From the Congressional Record Online through GPO
The PRESIDING OFFICER. Under the previous order, the Senate will
proceed to executive session to resume consideration of the Shanahan
nomination, which the clerk will report.
The legislative clerk read the nomination of Patrick M. Shanahan, of
Washington, to be Deputy Secretary of Defense.
The PRESIDING OFFICER (Mr. Flake). The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, the majority leader says that he will
move forward this week with a vote on a straight repeal of the
Affordable Care Act in its entirety. I don't believe that a majority of
Senators are willing to support a reckless leap in the dark, which that
vote would mean. It is a vote that would end protections for people
with preexisting conditions. It would take healthcare coverage away
from tens of millions of Americans and tens of thousands in New
Hampshire. It would terminate the Medicaid expansion that has been
critical to fighting the opioid epidemic in my State and so many States
across this country.
According to the nonpartisan Congressional Budget Office, a straight
repeal of the Affordable Care Act would result in more than 32 million
people losing their insurance coverage by 2026. Premiums would roughly
double in the individual marketplaces. I urge my Republican friends not
to go forward with this misguided approach.
The idea that they can repeal the healthcare bill now and give us a
new bill in 2 years or whatever period of time is in the bill just
doesn't pass the smell test. If we haven't seen an alternative to the
Affordable Care Act in the last 7 years, there is no reason to believe
that our Republican colleagues are going to be able to produce a bill
in 2 years when there is chaos in the marketplaces.
There is a better way forward for the Senate and for our country.
During the Fourth of July recess, Majority Leader McConnell said that
if he can't secure the votes to repeal the Affordable Care Act, he is
prepared to work in a bipartisan way with Democrats on legislation to
repair and strengthen the law.
I believe that bipartisanship is the best way to get something done.
That is what I tried to do when I was Governor of New Hampshire. I
worked closely with our Republican legislature, and we got things done.
It should not be a last resort for what we are doing; it should be the
first resort. It should be what we do to build a foundation for policy
in this country.
I am hopeful that following the floor consideration of whatever the
majority leader decides to do on healthcare--and, hopefully, it is
going to get defeated--we will move forward with the majority leader's
fallback plan, which I believe should be the starting position. We need
to start fresh with regular order to craft bipartisan legislation that
builds on the strengths of the Affordable Care Act, that builds on what
is working and fixes what is not working. As we have been hearing at
townhalls and in countless messages from our constituents, this is
exactly what the American people want us to do.
There is remarkable consensus in this country that the Republican
leaders' bill is the wrong approach. An ABC/Washington Post poll on
Sunday found that by a more than 2-to-1 margin, Americans prefer the
Affordable Care Act to the Republican leaders' bill. Their bill is
strongly opposed by hospital associations, by healthcare providers, by
the health insurance industry, and by nearly every patient advocacy
group, including the American Cancer Society and the American Heart
Association. There is no reason to think that just repealing the
Affordable Care Act is going to make that any better.
On Saturday, the New Hampshire Hospital Association, the New
Hampshire Medical Society--our physicians--and the New Hampshire AARP
joined together in opposition to the bill. They noted that more than
118,000 Granite Staters--nearly 1 in 10 people in New Hampshire--would
lose healthcare coverage under the Republican bill, and that number is
even greater if we just repeal the Affordable Care Act. Their joint
statement urges Senators “to start over and create a new version of
legislation that protects coverage for those who have it and provides
coverage for those who need it most.”
Mr. President, I ask unanimous consent that the joint statement by
these groups be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From the Concord Monitor, July 15, 2017]
Our Turn: Protecting Patients Must Be the First Goal of Health Care
(By Todd C. Fahey, Stephen Ahnen and James Potter)
The New Hampshire Hospital Association, New Hampshire
Medical Society and AARP New Hampshire have joined in
opposition to the Better Care Reconciliation Act currently
under consideration in the U.S. Senate.
Our three organizations oppose the BCRA because it would
erode health protections for millions of Americans and expose
them to increased costs and health risks. We believe that any
health care legislation should have the goal of protecting
We are concerned that the BCRA would reduce funding for
Medicare by cutting nearly $59 billion over 10 years from the
Hospital Insurance trust fund, which would hasten Medicare's
insolvency and diminish the program's ability to pay for
services in the future. This would affect hospitals, doctors
and consumers by reducing revenue and making it more
difficult to provide services to Medicare patients. To put a
sharper point on the issue, New Hampshire hospitals are
projected to receive approximately $1.5 billion less in
Medicare reimbursements over the next decade, reductions that
were enacted as part of the Affordable Care Act to help pay
for the coverage expansions that have occurred. To maintain
those spending reductions while millions of people lose
health insurance coverage is simply not feasible.
The BCRA threatens protection for people with employer-
sponsored health coverage by weakening consumer protections
that ban insurance companies from capping how much they will
cover annually or over a person's lifetime--leaving people
vulnerable to costs that could be financially catastrophic
In addition, the bill cuts more than $700 billion from
Medicaid by creating a capped financing structure in the
Medicaid program. This could lead to cuts in provider
payments, program eligibility, covered services or all three,
ultimately harming some of our nation's most vulnerable
citizens and dramatically impacting providers' ability to
serve patients and communities who depend on them every day.
It has been estimated that this would result in over $1.4
billion in reduced federal spending on Medicaid in New
Hampshire over the next decade. Where would New Hampshire
turn to find the resources necessary to care for our most
According to the CBO, the BCRA will leave 22 million more
people uninsured, including more than 118,000 Granite State
residents who were able to secure vital health coverage
through the Affordable Care Act, making it more difficult for
our most vulnerable to receive the services they need to stay
in their homes. Without health coverage for, and therefore
access to, critical health services, patients will seek care
in emergency rooms, ultimately raising uncompensated care
costs for hospitals throughout New Hampshire and increasing
cost-shifting to New Hampshire businesses.
We believe that the Better Care Reconciliation Act needs to
be viewed through the eyes of patients and the caregivers who
take care of them, and should make protecting health care
coverage for our most vulnerable citizens a higher priority.
We remain opposed to the BCRA and urge the Senate to start
over and create a new version of legislation that protects
coverage for those who have it and provides coverage for
those who need it most.
We appreciate the efforts of both of our senators to
protect access to affordable health care for all Granite
Staters, and we urge them to continue to work toward
bipartisan solutions that will cover more people, not less,
and reduce health care costs, including insurance premiums
and the high cost of prescription drugs.
Mrs. SHAHEEN. Mr. President, I strongly agree with these New
Hampshire groups. After spending 6 months trying to pass the deeply
unpopular, deeply flawed bill to repeal the law, shouldn't we welcome a
bipartisan effort to improve the law? I believe the answer to that is
yes, and the place to begin is by taking urgent action on a matter
where most of us agree, and that is providing certainty to health
insurance markets in order to hold down premium increases. In their
2018 rate request filings, insurers say that large increases are
necessary because of the uncertainty surrounding the repeal of the
Affordable Care Act and because the Trump administration refuses to
commit to making cost-sharing reduction payments--those payments that
go to insurance companies so they can help their consumers with
the cost of health insurance, making sure that more people can get
health insurance. Well, we now have an opportunity to end this
uncertainty by putting the repeal behind us and authorizing a simple
bill to authorize regular appropriations for the cost-sharing reduction
The current instability in the ACA marketplaces is a manufactured
crisis, and Congress can put a stop to it very quickly. That is why I
have introduced the Marketplace Certainty Act, which is a bill to
permanently appropriate funds to expand the funds for and to expand the
cost-sharing repayments. It does two things: It guarantees that these
payments are coming, and it is going to cover more people to help. I am
pleased to be joined by 26 Senators who have already cosponsored this
bill. We can end this artificial crisis. We can immediately restore
certainty and stability to the insurance markets, and, in turn, we can
get the time we need in order to come together in a bipartisan way to
improve this law to build on what is working and to fix what is not.
We have a number of these commonsense measures, and this is one that
has been embraced, not just by Democrats but by key Republican leaders,
including Chairman Lamar Alexander and House Ways and Means Chairman
Kevin Brady, who have urged that these payments be continued. As
Chairman Brady put it, the payments are needed “to help stabilize the
[health] insurance market and help lower premiums for Americans.” He
added: “Insurers have made clear the lack of certainty is causing 2018
proposed premiums to rise significantly.”
We have heard from our constituents at home. We have heard from
doctors, nurses, hospitals, particularly rural hospitals, nursing
homes, patient advocates, insurers, and those constituents who were in
the statement I asked to be printed in the Record. They are pleading
with us to set aside our partisan differences and work together to
repair the Affordable Care Act.
Again, we know what we can do. It is not just the Marketplace
Certainty Act; there are other bills that have been introduced that can
fix the uncertainty in the markets and allow us to address other issues
with the law.
Bipartisanship should be the Senate's first resort, not the last
resort. An excellent place to start is by coming together right now to
permanently appropriate funds for the cost-sharing reduction payments
that keep health coverage affordable and to look at some of the other
commonsense measures that are going to be talked about by my
colleagues, like Senator Klobuchar, who will be coming to the floor.
She has legislation that would help us deal with the high cost of
prescription drugs, which is one of the things that is driving the
increasing costs of healthcare. We need to pass these commonsense
measures, and we need to do it now.
I yield the floor.
The PRESIDING OFFICER. The Senator from Minnesota.
Ms. KLOBUCHAR. Mr. President, I want to thank Senator Shaheen for her
leadership, and I am proud to be one of the cosponsors of her bill with
her commonsense approach--which I believe is the one that will rule the
day--to work together on changes to the Affordable Care Act that will
help the American people.
I join my colleagues on the floor in sharing the concerns I have
heard from so many people in my State and across the country about the
bill that has been introduced by our colleagues. I also heard their
desire to have us work together to bring down the costs of healthcare
and to make fixes to the Affordable Care Act.
Healthcare leaders in my State have come out strongly against the
bill released last week because it would be devastating to the people
of our State, especially in our rural areas--rural hospitals--and
especially to our seniors who rely on Medicaid funding for nursing
homes and assisted living.
Last night we heard that we will not be proceeding to that bill, and,
instead, the majority leader wants to bring up repealing big parts of
the Affordable Care Act without a replacement. I just want to remind my
colleagues that the Congressional Budget Office has already looked at
this repeal without a replacement, and it is just as bad. Instead of 22
million people losing their insurance by 2026, the CBO has estimated
that about 32 million would lose insurance under the repeal approach,
and premiums would double. So this repeal effort doesn't help the host
of Minnesotans who, according to the Minnesota Medical Association,
would be harmed by what they call draconian Medicaid cuts.
It doesn't help our children's hospitals. I met with several last
week, and they were very concerned that Medicaid cuts would wreck their
ability to provide healthcare to our kids. This was something, by the
way, that I heard repeatedly on the Fourth of July. During the parades,
people would come out of the blue, out from the sides of the streets,
mixed in with the hot dogs and American flags, and there were these
families--predominantly families with kids with disabilities--and they
would bring children over to meet me and would say how important this
Medicaid funding is for their entire family. I remember that once, when
the mom brought her child over with Down syndrome, all of the people on
the parade route, on that block, cheered for that family.
We know that we are all in this together, and we know that what
happens to one family could, next year, happen to another family. You
can have a child with a disability. You can suddenly have a disease
that could be debilitating to your family's finances. Basically, we
never know what is going to happen to our health or to the health of
our family members. That is why we have health insurance, and we must
make sure that it is affordable.
In addition to that, we have had the CEOs of our healthcare system
stand up and say that these approaches would lead to major job losses
in our State. As I mentioned before, for seniors, AARP has said that,
in my State, nearly half of all of the adults who receive tax credits
under the Affordable Care Act are 50- to 64-year-olds and these
subsidies would be eliminated under the repeal bill. This could make
healthcare unaffordable, especially for the more than 350,000 people in
my State who are aged 50 to 64 who have preexisting conditions.
Now, it does not have to be this way, as Senator Shaheen has so
articulately pointed out. I know that several of my Republican
colleagues have said that they cannot support legislation that would
take away insurance for tens of millions of Americans, and I agree.
Instead of making these kinds of draconian cuts and moving backward, I
think we have to move forward to actually help make healthcare in
America better and more affordable.
We can and we should make changes to the Affordable Care Act. The day
it passed, I said this is the beginning and not the end. You simply
cannot have a major piece of legislation like that and go for years
without any significant changes. That is just not how it has worked
with major legislation in the past, but every time we have tried to
make changes, we have heard back that we have to repeal it. Maybe the
result of all of this chaos in the last month has been that people have
finally come to realize what the American people want, as Senator
Shaheen has pointed out, as well as what is the best policy, and that
is to make changes.
I support Senator Shaheen's Marketplace Certainty Act because it
would stabilize the individual market and protect and expand the vital
program that reduces out-of-pocket healthcare costs for consumers. I
also support the bill of Senator Kaine of Virginia, who is here with us
today, and Senator Carper, which is the Individual Health Insurance
Marketplace Improvement Act, which reestablishes a Federal reinsurance
program. By the way, this idea of reinsurance is something that our
Republican legislature in Minnesota just passed on a State basis and is
supportive of. So I see these as not just some pie-in-the-sky ideas. I
see these ideas as things that we can work on across the aisle.
I just want to end by talking about some of my ideas, many of which
have bipartisan support. Again, I throw them in a package of things
that we could be working on. I have a bill that would harness the
negotiating power of 41 million seniors who are on Medicare in order to
bring drug prices down. Right now, by law, Medicare is banned from
negotiating prices with all of
those seniors. Think of the better bargain that those seniors could get
if their marketing power were unleashed.
Senator McCain, the Presiding Officer's colleague, and I have a bill
to allow Americans to bring in safe, less expensive drugs from Canada,
which is, by the way, very similar to the American market. As I have
often noted, we can see Canada from our porch in Minnesota. We see
right across the border the kinds of prices they are able to get.
Senator McCain and I and several Republicans voted for a similar
measure, and we think we should be allowed to bring in less expensive
drugs from Canada and, perhaps, from other countries. You could also
tie to it a trigger, if there is no competition or if prices have
ballooned like they have for 4 of the top 10 selling drugs in this
Senator Lee and I have a bill that would allow for the importation of
safe drugs from other countries when there is not healthy competition.
Senator Grassley and I have a bill to stop something called “pay for
delay,” which is when big pharmaceutical companies pay off generics in
order to keep their products off the market. It would be $3 billion in
savings for the U.S. Government by just passing that, and I would
challenge my colleagues to vote against something as simple as that.
Lastly is the CREATES Act, and Senators Grassley, Leahy, Feinstein,
Lee, and I have that bill, which makes sure that we get the samples so
that we can get generics on the market, create more competition, and
bring prices down.
This debate is about the patients of a nurse practitioner who
provides psychiatric care in my State.
She wrote to me:
Please, please, do all you can to prevent these people from
losing the health insurance coverage for medical and mental
healthcare that is so vital to their lives.
In Minnesota, one-third--32 percent--of the funding for our State's
mental health agencies comes from Medicaid, and across the country,
Medicaid expansion has helped 1.3 million people receive treatment for
mental health and substance abuse issues.
This debate is about the mom in Minnesota who has private insurance
and who has colon cancer. She is working full time, raising two school-
age boys and going to chemo every single week. She said she fears she
will not be able to afford the care she needs to stay alive.
This debate is about the rural constituents whom I noted come up to
me at parades, like the Fourth of July, at nearly every other block,
and tell me their stories of how they are concerned about their kids
with disabilities and how they are concerned for their rural hospitals.
We have things we can do to make this better, and now is the time
when we must get them done. We have bipartisan support for these
changes to the Affordable Care Act. Let's work together on them across
the aisle, and let's remember that this is about one team, one country.
We can get this done.
I yield the floor.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. KAINE. Mr. President, I also take to the floor to talk about
healthcare. I appreciate my colleagues who are here, earnestly pleading
with all of our colleagues to be about a process--Democrats and
Republicans and the committee process that we have in the Senate--that
does the work that we are supposed to be doing, which is listening to
the American public and improving our healthcare system.
Let me tell you about my first meeting of the day. It was an amazing
one. I had a mom, Rebecca, and her 5-year-old daughter, Charlie, in my
office. They had asked for the opportunity to meet with me to talk
about healthcare. Here is their story.
Charlie is just about 5 years old. She starts kindergarten in the
Charlottesville public schools in September. She was born at 26 weeks,
or about 14 weeks early. She weighed 1 pound and 11 ounces at birth.
She went through the NICU and had great care. When she was released to
go home, the doctors thought she would be fine, but within a couple of
months, it was pretty clear that she had some significant challenges as
she has the diagnosis of cerebral palsy, and she gets 80 percent of her
food through a feeding tube. This family has many, many needs.
Charlie, from a cognitive standpoint, is very, very sharp and is
excited about starting school, but she has significant needs. Her
mother Rebecca said that Charlie is like the case study for why a
repeal of the ACA would be a disaster. Charlie has a preexisting
condition because of the CP and her challenges. Charlie has already hit
all of the lifetime caps that would have rendered her unable to get
In the hospital, because of her dramatically low birth weight,
Charlie was the recipient of Medicaid funds that would be cut under the
current bill. Charlie is currently the recipient of a Medicaid waiver,
which will help her afford supplies for her feeding tube. When she
starts kindergarten in the Charlottesville public schools, Charlie will
be given an individualized education plan under the Individuals with
Disabilities Education Act, and some of those expenses are being
compensated by Medicaid.
The preexisting condition, lifetime caps, and Medicaid cuts all
affect this dynamic, young 5-year-old, who is as entitled as any of us
to try to be all she can be. If we persist on the path that we are on
now with regard to the bill that is being proposed, we will hurt
families like these, and we do not need to do that. Instead, we can
Before the passage of the Affordable Care Act, we know that
Americans, like Charlie, who had preexisting conditions faced unfair
barriers to accessing health coverage. There are challenges that we
need to fix, but let's celebrate a few things. Since 2010, the rate of
uninsured Americans has declined to a historic low. More than 20
million people have gained access and have healthcare coverage--many
for the first time in their lives. Another statistic that is
interesting is that the number of bankruptcies in our Nation has been
cut in half. Pre-ACA, medical costs had driven up bankruptcies, but the
ACA has brought the bankruptcy rate down. We have to move forward to
make healthcare stronger, not to destroy it.
The Republican bill that is being discussed right now, because of its
reductions of coverage, slashing Medicaid, and increases to premiums
for seniors, would make the matter worse. The proposed amendment by the
Senators from Texas and Utah has led insurance companies to come out
and say that this will create a two-tiered system that will punish
those with preexisting conditions. The latest plan, which was discussed
this morning by the majority leader, would just be a straight repeal of
the Affordable Care Act with a promise that we would fix it in a couple
of years. It has been scored by the CBO, and the CBO says that it would
cause 32 million Americans to lose their coverage and would
dramatically increase premiums. Yet we do need to find improvements,
and we should be working on that together.
There have been some actions taken by this administration that have
compounded challenges. In January, the President signed an Executive
order that directed relevant agencies not to enforce key elements of
the Affordable Care Act. They terminated components of outreach and
enrollment spending. The administration has also threatened to end
cost-sharing reduction payments. These actions and additional inactions
have created such uncertainty in the individual marketplace that rates
have been unstable, and, in some areas, companies are not writing
individual policies. The amendment I discussed earlier, from the
Senators from Texas and Utah, would make these problems even worse.
There is a better way. There is a way forward, and I am here to just
briefly reference a bill that Senator Carper and I have put on the
table that we think will do a good job and should have strong
bipartisan support. It is the Individual Health Insurance Marketplace
One of the ways to address uncertainty in the individual market is to
establish a permanent reinsurance program that will stabilize premiums
and will give insurance companies some stability so that they can stay
in markets, but it will also enable those companies to write premiums
at an average level and not have to take into account the high-cost
claims. We think it could reduce premiums dramatically all over the
Now, the idea of reinsurance should not be controversial. We use it
programs--flood insurance, crop insurance, and Medicare Part D. A key
part of Medicare that was achieved under the Bush administration
includes a reinsurance provision. The Affordable Care Act had a
reinsurance in its first 3 years, but it expired. That reinsurance
helped to maintain stable premiums. This is an idea that is not a
Democratic idea. It is an idea that is tested.
Senator Carper and I introduced the bill to the Senators on the
Finance Committee. I am on the HELP Committee. We are just waiting for
the opportunity to be able to present it and get a hearing for it. We
ought to be able to work together on reinsurance, on the cost-sharing
guarantees that Senator Shaheen has proposed, and on a variety of other
ideas. Senators Cassidy and Collins have a bill in that uses auto
enrollment, which is an interesting concept that we should be tackling.
I am just going to conclude and tell you how naive I am.
I was a mayor and a Governor before I got here to the Senate. When
you are a mayor and a Governor, what you know is education and
healthcare. We have a Governor here and a Governor here and a Governor
here. We have four former Governors who are sitting on the floor. What
you know is education, which was your biggest line item, and your
second biggest line item is Medicaid--healthcare. I tried to get on the
committee when I got to the Senate, and I was not put on the committee.
I was very disappointed. For 4 years I tried to get on the HELP
Committee. I got on it on January 3. I was so excited. Finally, I am
working on something that I know about.
I got a group together of 13 Democratic Senators. Within 48 hours of
getting on that committee, on January 5, I wrote a letter to my
committee chair, Senator Alexander, a great committee chair, as well as
to the Finance chair, Senator Hatch, and to the majority leader,
Senator McConnell: If you want to fix healthcare, we are here to sit
down with you right now and fix it. I was naive enough to think that,
because I was on the HELP Committee, I might be included in a
discussion about healthcare. We have had hearings in our committee--
many hearings--on nominees, on pensions, on higher ed, on the FDA, but
there has been one taboo topic on the HELP Committee since I got on it
in January. We are not allowed to have a hearing about healthcare. We
haven't had a hearing about the House bill. We haven't had a hearing
about Senate proposals. We are being told that we are not going to have
a hearing, that we are just going to rush whatever we do to the floor
either on a House proposal, a Senate proposal, or a Senate repeal. We
are going to completely skip the committee.
Now, you know a little bit about this committee. We have a doctor on
the committee, Senator Cassidy from Louisiana. Our chair of the
committee, Senator Alexander, was a Governor. He had a Medicaid
Program. He was the president of the University of Tennessee. He had a
hospital. He had a medical school. He had physician practice groups.
There are people on the HELP Committee who know something about
healthcare. There are people on the Finance Committee, which covers
Medicaid and Medicare, who know something about healthcare, but we have
not been allowed to have a hearing about this. When you have a hearing,
you bring people up to the witness table, patients like Charlie, who
was in my office this morning, and doctors and hospitals. You ask them
what works, what doesn't work, and what can be fixed. We haven't had
the opportunity to hear from folks.
So why wouldn't we do exactly what Senator McCain said yesterday?
Senator McCain said: We have gone about this the wrong way. We should
be the U.S. Senate. We should take advantage of the Senate procedures
and the expertise on the Senate committees, including staff expertise,
and we should assign these various bills to the relevant committees and
have hearings and then come forward with a proposal that will actually
improve healthcare for this country.
I am completely confident that if we let the committees do the work
they are supposed to do, we will find improvements that can get
bipartisan support and that will help Virginians and help Americans.
That doesn't seem too much to ask. I hope my colleagues will consider
that, and I hope we will be engaged in those discussions soon.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Delaware.
Mr. CARPER. Mr. President, I want to preface my remarks today by
asking that you convey to your wingman, Senator John McCain, our
colleague, our best wishes and our hope that he is on his way to a
speedy recovery and will be back here because we need him. We need his
I want to thank Tim Kaine for the leadership that he and Senator
Shaheen are showing to help us try to stabilize the marketplaces.
Senator Hassan and I have talked a lot about this.
What do we do now? I think this is an opportunity. This is an
opportunity here. I realize there is a fair amount of confusion as to
which path to take and which way to go. I hope we don't waste this
I sent a message to the new chairman of the National Governors
Association and to the new vice chairman of the National Governors
Association. Brian Sandoval from Nevada is the new chair and the
Governor from Nevada, previously the vice chair, and Steve Bullock from
Montana is the vice chair. One is a Republican, and the other is a
Democrat. I sent them a message this morning saying that it would be
good to hear from the Governors. They have been working on a bipartisan
letter--they have been working on it for a while--and this is really
the time it could make a positive impact.
We have three people sitting here--four of us--who used to be part of
the National Governors Association. I loved it, and I am sure Senator
Kaine, Senator Hassan, and Senator Shaheen loved it as well. Here is
what I suggested that the Governors may want to consider in their
No. 1, urge us to hit the pause button. Hit the pause button. Let's
just stop in place for a moment.
No. 2, pivot soon--not in September, not in August, but now, like
this week, pivot to stabilizing the exchanges.
No. 3, return to regular order. Senator Kaine has already mentioned
this. When I talked with Senator McCain last week a couple of times
briefly, we both talked about the need for regular order. People have
good ideas on healthcare; introduce them. Committees with jurisdiction,
hold hearings. Witnesses, including Governors, should come before the
committees of jurisdiction--a couple of committees in the House and in
the Senate--and let's hear from the experts, and let's certainly hear
from the Governors, who have to run these Medicaid Programs and have a
lot of expertise in this area to offer us.
Then I would say, after the August recess, if we can actually do
something real in stabilizing the exchanges, what a confidence builder
that would be among us and, I think, around the country. It would be a
great confidence builder.
The other thing I would mention is that when we come back after the
August recess, don't just muck around and wonder what we are going to
do; we should pull together in a bipartisan way--something we talked
about doing a lot, but we don't often do it--to really do maybe a
couple of things.
Let's figure out what we need to fix in the Affordable Care Act.
Republicans believe that Democrats feel it is perfect and nothing
should be changed. Well, I don't feel that way. My guess is that most
of our Democrats don't, either. No bill I have ever worked on was
perfect. It can always be done better. The same is true with big
programs like Medicare and Social Security, veterans programs, and so
on. They can all be done better, and this is certainly the case as
well. Let's fix the parts of the ACA that need to be fixed, and let's
preserve the parts that ought to be preserved.
I would reiterate, speaking on behalf of some recovering Governors,
including me, the Governors need to be heavily involved in this. I
suspect that all of the former Governors who are on the floor with me
today, when we were part of the NGA, we weren't on the floor--actually,
I was on this floor any number of times because Governors had access to
the floor--but we had many opportunities, many invitations to testify
before Senate committees and House committees on a wide range of
issues. I think we brought value, and we need to hear from them today.
I want to go back and talk about how we go about stabilizing the
exchanges. The first thing that would help would be for the
administration to stop destabilizing them. That would be a big help.
Senator Kaine has led on legislation--and he has mentioned it, and I
want to drill down on it just a little bit--that would provide
reinsurance, much as we do in other ways in terms of the Medicare Part
D drug program. Using reinsurance is a very common tool, and we can use
it to help stabilize the exchanges.
How would it be used in our proposal? If this lady standing right in
front of me were getting healthcare and her healthcare needs were
expensive, under our reinsurance plan starting in 2018, 2019, 2020, the
first $50,000 in her healthcare that she used in year one, 2018, the
Federal Government--well, the insurance companies themselves actually
would be on the hook for the first $50,000 of care she got. Between
$50,000 and $500,000, under our proposal, the Federal Government would
pay for 80 percent of that cost--80 percent of that cost. Between
$50,000 and $500,000 would be on the Federal Government. Anything above
$500,000 would be back on the insurance company. That is what we would
do for the next 3 years.
Starting in 2021 and going forward, the first $100,000 would be on
the insurance company for the costs borne--created by an individual,
and then between $100,000 and $500,000, 80 percent of that would be on
the Federal Government, and after that, the rest of it is back again on
the insurance company to pay for.
That is our proposal. We have a bunch of cosponsors on it, and we
need some Republican cosponsors as well. It is not a Democratic idea.
It is not a Republican idea. It is just a good idea that deserves
Another thing we ought to do to stabilize the exchanges is what
Senator Shaheen has proposed; that is, we have these CSRs, cost-sharing
reductions. I think of them as subsidies to help subsidize people whose
income is under a certain level; I think it is 250 percent of poverty.
Folks who are in the exchanges getting healthcare coverage and whose
income is under 250 percent of poverty currently receive some subsidies
to help buy down and reduce the cost of their copays and their
deductibles. It is not really clear whether that is authorized. It is
not really clear whether that is being funded, but it has been done for
a number of years.
The current administration has been saying: Well, we don't know if we
are going to continue to do that.
There have been some States that want to go to court and say: You
can't do that.
We need to pass a law and say that we are going to have these cost-
sharing reductions and that the subsidies will continue to be offered.
The last thing we need to do is to make clear that the individual
mandate or something as good as or at least as effective as the
individual mandate is going to be around. For the administration to
say: Well, we don't know if we are going to enforce the individual
mandate--it just encourages young, healthy people not to get coverage.
We have to make it clear that the individual mandate or something as
good as--it could be a proxy for it or maybe several things that work
together that could be as effective as the individual mandate. If they
don't work, maybe we could just have a default position that would be
the individual mandate again.
We ought to have hearings on these kinds of things and discuss them
and hear from all kinds of folks.
The other thing I want to mention is just that when I go around my
State, my Lord, I have never heard people so interested in encouraging
us. I think I am regarded in my State--along with Senator Coons and our
Congresswoman, Lisa Blunt Rochester--I think we are regarded as
bipartisan people. We are Democrats and proud to be Democrats. We would
like to work with Republicans, too, and I think that is part of being a
recovering Governor. But on this subject, on healthcare reform, going
forward, the people in my State don't want a Democratic victory. They
don't want a Republican victory. Frankly, they don't want a Trump
victory. They want a victory for our country. That is what they want.
They want a victory for our country. And so do I, and I think so do
most Democrats in this Chamber and most Republicans.
So let me say again, if I could make this suggestion, let's hit the
pause button. Let's stop in place for right now. Let's pivot and figure
out how we can stabilize the exchanges. Let's return to regular order.
Let's hold bipartisan hearings, have expert witnesses, including folks
from all walks of life who know about healthcare coverage, who know a
lot about healthcare. After the August recess, let's launch a real,
bipartisan effort to fix the things in the ACA that need to be fixed
and retain, preserve those aspects that should be retained. As I said
before, we need Governors at the table, not just recovering Governors.
We need Governors at the table and a bunch of other folks as well who
have a lot to contribute.
If we do those things, we will, in the words of--paraphrasing Mark
Twain--Mark Twain used to say: When in doubt, tell the truth. You will
confound your enemies and delight your friends. I think that is what he
used to say. In this case, I would just say, paraphrasing Mark Twain,
when in doubt, do what is right. When in doubt, do what is right. We
will confound our enemies and delight our friends.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire.
Ms. HASSAN. Mr. President, I am honored to join my colleagues here
today. I thank Senator Carper for his excellent suggestions and
leadership in terms of reaching out to both the current and former
Governors as we proceed on this issue. I am very grateful to my
colleague Senator Kaine for his leadership on the HELP Committee and
what he brings as a former mayor and Governor.
I rise today to join my colleague from New Hampshire in supporting
her efforts to help lower healthcare premiums for middle-class
Americans and to stabilize the insurance marketplace.
The Trump administration has been working to sabotage the individual
market by playing games with cost-sharing reductions. Those cost-
sharing reductions help lower out-of-pocket expenses, such as
deductibles and copays, for individuals with health insurance plans in
the marketplace. This legislation from Senator Shaheen is a commonsense
measure that would work to prevent the instability and chaos being
pushed by the administration.
I also join my colleagues in making clear that we are ready and
willing to work across the aisle on priorities that will improve and
build on the Affordable Care Act and bring down costs for people in New
Hampshire and across the country.
Over the course of the last several months, we have seen that the
partisan process Republican leadership has pushed with TrumpCare simply
won't work. It is going to take a bipartisan approach in order to make
progress, not a senseless repeal bill that would pull the rug out from
millions of Americans.
I have seen firsthand that it is possible for Democrats and
Republicans to come together in order to improve our healthcare system.
As Governor of New Hampshire, I worked across party lines to pass a
bipartisan Medicaid expansion plan that delivered quality, affordable
insurance to over 50,000 hard-working Granite Staters. Expansion has
truly made a difference for communities across my State, particularly
for people impacted by the heroin, fentanyl, and opioid crisis.
Just last week, I visited Goodwin Community Health in Somersworth and
heard from a woman named Elizabeth. At one point in her life, as a
result of a substance use disorder, Elizabeth was homeless, and she
lost custody of her son. But Elizabeth is now in recovery, and she
works at the SOS Recovery Community Organization in Rochester, helping
others get the support they need. She said she owes her recovery to the
insurance she has received through the Medicaid expansion and the
Affordable Care Act.
Elizabeth's story is a great example of the power of what is possible
when we come together on bipartisan solutions to help improve the
health of our people. This is the same approach we need to take in the
Senate, and I believe there are areas for bipartisan cooperation that
we should be working on in order to improve the Affordable Care Act.
In addition to Senator Shaheen's legislation to stabilize the
individual market and in addition to the legislation we have heard
discussed by Senator Kaine and Senator Carper, there are other things
we can do.
I believe it is critical that we take on Big Pharma and bring down
the cost of prescription drug prices, including allowing importing safe
and affordable drugs and allowing Medicare to negotiate drug prices,
and I believe we should eliminate the existing income cliff in the
Affordable Care Act which blocks many middle-class individuals from
receiving premium assistance.
These are commonsense measures we should be taking now. People across
our Nation have made clear, they don't want Congress to do a wholesale
repeal of the Affordable Care Act because it would have devastating
impacts for them and their families.
I urge my colleagues to put the partisan gamesmanship aside. I join
Senator Kaine, as a member of the HELP Committee, in asking for a
hearing at the very committee which is supposed to set healthcare
policy in this body so we can listen to the voices of constituents, of
providers, of other stakeholders. We need to come to the table ready to
work on bipartisan solutions in order to improve our healthcare system.
All of our people deserve to have access to quality, affordable care so
they can be healthy. That makes our country healthy, productive, and
The PRESIDING OFFICER. The Senator from New Hampshire.
Unanimous Consent Request--S. 1462
Mrs. SHAHEEN. Mr. President, I am really pleased to have been joined
by my colleagues to talk about the importance of addressing healthcare
for all Americans, especially my colleague from New Hampshire. She and
I have been touring the State for months now, talking with people in
hospitals, with patients, with physicians, with providers, with people
with substance use disorders, with providers who are providing
treatment for people with substance use disorders, with people all over
New Hampshire about what we can do to make sure people get healthcare
when they need it.
That should be the goal of this body. It should not be throwing
people off their healthcare, which a repeal of the Affordable Care Act
would do. It would throw 32 million people off their healthcare.
We can address the instability in the marketplaces. We can do that
pretty quickly. Senators Kaine and Carper talked about reinsurance,
something which has worked very well for the first 3 years of the
Affordable Care Act, and the reason it doesn't work now is because they
have stopped. That is why we are seeing some of these rate increases.
We can address the uncertainty by being clear that we are not going
to repeal the Affordable Care Act, by addressing those cost-sharing
reduction payments. The ACA already stipulates that CSR--those payments
which reduce the costs of copays and deductibles--are to be made
pursuant to 31 U.S.C. 1324.
My bill provides for payments to be made jointly from a permanent
appropriation rather than subject to the year-to-year whims of the
annual appropriations process. The Marketplace Certainty Act removes
all bases for any further questions about what is already clear from a
fair reading of the Affordable Care Act as a whole; that both those CSR
payments and the advanced premium tax credit subsidies are to be funded
from the same permanent appropriation.
I see my colleague from Texas on the floor, and I am sure he is going
to object to the unanimous consent request I am going to be proposing
in a couple of minutes. He objected last Thursday when I asked for
unanimous consent to pass the Marketplace Certainty Act, and he
justified the objection by asserting that the cost-sharing reduction
payments are--I think he called it a bailout of the insurance
companies. That is an inflammatory term, and I think we ought to be
careful with how we use it because the truth is, the cost-sharing
reduction payments are in no way, shape, or form a bailout. They are
orderly payments built into the law to go directly to keep premiums,
copays, and deductibles affordable for lower income Americans. In fact,
those same payments were included in the bill Majority Leader McConnell
just said he is not going to go forward with, the Republican bill. It
included those very same cost-sharing reduction payments. I think they
were included because there was a recognition that these are important
to help address the cost of healthcare for all Americans.
As I said earlier, we have had statements by the chairman of the
Health, Education, Labor, and Pensions Committee, Lamar Alexander,
talking about that these payments should be continued. We have heard
from House Ways and Means Chairman Kevin Brady, who said we need to
continue these payments to help stabilize the insurance market. It is
the uncertainty that is causing the current problem, and we could
address that today--this week--if people were willing to work together.
As Democrats, we have come to the floor to say we want to work
together. We think we can address the challenges we face with the
Affordable Care Act. We can do it in a bipartisan way. I know we can
because Tim Scott and I have done it. We passed a bill several years
ago by unanimous consent, which basically gave States the ability to
control group size for people and for companies in the marketplaces so
I know it can be done, and I know we could do it today if there were a
willingness on the part of all of our colleagues to work together. That
is what the American people want. They don't want 32 million people
thrown off their health insurance. We don't want rural hospitals to
close in New Hampshire. We don't want nursing homes to close. We don't
want people to be thrown out of their nursing homes.
I was up in northern New Hampshire at a nursing home over the
weekend, where I talked to a group of women in their eighties and
older. One woman said to me: You know, I worked my whole life. I paid
my taxes. I did everything I was supposed to do. I sold my house so I
could get into this nursing home so I could qualify under Medicaid. I
got rid of all my assets. Now they are telling me I am going to get
thrown out? She said: What would I do? I have no place to go. I have no
family to help me.
People don't want that. What they want is for us to work together, to
help fix healthcare so people can get what they need when they need it.
Mr. President, I ask unanimous consent that the Committee on Health,
Education, Labor, and Pensions be discharged from further consideration
of S. 1462; that the Senate proceed to its immediate consideration;
that the bill be considered read a third time and passed, and the
motion to reconsider be considered made and laid upon the table with no
intervening action or debate.
The PRESIDING OFFICER. Is there objection?
The Senator from Texas.
Mr. CORNYN. Mr. President, reserving the right to object.
The Senator from New Hampshire has acknowledged that she had made
this previous request last week. The Kaiser Family Foundation, among
other publications, has clearly stated that the cost-sharing reductions
she is asking for are paid directly by the Federal Government to
insurance companies. Thus, when I call this an insurance company
bailout, I believe that is literally true.
The Congressional Budget Office estimates the cost of these payments
at $7 billion in 2017, $10 billion in 2018, and $16 billion by 2027.
So what my friend, the Senator from New Hampshire, is proposing is an
insurance company bailout in the tens of billions of dollars with no
reform, throwing more money at a broken Affordable Care Act, which has
been in existence 7 years now.
I know they would like to blame this on President Trump, who has been
in office just a short time--about a half a year--but this is built
into the very structure of the Affordable Care Act, and it isn't
I, personally, will not be part of any bailout of insurance companies
without reforms. That is why we were trying to structure something
under the Better Care Act, which unfortunately we haven't been
successful with so far. We are going to keep on trying, but this is not
The PRESIDING OFFICER. Objection is heard.
Mrs. SHAHEEN. Mr. President, I am disappointed but not surprised that
my colleague has objected. I don't believe he objected because of the
effort to help pay these subsidies, which are passthroughs to insurance
Reforming how we do those, I am certainly happy to sit down and talk
about that, but the fact is, that is not the issue right now. The issue
is, this is a way we could address the current uncertainty in the
marketplaces in a way that will be good for maintaining stability of
healthcare for all Americans. I am disappointed there isn't a
willingness to work together to do that.
I hope, as this debate continues, we will finally see people come
together to get something done to address, not just healthcare for
Americans but to address the one-sixth of the economy that depends on
the healthcare industry.
I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. REED. Mr. President, I rise to discuss the nomination of Mr.
Patrick Shanahan to serve as the 33rd Deputy Secretary of Defense. The
Senate Armed Services Committee held a hearing on his nomination on
June 20, and he was voted out of committee by voice vote.
Mr. Shanahan was born and raised in the State of Washington. He
received his undergraduate degree from the University of Washington and
then a master's degree and MBA from the Massachusetts Institute of
Technology. Mr. Shanahan then embarked on a 30-year career at the
Boeing Company, where he rose to the most senior echelons of
management, working on both the company's defense and commercial
programs. Most recently, Mr. Shanahan served as the senior vice
president for supply chain & operations.
The Deputy Secretary of Defense is one of the most important
positions within the entire national security system. The Deputy serves
as the number 2 official at the Department of Defense, as well as the
Department's Chief Management Officer. As the second in command to the
Secretary of Defense, the Deputy oftentimes is assigned a broad
spectrum of responsibilities which require strong management skills.
The Department currently faces challenges on multiple fronts. For
more than 16 years, our military has been consumed by two prolonged
wars against violent extremist groups like ISIS. As a result, the
military has faced a generational fight which has sapped readiness and
precluded our military personnel from training for full spectrum
operations. However, violent extremist groups are only one of the many
challenges facing our country.
The past several years have seen the rise of near-peer competitors,
most notably Russia and China. Russia has been a resurgent force bent
on disrupting Europe and undercutting our own Nation and our
Presidential election process. China continues its saber-rattling in
the Asia-Pacific region by undermining the freedom of navigation and
using economic coercion of its smaller, more vulnerable neighbors. When
we factor in the destabilizing actions of North Korea and the long
shadow of Iran, it becomes urgently clear that we need strong
leadership at the Department of Defense. If Mr. Shanahan is confirmed,
he will need to contend with all these challenges. It will not be easy
and hard decisions on policy and strategy will need to be made.
Perhaps one of the hardest decisions facing the Deputy Secretary of
Defense is the allocation of budget resources within the Department. In
an ideal world, a cogent defense strategy that takes into consideration
the multitude of concerns facing our Nation would inform how the
Department invests resources in weapons platforms and advanced
technologies to confront these challenges. However, the reality is that
the spending caps imposed by the Budget Control Act determine the level
of funding for most of these budget decisions.
The current budgetary crisis is compounded by the fact that the
President's most recent budget request adds much needed funding to
defense activities, but it shortchanges nondefense spending accounts in
order to increase spending for our military. Furthermore, the budget
request fails to recognize that the BCA budget caps are law. If these
spending levels are enacted, the President's budget request would
trigger sequestration, effectively wiping out increased defense
spending with mandatory across-the-board cuts.
This would be the worst of all worlds. Not only would we be giving
the money on the one hand and taking it back with the other hand, but
it would not be in any systematic way. We would be making cuts to
readiness. We would be making cuts to personnel. We would make cuts to
all sorts of things which are much more valuable than some programs
which would receive an additional cut.
Unless we resolve ourselves to act--which is going to take a
bipartisan effort to repeal the BCA--we can't effectively fund not only
the Department of Defense but every other Federal department. That is
one of the great challenges Mr. Shanahan will face. Indeed, these
multiple challenges will require strong leadership and the ability to
make tough decisions. Mr. Shanahan has developed a strong reputation
during his tenure at Boeing as someone capable of taking on challenging
programs, fixing problems, and turning them into successes.
When I met with Mr. Shanahan to discuss his nomination, he emphasized
that the public sector needed to work closer with the private sector to
get more cost-effective results while ensuring our warfighters have the
best equipment at their disposal. It is that kind of leadership that
the Department of Defense needs as our Nation faces as diverse an array
of threats and challenges to our national security as at any point in
Based on Mr. Shanahan's qualifications and experience, as well as his
testimony before the Senate Armed Services Committee, I believe he is
fully qualified for the job. Therefore, I will vote in favor of his
nomination to be the next Deputy Secretary of Defense, and I trust he
will do his best to lead the men and women who ably and courageously
serve this Nation.
On a final note, if confirmed, Mr. Shanahan will be relieving Bob
Work, who has served this Nation ably and selflessly for most of his
life. Bob Work served in the U.S. Marine Corps for 27 years, rising to
the rank of colonel. In 2009, he was confirmed as Undersecretary of the
Navy, where he shepherded the service through many challenges for the
next 4 years.
He tried to return to the private sector, but in 2014 he was then
nominated and confirmed as Deputy Secretary of Defense. Bob Work was
the continuity in the Defense Department through three Secretaries of
Defense. He stayed more than 6 months into the new administration in
order to aid Secretary Mattis. There is no task, no matter how
difficult or how big or small, that Bob Work would not devote all of
his energy to until it was resolved. Bob Work personifies his name. He
works, tirelessly. Our Nation owes him a great debt of gratitude, and I
hope he takes some well-deserved vacation time and enjoys the company
of his wife and daughter.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Cruz). The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Under the previous order, all time has expired.
The question is, Will the Senate advise and consent to the Shanahan
Mr. ALEXANDER. Mr. President, I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
The bill clerk called the roll.
Mr. CORNYN. The following Senator is necessarily absent: the Senator
from Arizona (Mr. McCain).
Further, if present and voting, the Senator from Arizona (Mr. McCain)
would have voted “yea”.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 92, nays 7, as follows:
[Rollcall Vote No. 162 Ex.]
The nomination was confirmed.
The PRESIDING OFFICER. Under the previous order, the motion to
reconsider is considered made and laid upon the table and the President
will be immediately notified of the Senate's action.