Marketplace Certainty Act

Mr. President, I am very pleased to join my colleague from North Dakota, Senator Heitkamp, and appreciate all of the efforts she is making to try to address the challenges we are facing in the healthcare markets across this country. Like her and like so many of my colleagues who are going to be here, I have come to the floor this afternoon because we want to take urgent steps and we can take steps today to address the uncertainty in our health insurance markets. We can take steps today that can hold down premiums.

I have heard Senators on both sides of the aisle who have expressed concern about looming premium increases in the Affordable Care Act marketplaces. We all need to understand, as Senator Heitkamp pointed out, what some of the causes of these premium increases are.

Insurers regularly cite the Trump administration's refusal to commit to making cost-sharing reduction payments, also known as CSRs. These CSR payments were included in the Affordable Care Act in order to help Americans afford insurance once they had it. The ACA requires insurers to reduce deductibles and copayments for working families who are buying insurance in the marketplace. Because of the cost-sharing reduction payments, the CSRs, patients pay less for their care and the government reimburses the insurers.

These reductions and payments are built into the rates insurers are charging for 2017. Yet the Trump administration has refused to commit to paying these reimbursements because of a partisan lawsuit that has been brought by House Republican leaders.

Because of the radically uncertain landscape insurers are facing right now, many of them are doing one of

two things: Some are pulling out of the ACA marketplaces altogether, and others are dramatically increasing premiums. The end result is fewer choices and higher costs for American families.

Last year in my State of New Hampshire--and Senator Hassan is here. We represent New Hampshire, and we have been very concerned about what is happening right now. Last year, the insurance markets were stable, and health insurance premiums increased an average of just 2 percent-- the lowest annual increase in history. Today is a radically different story, in large part because of the uncertainty this administration is causing by refusing to guarantee insurers cost-sharing reduction payments. What we are seeing is that those insurance companies are protecting themselves by raising premiums on patients.

The same thing is happening in other States. In some cases, insurers are filing two different sets of rates--a set that is premised on the administration continuing to make cost-sharing reduction payments and an alternative set with higher premiums to account for continuing uncertainty and the possibility that this administration will stop making those payments.

Unfortunately, the Trump administration continues to send mixed signals to insurers, and of course it has threatened to stop paying cost-sharing reduction payments altogether. If this were to happen, insurers could immediately exit the markets for breach of contract.

So we are kind of in this perverse limbo situation. The administration creates uncertainty by refusing to commit to continuing the CSR payments, and the insurers protect themselves by exiting the markets or raising rates. And it is the premium holders, the families out there, who are hurt by this political football that the administration seems to be intent on continuing.

That is why I have introduced the Marketplace Certainty Act, which is a bill to appropriate funding for the cost-sharing reduction payments in order to make good on our commitment to help working families with their deductibles and cost sharing.

I believe that the House Republican leaders' lawsuit has no merit but that the chaos it has caused by allowing the Trump administration to waver on these promised payments requires that we act now.

I am pleased to be joined in this legislation by Senators Baldwin, Blumenthal, Cardin, Carper, Coons, Kaine, Hassan, Heitkamp, Cortez Masto, King, Leahy, Markey, Wyden, Stabenow, and I am sure that by tomorrow, we will have even more Senators on this bill.

We could pass it right now. Right now, we could end this manufactured crisis. We could immediately restore certainty and stability to the health insurance markets for all of our constituents. That would be good for the Republicans, and it would be good for the Democrats. Mostly, it would be good for the families out there who are experiencing this uncertainty.

We could do this. It would give us the breathing space we need to come together on a bipartisan basis to improve the law, to strengthen what is working and to fix what is not. In poll after poll, that is what the American people want us to do. They want us to stop the partisan bickering. They want us to work together. They want us to make commonsense improvements so that this law works for every American.

Mr. President, at this point, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 1462, the Marketplace Certainty Act; that the bill be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

Mr. President, while I am disappointed, I am not surprised that my colleague from Wyoming has objected to our effort to move forward. He is objecting to ending the uncertainty we have experienced, which is forcing insurers to raise rates because of the uncertainty with which this administration is administering the Affordable Care Act. They have been very clear that they want marketplaces to implode so that the act does not work for people. Senator Barrasso is objecting to a commonsense step to stabilize the insurance marketplaces.

This is not going to be the last word because this is a commitment we made to American families. The instability here in Washington is what is causing the instability not only in insurance markets but in the country at large.

We are approaching the Fourth of July, which is next week. When our Founders declared independence on July 4, 1776, Benjamin Franklin warned that we must all hang together or we will all hang separately. It is no different today. We all need to come together. We need to work across the aisle. We need to improve the healthcare system so that it works for all Americans. That is our goal. That is why we are here on the floor today, and we need to start by making sure the insurers have some certainty so that they can keep rates low for American families. We will be back, have no doubts about that.

Mr. President, I rise to discuss the nomination of Mr. Patrick Shanahan to serve as the 33rd Deputy Secretary of Defense. The Senate Armed Services Committee held a hearing on his nomination on June 20, and he was voted out of committee by voice vote.

Mr. Shanahan was born and raised in the State of Washington. He received his undergraduate degree from the University of Washington and then a master's degree and MBA from the Massachusetts Institute of Technology. Mr. Shanahan then embarked on a 30-year career at the Boeing Company, where he rose to the most senior echelons of management, working on both the company's defense and commercial programs. Most recently, Mr. Shanahan served as the senior vice president for supply chain & operations.

The Deputy Secretary of Defense is one of the most important positions within the entire national security system. The Deputy serves as the number 2 official at the Department of Defense, as well as the Department's Chief Management Officer. As the second in command to the Secretary of Defense, the Deputy oftentimes is assigned a broad spectrum of responsibilities which require strong management skills.

The Department currently faces challenges on multiple fronts. For more than 16 years, our military has been consumed by two prolonged wars against violent extremist groups like ISIS. As a result, the military has faced a generational fight which has sapped readiness and precluded our military personnel from training for full spectrum operations. However, violent extremist groups are only one of the many challenges facing our country.

The past several years have seen the rise of near-peer competitors, most notably Russia and China. Russia has been a resurgent force bent on disrupting Europe and undercutting our own Nation and our Presidential election process. China continues its saber-rattling in the Asia-Pacific region by undermining the freedom of navigation and using economic coercion of its smaller, more vulnerable neighbors. When we factor in the destabilizing actions of North Korea and the long shadow of Iran, it becomes urgently clear that we need strong leadership at the Department of Defense. If Mr. Shanahan is confirmed, he will need to contend with all these challenges. It will not be easy and hard decisions on policy and strategy will need to be made.

Perhaps one of the hardest decisions facing the Deputy Secretary of Defense is the allocation of budget resources within the Department. In an ideal world, a cogent defense strategy that takes into consideration the multitude of concerns facing our Nation would inform how the Department invests resources in weapons platforms and advanced technologies to confront these challenges. However, the reality is that the spending caps imposed by the Budget Control Act determine the level of funding for most of these budget decisions.

The current budgetary crisis is compounded by the fact that the President's most recent budget request adds much needed funding to defense activities, but it shortchanges nondefense spending accounts in order to increase spending for our military. Furthermore, the budget request fails to recognize that the BCA budget caps are law. If these spending levels are enacted, the President's budget request would trigger sequestration, effectively wiping out increased defense spending with mandatory across-the-board cuts.

This would be the worst of all worlds. Not only would we be giving the money on the one hand and taking it back with the other hand, but it would not be in any systematic way. We would be making cuts to readiness. We would be making cuts to personnel. We would make cuts to all sorts of things which are much more valuable than some programs which would receive an additional cut.

Unless we resolve ourselves to act--which is going to take a bipartisan effort to repeal the BCA--we can't effectively fund not only the Department of Defense but every other Federal department. That is one of the great challenges Mr. Shanahan will face. Indeed, these multiple challenges will require strong leadership and the ability to make tough decisions. Mr. Shanahan has developed a strong reputation during his tenure at Boeing as someone capable of taking on challenging programs, fixing problems, and turning them into successes.

When I met with Mr. Shanahan to discuss his nomination, he emphasized that the public sector needed to work closer with the private sector to get more cost-effective results while ensuring our warfighters have the best equipment at their disposal. It is that kind of leadership that the Department of Defense needs as our Nation faces as diverse an array of threats and challenges to our national security as at any point in our history.

Based on Mr. Shanahan's qualifications and experience, as well as his testimony before the Senate Armed Services Committee, I believe he is fully qualified for the job. Therefore, I will vote in favor of his nomination to be the next Deputy Secretary of Defense, and I trust he will do his best to lead the men and women who ably and courageously serve this Nation.

On a final note, if confirmed, Mr. Shanahan will be relieving Bob Work, who has served this Nation ably and selflessly for most of his life. Bob Work served in the U.S. Marine Corps for 27 years, rising to the rank of colonel. In 2009, he was confirmed as Undersecretary of the Navy, where he shepherded the service through many challenges for the next 4 years.

He tried to return to the private sector, but in 2014 he was then nominated and confirmed as Deputy Secretary of Defense. Bob Work was the continuity in the Defense Department through three Secretaries of Defense. He stayed more than 6 months into the new administration in order to aid Secretary Mattis. There is no task, no matter how difficult or how big or small, that Bob Work would not devote all of his energy to until it was resolved. Bob Work personifies his name. He works, tirelessly. Our Nation owes him a great debt of gratitude, and I hope he takes some well-deserved vacation time and enjoys the company of his wife and daughter.

I yield the floor.

I suggest the absence of a quorum.

Mr. President, I am really pleased to have been joined by my colleagues to talk about the importance of addressing healthcare for all Americans, especially my colleague from New Hampshire. She and I have been touring the State for months now, talking with people in hospitals, with patients, with physicians, with providers, with people with substance use disorders, with providers who are providing treatment for people with substance use disorders, with people all over New Hampshire about what we can do to make sure people get healthcare when they need it.

That should be the goal of this body. It should not be throwing people off their healthcare, which a repeal of the Affordable Care Act would do. It would throw 32 million people off their healthcare.

We can address the instability in the marketplaces. We can do that pretty quickly. Senators Kaine and Carper talked about reinsurance, something which has worked very well for the first 3 years of the Affordable Care Act, and the reason it doesn't work now is because they have stopped. That is why we are seeing some of these rate increases.

We can address the uncertainty by being clear that we are not going to repeal the Affordable Care Act, by addressing those cost-sharing reduction payments. The ACA already stipulates that CSR--those payments which reduce the costs of copays and deductibles--are to be made pursuant to 31 U.S.C. 1324.

My bill provides for payments to be made jointly from a permanent appropriation rather than subject to the year-to-year whims of the annual appropriations process. The Marketplace Certainty Act removes all bases for any further questions about what is already clear from a fair reading of the Affordable Care Act as a whole; that both those CSR payments and the advanced premium tax credit subsidies are to be funded from the same permanent appropriation.

I see my colleague from Texas on the floor, and I am sure he is going to object to the unanimous consent request I am going to be proposing in a couple of minutes. He objected last Thursday when I asked for unanimous consent to pass the Marketplace Certainty Act, and he justified the objection by asserting that the cost-sharing reduction payments are--I think he called it a bailout of the insurance companies. That is an inflammatory term, and I think we ought to be careful with how we use it because the truth is, the cost-sharing reduction payments are in no way, shape, or form a bailout. They are orderly payments built into the law to go directly to keep premiums, copays, and deductibles affordable for lower income Americans. In fact, those same payments were included in the bill Majority Leader McConnell just said he is not going to go forward with, the Republican bill. It included those very same cost-sharing reduction payments. I think they were included because there was a recognition that these are important to help address the cost of healthcare for all Americans.

As I said earlier, we have had statements by the chairman of the Health, Education, Labor, and Pensions Committee, Lamar Alexander, talking about that these payments should be continued. We have heard from House Ways and Means Chairman Kevin Brady, who said we need to continue these payments to help stabilize the insurance market. It is the uncertainty that is causing the current problem, and we could address that today--this week--if people were willing to work together.

As Democrats, we have come to the floor to say we want to work together. We think we can address the challenges we face with the Affordable Care Act. We can do it in a bipartisan way. I know we can because Tim Scott and I have done it. We passed a bill several years ago by unanimous consent, which basically gave States the ability to control group size for people and for companies in the marketplaces so I know it can be done, and I know we could do it today if there were a willingness on the part of all of our colleagues to work together. That is what the American people want. They don't want 32 million people thrown off their health insurance. We don't want rural hospitals to close in New Hampshire. We don't want nursing homes to close. We don't want people to be thrown out of their nursing homes.

I was up in northern New Hampshire at a nursing home over the weekend, where I talked to a group of women in their eighties and older. One woman said to me: You know, I worked my whole life. I paid my taxes. I did everything I was supposed to do. I sold my house so I could get into this nursing home so I could qualify under Medicaid. I got rid of all my assets. Now they are telling me I am going to get thrown out? She said: What would I do? I have no place to go. I have no family to help me.

People don't want that. What they want is for us to work together, to help fix healthcare so people can get what they need when they need it.

Mr. President, I ask unanimous consent that the Committee on Health, Education, Labor, and Pensions be discharged from further consideration of S. 1462; that the Senate proceed to its immediate consideration; that the bill be considered read a third time and passed, and the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

Mr. President, I am disappointed but not surprised that my colleague has objected. I don't believe he objected because of the effort to help pay these subsidies, which are passthroughs to insurance companies.

Reforming how we do those, I am certainly happy to sit down and talk about that, but the fact is, that is not the issue right now. The issue is, this is a way we could address the current uncertainty in the marketplaces in a way that will be good for maintaining stability of healthcare for all Americans. I am disappointed there isn't a willingness to work together to do that.

I hope, as this debate continues, we will finally see people come together to get something done to address, not just healthcare for Americans but to address the one-sixth of the economy that depends on the healthcare industry.

I yield the floor.

Mr. President, I would like to associate myself with the comments from the former Governor and now Senator from the great State of New Hampshire.

It is not enough to say the system is failing. It is not enough to come here and say: We can fix it if you just agree to vote the way we are voting. If you just agree, you can present any amendments you want. You can do whatever you want.

We don't even have a CBO score on this legislation. We don't know what is in this legislation. There have been no hearings so that people on both sides of the aisle can ask questions and say: What does this mean for a family on traditional Medicaid who has to rely on this to keep custody of their kids? And by the way, what does it mean if, as a result of losing their Medicaid coverage, those children are no longer able to stay at home and they become foster children because it is the only way they can get healthcare? What does it mean for those families about whom we all think we ought to have a real discussion, young people, young families who have excellent health, how they might have been disadvantaged on the exchange? What do we need to do for them? Maybe they were doing better economically than a lot of folks until they hit the cliff.

That is why I want to see my bill debated, because it can, in fact, offer opportunity. Every time we talk about this, what we hear about is how much it would cost. Well, the bottom line is that if all you do is shift the burden of these costs without any discussions with Governors, with private payers, with corporate America that is self-insured--if all we are doing is shifting costs and saying ``It is now your problem,'' we are not doing our job.

If you look at the Rand Corporation study, 12 percent of the population of this country has five or more chronic diseases. As a result of those unmanaged--typically unmanaged chronic diseases, what you will see is they incur 40 percent of the cost. Is that a problem? The answer is yes, that is a problem. We need to figure out how we can better manage chronic disease.

A great friend of mine, a guy named Richie Carmona, who once was the Surgeon General of this country, used to say--and I think it is true-- 70 percent of all healthcare costs are related to chronic disease, most of which is preventible. Where in any of these bills are we talking about prevention? Where are we talking about wellness? Where are we talking about bending the healthcare curve? We are only dumping and running with these bills. We are not doing our job, and as a result, we are frightening people in this country. We are frightening the elderly. We are frightening people who say: Right now, I can afford my health insurance; I am on an exchange. But when we change the ratio from 1-to- 3 to 1-to-5 and reduce the amount of subsidies, then 30, 40, 50 percent of their disposable income will be used to pay for health insurance. That is the thing you are not hearing here.

So we have to come together. We have to come together with the fundamental questions of what is wrong with not just the Affordable Care Act but what is wrong with healthcare and how we fix it and how we change outcomes. We can't do that if we don't work together. This is a body that is divided 48 to 52. How do you come together if you don't come to the middle, if you don't come to the middle to compromise? You don't.

At the end of the day, we have not met our deepest obligation, which is to speak for those who are the least fortunate among us. We have not met our obligation to govern this country in a way that would make our Founding Fathers proud, to make our citizens proud, and that can advance this idea that the U.S. Congress can get something done in the United States of America--instead of partisan rancor.

We hold out the hope that we will at one point be able to debate these ideas that we presented. We hold out the hope that we will, in fact, meet somewhere to arrive at a better plan for the delivery of healthcare in this country.

I just want to close with one thought. There is not one organized healthcare group or advocacy group in my State that supports the Republican healthcare plan, so as we are looking at judgment on that plan, don't take my word for it. Take the medical associations' word for it, take the hospital associations' word for it, take AARP's word for it, take the consortium of large hospitals in my State, which urged a ``no'' vote on this legislation, take the disabled children's advocacy groups' word for it. This is not a path forward, but we are big enough people and good enough leaders that we can forge a path forward if we just find the will to do it.

I yield the floor.

I suggest the absence of a quorum.

Absolutely.

What is true about the Marketplace Certainty Act is that it would guarantee the payments that were promised under the Affordable Care Act--not to insurance companies but to families who need help affording health insurance. That is one of the goals as we think about what our challenge is to address the healthcare needs of the people of this country, and that, in fact, is what the Marketplace Certainty Act would do.

I want to be clear that what we need to do is to provide certainty in the marketplace right now. What is happening because of the effort by our Republican colleagues to repeal the Affordable Care Act--which is providing coverage for literally tens of millions of people--what is happening because of this administration's refusal to guarantee those payments that would help people with the cost of their health insurance is that we are seeing instability in the marketplace. But the answer is not the proposal that was released this morning, the second or maybe it is the third draft of healthcare legislation that was done behind closed doors by our colleagues.

Earlier today, I had the opportunity to meet with two children from New Hampshire: Parker, who is 8, and Sadie, who is 10. These kids were here advocating for the children's hospitals that have meant that they can continue to live. They are kids who were born with serious health challenges. They continue to have those serious health challenges, but thanks to Children's Hospital at Dartmouth and Boston Children's Hospital, Parker and Sadie are alive today. They are smart, they are beautiful, and they are the delight of their families. They have been able to get the healthcare they need through CHaD and through Boston Children's because they are able to get covered for their healthcare under Medicaid. What our colleagues' healthcare legislation would do is dramatically cut the Medicaid funding that Parker and Sadie and so many children and old people and disabled in this country depend on in order to stay alive.

That is a mean-spirited bill. That is not the answer to the serious healthcare challenges we have in this country, and that is not what we should be doing to fix what needs to be fixed in the Affordable Care Act. What we need to do is work together.

I am disappointed that my colleagues on the other side of the aisle continue to work behind closed doors instead of having an open process. If this legislation that was introduced this morning is such a great piece of legislation, then let's go through regular order. Let's have a hearing. Let's let the people of this country weigh in and then see whether this is a healthcare bill we should pass.

Thank you, Mr. President.

I yield the floor.