Madam President, today I would like to address my colleagues to discuss one of the latest attempts from the Trump administration to undermine and sabotage the Affordable Care Act. This week, the Senate will vote on a Congressional Resolution of Disapproval—CRA—on a Trump administration final rule that gives States broad latitude to ignore the consumer protections of the Affordable Care Act.
The rule essentially gives patients in those States the choice between health insurance that doesn’t provide coverage when it is needed the most—socalled junk plans—or being priced out of the health insurance market entirely. As we have already seen, Republican lawmakers in some States are more than eager to dismantle the protections of the Affordable Care Act and bring back the days of insurance companies being in charge, putting profits above the health of consumers in those States. In fact, about 20 such States have gone a step further by moving forward a lawsuit seeking to invalidate the ACA in its entirety.
This is not a theoretical threat to our healthcare system. Over the next year, we will see a final ruling on this lawsuit, and a ruling in favor of these States will be nothing short of catastrophic. Not only will this upend the healthcare system as we know it in those States, this ruling would apply to every State, even those like my home State of Rhode Island, which has done an outstanding job of implementing the ACA, expanding coverage, and making healthcare more affordable for all.
The Affordable Care Act has given individuals and families more choice, more affordable options, and more control over their healthcare. With these new options for health coverage, the uninsured rate in Rhode Island has reached historic lows, hovering around 4 percent. Today, because the ACA is the law of the land, insurance companies can no longer deny you coverage for preexisting conditions or put an annual lifetime cap on how much they will pay for your care. Because of the ACA, young adults can stay on their parents’ plans until they turn 26 years of age, and women cannot be charged more based on their gender. Also, under the ACA, basic healthcare services like maternity care and behavioral and mental healthcare must be covered.
The ACA has helped keep costs down by requiring insurance companies to provide preventive care at no charge so that the small things do not turn into bigger, expensive medical problems, like surgery. Yet President Trump continues to put all of this progress at risk. The rule that we are voting to invalidate this week is just one such example. In his first year in office, President Trump failed to pass his bill to repeal the ACA when he had Republican majorities in both the House and the Senate. Despite widespread opposition to these efforts, the administration has since moved forward with its sabotage strategy in the absence of a legislative win. President Trump ended Federal funding for a key ACA program which helps keep plans more affordable for those in the private market by covering some costs for patients with the most expensive medical conditions.
Next, the administration put forth new rules which allowed more junk plans, plans which can charge more for preexisting conditions and that can refuse to cover needed health services. Now, the rule subject to this week’s vote goes one step further in allowing States to expand these partisan attempts to weaken the ACA, increase costs on consumers, and increase the uninsured rate. If this was not enough, a single court case, championed by partisans looking for a political win, could overturn ACA as soon as next year. If President Trump’s strategy succeeds, many Americans will suffer. Preexisting condition protections will go away, and over 50 million Americans with preexisting medical conditions will go back to being priced out of coverage. The Medicaid expansion that helps States cover more than 12 million Americans will also go away. Young adults will be kicked off their parents’ insurance. Women could be charged more, as would older Americans. People will lose access to mental healthcare, and prescription drug costs for seniors will go up.
In Rhode Island, it is estimated that approximately 100,000 people could lose coverage if President Trump’s lawyers convince the courts to cut down the ACA. The State will lose hundreds of millions of dollars in Federal funding for healthcare, all to satisfy President Trump’s and congressional Republicans’ desire for a political win at the expense of the American people. We cannot afford to go back to the days when insurance companies were in control. We cannot wait until the Trump administration and Congressional Republicans come up with a plan. The ACA was signed into law almost 10 years ago and still its opponents have no alternatives. Americans with preexisting conditions, those who are fighting illnesses, parents with children with complex medical needs, young people who need coverage while they explore new career opportunities, these people—our constituents, our neighbors, our families— do not have the time to wait for Republicans to come up with a solution for a problem they, themselves, are creating.
We should instead be spending our time working on solutions to today’s problems. There are pressing issues that Congress should be spending time addressing to improve health in this country. Prescription drug costs continue to skyrocket. In fact, addressing prescription drug costs alone would go a long way towards bringing down healthcare costs overall; yet, if the ACA goes away, this will be for naught. It won’t matter if the drug companies are required to negotiate fair prices for drugs and are prevented from gouging customers. Without affordable health insurance, consumers will continue to be priced out of lifesaving drugs and treatment. Further, without the ACA, requirements that plans must cover prescription drugs would go away. Indeed, before the ACA, many plans did not cover needed prescription drugs, leaving patients to pay entirely out of pocket for lifesaving treatments and interventions that prevent more expensive conditions down the road.
Congress has made significant bipartisan progress over the last couple of years on the opioid epidemic, providing considerable funding to States to help people access treatment to get on the path to recovery. However, one of most effective interventions in the epidemic has been the ACA’s Medicaid expansion, helping those with substance abuse disorders get treatment and get back on their feet. Without the ACA, the bipartisan laws Congress has passed in response to the opioid epidemic will be nowhere near enough in both effort and funding to successfully combat this crisis.
We have also seen new data from the Centers for Disease Control and Prevention showing growing rates of suicide in this country, especially among young people—nothing short of an epidemic. I have been working with my colleagues across the aisle, such as Senator Kennedy from Louisiana, to increase funding for the National Suicide Prevention Lifeline, and with Senator Gardner to make the Lifeline more accessible. This is important work. We need to ensure that, when someone courageously reaches out to get help in a time of crisis, that we are able to connect them with affordable mental healthcare for the long term. Without the ACA, that care may be out of reach. There is certainly more we can be doing to increase access to healthcare, and I have been working with my colleagues to do just that.
However, allowing the administration to continue its efforts to destroy the ACA not only undermines healthcare for the most vulnerable Americans, but also all of our bipartisan work on critical healthcare issues such as lowering drug costs. The American people—my constituents and yours—expect better. I implore my colleagues on the other side of the aisle to stand up to this administration’s reckless plans to upend our healthcare system and work with us to improve our healthcare system instead.