A picture of Senator Lamar Alexander
Lamar A.
Republican TN

About Sen. Lamar
  • Healthcare

    by Senator Lamar Alexander

    Posted on 2017-12-07

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    ALEXANDER. Mr. President, let me tell you a story. Yesterday, I was in Nashville, and I went to Chick-fil-a on Charlotte Avenue about 2 p.m. in the afternoon, and I ordered six chicken nuggets, some mac and cheese, and some waffle fries. I was about to leave, and a lady walked up to me and said: Senator, thank you for what you are doing to help me with insurance.

    I said: Well, what do you mean? She said: My name is Marty Parish. I am a self-employed farmer, and the year before ObamaCare started, my monthly insurance premium was $300. Next year, it is $1,300, and that is very hard for me to afford.

    I said: I guess you are one of those Americans who work hard and you don't get any government subsidy to help you pay for your health insurance.

    She said: That is exactly right. I have to pay for the whole thing myself.

    I said: Well, Marty Parish, I have a Christmas present for you. The Congress can pass, by the end of the month, legislation that would lower your premiums in the year 2019 by 18 percent. That is according to Avalere, one of the country's leading health consulting firms, which made the announcement yesterday.

    So if your premiums are $1,300 a month, that is a couple of thousand dollars less that you will have to pay, and that is still way too high. If the Senate and the House agree on a tax bill that removes the individual mandate and the Congressional Budget Office is right, that will put some upward pressure on those same rates but only 10 percent. She was still going to get an 8-percent decrease in her rates in 2019, and that is about $1,000 in her pocket. Those are real dollars.

    Marty Parish has seen, if she is like the average Tennessean, her premiums rise 176 percent over the last 5 years, and she has seen them go up an average this year of 58 percent more. So a very good Christmas present for Marty Parish and men and women like her across this country would be for this Congress, before the end of the month, to pass what we call the Alexander-Murray and the Collins-Nelson legislation, which will lower premiums by 18 percent. More than that, that Christmas present, which is all wrapped up in a nice package and sitting in the White House, waiting for anybody who wants to consider it--according to the Congressional Budget Office, it will not just reduce premiums, but it will reduce the amount of Federal tax dollars that go to pay for ObamaCare subsidies. If the premiums are lower, the subsidies are going to be lower. And if the premiums are lower and the subsidies are lower, then the Federal debt is going to be lower.

    So here you have, for my friend whom I met yesterday at Chick-fil-a, an 18-percent, on average, reduction in her 2019 insurance premiums. Fewer of her tax dollars are going to pay for Affordable Care Act subsidies, and there will be less Federal debt for her and her family. Because the President has said that he will not put up with it and because Senator Murray, the Democrat who is ranking on the HELP Committee, and I agree on this, there will be no bailout of insurance companies in these proposals.

    Who would support something like this? Well, President Trump supports it. He told us that last week. In fact, he asked for it. He called me specifically a few weeks ago and said: I don't want people hurt in the next 2 years while we are still debating what to do in the long term about health insurance. Why [[Page S7918]] don't you work with Senator Murray and see if you can put together a bill that keeps people from being hurt and that stabilizes the market so premiums don't go up so much? I said: Mr. President, we are already working on that.

    I have talked with him half a dozen times about that. I met with him at the White House, talked to him the other day, and he has said publicly and privately that he supports the Alexander-Murray legislation, and he supports the legislation supported by Senator Collins, a Republican, and Senator Nelson, a Democrat. So that is a pretty big one.

    Senator McConnell, the Republican majority leader, supports it. He has said that publicly and privately. He supports both of them.

    Senator Schumer, who is the Democratic leader, said 2 or 3 weeks ago that every single Democrat in the Senate would vote for Alexander- Murray and that it had 60 votes, and Senator McConnell should put it on the floor as soon as possible. He thought it would pass with a lot of votes.

    Well, the bill hasn't changed except in one way. It has gotten better from the point of view not just of Democrats but of Republicans.

    The idea that Senator Collins and Senator Nelson have come up with is the idea of creating an invisible risk pool or a reinsurance fund. To allow States to do that would permit those States to do what Maine has done, what Alaska has done, and what Minnesota is trying to do, and it is this: Alaska created such a fund; they call it a reinsurance fund. Maine calls it an invisible risk pool. They put money into taking care of the very sick people in the individual market in Alaska, and once they did that, well, they were able to lower rates for everybody else by 20 percent. That is in addition to the 18 percent that Avalere talked about in our bill--in addition to that. Maine did a similar thing in a little different way in their State.

    Who else likes this idea? Well, Republicans in the House of Representatives like it. They, of course, are a full partner in this exercise. They will have to consider it and decide whether they are for it, but I think it would be pretty easy for them to support Collins- Nelson because it was in the repeal-and-replace bill for the Affordable Care Act that the House passed and voted for. In fact, the so-called compromise by Representative Meadows and Representative McCarthy included an invisible risk pool of up to $15 billion to allow States-- this is pretty good Republican philosophy--to make their own decisions about doing this and decide, as Maine did, Alaska did, and as Minnesota is trying to do, to say that we are going to create this fund, and we are going to take care of the very sick people who use most of the money we spend on healthcare. When we do that, we lower the rates for everybody else. In the Alaska case, because it lowered the rates for everybody else, again, premiums went down, subsidies went down, and Alaska was able to pay for 85 percent of its reinsurance fund with Federal dollars without any new Federal dollars going to Alaska. That is what happens when you allow States to use their own good judgment, and that is why Senator Collins, a Republican, and Senator Bill Nelson, a Democrat, have suggested it over here.

    The other thing that the House of Representatives did in its Republican replace-and-replace bill was continue the cost-sharing payments for 2 years. Cost-sharing payments are payments that the Federal Government makes so that low-income Americans will not have to make them when they buy their insurance. It makes them to the insurance companies, but the benefit from the lower rates is supposed to go to the individual consumer or to the taxpayer.

    The House of Representatives, in its repeal-and-replace bill, understood--just as the distinguished Presiding Officer Senator Cassidy, Senator Graham, and Senator Johnson understood--that if they are able to repeal and replace ObamaCare or make any significant major changes in it, it will take a couple of years to put it in place, and you don't want people to be hurt in the meantime. That is exactly what the President said to me when he called me a few weeks ago. He said: I don't want people hurt during this 2-year period.

    So the House of Representatives put into their repeal-and-replace bill 2 years of cost-sharing payments, not to bail out insurance companies. It doesn't bail out insurance companies. The benefits go to individuals. They wanted to make sure that rates stayed down and people didn't get hurt.

    The proposals we are talking about, the Christmas present I talked about to the young farmer in Tennessee--both have fundamentally been a part of the House repeal-and-replace bill. While I can't speak for the House of Representatives--what they do is their business--I believe as they study Alexander-Murray and Collins-Nelson, they will find that they like it because they have already voted for it once this year. The House of Representatives created the invisible risk pool. That was a real breakthrough in their ability to pass a bill. Then, second, they wanted to make sure that during this interim--the time we try to change the individual insurance market in this country--people aren't hurt.

    So I have come to the floor today just to say that there is a lot going on today and next week. It involves defense spending. It involves the amount of money we can spend for the next year in our government. It involves a tax bill. The Senator from Georgia has just talked about it--a historic tax bill that I hope we can pass. But there is also an opportunity for every single one of us to give a Christmas present to the 9 million Americans who have been hammered by skyrocketing insurance premiums.

    We don't need to debate whose fault that is. I don't need to say it is all the fault of the Affordable Care Act. Democrats don't need to say it is President Trump's sabotaging it. Let's forget that for a moment. Let's just say that the fact is, in Tennessee, premiums will go up in 2018 by 58 percent, and they are going to go up more the next year if we don't do something about it.

    We have two bills here that will say to the self-employed farmer in Tennessee or Iowa or Louisiana or the songwriter or the small business woman: We hear you. We know you can't afford these rates. If you are paying $1,300 a month for two of you, that is way too high.

    We can begin to take those rates down--according to Avalere, 18 percent in 2019. According to the Congressional Budget Office, if we don't take this action to pass the cost-sharing payments, rates will go up 25 percent. So if the present we have includes lower premiums, less debt, less money going to ObamaCare subsidies, and it doesn't bail out insurance companies, why should we not pass that? I think we will pass it.

    I think it would be pretty hard to explain--I don't want to run into Marti Parish at Chick-fil-A in Nashville between Christmas and New Year's and say: I am sorry about that Christmas present. I could have lowered your rates 18 percent, and I could have done it in a way that didn't run up our Federal debt. I just couldn't get it done.

    She would say to me: Wasn't the President for it? I would say: Yes.

    Hasn't the House already voted for that once? I would say: Yes.

    Didn't the Democratic leader say the Democrats were for it? I would say: Yes.

    She would say: Then why didn't it pass? I would have a hard time coming up with an answer to that.

    I hope that over the next few days, we are able to do what Democrats and Republicans have suggested and what 12 Democratic Senators and 12 Republican Senators have offered to this Senate in Alexander-Murray and what Senator Collins and Senator Nelson have offered in Collins-Nelson. Both ideas are very much like two provisions already voted on this year by the House of Representatives.

    Let's realize that it is the Christmas season. A very nice Christmas present for 9 million hard-working Americans who don't get any government help to pay for their skyrocketing health insurance premiums would be to pass these bills into law so they can count on insurance premiums in 2019 that are, on average, 18 percent lower.

    I thank the Presiding Officer.

    I yield the floor.

    The PRESIDING OFFICER. The Senator from Washington.

    [[Page S7919]] ____________________

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