[Congressional Record (Bound Edition), Volume 161 (2015), Part 7]
[Senate]
[Pages 9743-9744]
[From the U.S. Government Publishing Office, www.gpo.gov]




                        KING V. BURWELL DECISION

  Mr. DURBIN. Mr. President, there is a case pending before the U.S. 
Supreme Court that is being followed very closely. It is the case of 
King v. Burwell. It is a case that really is challenging one of the 
fundamental premises of the Affordable Care Act.
  The Affordable Care Act was passed 4 or 5 years ago here in the 
Senate and in the House and signed by President Obama. Because of it, 
over 11 million Americans have chosen or reenrolled in a health 
insurance plan, most with a tax subsidy that makes their coverage 
affordable. The subsidy is based on their income. In the private 
market, millions more now have access to expanded coverage for 
preventive health services, such as mammograms or flu shots, without 
any cost sharing.
  Because of the Affordable Care Act, a person no longer needs to stay 
in a job simply to carry health insurance or be denied coverage because 
of a preexisting condition. Because of this law, prescription drugs for 
seniors cost a lot less. There was a time not that long ago that if a 
member of your family--for instance, one of your children--had a 
history of diabetes or mental illness, they might find themselves in a 
position where the family couldn't afford to buy health insurance. But 
the new Affordable Care Act said: You cannot discriminate against a 
person or family because there is a preexisting health condition.
  The reason that works, the reason why insurance companies can still 
get by covering people who are sick is that there is also a requirement 
that people carry health insurance. That means healthy people need to 
buy health insurance as well as those who are sick and worried about 
coverage in the future. That enlarges the pool and diminishes the cost 
to the applicant for health insurance who is suffering from a 
preexisting condition.
  This month, the Supreme Court will make a decision in the case of 
King v. Burwell. The plaintiffs in this case have made an unusual 
argument. They claim that Congress intended to provide tax credits to 
help people buy health insurance only in insurance marketplaces 
established by each State but not in the Federal marketplace.
  I was here during the debate. I was here when we passed the 
Affordable Care Act. I can tell you that absolutely no one made that 
argument that I heard on the floor of the Senate. Overwhelmingly, those 
who were in exchanges--in either State or Federal exchanges--were 
treated the same way when we calculated the cost and savings of the 
Affordable Care Act.
  If Republicans get their way--and some of them are rooting for the 
Supreme Court to eliminate the subsidy--6.5 million people will lose 
their Federal tax subsidy for health insurance. According to the Urban 
Institute, premiums for people able to purchase insurance would 
increase by 35 percent. Now, $12 billion in uncompensated care would be 
shifted to hospitals and Americans with employer-based insurance, 
making a ruling in favor of King in the Supreme Court a tax increase on 
everyone.
  Here is how it works: If you have people--millions across the 
country--who have health insurance because of the Affordable Care Act 
and they lose their health insurance, they are still going to get sick. 
When they get sick, they will show up at a hospital. Nine times out of 
ten--maybe more--the hospital will treat them even if they can't pay. 
Their expenses and costs will be passed on to someone else who comes to 
that hospital, someone with health insurance.
  Ultimately, everyone who has health insurance is going to subsidize 
those who don't. I don't think that is a very fair or wise system. If 
the King v. Burwell decision goes the wrong way, it may move us toward 
that.
  There are some in the other party who say they have an alternative 
plan to the Affordable Care Act. The House and the Senate Republicans 
have already voted to repeal subsidies for working families by voting 
to repeal the law. I lost track in the House; I think it is 57 times, 
58 times they have voted to repeal the Affordable Care Act. They have 
come out with a plan that they say would restore the subsidies, but it 
eliminates the requirement that people carry insurance. It eliminates 
what is known as the individual mandate.
  There were some who argued--and I am one of them--that the individual 
mandate is a question of personal responsibility. If you want to drive 
a car in my State of Illinois, you need automobile insurance. It isn't 
a question of you making a decision. The State requires it because if 
you are going to be in that automobile and if you get in an accident, 
the victim in the other car shouldn't have to bear the expense of 
damage to their car or personal injury, the person responsible for the 
accident should, and the only way that works is if everybody carries 
automobile insurance.
  If you want to buy a home in my State and I think in almost every 
State, the mortgage company requires fire insurance. If a fire destroys 
that home, the mortgage company will get paid the proceeds and will not 
end up with an empty bag.
  Similarly, when it comes to health insurance, the individual mandate 
says: We think everyone should buy health insurance. We will help those 
in low-income categories with subsidies because we think everyone 
should have health insurance. That is what is behind the individual 
mandate.
  If you eliminate the individual mandate, you will be back in the 
situation where people seeking health insurance will be those who are 
the most vulnerable and sick, those with preexisting conditions. That 
makes it tough to create an insurance pool that makes sense when it 
comes to risk.
  According to the American Academy of Actuaries, putting out a plan 
that eliminates the individual mandate will really be of no help. That 
bill would only delay the onset of higher insurance premiums and loss 
of coverage for millions of Americans. The Affordable Care Act puts 
families in charge of their care instead of insurance companies. It 
expands health care coverage, lowers health care cost, makes Medicare 
stronger, and lowers the deficit. I

[[Page 9744]]

don't know why there is opposition to any of those elements.
  Before the enactment of the Affordable Care Act, 50 million Americans 
didn't have health insurance, while health care costs for working 
families and small businesses were increasing out of sight. The 
Affordable Care Act changed that, and 11 million people of the 50 
million now have private health insurance. Millions more are now 
covered by Medicaid. And for the first time ever, insurance companies 
have to live up to their promise of being there when you really need 
them.
  Many in the other party have argued that this is not the way to do it 
and that there should be a viable alternative. I would like them to 
meet a couple of people from my home State.
  The Supreme Court could put in jeopardy health insurance coverage for 
Ariana Jimenez. Ariana lives in Chicago and works part time as a 
nursing assistant at a community health center. Ariana pays $52 a month 
for her basic health insurance premium--$52 a month. When asked what 
would happen to her coverage if the Supreme Court took away her tax 
credit, Ariana simply said: I wouldn't be able to afford it.
  In Illinois, over 800,000 people--in my State of about 12.5 million, 
13.5 million--800,000 people in Illinois now have health insurance 
through the marketplace created by the Affordable Care Act or through 
Medicaid, and 240,000 people purchased a plan through the Illinois 
marketplace with a subsidy. I might say that the only marketplace is a 
Federal marketplace. If the Supreme Court decides in favor of the 
plaintiffs, a quarter-million people in my home State will not be able 
to afford their health insurance.
  What happens to everyone else? If the Court rules for King, the 
plaintiff in this lawsuit, consumers in the individual market in States 
such as Illinois who use the Federal marketplace would face premium 
increases of 47 percent--$1,600 a year more that people would have to 
pay for health insurance.
  A few years ago, Domingo Carino found out he had a health condition 
that required medication and he could not afford it. Thanks to the 
Affordable Care Act and help from the staff at the Asian Human Services 
Family Health Center in Chicago, Domingo found good health insurance. 
He pays $11 a month. Domingo's plan not only allows him to afford his 
medication, but it also keeps him in a position where he has access to 
a primary care physician. According to Domingo, he can now live without 
worrying about how to afford his medication.
  For Domingo and millions like him, tax credits provided by the 
Affordable Care Act are literally a lifesaver.
  Over 54 million people benefit from Medicaid. Before the Affordable 
Care Act, two out of three people on Medicaid were pregnant women and 
children. That is 36 million of our most vulnerable Americans. Medicaid 
also provides for people with disabilities. Before the Affordable Care 
Act, almost 3 million people were covered by Medicaid in Illinois, and 
more than half of the children born in our State were covered by 
Medicaid. Since the Affordable Care Act, another 530,000 people have 
signed up for Medicaid. That means that finally these people can get 
better from a condition they couldn't afford to treat. I call that a 
success.
  It is interesting, too, that now that people on Medicaid can shop at 
different hospitals, traditional hospitals that serve the poor--there 
is one, Stroger Hospital, which used to be Cook County Hospital, in 
Chicago--have to change the way they do business. They are competitive 
now. They realize that Medicaid patients can go shopping at another 
hospital. The administrator at Stroger Hospital told the doctors and 
staff: Be on your toes. Provide better care. We are competing for 
business now. These Medicaid recipients can go to every hospital.
  According to a recent Gallup poll, the uninsured rate has dropped 
3\1/2\ percentage points from 2013 to 2014. In Illinois, the uninsured 
rate dropped 4\1/2\ percent during that same period.
  The Affordable Care Act includes several changes meant to help slow 
the growth in health care costs. The CBO this week forecast lower 
private health insurance premiums. Health care spending per enrollee 
has slowed in the private insurance market and also in Medicare and 
Medicaid.
  Instead of paying hospitals for the services they provide, because of 
the ACA, hospitals are paid to make people well. If their patients have 
to go back to the hospital, many of the hospitals are penalized for 
that. Despite climbing readmission rates since 2007, those rates 
started to fall with the Affordable Care Act. Hospitals are responding 
to the incentives in the Affordable Care Act and more of their patients 
are getting better and staying better.
  The solvency of the Medicare Part A trust fund is now 13 years longer 
than it was prior to the passage of the Affordable Care Act--which 
means it will be solvent for 13 more years--which the trustees in 2010 
said had ``substantially improved'' the financial status of the trust 
fund.
  The law also helps seniors with the cost of prescription drugs by 
closing the doughnut hole. There was that moment in time when seniors 
weren't covered by Medicare Part D and had to reach into their savings 
account. Since the passage of the Affordable Care Act, people with 
Medicare in Illinois have saved over $554 million on prescription 
drugs. We closed the doughnut hole with the Affordable Care Act. That 
is an average savings for each senior in Illinois of $925. Those who 
want to abolish the Affordable Care Act have some explaining to do to 
seniors who are pretty happy that they have a helping hand when it 
comes to paying for drugs.
  It is my hope that the Supreme Court does the right thing and 
realizes Congress never intended to have tax subsidies go to only some 
Americans and not others. I have always said the Affordable Care Act is 
not a perfect law. As I have said several times on the floor of the 
Senate, the only perfect law was carried down a mountain by Senator 
Moses on clay tablets. Ever since, we have tried our best to put a law 
together that serves the purposes of our Nation. We do our best, but we 
can always improve it. The same thing is true for the Affordable Care 
Act.
  I hope the time comes--and I hope the Supreme Court doesn't force 
this sooner rather than later--when we can have a constructive, 
bipartisan conversation about the Affordable Care Act. It is not a 
perfect law. It can be improved. There are parts of it on which I would 
gladly work with Republicans to change.
  I have told my friends in the restaurant business that I know they 
are concerned about the number of hours employees have to work to be 
covered and how many employees work at the restaurant and so forth. All 
of those things can be and should be addressed. If they are addressed 
in a positive and constructive way, we can improve this law and make it 
serve the American people better. I think that is why we were elected.
  I yield the floor.

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