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Floor Speech

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Mr. CRAPO. Mr. President, tomorrow, this Chamber will have the opportunity to chart a new path forward on healthcare in this country.

Senators will be given the choice to extend the Biden COVID bonuses for another 3 years or to support healthcare reforms that will actually expand options, reduce premiums, and give power to patients instead of insurance companies. Both sides agree that the cost of healthcare is too high, but we need to address the root causes of the explosive increase in healthcare costs rather than mask them with unsustainable spending.

We are told that the expiration of the enhanced ObamaCare subsidies is a crisis and that there is no time left to do anything but extend them. If there is a crisis coming, it is entirely of the Democrats' making. My colleagues on the other side of the aisle created the premium tax credits as a part of the ObamaCare system because they did not trust their own policy to make healthcare insurance affordable without shifting the burden of paying for it from enrollees to taxpayers. When the original premium tax credits failed to bring down premiums, they enhanced the tax credits. Then, when that did not work, they extended the enhancements.

They did all this without a single Republican vote. They also chose the current expiration date that they now say must be changed. They created the very cliff that they now oppose.

Our colleagues on the other side of the aisle have had years to offer serious suggestions on how to reform the ObamaCare subsidies. Yet every time that deadline approaches, we are told there is no workable option except to extend them again. It seems that these subsidies were never truly meant to be temporary, but they should be.

We do not have to go along with their last-minute extension this time at the cost of $83 billion. Even our Democratic colleagues recognize that our healthcare system needs reform. Leader Thune recently quoted many of them here on the Senate floor.

They said:

We did fail to bring down the cost of healthcare.

They also said:

Now, right now, we have a broken health care system.

And it is not just the rising premiums that prove that ObamaCare is broken. We cannot ignore the pervasive fraud in this subsidy program. The rules governing eligibility for these credits are often flaunted. In September, the Wall Street Journal reported that the rule barring people who can access affordable insurance through their employers is ``barely enforced.''

Based on the Government Accountability Office's recent audit, income and citizenship verification rules are being ignored too. Of their 24 fake applications for enhanced tax credits, 22 are receiving subsidies despite submitting falsified paperwork or no paperwork at all. One of their applicants even received an email specifically confirming his income verification was approved even though he never submitted any proof of income in the first place.

The law prohibiting dual enrollment in ObamaCare and Medicaid was broken 1.6 million times last year.

Of course, unscrupulous insurance brokers have been signing people up for ObamaCare plans without their knowledge of them or their consent for them. Alarmingly, insurers make the most money through these fraudulent credits because they retain the money even if no payments are made on behalf of the patients.

As just one example, more people are signed up for zero-dollar premium ObamaCare plans in Miami-Dade County than there are low-income people living there. One woman in Miami said she had been paid five times by brokers to enroll in ObamaCare plans.

These are not isolated incidents. This year, 6.4 million Americans were improperly enrolled in enhanced ObamaCare subsidies at a cost of $27 billion. The true cost of fraud was likely even higher because the GAO also found in its report that tens of billions of dollars of subsidies in 2023 had not been reconciled to the enrollees' incomes, meaning they could have misrepresented their incomes to qualify for bigger subsidies.

This is the program our colleagues on the other side of the aisle are prepared to extend without changes, without even changing the policies that are generating fraudulent abuse.

We can't afford to do that. We cannot afford the $83 billion pricetag of their proposal, and we cannot afford to tacitly consent to this fraud nor can we afford to tell the hundreds of millions of Americans who are insured through means other than ObamaCare that we are not interested in their rising premiums.

While Republicans did not create this crisis--we did not create ObamaCare; we did not create these subsidies; and we did not create this expiration date--we do have plans to address it.

Senator Cassidy and I introduced a sound plan earlier this week. Our bill, the Health Care Freedom for Patients Act, is based on an idea endorsed by President Trump and many of our colleagues whereby Americans, not insurance companies, should control their own healthcare spending. Americans could use the permanent, original premium tax credits to purchase qualified bronze plans with a health savings account attached. They would then receive monthly contributions into that health savings account totaling $1,000 to $1,500 per person in the family annually.

Instead of lining the pockets of big insurance companies, like these subsidies, our HSA contributions would help patients pay expenses not covered by their insurance plans.

When patients can control their own care, they can seek the most appropriate treatment options for their individual circumstances, incentivizing care providers to compete for patients by improving prices and care outcomes.

Our plan would also provide funding for cost-sharing reduction payments, which will reduce out-of-pocket costs for low-income patients, save taxpayers money, and--get this--reduce premiums for benchmark Marketplace plans by 11 percent.

Additionally, our bill would ensure Federal health funding is spent for the benefit of Americans by strengthening citizenship verification requirements and discouraging States from providing taxpayer-funded healthcare to those who are not legally here and are not citizens of the United States.

Some of our Republican colleagues have offered plans of their own this week which are also worth considering as we move to the future. We welcome bipartisan cooperation on these proposals as with the pharmacy benefit manager reforms I recently introduced with Senator Wyden and many of our Senate Finance Committee colleagues.

But we must not simply kick the can down the road yet again. Every time we spend tens of billions of dollars for unsupervised and poorly designed subsidies, as our colleagues are asking us to do once again, we worsen the healthcare crisis that we all want to solve, and we do nothing to stop the explosive increase in premiums.

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