[Congressional Record (Bound Edition), Volume 161 (2015), Part 6]
[Senate]
[Pages 7707-7708]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          AFFORDABLE CARE ACT

  Mr. MURPHY. Mr. President, shown in this picture I have in the 
Chamber is Christina from Stratford, CT. She is a small business owner, 
and she has a story that is becoming pretty familiar all across the 
country. She left a job a couple of years ago that provided for 
employer-based health care, and she wanted to start her own business in 
Bridgeport, CT, right next to Stratford. So she stayed insured through 
COBRA for a period of time until it expired, and then she had to go out 
into the individual market. She recalls having to fill out a 15-page 
questionnaire when she was applying for individual coverage. She said 
it asked about ``anything that I had even remotely discussed with my 
doctor.'' Unfortunately for her, some of those things--preexisting 
conditions--meant that she was denied health care coverage.
  So she had to go into Connecticut's high-risk pool, which meant she 
was paying $1,200 per month. Anybody who has started up a small 
business from scratch knows that can be pretty prohibitive. Her 
salvation came through the Affordable Care Act. When it went into 
effect and Connecticut's exchange was established, she was able to find 
a plan that cost her $430 per month, which is frankly on the high end 
of plans but it was much more affordable than the one she had.
  She said: ``I'm thankful that there was a solution for me to be able 
to keep my business [and] have affordable health insurance'' that can't 
be taken away.
  Similar stories can be told all over the country, but it is not just 
anecdotes that we have to rely on any longer to talk about the success 
of the Affordable Care Act.
  I know that we are obsessed this week, appropriately so, with the 
PATRIOT Act, the transportation reauthorization, and the free-trade 
agreement, or the fast-track agreement. But the Supreme Court is likely 
upon our return after the Memorial Day recess to rule on one of the 
most important cases that it has heard during most of our tenures, and 
that is the King v. Burwell case. It is important to spend some time 
before we break talking about the subject of that case, the Affordable 
Care Act. Christina's story is miraculous--somebody who was able to 
start a business and keep that business open because of the Affordable 
Care Act. But she is one of 16.4 million people all across this country 
who now have health care because of the Affordable Care Act--most 
through Federal and State exchanges but some because they were able to 
stay on their parents' plan until age 26 or are able to access 
Medicaid.
  Last month's Gallup poll showed that the uninsured rate in this 
country has declined by 35 percent over the course of the last year and 
a half, or since 2013. That is a remarkable number. We shouldn't 
hesitate from noting that it is just absolutely exceptional in the 
history of this country to have a one-third reduction in the number of 
people who don't have insurance in such a short period of time. The 
good news is that most of the folks who have insurance are satisfied, 
just as is Christina. Opponent after opponent of the ACA tells us this 
is going to be terrible health care and that there is no way the 
government could have anything to do with a health care plan that 
people want. Of course, it is not government-run health care. It is 
subsidized by tax credits from the government, but it is private health 
care insurance, with the exception of those Medicaid plans.
  J.D. Power surveyed thousands of ACA enrollees and found that they 
like their exchange plans more than people like their nonexchange 
plans. So health care on this exchange is more popular than health care 
off of the exchange.
  The good news isn't just about the number of people who have 
coverage; it is that costs are coming down. For the accountable care 
organizations, which are an innovation in the Affordable Care Act to 
try to build big integrated systems of care, the pilot program just 
came in with their savings numbers, and $384 million were saved just on 
this one innovation alone. That is $300 per patient. That is a big deal 
because it speaks to a larger trend line in which we are for the first 
time in a very long time able to control health care costs. On an 
annual basis, last year we saw the lowest increase in medical costs, 
the lowest medical inflation number in a generation.
  But costs are coming down in part because of things that we put into 
place through the Affordable Care Act. My colleague Senator Barrasso 
was down here yesterday with a wonderful chart about Connecticut. I 
appreciate his giving Connecticut a little bit of extra publicity, but 
his speech really was a wonderful advertisement for the Affordable Care 
Act. He noted that several insurers in Connecticut just came out with 
rate increase requests, and he had the numbers up there. They were 8 
percent and 10 percent. They were substantial increases. They were not 
unfamiliar, because prior to the Affordable Care Act, that is what 
individuals and businesses were facing every single year. They were 
double-digit increases.
  The rate increases that Senator Barrasso was referring to were 
completely in line with what those same insurance plans requested last 
year in Connecticut. Last year Anthem Blue Cross Blue Shield requested 
a 12-percent rate increase. ConnectiCare requested 12 percent. Because 
of the Affordable Care Act, which allows States to do reviews and 
amendments to those rate increases, Anthem's request last year went 
from 12 percent to 0 percent, and ConnectiCare's request went from 12 
percent to 3 percent. We had in Connecticut one of the lowest increases 
in health care premiums on record because of the Affordable Care Act.

[[Page 7708]]

  So it is right that these health insurers are requesting big rate 
increases. But now, because of the law we passed, they don't get those 
rate increases in States such as Connecticut. They actually have their 
numbers vetted. They have their actuarial analysis reviewed, and they 
get a better number to the benefit of my constituents.
  But this Supreme Court case that is going to come up is important 
because it puts millions of Americans at risk for losing many of the 
protections that I just talked about. It basically says that the 
Affordable Care Act was designed in a way to only provide these 
subsidies to help people get insurance on State-based exchanges, and if 
they were on a Federal exchange, they, by design, weren't supposed to 
get these subsidies.
  Well, a lot of people talk about what the intent of the law is, but 
you don't even have to get into the intent of the law. On its face the 
text of the Affordable Care Act is absolutely clear, because, yes, 
there is a reference--one line to the fact that subsidies will flow to 
the State exchanges. But the plaintiffs' case completely ignores 
another section of the Affordable Care Act which gives the Secretary 
the power to establish exchanges in States that don't do it themselves. 
That is what has happened by the substitution of Federal exchanges for 
State exchanges. And, of course, the text of the bill just does not 
work if you believe the plaintiffs' analysis. The plaintiffs say this 
is supposed to be a penalty. If you didn't set up a State exchange, we 
are penalizing your constituents by withholding subsidies. Well, there 
is not a single line in the Affordable Care Act that suggests that this 
is a penalty. And there is the fact that the Supreme Court has said 
that if you want to do that, you have to make it explicit and you can't 
have guesswork involved as to the carrot-and-stick approach afforded to 
a State.
  Doug Elmendorf, who was the head of CBO at the time said:

       I could remember no occasion on which anybody asked why we 
     were expecting subsidies to be paid in all states regardless 
     of whether they established their exchanges or not. And if 
     people had not had this common understanding about what the 
     law was going to do at the time, I'm sure we would have had a 
     lot of questions about that aspect of our estimates.

  Finally, the bill doesn't work on its face if you believe the 
plaintiffs' argument. Why? Because the insurance reforms are national. 
And yet the subsidies, according to the plaintiffs, are only for States 
that established their own exchanges. Well, the insurance reforms don't 
work if everybody doesn't have insurance in those States. You can't say 
that folks who have preexisting conditions can't be discriminated 
against if people in those States don't all have insurance. That 
actuarially doesn't work. So the whole bill falls apart if you believe 
the plaintiffs' case.
  I am, frankly, totally confident that the Supreme Court is going to 
find in favor of the government because there is no other way to read 
the Affordable Care Act other than to believe that subsidies go to both 
State and Federal exchanges. It is plain on the face of the statute, 
but certainly you have to get to it in the intent as well.
  We are starting to see that Republicans are thinking they are going 
to need to have an answer if--in the unlikely case, as I believe--the 
Supreme Court decides in favor of the plaintiffs.
  But this is a pretty good summary of what the Republicans' plan is to 
respond to King v. Burwell. The Republicans' plan, if King v. Burwell 
goes in favor of the plaintiffs, is essentially a shrug of the 
shoulders.
  The predominant bill on the Republican side is offered by my friend 
Senator Johnson from Wisconsin. He claims that this bill is going to 
fix the problems in the Affordable Care Act if the King v. Burwell 
decision is decided in favor of the plaintiffs. But it is nothing 
except for just another attempt to repeal the Affordable Care Act. It 
is disguised as a way to address King v. Burwell, but it is simply an 
effort to repeal the law. You don't have to read too deeply in the bill 
to figure that out. It preserves the subsidies for about a year and a 
half, but after that period of time it ends subsidies in the Federal 
exchanges and then it also ends subsidies in the State exchanges.
  Let me say that again. The Johnson bill doesn't just end the 
subsidies that the Court might rule unconstitutional; it also ends the 
subsidies in the exchanges that the Court won't rule as 
unconstitutional if King v. Burwell is decided in favor of the 
plaintiffs. Thus, it is a repeal of the bill. It goes well above and 
beyond what would be necessary to address an adverse decision.
  It then goes even further. The Johnson bill then repeals the 
individual mandate. It repeals the employer mandate, and when you do 
that, the insurance reforms fall apart. Even Senator Cruz on the floor 
during his filibuster conceded that you can't protect people with 
preexisting conditions unless you also require people to get insurance.
  Lastly, the Johnson bill ends the essential-benefits packages. So 
this guarantee, that if you buy insurance you are going to get a basic 
floor of services, is no longer. The Republican response to King v. 
Burwell is simply to repeal the Affordable Care Act, and I hope we 
never get to the point where we have to debate how we address an 
adverse decision in the King v. Burwell decision, but this is a 
nonstarter. Everyone inside and outside of this building should 
understand that. I don't think it is coincidence at all that over 30 
cosponsors of the Johnson bill also support repealing the Affordable 
Care Act.
  One cannot deny that it is working. From the New York Times to the 
Washington Post to the Wall Street Journal, people understand that the 
Affordable Care Act is changing people's lives--16 million people with 
insurance, health care costs stabilized for the first time in many of 
our lifetimes, and quality getting better. The Affordable Care Act 
works, and I hope that our colleagues will come together, no matter the 
decision in King v. Burwell, to make sure that it continues to work for 
Americans all over this country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Arizona.

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