A picture of Senator Lamar Alexander
Lamar A.
Republican TN

About Sen. Lamar
  • Executive Calendar

    by Senator Lamar Alexander

    Posted on 2017-11-08

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    ALEXANDER. Mr. President, healthcare is on the minds of the American people. According to the Washington Post, in the elections in Virginia yesterday, it was by far the biggest issue in voters' minds. Maine expanded Medicaid.



    In my home State of Tennessee, because of the Affordable Care Act's structure, premiums have gone up 176 percent over the last 4 years and another 58 percent, on average, for 2018 is predicted.

    Tennesseans, like millions of Americans, are going through open enrollment and have sticker shock when they see the prices of the health insurance they might buy, and the 178 million people who are getting their insurance on the job--that is 60 percent of us--know they might lose their job, they might change their job, and they might be in the individual market themselves and might find themselves exposed to these skyrocketing premiums and the chaos that results from them.

    This is especially difficult for Americans who have no government subsidy to help them buy insurance. In 2016, according to the Department of Health and Human Services, there were about 9 million of those Americans.

    There are 350,000 people in Tennessee who buy insurance on the individual market. That means they don't get it on the job. They don't get it from the government. They go out and buy it themselves, and 150,000 of those pay the whole brunt. So if insurance costs go up 176 percent over 4 years, another 58 percent this year, that means the songwriter, the farmer, the self-employed person has a very difficult time buying insurance. It is a terrifying prospect. That is why healthcare is on the minds of the American people.

    One would think the American people might turn around and look at Washington and ask: Why doesn't the President of the United States and why don't Members of Congress--Republicans as well as Democrats--get together and do something about the skyrocketing premiums? Well, what would you think if I told you that last month the President of the United States, President Trump, called me and asked me to do just that? He said: I don't want people to be hurt over the next couple of years while we are continuing to debate the long-term structure of healthcare on the individual market. So why don't you get with Senator Murray from Washington--she is the ranking Democrat on the Senate HELP Committee-- and why don't you try to work something out so people will not be hurt during these 2 years.

    He said: I have to cut off the cost-sharing payments because the court has said they are not legal, but we can put them back. Go negotiate. See what you can do. Try to get some flexibility for the States.

    Fortunately, Senator Murray and I were already working on that and to have the President's call was encouraging to me. He called me three more times over the next 2 weeks, and the long and short of it is we produced a result.

    Here is what the result looks like--and I am going to talk about it from the point of view of why Republicans are supporting it. Senator Murray and Democratic Senators were here earlier saying why they were supporting it. Senator Rounds from South Dakota, a former Governor of that State, a man who understands insurance very well and helped develop this proposal--we are here today to say this happens to be one of those bills where there are [[Page S7099]] good reasons for Democrats to support it, there are good reasons for Republicans to support it, and the President has asked for it.

    Here is what it does, from my point of view. The so-called Alexander- Murray legislation, which was recommended to the Senate by Senator Murray and me--there were 12 Republicans and 12 Democrats who were original cosponsors, including Senator Rounds and myself. That doesn't happen very often here. That is one-quarter of the Senate offering a bipartisan bill on a contentious subject to the Senate.

    Here is what it does. One, it lowers premiums. In 2018, where the rates are already set, it requires the States to work with the insurance companies and give rebates for the high premiums that have already been set. In 2019, it will lower premiums. That is the first thing it does and the first reason why I and many Republicans support it.

    Because the premiums are lower, it also means fewer tax dollars are going to pay for ObamaCare subsidies. That is another reason Republicans and conservatives like the idea of the Alexander-Murray bill.

    Another reason we like it is, because there are lower subsidies, there is less Federal debt. The Congressional Budget Office has examined our bill and has said that it saves money over 10 years, nearly $4 billion.

    There are other reasons we like it. It gives States flexibility in increasing the variety and choices of the insurance policies they can recommend. That is the biggest difference of opinion we have between that side of the aisle and this side of the aisle. They want Washington to write the rules; we want the States to write the rules.

    We agreed to make some changes so that States can write more rules. For example, the Iowa Senators, Mr. Grassley and Mrs. Ernst, are cosponsors of the bill because the language in the Alexander-Murray amendment would permit the Federal Government to approve the Iowa waiver. Iowa has a way that it wants to use the Federal dollars to enroll more people and to give them lower costs. It would allow New Hampshire to use Medicaid savings to help pay for its Obama waiver. Both the Democratic Senators and the Republican Governor of New Hampshire have asked for that. It allows Minnesota to use a stream of Federal funding so that it can have its own waiver. It would allow Oklahoma, which has been waiting, to get its waiver approved.

    What do we mean by ``waivers''? What this means is that States can look at the people in their State and make their own decisions or more of their own decisions about a variety of choices. Alaska did that earlier. They are the only State that has been able to use the section 1332 innovation waiver, as we call it, and they were able to create a special fund for very sick people and then to lower rates for everyone else by 20 percent and to do 85 percent of that with Federal dollars-- no new Federal dollars, 15 percent by the States.

    The reasons Republicans like the Alexander-Murray bill, the reasons we have 12 of us on this side of the aisle cosponsoring it, along with 12 Democrats, are lower premiums, fewer tax dollars for ObamaCare subsidies, less Federal debt, more flexibility for States, a new so- called catastrophic insurance policy so you can buy a policy with a lower premium and a higher deductible so that a medical catastrophe doesn't turn into a financial catastrophe. Those are all reasons to support it.

    Here is the long and short of it. The American people have healthcare on their minds. It is certainly true in Tennessee, where the rates are up 58 percent. It was certainly true in Virginia yesterday. It is certainly true in Maine. I see the Senator from Maine is here, and he has been an important part of this discussion.

    The people of America say: Why don't the President, the Republicans, and the Democrats in both bodies get together and do something about it? I am happy to report we have. We have a bipartisan proposal. It doesn't solve every problem, but it limits the damage. It lowers premiums. It avoids chaos. It saves Federal tax dollars. It has the support of a significant number of Republicans and Democrats, and it is done at the request of the President.

    I hope that when the President returns from Asia, he will go to his desk and find a nice package there with a bow on it, presented by Senator Murray and me, 24 of us in the U.S. Senate--Republicans and Democrats--which does exactly what the American people, I think, want us to do: Lower premiums, avoid chaos, work together, take a step in the right direction, and let's see if we can help the American people in that way.

    I know the Senator from South Dakota is here, and I thank him for his leadership on this. He, along with the Senator from Maine who is here, Mr. King, spent a good deal of time working on this piece of legislation, which has a lot that Democrats like and a lot that Republicans like--so much so that we are able to recommend it in a bipartisan way. I know he may have things that he may want to say about the bill.

    I yield the floor.

    The PRESIDING OFFICER. The clerk will report the nomination.

    The legislative clerk read the nomination of William L. Wehrum, of Delaware, to be an Assistant Administrator of the Environmental Protection Agency.

    The PRESIDING OFFICER. The Senator from Maine.

    Healthcare

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