Healthcare (Executive Session)
Mr. President, I want to preface my remarks today by asking that you convey to your wingman, Senator John McCain, our colleague, our best wishes and our hope that he is on his way to a speedy recovery and will be back here because we need…
Mr. President, I want to preface my remarks today by asking that you convey to your wingman, Senator John McCain, our colleague, our best wishes and our hope that he is on his way to a speedy recovery and will be back here because we need him. We need his wisdom.
I want to thank Tim Kaine for the leadership that he and Senator Shaheen are showing to help us try to stabilize the marketplaces. Senator Hassan and I have talked a lot about this.
What do we do now? I think this is an opportunity. This is an opportunity here. I realize there is a fair amount of confusion as to which path to take and which way to go. I hope we don't waste this opportunity.
I sent a message to the new chairman of the National Governors Association and to the new vice chairman of the National Governors Association. Brian Sandoval from Nevada is the new chair and the Governor from Nevada, previously the vice chair, and Steve Bullock from Montana is the vice chair. One is a Republican, and the other is a Democrat. I sent them a message this morning saying that it would be good to hear from the Governors. They have been working on a bipartisan letter--they have been working on it for a while--and this is really the time it could make a positive impact.
We have three people sitting here--four of us--who used to be part of the National Governors Association. I loved it, and I am sure Senator Kaine, Senator Hassan, and Senator Shaheen loved it as well. Here is what I suggested that the Governors may want to consider in their message:
No. 1, urge us to hit the pause button. Hit the pause button. Let's just stop in place for a moment.
No. 2, pivot soon--not in September, not in August, but now, like this week, pivot to stabilizing the exchanges.
No. 3, return to regular order. Senator Kaine has already mentioned this. When I talked with Senator McCain last week a couple of times briefly, we both talked about the need for regular order. People have good ideas on healthcare; introduce them. Committees with jurisdiction, hold hearings. Witnesses, including Governors, should come before the committees of jurisdiction--a couple of committees in the House and in the Senate--and let's hear from the experts, and let's certainly hear from the Governors, who have to run these Medicaid Programs and have a lot of expertise in this area to offer us.
Then I would say, after the August recess, if we can actually do something real in stabilizing the exchanges, what a confidence builder that would be among us and, I think, around the country. It would be a great confidence builder.
The other thing I would mention is that when we come back after the August recess, don't just muck around and wonder what we are going to do; we should pull together in a bipartisan way--something we talked about doing a lot, but we don't often do it--to really do maybe a couple of things.
Let's figure out what we need to fix in the Affordable Care Act. Republicans believe that Democrats feel it is perfect and nothing should be changed. Well, I don't feel that way. My guess is that most of our Democrats don't, either. No bill I have ever worked on was perfect. It can always be done better. The same is true with big programs like Medicare and Social Security, veterans programs, and so on. They can all be done better, and this is certainly the case as well. Let's fix the parts of the ACA that need to be fixed, and let's preserve the parts that ought to be preserved.
I would reiterate, speaking on behalf of some recovering Governors, including me, the Governors need to be heavily involved in this. I suspect that all of the former Governors who are on the floor with me today, when we were part of the NGA, we weren't on the floor--actually, I was on this floor any number of times because Governors had access to the floor--but we had many opportunities, many invitations to testify before Senate committees and House committees on a wide range of
issues. I think we brought value, and we need to hear from them today.
I want to go back and talk about how we go about stabilizing the exchanges. The first thing that would help would be for the administration to stop destabilizing them. That would be a big help.
Senator Kaine has led on legislation--and he has mentioned it, and I want to drill down on it just a little bit--that would provide reinsurance, much as we do in other ways in terms of the Medicare Part D drug program. Using reinsurance is a very common tool, and we can use it to help stabilize the exchanges.
How would it be used in our proposal? If this lady standing right in front of me were getting healthcare and her healthcare needs were expensive, under our reinsurance plan starting in 2018, 2019, 2020, the first $50,000 in her healthcare that she used in year one, 2018, the Federal Government--well, the insurance companies themselves actually would be on the hook for the first $50,000 of care she got. Between $50,000 and $500,000, under our proposal, the Federal Government would pay for 80 percent of that cost--80 percent of that cost. Between $50,000 and $500,000 would be on the Federal Government. Anything above $500,000 would be back on the insurance company. That is what we would do for the next 3 years.
Starting in 2021 and going forward, the first $100,000 would be on the insurance company for the costs borne--created by an individual, and then between $100,000 and $500,000, 80 percent of that would be on the Federal Government, and after that, the rest of it is back again on the insurance company to pay for.
That is our proposal. We have a bunch of cosponsors on it, and we need some Republican cosponsors as well. It is not a Democratic idea. It is not a Republican idea. It is just a good idea that deserves bipartisan support.
Another thing we ought to do to stabilize the exchanges is what Senator Shaheen has proposed; that is, we have these CSRs, cost-sharing reductions. I think of them as subsidies to help subsidize people whose income is under a certain level; I think it is 250 percent of poverty. Folks who are in the exchanges getting healthcare coverage and whose income is under 250 percent of poverty currently receive some subsidies to help buy down and reduce the cost of their copays and their deductibles. It is not really clear whether that is authorized. It is not really clear whether that is being funded, but it has been done for a number of years.
The current administration has been saying: Well, we don't know if we are going to continue to do that.
There have been some States that want to go to court and say: You can't do that.
We need to pass a law and say that we are going to have these cost- sharing reductions and that the subsidies will continue to be offered.
The last thing we need to do is to make clear that the individual mandate or something as good as or at least as effective as the individual mandate is going to be around. For the administration to say: Well, we don't know if we are going to enforce the individual mandate--it just encourages young, healthy people not to get coverage.
We have to make it clear that the individual mandate or something as good as--it could be a proxy for it or maybe several things that work together that could be as effective as the individual mandate. If they don't work, maybe we could just have a default position that would be the individual mandate again.
We ought to have hearings on these kinds of things and discuss them and hear from all kinds of folks.
The other thing I want to mention is just that when I go around my State, my Lord, I have never heard people so interested in encouraging us. I think I am regarded in my State--along with Senator Coons and our Congresswoman, Lisa Blunt Rochester--I think we are regarded as bipartisan people. We are Democrats and proud to be Democrats. We would like to work with Republicans, too, and I think that is part of being a recovering Governor. But on this subject, on healthcare reform, going forward, the people in my State don't want a Democratic victory. They don't want a Republican victory. Frankly, they don't want a Trump victory. They want a victory for our country. That is what they want. They want a victory for our country. And so do I, and I think so do most Democrats in this Chamber and most Republicans.
So let me say again, if I could make this suggestion, let's hit the pause button. Let's stop in place for right now. Let's pivot and figure out how we can stabilize the exchanges. Let's return to regular order. Let's hold bipartisan hearings, have expert witnesses, including folks from all walks of life who know about healthcare coverage, who know a lot about healthcare. After the August recess, let's launch a real, bipartisan effort to fix the things in the ACA that need to be fixed and retain, preserve those aspects that should be retained. As I said before, we need Governors at the table, not just recovering Governors. We need Governors at the table and a bunch of other folks as well who have a lot to contribute.
If we do those things, we will, in the words of--paraphrasing Mark Twain--Mark Twain used to say: When in doubt, tell the truth. You will confound your enemies and delight your friends. I think that is what he used to say. In this case, I would just say, paraphrasing Mark Twain, when in doubt, do what is right. When in doubt, do what is right. We will confound our enemies and delight our friends.
With that, I yield the floor.