Transcripts For CSPAN2 Senators On Republican Health Care Legislation 20170728

Of americans who have been let dow down, not to mention deceived by the promises of obamacare, and its absolutely critical that we fulfill our commitments. This is not just about moving past the failures of obamacare but also laying the groundwork for providing americans access to better care. Weve said all along that we have four principles. One is to help stabilize the Insurance Market so People Living in iowa, for example, would make sure they have a place they can buy Health Insurance. Its about getting premiums lower, by eliminating mandates and making it possible for people to choose alternatives that happen to suit their needs at a price they can afford. Third, we said we are going to continue to do everything in our power to protect people with preexisting conditions so they are not afraid about changing jobs and being excluded from the new employers Insurance Coverage because of something that was we protect people against the preexisting conditions exclusion. Ke fourth, what we said we want to do is we want to take medicaid, and essential safety net Healthcare Program to make a sure we put it on a sustainable path. I know there are some in washington d. C. Who think we can continue to spend borrowed money endlessly. We cant. It really jeopardizes the very viability of some of our most essential safety net programs like Social Security, medicare, and medicaid in this instance. What we have done, what we intend to do, working with our colleagues in the house is to put medicaid on a sustainable path while we grow the expenditures to medicare each year and over a tenyear period by 71 billion. Tting those who say we are somehow getting medicaid or we are cutting medicaid, i think simply we have to deal with those facts and i havent heard a satisfactory can explanation for how you can conclude that somehow we are getting medicaid or cutting itie when we are actually making it sustainable in the long run. Throughout this process, what i have learned is that senators have a lot of different ideas, and everybody has come to the table to try to help make this better. Proces i would say unfortunately our democratic colleagues have chosen not to participate in the process. This would be a lot easier in the product we come up with would be a lot more durable over the long haul if democrats would work with us. The fact is, in this amendment process that we are engaged in the will be engaged in this evening, any senator, democrat or republican, majorityment Minority Party member can offer an amendment and get about. I dont really understand why our democratic colleagues are sitting on their hands and wont participate in the process. I fear what they want is to change nothing about the structure of obamacare, notwithstanding the failed experiment of the past seven years, and then what they want to do is come back and throw money at the Insurance Companies under these cost sharing risk pools. What we we are willing to do what we need to do to stabilize the Insurance Market, but im not going to vote for an Insurance Company bailout without reforms. Uents leader mcconnell reiterated yesterday that our constituents are counting on us, and i can tell you the 28 million texans that i have the privilege of representing are counting on me and senator cruz to do our part to come up with a solution. So is the texan whose premiums have tripled and lost as doctor counting on us. The er employee who witnessed the emergency room busting at the seams with medicaid patients, people who ostensibly have coverage but cant find a doctor who will accept the new medicaid patient so they go to the emergency room. So is the Small Business owner that was forced to fire employees to avoid a 100,000 fine. That person is counting on us too. As is the young woman coming out Nursing School who is forced to change her plan three times, only to end up with a plan with Coverage Options she didnt want at a price she could barely afford. She is counting on us too. My constituents in texas and americans across the country are counting on us. D they are sick and tired of the bickering and the lack of productivity here in washington d. C. , and i dont blame them one bit. They are counting on us to free them from some of obama cares mandates that force them to make very tough economic decisions. Like the 28 Million People under obamacare who either pay a fine, about six and half million or the rest who claim hardship exemptions so they dont have to buy insurance. But in texas alone, there are more than 400,000 texans who earn less than 25000. Year, who cant afford to buy the insurance so they pay the fine to the government. Their government fin finds them for not buying a product they cant afford. Now is the time to deliver some relief to our constituents. They are counting on us to keep the deeply personal choice of healthcare plans andr doctors in their plan hands and not the federal government. It is time to deliver. My goal is to make sure we find a solution and get it to the president s desk. One of the most offensive parts of the Affordable Care act, or we should call it the unAffordable Care act since premiums have gone up 205 since 2013. H people were told that familyly of four would see a reduction of 2500 a year have seen their premium go up by more than 3000 and there are a lot of stories, im sure even in this room and this chamber were people have seen their premiums go up, up and up along with their deductibles, basically denying them the benefit of their insurance, but the individual mandate is a prime example of government getting in the way of individual freedom and the right to choose. The socalled individual mandat mandate, we really should call this the penalty that government imposes on its citizens for failing to purchase a product they dont want and in some cases dont even need. But it forces them to do so at a cost that was crippling and continues to be crippling for many individuals and families. Here is a shocking statistic. An estimated 8 million americans pay the Fine Associated with this mandate each year. 8million americans ared penalized by their own government. Theyre forced to pay a fine that can be used on coverage that might actually suit their needs. If obamacare would make it possible that the market could prosper and Insurance Companies offer a variety of products at different prices that they could choose from, maybe some of these folks could take the money theyre paying their own government as a penalty and actually buy mandate. Then there is the employer mandate, this is one of the most pernicious of the w mandates because i remember sitting with a friend of mine who hope happens to own a small Architectural Firm back when obamacare past and i explained if you have more than 50 employees then you have to buy or provide obamacare compliant health care for your employees and he said well, i may have to lay some people off because we have 54 employees so i have to fire at least four of them to get below the 50 threshold to avoid the fine and the insurance that i cant afford to provide for my employees. Lil this has literally been a job killing employer mandate. This is not some benign requirement. This has been one of the reasons why the economy has been so anemic, even since the Great Recession of 2008 and this is why so many people feel like the economy has not really covere recovered because it hasnt provided Job Opportunities and larger wages. This mandate is stifled business growth, especially among Small Businesses that are the primary job engine of our economy, and often time jobs were cut to avoid encrypting the business through obamacare fines. So americans have been forced to their own government no less. Government is supposed to serve the people, not the other way around. Nd americans have been forced by their own government to live under mandates and taxes and broken promises and collapsing markets for too long. This week is about keeping our promises, demonstrating that we can govern, even without the assistance of our democratic colleagues, and paving the way to tackle other important issues like tax reform, infrastructure construction, things we need to do to keep the economy growing and moving forward. We will be hearing more about a possible solution and a way forward, something i call the freedom to choose plan where we free the American People from the destructive impact of the socalled individual mandate. Te we free small employers from f the employer mandate, letting them hire the employees they need and not having to choose between that bankruptcy. And yes, we will push more power out of washington d. C. Back to the states. I know based on the Public Opinion polling ive seen,r sta people sure trust their statear a lot more than they trust washington d. C. When it comes to healthcare. We need the insurance commissioners, but a viable market to provide to them. It would be better if we could all come together to find a solution and engage in debate and pass the final product and get it to the president s deatdesk. Thats how the legislature is supposed to function. Unfortunately we are in unusual times when almost half of the senate refuses to participate in actually, they will be actively trying to undermine our efforts to come to the rescue of the people who are hurting as a result of the deception and the failures of obamacare. I dont know how you explain that. You certainly cant explain it to constituents like i have, and i bet you a dollar every single one of the senators was trying to blow up this process and undermine the progress were making, i bet they have constituents back home who are suffering the same way my constituents are, but the turning a deaf ear to them and saying you know what, politics and party and ideology are p more important to me than addressing the needs of my constituents. Mr. Pres i yield the floor. The senator from louisiana. Thank you, mr. President. Mr. President , i wish i could stand here today and tell you that the Affordable Care act, socalled obamacare has worked. I wish i could sit here and tell you today that the American People were better off as a result of the Affordable Care act. , but i cant do that and it gives me no joy in having to make a statement. Now, as you know, not a single republican voted for the Affordable Care act. Affordable care act was passed in obamas suggestion by the democratic members of theey house and the senate. They had a majority and in this body majority rules. I dont want to subscribe to the president or to her democratic friends, any ill motives whatsoever. They wanted what was best for the American People. It wasnt a question of bad motives. It was just a bad idea. Didnt work. Let me say this another way, i believe that president obama and our colleagues on the democratic side of the aisle in the United States senate and in the United States housema of representatives passed obamacare with the best of intentions. But you know what, 150 years ago, mr. President , i know you also happen to be a physician, 150 years ago doctors used to b believe their patients andio they stopped doing that. Hey they didnt have any bad motives in doing it, they did it because they thought it would help the patients. Kille it killed many of them. So, they stop doing it. We were told when the Affordable Care act, socalled obamacare, i dont mean any disrespect and calling obamacare, president obamaers himself refers to it as obamacare, when the united c states congress, democrats and the United States Congress Passed obamacare, i remember well what we were told because i wanted to believe it. The president said, if you like your insurance plan, you can keep your insurance plan. I think he meant that at the time. Turned out not to be true. The president said if you like your doctor you can keep your i think thats what he wanted, but you couldnt. He said, the Affordable Care act would cover every american and cut the cost of a typical families premium by up to 2500. Year. Not not even close. He said, president obama said it would bend the cost curve for healthcare. He said without adding one dime to the deficit. None of that was true. I think h i think the president meant it at the time. I i think he wanted it at the time, i know i did, i know you did, but he just turned out not to be true. The simple fact of the matter is, i think every reasonable person that the Affordable Care act has not worked for the American People. Lets talk about the exchanges. As you know there are two parts. There are the exchanges for which people go and buy insurance directly from an Insurance Company, and theres the Medicaid Expansion. I want to talk about the exchanges for moment. In 2016, under obamacare, we started out with 281 Insurance Companies offering insurance to the American People. Good start. The problem is, now we have 141. They are dropping like flies. In my state in louisiana, we are down to three. Cou a third of all of the counties in america have only one choice. One Insurance Company that will still write insurance. Many have zero, none, not a. They cant get insurance at all. They been given a bus ticket n but theres no bus. In louisiana, let me talk about our state for a moment, in louisiana, premiums have gone up 123 on the exchanges since 2013. That is an average of 3600 increase. Plan. Nationwide, the average obamacare plan now cost 105 more than when it started. That is 3000. Person. Whats particularly incredible to me mr. President , you knowo these statistics better than i do, in louisiana, we have,000 136,000 people who, rather than buying insurance off the exchanges, have chosen to pay the fine. Let me say that again. 6,000 pe 186,000 people in my state have looked at the insurance offered to them with the subsidies and said we would rather pay the fine. Of that 136,000 who said i will pick the fine instead of the insurance, of that 136,000, 84 make 50000 or less. 48 of them hav make 20000 or less. You know what that tells me . That tells me 136,000 people in my state, most of whom are too poor to be sick, they looked at the Affordable Care act plan and said we can afford it. Wed rather pay the fine. We are better off paying the fine. Their outofpocket, the money for the fine, and they still have insurance. No reasonable person would call that a success. Mr. P let me give you a couple more examples. Er we talk around here in concepts, and we all know what were talking about, but the average american who gets up every day and goes to work and paces for her taxes and tries to do the right thing by their kids and tries to save some money for retirement, they dont have time to dealing concept. They just want to know what kind of Health Insurance do i have and whats it going to cost. Let me give you some examples right now from louisiana. This is brought to you by the Affordable Care act. Lets suppose im a 60yearold nonsmoking mail living in baton rouge louisiana. Im making 50000. Year mr. President. Dn according to healthcare. Gov, according to healthcare. Gov the cheapest and most basic plan available to me would cost me 689. 14. Month, with the 4500dollar for a total of 9000. Year. Im living in baton rouge, making 50000 and the federal government said we have a great deal for you. Past 9000 and we might be able to give you some healthcare for that 9000, what do i get . Suppose i say okay heres 9000. The note know where im gonna find it because im only making 50000 a year and the government is taking some of that for taxes, but i find 9000. You know what i get. I get for doctor visits i get to lab tests i get nine Prescription Drugs and additional metal cost for a grand total of 100. Thats not insurance. That is giving someone a bus ticket without a bus. Lets suppose im a 50yearold female. I dont smoke im living in lafayette louisiana which, as you know is to the west of baton rouge. Im making 50000 a year in lafayette. The most basic plan in lafayett lafayette, once again, im 50 years old im not 60, im a female and i dont smoke. The most basic plan i could get would cost me 450 a month in premiums with the 4800 deductible. Thats a grand total ofnto 6550. Ive got to come into my pocket for 6550 before i can get any kind of Health Insurance. Mr. President , thats not Health Insurance. I would remind you, you know this as a physician whos been on the front lines caring for people, and god bless you for that, you know as well as i do, the options i just described, there the cheap ones. Theyre the most affordable ones. Thats the best case scenario. Nobody wanted this. I know president obama didnt want to turn out this way. I know our friends on theor democratic side didnt. They wanted what was best for america. It wasnt a bad motive, it was just a bad idea. What do we need mr. President . Everybody has their own opinion of that and thats what we will try to convince each other over the next fewll days as we vote. De i think in the Healthcare Delivery system we dont need more government. I know some of my friends on the democratic side, they think they have the solutions, and i respect them for all the time and care theyve put into this, but some of my friends on the democratic side say weve got the solution. Government has failed we will admit. Ro they dont say very loudly, but they privately say we realize government has failed with obamacare. Our prescription to fix it is more government so lets go to a singlepayer system. Lets have the federal government to be in charge of everybodys healthcare and lets let the federal government regulator doctors and nurses and or hospitals in our health Insurance Companies and their patients in our lab techs like there were utilities. Mr. President , ive lived under a system like that word england has a system like that. You cant name me a single g20 country, not one that has a singlepayer system that is working. Its not the answer. Ken mr. President , quickly, because im running out of time, heres what we need. The senators time has expired. I will conclude. Thank you for your time and attention. America needs a Healthcare Delivery system and deserves it like somebody designed the po god dog thing on purpose. Flooro there has been a lot ofts, talk about the Skinny Healthcare package. If you believe the report, it was going to be written today as the Senate Republican lunch on the day the senate is supposed to vote, the future of American Healthcare may have gotten an overhaul between the salad course and the entree. I would like to talk a little bit about where things are and really contrast these reports p about the Skinny Health package with the process that brought together the Affordable Care act, our colleague, president of the senate now serves on the finance committee, there were dozens of hearings about the Affordable Care act. There were dozens of hearings and health committee. Both committees have markups that lasted longer than a week and incorporated ideas from both sides. I was a Junior Member of the finance committee at that time, and i remember a flock of republican amendments being added in the finance committee to the Affordable Care act. When to the floor of the Senate Debated it for 25 legislative days. It was the second oldest consecutive debate in history. We are not seeing anything that resembles that today. We got a rush job, and im minutes talking about what comes out when you have a rush job and some of the red flags that i think my colleagues, particularly some on the other p side of the aisle who are thinking about voting for the skinny package might want to think about. Any senator who believes that medicaid makes it out of the skinny package, without taking a hit are to take a look again. Senator murray and i spent a long time working with the Congressional Budget Office to get them to do some analysis with some of the ideas that are part of the cbo package. What the Congressional Budget Office said, and they are the impartial nonpartisan umpire is that under the skinny package that is not supposed to do any harm to medicaid, the Congressional Budget Office said medicaid gets hit with the 220 billion reduction under the socalledof skinny proposal over the course of a decade so if you are one of our colleagues on the other side of the aisleon who said you really feel strongly, you really feel strongly about medicaid, and about seniors data medicaid we all know picks up the cost of two out of three nursing homef beds, it covers a wide variety of communitybased services. Ive really just loved to watch the development of those communitybased services. We started them in oregon back in the days when i was the director of the great panthers, and the idea that medicaid, in this socalled skinny budget according to the Congressional Budget Office would get hit with a 220 billion reduction is something my colleagues on the other side of the aisle who are saying the skinny package is going to have any implications for medicaid we want to take a look at because i think the Congressional Budget Office is saying there really are implications for vulnerable seniors, for kids with special needs, for the disabled, for all of those americans who are walking on an economic tight rope every single month, balancing the food costs against the full fuel cost and the fuel cost against her health bill. The numbers on skinny repeal show that 16 million americans lose coverage and premiums will jump by 20 immediately if it becomes law. A Industry Experts are saying there isnt any way that this can work. It just causes too much uncertainty. Its like pouring gasoline on the fires of uncertainty in the marketplace. Republican and democratic governors have come out against the skinny bill, and by the way, as the ranking democrat on the Senate Finance committee, i guess we have one 100 of the senators were herei who serve on the finance committee, i dont even see republican senators making much of an attempt to defend the skinny bill on the merits. In fact, many of them, in the halls seem to be telling folks, including some folks in the press that theyre kind of worried about it becoming law. There are a few directions for this process to take. Its possible the house could, if you pass it, just take out the skinny repeal and then they could pass it. My guess is, when people think around here about what that means and what these cbo members and the premium hikes an application for medicaid, i think people look at those numbers and theyre probably getting a little heartburn. Republican colleagues in this chamber you are thinking about. [inaudible] the other possibility is that passing the skinny repeal bill leads to a conference. Im telling you, if it heads to conference, skinny repeal is sort of a gateway drug to trump care. The fact that a conference is going to fix every problem and j solve every disagreement is just fantasy. If this gets to conference and suddenly theres a new republican replacement plan that everybody likes, thats about as likely to happen as my joining the nba for the upcoming season. Ate lets take an honest look at how the debate has unfolded. Republicans have had seven years to come up with a replacement for the Affordable Care act that they can allvi agree to. Obviously, that has not worked out. In the senate, the process flatlined until the majority leader began michelle gain that culminated in todays vote. There were 50 votes for trump care here in the senate, there were 50 votes for repeal. Thats why skinny repeal is the only proposal left on the table, and as i indicated, who knows what was done at the republican lunch between the salad course and the entree today at noon. Lets be clear about whats likely to happen when the house gets involved. It guarantees members of this body are there to protect their constituents. They are out the window. Kids with disabilities and older people, say a baby boomer, and my colleague in the chair, a skilled physician understands this. If youve got a baby boomer whos had a stroke, late nursing home, theyre going to really face some challenges in terms of how to be able to afford that care with the kinds of cuts that cbo has set on page one that they believe will take place in medicaid. Rural hospitals, we know there the economic engine of communities. Ive made eight stops on a roll healthcare listening to her in my home state, and what we see is without roll healthcare, you are going to have rule life. It will be particularly important because other efforts could conceivably result in seniors between 55 and 64 paying five times as much as younger people and get getting fewer tax credits. Wit no one can honestly say the millions of americans with preexisting conditions willcr be shielded from discrimination, and what a step backwards that would be. Efe mr. President , before you weren here in this body, 14 senators, seven democrats and seven republicans joined me inan the 2008, 2009 time. And many of them are stillll here on both sides of the aisle, republicans, democrats and we wrote a bipartisan bill that had airtight whole free protection for those with preexisting conditions. They got it in the Affordable Care act, all the senators on that bill should feel pretty good about taking a big step to move america away from healthcare that is just for the healthy and wealthy. Now we are talking about the prospect of policies that will walk that back. So, its my view that the clear choice for my colleagues who dont like the risks in skinny repeal, and dont like trump care is to reject the process. It seems to me the surest way to prevent a bill you dont like from becoming law is to vote against it. Quaint idea. Just vote against it. Als now, i want to turn also to another bit of breaking news which comes from our parliamentarians who do so much good work and its an extraordinarily stressful job. Another key part of the republican plan has been deemed ineligible in the past few hours to move forward the partisan approach, reconciliation. The decision pertains to proposal that lets states undo the Consumer Protections builtc. Into Insurance Marketplaces under the Affordable Care act. Hold that proposal will not give fast track privileges or a 50 vote threshold under reconciliation here on the senate floor. Heres what that section of the bill was all about. I wrote a provision, again, ara group of bipartisan senators, 14 individuals can take that for this as well. An issue that the engine theyla have talked about a number of times, letting the states be the laboratories of democracy, taking the lead on Creative Health solutions. 14 out of our bipartisan bill, wer. Said we are going to give the states the chance to do better. The states would have a chance to do better. When we did it, we got some slack from all over the political spectrum. N we pushed very hard and we gotio it in to the final legislation. It was about providing flexibility to the state because so many on both sides of the aisle, my guess is ourm friends from pennsylvania, and anyone who is on the finance committee has heard again and again, state officials, business leaders, and others have said if you just give us the freedom we can do better. Gu those who give us the freedom to let us do words, they say give us the freedom to let us do better. Thats what section 1332 was all about. They said they could chart their own course on healthcarete as long as they were going to do better. Better for coverage, better for affordability. They made it clear, if you feel you can do better, if the Louisiana Legislature said you know, weve got ideas, weve got ideas for what works, i may not work for or again, begin is the freedom to go do our thing. Thats in the Affordable Care act. The freedom to do better. Ouisiaa i would be the last person to tell my friend from louisiana, still a physician who has a great interest in healther policy, id be the last person to say hey, im going to dictate in louisiana what an approach involving the waiver should be about. Quite the opposite. Im prepared to say to louisiana and pennsylvania and all of our colleagues, youve got ideas that will do better by people that are coverage more affordable, god bless you and your constituents. Goi thats what 1332 is all about. We said all we are going to say is we have to have some basic Consumer Protection. You cant just get a waiver and do do nothing or spend the money on a park project. Youve got to do better by people. Better by people. Better coverage, more affordable coverage. Have basic Consumer Protection. D senate come care bill tried to basically throw those Consumer Protections out the window. States would be able to get waivers to opt out of basic Consumer Protection, basic vanilla Consumer Protection for coverage and affordability. My view was that stuff is a backdoor way to set up junk insurance. Junk insurance that would were much more than gauze bandages and aromatherapy. Some people may wonder why this is important today since the senate resoundingly voted down the Better Care Reconciliation Act earlier this week. The answer is my colleagues on the other side still seem to be trying to shoehorn this scheme for worse coverage, not better coverage under a waiver into skinny repeal proposal the senate will vote on in the matter of hours. The decision has come down the decision has come down from the parliamentarian that c regulatory changes that got Consumer Protection that was right at the heart of that waiver in the Affordable Care act isnt going to fly. Frankly, i think it calls into question what the parliamentarian said. It calls into question whether any of these big anti consumer schemes are gonna get 50 votes. This is yet more uncertainty ahead of Senate Republicans if they pass the skinny repeal bill and the debate drags on. Now, at the risk of boring our wonderful pages and the staff you have heard me on the floor saying this before, there is a bipartisan approach. I think ive shown my bona fide over the years with respect to bipartisanship. Wi i mentioned our universal coverage bill. First time republicans democrats came together and said this is something theres Common Ground because of common sense. Ive worked with colleagues, perhaps some of the most conservative members of the congress should to move dedicate m that has what i wanted to dedicate my entire professional service too. Ith bipartisanship and health. Ever since those days with the oregon panthers, thats what i thought was the most important thing because, if senator toomey, the presiding officer, all our colleagues and all the people here, if you dont have your health, then pretty much Everything Else is upheld. Healthcare has always been the most important issue and important issue youve got to deal with in a bipartisan way. I have said, which is why a wanted to alert the pages in the professional staff about the prospect of true boredom and just nodding off for the afternoon that there is an alternative. If republican drop the reconciliation our way or the highway approach, colleagues on this side have said they want to work on a bipartisan basis. Needs it doesnt take Rocket Science to figure out what that needs to be. The first thing that democrats and republicans would do is stabilize the private Insurance Market, first thing. Everybody over here says the Affordable Care act is far from perfect, and we have colleagues here, senator kaine with his reinsurance proposal, senator shaheen with her cost sharing effort, senator mccaskill to try to help areasic where there is little or no coverage, and im certain there are republicans who have ideas that would be part of a good bipartisan package, if we drop this our way or the highway partisan approach. We ought to be working together to bring down Prescription Drug prices. Ive spoken on a number of occasions at the presiding officer about the fact that literally, out of nowhere over the past few years, weve saw a whole industry develop b around Prescription Drugs or a bunch of middlemen are supposed to be getting the consumer a good deal on medicine, but nobody knows what they put in their pocket and what they put in the consumers pocket. Theyre called pharmaceutical benefit managers. I said how about a little sunlight on that. Have a little sunshine. I should think people ought to be able to Work Together on those kinds of things. That colleague is not what is on offer right now. I urge my colleagues to say we are getting out of this game. Nobody has to accept the skinny repeal option or the dictate of the other body. If you are unhappy with the option on the table, and i hope more people will be unhappy now that ive outlined what some of the key considerations are in this Budget Office report. 20 working hard to get, i hope some people will think again, especially on the other side of the aisle about voting it down. 20 premium hike, those go into effect january 1 of this year. I expect we will have more information on it, but i think they will be 20 hikes after that. Thats real. Thats not what some Interest Group made up or some liberal partisan or anybody else, thats what our impartial umpire found. So if youre unhappy with the proposal with those kinds of options, you are about it down and i want to close by way of echoing a point that so many colleagues on this side have said, this is not about saying look, were just against what you want to do. Quite the opposite. For all of my time and profession in public service, i said what i want to do is find Common Ground with people of common sense. Let us defeat this skinny sham g shell game process that looks like what we are going to be voting on tonight, and then get serious about were doing what legislators do which is not take peoples crummy ideas but take good ideas and work on them in a bipartisan way. Failed for. Mr. President. The senator from pennsylvania. Mr. President , i ask unanimous consent is become healthcare topic for 15 minutes. Without objection. Mostly thank you, mr. President. I am going to speak mostly about the medicaid reform proposed in the be cra, but in the course of the discussion, i will touch on some of the issues our colleague who just finished raised. As we know, the be cra bill b will not be the vehicle that we will take to a Conference Committee with the house, but i hope we will get to a Conference Committee with the house, and i hope the results of that, among other things is that we will address the need to make important reforms to medicaid because they are long overdue. That let me start by introducing, ill start with the chart that illustrates our federal deficits and what exactly issp driving our federal deficit. The fact is, i think we all know we have two big categories of federal spending. One is the Discretionary Spending that Congress Approves and congress is discretionary year in the other category are the programs that are on autopilot. The spending is driven by a persons eligibility for the program without Congress Acting in any way. That latter category we call mandatory spending and in 1980, that was only 50 of the federal budget. By 1995, it was 64 . Last year that was 70 of our entire budget and we are on a path to have these mandatory spending, you can see the growt growth, you can see the relative lack of growth in the other categories be it fence or nondefense spending. The budgetary problem we have is mandatory spending. This not breaking news. This is nothing thatson controversial. No anybody who has taken an honest look at the numbers can come to know other conclusion. The discretionary portion of the budget which used to be the lion share of the budget has been relatively flat. Actually its even declined in recent years. The mandatory spending has been going to the roof. Of course there are multiple problems with this, not the least of which is with this kind of growth and mandatory spending, the first it does is squeezes out all other categories of spending. Is we are already living through that as the Discretionary Spending, including our Nations Defense have been declining because you can do so much of both, but in time maa you could zero out all the Discretionary Spending and there still wont be enough for all the mandatory spending that is coming our way if we stay on the path we are on. Where does all this mandatory spending coming from . The next chart shows that pretty clearly. The bulk of mandatory spending n , especially in recent years is from medicaid. The reason i say that is Social Security is a big program, but Social Security has a deck dedicated revenue stream. T while that fluctuated when we suspended payroll tax, by and large payroll tax pays most of the Social Security cost that we have daytoday. It medicare also has a revenues stream that is dedicated but it doesnt cover nearly as large a percentage of medicare cost is Social Security so you see the green line generally is higher than the blue line, but the line thats higher than all is the medicaid line. There is no dedicated revenueam stream to medicaid in the net expense, therefore is by far the biggest of all our entitlement programs. Medicaid has been growing at a shocking rate for years. In 1980, medicaid spending was only 2. 4 of our budget. Half a percent of our economy. By 95 is almost 6 of our budget and today it is 10 of a our whole budget. 17 of all healthcare spending. So, this is happening because medicaid is growing much faster than our economy is growing. The fact is, no federal program can grow faster than the economy indefinitely because the economy has to fund the federal government. Hopefully thats only a portion of what our economy isro doing. The main purpose is to provide a livelihood for the people who created. Medicaid, as you can see is very this summarizes the very definition of an unsustainable federal program. Consumi as it continues to grow at a rate thats much greater than our economy, it necessarily is consuming an ever grading percentage and portion of our economy. Nothing can grow faster than the economy indefinitely. This is the very essence of what is unsustainable. You dont have to take my word for it. Im certainly not the first person to observe this. We could take the words of democratic president Billl Clinton who told us this very thing. Wi he said back in 1995, and i quote, president William Jefferson clinton said, we all now, looking ahead no that our number one entitlement problem is medicare and medicaid. They are growing much more rapidly than the rate of inflation plus population. Icaid. President bill clinton wasnt making this point because he is some kind of ideologue that wants to get rid of medicaid. I dont think hes ever been accused of that. S its not because hes got some passionate ideologicaler commitment to reducing the size of government. I dont think hes ever been accused of that. I think bill clinton was making this point because he knew this program was unsustainable and he wanted to reform it so it would be sustainable so that our federal budget would be sustainable, so medicaid would be there for the next generation. Is i think that was bill clintons motivation at the time. What was his solution . What was it that bill clintonro thought we are to do about this program that was unsustainable. President bill clinton suggested that the federal government put caps on the amount of money that would contribute to the states based on the number of individuals enrolled. In other words, it was a. Beneficiary limit on the federal contribution. Thats what bill clinton proposed in 1995. He wanted to maintain the eligibility of individuals to participate in the program, but he wanted but limits on what the federal elements share would be and he wanted to have it grow at about the rate that the economy would grow. As bill clinton knew, the program would be sustainable over time. We would be able to afford it. We might wonder, what did congress think of this idea . Etr beneficiary caps on medicaid expenditures by the federal government, and lets limit the growth of those caps to about the growth of the economy. That was bill clintons idea. Well, helpfully the democrats who controlled the senate decided to weigh in on the matter. And on december 13 in 1959, senator patty murray, who serves with us today, she submitted a letter to the congressional record, and im going to read a very brief comment that she made when she comment that she made when she that she made when she submitted this for the record. She said, senator murray, the senior senator from washington said mr. President i hold in my head today a letter to president clinton that is signed by all 46 members of the democratic caucus. This letter urges him to hold firm to our commitment to basic health care for children, pregnant women, the elderly and the disabled in this country. This letter supports a per capita approach to finding savings in the medicaid program. It was signed by every single democratic senator. They expressed their strong support for the medicaid per capita cap structure. Now, i want to be very specific about this because as they develop the particulars, they decided that the caps should not grow at an index that was tied to Health Care Spending here they wanted it to be tied to an index that would grow with the rate of the economy overall. As a proposal going to affect the very next you. Ti they didnt want to wait, they didnt want to have a transition. They wanted it to go into effect the next you. A proposed implement the changes for the very next fiscal year. So, mr. President you can imagine some of us a little bitr surprised by the shrill over the top attacks we have been hearing from the other side. We republicans have been accused of launching a war on medicaid. Weve been accused of draconian cuts. Weve been accused of wanting to decimate health care for the most vulnerable. We could go on and as you and i both are all across the countryo on this floor in every form imaginable our democratic colleagues have attacked pr republicans for the proposal in the bcra bill that weve been considering. Out whats so really outrageous a about this is we propose a democrat solution. What w what we proposed was bill sin clintons idea as ratified by every single democrat serving ia the senate at the time including several who are still with us today. We proposed that we take medicaid and we restructure the way the federal government reimburses states for their expenses so that we would putry. Caps on the amount the federal government would contribute to a beneficiary and we would allow the caps to grow but just as president clintons all the democrats in the senate suggested, we would make sure that growth eventually converges to the growth of our economy so that we would have a Sustainable Program. Two big differences, mr. President , between what the democrats propose in the mid90s and what many of us have proposed these last few weeks. One is we propose the change occur more gradually. We suggested that we would implement these changes but we do it over time, not suddenly the way they have proposed it. And the other big difference i would suggest is that they proposed this structural change to medicaid before obamacare came along and made in aposi Sustainable Program worse. Ng it were proposing it in the. Aftermath of that huge problem. So i get that our democratic colleagues have done of 180 reversal. I get there no longer i unsustainable. I get that they dont want to do anything about entitlement. I understand that if you are entitled to change your opinion, entitled to decide you want tos ignore this issue. But its a little bit overthetop to attack our motives, our integrity, when wey are proposing exactly what theyve been themselves proposed just a few years ago under president clinton. So i wish we could have a substantive discussion about the policy without the character attacks. Let me get into a little bit more about these changes to tra medicaid. As you know very well, mr. President , traditionally medicaid was available from the time the program was launched in for candids of americans can four categories of people who were of very low income and were deemed to be unable to Purchase Health care for themselves. Those of the elderly poor, disabled, blind and disabled,de. Children, and adults with the dependence. So the program set up a a G Partnership with the states, the generous partnership. The federal government has always paid a majority of the costs, ranging anywhere in some states si 75 of the cost, and other states, no state less than 50 on average could be 7 pick obamacare came along a created in the category of eligibility. Under president obama for the under obamacare, a new category was created and that is adults working age ablebodied people with no dependence would now be eligible for medicaid if the income is below 138 of the poverty line, and the federal government would pay all of the cost initially and then after a short period of time it would go to 90 and then the federal this des perpetuity. Just a few problems with this design. The most fundamental and obvious is the federal government could not afford this. We would not unsustainable pathy before, now weve created this whole new liability. I can only make it worse and bring a fiscal crisis closer to the present. And the second thing is when states have no skin it again wem find out that they behave as though they have no skin in the game. Nk when states had to country would only 10 of the cost, think about it for every dollar estate spent in this category get matched with nine federal dollars. And guess 93. Thats huge incentive to spend a lot, guess what, thats exactly been done. Medicaid spun in this category has ended up being over 50 mor than what was expected. So what did the senate propose an hour legislation . This we propose not that we would disallow this coverage, not that we would eliminate this category of eligibility, not that we were through a Single Person medicaid. We said we will codify the expansion make it permanent. No one loses eligibility. No one gets thrown off. But what we do is gradually over seven years we will ask states s to pay their fair share for this new category, this expansion category, the ablebodied adults with no dependents. We will ask the states to pay the same amount for these folks that they pay for the traditional four categories of eligibility. Thats the first category. The second reform that we propose is what i alluded to earlier, that bill Clinton Democratic Senate proposal of establishing per beneficiary caps and that was in ourt legislation. Those caps though what the underlying senate bill did was allow the spending to grow very rapidly on those caps. Only in the eighth year did we ask that the growth rate would slowdowns slightly so that without a reasonable chance that the growth in the program would be about the same as the economy. So thats what we have proposed. That was what was in the bill. Thats what been hearing about all these draconian cuts. So lets get into this discussion about these cuts. We have another chart that illustrates some of this. This is been a favorite theme for some my colleagues on the other side to talk about all these cuts. If you look at cbo score, now again this is the senate bcra, the legislation that we didnt get enough votes this week to pass this, but i hope we will revisit this. The largest of the socalled cuts in medicaid spending comes from cbos assumption that if you repeal the individual, the statute that says you must buy insurance, you must have insurance, if we repeal that, millions of people on medicaid, and billions of people who get insurance will decide i dont d want free Health Insurance anymore. I am not being forced to buy, im not going to take free health care. Why would i do that . Okay, i dont know that you but thats a little counterintuitive to me. And to my friends from oregon who is attacking the socalled skinny bill, 100 of the socalled medicaid cuts in that bill come from exactly this source. The assumption that if people are not forced by the government to have insurance, they wont want medicaid. You can decide how much credibility you want to put in that assumption. It strikes me as ridiculous, but thats the truth. Thats the reality of the socalled cbo cuts in medicaid. In the bcra that was only the lions share of the socalled cuts. Another category of socalled cuts to medicaid in the cbo analysis of the bcra is theirs assumptions about expansion. They decide that under current law if nothing else happens a s whole lot of state will choose they to become Medicaid Expansion states. E they havent made that choice ship. They cant point to which once. Its a political decision in the first states. They dont know whos going to be leading. They have no idea about how that would happen but yet they predict that states that are chosen thus are not to be Medicaid Expansion states would adopt the expansion under current law. But if we passed the law thats, that was proposed earlier, though states will not make that decision and furthermore some states that have expanded will resend the decision to expand. E any honest person including the folks at the cbo have to acknowledge this is entirely speculative. Its entirely speculative. They cant name a single state that will expand under the a current law but hasnt yet. They cant name a single state that would resent this expansion having already done so. They are to speculate that could happen. That, my friends, is the lions share of the cbos headline and medicaid. O and despite that, go to chart five, despite that, even if you accept cbos unbelievable assumptions that people only participate in medicaid if they are forced to and that these mysteries states will expand and others wont, even if you accepc all of that, these are the dr. Cohen in cuts, each and every year under the bcra federal spending on medicaid grows. It grows every year. Every single year except only in washington can spending increase every year and its a draconian cut. No. The truth of the matter is what we do under that legislation is we slow down the rate of growth. We slow the rate at which the program grows to a rate that is sustainable so that this program is viable so that we are the diminishing the certainty of fiscal crisis. Thats what we do. Now, if someone has a better idea for how we put medicaid on sustainable path, im all ears. V id love to hear it. And we did in the 90s, our democratic colleagues proposedol exactly what were proposing now. That was a very constructive idea. Unfortunately, there wasnt a consensus to do it and thats a shame. But i would urge my democratic colleagues to go back to the notes can go back to the discussion, go back to the arguments they were making together with president bill clinton on the floor of the senate at around the country about medicaid because were making those arguments now. You think we might be able to a find some Common Ground. Medicaii mr. President , the fact is medicaid is a very, very ameri important program. The most vulnerable americans depend on medicaid to every it significant degree. The fact is in its current form it is unsustainable. Our democratic colleagues in the past used to recognize this. The use acknowledge this and be used to want to do something about it. I urge them to return to that attitude so that we can Work Together and get something done. The sooner we act on this the sooner we can have gradual, gradual, sensible, thoughtful reforms that makes the Program Sustainable and allow our states to plan for this change and allow for a transition. If we wait too long the fiscal crisis that will hit us will force sudden and dr. Cohen in changes. Mr. President , when i going to vote on this provision today. This was embedded in the bcra. That is behind us this week, but it is my hope that we will pass a version of Obamacare Repeal that will enable us to go to conference, that will be able to begin to repair the enormous damage to the individual market that obamacare has done, that will be able to move in the direction of consumers actually having control of their own health care, once again and that will put medicaid on a sustainable path because the time is overdue. I yielded the floor. N how the senator from oregon. How much time remains on oure side . Three minutes remain. Im going to be very brief. Just to respond to my friend from pennsylvania. Number one, none of what he has discussed has come up in the Senate Finance committee. What i can tell you about past debates is our side was always interested in reform minded ideas. Y for example, bring the private sector into the delivery systemt of medicaid. Thats number one. Number two, we still have not seen the skinny bill. Ha i said earlier who knows what happened to the Republican Senate lunch between one course and another. Would like to see the skinny bill. And i think once again weve heard from the other side that they disagree with the umpire. They disagree with the nonpartial cbo. And i think thats unfortunate. With that, mr. President , i yield. Mr. President . The senator from wyoming. Mr. President . G the senator from iowa. I asked for consent to speak with up to 70 minutes. Its my dissent if the managers the time to break into my speech ill be glad to accommodate that. I rise today to object those badly needed reality into this very important debate. Health care is a profoundly personal issue that matters to every single american. In fact, every single senator in this body ought to agree on this point. Health care hits home for each and every constituent we represent from our home states. W from Standard Wellness checks to lifesaving cancer treatments, each of us wants the best, most effective and Affordable Medical care for the people we love and for ourselves. As policymakers, its our job to solve problems. And it goes without saying that we are facing a big problemacces right now. Access to Affordable Health care is simply out of touch for millions of americans. And thats despite the promises made over and over again. Remember that obamacare was rammed through on a lastditch Christmas Eve party line vote. Look at what that got us. Health Insurance Markets are collapsing around the country. Since 2013 the average premium increase on the individual market has jumped 105 . Remember when president obama promised Affordable Health care for all, he promised we could keep our doctor, promised that americans they could keep their health care plan. And he promised all americans that the premiums would go down now by 2500. Now, we all know obamacare did not uphold these promises. Instead, we got higher taxes, costly penalties, doubledigit premium increases and unaffordable copays, job and wage crushing employer mandates, and thickets of federal regulations. And now obamacare is collapsing. No one on the other side of the aisle has made an attempt to desp legislate remedies to the law, despite its grave condition. At this very moment, 72,000 islands in islands in my home state are gripped with uncertainty. Ta to insurance carriers have dropped out of the exchanges leaving only want to offer the p january. The policies offered by that Insurance Company will go up over 40 next year on huge increases, on top of huge increases this year, making it still unaffordable. Obamacare is unsustainable, unaa unaffordable, and unacceptable. This brings me then to the reality check that i mentioned when i started. As i listened to some of my colleagues on the other side of the aisle, i am frankly astounded that they can deliver people to straight face. Ha they would like the American People to believe that republicans are dead set on eldy ripping health care highway frm children, the elderly, and the disabled. Despite their redhot rhetoric we have neither horns nor tails, but we are dead set on working out the devilish details to get to yes. Democrats hyperbole and fear mongering are standing in a way of getting the job done for the American People. Fear is easy to achieve. Legislating in good faith is hard work. Obamacare defenders would rather disparage than engage. Ng they would rather obstruct a path forward then to construct a path forward. They are standing in the way of solving problems, and in the process they are scaring the living daylights out of stret hardworking americans who are able to stretch their paychecks to afford Health Insurance for their families are not if theres one job the defenders of the Big Government have mastered, its the role of chicken little. They squawk, clock and crew at every opportunity to grow the size, scope and reach of government into our daily lives. To their way of thinking, a obamacare was a step towards say singlepayer. They will say and do whatever it takes to secure sweeping universal government control the health care system, no matter how much it costs the taxpaying public. Personal economy or the loss of personal freedom. Their message is dead wrong. Our Reform Efforts are making, are not making the sky fall. The democrat rhetoric reminds me of a similar situation, the debate 20 some years ago, was to reform welfare by reining in runaway federal spending and increasing the independence of. Individuals. Just like now, that debate was full of dire predictions. Some of my colleagues will recall the late senator Daniel Patrick moynihan, new york, chairman and then Senate Finance committee. He strongly opposed efforts to reform the welfare system. He predicted that the bipartisan proposals would result in an sa, apocalypse, and said, quote, its been ten years time it we find children sleeping on ana asked why are they here scavenging, awful to themselves, awful to one another, well, will anyone remember how it began . It will have begun on the house floor this spring, and the Senate Chamber this autumn. Thats the end of the quote 20 years ago from senator moynihan. The facts will show that welfare reform was, in fact, not, quote, legislative child abuse, unquote, as the former senate of massachusetts ted kennedy predicted. Quite to the contrary. Welfare two decades since the start bipartisan welfare reform was enacted, reality shatters this doomsday prophecy of 20 years ago. The reality is that our level in in poverty has fallen to its lowest level in history. The problems still exist and deserves our attention, of course, the 1. 5 million fewer million fewer children are in poverty today. Three in four more families are independent from assistance. At the time of welfare reform, the chicken little forecasted homelessness, poverty and despair. Send moynihan also said that requiring welfare recipients to work and limiting the length of time that they could collect benefits added up to quote the most brutal act of social policy since reconstruction. Those involved will take this disgrace to their graves, end oy quote. With all due respect to the memories of my formerc colleagues, their rhetoric simply does not square with reality. In 1996 welfare reform law lifted millions out of generational poverty. Replacing lifelong l impoverishment and lifestyles oy dependency with livelihoods restored with hope and opportunity. These facts separate democratic reddick from reality rhetoric. From the absence of a credible reason to continue with obamacare is failure, the only defense tactic left to the democrats is fear. In a similar vein to her predecessor from new york,esidel former senator and democratic president ial nominee hillaryhis clinton said, quote, if republicans pass this bill, they are the death party come into court. Another senator from massachusetts said quote, i would read the Republican Health care bill. This is bloodmoney. They are paying for tax cuts. With american lives. They are not alone in their obstructionism. The minority leader has said that republicanled efforts to reform obamacare are quote heartless. It is a wolf in sheep clothing. It brings shame on the body of ththe senate. Another democrat chimed in that this senate bill is downright diabolical and with the additional quote one of the blackest marks on our national history. Still another democrat said his constituents are quote scared for their children. They are scared for their spouses. They are scared for their aging parents, and scared for their own health and wellbeing. Another one chimed in quote, our Emergency Rooms will be overwhelmed. They would be unable to deal with the scope of that kind of humanitarian need. Not surprisingly, that was in the school, not surprisingly the laws championed chief president obama has fueled the fear factor saying that americans efforts to reform the Health Care Law would put pregnant mothers adding children with disabilities and poor adult in harms way. Such overheated rhetoric showsto democrats have abandon rhyme, reason and reality. Too often the arguments from the other side are based on what medicare was supposed to do, not what it actually did which phile fall short from projections by the experts. Defenders of obamacare aree reaf relying on a phantom rather than the reality of the law. Democrats are refusing to work with us towards a better solution that actually works. After years of neglecting consequential problems with a partisan past law now on the books. They say they have a better deal. Let me tell you, thousands of iowa families and Small Business owners have contacted me with their personal stories of hardships. To them, obamacare has been nothing but a raw deal rather than a better deal. What good is having insurance, they say, if its too expensive to use . After more than seven years of obamacare, the chickens have come home to roost. And in less than ten years look what happened when governmentt gets in the way of the free market and consumer choice. No, its obvious. Higher premiums, bigger copays, fewer choices, less freedom. Health insurance that cost too much to use is just not working for hardworking americanh families. Ill in my speech today with an appeal for an iowan from a boca iowa. Is contacted me many times about the hardships of her family hasp experienced since obamacare was enacted. She pays more than 25,000 a year to ensure her family and individual market. If that sounds like a chicken f feed to some of the obamacarede, defenders, i urge you with all sincerity to get your heads out of the clouds and join us to fix republicans and democrats can Work Together for the greater t good of the country. It is said when there is a will theres a way. Half obamacare isnt working as promised. He half of us voted this week to move ahead to fix this problem. The other half is blocking any effort put forward to reform the broken law. They are digging in their heels and pulling out all stops of a d new solution, and doing it and stopping it did in its tracks. F again, it reminds me of those who fought tooth and nail to stop welfare reform 20 years 20 ago. I have quoted those people fromt 20 years ago. At the time they predicted those dire consequences would befall our most vulnerable citizens. Thank goodness the pessimists act then did not prevail in their obstruction against welfare reform. While welfare reform has not been perfect, it has restoredni hope and opportunity to millions of americans. We cant afford to let the pessimists and obstructionists a prevail today against health care reform. And he seemed to be acting like the very same people that oppose welfare reform 20 years ago. The American People deserve high quality, Affordable Health care. Obamacare has not lived up to its promises. So its time elected leaders lived up to our promise that we made to the american