Mr. President, I call up amendment No. 8, which I send to the desk on behalf of Senator Murphy, me, and other Senators as well. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with. Mr. President, I…
Mr. President, I call up amendment No. 8, which I send to the desk on behalf of Senator Murphy, me, and other Senators as well.
Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.
Mr. President, I rise to offer this amendment, amendment No. 8, with Senator Murphy and other Senators, to the budget resolution we are currently considering, and the purpose of amendment No. 8 would be to create a point of order against considering any legislation that would either strip Americans of health insurance coverage, make health care more expensive, or reduce the quality of health coverage.
Our amendment creates a high hurdle to any legislation that would make America sick again, and basically that is what we are trying to do. If we are going to either strip coverage from people or make health insurance more expensive or reduce the quality of health coverage for Americans that they currently have, we shouldn't make that easy to do. We should have a high hurdle in place so we consider it before we do it.
The point of order is necessary because the entire purpose of this budget resolution is not to really address the budgetary matters facing the country. I say that as a member of the Budget Committee. In fact, the budget process was basically ignored in the last Congress.
This budget is only before us to set up a pathway to pass a fast- track repeal of the Nation's most consequential health care program in decades, a program that affects millions of people and a repeal being fast-tracked that would strip health care from millions of Americans.
I will come back to the health points in a second, but I want to address how we got to where we are on the budget question that was in the province of the Budget Committee.
I think it is a little strange that halfway into Fiscal Year 2017, which began in October 2016, we are going to be setting budget levels now. A budget resolution is a tool to set forth the guidelines for spending in Congress.
We know, in the history of this body, we are not always successful in passing a budget through both Houses of Congress and approving that budget through a conference process, but at least some progress is usually made; for example, both Houses doing their budget resolutions. As you know, that did not happen in 2016. Last year, our GOP counterparts in each House decided, for the first time in the modern budget era, not to hold a hearing on the President's submitted budget, not to have any activity on a budget in the Senate, either in the committee or on the floor.
To begin, I have to ask, if the budget wasn't important enough for us to consider last year, why is it now so important for us to be taking up a budget? The answer is obvious. We are debating a budget for the sole purpose--the sole purpose--of setting in motion a process to repeal health care coverage for tens of millions of Americans. This is really about an attack on people's health care.
I and many of my colleagues have said there is a significant need to make improvements to the Affordable Care Act and, more generally, to our health care system.
Mr. President, you were a chief executive of a State, just like I was. I learned something in my first year as Governor of Virginia, which was, when I looked at all the bills that were put on my desk for signature, amendment, or veto at the end of my State's legislative session, three-quarters of the bills were not new legislation or not repeals of legislation; three-quarters of the bills were improvements of existing law. That is the work of a legislative body. Overwhelmingly, it should be improvements to existing law. The Affordable Care Act needs significant improvement, just as other health care laws do, just as virtually everything we do needs improvement.
There is no reason, while we acknowledge the need for improvement, to repeal a law outright without having a sense of what the replacement will be because, by doing so, what we do is create chaos in the economy, chaos in the health insurance market, and especially chaos in the most intimate and important area of people's lives, their health.
Actually, on that subject, there was a wonderful letter that was sent on January 3 by the American Medical Association to the congressional leadership on
this very point, don't do a repeal that creates chaos for people. I am going to read some sections of the letter.
The AMA supported passage of the Affordable Care Act because it was a significant improvement on the status quo at that time.
We continue to embrace the primary goal of the law to make
high-quality, affordable health care coverage accessible to
all Americans. We also recognize that the ACA is imperfect,
and there are a number of issues that need to be addressed.
Continuing the quote:
It is essential that gains in the number of Americans with
health insurance coverage be maintained.
The letter concludes, from the American Medical Association, the largest organization representing American physicians:
Consistent with this core principle, we believe that before
any action is taken, through reconciliation or other means,
that would potentially alter coverage, policymakers should
lay out for the American people, in reasonable detail, what
will replace current policies. Patients and other
stakeholders should be able to clearly compare current policy
to new proposals so they can make informed decisions about
whether it represents a step forward in the ongoing process
of health reform.
The amendment Senator Murphy and I propose is designed to accomplish exactly the goal, exactly the goal the AMA has specified in the letter of January 3.
We would create a 60-vote point of order against any legislation that would, first, reduce the number of Americans who are enrolled in public or private health insurance coverage, so there would be a 60-vote point of order against any proposal that would reduce coverage for Americans; second, the point of order would also lie against any plan that would increase health care premiums or total out-of-pocket health care costs for Americans with private health insurance; and, third, the point of order would lie against any proposed plan on the table that would reduce the scope and scale of benefits offered by private health insurance because the ACA was not only about affordable care and it was not only about coverage, it was also about the quality of care.
Could your coverage discriminate against you because you are a woman? Could your coverage expire once you get diagnosed with an illness and now have a preexisting condition?
These bill of rights protections for patients were an important and integral part of the Affordable Care Act, and the budget point of order that we would put on the table would establish a 60-vote threshold for considering any legislation if it triggered one of those three concerns: reduction in coverage, increase in cost, reduction in quality.
The point of order actually goes right to promises that the President-elect has made. In September of 2015, President-elect Trump said:
I am going to take care of everybody. I don't care if it
costs me votes or not. Everybody is going to be taken care of
much better than they are taken care of now.
He has made a promise to the American public that we will not rush into a new health care chapter that reduces coverage, that reduces quality, or that increases costs.
Just 2 days ago, the key spokesperson for the President-elect Kellyanne Conway said: We don't want anyone who currently has insurance to not have insurance.
She is not setting a threshold of 1 million people or 100,000 people or 10,000 people or 10 people. She is saying the threshold is this: We do not want anyone who has insurance to have that insurance jeopardized by actions of Congress.
This is what a repeal of the Affordable Care Act, without a replacement plan, will mean. It will have three significant consequences, and then I want to finish with some personal stories.
First, a repeal with no replacement will inflict a significant wound on the American economy. Health care is one-sixth of the American economy, one-sixth. You cannot inject uncertainty into one-sixth of the American economy without having significant negative effects on our Nation.
Congress should be in the business of increasing certainty, not increasing uncertainty, and if we go into the biggest sector of the American economy with a repeal, without any replacement strategy, it is the equivalent of, ``I am now going to jump off a cliff and I will figure out how to land once I am in midair.'' This will be economic malpractice to affect that many people.
Second, the effect of the repeal of the Affordable Care Act is sort of an under-the-table tax cut for the wealthiest Americans. Millionaires, if the Affordable Care Act is repealed--there are two taxes on high earners that are part of the financing of the Affordable Care Act, and these taxes on high-earning Americans would expire, and this is hundreds of billions of dollars over 10 years of a tax cut. Millionaires would get 53 percent of the tax cuts from a repeal, which is more than double the same group's share of the 2001 and 2003 tax cuts that were done during the Bush administration.
Just to put that in some context, Americans in the top 0.1 percent economically would get an average tax cut of $197,000 if the Affordable Care Act is repealed. That is one way to sort of look at this repeal without a replacement. It is essentially a tax cut for the wealthiest, financed by reductions of health care on the people who are most in need.
Third, the impact that is the most significant is the impact on the health care of average Americans. The Urban Institute did a study in December and said: If there is a repeal with no replacement or a repeal with a delayed replacement to something that we know not what it will be, there will be 30 million Americans who will lose their health insurance. About 20 million will be people who got health insurance under the Affordable Care Act, and an additional 10 million will be people who will lose their insurance because of the chaos created in the insurance market.
I want to put that number, 30 million, into a context because numbers can just sound big and mysterious. Here is what 30 million people is. The number of people who would lose health insurance because of an ACA repeal is equal to the combined population of 19 States: Wyoming, Vermont, North Dakota, Alaska, South Dakota, Delaware, Montana, Rhode Island, New Hampshire, Maine, Hawaii, Idaho, Nebraska, West Virginia, New Mexico, Nevada, Utah, Kansas, and Arkansas. Nineteen States' combined populations, that is 30 million people, and that is who is going to lose health care coverage if we go forward with a repeal without a replacement.
Eighty-two percent of these 30 million who would become uninsured are working families, 38 percent will be between the ages of 18 and 34, and 56 percent are non-Hispanic Caucasians. Eighty percent of the adults becoming uninsured are people who do not have college degrees. There will be 12.9 million fewer people who have Medicaid or CHIP coverage in 2019 if the repeal goes through. These are some sobering statistics. These statistics show that, at a minimum, what we are doing here is very, very consequential and very, very important and should not be rushed into in a partisan 51-vote budget reconciliation process.
I want to conclude and tell a couple of stories from Virginians of people who are going to be impacted by this. When we essentially recessed in the Senate on December 9--between then and now--I went around the State and talked to people. I heard a story that I want to share, and then I will tell a couple of quick ones.
I met with Ashley Hawkins, a young mother in Richmond, a mother of two kids. We sat around a conference table in a federally chartered community health center in Richmond and talked to stakeholders. Ashley told her story. She had a preexisting health condition. Before the Affordable Care Act, health insurance was unaffordable. After the Affordable Care Act passed, she could suddenly get insurance.
Ashley owns a small business. She runs a nonprofit group that provides community arts education that serves others. Because of the ACA, she has been able to sign up on exchanges and get health insurance. Because of her income, she can receive subsidies to make that health insurance affordable. She makes $45,000 a year.
Without health insurance, the recent hospital bill for the birth of her youngest child would have been close to $16,000. With the Affordable Care Act, she receives a subsidy, and she is able to access high quality health insurance for her and her two kids for $280 a month. That is the difference between
not being able to afford to go to a hospital and deliver a child and to be able to afford, as a small business owner, a health insurance policy that covers her and her two kids for less than $300 a month.
This is what she said as we sat around the table and talked about what it means to have affordable insurance. She said: ``It has to do with self esteem and security and well-being.''
Having health insurance is about security, even when you are not sick. Obviously, when you are sick or when you are delivering a child, health insurance is needed. But when you are a mother of two children, even if you are at the peak of your health and even if your children are at the peak of their health, you would go to bed at night--and Ashley described this--wondering: What will happen tomorrow if my child gets sick? What will happen tomorrow if I am in an accident? Not having health insurance for a parent is a continuous agitating voice in your mind, an anxiety creator, about what is going to happen to my family if we get sick or get in an accident, which is something that happens to virtually every family. It has to do with self-esteem, with security, and with well-being. Without the protection for people with preexisting conditions, without the subsidies in the marketplace, people like Ashley will go back to not being able to afford coverage for their families.
After the Affordable Care Act passed, I happened to be in a position where I was trying to buy health insurance in the open market without an employer subsidy for the first time in my life. When I say I was doing this, what I mean is that my wife was doing all the work because she is the one who does all the work. She talked to two insurance companies who said: Hey, sorry, Anne, we can't afford your entire family because of preexisting conditions. One company would not cover me. One company would not cover one of my children. My wife said: Hold on a second. The Affordable Care Act just passed. You can't turn somebody down on a preexisting condition now.
In each case the insurance company said: I have to talk to my supervisor. They had to call back and say: You are right; we are wrong. We have to provide insurance for your entire family.
Can I tell you this? My family is the healthiest family in the United States. At the time my wife was making those phone calls, of the five of us, the only time any of us had ever been hospitalized was in the three occasions my wife went to the hospital to give birth to our kids. We are a healthy family, and we were turned down twice because of a preexisting condition by insurance companies that had to say: We are wrong, and because of the Affordable Care Act, now we can write a policy for your entire family.
I had a woman write me a letter--a Virginian from Williamsburg--a couple of years ago who said: My husband and I are self-employed, and we could never afford insurance. Because we couldn't afford insurance, we decided that we couldn't have children. We couldn't pay a hospital bill. This is what the Affordable Care Act has meant to them. We often talk about life and death issues in the sense of illnesses, sicknesses, cancer diagnoses, and preexisting medical conditions. They can be life or death issues, but they can also be life issues, in the sense of this couple who wrote and said that because they could now get insurance as self-employed individuals with subsidies to make it affordable, they are now going to start a family because of the Affordable Care Act. They could start a family.
Finally--and I will always remember this because this gives me great motivation--as I was getting outside of my native Virginia and exploring other States on an interesting 105-day summer vacation as part of a national ticket, I went to the Iowa State Fair. I told this story once before on the floor, but I am going to tell it again. A grandfather came up with a little boy in his arms. I said: What is that child's name? Jude. Jude, the patron saint of lost causes. There is St. Jude Children's Research Hospital in Memphis, a place where children have been able to go to get medical care.
I knew there must be a story. I said: Hey, Jude, tell me about Jude. Jude was a 3\1/2\-year-old who was diagnosed with a congenital heart defect and by age 3\1/2\--as his grandfather told me the story, now mom and dad were coming around me as well--Jude had to have multiple heart operations at the Children's Hospital in Omaha. The grandfather said to me that Jude would not have been able to have those operations and Jude would be uninsurable for the rest of his life if it were not for the Affordable Care Act.
Then Jude's father put his hand on my shoulders. He was a big guy. He said to me: You have to tell me that you will do everything you can to make sure that Jude isn't stripped away and consigned again into the outer reaches of preexisting conditions and uninsurable, with an uncertain future for my son. I made a pledge to him. I said: I am only one person. I don't know what, at the end of the day, I can do, but I can tell you this. I can stand up to make sure that your child and other children--such as Ashley's two kids and the family that wrote me about wanting to have children--will not be left high and dry and without the security of health insurance in the wealthiest and, to my way of thinking, still the most compassionate Nation on the face of this planet.
I encourage every Member of this body to ask their constituents for stories like Ashley's, like Jude's, like my family's, and like the family in Williamsburg about how an ACA repeal with no plan would impact them.
I will go back to the purpose of the amendment. The ACA is not perfect. We ought to be talking about reform. If Republicans want to call it replace and we want to call it reform or improvement, I don't care what we call it. We should have the AMA, hospitals, patients, and Members of Congress from both parties around the table to lay down what are our concern, what are our problems, and talk about how to fix them. There is so much we can do. There is so much we can improve. But by pushing an immediate repeal through a partisan budget process, we won't have the opportunity to work together to build on that common ground.
This is not a game. Sometimes we get into a budget vote-arama, and it has a little bit of a game aspect to it. I have been here until 2 a.m. or 3 a.m. when amendments are put on the table, there are 1-minute presentations of why it is good or bad, and we have a vote. It has a little bit of a feeling of a game. This is not a game. This is life and death.
Is there anything more important to someone than their health, because their health forms the foundation of their relationship with their spouse or their loved ones or their children? Health is what keeps a parent up at night worrying about the family. Health is what keeps a child worrying about an elderly parent. This is the most important thing to any person in this country, regardless of party, regardless of State, regardless of political persuasion. The worst thing we can do on a value of such importance is to rush and create chaos in the lives of millions of people.
So I conclude by saying that the amendment that Senator Murphy, I, and others offer would seek to protect what we have--protect coverage, protect costs, protect quality--by making it harder to enact legislation that would strip these important items away from tens of millions of Americans.
We should be sitting down at the table to talk about reforms. So many of us want to do that. But we should not be rushing into a repeal that would jeopardize people's lives.
I urge my colleagues to please support amendment No. 8.
Thank you, and I yield the floor.
Mr. President, I have spoken about this previously. The budget that is on the floor really isn't a budget; it is more of a focused attack on health care for millions of Americans. Amendment No. 8, which I have offered with Senator Murphy and others, is an attempt to stop the majority from passing a health care repeal through a fast- track process. The amendment does one thing: It creates a budget point of order against any legislation that would either reduce the number of Americans enrolled in public or private health insurance, increase health insurance premiums, or reduce the scope and quality of benefits provided.
I ask for the yeas and nays on the amendment.
Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974, I move to waive section 305(b) of that act for purposes of the pending amendment, and I ask for the yeas and nays.