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Floor Speech
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Mr. LANKFORD. Mr. President, the Senate is talking a lot about healthcare right now for good reason. There are major cost increases going up on insurance all across the country but especially for some folks that are in ObamaCare Marketplace plans.
I talked earlier this week with a gentleman from my State who is in his early sixties. He runs a small business, works his tail off. His insurance plan that he has taken on, he took on in the last few years because of the enhanced premium tax credit subsidies that were added in 2021. Those temporary tax gifts to insurance companies expire in just a few weeks.
Now, he knew that they would expire. As he told me in our conversation we had this week, he said he knew they were temporary, but now he is trying to figure out what to do to find affordable healthcare options for himself because his healthcare is going to go up about $500 a month. That is an enormous amount.
And his frustration was pretty clear. He is just looking for a plan that he can afford. He is just looking for an option. He is not asking for something unrealistic. He is just trying to figure out what to do. He asked me the question: How did we get here? How did this happen?
Well, let me just walk through that because the interesting thing about all of this is how confusing it has really been in the process. Everyone that I talked to about healthcare, they all say: It is incredibly confusing. I can't figure out any of this.
Let me try to explain just a couple of things we are talking about.
My Democratic colleagues are asking for a multibillion-dollar extension, not of ObamaCare but of a subsidy that was put on top of ObamaCare. And it doesn't apply to 320 million Americans. It applies to about 20 million Americans. If I want to make it even more specific than that, it is not just 20 million Americans because most of those qualify for the full subsidy; it is just for a certain group-- typically, folks that are 50 to 64--that it applies to.
It is that particular group that are on the ObamaCare Marketplace that are in that age bracket that are facing very high premiums that are coming up very, very soon. It is a big deal to them, as well it should be for any American.
Let me set the context for this. The Kaiser Family Foundation lists the average cost for healthcare insurance on the individual market--the average cost for healthcare insurance on the individual market--at $215 the year before ObamaCare came into effect. Let that set in for a minute. People in this room know how much your health insurance is now. If we went back to prior to ObamaCare's passage, the average cost for the individual marketplace for health insurance was $215. Not so any more. It has more than doubled--more than tripled for many people.
President Obama said at that time that ``it will cut the cost of the typical family's premium by about $2,500 a year.''
It has not been reduced for the typical family by about $2,500 a year. It has dramatically increased. It has become more and more complicated. There are more and more entities that are involved in healthcare decisions.
And the challenge for healthcare right now is the absolute complexity that has been created in the cost that continues to overwhelm. That is where we are as the baseline that every American is facing right now.
In 2021, my Democratic colleagues saw the skyrocketing costs. And in what they called the American Rescue Plan during COVID, they added in an additional subsidy on top of ObamaCare for about 10 million people. That was called the enhanced premium tax credit that got added on top of ObamaCare because the ObamaCare costs were skyrocketing so fast.
They called it, at the time, a temporary plan to be able to help during COVID. But then a year later, they added another 2 years on top of it. That is now what is expiring at the end of this year, their temporary COVID extension. The problem is, the price continues to go up so rapidly that now no one can afford the plan anymore.
In my State in Oklahoma, we asked our insurance commissioner to take a 6-year snapshot and tell us what is happening to the Marketplace, the ObamaCare Marketplace, without the subsidies. If the subsidies went away, what was the increase? And for the commercial insurance from my State, what changed during that time period?
For ObamaCare, the rates had gone up 198 percent in 6 years. In commercial insurance in my State, it has gone up 29 percent--apples-to- apples comparison.
There is a very real problem with the structure of how ObamaCare actually works. The request has been: Let's put more subsidies on top of it, more subsidies on top of it and add billions and billions more in taxpayer dollars to cover up the problem that is underneath. There is a problem in the way that ObamaCare was actually created and how it is actually operating and what it is causing not just for that group in the Marketplace but for what it is causing for everybody else, even people that are not in the Marketplace at all--how that is driving up premiums.
We are debating the next 24 hours, trying to be able to come to two sets of solutions here. My Democratic colleagues are bringing a proposal tomorrow to say: Let's just take the subsidies that we did during COVID and let's extend those 3 more years, and we will just do that, no reforms, no changes, no anything else. Let's just do that for 3 more years.
It was interesting. I asked about the 3 more years and the exact timing on that, how that would work. It is fascinating. When you pull back the politics of that 3-year extension, the 3-year extension goes through the end of 2028. But what they don't tell you is, it would actually set up to announce the new insurance rates for 2029 that would not have the subsidies anymore in it the week before the Presidential election in 2028.
Well, that was clever. They set up a little political timebomb for the Presidential election in 2028, saying they chose this certain date in this certain time to do it so that right before the next Presidential election, we would have the same argument all over again-- no reforms, no changes, political date-setting.
Republicans are actually bringing forward a proposal and saying: We see you. We see what has been dropped on you. We see individuals in my State and all over the country that have now fallen prey to what has happened in ObamaCare that they can't get options for different healthcare insurance, they can't get cheaper rates, and they certainly can't go back to what the rates were in 2010 at $215 a month anymore because under ObamaCare, if you are in the individual market, that is not allowed anymore. That is absolutely prohibited in Federal law now.
So we have a very simple proposal: We do want to assist folks who are stuck in this ObamaCare Marketplace to try to figure out how we help them through this, but we don't want to send the dollars to the insurance companies. That is a hole. We want to send it to the individuals who are there and give them some greater choice on it.
So our main proposal is, yes, we want to help them, and we want to help them immediately, but we don't want to send dollars to insurance companies and trust in them that it is going to be taken care of. We want to get the dollars to those particular individuals and say: Let us help you in this process and get through this next year as we, hopefully, reopen this whole debate about healthcare.
The second thing that we want to do is increase the options for coverage for those individuals and increase them right away so that they get greater flexibility in what they can choose. We trust the American people as they are shopping in the marketplace for healthcare insurance to be able to make better decisions.
Long term, what I would love to see is let's open up the conversation about how we have associations of healthcare plans. Right now, the small business owner I talked to earlier this week is limited to only choosing things in the ObamaCare Marketplace, and the price is absolutely skyrocketing for him. He doesn't have the option to actually join together with other small businesses to negotiate for a better rate. A big company can do that. If you are Walmart, you can do that, and if you are JPMorgan Chase, you can do that, but if you are my small business owner in Oklahoma, you cannot. They are prohibited from doing that. Well, that is ridiculous. They should be allowed to join together and be able to negotiate for better rates so they can get greater options on that.
We want to help expand health savings accounts. Health savings accounts allow individuals to actually talk to their physicians or their hospitals and say: How much does this cost, and actually try to find a way to be able to compete for cost on it. Greater price transparency allows people to choose, if they have got to get an MRI, a CT scan, or whatever it may be, to say: What are the best options to be able to do this that actually bring the cost down?
Most of the time when people go to the hospital, they never know what the cost is for anything. They have no idea because ``insurance'' is covering that until, suddenly, they don't, and then it becomes a big issue. That should be something we can all agree on as greater flexibility and greater options on plans do nothing but help people.
There is an issue that I have worked on with several of the folks in this room, and that deals with pharmacy benefit managers. We have got to be able to actually land this. We all know of the rising costs of pharmaceuticals that are out there. We all experience that, and everybody says: What is the problem? It is the middleman in the middle of this who is actually controlling the formulary and controlling a lot of the pricing, and that completely hides the cost of everything on it.
The pharmacy benefit managers are destroying our independent pharmacies in our rural areas all around the country as they continue to make more and more profits on Wall Street. We have got to say: We are not trying to destroy you, but you have got to stop destroying our independent pharmacies around the country, and you have got to actually be more transparent in the process on this.
We have a bill that is a bipartisan bill that has come out of the Finance Committee that we have unanimous support for--tell me how often that happens in this body--but that we can't seem to get to the floor. We should be able to agree that, if someone is trying to dramatically jack up the cost of pharmaceuticals on our individual constituents and on the families in our neighborhoods and is destroying our independent pharmacies, we should all be able to agree that that is anticompetitive. That has got to stop. We should be able to do that.
Listen, we already passed this last July--a $50 billion amount going to rural hospitals to stabilize those rural hospitals. We have already engaged in ways to be able to stabilize Medicaid in the long term and make sure that the program continues to work well. We have already taken on some of these things to be able to make things better. We have got to deal with the issue of individuals and their healthcare options and their opportunities to find better insurance to be able to take care of their healthcare.
Let's increase competition, and let's increase options for individuals in the days ahead; but in the short term, let's at least get immediate assistance to those folks who need the help right now by giving dollars to those individuals, not by sending cash to the insurance companies and setting up a political timebomb right before the Presidential election. That doesn't sound like that is actually helping people. That sounds like that is perpetuating the same problem that we have dealt with already. These are options that we should be able to have grownup conversations about and resolve. There is a way to resolve this. Let's get busy doing it.
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