National Defense Authorization Act For Fiscal Year 2018--Motion To
Mr. President, I have known and admired Thad Cochran for 40 years--since he first came to the Senate. At the time, I was a young staffer for Senator Bill Cohen, who also was elected to the Senate that same year. I saw from the start that…
Mr. President, I have known and admired Thad Cochran for 40 years--since he first came to the Senate. At the time, I was a young staffer for Senator Bill Cohen, who also was elected to the Senate that same year.
I saw from the start that this gentleman from Mississippi was so bright, insightful, and creative yet also humble, kind, and devoted to helping others. He treated everyone with such dignity. He was nice to everyone, from the elevator operators to the highest officials around the world. He truly is one who leads by example.
Those qualities are his legacy, and I have seen them time and again as a member of the Senate Appropriations Committee when Thad was an important member and, of course, when he became the chairman.
Last year was the 150th anniversary of the creation of the Appropriations Committee, and Thad marked that occasion by reminding all of us of our great responsibility to make thoughtful and informed decisions in the allocation of public funds. In managing appropriations bills, he was always so inclusive, willing to incorporate ideas and priorities from everyone who could make a persuasive case. The fact is, Thad has always placed careful consideration and compromise above partisan politics. That really reflects how Thad has led his life.
He has excelled at everything he has ever undertaken. When he joined the Boy Scouts, he became an Eagle Scout. In his high school, he was valedictorian. In college, he had the highest scholastic achievements. He excelled in serving in the Navy, and, of course, we know how much he has accomplished as our esteemed and dear colleague here in the Senate.
When Thad served as chairman of the Appropriations Agriculture Subcommittee, he traveled to the State of Maine with me, and we met with Maine's potato farmers and blueberry growers--not exactly staple crops of Mississippi. Thad listened intently to these farmers and growers. It was clear that he cared about them and that he valued our family farms and our rural communities.
That night, we had a lovely Maine lobster dinner at an inn on the coast. During that dinner, Thad shared with me his passion for good literature, his love of music, and his passion for education that had been instilled in him by his parents.
Of course, another issue that brought Thad and me together was making sure that our naval fleet was strong. As a U.S. Navy veteran who served for a time in Boston, MA, Thad has always been a dedicated advocate for his shipyard in Mississippi, as I am for Bath Iron Works in the State of Maine. Thad has twice visited BIW with me to see the great work done there.
In 2013, Thad received the Navy's Distinguished Public Service Award in recognition of his longstanding commitment to American sea power.
Through four decades in the Senate, plus three terms in the House of Representatives, Thad has compiled an admirable legislative record on issues ranging from education to libraries, the arts, our national defense, scientific and biomedical research, conservation initiatives, and civil rights. But perhaps his greatest legacy is that he taught us how a Senator should act, and that legacy will live on forever.
Thad, our Nation is so grateful for your service, and I, personally, am so appreciative of your friendship. I offer my best wishes to you and to Kay. You will be greatly missed.
Mr. President, I ask unanimous consent that I be permitted to speak for up to 30 minutes.
Mr. President, we have the opportunity today to take immediate action to lower the cost of health insurance by as much as 40 percent and to increase the affordability of insurance for millions of Americans who purchase plans in the individual market.
I commend Senator Alexander, the chairman of the Senate Health, Education, Labor, and Pensions Committee, for his extraordinary leadership and hard work in this area.
I am also very pleased with the work that has been done by Representative Greg Walden, the chairman of the House Energy and Commerce Committee, and Representative Costello.
We have come together, along with a substantial number of our colleagues, including Senators Graham, Rounds, Isakson, and Murkowski, among many others, on this very important insurance stabilization and rate reduction package.
Let me begin by outlining the major provisions of what it is that we are proposing, because there has been, unfortunately, a lot of misunderstanding and, dare I say, misinformation.
First, our legislation, based on the Alexander-Murray bill, would fund the cost-sharing reduction subsidies for 3 years. These are vital for Americans who have incomes that are below 250 percent of the poverty level. CSRs provide government assistance to help them pay for their deductibles and their copays.
Second, our proposal also improves the ability of the States to take further steps to lower insurance premiums for their citizens. We provide meaningful flexibility for States by revising section 1332 of the Affordable Care Act, which authorizes State innovation waivers.
Third, based on a bill that I authored with Senator Bill Nelson, our proposal provides a total of $30 billion over 3 years for States to have reinsurance, or invisible high-risk pools, by applying for a waiver under the section 1332 program I just mentioned.
As I know the Presiding Officer well knows, reinsurance is a proven method for dealing with high-risk, expensive claims. It reduces uncertainty and has benefits not only for those who have preexisting conditions and need expensive healthcare but for the entire individual market, and it has been proven to work in States like Maine and Alaska.
We have also included $500 million to assist States with the planning of the designs of their own reinsurance, or invisible high-risk pools. In the House, the Costello bill also had a Federal fallback in recognizing that we were late in the year and that we wanted to provide help immediately, which we have included for 2019, to give States
time to apply for waivers under section 1332.
What does our bill not do?
Our proposal does not change the Affordable Care Act's essential benefit requirements. It does not change the guarantee that an individual will be able to buy insurance. It does not change the protections for people with preexisting conditions. Yet it ensures that the Federal funding directly benefits consumers and not insurance companies.
In considering this plan, Congress faces a fundamental question: Do we want to take action to significantly reduce the cost of health insurance for millions of Americans or are we just going to sit back, say no, and let this opportunity pass us by?
Time is short. If Congress fails to act, insurance rates in the individual market will skyrocket this fall. This will directly harm the 9 million Americans who pay for their own insurance without government or employer assistance. That is, for example, the fisherman in my State who is self-employed, the electrician, the plumber, the carpenter-- there are so many--the hair stylist. They are already paying far too much for their healthcare costs. Well, all of them will be facing another double-digit premium increase if they are to be insured, and rates can only be expected to continue to climb.
Healthcare premiums are already too expensive under the Affordable Care Act. That is one of the problems with the Affordable Care Act that I have been committed to fixing. Last year, the average price of the Affordable Care Act silver plans, which are the most popular plans, increased on average by 34 percent. A growing number of counties in our country are at risk of having no insurers or only one insurer, leaving hard-working individuals with few or no choices for health insurance coverage. Inaction will only exacerbate the premium spikes and the market instability we have already experienced.
When our country is confronted with such a serious problem--I mean, what is more important to people than healthcare?--Americans expect us to come together. They expect us to work constructively. They expect us to provide real relief from the rising cost of health insurance, which makes health insurance unaffordable for far too many Americans, and that is precisely what our plan would do.
Let me be crystal clear. Our proposal is the last opportunity--the last opportunity--to prevent these rate increases that will go into effect, which will be announced on October 1. Our package will help to stabilize the insurance markets and make them more competitive.
Every study has shown that our bill would make health insurance more affordable. According to the leading healthcare experts at Oliver Wyman, our bill would lower individual health insurance premiums in the individual market by as much as 40 percent compared to what people will otherwise pay if Congress fails to act. According to Oliver Wyman, it would also expand coverage to an additional 3.2 million Americans.
I want to touch on a complicated but important issue that some of my colleagues on the other side of the aisle have raised as a reason not to pass this bill. There have been two reasons. One is the application of the Hyde amendment, which has been law for decades, which I will talk about subsequently, but the first has to do with what is referred to as silver-loading and zero-premium bronze plans.
First a little background. The Affordable Care Act was designed to provide two key subsidies for enrollees who purchased coverage on the exchange and qualified from an income standpoint. The first are premium tax credits to help cover the cost of premiums for individuals earning between 100 and 400 percent of the Federal poverty level. The second are cost-sharing subsidies, or CSRs, to help cover the cost of deductibles and copays and other out-of-pocket expenses for individuals who are very low-income--earning between 100 and 250 percent of the Federal poverty level.
Despite the fact that Congress never appropriated the funds to pay for the cost-sharing reductions, the Obama administration paid them anyway. The House sued to block this strategy and won in Federal district court.
Lacking an appropriation from Congress, President Trump stopped making these payments last year. That concerned many of us, but let me make clear--he was following the court's decision. In response, insurance companies came up with the silver-loading strategy, under which they increased the price of their silver plans to compensate for the cost-sharing reduction payments they were no longer receiving. In essence, insurers have created silver plans that mimic CSRs for low- income enrollees. Because the ACA's tax credits are tied to the silver plan premium, the tax credits ballooned in size, producing credits so large that they are often sufficient to fully cover the premiums on the bronze plans for lower income enrollees and, by the way, greatly increased the cost to Federal taxpayers, which is why the bill we put together, by right-sizing the market and avoiding the games that were played, actually pays for itself.
We all remember the old saying that ``if something sounds too good to be true, it probably is.'' Well, free bronze plans for low-income individuals sounded too good to be true, and they are. I hope my colleagues on the other side of the aisle are listening to this explanation. The fact is that free bronze plans are only a good deal for low-income Americans who never get sick, who never get hurt, who never need to use their insurance. If they do, they will pay hundreds or even thousands of dollars more out of pocket.
While these plans might have lower monthly payments or even be free, they have much higher deductibles and copays. Based on publicly available data pulled from the exchanges, I am going to describe an example illustrating that individuals with free bronze plans will face much steeper costs when they try to access care than if they paid the small premium for the silver plan.
Let's take the example of Chris and Caroline, ages 34 and 32, who live in Portland, ME. They bought coverage on the exchange for themselves and their two young children for 2018. They make about $34,500 a year, which is about 140 percent of the Federal poverty level. They saw that they could get a ``free'' bronze plan, or they could choose to buy the cheapest silver plan for $54.83 a month. They chose the free bronze plan, not realizing that the silver plan would have given them access to subsidies, which provide lower deductibles and copays to low-income people. If Caroline gets pregnant this year and they are under the free bronze plan, they are going to have to pay out of pocket $7,350--and they make $34,500 a year. Had they picked the least expensive silver plan, they would have had to pay $500.
Consider a hypothetical couple in their early thirties, Jacob and Emma, with two young children, living in Seattle, WA. They are making just under $35,000 a year. When they went shopping for coverage on the exchange, they, too, saw that they could get a free bronze plan, or they could buy the least expensive silver plan for about $84 a month. Jacob and Emma chose the free bronze plan, which doesn't come with the subsidies included in the silver plan to help low-income families with deductibles and copays. If someone in this young family faces a serious illness this year, the silver plan in Washington State would have capped Emma and Jacob's additional expenses at $660. Unfortunately, they have the so-called free bronze plan that some of my colleagues have been touting. They would face up to $7,210 in out-of-pocket expenses--hardly an affordable option for this low-income family.
It used to be well understood by the affordability advocates in and out of the Senate that low-income Americans struggled to meet deductibles and out-of-pocket expenses. Just 1 year ago today, the Kaiser Family Foundation issued a report arguing against the House reform bill because it did not contain CSRs, noting that ``cost-sharing reductions are a key part of the financial support currently provided to [low-income] enrollees'' and that without such support, deductibles ``are often out of reach for people with lower and modest income.''
A prior Kaiser Family Foundation report from 2015 showed that only 1 in 10 individuals earning between 100 and 250 percent of the Federal poverty level--those are the individuals who would be eligible for CSRs under our bill--has savings or other assets large enough to cover a $6,000 deductible. In other
words, without CSRs, 90 percent of these individuals will have to wipe out their savings to cover their medical expenses before they even meet their deductible. Those who can't meet their deductible won't get reimbursed. For these Americans, a zero-premium plan will really mean a zero-benefit plan.
I cannot believe that silver-loading and free bronze plans is a credible long-term strategy. First, I would note, in addition to the examples I have given, that CBO assessments from last year were that the silver-loading strategy would cost the Federal taxpayers $194 billion over the budget window. Second, because low-income individuals will struggle to meet their deductibles, they will be unable to secure reimbursement of expenses. Sooner or later, taxpayers are going to be asking why they are paying nearly $200 billion more to subsidize policies that deliver such poor benefits.
To be clear, the amendment we are offering prevents this strategy, protecting lower and modest-income enrollees, low-income families and individuals and the taxpayers.
Now, let me discuss the Hyde amendment. I am disappointed, to say the least, that Democrats, who ought to have embraced this proposal, have instead rejected it because its funding is subject to the Hyde amendment. As a pro-choice Republican, I must say this puzzles me. The Hyde amendment has prohibited the use of taxpayer dollars to pay for elective abortions for more than 40 years. It is not new policy. The entire Labor-HHS title of the omnibus before us today is subject to the Hyde amendment.
There are variations of the Hyde amendment in other titles of the omnibus spending bill. It applies to a long list of Federal programs, including Medicare, Medicaid, CHIP, TRICARE, Veterans Affairs, Indian Health Service, the Peace Corps, the Bureau of Prisons, Immigration and Customs Enforcement. I have heard it said that it doesn't apply to commercial insurance that is offered by the Federal Government--that is just not true. It applies to the Federal Employees Health Benefits Program, through which 8.3 million employees, retirees, and their families get their health insurance coverage. I have not seen my Democratic friends make any effort to change the applicability of Hyde to that insurance program.
Together, these programs account for more than $1 trillion in government spending each year--all of which is covered by the Hyde amendment. That is 100 times the amount of reinsurance we are proposing in our amendment. A trillion dollars of Federal healthcare funding is already covered by the Hyde amendment, which has been policy for 40 years. So how is this, in any way, a radical departure from current policy?
I find it frustrating that some on the other side of the aisle are choosing to block this important package that will provide relief to those who need it most because of the application of the Hyde amendment. Let me say, they cite the Stupak amendment, which is section 1303 of the Affordable Care Act. We leave that in place, we don't touch it, and we do not change the Hyde amendment's exemptions found in section 507, which allow private entities, State governments, or individuals to use their own funds to provide coverage for abortion. In other words, this is nothing radical or new, and it is baffling and gravely disappointing that this should be used to block this package.
Dozens of healthcare consumer and business groups, as well as the National Association of Insurance Commissioners--those State commissioners whose job it is to look out for consumers--have called upon Congress to take action to lower premiums for millions of Americans and their families. These groups include the American Hospital Association, Blue Cross Blue Shield, the U.S. Chamber of Commerce, the American Medical Association, the American Cancer Society, the American Academy of Family Physicians, the Federation of American Hospitals, and there are a wide range of groups representing people with diseases, such as arthritis, cancer, epilepsy. The United Way has called for action, the Cystic Fibrosis Foundation, the American Lung Association. Just yesterday, the National Association of Insurance Commissioners put out a new letter in support of market stabilization.
Mr. President, I ask unanimous consent that these three letters be printed in the Record at the conclusion of my remarks.
Mr. President, how incredibly disappointing it would be if some Members derailed this serious effort to reduce the cost of health insurance for millions of Americans. While Members may disagree with certain provisions, the time has come for each and every Senator to decide: Are you for lower rates and more affordable coverage for the 18 million Americans who get their insurance from the individual market or are you content to just sit back and let their insurance rates soar once again this fall, making health insurance even less affordable than it already is?
In my view, the answer is clear and obvious. We must not lose sight of our goal, and that is making health insurance more affordable for millions of Americans. Including our insurance package in the omnibus funding bill is the right thing to do, and it is urgent that we do it now.
Thank you.
Mr. President, I ask unanimous consent that when the Senate proceeds to the consideration of the House message to accompany H.R. 1625, the omnibus appropriations bill, the Collins-Alexander amendment at the desk be considered and agreed to.