[Congressional Record (Bound Edition), Volume 163 (2017), Part 1]
[Senate]
[Pages 1115-1117]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   REPEALING THE AFFORDABLE CARE ACT

  Mr. DURBIN. Mr. President, I was listening carefully to the comments 
made by my colleague from West Virginia. I thank her for coming to the 
floor and expressing her feelings about the Affordable Care Act. It is 
truly an article of political faith on the Republican side that we must 
repeal ObamaCare. We have heard that for 6 years, maybe longer, and 
each and every time, Democrats have asked: And then what?
  We have asked Republicans: What would you replace ObamaCare with? 
Until some of the most recent moments, there was never an answer. Now 
they are starting to put at least some ideas forward, but repealing 
ObamaCare and then talking about the possibility of replacement is a 
disaster. It is an invitation to uncertainty and chaos. We might expect 
that from a Democratic Senator who voted for the Affordable Care Act, 
but what I ask my colleagues in the Senate to do is, please go home. 
Please go back to your States. Do as I did yesterday. I called together 
the administrators of hospitals in Central Illinois, smalltown rural 
hospitals and larger hospitals such as Memorial Medical Center in my 
hometown of Springfield. I asked them, in a nonpressurized setting: 
What would you do? What is wrong with the Affordable Care Act? How 
would you change it? What would be the impact of repeal?
  I knew, and they did as well, that there had been some reports from 
the Congressional Budget Office. Just last week, the nonpartisan 
Congressional Budget Office told us exactly what repeal without replace 
would look like: 18 million Americans would lose health insurance in 12 
months, 32 million within 10 years. According to the Congressional 
Budget Office, if they went through with the Republican repeal plan, 
premiums in the individual health insurance market would increase by 20 
to 25 percent the first year and double within 10 years.
  Despite this, on his first day in office, President Trump signed an 
Executive order that began to dismantle our health care system. We 
still haven't seen the President's secret replacement plan, even though 
he has repeatedly said he wants to replace the law at the same time he 
repeals it, and we are going to be so proud of what he does.
  Let's talk about what repeal without replace means in Illinois, now 
that I have taken it home and asked the people who are actually running 
the hospitals. With repeal, 90,000 young people in Illinois would be 
thrown off their parents' health care plans. More than 7 million 
Illinoisans with health insurance through their employer would once 
again be subject to discriminatory health insurance practices, like 
discrimination based on preexisting conditions, annual and lifetime 
caps on

[[Page 1116]]

coverage, and discrimination against women. In my State, the Republican 
repeal plan would have an impact statewide because insurance plans 
statewide could once again decide not to cover maternity or newborn 
care, mental health, or substance abuse. Those things are required 
under the Affordable Care Act. That would be removed with this repeal.
  In my State, more than 1 million people would lose their health 
insurance--in fact, 1.2 million, to be exact. According to the Illinois 
Hospital Association, my State would lose $11 billion to $13 billion in 
annual economic activity with Republican repeal, translating to a loss 
of up to 95,000 jobs. Let me talk about those jobs in towns like 
Taylorville and Pana, IL, near my hometown of Springfield. Those are 
good-paying jobs. Sometimes they are the best paying jobs in the 
community. Those would be the jobs lost by the Republican repeal of 
ObamaCare.
  For years, we have been hitting back against misguided and misleading 
claims about the Affordable Care Act. Who is hitting back now? 
Hospitals. And not just hospitals. Health care providers across the 
board are pleading with the Republicans: We know you have some campaign 
promise you want to keep, but keep first your promise to the people you 
represent to provide quality, affordable health care.
  Senator Tammy Duckworth and I have sent letters to every single 
Illinois hospital--over 200 of them--asking about the impact of 
repealing the Affordable Care Act without enacting a replacement to 
prevent total chaos. Just yesterday morning, I met with these hospital 
administrators and heard firsthand. I met at Memorial Medical Center in 
Springfield, IL, representatives from Hopedale Medical Center, Pana 
Community Hospital, Carlinville Area Hospital, and Warner Hospital and 
Health Services.
  Memorial Health System is a nonprofit, community-owned health care 
organization. When I asked about the impact of repealing the Affordable 
Care Act, here is what they told me: ``Repeal without replacing the ACA 
would adversely impact patients' access to care and our hospitals' and 
health systems' ability to provide services as well as potentially 
result in job losses.'' They went on to say that Memorial Medical 
Center in Springfield, with Republican repeal of ObamaCare, could lose 
over $140 million over the next 6 years, and their uncompensated care 
costs would ``rise dramatically due to both a rise in charity care and 
decline in Medicaid coverage and reimbursement.''
  They cautioned:

       We would be forced to cut spending by reducing services, 
     reducing staff, and delaying investment in new technology and 
     facility improvements. . . . Losses of this magnitude with 
     repeal of the [Affordable Care Act] coverage simply cannot be 
     sustained and would adversely impact patients' access to care 
     and our hospitals' and health systems' ability to continue to 
     provide services.

  This is not the only hospital telling me in our State. I am from 
downstate Illinois, proud to represent Chicago, but I have represented 
in the Congress and in the Senate smalltown rural America, communities 
where the hospital makes a difference. If you don't have a hospital 
nearby, you could be an hour's drive--if you are lucky--from quality 
medical care, not to mention the impact that hospital has on the local 
economy, keeping and attracting new businesses.
  According to the Illinois Hospital Association, the 15th 
Congressional District of Illinois stands to lose $470 million under 
Republican repeal of the Affordable Care Act. That means 3,400 jobs 
lost in that congressional district in Central Illinois with repeal of 
affordable care. We talk about good jobs and creating them in this 
State. The President goes and makes trips, as he should, to try to save 
American jobs. Yet the first congressional action by the Republican 
majority this year is to threaten 3,400 jobs in the 15th Congressional 
District.
  Washington County Hospital in Nashville, IL, is a 22-bed critical 
access hospital 50 miles from St. Louis. They provide acute care, 
surgical service, and gynecological services. When I asked them what 
Republican repeal of the Affordable Care Act would mean to Washington 
County Hospital in my downstate area, they said the following:

       To eliminate [the ACA] would be detrimental to the 
     thousands of people in our county that were previously 
     uninsured either because of part-time work or serious health 
     problems.
       I guarantee that [repealing the ACA] without a strategic 
     healthcare replacement plan, will result in more downsizing 
     and more staff reductions at Washington County Hospital. Our 
     community cannot continue to lose these good paying jobs and 
     I believe our county residents will continue to move to 
     neighboring states with more favorable job markets, better 
     job security and stable benefits.

  They ended their response with this warning:

       I truly fear that many Illinois communities will lose their 
     Critical Access Hospitals--the only sources of healthcare in 
     many of our rural counties and a vital part of infrastructure 
     in our communities.
       As you know, our rural areas have vulnerable populations of 
     elderly folks that have many chronic healthcare needs and 
     limited ability to travel long distances for emergency care. 
     . . . I sincerely hope that you heed the warnings of our 
     physicians and hospitals--do NOT repeal the ACA in a hurried 
     political rush.

  Washington County is not a blue county, it is not a Democratic 
county. It is a county that votes regularly for the other party. It is 
a conservative-voting populous, representing a lot of farmers and small 
businesses, and this is their hospital administrator warning the 
Republicans here in the Senate and the House: Be careful what you do in 
eliminating the Affordable Care Act.
  According to the Illinois Hospital Association, the 16th 
Congressional District in Illinois stands to lose $453 million under 
Republican repeal of ObamaCare, and that means the loss of 3,300 jobs.
  SwedishAmerican Hospital in Belvidere, IL, in the northern part of my 
State, provides health care to Belvidere, Boone, western McHenry, and 
northern DeKalb Counties. When asked how the hospital has fared since 
the passage of the Affordable Care Act, the administrator of 
SwedishAmerican said the following:

       The passage of ACA has afforded our health system with 
     significant benefit related to [compensation] of patients 
     with uncompensated care. . . . SwedishAmerican experienced an 
     average annual increase of $43 million in Medicaid payments, 
     and a $10 million reduction in uncompensated care.

  When asked about the impact of the Republican repeal of the 
Affordable Care Act, SwedishAmerican Hospital of Belvidere, IL, said 
the following:

       The impact would be significant . . . it would create an 
     unsustainable financial result and we would be forced to make 
     significant reductions in staff and curtail future plans for 
     capital expenditures.

  Yesterday, at my roundtable in Springfield, I asked some of these 
hospital administrators: What is wrong with the Affordable Care Act? 
And they told me. Let me add quickly, I believe--as they do--there are 
things which need to be changed in that law. It is not perfect, by any 
means. They talked about the cost of care, and they should. In some 
areas, premiums have gone up too quickly, and the availability of 
insurance is not as it should be.
  I have talked to the health insurance companies, including the big 
companies like Blue Cross Blue Shield. They have told me specifically 
that the method of enrollment now under the Affordable Care Act leaves 
loopholes for people to jump in and out of coverage as they need it. 
You cannot run a viable insurance risk pool if people are only forced 
to sign up when they are facing a health care crisis. You have to have 
healthy people paying premiums to cover those who get sick and need to 
be compensated.
  So there are things certainly within the Affordable Care Act which 
need to be changed, and these administrators told us.
  So I said: I hear commonly from my Republican friends, if we would 
just allow people to buy health insurance over State lines, there would 
be more competition.
  They laughed. They said: You mean to say, if you heard that there was 
a health insurance plan in Alabama and you lived in Illinois, that you 
would buy health insurance there; is that the idea?

[[Page 1117]]

  I said: I suppose. I hear it over and over again, if we could just 
buy policies across State lines.
  They laughed. They said: Do you know what is going to happen? Do you 
know what happens when you buy insurance in Illinois and they tell you 
the hospitals and doctors who are eligible? You certainly want to have 
doctors in your home area eligible who may not be eligible under an 
Alabama plan. That makes sense.
  Secondly, they said: If people outside the State who are truly sick 
start buying into Alabama to get lower premiums, the premiums are going 
to go up. They are going to engineer the risk pool to make sure that it 
is viable.
  That is a notion that they rejected out of hand. I asked them about 
health savings accounts. That is another thing you hear over and over 
again. If people could just set aside nontaxable income and leave that 
in a pool of money to pay their copayments and other expenses, then 
there would be a disincentive to overutilize health care. These 
administrators said: But people who are living paycheck to paycheck 
don't have money to set aside--even non-taxable money to set aside at 
that point--and, ultimately, many of them would put off care they 
desperately need until they become even sicker.
  Each one of these approaches has its critics. There are people who 
think we ought to look at it more carefully. I think that ought to be 
the bottom line. To my Republican majority, look at this carefully. It 
is not a matter of keeping a campaign promise; it is a matter of 
keeping a promise to the people you represent not to leave our health 
care system in chaos.
  I hope President Trump and my congressional Republican colleagues are 
listening to what my constituents back home told me yesterday, things 
that they will hear themselves if they will go back home and listen to 
people who run the hospitals in the communities where the voters they 
represent live.
  I wish to conclude with a quote on the subject from Dr. William 
Gorski, president and CEO of SwedishAmerican, who wrote to me. He said:

       I must also speak forcefully as a former practicing 
     physician. Irrespective of any financial impact of repeal, 
     real lives are at stake here. President Obama's vision 
     recognized a great understanding of the importance of health 
     care access to the quality and outcomes of care. Any 
     diminishment of this access threatens the health and well-
     being of millions of our fellow citizens. . . . My strong 
     view is that rather than repealing the ACA, we should be 
     looking for ways to refine and expand it.

  That comes from a doctor. I solicited his view. I don't know him 
personally, but it represents the feelings of many.
  Mr. President, I ask unanimous consent to have printed in the Record 
the State Journal-Register article from Springfield, IL, on my meeting 
yesterday.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

            [From the State Journal-Register, Jan. 23, 2017]

        Durbin Hears Hospitals' Concerns About Obamacare Repeal

                            (By Dean Olsen)

       Executives from Springfield-area hospitals and health 
     systems told U.S. Sen. Dick Durbin Monday morning that a 
     threatened repeal of the Affordable Care Act by Congress 
     would jeopardize local patients' access to medical services 
     and harm their organizations' finances.
       ``We'd just hate to see this go away,'' Memorial Health 
     System chief executive officer Edgar Curtis said of the law, 
     also known as Obamacare, during a meeting at the Memorial 
     Center for Learning and Innovation with Durbin and leaders 
     from other hospitals.
       Tina Casner, chief executive officer of Pana Community 
     Hospital in Christian County, said Illinois' expansion of 
     Medicaid eligibility--funded by the ACA--and reduced-price 
     private insurance sold through the state's health insurance 
     exchange have reduced the number of uninsured patients and 
     improved the 25-bed hospital's bottom line.
       ``There are now folks in our community who are seeking that 
     care,'' she said.
       Durbin, D-Springfield, said he doubted that congressional 
     Republicans pledging a comparable replacement of the ACA 
     would be able to fulfill their promise without big gaps in 
     coverage for many Americans.
       Instead of ``repeal and replace''--the plan for the ACA 
     supported by local congressmen Rodney Davis, R-Taylorville, 
     and Darin LaHood, R-Dunlap--Curtis said he is ``very afraid'' 
     that Congress instead will ``repeal and delay'' a decision on 
     a permanent replacement.
       Action to repeal without a replacement is likely to cause 
     disruptions in care because more insurance companies would 
     pull out of the exchange and increase the prices of plans 
     even more, health-care industry officials have said.
       Durbin, the No. 2 Democrat in the U.S. Senate, was told by 
     hospital administrators that the federal law isn't perfect 
     and needs to be tweaked, especially when it comes to the high 
     cost of private coverage and excessive paperwork.
       ``I'm for that,'' he said.
       But he and the administrators expressed concerns about 
     Republicans' plans to change Medicaid from a federal 
     entitlement program to a block grant given to individual 
     states as a way of getting control of Medicaid's rising cost 
     to the federal government.
       The Illinois Health and Hospital Association has said block 
     grants for Medicaid could lead to reductions in funding in 
     Illinois, a state that already spends less per Medicaid 
     patient than almost all other states.
       Dr. Jerry Kruse, dean and provost of Southern Illinois 
     University School of Medicine, said the expansion of Medicaid 
     eligibility ``has been really great for us.''
       The expansion has decreased the uninsured rate by 80 
     percent for patients of SIU's federally subsidized outpatient 
     primary care clinic, the SIU Center for Family Medicine, he 
     said.
       With insurance coverage, formerly uninsured patients are 
     less likely to worry about incurring medical bills they can't 
     afford to pay and more likely to seek care, Kruse said.
       ``It's that peace of mind,'' he said.

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