06.27.17

Cantwell on Senate Floor: Republicans Must Come to the Table on Health Care, not Throw “Another Hail Mary Pass”

Senate Republicans back down on hurried Trumpcare vote, delay until after July 4 recess

Senator: “Just get rid of this notion that cutting poor people off of Medicaid is somehow going to magically fix the individual market. It’s not. 

WASHINGTON, D.C. – Today, U.S. Senator Maria Cantwell (D-WA) gave a speech on the Senate floor to drive home her message that Trumpcare’s drastic cuts to Medicaid would be a tragedy for people in Washington state and nation-wide. The speech came shortly after news broke that Majority Leader Mitch McConnell (R-KY) would be delaying a vote on the bill until after the July 4th recess.

To date, no hearings have been held on Trumpcare. None are planned.

A transcript of the Senator’s floor remarks is below.

Sen. Cantwell: Mr. President, I join my colleagues here from the Finance Committee, and although I don't want to admit it, it was 10 years ago that we had this discussion in the Finance Committee. My colleagues from Maryland and from Delaware and from Oregon. And I think what people don't realize -- even the presiding -- the president knows that we spent a lot of time talking about health care. This was not a, ‘let's have a few meetings and let's roll out the bill.’ There was a very, very long period. In fact, the president knows that in fact our side got a lot of heat for a lot of dialogue that happened with them. And our colleague from Maine, at the time, took a lot of heat for the dialogue with her. And there was a period of time, about six or seven months, where every single day I went to at least one thing in the discussion of the health care policy. At least one thing every day for, like, six months. That wasn't even the markup, that wasn't even the meetings. That wasn't -- that was just a time period where the committee had designated various subgroups that we would talk about policy. I don't know if the two of you remember that period, but my recollection is every single day I was going to something regarding the health care policy and listening to experts and recommendations. And then of course we had these -- I call them more roundtables than hearings. We had a lot of roundtable discussions. Then we went through a very, very formal bill process.

So there is a little bit of irony that we're the ones out here today still talking about this health care bill. I think because we know what the challenges were and we tried to address them, and we're not afraid to keep addressing them. We're not afraid to be out here today talking about solutions that we want to see as well. So I thank my colleague from Delaware, my colleague from Oregon, for both being part of that effort because it really was an unbelievable amount of time and energy and discussion and formulation. And the notion that somehow now we would take something that's one-sixth or one-seventh of the economy and draft something up in a dark process and then throw it out here, I'm not surprised today that there aren't the votes.

But the thing to do now is not try to just break up some votes in the next few days and then come back in July. The thing is to sit down and have a serious discussion. I notice that a couple of my colleagues are down at the White House. He's sitting there talking about the individual market. He's talking about the individual market in Alaska. And all I'm thinking is the individual market in Alaska, we're sitting here proposing -- the other side is proposing to cut 15 million people off of Medicaid. What does that have to do with the individual market? Nothing.

So I don't know if people are ready to focus on this the way we focused on it, you know, in that time period for more than a year. More than a year, day after day after day, in meetings and hearings. But I would hope what they would do is stop this proposal and sit down and have an open process and have a discussion on these policies because they're so important. Now, we've been having all this discussion and a lot of frustration that people have talked about is the 7% individual market. And there are ways to fix and improve the individual market.

I feel like I was fortunate enough to put forward one of the better ideas that has worked successfully, at least its working successfully in the state of New York. 650,000 people are on the basic health plan, as I think they call it in that state, essential care, that you can buy a premium for $500 on an annual basis instead of the $1,500 on the exchanges for that population that is above the Medicaid rate that needed to have a solution in the marketplace. There's 13 different people offering insurance to those 650,000 people. So that's obviously working. It's working. Now, it got implemented late. New York did it in 2016 because they were off to the races. But other states should now consider this.

What's so great about this in helping to address the individual market is because where we are on this side, we are willing to allow individuals that don't work for a large company to get the same clout as if they worked for a large company. Because when you buy in bulk, you get a discount. Americans know that. That's why they shop at Costco. That's what they do in New York. 650,000 people have bundled up and are saying to the marketplace, ‘who wants to bid to us on selling insurance?’ The end result is more affordable insurance in the market. That's what they should be discussing down at the White House, not cutting 15 million people off of Medicaid. That is not a smart idea. And I'm sure my colleagues here have already gone over this notion that once you cut people off of care, they just end up in the emergency rooms or exacerbated health needs.

So longer periods of time to get access to health care, more complicated health care costs, rising premiums. When we've gone around our state, we've heard loud and clear from the provider community and the hospitals, that they saw downward pressure on price of private insurance because we expanded Medicaid.

And the economic numbers are out there now to show the same thing. So cutting people off of Medicaid is not the solution to the individual market. I hope somebody down there at the White House brings that up.

In 2020 when Medicaid cap, if it did go into effect, the analysis is that it would cost-shift $324 million per year to my state. They would be cutting people off of Medicaid and then basically the cost would be $324 a million to our state. So you can imagine that our state doesn't have that money and isn't interested in picking up that tab.

And by 2028, we would be cost-shifting $4.2 billion. So not something that is smart economics for us, and I just, you know, over the weekend visited Virginia Mason Hospital in the Northwest again. Great success in delivery system reform. They've kind of implemented the Toyota model of production.

So literally faster turnaround time on lab reports, better expedience of nursing care. I think it was something like a 72% reduction in insurance liability. I mean, huge successes by changing and improving the delivery system that helps put pressure down on price.

This is what we need to be talking about. And there is much innovation that was in the Affordable Care Act, and we need to now ask the question, what further things do we need to do to make sure that that kind of driving down cost is there in the individual market as well?

But you are not going to drive down price. There are reports now out by the Center on Budget Priorities that shows that the price will actually go up in the individual market if you cut people off of Medicaid. Basically, it will just increase by several thousand dollars the actual amount of money that the individual market will have to pay in insurance.

So that clearly is not the solution. I urge my colleagues on the other side of the aisle -- I hope they come back and say, it's time to work in a discussion about these ideas, in a broad way, not just another Hail Mary pass, just get rid of this notion that cutting poor people off of Medicaid is somehow going to magically fix the individual market. It's not.

And so I just thank my colleagues from the finance committee who went through all of that. And believe me, I'm telling you, these discussions went on for weeks and weeks and weeks. Some people here are trying to come up with a score and get an answer, you know, in a week on this entire package. I think we probably debated probably for, I would say probably two or three weeks just on the motion of reforming the getting off of fee-for-service a value index and getting the priorities of the delivery system focused on better outcomes at lower costs.

This is something that really should be a big priority in health care. And I remember we had private meetings, we had the head of CBO come down and talk to us. We had hearings. We probably spent three weeks just on one concept of how effective that would be in the health care delivery system. So I just -- I see we're still here. We're still talking. We're still willing to improve this delivery system and make sure people have better access to care. And I thank my colleagues for including me in this discussion today.

And I see my -- I just want to again thank my colleague from Oregon, the ranking democrat on the finance committee. I know he knows exactly what I'm talking about, when we talk about innovation, there's so much innovation that he put into the Affordable Care Act giving states the discretion. They already have all the discretion they need. They have all the discretion they need to keep innovating. And hopefully we will get our colleagues to follow suit, because this is where -- this is where we're going to deliver better care at lower cost and help improve the access for everybody in America. So I thank my colleague.

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