tv Sens. Cassidy Graham on Health Care Proposal CSPAN September 19, 2017 6:09am-6:43am EDT
occasions when i've risen to speak about the need to repeal and replace obamacare. mr. cassidy: although we did not begin in our last effort i personally allege with senators graham and heller making one more try and folks ask why. there is a fellow back home who is a conservative talk show host who speaks with passion about the affordable care act. and why does he speak with passion? moon performs very open. he's got a special-needs child and he has to buy insurance. and his premium per year is over $40,000. $40,000, mr. president, with a $5,000 deductible and additional deductible for his pharmaceutical costs. he could.$50,000 a year -- could pay $50,000 a year in insurance deductibles. the mortgage payment for a $500,000 is what he puts up
because he has to buy insurance. he has a child with special needs. mr. president, there are many moon graffons across our nation. someone said kind of as a wag, but i think there's a ring of truth to it that obamacare, the individual exchange only works if you don't. because if you do work and you don't qualify for a subsidy, then you cannot afford. by the way, i think there's bipartisan agreement on this. senator bernie sanders is now putting forward a, we call it berniecare, a single payer proposal. he would not be putting that forward if he thought that the status quo was working. he is putting it forward because he realizes that it is not. and he has 15 cosponsors, if you will, cosponsors are testament to the fact that the status quo is not working. well, i can tell you since medicare is going bankrupt in 17 years, the seniors who are on it will have their benefits threatened by adding another 100
million or 150 million more americans to the program and those who have employer sponsored insurance i don't think want to give up their employer-sponsored insurance and trust in berniecare. so our last hope, we think is relieving folks from the burdens of the affordable care act in a way which preserves president trump's goals of caring for all, taking care of those with preexisting conditions, covering all, lowering premiums and eliminating mandates. now, we have the basics of an approach. this past week the help committee has been having hearings as well as the finance committee. both democrat and republican governors, insurance commissioners, stakeholders of other sorts, medicaid directors, and all, whether democrat or republican, governor or medicaid director or insurance commissioner, have said that if we give the states the flexibility to come up with their own solutions, they will find solutions that work better
for their state than the affordable care act. and it makes total sense. clearly alaska is different than rhode island. louisiana is different than missouri. and so if we can come up with solutions specific for each state as opposed to a one size fits all that comes out of washington,d.c., these governors, medicaid directors and insurance commissioners of both parties think that we could do a better job. we have a model of this. the children's health insurance program, also known as the chip program, has been very successful. it works on a block grant that comes down to states. states pull down the dollars. they can roll over the money for two years, and they provide a policy for the children in their state and there is certain criteria and safeguards regarding what that policy must look like. senator ron wyden last night finished up his remarks praising the chip program, that it was reauthorized and what a victory for the health of children because this is a program that will work. there's a little irony there.
senator wyden had just finished criticizing the graham-cassidy-heller-johnson amendment which is patterned after the chip program. the irony is he's saying our amendment won't work and then he goes on to praise the program through which the money will flow and after which it is patterned. so what we do with our program is we take the dollars going to states currently through the affordable care act and we pool them together and deliver them to states in a block grant very similar and indeed through the chip program. and along that way, we equalize how much each american receives towards her care irrespective of where she lives. why do i say that? right now, mr. president, 37% of the revenue from the affordable care act goes to americans in four states. 37% of the revenue goes to those who live within four states.
that's frankly not fair. i have nothing against those four states, but i don't see why a lower-income american in mississippi should receive so much less than a lower american in massachusetts, or why someone in arizona should be treated differently than someone in new york. i think that we should equalize that treatment. americans think that is fair. we do that with medicare and social security and other popular programs. it is something we should do as well as we attempt to provide insurance for all to achieve president trump's goals. one example of this, by the way, pennsylvania has twice the population of massachusetts. both of those states expand to medicaid. massachusetts gets 58% more money than does pennsylvania. again, pennsylvania has twice the population of massachusetts, but massachusetts gets 58% more money. both northeastern states with
cities with high cost of living, but somehow massachusetts does that much better. our goal, though, is through this grant that goes to the chip program which senators like senator wyden have praised, rightfully so, as being an effective program for improving health, with safeguards needed to make sure the money is used wisely, that all states and all residents within those states will receive about the same amount of money towards their health care. this will be, if you will, not a democratic plan, not a republican plan, but an american plan in which senators would vote to trust the people in their state over a washington bureaucrat. now we have critics who don't understand our bill. it's a partisan bill, we're told. no. if you look at the residents of the states that do better under our plan, it includes states represented by democratic senators. virginia does far better because they will get the dollars they currently are not. so do floridians represented by
a democratic senator. missouri does, represented both by the president, the presiding officer right now, but also by a democratic senators; and others that are represented by democratic senators, but the lower-income americans in those states actually have resources that they currently do not have. indeed i implore those senators not to vote a party line but rather to vote for those low-income americans in their state so that they can have the resources needed for their better health. mr. president, i'll conclude by saying one more time we have one more chance. whether on a democrat or republican side, we recognize that the affordable care act is unsustainable. on the republican side, we want to get power back to the patients, back to the states, fulfilling the wish of those democratic and republican governors, insurance commissioners and medicaid directors to give them the flexibility to do what they wish to do. the democratic vision, berniecare, if you will of which he has 15 cosponsors is to
consolidate every decision into washington, d.c. as for me, mr. president, i will volt with the states, i will vote with the people. i will vote with the wisdom. average american as opposed to the benign we know better than you attitude of washington, d.c. mr. president, thank you, and i yield the floor. the presiding officer: the gentleman from south carolina. mr. graham: is this a partisan approach to health care? i don't think so. if missouri does better, there's a democrat representing missouri. there's a republican representing missouri. here's the good news. we've got the republican on board. we appreciate the republican. let me tell you how this works. i like massachusetts. i like maryland. i like new york. i like california. but i don't like them that much to give them a bunch of money that the rest of us won't get. if you live in massachusetts, you don't get twice the social security or 50% more than if you live in pennsylvania. how can this happen?
obamacare, for whatever reason, favors four blue states against the rest of us. now our friends in mississippi, like south carolina, we have a 31% african american population in south carolina. i think the highest in the country is mississippi. under this block grant approach, our friends in mississippi get a 900% increase. how can that be? well, that's money that was going someplace else other than mississippi. so what have we learned about obamacare? rural poor, particularly african americans, don't do so well. these four states -- new york, california, massachusetts, and maryland -- they have a lot of high wage earners. we've got poor rural states. missouri is a very wonderful state. big cities, rural areas. how do you get more money? well, under this formula, you're getting money that would have gone to the four other states. 50% to 138% of poverty. there's 45 million people in
america, mr. president, following that demographic, we can figure out how many live in missouri. and we use that as the basis fosh formula. you're not limited to spending the money on 50% to 138% of poverty. by 2026, the goal is no matter where you live, missouri, south carolina, or california, you're going to get the basic, same basic contribution from the federal government regardless of where you live. what a novel idea. that means places like missouri and south carolina do better. to our friends in new york and california, we're giving you a long time to come down. our friends in massachusetts -- and we've got a great republican governor -- i don't know how to explain a system where you get that much more money than everybody else. the goal is for you to have time to adjust, become more efficient. and charlie baker can do this. is it unfair for people like me and louisiana and missouri to say no four states should get
twice their population? i'm trying to fix a problem in obamacare. now, who should get the money is another question. should some bureaucrat you'll never meet in washington be in charge of your health care? or should somebody that you actually know and vote for be in charge of your health care? a block grawnt has a beautiful -- grant has a beautiful concept to it. the people in power, you actually live with them and you vote for them. if you don't like obamacare, and god knows if you don't like berniecare, who who do you compn to? you can tell me you don't like obamacare, complain to me all day long and i'll call somebody up who could care less what i think. if you had south carolina responsible for the money instead of some bureaucrat in washington, let me tell you what would happen. you'd call me up and say, hey, listen, this is not working for my family. i'll find out who the statehouse person is and we'll call them
together. i guarantee you the governor will listen to you because the governor wants you to vote for him or her. the bottom line is the concept of who should be in charge of your health care is what this is all about. our friends on the other side deserve a great compliment. you know where you're going on health care. you've got a plan to get there. i just don't agree with your plan and i don't agree where you're talking the country. but i will say this for you. you've got a plan. and i'll say this for my democratic colleagues. when it comes to your ideas, you fight like tigers. i remember voting on obamacare on christmas eve, for god's sakes. and we would have been here christmas day if that's what it took for harry reid to pass obamacare. now, on our side, have we done everything we could to repeal obamacare? they will say they did everything they could to pass it. president trump is now behind this bill. thank you, mr. president. i appreciate it very much.
without your voice, we cannot succeed. with your voice, we will be successful, but it's going to take more than a letter. get on the phone, start calling people. obama did. senator mcconnell was very good today at lunch, saying this is a good idea, we need to get behind it. a c.b.o. score is necessary. i'm sure there are a lot of good people at c.b.o., but if i had one place to go before i died, it would be c.b.o. because you would live a long time. we need to get c.b.o. to score things in a timely fashion. and my friends at c.b.o., this is a block grant. we're going to spend $1.2 trillion in the next decade. not more, not less. i didn't do that well at math, but i can figure out how much we're going to spend. i don't mean to be super supercritical, but we haven't had scores on the portman language, on the cruz language eight weeks. let me tell you, my republican friends, if you're upset about
us not successfully repealing or replacing obamacare after seven years, count me in. we tried, and we were one vote short. we have got 17 days left. what would the democrats do? they would be fighting, there would have been no august break, we would be right here on this floor, we would be arguing about their view of health care. i'm encouraged that our leadership is going to push the c.b.o. and get behind this bill. i'm encouraged that the president came out for the bill. the vice president, above all others in the administration, has been on the phone calling governors. we have got over 15 governors now on the republican side saying give me the money, give me the power, i can do a better job than some bureaucrat in washington. so the other republican governors, check it out for your state, but here's what i would ask you to consider. the money you're getting from obamacare is unsustainable. it's a false promise. it's going to collapse, and we can never match that system
because that system is unsustainable, it's going to fail. what have i learned about republican governors? most of them practice what they preach, and some of them it's been hard to get on board. it's almost like crack cocaine in terms of obamacare dollars. i'm telling you right now, republican governors and democratic governors, this system's going to collapse in washington. there's not enough money to keep it afloat. and i'm not going to spend good money after bad. this is a chance for you at the state level to have control over funds as flexible as we possibly can be to design systems that make sense for your state. if california wants to go to single-payer health care, they can. if they want to reimpose the employer mandate, the individual mandate, they can, but we repealed the individual mandate, the employer mandate for the country at large, but if you want to put it back in place, you can. here's the good news. california can't take the rest
of us down the tube with them. we'll have a debate in california about what works and what doesn't. give south carolina, louisiana, missouri, the space they need to design health care based on their individual demographics. you can't spend the money on football stadiums. you have got to spend it on health care. you have got to take care of people who are sick. there are guardrails around this block grant. but innovation will flourish under obamacare. where is the incentive to be innovative? all you need to do is print more money. under berniecare, there is zero incentive to be creative. just tax the rich. this is what happens. we go from four states getting 30%-something of the money, representing 20% of the population. basically everybody gets the same. talk about medicaid. bernie sanders, who is a good man with a good heart and an avowed socialist. he's the most honest guy in this
building. if you left it up to bernie, we would have a rowboat for a navy, a gun for the army, and a prop plane for the air force, and everything else would be spent on entitlements. most of us are not in that camp. medicaid. it's a program for low-income americans to help them with their health care. there's a state match. right now, we're spending almost $400 billion on medicaid. by 2027, we're going to be spending over $650 billion. that's more than we spend on the military right now. no end in sight. we do two things in this bill. we tell the states that we're going to give you more flexibility. this is what we spend on the military -- $549 billion under sequestration. i hope that number goes up. but by 2027, we're going to spend more money on medicaid, let alone medicare, than we do on the military. that's just unsustainable.
so what do we do? we keep medicaid in place as it is today. we try to give more flexibility because indiana was a good example of what can happen if you give states flexibility to help poor people. one thing about medicaid i don't like is if you get a headache, you can run to the emergency room. we pay a big medicaid bill. i want to put medicaid people into managed care. i want them to have some ownership over their health care. if you smoke, then that's something that ought to be considered in terms of costs. i like co-payments. i want to treat people who are low income and poor fair, but all of us need to be responsible for our health care. rather than having a medicaid program that just writes checks no matter what the outcomes are, we're going to in year eight, again to slow the growth of medicaid down. it grows faster than medical inflation. medical inflation is what it calls for in your family. medicaid is way beyond that. why? it's insufficient. we have proven at the state level you can get a better bang for your buck from medicaid. the bottom line is the first
block grant begins to slow the growth of medicaid to make it affordable for the rest of us and incentivize innovation in year eight, and if we don't do that, here's what happens to the country. by 2038, all the money you spend sending taxes to washington goes to pay the interest on the debt, medicare and medicaid and social security. there won't be one penny for the department of education, the department of defense. that's how quickly these programs are growing. so we do two good things. we put medicaid on a more sustainable fashion -- path because it's an important program, and we allow flexibility to get better outcomes for the taxpayer and the patient. what a novel idea. the second block grant. this is money that would have been spent by a bureaucrat in washington. under the first republican proposal, you would get a refundable tax credit to go out and try to buy insurance somewhere, and we would give insurance companies money so they wouldn't collapse on the obamacare exchanges. what we have decided to do is
instead of giving a refundable tax credit to an individual to buy a product that's going to go away because obamacare won't work, instead of giving a bunch of money to insurance companies to prop them up, we're going to take that same amount of money and give it back to the states so by 2026, they all get the basic same contribution. now, what did we do? we repealed the individual mandate, the employer mandate. that's $250 billion of savings. states can reimpose if they like. that's up to the states. we repeal the medical device tax because that hurts innovation. we left the other obamacare taxes in place. there is no more taking from the poor, giving to the rich. i wish we didn't have to do that, but we need the money to transition in a fair, sound way to a state-centric system. so to my friends on the other side, we leave the taxes in place. we just give the money to somebody else. it's called state control, local control, not washington-based health care. and we do it in a way where
basically everybody gets the same contribution from the federal government. what a novel idea. now to president trump. without you, we can't do this. your pen will be the one that signs the law, if we can ever get it to your desk. you said today you would veto bernie sanderscare. let me tell everybody in americ, single-payer health care will never get through the republican-controlled house. we have the majority in the senate. mr. president, we're not going to need you to veto single-payer health care. what we need you to do is put in place a new system to stop the march toward single-payer health care, because if we don't change where we're going, the federal government's going to own it all from cradle from grave. mr. president, on your watch, you can stop that. once we get the money and the power out of washington, that's the end of single-payer health care. once people know they have somebody to respond to their
needs at the state level versus some bureaucrat they'll never need, there's no going back to washington-based health care. so president trump, you have the chance in your first term to set us on a new path. health care closer to the patient, money based on not where you live but parity, innovation versus bureaucracy. what a legacy it would be. but for that to happen -- and i know you're busy with hurricanes and north korea -- you're going toof to get on the phone, you're going to have to sell this, and i believe you will, i know you can, and i'm asking you to do it. to senator mcconnell, thank you for what you said today. thank you for being willing to push this forward. to my colleagues on this side, there is three options let for america. propping up obamacare, which will never work. berniecare, which is full-blown single-payer health care, or this block grant approach.
i ask a question -- who are we and what do we believe as republicans? our democratic friends are pretty clear on who they are and what they believe when it comes to health care. here's what i believe. send the money home. send the money back to where the patient lives. put it in the hands of doctors and hospitals in the community and make sure that the people in the state are responsive to the needs of the individuals in that state. replace a bureaucrat with an elected official. you'll improve quality and outcomes will be better and it will be more fiscally sustainable. at the end of the day, those governors, whoever he or she might be, that can figure out quality health care in a sustainable fashion will not only get re-elected, but other people will copy what you do. if we leave the money and power here, there's never going to be any more innovation.
there's always going to be more money. single-payer health care only works with a printing press. unlimited dollars. just keep printing the money. a block grant will bring out the best in america. it will create better outcomes for patients, and it will take us off the path of becoming greece. because this is where we're headed. senator cassidy was a doctor in a low-income nonprofit hospital. he knows more about this than i could ever hope to learn. there's a reason i didn't go to medical school. i could not get in, and i just cannot tell you how impressed i have been with bill cassidy's understanding of how health care works for average everyday working people. he has dedicated his life to that segment of the population. rick santorum.
there would be no grant, cassidy or heller johnson without rick. we block granted the money, unleashed innovation at the state level, and not one dime of extra spending has occurred since 1996. we were generous in the beginning, and the governors figured it out, there was a better way of dealing with welfare population. i had a bill to opt out of obamacare. rick said why don't you just do the block grant like we did with welfare reform. when you look at it, it's such an elegant, fair, commonsense solution to a complicated problem. dean heller. dean heller is in the fight for his political life. a lot of people around here -- and i understand it. i'm included sometimes myself -- just wish hard problems would go away. this is a tough business to be in. but dean was told -- and he said this today -- by all the experts, just lay low, don't get
your fingerprints on this health care debate, there is no winners, health care is too complicated. we just can't -- just stay away from this fight, lay low. and dean told us today in the conference i didn't get elected to lay low. if we don't get health care right now, all of us are going to pay later. so dean heller, in one of the most competitive seats in the country, said sign me up. nevada gets 30% more money under this formula. they get more control than obamacare would ever give them. and dean heller believes that medicaid is worth saving, and this is a way to save it. the second block grant, 20% can be used to help traditional medicaid. the bottom line is that dean heller stood up today and said nobody in this conference has a tougher race than i do, count me in because this is the right thing to do. ron johnson. if there was ever a mr. smith
goes to washington, it's ron johnson. this is his last term. if you want to have an interesting evening, do not go to dinner with ron johnson and bill cassidy. they are wonderful people, but they -- they know numbers, and they love to talk about details and how systems work. ron johnson has brought energy and a can-do attitude to this debate. he's the closest thing i have seen in a long time to mr. smith goes to washington. he's not -- he's not going to run again. scott walker. if it were not for scott walker, we would not be here today. scott walker said i have been talking about federalism all my political fief -- life. this is the first time i have seen somebody in washington try to empower me here since welfare reform. scott walker has been a moving
force on the governor's side. the governor of utah, mike, you should be proud of him, really great guy. mike, thank you for working with us to make this as flexible as possible. senator lee has helped to get this at the state level. thank you. asa hutchison in arkansas stepped up. our good friend, governor bryant in mississippi, he is all in. i could go on and on and on. i know john mccain likes the concept of the block grant. john mccain wants to reform health care. he knows what happens to arizona under obamacare and this is our last best chance to stop what is a march to single-payer health care. i hope our friends will get on board because obamacare is failing your state and if we
don't find a replacement and i think this is a great replacement for the people of arizona, everything is going to collapse. to all of those on the staff who spent hours and hours and hours of listening to us change our mind, do it one way, do it another, thank you, thank you, thank you. i have been in politics now -- i came in a little bit before -- the presiding officer of the senate. i worked on a lot of things and had a lot of fund and a lot of disappointments. i don't think i worked on anything more important than this. it's been fun, it's been frustrating, but i do believe this is our last best chance to get health care on a sustainable footing and to stop the march toward single-payer health care, which i believe with all of my heart, will reduce quality and explode in costs, and that doesn't have to be the choice.
to my republican friends, they know what they are for. do we know what we're for in they are committed to their causes. are we equally committed to ours? i hope the answer is yes. if we can get 50 year, i make a prediction. a few of them will sign on because their state does so well. there are some democratic senators, who are my dear friends, who are going to have to turn down more money and purr for their -- power for their state to keep the status quo. i can tell you this about bipartisanship. i have -- i am a big believer in bipartisanship. i believe climate change is real. i have done deals and i understand that you have to work together, but our friends on the other side are never going to vote for anything that
fundamentally repeals or replaces obamacare. they just can't do it. they are not just bad people. they are just locked into a different way. and their way is the government makes these decisions, not private sector. my belief is health care closer to the patient, like government, is better health care. is this the last best chance we will have to stop the march toward single-payer health care. mr. president, we need you. we need the weight of your office and the strength of your voice. senator mcconnell, thank you for what you said today, put all hands on deck. our friends on the other side, they moved heaven and ersdz to -- and earth to pass obamacare. i will do everything i can to repeal obamacare and replace it with something that is not good for republicans, it's good for americans. because many, many democratic states, including illinois, do better under this approach than
under obamacare and all of us will do better than bernie care. mr. president, if we don't stop this now, single-payer health care is the fate of the nation. to all who have been involved, thank you very much. we can do this. we've got the time. do we have the will? important legislation. now i'm going to use the rest of my address to address something that is not so bipartisan, terribly partisan. that is the issue of health care. and i hope the american people l closely. -- and i hope the american people listen closely. after a few months of