Executive Session

Floor Speech

BREAK IN TRANSCRIPT

Mr. DURBIN. Mr. President, the Senate has spent a great deal of time over the last 6 or 7 months on healthcare in America. For years after the passage of the Affordable Care Act, the Republican Party--the House and Senate--has called for repeal of the bill. Yet, when the time came, with the majority of Republicans in the House and the Senate and, of course, a Republican President, and the task was immediately before them, they faltered because they didn't have a replacement. They didn't have something to propose that was better. As a consequence, their efforts stopped short--one vote short--on the floor of the Senate several weeks ago.
We still face some significant challenges. Some of those are very immediate.

Before the end of September, we will face the prospect of needing to reauthorize the Children's Health Insurance Program, known as CHIP.

This program provides health insurance coverage for more than 9 million children and pregnant women across the country--350,000 in my State.

This vital program, the CHIP program, has had two decades of broad bipartisan support, and it is going to expire in 12 days.

The good news is that the Finance Committee chairman, Orrin Hatch of Utah, and his ranking member, Ron Wyden of Oregon, have reached a bipartisan agreement on a 5-year reauthorization of the CHIP program.

[[Page S5797]]

The bad news is that instead of preserving healthcare for low-income children and pregnant women, the Senate Republican leadership seems more interested in the next 12 days in calling a different issue--a different bill--altogether, the Graham-Cassidy bill, relating to health insurance across America. That bill would take health insurance coverage away from millions of Americans, including 1 million in the State of Illinois.
From where I am sitting, reauthorizing the CHIP program is a priority to not only serve the 9 million children and pregnant women across our country but 350,000 in my State.

There is another bill we need to reauthorize before the end of September: the funding of our Nation's community health centers. Like CHIP, funding for community health centers expires at the end of this month--in just a few days. Also like CHIP, community health centers have enjoyed decades of broad bipartisan support. We have 10,000 community health centers across our country. They serve 26 million Americans. Community health centers serve 1 out of every 10 children, 1 in 6 Americans living in rural areas, and more than 330,000 of our Nation's veterans.

Illinois' 52 health center organizations receive $150 million in Federal funding in order to provide care to the 1.3 million people in 360 locations in the State of Illinois. I have been to many of these locations, and I have said in real candor and honesty that if I had a medical issue or if there were one in my family, I would enter the community health centers in my State with confidence that I and my family would receive the very best of care. They are outstanding organizations.

If Congress doesn't act within 12 days, community health centers in my State and across the Nation will see their funding cut by 70 percent. That dramatic funding cut would result in 2,800 community health centers closing across America, 50,000 jobs lost, and 9 million people losing access to healthcare.

Well, there is good news here as well. Because of Senators Blunt and Stabenow taking the lead, they are pushing for swift reauthorization of community health center funding. But the problem is that there is another bill--the Graham-Cassidy bill--which has captured the attention and apparently the calendar time for the Senate--at least that is the possibility we hear. So why shouldn't Congress be spending the next 12 crucial days reauthorizing the Children's Health Insurance Program across America and making certain our community health centers don't lose the critical Federal funding they need to serve so many people? Right now, we know we face some challenges when it comes to the health insurance market in America.

Approximately 6 percent of Americans--3 percent of people in my State--purchase their health insurance in the individual marketplace, with more than 50 percent of these people receiving some subsidies to help pay for costs. However, many of these people are seeing dramatic increases in premiums. We know that, and we know it is a challenge and one we need to address.

Here is the good news--and it is time for some good news when it comes to healthcare. Almost from the minute that the critical vote was cast ending the repeal of ObamaCare, meetings started taking place. I can recall, as the Senate was adjourning, I looked back by the cloakroom, and there was Senator Lamar Alexander and Senator Patty Murray talking in the middle of the night--about 3 o'clock in the morning. I later learned that they had reached an agreement between them--a Republican, a Democrat--on the HELP Committee to start a series of hearings about what we could do as a Senate to actually strengthen the healthcare system in America. That was before our August recess.

When we got back from recess, they had kept their word. I attended three or four of the Member hearings, which they held before the official public hearings a little later in the morning. These were good meetings. At the first one, I recall Senator Alexander saying 53 Senators--Democrats and Republicans--showed up for coffee and doughnuts to meet with insurance commissioners from five different States. Just a few days after that, there was another coffee-and-doughnut session, another good bipartisan turnout of Senators as we sat down with five Governors, Democrats and Republicans, who talked about health insurance. A few days later, another meeting took place where experts came in and talked about the subject.

I felt there was more accomplished in those 3 hours with those outstanding witnesses from across the country than all of the time we had spent giving speeches to one another on the floor of the Senate in the previous 7 months. It was interesting. We brought in these people from different States, different political parties, and they virtually had the same thing to tell us. There were a handful of things which we could do that could make an immediate, positive impact to make the cost of health insurance a lot more predictable--not to say we are going to bring it down--I don't want to be overpromising--but to slow the rate of growth in health insurance costs as well as provide stability in the insurance market.

Here are the things that came out loud and clear from these bipartisan Senate meetings.

First, they told us to stop playing games with cost-sharing reduction subsidies. These are subsidies to insurance companies that take on individuals with expensive health histories. These insurance companies are given support by subsidies so that they can keep the premium costs for these individuals under control.
These cost-sharing reduction subsidies help 7 million Americans afford their copayments and deductibles on their health insurance policies. The current Trump administration has repeatedly threatened to stop the payments. As a result, individual market premiums keep going up because of the uncertainty of whether the government is going to keep its promise to make these cost-reduction subsidies.

I remember the commissioner from the State of South Carolina told us, I say to the Senator from Oregon, who is our ranking Democrat on the Finance Committee--he said: I am going to announce a 30-percent increase in health insurance premiums. If I knew that these cost- sharing reduction subsidies were coming, it would be 10 percent. I can eliminate 20 percent of the anticipated increase in premium costs if these subsidies come through.

It is pretty clear to me, this is sound policy, on a bipartisan basis, which would have a dramatic impact in reducing the cost of premiums to many individuals. That came through loud and clear in every meeting we had with Senators Murray and Alexander.

The second thing they talked about was State reinsurance. I don't understand that as well as some, but it has worked in States where the State picks up a share of the liability for health insurance between certain dollar amounts so the private insurance companies don't end up with that burden. Because of this reinsurance, they are able to keep premium costs down.

The third thing is to provide States with more flexibility without undermining some really fundamental issues--without undermining, for example, the preexisting condition protection we currently have.

I left those meetings feeling encouraged. After 7 months of bitter political rhetoric, which led to nothing on the floor of the Senate, we were finally sitting down, on a bipartisan basis, with Democrats and Republicans all across our country with specific suggestions which could help our healthcare system. That, to me, is the way to move forward. That, to me, is the lesson learned from much wasted time so far this year. Unfortunately, this whole effort may be derailed.

Senators Cassidy and Graham have come up with a legislative alternative they want to move forward. Unfortunately, the measure they have proposed has not been scored by the Congressional Budget Office nor carefully measured to find out what impact it would have on the American healthcare system, which accounts for one-sixth of the American national economy.

Here is what we know about the Cassidy and Graham proposal. What they are suggesting is basically eliminating the subsidies which help individuals pay for private health insurance and bringing to a halt the Medicaid expansion which has covered millions of Americans and given them health insurance.

What they say instead is something which has been said many times on the

[[Page S5798]]

floor: We will just give all the money to the Governors, and they will figure it out. They will figure out how to save money in their States.

It turns out, Governors of both political parties warn us: If you are going to give us a set amount of money as the cost of healthcare continues to go up, don't expect us to cover as many people or provide as good a coverage if we do it on a State-by-State basis.

So who supports this new Cassidy-Graham approach and who opposes it? Every single medical advocacy group--the hospitals, the doctors, the nurses--all across America oppose this Cassidy-Graham approach, as well as the medical advocacy groups, because they understand their approach would allow discrimination against individuals insured based on a history of preexisting conditions--going back to the bad old days before we passed the Affordable Care Act.

The Cassidy-Graham approach, which they brought to us, doesn't add up. If you take $300 billion or $400 billion out of this healthcare system, dump it into the laps of Governors across this country and say, ``Good luck. Do it on a local basis. I am sure it will all work out,'' they will quickly tell you, as they have had in the bipartisan meetings we have had, it will not work. It does not compute. It may be able to check the box from some things to repeal the Affordable Care Act, but they certainly didn't replace it with anything of equal or better value. The opposite is true. That is why I think we ought to think twice.

There is a mad dash now in the last 12 days to do many things. From a political viewpoint, there is a limited opportunity for this repeal effort. That 12-day period is a limited window under the Senate rules of reconciliation. It is a mistake, as far as I am concerned, for us to move toward Cassidy-Graham--concepts which have been roundly opposed in my State and across the Nation, concepts which have failed on the floor of the Senate.

Let us roll up our sleeves and do three things that do make sense: Let's reauthorize the Children's Health Insurance Program. Let's make sure those kids and their pregnant moms are going to have the basic coverage they have enjoyed for almost 20 years.

Let's also reauthorize the community health centers. We know they work. We know when people have a medical home, they are less likely to let medical conditions get worse and more expensive. That, to me, is a good investment to make sure they continue.

Finally, let's turn toward a real bipartisan effort, a measure which can emerge soon--I hope within days--from Senators Murray and Alexander on a bipartisan basis. I know they are still working on it. They haven't reached a final agreement on what they are doing, but I hope all of us, in both political parties, will encourage them to do the right thing.

Remember when John McCain came to the floor after he had been diagnosed with the cancer he is battling now. He came here and cast a crucial vote to proceed to debate this whole issue of healthcare. Then he asked to speak for 15 minutes, and I stayed in my chair. I wanted to hear it. He reminded us of the importance of doing things on a bipartisan basis and doing them thoughtfully when it comes to something as important as healthcare. Let us keep that speech by John McCain and that lesson in mind. Let us resist this Cassidy-Graham approach, which has no support when it comes to the medical community, and instead work on the bipartisan approach from Alexander and Murray, together with the Finance Committee--which I know Senator Wyden is going to address next--so we can have a bipartisan solution.

The American people sent us here to solve problems, not to create them. Cassidy-Graham creates problems. Let's find solutions which solve problems.

Mr. President, I yield the floor.

BREAK IN TRANSCRIPT

Source