Speeches & Floor Statements

Floor Speech: Bipartisan Bill to Stabilize Individual Health Insurance Market, Then Lower Premiums

Posted on October 18, 2017

Senator Murray and I, along with are other senators, will offer bipartisan legislation to create more choices of health insurance and reduce cost-sharing subsidies. These subsidies pay for copays and deductibles for millions of low-income Americans who buy health insurance on the Affordable Care Act exchanges. Our goal is to stabilize and then lower the costs of premiums and to enable all Americans to have access to health insurance. Our legislation will be based on the four hearings and other meetings that the Senate's health, education, committee held last month.

These hearings and meetings were bipartisan. They were lengthy and they were remarkable in this sense -- they engaged nearly 60 senators from both political parties in extensive discussions. We not only had the four hearings which involved the 23 members of our health committee, we invited any other senator to come to a committee hearing ahead of time and meet governors and state commissioners who were of citing -- testifying. We had extensive participation by 60 members of the United States Senate through four hearings and a variety of committee meetings.

In the process that developed what Senator Murray and I have agreed upon. According to witnesses at our hearings, according to the Congressional Budget Office, without these cost-sharing payment reductions – deductibles, premiums will raise, the debt will increase by $194 billion over ten years and up to 16 million Americans may find themselves living in counties where no company sells insurance in the individual market. Now, imagine yourself, a 45-year-old songwriter in Tennessee who loses her job, has three kids, goes out into the individual market and finds out she can't by health insurance because no company is offering it because we did not act. Those are the consequences we're talking about. 

Witnesses also testified that one way to lower costs for consumers is to give states more flexibility than the Affordable Care Act now allows to design health insurance plans that give consumers more choices. We have purposely limited our proposal to these, first, two years of temporary cost-sharing payments, and, second, amendments that would give states meaningful flexibility in using the section 1332 innovation waiver that is already a part of the Affordable Care Act. The problem with the waiver is that while it was designed to give opportunity for waivers, it was restricted. It limited the number of opportunities that states could use. It would be like saying to somebody, you can drive anywhere you want to in the United States as long as you end up in New York, Nashville, or Birmingham, Alabama.

Now, there are, of course, many other good and useful ideas that would improve federal laws regulating health insurance. There are many on the Republican side and there are many on the Democratic side. There are probably even ideas that both of us would agree on.

Well, Mr. President, congress has been stuck for seven years -- seven years -- in a partisan stalemate over the Affordable Care Act. Most of that stalemate is about the individual insurance market. Most people get their insurance from the government, Medicare and Medicaid. Most of the rest of the people get the rest of their insurance from their employer on the job, that's 60% of Americans. So only 6% of Americans get their insurance in the so-called individual market. 

It's about 350,000 people in Tennessee, but every single one of them find it important and every single one of them is terrified by the skyrocketing premiums and possibility that they may not able to buy insurance at all if we don't act. The best course is to take this limited bipartisan first step that would avoid the chaos that could occur during 2018 and 2019 if premiums continue to skyrocket and millions of Americans find themselves without a way to purchase health insurance. 

Once we complete this limited first step, we can take a second and a third step. I want to undersell this proposal rather than oversell it. It has significant advantages in terms of the cost-sharing reductions which make -- reductions which make it more likely that the premiums will stabilize. It has significant advantages in changing the law so that states will have more flexibility in offering choices, which is another way to lower costs, but it is it only a limited first step. 

Senator Murray and I hope that we can present senate leadership, Senator McConnell and Senator Schumer, with a significant portion of senators. We hope that it will pass legislation, the house will agree to it, and the president will sign it. 

I have had encouraging discussions with President Trump who called me on two different occasions encouraging me to work with Senator Murray to come to a bipartisan agreement. I'm grateful to him for that encouragement, and I'm grateful to her. I see she's just come to the floor. For her patience and working on this so diligently for such a long period of time. I think the one other thing that Senator Murray and I can agree on is that we hope that our next legislative assignment is easier than this one. But I think we both also agree that the sooner we act, the better so that Americans will have the premium of lower -- the benefit of lower premium costs and the peace of mind of knowing that they'll be able to buy insurance for themselves and their families. 

I would like to say through the chair to Senator Murray that I ask for ten minutes to speak and then I ask for ten minutes for her following me. So I'm about finished and when I'm through, she has the floor, according to my request. I ask consent to place into the senate at this point in my remarks a brief summary of the agreement that Senator Murray and I have.

The presiding officer: Without objection.

Mr. President, I have said repeatedly over the last several weeks, while it's important that the two of us as ranking members of the help committee come to an agreement, that's not nearly enough. Because our real job was and is to see if we can find a consensus among a significant number of Republicans and significant number of Democratic senators that will cause this to be enacted, that will cause the senate to pass it and the house to pass it, and the president to sign it. 

In my opinion, we wouldn't have come to an agreement ourselves unless we thought that that was likely. I won't go into the specific provisions that are in this except to -- except to briefly summarize them. The first group of them make the section 1332 innovation waivers work by giving more flexibility.

In New Hampshire, for example, the state would like to use Medicaid savings to help pay for the cost of its Affordable Care Act waiver and this would allow that. In Minnesota, for example, the state has applied for a waiver. The waiver has been approved but the use of the funding has not been approved. This would allow that. Alaska, for example, Oklahoma, Iowa, all have waivers in line that they would like to submit to give a greater variety of choices in their state and hopefully lower premium costs but it's too restrictive in the current conditions.

About the only sort of waiver that the current director of the center for Medicare and Medicaid services can approve is the Alaska type waiver, which is a good idea where Alaska took -- created a reinsurance fund which helped the very sick Alaskans, immediately lowered premiums 20% for all other Alaskans and then used the savings from the lower subsidies as a result of the lower premiums to pay for 85% of the cost of the fund. Minnesota is trying a similar thing. Maine did that on its own a few years ago. We have streamlined the approval process for those waivers so that that can be done more easily.

I would emphasize that a number of these, while their limited plans could not be done in a budget reconciliation process, they would have to be done with 60 votes. The proposal also includes what we call a new copper plan, catastrophic insurance for all ages. We still keep the patient protections. That's preexisting conditions, et cetera. We still keep the essential health benefits, but we allow someone who is healthy and young, for example, to pay a higher deductible and a lower premium, if that's what they choose to do.

We direct the health department of -- Department of Health and Human Services to go ahead and write regulations to encourage interstate health insurance compacts. We compromised on the outreach funding and have agreed that we will spend about twice as much or more than President Trump wanted to expend but we'll do most of that by grants to the states. And, of course, we agree on two years of funding for the cost payments. Finally, I would say that if we do not do this, according to the Congressional Budget Office, joint tax committee and C.M.S., premiums next year will increase 20%. There will be $194 billion increase in the federal debt over ten years and up to 16 million Americans might find themselves unable to buy insurance on the individual market. 

In my view, this agreement avoids chaos. I don't know a Democrat or a Republican who benefits from chaos. I thank President Trump for his encouragement to me and to Senator Murray to try and succeed on negotiations. 

I thank Senator Schumer, the Democratic leader for creating an environment in which we could get to this point. I thank the majority leader, Senator McConnell, for despite his focus on tax reform for allowing us to work together and try to do this, and I especially thank Senator Murray, who whenever she sets about to get a result, I found usually gets one. I could not have a better partner to work with on difficult issues in the senate. The one thing -- in fact, the one thing we probably most agree on, we found the most difficult to solve, and that is, in 2018, we want to make sure that the cost-sharing payments go to the benefit of consumers, not the insurance companies. I want that. Senator Murray wants that. The president wants that. My Republican colleagues want it. I know Democrats want it. We believe we have strong language in our proposed agreement to do that, but we are going to make sure that it's the strongest possible language. I thank the president. I look forward to working with Senator Murray over the next few days to see if we can find a consensus among Republicans and Democrats to present to the senate leadership. I hope we can then pass it. The house will pass it and the president will sign it. I thank the president. I yield the floor.