Affordable Care Act

Floor Speech

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Mr. WYDEN. Mr. President, before the Senator leaves the floor, I just want everyone to note that what the Senate just heard was Senator Hassan--vintage Senator Hassan--saying repeatedly: Let us find a way to move forward in a bipartisan way. And through example after example, she cited the progress. It has always been that, even before the Affordable Care Act.

I was the author of the Healthy Americans Act, the first bipartisan universal coverage bill in the history of the Senate--14 Senators, 7 Democrats and 7 Republicans--because we learned the lesson Senator Hassan has described and took it into the Affordable Care Act. So I thank my colleague for her wonderful remarks. And for people who are paying attention, this is what we get in the Senate Finance Committee every single time Senator Hassan is in the house.

Mr. President, the landscape of American healthcare is shifting dramatically in the 13 years since the Affordable Care Act was signed into law.

I believe many find it hard to even recall the day when an American could be denied health insurance because of preexisting medical conditions, but we ought to remember the history. Those were the days when healthcare was for the healthy and the wealthy. The insurance companies, under the law, could just clobber--clobber--somebody with a preexisting condition. You were basically on your own.

And, apropos of the implications to the economy, I have talked to the President of the Senate often about encouraging innovation enterprise. When we discriminated against people with preexisting conditions, the big problem we saw was job loss. When somebody had the opportunity to be mobile and to move somewhere else, they weren't able to do it because they were tethered to their position because they had coverage, and they couldn't get it if they moved on. Now, tens of millions of Americans have health and financial security thanks to 39 States--39 States--that have moved beyond just ending the discrimination against those with preexisting conditions to expanding Medicaid coverage.

The Affordable Care Act was also, we should remember, passed in a moment of great need. The recession--the great recession--caused massive economic damage and layoffs across the country. Millions lost the employer-provided health insurance they had. More than 50 million Americans lacked any form of health insurance coverage, and there was no backstop for them.

At that time, you basically were literally on your own. If you were sick and you were faced with providing for your family, you could lose virtually everything in those tragic kind of days when people didn't realize the importance of the changes that needed to be made.

It is now clear, for example, how important the Medicaid safety net truly is. The number of uninsured Americans has been cut in half. In addition to Medicaid, the individual marketplace hit record enrollment with 16 million people buying plans. In Oregon, that amounts to 140,000 Oregonians getting high quality, affordable health insurance. This was particularly obvious when the pandemic hit in 2020. Not only was the individual marketplace there to help the millions who lost their jobs, but Medicaid was the lifeline to help families get healthcare.

By the way, it is clear now that Medicaid can be a leader when it comes to innovative healthcare. I was particularly proud that in the rescue plan in 2021, we were able to bring together, for the first time, mental health leaders and law enforcement leaders to develop a multidisciplinary system with mental health and law enforcement to provide crisis services when someone on the streets of this country is struggling.

At the end of last year, the Congress passed a nationwide-- nationwide--guarantee of a full year of continuous health coverage for kids up to 19 years of age who were enrolled in Medicaid and a permanent option for States to provide a full year of postpartum coverage for new moms. I am proud that Oregon pioneered this continuous coverage policy for kids before it was adopted nationwide.

It is just commonsense that kids need reliable health coverage even if their parents' income is changing from month to month, and all of the research--all of the healthcare research about brain development-- makes that very clear.

We understand that there is a lot more to do. Tomorrow, we will hear from the administration in the Senate Finance Committee about some of the next steps. The Affordable Care Act moved forward significantly to resolve the crisis of health coverage, but there are still gaps.

I also mention that, for a lot of us, we now recognize that it is not just a question of expanding coverage. It is a question of controlling costs, and we are going to be focusing on that in the days ahead as well. Elected officials are often pretty good talking about expanding coverage, but not so good at controlling costs.

With respect to that, the Inflation Reduction Act made a significant down payment on cost containment by finally lifting that Holy Grail guarded zealously by Pharma--the prohibition on negotiating. Now Medicare can negotiate lower drug prices and implement what we wrote in the Senate Finance Committee in 2019--the price-gouging penalty. In 2019, with bipartisan support in the Finance Committee, we said, if Big Pharma raises prices faster than inflation, there is finally accountability for high pharmaceutical prices, and they are going to pay penalties.

Improvements to the affordable healthcare system is still in progress. Last week, the North Carolina State Senate passed a Medicaid expansion bill by an astounding 44-to-2 margin. That is a very obvious indication that, as Senator Hassan talked about and Senator Casey, there could be bipartisan support here. Medicaid expansion saves lives. It is a good deal for States, and it is wonderful to see States across the political spectrum following the example of North Carolina.

Finally, we took additional steps recently to help improve our coverage, particularly with the advanced premium tax credit, increasing the amount of financial help for middle-class families trying to balance health expenses against food, rent, and other costs. It also expanded eligibility for these tax credits for more middle-class Americans. The President's budget supports making these kinds of enhancements in coverage permanent and so do I.

I will close with this. One of the dividing lines in American Government is whether you think healthcare is a basic human right. My experience, having specialized in this for a lot of years, since the days when I was director of the Gray Panthers, is that there are a variety of ways you can get there. And that is what we do in the Congress. We debate ideas. But I feel right to the core of my time in public service and those days with the Gray Panthers that healthcare is a basic human right. The Affordable Care Act was a monumental step toward that long sought goal, and, as long as I have the honor and the privilege to chair the Senate Finance Committee, I will do everything I possibly can to work with Senators of both political parties to make that crucial goal a reality.

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