Providing for Congressional Disapproval Under Chapter 8 of Title United States Code, of the Rule Submitted By the Secretary of the Treasury and the Secretary of Health and Human Services Relating to ``State Relief and Empowerment Waivers''

Floor Speech

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Mr. BARRASSO. Madam President, I come to the floor today to once again discuss healthcare in America and, specifically, to oppose S.J. Res. 52, which is the latest congressional disapproval resolution.

What is happening here is that the Democrats are trying to block the efforts Republicans are making to actually lower the cost of health insurance. We are working on ways to lower the cost of health insurance for American families, and the Democrats are trying to block it.

Let me explain. People certainly understand that after the Obama healthcare law was passed, healthcare insurance premiums all across the country went way up. I strongly oppose the passage of this resolution, and I strongly opposed the passage of this law, which many of the Democrats running for President are now willing to admit has failed.

It is interesting that the Democrats now just say: Scrap the whole thing, and go with a one-size-fits-all, government-run healthcare program in which people will pay more to wait longer for worse care.

Ironically, it is the Republicans who, today, are delivering on so many of the Democrats' empty promises about ObamaCare because Republicans are actually doing things to lower the cost of care and the cost of health insurance for American families.

I like to think of Republicans as EMTs arriving on the scene of the ObamaCare train wreck. We didn't cause the accident. We are trying to help the victims, and the victims live in States all across this country. For nearly 3 years, Republicans have tried to treat the victims of ObamaCare and tried to help people who have been hit by skyrocketing health insurance premiums.

Last week we saw a major breakthrough. For the second year in a row, on average, we saw insurance premiums on the ObamaCare exchanges actually come down. They have actually come down. Well, it is very welcome news for people who have to pay these premiums. Yet, what we see is that the 2020 Democratic candidates, when you listen to them, don't seem to be concerned about lowering the costs. They are too busy pushing this astronomically expensive $34 trillion Medicare for All health insurance healthcare scheme--one that by Republicans and Democrats alike has been called a pipe dream.

To put the cost into perspective, this total dollar figure has been estimated by people on the Republican side of the aisle, the Democratic side of the aisle, folks who looked at what promises are being made, and all have come to the conclusion that the cost will be greater than what we spend right now in this country on Medicare, Medicaid, and Social Security combined. Add it all up, and it does not even reach the point of what the Bernie Sanders-Elizabeth Warren Medicare for All plan would cost.

Interestingly, when taking a look at the proposal, they actually want to take away from the American people--the 180 million people who have earned health insurance through work--they want to take that away from 180 million Americans and put them all on a one-size-fits-all, government-run program. Even union workers, who, as part of their contract negotiations, negotiated the health insurance they want, would lose their hard-fought healthcare benefits if it were ever to become law.

We see Democrats backing what I believe is a very foolish resolution of disapproval. They are attacking part of President Obama's healthcare law. We are talking about ObamaCare section 1332. This section of the law helps give States more flexibility. The Presiding Officer's State and mine like to have flexibility to provide better coverage and to bring premium costs down.

We need to set the record straight on one key point. Section 1332 never can be used to waive protections for the American people, such as for people with preexisting conditions. They can never waive those. It is not happening.

My wife is a breast cancer survivor. She has had three operations, chemotherapy twice, and dozens of radiation treatments. I know, as a doctor and as a husband, how important it is for patients to have protections of their preexisting conditions. Republicans remain 100 percent committed to protecting people with preexisting conditions. We will protect them today, tomorrow, and always.

The House Energy and Commerce Committee Chairman, Greg Walden, asked the Centers for Medicare and Medicaid Services for clarification regarding this section 1332.

Greg Walden, Ranking Member, Committee on Energy and Commerce, House of Representatives, Washington, DC.

Dear Representative Walden: Thank you for your continued interest in new state flexibility available under guidance recently issued interpreting section 1332 of the Patient Protection and Affordable Care Act (PPACA) (the 2018 guidance). Working within the limitations of the PPACA, this 2018 guidance is an important element of the Administration's actions to expand options and lower costs for patients around the country. I wanted to take this opportunity to set the record straight and reaffirm this Administration's commitment to lowering healthcare costs, increasing consumer choices, and protecting our most vulnerable citizens. including those who have pre-existing conditions.

To be very clear, the 2018 guidance does nothing to erode the PPACA 's pre-existing condition provisions, which cannot be waived under section 1332. Section 1332 does not permit states to waive Public Health Service Act requirements such as guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on pre-existing conditions exclusions. Furthermore. a section 1332 waiver cannot be approved that might otherwise undermine these requirements. This Administration stands committed to protecting people with pre-existing conditions.

Under the PPACA, we have seen dramatically higher premiums and decreased options for millions of consumers, in large part due to the law's overly prescriptive mandates and excessive Federal government takeover of areas traditionally under state oversight. In 2019, the average monthly premium for a benchmark plan for a family of four on HealthCare.gov is now over $1,500, which can easily exceed a family's mortgage. There are many areas of the country with far higher monthly premiums. For example, a 60-year-old couple living in Grand Island, Nebraska, making $70.000 a year, will need to pay over $3,000 per month for the lowest cost silver plan available. That's almost $38.000 per year for a plan with an 11,100 deductible. That's over half their income.

For millions of Americans, coverage this expensive is not a realistic option, and many choose to go without coverage at all. In fact, after average premiums rose by 21 percent, 1.3 million unsubsidized people walked away from the market in 2017 last year the prior administration oversaw open enrollment. While these higher premiums force some people to go uninsured, coverage is generally not optional for people with a pre-existing condition and so, without a subsidy, someone with a pre-existing condition must face the full burden of the PPACA's skyhigh premiums. This Administration has not forgotten the people facing this hardship.

Section 1332 of the PPACA provides the discretion to approve a section 1332 state waiver plan if the following four statutory guardrails are met: affordability, comprehensiveness, coverage, and federal deficit neutrality. Section 1332 allows states to develop new healthcare programs and solutions that would be not permissible without a section 1332 waiver.

Unfortunately, guidance issued under the prior Administration in December 2015 (the 2015 guidance) regarding section 1332 waivers had the effect of significantly restricting the innovation states could pursue. The prior Administration imposed a one-size-fits-all approach to these waivers, making it difficult for states to address the specific needs of their residents.

In October, the Administration issued guidance under section 1332 of the PPACA to provide states with significant opportunities to chart a different course for their markets through expanded flexibility. Section 1332 and the 2018 guidance ensure that consumers who wish to retain coverage similar to that provided under the PPACA can do so, but they empower states to take steps to stabilize their markets and allow more affordable coverage options that may be more attractive to individuals and families priced out of the current market, including people with pre-existing conditions.

Over the past two years, this Administration has approved seven section 1332 waivers authorizing reinsurance programs to help fund claims for people with high healthcare costs. These reinsurance programs provide much needed premium relief for people in the market and, in particular, for people with pre-existing conditions without other coverage options. These section 1332 waivers were all approved under the prior, more restrictive 2015 guidance. I believe, given the expanded flexibility discussed in the 2018 guidance, states will be able to develop additional healthcare programs and solutions that work for their residents.

As you know, some have criticized the state flexibility offered under the 2018 guidance, claiming that states will pursue section 1332 waivers that undermine their own individual market risk pools and make coverage more expensive for their own residents with pre-existing conditions. Again, I want to make clear that a section 1332 waiver cannot undermine coverage for people with pre-existing conditions. Moreover, any section 1332 waiver will need to carefully account for any impact on the individual market risk pool and guarantee that access to coverage is at least as comprehensive and affordable as would exist without the waiver.

So, if a state seeks to pursue the use of more affordable options, such as catastrophic plans or short-term limited duration plans, under a section 1332 state waiver plan, the state must ensure access to coverage that is overall as affordable and comprehensive for people who remain in the individual market risk pool.

Thank you again for your shared interest in bringing down healthcare costs and protecting our fellow Americans with pre-existing conditions. We remain focused on improving our nation's health care system by empowering states to innovate and develop new solutions to expand access to affordable and high value coverage options, and we look forward to working with you to achieve these goals. Should you have questions, please contact the CMS Office of Legislation. Sincerely, Seema Verma.

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Mr. BARRASSO. Madam President, the letter proves that all patients will be protected. Section 1332 simply gives States some leeway--a little wiggle room for following the law and how to use and apply the law best in their own States.

All State waivers must meet the following conditions: They must provide coverage at least as broad as is currently offered under the healthcare law; they must provide coverage and cost-sharing at least as affordable as under the healthcare law; they must provide coverage to at least as many people as under the healthcare law; and they must not increase the Federal deficit.

The section 1332 waivers leave protections for preexisting conditions unharmed. They are not just popular with Republican Governors. It is interesting that the people applying for these 1332 waivers are Democratic Governors from around the country. They are at odds with what the Democrats in the Senate are trying to do. They are pursuing waivers. They are asking the Trump administration for waivers for their States as well. Why would these Democratic Governors come to the Trump administration and ask for waivers? It is because they work. The reason the Democratic Governors are coming to the Trump administration asking for waivers is that they work. In fact, a number of States are using these waivers today to help lower the cost of health insurance.

Let's look at the States whose section 1332 waivers have been approved since the Trump administration guidance was issued. Let's look at just the States that have applied for waivers since the new Trump administration guidance was issued. Again, these waivers were approved using the very same guidance that the Democrats in the Senate now want to have repealed.

It is astonishing. The States with 1332 waivers since the Trump administration came out with its guidance are Colorado, Delaware, Montana, North Dakota, and Rhode Island. Nearly all have Democratic Governors--four out of the five do--and have Democratic Senators in many cases or they have both.

Take a look at what has happened for the proposed premiums for 2020-- what they are expected to be in States under the leadership of Democratic Governors who have asked for and have been granted waivers from the Trump administration and what the impact is on insurance premiums in these States. In Colorado, with a Democratic Governor and one Democratic Senator, the rates are going to fall this next year by about 16 percent. In Delaware, with a Democratic Governor and two Democratic Senators, the rates will fall about 13 percent. In Montana, with one Democratic Governor and one Democratic Senator, one Republican Senator, rates will fall by 8 percent. In Rhode Island, with a Democratic Governor and two Democratic Senators, rates will fall by about 6 percent.

So in State after State where Democratic Governors applied for and were granted a waiver, they have seen rates go down. Yet Democratic Senators on the other side of the aisle are offering a resolution to remove these waivers, to remove the guidance from the Trump administration that is resulting in rates of insurance and the costs going down.

Of course we need to fix healthcare in this country, but we need to take a scalpel to our healthcare problems, not a meat cleaver, which is what we see the Democrats doing.

The Obama healthcare law was a train wreck. Republicans opposed it all the way. We are still treating the victims of this wreck, and we want to help them for years into the future by changing and coming out with guidance that will make it easier and give flexibility to the States, whether their legislature is Republican or Democratic, to help lower the high cost of ObamaCare insurance.

I find it outrageous that Senate Democrats are wasting precious healthcare debate time. They should be working with us to find solutions to lower the cost of care, to lower the cost of prescription drugs, to provide more accountability and more transparency so that patients can make more informed decisions.

Even as we address this issue and vote on this joint resolution tomorrow, it is time to really take a look at what the Democrats are saying in the Senate as opposed to what the Democrats who are in the statehouses are doing across the country.

I say, let's make sure the States can keep the relief they are asking for and are getting by rejecting what the Democrats in the Senate are proposing. Let's keep working to give patients what they need, which is the care they need from a doctor they choose at lower costs.

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