[Congressional Record Volume 171, Number 209 (Thursday, December 11, 2025)]
[Senate]
[Pages S8643-S8654]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
LEGISLATIVE SESSION
______
HEALTH CARE FREEDOM FOR PATIENTS ACT OF 2025--Motion to Proceed
The PRESIDING OFFICER. Under the previous order, the Senate will
resume consideration of the motion to proceed to S. 3386, which the
clerk will report.
The senior assistant legislative clerk read as follows:
Motion to proceed to Calendar No. 285, S. 3386, a bill to
provide a health savings account contribution to certain
enrollees, to reduce health care costs, and for other
purposes.
The PRESIDING OFFICER. The Senator from Iowa.
Tribute to Terry Branstad
Mr. GRASSLEY. Mr. President, former Governor Branstad is being
honored today. Before I read that tribute about his honoring today, I
thought I would give a little bit of background about what I know about
former Governor Branstad.
I first met State Representative Terry Branstad in January 1973, when
he was a new member of the legislature. He would tell you that I
actually spoke to a group of Republicans who were at the University of
Iowa in 1966. I will take his word for that.
He served 6 years in the State legislature. Then, we used to elect
our Lieutenant Governor separate from the Governor, and he served 4
years as Lieutenant Governor. Then he was elected Governor of Iowa in
1982 and served 16 years, until 1998.
Then he decided to have a private life and a business life, and
during those 12 years that he was not Governor, we had 12 years of
Democratic Governors. They left a big fiscal hole. There was a real
feeling among Iowans that only former Governor Branstad, then, could
get us back on a strong fiscal path to fiscal sanity in Iowa.
So he decided to run for Governor again, and he selected now-Governor
Reynolds as his running mate. And Terry Branstad served until the Trump
administration, when he was appointed Ambassador to China.
The second Branstad administration, continued by Governor Reynolds,
has had Iowa on a strong fiscal path, not with any deficits, and
reducing taxes, having balanced budgets, and having several billions of
dollars in reserve funds.
So now I would like to, with that background, talk about the honor
that he is getting today.
It is an honor for me, today, to congratulate my good friend Terry
Branstad. This very day, he will become the 26th recipient of what is
called the Iowa Award, our home State's highest citizen award.
Governor Branstad is the longest serving Governor in U.S. history,
who also served Americans as U.S. Ambassador to China during the first
Trump administration.
Like me, Terry grew up on a family farm. Throughout his lifetime of
public service, Terry applied the bone-deep work ethic of an Iowa
farmer, with extra elbow grease, fiscal conservatism, and rock-solid
tenacity. He is famous for his retail politicking and his political
skill.
I am proud to say that Terry has been a supporter of mine in every
one of my congressional campaigns, dating back to 1974.
He joins an esteemed group of Iowans--examples like President Herbert
Hoover to Norman Borlaug and Grant Wood--who have helped make our State
the best place to call home.
Barbara and I congratulate Governor Branstad on his well-deserved
award and thank him for his friendship and decades of service.
I yield the floor.
The PRESIDING OFFICER. The majority whip.
Waiving Quorum Calls
Mr. BARRASSO. Mr. President, I ask unanimous consent to waive the
mandatory quorum calls with respect to Calendar No. 285, S. 3386; and
Calendar No. 284, S. 3385.
The PRESIDING OFFICER. Without objection, it is so ordered.
Healthcare
Mr. BARASSO. Mr. President, $83 billion--that is how much Democrats
[[Page S8644]]
want to send and will vote today to send to bail out the failed
ObamaCare healthcare system.
Look, I am a doctor--as are you, Mr. President. We want patients to
get the care they need from a doctor they choose at lower costs.
ObamaCare robbed the American people of choice, as well as
affordability.
So the Democrats are back here, today, saying they want to send an
additional $83 billion directly from the Treasury of the United States
to the pockets of the health insurance companies of America.
Mr. President, ObamaCare has failed so badly that Democrats continue
to use taxpayer dollars to try to hide the failures. That is what this
whole Biden COVID bonus scam is all about. These are juicy subsidies--
extra subsidies on top of the regular ObamaCare subsidies--and they are
the ones that are expiring at the end of this month.
You may recall that, in 2021, the Biden COVID bonuses were rushed
through by Democrats, and they called them temporary emergency measures
because of COVID. They created these Biden COVID bonus payments without
a single Republican vote.
So why did they create it? It is because ObamaCare is unaffordable.
People all across the country understand that. Democrats have known it
from the beginning; they just refuse to admit it.
In 2022, they extended the Biden COVID bonuses--again, without a
single Republican vote. Now, the tax-and-spend radicals who run the
Democrat party want to extend them again--these bonus payments--for an
additional 3 years. Oh, and they want to do it with zero reforms.
This is a program that is chock-full of waste, fraud, abuse, and
corruption; and they do nothing to help try to make healthcare
affordable for the families of America.
So the choice today is simple. Do we want to send more taxpayer
dollars as welfare to insurance companies? Or do we want to make
healthcare more affordable for patients and put patients in control?
So let's start with the Democrat bill. The Democrat bill forces
Americans to pay $6,000 out of pocket before insurance even kicks in.
That is called the deductible. It continues the same failed ObamaCare
policies that raise premiums for American families by over 220 percent
since ObamaCare became law--no reforms.
Well, remember, wasn't it President Obama who said to the Nation: Oh,
if you pass my plan, premiums will go down by $2,500 per year per
family. They didn't. They doubled. I think they called that one ``the
lie of the year'' of ObamaCare. Democrats refused to include any of the
needed reforms to deal with the significant flaws and fraud of
ObamaCare.
This month, the government investigators at the GAO, the Government
Accountability Office, uncovered $21 billion being sent in 1 year
alone--in 2023, $21 billion sent to insurance companies--for policies
where there was no verification of the person's income, no verification
of their citizenship, no verification, in many cases, of the person's
actual existence. It is hard to believe, but true. Opinion pieces have
been written, even by the Washington Post, that talked about the level
of fraud.
There are 20 million people on ObamaCare right now. You talk about
$21 billion and with the 20 million divided out. It is about $1,000
worth of potential fraud for each and every enrollee in ObamaCare.
What do Democrats want? They want to continue this unchecked for the
next 3 years--no changes, no reforms, nothing. Worst of all, Democrats
want to send tens of billions of dollars every year directly from the
government, directly into the bank accounts of the insurance companies.
How do insurance companies feel about this? Hey, they are licking
their lips for $83 billion more, because for insurance companies, their
stock prices have gone up between 500 and 1,000 percent since ObamaCare
became law. It seems like Democrats are interested in making them even
richer.
What they are proposing isn't a serious plan; it is a disaster. Our
Nation can't afford it, and the American people can't afford to pay
these high costs for healthcare.
We need to focus on the cost of care and how we as doctors can lower
that cost of care for American families. So we have a better approach.
It is a simple approach.
We start with a simple principle, and that principle is that
healthcare should work for patients, not for big insurance companies.
Our plan sends money that is now going to insurance companies and sends
it directly into the pocketbooks and into the pockets of the hard-
working families of America. That is where the money belongs. It does
that by expanding health savings accounts, not direct payments to
insurance companies for more ObamaCare.
Our plan reduces the payments to insurance companies by $30 billion,
and it will lower healthcare premiums by 11 percent. Our plan puts
patients in charge. They would be in the driver's seat. That is who
needs to be in the driver's seat, with real freedom to get the
healthcare that works best for them and their families.
Our plan restricts Federal Medicaid funding to States that give
health insurance to illegal immigrants.
People say: Oh, you can't be giving it to illegal immigrants. It is
illegal to give it to illegal immigrants.
It doesn't mean States aren't doing it. And the GAO study found that
the ObamaCare plans are also and have been used by illegal immigrants.
It requires States to verify citizenship prior to signing someone up
for Medicaid, as well as for ObamaCare. And our plan upholds Hyde
amendment protections--protecting Americans' rights of conscience.
Our plan is fully paid for. It is an end to the Democrat era of
runaway spending to cover up ObamaCare's high prices.
I am a doctor. I practiced medicine for 24 years in Wyoming. And I
can tell you this: When patients have more freedom and more choices,
healthcare improves. When patients have more freedom and more choices,
costs go down. That is what Republicans are voting for today.
I really want to thank Senator Mike Crapo of Idaho and Senator Bill
Cassidy of Louisiana for leading this effort. I want to thank the
Presiding Officer for his efforts to find reforms that will actually
work, that will help patients, will help lower the costs, put them in
charge. That is what we really need to do--lower healthcare costs for
hard-working families.
So the contrast is clear. Today, Democrats are going to vote to
protect a broken system of higher costs, of rampant fraud, and big
checks to insurance companies. Republicans are going to vote for a plan
that lowers healthcare prices and empowers patients. It empowers them
to choose the doctor and the care that works best for them. That is
what Republicans are committed to.
We are committed to delivering what the American people deserve,
which is the care they need from a doctor they choose at a cost they
can afford.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Recognition of the Minority Leader
The Democratic leader is recognized.
Healthcare
Mr. SCHUMER. Mr. President, today is D-day--decision day for
Republican Senators. Will Republicans side today with the American
people and avert the impending healthcare crisis or will they abandon
American families as premiums shoot through the roof on January 1? That
is the decision Senate Republicans must make today.
I say to my Republican colleagues: Our bill is the last train to
leave the station.
After wasting precious time fighting among themselves, Republicans
have one last shot at a clean, realistic plan to lower healthcare
premiums. The Democratic bill is the only bill that will do that today.
Ours is the only bill on either side in the House and Senate that has
the full support of every Member on our side of the aisle.
Democrats are fighting to lower healthcare costs for the American
people, while Republicans are fighting among themselves. By my last
count, Republicans are now at nine different healthcare proposals and
counting, and
[[Page S8645]]
none of them give the American people the one thing they most want: a
clean, simple extension of these healthcare tax credits. But our bill
does extend these credits cleanly and simply, and it is time for
Republicans to join us.
So I repeat, our bill is the last train to leave the station. After
this, we will not have time to try again before premiums shoot through
the roof next year. This is not a political fight. This is not a
symbolic vote. This is a life-and-death vote because people who will
lose their healthcare could face that horrible, horrible end.
This is about ensuring that working- and middle-class people can
afford to see a doctor without going broke, to afford treatment for
illnesses like cancer and enjoy the dignity of good health without
wiping out their life savings.
For many Americans, affording health insurance is the difference
between life and death, as I have said, so we must act. People are
counting on us. The American people are counting on us--counting on
you, Republican Senators--to act.
Now, of course, this morning, the Senate will first vote on the
Republican healthcare proposal, but the Republican plan is nothing more
than a reflection of the deep divisions inside the Republican caucus
and the Republican Party.
Republicans have had so many differences amongst themselves that for
a while, it looked like they weren't going to put up a bill at all. But
after that became too embarrassing an option for Republicans, they used
Scotch tape and glue to come up with this ridiculous proposal that
can't be taken seriously and does nothing--nothing--to avoid the
impending healthcare crisis. It doesn't extend the ACA tax credits for
a day, month, a year--none of that. Not even a day.
Even calling this Republican bill a proposal is generous because the
Republican bill is little more than junk insurance. It is no real plan
at all. It has been repudiated time and time again in the past and will
be repudiated by the American people again.
Under the Republican plan, the big idea is essentially to hand people
about $80 a month and wish them good luck. And even to qualify for that
check--listen to how bad this is--Americans would be forced onto bare-
bones bronze plans with sky-high deductibles--$7,000 or $10,000 for an
individual, tens of thousands for a couple. So to get that $80 a month,
you are going to pay $7,000 off the top before you even get any health
insurance. How ridiculous, how stingy, and how mean and cruel to the
American people. What Republicans offer is not a healthcare plan. The
Republican plan is a ``When you get sick, you go broke'' plan.
You know, it is sad that the Senate even got to this place to begin
with. Republicans in the Senate should have solved this problem months
ago. Democrats warned this crisis was coming. We gave Republicans more
than three chances to extend the tax credits this year--in the spring,
the summer, and the fall--and every time, Republicans said no.
Instead of lowering premiums, Republicans chose instead to ax
healthcare funding, kick millions off insurance, close rural hospitals,
all the while ripping away nutrition funding for working people. Why?
So they could give their billionaire buddies a tax break. And now,
after so much delay, Republicans are about to let the clock hit
midnight.
So there is only one option left to avoid falling over this
healthcare cliff that Republicans have brought us to--a clean, simple,
direct extension of the current ACA credits. Every single Democrat is
unified behind this proposal. I urge Republicans to drop their
divisions and join us.
Republicans, join us, and let's avert a disaster. Join us, and let's
lower costs for the American people. We have one shot to get this
right. Republicans, join us.
The American people are watching how Republicans vote today.
Nominations
Mr. President, on the nomination package, today, Senate Republicans
will move forward with a package of 97 nominees that includes some of
the most horribly unqualified, shockingly radical nominees Donald Trump
has appointed to date.
Historically, when a President nominates such terrible people to
positions of power, the Senate has stood as a check on the Executive no
matter which President, Democrat or Republican, was in charge, but not
this Senate majority, not this Republican Party. Senate Republicans
continue to bend the knee to Donald Trump and give him practically any
nominee he wants no matter how awful they are. They support these
nominees no matter how unqualified they are, no matter how partisan
they are, no matter how unethical they are--no questions asked.
That is why people like Paul Hollis--to be the Director of the Mint
at the Department of the Treasury--are in the package. If confirmed,
Mr. Hollis's first act would be to rubberstamp the Trump one-dollar
coin. That is why they pick somebody--because Trump wants a one-dollar
coin with his face on it, I think. And he refused to share details on
how he would increase efficiency at the Mint because he doesn't have a
plan. He probably doesn't even know much about it.
It is why people like Charles Arrington to be a member of the Federal
Labor Relations Authority are in this package. Unlike nearly all former
FLRA members, Arrington is not a lawyer. And he has a history of
engaging in bad-faith bargaining while at the VA.
The Senate should be considering each of these nominees one by one,
with time to debate each nominee on the floor in front of the American
people and with a rollcall vote on each nominee so every single Senator
is on record.
Unanimous Consent Request
Mr. President, I ask unanimous consent that the following Senators be
permitted to speak for 5 minutes each prior to the cloture vote on the
motion to proceed to S. 3386: Senator Shaheen, Senator Ossoff, Senator
Wyden, Senator Durbin, Senator Hassan, Senator Baldwin, and Senator
Schumer.
The PRESIDING OFFICER. Without objection, it is so ordered.
Recognition of the Majority Leader
The PRESIDING OFFICER (Mr. Mullin). The majority leader is
recognized.
Healthcare
Mr. THUNE. Mr. President, later today, we will vote on the Democrats'
partisan messaging bill, which is a clean, 3-year extension of the
Biden COVID bonuses. And when I say ``clean,'' all that I mean by that
are no reforms, straight-up extension--3 years of a program without any
reforms, any revisions, any changes that would actually help drive down
healthcare costs instead of increasing healthcare costs and get rid of
the rampant waste, fraud, and abuse in this program.
The Democrats' plan--that the Democrat leader called it on the floor
the other day. It is their ``plan.'' Apparently, they think that a 3-
year extension with no reforms to try and disguise the real impact of
ObamaCare's spiraling costs is actually a plan. I don't know how you
can call it a plan.
I came down here yesterday to talk at length about some of the many
problems with ObamaCare and the perverse incentives it provides to move
employees off of employer-provided insurance and into taxpayer-
subsidized plans that have rampant year-over-year increases in
premiums; the perverse incentives it provides to insurance companies to
enroll Americans--some of whom don't even know that they have been
enrolled--so that the insurance companies can rake in even more
subsidies.
And then this so-called plan is rampant--and I say ``rampant''--with
fraud and abuse. A Government Accountability Office report released
just last week found a whole host of problems, including the successful
enrollment of fake individuals, Social Security number fraud, failure
to verify or sometimes even request documentation, improper payment of
subsidies, and the list goes on.
I want you to take a look at this. This is the finding that came out
of that study that was done by the Government Accountability Office.
This was their conclusion:
ObamaCare subsidies granted without documentation to 90
percent of fake accounts set up by government watchdog.
Ninety percent--not 10 percent, not 5 percent. I mean, if you had a
program that had 10 percent fraud in it, I think that would be a huge
red flag, right? Wouldn't you be alarmed by that? I
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think most people would. I think most people would go: Wow, that is a
huge number. We need to do something to fix that.
This program that we are talking about today, that they want to do a
straight-up extension on--no reforms, no revisions--was found by the
Government Accountability Office--an entity and Agency the Democrats
love and support found that 90 percent of the accounts that were set up
in the ObamaCare exchanges were fake--fake. Think about that. You can't
make this stuff up. We are talking about tens of billions of dollars in
waste, fraud, and abuse on a yearly basis. They don't want to do
anything about it. They just want a straight-up extension on a program
that the Government Accountability Office says has a 90-percent fraud
rate.
That is obviously a huge problem, but I haven't even gotten to the
central problem. That is that ObamaCare has utterly failed to control
healthcare costs.
Since 2013, ObamaCare enrollees have seen a 221-percent increase in
premiums.
Let me just repeat that. Since 2013, ObamaCare enrollees have seen a
221-percent increase in premiums--221 percent. That means ObamaCare
premiums have grown at approximately five times the rate of inflation--
so much for making healthcare more affordable.
This graph, I think, illustrates that. Actually, this understates the
problem because this shows that since 2014--in the first year of its
inception, when the Obama exchanges went live, there was a huge
increase that the insurance companies built into their premium costs to
cover all the things they had to cover in the new program.
So since 2013, that number is 221 percent, but even since 2014, when
the exchanges were fully up and operating, it has had a 129-percent
increase in premiums at the same time that the group market--in other
words, the large- and small-group market where a lot of people get
their insurance coverage through their employer--was going up at about
half that rate; 68 percent in the small- and large-group market, which
is about where 150 million people get their insurance.
Frankly, the more people we could push into that market, it would not
only lower their costs, but it also spreads the risk among a bigger
pool. That, ultimately, is the way, in the long term, you want to
spread your costs.
But what ObamaCare does, because it uses taxpayer dollars to
subsidize and pay insurance companies directly--premiums go directly to
the insurance companies, so insurance companies are making bank. They
are getting enriched by this. But what it does at the same time is
there is no incentive to control costs, and it is pushing people into
that market.
If you are an employer or employee, for that matter--because most
people respond to incentives--and you are told that you can get into a
market where the taxpayers are going to cover it, the employer is going
to say: Well, why should I pay for health insurance coverage for my
employees if I can have the taxpayers pay for it?
So it is pushing more and more people out of the group market, this
market right here, where there is a 68-percent increase--still way too
much--over the last decade, pushing more and more people out of that
market into this market, which has double the rate of increase in
premiums. That doesn't include, as I said, the first year of its
inception. If you add that first year back in there, that number is 221
percent.
So you have this system that is pushing more and more people into
insurance coverage where the rates are skyrocketing, where the payments
are going directly to the insurance companies, and where lower income
taxpayers are subsidizing higher income taxpayers because there are no
income levels.
So now you can have people making $500,000, $600,000 a year who are
getting subsidized by the Federal taxpayer--people making $40,000 or
$50,000 a year--at a cost to the Federal taxpayer, in their bill alone,
which is just a 3-year extension, of $83 billion. You tell me in what
universe that makes sense.
That is astonishing, to have a program where 90 percent of the people
who are fraudulently enrolled got approved; a program where the rate of
increase is twice the rate in the group market and three times the rate
of inflation, the Consumer Price Index, over the same time period.
Insurance companies are getting rich. Lower income taxpayers are
footing the bill so more affluent Americans can have coverage. The
American taxpayer is paying $83 billion just for the 3-year extension--
waste, fraud, and abuse, higher rates, fiscally irresponsible, and the
list goes on.
Mr. President, even Democrats have to be well aware of the fact that
ObamaCare has utterly failed to do what it promised. As I mentioned
yesterday, we had one Democrat Senator come down to the floor during
the shutdown, and, to his credit, he admitted the truth.
This is what he said:
We did fail to bring down the cost of healthcare.
That is a direct quote: ``We did fail to bring down the cost of
healthcare.''
So what are Democrats proposing to do about that failure? As I said,
exactly nothing. Democrats' so-called plan is a 3-year extension of the
status quo--no reforms, no revisions, no rethinking of the way that
ObamaCare works; just a 3-year extension of the status quo which, I
might add, was put in place in response to the pandemic. When they
extended these subsidies back in 2022, it was in August. The pandemic
was long over--long over.
As I said, you can't make this stuff up.
So it is not going to do anything to address the perverse incentive
to push Americans out of the employer-sponsored healthcare system and
onto taxpayer-subsidized plans. It is not going to do anything to
address the perverse incentives that encourage insurance companies to
enrich themselves at the taxpayers' expense and do nothing to address
the rampant waste, fraud, and abuse in ObamaCare. Most of all, it will
do nothing to bring down healthcare costs. Nothing. Zero.
Under Democrats' plan, insurance premiums will continue to spiral.
American taxpayers will find themselves on the hook for ever-increasing
subsidy payments. And don't think all those payments are going to be
going to vulnerable Americans. As I said, the Democrats' decision to
remove any income cap on the Biden COVID bonuses has Americans making
as much as half a million dollars or more qualifying for
taxpayer subsidies--half a million dollars. Do Democrats really think
middle-class families should subsidize healthcare premiums for those
making half a million dollars?
Democrats don't have a healthcare plan. They want to extend the
status quo--a failed, flawed, fraud program that is increasing costs
three times the rate of inflation.
On the other hand, Republicans today will offer something that does
actually lower costs. Earlier this week, we introduced legislation--
drafted by the chairmen of the relevant committees, Senators Crapo and
Cassidy--to make structural reforms to the individual health insurance
market.
In contrast to the Democratic bill, our bill would actually lower, as
I said, ObamaCare premium costs, and it would redirect government
savings from the bill into health savings accounts for eligible
ObamaCare enrollees earning less than 700 percent of the Federal
poverty level, paired with more affordable insurance plans.
These accounts would help individuals to meet their out-of-pocket
costs, and for many individuals who don't use their insurance or who
barely use it, it would allow them to save for healthcare expenses down
the road.
We have two paths here--one, a plan to start addressing the spiraling
healthcare costs in ObamaCare and make structural reforms that would
drive down premium prices; two, a proposal for a 3-year extension of
the status quo. So you tell me who is serious about actually addressing
the affordability of healthcare.
Democrats may talk about helping Americans, but their bill is nothing
more than a political messaging exercise that they hope they can use
against Republicans next November. So I hope that after today, they
will feel like they have checked the messaging box and will get serious
about actually doing something about the spiraling healthcare costs
under ObamaCare.
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Republicans are ready to get to work. I am not sure yet the Democrats
are interested.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, before I begin my official remarks to
address the vote that we are going to be having shortly, I just want to
respond to the majority leader's remarks because I think there was some
misinformation there.
The fact is that 92 percent of people who get those enhanced premium
tax credits are making $200,000 or less, and the average income for a
person who receives those premium tax credits is $32,000 a year. That
is not somebody in a higher income bracket. In fact, about 50 percent
of the people who receive premium tax credits are small business owners
or their employees, who have no other option for healthcare because
they can't afford employer-sponsored health insurance.
I think much of what the majority leader said about costs and about
addressing fraud and about lowering the cost of healthcare are things
that we all ought to support. I am ready to come to the table.
I think we would be better served if, after we get through these
votes, we sit down and come to a compromise to address the real costs
that people are facing in terms of healthcare, and I am ready to do
that.
But in a few moments, we are going to vote on whether millions of
Americans can keep the Affordable Care Act enhanced premium tax credits
or whether they will face a crushing financial blow. These credits have
helped millions of families, including tens of thousands of people in
New Hampshire, keep their coverage and balance their family budgets.
For many, they are the only thing that is standing between stability
and a crisis.
I have worked on these tax credits since 2019 when I first introduced
the bill. I have warned for more than a year about what would happen to
rates if we failed to address this issue in Congress. Well, now that
open enrollment has begun, we are seeing the consequences of that
failure to act in real time.
States and insurers are reporting that significantly fewer people are
reenrolling in health insurance plans because families simply cannot
afford the rising premiums. The Republican proposal that Senators
Cassidy and Crapo are introducing doesn't really address that issue.
Even those who are reenrolling are often being pushed into less
comprehensive plans that leave them exposed to substantial out-of-
pocket costs.
Yesterday, at a forum that I cohosted with Senator Warner, we heard
directly from people who depend on this coverage. Their stories were
personal, and they were urgent.
One small business owner who is also a healthcare provider told us
that affordable ACA coverage allows her to keep serving new mothers in
her community while still caring for her own family. But she also
pointed out that if we don't address these premium tax credits, the
cost of her health insurance was going to quadruple.
Another woman from Concord, NH, described the moment her son, who
lives with a serious mental illness, had his coverage approved. She
said she wept with relief. With that coverage, he has been able to
work, to live independently, and to get the treatment he needs.
These are real families who have real stakes in this debate that we
are having. This is not a game, and people are already feeling the
impact of inaction.
Democrats have put forward a straightforward, immediate solution to
prevent the premiums from jumping and to keep people insured. Some of
my Republican colleagues have offered ideas that they believe could
help. I think that engagement has been constructive, but the time is
short. We need to act now, and we need to extend the tax credits.
I know there are Members in both parties who want to find a
responsible path forward. I welcome the discussion on where we can find
common ground, and I am ready to come to the table, as I said, with any
of my colleagues, to work on long-term reforms.
First, we must keep millions of Americans from losing coverage in the
coming months. Extending these credits is the easiest and most direct
way to protect families.
I yield the floor.
The PRESIDING OFFICER. The Senator from Georgia.
Mr. OSSOFF. Mr. President, what is an American supposed to do who
loses health insurance in the middle of chemotherapy?
That is the question confronting one of my constituents right now, a
Georgian who wrote in to my office. She is a woman in her early
sixties, who is in the middle of a breast cancer fight. She waits
tables for a living.
If Republicans allow these Affordable Care Act benefits to expire,
her premiums will go up by hundreds of dollars, and she says she will
have to cancel her health coverage. She needs chemo monthly to fight
her cancer. What is she supposed to do?
Or there is my constituent with diabetes, who just had major surgery
for another health issue, just a few months ago, and told me that, when
she learned that this Congress might let these tax credits expire, she
cried. She cried not for herself; she cried because she feared that
others would die as a result of this policy choice.
Then she got her own insurance quote for next year: hundreds of
dollars higher than she is paying now. She is a diabetic, in Georgia,
who just had major surgery, who says she, too, will have to cancel her
health insurance. She cried again when she got that insurance quote
because, suddenly, she feared that she might die--she might die.
What is she supposed to do?
Another constituent who reached out to my office this week is a
single mother who relies on medicine that, if she is not insured, will
cost her $80,000 per year without insurance. Her premiums are about to
go up by hundreds of dollars. She, too, says she probably will have to
cancel her insurance. What is she supposed to do? How is she going to
afford medicine that costs, without insurance, $80,000 per year?
The whole conversation about these Affordable Care Act tax credits in
this town, in this building, has been focused on the politics of this
issue. This is life or death. People will die.
This is one of the most consequential votes this Senate will take all
year. By saying yea or nay to the clerk of the Senate later today,
Senators will decide whether people live or people die. Senators will
decide whether Georgians and folks across the country are financially
ruined or have a shot.
Half a million Georgians, it is projected, will lose their coverage
altogether. More than a million more will see their premiums double or
worse. This is a choice. What is the point of having all of this power
if you won't use it to help people?
I remember, just a few weeks ago, Members of this body wrote into a
funding bill half-million-dollar payments to themselves.
Do you remember that?
But our own constituents who stand to lose their health insurance in
the middle of a cancer fight--what are they supposed to do?
My constituents cannot afford this, and some of my constituents
cannot survive it.
I urge my Republican colleagues to put the politics aside and vote to
extend these tax credits for the health of our constituents.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, there is a runaway train barreling toward
our country in the form of a massive increase in healthcare costs for
millions of Americans who are tied to the tracks.
Today, the Senate will vote on two different plans: One, offered by
Democrats, would save Americans from the health cost freight train and
get them off the tracks. The other, offered by Republicans, amounts to
tossing Americans a hacksaw and wishing them luck as the train speeds
into view.
Come January 1, millions of Americans are going to have to figure out
how they are going to pay for their healthcare. Families will be making
a near-torturous decision between paying their premiums or paying for
rent and groceries. Millions will decide to forgo coverage completely.
The Republican plan on offer is snake oil in a gaping wound. It is
going to spark an avalanche of junk insurance plans designed to enrich
big insurance
[[Page S8648]]
companies. A puny savings account to cover the cost of an appendectomy,
having a baby, or getting your tonsils out under the Republican plan is
going to leave patients up to their eyeballs in financial debt.
The biggest winner under this Republican scheme won't be Bartley and
Carla of Eugene, OR, whose premiums will skyrocket by 500 percent on
January 1. The real winner under the Republican proposal will be Big
Insurance--specifically, the biggest, UnitedHealth Group. But enriching
rich donors and giant corporations while typical Americans foot the
bill is pretty much par for the course under a failed Republican
leadership.
What Democrats are offering today is a clean extension of the tax
credits to keep ACA plans in place.
Every Member of this body can agree that healthcare costs and
insurance companies are spinning out of control and that more needs to
be done to rein them in, but the solution is not to kick millions of
people off their healthcare until Republicans get their act together to
find a replacement.
I am now going to take a brief moment to talk about the off-base
Republican claims about fraud in the individual market.
The fact is, Republicans are cherry-picking statistics or are
outright distorting the facts to justify kicking millions of people off
their healthcare under the guise of fighting fraud. Independent Federal
watchdogs recently posed as sleazy insurance brokers to fraudulently
enroll Americans in healthcare plans. That tells me that what is needed
is tough criminal penalties aimed at stopping these unscrupulous
insurance brokers.
I wrote that legislation--legislation that would, for the first time,
hit the sleazy insurance brokers with criminal penalties.
Based on how much my Republican colleagues talk about fraud, you
would think they would be tripping over themselves to support our bill,
but none of them are doing so. That tells me that their rhetoric is
just empty talk.
I will close with this: The only timely solution that saves Americans
who are now in harm's way is by extending these credits and keeping
costs down for families. Once the crisis is averted, let's look in a
bold, new direction for American healthcare because it is clear the
status quo doesn't work.
I urge my colleagues to support a clean extension of the ACA tax
credits to provide American families the money they need to pay for
high-quality healthcare.
I yield the floor.
The PRESIDING OFFICER. The Senator from Kansas.
Unanimous Consent Request--S. 3389
Mr. MARSHALL. Mr. President, my grandma taught me so many things and
had so many great, old sayings.
One of the things she taught me is that, if you have your health, you
have everything. If you have your health, you have everything. I think
that is one of the reasons I wanted to become a doctor. I wanted to
help give people their health.
But healthcare is in a crisis right now. Healthcare is in a crisis.
Doctors think healthcare is in a crisis. Nurses think healthcare is in
a crisis. Patients, families, Americans--we all think that healthcare
is in a crisis.
The Democrats' solution is, frankly, just to throw more money at the
problem--to throw more money at the problem--which really inflates
everybody else's costs of healthcare.
What our party would like to do is to empower patients, not insurance
companies. We want to put patients in charge, not insurance companies.
Before we, you know, dive a little deeper into our bill that we are
asking unanimous consent for today, I want to answer, I think, one of
the toughest questions I have been asked. The question is--you know,
when I go back home, in January, families are going to look to me and
say: Why couldn't you fix healthcare?
I want the record to show right now that the Democrats are walking
away from a yearlong extension on the enhanced subsidies. They are
walking away. We are offering it. I don't think the subsidies are a
good idea--I never did--but my heart says it is the right thing to do.
So let the record show, if the Democrats object to this bill, they are
walking away from a yearlong extension of ObamaCare in exchange for
empowering patients.
You know, this crisis--I think we need to understand a little bit
more where this crisis came from. ObamaCare has been the law of the
land now for 15 years. And perhaps Speaker Pelosi's most famous moment
of her career is when she said we need to pass the bill so we can see
what is in it.
Well, now we know what is in it. We know it was written by insurance
companies. We are giving them $150 billion a year. It was written by
PBMs. It was written by big hospital systems, big healthcare systems
who have driven the spend on healthcare now to $5 trillion a year.
What have we ended up with? Of course, the costs are higher. No one
can deny that the average premiums are now more than 200 percent higher
than they were. Access is worse. Fraud is rampant. And really ObamaCare
is junk insurance, right?
When they talked about what junk insurance was, they argued for
ObamaCare. ObamaCare has turned into junk insurance. When families have
a deductible of $15,000 a year, that is junk insurance, right? So we
ended up doing just the opposite of what they stated their intended
goals were. So listen--listen--to what the Democrats are saying now and
what they are willing to do.
Let me just sum up, briefly, what our plan does, and then I will
maybe go a little bit deeper. No. 1 is we address the fraud. No. 2, we
extend the ObamaCare--the Biden-era extended subsidies for another
year. We fund CSRs. We address fraud, if I didn't say that yet. And
then starting in 2027, we would start taking some of that money that we
were using on these extended subsidies--that is about $35 billion a
year--we would start putting that into your debit card, into your
healthcare debit card, thousands of dollars per family.
You know, for some it might be $7,000. For some, it might be $5,000,
but we want you to start making choices. And then, lastly, what our
bill does--and this is why I am so confused why Democrats are walking
away from this. If there was one good thing about ObamaCare is it
addressed preexisting conditions. And we will talk about that more in a
second. But our bill funds invisible high-risk reinsurance pools.
So it is like belt and suspenders for people that develop high-risk
conditions.
Let's dive into each of these pillars a little bit more. No. 1 is
let's stop the fraud. No one can deny that there is significant fraud
in ObamaCare. We don't know exactly how much. Is it $20 billion? Is it
$30 billion?
We know that a third of people on ObamaCare never make a claim. A
third of people on ObamaCare never make a claim.
And we know that--we saw the number--the fraud increased
significantly when we allowed people to have zero dollars in the game.
So what our bill does is, No. 1, it requires an ID--ID verification. It
requires work verification. It requires income verification. And it
requires you to contribute $5 a month.
If these were implemented, I really think we would save the country
$25 billion a year. And again, that would more than fund this high-risk
pool that I would like to do. I think stopping the fraud, there
couldn't be anything more simple. But even just yesterday, the
Democrats refused, and they voted down addressing the fraud.
Next, our pillar is real price transparency. If we adopted this, the
cost of healthcare for everyone--whether you are on ObamaCare or get
your money through your work or you are on Medicare--it would drive
down the cost of healthcare for everybody by 20 percent.
Rather than spending $5 trillion a year, this country would be
spending $4 trillion a year. Think of the great things--what else we
could do if we had that money to do better things with. We could fund
community health centers. So many great things we could do out there
from a healthcare standpoint as well.
But by giving pricetags to patients--by forcing every healthcare
provider, upfront, to have a list of everything that they offer and
have that already on a website run by CMS and you are sitting there in
your hometown and the doctor says you need to have your knee replaced
and you could automatically
[[Page S8649]]
have populated within 60 miles all the hospitals charges.
You are going to find some hospitals charge $10,000 for that hip
replacement; others charge $60,000 for it; some $120,000 for it. Heck,
you might even hop on a plane and fly from New York City to Kansas to
save $120,000 on a hip replacement--and we will put you up in the best
hotel in all of Kansas to do that.
Pricetags are what cures that. Pricetags turn patients into
consumers. It lets patients become shoppers again. Over and over again
on Black Friday, Americans demonstrate to me that they have strong
purchasing power and know what they are wanting to do with those
dollars.
So by empowering patients, by turning them into shoppers again, by
forcing pricetags, this is going to lower the cost of healthcare for
everybody by 20 percent.
Our third pillar is to bridge subsidies for families. Look, you don't
have to convince me of the cliff people are facing. Because of
ObamaCare, premiums are going to go up 20 to 30 percent regardless.
Regardless of what we do here in Congress, premiums are going to go up
30 percent.
I want to help those people. Maybe, you know, the people most
impacted by this cliff--there are probably 1 million of them, maybe
there are 2 million of them as well. That is why we need to do more
than this bill to impact them long term by allowing them to purchase
healthcare across State lines and expand association healthcare plans.
But again, we are extending the subsidies for 1 year. No other deal
up here, really, on the Republican side addresses that except for this
particular deal. I know my friends want 3 years. Look, let's talk about
it.
What would it take for you to actually consider driving the true cost
of healthcare down and not just throw money at the problem?
I just can't emphasize enough. You are a family of four. You are
making $80,000 a year, which is more than the average salary in Kansas,
and have a $15,000 deductible. That is not access to healthcare.
You have to admit--and I think my Democrat friends do admit--that
ObamaCare is broken.
Next, I want to just talk about our invisible State-run high-risk
pool. Look, I talked a second about preexisting conditions. The one
thing I was really excited about ObamaCare is that it took care of the
preexisting conditions.
Guess what the most common preexisting condition is in America. It is
pregnancy. I delivered a baby almost every day of my life for 25 years,
and believe it or not, less than half of pregnancies are planned.
And when couples are purchasing--they get married, they purchase
health insurance, and they were going to save a couple hundred bucks by
not including pregnancy, they thought it was a good idea. But guess
what. Mother Nature doesn't always cooperate. Again, half these
pregnancies were not planned. So I was glad to see us address
preexisting conditions.
But even now we know insurance companies do play games to try to keep
you out once you have a tough diagnosis. But if those insurance
companies knew that, based upon your diagnosis and the money you are
spending, you are already going to this partially federally funded
high-risk pool, it would keep everyone's premiums down.
My friends across the aisle talk about--you know, they tug at
people's hearts, which I want to do as well. We don't want anyone to
face bankruptcy because of healthcare. But that is happening now,
right?
Admit it. Your plan is not working. All these many, many families are
facing and have taken bankruptcy because of the cost of healthcare.
So we use this belt-and-suspenders approach. We have the preexisting
conditions in ObamaCare. We keep those. But then we do something better
by funding these high-risk pools as well.
You know, high-risk pools let us protect the sick without punishing
the healthy. If these catastrophic costs are covered, premiums fall for
everyone. That is just simple common sense.
If you think about these five pillars here that I want the Democrats
to agree with, I bet we drive down the cost of healthcare by 40 to 50
percent.
You know, our last pillar is just this theme of turning patients into
consumers by giving them pricetags, by putting Federal dollars in your
debit account for healthcare, by giving you pricetags. We turn you into
shoppers again. It is going to lower the cost for everybody, and then
we start reallocating that waste from fraud and abuse.
What makes our plan different than anybody else's out there? We
address the fraud. We have pricetags that no other plan has. It bridges
the subsidies.
And instead, my Democrat friends are offering a $83 million fix. The
Democrats are just compounding the junk insurance. With all due respect
to my friends across the aisle, you are just throwing good money after
bad money.
By extending these subsidies for 3 years, it will be at least $83
billion. And the way healthcare is accelerating, it will be $100
billion. Again, I do feel the pain of these folks. I mean, these are my
friends, my neighbors.
A top-three issue for every family in America, for every business in
America, is the cost of healthcare. How can you walk away from a plan
that is going to drive the cost of healthcare down 40 to 50 percent?
And instead, you just want to offer more junk insurance.
Your plan doesn't do anything to bring down the cost of the
deductibles in the plan. That is the problem. You could pay for their
whole premium--you are. We are paying for their whole premium. But then
they have a $15,000 deductible. That is not access to healthcare.
I don't know why my friends across the aisle don't want to have
meaningful discussions. Why do we not want to talk about fixing the
problem? There is so much more than this that we should be talking
about right now.
Again, pharmacy benefit manager reform comes to mind, expanding
community health centers, making sure everybody has meaningful access
to primary care, bringing mental health into those community health
centers. Those are all real solutions: expanding association healthcare
plans, letting it be purchased along State lines.
Could you imagine if Sam's Club or Costco or Amazon had an
association health plan that you could sign up for? Think of the
purchase power that they would have.
There are real solutions out there. These are real solutions.
Democrats have asked for a plan. This is, frankly, just the start of a
good plan, but it would help bridge us over the next year to go after
these other issues we can address on a bipartisan basis.
And remember--I will just close with this. When patients ask their
Senators in January why their health insurance premiums went up, and
they are going to ask you: Why did you vote against Senator Marshall's
plan that extended the subsidies for a year, I hope you have got a
great answer for that.
Mr. President, I ask unanimous consent that the Finance Committee be
discharged from further consideration of S. 3389 and the Senate proceed
to its immediate consideration. I further ask 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 Delaware.
Ms. BLUNT ROCHESTER. Mr. President, reserving the right to object, I
had the honor of serving with Senator Marshall in the House. We were
classmates. We came in together in 2016. It is kind of ironic to think
back to that time because as a freshman, I watched my colleagues try to
repeal and replace and repeal and replace and repeal and replace.
Just last week, Senator Marshall and I introduced the PBM Disclosure
Act together, a bill regarding PBM transparency. We worked on some
important things, but at this moment I can think of nothing more
important than addressing our Nation's healthcare
crisis. Unfortunately, I cannot support what is being proposed here
today.
Now, we all agree that our healthcare system needs improvement. The
Democrats have put forward proposals to do just that. As a matter of
fact, Senator Wyden, who is sitting on the floor right here, today, has
put forward a proposal--a bill--that deals with the issue of fraud. And
as he said, he would love his Republican colleagues to join him in that
effort.
[[Page S8650]]
This bill claims to actually attack fraud. It also claims to fix the
premium crisis. But, in reality, it would kick millions of Americans
off their ACA healthcare coverage. Premiums would go up for over 10
million people by an average of $1,000. And to top it all off, this
bill adds new abortion restrictions. It is yet another harmful proposal
from Republicans, while the clock is ticking for the American people.
Almost a dozen proposals have been offered by Republicans in the
Senate and the House, in just the last few weeks. That is tantamount to
throwing spaghetti up on a wall to see what sticks.
For months, we have asked Republicans to come to the table. During
the shutdown, they said they couldn't talk to us about healthcare. Yet
they were still holding hearings on a whole host of things.
They spent 6 months before that, in the beginning of the year,
passing tax cuts for billionaires. Apparently, that wasn't the time to
talk to us either.
The very first bill I sponsored--I cosponsored--as a U.S. Senator,
back in January, was the Healthcare Affordability Act, which would have
permanently extended the ACA tax credits. Now, it is December, almost a
year later.
As I already said, we have received almost a dozen plans from
Republicans, and they are still coming in. As a matter of fact, I think
one came in last night.
Let us help you help your constituents. Democrats are offering the
cleanest, easiest, simplest way to deal with the immediate healthcare
crisis, the immediate healthcare cliff that Americans are facing, and
it gives us time to improve our healthcare system. It would even give
us the chance to review the thousands of plans and concepts of plans
that my colleagues are putting forward.
This bill is too little, too late. And for that reason, I
respectfully object.
The PRESIDING OFFICER. The Senator from Kansas.
Mr. MARSHALL. Mr. President, again, I greatly respect the words and
have great respect for the Senator, my colleague and good friend from
Delaware. And I know both of us share the same heart--that we want
every American to have meaningful access to healthcare.
There are many things we agreed upon. The PBM Disclosure Act is but
one example. Bringing down the cost of prescription drugs would be a
huge priority for us as well. We both agree that fraud is a problem.
Take this bill and improve it. Is it too little? It probably is too
little. But it is a start; it is a framework. You have the legislative
text.
Look, I have become very pragmatic in my days in Washington. I can't
change what happened in 2010, before I got here. I can't change all the
histories of dealing with healthcare. I can't change the fact that we
have 100 Senators with 100 ideas to fix ObamaCare. I have already said
ObamaCare--tackling ObamaCare is like tackling a buffalo that just ran
through a barbed-wire fence; and every time you try to pull a layer of
that barbed wire off, you get poked with it. I understand that.
But this is a great framework. It is my effort at a bipartisan
framework to get us started. And, again, offering the olive leaf of
extending the Biden-era subsidies for another year, I think, is just
the biggest olive branch I can make.
Again, come January, my Democrat friends are going to have to answer
that question: Why did you walk away from Senator Marshall's plan to
extend those subsidies for a year?
I yield the floor.
The PRESIDING OFFICER (Mr. Sheehy). The Senator from Louisiana.
Healthcare
Mr. CASSIDY. Mr. President, what we are debating here are two visions
of the future of the ObamaCare exchange. Democrats want to cover the
cost of health insurance to benefit health insurance companies. And
Republicans want to cover the cost of health insurance to benefit
patients.
Now, I can actually kind of develop that idea. If you look at what
insurance--what Democrats want to do, they want to give 100 percent of
the money to the insurance companies. And the insurance company, by
law, under ObamaCare, can take 20 percent of it for overhead and
profit. Eighty percent of it goes to patient care, but, of course, you
have got to get your prior authorization and permission for this 80
percent to be spent upon you.
On the other hand, the Republican plan is to put the money into the
patient's pocketbook so that she has money to pay for the insurance out
of pocket. And here, 100 percent of the money she receives goes toward
some sort of healthcare or dental care or vision care. By the way, that
is a distinction. Under the Democratic plan, the insurance company
doesn't cover your dental work, they don't cover the orthodontia for
your child, and they don't cover the eyeglasses you need. Under what we
are doing, putting it into her pocketbook, for physicians, dentists,
drugs, vision care--this is a patient-driven account, of which 100
percent is going to the care she knows she needs. And she does not need
to seek permission in order to obtain it.
Now, to put a little bit of a point on it, a 50-year-old couple with
children 19 and 20 could get as much as $5,000 in their account. Think
about what that means for somebody with chronic disease. If you have
diabetes, under the Democratic plan, there is a $6,000 deductible; and
someone has to pay $6,000 before they begin to get coverage for
everything they need for their chronic disease. Under the Republican
plan, putting $5,000 for that couple I spoke of earlier, with two
children, it is in their pocketbook. They can pay for that which they
need for chronic disease. So what is not to like?
I would say that the Republican plan meets Americans where they are
financially. Most Americans don't have more than $1,000 in their
savings account.
Let me repeat that: Most Americans don't have $1,000 in their savings
account.
The Democratic plan would require them to have a deductible and to
pay $6,000 before the insurance kicks in.
So let's compare the two plans. The red side is the Democratic plan,
and the green side is the Republican plan. The Democratic plan is to
give 100 percent of the enhanced premium tax credits to insurance
companies. The Republican plan is to give the money to the patient--
into her pocket, her pocketbook, her purse--to pay the out-of-pocket
for the insurance plan.
What could it be used for? Under the Democratic plan, it subsidizes
premiums. Under the Republican plan, the patient gets the care she
knows she needs--the physician visit, the dental visit, the glasses,
the prescriptions. And she doesn't need permission to do it. She does
it because she knows she needs it.
Who makes the decision?
Anyone who has fought with an insurance company over prior
authorization knows that the golden rule applies: The one who has the
gold makes the rules. And the insurance company makes the rules as to
what you can get. And by the way, that does not cover dental,
orthodontic work, eyeglasses, and other things.
Here, the patient decides. The patient has the power. It is not
profit to insurance companies; it is power to the patient. And if she
needs eyeglasses, she uses this money that we put into her account to
purchase them. If her child needs to go to the dentist for dental
cleaning, she can do that.
Does it lower costs? Well, if you give the money to the insurance
company, clearly, it does not, because since the ObamaCare law passed,
costs have exploded. But studies show that if you give the patient the
money in her pocketbook, she is going to shop for the best deal. She is
going to say: Wait a second. The x ray costs $50 here and $500 there--
and the difference can be that much. I am going to go to the place
where it is cheaper.
Now, as soon as everybody starts going to the place where it is less
expensive, the place that is more expensive lowers its cost. That has
been shown empirically to work.
The Republican plan gives the patient the power to shop, the power to
take advantage of price competition; and that lowers costs.
One more thing, how does it work with low-cost bronze plans? Under
the tax cuts for working families bill, Republicans passed a law saying
that health savings accounts--this kind of putting money in the
pocket--can work with a bronze plan. So, if you
[[Page S8651]]
give the money to the bronze plan, which is permitted under current
law, the patient now has the ability to purchase a cheaper plan on the
exchange, saving thousands of dollars relative to the plan that
Democrats want to force somebody to buy. And what we have seen under
the current system is that there are all kinds of fraud and there are
all kinds of unauthorized enrollment, costing taxpayers billions of
dollars.
Now, it has been said that somehow Republicans are supporting junk
insurance. And you have got to laugh. Mr. President, you have got to
laugh. Republicans are using the same plans on ObamaCare that Democrats
fought for. We are merely taking the framework, set up on a unanimous
partisan vote by Democrats, to create these plans on ObamaCare, and
that is the one we are using. So for some to call those junk plans, it
is kind of like saying: We gave the American people junk.
I would argue that the Republican Party is making these better.
Look at this. Under the Democratic plan, there is a $6,000
deductible. Imagine the housewife who has to take her child to the
urgent care center and knows she doesn't have the money.
This is a cartoon, but in that cartoon, there is real stress and
anxiety for that mama who cannot afford the care she knows her daughter
needs.
Look at this one, the Republican plan. She has got money in her
pocket. She has got money in her account. She has got money in her
pocket for the insurance out-of-pocket. And if she starts off with
money in her purse to pay for that need, why can't people see that is
where the American people are?
If the average American family has less than $1,000 to spend and our
plan puts thousands in their account to pay for the healthcare that
they know they need, what is the objection to that?
Now, by the way, I think you finally found the objection. There is a
concern that Republicans are somehow interjecting abortion politics.
And I will point out that Democrats have voted for appropriations bills
with Hyde protections since the 1970s. For over four decades, Democrats
have voted for language on this issue, and suddenly--suddenly--they are
shocked. So instead of giving this patient the money she needs, it is
going to be sacrificed on the altar of abortion politics.
I say: Go with her. I say: Support her.
Let's go to the last slide, please.
We need to make healthcare affordable again.
One, we know the Democratic extension will not pass. It is going to
stick people with $6,000 deductibles. It does nothing for fraud. It is
not a solution. What we need--by the way, I am also going to say this:
I am, obviously, saying we don't need the Democratic solution. My
Democratic friends will say they don't like the Republican solution.
Let me argue that we try and get an American solution, not an R, not
a D, but an A solution. And if we do so, let's give power to the
patient, not profit to the insurance company. Let's make healthcare
affordable again.
With that, I yield the floor.
The PRESIDING OFFICER. The minority whip.
Mr. DURBIN. Mr. President, Senator Bill Cassidy of Louisiana is my
friend and my colleague. We work together, and he is a real doctor--a
real doctor. And what I have read about his medical career is that he
treated people with limited income, and I respect him so much for doing
that.
Thank you for all that.
I happen to disagree with his policy on this, and let me explain why.
How far does $1,000 take you in medical bills? How far does $1,500 take
you in medical bills?
Well, I had a knee replacement last year. Do you know what the
surgeon's bill was for that? It was $30,000.
Mr. President, $1,000 doesn't take you very far in the 21st century.
It didn't take you very far in the 20th century. And to have that as
your fallback position to protect yourself--imagine a cancer
diagnosis--a shocking cancer diagnosis. And you think: Well, thank
goodness I have got $1,000 in the bank for treatment for cancer.
That isn't going to work.
To say that people are going to have money left over at the end of
the day and this is what they really want doesn't reflect reality.
Mr. CASSIDY. Would the Senator yield?
Mr. DURBIN. I would be happy to yield.
Mr. CASSIDY. I didn't show the poster, but in our proposal taking the
50-year-old couple with 2 kids, 19 and 20, their family would get
$5,000 in their account, and the net deductible would be less than the
silver plan the Democrats want. And the policy premium would be $6,000
less a year.
So if the plan, that my good friend the minority whip is saying is
the better plan, has a higher net deductible, that, I don't think,
works for the gentleman's knee replacement.
And the family $5,000 deductible can be applied, so you would have
$5,000 top.
I have taken too much time, but thank you for yielding.
Mr. DURBIN. No, I am happy to yield, and we came perilously close to
debate on the Senate floor, by my recollection. Wouldn't it be
something if we did this on a regular basis? Wouldn't it be something
if we took this whole issue, the subject matter, and put it in a
committee for a real hearing, with experts, where Democrats and
Republicans sat at the same table? It would be almost like the U.S.
Senate used to be. It doesn't anymore.
What I am suggesting today is simple and direct. I met a waitress at
a Chicago Loop restaurant for breakfast last Sunday. She is 63 years
old, and she spent her life as a waitress. It has taken its toll on her
physically.
She was in tears as she described to me what is going to happen to
her if we fail to act the right way today on this legislation. She is
going to see her health insurance bill more than double--$300 or $400
more per month. Let me tell you, she doesn't know how she can do it,
and I don't either.
That is what we have to address first. Triage, I would say to my
friend Dr. Cassidy, triage is first. Help these families pay for their
premiums, and then let's do our job. Our job is to sit down and debate
his idea, my idea, the ideas of the Senate, and to come up with an
alternative that serves the needs of this Nation. That is what the
Senate is supposed to do. But this take-it-or-leave-it, high-noon
strategy isn't fair.
If, at the end of the day, we fail to help this waitress pay for her
premiums and she loses her health insurance, I don't know what is going
to happen next. This poor lady is working hard, and she has every day
of her life. Why we won't come to her rescue first and then get into
this policy debate, I just don't understand.
As Members of the Senate, we cast votes, and many of them are
routine, but there are votes that stay with us for decades. I will
never forget voting for the Affordable Care Act. It was this time of
year, December 24, 2009. The Senate passed a bill that helped make
healthcare affordable for millions of Americans.
It was 8 years later, on a late night in 2017, that the late Senator
John McCain of Arizona came through those doors at 2 in the morning,
stood in the well right by this table, lifted his right arm as high as
he could, and came down with the thumbs no. With that, he saved the
Affordable Care Act. That ``no'' vote sunk President Trump's first
attempt to abolish the Affordable Care Act, and it gave peace of mind
to millions of Americans who would come to rely on it.
It has been more than 8 years since Senator McCain showed that
courage and 16 years since we passed the original bill. Yet, once
again, the Senate is about to take another vote on healthcare that will
reverberate for decades throughout America.
The question today is whether the Senate will extend the ACA's
enhanced premium tax credits. What is that? In the Tax Code, it is a
helping hand to pay your premium based on your family income.
If we fail to extend these tax credits, that waitress I described to
you and 22 million Americans will begin to pay double or triple for
their insurance in 3 weeks, including 500,000 people living in
Illinois. More than 4 million Americans will not be able to afford
their insurance at these higher rates and will be forced to forgo
health coverage for next year. Merry Christmas.
Senate Democrats have sounded the alarm bell about the need to
prevent this catastrophe. We have told the stories of people who have
called our offices, crying because they are afraid
[[Page S8652]]
they won't be able to afford their healthcare next year. We have shared
reports from farmers, small businessmen, and rural hospitals that rely
on these tax credits. The only thing left to do is vote.
The question is whether 13 Republicans will not endorse the
Affordable Care Act but will stand by the people who face these
premiums and then be willing to sit down and have a meaningful,
bipartisan debate on where we should go as a matter of policy. Isn't
that what the Senate is all about?
Every Senate Democrat is united behind the plan just to extend the
ACA enhanced premium tax credits and ensure continued access to
quality, affordable health coverage. Republicans are not united behind
any plan. They haven't been for 15 years. The Republicans hate
ObamaCare like the Devil hates holy water. They can't imagine voting
for it.
What I ask them to do is hold your nose if you don't like it, vote
for it today with the promise that you have the power as the majority
party in the Senate to introduce a bill and start a meaningful debate
in the appropriate committees. It is your authority. You are in the
majority.
We need 13 of you today to join us and show the bravery that Senator
McCain did in that early morning hour. Otherwise, it will not only be
those here in the Senate who will remember this vote; it will be
millions of Americans who saw their Senators take their health
insurance away.
I want to face this friend of many, many years, this waitress in this
restaurant, and tell her we not only had the chance to help her, we did
help her. Let's do that together and then go home and decide what we
are going to do as a matter of policy and bring that back to the Senate
for deliberation.
I yield the floor.
The PRESIDING OFFICER. The Senator from Wisconsin.
Ms. BALDWIN. Mr. President, I rise today on behalf of the 275,000
Wisconsinites who buy their health insurance through the Affordable
Care Act Marketplace, many of whom are downright scared. They are
scared because their healthcare costs are about to double on average.
They are scared because they now have to figure out which necessity in
their life they can go without. And they are scared because maybe this
just puts it beyond reach, and they won't be able to afford healthcare
at all.
They are scared, and you know what, we actually have the ability to
do something about it. At the end of the day, that is what this job is
all about--listening to our constituents, fighting for them. I am not
here to instill more anxiety or fear; I am here to help. It is why I
first got into public service, and I still believe that to my core.
Right now, what Wisconsinites are crying out for is for some
breathing room and healthcare that they can afford. These are real
people with very real stories.
Take Mark, a retired firefighter from Eagle River. He wrote to me:
As it stands, my monthly healthcare premiums will increase
almost six-fold under this Republican refusal to provide
adequate, affordable healthcare to hardworking Americans and
especially retirees after a lifetime of service.
Take Alicia from Chippewa Falls, who works hard as a childcare
provider. Like so many workers in the childcare industry, Alicia needs
these tax credits to afford their insurance and do what they love.
Callie from Mercer, WI, is a cancer survivor who is facing down a
$110 increase to her premiums each month. That might not seem like a
lot to my Republican colleagues, but for a local library director in a
small, rural, Wisconsin community, a 30-percent increase could be the
difference between having insurance or not.
My Republican colleagues have kicked the can and this crisis further
and further down the road, and now Wisconsin families are looking at
changing careers, coming out of retirement, shuttering their small
businesses, or selling their family farm.
These are real, life-changing cost increases that my Republican
colleagues seem to be fine with, because, let's be clear, this is, in
fact, a choice. It is a fairly simple decision, one that Americans
understand: Vote to extend these tax credits or send 22 million
Americans off a cliff. The choice is yours.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire.
Ms. HASSAN. Mr. President, I thank the Senator, my colleague from
Wisconsin, for her remarks.
You know, sometimes the wheels of our democracy don't turn as quickly
as we would like. Sometimes progress is painfully slow. But it is a
singularly bad day for this body, a bad day for this country, when, far
from simply failing to move forward, this body chooses to take a great
lurch backward, to decide to make the lives of the American people
worse. By letting the Affordable Care Act tax cuts expire, by letting
healthcare slip away from families all across our country, today, the
majority in this body appears to be prepared to do precisely that.
Now, just a comment or two about my colleague and friend Senator
Cassidy's presentation about the Republican plan just now. Senator
Cassidy and I are good friends, and we have worked on a lot of
bipartisan healthcare legislation to date. But let's be clear. The
Republican plan that he is talking about doesn't help people afford
their premiums in the first place. That is what this is about.
The other issue that my colleague raised about the Hyde amendment--
the Hyde amendment applies to the Affordable Care Act already. What the
Republican plan does is now say that people who pay private premium
dollars into the ACA cannot use their private dollars to fund what are
called elective abortions.
So I just want to be clear about those two points.
Now I want to talk about the progress we have made and the progress
we still need to make when it comes to the Affordable Care Act. It is
easy to take it for granted now, as we have grown accustomed to its
benefits, but the Affordable Care Act was an important milestone in
expanding opportunity for more Americans.
The ACA helped millions of Americans who were previously unable to
afford insurance to get lifesaving care for themselves and their
families without breaking the bank or facing bankruptcy. It allowed
Americans who have preexisting conditions to actually buy insurance. It
ended lifetime caps on how much treatment people could get.
Is the Affordable Care Act perfect? No. It was the product of a
legislative compromise. But has the Affordable Care Act made Americans
healthier, strengthened our economy, and saved lives? Yes.
I want to remind people what our healthcare system was like before
the ACA was passed. People with preexisting conditions could not get
health insurance unless they worked for an employer who offered a group
plan, and even then, they had to work enough hours to qualify for that
plan.
Even people who had insurance were subjected to something called
lifetime caps. Often, the cap was about $1 million, meaning that if you
had a terrible accident or expensive disease, the insurer simply
stopped covering your care when the limit was reached regardless of how
long you had been paying your premiums and regardless of whether you
still needed lifesaving care.
Preventive care could be expensive and was often excluded from health
insurance coverage.
The ACA changed that. People with preexisting conditions can now buy
insurance. People between jobs can buy insurance. Self-employed people
can buy insurance. Lifesaving and cost-saving preventive care is
covered at no charge. There are no lifetime limits on care.
Now, the smart thing for us to do right now would be for us to build
on this progress. There is no shortage of ways in which we need to
improve our healthcare system. We need to lower healthcare costs, and
there are good, bipartisan proposals in this body to do that. We need
to end the inefficient and harmful fragmentation of care. I am ready to
work together on a bipartisan basis to do just that.
But rather than tackle those problems, the Trump administration has
actively worked to make healthcare even less affordable. This summer,
the Republicans gutted Medicaid in order to pay for tax breaks for
billionaires. Now, with tax credits for the Affordable Care Act due to
expire, the President and Washington Republicans will instead allow
health insurance premiums to skyrocket for millions of
[[Page S8653]]
Americans. The American people asked for lower costs; the President is
handing them a steeper bill.
In recent weeks, too many of the conversations in this Chamber about
the path forward have gotten stuck in the abstract. We have seen
proposals that resemble ideological wish lists rather than the type of
compromise that would recognize the reality that Americans are facing
on the ground. But I can assure you that, for my constituents, rising
healthcare costs are not abstract. It is not abstract for a Granite
Stater who will have to pay $1,000 more a month for health insurance.
It is not abstract for the family who depended on these cuts in order
to make ends meet and who doesn't know if they will have to pull from
their savings or find a cheaper place to rent just to afford these new
premiums.
And it is not abstract for the untold number of Americans who will
miss out on routine care and preventive screenings for cancer and other
diseases because they couldn't afford their new premiums.
I find myself struck by some of the words that we use in this Chamber
to talk about healthcare: risk pool, cost sharing, silver tier, gold
tier. Behind all these words and jargon, we are talking about people.
We are talking about being sick and being healthy, about living with
dignity or struggling in despair. We are talking about living and
dying.
This is an issue that demands the most serious of leadership, but
plainly that is just not what the American people are getting from
Donald Trump's Washington today. Today's vote leaves me with a simple
question, a question that the majority in this body ought to answer: By
your vote today to make insurance premiums more expensive, who in
America wins?
The majority in this body may carry the day with their votes, but who
exactly will this victory be for? What family will be made better off
by health insurance becoming more expensive? Which child is going to
become healthier?
Make no mistake, today's healthcare vote is more than a vote on a
single bill. In the greater sense, in the fight to make American life
more affordable, in an effort to save the American people from a
looming healthcare calamity, the majority of this body, the majority in
the House, and, above all, the President himself, are, in short,
choosing to abstain. They are throwing up their hands, essentially
saying: Nothing we can do here.
Given the choice between keeping healthcare premiums from
skyrocketing for millions of Americans or letting these tax cuts
expire, the President is content to do nothing. In the face of this
healthcare crisis, in the face of Americans of all political stripes
clambering for a solution, the Republican majority is deciding that the
world's greatest deliberative body ought to shrug its shoulders and
abdicate its responsibility.
So, yes, I will close with this: It is a bad day for this country and
for the U.S. Senate. And it is a day that the American people will
remember.
I yield the floor.
The PRESIDING OFFICER. The Senator from Idaho.
Mr. CRAPO. Mr. President, I ask unanimous consent to speak for up to
5 minutes before the scheduled rollcall vote.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CRAPO. Mr. President, we spent a lot of time this week talking
about the problems of our healthcare system: Premiums are rising;
hospitals are struggling; and out-of-pocket costs are out of control.
These problems are not new. And, frankly, notwithstanding all of the
rhetoric of my colleagues from the other side, the fact is, these
enhanced premium tax credits that we are debating today, if they were
extended or not extended, are not going to change the fact that
premiums are skyrocketing. They are skyrocketing because of the failure
of our current healthcare system.
These problems were used to justify ObamaCare in the first place, and
ObamaCare has progressively made them worse. Americans did not keep
their doctors, as was promised under ObamaCare; Americans did not keep
their insurance plans; and their premiums did not go down. In fact,
ObamaCare premiums have risen at roughly double the rate of employer-
provided healthcare plans since their inception.
Our Democrat colleagues have only had one response to these
skyrocketing premiums: more spending, which they claim is going to stop
premium increases. It, in fact, facilitates greater premium increases.
Without ever winning a single Republican vote, they created the Obama
premium tax credits, expanded them to all Americans--to Americans of
all income levels--and then extended that expansion. These credits did
not reduce costs and did not reduce premiums. All they did was shift
the cost to taxpayers and help insurance companies to continue to hike
premiums higher and higher.
Democrats know that ObamaCare has failed. They themselves have said
so on this floor. But with a deadline quickly approaching again--a
deadline that was set by my own Democrat colleagues--they say we have
no choice but to extend this failed policy one more time on these
premium tax credits. This is a policy they could not even make
permanent when they controlled the Presidency, the Senate, and the
House. Even so, their only offer is more spending.
They call their plan a clean extension. A 3-year extension of this
program with no reforms, costing hard-working families $83 billion,
with tens of billions of dollars going to insurance companies and
fraudsters, is anything but clean.
Twice on this floor this week Republicans have offered the Democrats
a unanimous consent to have a temporary extension of these premium tax
credits with needed reforms to address waste and fraud and abuse that
is rampant, and twice this week that has been rejected.
The Government Accountability Office recently uncovered how
embarrassingly easy it is to game this ObamaCare subsidy system, with
the Wall Street Journal calling it a ``Mecca for Fraud.''
Even the Washington Post recognized that ``ObamaCare subsidies make
it too easy to scam the system.''
Fortunately, we have another option. Instead of the minority leader's
$83 billion extension, which would do absolutely nothing to reduce
fraud and would keep driving premiums higher, Senator Cassidy and I
have offered a fiscally responsible proposal that will reduce premiums,
save taxpayers money, and give Americans control over their healthcare.
Our bill provides prefunded, patient-driven health savings accounts for
Americans enrolled in qualified ObamaCare bronze and catastrophic
plans.
Importantly, low-income Americans will still receive subsidies for
those ObamaCare plans through the permanent portion of the premium tax
credits system. Americans who choose this option will have both
insurance coverage and help paying for their remaining out-of-pocket
costs--all without giving insurance companies a reason to enroll them
in plans without their knowledge, as has occurred for years.
Our bill also fixes an error in the original design of ObamaCare by
funding the cost-sharing reductions that it mandated, reducing
benchmark premiums by 11 percent. Let me point that out. That piece of
our proposal will reduce premiums by 11 percent.
The minority leader's plan is not going to pass. But if just a few of
my Democrat colleagues will join us in voting for our bill, we can put
this crisis behind us and lay the groundwork for true reforms.
For instance, Senator Wyden and I remain intent on getting our
bipartisan pharmacy benefit manager reform to the President's desk. We
have many other bipartisan agreements on needed healthcare reforms that
we need to move forward on.
The choice before us is clear: We can continue with business as usual
and extend the same policy that has brought our healthcare system to
the point where every Member of this body admits that it is broken or
we can try something different. We can change the incentives that
ObamaCare gives insurers to drive premiums higher and put our
confidence in Americans to make the best decisions about their own
healthcare.
If we fall off the Democrat-created subsidy cliff, it will not be
because we did not have a different choice.
I yield the floor.
[[Page S8654]]
The PRESIDING OFFICER. The minority leader.
Mr. SCHUMER. Mr. President, today is D-day--decision day--for
Republican Senators. Will Republicans side with the American people and
avert the disastrous impending healthcare crisis or will they abandon
American families as premiums shoot through the roof come January 1?
In a few moments, the Senate will vote on two bills: the Republican
bill and Democrat's clean, simple extension of the ACA tax credits.
I say to my Republican colleagues: Our bill is the last train to
leave the station. It is the only realistic option before the Senate
today that solves the healthcare crisis. If Republicans don't climb
aboard, there won't be another chance to act before premiums skyrocket
next year.
Now, Republicans have dithered long enough. Democrats are fighting to
lower costs for the American people, while Republicans are fighting
among themselves.
And let me say this about the Republican bill. The Republican bill is
not true healthcare reform. It is not a healthcare plan whatsoever. It
is junk insurance. The Republican bill is simply junk insurance.
For a while, it actually looked like the Republicans wouldn't put up
a bill at all. But after that became too embarrassing an option for
them, they used Scotch tape and glue to come up with this ridiculous
proposal that can't be taken seriously.
The Republican plan does nothing--nothing--to extend the tax credits
for even a day. Our bill, of course, extends them for 3 years.
Under the Republican plan, the big idea is essentially to hand people
about $80 a month and wish them good luck; say that you are on your own
no matter what happens. And to even qualify for that check, Americans
would be forced onto bare bones bronze plans with sky-high deductibles:
7,000 or 10,000 for an individual and tens of thousands for a couple.
So the deductibles are so high, even that is not paid for by the $80 a
month. And then Americans are stuck and have nothing, nothing, nothing.
The Republican plan is a ``When you get sick, you go broke'' plan,
plain and simple.
The only answer--the only right answer--to solve this crisis is what
Democrats propose today, a clean, simple extension of current tax
credits. Our bill is the only plan that halts premiums from shooting
through the roof.
And as Americans know, this is not a symbolic vote. This is a life-
and-death vote for millions of people wondering if they will be able to
afford health insurance next year.
Millions will lose health insurance. Tens of millions will have to
change plans and doctors and get high deductibles and high copayments
that they can hardly afford healthcare if we don't do this. So America
is counting on us--counting on us--the Senate.
Republicans, America is counting on you to do the right thing and
vote yes on our bill.
A ``yes'' vote on our bill means premiums will not double or triple
or more starting January 1. A ``yes'' vote means lower costs for the
American people and greater help for them to pay for the things they
need. A ``yes'' vote means dignity, security, and peace of mind for
tens of millions of American families. It means our healthcare system
averts a disaster.
There is only one right thing to do, and that is for Republicans to
vote yes on our bill. The American people will not forget which way
Senators vote today.
I yield the floor.
Cloture Motion
The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before
the Senate the pending cloture motion, which the clerk will state.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the motion to
proceed to Executive Calendar No. 285, S. 3386, a bill to
provide a health savings account contribution to certain
enrollees, to reduce health care costs, and for other
purposes.
John Thune, John R. Curtis, Tim Sheehy, Roger F. Wicker,
Joni Ernst, Markwayne Mullin, Mike Crapo, Jon A.
Husted, Lindsey Graham, James E. Risch, Todd Young,
Mike Rounds, Chuck Grassley, David McCormick, John
Boozman, John Barrasso, Bill Cassidy.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to S. 3386, a bill to provide a health savings
account contribution to certain enrollees, to reduce health care costs,
and for other purposes, shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. BARRASSO. The following Senator is necessarily absent: the
Senator from Montana (Mr. Daines).
The yeas and nays resulted--yeas 51, nays 48, as follows:
[Rollcall Vote No. 643 Leg.]
YEAS--51
Banks
Barrasso
Blackburn
Boozman
Britt
Budd
Capito
Cassidy
Collins
Cornyn
Cotton
Cramer
Crapo
Cruz
Curtis
Ernst
Fischer
Graham
Grassley
Hagerty
Hawley
Hoeven
Husted
Hyde-Smith
Johnson
Justice
Kennedy
Lankford
Lee
Lummis
Marshall
McConnell
McCormick
Moody
Moran
Moreno
Mullin
Murkowski
Ricketts
Risch
Rounds
Schmitt
Scott (FL)
Scott (SC)
Sheehy
Sullivan
Thune
Tillis
Tuberville
Wicker
Young
NAYS--48
Alsobrooks
Baldwin
Bennet
Blumenthal
Blunt Rochester
Booker
Cantwell
Coons
Cortez Masto
Duckworth
Durbin
Fetterman
Gallego
Gillibrand
Hassan
Heinrich
Hickenlooper
Hirono
Kaine
Kelly
Kim
King
Klobuchar
Lujan
Markey
Merkley
Murphy
Murray
Ossoff
Padilla
Paul
Peters
Reed
Rosen
Sanders
Schatz
Schiff
Schumer
Shaheen
Slotkin
Smith
Van Hollen
Warner
Warnock
Warren
Welch
Whitehouse
Wyden
NOT VOTING--1
Daines
The PRESIDING OFFICER (Mr. Hagerty). On this vote, the yeas are 51,
the nays are 48.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is not agreed to.
The motion was rejected.
____________________