Mr. President, is this a partisan approach to healthcare? I don't think so, if Missouri does better. There is a Democrat representing Missouri. There is a Republican representing Missouri. Here is the good news. We got the Republican on…
Mr. President, is this a partisan approach to healthcare? I don't think so, if Missouri does better. There is a Democrat representing Missouri. There is a Republican representing Missouri. Here is the good news. We got the Republican on board. We appreciate the Republican.
Let me tell you how this works.
I like Massachusetts, I like Maryland, I like New York, I like California, but I don't like them that much to give them a bunch of money that the rest of us will not get.
If you live in Massachusetts, you don't get twice the Social Security or 50 percent more than if you live in Pennsylvania. How can this happen? ObamaCare, for whatever reason, favors four blue States against the rest of us.
Now, our friends in Mississippi, like South Carolina--we have a 31- percent African-American population in South Carolina--I think the highest in the country is Mississippi. Under this block grant approach, our friends in Mississippi get a 900-percent increase. How can that be? Well, that is money that was going someplace else other than Mississippi.
So what have we learned about ObamaCare? Rural poor, particularly African Americans, don't do so well. These four States--New York, California, Massachusetts, and Maryland, they have a lot of high wage earners.
We have some rural poor States. Missouri is a very wonderful State, with big cities and rural areas. How do you get more money? Well, under this formula, you are getting money that would have gone to the four other States. So 50 to 138 percent of poverty, and there are 45 million people in America who fall in that demographic. We can figure out how many live in Missouri. We use that as the basis for the formula. You are not limited to spending the money on 50 to 138 percent of poverty, but that seems to be a fair way to redistribute the money. By 2026, the goal is, no matter where you live, Missouri, South Carolina, or California, you are going to get the same basic contribution from the Federal Government, regardless of where you
live. What a novel idea. That means places like Missouri and South Carolina do better.
To our friends in New York and California, we are giving you a long time to come down. To our friends in Massachusetts--and we have a great Republican Governor--I don't know how to explain the system where you get that much more money than everybody else. The goal is for you to have time to adjust, become more efficient, and Charlie Baker can do this.
Is it unfair for people like me, and Louisiana and Missouri, to say: No four States should get twice the amount of money for their population. I am trying to fix the problem in ObamaCare.
Who should get the money is another question. Should some bureaucrat you will never meet in Washington be in charge of your healthcare or should somebody you actually know and vote for be in charge of your healthcare?
The block grant has a beautiful concept to it. The people we empower, you actually live with them, and you vote for them. If you don't like ObamaCare and, God knows, if you don't like BernieCare, whom do you complain to?
You can tell me: I don't like ObamaCare. My premiums have gone up. My deductibles are going through the roof. You can complain to me all day long, and I will call somebody up who could care less what I think.
Now, if you have South Carolina responsible for the money instead of some bureaucrat in Washington, let me tell you what would happen. You would call me up, say: Hey, listen, this is not working for my family. I will find out who the statehouse person is, and we will call them together, and I guarantee you the Governor will listen to you because the Governor wants you to vote for him or her.
The bottom line is, the concept of who should be in charge of your healthcare is what this is all about.
Our friends on the other side deserve a great compliment. You know where you are going on healthcare. You have a plan to get there. I just don't agree with your plan, and I don't agree with where you are taking the country. But I will say this for you: You have a plan. I will say this to my Democratic colleagues: When it comes to your ideas, you fight like tigers.
I remember voting on ObamaCare on Christmas Eve, for God's sake, and we would have been here on Christmas Day if that is what it would have taken for Harry Reid to have passed ObamaCare.
Now, on our side, have we done everything we can to repeal ObamaCare? They did everything they could to pass it.
President Trump is now behind this bill.
Thank you, Mr. President. I appreciate it very much. Without your voice, we cannot succeed. With your voice, we will be successful, but it is going to take more than a letter. Get on the phone. Start calling people. Obama did.
Senator McConnell was very good today at lunch, saying that this is a good idea and that we need to get behind it.
A CBO score is necessary. I am sure there are a lot of good people at the CBO, but if I had one place to go before I died, it would be at the CBO because you live a long time. We need to get the CBO to score things in a timely fashion.
To my friends at the CBO, this is a block grant. We are going to spend $1.2 trillion in the next decade--not more, not less. I didn't do that well in math, but I can figure out how much we are going to spend. I don't mean to be super critical, but we have not had scores on the Portman language or on the Cruz language in 8 weeks.
Let me tell my Republican friends, if you are upset about our not successfully repealing and replacing ObamaCare after 7 years, count me in. We tried, and we were one vote short. We have 17 days left. What would the Democrats have done? They would have been fighting. There would have been no August break. We would have been right here on this floor. We would have been arguing about their view of healthcare.
So I am encouraged that our leadership is going to push the CBO and get behind this bill. I am encouraged that the President came out for the bill. The Vice President, above all others in the administration, has been on the phone, calling Governors. We have over 15 Governors now on the Republican side who are saying: Give me the money. Give me the power. I can do a better job than some bureaucrat in Washington.
To the other Republican Governors, check it out for your States, but here is what I would ask you to consider. The money that you are getting from ObamaCare is unsustainable. It is a false promise. It is going to collapse. We can never match that system because that system is unsustainable, and it is going to fail.
What have I learned about Republican Governors? Most of them practice what they preach, and some of them have been hard to get on board. It is almost like crack cocaine, in terms of ObamaCare dollars.
I am telling you right now, Republican Governors and Democratic Governors, that this system is going to collapse in Washington. There is not enough money to keep it afloat, and I am not going to spend good money after bad. This is a chance for you, at the State level, to have control over funds and for us to be as flexible as we possibly can be in our designing systems that make sense for your States. If California wants to go to single-payer healthcare, it can. If it wants to reimpose the employer mandate and the individual mandate, it can. We will repeal the individual mandate and the employer mandate for the country at large, but if you want to put it back in place, you can.
Here is the good news. California cannot take the rest of us down the tubes with them, and we will have the debate in California about what works and what does not.
Give South Carolina, Louisiana, and Missouri the space they need to design healthcare based on their individual demographics. You cannot spend the money on football stadiums. You have to spend it on healthcare. You have to take care of people who are sick. There are guardrails around this block grant, but innovation will flourish.
Under ObamaCare, where is the incentive to be innovative? All you need to do is print more money. Under BernieCare, there is zero incentive to be creative. Just tax the rich. This is what happens. We go from four States getting 30-something percent of the money and representing 20 percent of the population to where, basically, everybody gets the same.
Let's talk about Medicaid. Bernie Sanders, who is a good man with a good heart, is an avowed socialist. He is the most honest guy in this building. If you left it up to Bernie, we would have a rowboat for a Navy, a gun for the Army, a prop plane for the Air Force, and everything else would be spent on entitlements. Most of us are not in that camp.
As to Medicaid, it is a program for low-income Americans to help them with their healthcare. There is a State match. Right now, we are spending almost $400 billion on Medicaid. By 2027, we are going to be spending over $650 billion. That is more than we spend on the military right now--with no end in sight.
So we do two things in this bill. We tell the States that we are going to give them more flexibility. This is what we spend on the military--$549 billion under sequestration. I hope that number goes up, but, by 2027, we are going to spend more money on Medicaid, let alone Medicare, than we do on the military. That is just unsustainable.
So what do we do?
We keep Medicaid in place as it is today. We try to give more flexibility because Indiana was a good example of what can happen if you give States the flexibility to help poor people. The one thing about Medicaid that I do not like is that, if you get a headache, you can ride to the emergency room, and we will pay a big Medicaid bill. I want to put Medicaid people into managed care. I want them to have some ownership over their healthcare. If you smoke, then that is something that ought to be considered in terms of cost. I like copayments. I want to treat fairly the people who are low-income and poor, but all of us need to be responsible for our healthcare.
Rather than having a Medicaid Program that just writes checks no matter what the outcomes are, we are going to, in year 8, begin to slow down the growth of Medicaid. It grows faster than medical inflation. Medical inflation is what it costs for you and your
family. Medicaid is way beyond that. Why? Because it is inefficient. We have proven at the State level that you can get a better bang for your buck from Medicaid.
The bottom line is that the first block grant begins to slow the growth of Medicaid to make it affordable for the rest of us and incentivize innovation in year 8.
If we do not do that, here is what will happen to the country. By 2038, all of the tax money that you send to Washington will go to pay the interest on the debt, Medicare, Medicaid, and Social Security. There will not be one penny for the Department of Education or the Department of Defense. That is how quickly these programs are growing.
So we do two good things. We put Medicaid on a more sustainable path because it is an important program, and we allow flexibility in order to get better outcomes for the taxpayer and the patient. What a novel idea.
The second block grant is money that would have been spent by a bureaucrat in Washington. Under the first Republican proposal, you would get a refundable tax credit to go out and try to buy insurance somewhere, and we would give insurance companies money so that they would not collapse on the ObamaCare exchanges.
Instead of giving a refundable tax credit to an individual to buy a product that is going to go away because ObamaCare will not work and instead of giving a bunch of money to the insurance companies to prop them up, we are going to take that same amount of money and give it back to the States so that, by 2026, they will all get the same basic contribution.
Now, what did we do?
We repealed the individual mandate and the employer mandate. That is $250 billion in savings. The States can reimpose it if they would like. That is up to the States. We repealed the medical device tax because that hurts innovation. We left the other ObamaCare taxes in place. There is no more taking from the poor and giving to the rich. I wish that we would not have to do that, but we need the money to transition in a fair and sound way to a State-centric system.
To my friends on the other side, we leave the taxes in place. We just give the money to somebody else. It is called State control, local control, not Washington-based healthcare. We do it in a way in which, basically, everybody gets the same contribution from the Federal Government. What a novel idea.
Now, to President Trump, without you, we cannot do this. Your pen will be the one that signs the law if we can ever get it to your desk. You said today that you would veto BernieCare.
Let me tell everybody in America not to worry. Single-payer healthcare will never get through the Republican-controlled House, and we have the majority in the Senate.
Mr. President, we are not going to need you to veto single-payer healthcare. What we need you to do is to put in place a new system to stop the march toward single-payer healthcare because, if we do not change where we are going, the Federal Government is going to own it all from cradle to grave. On your watch, you can stop that.
Once we get the money and the power out of Washington, that will be the end of single-payer healthcare. Once people know that they have somebody to respond to their needs at the State level versus some bureaucrat they will never meet, there will be no going back to Washington-based healthcare.
President Trump, you have the chance in your first term to set us on a new path: healthcare that is closer to the patient, money based not on where you live but parity, and innovation versus bureaucracy. What a legacy it would be. For that to happen--and I know you are busy with hurricanes and North Korea--you are going to have to get on the phone, and you are going to have to help us sell this. I believe you will, and I know you can, and I am asking you to do it.
To Senator McConnell, thank you for what you said today. Thank you for being willing to push this forward.
To my colleagues on this side, there are three options left for America: propping up ObamaCare, which will never work; BernieCare, which is full-blown single-payer healthcare; or this block grant approach.
I ask this question: Who are we, and what do we believe as Republicans? Our Democratic friends are pretty clear on who they are and what they believe when it comes to healthcare.
Here is what I believe. Send the money home. Send the money back to where the patient lives. Put it in the hands of doctors and hospitals in the communities and make sure that the people in the State are responsive to the needs of the individuals in that State. Replace a bureaucrat with an elected official. You will improve quality, and outcomes will be better, and it will be more fiscally sustainable.
At the end of the day, that Governor, whoever he or she might be, who can figure out quality healthcare in a sustainable fashion, will not only get reelected, but other people will copy what he does. If we leave the money and power here, there is never going to be any innovation. It is always going to be more money. Single-payer healthcare only works with a printing press--with unlimited dollars. Just keep printing the money. A block grant will bring out the best in America. It will create better outcomes for patients, and it will take us off the path of becoming Greece, because this is where we are headed.
Senator Cassidy was a doctor in a low-income, nonprofit hospital. He knows more about this than I could ever hope to learn. There is a reason that I did not go to medical school. I could not get in. I just cannot tell you how impressed I have been with Bill Cassidy's understanding of how healthcare works for average, everyday working people. He has dedicated his life to that segment of the population.
Rick Santorum. There would be no Graham, Cassidy, Heller, Johnson without Rick. Rick said: Lindsey, we did this with welfare reform. They said that we could not do it, but we block-granted the money and unleashed innovation at the State level, and not one dime of extra spending has occurred since 1996 because we were generous in the beginning. The Governors figured it out. It was a better way of dealing with the welfare population.
I had a bill to opt out of ObamaCare, and Rick said: Why don't you just do a block grant like we did with welfare reform. So, when you look at it, it is such an elegant, fair, commonsense solution to a complicated problem.
Dean Heller. Dean Heller is in the fight of his political life. A lot of people around here--and I understand it; I am included sometimes-- just wish hard problems would go away. This is a tough business to be in. Dean was told by all of the experts--and he said this today--to just lay low. Do not get your fingerprints on this healthcare debate. There are no winners. Healthcare is too complicated. Just stay away from this fight. Lay low.
Dean told us today in the conference: I didn't get elected to lay low. If we don't now get healthcare right, all of us are going to pay later. So Dean Heller, who is in one of the most competitive seats in the country, said: Sign me up.
Nevada gets 30 percent more money under this formula. It gets more control than ObamaCare would ever give them. Dean Heller believes that Medicaid is worth saving and that this is a way to save it. With the second block grant, 20 percent can be used to help traditional Medicaid.
The bottom line is that Dean Heller stood up today and said: Nobody in this conference has a tougher race than I do. Count me in because this is the right thing to do.
Ron Johnson. If there were ever a ``Mr. Smith Goes to Washington,'' it is Ron Johnson. This is his last term. If you want to have an interesting evening, do not go to dinner with Ron Johnson and Bill Cassidy. They are wonderful people, but they know numbers, and they love to talk about details and how systems work. Ron Johnson has brought energy and a can-do attitude to this debate. He is the closest thing that I have seen in a long time to ``Mr. Smith Goes to Washington.'' He is not going to run again. He is doing what he thinks is best for Wisconsin and the Nation.
Scott Walker. If it were not for Scott Walker, we would not be here today. Scott Walker said: I have been talking about federalism all of my political life, and this is the first time that I have seen somebody in Washington try
to empower me here since welfare reform.
Scott Walker has been the moving force on the Governors' side.
As for the Governor of Utah, Mike, you should be proud of him. He is a really great guy. Mike, thank you for working with us to make this as flexible as possible.
Senator Lee has really driven this very hard in order to give as much flexibility to the State level as possible.
Thank you. Your Governor has been just absolutely awesome.
Asa Hutchinson in Arkansas stepped up. Our good friend Governor Bryant in Mississippi is all in. I could go on and on and on.
I know John McCain likes the concept of the block grant. John McCain wants to reform healthcare. He knows what happens to Arizona under ObamaCare, and this is our last, best chance to stop what I think is a march toward single-payer healthcare. I hope we can find a way to get our friends in Arizona at the State level on board because ObamaCare is failing your State. If we don't find a replacement--and I think this is a great replacement for the people of Arizona--everything is going to collapse.
So to all of those on the staff who have spent hours and hours and hours listening to us change our minds, do it one way, do it another: Thank you, thank you, thank you.
I have been in politics now--I came in a little bit before the Presiding Officer in the Senate. I have worked on a lot of things. I have had a lot of fun, a lot of disappointments. I don't think I have worked on anything more important than this. It has been fun. It has been frustrating.
I believe this is our last, best chance to get healthcare on a sustainable footing and to stop the march toward single-payer healthcare, which I believe with all my heart will reduce quality and explode costs, and that doesn't have to be the choice.
To my Republican friends: They know what they are for. Do we know what we are for? They are committed to their causes. Are we equally committed to ours? I hope the answer is yes. And if we can get 50 of us here, I will make a prediction. A few of them over there are going to sign on because their State does so well. There are some Democratic Senators who are my dear friends who are going to have to turn down more money and more power for their State to keep the status quo.
I can tell my colleagues this about bipartisanship. I am a pretty big believer in bipartisanship. I have taken my fair share of beatings-- working on immigration; I believe climate change is real. I have done deals, and I understand that you have to work together. But our friends on the other side are never going to vote for anything that fundamentally repeals and replaces ObamaCare. They just can't do it. They are not bad people; they are just locked into a different way. And their way is that the government makes these decisions, not the private sector. My belief is that healthcare closer to the patient, like government, is better healthcare.
This is the last, best chance we will have to stop the march toward single-payer healthcare.
Mr. President, we need you. We need the weight of your office and the strength of your voice.
Senator McConnell, thank you for what you said today, but all hands on deck. Our friends on the other side moved Heaven and Earth to pass ObamaCare. I am going to do everything I can to repeal ObamaCare and replace it with something that is not good for Republicans but is good for Americans, because many Democratic States, including Illinois, do far better under this approach than under ObamaCare, and all of us will do better than BernieCare. If we don't stop this now, single-payer healthcare is the fate of the Nation.
To all who have been involved, thank you very much. We can do this. We have the time. Do we have the will?
I yield the floor.