[Congressional Record (Bound Edition), Volume 163 (2017), Part 9]
[Senate]
[Pages 12596-12599]
[From the U.S. Government Publishing Office, www.gpo.gov]




                               HEALTHCARE

  Mr. CARPER. Good afternoon, Mr. President. It is good to see the 
Presiding Officer and to hear my colleague Senator Perdue, as he 
prepares to probably head for home for the next several weeks.
  A number of our Senators are heading for their home States this 
afternoon and tomorrow to begin what is traditionally called the August 
recess. I am fortunate to live in Delaware, and I can go home every 
night. Some people see it as a blessing, others as a curse. I see it as 
a blessing to go home and stay a while. I am looking forward to that.
  We have three Senate office buildings here on Capitol Hill that 
Senators share and where they have their office space. The oldest is 
Russell. The next oldest is Dirksen. The newest is a building they call 
the Hart Senate Office Building. For 16 or 17 years, my staff and I 
have been in the Hart Building--and by choice. Every 2 years we can 
change offices, but we always want to stay in the same office, which is 
sort of unusual when you have been here for 16 or 17 years.
  Sometimes a lot of people say the names Russell or Dirksen or Hart. 
Russell and Dirksen are pretty famous folks, even now. Hart is less 
well known. I will not take a lot of time to give a deep history of who 
Philip Hart was, but he was a Senator from Michigan and he was a 
Democrat. His time here preceded my time.
  I was elected State treasurer for Delaware in 1976, a Congressman in 
1982, and Governor in 1992. Then, I came to the Senate in 2001. But for 
Philip Hart and me, as far as I know, our service never crossed. If we 
did, I am not aware.
  I don't know a lot of the things he was famous for. There are some of 
his famous quotes, but one of my all-time favorite quotations are the 
words I believe he said when he left this place. He left the Senate and 
retired. Some say he left too soon, but when he retired, he said these 
words: ``I leave as I arrived, understanding clearly the complexity of 
the world into which we were born and optimistic that if we give it our 
best shot, we will come close to achieving the goals set for us 200 
years ago.''
  That is what he said. Aren't those wonderful words? At a time when we 
could actually use a little bit of encouragement, I hope that, maybe, 
his words provide at least a small measure. For me, they always 
provided a large measure.
  If you go back to the beginning of this Congress, January 3, and the 
inauguration of the President on January 20 of this year, there were 
high hopes on both sides to immediately get to work on comprehensive 
tax reform; on transportation and infrastructure policy for roads, 
highways, bridges, rails, ports, broadband, and maybe our electric 
grid. There was the idea of doing something for our Republican friends 
to repeal the Affordable Care Act.
  As it turns out, we have in some cases disappointed, and in other 
cases we probably have pleased the folks who elected us to serve them, 
in developing and creating some of the policy for our country.
  I spent a fair amount of time on healthcare. I know the Presiding 
Officer, the Senator from Wisconsin, has as well. I spent a fair amount 
of time thinking and working on healthcare before, as a Governor and 
even as a Congressman. I am not a doctor. I have never pretended to be 
and have never wanted to be, but I think one of the credos for the 
folks in the medical field and physicians is ``do no harm.'' I hope 
that, at least on the healthcare front, in these 7 months here of this 
legislative session, we have not done a great deal of harm. I don't 
think we have.
  We had a robust debate on whether the Affordable Care Act should be 
repealed, with a special focus on the section called ObamaCare, and not 
much of a debate on how we get better healthcare results for less 
money, although it is a goal we all share, as Democrats and 
Republicans, in the executive branch and in the legislative branch. I 
think that we all share the goal of trying to figure out how to provide 
better healthcare for less money to everybody so everybody has 
coverage. I think that is a shared goal.
  Lamar Alexander, my Senate colleague from Tennessee, likes to say: A 
pilot wouldn't take off in an airplane without knowing what his or her 
destination is. Think about that. With respect to our destination on 
healthcare, I think we know what the destination is; that is, as I said 
earlier, to make sure we provide better coverage for less money and 
cover everybody. That is the destination.
  Just as a guy who spent a lot of time as a naval flight officer in 
airplanes for about 23 years, I know there are different ways to get to 
places. Sometimes it is a straight line; sometimes it is not. Sometimes 
you have to go around turbulence, around storms, or under them. You may 
run short on fuel, and there may be mechanical malfunctions. It is not 
always a straight line to get to where we want to go in an airplane. It 
turns out that it is not a straight line--that destination that we want 
to get to with respect to healthcare, for better results, less money, 
and covering everyone.
  One of the efforts to reach that destination has its roots in 1993. 
In fact, here in Washington there were two

[[Page 12597]]

ideas for reaching that destination in terms of healthcare. Our shared 
goals go back to 1993, where you had here in Washington two different 
ideas that were put on the table.
  One idea was from our First Lady, Hillary Rodham Clinton. She worked 
with really smart people to come up with a healthcare plan called 
HillaryCare, to essentially try to achieve those three goals I 
mentioned. Our friends in the Republican Party were not always kind in 
characterizing her proposal. I think, when they called it 
``HillaryCare,'' it was not meant to be a compliment. Even now, in 
television commercials, I remember seeing them kind of denigrating her 
efforts.
  One of the responses from the folks who supported it--at least, 
something that First Lady Hillary Clinton proposed--or one of the 
things that the Democratic side said to the Republicans was this: What 
is your idea? At least we have an idea.
  Then, some really smart people over at the Heritage Foundation went 
to work and they came up with what turns out to be a good idea--several 
very good ideas--to draw on market forces in order to try to meet those 
three goals I stated earlier on healthcare.
  The first great idea of the five ideas was to create exchanges in 
every State for people who don't have coverage under Medicaid or 
Medicare or they don't work for an employer that provides healthcare 
for them. These are large purchasing pools in every State where people 
can get healthcare coverage and be part of a large group plan and 
realize the benefits of being a part of that large group plan.
  The second aspect or pillar of their five ideas was the idea of a 
sliding-scale tax credit for people whose income was low. They would 
get a tax credit to lower the cost of a premium in the exchange in 
their State. As that person came up and up, at least to a certain 
level, the tax credit would go away. It is a sliding-scale tax credit. 
That was a Heritage Foundation idea.
  Their third idea was something called an individual mandate, which 
said that, if you don't have coverage, you have to get it. 
Particularly, you have to sign up for it in the exchange. If you don't 
want to sign up, you are going to be fined. You can't actually make 
people sign up and get coverage, but the idea behind Heritage was that 
we would incentivize people to get coverage, because, eventually, 
people who don't have coverage will have to get care. Unfortunately, it 
is really expensive if they go to the emergency room. A lot of times 
they are so sick that they end up getting admitted. That costs a 
bundle, and the rest of us end up paying for it. So the third pillar 
was the individual mandate.
  The fourth pillar was the employer mandate, because we want employers 
to cover their employees. That may not be absolute full coverage or 
Cadillac coverage. You don't have to necessarily cover their family, 
but we want you to offer coverage to your employees--hopefully, decent 
coverage.
  The last part dealt with preexisting conditions. The Heritage folks 
said that there should be a prohibition against insurance companies 
being able to say to people who are sick or have some kind of 
preexisting conditions: We are not going to insure you because you have 
a preexisting condition. Heritage said that should be verboten. You 
shouldn't get away with that if you are an insurance company.
  Those were the five ideas. Our friends here on the Republican side of 
the aisle said: We want to take those ideas.
  They did. The lead sponsor was John Chafee. I think he had 22 
Republican sponsors in 1993, including Senator Hatch, who was the 
senior Republican on the Finance Committee and chaired the Finance 
Committee, and Chuck Grassley, a senior Republican on Finance who was 
also the chairman of the Judiciary Committee. They were some of the 22 
cosponsors of the Republican bill, which really reflected the Heritage 
Foundation's ideas. Neither HillaryCare nor the Chafee legislation went 
forward and was adopted.
  But about 13 years later, in 2006, a fellow Governor of Massachusetts 
was thinking about what were some things he could do to really 
differentiate himself in the field for running for President in 2008. 
His advisers came up with this idea: Why don't we try to cover 
everybody in Massachusetts and be the first State with everyone having 
healthcare coverage? They dusted off the Heritage Foundation's five 
ideas and introduced the legislation in Massachusetts. They amended it 
and changed it a little bit, but, in the end, they passed the 
legislation. They implemented legislation in 2006, I believe, that 
reflected Heritage's ideas from 1993 and reflected the legislation that 
was written in this Chamber by John Chafee in 1993. It worked. It 
worked in Massachusetts.
  They fairly quickly were able to cover a lot of extra people in their 
State who hadn't been covered before. One of the things they wrestled 
with early on was portability. As it turns out, the folks who are young 
and invincible, like our pages here with us--I think this may be the 
last day or two before they head back for home.
  The Presiding Officer may not know this, but the pages are here on 
overtime. Most of the pages returned to their home States across the 
country, but there are a half dozen or so volunteers that are still 
sticking with us to the bitter end. Hopefully, it is not too bitter an 
end. We hope that someday you will come back here as interns or maybe 
staff Members, and, who knows, maybe even as Presiding Officers or just 
mortals--mere mortals like me. Thank you again for your service.
  Anyway, the Romney folks found out that they had this fine setup. So 
if people didn't get coverage in Massachusetts, they would have to pay 
a fine. It went up over time. It was later that they decided that if 
they had to do this over again, they would have had the fine start 
higher and escalate faster in order to send a clear message to the 
young invincibles and others who didn't have coverage that you have to 
get serious about getting coverage. They wanted a mix of people in 
their exchanges so that insurance companies would be able to insure 
them and not lose their shirts--to make money off of it.
  Anyway, when we were working on the Affordable Care Act in 2009, my 
first year on the Finance Committee, we were trying to figure out what 
to do. We proposed a lot of ideas to sort of keep our eye on the ACA. 
The Affordable Care Act was a way to just sort of pivot away from sick 
care, where we just spend money on people when they are sick, and do 
more to invest on how we help people stay healthy through prevention 
and wellness, by doing screenings for colorectal cancer, breast cancer, 
and prostate cancer, in ways that, if you take away the copays for 
people and they can go ahead and get the screenings, they save 
themselves a lot of money and a lot of pain and maybe from dying, which 
otherwise wouldn't be the case.
  There are a lot of aspects of the Affordable Care Act. We raised the 
eligibility for folks for Medicaid.
  When I came back from Southeast Asia in 1993, I went to business 
school in Delaware and got an MBA. The next year, I became State 
treasurer. I was 29. At that time, I thought of Medicaid as healthcare 
coverage for poor women with children. At the time, that was pretty 
much what it was, but not today.
  Almost two-thirds of the money we spend on Medicaid is for people who 
are in nursing homes--our parents, our grandparents, our aunts, our 
uncles. A lot of them are veterans. I think 2 million are veterans. We 
spend a lot of money on Medicaid today to treat addiction for heroin 
and opioids, and we spend money on poor families, including women and 
children, but the nature of the coverage has changed a whole lot.
  For many years, it has been a 50-50 yield. Largely, States pay 50 
percent, and the Federal Government pays 50 percent. We changed that in 
the Affordable Care Act because we wanted the States to cover more than 
just the people up to 100 percent of poverty. The Federal Government 
stepped in and said to the States: If you would go along with this, we 
would like to cover people from 100 percent to 135 percent of poverty. 
The Federal Government,

[[Page 12598]]

at least for a while, would pay for that marginal increase in coverage 
up to 135 percent of poverty. It is a pretty good deal for the States, 
and about 31 States have signed up to do that. So a lot of people have 
coverage today who did not have it before through Medicaid.
  The other thing we did in writing the Affordable Care Act was to take 
the idea that they have sort of glommed onto in Massachusetts with 
RomneyCare--which has its roots back to the 1993 proposal from Heritage 
and that was proposed here in the Senate by Senator Chafee--and put 
that into the Affordable Care Act. I know that there are some people 
who wanted to have a single-payer system in that their idea of 
healthcare reform was to cover everyone under Medicare who did not have 
coverage. We were just not ready to go there, so we said: Let's try 
something that has been put in place in one of our States, maybe with 
the idea that Massachusetts could be the laboratory of democracy--to 
find out what works and do more of that--and that was what we did.
  We passed legislation that created exchanges in all 50 States, and we 
had an individual mandate to encourage people to get coverage and 
incentivize them but fine them if they did not. A lot of people say 
that we started too slowly, as Massachusetts did not implement it fast 
enough to get people signed up in the exchanges, but we learned, maybe, 
from our mistakes. We had the employer mandate, and we had the sliding 
sales tax credit in the Affordable Care Act.
  Then we had the prohibitions against insurance companies that refused 
to cover people because they had some kind of preexisting condition. 
That was the part of the Affordable Care Act that had its roots, 
really, in Heritage and Republican Senators--really good ones. Some of 
them are still here. Somehow, this has turned out to be that part of 
the Affordable Care Act with the exchanges and so forth. It ended up 
being called ObamaCare, which is really ironic because he did not have 
anything to do with creating it. It was not his idea, but, somehow, it 
has been deemed to be ObamaCare. It is the part of the Affordable Care 
Act that has been most attacked by our Republican friends. It was their 
creation, their suggestion, and now they want to get rid of it.
  We have had some tough debate here in recent weeks, and the Senate 
has decided not to repeal that part of the Affordable Care Act. I think 
that we are smart not to repeal it, but the idea is to help make it 
work. One of the best ways is to sort of calm down the exchanges--quit 
disrupting and destabilizing the exchanges. When the President says 
that we do not know if we are going to enforce the individual mandate 
or the subsidies that we provide for low-income people, who get their 
coverage in the exchanges, to help cover their co-pays or deductibles--
they do not know if they are going to keep doing that. They are 
basically saying of the ObamaCare exchanges to just put them in a death 
spiral. Let them just die. Then, maybe, the Democrats will come to the 
table.
  I think all of that would be a huge mistake. Most of the people would 
suffer. As a matter of fact, a lot of the folks who voted for them are 
in rural States, and a lot of them are in red States around the 
country. I think it is cruel, and I do not think it is very smart.
  Last Friday morning at 2 a.m., three Republicans--Lisa Murkowski, of 
Alaska; Susan Collins, of Maine; and John McCain, of Arizona--joined 48 
Democrats in saying: Let's hit the pause button on degrading, further 
bringing down, the Affordable Care Act. Let's hit the pause button. It 
is not because the Affordable Care Act is perfect, because we know 
there are things in it that need to be fixed, but there are portions 
that need to be preserved as well.
  We said: Let's see if we can't hit the pause button--kind of pivot--
and stabilize the exchanges, first of all, then do the fix, and do the 
repair that needs done in the ACA. We would keep the stuff that is 
really good and that everyone says is good and move on. Let's not just 
do it as Republicans by themselves or Democrats by themselves. We have 
tried that. Let's try working together.
  Now we have a chance to do that, and people, like the Presiding 
Officer, who have very good ideas will have a chance to present those 
ideas in hearings that will be held by Senators Lamar Alexander and 
Patty Murray right after we come back here, just after the Labor Day 
holiday.
  I learned in our Finance Committee today that Chairman Orrin Hatch 
and Senator Ron Wyden, who is the senior Democrat on the committee, 
will also be holding a hearing or hearings on how do we stabilize the 
exchanges and how do we, maybe, find some ways to improve on what we 
have done in the Affordable Care Act. I can think of any number. I am 
sure that the Presiding Officer can as well.
  I do not leave here discouraged. This is a country about which people 
say: You must be miserable serving in the U.S. Senate.
  I say: Oh, no, not at all. I am sort of energized by what has been 
going on, not discouraged.
  A long time ago, we fought the Civil War. One hundred fifty years 
ago, we fought the Civil War. My friend here from Mississippi remembers 
that. I grew up in the last capital of the Confederacy--Danville, VA. I 
remember that. One hundred fifty years ago, hundreds of thousands of 
people were killed, maimed, or wounded. When it was over, our President 
was assassinated, and his successor was impeached.
  Somehow, we got through that and made it to the 20th century and 
fought, not one, but two World Wars. We won them both and led them 
both. We fought the Cold War--won it, led it. We led the world out of 
the Great Depression and into the 21st century.
  The 21st century emerged, and the Sun came up that January day in 
2001. America had the strongest economy on Earth and the most 
productive workforce on Earth. We are a nation of peace. We had four 
balanced budgets in a row. We had not balanced a budget since 1968. 
Then we figured out how to do that four times in a row during the last 
4 years of the Clinton administration. In 2001, we were the most 
admired Nation on Earth and the most admired force for justice on 
Earth.
  I like to remind people that if we can get through the 150 years 
after the Civil War and end up where we were on January 1, 2001, we 
will get through this as well.
  The last thing I would say is this: When we come back, there is 
plenty to do. One of the things we have to do is deal with our 
financial plan, our budget, and figure out what to do with respect to 
the debt ceiling. We will be coming back and holding the hearings that 
I described on the Affordable Care Act and trying to stabilize the 
exchanges. We will begin to figure out what we ought to do beyond 
stabilizing the exchanges and do it as Democrats and Republicans 
working together.
  When we passed Social Security, Medicare, the Civil Rights Act, and 
the GI bill, those were not all Democratic ideas or all Republican 
ideas. Some of the best work we do is when we work together.
  We will also have the opportunity to tackle our Tax Code. We have a 
tax code that, in some cases, discourages companies, especially larger 
companies, from staying in the United States and continuing to do 
business here and employing people here. In some cases, we encourage 
them to look for other places around the world in which to locate their 
businesses. We need to make sure we have a tax code that encourages 
innovation and that encourages companies to expand and grow here. My 
hope is that we can, especially on the Finance Committee, really focus 
on that and work with our colleagues, work with the House, and work 
with the administration.
  I am a really optimistic person about most things, but the last time 
we did comprehensive tax reform in this country was in 1986. At that 
time, we had Republican President Reagan, who was for it. He had a 
great Treasury Secretary, Jim Baker, who was for it. Dan Rostenkowski, 
the chairman of the Ways and Means Committee in the House, was for it. 
Tip O'Neill, the Democratic Speaker of the House, was

[[Page 12599]]

for it. We had Bob Packwood and Bill Bradley, a Democrat and a 
Republican--brilliant people on the Finance Committee. They were for 
it, and it still took 5 years to do it--really hard stuff.
  We need to get serious about it, and we need to get going. My hope is 
that we will end up being revenue-neutral. We could use some revenues, 
but I hope it will be revenue-neutral. At the end of the day, I hope 
that what we do will answer these four questions: Is it fair? Does it 
foster economic growth? Does it make the Tax Code less complex or more 
complex? Finally, how does it affect our fiscal situation--our budget 
situation? My hope is that we can keep those questions in our minds as 
we formulate tax reform and answer them in an appropriate way.
  I see my colleague here with whom I serve on the Finance Committee 
and on the Environment and Public Works Committee. He is waiting his 
turn, and I have talked long enough.
  I will close where I started, with the words of the late Senator 
Philip Hart, of Michigan, who was admired by a lot of people here in 
this body before we came here. He said these words:

       I leave as I arrived, understanding clearly the complexity 
     of the world into which we were born and optimistic that if 
     we give it our best shot, we will come close to achieving the 
     goals set for us 200 years ago.

  Boy, those words ring true today, don't they?
  As we are about to leave, unlike our friend Philip Hart, who left the 
Senate, those who serve today in the Senate are going to come back in 4 
weeks. My hope is that when we come back, we will come back determined 
to work together. That is what people want us to do. They want us to 
work together because, if we do, we will get a lot more things done.
  My wife and I went to Africa and actually met up there with one of 
our sons and a friend of his two summers ago in August--2 years ago 
this August. I learned more about Africa in, actually, a week to 10 
days than I had learned in all of my life. One of the things I learned 
was an African proverb that some of you already know. It goes something 
like this: If you want to go fast, travel alone. If you want to go far, 
travel together.
  Think about that: If you want to go fast, travel alone. If you want 
to go far, travel together.
  We have tried going it alone, and we have not gotten that far. My 
hope is that when we come back, we will travel together, and we will go 
a long, long way and make everyone proud of us.
  I say again to my colleagues and the pages and our staffs, thank you 
for the good work that you have done. It is a pleasure serving with all 
of you.
  I bid you adieu. Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Mississippi.

                          ____________________