Speeches & Floor Statements

Senator Lamar Alexander Floor Speech — Goals for Senate Health Care

Posted on May 4, 2017

The House of Representatives has just passed a bill that would make major changes in the Affordable Care Act. I congratulate the House. In the Senate, we will carefully review the House bill and now we'll go to work on a Senate bill. 

Here are my goals for a Senate bill. I don't pretend to speak for every member of the Senate or even every Republican, but these are my goals for a bill we will fashion here. 

Number one – rescue the thousands of Tennesseans and millions of Americans who under the Affordable Care Act will be trapped in Obamacare exchanges with few or zero options for health insurance in the year 2018 unless Congress acts. 

Number two – my second goal is to lower premium costs. Premium costs have increased and in some states are going through the roof under the Affordable Care Act. 

Number three – to gradually transfer to the states more flexibility in administering the Medicaid program, and to do that in such a way as to not pull the rug out from under those who rely on the Medicaid program. 

And number four – to make sure that those who have pre-existing health conditions have access to health insurance. This is one thing in the Affordable Care Act that has strong support from just about everybody, including the president, that if you have a pre-existing condition, you must have access to health care. And we need to make sure that is still true in any bill that we create in the Senate. 

There is some urgency here, Mr. President, because of what is happening in the individual market. 

When we say individual market, here's what we're talking about: Most Americans get their insurance either from the government or on the job. 18% of Americans get their insurance through Medicare. We're not talking about Medicare today. The bill in the House or the bill we will create in the Senate does not affect Medicare. About 60% of Americans get their insurance on the job. About 20% or so through Medicaid. 

And that leaves about 6% who go into an Obamacare market to buy it. Many of these Americans buy their insurance on marketplaces or exchanges created by the Affordable Care Act. We call those the Obamacare exchanges. 

And about 85% of those who buy their insurance on the exchanges have a government subsidy to help them buy the insurance. As every day goes by, we hear and we're going to continue to hear, about insurance companies pulling out of  Obamacare exchanges in counties and states. 

Yesterday we heard that the only insurer left in Iowa is now likely to leave. That means more than 70,000 people on the exchanges will have no insurance to buy. Most of them will have subsidies from the government so it's like thousands of people in Iowa who have bus tickets in a town where no buses run. 

And that's what's happening right now because of the 2010 law which we call the Affordable Care Act. 

I know this all too well because 34,000 people in the Knoxville, Tennessee area, my home area, are going to have subsidies in 2018 but no insurance to buy with the subsidies unless Congress acts. 

That's because of the 2010 law that we seek to change. 

In 2016, last year, 7% of counties in the United States had just one insurer offering plans on their Affordable Care Act exchanges. This year 2017, that number jumped to 32%, one in three counties in the United States. If you have a subsidy to buy insurance on the Obamacare exchange, you have only one insurance company offering you insurance. Five entire states have only one insurer offering A.C.A. Plans in their entire state this year: Alabama, Alaska, Oklahoma, South Carolina, and Wyoming. 

That's because of the Affordable Care Act passed in 2010. 

Unfortunately, we're going to be hearing every day, not just about insurers leaving counties and states but about the ones that remain because they're going to be charging sky high premiums. Premiums went up by as much as 62% this year in Tennessee and by 116% in Arizona. And as the new rate increases are proposed to the states over the next few weeks and months, our constituents are going to be saying “what are you going to do about that?”

So there is an urgency, but we want to get it right. 

So again, here are my goals for the Senate bill, which we will now write in the next few weeks”

Number one – rescue, and rescue is not too strong a word, the millions of Americans across this country who are going to have few or zero insurance options in the year 2018 because of collapsing Obamacare exchanges unless Congress acts. 

Number two – lower premium rates because in many states, premiums are going through the roof under the Affordable Care Act. 

Number three – gradually transfer to states more flexibility in managing the Medicaid programs. About 18% of Americans get their insurance on Medicaid. And do so in such a way that doesn't pull the rug out from under those who are currently served by Medicaid. 

And finally, pre-existing conditions – make sure that Americans who have insurance for pre-existing conditions continue to have access to it. If you're on Medicaid or if you're on Medicare or in almost every case if you get insurance on the job, you have insurance for pre-existing conditions. Under the Affordable Care Act in 2010, there had to be insurance for people with pre-existing conditions. We want to make sure that those Americans continue to have access, if they have a pre-existing condition. 

We'll move ahead with deliberate speed. We're doing that because exchanges are collapsing, people could be without insurance, premiums will go up if we don't act, but we want to get it right. There will be no artificial deadlines. We'll carefully consider the legislation passed by the House. We will work together carefully to write our own bill. We will make sure we know what our bill costs when we vote on it. In fact, by law we have to do that. We will get it right and then we will vote. 

And hopefully, Mr. President, the end result will be significant improvements for most Americans, giving them more choices of health insurance at a lower cost. And to do that by gradually transferring more decisions from Washington, D.C., to the states and to individuals.