[Congressional Record (Bound Edition), Volume 163 (2017), Part 6]
[Senate]
[Pages 8517-8518]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         HEALTHCARE LEGISLATION

  Mr. CASSIDY. Mr. President, I thank the Senator from Colorado for his 
kind words.
  I rise to speak about our Republican effort to repeal and replace the 
Affordable Care Act. I always kind of chuckle when I say the 
``Affordable Care Act,'' as I have a friend back home whose quote for 
his insurance was $39,000 for 1 year. That is the un-Affordable Care 
Act.
  A family member from San Francisco whose policy was $20,000 for 1 
year had a $6,000 deductible for each person. I think her husband 
actually voted for Bernie Sanders, but she is like: The heck with this 
because I cannot afford it.
  Then there is another fellow here in Washington, DC, who is an 
insurance consultant. If anybody can get a good deal, an insurance 
consultant should be able to. He says:

       My family premium is $24,000 a year with a family 
     deductible of $13,000. We will pay $37,000 before we receive 
     benefit from our insurance policy.

  That is unsustainable.
  President Trump saw that during the campaign. He said over and over 
again--kind of his four pledges, if you will--that he wished to 
maintain coverage, lower premiums, get rid of those mandates that 
Americans hate in ObamaCare, and care for those with preexisting 
conditions. This is what he said over and over. It is a great pledge.
  He actually said something else as well: He said he wanted to make 
healthcare easy. Now we have an approach to do this. Some people call 
it auto enrollment, but I call it making it easy. In this way, we can 
increase coverage and achieve the goals of President Trump's to lower 
the premiums. We are using something that is already used in Medicare 
and 401(k) plans. Again, we make it easy to enroll. Let me elaborate on 
this.
  People argue that we have to have a mandate because without a 
mandate, people will lose coverage, and if people lose coverage, only 
the sick enroll and healthcare expenses increase. I think the Senate 
actually has an opportunity to do something better. We can make it 
easy. Under this, we can imagine that someone is eligible to be 
enrolled in our program unless he calls us up and says he does not want 
to be.
  This is what we do in Medicare. When we--when I, when you, when any 
of us--turn 65, we are automatically enrolled in Medicare. I turned 65, 
and I am on Medicare. It is not a mandate. I can call them up and say 
that I do not want to. You have never heard anybody complain about it. 
It is just called making it easy.
  Similarly, when a Fortune 500 company puts in a 401(k) plan, it has 
learned that if it asks somebody to sign all of the forms, and they can 
opt into its 401(k) retirement plan, it gets about 65 percent 
participation, but if they say: You are in unless you call us up and 
tell us you do not want to be--if they make it totally easy, they get 
95 percent participation in that 401(k) program.
  We know both from Medicare and from business that if you make 
enrollment easy, you have 95 percent participation. Now, that is so 
good in the setting of this because if we have all of those enrolled 
who are eligible to join the ObamaCare replace plan, we make that 
insurance pool large.
  We call it a pool for a reason. If you pour a cup of water into an 
ocean, it does nothing to the level of the ocean. Similarly, if you 
have one person who is ill who is in a big pool of otherwise healthy 
people, it does nothing to the expense because the expense of that one 
person's illness is spread over many. So by making enrollment easy--
fulfilling President Trump's pledge--just like the ocean with one cup 
of water, that one person who is sick, the expense spread out over 
many, the impact on any one person's premium is nil.
  By the way, there is a lot of conservative support for this sort of 
concept. First let me just say that coverage is important. If we 
pretend that people having coverage is not important, it is just not 
true. I am a physician. I can tell my colleagues there are many 
conversations I have had where someone who was poorly insured or 
uninsured might need some critical medicine or critical procedure and 
we had to work, scramble, do everything we could to get her the 
coverage she needed to have sometimes a lifesaving procedure.
  Rich Lowry is a conservative columnist for the National Review. He 
had a column saying that the worst argument against replacing the 
Affordable Care Act is that coverage is not important. Coverage is 
important.
  If we go on toward this kind of concept--make healthcare enrollment 
easy; you are in unless you are out--Jim Capretta, Joe Antos, and 
Stuart Butler have all spoken about using this concept. Nina Owcharenko 
and Bob Moffit of the Heritage Foundation wrote in Senator John 
McCain's Presidential plan in 2008 that it would be accompanied by a 
system of automatic enrollment of health insurance, either at the 
workplace--and then they go on. But they were praising the Presidential 
candidate's--but now Senator John McCain's--employment of let's make it 
easy to enroll.
  By the way, President Trump kind of emphasized this. Just before he 
was inaugurated on January 15, he gave an interview to the Washington 
Post and he was talking about his proposed healthcare law. We have 
already mentioned the components that he said were in it. He wanted all 
covered, caring for those with preexisting conditions, getting rid of 
the mandates, and

[[Page 8518]]

lowering premiums, but he added this: People under his law ``can expect 
to have great healthcare. It will be in a much more simplified form. 
Much less expensive, and much better.''
  I like that: simplified.
  Under ObamaCare, we have like 16 pages online that people have to 
fill out with all their W-2s with them in order to find out if they are 
eligible. The patients I saw in a hospital for the uninsured where 
median income may have been $16,000, people lived in perhaps public 
housing, they took public transportation to the public library in order 
to log on because they did not have a home computer, much less 
internet. That is not simple. That is why enrollment numbers are lower 
for lower incomes. We make it easy.
  Let me just emphasize one more time: If we can get that bigger pool 
of people, premiums fall. So for my family member in San Francisco who 
can't afford that premium, if we get that pool bigger, premiums fall. 
Similarly for the insurance consultant here or my friends back home in 
Louisiana, if we can make that pool bigger by making enrollment easier, 
their premiums will fall.
  I will just say that I call myself a kitchen table conservative. All 
those conservative families who voted for Donald Trump, who sit down at 
their kitchen table and they know they can't afford a $20,000 premium 
and already they are struggling with their car note, their house note; 
they have given up sending their kids to a private school; they are 
doing whatever they can to make ends meet. Under the un-Affordable Care 
Act, they are required to pay so much. When they heard President Trump 
say that he would lower their premiums, they saw that as a lifeline for 
their family budget. Their vote for President Trump was a cry for help: 
Help us with insurance premiums we cannot afford.
  Now, as a kitchen table conservative myself, to those families who 
voted for Republican candidates over the last several elections but who 
absolutely know they need help with their health insurance, we have a 
solution for them.
  But let me pause for a second. You don't have to be a conservative to 
care for this solution. In fact, people on the left have actually 
endorsed this concept as well.
  I will end by saying this. As we come up with a replacement plan for 
the Affordable Care Act, it will not be a Republican solution and it 
will not be a Democratic solution. At its best, it will be an American 
solution--an American solution for that family at the kitchen table, 
struggling to pay their premiums, who can't do so now but know that 
they need coverage. In so doing, if we can fulfill President Trump's 
campaign pledges to cover all, caring for those with preexisting 
conditions, eliminating mandates, and lowering premiums by making 
enrollment easy through something called auto enrollment, we will have 
done our job.
  Mr. President, I yield the floor.

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