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Floor Speech

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Mr. CASSIDY. Mr. President, I am a physician. I used to work in a hospital for the working uninsured and the uninsured, the poorly insured, and so, as you might guess, I am very sensitive to the idea, to the understanding, to the fact that healthcare is becoming more expensive and less obtainable to the American people.

And last week, if I can put this up, I pointed out that the average American household has $10,000 in credit card debt, and these aren't people paying it off every month. These are people, like in the State of Tennessee or in the State of Louisiana, who are carrying a balance. And over the last 5 years, to show that this is becoming an increasing problem, the average--if I remember correctly--the average percent of someone's income going to credit card interest has risen from 1.9 to 3.2 percent of their income. They are not paying this off. They are carrying a balance with 22 percent interest sometimes, and they are paying more and more.

And the way this factors into healthcare is that, when someone has a multithousand-dollar deductible, even if they have insurance--they have a multithousand-dollar deductible--in order to pay for the out-of- pocket, they are putting it on their credit card, so much so that over 60 percent of personal bankruptcies relate in part to healthcare expenses, period.

Credit card debt reflecting the overall debt burden--the overall problems of affordability in our society--is huge.

Now, we have an obligation here. We in Congress, whatever our party, working with the President, we all have a mutual obligation to address this issue.

And now I would like to stress that it is not just for the patient, if you will, the family, the individual, the employee--you name how you want to put it--to address this, but it also is important for businesses.

I had a townhall a couple of months ago back home, or a roundtable, and there was a woman named Debbie in DeRidder, LA, who owns a coffee shop. She has 50 employees, and that is 50 employees for which she has to provide insurance. And so she is having a difficult time expanding her business because then she has to provide coverage to more employees, and she cannot afford to expand because of the money that she is putting toward their benefits.

Now, we need businesses to be strong. We need businesses creating more jobs, paying better wages for the people of the United States. By the way, that is not a Republican or Democrat or congressional or Executive office--that is an American priority for our fellow Americans.

So one thing that is kind of lost is the ability to hire new employees--or, I should say, more employees--and the ability to pay them more is getting swallowed up by the increased percent of compensation to an employee that is going to provide health insurance.

To give a little bit more background, whenever a person, whenever a business owner makes a decision to hire an employee, the amount they set aside for that employee is the wage, the Social Security tax they pay upon those wages on behalf of the employee, and then their benefit package. The more that benefit package costs, the less they can pay the employee.

And, right now, we are seeing the cost of health insurance climb to the extent that businesses are not able to pay more wages because they are having to put more into paying for the health insurance.

This is not new. This is getting worse. And we spoke earlier--to kind of feed back into the credit card debt--businesses are compensating by buying the cheapest policy they can. It is still more expensive but cheaper. But that cheaper policy has a deductible that is more and more. That cheaper policy may have a deductible of $5,000.

The average family carrying a $10,000 credit card debt doesn't have $5,000 to pay expenses, and that brings us back to where we started. They don't have it in their money. They don't have it in their pocket. So they are putting it on their credit card. They are carrying the debt, and more and more of their income is going toward paying interest on rolled-over credit card debt.

By the way, it is a big problem in my State of Louisiana. I think we are the No. 3 State in the Nation, in terms of families carrying credit card debt.

And if I remember correctly, 11 percent of families nationwide are going delinquent on their credit card debt, which means they are not even paying the minimal balance required.

This is an issue for Congress, whatever your party, for President Trump to engage with each other to accomplish this mission. And, by the way, we need the President, and I personally will make an appeal to President Trump.

Let's do something for the American people. And you can say it is an election year. No, say it is not an election year. This is the year in which we have got to help the American people afford their household items. It is a huge issue.

And the answer is that President Trump's intuition on this is fantastic. During the debate over extending the enhanced premium tax credits on the exchanges, President Trump said: Don't give the money to the insurance company; give the money to the family--because if you give it to the insurance company, the insurance company takes 20 percent of it for profit and overhead. And, by the way, the family is still left with a multithousand-dollar deductible. So President Trump's intuition on this is the correct intuition.

We need to make it so that, when the Federal Government is taking the money we are already using to subsidize the purchase of health insurance by employers and by the employee, the money is going to the patient, not to the insurance company. Give the patient the power, not the profit to the insurance company.

And so I emphasize: The President's intuition is correct, because that opens the door for the President and for the Congress, no matter your party, to come together to address this issue.

By the way, you could say that it is good politics. I would say: Good policy is good politics. And so it would be important for us to consider to do this.

Now, I have come up with a plan. I call it the MVP plan--MVP, Money and Value for the Patients. How do we do this? So, again, taking the President's intuition, don't give the money to the insurance companies; give it to the patient. We advance the dollars to the patient in a health savings account that they can use to pay for that out-of-pocket expense. Under this plan, a family of four would get about $2,000.

And, by the way, there is a way to pay for this. This would not add to the Nation's debt, because we already are subsidizing the purchase of health insurance by Americans. We just do it a little differently.

And in this you give $2,000 to the health savings account. Why is that important? Sixty percent of American families will not spend more than $2,000 in a calendar year on out-of-pocket expenses for healthcare.

And once you take care of that first 2k, they can take a higher deductible policy, which will lower the cost of the premium. Put together, this could save a family as much as $6,000 on healthcare, on the cost of being insured.

So $6,000 a year, $500 a month--this could help that family carry a $10,000 load right now, the part of that credit card debt coming from the need to put healthcare expenses on the card.

This would help the employer because the employer could, plausibly, get a policy which is less expensive, which keeps more money in the employer's pocket--better able to hire more people or pay more compensation.

And it doesn't increase the Nation's debt. We make it debt neutral.

And it builds upon the President's insight: You don't give the money to the insurance company; you give it to the patient. And you add value. So we bring money in with value to the patient.

In the HELP Committee right now, the committee I am privileged to be the chairman of, we have a bill--bipartisan, with Roger Marshall from Kansas and John Hickenlooper from Colorado. Our committee staff is working hard with them on this, to increase price transparency.

Now, price transparency began with legislation and Executive orders in the first Trump administration. I am familiar with that. Part of it was the No Surprises Act, which I helped author, and that began the process of price transparency.

Price transparency, just to be clear, we know what it means. Price transparency is knowing the price of something before you make the purchase, as opposed to knowing the price afterward.

I use the example--in the No Surprises Act, we made it so that, when you go in for a colonoscopy, they are obligated to tell you if it is going to cost more than anticipated. They have to tell you what that additional cost is going to be.

I chuckle because, in the bad old days, you would find out that you are obligated to pay the extra cost for a colonoscopy when you are waiting to go back for the colonoscopy, and you have been prepped--and, if you have ever had one, you know what that means--and you are sitting there with a thin sheet over you, and they say: By the way, if you want to walk out, you can. Otherwise, we are going forward. Just sign this sheet of paper.

It was not a way to acquaint people with the price beforehand, at a point in which they were prepared to walk away.

Now, under the No Surprises Act, we have to be informed. We are going to increase that--increase the power of price transparency--so that the patient would know, when she is going to go in, how much it is going to cost beforehand, as opposed to afterward.

We teamed this up. There are a lot of applications being developed right now by the private sector, taking the information we are creating to bring value to the patient. For example, I use the example of ``my daughter has an earache, and I need to bring my daughter to the hospital or to an urgent care center.''

You can take your phone and say: Urgent care center near me. Which one has the lowest price? Is there any difference in quality?

These apps will be able to give the patient--the mom, the dad--the information she or he needs right then as to which urgent care center is near them, is open, their cost for a routine visit or any other type of visit, and the quality of the care.

When you walk out, you can say: Pharmacies near me. Which has the best price for Bactrim DS--I forget the dose; I am a doc, but I haven't prescribed it for so long--say 250 milligrams twice a day?

And they are going to send you to the pharmacy with the best price. Now, you are paying for this from the prefunded money in the health savings account. So you are bringing money in the pocket of the patient, coupled with value proposition, price transparency, and the apps being developed in the private sector for the patient. The effect of this is to take power from the insurance company, power from the middlemen, and give it to the patients--power to the patient, not profit to the insurer.

Now, we can do this. We can do this, but it will take a commitment from Congress and from the President of the United States to do it. But first, you have to care about it. We have to care that the families back home are carrying a balance of $10,000 on their credit cards.

If we care about this, if the President of the United States cares about it--when I say ``we,'' I mean the Senate; I mean the House of Representatives--we can come together and fix it. Let's be constructive. Let's acknowledge that this is something we have to do together, but first, we have to care about it together.

Just to point out that it is doable, earlier this year, the President signed into law a PBM reform bill that Congress had negotiated last Congress but got signed into law this Congress. President Trump is attempting to do this through TrumpRx. The MVP plan would allow--could work with TrumpRx to give the patient access to the better price.

So, ultimately, we have to care. Ultimately, we have to make a decision as a Congress, as a government, to address the issue which is most pressing upon the American people: affordability.

There are some things we can't touch. Housing--whatever solution we put into housing will not affect next year. The price of gasoline and groceries--we cannot affect that as long as the Iranians are holding the Strait of Hormuz. That will be up to the President to come up with an end game that addresses that issue. But one thing we can do collectively is to address the cost of being insured. Some of the things we do immediately, when this happens, will begin to decrease the amount of money a family puts in their personal budget in the cost of healthcare.

Get engaged, all of us. With the President, get engaged. We will be held accountable by those families if we don't, and by golly, we should be.

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