[Congressional Record (Bound Edition), Volume 163 (2017), Part 1]
[Senate]
[Pages 963-964]
[From the U.S. Government Publishing Office, www.gpo.gov]




                       OBAMACARE REPLACEMENT PLAN

  Mr. CASSIDY. Mr. President, I was pleased to see on the front page of 
the Washington Post that President-Elect Trump was speaking about how 
we should maintain at least the number of people covered under 
ObamaCare in a new kind of replacement for that portion of ObamaCare. 
If you will, I agree totally with him. We should fulfill this promise 
and do it, as he said, at a lower cost.
  We think we have a mechanism to do so with Senator Collins. We will 
speak to that today. First, let me point out, for those who are 
praising ObamaCare, I will say that since it has passed, the American 
people have been voting consistently against candidates who supported 
ObamaCare, culminating in the election of President-Elect Trump. So 
whatever folks might say about how wonderful it is, the American people 
are voting against it consistently.
  That said, there is a mandate from the American people not just to 
repeal but to replace. So it is not that the American people don't want 
to have coverage, and they want folks with preexisting conditions to 
have their issues addressed, but what they are concerned about is the 
way ObamaCare was forced upon them, with the power of Washington, DC, 
reaching into their own life, if you will, to their kitchen table, 
promising them penalties unless they comply with the Washington 
bureaucrats directly. That is what the American people do not like.
  So, first, can we maintain coverage? President-Elect Trump said we 
are going to have insurance for everybody. Two, will we cover more? 
Yes. Three, can we lower costs? The answer there is yes.
  Now, let's first speak to covering more Americans than ObamaCare. 
President-Elect Trump, Majority Leader McConnell, and Speaker Ryan have 
all committed to maintaining coverage for all.
  People speak of the advances made under ObamaCare. I will give them 
those advances. There are still 30 million people uninsured. Our 
alternative has the potential to cover 95 percent of Americans without 
a mandate. The way we do this is that as we return power to the States, 
we give States the option of saying that everyone who is eligible for 
coverage is enrolled unless they choose not to be.
  Just like when I turned 65 and I am on Medicare. I am on Medicare. I 
don't feel it is a mandate. No one calls me up. Indeed, if I don't want 
to be on Medicare, I have to call someone up and tell them I don't want 
to be on it. State legislatures would have the option to say you are in 
unless you call and tell us you are out. I say that addresses two folks 
who are hard to reach; the fellow whose life is so in disarray that he 
is living beneath a park bench and the typical 28-year-old male who 
never thinks about health insurance. All of a sudden he is in without 
even realizing he is in, until he needs it, and then he will be very 
pleased.
  On the other hand, if you don't want to be in, we make it easy to get 
out. By the way, I spoke of that fellow living beneath the park bench. 
As a physician who has worked in a hospital for the uninsured for 30 
years, that was not tongue-in-cheek, and that is not a throwaway line. 
That person living beneath the park bench will never have his life well 
enough together, or almost never, to go to a public library to log onto 
healthcare.gov. He does not have a W-2--and if he did, he lost it long 
ago--to submit it to sign up.
  Under our program, he is enrolled. What are the benefits that he 
would get? He would have a health savings account so that if he goes to 
the urgent care center with a nail in his foot, it is covered. He has a 
pharmacy benefit, so that if he gets his life together while he is at 
that urgent care center to take an antipsychotic, he has a pharmacy 
benefit. Lastly, if something terrible happens, he is hit by a car or 
something, then he is brought to the hospital and that catastrophic 
coverage protects society against the cost of his hospitalization.
  By the way, under our plan, we give States the power. I would like to 
think that this is something Democrats and Republicans can agree to. 
When Republicans say: You can keep your plan if you like it, and we 
mean it, we mean it. The way we would do this is that Congress would 
give States alternative options. The State would have the choice.
  The State could go with the alternative, which we will lay out. The 
State could opt for nothing, no Medicaid expansion and no help for 
their lower income folks, or the State could opt to stay in ObamaCare. 
If Illinois, California, Massachusetts, New York want to stay in 
ObamaCare, we think they should have the right to stay in ObamaCare.
  ObamaCare, if it is working for your State, God bless you. On the 
other hand, it is not working for a State where there are double-digit 
and sometimes triple-digit premium increases in 1 year.
  So the State could choose to stay in ObamaCare, for nothing, or for 
the alternative, which we lay out for them. By the way, I would say 
that those who govern closest to those who are governed govern best. We 
know that the State of Alaska is far different than the State of 
California, Illinois, Louisiana, or New York. So let those States 
decide the system that works best for them.
  What is the timeline? This year, 2017, we would like to repeal 
ObamaCare but put in place the legislation which allows, in 2018, for a 
State legislature or a Governor to choose the option they wish and the 
method by which they wish to enroll the people of their State. In 2019, 
the State would implement the replacement option of their choice. By 
2020, the repeal and the replace would have been finished.
  If, at a later date, a State wishes to change their option--they 
decided to stay with ObamaCare but on second thought now they wish to 
have the alternative we lay out, which I actually think would be 
something that might happen, they could choose that as a later option.
  We are not being partisan. I tell folks, this is not a Republican 
plan, not a Democratic plan, it is a patient plan, born out of my 
experience working in a public hospital for the uninsured; that if you 
give the patient the power, things line up. If we can make it an 
American patient plan, it does not matter what your State decides. I am 
comfortable that we will end up in the right place.
  Our goal is to fulfill President-Elect Trump's promise, more coverage 
at lower cost. We think we have laid out a pathway which can truly be 
bipartisan to achieve that goal.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. COLLINS. Mr. President, first, let me start by commending the 
Senator from Louisiana for all of the thought and the work he has put 
into

[[Page 964]]

coming up with an alternative plan that would fix ObamaCare and result 
in more Americans having affordable health insurance. As a physician, 
Senator Cassidy cares deeply about his patients and about patients in 
general. His goal, which I share, is to make sure every American has 
access to affordable health care. I commend him for his hard work and 
leadership.
  There has been much debate lately on the best approach to replacing 
and reforming the Affordable Care Act, also known as ObamaCare. Some of 
my colleagues have argued for immediate repeal without any replacement, 
an option I reject, for it risks leaving millions of vulnerable 
Americans without affordable health insurance and would undo important 
consumer protections provided by current law.
  Others have proposed repeal with a delayed effective date of 2 or 3 
years to allow time for the Senate to devise legislation that would 
provide a better approach to health insurance. My concern with the 
repeal-and-delay plan is that the ObamaCare exchanges, already on very 
shaky financial ground, would go into a death spiral as consumers would 
face uncertainty and insurers would have no basis for pricing their 
policies.
  Already we have seen insurers fleeing the marketplaces in many 
States, reducing choices for consumers. In some States, only one or two 
insurers remain on the exchanges, leaving individuals and families with 
few, if any, choice of insurance carriers. Every single one of the 23 
State cooperatives whose startup costs were financed by ObamaCare has 
experienced severe financial problems and only five remain operational 
today.
  Many States, including Maine, are experiencing double-digit increases 
in premiums, causing increased costs for consumers and for taxpayers. 
So repeal and delay would only exacerbate this problem.
  I am pleased to see a growing consensus among Members of both the 
Senate and the House that we must fix ObamaCare, provide reforms at 
nearly the same time that we repeal the law, in order to protect 
families who rely on the program and to give insurers time to 
transition to a new marketplace that is based on more choices for 
consumers.
  Many of us have been working for years on proposals to reform our 
health care system, to expand coverage, and to encourage new delivery 
systems that would help restrain the growth in health care costs. That 
is what the legislation that I am going to be pleased to be joining my 
colleague from Louisiana on, would do. It is focused on giving more 
choices while ensuring that consumers have access to affordable health 
insurance.
  We have advanced bipartisan proposals in the past to deal with 
provisions of the law that have increased costs and discouraged 
employers from hiring full-time workers. Regrettably, every such reform 
has been met with a veto threat. That is why we continued to work.
  In 2015, I joined Senator Cassidy in introducing a more comprehensive 
and creative approach, the Patient Freedom Act, which is the basis for 
the legislation we are going to be introducing soon. It would allow 
States to have more choices. If they like the Affordable Care Act, they 
can keep the Affordable Care Act. If they want to go an alternative 
route that is more patient-centered, that would provide more choices 
and help to restrain costs, they can do that, too, and the Federal 
Government would bundle the funding that would otherwise be used for 
ACA subsidies and the expansion of Medicaid in their State and allow 
them to proceed along a more creative route.
  We recognize how different the needs of our States are, but our 
citizens should have access to affordable health care and be able to 
choose the path that works best for them.
  We will be talking more about the specifics of our bill when we 
introduce it, but I am excited about this approach. I am not saying it 
is perfect, but it is important that we put specific proposals on the 
table that our colleagues can coalesce around, debate, and refine so 
that we can move ahead and remove the fear and uncertainty of families 
who are relying on coverage through the exchanges without putting an 
undue burden on the employers who create jobs in this country.
  Mr. President, let me again commend the Senator from Louisiana. He 
has worked so hard to come up with a fresh approach. He has been very 
open to suggestions that I and others have made.
  We all understand the importance of maintaining the consumer 
protections that help individuals with preexisting conditions, that 
ensure that young people can remain on their parents' insurance 
policies until age 26, and that prohibit lifetime caps. Those 
provisions would remain. But what we want to do is to allow our States 
the option of selecting a different path that will lead to patient-
directed reforms that contain costs and provide citizens with more 
health care choices. The Patient Freedom Act does just that.
  Again, I want to commend my colleague Senator Cassidy for his 
leadership.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. Mr. President, let me start by commending my colleagues 
from Louisiana and Maine. I really believe their approach to the 
Affordable Care Act is much more reasonable than what we have heard in 
the past from some.
  Senator Collins just went through a litany of options of repeal and 
run or repeal and replace 2 years from now. None of those are good 
options, and there is a reason why there is a backlash against this 
repeal effort across the country now, even among many Republicans as 
they consider the chaos that would be created by simply repealing it.
  I don't know the merits of the proposal they brought before us. I can 
tell you, having been through the debate on the Affordable Care Act, 
which went on for years, that there are many complex questions that 
need to be addressed to satisfy all of us that we are doing the best we 
can do to give affordable, quality health care to more and more people 
across the United States.
  The Congressional Budget Office just put out its report on what would 
happen if we just repealed, and it is a disaster. The number of people 
who are uninsured would increase by 18 million in the first new year 
following enactment of a repeal bill.
  Later, after the elimination of the ACA's expansion of Medicaid 
eligibility and subsidies for insurance purchased through the ACA, that 
number will increase to 27 million more uninsured and then to 32 
million in 2026. Disastrous.
  Premiums in the nongroup market--and those are folks who don't work 
for companies that provide health insurance--premiums in the nongroup 
market, with just repeal, would increase by 20 to 25 percent in the 
first year and then reach 50 percent in the year following the 
elimination of the Medicaid expansion and would double by 2026. So 
fewer people would have insurance, and those who do would pay 
dramatically more.
  So we shouldn't take this as just a matter of being able to have a 
bragging right about repeal. If we are serious about legislating, we 
should be looking at the options to find out how to make the Affordable 
Care Act better or how to approach it in a different manner.
  I commend my colleagues on the Republican side. Here is what it comes 
down to: If a handful of Republican Senators will say to the 
leadership: We are not going to vote to repeal until we have a 
replacement, then we can have a constructive conversation. But this 
notion of repealing the Affordable Care Act and then getting around to 
replacing it at some later time is irresponsible, will create chaos, 
and really says to the American people: We are no longer committed to 
making sure your family has the peace of mind of good health insurance. 
So I thank them for the efforts they have put into this, and I look 
forward to working with them.

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