test. They had heard anecdotally about some
of this fraud, but the GAO, which is nonpartisan, said: Let's get into
this. Let's dive in. Let's do an undercover test.
So they submitted applications for these Biden subsidies for 24
fictitious individuals, for people who don't exist, with addresses that
are not accurate and names and Social Security numbers that are not
accurate. Each application had false and missing information on
identities and incomes. They just made it up. So they ran their test.
To their surprise--get this--they didn't have one or two people who
were approved or even half of the people--a dozen--of these fictitious
people who made it through. They had 23 of the 24 fake people approved.
They had fake identities and fake income--nothing was real--but
ObamaCare approved 23 of the 24 applications. The U.S. taxpayer who is
footing the bill for this paid more than $10,000 a month to insurance
companies to provide for these people who don't exist, for these
fictitious enrollees. Think about that--$10,000 a month.
A preliminary analysis by the GAO found that there were at least
190,000 applications between 2023 and 2024 that had unauthorized
changes by agents or brokers. That means people didn't know that they
were enrolled or they didn't know that changes on income and personal
data had been made to their applications. Over the same period, there
were close to 100,000 duplicate Social Security numbers enrolled in the
program. So you have a broker or somebody who is enrolling people. They
get a Social Security number, and they are going to town with it. They
are wearing that thing out.
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So you have got 100,000 duplicate numbers enrolled in the program. In
one case, a single Social Security number--one number--was used to
apply for more than 125 policies.
I call that fraud. And I think it is amazing that ObamaCare is so
poorly run that they are allowing this level of fraud and waste of your
tax dollars, which are paying for every bit of this.
This is a program that now our colleagues across the aisle are
saying: We don't want to fix it. We just want to kick the can. We want
to extend these subsidies for 3 more years because the program is
really expensive.
And why is it expensive? Waste, fraud, abuse, and government
mandates. And ObamaCare is too expensive to afford.
Now, Republicans have already started to address the root cause of
the issue, and in the Big Beautiful Bill, there are provisions that
require individuals who misstate their income to repay the excess
subsidy amount in full.
Requiring applicants to verify their income, their family size, their
immigration status, and residence before enrolling ensures no one can
abuse the system at the expense of American taxpayers.
This is what you call old common sense. If you are going to go apply
for a credit card or a loan at the bank, you have got to verify this,
and you are going to be held legally responsible.
Under ObamaCare, it is like nobody gave a ripping flip about what you
put on the paper. Whatever you said, all right--there was no
verification that was done.
Republicans are also working on solutions to lower the cost--how
about that one?--and to promote healthcare freedom, to let you, the
patient, the individual, have more choice, more options, and make
decisions that affect your healthcare.
This week, our Finance Committee chairman, Senator Crapo, and the
Health Committee chairman, Senator Cassidy, introduced legislation that
would direct funds directly to patients, not to insurance companies.
Well, how about that?
Let's make certain that patients--patients--are the ones who receive
those funds, not the insurance companies, because we have already
defined the waste, the fraud, and the abuse that is taking place in the
program.
Now, doing this through health savings accounts and funding for cost-
sharing reduction payments, these are things that are positive, that
would help to bring some transparency to the system.
Unlike the Democrat proposal, which only further adds to our $38
trillion in debt, the Crapo-Cassidy bill would drive down the cost of
premiums and provide an off-ramp for the Biden plussed-up bonus COVID
credits for individuals that were making six-figure incomes.
Now, last week, I introduced a package of bills to support and expand
Tennessee's Medicaid innovation, including the Medicaid Primary Care
Improvement Act, which would allow States to use Medicaid dollars to
pay for direct primary care arrangements, expanding healthcare access
for Medicaid beneficiaries and improving outcomes.
And we are introducing legislation that I have worked on for years to
empower citizens to purchase health insurance across State lines and
have portability on policies. If they get a policy that works, that
they like, that they can afford, allow them to take that policy with
them, regardless of where they live--again, common sense.
We do know this: You have got to promote competition so that we can
bring down prices and give consumers--individuals, patients--more power
to price shop for affordable plans.
Americans do not want the Federal Government in charge of their
healthcare. They do not want socialized medicine. They do not want
government-run healthcare plans. And they definitely do not want their
hard-earned tax dollars underwriting fraud.
I yield the floor.
The PRESIDING OFFICER (Mr. Banks). The Senator from Iowa.