Executive Calendar

Floor Speech

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Mr. BARRASSO. to 4 p.m. today.

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Mr. BARRASSO. Mr. President, I come to the floor because Democrats out on the campaign trail continue to spin their one-size-fits-all healthcare plan that they call Medicare for All. The name itself is misleading. I will state that as a doctor who has practiced medicine in Wyoming for 24 years.

Even many Democrats in the first Presidential debate sounded confused about their own proposal. The candidates were asked a simple question. They were asked to raise their hands if they supported eliminating private health insurance. That is the health insurance people get from work. ``Just four arms went up over the two nights,'' but ``five candidates who kept their hands at their sides,'' the New York Times has now reported, ``have signed onto bills in [this] Congress that do exactly that''--take health insurance away from people who get it from work.

On one point, though, they all raised their hands. That was on the question that was asked of all 10 Democrats in round 2 of the debate. They all endorsed taxpayer-funded healthcare for illegal immigrants. Every hand went up.

It seems Democrats have actually been hiding their real, radical agenda. ``Most Americans don't realize how dramatically Medicare-for- all would restructure the nation's health care system.'' That is not just me talking; that is according to the latest Kaiser Family Foundation poll. We need to set the record straight, and I am ready to do that right now.

The fact is, Democrats have taken a hard left turn, and they want to take away your health insurance if you get it from work. The proposal abolishes private health insurance, the insurance people get from work. In its place, they would have one expensive, new government-run system. Still, Democrats know most of us would rather keep our own coverage that we get from work. Even the people on Medicare Advantage--20 million people--would lose it under the Democrats' proposal. The Kaiser poll confirms Americans' top concern is, of course, lowering their costs or, as the Washington Post ``Health'' column put it, people simply want ``to pay less for their own health care.''

That is what we are committed to on this side of the aisle.

Many Democrats running for President continue to promote and support this radical scheme by Senator Sanders. The Sanders legislation would take away healthcare insurance from 180 million people who get their insurance through work, through their jobs. In addition, 20 million people who buy their insurance would lose coverage as well.

You also need to know that the Democrats' proposal ends the current government healthcare programs. Medicare for seniors would be gone. Federal employees' health insurance would be gone. TRICARE for the military would be gone, and the children's health coverage also would be gone under this Democratic healthcare, one-size-fits-all plan. That is confirmed by the Congressional Research Service.

The Congressional Research Service recently sent me a formal legal opinion. I requested it from them. It is a formal, legal opinion, stating: Medicare for All ``would . . . largely displace these existing federally funded health programs'' that I just mentioned--Medicare, Federal employees' health insurance, TRICARE, children's health coverage. It would largely displace these existing Federal health programs as well as private health insurance, the insurance people get from work.

From: Wen S. Shen, Legislative Attorney. Subject: Effect of S. 1129 on Certain Federally Funded Health Programs and Private Health Insurance.

Pursuant to your request, this memorandum discusses the legal effect of S. 1129, the Medicare for All Act of 2019 (MFAA or Act) on various public and private health care programs or plans. Specifically, the memorandum analyzes whether the MFAA would authorize the following programs or plans to continue in their current form:

Medicare (including Medicare Advantage and Part D);

Medicaid (including the Children's Health Insurance Program);

TRICARE;

Plans under the Employee Retirement Income Security Act; and

Individual, Small and Large Group Market Coverage.

For reasons discussed in greater detail below, the Program created by the MFAA would, following a phase-in period and with some limited exceptions, largely displace these existing federally funded health programs as well as private health insurance. This memorandum begins with a description of the key provisions of the MFAA before turning to its legal effect on the programs and plans that are the subject of your request. Medicare for All Act of 2019

The MFAA aims to establish a national health insurance program (Program) that would ``provide comprehensive protection against the cost of health care and health-related services'' in accordance with the standards set forth under the Act. Specifically, under the Program, every resident of the United States, after a four-year phase-in period following the MFAA's enactment, would be entitled to have the Secretary of Health and Human Services (Secretary) make payments on their behalf to an eligible provider for services and items in 13 benefits categories, provided they are ``medically necessary or appropriate for the maintenance of health or diagnosis, treatment or rehabilitation of a health condition.'' Except for prescription drugs and biological products, for which the Secretary may set a cost-sharing schedule that would not exceed $200 annually per enrollee and meet other statutory criteria, no enrollee would be responsible for any cost-sharing for any other covered benefits under the Program. The bill would direct the Secretary to develop both a mechanism for enrolling existing eligible individuals by the end of the phase-in period and a mechanism for automatically enrolling newly eligible individuals at birth or upon establishing residency in the United States.

All state-licensed health care providers who meet the applicable state and federal provider standards may participate in the Program, provided they file a participation agreement with the Secretary that meets specified statutory requirements. The Secretary would pay participating providers pursuant to a fee schedule that would be set in a manner consistent with the processes for determining payments under the existing Medicare program. Participating providers would be prohibited from balance billing enrollees for any covered services paid under the Program, but providers would be free to enter into private contracts with enrollees to provide any item or service if no claims for payment are submitted to the Secretary and the contracts meet certain statutory requirements.

With respect to payment for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment, the Secretary would negotiate their payment rate annually with the relevant manufacturers. The bill would further direct the Secretary to establish a prescription drug formulary system that would encourage best practices in prescribing; discourage the use of ineffective, dangerous, or excessively costly medications; and promote the use of generic medications to the greatest extent possible. Off- formulary medications would be permitted under the Program, but their use would be subject to further regulations the Secretary issues.

With respect to the Program's administration, the bill would authorize the Secretary to develop the relevant policies, procedures, guidelines, and requirements necessary to carry out the Program. The Secretary would also establish and maintain regional offices--by incorporating existing regional offices of the Centers for Medicare & Medicaid Services where possible--to assess annual state health care needs, recommend changes in provider reimbursement, and establish a quality assurance mechanism in the state aimed at optimizing utilization and maintaining certain standards of care.

To fund the Program, the bill would create a Universal Medicare Trust Fund. Funds currently appropriated to Medicare, Medicaid, the Federal Employees Health Benefits Program (FEHBP), TRICARE, and a number of other federally funded health programs would be appropriated to the new fund.

The MFAA also includes a number of other provisions related to the administration of the Program, including an enforcement provision aimed at preventing fraud and abuse, provisions relating to quality assessment, and provisions concerning budget and cost containment.

Effect of the MFAA on Certain Federally Funded Health Programs and Private Health Insurance Federally Funded Health Programs

The federal government currently funds a number of health programs, including (1) Medicare, which generally provides health insurance coverage to elderly and disabled enrollees, (2) Medicaid, which is a federal-state cooperative program wherein states receive federal funds to generally provide health benefits to low-income enrollees, (3) the Children's Health Insurance Program (CHIP), which is a federal-state cooperative program that provides health benefits to certain low-income children whose families earn too much to qualify for Medicaid but cannot afford private insurance; (4) the FEHBP, which generally provides health insurance coverage to civilian federal employees, and (5) TRICARE, which provides civilian health insurance coverage to dependents of active military personnel and retirees of the military (and their dependents). Following an initial phase-in period, the MFAA would prohibit benefits from being made available under Medicare, FEHBP, and TRICARE while also prohibiting payments to the states for CHIP. These payment prohibitions would effectively terminate these programs in their current form. This reading is confirmed by Sec. 701(b)(2) of the MFAA, which redirects funding for these programs to the national Program.

With respect to Medicaid, the MFAA would significantly limit its scope. After the MFAA's effective date, Medicaid would only continue to cover services that the new national Program would not otherwise cover. Thus, Medicaid benefits for institutional long-term care services (which are not among the 13 categories of covered services under the MFAA) and any other services furnished by a state that the Program would not cover, would continue to be administered by the states. The bill would direct the Secretary to coordinate with the relevant state agencies to identify the services for which Medicaid benefits would be preserved and to ensure their continued availability under the applicable state plans. Private Health Insurance

Currently, private health insurance in the United States consists of (1) private sector employer-sponsored group plans, which can be self-insured (i.e., funded directly by the employer) or fully insured (i.e., purchased from insurers), and (2) group or individual health plans sold directly by insurers to the insured (both inside and outside of health insurance exchanges established under Section 1311 of the Affordable Care Act). The MFAA would prohibit employers from providing, and insurers from selling, any health plans that would ``duplicate[]the benefits provided under [the MFAA].'' Given that the benefits offered under many existing private health plans would likely overlap with--i.e., be the same as--at least some of the benefits within the Program's 13 categories of covered benefits, those existing health plans would likely ``duplicate'' the benefits provided under the MFAA. Thus, this prohibition of duplicate coverage would effectively eliminate those existing private health plans. Employers and insurers, however, would be allowed to offer as benefits or for sale supplemental insurance coverage for any additional benefits not covered by the Program. As a result, employers and insurers could offer, for instance, coverage for institutional long-term care services, which are not among the 13 categories of covered services.

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Mr. BARRASSO. Mr. President, this report details how the bills cut off funding.

The CRS memo concludes: These payment prohibitions would effectively terminate all of those programs I mentioned in their current form.

The Congressional Research Service finds that Medicare for All actually terminates Medicare in this country. So Democrats want to turn Medicare, currently for 60 million seniors, into Medicare for None. It will become Medicare for None, not Medicare for All. Plus, 22 million people would lose Medicare Advantage. I know many of my patients who signed up for Medicare Advantage because there are advantages to doing it--coordinated care, working on preventive medicine. There are reasons for signing up for Medicare Advantage. That would all be gone under the one-size-fits-all approach that the Democrats are proposing.

That is not all. This report says the Sanders bill ends Federal employee health insurance. There are more than 8 million Federal workers, families, and retirees who rely on this Federal Employee Health Benefits Program.

The Congressional Research Service says that this bill, sponsored by over 100 Members who are Democrats in the House of Representatives and sponsored by a number of Democrats in this body, will abolish TRICARE, the insurance for the military. More than 9 million military members, their families, and retirees rely on TRICARE for their healthcare.

The report says the bill ends the Children's Health Insurance Program. Nine million of our Nation's children rely on the CHIP program.

Interestingly, ObamaCare would end as well, according to the CRS report. After less than a decade, Democrats want to repeal and replace their failed ObamaCare healthcare law with a one-size-fits-all system.

Again, the Congressional Research Service says the bill bans private health insurance. One hundred eighty million people get their insurance through work.

To sum up, hundreds of millions of American citizens--American citizens--stand to lose their insurance, and I believe that is just the start of the pain for American families. In the new system, we would all be at the mercy of Washington bureaucrats. That means we would be paying more to wait longer for worse care--pay more to wait longer for worse care. The Democrats' massive plan is expected to cost $32 trillion. That is trillion with a ``t.'' That is a 10-year pricetag.

Guess who is going to pay for that mind-boggling bill--of course, every American taxpayer. Senator Sanders admitted in the Democratic debate the other night that his proposal would raise taxes on middle- class families. His proposal will raise taxes, he said, on middle-class families.

In fact, even doubling our taxes wouldn't cover the huge cost of what they are proposing. So Washington Democrats are planning to drastically cut payments to doctors, nurses, hospitals, and to people who are providing care. The bureaucrats would ration care, restrict care--the care you get that you need--and it would be restricted in terms of treatment as well as technology. People would lose the freedom to choose the hospital or doctor they want.

As a doctor, I am especially concerned about the impact on patient care. Patients could wait weeks, even months, for urgently needed treatment. Keep in mind care delayed is often care denied. So the Democrats' grand healthcare vision is to force you to pay more to wait longer for worse care.

As a Senator and a doctor, of course, I want to improve your care, make it less costly. You should get insurance that is appropriate for you and affordable. You should be free to make your own medical decisions. That is what it is like in America.

No question, healthcare needs to be more affordable, and Republicans are working to lower costs without lowering standards. To me, that is the big difference. Democrats are proposing the reverse. Their plan would lower your standard of care and raise your costs. Democrats can keep campaigning hard left on healthcare. That is where they are headed.

Republicans are going to stay focused on real reforms that promote more affordable healthcare, cheaper prescription drugs, protections for patients with preexisting conditions, and, of course, the end of surprise medical bills. President Trump recently took Executive action that increases price transparency to lower the costs that patients pay.

You just need to know the facts about the Democrats' one-size-fits- all healthcare. Don't let far-left Democrats fool you. Radical Democrats want to take away your current healthcare. There would be no more Medicare or private plans, just a one-size-fits-all Washington plan.

Why pay more to wait longer for worse care? Instead, let's give patients the care they need from a doctor they choose at lower costs. That is our goal. That is our objective, and that is what we are going to accomplish.

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