tv U.S. Senate Democrats Accuse Republicans of Repeal and Run in Late Night... CSPAN January 9, 2017 1:59pm-4:00pm EST
at the 110th president. i would like to present our guests with the traditional national press club mug. [applause] >> thank you all for having me. [applause] >> thank you. one must question if i could. i wonder after january 20 what your plan fire, a sickly wet beach are you headed to? >> so, my plans after january 20th are to walk our mind and 7-year-old to school and then that monday, to actually pick them up, to walk them to school and pick them out. so that is the main plan that i have when we leave. the >> thank you command secretary. we are adjourned. [applause] [inaudible conversations]
>> you can always find us another press club luncheon timeline c-span.org. life to the florida senate gambling man for legislative business. on capitol hill, the house and senate iran. the senate continuing debate on resolutions and more expected on reclaim the health care law. at 5:30, about from kentucky republican senator rand paul that would link the repeal of the health health care act to a balanced budget. over on the other side come in the house taken up the measure this week dealing with reducing federal regulations in every appeal of the health care law. those after 6:30. the chaplain: let us pray. we acknowledge today, o lord, your power, mercy and grace.
we need your power, for the challenges we face require more than human wisdom and strength. we need your mercy, for we trespass your law and fall short of your glory. we need your grace, for we cannot offer anything to merit your favor or gain your love. empower our senators for today's journey. give them confidence to draw near to you that they may find grace to help them in this time of need. may they pass their days in the companionship of your
everlasting mercy. enable them to learn the stewardship of time, energy and abundance. temper their gifts with your wisdom, as you help them with their decisions. remind them that leadership can work miracles with cooperation but accomplishes little with criticism and bitterness. we pray in your holy name. amen. the president pro tempore: please join me in reciting the pledge of allegiance to our flag. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands,
the presiding officer: under the previous order, the leadership time is reserved. under the previous order, the senate will resume consideration of s. con. res. 3, which the clerk will report. the clerk: calendar number 1, s. con. res. 3 setting forth the congressional budget for the united states government for fiscal year 2017, and setting forth the appropriate budgetary levels for fiscal years 2018-2026. the presiding officer: who
mr. schumer: thank you, mr. president. now, mr. president, last wreak i expressed my sincere hope that the majority leader and i could come to some agreement on the process of nominations. he has negotiated in good faith, and we've made some progress. i sincerely appreciate his willingness to work with us so far. but i do want to clarify why democrats are doing this. yesterday my friend, the majority leader, went on television and suggested that we were raising concerns about the nominations out of peek or anger. he choked up these -- quote -- "little procedural complaint co" to "sour grapes." we're not doing this for sport. democrats feel very strongly that pushing for a thorough and thoughtful vetting process is the right thing to do. and here's why.
the democratic majority was and is concerned about the hearing schedule, which is so jammed right now that several high, important hearings will fall on the same day, depriving senators and the american people a chance to properly participate in the vetting process of these nominees. our caucus was and is concerned about the timely completion of the standard paperwork and ethics clearance for nominees before proceeding full steam ahead with confirmation hearings and votes. now, bear in mind that president-elect trump's nominees pose difficult conflict of interest challenges. they come, many of them, from enormous wealth. many have vast holdings in stocks and very few have experience in government. so they have not been appropriately vetted for something like a cabinet post
before. what had been standard practice for the vast majority of nominees, the completion of a preliminary ethics review before their nomination, was skipped over for the vast majority of president-elect trump's nominees. in fact, the independent office of government ethics went so far as to send a letter warning that their -- the republican's schedule -- has created undue pressure on o.g.e. staff and agency ethics officials to rush through these important reviews. the o.g.e. office is nonpartisan. it's never been political. so this has nothing to do with politics. quote -- "i am not aware" wrote the director, of any occasion in the four decades since o.g. was established when the senate held a confirmation hearing before the nominee had completed the ethics review process."
unquote. and the very same majority leader, my friend senator mcconnell, who suggested that democrats were raising concerns out of pique or resentment in fact raised the same concerns in 02009 -- in 2009 when he was minority leader. in fact, then-minority leader mcconnell sent then-majority leader reid a letter saying out his prerequisites for time agreements on the floor for president obama's nominees. they're almost exactly what democrats request. mr. president, i don't bring this up to play gotcha. i'm doing it to show that our requests are eminently reasonable and, in fact, have been shared by leaders of both parties. now, i'm going to read the letter, because it's amazing how it mirrors our requests. it was sent to harry reid from
mitch mcconnell in 2009, just as president obama became president. "dear harry," the letter reads. "the senate has the constitutional duty to provide its advise and consent on presidential nominations, a duty we take seriously. in consultation with our ranking members, we affirm our commitment to conduct the appropriate review of these nominations, consistent with the long-standing and best practices of committees regardless of which political party is in the majority. these best practices serve the senate well, and we will insist on are their fair and consistent application. therefore, prior to considering any time agreements on the floor of any nominee, we expect the following standards to be met: 1 -- the f.b.i. background check is complete and submitted to the
committee in time for review and prior to a hearing being noticed. 2 -- the office of government ethics letter is complete and submitted in time for -- and submitted to the committee in time for review and prior to a committee hearing. 3 -- financial disclosure statements and applicable -- and tax returns for applicable committees are complete and submitted to the committee for review prior to a hearing being noticed. 4 -- all committee questionnaires are complete and have been returned to the committee, a reasonable opportunity for follow-up questions has been afforded committee members, and nominees have answered with sufficient time for review prior to a committee vote. 5 -- the nominee is willing to have committee staff interviews, where that has been the
practice. the 6 -- the nominee has had a hearing fl 7 -- the nominee agrees to courtesy visits with members when requested. and 8 -- the nominee is committed to cooperate with the ranking member on requests for information on transparency. there will be additional requirements," the letter continues. "honoring the traditions of the senate for judicial nominees. these scwns standards and long-standing practices will ensure that the senate has had the opportunity to fairly review a nominee's record and make an informed decision prior to a vote. sincerely, mitch mcconnell, republican leader." and i ask unanimous consent the letter be added to the record. the presiding officer: without objection. mr. schumer: so i plan to return the exact same letter, the exact same letter, to my friend, the majority leader, with the same requests. in 2009 the then-minority leader
called these benchmarks "contributory negligence "-- -- "commonsense standards" these standards don't indicate a lack of maturity. they show an abundance of common sense. just as his letter said. and i remind the majority that several, if not most of the nominees, have actually failed to meet the qualifications laid out by this letter, given the hearing schedule. mr. president, the majority leader is fond of mentioning that many obama nominees passed quickly in 2009, and he asks this we do the same. but there's a big difference between 2009 and today. president obama's nominees made -- met all the standards laid out in then-minority leader mcconnell's letter. president-elect trump's nominees
have not. back in 2009, every obama cabinet nominee had an ethics agreement in before their hearing. every obama cabinet nominee underwent a full f.b.i. background check before the senate considered their nomination. president-elect trump's nominees are way behind that mark. mr. president, i only ask respectfully that the republican majority follow the same set of standards they had in 2009 when the shoe was on the other foot. especially because these nominees raise particular concerns. the standards we've laid out as leaders of both parties address conflict of interest and security concerns. those, of course, are prime concerns. but there's another concern as well. these nominees have even
collectively very little experience or record in government. many of them have taken positions quite different from the president-elect. they need to be thoroughly vetted, not just before the u.s. senate, before the american people. if, for instance, representative price is for the privatization of social security but president-elect trump said he is not, what position is nominee price going to take? jamming all these hearings into one or two days, making members run from committee to committee makes no sense. after all, they're going to hold -- these nominees are going to hold incredibly powerful positions for potentially the next four years. to spend an extra day or two on each nominee, even if it takes a few weeks to get through them all in order to carefully consider their nominations, that is well worth it.
it is only fair that they are given a thorough and thoughtful vetting and that they abide by the -- quote -- "long-standing ethics practices that were established and laid out quite clearly by the majority leader himself to ensure cabinet officials were in good standing to work on behalf of the american people. thank you, mr. president. i yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:
mr. mcconnell: mr. president? the presiding officer: the majority leader. mr. mcconnell: are we in a quorum call? the presiding officer: we are. mr. mcconnell: i consent that further proceedings under the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: earlier today i
had a good conversation up in new york with president-elect trump about a number of pressing issues. we talked about the upcoming senate agenda, the president-elect's nominees and the way forward on repealing and replacing obamacare. as i told him, the senate's focus this week will remain on the process to repeal obamacare and to keep our commitment to the american people. obamacare has been a flawed system from the start, and things have gotten progressively worse over the last seven years. from skyrocketing premiums to dwindling insurers in the exchanges, obamacare has corroded insurance markets across the country to a point that is simply unsustainable. that's why we're taking action to bring relief to the countless american families who have been hurt by obamacare. unfortunately, there are some who will never accept the
realties of this failed partisan law. they seem more interested in messaging exercising than replacing obamacare with real solutions to improve health care. catchy slogans, expensive campaigns or messaging amendments are not going to undo the damage obamacare has caused. our nation cannot continue on this trajectory as obamacare continues to unravel at every level, leaving americans to pick up the pieces. we may not be responsible for the damage of this law, but we're committed to bring relief, nonetheless. we'll continue working this week to pass the legislative tools necessary to begin clearing the way for repeal and then a different way forward that will lower costs and increase choices from where they are now. it is no quick fix to undoing the damage created by this broken and complex law, and repeal is just the first step in
that process. but the sooner we act, the sooner we can begin bringing relief to those who need it. so let's continue working to keep our promise to the american people by passing legislation that will help us finally move beyond obamacare's broken promises. a senator: mr. president? the presiding officer: the senator from massachusetts. mr. markey: thank you, mr. president, very much. mr. president, i rise to speak about this impending attack upon
the affordable care act upon the impact that it can have, upon the hospitals of our country in terms of draining revenue from them on the issue on the impact on community health centers across our country and the impact that it can have upon them. upon the impacts that the repeal of the affordable care act would have upon the access of those who are addicted to opioids, who need help for opioids, who are in a situation where they are going to need the affordable care act. the access to coverage so that their problems can be taken care of. so this is no small threat.
this in fact goes right to the core of what started in massachusetts back ten years ago when we as a commonwealth decided that care for people who needed health care was going to be made available to them. now, we have proven in massachusetts that we are able to provide health care for 98% of our population while at the same time having an unemployment rate at 3.2%, while simultaneously having the highest scores for kids in the fourth, eighth and tenth grades in math, verbal and science, while having the strongest protections for the environment in the united states, while having an energy efficiency
standard that is the tops in the united states. we have proved conclusively that it is possible to ensure that people do in fact receive access to the health care which they need while simultaneously discharging our responsibilities to the economy, to education, to the environment, to all of the other interests, all of the other important stakes that we have in our country to ensure that they're given the attention which they need. it would be tragic if what we did as part of the affordable care act was to once again flood the emergency rooms of america with people who otherwise would have had health care coverage under the affordable care act. that is a system which we have
used for 100 years, and it doesn't work because it winds up with the insurance rates of people who do have coverage going up in order to cover. it winds up with the whole rest of the medical system in a very chaotic way being forced to deal with the consequences. if we begin simultaneously to defund the community health centers across the country and their ability to provide health care, then what we have is a cascading impact that ultimately hits those people who are the poorest, those people who are the most vulnerable. they are the ones who are caught in the cross hairs of this
incredible, almost unbelievable attack which the republicans are waging upon a health care system that has already transformed the lives of 22 million people in the united states. it is unimaginable to me that we could be in that kind of a discussion right now on the floor of the united states senate. but i understand it. this is ideological. it is something that is completely and totally detached from the reality of the benefits of the affordable care act, as they have in fact already positively affected tens of millions of families inside of the united states. so this week we are about to have an incredible battle which is waged against the affordable care act. but understand this, right in
the cross hairs are the hospitals of our country. not just the famous, you know, big hospitals that we all know their names of, but catholic hospitals across our country, hospitals that provide the service for people in a much more orderly system than they would have done so if we had never put the affordable care act on the books in the first place. and so, at the forefront of all of these issues, though, is this largest of all public health epidemics that has ever faced the country. the heroin and prescription opioids epidemic, like oxycontin, which are claiming the lives of more than 90 people every single day across this country. in massachusetts alone, when all the final numbers have been
gathered, 2,000 people will have died in the state of massachusetts in the year 2016. 1,500 of them will have been found to have had fentanyl in their blood system. this is an epidemic of unbelievable proportion. fentanyl is the godzilla of opioids. it is powerful, it is deadly, it is knocking people down on the streets all over massachusetts, all over new england, all over our country. people are being robbed of their potential and god-given abilities from this epidemic that knows no socioeconomic, ethnic or political boundaries. and congress has recognized the importance of tackling the tsunami of heroin and prescription opioid addiction that is laying waste to these communities. just one month ago right here on the senate floor republicans and democrats came together and passed a bill to provide $1 billion in new resources to states to address the opioid
crisis, resources that can be and are being dedicated to increasing access to treatment for opioid use disorders. yet today, pending before the senate is a republican budget which entire premise is to repeal coverage of the exact same vulnerable people who need access to treatment. not only is that nonsensical, it is down right cruel for all those families and individuals who finally felt a sense of hope, the hope that new resources could mean the difference between life and death for their loved ones. if you kicked this policy in the heart, you would break your toe. that's how heartless it's going to be in terms of its impact upon ordinary families. with this budget, republicans are repealing the hope that has given families a reason to ensure that they will have the coverage. this is going to make the
problem even worse. medicaid pays one out of every $5 for substance use disorder treatment in the united states. without federal investment in the medicaid program, states like massachusetts, new hampshire, ohio, west virginia and kentucky that are bearing the brunt of the opioid epidemic today will have to find even more money in their already dwindling state budgets to aid those who need treatment. but we all know what happens in this scenario. when states can't find that money, the most vulnerable among us, the ones who don't have a voice, are the ones who will suffer the most. the repeal of medicaid expansion would rip coverage from an estimated 1.6 million newly insured individuals with substance use disorders, and at the same time repeal will put big insurance companies back in
charge. if the republicans have their way, insurance companies would be able to discriminate against people, including individuals with a preexisting condition like an addiction disorder. oxycontin, heroin, fentanyl coverage gone under the proposal which the republicans are making out here on the senate floor this week. let us recognize that the republicans are not just repealing obamacare. they're repealing hope. those suffering from addiction don't have time for republicans to come up possibly, maybe, potentially soon, sometime in the indefinite future with a replacement plan. these are 1.6 million people who have insurance for substance disorders right now. for heroin. for oxycontin. for fentanyl. these are the people who could
potentially die because they don't have medical coverage. what's the plan that the plans have to deal with these 1.6 million people who are already under a substance disorder medical coverage plan? what's their plan for these families who are already desperate for the medical help they're going to need in order to stay alive, in order to get the help which they and their families need? those families know that any delay in a replacement being put on the books could be the difference between getting clean or getting buried. this repeal effort is the worst kind of bait and switch, and it's happening at a time when the american people can least afford it, and repeal is being done at the same time the
republican budget gives billions, tens of billions, hundreds of billions of dollars to corporations and to the wealthy in tax breaks. so look at that as the balance that we're talking about. 1.6 million people who have an addiction, a substance abuse problem, they lose their coverage but billionaires and corporations get the money through tax breaks that are going to be saved from cutting these programs for those who have a medical problem. that is immoral, ladies and gentlemen. that is just plain and simple immoral. you cannot give tax breaks to the wealthiest in our country until you have taken care of those who are the sickest, until you take care of those who are most in need, until you take care of those with substance abuse disorders in our country.
it is immoral to cut the programs so that you can give tax breaks to the wealthiest within our society. we will not save lives and stop this scourge by paying lip service to providing treatment, but this is not the only casualty of this misguided budget before us. the hospitals that each and every one of our constituents depend upon are also at risk. the affordable care act became law in no small part due to the support of those hospitals across the country. during that debate, they knew full well that the impact that a lack of insurance had not just on individuals but on the entire health care system. the hospitals are on the front lines of witnessing the financial burden that uninsured patients have on the system. we tell them that they can never turn away a patient in need, and then when these patients cannot afford to pay for the care, it is up to the hospitals to foot
the bill, so the hospitals told us that if we work to reduce the number of uninsured that they had to care for, then they would help us pay for improving the entire system. they did pay, and in no small part that is why we have a new system in our country. as part of the a.c.a., the hospitals agree to give up over $150 billion in payment reductions between 2010 and 2019, and those payment reductions came largely from medicare and were attacked relentlessly by opponents of obamacare as an act to destroy the program, but the prophecied destruction did not occur and the impact on medicare has been quite the opposite. since passage of the affordable care act, medicare has seen its lowest per-member rate of spending growth into its 50-year
history. premiums paid by enrollees and medicare part d and e have gone down, and perhaps most importantly, the savings have contributed to keeping our promise to america's seniors by ensuring that the program will continue to be there for them. medicare's projected insolvency in the year 2017 has been extended for over a decade. all of this is possible thanks to america's hospitals. here's what the republicans are saying to grandma and grandpa -- yes, the affordable care act extended the solvency of medicare ten years beyond 2017. we're repealing that bill. so insolvency comes almost immediately to the medicare system. what a great signal to send to grandma and grandpa this year with this bill out here on the senate floor. insolvency of the medicare system, the one thing that grandma and grandpa -- and by the way, everybody else inside
of every family in america is depending upon to take care of grandma and grandpa. so will the budget before us return the savings that they're expecting from this bill to the hospitals to help them cover the cost to grandma and grandpa? no. for that to happen, medicare costs will go up. higher costs will lead to higher premiums to every enrollee in medicare parts d and e. the higher costs will also be realized in the entirety of medicare part a program, reducing the time of insolvency from 2028 down to 2024, 2023, 2022 or even earlier. these results are unacceptable to the members of this chamber and to their constituents. so it is now going to be an historic debate which we have --
we can decide instead to simply not cut off the 20 million americans from the insurance they need. we can ensure that hospitals have the resources to focus on the care for patients when it matters most. and we can keep the promise to america's seniors that medicare will be there to cover their needs when necessary. i thank you, mr. president, and i yield back the balance of my time. mr. markey: mr. president, i question the presence of a quorum. the presiding officer: the clerk will call the roll. quorum call:
ms. cantwell: mr. president, i ask that the quorum call be dispensed with. the presiding officer: without objection. ms. cantwell: thank you, mr. president. i look forward to having this discussion this afternoon about the affordable care act and the many votes and actions that we're going to be taking. i especially look forward to having this discussion with the president in the chair because i know he's a state that is greatly impacted by the health care delivery system and it's short fallings and look forward
to discussing with him many of the ideas that our colleagues have. i'm willing to work with anybody to improve our health care delivery system. i'm willing to discuss with anybody what we need to do to improve the quality of health care for americans, and i'm specifically interested in making sure that we improve the outcomes of many americans' health care and also lower cost. that's kind of been the hallmark of what the northwest delivery system has been all about. yes, that's right. we get less money and deliver many outcomes. it is not because we all like to hike, although there are many washingtonians who like to hike. it's because we have had to do with less to we have perngh perd the system. i'm here to talk about the affordable care act and the many aspects of that that are so important to our nation in actually slowing the cost of
increases and reducing our deficit. that is one of the keystones of why we did delivery system reform and we did health care reform. because we needed to slow the rate of increase of health insurance and we needed to lower the cost for us as a nation as well as the private sector, and that was the task at hand. so to my colleagues who are ready to repeal all that, i ask you to wait. i ask you to stop and think about what we're doing. and before you repeal that, think about what we are going to put in its place, because this is such an important issue. so what does the affordable care act mean? well, one of the aspects that i think is getting lost in this debate right now is that people are talking about what has happened in a percentage of the individual market. they're talking about the plans
as they related to last october and what happened with rate increases. some people say, oh, well, a lot of providers went out and offered very low-ball coverage costs and then came back at higher rates later. some people said some of the pools aren't big enough. some people have said, oh, well, the coverage that we're going to guarantee is going to help. but the issue is, is that the affordable care act is much mort what we tried to do in the individual market. it is about providing affordable coverage, but it was also about reducing costs, improving the health care delivery system, protecting women's health and saving taxpayers money. so i would hope that my colleagues on the other side of the aisle will think about all of these things, about providing affordable coverage, about reducing costs, about improving the health care delivery system. i warn my colleagues if you repeal this and take away the
improvements to the delivery system, you are going to balloon the deficit, and that is something we cannot afford. so what am i talking about when i say affordable coverage? well, let's just take our state, for an example. let's take washington state. i'm sure the presiding officer could take his state. but in our state there are three million washingtonians with three million conditions that have been covered. there are 5,000 young adults nog adults now who will have coverage through their parents plans and more than 600 thousand thowl washingtonians covered by the medicaid expansion. to me, the medicaid expansion is about simple math. you decide you're going to expand medicaid because it's the most cost-effective economic way for that population to get health care coverage and to be part of the health care system and keep our costs down and keep that population healthy. now depending on what state
you're from and what philosophy you have as an individual, you may not be for medicaid expansion. but there's been many times that across the aisle we have been able to come to terms both on medicaid expansion and on the chip program. why? because we believe that having a healthier population is the best economy for our nation. and we have now, after the affordable care act's implementation, we actually have results and studies, analysis by various states in the nation who have said by expanding the medicaid population, it has helped our economy and it has helped our state overall. so i would say to my colleagues, please do not repeal the medicaid expansion. please do not put these people back on the street with their health care problems and their health care issues to increase the cost of uncompensated care. that is not a strategy. so what else do we want to do? we want to take the rate of uninsured americans and drop
them down and the affordable care act has done that. it has decreased more than 40% the number of uninsured americans. less than 9% of americans are now uninsured. and in our state, that has dropped to 5.8%. that's a 60% decrees. so for us in the state of washington, we have more people covered and the affordable care act is covering more people. so we've taken more people out of the uninsured market. the way the other side of the aisle would like to describe this is that the whole thing is falling apart because of some changes and shifts in the individual market. but the facts are there. and if we can look at what the lowering costs have been between 2010 and 2019, because this is always a tricky issue. the rate of health care costs were going up. i like to say that this is an
issue about wishing that the health care costs would keep pace with the rate of inflation, and i will give it a little bit of a bump because of technology and new innovations. it's not the same as the rate of inflation for everything else, but that we shouldn't be seeing double-digit increases in the cost of health care. that our goal is to change the system to the degree that we are seeing health care costs more in line, a little bit above the rate of inflation. so what does this chart show? it shows the national expenditures for health care on the dotted line on these actual and most recent projections of what the health care system is doing and what, before the affordable care act would be. so again, people are over here debating about what these increases are when in reality we are seeing double-digit increases, and now we are trying to keep the cost of health care down.
so, why are we trying to -- i'm going to go back to this chart for a second. the reason why this projection is so big is because there are many facts here. this is about changing the delivery system. this is about making sure that there is not exorbitant amounts of uncompensated care. it's about making sure that we don't overspend on a health care delivery system. and i can imagine for some states, this may be the most frustrating issue, particularly if the reimbursement rate has led to a population that is constantly underserved because no one wants to see those patients. we in the northwest have had that frustration because we get somewhere $1,000 though $2,000 less, maybe more for medicare beneficiary than many other states in the country. so what that's led to is parts of our state where people don't even see medicare beneficiaries. that's right, people have to
travel a great distance to find a doctor because they can't find one because of the medicare reimbursement rate. well, my solution is if we're providing health care in my state with better outcomes and lower costs, i shouldn't be penalized for that. i should be rewarded. and every other state should try to practice medicine that actually helps us lower the costs. so why are we working on this issue? the affordable care act slowed the rate of growth for a population in the nation, and medicare will spend $1 trillion less between that benchmark. $1 trillion less between 2010 and 2020, what was going to be done if we did nothing. so my colleagues on the other side of the aisle, i know that you're all for repeal. where are you going to replace this money? where are you going to replace it? where are you going to come up with those savings? if you're going to come to the
floor and say you don't want to repeal the delivery system reforms that we fought so hard for and drafted, just wait a second, that if you are willing to make those changes and keep the delivery system, we'll be listening with open arms and great receptivity because there are many people on this side of the aisle who worked very, very hard on these reforms. in the private sector, we have also slowed the rate of growth in insurance premiums. that is now i'm talking about the employer-based plans. they slowed the rate to one-third of what it was before. so in the employer system we also have slowed the rate. and individuals are seeing a lot less than what they would have to pay if they previously bought. so what is the debate about now?
the -- what we are doing in health care reform is we are trying to improve the costs, improve the health care by decreasing the costs, have better outcomes and help doctors spend more time with their patients than they are with paperwork. now this is critically important because so many of what we are seeing in the united states is doctors spending more time on the paperwork of the system than on the actual outcomes of their patient. we want everybody to have a medical home. we want everybody to have a cost-effective delivery system that rewards outcomes. and that's what we're driving towards. but the debate we've had here in washington has been not over this issue of where do americans get their insurance coverage. 49% of them through work, 34% of them through the medicaid and medicare population.
then we can see the uninsured in the individual market. the debate right now is over that individual market. that's 7%. that's 7% individual market is what the debate has been about. and states where the individual market, as i explained earlier, was out of whack for a variety of reasons. maybe the risk pool was too small. maybe insurers went too low on their original estimates. maybe they made some changes that didn't work in that marketplace. but that does not mean we throw out all of the affordable care act that is doing such great work just because 7% of the population in the individual market needs further attention. it doesn't mean that we repeal all of this. and it certainly doesn't mean we give this uncertainty to the american people about whether they're going to have h health care coverage and give the illusion that the other side of the aisle is for somehow just taking the system and capitating
medicare/medicaid, giving you a check that never keeps pace with inflation and then taking the savings from the system and channeling it into corporate tax reform relief. no, no, no. no. we need to make the health care delivery system work for the american people, deliver better outcomes and continue to make reforms. so what are the innovations that we are talking about in the delivery system? well, my colleague from -- the presiding officer will know because he understands health care. that the innovation in health care is about everything having a medical home. why do you need a medical home? you need a medical home because you need to be seen not by the emergency room physician, but by your doctor and someone who is going to understand your health care needs. we need to make investments in primary care and prevention and wellness. i'm sure the presiding officer
understands that very much. we don't have enough primary care physicians in the united states, and we need to change our delivery system for g.m.e., that's graduate medical education, so we can get more primary care physicians. but we also need to focus on health and well in the, and -- wellness and that is what the affordable care act starts to do. it starts to focus on those aspects of the system that rewards, not fee for service, but rewards in investment in prevention and wellness. and the affordable care act says, well, okay, let's try to do this in a new way, accountable care organizations that would get a global budget instead of all the paperwork that has to happen. or a provision that i authored, the basic health plan which is being used in the state of new york and is showing phenomenal results in lowering the costs of premiums and giving affordability to people way beyond what they were able to do on the exchange.
this other idea, rebalancing nursing home care to community-based care, i think 20 different states in the nation have done rebalancing. i would say a lot of republican states, a lot of states in the south, they took the money from the affordable care act and they bought into a notion that's a really smart notion. it says let's rebalance away from nursing home care into community-based care. and we as the federal government will help incent that. so all the republican governors that took that money from the affordable care act to try to rebalance a population away from a very expensive delivery system to a new delivery system, are they going to pay us back for that? is that what repeal is going to mean? that we're going to ask them to pay us the money back or that we're going to forego this notion that moving people out of nursing homes and keeping them in their community homes isn't more important? i can tell you this, we have a problem of an ainging population in the -- aging population in
the united states of america, and the best thing we could do is help change the delivery system so it's more cost-effective for the future. that's what the affordable care act did. and then the center of medicare innovation, which is also a part of the affordable care act, drove in some incredible efficiencies that i know the secretary just spoke of today at the national press club when she's talking about targeting and focusing managed care on the health care of many people in the area of diabetes, because they are one of the biggest cost drivers. so all of this innovation is part of the affordable care act. so are you going to repeal that too? are you going to repeal all of these delivery system reforms that are helping us improve the cost of health care? so, what does repeal actually mean? well, i'm taking it from two different sources here. that is that the republican repeal of the affordable care act will increase the deficit
$350 billion over ten years. $350 billion over ten years. increase the deficit. why does the congressional budget office and the committee for responsible federal budget say that? why do they say that? why would they make such a claim? because they know that built into the affordable care act are changes to the health care delivery system that improve access, focus on better outcomes and change our system for the better. we cannot afford to repeal this as a way to try to say to our base this is a better way of delivering health care. so what does it come down to, the affordable care act? the philosophy that we push through is to put the patient at the center of the health care delivery system so that the consumer has more market-driven choices, so that the delivery
system works for them. the repeal attempt pie the -- by the other side is nothing more than basically saying we're going to come up with a way where you're not at the center of this. you're going to get a check that no longer pays for your full health insurance costs, and you're going to get capitated and so is medicare and medicaid. or at least that's all we can get out of the other side right now about the system. so it's very important to me that we do not repeal the affordable care act, and that we certainly don't repeal the affordable care act without any idea what it is that we are going to be doing instead. we have millions of americans who won't be covered, and we are going to throw our whole system which is -- which has managed to save federal dollars, private employer dollars and individual families millions of dollars, i would say billions of dollars
over the time period of this legislation and put us on the right track. if we have to make some changes and adjustments to the system, let's make some adjustments in changes to the -- and changes to the system, but let's not throw out the entire legislation and certainly let us not steal away the affordable care act from the american people. basically, that's what repeal is. repeal is stealing away the affordability that they have been granted under these last several years and instead taking it for some other corporate interest. i hope it is not to stuff it into a tax reform bill to give relief for corporate america because that is not what we need. we need a delivery system that works for everyone. we need to save those individuals by making sure there is a cost-effective health care option for them in the marketplace, and i look forward to seeing which of those legislations, not a poster board
but a solution, and i love working with my colleagues who want to work on these ideas. i do, i will because this is a solvable problem. it is. we have shown that. we have enough results. we have to make some adjustments, but repealing, repealing is just stealing health care from hardworking americans, and i urge my colleagues to turn that down. i thank the president, and i yield the floor. a senator: madam president? the presiding officer: the senator from louisiana. mr. cassidy: i rise today to address a very important issue as regards to the health care of our poorest americans and discuss my plan, the medicaid atability and care act or the m. a.c. act, which is also
includes in the obamacare replacement plan. my colleague from washington just extolled the virtues of obamacare and medicaid is clearly, as she pointed out, a major part of the obamacare kind of response, and so it's apropos that i would follow. let me first tell you my perspective. i'm a physician and i have been working in a hospital for the uninsured for 20 or 30 years, until they blew it up. and i saw prisoners, the uninsured and medicaid patients. you might say wait a second. medicaid. it's insurance. why would somebody with medicaid, insurance, be seen at a hospital for the uninsured? it's because in my state, like in most others, medicaid pays beneath the physicians' cost of seeing a patient. it is to paraphrase st. paul the illusion of coverage without the power of access. i'll point out that the week that obamacare passed, there was an article in "the new york times" written by robert pair, a
very respected journalist, tracking a medicaid patient in michigan. the physician, the oncologist seeing -- the oncologist seeing her had so many medicaid patients was going bankrupt, going bankrupt because she could not afford to pay her bills, so she had to discharge the medicaid patients from her practice. i followed up just to find out what happened. two weeks after being discharged from this oncologist's practice, this patient died. now, this is medicaid, which is so critical to the purported success of obamacare. now, is it that we're not spending enough money, that maybe if we just spent a little bit more on medicaid, it would all be better? a study at m.i.t. found that -- oregon did an expansion of medicaid, the state of oregon. and so researchers from there went and studied it. this study found that 60% of the
dollars used for the oregon medicaid expansion went to institutions, not for patients. as little as, say, 20% to 40%, but as little as 20% of the money that was put towards the medicaid program actually was a benefit for the patient. let me repeat this. 60%, as much as 60% went to benefit institutions, not patients. they also found that patients on medicaid did not have improved outcomes. think about this. we're giving everybody all this coverage, it's supposedly wonderful, and yet when they went back a year later and two and three years later, looked at the patients covered on medicaid versus those not, those who continue to be uninsured, there were no better outcomes, no better health outcomes among those who were on medicaid. now, if we can't agree that this is a program to reform, it's going to be hard to agree on anything. now, let's talk a little bit for those who are not familiar with medicaid. medicaid is a federal-state
program. the federal government provides a certain percent, different percent for each state but the state actually administers the program. so in some states, the federal government pays 50% of the cost. they can go up as much as 75% of the cost. so in mississippi, they put up $25, they get $75. in a state like new york, they would put up $50 and get back $50, so it's a one to one. now, this open-ended financing structure is based solely on how much the state spends. i'll agree with my colleague from washington state we should not reward states that spend incontinently. we should not reward states that just spend. but under medicaid, the state is rewarded. the more it spends, the more it draws down from the federal government. i always smile when people speak about the economic development of medicaid expansion. medicaid expansion is not about economic development. it should be about taking care of patients. but i understand their perspective because they pull
down at least one dollar for every dollar the state spends. sometimes 75% -- sometimes the 75% ratio. and under the obamacare medicaid expansion, states have been drawing down 100% of what they spent. now, if the state's going to draw down 100% of what it spends on the medicaid expansion population, surprise, surprise, they're actually spending at a higher rate on the expansion population than on those medicaid patients for which the state actually has to cover part of the cost. now, the federal government has very little motivation -- excuse me, very little ability to weed out the corruption of the inefficient programs. again, this matching incentive disincentivizes states from looking for ways to be more efficient. but still states have to balance their budget every year. and medicaid is either the second largest or largest budget item in every state.
so even though the federal government's paying 50% to 75% of the traditional medicaid population and 100% of the expansion population, the state taxpayer is still on the hook for a lot. on average, states spend 17 cents of every state dollar on medicaid. my state of louisiana has the highest percent. 19% of our budget goes to medicaid. the percent is steadily increasing, nearly doubling since 2000. and sooner or later, even though the federal government covers the majority of the costs, the budget crunch gets more difficult because the rate of medicaid spending is climbing faster than the state tax base. now, because of all the federal requirements on what a state can change in the medicaid programs, in order to come up with the state match, states have two options. they can pay providers less or they can cut other programs like education and move the money to
the medicaid program. first, paying physicians less brings us back to the situation robert pair described in his "new york times" article where the oncologist was going bankrupt because she could not afford to see more medicaid patients. but let's speak a little bit about education. in 1963, state government spent -- i'm just going to use my hands -- about that much for education and that much, 1964, 1965 when medicaid started, about that much for medicaid. in 2009, for the first time ever, on average states spent more on medicaid than on education, and now the percent on medicaid continues to climb, if you will, cannibalizing the state dollars that could be used to support higher education, primary and secondary education. let's look at the effect of the obamacare medicaid expansion. let's look at kentucky. not my own state, but kentucky,
a state which has been at this for a little bit longer. the previous governor, governor bashear, implemented the obamacare medicaid expansion, just kind of traditional medicaid and expanded. my colleague from washington state was kind of extolling how much obamacare has lowered costs. well, when kentucky originally implemented it, they expected the long-term costs of the medicaid expansion to be only a 4% increase in their current state spending on medicaid. after only one year of the expansion, updated projections show that the expansion cost the federal government more than half a billion dollars more than governor bashear had projected for 2014, and this will double in the coming years, meaning that the medicaid expansion will cost a billion dollars more per year than expected. again, this was the projected
cost. this is actual cost. now, if this is saving money, oh, my gosh, let's not -- what would happen if we actually lost money? by anybody's calculation, this is losing money, and this has been the situation across the country. states that have expanded medicaid, it has turned out far more expensive for the federal taxpayer than originally anticipated. it isn't just a federal program. like many other states across the nation, kentucky is facing serious fiscal issues. they don't have a billion dollars lying around. on its current path, kentucky's own projections suggest that the state will start losing $45 million in perpetuity beginning in 2021. this is a 10% increase. so the federal government's putting up most, but kentucky itself will have to put up an extra $45 million per year. now, also, given that the federal taxpayer, you and i, us,
the people watching on tv and the gallery, given that we, the federal taxpayer, put up 90% of kentucky's costs but every state's costs, we're just happen to be speaking about kentucky, 90% of the costs in perpetuity, as this cost grows, taxpayers are on the hook for 90% of it. such a deal. it doesn't have to be this way. let me compliment indiana. in indiana, vice president-elect mike pence, when he was governor, rather than kind of adopting obamacare as this is due to traditional medicaid and watch this cost explosion, took an innovative approach and created the healthy indiana plan or h.i.p. as an alternative to simply doling out the dollars. the plan gave each beneficiary a high-deductible plan in combination with a health savings account. it was capitated, so again my colleague from washington who just spoke kind of criticized these capitated plans, which means there is a set amount, and the person is, if you will,
gauged in managing her dollars. the state will put up a certain amount on a sliding scale based upon the -- the hoosier who enrolled, their income. the plan empowered low-income enrollees to become better consumers of health care. hoosiers who participated, for those not from indiana, i've learned. you don't say indianaians, you say hoosiers. they used 40% less charity care than traditional medicaid patients, 70% contributed to their own h.s.a. once they started contributing, virtually all continued to do so regularly. that is in spite 83% of the participants in the indiana plan earning less than the federal poverty level. those healthy indiana plan patients also saw clear improvements in care over traditional medicaid. they decreased their emergency room utilization by 40% relative
to the medicaid's average, had thousands more physicians chose to take medicaid patients. remember i discussed at the beginning how physicians often can't see medicaid patients that pays them below their costs of seeing care. and in indiana, thousands more chose to take medicaid patients, improving access to quality care. clearly, the healthy indiana plan was able to work for indiana patients. this is the sort of quality innovation that states can devise if we give them the power. now, revising the current funding structure would also encourage states to follow indiana's example and develop innovative medicaid programs to increase the efficiency in which the program spends money. again, that's federal taxpayer money. that's our money. that's -- anybody watching right now, it's our money. we want to encourage states to be efficient as how they spend this. there should be greater flexibility to design the medicaid program to better meet the needs of state residents.
states will be given the latitude to develop various coverage options and specialize delivery. this is why i developed the medicaid accountability and care act. it reforms the flawed financing of medicaid by giving each state a set amount according to how many people each state has enrolled in the different categories that each state's medicaid program treats. that's a mouthful. but it's basically exactly like ththe federal employees health benefit program or like any employee who goes to a state's program and says i'll give you a set amount of money. it's like medicaid managed care where thely state go to a managed care company and give the managed care company a set amount per enrollee in that plan. now, i hear people say, oh, my
gosh. it's a set amount. that's all we do in health care. except in medicaid, where we reward inefficient spending. so if it's good enough for the state to $it to the medicaid managed care program, why isn't it good enough for the federal taxpayer to do it to the state? i'm not quite sure i understand the critics of this approach. but again, under the medicaid accountability and care act, or the mack act, each state would tell the federal government how many beneficiaries it has in different categories of medicaid and the federal government would give each state the amount of money appropriate for that number of enrollees in each category. the advantage of this, it is a set amount. it allows the federal government to do that which it does not do now, which is to say to the state government, if you recover fraud, you can keep that money. now, let's go back.
under the current situation, the federal taxpayer pays 50% to 75% of a state's medicaid cost. if there is fraud -- and there's lots of fraud in medicaid -- and the state government recovers it, it has to give back to the federal taxpayer whatever the percent was the federal government put up. so if the state goes out and recovers $1 million, spends money on the attorneys, spends money on the investigation, all of the court case, it recovers $1 million. it has to give half a million to $750 million back to the federal taxpayer. it's responsible for the prosecution, the investigation, but it gives most of the money back to the feds. so the states don't investigate. i mean, it's just -- it's a disincentive to go after fraud. under the mac act, if the state goes out and gets $1 million worth of fraud, the state keeps the money. that's good for the state. it encourages the state to route
out that -- to root out that fraud and to keep the money rand to make sure that fly-by-night scam artists never get to become medicaid providers in the first place. the m.a.c. act's reforms will result in improved health care for patients. i'm a physician who worked in a hospital for the uninsured and medicaid patients. these are my patients. and if this proposal was not about improving patient kairks i would not advance it. but oregon with their medicaid program, upon review by m.i.t., found no improvement in patient outcomes. then let's go to indiana which actually set up health savings account, engaging the patient in managing their own health. there we do see better outcomes. we should all be about patients having better outcomes. along the way we do other things, such as equalizing the amount of money the federal government gives to each state
per beneficiary. again, my colleague from washington state kind of pointed out that folks in washington get less money from the federal government than do other states. i would attempt to equalize that with the m.a.c. act. and so let me finish. the american people have been voting against obamacare for the last eight years. whatever it's proponents may say, the american people have found it wanting. one aspect which has been wanting is medicaid. we have a proposal before us based upon my experience treating pawshts in a hospital for the -- patients in a hospital for the unsnawndz for comid, but also making experience from states like indiana and elsewhere where we attempted to give taits the initiative to create specialized programs that focus on patient-centered care. and in that way we will see better outcomes. the current medicaid funding system under obamacare works against states, penalizing them for addressing fraud and abuse and waste. this must change.
we need to change this broken framework with a system that will work with states to get their medicaid programs back on track, benefiting their patients as much as possible. with that, madam president, i yield the floor. the presiding officer: the senator louisiana. mr. cassidy: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.